2-15-23 Feminist Bioethics with Elizabeth Lanphier

February 22, 2023

Information

February 15, 2023

Elizabeth Lanphier, PhD, MS

Ethics Center & Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center

Clinical Assistant Professor, University of Cincinnati College of Medicine Department of Pediatrics

Research Assistant Professor, University of Cincinnati Department of Philosophy

Affiliated Faculty, University of Cincinnati Department of Women, Gender, and Sexuality Studies

Non-Resident Research Fellow, George Mason University Institute for Philosophy and Public Policy

ID9548

To CiteDCA Citation Guide

00:00Good evening, and welcome to the Yale School
00:03of Medicine program for Biomedical ethics.
00:05My name is Mark Mercurio.
00:06I'm the director of the program and
00:08on behalf of the associate directors,
00:10Jack Hughes and Sarah Hull,
00:12as well as our manager,
00:13Karen Cole, I welcome you tonight.
00:15We've got folks from all over.
00:17One of the advantages of doing these
00:18things online is I even see a colleague,
00:20an old friend,
00:21all the way from New Zealand.
00:22So welcome to all of you.
00:24It's going to be a special evening and
00:27we're going to get to it in just a minute.
00:29But to let you know kind of
00:30structurally how we're going to do this.
00:32Our guests will speak for about 45 minutes.
00:36After that,
00:36I'm going to invite you please to
00:38submit the questions or comments
00:40via the Q&amp;A function on zoom and
00:42then I will moderate a session.
00:43I'll be reading those questions to
00:45Elizabeth and she'll be responding and we'll,
00:47we'll see how we do,
00:50but I will promise you that by at 6:30
00:52Eastern Time, we will have a hard stop.
00:56So if there's still questions,
00:57I apologize.
00:57And sometimes we finish a little early,
00:59but we will finish by 6:30 in any case.
01:03There are other important events coming
01:05up which you can find on our website.
01:08You can just Google biomedical ethics
01:09at Yale and you will find the the
01:11website for the program for biomedical
01:13ethics with our schedule and I
01:14encourage you to take a look at that.
01:16We've got some wonderful talks coming
01:18up and some special events as well.
01:20But for tonight we have a very important
01:23event and let's focus on that.
01:25Tonight we're going to hear from
01:27Professor Elizabeth Landfair,
01:28who is a philosopher of bioethicist
01:29and assistant professor in the ethics
01:31Center at Children's Hospital at.
01:33Cincinnati,
01:33where she works as a clinical ethicist
01:36and engages in scholarship on feminist
01:38and narrative narrative approaches
01:40and her philosophy and bioethics.
01:43She's affiliated with the University of
01:45Cincinnati departments of Pediatrics,
01:46philosophy and women,
01:48gender and sexuality studies,
01:50and the Center for Public Engagement
01:53with Science.
01:54Professor Lamphier got her bachelors
01:56at NYU and Masters at Columbia,
01:58a PhD in philosophy at Vanderbilt,
02:00as well as a fellowship in
02:02clinical ethics at Vanderbilt.
02:03In addition,
02:04she's a certified healthcare
02:05ethics consultant.
02:06I have wanted for a long time to have a
02:10session on devoted specifically to feminist
02:12ethics and feminist bioethics in particular,
02:14and so I did my homework to
02:16find out who should we get.
02:18And last year I did my homework and found
02:20out who we should get is Elizabeth Lanphear.
02:22So I'm delighted that she was
02:23kind enough to accept her.
02:24Invitation.
02:24So with that,
02:25I am going to turn it over to you,
02:28Professor Lanphier.
02:30Thank you so much, Mark.
02:31It's great to be here.
02:32I'm going to go ahead and get
02:34started sharing my screen.
02:35So give me one second as we get going
02:38and hopefully that works and you
02:41should all be able to see my slides.
02:44It's great to be here.
02:45I there's so much to say,
02:47many, many experts in feminist
02:49ethics and bioethics.
02:50So I really appreciate the invitation.
02:54So as we get going tonight, again,
02:56my name is Elizabeth Lanfear,
02:57and I do use she and her pronouns.
03:00I want to note that there is
03:01a QR code on this screen,
03:02so if you would benefit from
03:04having access to the slides
03:06in order to better read them,
03:08you're welcome to do that.
03:10For those folks who end up
03:11catching the recording later.
03:12You also can get the slides
03:14through this QR code.
03:15I have no relevant disclosures
03:17other than saying that I do
03:18identify as a feminist scholar.
03:20I have a love,
03:21hate relationship with the
03:22label of bioethicists.
03:23You can ask me about that later if
03:24you want to, but you don't have to.
03:26And really,
03:26I'm really just pleased to be
03:28sharing this time with you today.
03:29Again, thank you, Tim.
03:30Mark,
03:30the program of biomedical ethics
03:32for really putting feminist
03:34ethics and bioethics on the agenda
03:36and part of the speaker series.
03:38I really appreciate Karen Cole for
03:40making this happen logistically,
03:42as well as Duncan Moore,
03:43who's helping run tech.
03:44So let's get going.
03:46OK,
03:46here's here's my plan for our
03:48next stretch of time together.
03:51I'm calling up my feminist
03:53bioethics agenda and.
03:54You mean that it is somewhat
03:55tongue in cheek way it apart like
03:58reflects my intentions of how I'm
04:00going to use our time together,
04:02which we'll start with an overview
04:04of various meanings of the term
04:06feminist and what feminism or
04:08feminist would mean specifically
04:09for bioethics.
04:10And to do that I'm going to then
04:13look at some examples or an
04:15example from different settings
04:17including clinical ethics,
04:19ethics of patient care and
04:21policies relating to patient care
04:22and then some questions around
04:24structural approaches to health.
04:26And healthcare and how feminism and
04:28feminist approaches might help us there.
04:30And then have time for discussion
04:32and your questions and and remarks.
04:35You know,
04:36my remarks are really by no
04:38means meant to be exhaustive,
04:40although I hope it's not exhausting to you,
04:43right?
04:44Like,
04:44I think one element really of
04:46feminist theory and feminist
04:47approaches is recognizing
04:49differently situated knowledges.
04:50So on the one hand,
04:51like I'm here to give some framing
04:54remarks and fuel a conversation.
04:56But I take it that there's a wealth
04:58of expertise here in this session
05:00and that will be joining the conversation.
05:02So I really look forward to thinking
05:05alongside you all this evening to
05:07the extent that we are able to do that.
05:10OK, so in our recent book,
05:13Carol Hay, who's a fat hey,
05:14who's a feminist philosopher,
05:17notes.
05:18If you were to ask 10
05:20different feminists to define
05:22feminism, you would probably
05:23get 11 different answers.
05:25And like, I think this is just like
05:27a useful recognition that when
05:29we talk about feminist ethics and
05:31feminist bioethics and really by we,
05:33I want to be clear that I mean
05:34those of us who understand ourselves
05:36to be doing feminist bioethics,
05:38but also its critics and and
05:40critics who are going to levy,
05:43you know, challenges to feminism and
05:46feminist approaches like we don't.
05:48Always mean only one thing or always
05:51the same thing, and I think getting
05:54clear about that is important.
05:56So, you know,
05:57when we're talking about feminism,
05:58like we're probably entering this talk with
06:02certain operative conceptions in mind.
06:04We might have terms that we've heard,
06:05terms that we use ourselves
06:07related to feminism on,
06:08on this slide,
06:09I've just gathered several images
06:11that capture some of the ways
06:13people can talk about feminism.
06:15And I'm thinking specifically
06:17from a US context tonight.
06:19I know not everyone here is necessarily
06:20from the US as mark already mentioned,
06:22right,
06:23feminism is certainly not an
06:25exclusively American concept.
06:26Any stretch feminist bioethics
06:28like feminism spans from local
06:30to global context and settings.
06:33I have 45 minutes and my own work is
06:36really embedded in a backdrop of US society,
06:39politics and healthcare.
06:40So you know I take it that that's
06:43going to be the case for most
06:44of the obviously not all of you.
06:46And and so I am drawing on this US
06:48context and I think some of these
06:50phrases that you've likely heard
06:52may be used include the various
06:54waves of feminism.
06:55So they largely relate to
06:57political movements and.
06:57Historical periods when we're
06:59talking about first, second,
07:00third, 4th wave feminism.
07:02Some of those terms like liberal feminism,
07:04radical feminism, intersectional feminism,
07:06black feminism, white feminism,
07:08trans inclusive, trans,
07:09exclusive feminism.
07:10Some of these terms are used to indicate
07:14philosophical and political commitments.
07:17Some are used to deride and
07:19critique and and you know,
07:20I think that as a periodic like
07:22dust UPS over which you know,
07:24which celebrities consider themselves
07:26feminist or not and suggest that I think
07:29feminism can be a charged word or concept.
07:32So part of what we want to do is get clear
07:35about what it is we're talking about.
07:37Right.
07:37So feminist as a term can be
07:41deployed to talk about topics.
07:44The notion of feminist
07:45activism and movements.
07:47It can be a form of politics,
07:49and it can be forms of theory
07:52or theoretical methodology,
07:54right including but not
07:55limited to feminist ethics.
07:56You can also have other
07:58forms of feminist theory.
07:59And so clearly some of these things overlap,
08:01right?
08:01Like activist movements address
08:03particular topics that align with
08:06feminist interests and might entail or
08:08are subject to political responses.
08:10I think abortion access is
08:12a clear example of this.
08:14I'm not going to talk about
08:15abortion access in my remarks,
08:16so if you if you want to talk
08:18about it in Q&amp;A, we can.
08:20You know,
08:21I think that right.
08:23Again, we'll talk about this
08:24in relation to bioethics,
08:25but taking some topics to be sort
08:28of so-called women's issues, right?
08:30Or topics that should be of interest
08:32to women or pertain to women in
08:34addition to political or activist
08:35issues like risks limiting the frame
08:37in ways that are actually not aligned
08:39with feminist theory or methodology.
08:42So for example,
08:43feminist sort of first wave feminisms,
08:46involvement in women's suffrage and
08:48making women the central target
08:50there of of that activism was.
08:52Hopeful at expanding voting rights
08:54to largely white women at the
08:56exclusion of expanding and protecting
08:58voting rights for black Americans,
09:00including black women,
09:01but not exclusively, right?
09:02So we're going to talk more about
09:05these intersections as we go.
09:06Umm. And you know,
09:08arguably, like I've,
09:09I've tried to like clear the air a
09:10little bit about the fact that there
09:12are background assumptions and plural
09:14uses of the concept in term feminism,
09:15sort of,
09:17generally speaking.
09:18And so I think it's worth asking
09:20sort of does feminist bioethics
09:21work in all of these ways as well
09:23in terms of the activist politics,
09:25theoretical right kind of framing,
09:28and as a reader on meaning in medicine,
09:31it was published like over 20 years ago now.
09:33Maggie little sort of has this prompt
09:35for chapters called why a feminist
09:37approach to bioethics, bioethics.
09:39And she argues that feminist bioethics is
09:43a valuable theoretical aid to bioethics.
09:46To be this like, like,
09:48little really wants to be.
09:49Earlier that umm and sort of
09:51dispel some myths around feminism.
09:53And she suggests that,
09:54you know, feminist bioethics.
09:56Bioethics isn't only or necessarily
09:59bioethics by women, which is true, right?
10:03Feminist bioethicists like feminists
10:04or people of all gender identities,
10:06it isn't, you know,
10:08bioethical issues necessarily
10:10pertaining to women,
10:11or at least not exclusively.
10:13And we'll talk about more
10:14about that in a minute.
10:16And, you know,
10:17while feminist bioethics is at times.
10:19Done by women or on topics
10:21pertaining to them,
10:22it's first and foremost
10:23according to little a theory,
10:25or perhaps several theories.
10:27So let's,
10:28let's talk about the theory,
10:30and also why the theory can and does
10:33overlap at times with issues of politics
10:37and perhaps activism and topics,
10:39right?
10:40While being careful to not sort
10:42of pigeonhole feminist bioethics
10:44on certain issues, topics,
10:46or political commitments.
10:47I think that that's kind of
10:49an important distinction.
10:51Umm,
10:51so right.
10:52In the same essay that I just
10:54mentioned by Maggie Little,
10:56she sort of describes feminist theory
10:58as and here's this quote from her,
11:00and attempts to uncover the ways
11:02in which conceptions of gender
11:04distort people's view of the world,
11:06and to articulate ways in
11:08which these distortions,
11:09which are hurtful to all,
11:10are particularly constraining to women.
11:14OK,
11:14so from these uncovering about how
11:16gendered conceptions right distort views,
11:18including views of philosophy and ethics,
11:20of medicine and healthcare,
11:22of gender itself,
11:23right.
11:23Particularly I think also we
11:25have to be indebted to the
11:27black women scholars who've
11:28shown like the attention
11:30to only gendered concepts can also further
11:32distort views of women and disparate
11:34aspects and impacts based on gender.
11:37I'm going to get to that in a second,
11:38but I want to flag that right.
11:39I think it's fairly overall uncontroversial
11:42to say that contemporary feminism.
11:45Is best understood as uncovering and
11:47responding to sites and structures
11:49of oppression more broadly, right?
11:51This may be the insight was initially
11:54drawn from the oppression of women,
11:56but feminist theory has really
11:58taken up this mantle of being anti
12:00oppressive and uncovering oppression.
12:02In many forms.
12:03And so again in Carol Hay and her
12:05book think like a feminist that I've
12:07already mentioned says, you know,
12:08if there's one theoretical concept
12:10that's central to feminist philosophy,
12:11it's oppression.
12:12Oppression is a cluster of harms and
12:15injustices forming an interconnected
12:16web made-up of economic, political,
12:18social and psychological elements.
12:20And so that the harms, you know,
12:23have economic, political,
12:25social and psychological dimensions is
12:27really going to be crucial for how a
12:31feminist bioethics fundamentally approach.
12:33Which is bioethics is one that
12:34cannot be detached from the social,
12:36political context in which Healthcare
12:38is given and received and which
12:40healthcare conditions are studied
12:41or are failed to be studied,
12:44ignored as sites of study and you know,
12:47as novel technologies are developed
12:50or ignored.
12:51Which patients and with what conditions are
12:53seen as targets of research or treatment?
12:55Which conditions are understood
12:57as diseases like.
12:58I think all of this relates to
13:01these many layers of situated.
13:03Contacts that feminism can help address.
13:06OK.
13:08Before I go too much further here,
13:09I want to ground some of what I'm
13:11talking about in some examples.
13:12And so kind of thinking about this,
13:14like,
13:15feminist topic or what's a topic that is,
13:17you know,
13:18feminist or specific to a woman's issue?
13:20Like,
13:20we might think about contraception
13:22as a bioethical issue that is
13:24ripe for feminist treatment.
13:25And it is,
13:26right.
13:27Like the kinds of contraception
13:28that are prescribed or administered
13:31by health professionals are
13:32typically available to women,
13:33trans, nonbinary folks.
13:34So it's a topic that might be
13:37seen as a women's issue.
13:38They're broadly construed,
13:39right?
13:40And there are ethical issues related
13:42to access to risks and benefits of
13:44side effects to considerations about
13:46conscientious objection in the provision.
13:49Prescription administration
13:50dispensation of contraception,
13:52and how like all of these interventions
13:56pertain to women and might produce unique
13:59gendered harms is important to think about.
14:02But, you know, certainly contraception
14:05like relates to economic,
14:07political, social elements.
14:08It can also be a topic of activist
14:10agendas in terms of expanding access.
14:13Again.
14:13So I want to just be clear,
14:14we're talking about this connection between
14:16topics and politics and activism and theory,
14:19right?
14:20And I think that the theory can help
14:22to analyze all of these angles.
14:24But feminist bioethics also can
14:26provide theoretical frameworks
14:28to really disclose the distorted
14:30conceptions that have permitted.
14:32Women to be the targets of research
14:35into pharmacological methods
14:36of contraception, right,
14:38in ways that impose the burdens
14:40of these interventions on women,
14:42but also limit men from potentially
14:44accessing benefits of reversible
14:45but effective contraception for
14:47themselves that they might experience
14:49if they're able to access this
14:51these kinds of treatments, right.
14:54Like I think moreover, you know,
14:55the associations of contraception
14:57with women certainly can be
14:59exclusionary for trans and non binary
15:01individuals and so contraception.
15:02Is, on this one hand, as I said,
15:05like a topic that is right for
15:06feminist theory to help unpack,
15:08and it can unpack harms that might arise
15:13by construing it as a woman's issue.
15:16Right. Harms to to all sorts of things.
15:20OK. I think similarly, and you know,
15:23here is a sort of related example
15:25perhaps of what we're talking about,
15:28assisted reproductive technologies,
15:29which are sometimes understood as like
15:32a quintessentially feminist bioethical
15:34topic of study for good reason, you know.
15:37And certainly there are all sorts of
15:39questions around status of gametes,
15:41embryos that are harvested,
15:42created, stored, saved,
15:43like all of these things are open for
15:46bioethical analysis and investigation.
15:48That affirmative analysis might be,
15:50you know, really particularly apt,
15:51not only because these are technologies that.
15:56You know,
15:56predominantly women or people
15:58who identify as women often use.
16:00But really because these technologies
16:02open up various concerns about
16:04disparate access to them that may
16:07perpetuate harms and injustice,
16:08how access to them may involve
16:11forms of injustice.
16:12And I think that what's interesting is,
16:14you know,
16:15taking a feminist lens to this kind of topic,
16:17let's say like egg freezing and
16:20and preservation of fertility,
16:22doesn't yield an obvious,
16:23like, feminist answer.
16:24I think a feminist lens
16:25gives us tools to think.
16:26Through some of the questions
16:28and considerations,
16:29but isn't going to yield some
16:30sort of consensus result, right?
16:32So, for example,
16:33like,
16:33some might note that employer motivations
16:35to fund egg freezing programs in
16:38health insurance packages might seem
16:40beneficial to women in the workplace and
16:42give them sort of more equal standing.
16:44But it also reveals sort of the
16:46potential exploitation of workers,
16:48expecting them to put their
16:50childbearing interest on hold.
16:51Others suggest that better
16:52interventions should, you know,
16:54enable people to become
16:55parents earlier in life,
16:56should they want to.
16:57And when there may be more fertile but
16:59others emphasize that childbearing
17:01should be something to do if and
17:03only if and when you desire it.
17:05Like all of these options
17:06should be on the table.
17:06Sort of taking your reproductive
17:09justice approach about, you know,
17:11the choice to be or not be a
17:13parent if and when you want to,
17:15and parent safely, right?
17:16So I think like,
17:18it's interesting to think
17:19through a quote from feminist
17:21philosopher Camisha Russell here,
17:22who says that much of the
17:24fertility industry seems designed
17:26around the needs and desires of
17:28socioeconomically secure white people.
17:30And Russell draws on Dorothy Roberts
17:32work to observe that her quote doctors,
17:35governments,
17:35and pharmaceutical companies
17:36seem far more
17:37interested in implanting poor women of
17:39color with long acting contraceptives
17:41than with preserving and restoring
17:42their fragility through accessible,
17:44high quality gynecological care.
17:45So again, I think that.
17:47A feminist analysis and an intersectional
17:49feminist analysis like raises up
17:51all sorts of potentially competing
17:53interests and questions without
17:55obvious answers about what's right
17:57but for bioethics to contend with.
17:59And so I just mentioned intersectionality
18:01and an intersectional analysis,
18:03and it's maybe a term that's familiar
18:04to many, but I want to be clear about
18:07what we're talking about, right.
18:09So this is intersectionality is a term
18:12coined by legal scholar Kimberly Crenshaw.
18:15And Crenshaw had found
18:16that in discrimination.
18:17Places in employment law sexual harassment
18:21and race racial harassment intersected
18:23in ways for black women that could
18:26not be accounted for in the law and
18:29and therefore undermine the ability
18:31to really successfully address either
18:34the sexual harassment or the racial
18:36harassment as it was intersecting in
18:38this like confoundingly harmful way.
18:40So she noted really that multiple
18:42identity markers intersect and compound
18:44oppression which led to this like broader
18:46theorizing of intersectionality and the
18:48ways in which identity markers like race.
18:50Class, age, ability,
18:52immigration status,
18:53education level,
18:54many others that I'm not naming
18:56right can perpetuate injustices.
18:59And so I think this case of assisted
19:01reproductive technology and the idea
19:03that certain of these technologies
19:04really might respond to certain kinds of
19:06feminist interests in terms of, you know,
19:08feminist equality in the workplace,
19:10but actually might further marginalized
19:12women who are not part of this,
19:16you know,
19:16white upper class group who can
19:18access those treatments and might be.
19:20Really.
19:22Unjustly inaccessible to other women
19:24is is important to think through OK
19:27and you know another example of this,
19:29just it was recently in the news.
19:32Thing about intersecting forms of oppression,
19:34right?
19:34Again,
19:34this was like on the home page of
19:37the New York Times that this an
19:39article about this research study
19:40that confirms some research that
19:42has been known for a while, right?
19:44But that black birthing people face
19:46disproportionate mortality rates
19:48for both birthing person and baby.
19:50And what this study added was that even
19:52when you control for other variables
19:55like income level and education,
19:56this remains true,
19:57right?
19:58The the mortality rates for black birthing
20:00people in babies really far outstripped.
20:03Goes up even like the lower lowest
20:06income white birthing people and babies.
20:08So understanding,
20:09you know,
20:10something like birthing mortality and
20:13perinatal mortality as a women's issue,
20:16right?
20:16I mean,
20:16it does pertain to women who
20:18are birthing people like,
20:19but it might obscure the really
20:21disparate harms that are going on when
20:24we then layer on racial difference.
20:26And also it might exacerbate harms
20:28if you understand it as a women's
20:30issue in terms of understanding
20:32that trans and nonbinary folks.
20:33Um have interests in and become
20:35pregnant and fair children, OK.
20:38So.
20:40Couple more broadly feminist
20:41blends thoughts here just to
20:43motivate what what I'm saying and
20:45then I'll move to some
20:47more specifically bioethical examples.
20:49You know I'm coming a feminist bioethics
20:52from philosophy and feminist philosophy
20:55and feminist philosophy in part really
20:57identifies the ways in which women
20:59were left out of philosophizing.
21:01And we're not understood to be moral
21:03agents in philosophical production such
21:05that their concerns and experiences were
21:07not perhaps represented in ethical theory.
21:10Right. And and in this way,
21:13I think feminism and feminist theory,
21:17not exclusively in philosophy or ethics,
21:19but in part right,
21:21can be a methodological critique,
21:23like about the exclusion of voices and
21:26experiences from theory that marginalized
21:28insights that could be drawn from and and
21:30really enriched by diverse experiences.
21:33Again, not only the experiences of women.
21:34I think, because I've hopefully made clear
21:37feminist theory really is about a plural.
21:40Range of diverse experiences and not
21:41just those of women even if that might
21:44be where it initially arose out of.
21:46And I think this critique you know this
21:48kind of critique at least introduces
21:50ways to to modify existing theory.
21:52So if we take you know the four principles
21:55in biomedical ethics and really their
21:57primacy in the field of biomedical ethics,
22:00I think is an example if I'm going
22:03to bioethics is not necessarily
22:05like a rejection of or replacement
22:08of principalis approaches.
22:10So it could be.
22:10As much as it could be a corrective for
22:13how those principles could be better
22:15conceptualized than applied right,
22:16and I think Beecham and Childress,
22:18and if this is too insider for
22:19the entire audience, right, them.
22:21But who developed these four principles of
22:23biomedical ethics in a book by the same name?
22:25And the four principles being autonomy,
22:27beneficence, non maleficence,
22:29and justice, right.
22:30These children really acknowledge
22:32that like feminist theory,
22:33at least in the later editions,
22:35that I own right, like,
22:36enriches a view of autonomy and,
22:39and sure, some feminist.
22:41Approaches are going to entail
22:42like a decentering of autonomy
22:43among the other principles,
22:45and that might be a good thing.
22:46It might kind of put it back
22:48in its place rather than to,
22:49you know,
22:50autonomy being like understood as prior
22:51or sort of above the other principles,
22:53as it sometimes is.
22:54But right feminist theory has
22:56really helped to better theorize
22:58autonomy by appreciating how
23:00autonomy is social and relational,
23:02and it's complex in ways that are shaped
23:05by power and oppression in terms of how
23:08when if someone is or is not really a.
23:11Assessed by others to be an autonomous agent,
23:15right?
23:15This is relational component of
23:17being recognized as autonomous as
23:19a relational process that isn't
23:21always equally available to all.
23:23And so you know.
23:26Feminist methodology also like offers up,
23:28you know, raising up,
23:30centering, as I've said,
23:31diverse voices and experiences that have
23:33been previously marginalized as part of
23:35ethical reasoning and as moral agents and,
23:37and I think this connects to
23:40narrative approaches and bases for,
23:43you know,
23:45ethical.
23:45Uh.
23:46Narrative approaches are the
23:47basis for moral reasoning and
23:49construct, and kind of contrast to abstract,
23:52universal experience that only
23:54captures sort of certain,
23:56maybe typically dominant experiences
23:58and takes them to be universal in
24:02ways that feminist theory would
24:04will highlight as being harmful.
24:06And then from the cereal so really
24:08recognizes a range of knowers and
24:10types of expression of knowledge.
24:11And we see this in bioethics and
24:13the ways in which rich experience,
24:15you know, confers knowledge not
24:16only for the experienced clinician,
24:18but also for patients and caregivers
24:20and their experiences and their bodies,
24:22their experiences of receiving
24:24or providing care,
24:25relevant knowledge that contributes to
24:27and is part of clinical experience.
24:30And I think this can lead to
24:31attention at times, right,
24:32in terms of the sources of knowledge
24:34that are considered, you know?
24:35Sort of valid, so to speak,
24:37in healthcare context.
24:38And I'm not gonna go deeply
24:40into examples here,
24:40but want to flag this as something
24:42we can certainly come back to in
24:45questions if you're interested.
24:46And then I think the last sort
24:48of broad brushstroke of feminist
24:49methodology that I want to touch on
24:51relates to what I've already said
24:53about autonomy and and how feminist
24:55ethics and bioethics pays attention
24:57to relationships and understands
24:59individuals as relational beings,
25:01right,
25:02with duties and identities shaped
25:04by relationships to others.
25:06As well as relationships to social
25:07and political systems and norms and
25:10relationships to conceptual structures.
25:12So that's kind of a lot of background
25:14that we're moving through.
25:16I'm going to try to take us more
25:19narrowly into bioethics here.
25:21And kind of drawing on this example
25:24of relationality, you know,
25:26one outgrowth of relational ethics
25:28is care ethics.
25:29I will admit that I sometimes
25:31find care ethics,
25:32and to be presumed in clinical
25:34context to be something actually
25:36much narrower than it in fact is,
25:39as though it's you know.
25:41Specifically about the ethics of
25:43like providing care for patients
25:44and This is why it's aligned
25:46maybe with certain more caring
25:47roles in healthcare like nursing
25:49or bedside clinical roles that
25:50are are doing more of that.
25:53And sort of the labor of
25:55routine care for patients.
25:57But from a feminist theory standpoint,
25:58like I think we really want to reflect
26:00on how you know care ethics and
26:03care work right including nursing
26:05are frequently gendered and also
26:07the ethical implications of care
26:09ethics kind of you know aligning
26:11more clearly with nursing right.
26:13I think that that that's actually
26:14something feminist ethics would
26:15want to challenge.
26:16So I'm just showing here on the
26:19screen one reader in biomedical
26:20ethics that is an example of how
26:22sometimes the ethics of care and.
26:24Feminist ethics get lumped together
26:25like this is the treatment of
26:27the ethics of care and feminist
26:28ethics in this textbook,
26:29which is which is fine,
26:30you can't move through all the theories,
26:32but they're sometimes twins together
26:34in ways that I think miss the insights
26:37they both contribute and and confuses
26:39ways that suggest that they're sort
26:41of commitment theories and when
26:43in fact they really aren't.
26:45So care ethics, you know, is rooted in,
26:47again this feminist insight,
26:48like the historical separation of
26:51public and private spheres with men.
26:54Correctly, you know,
26:55realigning with reasoning,
26:57with a public sphere,
26:58with the space that
27:00philosophizing was happening in,
27:02while women were relegated to a.
27:05Admittedly understood as lesser but private
27:08domain of domesticity of care of emotion.
27:11And this meant that women and the
27:14experiences and relationships of
27:15care that fell largely within you
27:17know the domain of woman's work
27:19were absent from ethical theory.
27:21And so it care ethics actually takes
27:23such relationships as foundational
27:25these caring relationships and
27:27and part of a relational theory
27:30of ethical obligation and it's
27:32often modeled on apparent.
27:35Child relationship,
27:35and this might be part of its historical
27:38it is part of its historical origins.
27:39But it carried this is certainly
27:41now no longer exclusive to sort
27:43of the parent child relationship.
27:45It encompasses ways in which really
27:47humans are dependent and interdependent
27:49and and even when I say humans,
27:51we need to make it even necessarily
27:53that anthropocentric but right
27:55about dependence and interdependence
27:57and care and relationships.
27:59Umm.
27:59You know and feminist theory like also
28:01can push back at sort of concerns
28:04about care ethics as potentially
28:06essentializing women as caregivers
28:08essentializing women as mothers.
28:11I think thoughtful care ethics really works
28:13well with through and with this tension.
28:15So for example,
28:16Virginia health you know,
28:17endorses what I think is really helpful
28:20normative rather than descriptive
28:21view of caring relationships and they
28:24include familial relationships that
28:25are not exclusive to them and how,
28:27you know notes that relationships are.
28:30Occasions for theorizing about care
28:32but are not prescriptive of care.
28:35And certainly we see scholars like Joan
28:37Toronto, Cheryl Branson taking care,
28:40ethics into political domains,
28:42theorizing about the role of care,
28:43and deliberative democracy, for example.
28:46And some of my own work.
28:47I've written about the need for an
28:49institutional ethic of care that centers
28:51the obligations of like systems and
28:53structures and collective action to
28:55attend to care needs and trying to
28:57move it away from understood as this
29:00sort of interpersonal interrelational.
29:03Set of obligations, burdens,
29:05rights, duties, et cetera.
29:07So I think again,
29:08you know,
29:09thinking normatively about care not only
29:12as a familial or gender activist and
29:15also not only as a medical or clinical,
29:18you know,
29:19care practice provided by
29:21clinicians offers all kinds of
29:23opportunities for bioethics.
29:25And that's really including you
29:26know within clinical ethics domains,
29:28within patient care domains,
29:30within broader structural health domains.
29:32I'm going to move through some of those next.
29:34And and so I hope we'll see that
29:36Kara ethics is 1 foundation that
29:38can be drawn from feminist ethics,
29:40but it's certainly not the only one
29:42for from a feminist standpoint.
29:46OK. So I want to talk again as I said,
29:48I'm going to talk about clinical
29:50ethics example, a patient care and
29:52policy example hopefully and the sort
29:55of a more structural example and.
29:57This is a really busy chart, so.
30:00So I put it up here.
30:03It's from some work I've
30:04done with Uchenna and Addie,
30:05who is a neonatologist,
30:07and Vanderbilt.
30:08We've worked on this project related to
30:11trauma informed ethics consultation together,
30:13and we conceptualize it as an extension
30:16of clinical ethics frameworks not
30:18only espoused by the American Society
30:21for Bioethics and Humanities or SH,
30:23but one that builds also on feminist
30:25approaches to clinical ethics.
30:26And so this is a chart we
30:28developed a sort of.
30:28Understand some of the connections
30:30between maybe this more traditional
30:32view of clinical ethics,
30:33a feminist view that's in the middle column,
30:35and then some of the trauma
30:37informed principles and practices
30:39that we're highlighting,
30:40kind of where they align
30:42in the right hand column.
30:45But I'll just say, you know,
30:47I think that while I've sort of added
30:49on the trauma and form component,
30:51which I do think is like a further
30:53instantiation of feminist,
30:54you know, clinical ethics all.
30:55I'll say a little bit more about
30:57the feminist piece in particular.
30:58And and recognizing that some folks
31:00are not going to be as deeply enmeshed
31:02in clinical ethics practice or its
31:04surrounding literature as perhaps I am.
31:07As someone who does clinical
31:08ethics consultation,
31:09I want to be clear that when I'm talking
31:11about clinical ethics consultation,
31:12I'm talking about a service that is.
31:15Rather than many hospitals and
31:17health systems that generally it gets
31:20involved in questions or ethical
31:22dilemmas arising and specifics patient
31:24care situations though clinical
31:26ethics services often also provide
31:29organizational ethics support,
31:30policy support,
31:32formal and informal ethics
31:34education etcetera.
31:35And and you know notably like the
31:37models of ethics consultation
31:39the levels of ethics support and
31:42ethics consultation utilization
31:44really vary by setting.
31:45In terms of adult versus pediatric,
31:47rural, urban academic,
31:48non academic center,
31:50so I'm talking very broad
31:52brushstrokes and here I'm,
31:54I'm really going to mostly be
31:56referencing the kinds of ethics
31:58consultation that's done that involves
32:00independent ethicists who spend,
32:02you know some or all of their time
32:04engaged in ethics consultation work
32:07at kind of higher volume healthcare
32:09hospitals that have higher utilization
32:11of other consultation services.
32:13OK, so like on this a SBH, you know,
32:17model of ethics consultation,
32:18right?
32:18A consultant moves through several
32:20process steps that's reliant on their
32:23core knowledge and ethical theory,
32:24their ability to analyze and then
32:27knowing something about consultation
32:29method and some core skills for
32:31facilitation as part of the process.
32:33And so we can see that there are
32:35all of these opportunities, I think,
32:37related to process and knowledge for
32:39feminist theory and practice to intervene,
32:41like ethics.
32:42Saltation already really lends
32:44itself to narrative approaches that,
32:45as I said, are,
32:46you know,
32:46not exclusive to feminist methodologies
32:49but are developed sometimes within
32:52them. And within,
32:53within bioethics in general.
32:55And so feminist bioethics is
32:56sort of a natural setting to
32:58be doing some narrative work,
32:59but feminist methodology
33:00really also affords, you know,
33:02new theoretical commitments and
33:04frameworks that one could bring to that
33:07piece of the ethics analysis process
33:09at the consult and paradigmatic,
33:11you know, feminist approaches in
33:14clinical ethics centers concerns
33:16around power and oppression,
33:17again relating turning to these themes
33:19of power and oppression within the
33:21space of the ethics consultation.
33:23Or the hospital setting and it
33:25brings an intersectional awareness.
33:27And I think this attention is showing,
33:28you know,
33:29not only to the participants in the
33:31ethics consultation but to also the
33:33organizational structures involved
33:35in healthcare and to the systems
33:37of ethics complication itself.
33:39So it's hopefully a somewhat,
33:40you know,
33:41self aware process when we engage in
33:43these like feminist approaches and
33:45doctor Nanny and I have found that you know,
33:47while feminist approaches are
33:49diverse as I've tried to make
33:51clear rate some of the shared.
33:53Central commitments and feminist
33:54methods for ethics consultation also
33:56share features that we've identified
33:58of trauma informed care and bringing
34:00trauma informed principles and
34:01practices to ethics consultation like
34:03is a concrete tool to build on and
34:06enact certain feminist commitments,
34:08particularly related to inclusion,
34:12empowerment,
34:12attention to historical,
34:14cultural, social difference,
34:15the need to respond to marginalization,
34:17right?
34:17And these are parts of trauma
34:19informed care that align very closely
34:21with feminist practice and so.
34:23You know Margaret urban Walker?
34:26Philosopher and feminist scholar
34:28has written about like the ethics
34:30consultant as sort of this architect,
34:32architect of moral spaces,
34:34this metaphor she uses.
34:35And inside an ethics consultation,
34:37you know, they're holding space.
34:39And it's a metaphor that I think
34:41is not only useful to feminist
34:43or trauma informed approaches,
34:45but can be particularly apt to them.
34:48And that's because really this idea
34:49of the holding the space is not
34:52prescriptive right for how the space
34:54like will can ought to be shaped.
34:56That needs to be filled out based on the
34:59particularities of the situation at hand.
35:01And again,
35:02feminist theory helps like engage with
35:04some of those moral particularities.
35:08And when I started to get
35:09into them like this,
35:09like feminist clinical ethics example,
35:11this is where I start to disagree a
35:14little bit with little Maggie little
35:16from the that I referenced earlier.
35:18Because I want to under score
35:20that feminist bioethics is not
35:22only a theory or set of theories,
35:23but it's also about practice.
35:25And I don't know that little would
35:26necessarily disagree with me on this,
35:27but I think in terms of that kind
35:29of framing that she gave about
35:31feminist bioethics is is theory.
35:33You know, theory can fall short,
35:34it can be difficult to implement.
35:37It takes work at the practice of enacting it.
35:40And I think when it's done well,
35:42and I don't mean enacted well,
35:43but I mean when that when
35:45it's practiced well,
35:46recognizing where there are those limits,
35:49those where the theory falls short can
35:51then lead to a revision of the theory.
35:53So ideally right, the relationship between
35:56theory and practice is interdependent,
35:58is relational and that's part of you know,
36:02feminist practice, practice and
36:04practice and and kind of methodology.
36:07Um, so let me let me give an
36:08example just from, you know,
36:10feminist approaches to ethics
36:11consultation that might make this
36:12make a little bit more sense.
36:14So one thing in the literature
36:16was this example that about the
36:18location of where the activities
36:19of the ethics consult occur, right,
36:22and how they can perpetuate power dynamics.
36:25And paying attention to this is a great
36:28suggestion, super important, right?
36:29But the recommendation in this
36:32essay that that follows from it
36:34that I have in mind really says,
36:36you know well.
36:38Consider moving a care conference or
36:40family meeting that is part of this
36:42ethics consultation off-site from
36:44the hospital right in order to like
36:47level power dynamics and maximize,
36:49you know,
36:50inclusion and minimize marginalization.
36:53Which, like, sounds great in theory,
36:56but it's it.
36:56Maybe this is the limits of my imagination.
36:58It feels nearly impossible to,
37:00like,
37:00you know,
37:01achieve that sort of off-site setting
37:03and figure out how to remove all
37:05the barriers that would make it
37:06possible and then recognize that it
37:08might create new barriers as well.
37:10And, and maybe like, I don't know,
37:11maybe you're thinking, gosh,
37:13Elizabeth,
37:13you just,
37:13you really do lack the imagination
37:15to imagine how this could work.
37:17And you might be right.
37:19But like I think that you know,
37:21while identifying an alternate location
37:23for an ethics consult may be attractive,
37:25in theory,
37:25again like the barriers might be
37:27too great and I don't think that
37:30means we shouldn't pursue it.
37:31It's not what I want to apply like
37:32but it is something that I think
37:34in my work on trauma informed
37:35ethics consultation,
37:36I really continue to puzzle over,
37:38which is that you know,
37:39if a principle is to foster
37:41physically and psychologically
37:42safe spaces for all stakeholders,
37:43anti oppressive spaces and as these
37:45things are in trauma informed care
37:47rate and feminist approaches like.
37:49How could, how could this be achieved?
37:51You know,
37:52I think feminist theory like also helps
37:54us see like there's no neutral space,
37:56that dynamics of power and depression
37:58are not going to be erased.
38:00They might be able to be worked through.
38:02And there isn't an obvious or easy
38:04solution that doesn't create maybe
38:06new opportunities for oppression,
38:08marginalization,
38:10limits on feelings of safety.
38:12And I think, you know,
38:12we've learned through the tech like
38:14pandemic like technology might be one
38:16opportunity for remote participation.
38:17And I'm able to participate
38:19here remotely tonight.
38:20And and be able to do that and
38:22maintain my care responsibilities
38:23in in my life right now, right.
38:25But like again I think that this is
38:27just it's not an obvious solution.
38:29It it sort of gives us theory to
38:32think through new ways of imagining
38:34some of these practices though.
38:36OK, let me move on to this example then
38:39of feminist policy and patient care.
38:42And this is an example that I wrote up
38:46that comes from a case I wrote up with
38:47some colleagues in Cincinnati Children's,
38:49which was a case of a tracheostomy
38:51dependent 5 year old who had been ventilator
38:54dependent continuously remained so.
38:56Only nocturnally, whose mother brought
38:59her into the emergency department
39:01after accidental decannulation and
39:02the cannula was successfully replaced.
39:05But there were some concerns.
39:06That she needed a stoma revision,
39:08and without it there might be
39:10further complications or repeat
39:12decanonized decannulation.
39:13Uh wasn't so emergent that it
39:15had to happen immediately.
39:16They were able to schedule
39:17out this procedure,
39:18and it was going to require
39:20an overnight hospital stay.
39:22But then prior to the overnight admission,
39:24like the team calls the patient's mom
39:26to review the plans for this admission.
39:28It was again during a phase in the
39:30pandemic when there were COVID-19
39:32specific visitor policies and
39:34COVID-19 precautions for testing
39:36prior to the procedure in place,
39:38and so reminded the mom that one
39:41of the visitor policies was that.
39:44Minor siblings can't stay in the hospital
39:46overnight with patients and in addition,
39:48due to COVID-19,
39:49minor siblings couldn't go to the hospital
39:51at all at this period in the pandemic.
39:53And and the mom really expresses concern,
39:55she's a solo parent, she doesn't have
39:58extended family or friends in the area.
40:00She doesn't have childcare for
40:01the patients younger sibling.
40:03And you know, the team understands
40:04the challenge and they say,
40:05like, you don't have to be on,
40:07you don't have to be in the hospital
40:09during this procedure.
40:10You don't have to stay overnight.
40:11It's OK.
40:11We'll take care of the patient.
40:14And the moms like, yeah,
40:16I'm uncomfortable with that,
40:17though I understand that you're OK with it.
40:20But the patient,
40:21you know,
40:21has some emotional and behavioral issues
40:23that are such that she becomes really
40:26agitated and unfamiliar settings.
40:28And Mom's worried that if she's
40:30not there to help support her,
40:32she might become so agitated as to
40:34cause unintentional harm to herself.
40:36Make things essentially worse.
40:37And so then the social worker says,
40:39OK,
40:39well we can connect you to some free
40:41resources for temporary childcare
40:43with an agency we've worked with.
40:45Mom says I appreciate the support.
40:47I also really have concerns about
40:49leaving my younger child with
40:50unknown persons.
40:51I'm concerned about creating additional
40:54COVID exposures for our family,
40:56you know, and the patient's mom says.
40:57Can I request an exemption
41:00from the visitor policy?
41:01The social worker is faced with
41:03reviewing this and and and really
41:05empathizes with the burdens that are
41:08specific to this mom and this family,
41:10and also worries that it would be unfair
41:12to other families and potentially
41:14unsafe to the patient sibling to grant
41:17an exception exemption in this situation.
41:20And,
41:20you know,
41:20I think that looking at this case from
41:22a feminist bioethical perspective,
41:23we can notice a couple things.
41:26One is the way in which caretaking is
41:27certainly central to the case, right?
41:29The team's ability to care for the patient,
41:31the mom's ability to participate in
41:32patient care and care for the sibling,
41:35the structural like lack of adequate care
41:37resources that this family is facing,
41:39the medical team's attempts to address them.
41:42But I think another thing to notice
41:44are the concerns about fairness and
41:45how fairness and justice are construed.
41:47And and feminist bioethics, you know,
41:49doesn't again necessarily replace
41:51other modes of bioethical analysis,
41:53but it can bring a critical lens to them.
41:55And so here I think we might find.
41:59Still find value in taking
42:01a principled approach,
42:02analyzing considerations of autonomy,
42:04beneficence, nonmaleficence, injustice.
42:05But a feminist reading might update
42:08how we construe these concepts, right?
42:10And so autonomy, you know, right,
42:13as we talked about is can do this
42:16relational concept and justice
42:17in this case and and which cases
42:20to treat alike or not alike,
42:23I think is where sometimes feminist
42:26attention to difference can really matter.
42:28Right, so.
42:29So sometimes I hear the thought that
42:32feminism is so concerned with particulars
42:34that it resists any applicability to policy.
42:38Or it resists, resulting in a, you know.
42:43It it risks resulting, I should say,
42:45in a type of moral relativism.
42:47And I think this is a really
42:48uncharitable idea of feminist theory.
42:49I'm going to be honest,
42:50right?
42:50I think that the issue is not the
42:52justice is incompatible with paying
42:54particular attention or incompatible with
42:56the focus on care and relationships.
42:58I think, like, more interestingly,
43:01feminist theory adds sort of nuanced
43:03concepts of justice and fairness, right?
43:06So again,
43:07I'm going to turn to Margaret Urban Walker,
43:09who argues that justice requires
43:12adequate attention.
43:13And to moral matters.
43:15And that following from adequate
43:17attention is the ability to assess unique
43:21circumstances with an understanding
43:23that they may result in in a solution
43:26or conclusion or policy or outcome
43:29that appears to be formally unequal
43:32but needs to be in order to be equitable,
43:35right.
43:35And so I think walkers be recognizes
43:37that different needs starting points
43:38and hardships and whether they're due
43:40to like chance choice doesn't matter.
43:44Requires attention to difference and
43:47and posits those sort of form of
43:50procedural justice to train adequate
43:52attention and yield more equitable results,
43:55right.
43:56And so I think in this case we
43:57could think about.
43:58How policies could be influenced
44:00by feminist approaches that are
44:02not going to yield some sort of
44:04policy free world right, but could.
44:08Could take into account how they will
44:12address difference and potential
44:14unintended harms and mitigate those.
44:16And so sort of.
44:17In my commentary on this case,
44:18I really drew on some work by Crystal
44:20Brown and Georgina Campiglia,
44:22who advocate for equity consultant
44:24committees and healthcare contexts.
44:26And I take this to really be like
44:28a feminist procedural supplement
44:30to widen the frame for what's
44:32understood as risks and benefits in
44:34situations and taking account,
44:36you know, of the risk.
44:38Of perpetuating inequity and burdens
44:40already created by inequities as
44:42part of the sort of the overall
44:44calculus for how to think about.
44:46Good and bad outcomes,
44:48risk and benefits in clinical contexts.
44:51No, I mean in this case is the
44:53hospital's willingness to provide
44:54respite childcare for the patients
44:55sibling like a sufficient accommodation
44:57such that it already addresses moms
45:00multiple caregiving responsibilities?
45:03I mean, I think you can argue this.
45:06You know, but I think that.
45:08We might wonder about how the team
45:10perceives a low clinical risk to
45:11the patient if Mom is not present,
45:13but Mom is really perceives
45:15that her absence will lead to
45:17potentially not only clinical,
45:19but psychological, emotional risks.
45:21And again,
45:22taking into account this sort of political,
45:25psychological,
45:25emotional harms that hey had clued
45:28us into at the beginning here,
45:31as well as how, you know,
45:32accepting respite care might
45:33also involve these like clinical,
45:35psychological,
45:36and emotional risks of harm,
45:38right?
45:38So I think that a feminist lens helps
45:41us just think more broadly about the
45:44relevant landscape of risks and benefits.
45:47And then you know my my final example
45:48is going to be about feminist
45:50insights into sort of broader public
45:52health and structural matters.
45:53And here I'm going to take COVID-19
45:57vaccine allocation in the early days
45:59as this is sort of my case study
46:01again in those early days of 2020,
46:03like COVID vaccines were on the horizon,
46:05they were going to be scarce,
46:07there needed to be a careful
46:09rollout strategy and the national
46:10academies of Science,
46:11Engineering and medicine produced really
46:13thoughtful document about guiding
46:15allocation based on a risk based
46:16approach that really did look at a broader.
46:18Array of risks beyond just clinical ones,
46:21right?
46:22It took into account relational risks
46:25and and social inequities, right and.
46:29I think it embodied many feminist
46:32theoretical objectives about understanding,
46:34like risks and harms related
46:36to social and economic factors,
46:37racial and gender equity considerations,
46:40caregiving, and obligations to others.
46:43Umm.
46:45And they write to the set of
46:47recommendations that were not
46:48based on identity markers,
46:49but did sort of take this composite
46:51view of risk such that they
46:52anticipated that historically
46:54and presently marginalized groups
46:56might have higher vaccine priority.
46:59For many of the reasons related
47:01to social determinants of health
47:03and disparate exposures.
47:05You know,
47:06that people might have due to who
47:09provides essential public facing
47:11work and risks of transmission
47:13due to care obligations.
47:15Um.
47:17Many states took parts of this
47:18guidance and not others when they
47:19actually rolled out vaccines.
47:20And yes, I know, you know,
47:21allocation schemes had to work fast
47:23and on a large scale, consider feasibility,
47:26among many other things.
47:28That said, I do.
47:29You know,
47:29I worry a bit that.
47:32That the idea that speed and scale
47:34require deference to some sort
47:35of more basic ethical framework,
47:37or that public health emergencies,
47:38as we sometimes heard, you know,
47:40require a normative framework like
47:41utilitarianism as the only one
47:43that is appropriate or feasible.
47:45And I think even if we hold that view,
47:48I think that a feminist.
47:51Approach to utilitarian framework really
47:53does invite questions about again,
47:55what are the benefits being maximized,
47:57what are the harms minimized?
47:59Are those balances and distributions of
48:02burdens and harms being equally or equitably,
48:06you know felt who is facing them, right.
48:09I think that again an anti oppressive
48:11set of considerations can and should be
48:13still part of an analysis even if we're
48:15going to take sort of that utilitarian
48:17framework and you know like as I said, like.
48:21Feminist theory doesn't just apply to issues
48:23that are obviously pertaining to women,
48:26but, you know, although COVID-19
48:28has impacted women in all sorts of
48:30interesting and and troublesome ways,
48:32we've, you know, read the news.
48:34I'm sure we we're familiar with
48:35some of these stories related to,
48:37you know, work and school,
48:38healthcare access, childcare,
48:40all sorts of things.
48:41But from a vaccine allocation standpoint,
48:43like I'm really interested in sort of
48:45these two examples that stand out to me
48:47about attention to oppression and how
48:49it yields considerations that aren't,
48:50you know, specific to women's oppression.
48:52And so one is a critique of age based
48:55stratification for vaccine access,
48:57right,
48:58and the allocation of COVID
49:00vaccine COVID-19 vaccines by age,
49:02according to which after we got through,
49:05you know,
49:06certain frontline healthcare
49:08workers and certain.
49:10People with limited comorbidities.
49:14People were then had access
49:15based on sort of descending age,
49:17like older to younger, right?
49:19But in using age,
49:20like in the absence of meeting
49:22sort of these other criteria is
49:24the only metric once allocation,
49:25you know, moved to this broader
49:28public did mean that white, white,
49:30older adults who have lower risks
49:33access vaccines before, for example,
49:36black adults with higher risks,
49:38but who were younger and had
49:40higher risks often due to deep
49:42histories of systemic oppression.
49:44And racism in the US and and we
49:46know that the burdens of COVID,
49:47including death rates from the virus,
49:49have been disproportionately
49:50experienced by black as well as
49:51Hispanic and Native American groups.
49:53And again,
49:54I think this feminist analysis helps us,
49:56although not exclusively a feminist
49:58analysis helps us train adequate
50:00attention on the problem and aim
50:02to provide a procedure that could
50:05adjust for structural difference.
50:06Lots of debates on how to do this,
50:08most of which remain, you know,
50:10hypothetical and theoretical because
50:11they weren't put into practice.
50:13At least in this example.
50:15In a similar vein,
50:15you know,
50:16I've done some work advocating for
50:18earlier prioritization of incarcerated
50:19individuals to receive access to vaccines
50:21that I think aligns with bioethical,
50:23feminist bioethical commitments around
50:25addressing vulnerability and oppression.
50:27So in Ohio,
50:28incarcerated individuals were initially
50:30prioritized for vaccines and pretty
50:33high in the allocation scheme,
50:34but then when the rollout
50:36actually took place,
50:38they incarcerated individuals
50:39did not appear in any
50:41prioritization and only had access.
50:44Based on meeting either specific
50:46comorbidity requirements or age,
50:49right. And this really perpetuated
50:51vulnerability due to oppressive
50:53conditions of carceral contacts.
50:55And again, feminist analysis can
50:57disclose the oppressive as well as
50:59relational dynamics really relevant
51:01to mass incarceration within
51:03healthcare settings as well as,
51:05you know, in communities in which
51:08crucial carceral settings exist
51:10and in sort of relationships for
51:12those who are in relational.
51:13You know, engagements as family,
51:16as, etcetera with community
51:19members who are incarcerated.
51:21OK, so, you know,
51:22I hope to have sort of shown that
51:24feminist bioethics is and not only a set
51:27of theoretical commitments and approaches,
51:30but also entails engagement and
51:31practices that confront the moral
51:33dilemmas we face in healthcare,
51:35many of which are often upstream
51:37and downstream from the immediate
51:38provision of healthcare.
51:39And this isn't to say that bio
51:42that feminist bioethics like
51:43necessarily demands radical action.
51:45And I think that sort of 1 concern
51:48sometimes raised in response in two
51:50feminist bioethics is that what are the?
51:52Two seems to fall outside the scope
51:54of healthcare or its institutions,
51:56or outside the clinical encounter.
51:58And maybe so right like.
52:00Or maybe feminist theory like
52:02combined with other theoretical
52:04approaches which with which it
52:06really shares affinities can help
52:08disclose why this kind of thinking
52:10also can perpetuate oppression.
52:11And that practices of care and attention,
52:15including healthcare and healthcare
52:16attention necessarily occur within systems
52:19and structures that demand a wider lens.
52:21Right to not only address abstract social
52:24problems related to equity, inclusion,
52:25anti impression anti oppression.
52:27Because those are.
52:28Things we have,
52:29but because those social
52:31problems inhibit good healthcare.
52:34So I wanted to just kind of anticipate
52:36a couple concerns and then I'll
52:37stop talking for a little bit
52:39so we can get to some questions.
52:41So sometimes the critique levied at
52:43feminist theory is that it isn't a
52:45comprehensive theory that provides
52:46a clear procedure or standards for
52:48analyzing ethical matters doesn't kind
52:50of have this clear ethical program,
52:52and I want to push the idea that
52:55that's a shortcoming. Right, like that.
52:57Maybe it's a feature, not a bug.
52:58So in her book no longer a patient right,
53:02feminist bioethics scholars,
53:03Susan Sherwood writes,
53:05and I have this quote up here,
53:06I do not envision feminist ethics to
53:08be a comprehensive theory that can
53:10be expected to resolve every moral
53:12question with which it is confronted.
53:13It's a theoretical perspective
53:15that must be combined with other
53:17considerations to address the multitude
53:19of moral dilemmas that confront human beings.
53:21And this seems right to me,
53:23right?
53:23Feminist methods should reject the
53:25idea of a totalizing ethical theory.
53:27One that could dominate an all and
53:29any situation actually seems to be
53:31like inherently opening the door for
53:33a kind of oppression that that cannot
53:36accommodate the moral particularity
53:38of circumstances and situations,
53:39right.
53:40I think like a feminist,
53:41bioethics works in combination
53:42with with what we might call
53:44more mainstream ethical theories,
53:46adding layers of nuance to their analysis,
53:48as well as in a dialectical
53:50relationship with other,
53:51you know, critical approaches to
53:52ethics and bioethics like disability,
53:54bioethics, black bioethics, etcetera. Umm.
53:58Amia Austrina Hassan and her her recent
54:00book that's called the Right to sex,
54:02feminist Feminism in the 21st century,
54:04addresses ways in which feminism may
54:07yield contradictions and lack cohesion.
54:10And you know, she says of this,
54:11and here's a quote from her
54:14feminism cannot indulge fantasy,
54:15that interests always converge,
54:17that our plans will have no
54:19unexpected undesirable consequences.
54:21Um, you know, notably,
54:23Srinivasan understands feminism
54:24as inherently political.
54:26She says feminism is not a philosophy
54:28or a theory or even a point of view.
54:30And here I take her to mean,
54:31you know, not a singular one.
54:32And certainly I've talked about many theories
54:35and philosophies that it does contain.
54:36But rather, she says,
54:38it's a political movement to transform
54:40the world beyond recognition.
54:42Further, you know,
54:43she suggests that she doesn't know,
54:45and feminism doesn't know what it
54:47would be to transform the world.
54:49But it offers this invitation to,
54:52as she says, try and see.
54:55So with that,
54:56I really want to thank you for your
54:57time and attention tonight and the
54:59Yale program and biomedical ethics for
55:01creating and holding this space together.
55:03I want to recognize that,
55:04you know,
55:04many feminist scholars came before
55:05me and paved the way,
55:06and many will come after and
55:08look forward to your questions.
55:13That was marvelous. Thank you so much.
55:16I've got a I've got a whole mess of
55:18things I'm scribbling here like crazy as
55:20you're talking because there's so many
55:22wonderful ideas and so much to talk about.
55:24But I want to start by inviting the
55:26folks in the everybody at the conference
55:28here to to submit questions or comments
55:31via the Q and a portion of the zoom,
55:34the Q&amp;A function.
55:35I'm going to get rid of this for a second.
55:38You know that on the the Q and the
55:40Q&amp;A function not the chat function
55:42just to remind you folks.
55:44And while while we're working on that I've
55:46got a couple of thoughts to share with you.
55:49And you know when we were talking
55:52beforehand I mentioned that that that I
55:54may have a principled approach to things.
55:56And I and I realize that that's
55:58not exactly true,
55:59but I did quote one of my mentors,
56:00my major, my primary mentor in
56:02grad school who was Ross Ladd,
56:04who I think would probably identify
56:05as a as a feminist ethics and she
56:08would refer to the principles.
56:10Approach as cookie cutter ethics.
56:13And and your talk I think really
56:16brought that brought that into focus.
56:18So a couple of image well images
56:20come to mind well while others
56:21maybe think about what they think.
56:23So first of all let me say that that
56:24in terms of visuals and I don't,
56:26I forgot already who said it.
56:27So I'm going to just distribute
56:28it to you for the rest of my life.
56:30The notion of the folks all in the
56:32room standing on each on the shoulders
56:34starting with those who have everything,
56:36so many forms of oppression for various
56:38things up until the one has only one
56:40and then there's the ceiling and
56:41the people who have none of those.
56:43Stand on that ceiling.
56:44And I was trying to think,
56:45well, who's above that?
56:46Who's above that ceiling?
56:47And I was thinking, well,
56:48that's a really interesting question
56:50because one could start by saying,
56:51well, it's all men.
56:53Well, it's obviously not all men.
56:55Or we could say, OK,
56:55so that's half the population.
56:57And we say, well, OK, well,
56:58we're going to say men from primarily
57:00European ancestry, OK, well,
57:02that's going to narrow that significantly.
57:03And then we might say, well,
57:04in terms of a person, say, OK, maybe only.
57:08Heterosexual binary men of European ancestry.
57:12That's OK what about old?
57:13Well, they're vulnerable.
57:13OK?
57:14So now I know that take away the old,
57:15take away the kids,
57:16and this gets narrow and
57:18narrow until who's above there.
57:19But the one group that occurs to
57:22me that that comes down to it is
57:24also in that group was the sick.
57:27Included in that group,
57:28below that ceiling is anybody who is sick.
57:31Because you talked about the focus
57:33of feminist ethics on a a recognition
57:36of oppression.
57:37And also, you know, it translates,
57:39I think, to a recognition,
57:40recognition of vulnerability
57:42and vulnerable populations.
57:44And this, of course,
57:46is where healthcare lives.
57:47This is why feminist ethics and why
57:49every Ethics Committee needs to have
57:51someone who is so well schooled in this,
57:53hopefully several people
57:54who are but but healthcare.
57:57Ethics is has to be about largely
57:59in the hospital setting about
58:00the sick who are by definition
58:02vulnerable people and they're often
58:05vulnerable for many other reasons
58:07including socioeconomic factors.
58:08Right.
58:09So a recognition of that it it
58:12strikes me that there are so few
58:13people above that ceiling and
58:15there there are more and more of us
58:17who are higher higher up perhaps,
58:18but to to actually be.
58:20And if if you are above that
58:21ceiling you know,
58:22and you've got no sources of
58:25vulnerability or oppression,
58:26I guess the only thing I could say to you is.
58:28You know,
58:29pay more attention to people
58:30who are below the ceiling,
58:31but also if you're above that ceiling now,
58:33just stay tuned because soon
58:36enough you'll fall in that.
58:39So I guess that that.
58:43What it what it seems to come
58:44down to me and I want want you
58:45to comment on this if you could.
58:46Is it so much of this seems to be?
58:50As you were going into this in various
58:52angles it struck me and you used the
58:55term a couple time about the you said
58:58the feminist theory engages with the
59:02moral particularities and and it's about
59:04taking you know the time to look deeper.
59:07That there are more factors going into
59:09this than just a simple assessment of you
59:11know quick look on this scale benefits
59:13burdens done go or quick on the scale
59:15autonomy that that as someone once said
59:18long ago God is in the details. Umm.
59:23It's so much about having the time,
59:26having the insight to realize we
59:27should look at those vulnerabilities.
59:29But taking the time to look at that,
59:31I mean when you use another phrase
59:33about the nuance is recognizing
59:35the nuance and all these things.
59:36So applying our principle is to approach,
59:38if you will, to the nuances in your work.
59:42I'm getting, I am,
59:43I promise I'm getting my question then
59:45I'm going to go to other questions
59:47that folks have but in your work.
59:49Professional landfill in your work,
59:51particularly in the clinical setting.
59:53Do you find a challenge?
59:56With finding the time to get
59:58into those nuances,
59:59take it into those particularities.
01:00:01Well, you know, I mean it's a
01:00:03great question and I think like
01:00:04I when I enter a clinical space,
01:00:06I'm doing so as a clinical ethicist.
01:00:08I mean I, I am really
01:00:09philosopher by training, right.
01:00:11And so I think that one.
01:00:15One feature and sometimes one
01:00:17value of clinical ethics can be
01:00:19that we are people whose job it
01:00:22is to spend the time and maybe
01:00:24that depends on the setting.
01:00:25You know, I trained in a very,
01:00:26very busy.
01:00:30Consult service that was receiving
01:00:31many consults today and you maybe
01:00:33don't have the time and attention you
01:00:34want to spend always. And I, you know,
01:00:37work in a pediatric setting now.
01:00:38And and for those who similarly are
01:00:42familiar with pediatric medical centers,
01:00:44you you may know that there is an overall
01:00:46lower volume of clinical ethics consultation,
01:00:49which means that sometimes you
01:00:50actually do have the time, right.
01:00:52Like we're not getting demands.
01:00:54You know, I'm not getting 3 consults
01:00:56a day and so there is that ability.
01:00:59Sometimes I think that.
01:01:03Whether or not there's an obvious
01:01:05ethical dilemma in this situation,
01:01:07the value sometimes I can bring
01:01:08as the clinical ethicist is I can
01:01:10go in the room and spend the time
01:01:12that other people don't have.
01:01:13And it's not that I may have like
01:01:15magical skills of eliciting values
01:01:17and preferences and understanding
01:01:18a situation any better than anyone
01:01:20else's role except that my role like
01:01:22creates that space and sometimes that
01:01:25the ethics consult like the process
01:01:27of doing it again drawing on on
01:01:30walkers kind of concept of of being
01:01:32an architect and moral spaces it.
01:01:34Creates and holds spaces to have
01:01:37conversations that otherwise
01:01:38sometimes you can't slow down and
01:01:40ask about and and hold.
01:01:42And make the time for.
01:01:45How do you really curious
01:01:46like what other you know,
01:01:47I mean I don't know do you have the time
01:01:49and you're kind of clinical experience
01:01:52sure. So I mean I'll tell you I
01:01:55had a a fascinating experience
01:01:57recently which was? That uh, I, I'm,
01:02:00I'm not on the clinical service,
01:02:02but an ethics consult came in and I was
01:02:04helping this family deal with the situation.
01:02:06And so I was in a position to to sit
01:02:09there and spend a fair amount of time
01:02:11with these folks and they started
01:02:13asking me some neonatology questions
01:02:14and we got into a lot of that stuff,
01:02:16which is my clinical work is something
01:02:18expert and I tried to differentiate
01:02:19more than a couple of times.
01:02:21You know, just so we're clear,
01:02:22here's the answer to your question,
01:02:24but you really need to be talking to
01:02:26your neonatologist about this stuff.
01:02:27They'll talk to you then they
01:02:29will the neonatologist.
01:02:29I mean they're wonderful,
01:02:30they make the time,
01:02:31but the truth is that the neonatologist
01:02:33may have 15 or even 25 patients that
01:02:36that that individual is responsible for,
01:02:38whereas in ethics Council
01:02:39I clearly have more time.
01:02:41So I do think that our Ethics Committee,
01:02:43particularly our pediatric Ethics Committee.
01:02:47Finds the time and has the time
01:02:48I would say and I'm I I welcome
01:02:51the father's disagree with me.
01:02:52I think our adult Ethics Committee
01:02:55makes time and finds time beautifully.
01:02:57But it's because the volume of consults
01:02:59that they're brought in on is so much
01:03:01higher that that's they're a little
01:03:02bit more pressed for time that way
01:03:04than perhaps the pediatric committee is.
01:03:06But certainly the Clinical Ethics
01:03:08Committee in general committees in
01:03:10general have a lot more time than the
01:03:12clinicians and that's all I'll say as a
01:03:14physician that's a little bit of too bad.
01:03:16Because you're,
01:03:17you're you're teaching us here that we
01:03:19need to find the nuances and of course
01:03:21we're not going to find the nuances
01:03:23unless we take the time to look into this.
01:03:25But that's half the half
01:03:26the job is taking the time.
01:03:28The other half is having the,
01:03:29the the insight to know which
01:03:31of these nuances are leading to
01:03:33increased vulnerabilities are leading
01:03:34to increased power dynamics are
01:03:36different power dynamics that we
01:03:38really didn't appreciate to begin with.
01:03:40You know
01:03:41well, and I do.
01:03:41I mean I want to add you know,
01:03:43I think to your point, but that
01:03:44yes it is about taking the time and
01:03:46looking at that moral particularity.
01:03:48But that there might then need
01:03:50to be more structural approaches
01:03:52to how to do that, right.
01:03:53Like I think that just tasking clinicians
01:03:55with one more thing to do in their
01:03:57day that is already overburdened
01:03:59isn't necessarily fair either.
01:04:00I mean, I think we want to be
01:04:01thinking about fairness and equity,
01:04:02not just two of the patients
01:04:04but two caregivers.
01:04:05And we know that we're experiencing,
01:04:07you know,
01:04:07huge burnout and turnover in healthcare
01:04:09for all sorts of reasons right now.
01:04:10And so I think thinking,
01:04:12you know about how to turn attention
01:04:14also on those providing care and what
01:04:15they need to be able to provide better.
01:04:18There.
01:04:18And I think that again might start to
01:04:20look at like upstream considerations
01:04:22around how much time clinicians get
01:04:24to spend in the room with the patient,
01:04:26how many patients are on
01:04:27their caseload for the day,
01:04:28like what would be some structural solutions,
01:04:30thinking about alternatives like
01:04:31you know equity committees or other
01:04:33resources that could be tapped into
01:04:35using your ethics consultants or
01:04:36resources that you do have at your disposal.
01:04:38I mean as you're talking,
01:04:39I was thinking about just the question
01:04:41of equity of attention in terms of.
01:04:44Like, who gets the ethicists attention even,
01:04:47right? I'm, I wonder.
01:04:48I don't know that I always am equitably
01:04:50spending my attention when I think about,
01:04:53like all of the stakeholders
01:04:54involved in a console,
01:04:55I might end up spending an hour in a
01:04:58patient's room and not talk nearly.
01:04:59You know,
01:05:00I'm not going to necessarily be
01:05:01able to spend an hour talking
01:05:02to the bedside provider and the
01:05:04social worker and the fellow.
01:05:05And you know,
01:05:05I mean you can't do that for everyone.
01:05:07And so there is sort of this disparate.
01:05:11Distribution of attention.
01:05:12Sometimes that's OK because maybe I need to
01:05:14spend more time and train my attention again,
01:05:16like on a particular stakeholder,
01:05:19for good reason and doesn't
01:05:21need to be formally equal,
01:05:23right?
01:05:23But I think you're you're also
01:05:24introducing questions for me
01:05:25about my own practice here.
01:05:27Sure. So I. There's there's
01:05:31lots more I want to say and ask,
01:05:32but I wanted this as a question that's
01:05:34come up so I wanted to refer to this.
01:05:35So I'll read this to you.
01:05:36Please can you speak a bit more
01:05:38on how feminism and feminist
01:05:40approaches to moral philosophy and
01:05:43bioethics can benefit all genders?
01:05:45I know you touched on this a bit,
01:05:46but I would love to hear more on this.
01:05:48I think there is such a strong tendency
01:05:50for many to dismiss these as in quotes
01:05:53solely women's concerns and quote,
01:05:55when in fact it seems that rejecting
01:05:57rigid gender dichotomies and
01:05:59recognize the importance of both.
01:06:01General ethical principles and
01:06:03specific relational concerns
01:06:05really stands to benefit everyone.
01:06:10I think the question is spot on.
01:06:13I mean yes, right and I think that's exactly,
01:06:16that's exactly it is, is.
01:06:20There are examples, right?
01:06:22OK, you know. So I said I wasn't
01:06:25going to use abortion as an example,
01:06:26but it's an easy one for me right now.
01:06:27So I'm going to to use this and
01:06:29it's certainly in in our news and in
01:06:31our awareness in clinical settings
01:06:33and in non clinical settings.
01:06:34But like we know that abortion
01:06:36access is coming under fire right
01:06:38now in the US and depending on
01:06:40where you live you have very,
01:06:42very different access to abortion
01:06:45care fair state by state.
01:06:47And a lot of things we're hearing
01:06:50right are about the impacts on.
01:06:52On women and and women seeking,
01:06:54you know, having control over
01:06:57their reproductive choices,
01:06:59on women encountering all of
01:07:01these healthcare, you know,
01:07:03catastrophes when they're having,
01:07:05you know,
01:07:06routine pregnancies that encounter
01:07:07these complications that would
01:07:09require an abortion procedure, right.
01:07:11And I think that it's helpful to,
01:07:14you know, remember that yes,
01:07:16this is an issue.
01:07:17That impacts women,
01:07:18and that the fact that it impacts women
01:07:22probably speaks to why it continues to be.
01:07:27Address the way it is in our
01:07:29political context, right.
01:07:29And and the reasons of misogyny
01:07:32and all sorts of things.
01:07:34But again, I think it's one of those
01:07:35cases where it's really been helpful.
01:07:37I think that we recognize how not
01:07:39only women get pregnant, right?
01:07:42Again, thinking about gender inclusivity
01:07:44and identity with the way that trans
01:07:47and nonbinary folks become pregnant,
01:07:49can become pregnant, can have abortions,
01:07:51may need abortions, that's important.
01:07:52But also that this really.
01:07:54Impacts how all people and all
01:07:57family structures and units are
01:07:59going to experience, you know.
01:08:02Child rearing and when and
01:08:04when to become parents,
01:08:07if their partners, if it's not them,
01:08:09if their partners or their loved ones or
01:08:11their mother or their child can get adequate
01:08:13access to health care when they need it.
01:08:15I mean this isn't,
01:08:16it's not a women's issue, right?
01:08:17I mean it, it isn't.
01:08:18It isn't.
01:08:19And I think that that's part of it is,
01:08:21are all, are all people equally oppressed by,
01:08:25you know,
01:08:25limits on access to safe and legal abortions?
01:08:29No. And we know that, you know,
01:08:31for example, women of color.
01:08:33Are particularly oppressed by that.
01:08:35So again, this,
01:08:36this intersectional framework helps us think
01:08:38through some of the unique kinds of harm,
01:08:41but it's certainly not a harm
01:08:42that is exclusive to women and,
01:08:43and I think that, you know,
01:08:45if we could have better conversations
01:08:48about how everyone is potentially
01:08:51harmed by lack of access to abortion care.
01:08:55You know,
01:08:55maybe we would have more political consensus,
01:08:58you know?
01:08:58So again,
01:08:59this is the healthcare stuff,
01:09:00I think inevitably does connect to politics
01:09:02in ways that feminism makes kind of apparent.
01:09:05And it's hard to have these
01:09:06conversations and say, well,
01:09:07we're only doing theory,
01:09:08we're only doing healthcare.
01:09:09Sometimes we might have to do politics
01:09:11or we might have to do some activism,
01:09:13whether it's around policies in our
01:09:15healthcare institutions or policies
01:09:16in our communities or government.
01:09:19Thank you. The next question please
01:09:21is how do we get the caregivers?
01:09:23This gets back to our issue with time.
01:09:25How do we get the caregivers to spend
01:09:28the time and seek the nuance if they
01:09:31do have the time instead of just
01:09:33leaving a little early for the day?
01:09:37I mean, again, I'd like.
01:09:40Yeah, sometimes we have to leave
01:09:41early for the day. That's OK.
01:09:43I don't want to say you know,
01:09:44you you must be putting in more time.
01:09:45I I think that it's.
01:09:49Hopefully about sort of training
01:09:51attention on to questions that
01:09:54might not be obvious in clinical
01:09:56settings right some of the issue.
01:09:59So I think about this in the way
01:10:01and some of it again could be I
01:10:02think helpful to think about how to
01:10:04standardize or procedure realize.
01:10:06It's funny because I'm talking
01:10:07about particularities.
01:10:07But I also think that systems and
01:10:10standardization can really help us here
01:10:12in making things have it or making
01:10:13things routinely part of what is being asked.
01:10:16So like.
01:10:17Now, you know,
01:10:18you go to a pediatrician's office
01:10:20and they ask you questions about.
01:10:22If you have a gun in the hall,
01:10:23right.
01:10:23And there's a lot of like and it doesn't
01:10:25seem obviously like a medical question,
01:10:27but that's part of something that
01:10:29pediatricians have increasingly
01:10:30adopted and is endorsed right by the
01:10:32AP around gun safety and understanding
01:10:34it as a child health issue.
01:10:36You know my hospital has some
01:10:39standardized questions around
01:10:40around food equity or food access,
01:10:42sorry like whether you are you know food
01:10:46secure because these are health issues,
01:10:48but it also helps get at maybe under
01:10:51identified or underappreciated.
01:10:53Exclusions,
01:10:53marginalization that families are facing,
01:10:56and ways in which health care actually
01:10:58can connect them to resources that would.
01:11:00You know not only improve their health
01:11:02but would also improve their health,
01:11:03right.
01:11:04Right. But that that question doesn't
01:11:06get asked if I'm if I am a wonderful
01:11:09physician and I really understand
01:11:11Physiology and I'm explaining the
01:11:13importance of fruits and vegetables
01:11:15into a good diet and and I'm not
01:11:18aware that some of my patients live
01:11:20in what we call food deserts, right.
01:11:23Don't have access such easy
01:11:24access to these as other people
01:11:26might have if I'm not aware that.
01:11:28So there's there's two parts.
01:11:30One is a willingness to
01:11:31pursue that information,
01:11:32but that's got to be preceded by
01:11:34an understanding of that inequity,
01:11:36for example,
01:11:37a recognition of knowledge of it.
01:11:40100%, But again this is where
01:11:42I think sometimes encouraging
01:11:43some things being part of,
01:11:45like formalized processes of
01:11:47intakes or well checks or you know,
01:11:50helps that you don't have to
01:11:52remember or you don't have to like.
01:11:54Try to use your own biases or
01:11:55preconceptions about a patient and
01:11:56how they're presenting, how they look,
01:11:58what other identity markers they might have.
01:12:00But. Should that flag that
01:12:02they might be food insecure?
01:12:03No, I don't think they seem like
01:12:05the kind of person who lives in
01:12:06a food desert for XYZ reason.
01:12:08Like, I don't think that's what
01:12:08we want to be doing.
01:12:09I think we want to be thinking about
01:12:11how to make this part of routine care.
01:12:13I mean, this is actually where a
01:12:15lot of my work starting in feminist
01:12:17bioethics has has kind of moved toward
01:12:20trauma informed care that thinks
01:12:22about ways of thinking about trauma
01:12:24informed care is like a universal precaution.
01:12:26So we want to understand what's going
01:12:28on for people and try to be attentive to.
01:12:32Biases stereotype exclusions,
01:12:33whether they are safe and secure
01:12:36in all settings,
01:12:37not just when we have a flag concern,
01:12:40but with every patient.
01:12:41And think about mechanisms
01:12:42to help enhance that.
01:12:43I don't have all the solutions,
01:12:44but I think those are the directions
01:12:45we need to be moving in ideally.
01:12:47And actually I think like trauma,
01:12:48informed Care offers a really nice sort of
01:12:51supplement to feminist ethics in that way.
01:12:53That also already aligns with
01:12:54sort of practices that are being
01:12:56increasingly adopted into healthcare.
01:12:58So I think there's a nice synergy there.
01:13:01An opportunities to build on it.
01:13:03Thank you. Here's a here's
01:13:05an interesting question.
01:13:07There are something that's changed
01:13:10significantly over the years
01:13:12and something that hasn't and
01:13:14potentially your your take on on both.
01:13:17So I will tell you that over the
01:13:19last I've been hanging around
01:13:21hospitals now for a very long time.
01:13:23And it wasn't,
01:13:24it wasn't that long ago in the grand
01:13:26scheme of things when the physicians
01:13:28were almost all men or certainly mostly men.
01:13:31There's been a while now.
01:13:33It's been a long time they've
01:13:34been and and now,
01:13:35I mean half of our medical school
01:13:36class roughly is going to be women.
01:13:38And and while there's some certain
01:13:40specialties where where women are
01:13:41still underrepresented, by and large,
01:13:43that tremendous difference that we saw,
01:13:46you know, 40 years ago,
01:13:47we don't see now.
01:13:48The physicians were mostly all men
01:13:51and the nurses were mostly all women.
01:13:53We've seen that change for physicians.
01:13:56I think we've seen a change relatively
01:13:58little with regard to nursing.
01:14:00I don't know what percentage
01:14:01of the nurses in this hospital
01:14:03or your hospital are women.
01:14:04I would suspect it's still
01:14:06over 90% based on what I see.
01:14:08I wonder if you have any thoughts
01:14:09on why that might be,
01:14:10why these two,
01:14:11these the two primary in
01:14:13hospital professions,
01:14:14one has evolved significantly in
01:14:15that regard and the other very little?
01:14:19That's a great, I mean
01:14:20that's a great question.
01:14:24I I don't have an answer.
01:14:25I only have speculation right,
01:14:27but I do think that that.
01:14:31Some of the has sort of historical.
01:14:36Connections between women and and
01:14:39caring are maintained and how we see
01:14:42that women are overrepresented in
01:14:44nursing professions in in in teaching
01:14:47you know K through 12 education
01:14:50typically in home health workers
01:14:52right and in some in many of these
01:14:54roles where people are doing white.
01:14:59Physical or intimate or you know or care.
01:15:02They tend to be women and
01:15:05and they often tend, I mean.
01:15:08Tends to be,
01:15:09I think maybe under compensated
01:15:11all sort of goes together, right.
01:15:13And kind of this gendered and
01:15:15compensated because it's done
01:15:16primarily by women is your point.
01:15:18Yeah, exactly. And I think that,
01:15:20I mean that's a problem.
01:15:21I think I don't have a solution for it,
01:15:22but I think that's right.
01:15:23I think that that sort of feminist
01:15:25analysis and certainly care theory in
01:15:26some this is I think why some care theory,
01:15:28some resist care theory because it
01:15:30returns to this sort of centralized
01:15:33connection of women with care.
01:15:35That also has harmful ramifications,
01:15:37right, that care.
01:15:38Continues to be undervalued.
01:15:39I mean we saw it in politically all
01:15:42these moves to create more care
01:15:45infrastructure as part of some of these.
01:15:48Legislative bills recently and
01:15:49all of the care infrastructure,
01:15:51parts of the infrastructure largely fell,
01:15:53fell to the wayside.
01:15:53There's a recognition that we need,
01:15:55you know, more childcare,
01:15:56more preschool teachers, more,
01:15:58you know, home health workers,
01:16:00better funding for those jobs
01:16:02like preschool teachers are,
01:16:03you know, under compensated.
01:16:04I mean arguably nurses for the volume
01:16:07of work they're doing probably under
01:16:10compensated largely in terms of
01:16:12the demands on that of that work.
01:16:14And and that traditional gendered alignment
01:16:17I think is still harmful and still present.
01:16:21You know,
01:16:22I think people should go into nursing if
01:16:24they want to have any gender identity.
01:16:25I think it should be really,
01:16:26really highly valued.
01:16:27You want a good, thoughtful,
01:16:29well compensated nurse caring for you
01:16:30if you need to be in the hospital.
01:16:32I do.
01:16:35So I think there's work to be done
01:16:36on a societal level there really.
01:16:38Again going back to the systems
01:16:39and structures.
01:16:40Absolutely. And I think you're on to
01:16:41something with regards specifically to care.
01:16:43Because if we look at it in terms of
01:16:46undervalued or underpaid professions,
01:16:48high school teachers,
01:16:49I know there's one high school
01:16:50teacher on this call will appreciate
01:16:52me that someone throwing a mention
01:16:53of the shout out to them.
01:16:54But high school teachers an example
01:16:56that's that's undervalued and
01:16:58underpaid by the lights of many of
01:16:59us and yet high school teachers,
01:17:01I think men are are much more
01:17:03represented among high school teachers.
01:17:04Than they are about nurses when
01:17:06they're and there are similarities
01:17:07these are these are professions that
01:17:09require a college education and you
01:17:10know and a great deal of dedication
01:17:12and there are different form of caring
01:17:14as you say the physical intimacy
01:17:15perhaps related to some nursing
01:17:17makes that still seem like it's more
01:17:19appropriate in the minds of some
01:17:20to one gender more than another.
01:17:23I'm not sure
01:17:24and like I don't want to say that
01:17:26physicians aren't caring for their
01:17:28patients they are but I think that
01:17:29certainly are but you know 12 hour
01:17:31shifts of carrying the bedside is.
01:17:34Different, all right.
01:17:35It's a different,
01:17:36it's a different kind of care.
01:17:39Undoubtedly our next.
01:17:40Another question for you, please.
01:17:42We got all the big questions for
01:17:43you here today. Professor lamphier.
01:17:45I know you referred to the
01:17:47issues of social stratification
01:17:49and financial vulnerability,
01:17:50which seemed to have so much to
01:17:52do with the ultimate determination
01:17:54of vulnerability in our society.
01:17:56Is it our moral obligation to
01:17:59push for income redistribution?
01:18:01You didn't want to get political,
01:18:02but you know that we're,
01:18:04we're, we're taking you here.
01:18:06I know. Well, yeah.
01:18:07You can't not be political.
01:18:08I just don't. I don't,
01:18:11I don't worried about the sound bite on the,
01:18:13you know, Yale YouTube page if
01:18:15depending on what I say.
01:18:17I mean, I think.
01:18:19I don't have theories about
01:18:22economic redistribution.
01:18:23I will say that I think that there are
01:18:25good reasons to think that programs like
01:18:27Universal basic income and you know,
01:18:29what we saw with like the child
01:18:30tax credit during the pandemic,
01:18:32forms of universal basic income during
01:18:34the pandemic definitely raised people
01:18:36up to better standards of living.
01:18:38It, you know, removed children and
01:18:40adults from food insecurity and poverty.
01:18:43I think that that's going to
01:18:44have good health outcomes.
01:18:45Like, I think there's a whole bunch
01:18:46of reasons if we just look from
01:18:48a health perspective that yes,
01:18:49we want to think about.
01:18:50People having more stable,
01:18:52secure, predictable,
01:18:53less precarious financial situations.
01:18:57Whether I don't know what form
01:19:00that's going to take, but.
01:19:03Yeah.
01:19:05But yes, that's that's what I'll say.
01:19:08Appreciate it. Now I've got a comment
01:19:10and then a question for you here.
01:19:12So here's, here's the comment
01:19:13was on the conversation we
01:19:14were just having a minute ago.
01:19:16It is worth noting that more than 40%
01:19:18of nurse anesthetists identify as men.
01:19:20The difference between them say floor
01:19:23nursing and certain types of advanced
01:19:26practice nursing may be an effect of the
01:19:29general time and energy tax on women.
01:19:31That's an observation from one
01:19:32of our one of our guests here.
01:19:34And now a specific question,
01:19:37how does the ethics of care
01:19:39deal with Maga people?
01:19:45I think this is a political philosophy
01:19:47talk that you want to go to.
01:19:49I really curious what the the
01:19:51they mean by that exactly?
01:19:55You know, I think.
01:19:57I don't want to assume too
01:19:58much about the question.
01:20:02And if the question.
01:20:05Is trying to get at like how to
01:20:07show attention or care for people
01:20:09maybe with whom we disagree or
01:20:11have different political values.
01:20:12I mean, I think that partially
01:20:14gets into some of the literature,
01:20:16actually more around. Ohh, my gosh.
01:20:22Civic friendship and political
01:20:24polarization and trying to,
01:20:26you know, hold space.
01:20:27But there. But there is again,
01:20:29there's just like small literature
01:20:30around that connects some care ethics.
01:20:32Sure.
01:20:32As I mentioned,
01:20:34deliberative democracy and thinking
01:20:35about the role of care and deliberative
01:20:38democracy and the kinds of deliberations
01:20:39that take place and and the place of
01:20:41vulnerability in those deliberations.
01:20:42So maybe there's something in
01:20:45that kind of Sheryl Branson,
01:20:47Joan Toronto work that could be.
01:20:49Useful to the questioner,
01:20:51and if that's a direction they're
01:20:52going to think about for themselves,
01:20:54because I'm not exactly sure how I.
01:20:58Address that, yeah.
01:20:59Thank you.
01:21:01Well, I wonder if improving clinician skills
01:21:04and feminist ethics and intersectionality
01:21:06can actually cut through barriers,
01:21:08improve doctor patient relationships,
01:21:10and ultimately serve to save
01:21:12time and speed and speed.
01:21:14Better care? Excuse me?
01:21:16Embedded routine questions may not
01:21:18be translated into patient care if
01:21:21organizational values don't shift.
01:21:23We can't all be ethicists as we sure
01:21:26need and we sure need ethicists,
01:21:28but we must not marginalized
01:21:30basic ethics skills.
01:21:31As the province of a specific
01:21:34or a specialty group.
01:21:38It's hard to argue with that.
01:21:39I think that's right.
01:21:40I mean hopefully your ethicists
01:21:41can help do some of that.
01:21:42You know, you, you know,
01:21:44like I know we're talking about
01:21:46particulars versus universals,
01:21:47but like cross institutional,
01:21:48cross organizational education and be
01:21:50part of those efforts because I agree.
01:21:52Like, you know one colleague I know talks
01:21:55about sometimes preventative ethics, right.
01:21:57Like we talked about sort of
01:21:59other kinds of preventative care,
01:22:00the preventive ethics is right like this,
01:22:02this sense of anticipating the needs and so.
01:22:06I think there are opportunities to
01:22:09think about changing organizational
01:22:11culture or infusing it with
01:22:13awareness to feminist considerations.
01:22:15Intersectionality, as I said,
01:22:17trauma informed care might be
01:22:19another framework to do that work.
01:22:21And maybe you know,
01:22:22I think that like things like cultural
01:22:23competency are already kind of part of
01:22:25the lingua franca of healthcare settings.
01:22:27I think this might be an expansion
01:22:30on that or help build out some of
01:22:32those initiatives that already
01:22:33take place in health systems.
01:22:34And so opportunities to build
01:22:36and and grow rather than try
01:22:38to like necessarily overturn,
01:22:39we could have a whole debate about
01:22:41incremental change versus like revolution.
01:22:43But I think probably more realistically
01:22:45incremental changes is feasible and so
01:22:48thinking about how to layer on some of these.
01:22:51Concepts and and teachings to
01:22:54existing frameworks as I think ripe
01:22:57for the for the the development.
01:22:59So with that in mind the layering
01:23:01on it strikes me as as as we
01:23:03kind of wrapping up the session.
01:23:04It strikes me Elizabeth that that the
01:23:07layering on is a wonderful way to frame
01:23:10it which is to say I think feminist
01:23:12ethics if I were going to give a title
01:23:15to this talk or if I was going if I
01:23:17were to or I think moving ahead as I
01:23:19teach ethics as they were advertising.
01:23:21This is I wouldn't say. And I say
01:23:23this is this is the advanced course.
01:23:24This is advanced ethics.
01:23:25OK. So we start saying, OK,
01:23:28justice is one of our four principles.
01:23:30So treat equals equally and
01:23:32don't treat unequals equally.
01:23:34All right, there you go.
01:23:35Now let's take.
01:23:36Now let's take a deeper look
01:23:37as as feminist ethics says,
01:23:39let's look at the nuances.
01:23:40Let's look at the inequities.
01:23:42So we think these people are equal,
01:23:43we should treat them the same.
01:23:44But actually there may be.
01:23:46And, and we worry about
01:23:47treating people differently.
01:23:48We worry about treating equals unequally,
01:23:50but on the other hand,
01:23:51ignoring the vulnerabilities.
01:23:52Some people face,
01:23:53ignoring the oppression that some
01:23:55people face is itself an injustice.
01:23:57This is not,
01:23:58I think this is not in conflict with
01:24:00a basic principle list approach.
01:24:02This is the advanced course.
01:24:03I think that your lecture here for
01:24:05us has been the advanced course.
01:24:07To look a little deeper,
01:24:08consider the nuance layer
01:24:09that feminist ethics,
01:24:11not just theory,
01:24:12but approach but viewpoint onto
01:24:14the basics that we teach everybody.
01:24:16I think that it's incumbent on all of us
01:24:19who teach medical ethics to bring this
01:24:21at this advanced level of the feminist.
01:24:23Ethics to what we teach.
01:24:25I I think it's been a marvelous session.
01:24:27I'd be happy for any final
01:24:29comment you'd like to make,
01:24:30and I don't mean to put
01:24:31you on the spot with that.
01:24:32So I'll mumble here for 10 or 15 seconds
01:24:34in case you want to think of something.
01:24:36But it's been a terrific session
01:24:37and I thank you so very much.
01:24:39It's been a pleasure to be here,
01:24:41and I've really enjoyed this
01:24:42conversation and the questions.
01:24:44And I agree that hopefully that we can
01:24:48make feminist ethics and bioethics
01:24:50part of sort of the, as you said.
01:24:54Layered advanced approach to biomedical
01:24:56care and and biomedical ethics and
01:24:58I'm happy to be a part of that.
01:25:00Thank you so much.
01:25:01I think we took a step in that
01:25:03direction tonight. Thanks to you,
01:25:05Professor Elizabeth Lanphier.
01:25:06Thank you very much.
01:25:07Thanks everybody for joining us tonight
01:25:09and we'll be back on March 1st.
01:25:11You'll be getting the
01:25:12notification about that and I
01:25:13hope our paths cross again soon.
01:25:14Elizabeth. Goodnight folks.