This book explores the social practice of holding each other in our identities, beginning with pregnancy and on through the life span. Lindemann argues that our identities give us our sense of how to act and how to treat others, and that the ways in which we we hold each other in them is of crucial moral importance.

Naturalized bioethics represents a revolutionary change in how health care ethics is practised. It calls for bioethicists to give up their dependence on utilitarianism and other ideal moral theories and instead to move toward a self-reflexive, socially inquisitive, politically critical, and inclusive ethics. Wary of idealisations that bypass social realities, the naturalism in ethics that is developed in this volume is empirically nourished and acutely aware that ethical theory is the practice of particular people in particular times, places, cultures, and (...) professional environments. These essays situate the bioethicist within the clinical or research context, take seriously the web of relationships in which all human beings are nested, and explore a number of the different kinds of power relations that inform health care encounters. Naturalized Bioethics aims to help bioethicists, doctors, nurses, allied health professionals, disability studies scholars, medical researchers, and other health professionals address the ethical issues surrounding health care. (shrink)

This essay takes a close look at a species of care that is particularly needed by people with progressive dementias but that has not been much discussed in the bioethics literature: the activity of holding the person in her or his identity. It presses the claim that close family members have a special responsibility to hold on to the demented person's identity for her or him, and offers some criteria for doing this morally well or badly. Finally, it considers how (...) even those with dementia can hold others in their identities, and suggests that this kind of holding too can have great moral worth. (shrink)

An Invitation to Feminist Ethics is a hospitable approach to the study of feminist moral theory and practice. Designed to be small enough to be used as a supplement to other books, it also provides the theoretical depth necessary for stand-alone use in courses in feminist ethics, feminist philosophy, and women's studies. The "overviews" section introduces important concepts in feminist ethical theory and contrasts that theory with the standard moral theories. The "close-ups" section looks at three topics--bioethics, violence, and the (...) globalized economy--to help students put the theories presented in the Overviews section to practical use. (shrink)

Hilde Lindemann Nelson focuses on the stories of groups of people--including Gypsies, mothers, nurses, and transsexuals--whose identities have been defined by those with the power to speak for them and to constrain the scope of their actions. By placing their stories side by side with narratives about the groups in question, Nelson arrives at some important insights regarding the nature of identity. She regards personal identity as consisting not only of how people view themselves but also of how others view (...) them. These perceptions combine to shape the person's field of action. If a dominant group constructs the identities of certain people through socially shared narratives that mark them as morally subnormal, those who bear the damaged identity cannot exercise their moral agency freely.Nelson identifies two kinds of damage inflicted on identities by abusive group relations: one kind deprives individuals of important social goods, and the other deprives them of self-respect. To intervene in the production of either kind of damage, Nelson develops the counterstory, a strategy of resistance that allows the identity to be narratively repaired and so restores the person to full membership in the social and moral community. By attending to the power dynamics that constrict agency, Damaged Identities, Narrative Repair augments the narrative approaches of ethicists such as Alasdair MacIntyre, Martha Nussbaum, Richard Rorty, and Charles Taylor. (shrink)

There are no moral cookbooks—no algorithms for whipping up moral confections to suit every occasion. But more modest and flexible tools might still be useful for practical ethics. One team describes how professionals can be taught to use a framework for understanding moral problems.

The authority of surrogates—often close family members—to make treatment decisions for previously capacitated patients is said to come from their knowledge of the patient, which they are to draw on as they exercise substituted judgment on the patient’s behalf. However, proxy accuracy studies call this authority into question, hence the Patient Preference Predictor (PPP). We identify two problems with contemporary understandings of the surrogate’s role. The first is with the assumption that knowledge of the patient entails knowledge of what the (...) patient’s choice of treatment would be. The second is with the assumption that a good decision reproduces the content of that choice. If we are right, then the PPP, helpful though it might be in guiding surrogates’ decisions, nevertheless would hold them to the wrong standards and in that way could add to, rather than relieve, the stress they experience as they try to do their job. (shrink)

Clinical ethicists tend to see themselves as moral experts to be called in when clinicians encounter a particularly difficult moral problem. Drawing on a naturalized moral epistemology, we argue that clinicians already have the moral knowledge they need—the norms and values that guide clinical practice are built right into the various health care professions. To reflect on their practice, clinicians need to (a) be aware of their own professional norms and values; (b) be able to express them to their colleagues, (...) their patients, and the patients' families; and (c) work together with these other actors to provide ethically responsible care. The ethicist's job is to use her own training in three kinds of philosophical reflection as the basis for teaching clinicians how to think about what they do. (shrink)

This chapter contains sections titled: Familial Responsibility to Hold Good and Bad Holding Clumsy Holding Acknowledgments References.

Several criticisms of the Groningen Protocol rest on misunderstandings about how it works or which babies it concerns. Some other objections—about quality‐of‐life judgments and parents' role in making decisions about their children—cannot be easily cleared away, but at least in the context of Dutch culture and medicine, the protocol is acceptable.

Narratives have always played a prominent role in both bioethics and medicine; the fields have attracted much storytelling, ranging from great literature to humbler stories of sickness and personal histories. And all bioethicists work with cases--from court cases that shape policy matters to case studies that chronicle sickness. But how useful are these various narratives for sorting out moral matters? What kind of ethical work can stories do--and what are the limits to this work? The new essays in Stories and (...) Their Limits offer insightful reflections on the relationship between narratives and ethics. (shrink)

Several criticisms of the Groningen Protocol rest on misunderstandings about how it works or which babies it concerns. Some other objections—about quality‐of‐life judgments and parents' role in making decisions about their children—cannot be easily cleared away, but at least in the context of Dutch culture and medicine, the protocol is acceptable.

We should not always expect parents to put their children first.

American bioethicists lack the theoretical resources to work in cross‐cultural settings. All we have are two approaches to ethics—principles vs. narratives—that are mostly at odds, and neither of which is up to the job. If moral principles are too abstract to be useful, and if stories cannot provide moral authority, then where do we find our moral norms?

Starting from the intuition, shared by many women, that the legal right to an abortion must be defended but that they themselves could never undergo one, I offer an account of why pregnancy is morally valuable and why, nevertheless, it is often permissible to end one. Developing the idea that human pregnancy centrally involves the activity of calling a fetus into personhood, I argue that the permissibility of stopping this activity hinges on the goodness or badness of one's moral luck.

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

Starting from the intuition, shared by many women, that the legal right to an abortion must be defended but that they themselves could never undergo one, I offer an account of why pregnancy is morally valuable and why, nevertheless, it is often permissible to end one. Developing the idea that human pregnancy centrally involves the activity of calling a fetus into personhood, I argue that the permissibility of stopping this activity hinges on the goodness or badness of one's moral luck.

In this article I begin with an anecdote as a way of exploring just exactly what activism entails. Are we talking about the kind of activism every citizen ought to engage in? Should we confine our topic to activism in health care settings? Just what is activism anyway, and how much and what kind ought bioethicists to engage in? Finally, I consider the possibility that it’s perfectly permissible for bioethicists not to be activists of any kind.

Stories do many different kinds of moral work. Because they can depict time passing, feature certain details while downplaying others, draw connections among their internal elements, display causal relationships, and connect themselves to other stories, they are particularly well suited to the task of modeling a puzzling clinical situation. A story maps the situation's contours, picking out the details that, together, constitute the moral reasons for doing what may or must be done. When moral deliberators construct a story, they come (...) to understand the situation in a certain way, and that, in turn, guides their sense of how they should act in or with respect to it.But stories don't just represent situations‐they can also misrepresent them. For that reason, if we are to use stories as guides to action, we have to be sure we get them right. In what follows I offer three clinical situations that are either about to be or have already been narratively misrepresented. I'll explain how the stories go wrong, point out the undesirable consequences of acting on them, and offer alternative ways of depicting the situations that could bring them to a morally successful resolution. (shrink)

This chapter contains section titled: Where We've Been Where We're Going Feminist Epistemology Counterstories Acknowledgments Notes References.

Daniel Brudney's clear-headed analysis, in this issue of the Hastings Center Report, of the difference between a patient's and a surrogate's right to make medical treatment decisions contributes to a longstanding conversation in bioethics. Brudney offers an epistemological and a moral argument for the patient's and the surrogate's right to decide. The epistemological argument is the same for both parties: the patient has a right to decide because she is presumed to know her own interests better than anyone else, and (...) the surrogate is entitled to make decisions because she knows the patient better than anyone else. However, argues Brudney, the moral arguments are not parallel. The patient's moral right to decide for herself is an exercise of autonomy, but the only ground for the responsibility held by the surrogate, says Brudney, is that she knows the patient better than the health care professionals do. If in fact that's not the case, then she forfeits her right to be the patient's surrogate. For all the clarity and force of his argument, I think Brudney may be barking up the wrong tree. In cases of proxy decision-making, it's intimacy, not knowledge, that does the heavy moral lifting. (shrink)

Medicine and families, two venerable institutions crucial to human well-being, are in crisis. The medical profession, struggling to control and equitably distribute care, finds itself compromised by its own success; families are shattered by divorce, violence and confusion about their own nature. What has gone unnoticed is the way these two powerful and pervasive spheres contribute to each other's loss of direction. The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. (...) The authors explore how medicine, through its new reproductive technologies, is altering the structure of families, how families can participate more fully in medical decision-making, and how to understand the impact on families when medical advances extend life but not vitality . This book takes an unprecedented perspective on both institutions. Innovative and vivid, their stories tell the tales of families interacting with the medical establishment. (shrink)

American bioethicists lack the theoretical resources to work in cross‐cultural settings. All we have are two approaches to ethics—principles vs. narratives—that are mostly at odds, and neither of which is up to the job. If moral principles are too abstract to be useful, and if stories cannot provide moral authority, then where do we find our moral norms?

I argue that the field of bioethics is gendered feminine, but that the methods it uses to resist this gender identity pose real harm to actual women. Starting with an explanation of what I take ?gender? to be, I enumerate four drawbacks to being gendered feminine. I then argue that bioethics suffers from three of the same four drawbacks. I show how the field escapes the fourth disadvantage by adopting a masculine persona that inflicts damage on women, and conclude by (...) urging bioethicists to reflect on their complicity in abusive power systems such as gender, race and class. (shrink)

When I accidentally fell into the job of Associate Editor at the Hastings Center Report, I soon learned that one of my duties was to copyedit the case studies that the Report publishes on a regular basis. The Hastings Center being the kind of institution it is, as I edited the essays, I also imbibed a good deal of bioethics. I began to publish scholarly articles and coauthor a book, all under the mentorship of Dan Callahan and the Center's other (...) associates. Joe Fins, then the Associate for Medicine, patiently answered all my many questions about ethical issues surrounding the doctor-patient relationship; Susan Wolf, the Associate for Law, taught me some classic court cases, starting with Schloendorff; and Jamie... (shrink)

Gender, most feminists agree, isn’t a fact about people in the same way that height or hair color is. Genders are constructed within and are part of a power system circulating through all of society that sets standards for men’s and women’s identities and places men’s interests above women’s. The system is bad for all of us, but especially for women, genderqueer people, and men of color. Here, I want to point out ways in which it’s bad for our health. (...) I’ll start with abortion, as laws recently passed in a number of states have restricted women’s access to the point where it’s nearly nonexistent. (shrink)

In this article, I want to reflect on the patient’s voice and why it is sometimes faint or goes altogether unheard. The patient may be too ill to speak or too incapacitated for her voice to express her autonomous wishes. She may speak a foreign language. She may be deaf and lacking an interpreter qualified to sign medical terminology. Her own views may be outshouted by a patient association that presumes to speak for her. Or she may be the target (...) of prejudice that makes it easy for socially privileged people to discount or ignore or not hear what she says.In this article, I examine a rather different, more subtle kind of voicelessness—one that is pervasive, causes moral... (shrink)