Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia
Susan M. Wolf, FEMINISM & BIOETHICS: BEYOND REPRODUCTION, pp. 282-317, New York: Oxford University Press, 1996
38 Pages Posted: 11 Jan 2011
Date Written: 1996
This widely cited chapter was one of the first to analyze the importance of gender and feminist theory in the debate over whether to legitimate physician-assisted suicide and euthanasia. The author argues that the usual debate is about a patient who does not exist - one with no gender or insurance status. Yet there is ample reason to suspect that gender, among other factors, deserves analysis. The prominent cases in the U.S. debate mostly feature women patients. Data show that dimensions of health status and health care that affect a patient’s vulnerability to considering physician-assisted suicide and euthanasia - including depression, poor pain relief, and difficulty obtaining good care - differentially plague women. Suicide patterns themselves show a strong gender effect: women less often complete suicide but more often attempt it. And women still face social circumstances marred by sexism, particularly women with illness, disability, or advanced age.
This chapter thus examines four potential gender effects: an effect on the incidence of assisted suicide and euthanasia by sex; differences in the reasons women seek assisted suicide and euthanasia, in part based on the long history of valorizing women’s self-sacrifice; a difference in the doctor-patient dynamic for female patients seeking assisted suicide or euthanasia, especially if physicians may be susceptible to affirming women’s negative self-judgments; and a gender effect in the public debate, reflecting the sense that the cases featuring female patients fit cultural stereotypes and so seem 'right.' The chapter analyzes the available data, and the way gender figures in our cases, cultural imagery, and health care practice.
The chapter then brings feminist critiques and theoretical tools to bear. The debate over assisted suicide and euthanasia focuses on precisely the kinds of issues on which much feminist work has focused: what it means to talk about rights of self-determination and autonomy; the reconciliation of those rights with physicians’ duties of beneficence and caring; and how to place all of this in a context including the strengths and failures of families, professionals, and communities, as well as real differences of power and resources. The chapter criticizes the usual argument that patients’ rights of self-determination legitimate physician-assisted suicide and euthanasia, on the grounds that this misconstrues the utility of rights talk for resolving this debate, and ignores essential features of the context. Nor does the usual appeal to physician beneficence and "mercy" provide resolution, as it typically relies on a shallow understanding of physician care. The author elaborates what a deeper and contextualized understanding demands and argues that physicians as professional caregivers should be guided by a notion of "principled caring." Finally, the author suggests what a proper integration of rights and caring requires, and how it can be coupled with attention to the actual circumstances and fate of women.
Keywords: Physician-assisted suicide, euthanasia, suicide, gender, women, feminism, death and dying, end-of-life care, doctor-patient relationship, bioethics, health law, constitutional law, rights, empirical studies, Dutch euthanasia, Netherlands
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