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Medical ethics and women r. Eike-Henner Kluge (Can Med Assoc J 1990; 142: 876, 879) takes an unnecessarily narrow view of what might more appropriately be termed women's views on matters of morality and ethics. The possibility of differing views seems to frighten him, and his conclusion that there should be no difference is historically premature. Kluge acknowledges that there are some ethical issues of more relevance to women than to men. However, he narrowly attributes the different views of women on these issues only to gender and biology, ignoring the

different significant psychologic and sociologic life experiences of -

For prescribing information see page 330

women. It is only in recent decades that we have begun to acknowledge such difference and to learn its nature and potential ramifications for society. Since women constitute at least 50% of the population to which morality and ethics apply, it would seem paramount that everyone, regardless of gender, learn more about their particular viewpoints and experiences. I must remind Kluge that the present body of knowledge in ethics and moral thought, like that in other fields (for example, law, theology and medicine), reflects almost exclusively the norms, views, experiences and reasoning of men. Indeed, the very concept of "person" to which he refers did not historically include women and, sadly, in large parts of the world today still does not. Thus, this body of knowledge is incomplete. Fortunately, some excellent work is being done. Gilligan,' for example, describes the fact that women differ significantly from men in their manner of moral reasoning and weighing moral dilemmas. Although Kluge is correct that the basic moral principles (autonomy, beneficence, nonmaleficence and justice and their related rules) may remain the same, there is evidence, as Gilligan describes, that women may evaluate and "weight" them from a framework of conflicting moral responsibilities rather than one of competing rights and that they may think more in a contextual and narrative framework than in the formal and abstract process that has been the basis of ethics to date. Thus, a morality of rights and noninterference may seem frightening to women because of

its sense of indifference and unconcern. I agree with Kluge that a separate women's ethics is inappropriate. Rather, I propose that women's views on all matters of ethics and morality need to be integrated as such throughout the whole of ethical theory, reasoning and practice. No doubt in this process change will occur. Why, we may even find new solutions to age-old problems! It is difficult for human beings to speak of "difference" without implying better and worse or right and wrong. Nevertheless, we must have the courage to explore all of the differences that exist in our pluralistic society if ethics is to reflect, as it should, the views of all members. Premature closure on difference will not be to our society's benefit. Elizabeth J. Latimer, MD Associate professor Department of Family Medicine McMaster University Hamilton, Ont.

Reference 1. Gilligan C: In a Different Voice. Psychological Theory and Women's Development, Harvard U Pr, Cambridge, Mass, 1982: 19

Dr. Kluge suggests that political interpretation of women's health care issues offers two possible conclusions. I suggest a third, namely that the female orientation should be incorporated into all of medical ethics (and all of medicine). A female or feminist orientation would suggest valuing subjectivity and relationship along with objectivity and control, the major values of our patriarchal system. I believe that the subjective CAN MED ASSOC J 1990; 143 (4)


Medical ethics and women.

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