Globalizing Feminist Bioethics

Crosscultural Perspectives

Rosemarie Putnam Tong

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429979804
• Edition: 1
• Topic: Philosophie
• Subtopic: Histoire et théorie de la philosophie

Globalizing Feminist Bioethics is a collection of new essays on the topic of international bioethics that developed out of the Third World Congress of the International Association of Bioethics in 1996. Rosemarie Tong is the primary editor of this collection, in which she, Gwen Anderson, and Aida Santos look at such international issues as female genital cutting, fatal daughter syndrome, use of reproductive technologies, male responsibility, pediatrics, breast cancer, pregnancy, and drug testing.

PART ONE
Theoretical Perspectives

1
Feminist Reflections on the Role of Theories in a Global Bioethics

SUSAN SHERWIN

From the beginning of their reflections, bioethicists have been uneasy in their relationship to moral theories. They have felt the attraction of comprehensive moral theories as a way of systematizing moral knowledge, providing their work with theoretical legitimacy and coherence and offering a logical methodology for investigating the hard cases they confront. On the other hand, most bioethicists have been uncomfortably aware of the fact that when faced with difficult cases, they are unlikely to be happy with the strategy of deducing answers from a single moral theory. Most find themselves reasoning in a fashion that is significantly more involved and complex than the relatively straightforward task of applying a single theory. For example, they are likely also to be occupied with deciding how to understand and categorize the problem before them lest they leap to a description with a prescribed solution that does not meet their intuitions (e.g., should physician-assisted suicide be classified as murder, mercy killing, suicide, or medical termination of suffering?).

There are other difficulties as well with the typical view of theories as the basis of moral reasoning. For example, when bioethicists try to invoke major moral theories, most find it difficult to fit the theories' criteria to the problems before them, a restriction that clearly limits their practical usefulness. Moreover, many bioethicists find that a single comprehensive moral theory is inadequate to capture all of their moral intuitions; in such cases, they may sometimes find themselves tempted by the attractions of alternative theoretical approaches for addressing different sorts of issues. However, theoretical disloyalty or inconsistency in theoretical perspective is not tolerable under standard views of the role of moral theories.

Another complication is many bioethicists' feeling responsible to consider the geographical and political scope of their positions. Many of the issues they explore arise in various forms around the world. This is not surprising, since all societies must deal with questions of how to handle childbirth, illness, disability, death, and dying in morally responsible ways. The difficulty is that local conditions can vary considerably. For example, there can be very great differences in the sets of expectations and opportunities that surround local discussions of particular bioethical issues, and the range of available practical options can be diverse (as happens when the rich have access to types of care unavailable to the poor). The question arises, then, of whether or not to seek common ethical answers to similar problems as they arise in culturally different contexts. Most moral theories would tell us that there is some underlying commonality in moral commitments that should transcend local variations, even though current conditions may determine how a theory applies in a particular society.

In general, feminist bioethicists have been especially dissatisfied with the centrality of traditional moral theories in bioethics. They note that the theories ignore rather than highlight and critique the ways in which oppression is woven into the various medical practices under review. By abstracting away from the details that are specific to particular patients (or research subjects, caregivers, policymakers, etc.), traditional moral theories obscure the ways in which power relations structure health care practices. Focusing on the generic human being (or generic patient, research subject, etc.), they have generally imagined that what is arrogantly believed to be the norm for all persons (white, educated, healthy males) is representative for all people in the same circumstances. This has allowed bioethicists to ignore the implications of gender, race, class, age, disability, sexuality, ethnicity, and other forms of difference associated with power in their analyses.¹

Many feminist bioethicists have learned from their colleagues in feminist epistemology that knowledge claims, in ethics as in science, are inevitably situated in particular social and historical locations. That means that the moral beliefs each of us acquires and the moral analyses we bring to problems reflect the particular values, attitudes, and needs of our own historical position. Many feminists urge us to be careful in our use of the universal voice when addressing moral matters and to recognize that our commitment to the specific (universal) values we hold dear has emerged in a particular time and place. This awareness suggests that we need to learn to listen attentively to different voices and perspectives if we hope to understand where moral intuitions can legitimately be shared crossculturally and where they founder on differences in experience and cultural values. This recognition of the specificity of our particular moral views does not mean that we must adopt unconstrained moral relativism or moral nihilism, but it does require that we speak cautiously when we attempt to make universal claims and that we attend carefully to possible sources of difference.²

There is a tendency in any culture to judge alternative conceptual and value systems as incomprehensible and then to either dismiss them altogether from consideration or to "translate" them into something more familiar. Unless we make explicit efforts to hear and understand alternative perspectives, it is easy to assume that they are either misguided or reducible to one's own. Efforts to articulate a common basis of moral concern are especially vulnerable to inappropriate universalization when they reflect the moral values and priorities of the currently dominant global culture, since it is in the nature of dominant cultures to be ignorant of not only the reality but also the possibility of alternative (legitimate) moral systems. Thus, for example, it is important to be particularly wary of attempts to export uncritically the distinctly American value of privileging the autonomous individual above other moral concerns. Cultures that do not share Americans' enthusiasm for individualism (or, for that matter, Americans' understanding of individuals) have a difficult time expressing their alternative moral conceptions to those who assume that a moral perspective must begin with a belief in the fundamental importance of respect for the individual.

We need, then, to consider how we can understand the role of basic moral beliefs and theories in ways that leave space for respecting alternative moral positions and perspectives as legitimate guides to bioethical analysis. Rather than try to impose their own moral beliefs on other cultures, bioethicists would do well to consider the insights available to them if they examine different perspectives. I propose that we view alternative moral theories and positions as representing a collection of available guides to bioethical reasoning. To do this, we need to reconsider the role that is usually assigned to moral theory in bioethics. In the remainder of this chapter, I shall explore three different ways of understanding the role of moral theories in bioethics.

The Role of Metaphors

The most common way to think of moral theories in bioethics is to credit them with providing foundations for the more specific moral judgments of practical moral life. Many bioethicists speak of the need to appeal to well-developed foundations to ensure the legitimacy of their claims. The implication is that if we can "ground" our bioethical views on a solid theoretical footing, we can establish the validity of our practical judgments. Whenever we make this sort of reference to a theoretical foundation, we are appealing to a familiar and evocative structural metaphor: just as the foundations of buildings are meant to provide a strong, solid base for whatever rests on them, so too theoretical ethical foundations should provide the necessary support to justify the bioethical claims that rely on them.

It is important to recognize the role of metaphor in this picture. Understanding that the foundational view of theories is metaphorical allows us to understand both the virtues and the limitations associated with the foundational conception. Moreover, it provides us with the conceptual space to consider alternative, less familiar metaphors in its place. I shall take advantage of that space to compare how two other metaphors—frameworks and lenses—can provide different, and I think better, understandings of the place of moral theory within bioethics.

Before turning to the specific metaphor of foundations for ethics, let us briefly consider the necessary role that metaphors play in bioethics. Metaphors are pervasive throughout the domains encompassed by bioethics—medicine, nursing, law, health policy, and ethics itself—as they are in other areas of abstract thought. Probably the most familiar and least controversial task of metaphors is their aesthetic role, for it is clear that they can add color and interesting connections to discussions. It is also the case that metaphors perform an important epistemological function; this role is especially important in any task that involves abstract reasoning. In ethics, they provide us with access to moral understandings that may be unavailable through other means. They aid in the understanding of complex ideas by transferring the relations that hold in the domain of the metaphor to those that exist within the domain of the field we are contemplating.³ For example, we can speak of a sports team as being "hot," "cold," or "heating up" to describe its recent record as successful, poor, or improving. This understanding is possible because the metaphor works by transferring the relations among temperature ranges to the realm of sport. Similarly, when we speak of medicine as waging a "war" against disease, we are suggesting that illness is similar to an invasion of some alien force (or internal subversion). When our goal is taken to be eradication of the harmful agent, we speak of strategies that involve the use of available "weapons" in the form of medical interventions. We grant the physician the authority of a military commander, and we often reduce the patient to her body, which is treated as a battlefield.

Metaphors also play an important ethical role, for they determine our understanding of the practices in question and, in doing so, they influence our evaluation of each. For instance, when we think of the subjects of medical care as "patients"—passive recipients of medical interventions—we evaluate medical practices differently than we do when we think of patients as active participants engaged in decisionmaking about their own health. Labeling them "consumers" or "clients" invokes quite different sorts of behavior and relationships than the term "patients" and creates other sorts of distortion in understanding the relation between physicians and those who consult them. These understandings determine the sorts of interactions we expect to find in medical encounters. When it comes time to morally evaluate those encounters, our analysis will be conducted according to what sorts of behavior seem to be appropriate to the relationships that the central metaphor has helped us to imagine. Hence, paternalism is a meaningful option to explore within the traditional patient metaphor, but it is quickly dismissed in the type of encounter suggested by the consumer metaphor. By the same token, we have no difficulty imagining the need for "caveat emptor" warnings in the consumer-provider framework, but such advice is disturbingly jarring in traditional doctor-patient relationships.

Metaphors have other important functions, as well. For one thing, they translate affective attitudes or emotions from one domain to another—one wages war against something that evokes feelings of dread and hostility, and one nurtures that toward which one feels protective. Moreover, tine metaphors that are selected often affect our ability even to perceive the possibility of other approaches to a problem. When metaphors become so well entrenched that they seem natural and fully accurate descriptors, alternative ways of constructing the relations in question seem artificial and misleading, if they can be imagined at all. These limits on the ways of understanding a phenomenon limit the responses that will be considered reasonable. For example, the metaphor of the body as machine supports development of high-tech medical interventions in response to illness, but it makes spiritual responses seem irrelevant. Thus metaphors not only shape our understanding of central concepts but also frame the issues we recognize as morally significant or problematic; they also inform our sense of available solutions.

All metaphors function as models or analogies. As such, they emphasize similarities between the two realms in question while obscuring differences. That is, in the process of helping us to understand one set of relations in terms of another, metaphors highlight certain features of the domain to which they are applied and, inevitably, they hide or distort others. Thus, while facilitating one way of understanding a concept, situation, practice, or theory, the specific metaphors invoked may limit our ability to conceive of alternative ways of interpreting the subject matter and may divert our gaze from other possible strategies.

Theories As Foundations

Consider, then, the very familiar metaphor of "foundations" for bioethics. Foundationalism is a highly attractive way of understanding the nature of abstract thought in ethics. It encourages us to believe that all true moral claims can (at least in principle) be "grounded in" solid, undeniable truths. It also directs us to evaluate controversial claims by considering whether or not they are supported by plausible theoretical assumptions. But we should keep in mind that foundationalism is a metaph...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of Figures and Tables
• List of Acronyms
• Acknowledgments
• Introduction
• Part 1 Theoretical Perspectives
• Part 2 Reproductive, Genetic, and Sexual Health
• Part 3 Medical Research and Treatment
• Epilogue
• About the Editors and Contributors
• Index