An A–Z of medical philosophy: Gender and ethics

David Misselbrook

doi:10.3399/bjgp13X669275

Surely gender has nothing to do with morality? Well, perhaps it just might. All approaches to ethics make assumptions about what constitutes human nature and the human good. A conventional description of a mature ethical person would value ideals such as autonomy, rationality, and justice. The feminist ethicist Carol Gilligan in her book In a Different Voice: Psychological Theory and Women’s Development, would see such a description as a specifically masculine picture of identity. Gilligan would see mature human flourishing more in terms of a network of mutually caring relationships. Carol Tavris claims that we have divided our world into the ‘public’ sphere, where virtues such as reason and justice are recognised, but we have marginalised the ‘private’ sphere where virtues such as care and nurture are central. By marginalising the female virtues we marginalise women themselves.

The classic feminist account of gender identity is rooted in childhood experience. Infants of both sexes start out with strong bonds of attachment and intimacy to their mothers. Boys learn their male identity by a process of separation from their mothers and therefore masculinity is defined by separation, autonomy, and distancing oneself from others. Men therefore need a strong sense of justice and rationality to balance the needs of others.

Girls, however, attain a female identity by continuing to identify with their mothers, and by modelling their behaviour on the mutually caring bond they have learned. Femininity is characterised by networks of mutually dependant caring relationships. Relationships matter more than abstract principles or rules.

Some feminists argue that love, not justice, should be the central value in ethics, for justice sees people as objects for competing interests, and may fail to find a real concern for the people themselves. The care perspective is claimed to be superior as it is defined by the central importance it gives to human relationships that spring from personal attachment.

There are problems with a feminist ethic. Care-based ethics are ideally suited to behaviour in families or small social groups. But how big can my networks get? A feminist ethic may be suitable for running a family, a clinical department, or a practice. But who will speak for those beyond my known networks if my actions affect them? And what if I cannot love all those who come into my consulting room, for it is hard to be motivated by love and emotional commitment to several dozen new strangers every day.

Perhaps it is better to see the ethics of care and the ethics of justice not as rivals, but as appropriate responses to different sorts of situation. Perhaps we should embrace an ethical androgyny that seeks an ethic appropriate to individual circumstances. The ‘Four Principles’ manage to balance our male and female sides — we could see autonomy and justice as rationalistic male characteristics, and doing good and not doing harm as caring female characteristics. Perhaps we all need to show both care and justice in a complex world as best we may.

CPD further study and reflective notes

The notes in Boxes 1 and 2 will help you to read and reflect further on any of the brief articles in this series. If this learning relates to your professional development then you should put it in your annual PDP and claim self-certified CPD points within the RCGP guidelines set out at http://bit.ly/UT5Z3V.

Box 1.

Reflective notes

Morally equal but ethically differently wired: what are your thoughts on this central idea?
Do you see specific value in the ethical model attributed to the opposite sex from yourself?
How might valuing both male and female ways of being work for you in practice?

Box 2.