Susan Sherwin

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved...

In the face of rapid technological developments and growing economic pressures, governments around the world are being called upon to regulate activities in the realm of biotechnology. My aim in this paper is to argue that core conceptual insights of feminist ethics are essential to ethically adequate policy-making in this area. Specifically, I shall argue that development of ethical biotechnology require that policy-makers undergo an ontological shift from the currently widespread assumptions of the dominant political framework of liberal individualism to an explicitly feminist understanding of subjects as relational beings. To ground my discussion, I shall explore the field of reproductive technologies, especially as they are used for genetic “improvements.” I shall pay particular attention to the use ofin vitrofertilization in conjunction with pre-implantation genetic diagnosis and related variations.Briefly, IVF, the core technology of so-called new reproductive technologies, is a platform technology that facilitates many other practices through affording access to oocytes and embryos.

In this anthology of new and classic articles, fifteen noted feminist philosophers explore contemporary ethical issues that uniquely affect the lives of women. These issues in applied ethics include autonomy, responsibility, sexual harassment, women in the military, new technologies for reproduction, surrogate motherhood, pornography, abortion, nonfeminist women and others. Whether generated by old social standards or intensified by recent technology, these dilemmas all pose persistent, 'nagging,' questions that cry out for answers

New technology in human reproduction has provoked wide ranging arguments about the desirability and moral justifiability of many of these efforts. Authors of biomedical ethics have ventured into the field to offer the insight of moral theory to these complex moral problems of contemporary life. I believe, however, that the moral theories most widely endorsed today are problematic and that a new approach to ethics is necessary if we are to address the concerns and perspectives identified by feminist theorists in our considerations of such topics. Hence, I propose to look at one particular technique in the growing repertoire of new reproductive technologies, in vitro fertilization, in order to consider the insight which the mainstream approaches to moral theory have offered to this debate, and to see the difference made by a feminist approach to ethics.

As one might expect, feminist health‐care ethics takes place at the intersection of feminist ethics and health‐care ethics (also known as (bio)medical ethics and bioethics). It encompasses a wide range of efforts to bring feminist perspectives and tools to bear on the set of ethical issues that arise within the realm of health and health care. These efforts expand and modify debates in both fields: that is, they add the perspective of gender analysis to the apparently gender‐neutral tradition of medical ethics, while also enriching the often theoretical discussions of feminist ethics through focus on the concrete reality and complexities of health‐care practices.