Abstract
In the Foundations of Bioethics and elsewhere,1 Engelhardt develops a contextual account of disease. As this essay illustrates, Engelhardt’s account can be employed in framing a feminist clinical epistemology. Feminists2 claim that medicine, with its authority to define what is normal and pathological and to command compliance to its norms, tends to strengthen patterns of stereotyping and reinforce existing unjustified power inequalities. As a consequence, ageism, gender bias, and racism occur as various ways of accounting for the structure of and procedural character of contexts in medicine. This essay focuses its attention on gender bias in clinical medicine and argues that a gender-neutral account of clinical reality (and the diagnosis and treatment of disease) is not the response one can or should give to current concerns regarding gender bias in clinical medicine. Rather, the essay establishes that a feminist clinical epistemology is worth considering in order explicitly to incorporate gender into our accounts of clinical reality. Moreover, a feminist clinical epistemology is what is needed if we are to develop scientific research projects, medical care, and public health policies that more accurately reflect biological and psychosocial gender differences. This analysis is to extend Engelhardt’s work in ways that carry special implications for our discussions concerning how we are to understand clinical reality, which in turn fuel our dialogues in biomedical ethics and public health policymaking.
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Notes
H. Tristram Engelhardt, Jr., “The Concepts of Health and Disease,” in A. L. Caplan, H. T. Engelhardt, Jr., and J. J. McCartney eds., Concepts of Health and Disease (Massachusetts: Addison-Wesley Publishing Co., 1981): 31–45. See also, Engelhardt’s “Explanatory Models in Medicine: Facts, Theories, and Values,” Texas Reports on Biology and Medicine 32, no. 1 (1974): 225–239.
Helen Bequaert Holmes, and Laura M. Purdy, eds., Feminist Perspectives in Medical Ethics, (Indiana: Indiana University Press, 1992); Susan Sherwin, “Feminist and Medical Ethics: Two Different Approaches to Contextual Ethics,” in H. B. Holmes and L. M. Purdy, eds., Feminist Perspectives in Medical Ethics (Indiana: Indiana University Press, 1992): 17–31.
Engelhardt, The Foundations of Bioethics, 2nd Ed. (Oxford and New York: Oxford University Press, 1996), see especially, Chapter 5, “The Languages of Medicalization.”
See Foundations, 195.
Engelhardt, “The Concepts of Health and Disease,” 33.
Engelhardt, “The Concepts of Health and Disease,” 43.
Engelhardt, “Explanatory Models in Medicine,” 237.
Engelhardt, “Explanatory Models in Medicine,” 233.
Mary Ann Gardell Cutter, “Negotiating Criteria and Setting Limits: The Case of AIDS,” Theoretical Medicine 11 (1990): 193–200.
Engelhardt, “Explanatory Models in Medicine,” 237.
Autumn Stanley, “Women Hold Up Two-Thirds of the Sky: Notes for a Revised History of Technology,” in Larry A. Hickman, ed., Technology as a Human Affair (New York: McGraw Hill Publishing Co., 1990), 308–323.
Boston Women’s Health Book Collective, Our Bodies, Ourselves (New York: Simon and Schuster, 1973). Second edition appeared in 1984 under the title The New Our Bodies, Ourselves.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (Washington, D.C.: Department of Health, Education, and Welfare, 1978 [No. 78-0012]). See also, President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions (Washington, D.C.: U.S. Government Printing Office, 1983).
U. S. Department of Heath and Human Services, Women’s Health: Report of the Public Health Service Task Force on Women’s Issues 2 (Washington, D.C.: Public Health Service, 1985).
U. S. Food and Drug Administration, Guidelines for the Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs (Washington D.C.: FDA, 1993).
Science, Special Issue on “Women’s Health Research,” 269 (August 11, 1995): 765–801.
Science, “Women’s Health Research.”
Alison Jaggar, ed., Living with Contradictions: Controversies in Feminist Social Ethics (Colorado: Westview, 1994).
See S. Sherwin, “Feminist and Medical Ethics,” 17–31, and Sue V. Rosser, “Re-Visioning Clinical Research: Gender and the Ethics of Experimental Design,” 127–139; Holmes and Purdy, Feminist Perspectives in Medical Ethics.
Carroll Smith-Rosenberg, and Charles Rosenberg, “The Female Animal: Medical and Biological Views of Women and Her Role in Nineteenth-Century America,” in A. L. Caplan, et al., eds., Concepts of Health and Disease, 281–303.
Engelhardt, “Explanatory Models in Medicine.”
Miriam Greenspan, A New Approach to Women and Therapy (Summit, Pennsylvania: TAB Books, 1993).
J. Waisberg and P. Page, “Gender Role Nonconformity and Perception of Mental Illness,” Women Health 14 (1988): 3–16, and I. K. Broverman, et al, “Sex-role Stereotypes and Clinical Judgements of Mental Health,” Journal of Consulting Clinical Psychology, 34(1970): 1–7.
Council on Ethical and Judicial Affairs, American Medical Association, “Gender Disparities in Clinical Decision Making,” Journal of the American Medical Association 266 (1991): 560.
Council on Ethical and Judicial Affairs, AMA, “Gender Disparities,” 561.
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Cutter, M.A.G. (1997). Engelhardt’s Analysis of Disease: Implications for a Feminist Clinical Epistemology. In: Minogue, B.P., Palmer-Fernández, G., Reagan, J.E. (eds) Reading Engelhardt. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5530-4_8
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