Bioethics and women across the life span (review)

Women represent the majority of health care patients and caregivers. Yet the traditional bioethical discourse has not always recognized the variety of women's experiences in health care. Additionally, the ethical analysis of issues that are especially pertinent to women has had a tendency to focus on the clinical details of particular cases rather than on the context in which these cases occur. However, ignoring the uniqueness of women's experiences overlooks a whole realm of morally relevant issues and threatens to undermine the ideal of justice. Starting from the assumption that "gender justice is a necessary subset of justice, requiring explicit and deliberate attention to the impact of healthcare decisions on women," Mary Briody Mahowald's Bioethics and Women Across the Life Span offers an egalitarian analysis of topics ranging from decisions made at parturition and birth to research ethics and the treatment of minors.

The opening chapters of Bioethics and Women (1–3) provide an "overview of theoretical considerations relevant to women's health care" (p. 3). These introductory chapters lay the foundations for the author's egalitarian approach by presenting a succinct, well-balanced critique of the principle-based and case-based approaches dominating North-American bioethical reasoning. Because these approaches can obfuscate factors associated with inequality, Mahowald appeals to standpoint theory. She favors this epistemological approach for two principal reasons: its "recognition that the experiences on which knowledge depends are incomplete and partial, and [its] desire to reduce this limitation through collaborative enquiry" (p. 25). Like other proponents of standpoint theory, Mahowald argues that it has the capacity to "promote justice while reducing moral, epistemological, and political limitations (p. 26 )." In her view, gender justice can be achieved only if women's standpoints are considered in the decisions that affect them.

The first part of Bioethics and Women continues with a critical overview of some issues with special relevance for women's health care such as dominant models of physician-patient relationships, the moral status of the fetus in obstetrical health care (is the fetus a patient?), and professional guidelines and regulations that thwart the implementation of an egalitarian perspective in health care delivery. Mahowald's introductory chapters conclude with a preview of key terms used throughout the book such as "moral status," "moral agency," and "personhood" (p. 51).

The second part of Bioethics and Women aims at implementing Mahowald's egalitarian approach, in a semi-chronological progression, to ethical quandaries arising in health care that have special significance for women; from preconception and prenatal decisions (chap. 4) to care of the elderly and end of life-care (chap. 12). Each chapter of Part II opens with an introduction to the issue and an explanation of its relevance to women's health care before proceeding to an analysis of cases. Mahowald's paradigmatic cases stem at times from her personal experience as a hospital ethicist and at times, from court cases reported in the mainstream or academic press. Other cases emerge from the author's desire to illustrate a point. At times, this can make them a bit too paradigmatic and somewhat artificial. Still, Mahowald's cases on the whole are engaging and thoughtfully presented. Each series of cases is followed by sub-sections on empirical considerations and theoretical considerations. Each chapter ends with concluding remarks.

One of the most notable features of the book is Mahowald's appeal to empirical and theoretical considerations. This presents an analytical framework that is often absent in clinical ethics consultation. As a student who is privileged to study bioethics in a clinical setting, often I am baffled by what passes as an ethical query in day-to-day clinical encounters. Often more baffling is what passes as an ethical answer. Mahowald's systematic separation of empirical and theoretical considerations offers a refreshingly clear-headed perspective on ethical dilemmas that is free of persuasion and psychologizing.

I was intrigued by Mahowald's presentation of standpoint theory, yet feared that it would amount to moral relativism in its practical...