Complementary Theories: Feminist Approaches

1. Complementary Theories: Feminist Approaches Ethics Champions August 8, 2012 Carol Bayley VP Ethics and Justice Education Dignity Health

2. Expectation Management • What this hour is not • Male bashing  • A definition/overview/defense/critique of feminism • A description of “the way women do bioethics” • comprehensive • What this hour is • General effects of feminist thinking on the discipline of ethics • A look at some of the ways medicine is “gendered” • A consideration of feminist approaches to bioethics as corrective or complementary to traditional approaches

3. Traditional Ethical Theories Consequentialist theories Deontological theories Virtue theories

4. But wait—what’s a theory? Systematic way of thinking To account for “the way things are” To answer questions (To predict or control) To determine right behavior, praiseworthiness, blameworthiness

5. Feminist approaches to ethics are not “theory” • Critique of dominant theories of “the way things are” • History is written by the winners, etc. • Take insight from feminist theories (of politics, of psychology, of economics, of linguistics) and applies them to ethics • When your worldview is different, many differences follow

6. What’s wrong with using “man” when you mean everyone?

7. Some Room for Correction • Theories are concerned with the objective, the universal, not the particular or the local • Traditional theories govern relations between strangers; much in medical ethics occurs between intimates • “highest level of functioning” • Capacity to engage in cause and effect reasoning? • Capacity to love or relate empathically?

8. More Room for Correction • Consequentialism—the good act produces the greatest good for the greatest number (but what about protection of the individual?) • Deontology—the right thing to do is the one you do because it is your duty, not because of any consequence it produces (what about what you do out of love?) • Virtue theory—from the days of Aristotle, when the virtues were MANLY characteristics. (“virile” and “virtue” come from the same root!); public exemplars are more often men than women

9. Feminist Approaches in bioethics consider and analyze • Experience • The locus of the moral act; who is at the center • Power relations • Socialization into roles • Traditional views of moral development • Pathologization (is that a word?) Eg • Pregnancy, childbirth • Menopause • Mental illness

10. Experience Considers how experience shapes the person Views experience of the person (the patient) as central to the decision or the action “Stand (or lie) here for a while and you’ll see what I’m talking about.” Difference (race, sex, gender, language) matters

11. The Locus of the Moral Act • Other approaches: the person is an individual, individually responsible, discrete from others, autonomous (think of Kant’s autonomous actor or Mill’s rational calculator) • Feminist thought: the person is constituted in a family, in society, in a culture, in a language. There is no such thing as an atomistic, autonomous individual free from the influences of culture and experience, severed from relationships with others. We are socially hardwired. • language • face recognition • mirror neurons Locus of the moral act matters

12. Power Relations • Power is important; rank impersonates power • Men are more powerful than women • Public is more powerful than private • Adults are more powerful than children • Doctors are more powerful than nurses • Almost everyone is more powerful than a sick person Power relations matter Physician-nurse relationships Informed consent Medical error

13. Socialization into gender roles • Boys do x; girls do y • Men act x; women act y • Gender stereotypes begin before birth and influence early • Kicking fetuses are boys • “it’s a girl!” and “it’s a boy!” evoke different responses • Boys in school are rewarded for the right answer; girls are rewarded for neatness and diligence Socialization matters

14. Traditional Views of Moral Development • Kohlberg • 6 stages (obedience, self interest, conformity, authority, social contract, universal ethical principles) • Look at locus • Look at pinnacle • Gilligan • Critique of Kohlberg • Studied girls’ games and boys’ games • Boys want a winner and a loser; girls will choose games with no winner and loser or change games to preserve the relationship • Locus, pinnacle

15. Pathology or Not? • Pregnancy • “dangerous time,” two patients, obstetrics (a surgical specialty), risks OR • One of several ‘normal’ states for a woman; one patient with a special status, including a new developing person; not a disability • Menopause • Medically characterized as “loss” • Contrast sperm with eggs (sperm are “abundant!”; eggs are “wasted”) • Mental Illness • “hysteria” • Non-conformance to social roles

16. Catholic Moral Teaching--which is it? • Consequences--maximize the good • Deontology—by the nature of the act, certain things are always wrong • Virtue--learning, habituation, wisdom • Casuistry—evaluate each case • “Feminist approaches” • Constitution of the human person in community • Consideration of vulnerability; powerlessness • Moral development • Universal and relational • Individual flourishing and the common good