Feminist thought has provided a fresh approach to the discussion of a broad range of issues in the context of health care. This issue of the journal is a new attempt to challenge those working in bioethics to consider the limitations of their assumptions and to listen to new ideas. Bioethicists from different cultures and traditions may have a wide variety of issues to deal with; and even if they share the same ethical concerns, they may not address them in the same way. Drawing resources from different voices can help bioethics become more productive. Accordingly, this issue presents a wonderfully diverse selection of papers about health care from the context of particular countries, aiming to enrich and expand the discussion and conception of bioethics.
The first three articles of this issue are followed by responses. The first two and their responses are intended to provide a discussion by different voices from the North and the South. In the leading article, Heather Widdows worries about the significance of the notions of autonomy and choice in bioethics and the extent to which the problem of exploitation has been downplayed. She focuses on two practices, trafficking for prostitution and egg donation for stem cell research, which she considers exploitative. Widdows argues that transnational feminism will be well served by a return to a more traditional feminist stance that privileges fighting oppression and exploitation rather than respecting choices that may not be truly free. Her commentator, Liliana Acero, examines four main sets of issues raised by the paper and considers their relevance in the context of developing countries. [End Page 1]
In her paper, María Julia Bertomeu does two things. First, she identifies different stages in the evolution of bioethics and argues that those stages are closely connected to the economic and political processes characteristic of globalization. Second, she urges bioethicists from Latin America to change the way in which they practice the discipline. Bertomeu concludes that if bioethics is going to be truly valuable in Latin America, it must address the economic, political, and social conditions of people in the region, particularly the many whose rights are systematically restricted either directly, or indirectly. In her response, María José Guerra Palmero adds to Bertomeu's argument by noting the pressures of capitalist investment on scientific research and how such research fails to serve the interests and needs of the poor in developing countries.
The authors of the third pair of articles share a country and a culture, but they address the issue of women's poverty and health care problems from different perspectives. John Ouko's paper asks the reader to consider the impact of economic policies imposed on nations in the global South primarily by nations in the global North on the health care of women. He focuses on the plight of women in Kenya. His commentator, Obioma Nnaemeka raises further considerations, criticizing Ouko's paper for missing the complexity of the issue, particularly the interactions between the externally imposed policies and the internal cultural, political, and economic factors that oppress Kenyan women in every facet of life. This oppression impacts the health of women and their children in ways that require more than a mere change in international money lending policies.
The next three papers by Zahra Meghani and Lisa Eckenwiler, Kirsten Stoebenau, and Florencia Luna, highlight issues of general justice faced by specific populations in different parts of the world.
Eckenwiler and Meghani's piece emphasizes the need for a theory of global justice that is able to address the condition and injustices suffered by undocumented workers from the global South that flow to richer nations. Many of them, the authors observe, are employed in labor-intensive, low-wage jobs. The aim of the paper is to flesh out some of the injustices suffered by this population, identify some of the factors and agents responsible for them, and propose the kind of reforms needed to treat this group of people justly.
Few topics raise as many ethical issues as the one about women who practice different forms of sexual exchange. In her piece, Kirsten Stoebenau focuses on the labeling of women who participate in those practices in Antananarivo, Madagascar. Stoebenau questions the adequacy of applying the Western discourse on [End Page 2] sex work and prostitution in reference to them. She argues that the inappropriate application of those identities simplifies and misunderstands the lives of those women, leading to negative health and social consequences. Feminist relational theory, she suggests, could correct this misunderstanding and promote more humane and effective means to address these issues and their causes.
In her article, Florencia Luna focuses on the notion of vulnerability itself, especially as it is used within human subjects research. Luna reviews the main criticisms of the notion and holds that they can be avoided by conceiving it in a more dynamic and relational way. This will change vulnerability from a broad label to a multi-layered concept which identifies real vulnerability for each individual. Only then will vulnerability become the operative intellectual tool that bioethics requires to discuss and address a number of pressing issues.
In the commentary section of the journal, we have included three pieces. The first two are a discussion on a popular issue, the rising rate of cesarean sections (C-sections) worldwide. Lauren A. Plante's commentary addresses this topic from a new angle. She considers how factors are changing obstetrics from an art to an industrialized practice—designed to produce a statistically improved result while minimizing individual options. She calls for women to take a long, hard look at whether the trend toward increased use of C-sections advances or diminishes women's rights and interests. In turn, Martha Sañudo and Inmaculada de Melo-Martín examine the current increase of C-section rates in some Latin American countries, particularly Mexico. The authors speculate on some of the social and economic factors that may affect the attitudes of Mexican physicians toward C-sections and the willingness of Mexican women to undergo them.
Rustem Ertug Altinay's commentary calls our attention to an issue of justice that impacts young rape victims in Turkey. Law, culture, and bioethics intersect in his call for a discussion of the justice of forcing young rape victims to undergo forensic examinations to verify their ages. The layers of justice include issues of liberty, bodily integrity, professional integrity, and power. Furthermore, there is the question of the justice of judging all women against a single standard body type and growth rate. His paper provides an example of the multiple, subtle layers in which poor women can become disempowered by the very groups that are supposed to protect them.
Rosemarie Tong wrote, "If I wish to secure a truth greater than my own, then I must talk to as many different kinds of people as possible" (Tong 1997, 95). She goes on to note that talking is not as important as listening. Hopefully, listening [End Page 3] to these diverse voices and discussing their ideas will improve the ability to promote justice for all, not just those within the narrow scope of each reader's experience and imagination.
Arleen L. F. Salles is currently a researcher at Centro de Investigaciones Filosóficas (Buenos Aires, Argentina). Her research interests are in ethical theory, moral psychology, and bioethics. She has published articles on emotions in ethical reasoning, health care ethics and autonomy, and cultural differences. She has edited several collections and is the co-author of Bioetica: Nuevas reflexiones sobre debates clásicos.
Constance Perry is Associate Professor in the Health Services Administration Program of Drexel University's College of Nursing and Health Professions. She has published articles dealing with ethical issues in pregnancy, personhood, animal experimentation, organizational ethics, and autonomy.