Abstracts Philosophy, Religion, and Theology

Caring differently: Sexual difference and the ethics of health care relationships

by Susan McPhail Wittjen

The ethical issues that are associated with interprofessional relationships in health care affect the care that patients receive in an institutional setting. There are many components of difference that affect relationships, but this work focuses on sexual difference and how it is revealed in the discourse of health care. Since the ethical obligations of health care providers historically have been derived from the roles of those professionals, the patient and provider relationship is described to establish the obligations of nurses, physical therapists, and physicians to patients. Because health care principles traditionally have been narrowly interpreted and applied, as well as limited in choosing ethical cases for analysis, the traditional ethical frameworks of principlism and casuistry have been insufficient in addressing the ethical concerns that arise from interprofessional relationships. A feminine ethic of care is also inadequate in addressing these concerns because it is not sensitive to sexual difference and because it involves the possibility of promoting self-sacrifice. Luce Irigaray uses a technique of mimesis to expose and undermine sexual indifference in several western texts to explain how woman's voice has been overlooked in a culture based on masculine discourse. Her phenomenological interpretation of woman's body as being fluid, multiple, and intermediate is associated with those health care professions that are grounded in maternal nurturing and touching. These qualities are also revealed in the gendered discourse that permeates health care. Using Irigaray's work on feminine imaginary and gendered discourse, health care ethical issues can be analyzed at a deeper level than via principlism, casuistry, or care. By recognizing how the gendered nature of health care discourse prevents the female voice from contributing to the decision-making process, new and creative possibilities for approaching ethical issues can be developed to provide the patient with care based on a broader interpretation of the issues. A case study based on a patient at the end-of-life is used to illustrate how the recognition of the role of sexual difference in ethical analysis can affect how decisions about patient care are made.