Susan Sherwin

A relational perspective on autonomy for older adults residing in nursing homes.

Aim  To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults.

Foundations, Frameworks, Lenses: The Role of Theories in Bioethics

I explore the implications of the foundation metaphor for understanding the role of moral theories in ethics and bioethics and argue that its disadvantages outweigh its advantages. I then consider two other metaphors that might be used instead, those of frameworks and lenses. I propose that the metaphor of lenses is most promising in providing methodological guidance for drawing on moral theories when deliberating about bioethical problems.

The Myth of the Gendered Chromosome: Sex Selection and the Social Interest

Sex selection technologies have become increasingly prevalent and accessible. We can find them advertised widely across the Internet and discussed in the popular media—an entry for “sex selection services” on Google generated 859,000 sites in April 2004. The available services fall into three main types: (1) preconception sperm sorting followed either by intrauterine insemination of selected sperm (IUI) or by in vitro fertilization (IVF); (2) preimplantation genetic diagnosis (PGD), by which embryos created by IVF are tested and only those of the desired sex are transferred to the womans uterus; and (3) prenatal testing of fetuses through ultrasound or chromosomal analysis, followed by selective abortion of fetuses detected to be of the undesired sex. Victoria Seavillekleins research was supported by the following grants: Izaak Walton Killam Memorial Scholarship, Social Sciences and Humanities Council Doctoral Fellowship, and CIHR Training Program in Ethics of Health Research and Policy. Earlier versions of this paper were read to the Philosophy Department at Dalhousie University and to the participants of the CIHR Training Program in Ethics of Health Research and Policy. We are grateful for the helpful feedback we received on both occasions. We also appreciate the comments made by Micah Hester and two anonymous reviewers.

Abortion Through a Feminist Ethics Lens

Abortion has long been a central issue in the arena of applied ethics, but, the distinctive analysis of feminist ethics is generally overlooked in most philosophic discussions. Authors and readers commonly presume a familiarity with the feminist position and equate it with liberal defences of womens right to choose abortion, but, in fact, feminist ethics yields a different analysis of the moral questions surrounding abortion than that usually offered by the more familiar liberal defenders of abortion rights. Most feminists can agree with some of the conclusions that arise from certain non-feminist arguments on abortion, but they often disagree about the way the issues are formulated and the sorts of reasons that are invoked in the mainstream literature.

Looking Backwards, Looking Forward: Hopes for Bioethics' Next Twenty‐Five Years

I reflect on the past, present, and future of the field of bioethics. In so doing, I offer a very situated overview of where bioethics has been, where it now is, where it seems to be going, where I think we could do better, and where I dearly hope the field will be heading. I also propose three ways of re-orienting our theoretic tools to guide us in a new direction: (1) adopt an ethics of responsibility; (2) explore the responsibilities of various kinds of actors and relationships among them; (3) expand the types of participants engaged in bioethics.

Moral perception and global visions.

Because moral perception plays an essential role in guiding morally responsible behaviour, agents have a responsibility to develop their capacities in this area. There are several strategies agents can (and should) pursue in order to improve their skills at moral perception. I appeal to insights derived from the work of feminist epistomologists [sic] and philosophers of science to argue that feminist approaches to multiculturalism are particularly valuable tools for improving moral perception.

Women in Clinical Studies: A Feminist View

There is significant evidence that the health needs of women and minorities have been neglected by a medical research community whose agendas and protocols tend to focus on more advantaged segments of society. In response, the National Institutes of Health (NIH) and Food and Drug Administration (FDA) in the United States have recently issued new policies aimed at increasing the utilization of women in clinical studies. As well, the U.S. Congress passed the NIH Revitalization Act of 1993, which specifically mandates increased inclusion of women and racial and ethnic groups in clinical studies. On the face of it, such gender and race-specific policies would appear to be morally problematic because traditionally ethics opposes the use of sex or race as legitimate criteria for distributions of benefits or burdens in social policies. Hence, these policies pose some significant moral questions. Feminist ethics provides us with a framework for evaluating such policies because of its readiness to recognize that socially and politically significant factors such as sex and race are morally relevant in setting public policy. Of course, feminist ethics does not simply endorse all appeals to sex and race but only the policies in which attention to such factors will contribute to social justice. In this essay, I Identify some of the Important ethical questions that a feminist ethics perspective raises about research policies devised to promote the Inclusion of women in clinical studies.

Ethical issues in maternal–fetal medicine: Judgements of non-compliance in pregnancy

Introduction Medical knowledge regarding the ways in which women can actively pursue healthy pregnancies and the birth of healthy infants covers an increasingly broad spectrum of activities before, during and after the usual nine months of pregnancy. In fact, depending upon the clinical situation, the number and range of activities are such that, if a woman were to take all obstetrical advice seriously, she would be faced with a daunting list of instructions ranging from mere suggestions to strong professional recommendations. Few women could (or would want to) fully adapt their lives to the entire range of advice from physicians, midwives, nurses, nutritionists, physiotherapists and childbirth educators, and generally this is not a problem. In principle, professional advice is something that patients can choose to follow or not – this is the essence of informed choice (Faden and Beauchamp, 1986). In some instances, however, failure to follow professional recommendations elicits pejorative judegements of non-compliance, and while these judgements are provoked by a failure to comply with specific advice, typically they are applied to the patient as a whole. Moreover, even if the patient ultimately consents to the recommended course of action, she may continue to carry the label of non-compliant because of her initial efforts to resist medical authority, and this labelling frequently has repercussions for her subsequent interactions with health care professionals.

Ethical Questions in the Pursuit of Genetic Information

Breast cancer is a disease that will directly affect more than 10% of all women (and a small percentage of men) in North America. All who realize they have this disease will have their lives disrupted; most will undergo surgery to remove the offending cells and surrounding tissue. Many will also undergo radiation, chemotherapy, and/or long term prophylactic drug regimens; all will be advised to seek ongoing medical surveillance of their breasts and related tissues for the rest of their lives. An unacceptably high number of these people will die from this disease or from complications associated with it. The lives of all those who are close to people who experience breast cancer will be dramatically changed and their own sense of safety will be noticeably reduced. And most women, including many of the more than 85% of the North American population which will never develop breast cancer, will live their lives in fear of developing this disease; many will come to depend upon regular medical reassurances that they are (for now) cancer free.

Genetic enhancement, sports and relational autonomy

This paper explores the question of what attitude we should take towards efforts to develop the technology required to allow genetic enhancement of individuals in order to improve performance in sports: specifically, should we (a) welcome such innovations, (b) resign ourselves to their inevitable appearance or (c) actively resist their development and widespread adoption? Much of the literature on this topic leans towards options (a) or (b). I argue against both (a) and (b) and appeal to the concept of relational autonomy in support of option (c). I argue that we should situate the debate as a question of social policy rather than simply a matter for individual choice.