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Towards a Feminist Global Bioethics: Addressing Women's Health Concerns Worldwide
Abstract
In this paper I argue that a global bioethics is possible. Specifically, I present the view that there are within feminist approaches to bioethics some conceptual and methodological tools necessary to forge a bioethics that embraces the health-related concerns of both developing and developed nations equally. To support my argument I discuss some of the challenges that have historically confronted feminists. If feminists accept the idea that women are entirely the same, then feminists present as fact the fiction of the essential "Woman." Not only does "Woman" not exist, -she" obscures important racial, ethnic, cultural, and class differences among women. However, if feminists stress women's differences too much, feminists lose the power to speak coherently and cogently about gender justice, women's rights, and sexual equality in general. Analyzing the ways in which the idea of difference as well as the idea of sameness have led feminists astray, I ask whether it is possible to avoid the Scylla of absolutism (imperialism, colonialism, hegemony) on the one hand and the Charybdis of relativism (postmodernism, fragmentation, Balkanization) on the other. Finally, after reflecting upon the work of Uma Narayan, Susan Muller Okin, and Martha Nussbaum, I conclude that there is a way out of this ethical bind. By focusing on women's, children's, and men's common human needs, it is possible to lay the foundation for a just and caring global bioethics.
... Feminists challenged the structures, background values, and philosophical perspectives in standard bioethics; and questioned why certain issues were prioritized over others. One of the central issues in feminist bioethics was the issue of social justice-feminists explored whether mainstream bioethics supports or impedes overall equality in the realms of health and health care (Donchin 2001(Donchin , 2008Inhorn, 2007;Nyrövaara, 2011;Tong, 2001). ...
... Other feminist objections to standard bioethics include: its emphasis on deduction from abstract ethical principles rather than induction from concrete cases because such approach privileges the perspective of elite groups and legitimates the status quo within and between societies; a tendency to view ethical problems as problems between individuals, or as problems for the entire society, but rarely at an intermediate level to take into account the moral significance of various groups; privileged status of expert opinions and disregard for input that could be given by social movements like, for example, feminism, environmentalism, and workingclass organizations; finally, standard bioethics usually does not reflect upon whom the field serves and how (Donchin 2001(Donchin , 2008Inhorn, 2007;Nyrövaara, 2011;Tong, 2001). ...
The article explores two questions: what is feminist bioethics, and how different it is from standard bioethics. Development of feminist bioethics, it is argued, began as a response to standard bioethics, challenging its background values, and philosophical perspectives. The most important contribution of feminist bioethics has been its re-examination of the basic conceptual underpinnings of mainstream bioethics, including the concepts of “universality”, “autonomy”, and “trust”. Particularly important for feminists has been the concept of autonomy. They challenge the old liberal notion of autonomy that treats individuals as separate social units and argue that autonomy is established through relations. Relational autonomy assumes that identities and values are developed through relationships with others and that the choices one makes are shaped by specific social and historical contexts. Neither relational autonomy, nor feminist bioethics, however, represents a single, unified perspective. There are, actually, as many feminist bioethics as there are feminisms-liberal, cultural, radical, postmodern etc. Their different ontological, epistemological and political underpinnings shape their respective approaches to bioethical issues at hand. Still what they all have in common is interest in social justice-feminists explore mainstream bioethics and reproductive technologies in order to establish whether they support or impede gender and overall social justice and equality. Feminist bioethics thus brings a significant improvement to standard bioethics. [Projekat Ministarstva nauke Republike Srbije, br. 41004: Bioethical Aspects: Morally Acceptable Within the Biotechnologically and Socially Possible i br. 43007: Studying climate change and its influence on the environment: impacts, adaptation and mitigation]
... (Tong, 2001;Tong, 2004;Tong, 2005;Tong, 2013;Tong, 2014), I realize the many shortcomings, inconsistencies, and limitations of my thought so far. Nevertheless, I am determined to try, once again, to explain what I mean by a feminist global bioethics and why I think it is important for the field of global bioethics in general. ...
In this article, I explain what makes a global bioethics "feminist" and why I think this development makes a better bioethics. Before defending this assertion explicitly, I engage in some preliminary work. First, I attempt to define global bioethics, showing why the so-called feminist sameness-difference debate [are men and women fundamentally the same or fundamentally different?] is of relevance to this attempt. I then discuss the difference between rights-based feminist approaches to global bioethics and care-based feminist approaches to global bioethics. Next, I agree with a significant number of feminist bioethicists that care is a more fundamental moral value and practice than justice. Finally, I conclude that feminists' insights about care, even more than rights, can bring us closer to achieving an inclusive, diverse, and fair feminist global bioethics.
... rs and patients, illustrates that the experience of illness, whether lived by the patient or by the carer, is closely tied to cultural meanings and role expectations. The role of cultural values and attitudes in shaping illnesses experiences is the subject of the next section. 425 Pierret, 2003. 426 Young and Cullen, 2001, p. 337. 427 Pierret, 2003. Tong, 2001, Young and Cullen, 2001 As Hahn points out, the experience of illness is influenced by a combination of conscious and unconscious meanings attached to it, which result from memories of experiences of illness in oneself and others and from the incorporation of established social meanings. 428 The sense of deligitimation that many patient ...
... A focus on the relational nature of social and human relationships highlights the interconnectedness of social relationships, nurses' interpersonal connections, and nurses' relationship to the world. It also shows how relations of difference and social privilege (including gender), social disparities, and vulnerability related to social disadvantage are pertinent to ethical inquiry, as are actions that enhance care and social justice (Sherwin, 1993;Tong, 2001). A feminist bioethical analysis in this case study could reveal social structures that have an oppressive effect on nurses and their communities. ...
This case study of community nurses in the Canadian province of Ontario explores the relevance of power relations to nursing ethical inquiry. Public health nurses critically reflected on their role in challenging social inequities as they generated evidence to inform practice. In the process, they developed a policy resolution articulating values and principles for ethical nursing research with diversely situated sexual minorities. The author uses a qualitative case study design and applies a feminist bioethics framework using critical literature to analyze this document and the practice context. The findings suggest that dynamics of power, including gender, influence nurses' ability to advocate for sexual minorities through research, prompting the development of a public statement on knowledge production. There are implications for undertaking nursing ethical inquiries that explore how dominant and counter-discourses and multiple dimensions of power shape nurses' moral agency in challenging the status quo.
We engage with feminist and critical disability studies and cosmopolitan ethics to search for a cosmopolitan vernacular of the “right to choose” among people faced with the predicaments surrounding fetal genetic difference. Our argument is grounded in reflections on a decade of ethnographic fieldwork on everyday decision-making in these circumstances in Aotearoa/New Zealand. We argue that the ethical notion of “obligations to strangers” rather than the dialectic of “right to choose”/“right to life” has a greater capacity to recognize a shared horizon of meaning between publicly polarized positions on reproductive choice among various activist groups. These groups include the Abortion Law Reform Association New Zealand, Saving Downs, Parent to Parent and the New Zealand Organisation for Rare Disorders. We also debate the merits of a more superficial (cosmopolitan) engagement with others in discussions of these highly politicized topics versus the deeper engagement more commonly associated with feminist research projects such as this.
Global ethics addresses some of the most pressing ethical concerns today, including rogue states, torture, scarce resources, poverty, migration, consumption, global trade, medical tourism, and humanitarian intervention. It is both topical and important. How we resolve (or fail to resolve) the dilemmas of global ethics shapes how we understand ourselves, our relationships with each other and the social and political frameworks of governance now and into the future. This is seen most clearly in the case of climate change, where our actions now determine the environment our grandchildren will inherit, but it is also the case in other areas as our decisions about what it is permissible for humans beings to do to each other determines the type of beings we are. This book, suitable for course use, introduces students to the theory and practice of global ethics, ranging over issues in global governance and citizenship, poverty and development, war and terrorism, bioethics, environmental and climate ethics and gender justice.
Tens of thousands of people around the world die each day from causes that could have been prevented with access to affordable health care resources. In an era of unprecedented global inequity, Cuba, a small, low-income country, is making a difference by providing affordable health care to millions of marginalized people. Cuba has developed a world-class health care system that provides universal access to its own citizens while committing to one of the most extensive international health outreach campaigns in the world. The country has trained thousands of foreign medical students for free under a moral agreement that they serve desperate communities. To date, over 110,000 Cuban health care workers have served overseas. Where No Doctor Has Gone Before looks at the dynamics of Cuban medical internationalism to understand the impact of Cuba’s programs within the global health landscape. Topics addressed include the growing moral divide in equitable access to health care services, with a focus on medical tourism and Cuba’s alternative approach to this growing trend. Also discussed is the hidden curriculum in mainstream medical education that encourages graduates to seek lucrative positions rather than commit to service for the marginalized. The author shows how Cuba’sEscuela Latinoamericana de Medicina (ELAM) serves as a counter to this trend. An acknowledgement of Cuba’s tremendous commitment, the book reveals a compelling model of global health practice that not only meets the needs of the marginalized but facilitates an international culture of cooperation and solidarity.
Ethical Choices in Contemporary Medicine examines the epistemological foundations of medicine to show that many of today’s bioethical problems have their roots in how medical knowledge is established, evaluated and transmitted. These epistemological concerns frame the medical choices and claims we make, from how medical responsibility is sanctioned to how medical care is allocated. The present predicaments of medicine are examined within a broad cultural context that exposes the expectations individuals have of their health-care providers and of themselves. The authors explore some of the historical roots of these concerns and suggest that rational discourse and parochial ethical dialogue may be futile in the face of competing and incommensurable frameworks, attitudes and wishes. The authors show that, in the postmodern age, two interrelated issues surface when it comes to medicine. On the one hand, there is a strong critique of science and the privileges associated with the scientific discourse and, on the other, there is still a deep-seated quest for certainty in all medical matters. Ethical Choices in Contemporary Medicine investigates the fundamental nature of medicine and medical knowledge in health-care provision today and offers a radical and practical rethinking of medical ethics. It will be required reading for philosophers of medicine and will be of interest to those working in bioethics, sociology of medicine and philosophy of science more generally, as well as to health-care practitioners interested in the foundational issues of their discipline.
Currently, the ethics infrastructure – from medical and scientific training to the scrutiny of ethics committees – focuses on trying to reform informed consent to do a job which it is simply not capable of doing. Consent, or choice, is not an effective ethical tool in public ethics and is particularly problematic in the governance of genetics. Heather Widdows suggests using alternative and additional ethical tools and argues that if individuals are to flourish it is necessary to recognise and respect communal and public goods as well as individual goods. To do this she suggests a two-step process – the 'ethical toolbox'. First the harms and goods of the particular situation are assessed and then appropriate practices are put in place to protect goods and prevent harms. This debate speaks to core concerns of contemporary public ethics and suggests a means to identify and prioritise public and common goods.
The end of the last century was a particularly vibrant period for feminist bioethics. Almost two decades on, we reflect on the legacy of the feminist critique of bioethics and investigate the extent to which it has been successful and what requires more attention yet. We do this by examining the past, present, and future: we draw out three feminist concerns that emerged in this period-abstraction, individualism, and power-and consider three feminist responses-relationality, particularity, and justice-and we finish with some thoughts about the future.
This paper discusses how genetics is influencing ethical frameworks with particular focus on the effectiveness and appropriateness of individual and communal models. It suggests that genetics supports a relational understanding of the person and therefore that genetic ethics requires ethical models which respect both individuals and groups. First, the inadequacy of individualistic frameworks – at conceptual, ethical and practical levels – is outlined. Second, the “communal turn” in genetic ethics in both clinical and population ethics is considered. Third, it is claimed that this communal turn is applicable to genetic ethics in general and to illustrate this two further examples are explored: those of UK Biobank and personalized medicine. The paper concludes that ethical frameworks in genetic ethics must accommodate both group and individual concerns.
Expatriate health care professionals frequently participate in international responses to natural disasters and humanitarian emergencies. This field of practice presents important clinical, logistical and ethical challenges for clinicians. This paper considers the ethics of health care practice in humanitarian contexts. It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. These tools and frameworks provide important ethics resources for humanitarian settings. Finally, it elaborates a set of questions that can aid health care professionals as they analyse ethical issues that they experience in the field. The proposed process can assist clinicians as they seek to establish their moral bearings in situations of ethical complexity and uncertainty. Identifying and developing ethics resources and vocabulary for clinical practice in humanitarian work will help health care professionals provide ethically sound care to patients and communities.
This paper is a report of a study of factors associated with ethnic differences in exercise and leisure time physical activity levels among midlife women.
Most studies on physical activity have focused mostly on identifying correlates of physical activity. However, 'ethnicity/race' as a factor affecting exercise and leisure time physical activity has rarely been considered.
This study was a secondary analysis of data from a larger Internet study on menopausal symptoms of midlife women from four ethnic groups in the United States of America. A total of 441 women aged 40-60 years were recruited through the Internet from 31 January 2005 to 31 December 2007. The data were analysed using descriptive statistics, chi-square analysis, analysis of variance and multiple regressions.
Non-Hispanic White people had a statistically significantly higher level of leisure time physical activity than Asian Americans and Hispanics. African Americans reported the lowest level of exercise. Body mass index was inversely associated with exercise among African Americans. Menopausal symptoms were positively associated with exercise among non-Hispanic White people and African Americans. Employment and number of children had a statistically significantly inverse association with exercise among Asian Americans.
Correlates of exercise are ethnic-specific. The dual role situation of working outside and inside their homes is an important factor in explaining the lower participation of exercise among Asian Americans. Health factors influence exercise participation in non-Hispanic White people, African Americans and Hispanics. Nurses should take into account ethnic diversities when designing physical activity interventions for women.
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This article discusses what 'global bioethics' means today and what features make bioethical research 'global'. The article provides a historical view of the development of the field of 'bioethics', from medical ethics to the wider study of bioethics in a global context. It critically examines the particular problems that 'global bioethics' research faces across cultural and political borders and suggests some solutions on how to move towards a more balanced and culturally less biased dialogue in the issues of bioethics. The main thesis is that we need to bring global and local aspects closer together when looking for international guidelines, by paying more attention to particular cultures and local economic and social circumstances in reaching a shared understanding of the main values and principles of bioethics, and in building 'biodemocracy'.
This paper considers the possibility and desirability of global ethics in light of the claim that 'global ethics' in any form is not global, but simply the imposition of one form of local ethics--Western ethics--and, as such, a form of moral neo-colonialism. The claim that any form of global ethics is moral neo-colonialism is outlined using the work of a group of 'developing world bioethicists' who are sceptical of the possibility of global ethics. The work of virtue ethicists is then introduced and compared to the position of the developing world bioethicists in order to show that the divide between 'Western' and 'non-Western' ethics is exaggerated. The final section of the paper turns to the practical arena and considers the question of global ethics in light of practical issues in bioethics. The paper concludes that practical necessity is driving the creation of global ethics and thus the pertinent question is no longer 'Whether global ethics?', but 'Why global ethics?'.
The feminist movement may seek democratization on a global scale, but women are still hampered by a democratic deficit in terms of economic and political power. On the other hand, global feminist networks and new expanded forms of non-territorial political space do appear to be increasing democratic participation for women.
This volume, which grows out of The Quality of Life (eds. Martha Nussbaum and Amartya Sen, 1993), combines philosophical inquiry with economic concerns regarding women's equality in the developing world. Adopting Amartya Sen's capability framework, international contributors tackle issues of cultural relativism vs. cultural imperialism on the one hand, and questions of local traditions vs. universalist critical judgement on the other. The chief aim of this work is to critically explore the relationship between culture and justice as pertinent to women's development, with special attention paid to cultural sensitivity but without compromising the clarity of rational judgement in cases where women's capabilities are at stake. Building upon the practical and philosophical implications of the lived experience of women from a variety of cultures, the authors theorize the pragmatics of economic development beyond utility towards a vision of gender equality. This book is a must‐read for anyone interested in the ethics of women's economic development.
Biomedical research has failed to address the health needs of women. The eligibility criteria in many scientific protocols explicitly bar some or all women. Other, apparently gender-neutral criteria in clinical trials in fact operate to exclude women. Biomedical research has concentrated on the investigation of health problems as they affect men—not surprisingly, largely explored in male research subjects. Until quite recently, bioethical analysis has failed to recognize and analyze the ethical issues inherent in this situation.
This chapter scrutinizes the arguments that have been used to justify the exclusion of women from biomedical research. Bringing to bear a feminist critique, I suggest that those arguments fail to justify that exclusion.
Is there a duty to die? Consider the stark differences in life expectancy around the world, from as high as 80 in the richest nations to below 50 in the poorest. There are also stark global differences in access to health care. However, despite these stark differences, many theorists of distributive justice will reject the claim that inhabitants of the rich countries owe those of the poor countries anything at all, and certainly have no duty to die to conserve and redistribute health care resources in order to even these life expectancies out.
I explore arguments by John Hardwig about duties to one’s family, and, against a Rawlsian background explored by Norman Daniels, arguments by Margaret Battin and Dan Callahan concerning duties in a larger social setting. I suggest that although these arguments initially seem not to support any such “duty to die” for reasons of global equity, they can plausibly be stretched to do so. In the end, what blocks the current existence of any global “duty to die” is the lack of global redistributive structures that would convey the savings from one person’s earlier death in the first world—whether the result of declining expensive life-prolonging treatment or physician-assisted suicide—to fund health care and related measures that would increase life expectancies in the second and third worlds, as well as a failure to recognize the existence of mutual health-related obligations between rich nations and poor ones. I argue that there may well be a moral obligation to develop these redistributive structures against a background of mutual obligation, which then would underwrite a more general “duty to die” for reasons of global equity.
Is this argument a reductio ad absurdum, or is it a “highly demanding” one? This paper closes with attention to this question, and makes some predictions about the evolution of moral obligations in the future.
DURING the women's health movement of the 1960s, women began to express their discontent with the traditional hierarchical model of physician-patient interaction.1 In recent years, several developments reflect an increasing appreciation of women's health needs by the US medical profession.
The recognition of systematic biases in biomedical research excluding women from clinical trials led to the establishment of the Office of Research on Women's Health at the National Institutes of Health.2
Health services researchers have reported significant disparities in the use of major diagnostic and therapeutic interventions for women compared with men.3-7
Certain women's health problems (eg, menopause, osteoporosis, breast cancer) have received increased attention and resources.
Women's health care centers that offer many services at a single site have evolved as a new model for comprehensive health care.8
The number of female physicians has increased.9 Two studies have found that, compared with male physicians, female physicians spend more
While we have questioned patriarchal politics, we have not questioned patriachal ethics. This paper comes from the introduction of my forthcoming book, Lesbian Ethics: Toward New Value (Institute of Lesbian Studies, P.O. Box 60242, Palo Alto, CA 94306, U.S.A.), and lays the groundwork for the challenge to patriarchal ethics I pose: I argue that the concept ‘lesbian’ is connected in important ways to the idea of female agency. I suggest the function of traditional ethics is social control and that we might instead focus on the development of individual moral agency and integrity. I discuss the use of language in structuring reality and trapping us in oppression. And finally I discuss the directions my work takes.
The recent global movement for women's human rights has achieved considerable re'thinking of human rights as previously understood. Since many of women's rights violations occur in the private sphere of family life, and are justified by appeals to cultural or religious norms, both families and cultures (including their religious aspects) have come under critical scrutiny.
American Women’s Healthcare: A Patchwork Quilt with Gaps Subtle Forms of Sterilization Abuse: A Reproductive Rights Analysis
- C Clancy
- C Massion
Clancy, C. and Massion, C. (1992) American Women’s Healthcare: A Patchwork Quilt with Gaps. JAMA 14, 268. r245 Clark, A. (1985) Subtle Forms of Sterilization Abuse: A Reproductive Rights Analysis. In: R. Arditti, R. Duelli, D. Klein and S. Minden (Eds.), Test-Tube Women: What Future for Motherhood? London: Pandora Press
Women's Equality and National Liberation
- A Gillian
Gillian, A. (1991) Women's Equality and National Liberation. In: C.T. Mohanty, A. Russo, and L. Torres (Eds.), Third World Women and the Politics of Feminism (pp. 215–236).
Abortion and a Woman's Right to Decide Women and Philosophy: Toward a Theory of Liberation
- A M Jaggar
Jaggar, A.M. (1995) Abortion and a Woman's Right to Decide. In: C.C. Gould and M.W. Wartofsky (Eds.), Women and Philosophy: Toward a Theory of Liberation (pp. 347–364).
Neglected Women's Health Research Wins Funds. The Philadelphia Inquirer
- J H Rubia
Rubia, J.H. (1991) Neglected Women's Health Research Wins Funds. The Philadelphia Inquirer March 21, A3.
The Rejected Body: Feminist Philosophical Reflections on Disability New York: Routledge. Report of the National Institute of Health: Opportunities for Research on Women's Health
- S Wendell
Wendell, S. (1993) The Rejected Body: Feminist Philosophical Reflections on Disability. New York: Routledge. Report of the National Institute of Health: Opportunities for Research on Women's Health. Hunt Valley, Maryland: September 4–6, 1991, 19.
Women Join the Ranks of Science But Remain Invisible at the Top. The New York Times
- N Angier
Angier, N. (1991) Women Join the Ranks of Science But Remain Invisible at the Top. The
New York Times May 21, 88.