Abstract
Childfree females encounter greater obstacles in obtaining voluntary sterilizations than childfree males. This paper discusses what might explain this and it proposes that female patients encounter particular credibility deficits that undermine their ability to grant informed consent. In particular, the paper explores Miranda Fricker’s recent suggestion that members of structurally disadvantaged groups encounter a particular sort of injustice that harms them in their capacity as knowers: they sustain testimonial injustice. The task of the paper is to investigate whether and in what sense this holds.
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Notes
The prefix ‘cis’ denotes those who have typical gender identities and presentations. So, roughly put, it denotes women-born-female and men-born-male. This presupposes a prima facie distinction between gender and sex. Speakers ordinarily seem to think that ‘gender’ and ‘sex’ are coextensive: women and men are human females and males, respectively, and the former is just the politically correct way to talk about the latter. Feminists typically disagree and many have historically endorsed a sex/gender distinction. Its standard formulation holds that ‘sex’ denotes human females and males and depends on biological features (chromosomes, sex organs, hormones, other physical features). Then again, ‘gender’ denotes women and men and depends on social factors (social roles, positions, behaviour, self-ascription) (for more, see Mikkola 2012). It is worth noting that some works cited in this paper do not consistently follow this convention and often use ‘woman’ and ‘female’ synonymously.
Fricker holds that members of stigmatized groups can sustain another kind of epistemic injustice too, which she calls ‘hermeneutical’. My focus here will, nevertheless, be solely on the testimonial kind of epistemic injustice.
Some recent US-research suggests that African-American, Latinas and low-income women are more likely to use female sterilization than whites and women with higher incomes (after controlling for intersectionality). By contrast, for white and higher-income heterosexual couples male vasectomy is more common as a means of contraception than voluntary female sterilization. That said, there is also evidence that minority and low-income women too experience barriers to sterilization: they also report being dissuaded by healthcare professionals on the basis of being too young or having too few children (White and Potter 2014, 550).
In fact, the credibility deficit must also be ethically bad in order to count as an instance of testimonial injustice: the female patient must be wrongfully undermined in her capacity as a knower. I will not discuss this aspect here though, since nothing hangs on it for my purposes.
We can also think about implicit bias in terms of schemas (Valian 1999): we use various schemas as cognitive tools to categorize the world around us, which renders our environment and experiences intelligible to us. To illustrate: we have various schemas, including gender- and professional-schemas, which encode common stereotypes about women, men and practitioners of certain professions. Given the current state of academic philosophy, for example, it is conceivable that the male gender-schema coincides with the general philosopher-schema. This may, then, explain why women in professional settings are often automatically assumed to be part of the administrative staff or to occupy junior positions: the woman- and philosopher-schemas clash (Haslanger 2009). Tamar Szabo Gendler’s (2008) notion of alief provides another way to think about implicit bias. Aliefs are mental states distinct from beliefs and desires. They are associative, automatic, arational, antecedent to other cognitive attitudes, affect-laden and action generating. Social distancing provides a plausible example of an alief in action. An example would be someone unconsciously holding on to their handbag more tightly when entering an elevator with a black male, despite self-proclaimed egalitarian beliefs. Such instinctual behaviour seemingly demonstrates an activated associative, automatic, affect-laden mental state (‘black male, thief, danger!’), which is action generating (one holds onto the bag more tightly).
There is a further complication: showing that medical practitioners are influenced by implicit gender bias is one thing; but showing that this influence is operative when they make unduly deflated credibility judgements is another. Although clinical practice prima facie supports this hypothesis, proving the point would require careful social psychological experimentation.
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Acknowledgments
I have presented an earlier version of this paper at the GRSeminar at the University of Barcelona. I am grateful to those present and especially to Esa Díaz-León. I am further indebted to Chloë FitzGerald for literature tips and to two anonymous referees for their comments.
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Mikkola, M. Sex in Medicine: What Stands in the Way of Credibility?. Topoi 36, 479–488 (2017). https://doi.org/10.1007/s11245-015-9350-3
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DOI: https://doi.org/10.1007/s11245-015-9350-3