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Susan Sherwin No Longer Patient: Feminist Ethics and Health Care. Philadelphia, PA: Temple University Press 1992. Pp. xi + 286.

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Susan Sherwin No Longer Patient: Feminist Ethics and Health Care. Philadelphia, PA: Temple University Press 1992. Pp. xi + 286.

Published online by Cambridge University Press:  01 January 2020

Keith Burgess-Jackson*
University of Texas at Arlington, Arlington, TX, 76019-0527, USA


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1 Sherwin, Susan No Longer Patient: Feminist Ethics and Health Care (Philadelphia: Temple University Press 1992), 49Google Scholar. Subsequent references to this book are in the text.

2 Sherwin doesn't define the term ‘applied ethics.’ All she says is that ‘it explores the implications of a set of theoretical claims in specific contexts of behaviors’ (36). This is problematic, because it implies that ethical theory as traditionally done was inattentive to its applications, and that is not true. For example, Kant strove to show that his ethical theory had acceptable implications in a diverse set of cases. See Kant, Immanuel Foundations of the Metaphysics of Morals, Beck, Lewis White trans. (Indianapolis: Bobbs-Merrill 1959 [1785)), 3942Google Scholar. Mill's insistence that utilitarianism give practical guidance is well known. See Mill, John Stuart Utilitarianism, Piest, Oskar ed. (Indianapolis: Bobbs-Merrill 1957 [1861]), 30-2Google Scholar.

3 I found only eight typographical errors in the book.

4 Much of the work in this area derives from or was inspired by Carol Gilligan's study In a Different Voice: Psychological Theory and Women's Development (Cambridge: Harvard University Press 1982), which was itself a response to work done by Gilligan's colleague at Harvard University, Lawrence Kohlberg.

5 Proponents of feminine ethics are impressed by statistical correlations between being female (understood biologically) and having a capacity to nurture, mother, or care. They conclude, by something like Mill's method of agreement, that the first characteristic causes the second- that women, as women, are disposed to nurture. See Mill, John Stuart A System of Logic Rntiocinative and Inductive: Being a Connected View of the Principles of Evidence and the Methods of Scientific Investigation, Robson, J.M. ed. (Toronto: University of Toronto Press 1974)Google Scholar, Book ill, ch. VIII, §1, 388-90. But if radical feminism is correct, there is another significant correlation, that between being sexually oppressed (oppressed on the basis of one's sex) and having a capacity to nurture, mother, or care. In this view, what explains women's propensity to nurture is their status as oppressed individuals, not their status as women. What is needed is a study of other oppressed groups. If members of those groups also exhibit nurturing characteristics, that supports the second causal claim.

6 For example, it makes it impossible to criticize the practice of female genital mutilation (for example, clitoridectomy), which continues in various parts of the world. To criticize such a practice is to betray a misunderstanding of the nature of morality. A feminist, as a feminist, insists on being able to judge such practices adversely.

7 An anonymous referee says that I ‘fail to take seriously [Sherwin's] insistence on nonoppressive processes of decision making and evaluation of practice.’ According to the referee, ‘If the participation of women in these processes is tainted by patriarchal values then these processes, for Sherwin, are not free of oppression or its effects’ (emphasis in original).

Perhaps I haven't made myself clear. My point is that, even if the process itself, as a process, is nonoppressive (everyone has a fair opportunity to be heard and so on), the outcomes of that process may be morally unacceptable. This is a logical possibility and would occur, for example, if those participating in the process had a false consciousness as a result of oppressive socialization. As I read Sherwin, she would accept the outcomes as long as the process itself were nonoppressive. A radical ferrllnist would and should insist on evaluating outcomes on substantive grounds.

8 See Burgess-Jackson, KeithThe Problem with Contemporary Moral Theory,’ Hypatia: A Journal of Feminist Philosophy 8 (1993) 160-6Google Scholar.

9 These topics and more are covered in a new anthology: Holmes, Helen Bequaert and Purdy, Laura M. eds., Feminist Perspectives in Medical Ethics (Bloomington and Indianapolis: Indiana University Press 1992)Google Scholar. All but three of the essays in the anthology were published in special issues of the journal Hypatia: A Journal of Feminist Philosophy. Sherwin herself contributed a piece (‘Feminist and Medical Ethics: Two Different Approaches to Contextual Ethics’) to the journal and to the anthology.

10 The usual practice is to bracket distributive considerations, such as the allocation of scarce medical resources. One asks ‘Given that the existing distribution of power, wealth, medical resources, or other goods is just, what should be done in this case?’ One might just as well ask-and the radical feminist insists on asking-a different question: ‘What distribution of goods must obtain in order to do the right thing in this case?’ For an essay that goes some way toward bridging the gap between ‘macro’ and ‘micro,’ see Buchanan, AllenHealth-Care Delivery and Resource Allocation,’ in Medical Ethics, Veatch, Robert M. ed. (Boston: Jones and Bartlett 1989), 291327Google Scholar, esp. 294-5.

11 For exemplary essays, see Garfield, Jay L. and Hennessey, Patricia eds., Abortion: Moral and Legal Perspectives (Amherst: University of Massachusetts Press 1984)Google Scholar. A conspicuous exception to the generalization is the essay by Catharine MacKinnon, ‘Roe v. Wade: A Study in Male Ideology,’ in Garfield and Hennessey's book.

12 The same referee wonders whether this line of reasoning has unpalatable implications for the radical feminist. ‘Suppose one agreed [the referee writes] that the autonomy of women's “choices” concerning intercourse is problematic because of cultural patterns of oppression. Why will this same difficulty not transfer to women's decisions about abortion?’

The referee's question misconceives the issue. My textual comments are in response to a particular argument made by antiabortionists- namely, that because sexual intercourse is (in all but cases of coercion, such as rape) a voluntary action on the part of women, they (women) are responsible for their pregnancies. This responsibility is supposed to ground a moral obligation not to abort the fetus, from which the moral impermissibility of abortion is claimed to follow. What I'm suggesting is that the assumption concerning the voluntariness of sexual intercourse is problematic. (For a discussion and defense of this claim, see my ‘The Radical Implications of Thomson's Defense of Abortion’ [unpublished ms].) If so, then the argument is unsound. As far as I know, nobody makes an analogous argument concerning the voluntariness of the decision to abort (or not to abort); so the referee's comment, while interesting, is neither here nor there. To put the point differently, what are suspect, from a radical-feminist point of view, are decisions made by women that (1) reflect or further male interests while at the same time (2) redounding to the detriment of women. Decisions to engage in sexual intercourse are of this sort. Decisions to abort or not to abort are not obviously of this sort.

13 For a discussion of this and related points, see Beauchamp, Tom L.Informed Consent,’ in Medical Ethics, Veatch, Robert M. ed. (Boston: Jones and Bartlett 1989), 173200Google Scholar, esp. 187-91.

14 It has languished because philosophers have too readily adopted the liberal framework of free, equal, and predominantly (or exclusively) self-interested individuals. Given this assumption, the problem is how to explain and justify various forms of association, such as political association. An equally plausible approach would be to begin with the associations individuals already have and try to reconstruct their natures from them.

15 To continue the previous footnote, it is nothing less than ironic that philosophers, who pride themselves on calling even the most fundamental of assumptions into question, have (until recently, anyway) been blind to power relationships and to the effect of those relationships on liberty, autonomy, and responsibility—each of which looms large in the philosophical literature. I can only speculate as to the explanation. Philosophy, much as it might hate to admit it, reflects the conceptual scheme, priorities, and values of the larger culture. To call prevailing power structures into question is to question the legitimacy of one's own profession, and hence one's individual authority. This, for obvious reasons, is difficult to do.

16 See Mill, Utilitarianism, 12-15. Mill discusses the quality of pleasureful episodes, but presumably there is a qualitative aspect to painful episodes as well.

17 See Dworkin, RonaldReverse Discrimination,’ in Taking Rights Seriously (Cambridge: Harvard University Press 1978), 223-39Google Scholar. An external preference, to Dworkin, is a preference for the assignment of goods and opportunities to others (as opposed to oneself, which is a personal preference). If external preferences are counted, Dworkin says, the egalitarianism of utilitarianism — which in his view is its most attractive feature — is undermined.

18 I have mentioned only two possibilities: hedonistic and preference utilitarianism. There are other versions, of course, such as welfare utilitarianism.

19 Later in the same chapter Sherwin writes: ‘[R]esearch should be evaluated not only in terms of its effects on the subjects of the experiment but also in terms of its connection with existing patterns of oppression and domination in society’ (174-5). This shows that Sherwin has an enlarged — that is to say, nonliberal — conception of harm and benefit. We might call her an idealistic or holistic consequentialist.

20 410 US 113-78 (1973). Subsequent references to the opinion are in the text.

21 On the following page, Sherwin restates the argument so as to make the normativity of her conclusion explicit: ‘The fact that fetal lives can neither be sustained nor destroyed without affecting the women who support them implies that whatever value others may attach to fetuses generally or to specific fetuses individually should not be allowed to outweigh the ranking that is assigned to them by the pregnant women themselves’ (111; emphasis added).

22 Oppression, as conceived by Sherwin, is a state of affairs, not (or not just) a state of mind.

23 I address this and related matters in ‘Friedman, Sommers, and Women's Desires,’ Journal of Social Philosophy 24 (1993) 62-8.

24 Sherwin writes: ‘[M]any women are persuaded that their most important purpose in life is to bear and raise children; they are told repeatedly that their lives are incomplete, that they are lacking in fulfillment if they do not have children’ (131-2). If this is right, the question is ‘Why?’ Mainstream medical ethics, according to Sherwin, does not ‘seem interested in probing the desire to procreate or the expectations placed on people to develop such desires’ (130). I think it is fair to say that mainstream medical ethics is firmly planted in the liberal tradition. For illustrative mainstream essays, see Robert M. Veatch, ed., Medical Ethics (Boston: Jones and Bartlett 1989).

25 See my ‘On the Coerciveness of Sexist Socialization,’ Public Affairs Quarterly (forthcoming).

26 I wish to thank an anonymous referee for several helpful comments and criticisms, two of which I addressed in footnotes during the final revision of the essay. I am also indebted to my partner, Lora Schmid-Dolan, for many fruitful (and alas, some fruitless) discussions of feminism, feminist ethics, and ethics in general. This essay is dedicated to my late beloved grandmother, Florence Mae Edgett Burgess (1907-1992).