Mary Mahowald: Bioethicist

The Work of Mary Mahowald ranks highly alongside any pragmatic philosopher in the past forty years, and she has been a leader in the fields of pragmatism, feminism, and bioethics during those years. The following aims to highlight her work in bioethics, but as will become clear, Mahowald’s work cannot be disentangled so neatly. That is, pragmatist, feminist, and bioethical considerations are not separate concerns for her. They make up a rich, complex story of philosophical insight. But what I hope to do is to give a reasonable glimpse into her work as an internationally recognized thinker in the world of health care and ethics.

Mahowald is emerita professor in Obstetrics and Gynecology (among other areas) at the University of Chicago, and has been involved in biomedical ethics professionally for at least thirty years. Her work at the crossroads of pragmatism, feminism, and bioethics began with publications on the issue of abortion, and then she turned to a wide variety of issues in the health care of women and children in particular. While Mahowald has written on issues such as women’s health, parenthood, pediatric interests, and end-of-life decision making, the following will look at her thinking more broadly, and then move to a specific case-based topic—namely cesarean deliveries upon maternal requests (or “elective” C-sections). This topic has grown in importance in the last twenty years (cf. Coleman, Lawrence, and Schulkin), and is a topic that she addresses briefly in her latest book, Bioethics and Women: Across the Life Span (2006). I will lay out some of the positions that exist in the published literature, look at Mahowald’s philosophical reasoning when approaching the issue, and briefly comment on that reasoning while laying out my own argument regarding the obligations of health care providers in relation to elective C-sections.

I was a first-year graduate student taking a class on Kierkegaard or Foucault or some other philosopher I did not understand when I decided to stop by the professor’s office to ask a question. Frankly, I have no idea what I asked him (something about a philosophical point that confused me, I am sure), but to this day, I remember clearly his response: “Where do you stand when you say that?” Now, I am not the brightest bulb in the pack, and my struggles with even the fundamentals of philosophy are replete, and to be honest, at that moment, I did not understand his response in the slightest. In my (quite possibly revisionist) memory, I think I may have even looked down and around me to see where I was standing at the time.

Of course, what my professor was trying to get me to see was that the comment I made or question I had asked was coming from me—a specifically situated, embodied being. The question of where one “stands” when one speaks, thinks, or acts is the question that Mary Mahowald has been asking for some forty-five years. Her concern for taking seriously the gendered, communal, and environmental conditions that are constitutive of individual lives undergirds all her work.

The concern that Mahowald tries to address over and over again is this: How can we do justice to the unique aspects of human existence while remaining just toward all human beings? It is a kind of perpetual struggle. One response could be simply to say that the infinite varieties of human experience do not admit of just solutions. But many philosophers go a different way. For them the answer is that we must forgo a concern for uniqueness in order to achieve justice. That is, we must eradicate difference (by argument or fat) through universalization—whether it is the categorical universalization of Kant, the “view from nowhere” of Nagel, or the “original position” of Rawls. Such philosophical moves are intended to treat all of us equally. But do they? Can they?

Mahowald (Genes 14–23; Bioethics and Women 24–26) argues that such philosophical positions cannot. Instead she offers the following insights:

1. (a). Individuals cannot hold the whole of truth;

2. (b). Epistemological honesty requires communal engagement in truth-seeking...