Although feminist bioethicists seek the transformation of bioethics, they are faced with epistemological questions. It is unclear whether bioethics involves a distinctive epistemology, yet feminist bioethicists maintain that the transformation of bioethics entails modifying the ways knowledge is produced in bioethics.86 To achieve this modification, they are identifying, challenging, and rebuilding traditional ways of knowing.87 Here I will examine how feminist bioethicists contest and reconstruct the current ways of knowledge production in bioethics and consider whether the transformation suggested by feminists entails moral relativism, that is, the idea that no single objective standard exists by which one can assess the truth of a moral proposition.
82 Sherwin 2001, 24.
83 Overall 1996, 172;
84 Wolf 1999, 75.
85 Wolf 1999, 75-76.
86 It should be noted that “knowledge” is not necessarily defined in feminist bioethics. It seems, however, that in feminist bioethics knowledge is understood as the expertise and skills acquired by a person through experience or education or the theoretical or practical understanding of a subject. Moral knowledge can be defined as justified moral belief. Bioethical knowledge may refer both to knowledge about bioethical theories (the theoretical understanding of a subject) or the right conduct in the face of a bioethical problem (skills or practical understanding of a situation). Feminist bioethicists cannot be criticized heavily for their lack of definition of knowledge, for the issue is debated in philosophy in general. However, a clearer definition of knowledge could help feminist bioethicists to articulate their aims.
87 Wolf 1996, 24-25.
33
Feminists maintain that social arrangements and political organizations affect the production of knowledge. Therefore, the arrangements through which knowledge and dominance are implemented must be brought to light. This can be done by examining the importance of social and cultural standards in the production of knowledge, because social and epistemological issues are intertwined.88 Feminists argue that the relationship between knowledge and dominance has affected and still affects how and why women have been left out as both objects and subjects of knowledge. As objects of knowledge, women are left out because they “fail to be known.”89 Examples from the arts and sciences are legion: women are excluded when historians chronicle kings, dates, wars and so on, and they are omitted when the symptoms of heart-diseases are defined on the basis of male patients.90 The history of science and the arts has shown that women remain largely in the background as objects of knowledge in culture, society, and academia. One reason is the traditional focus on the justification process of knowledge instead of on the selection process of research topics in sciences and the arts.
This predisposition leads to neglecting the methods of discovery or heuristics and also limits the variety of research topics. Heuristic biases especially influence the formulation of hypotheses and the selection of research themes such as those related to women and other marginalized groups.91 According to the first two transformation strategies presented in the Introduction, feminists have endeavored to make women visible in different fields of science and the arts as well as in society at large. Recently, a growing number of scholarly works has focused on women as the objects of those studies.
Women have not been left out simply because they have not been recognized as the objects of knowledge. Most importantly, they have not been regarded as knowers, as the subjects of knowledge.92 Feminists who advocate the third transformation strategy maintain that women’s exclusion is not accidental, but systematic. The point where feminist criticism should be most radical they maintain, is where women are excluded as knowing subjects because “there is something wrong with traditional conceptions, or traditional ideals, of knowledge.”93 Feminists wish to correct the partiality of existing
88 “For any adequate epistemology, social organization must be shown to be crucial to knowledge.” Addelson 1993, 267. Alcoff
& Potter 1993, 1-3; Crosthwaite 1998, 35-38; Langton 2000, 129; Wolf 1996, 25. Feminist bioethicists, such as Rosemarie Tong (1997, 95-96) and Susan Wolf (1996, 26), maintain that despite the variety in different feminist epistemologies, bioethics would change if feminist perspectives were included in the production of bioethical knowledge. On different kinds of feminist epistemologies see Tong 1997, 86-89.
89 Langton 2000, 130. Emphasis in the original.
90 Langton 2000, 130.
91 Longino 1993, 101-104. “There can be no doubt that research is – often imperceptibly – shaped by presuppositions and interests external to the inquiry itself, which cannot be filtered out by standard, objective, disinterested epistemological techniques.” Code 1993, 31. According to Longino (1993, 101-104) androcentrism, sexism, and gender ideology limit the nature and number of hypotheses in scientific realm.
92 According to Langton (2000, 130), women may not be counted as knowers because they “are deprived of the knowledge men have.” “[W]omen may be left out as subjects not by failing to be knowers, but by failing to be counted as knowers, even when they do know.” Langton 2000, 132.
93 Langton 2000, 133.
34
knowledge and include women’s perspectives.94 Feminist bioethicists maintain, for example, that the ideals of neutrality and objectivity are untenable if they are described as in the traditional philosophy of knowledge, which does not give consideration to power relations that affect the way knowledge is justified.95 In order to avoid power-biased bioethics, feminist bioethicists recommend two approaches:
bioethical knowledge should be produced “democratically,”96 and bioethical theory should be constructed from the lived experiences of different groups and people.97
The democratic production of knowledge can be understood in relation to the larger aims of feminist epistemologies, which resonate with feminist bioethics. According to feminist epistemologists, the democratic production of knowledge differs from the traditional Western epistemologies by taking seriously the contexts and relationships of the subject. Feminists criticize traditional Western epistemologies for highlighting the knowing subject’s ability to exceed the limitations established by social relations and cultural practices. In feminist criticism, subjects are interchangeable, and the identities, backgrounds, life contexts, and relationships of the knowing subjects are irrelevant in traditional epistemologies. Feminists maintain that traditional accounts of knowledge falsely suppose that the subject generates knowledge in an objective and value-neutral manner.98 Hidden subjectivities are always in play when knowledge is produced. Although subjectivities might not be recognizable, they are not non-existent. Subjectivities are often indistinguishable and seemingly neutral.99 In the traditional epistemological view “a certain range of contexts is … presupposed,”100 albeit implicitly. According to feminist criticism, the misleading impartiality of traditional epistemologies is the result of considering knowledge to be individual matter, rather than a community activity. Such criticism is valid. However, it should be noted that not all contemporary mainstream epistemologies argue for knowledge as an
94 Langton 2000, 133.
95 Lindemann Nelson 2003, 885.
96 Wolf 1996, 26.
97 Carse & Lindemann Nelson 1999, 17; Mahowald 1996, 100, 103-104; Roberts 1996, 122; Sherwin 1992a, 49; Tong 1996, 88; Warren 1992, 35, 42; Wolf 1996, 22-23, 27. For example Virginia L. Warren (1992, 35, 42) proposes that women’s perspectives open up new questions for bioethics. Furthermore, she proposes that “theory should be constructed from one’s life experience”.
98 Code 1993, 16; Longino 1993, 104-105. Lorraine Code (1993, 16) maintains that especially “positivist-empiricist orientations” of “the mainstream” epistemologies privilege “ideal, universal and homogenous human nature that allows knowers to be substitutable for one another.” In other words, traditional accounts of knowledge promote “a view from
nowhere.” The positivist-empiricist account does not seem to have room for circumstantial issues and the personal interests of the knowers. According to feminist epistemology, the idea of objective knowledge leads to a devaluation of relationships and contexts. Furthermore, it misses the connections between emotion and reason, knowledge and power. “The legislated (not
‘found’) context-independence … generates the conclusion that knowledge worthy of the name must transcend the particularities of experience to achieve objective purity and value neutrality. This is a model within which the issue of taking subjectivity does not simply arise.” Code 1993, 19.
99 Code 1993, 19. “[K]nowledge is not ‘in the head’ of solitary reasoners, but rather is produced and imparted in communities of knowers.” Lindemann Nelson 2003, 885.
100 Code 1993, 19.
35
individual activity. For example, Ilkka Niiniluoto maintains that the community alone guarantees the objectivity of knowledge.101
The criticisms of individual-based standards of inquiry are especially relevant in science because individually-centered modes of analysis are disadvantageous in discovering the facts. However, the feminist criticism is also partly moral, since it emphasizes the need for democratic values in the context of scientific inquiry. Feminist bioethicists maintain that the primary tool for democratic decision-making is conversation within the community. For example, Susan Wolf suggests that, in bioethics, the democratic production of knowledge means that relevant knowledge is produced not only by experts, but also by lay-people affected by bioethical questions: “This kind of bioethics would require us to learn from patients, subjects, families, and communities.”102
Wolf draws on the ideas introduced by Helen Longino (1993) whose original context is the philosophy of science and thus Wolf’s account is not altogether clear on the differences between moral knowledge and scientific knowledge. In science, not everyone can be an expert, whereas moral knowledge is more like practical knowledge in which anyone can gain expertise. Or to put it differently, the difference between an expert and an amateur is not necessarily relevant in the realm of morals.
Despite this ambiguity, Wolf’s point seems to be that within moral knowledge anyone can be an expert.
Wolf maintains that physicians, philosophers, and bioethical consultants are given the status of experts in traditional bioethics, even though it is questionable whether moral expertise can be acquired through academic training.103 This should be embraced more willingly in decision making and in the structuring of public standards for agreement in bioethics, for example.
Another way to avoid power-biased bioethics is to use experiences in bioethical analysis.
Experiences are important when “the creation of moral consensus through conversation and collaboration”104 is sought. According to feminist bioethicists, attention to lived experiences can be a tool for identifying bioethical problems in need of analysis. This is to say that bioethical problems cannot be treated in separation from the individuals experiencing the problems.105 On the one hand, feminists are convinced that mainstream ethics has focused on areas that men dominate, while, on the other hand, ethics reflects men’s experiences. Therefore, feminists claim that it is doubtful whether traditional ethics can serve women and their interests.106 Feminist ethicists have tried to overcome this problem by
101 Niiniluoto 2003, 189.
102 Wolf 1996, 26.
103 “While surely training in bioethics confers some kind of expertise, few would argue that only bioethicists, medical and scientific experts, and governmental authorities should deliberate over questions such as whether a patient receives further life-sustaining treatment, who receives an organ transplant, whether physician-assisted suicide should be allowed, or how scarce medical resources should be allocated.” Wolf 1996, 25.
104 Tong 1996, 70.
105 Tong 1996, 88; Wolf 1996, 27.
106 Brennan 1999, 860-861.
36
promoting “ethics of lived, concrete experiences which takes most seriously women’s experiences of morality.”107
The attention to lived experience can be equated with “rich empiricism.”108 Rich empiricism refers to taking seriously specific cases and experiences in moral analysis while focusing attention on power and disadvantages in bioethics.109 According to feminist bioethicists, women’s experiences are shaped by “our system of beliefs.”110 Mary B. Mahowald suggests that feminist standpoint theory provides a corrective to mainstream bioethics in this respect.111 Feminist standpoint theory is based on the idea that “knowledge derives from situated perspectives.”112 Women’s experiences and perspectives can be the starting point for the critique of social injustice, exploitation and domination.113 In this view, women and other marginalized groups should be encouraged to question both traditional cultural explanations and the authority of experts and trust their own judgment as their experiences can provide liberating possibilities for those dominated.114
Paying attention to lived experiences would move bioethical problems into a larger context and have relevance not only for the case in question, but also for the larger bioethical community. Ethical transgressions are not single events, but have social roots and meanings, which can be shown through the experiences of different people. The meanings of otherwise inexplicable situations can be discovered by listening to the moral contents of people’s individual experiences. For example, Rosemarie Tong refers to “conversationalists” who maintain that “if people listen to each other attentively, over time they will conclude their unique stories satisfactorily, that is, in a way that provides significance to otherwise incomprehensible situations.”115 Rich empiricism understood as attentiveness to experiences can help to understand the effects of domination.116
The feminist understanding of the importance of experience is not without its problems.
The first problem is that the relevance of experiences is at best vague, given the examples provided by feminist bioethicists. Susan Wolf’s example of distorted power relations shows that experiences as the basis for moral analysis can have multiple meanings and lead to odd conclusions. According to Wolf,
107 Brennan 1999, 861.
108 Wolf 1996, 27.
109 Wolf 1996, 27.
110 Warren 1992, 42.
111 “Because feminism is committed to equality and the moral significance of women’s experience, both collectively and individually, it supports this strategy for reducing the flaws of nearsightedness, unselfconsciousness, and arrogance. Because care involves ongoing recognition of the dynamic character of individuals and groups, and the complexity of their relationships, it demands attention to differences. The crucial contribution of feminist standpoint theory to bioethics is the egalitarian critique that it adds to that attention.” Mahowald 1996, 111.
112 Mahowald 1996, 100.
113 Mahowald 1996, 100-103.
114 Sherwin 1992a, 179-187; 198-199; Warren 1992, 42.
115 Tong 1997, 70.
116 Wolf 1996, 22.
37
“women’s experience of health care and science would give one set of problems a new prominence.”117 She uses father-daughter incest as an example and maintains that feminist bioethicists should not consider incest an isolated happening within a family unit, but part of the larger abuse of power relations in a society. Similarly, sexual relationships between a physician and a patient should not be considered single incidents, but something that reveals significant problems in patient-physician relationships in general. Larger cultural and societal contextual details are important in the analysis.118 Although Wolf may be right that abuses of power in close relations reflect distorted power-relations on a more general level, her remedy is disturbing. She proposes that the prevention of incest “lies in part in restructuring familial relationships so that fathers share with mothers a real parenting role.”119 The leap from the importance of women’s experience to healing incest by restructuring parenting roles is problematic.
Although Wolf’s perspective on incest may reveal something about power structures in certain societies it may not be compatible with women’s experiences. Would women who have been molested by their fathers be willing to say that the crime of incest could have been prevented if their fathers had had active roles as parents? It is uncertain whether Wolf’s conclusion reflects women’s experiences.
The second problem is that feminist bioethicists seem to have various explanations of how women’s experiences are influenced and by whom. Susan Sherwin describes women’s experiences of symptoms related to the menstrual cycle, such as premenstrual syndrome, menstrual pain and menopause. Many women seek medical help to relieve the pain and discomfort. These symptoms should not, however, be perceived solely as illness, nor should they be treated exclusively medically, because cultural attitudes affect how one experiences and interprets one’s body.120 Sherwin suggests that women should have the opportunity to experience their bodies differently than the way proposed by the mainstream culture, which describes menstruation and its related symptoms as medical conditions.
Although Sherwin’s argument is directed against uncritical acceptance of the cultural view of menstruation and to not women’s experiences per se, her account is problematic because she implies that if women comply with the mainstream culture, their experiences may be criticized from a feminist perspective.121 One must ask if Sherwin indicates that there are right kinds of experiences. Sherwin
117 Wolf 1996, 22.
118 Wolf 1996, 22.
119 Wolf 1996, 22.
120 Sherwin 1992a, 179-187; 198-199. Sherwin (1992a, 198) proposes that “[p]erhaps many more women could accept premenstrual changes and even come to welcome them if society allowed them the space to experience them differently [from mainstream cultural attitudes].”
121 “These warnings are not meant to imply that there are no such things as problematic premenstrual changes or to suggest that no women suffer from severe premenstrual or menstrual changes that might properly be relieved by medical means. It is not an argument against women seeking medical assistance in the pursuit of such relief. It does constitute, however, an argument against accepting the view that premenstrual and menstrual changes are necessarily undesirable and that medicine is the best place for women to turn if they do judge these changes negatively.” Sherwin 1992a, 199.
38
seems to have an implicit assumption of what women’s experiences should be like – at least for them to reflect feminist values.
Virginia Warren suggests that when women learn to identify their experiences they can learn to challenge the authority of experts and trust their own judgment and “other ordinary folk.”122 Warren’s point seems to be to encourage women to question professional expertise and trust themselves. What remains unclear is Warren’s reference to “ordinary folk.” Who are they? The question is even more interesting when Warren’s proposal is compared with Sherwin’s. While Sherwin questions the mainstream cultural accounts, Warren promotes the experiences of ordinary folk. What is the distinction?
Despite this difference, Sherwin and Warren’s main points are similar; both encourage women to challenge authorities and cultural explanations. What is problematic is that the writers do not observe that authorities, experts, and mainstream culture may not be opposed to women’s experiences.
The issue can be linked to the larger question of when women’s experiences are authentic. Are they authentic if the motivational structure is not self-imposed, but rather affected by the social order? The question of authenticity is important for feminist bioethicists who wish to use experiences as the starting point for analysis. Must one conclude, for example, that in order to serve feminist bioethical analysis, women’s experiences must be authentic and not influenced by the social order? In my opinion, what is needed is a multifaceted analysis of the influence of social order, an issue I will discuss in detail in chapter 3.3. Here it suffices to say that, even though women cannot escape the social order, they are nevertheless among those who build, maintain, and contest that order. As such, authenticity is not necessarily found only in experiences that are in opposition to mainstream cultural explanations.
The third problem with invoking the moral significance of women’s experiences is that there is no collective women’s experience.123 Consequently, how could different experiences of different women affect the nature of knowledge? Feminist bioethicists maintain that individual women’s experiences should be taken into account, but they also recognize the experiences that women as a dominated group have. Those who have historically been “least served and most harmed”124 should be the focus of the analysis.125 However, according to Mary B. Mahowald, there will always be tension between group and individual experiences. On the one hand, feminist bioethicists are encouraged to consider the experiences individuals have. On the other hand, they are directed to look for systemic oppression and injustices in different groups. The tension occurs when the “standpoint of an individual is
The third problem with invoking the moral significance of women’s experiences is that there is no collective women’s experience.123 Consequently, how could different experiences of different women affect the nature of knowledge? Feminist bioethicists maintain that individual women’s experiences should be taken into account, but they also recognize the experiences that women as a dominated group have. Those who have historically been “least served and most harmed”124 should be the focus of the analysis.125 However, according to Mary B. Mahowald, there will always be tension between group and individual experiences. On the one hand, feminist bioethicists are encouraged to consider the experiences individuals have. On the other hand, they are directed to look for systemic oppression and injustices in different groups. The tension occurs when the “standpoint of an individual is