Health Care Analysis 9: 229–246, 2001.

© 2001 Kluwer Academic Publishers. Printed in the Netherlands.

Towards a Feminist Global Bioethics:

Addressing Women’s Health Concerns Worldwide

ROSEMARIE TONG
UNC-Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
(E-mail: rotong@email.uncc.edu)

Abstract. In this paper I argue that a global bioethics is possible. Specifically, I present the
view that there are within feminist approaches to bioethics some conceptual and methodolo-
gical tools necessary to forge a bioethics that embraces the health-related concerns of both
developing and developed nations equally. To support my argument I discuss some of the
challenges that have historically confronted feminists. If feminists accept the idea that women
are entirely the same, then feminists present as fact the fiction of the essential “Woman.”
Not only does “Woman” not exist, “she” obscures important racial, ethnic, cultural, and class
differences among women. However, if feminists stress women’s differences too much, femin-
ists lose the power to speak coherently and cogently about gender justice, women’s rights, and
sexual equality in general. Analyzing the ways in which the idea of difference as well as the
idea of sameness have led feminists astray, I ask whether it is possible to avoid the Scylla
of absolutism (imperialism, colonialism, hegemony) on the one hand and the Charybdis of
relativism (postmodernism, fragmentation, Balkanization) on the other. Finally, after reflecting
upon the work of Uma Narayan, Susan Muller Okin, and Martha Nussbaum, I conclude that
there is a way out of this ethical bind. By focusing on women’s, children’s, and men’s common
human needs, it is possible to lay the foundation for a just and caring global bioethics.

Key words: care-focused feminist bioethicists, difference, functional human capabilities,

global feminist bioethics, justice, power-focused feminist bioethicists, reproductive rights,
sameness, women’s health specialty

Abbreviations: AIDS – auto-immune deficiency syndrome; IVF – In vitro fertilization; NIH

– National Institutes of Health; ORWH – Office of Research on Women’s Health; US –
United States

Due to technological and communication advances, we are virtually forced to

recognize that not only our own people but all people are capable of feeling
pain and experiencing suffering. Our media routinely flash before our eyes
images of real people who are dying from AIDS in our world’s rural outposts
and overcrowded cities; suffering from neglect or even abuse in our world’s
orphanages; and huddling in our world’s refugee camps. This aspect of so-
called globalization invites bioethicists to develop morally sound criteria for
improving people’s health status and health care worldwide. Bioethics must,
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it seems, become more global in its scope, as justice can no longer remain
blind to the fact that people live in more than their own nations. They live in
the world.
But just because a global bioethics is desirable does not mean it is
possible. Upon what moral foundation can we build a robust global bioethics?
Although I do not have a complete answer to this enormously difficult ques-
tion, I believe the beginnings of such an answer can be found in several
approaches to bioethics. I particularly endorse those feminist approaches to
bioethics that use “universal human rights” language but move beyond it to
“universal human needs” language, thereby emphasizing the importance of
people’s positive as well as negative rights. If we wish to create international
healthcare policies that are just, that treat all people as deserving of equal
respect and consideration, we must first convince ourselves that, for all our
differences, we human beings are united in our common need for freedom
and well being.

I. Feminist Approaches to Bioethics

In order to appreciate the role certain feminist approaches to bioethics might

play in the greater globalization of bioethics, it is helpful to understand that
these approaches are of two basic types: care-focused and power-focused.
Care-focused feminist approaches to bioethics have as their central task
the rehabilitation of such culturally-associated feminine values as compas-
sion, empathy, sympathy, nurturance, and kindness. Power-focused feminist
approaches to bioethics have as their first imperative the elimination or modi-
fication of any system, structure, or set of norms that contribute to women’s
oppression. Although most feminist bioethicists include aspects of both of
these approaches in their work, they tend to favor one over the other, often
with interesting results. Here I focus primarily on how U.S. feminists use
the concepts of care and power in their approaches to bioethics, although
much of what I observe about their use of these concepts applies to feminists
elsewhere.

II. Care-Focused Feminist Approaches to Bioethics

Care-focused feminist bioethicists are, as a rule, more attentive to the

immediate spiritual, mental, physical, and social needs of people than the
systems and structures that indirectly affect people’s freedom and well-
being. Although care-focused feminist bioethicists appeal to principles such
as autonomy, beneficence, and justice, they typically resolve moral dilemmas
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at the bedside by sorting through a complex web of human relationships. For

them, the emotions, no less than reason, are appropriate moral guides.
For example, in an anthology entitled Empathy and the Practice of Medi-
cine, Dr. Joanne Lynn, a U.S. physician, defends her view that health care
practitioners must meet their patients’ spiritual and social, as well as physical
and psychological needs. She describes her efforts to care for an octogenarian
patient with Alzheimer’s dementia. The elderly man was not getting adequate
nutrition by mouth feeding. Focusing strictly on her patient’s emaciated
body, Dr. Lynn prescribed tube feedings for him. She then sent him home
with his wife, instructing her to tie her husband’s hands down to the bed
to prevent him from removing the feeding tube. After about two weeks of
physically restraining her husband, the patient’s wife broke down in tears to
Dr. Lynn. Responding to the wife’s distress, as one woman to another, Dr.
Lynn suddenly realized why her patient’s wife found tube feeding her dying
husband so difficult. The wife was most distressed about having to tie her
husband down to the bed in which they had shared years of intimate moments.
Dr. Lynn told the wife that she would discontinue the tube feedings. Less
harm and more good would be done not only to the patient but also to his
wife were he simply allowed to live as well as he could, taking a spoon of
food now and then from his loving wife in the bed that had brought them so
much happiness (Lynn, 1992: 44).
Significantly, care-focused feminist bioethicists are well aware that care,
empathy, and sympathy are not without their perils. Power dynamics may
distort care in at least two ways. First, care may disserve the care giver’s
interests. Care can become a trap for women, particularly women who work
in the service industry. Since society has viewed women far more than men as
being responsible for the care of the young, the old, and the infirm, continuing
to associate women with caring might easily reinforce the idea that women
should always be the care givers no matter the cost to themselves. For this
reason critic Sarah Lucia Hoagland faults care-focused thinkers like Nel
Noddings for implying that the only adequate justification for a withdrawal of
care is one that enables the care giver to return an even better carer (Noddings,
1984). In Hoagland’s estimation, if concern for others’ good is the only kind
of reason that justifies a withdrawal of care, then people get their “ethical
identity from always being other-directed and ‘being moral’ becomes another
term for being exploited” (Hoagland, 1991: 255).
Hoagland cautions there is more to the moral life than being responsive to
other persons’ needs and wants. With respect to dramatically asymmetrical
caregiving situations, Hoagland comments that: “I must be able to assess any
relationship for abuse/oppression and withdraw if I find it to be so. I feel
no guilt, I have grown, I have learned something. I understand my part in
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the relationship. I separate. I will not be there again. Far from diminishing
my ethical self, I am enhancing it” (Hoagland, 1991: 256). Ethics is about
knowing when not to care for others as well as when to care for them. A nurse
not only may, but should, seek some other type of work if she discovers that
she has no time for herself or life of her own. She needs no other justification
for withdrawing from care other than her own good.
Care can be distorted by power in a second way, however, this time in
a manner which disserves the care receiver’s interests. In a discussion of
disability, Susan Wendell articulates the ideals which should guide relation-
ships of dependency and interdependence. She notes that her culture, like the
cultures of other highly-developed Western nations in particular, is one which
treasures autonomy and independence, being in control of one’s own destiny,
and doing things on one’s own terms. Because persons with disabilities
have trouble performing so-called “activities of daily living” (e.g., washing,
dressing, cooking, shopping, cleaning), society views them as dependent on
others. However, as Wendell sees it, because all people are dependent on
others to a greater or lesser extent, we should realize that no one of us is
without disabilities (Wendell, 1993: 145–146).
Among the least desirable effects of drawing a line of demarcation
between “independent” persons without disabilities and “dependent” persons
with disabilities, stresses Wendell, is that doing so prevents us from appreci-
ating how interdependent we are. It is typically assumed that care receivers,
particularly multiply-disabled persons have nothing to give to their care
givers. But this is not necessarily or even typically the case. According to
Hoagland, for example, care receivers give many emotional and spiritual gifts
to their care givers. Hoagland narrates the story of Karen Thompson, a lesbian
who expended enormous emotional and financial resources to obtain legal
guardianship of her brain-stem injured partner, Sharon Kowalski. Asked if
she considered what she had done for Sharon a sacrifice, Karen responded
with the comment “No, I did this to make my life meaningful.” Sharon’s care-
giving granted her the opportunity to act decisively and deliberately, to reveal
her best self, and to create meaning for herself and Karen within oppressive
circumstances (Hoagland, 1992: 198).
Care-focused feminist bioethicists must develop the concept of care more
fully in order to employ it appropriately in the realm of health care. In partic-
ular, they must adequately distinguish between distorted forms of care and
genuine care. Seeking to define some of the necessary conditions for genuine
feminist care, Sheila Mullett observes that until gender equity is achieved,
women must continually ask themselves whether the kind of caring in which
they are engaged
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1. fulfills the one caring;

2. calls upon the unique and particular individuality of the one caring;
3. is not produced by a person in a role because of gender, with one gender
engaging in nurturing behavior and the other engaging in instrumental
behavior;
4. is reciprocated with caring, and not merely the satisfaction of seeing the
ones cared-for flourishing and pursuing other projects; and
5. takes place within the framework of consciousness-raising practice and
conversation (Mullett, 1989: 119–120).
Although Mullett’s criteria for genuine care provide a helpful first step
in articulating a robust ethics of care, they remain partial and provisional in
nature. Assume, for example, that a (female) nurse is not sure whether her
kind of caring for patients constitutes moral virtue or moral vice on her part.
In order to determine if she is caring in the right or wrong way, the nurse must
ask herself many questions. First, she must ask herself if her caring acts fulfill
her. Does she derive meaning and a sense of purpose from her work? Does
she take pride in the fact that she is able to ameliorate her patients’ pains and
sufferings? Second, the nurse must ask herself if the profession of nursing
calls upon her unique and particular individuality. Does she feel “called” to
be a nurse, so much so that she has no regrets about not being a physician, for
example? Does she view herself as well suited to being a nurse, seeing her
chosen profession as an outgrowth of her deepest values, or does she instead
view nursing as a mere role – as an ill-fitted uniform she can’t wait to get out
of at the end of the day?
Third, the nurse should frankly ask herself a series of questions. Does she
feel the way she feels about nursing because she is a woman? Would she
feel the same about nursing if she were a man? Why does nursing remain
a female dominated profession despite the fact that doctoring is no longer
a male dominated profession? Has she been “brainwashed” into being a
caring person? Why isn’t nursing as socially esteemed as doctoring? Fourth,
the nurse must ask herself: what is she receiving from her patients? Their
co-operation? A sense of meaning? Should nurses expect to get from their
patients a sense of fulfillment, such as the feeling mothers get from their
infants? Finally, the nurse must ask herself whether she has a safe moral
place within her institution. For example, is she able to discuss freely with
her colleagues her frustrations, anxieties, and irritations? Absent such a place,
the nurse will be unable to secure the kind of support and help she may need
to request a more manageable schedule or to be assigned a different set of
duties.
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III. Power-Focused Feminist Approaches to Bioethics

In contrast to care-focused feminist bioethicists, who stress bedside or clinical

issues, power-focused feminist bioethicists focus on boardroom and organ-
izational issues. Within the realms of U.S. science, medicine, and health
care, power-focused feminist bioethicists are always on the alert for patterns
of domination and subordination that unjustly favor one gender (or race,
class, ethnic group) over another. Particularly concerned about the oppres-
sion, neglect, or devaluing of women, power-focused feminist bioethicists
strive to view the realm of health care through women’s rather than men’s
eyes. Among other questions they have raised, they have asked why certain
diseases, treatments, and surgeries are so prevalent among women. The fact
that far more women than men suffer from eating disorders and depres-
sion, elect cosmetic surgery, and seek infertility services in the U.S. speaks
volumes to power-focused feminist bioethicists. As they see it, women’s self
esteem and social worth remain too strongly linked to women’s sexual and
reproductive function. Indeed, this linkage is so tight that women who are
not pencil-thin, perpetually cheerful, strikingly beautiful, and/or amazingly
fecund often view themselves as “sick,” deficient, and generally lacking in
society’s eyes (Bordo, 1993: 139–214).
Power-focused feminist bioethicists have also contributed to women’s
health by helping to end discrimination against women in research studies
conducted in the U.S. In the 1970s and 1980s, women were severely under-
represented in health research studies. For example, the often cited 1990
NIH-sponsored study on the links between aspirin use and reduced heart
attacks was conducted exclusively on men, despite the fact that heart attack is
the leading cause of death in older women (Merton, 1996: 220). Outraged by
such cases, power-focused feminist bioethicists lobbied their Congressional
representatives to make women’s health a national priority. In particular, they
encouraged the National Institutes of Health (NIH) to create an Office of
Research on Women’s Health (ORWH). The goal of the office, established
in September 1990, is threefold: (1) to increase women’s participation in
health research studies, (2) to insure that NIH-supported research pays due
attention to women’s health issues, and (3) to promote the number of women
in biomedical and biobehavioral careers (Report of the National Institute of
Health: Opportunities for Research on Women’s Health, 1991: 19).
In April 1991, Dr. Bernadine Healy, the first woman to head the NIH,
launched a $625 million study of over 160,000 women ages 50 to 79 at forty-
five clinical centers across the country to investigate the causes and potential
prevention of major diseases of women – particularly heart disease, cancers
of the breast, colon and rectum, and osteoporosis (Angier, 1991: 88). Now
 235

well underway, this study and others like it have been so successful that some
critics fear that the health interests of U.S. men are being slighted. They
note, for example, that although 78.3 percent of 1991 NIH funds went to
study diseases afflicting both women and men, 16 percent went to diseases
exclusive to women and only 5.7 exclusive to men (Rubia, 1991: A3).
Despite such strides in women’s health, power-focused feminist
bioethicists have not rested content. In an effort to make certain that
recent gains in serving women’s health interests are not only maintained
but increased, they have proposed a women’s health specialty that would
focus exclusively on women’s health concerns, both non-reproductive and
reproductive. Interestingly, this recommendation has not met with feminist
bioethicists’ universal approval. In the same way that U.S. feminist academics
in the 1970s debated whether to establish separate women’s studies programs,
or instead to “mainstream” materials related to women into the traditional
academic disciplines, present-day U.S. feminist bioethicists debate whether
to establish a separate women’s health specialty, or instead to “mainstream”
women’s health concerns into traditional medical specialties. So far the emer-
ging consensus seems to be a “both-and” approach that supports a women’s
health specialty until women’s health concerns are fully integrated into the
relevant existing specialties (Clancy and Massion, 1992: 1920). No one wants
to create a low-paying, unprestigious “ghetto” for women’s health concerns.
Power-focused feminist bioethicists do not stop at urging the U.S. health
care establishment to pay equal attention to women’s and men’s health
care concerns. They also consider the consequences of specific medical
treatments, scientific studies, and health care policies on women’s overall
well-being and freedom. They ask, for example, whether the reproduction-
controlling technologies of contraception, sterilization, and abortion are
necessarily “women-liberating.” Although these technologies have benefitted
many women in the U.S. and enabled them to take charge of their destiny,
they have not benefitted all U.S. women (let alone all women in other nations)
equally well.
The liberalization of U.S. sterilization laws in the twentieth century serves
as a good example of how the reproduction-controlling technologies bene-
fitted some U.S. women but not others. In the 1960s the so-called rule of 120,
which precluded sterilization of a woman unless her age times the number
of her living children equaled 120 or more (Clark, 1985: 198), was widely
followed by U.S. obstetrician-gynecologists when it came to healthy, white,
middle-class, married women – a fact which angered many advantaged U.S.
women. These women wanted physicians to adopt more permissive sterili-
zation policies so they could take advantage of a mode of birth control they
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perceived as safer, more effective, and less bothersome than other available
modes of birth control (e.g., hormonal-based contraceptives). What these
advantaged women failed to realize, however, was that the same obstetrician-
gynecologists, who were reluctant to sterilize them, were often only too
willing to sterilize women of color. Indeed, in some southern states, ster-
ilizations of indigent African-American women were so common that they
were irreverently referred to as “Mississippi appendectomies” (Rodriguez
and Trias, 1982: 150). More recently, but in the same spirit, some U.S.
legislators have drafted policies and laws linking fertile women’s welfare
eligibility with their consent to use the contraceptive Norplant. In the estima-
tion of these lawmakers, unless a woman who needs government subsidies
agree to use this long-lasting contraceptive implant, she and any children
she might already have should be denied Aid to Families with Dependent
Children.
The kind of policies and laws described above have caused many U.S.
women of color, particularly those whose incomes are very low, to suspect
that “white society” actually wants women of color to have abortions. They
note that a considerable number of people who view abortion as the murder of
innocent human life also support cutting benefits for welfare mothers – even
though such limits might cause more than a few welfare mothers to terminate
their pregnancies. Realizing the extent to which a woman’s race and class
affects the scope of her reproductive freedom, feminist philosopher Alison
Jaggar has commented:
A real choice about abortion requires that a woman should be able to opt
to have her child, as well as to abort it. This means that the full right to life
of the child must be guaranteed, either by community aid to the mother
who wishes to raise it herself, or by the provision of equally advantageous
alternative arrangements in the event the mother is unwilling or unable to
assume demanding child-rearing responsibilities (Jaggar, 1976: 357).

IV. Towards a Global Feminist Bioethics

Given that what is good for one woman or one group of women is not
necessarily good for another, both power-focused and care-focused feminist
bioethicists have wondered whether women share anything in common
over and beyond a few biological characteristics. In recent years feminist
bioethicists have increasingly rejected not only women’s sameness with men
but also women’s sameness to each other. At first, it might strike us as
ethically counterintuitive to reject locutions such as “Policy X is (is not) in
Women’s best interest” or “Women want to be equal to men.” After all, the
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idea of sameness has enabled us to develop a rich theory of human rights and
the conviction that all people are created equal.
Yet, upon careful reflection, it becomes possible to see how the idea of
essential human sameness can function oppressively. For example, in the
course of analyzing the work of historian Kenneth Stampp, feminist philo-
sopher Elizabeth Spelman focuses on one of his well-meaning comments,
intended to break down racial barriers in the United States. In an effort to
convince white men that black and white men are equal, Stampp asserted
“that innately Negroes are, after all, only white men with black skins, nothing
more, nothing else” (Spelman, 1988: 12). Rather than affirming Stampp’s
words, Spelman criticizes them as unintentionally racist. Why, she asks, is
it that black men are “nothing more, nothing else” than white men? Why
assume that black men want only to be white men? Why not assume instead
that white men are “nothing more, nothing else” than black men – that white
men want only to be black men? Could it be, asks Spelman, that white people
cannot imagine black people preferring to be black?
Not wanting to fall into the trap that ensnared Stampp, feminists, including
feminist bioethicists embraced the idea of difference enthusiastically. It has
become routine for them to precede their analyses of any issue related to
women with disclaimers such as, “Please note that I am speaking from the
perspective of a white, middle-class, middle-aged, heterosexual, married with
children, well-educated U.S. academic. I do not assume that what constitutes
good health care for a woman like me also constitutes good health care for
a woman unlike me. Nevertheless, I will share my thoughts for what they
are worth.” But, just how worthy are moral thoughts without any prescriptive
or normative force? And if women’s differences truly preclude there being
anything the same about all women, then how can feminist bioethicists speak
forcefully about women’s rights, gender justice, or sexual equality? Clearly,
in its extreme form, the idea of difference, like the idea of sameness, is an
ethically counterproductive concept.
Fortunately, as a result of greater participation in international conferences
and organizations, feminists are now rethinking the balance between women’s
differences and samenesses. Particularly successful was the Beijing Women’s
Conference (1995). It succeeded, where earlier women’s conferences faltered
(Mexico, Copenhagen, Nairobi), because it was able to draw on previous
groundwork through regional and global electronic networks and because it
insisted on linking women’s rights to human rights. Even more importantly
for our purposes, the Beijing Women’s Conference spent far less time on
“ideological slogoneering” than on identifying “practical targets” for action
that would satisfy specific groups of women’s immediate needs for better
health care, education and employment (Dickenson, 1997: 107–113).
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Among the feminists who have contributed to developing a theory that

fits the practice of a feminist global bioethics is Uma Narayan, a woman of
Indian background who now lives in the United States. In her book Dislo-
cating Cultures: Identities, Traditions, and Third World Feminisms, Narayan
observes that Westerners should acknowledge their role in creating unfavor-
able representations of the so-called Other as uncivilized, primitive, barbaric,
or animalistic, and for letting their negative ideas about the Other be used
as conceptual ammunition to defend unjust colonial policies. However, she
adds the important point that Westerners should not seek forgiveness for
their past sins against people in the East by refusing to engage in any moral
criticism of them now (Narayan, 1997: 127). Narayan stresses that she does
not want guilt-ridden Westerners to unreflectively respect her native land as
incapable of evil, but to insist with her that what was wrong about U.S.
segregation and South African apartheid is what is wrong about the Indian
caste system, for example. In addition, Narayan pleads that when she, Uma
Narayan, condemns female genital mutilation, the sale of human organs, or
sex-selective abortion, she not be dismissed by Westerners as, afterall, only a
“Westernized” Indian woman, unable to speak on behalf of “authentic” Indian
women, who presumably endorse every feature of their society, no matter how
morally dubious or unjust (Narayan, 1997: 146).
Narayan’s conviction that Westerners, but particularly Western feminists
need to apply the same moral standards to all people is not unique to her. It
is a viewpoint shared by an increasing number of feminists who believe that
now is the time to develop a “feminist humanism” that combines “the respect
for differences characteristic of progressive movements since the 1960s with
the universalistic aspirations of earlier liberatory traditions” (Holstrom, 1998:
288). For example, feminist political theorist Susan Moller Okin has argued
that feminists must talk about women’s needs generically, for, as she sees
it, the category of gender is of great political importance. She stresses that
without the concept of Woman, feminists have no way to make cross-cultural
comparisons about male-female inequalities and to condemn them as wrong
(Okin, 1995: 294).
Although all women do not experience a particular gender inequality to the
same extent and degree, Okin stresses they all experience it in some way or
another, for the same reasons, and with the same consequences (Okin, 1995:
294). Because virtually all societies regard women as the “second sex,” as
somehow existing for men’s sexual pleasure and reproductive use, and as less
intelligent, strong, and rational than men, women throughout the world tend
to have less sexual freedom, fewer reproductive rights, and a worse socio-
economic status than men. Indeed, at all of the most recent International
Women’s Conferences, including the relatively unsuccessful ones, women
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from both developed and developing nations similarly commented that their
quality of life is negatively affected by virtue of their sex. They discussed
how their nations’s sex, reproduction, marriage, divorce, child-custody, and
family-life laws lessen their lot in life; how women and girls, far more than
men and boys, are sexually vulnerable; and how less healthy, wealthy, and
educated their nations’ women are than their nations’ men (Okin, 1998: 42).
Given that throughout the world men remain the “first sex,” Okin comments
that women’s sameness consists simply in women’s lesser or greater subor-
dination to men. Therefore, women in countries where there is more gender
inequality should work together with women in countries where there is
less gender inequality to achieve for all women the kind of freedom and
well-being that men typically have. For more advantaged women to help
less advantaged women is not an exercise in cultural imperialism on the
part of more advantaged women, but simply their response to a call for
assistance.
Okin’s growing conviction that the idea of women’s sameness – indeed of
a common human nature – can be used to liberate rather than oppress women
has been further developed by feminist philosopher and political theorist
Martha Nussbaum. Nussbaum argues that a conception of the human being
and human functioning is the best basis for evaluating women’s position vis
á vis men’s position around the world. Just because some philosophers have
conflated human nature with male nature, thus wrongly defining the quint-
essential human being as a male human being, does not mean that feminists
cannot appropriate the concept of human nature effectively and use it to prove
that women are no less fully human than men. This being the case, there is no
basis for the claim that men and women should have different norms of human
functioning, or that they should exercise the same norms in different spheres
– men in the public realm and women in the private realm. What all persons
need, in Nussbaum’s estimation, is an equal opportunity to develop two sets
of functional human capabilities – those which, if left undeveloped, render a
life not human at all; and those which, if left undeveloped, render a human
life less than a good human life. Among the latter capabilities, Nussbaum lists
some which are of particular interest to all bioethicists: (1) “being able to live
to the end of a human life of normal length, not dying prematurely or before
one’s life is so reduced as to be not worth living;” (2) “being able to have
good health . . . adequate nourish(ment) . . . shelter . . . opportunities for sexual
satisfaction and choice in matters of reproduction;” and (3) “being able to live
with concern for and in relation to animals, plants, and the world of nature”
(Nussbaum, 1999: 41).
To be sure, Nussbaum’s complete list of functional human capabilities
– (1) life (2) bodily health and integrity, (3) bodily integrity, (4) senses,
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imagination, and thought, (5) emotions, (6) practical reason, (7) affiliation,
(8) other species, (9) play and (10) control over one’s environment – is the
product of her own mind. As such it is contestable on the grounds that, once
again, a self-appointed Western/Westernized expert is determining what is
to count and not count as a functional human capability for human beings
throughout the world. But this objection is surmountable. Nussbaum’s list is
not a novel one. In fact, it is virtually indistinguishable from the “capabil-
ities lists” that are produced whenever and wherever people are permitted to
freely reflect upon and express their basic aspirations for themselves and their
children.
According to Jürgen Habermas, for example, before we endorse the
norms of a community, we must determine whether its members genuinely
accept them. In order to make this determination, we must ask ourselves
whether, under conditions of undistorted communication, virtually all of the
community’s members would affirm their community’s norms as rational
ones for themselves. If the answer to this question is “no,” we should,
in Habermas’s estimation, conclude that at least some members of the
community in question have been tricked, mystified, or otherwise mani-
pulated into espousing and even internalizing its norms (Habermas, 1979:
75).
If Habermas is correct, and I believe he is, we should not assume that
simply because an individual woman defends cultural practices or institutions
that demean, denigrate, neglect or harm other women, that woman would
not, upon reflection and given certain opportunities, speak out against and
even rebel against such practices. Defending what she terms a “capabilities
approach” to constructing a globally just ethics, Nussbaum comments:

The capabilities approach insists that a woman’s affiliation with a certain

group or culture should not be taken as normative for her unless, on due
consideration, with all the capabilities at her disposal, she makes that
norm her own. We should take care to extend to each individual full
capabilities to pursue the items on the list and then see whether they
want to avail themselves of these opportunities. Usually they do, even
when tradition says they should not. Martha Chen’s work with [Indian]
widows like Metha Bai reveals that they are already deeply critical of the
cultural norms that determine their life quality. One week at a widows’
conference in Bangelore was sufficient to cause these formerly secluded
widows to put on forbidden colors and to apply for loans; one elderly
woman, ‘widowed’ at the age of seventy, danced for the first time in her
life, whirling wildly in the center of the floor . . . Why should women cling
to a tradition, indeed, when it is usually not their voice that speaks or their
interests that are served (Nussbaum, 1999: 146–147).
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Conclusion

Because I recognize both the samenesses and differences among women, and
for that matter, human beings, I believe that in order to speak meaningfully
of a global bioethics, feminist bioethicists must perform two tasks. First, they
must create safe moral spaces for dialogue in which all voices are free to
speak, and in which those who do not ordinarily speak are encouraged to
speak first. This would create the kind of forum in which the authority of so-
called expertise demurs to the authority of lived experienced. According to
Jaggar, for example, it takes effort, skill, and the practice of such virtues as
responsibility, self-discipline, sensitivity, respect, and trust. It also assumes
“that understanding between diverse people becomes possible only when
those involved care for each other as specific individuals” (Jaggar, 1995: 116).
In this connection, Jaggar notes an article in which feminist philosophers
María Lugones and Elizabeth Spelman propose that neither self-interest nor
duty but friendship is the only appropriate motive for Anglo and Hispanic
women, for example, to come together to iron out their differences. Lugones
specifically writes that “[a] non-imperialist feminism requires that . . . you
[Anglo feminists] follow us into our world out of friendship” (Spelman and
Lugones, 1992: 363). Feminist bioethicists must imaginatively and “electron-
ically,” if not also physically, travel to each other’s worlds. Together they
must create a greater number of democratic forums such as the one created
during the Beijing Women’s Conference (1995) which enabled feminist
bioethicists to obtain the kind of data they need to help shape health care
policies, practices, and institutions that are globally, and not simply locally
just.
Yet, as important as it is for feminist bioethicists to engage in genuine
dialogue, it is even more important for them to actively work to eliminate the
gap between the world’s ‘Haves” and “Have-Nots,” particularly because far
more women and girls than men and boys populate the class of the “Have-
Nots.” If feminist bioethicists want to improve women’s health worldwide,
they must do more to educate themselves about women’s health issues in
both the developing and developed nations. They must also organize and
participate in more conferences such as the recent Feminist Approaches to
Bioethics Network Conference (2000) held in London, where over a hundred
feminist bioethicists from approximately twenty-five countries gathered
together to educate each other about their specific problems, concerns, and
interests. Although everyone learned much about how the “Other” sees the
world, on the whole, feminist bioethicists from developed nations discovered
just how little they knew about the plight of women in most developing
countries.
242

Among the lessons learned at global conferences by feminist bioethicists

from the developed world are precisely how discrimination against women
and girls in many developing countries often begins before birth in the form
of systematic prenatal diagnosis and techniques and abortion for the purpose
of sex-selection. The fact that many Indian and Chinese women, for example,
willingly abort their female fetuses is, of course, not surprising. Knowing just
how difficult it is to be a woman as opposed to a man in their societies, some
Indian and Chinese view no life at all as preferable to life as a woman (Myntti,
1998: 143).
Discrimination against females does not, of course, end in the womb.
In many developing societies it continues in particularly blatant ways
throughout childhood. For example, throughout South Asia and the Arab
world, girls typically receive less food and less health care than boys. As
a result, girls’ growth may be stunted from the combined effect of malnutri-
tion and untreated illnesses. Already weakened, these girls grow yet weaker
when they begin what will probably be but the first of many pregnancies. In
developing nations where fertility is still relatively high – about four chil-
dren per woman – the physical and psychological demands of child bearing
and child rearing typically lead to so-called maternal- depletion syndrome,
characterized by severe anemia (Myntti, 1998: 144).
Of course, like women in developed nations, women in developing nations
have all sorts of health concerns. Their problems are not limited to repro-
ductive and sexual concerns. Yet many feminist bioethicists in the developed
nations have paid little attention to anything other than the fertility rates
of women in many developing nations and the practice of female genital
cutting (female circumcision/female genital mutilation). Not surprisingly,
many thoughtful women in the developing nations have criticized this myopic
tendency for two reasons.
First, women in the developing nations believe that feminists in the
developed nations frequently fail to understand that the main concerns of
women in the developing nations are more social and economic than sexual
and reproductive in nature. For example, at a very large international women’s
conference in Nairobi, Kenya held in 1985, Nawal el Saadawi, an Egyptian
writer, lamented that “Western women often go to countries such as Sudan
and ‘see’ only clitoridectomy, but never notice the role of multinational
corporation and their exploited labor” (Gillian, 1991: 224). As Saadawi sees
it, women in developed nations frequently fail to appreciate the extent to
which they contribute to the economic and political oppression of women
(and men) in developing nations. The same U.S. woman who is willing to
attend protests against clitoridectomy might not be willing to attend protests
against the multinational corporation that pays its employees in developing
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nations meager wages. As a result of this practice, the corporation can pay its
employees in developed nations generous salaries.
Second, and relatedly, women in developing nations are bothered when
feminist bioethicists in developed nations do not look at the health-related
problems of women in developed nations through the eyes of women in
developing nations. Feminist bioethicists in the developed nations need to
understand that from the point of view of many women in the developing
nations, feminists in the developed nations are “spoiled.” Their concerns –
for example, too much elective cosmetic surgery, a rash of eating disorders,
multiple pregnancies caused by IVF, and the race to create perfect babies
– would evaporate were their advantaged nations willing to transfer more
of their health care resources to disadvantaged nations. The money some
Western women spend on perfecting their bodies could instead be spent on
corrective surgeries for the maimed and scarred victims of torture and war
throughout the world. Similarly, the money some women in the developed
nations spend on diet drugs, “diet doctors,” and diet books could instead be
spent on much needed food supplies for people in developing nations who
would be glad to eat a full meal.
Clearly, if U.S. feminist bioethicists, for example, want to improve
women’s health status and health care worldwide, they must try harder than
they have in the past to understand what women in all sorts of nations want
for themselves and their daughters. What they will probably discover is that,
generally, all people want the same things: health, wealth, happiness, security,
family and friends, work, and so on. It is just that they want these same things
differently.
Particularly instructive in this connection is a study conducted by Rosalind
Petchesky and Karen Judd. They studied how low-income, urban women
in seven, very different nations (Brazil, Egypt, Malaysia, Mexico, Nigeria,
Philippines, and the United States) interpret what the Western world terms
“women’s reproductive rights.” Despite the fact that the women in the study
shared neither the same political and religious beliefs nor the same cultural
and social traditions, all of them used the idea of “motherhood” to justify their
conviction that it should be up to them to decide the size of their families since
women and not men “suffer the greatest burdens, pains and responsibilities of
pregnancy, child bearing and child rearing” (Petchesky and Judd, 1998: 362).
Feminist bioethicists in the developed nations, particularly in the U.S.,
who focus on theory must develop theoretical perspectives that better reflect
the enormous strides feminist activists have made to improve the status of
women’s health worldwide. In other words, at least in the U.S., feminist
bioethicists need to be as serious about the justice of redistribution as they
have been about the justice of recognition moving beyond a celebration of
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diversity to narrowing the gaps between the different lives the “Haves” and
“Have-nots” of this world respectively lead.
In a recent article, philosopher Margaret P. Battin has argued that given
“stark differences in life expectancy around the world, from as high as 80
in the richest nations to below 50 in the poorest,” people in the developed
world should consider not spending excessive amounts of money in order to
prolong their lives for at most a month or two. What is more, argues Battin,
the monies saved by people in the developed nations, who decline expensive
life-prolonging treatment, should be redistributed to people in the developing
nations in an effort to fund the basic health care measures that would increase
their life expectancy (Battin, 2000: 1). Feminist bioethicists in the developed
world must honestly confront whether they are really interested in creating
the kind of structures and systems that would facilitate the kind of global
redistribution program Battin envisions.
The picture of justice that most inspires me is not the image of justice
blindfolded and holding a sword and scales, but that of the Greek goddess
Nemesis – she of the “Third Eye” – continually looking for wrongdoers,
for oppressors, for those who would deprive anyone, particularly the most
vulnerable members of a population of what they need to lead a truly good
human life. Unless we continually remind ourselves what is wrong about a
world in which some of us live well into our 80’s and 90’s, while others
of us die before we have had a chance to live; in which some of us go on
diets and pay cosmetic surgeons to excise our excess flesh, while others of
us starve or beg for food; and in which some of us have access to life-saving
technologies, abundant pharmaceuticals, and every manner and fashion of
care giver conceivable, while others of us drink contaminated water, breath
foul air, and lack the simplest of immunizations, feminist bioethicists will fail.
They will fall tragically short of their core goal; namely, making the realm of
health care one that structures and organizes itself so as to serve women and
men (as well as all races, classes and nations) equally, for in the end we are
all the same, united as we are in our carnality and mortality.

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