Feminist bioethics began as a criticism of mainstream bioethics. It focused on two issues from descriptive and normative perspectives: what ethical problems receive attention in standard bioethics and what problems should receive attention; and how these issues are covered in bioethics and how they should be covered. Behind this analysis are questions about the structures, background values, and philosophical perspectives in mainstream bioethics: why is attention paid to certain issues and not to others? And more importantly, how does the makeup of mainstream bioethics support or hinder overall equality?
The goal of feminism is to identify, analyze, and overturn oppression at the practical and theoretical levels. Feminist bioethicists present different ways to rectify systemic injustices in medicine and bioethics. They maintain that contemporary bioethics is ill-equipped to discuss problems related to oppression and injustices, the prime reason being that most bioethical problems are regarded as
364 Hekman 1999, 130-131.
365 Hekman 1999, 131.
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problems between individuals. As such bioethics’ view is limited and the field is unable to identify problems that are based on systemic injustices.
Feminist bioethicists propose that in order to transform bioethics, attention should be devoted to the theoretical, conceptual, and practical levels of bioethics. How should the understanding of moral knowledge, moral agency, and embodiment be transformed? In this chapter I have covered feminist bioethicists’ accounts of the following themes: the nature of bioethical knowledge and how it is produced; the kind of moral agency feminist bioethicists suggest for transformed bioethics if subjects are based on differences instead of stable essences; whether sexual difference become meaningless, if female and male essence is being questioned; and if female and male essence is questioned, how does this affect the understanding of embodiment and corporeality in bioethics.
Feminist bioethicists maintain that moral knowledge is produced socially. Feminists contend that bioethics is biased if it does not acknowledge the social and cultural influences on the production of knowledge. Feminist bioethicists also emphasize the social basis of moral agency. They maintain that it is important to construct accounts of moral agency that are in accordance with women’s experiences, and therefore, they emphasize the relational nature of moral agency. Additionally, feminist bioethicists maintain that embodied experience should inform the production of bioethical knowledge.
Moral agents are embodied beings who interact with one another. Embodiment highlights the physical, social, and symbolic elements of human life. Fourth, feminist bioethicists maintain that the category of women is problematic because women are different from one another and because there is no exhaustive list of characteristics that must be fulfilled in order to be a woman. The category of women can be evoked in the sense that women as a group are oppressed. Oppression does not need to be total or permanent. A Foucaultian perspective helps to show that resistance is included in being oppressed.
Throughout the analysis of these themes, two issues are emphasized, namely, the contextual and the relational approaches to bioethical problems. By contextuality, feminist bioethicists mean the approach that involves evaluating ethical questions by taking into account both personal frameworks of an individual and the social, cultural and societal circumstances to which the questions are related.
Relational ethics, on the other hand, is based on the idea that people are connected.
Individuals are continually in relationships with each other. In fact, according to feminists, the self is built relationally. People become who they are through relationships. Feminist bioethicists use relationships to refer not only to personal relationships between individuals, but also to larger-scale, social relationships.
Relational ethics is based on the idea of responsibility. If people want to adopt an ethical stance, then they must realize the interconnectedness of moral agents. The idea of relationality is reflected, for example, in the deconstuctionistic view of the boundary of the self and the other. Once the boundaries of
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the self and the other are deconstructed, they become unstable. There are traces of the other in the self and vice versa. Furthermore, if there are traces of the other in the self, then responsibility for the self also means responsibility for the other, namely, the other in the self.
Analyzing of these theoretical themes in feminist bioethics reveals that power is used as a tool when feminist bioethics is evaluated. The Foucaultian perspective on power indicates that agency is possible, regardless of and because of power. Agency should be understood as a capacity that both resists and inhabits norms. Therefore, oppression and subjugation do not eliminate women’s agency. In addition, the analysis of power reveals that power gives rise to knowledge. Knowledge is socially constructed and truth is socially embedded. However, this does not mean that the feminist transformation has been in vain. Feminist bioethicists must work with the beliefs, concepts, and practices that construct our world and through these, make changes toward feminist values. In the following chapters I discuss how feminist bioethicists have questioned bioethical concepts and practices.
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3 The Concept of Autonomy in Feminist Bioethics
In the previous chapter, I suggested that the transformation of feminist bioethics involves analyzing central bioethical concepts. Recognizing strange elements in familiar concepts can illuminate the overall feminist analysis of bioethics. By strange elements I mean aspects that do not reflect feminist values or aspects with perplexing implications when studied closely. Once these elements are identified, it is crucial to provide new interpretations of the old concepts. In this chapter I will discuss how feminist bioethicists have analyzed a central concept in bioethics, namely, autonomy. First, I will explain the feminist criticism of standard understanding of the concept of autonomy. Then, I will present feminist alternatives to the old concept of autonomy. These alternatives rest on the idea of relationality. Third, I will discuss a consequence of the feminist understanding of autonomy as relational, namely, socialization. How can individuals be autonomous if they are affected by oppressive socialization? Fourth, I will discuss how autonomy can be applied in practical bioethics. Here I will focus on the issue of respect for autonomy.
The importance of autonomy is widely recognized in contemporary moral and political theory. However, there is no consensus about what autonomy means or how it should be employed.
Autonomy stands for different ideas in different fields of moral and political theory. Autonomy can be classified as either moral or personal autonomy. Moral autonomy refers to the ability to impose the moral law on oneself. It is about identity constrained by what one regards as morally permissible. Personal autonomy is about living according to one’s own choices and values in any aspect of one’s life, not only in relation to questions of moral obligation.366
In Western bioethics, autonomy is often equated with informed consent and treated as a practical tool in health care settings. It has not only been interpreted as informed consent, but also as both a right and as a capacity. Bioethicists refer to autonomy from both the practical and theoretical perspectives and assess it from different point of views, designed to help both philosophical theorizing and practical decision making in the medical arena.367 Autonomy is thus widely held to be the cornerstone of the discipline of bioethics.
Much of modern Western bioethical theorizing relies on the characterization of four bioethical principles introduced in Principles of Biomedical Ethics by Tom L. Beauchamp and James F.
Childress (first published in 1983). One of these principles is respect for autonomy. The others are benevolence, nonmaleficence, and justice.368 Although Beauchamp and Childress were not the first to formulate the principle of respect for autonomy, it is fair to say that their understanding reigns in the field
366 Friedman 2000a, 37.
367 “There is a remarkably sharp contrast between discussions of autonomy among ethical theorists and those among bioethicists working in the practical health care delivery, research, and legislation.” Kukla 2005, 34.
368 Beauchamp & Childress 1983.
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of bioethics today.369 Their account can be considered to belong to the practical discourse, because it is designed to solve “concrete dilemmas that arise within the practice of medicine.”370 Beauchamp and Childress maintain that their account of the respect for autonomy does not involve an ideal of autonomy, but is within the reach of a normal human being. Within this context respect for autonomy is defined as follows:
[O]ur analysis will be closely tied to nonideal moral requirements of “respect for autonomy.” We analyze autonomous action in terms of normal choosers who act (1) intentionally, (2) with understanding, and (3) without controlling influences that determine their action.371
The principle of respect for autonomy implies that an individual should be free from coercion in deciding to act, and that others are obligated not to interfere with the individual’s choices.
Feminist bioethicists have offered critiques of autonomy and presented different alternatives, both to a more general account of autonomy and Beauchamp and Childress’ specific principle of respect for autonomy.372 Below, I will describe the debate over the status and meaning of autonomy in feminist bioethics.