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Introduction

Fifteen years ago feminist approaches in bioethics emerged as a distinct and recognizable constituency. For the most part, the established scholarly field of bioethics greeted its appearance in one of two ways. Some critics argued that a feminist bioethics could supply only a "partial ethics," an ethics that would address only women. Others welcomed the feminist perspective, but only while insisting that its concerns, concepts, and methods were already anticipated by and merely specifications of dominant political and ethical theories derived from the ideas of contract, law, and the rights of man.1

It was as if the masculine marking of the subject in the history of ethics and politics made no difference. Just as medicine has often assumed that it could approach the female body through nosologies and clinical practices drawn from a study of the male body, philosophers and theorists in ethics and politics seemed to think that if feminism requires an extension of the rights of man, it does not require any rethinking of the basic concepts and strategies of bioethics itself.

This assessment assumes that man, the subject of both the sciences of man and the rights of man, supplies an absolute generic. Thus, women's experience is either a special case, whose logic may apply only to itself, or its difference is irrelevant and can be subsumed without harm or loss under the generic man. [End Page 1]

From the beginning, feminist bioethics was suspicious of this logic of abstraction in both medicine and bioethics. Its approaches were informed by the feminist critique of this sleight of hand, in which a specific historical experience is installed as the absolute universal in science or ethics. As Anne Donchin and Margrit Shildrik note in this volume, early on feminist bioethics disputed the adequacy of abstract universal norms. Feminist approaches to bioethics challenged the field for its reliance on abstract principles disconnected from the material conditions of action and the specificities of the relationships in which ethical urgencies arise. Feminist bioethics continues to contribute significantly to this critique of abstraction in ethics by exposing the complicity of its supposedly generic subject with concepts of property, propriety (norms), and privilege, as well as with the material practices that these concepts authorize in relation to others.

From the beginning, however, feminist bioethics insisted, as well, on the positive project of turning to women's experience and women's bodies as points of departure in science, politics, and philosophy, as resources or sites for the production of concepts that might function generically, informing us about human experience. In her scholarly history Donchin cites the "strong argument" from Susan Wolf's 1996 essay that "mainstream bioethics had been impoverished by ignoring feminist theory and perspectives." Thus, from the very beginning feminist approaches to bioethics have refused, as Wolf did, to be confined to a special set of "women's problems" or to relinquish the claim that women's experience might reveal something universal about ethical agency and ethical urgency.

Indeed, early on scholars coalesced around the idea that doing justice, not only to the experience of women and other marginalized groups, but also to our human experience would require a fundamental refiguring of the concepts of ethics. Within the larger feminist critique of abstraction, feminist approaches in bioethics criticized, in particular, the focus of bioethics on individual agency and the principled calculation of rights and duties between individual subjects. Feminist approaches in bioethics developed a concept of the ethical subject as relational and defined by actions in a world of others.2 In a remarkable, if often unacknowledged, kinship with Hegelian and post-Hegelian philosophies of the body and difference that is explored by Margrit Shildrik in her essay, feminist approaches to bioethics developed an account of agency as socially and historically constituted, as inseparable from its specific world and relations with others.

This recognition of the relationality of ethical agency prompted attention to the question of what material infrastructures are necessary to sustain our life [End Page 2] in common and how these are to be produced. On the one hand, feminist approaches in bioethics understood individual agency to be impossible without these collective structures. On the other, these approaches appreciated the way in which the production of these material infrastructures requires collective action. Feminist bioethics recognized that just as ethical agency is socially constituted, so too, the material structures required to sustain it can only be produced collaboratively.

Informed by this analysis of the sociality of agency and its dependence on material infrastructures of collaboration, feminist approaches in bioethics linked health with global and environmental justice. Feminist approaches gathered around the idea that specific ethical issues must be seen in the larger social, economic, and institutional context in which they arise. These approaches recognized, for example, transnational issues in care-giving or the way in which technological advancement can contribute to social inequity. Understanding the problems of bioethics as international and requiring collective action, feminist approaches in bioethics have always identified ethics, both in theory and in practice, with crossing borders.

Since 1992, the International Network on Feminist Approaches to Bioethics has worked to create a global community of discussion, debate, and action around problems in bioethics. The International Journal of Feminist Approaches to Bioethics is itself a result of that commitment and collaboration across theoretical and material borders.

This inaugural issue of the International Journal of Feminist Approaches to Bioethics demonstrates not only the necessity in bioethics, as in medicine, of taking into account the specificity of women's experience and women's bodies, but also the possibility of finding in them new figures of universality for bioethics itself. By departing from the difference of gender and taking into account the specificity and irreducibility of the experiences and bodies of women, feminist approaches to bioethics are producing new concepts and strategies for bioethics that better articulate and more effectively address our human situation with respect to health and health care.

Building on fifteen years of critical scholarship, each of these essays is animated by a moral imagination that is focused less on individual choice, the rational calculation of rights and duties, or principles of virtue than on imagining what the French philosopher Luce Irigaray calls a "livable future." Each essay engages the question of how we might collaboratively reorganize the material infrastructures of our lives to promote our collective health and happiness. [End Page 3]

Susan Sherwin's essay undertakes nothing less than a revisioning of bioethics itself as a "public ethics." She argues that only such a collective ethic will be adequate to address the environmental and political crises that threaten catastrophe in our time. Explicitly employing an analogy to public health, Sherwin refocuses bioethics on the social and institutional constitution of agency, as well as the complex levels of collective responsibility for health. Her essay reveals the implications of such a rethinking of bioethics for both theory and practice. She offers a detailed critique of the way in which the traditional rights-based approach of bioethics frames ethical problems in relation to stem-cell research or reproductive technologies as matters of individual protection or choice, so that questions of social justice are rendered invisible. Sherwin's analysis exposes the necessity of proactively setting an agenda for bioethics that recognizes the sociality of agency and the link between justice and health. Her essay establishes the leadership role of feminist approaches to bioethics in this project.

Margrit Shildrik's essay also calls for an expansion of the discourse of bioethics. In the spirit of feminist bioethics' methodological pluralism, Shildrik shows how the resources of post-Hegelian philosophers of the body and difference can be productively brought to bear on ethical issues in health care. This literature, she argues, provides crucial conceptual resources for feminist bioethics in rethinking agency as social and choice as dependent on collective infrastructures. Moreover, its analyses of embodiment and intercorporeality address questions of bodily integrity, of the differentiation of bodies, and of the boundary of life and death that are central to inquiry in bioethics. Specifically, Shildrik shows how Derrida's analysis of the logic of the gift productively clarifies the complex ethical relations in the case of heart transplantation.

Rebecca Kukla's account of reproductive ethics also demonstrates how feminist bioethics requires a transformation of bioethics itself, away from a focus on the regulation of individual choices and actions toward an understanding of bioethical issues as embedded in "larger questions of social, economic, and environmental justice." Rather than "measuring mothering," Kukla argues, health promotion policies ought to focus on "providing families with the systematic support that would enable women to engage in ongoing narratives of good mothering." Her account recognizes both the historicity of mothering and the dependence of maternal agency on supportive collective infrastructures. Kukla's analysis suggests a reproductive ethics that focuses less on evaluating mothers and more on imagining a world in which each mother enjoys the resources and security necessary to her task. [End Page 4]

Focusing on reproductive technologies, the essay by Sandra Reineke presents a detailed historical example of how individual choice depends on public policies and collective conditions of agency. Reineke analyzes the French "pronatalist paradox:" although the highly controlled dissemination of NRGTs in France has precipitated concern about discrimination and the commodification of the female body, it has been coupled with an expansion of policies and infrastructures that facilitate and support childbearing and childrearing. Reineke's essay confirms both the necessity of a feminist perspective to public policy and, more specifically, the emptiness of political valorizations of mothering without the concomitant elaboration of infrastructures of support for it.

Carolyn McLeod and Julie Ponesse also address the politics of reproduction and individual agency. Their analysis reveals how the rhetoric of choice obscures the social and collective features of agency, as well as the role of luck in determining the ethical situation. Criticizing a pronatalism that identifies female agency with biological reproduction, McLeod and Ponesse show how the medical approach to infertility invites the ascription of blame to women for the bad outcome of infertility. Their analysis makes clear how collective infrastructures can undermine agency, as well as support it.

The analysis by Wendy Rogers and Angela Ballantyne of gender and trust in medicine also links the ethical dimensions of medical practice to an understanding of the way in which the relation between health care provider and patient is embedded in a larger social context. Rogers and Ballantyne demonstrate how some social groups suffer "pre-existing vulnerabilities" to the abuse of trust as a result of a history of systematic discrimination. Focusing on the experience of women, the authors address the general problem of vulnerability and trust in health care. Their analysis makes clear the ethical impropriety of relying on individual trustworthiness, as well as the necessity of establishing collective mechanisms of assessment and review to protect vulnerable patients from abuses of trust.

Similarly, focusing on the way in which vulnerability may derive, not from an attribute of the individual, but from structural features of the social context, Lisa Eckenweiler, Dafna Feinholz, Carolyn Ells, and Toby Schonfeld offer a feminist revision of the Declaration of Helsinki. Their account of feminist research ethics develops the commitment of feminist bioethics to global and environmental justice. They argue that research agendas must be evaluated with respect to their impact on social cohesion and global health disparities. Their feminist analysis suggests a transformation in the very form and focus of codes like the Declaration. They argue that such codes ought to invest ethics committees with the proactive [End Page 5] responsibility to promote research on understudied groups or to intervene when economic structures compromise the integrity of research agendas. Like the other essays in this volume, this critique makes evident the power of a feminist approach in bioethics by showing how its rethinking of ethical relationships prescribes a new future for bioethics.

This inaugural issue of the International Journal of Feminist Approaches to Bioethics exhibits the disciplinary and methodological diversity that characterizes the field. It exposes points of contestation and divergence. These essays demonstrate that feminist bioethics, with its multiplicity of strategies and approaches, is not so much a methodology or a school of thought, as a form of scholarly solidarity, a commitment to conceptual work that is engaged by the idea of a more livable future. As Anne Donchin remarks, feminist bioethics is defined by a "vision" of a community of mutual support in which each is committed to optimizing the health of all. This issue exhibits the extraordinary theoretical and practical range across which feminists in bioethics are working to achieve this vision. Beginning with this issue, IJFAB commits itself to facilitating and advancing what Margrit Shildrik calls "the adventure of a possible and future feminist bioethics."

Notes

1. For a discussion of the former position, see Rawlinson 2001. For the latter, see Beauchamp and Childress 2001.

2. See, e.g., the essays by Anne Donchin, Sue Dodds, Carolyn McLeod, and Susan Sherwin in Mackenzie and Stoljar 2000.

References

Beauchamp, Tom L. and James F. Childress. 2001. Principles of bioethics. New York: Oxford University Press.
MacKenzie, Catriona and Natalie Stoljar, eds. 2000. Relational autonomy: Feminist perspectives on autonomy, agency, and the social self. New York: Oxford University Press.
Rawlinson, Mary C. 2001. The concept of a feminist bioethics. Journal of Medicine and Philosophy 26. [End Page 6]