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

2. 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 Expectation Management

3. Consequentialist theories Deontological theories Virtue theories Traditional Ethical Theories

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

5. 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 Feminist approaches to ethics are not “theory”

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

7. 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? Some Room for Correction

8. –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 More Room for Correction

9. 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 Feminist Approaches in bioethics consider and analyze

10. 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 Experience

11. 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 The Locus of the Moral Act

12. 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 Power Relations

13. 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 Socialization into gender roles

14. 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 Traditional Views of Moral Development

15. 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 Pathology or Not?

16. 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 Catholic Moral Teaching--which is it?