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Idealism vs. Pragmatism and Other False Dichotomies
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As I thought of a response to their comments on my work, I was reminded of how Hester distinguished its three main thrusts as classical American philosophy (especially in the writings of Royce), feminism, and bioethics. In my professional life, I came to each of these content areas in succession, mainly incorporating each previous focus into the other. But then I realized that my interest and involvement in each was sparked and sustained, in a very Deweyan way, by my own life experience, that is, my personal life. Events in my personal life have not been entirely separable from my professional pursuits, and this has led me to describe my remarks today as a critique of the dichotomy that is often assumed between the personal and professional domains. I think this critique is applicable to other often-assumed dichotomies such as those between mind and body, or reason and feeling, or theory and practice, as well as in the relationship between idealism and pragmatism that I identified long ago in my work on Royce (Mahowald, Idealistic Pragmatism). In the intervening years, I have become quite comfortable with describing myself, not just Royce, as an idealistic pragmatist.

Both Hester and Kegley have well articulated my overall approach, my understanding of an idealistic pragmatism, as applicable to issues involving nondominant groups in society, especially in the context of health care. Both have stressed the standpoint theory that is, I believe, another way of expressing the perspectival account of knowledge found in the classical American philosophers. My central starting point, which Hester accurately identifies, is the assumption that all human beings are equal in value, but we are all unalterably different in many respects (Mahowald, Genes). Moreover, most if not all of us embody both dominant and nondominant characteristics.

As Kegley notes, I use a favorite metaphor to characterize the inevitable limitations of human perspectives: myopia, or nearsightedness (Mahowald, "On Treatment of Myopia"). What can and should reduce our nearsightedness is putting on the lens of others' standpoints to reduce the limitations of our own. But standpoint theory adds an important point to this, that the lenses of nondominant groups should be given priority status by the dominant groups who would otherwise make decisions for everyone based solely on their own myopic perspectives. In other words, the nondominant input is remedial. Grounds for giving priority to inclusion of nondominant standpoints in decisions and policies are both epistemological (to reduce the limitations of our knowledge) and moral (it is the fair or just thing to do, to involve those affected in decisions affecting them).

I think a lot of my work in philosophy is remedial. In the first book I published after my dissertation, for example, I assembled writings about women written by well-known Western philosophers from ancient Greece to the present (Mahowald, Philosophy of Woman). Most people, including me, thought that what they wrote about "man" applied to both sexes, but in fact, what they wrote about women is generally inconsistent with what they wrote about "man" as the supposedly generic human being. My goal was to help develop a less inadequate account of what it means to be human. Although I have often focused on gender differences, I have also acknowledged that nondominance is characteristic of some men, for example, those who are poor, non-white, or disabled, and that I, like some other women today, have long been in a position of dominance in terms of my race, class, ability, and sexual orientation.

Hester has asked me to comment on the issue of elective cesarean sections, which he addressed at grand rounds a while back, basing it on a case he has described to you. In my last book, I described four different scenarios involving these surgeries for non-medical reasons (Mahowald, Bioethics and Women). One of the cases is a lot like the one he described; it involved a woman who wanted to give birth on New Year's Eve, apparently so that her newborn could be listed as a tax write-off for the previous year. Hester cites the contrasting positions of organizations on the issue, including the American Council of Obstetrics and Gynecology, which in my view...



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