Ethics of Health Care and Reproduction
The mainstream tradition of ethics has been preoccupied with principles articulated in highly technical language ( Fry, 1992). Kohlberg's hierarchical model of moral dilemma resolution (e.g., 1969, 1981) dominated the field of ethical reasoning, but, by reexamining reactions of subjects, Gilligan ( 1982) found that boys and men apply abstract principles not necessarily relevant to situations, whereas girls and women attend to details of circumstances, and, in their reasoning, all parties retain life histories, identities, and emotions. Because women experience relations as asymmetrical interdependencies, they are likely to consider individuals' positions in situations ( Sherwin, 1992a). Feminists (e.g., Noddings, 1993; Sichel, 1992) resist seeing ethics as abstract rules that can be specified apart from context. Also criticizing prevailing medical ethics as too formal and rational to contribute to the resolution of concrete cases, Christie and Hoffmaster ( 1986) prefer a contextualist morality in which preoccupation with deontological reasoning is abandoned. Prac tice is based on understanding, coping with, and muddling through problems as they arise. To show that a priori decision making does not fit, Hoffmaster observes that when confronted with the risk that any child they conceive will be disabled, parents in genetic counseling tailor decisions about childbearing to their particular circumstances. Joffe ( 1986) shows how conflicting ideologies of family planning--as a medical service, a political issue of women's rights, and a profamily moral issue--get translated into workable policies. Clinical work causes counselors to reject simple views of abortion in response to the complex realities of those who seek abortions.