As new technologies emerge, so do new areas of bioethics, to deal with the allegedly unique ethical issues they raise. The human genome project led to genethics, the promises of nanotechnology led to nanoethics and so on. The pattern continues, for example with ‘AI ethics’ (ethics of artificial intelligence) and ‘synbio ethics’ (ethics of synthetic biology). There is often a familiar pattern: high level principles are enunciated, frequently bearing a striking resemblance to Beauchamp and Childress’ four principles of biomedical ethics. For example, Florido and Cowls’ highly influential set of AI ethical principles adds ‘explicability’ to the familiar respect for autonomy, beneficence, non-maleficence and justice; other commentators suggest that ‘transparency’ is a key principle for automated decision making. Synthetic biology differs somewhat as there is no imagined autonomous individual at the centre of the practice, but the weighing up of potential benefits and harms still constitutes a major part of that ethics literature, albeit using a wider frame for harms than is usual for biomedicine.
Coming to these topics as feminist bioethicists, we have a feeling of (weary) déjà vu. It feels as if the well established feminist criticisms levelled against high level, disembodied, universalist abstract principles have disappeared without trace, while ‘mainstream’ bioethics is caught in an epistemological ‘Groundhog day’, constantly reinventing the same principles and approaches. There is an apparent lack of traction of feminist approaches emphasising detailed contextual analyses, attention to relationality and how power is exercised in relationships, the role of embodied experience, and the identification of concrete individuals who are benefited or harmed by these new technologies. Given this lack of traction, is it time to re-imagine feminist bioethics?
In this panel, we question what that really means. As the three papers show, feminist concerns remain strong and salient. It is not possible to address the ethical issues raised by AI in healthcare by, for example, relying on the beneficence of program developers (for one thing, there’s no obvious duty of care owed by a program developer, comparable to that owed by a clinician), or assume social justice will necessarily be factored into decision making algorithms. Likewise, the view that synthetic biology offers a technofix for the climate catastrophe cannot be investigated without a nuanced understanding of what is proposed, by whom, and who will bear the impacts. We argue that it is not the content of feminist bioethics that needs re-imagining – these concerns remain as central as ever. Perhaps what needs reimagining is the way that we develop and present our bioethics – not as a marginal add-on, but through a more assertive centring of the key values of feminist bioethics.
Re-imagining the way we present feminist bioethics has some dangers. One is that we dilute our claims, so as not to frighten the punters. Another is that the spin takes over from the substance, leading to lip service being paid to key concepts with little actual understanding of their scope and application. (Here the frequent misuse of the term ‘relational autonomy’– often interpreted simply as an injunction to include family members in decision making – comes to mind). A third is that it seems persistently unfair that the onus remains on feminist bioethicists to do the work of reaching out, building bridges, communicating calmly, reasonably and gently, etc. There’s a gendered pattern going on here.
In the work we present, we have tried to strike a path through these dangers. All the panellists are involved in large multi-disciplinary projects, only one of which is explicitly led by an ethicist. All of us have developed skills in communicating outside our fields and ‘helping’ others (scientists, clinicians, technicians, data specialists etc.) to see the ethical world though our eyes. Yes, it takes a lot of time and energy. But the stakes are high. Even if these new technologies fulfil only a fraction of their promises, the impacts on people’s lives will be profound. Some people’s lives will improve with the use of automated decision making or of AI in healthcare. Others’ lives will be harmed. Without detailed context-sensitive research informed by feminist principles, we will not know or understand these impacts, nor how to address them.
“Violence” and “Healthcare” do not sit together comfortably as themes. Healthcare is traditionally understood as about providing care, well-being and treatment. It seems, if anything, the very opposite of violence. Indeed, the absence of adequate healthcare is a major issue facing the world today. Yet women in particular have experienced healthcare as violence. Women’s bodies have been used in healthcare contexts to pursue the interests and goals of others. Assumptions are made that women are not competent to make decisions for themselves and their bodies can even be seen as posing a risk or danger to others.
Complaints by women of violence through healthcare are often minimised. Indeed, there is strong resistance to the concept that a doctor or nurse can be guilty of violence. The assumption is they are acting for “good motives” and for the “good of the patient”. Treatment given to those who object is justified on the basis that the patient will come to benefit from the treatment. However, by centring the experience of the female patient, the violent nature of the treatment becomes apparent.
The panel will explore these themes. Jonathan Herring’s paper will examine the place of violence through healthcare in the context of the broader conception of violence against women. Marthe Goudsmit’s paper will examine the difficulty the law has in understanding the concept of sexual violation, and particular how to respond to cases where the touching is regarded as sexual by one party but not others. Carlos Herrera Vacaflor will examine the sense in which healthcare can be regarded as masculinist and therefore part of patriarchy. The final papers look at the issues in two particular contexts. Rebecca Brione traces the historical roots of vaginal examinations and explores how it has come to take a form of a procedure that reflect violation rather than care, while Sara Cohen Shabot and Dianna Taylor consider the emerging issue of non-consensual rectal examinations of women soon after birth.
We have sought to produce a panel with a degree of diversity in terms of gender; position in career (three of our speakers are in the early stages of their career) and in terms of geographical location.
We plan to have 5 papers of 15 minutes each, followed by 15 minutes questions and answers.