Women’s perspectives and life experiences
are not adequately represented in current bioethical debate, public
policy decisions, or academic research. The realities of women’s lives
are different from men’s—socially, politically, and economically. By
and large women are the world’s caretakers, caring for the young, the
old, and the sick in communities all over the globe. Relative to men,
women are politically disenfranchised and economically dependent.
Women’s access to healthcare, including contraception and prenatal
care, is subject to outside control in a way that men’s is not.
Likewise, women’s bodies are different from men’s.
Yet the majority of those leading the public debate are men. Women can
neither rely on, nor expect, men to represent the entire range of human
experience and perspectives. Although several other women’s policy
institutes exist, not one is focused on bioethics. It’s not that they
aren’t concerned about bioethical issues; it’s just that their
resources are stretched. The bottom line is that women’s policy
institutes just aren’t funded at the level that conservative think
tanks are. In this absence of rigorous, accessible, and thorough
scholarship focused through the lens of women’s experience, women risk
not being considered or heard on complex bioethical issues.
Many bioethical issues have different and disproportionate effects on
women’s lives—effects that current policy does not take into account.
For example, women have been excluded from heart disease studies until
recently. As a result, many women who were presenting in the emergency
room with heart attacks were misdiagnosed because their symptoms and
risk factors were different from those of men. Because physicians did
not have the information they needed to treat their patients, countless
women did not receive the life-saving care they needed. This
information gap resulted in many deaths, with families suffering the
needless loss of a mother, sister, or daughter.
The gynecological health of HIV-positive women was also not studied
until recently. As in heart disease, AIDS looks different in women.
Early symptoms in women with AIDS include pelvic inflammatory disease,
cervical cancer, or abdominal pain, whereas men often present first with
sarcoma and other symptoms. Consequently, HIV-positive women in this
country—who are often drug users, poor, and minority women—have not
received the same level of care as men. Delayed diagnosis makes many
AIDS patients ineligible for life-saving drugs and other supportive
services.
Analysis that takes into account the realities of women’s lives offers
a new perspective on familiar questions. For example, surrogate
decision-making (in which a previously designated person speaks on
behalf of the patient) is the standard model for patients who are
unable to make their own choices about their medical treatment.
Considering this model from a gender perspective, and taking into
account other relevant facts—for instance, the average age of widowhood
in the U.S. is 55, meaning that there are women with many years left to
live who have lost the person who may have been their best proxy-we
begin to see why gender-based differences must be considered in policy
formulation.
Reproductive issues are central to any discussion of bioethics and
women. For decades Americans have been engaged in the pro-choice versus
pro-life debate. But what does that mean in light of biotechnological
advancements? For example, who decides the fate of a frozen embryo if
the parents cannot reach agreement? What if the father wants the embryo
destroyed, but the mother wants it implanted into her uterus—or someone
else’s? The established terms of debate do not accommodate such
emerging questions. Currently, these decisions are being made by the
courts, without the benefit of public debate or legislative oversight.
We tend to think of surrogate motherhood as a non-economic exchange, in
which a woman has a baby for an infertile friend or family member. The
surrogate is artificially inseminated by the father’s sperm, carries the
child, and then turns the child over to the couple. However, with
assisted reproductive technology, it is now possible to harvest an egg
from one woman, fertilize it outside the womb, and then implant it into
a surrogate womb for gestation. Certain states prohibit surrogacy
contracts, but others, such as California, allow them. An unintended
consequence of all this is that increasingly, minority and immigrant
women are serving as “host wombs” for wealthy white couples. Is that
reproductive freedom or is it economic exploitation?
Babies can now survive outside the womb at 24 weeks, and scientists
expect that number to decrease. What if technology allowed us to
perform an “eviction” instead of an abortion, so that we could safely
remove the fetus without destroying it and implant it into another
woman or an artificial womb? Under what circumstances would we compel a
woman to have one procedure instead of the other? These are not
science-fiction scenarios; we must have the courage to tackle these
issues, ask hard questions, and be creative with our solutions.
For most of history, positions of power and seniority have been
occupied by men. Men have set research agendas, chosen funding
priorities, written laws and public policy, and determined which
questions are worthy of attention. These decisions affect all of us—not
only men. Women must have a place at the table to influence policy and
protect their interests.
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