Creating Space for Feminist Ethics in Medical School

Abstract

Alongside clinical practice, medical schools now confront mounting reasons to examine nontraditional approaches to ethics. Increasing awareness of systems of oppression and their effects on the experiences of trainees, patients, professionals, and generally on medical care, is pushing medical curriculum into an unfamiliar territory. While there is room throughout medical school to take up these concerns, ethics curricula are well-positioned to explore new pedagogical approaches. Feminist ethics has long addressed systems of oppression and broader structures of power. Some of its established concepts can offer distinct value as medical climates change and adapt in response to increased awareness of the experiences of marginalized individuals and populations. In this essay, we offer a set of concepts from feminist ethics that have a fundamental role to play in medical school curriculum: relationality, relational autonomy, and epistemic justice. Though these concepts are not exhaustive, they can be taught in tandem with the concepts that have historically grounded ethics education in medical school, such as autonomy and beneficence. Ultimately, we contend that these concepts hold particular value in ethics curriculum insofar as they diversify mainstream ethical approaches, directly address the pervasiveness of systems of oppression in medicine, and recognize the voices and concerns that may be marginalized in standard approaches.

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References

  1. Aviv, R. (2018). What does it mean to die? The New Yorker.

  2. Baier, A. (1981). Cartesian persons. Philosophia,10, 169–188.

    Article  Google Scholar 

  3. Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics. New York: Oxford University Press.

    Google Scholar 

  4. Bleakley, A. (2013). Gender matters in medical education. Medical Education,47(1), 59–70.

    Article  Google Scholar 

  5. Bullock, J. L., Lai, C. J., Lockspeiser, T., O’Sullivan, P. S., Aronowitz, P., Dellmore, D., et al. (2019). Pursuit of honors. Academic Medicine,94, S48–S56.

    Article  Google Scholar 

  6. Clayton, E. W., & Kodish, E. (1999). Baby Aaron and the elders. Hastings Center Report,29(5), 20–21.

    Article  Google Scholar 

  7. Code, L. (1991). What can she know? Ithaca: Cornell University Press.

    Book  Google Scholar 

  8. Cowart, D., & Burt, R. (1998). Confronting death: Who chooses, who controls? The Hastings Center Report,28(1), 14–24.

    Article  Google Scholar 

  9. Freeman, L., & Stewart, H. (2018). Microaggressions in clinical medicine. Kennedy Institute of Ethics Journal,28(4), 411–449.

    Article  Google Scholar 

  10. Fricker, M. (2003). Epistemic justice and a role for virtue in the politics of knowing. Metaphilosophy, 34(1–2): 154–173.

    Article  Google Scholar 

  11. Fricker, M. (2007). Epistemic injustice: Power & the ethics of knowing. New York: Oxford University Press.

    Book  Google Scholar 

  12. Goodwin, M. (2018). Revisiting death: Implicit bias and the case of Jahi McMath. Hastings Center Report,48(12), S77–S80.

    Article  Google Scholar 

  13. Greysen, S. R., Allen, R., Rosenthal, M. S., Lucas, G. I., & Wang, E. A. (2013). Improving the quality of discharge care for the homeless: A patient-centered approach. Journal of Health Care for the Poor and Underserved,24(2), 444–455.

    Article  Google Scholar 

  14. Held, V. (2006). The ethics of care: Personal, political, and global. Oxford: Oxford University Press.

    Google Scholar 

  15. Judd, B. (2014). Patient: Poems. New York: Black Lawrence Press.

    Google Scholar 

  16. Kripke, C. (2016). Supported health care decision-making for people with intellectual and cognitive disabilities. Family Practice,33(5), 445–446.

    Article  Google Scholar 

  17. Lindemann, H. (2019). An invitation to feminist ethics (2nd ed.). New York: Oxford University Press.

    Book  Google Scholar 

  18. Low, D., Pollack, S. W., Liao, Z. C., Maestas, R., Kirven, L. E., Eacker, A. M., et al. (2019). Racial/ethnic disparities in clinical grading in medical school. Teaching and Learning in Medicine,31(5), 487–496.

    Article  Google Scholar 

  19. Mackenzie, C., & Stoljar, N. (2000). Relational autonomy: Feminist perspectives on autonomy, agency, and the social self. New York: Oxford University Press.

    Google Scholar 

  20. Miller, P. (2019). #MeToo in surgery: Narratives by women surgeons. Narrative Inquiry in Bioethics,9(3), 179–183.

    Article  Google Scholar 

  21. Minkoff, H., & Lyerly, A. D. (2010). Samantha Burton and the rights of pregnant women twenty years after in re A.C. Hastings Center Report,40(6), 13–15.

    Article  Google Scholar 

  22. Nedelsky, J. (2011). Law's relations: A relational theory of self, autonomy, and law. New York: Oxford University Press.

    Google Scholar 

  23. Noddings, N. (2013). Caring: A relational approach to ethics and moral education (2nd ed.). Berkley: University of California Press.

    Google Scholar 

  24. Paturel, A. (2019). Closing the gender pay gap in medicine. Retrieved January 10, 2020 from AAMC: https://www.aamc.org/news-insights/closing-gender-pay-gap-medicine.

  25. Phelan, J. C., & Link, B. G. (2015). Is racism a fundamental cause of inequalities in health? Annual Review of Sociology,41(1), 311–330.

    Article  Google Scholar 

  26. Sabin, J. A. (2020). How we fail black patients in pain. Retrieved January 10, 2020 from AAMC. https://www.aamc.org/news-insights/how-we-fail-black-patients-pain

  27. Sharma, M. (2019). Applying feminist theory to medical education. Lancet,393, 570–578.

    Article  Google Scholar 

  28. Sherwin, S. (1992). No longer patient: Feminist ethics and health care. Philadelphia: Temple University Press.

    Google Scholar 

  29. Stacey, D., et al. (2017). Patient decision aids to engage adults in treatment or screening decisions. JAMA,318(7), 657–658.

    Article  Google Scholar 

  30. Vedantam, S., et al. (2017). Remembering Anarcha, Lucy, and Betsey: The mothers of modern gynecology, National Public Radio. Retrieved January 10, 2020 from https://www.npr.org/2017/02/07/513764158/remembering-anarcha-lucy-and-betsey-the-mothers-of-modern-gynecology.

  31. Warsaw, A. (2018). Learning without walls, AAMC. Retrieved January 28, 2019, from https://www.aamc.org/news-insights/insights/learning-without-walls.

  32. Weeks, W. B., et al. (2009). How do race and sex affect the earnings of primary care physicians? Health Affairs,28(2), 557–566.

    Article  Google Scholar 

  33. Wendell, S. (2006). The social construction of disability. In E. Hackett & S. Haslanger (Eds.), Theorizing feminisms: A reader (pp. 23–29). Press: New York, Oxford University.

    Google Scholar 

  34. Wightman, A., et al. (2019). The relational potential standard: Rethinking the ethical justification for life-sustaining treatment for children with profound cognitive disabilities. Hastings Center Report,49(3), 18–25.

    Article  Google Scholar 

  35. Williams, D. R., & Cooper, L. A. (2019). Reducing racial inequities in health: Using what we already know to take action. International Journal of Environmental Research and Public Health,16(606), 1–26.

    Google Scholar 

  36. Witte, F. M., Stratton, T. D., & Nora, L. M. (2006). Stories from the field: Students’ descriptions of gender discrimination and sexual harassment during medical school. Academic Medicine,81(7), 648–654.

    Article  Google Scholar 

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Correspondence to Georgina D. Campelia.

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Campelia, G.D., Feinsinger, A. Creating Space for Feminist Ethics in Medical School. HEC Forum 32, 111–124 (2020). https://doi.org/10.1007/s10730-020-09403-x

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