Jamie Nelson

With this issue of IJFAB, we mark the end of one phase of the journal’s life and take our first steps into the next. It was eleven years ago, in 2007, that the first issue of IJFAB, then based at Stony Brook University and published by Indiana University Press, appeared with Mary Rawlinson as editor. That first issue was made possible by long months of work on the part of Mary and a group of others who were convinced that for feminist bioethics to develop as a field, it needed its own journal with dedicated space to publish the best of contemporary feminist perspectives in bioethics. The first issue included a foundational paper by Sue Sherwin on how feminism could revitalize mainstream bioethics; one by Margrit...

Midway in Martha Holstein’s article, these words occur: “[P]eople [should] get the help they need, when they need it, in the way that they would like to receive it, without exploiting family members or imperiling their dignity or self-respect” (24). In an essay that brims over with worrisome news, that this seemingly anodyne sentence appears in the section devoted to utopian thinking is perhaps the most dispiriting thought it conveys. Not that there isn’t keen competition for the role. Holstein reminds her readers that the roots of the present and building crisis in long-term care sink deeply into an ideology especially entrenched in the United States; she suggests, as well, that the pernicious norms..

There is reason to believe that procuring organs from recently dead people who did not explicitly refuse to provide them—here referred to as “opt-out” arrangements—would ease growing shortages, thus extending the lives of many who otherwise would die soon. There is also a simple, apparently powerful argument—the “easy rescue requirement”—for believing that many people have strong moral reason to provide such life-extending support to others, thus bolstering the case for implementing opt-out systems. Here I consider two broad types of feminist reservations about opt-out arrangements, one concerning the motivating argument, the other concerning ways in which opt-out practices might disproportionately burden women. I conclude that both reservations can be answered sufficiently so as to encourage further feminist reflection on opt-out proposals and easy rescue arguments.

How ought we to understand the sources and limits of the authority of family members to make health care decisions for their decisionally incapacitated relatives? This question is becoming increasingly crucial as the population ages and the power of medical technology waxes. It is also becoming increasingly contested, as faith in advance directives shows signs of waning, and the moral complexities of intimate relationship become more theoretically patent.This last point—the newly visible moral richness of intimate relationship—provides this paper with its field. I am interested in probing the images of the relationship between self and other, particularly self and intimate other, that seem presupposed by some leading attempts to determine the basis for proxy decision-making authority, and what constraints it must observe. In the light of both recent work in the philosophy of mind and considerations closer to common experience, the reigning images seem too slight to support the weight of current practices and beliefs about proxy authority; supplanting them with images more faithful to our experience will have implications for our practice with proxies.

Surrogate motherhood-at least if carefully structured to protect the interests of the women involved-seems defensible along standard liberal lines which place great stress on free agreements as moral bedrocks. But feminist theories have tended to be suspicious about the importance assigned to this notion by mainstream ethics, and in this paper, we develop implications of those suspicions for surrogacy. We argue that the practice is inconsistent with duties parents owe to children and that it compromises the freedom of surrogates to perform their share of those duties. Standard liberal perspectives tend to be insensitive to such considerations; we propose a view which takes more seriously the moral importance of the causal relationship between parents and children, and which therefore illuminates rather than obscures the stake that women and children have in surrogacy.

The article by Professor Baergen and Dr. Woodhouse makes a succinct and serious contribution to progress in bioethical understanding of deciding for others. They begin with what is by now a familiar claim: family proxy decision makers may sometimes make decisions on behalf of incapacitated relatives that depart from what might be optimal from the patient’s point of view, since the well-being of family members, or of the family as such, may be substantially affected by the direction of a patient’s care. They then develop this idea, noting that others apart from family members can also be substantially affected by a patient’s treatment, and arguing that the interests of strangers ought also to sometimes have a role in determining the aims and means of a patient’s treatment.Baergen and Woodhouse also devote attention to how extra-familial interests might be implemented in medical decision making. While I unearth a troubling consequence of the effort to realize their theoretical conclusion practically, my chief task is to point to some disanalogies between families and strangers, and consider the extent to which they call into question the relevance of the interests of strangers to the treatment of patients.

In her final fragmentary novel Sanditon, Jane Austen develops a theme that pervades her work from her juvenilia onward: illness, and in particular, illness imagined, invented, or self-inflicted. While the “invention of odd complaints” is characteristically a token of folly or weakness throughout her writing, in this last work imagined illness is also both a symbol and a cause of how selves and societies degenerate. In the shifting world of Sanditon, hypochondria is the lubricant for a society bent on turning health into a commodity. As a result, people’s rationality and their moral character come under attack. Catherine Belling’s recent subtle study, A Condition of Doubt: The Meanings of Hypochondria, unveils hypochondria’s discursive and cultural character. Running sharply against the tenor of Austen’s treatment, however, she argues in defense of the rationality of hypochondriacs; the notion that the condition may involve morally significant defects is not entertained; any connection to the commercialization of health care is muted. Here, I contrast Austen’s morally and epistemically negative rendering of her hypochondriacal characters in Sanditon with Belling’s efforts to create a sympathetic understanding of people with hypochondria. I will argue that, despite time gaps and genre differences, joint consideration of these texts can help bioethicists better appreciate how medicine can intensify, pathologize, and exploit anxieties about illness and death, thus adding to the challenges of living well in the face of mortality and morbidity