A review of The Feminist Transformation of Bioethics: An Analysis of Theoretical Perspectives and Practical Applications in Feminist Bioethics, by Eeva Nyrövaara.
In The Feminist Transformation of Bioethics, Eeva Nyrövaara assesses the extent to which feminist bioethics as a subfield has successfully transformed the foundations and practice of bioethics, and the central role that such transformation plays within feminist bioethics. Nyrövaara performs this task by first examining the theoretical foundations of feminist bioethics. The project then looks at how these thematic elements are carried over in the feminist treatment of autonomy, a central principle of mainstream bioethics, and in the ethics of stem cell research, a contemporary discourse surrounding novel biotechnologies. The project ends with Nyrövaara’s constructive supposition of two future directions for the development of feminist bioethics. The first chapter introduces the topic with a brief history of feminist bioethics where, despite bioethics and second wave feminism coming to being at the same time, the two movements interacted relatively little until the 1980s and ‘90s.
Chapter 2 begins by challenging a foundational view of bioethics that understands theory to be a firm grounding from which to make normative proclamations about biomedical issues. Instead, Nyrövaara draws attention to those like Susan Sherwin who understand the role of theory in bioethics to be that of a lens. Here a given theoretical lens offers just one way to look at a given topic, one that can be used in tandem with multiple lenses. Each theoretical lens contributes to the moral picture that takes its form—and the lenses interact with one another. With this in mind, Nyrövaara identifies and explicates basic theoretical themes common to feminist bioethics, and argues that each has transformation of convention as its underlying practical goal. These topics are: moral epistemology and contextuality, moral agency and sexual difference, the body and embodied experience, and relationality and power.
Feminist moral epistemologies, Nyrövaara notes, begin with an emphasis on knowledge as something produced by societies rather than waiting in the world to be discovered. Within this frame, feminist epistemologists argue that women are not only largely passed over or misrepresented as objects of knowledge (especially historically), but they are also often denied as subjects of knowledge. Feminist standpoint epistemology steps in here as corrective, where self-examination of the situatedness of all knowledge, including moral knowledge, can help make knowledge production more “democratic” or representative. Nyrövaara briefly notes the potential for over-individualization, however, that could follow from the rush to personal experience in considering moral knowledge. That is, an emphasis on standpoint and personal experience threatens to entail that one can make normative claims only regarding instances of immediate experience. This, however, is not an entirely novel challenge for standpoint theory, and Nyrövaara recounts several responses.
Nyrövaara turns next to the centrality of contexts in feminist thought, and the function of contextuality as a means of revealing structural oppression and relations of power. By looking to the contexts of bioethics issues and cases, Nyrövaara notes, feminist bioethicists further challenge the ossified nature of the acontextual bioethics case. Investigations into contexts reveal biases of interpretation and the hidden moral strictures of patients, physicians, and researchers alike.
The third chapter then applies the elements of the overview of feminist bioethics to one philosophical concept that is central to bioethics: autonomy. The chapter notes the feminist critiques of autonomy as individualist and atomizing, as setting unrealistic standards of freedom from external factors that may actually marginalize women and other oppressed persons when they are applied in medical practice. Moreover, Nyrövaara illustrates critiques of autonomy as limiting theorization of communal responsibility and action because of this individual focus. The response has been for feminist thinkers to conceive of new concepts of autonomy that tend to focus on relationality rather than atomized individuals. Nyrövaara explicates several of these accounts and takes a critical look at substantive accounts of autonomy in particular. These notions of autonomy support an inherent notion of good or better values as opposed to procedural accounts that allow for any values to motivate action. Nyrövaara argues in favor of procedural accounts of autonomy for their value-neutrality, appearing to presuppose neutrality as preferable. The chapter wraps up by illustrating those ways that relational autonomy is applied to bioethics and therein transforms how both bioethics and medicine itself are practiced. When a principle of autonomy utilizes a feminist relational account, respect for autonomy takes a different form that is less contractual or based more upon ongoing relationships of understanding, communication, and empowerment.
The fourth chapter looks at contemporary bioethics discourse surrounding stem cell research in order to identify feminist contributions to the debate. This begins with an overview of stem cell research itself—beginning with the science and moving on to the policies regulating it in the European Union, United States, and Scandinavia. Nyrövaara then outlines the basic ethical and philosophical issues at hand in the debate, starting with arguments about the personhood and therefore moral worth of embryos used in embryonic stem cell research. Arguments for some moral value of embryos fall along lines that Nyrövaara identifies as continuity arguments that claim embryos have moral status immediately, graduality arguments that claim embryos develop greater moral value as they develop toward becoming a human being, and potentiality arguments that claim embryos gain value from their potential to become human beings. The author argues that biological (descriptive) accounts of embryos that are called upon to support such moral arguments are not themselves sufficient to establish any moral status for embryos. Instead she argues that greater philosophical attention should be paid to categories of moral value and respect to better identify their existence in the world.
While few feminist bioethicists have written explicitly on the ethics of stem cell research, feminist thinkers have been considering the moral status of embryos and fetuses in the context of abortion for some time. Yet Nyrövaara looks to draw more attention to those ways that feminist theory in bioethics brings unique insights to stem cell ethics that go beyond questions of moral status and start considering social justice and relations of gender. That is, Nyrövaara argues that feminist bioethics can help to expand and transform the content of the debate. This includes feminist authors who focus more on the issues of egg and embryo donors (women, foremost, and infertile couples) and less on the metaphysics of embryos. This leads feminist bioethics to such issues as the nature of informed consent dialogues with women and couples undergoing reproductive procedures and the implications of the commodification of eggs and embryos for both reproduction and research. These more nuanced social accounts reflect the contextual emphases of feminist approaches to applied ethics and philosophy.
Nyrövaara ends her study with a few critical claims about feminist bioethics. The first is that it needs greater empirical insight, calling upon social science research to bring the insights of feminist bioethics closer to women’s experiences and more into the practical realm that feminist theory tends to espouse over the highly abstract. Second, Nyrövaara argues that feminist bioethics needs a different account of agency in order to address the common stumbling blocks in feminist theory, namely when women and other marginalized individuals choose paths or actions that are oppressive. I understand Nyrövaara to be calling for investigations into such issues that examine the relations of power between individuals and institutions more than problematizing a narrow concept of autonomy and agency. That is, Nyrövaara argues that feminist bioethics ought to adopt richer notions of responsibility based on complex interrelational accounts of individual actions and do not focus solely on individuals. The result, I gather, may be less a different account of individual agency than a decentering of its moral or philosophical importance.
Alex B. Neitzke
Michigan State University
Catriona Mackenzie and Natalie Stoljar, eds. Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. Oxford: Oxford University Press, 2000.
Policy documents of the European Union,European Science Foundation, Finland’s National Advisory Board, NordForsk, and the United States National Institutes of Health, National Bioethics Advisory Board, and President’s Council On Bioethics
University of Helsinki. 2011. 251 pp. Primary Advisor: Jaana Hallamaa.
Image: Human Embryonic Stem Cell. Colony Phase. Wikimedia Commons.