Feminist Approaches & Bioethical Responsibilities in 21st Century Crises

IJFAB blog co-editor Elizabeth Lanphier talks with Larry R. Churchill about the new book they co-edited, Bioethical Responsibilities in 21st Century Crises. The collection is out now as part of the Revolutionary Bioethics series with Bloomsbury Press.

Elizabeth:  Well, Larry, we edited a book! And it is out now.

Larry:  We did. It's great to have it out.

Elizabeth:  Larry, could you say something about why we put this particular collection together now?

Larry:  Well, I think our feeling has always been that bioethics has been a bit too narrow. A but to clinically focused: doctor-patient relationships, researcher subject interactions, from the point of view of medical care as a distributional good – who gets it and who doesn't, and why, and so on.

Those are still good and important questions, but it's a changed world since the early 1970s, when bioethics really kind of got cranked up. We have global warming. We have tremendous social issues that are biological in nature. We have a great range of awareness about populations that we didn't before, and the complexity of healthcare needs, and how important health policy is. All policy is health policy, essentially.

Elizabeth:  I think it's fair to say that the kinds of crisis we had in mind when we were thinking about bioethical responsibilities in 21st century crises were social, political, and environmental: issues like social and political policy and polarization impacting health policy, and certainly environmental crises, with a good chunk of the book dedicated to global warming and climate change, but also to some topics we identify as largely neglected by bioethics to date. Do you think we're thinking about bioethical crises in the same way as the book comes out in early 2026 as we were when we were putting the collection together over the last year and half?

Larry:  Well, no, I think it's a moving target. Our political situation is far more precarious than it was then, and the implications of a tyrannical attitude on the part of the US administration has made everything far more difficult. I just read a piece in the New York Times yesterday which says the Environmental Protection Agency has now been instructed not to calculate  lives lost in terms of its requirements about pollution, and that is antithetical to what the congressional mandate originally was for the EPA. This change is saying human lives don't count anymore. It's all about the cost that businesses would have to meet the EPA requirements. This is just one sign of the times, I think. Things are worse, generally, in almost every respect I can think of than when we first envisioned the book.

Elizabeth: Yes, I think we were hopeful that we would be thinking about progressive solutions toward improvement toward existing problems, and now we're thinking about entirely new hurdles and different challenges.

Larry:  Right. Which relates to the question about the public consciousness about all this, and the extent to which the public has more or less gone to sleep on many of these issues.

Elizabeth:  One of our goals in this book was to make these chapters interesting not only to those of us in academia on the inside of these issues, but also to those outside of the academy and the field of bioethics and to be able to communicate with a wider public.

Larry:  Yes, that's absolutely right. And some of the authors tried to address that exact set of questions: The difficulties, the obstacles to overcome, to communicate effectively.

Elizabeth: This is a blog on feminist approaches to bioethics. How would you describe the role of feminist methodologies or approaches in the various essays in the collection?

Larry:  If you look carefully, I think feminist methodologies, are involved in many of the essays, not just the ones that quote feminist theories.

I want to go back to my own history. In 1982, Carol Gilligan wrote In a Different Voice. She opened up a whole new arena of thinking for me, and I think for a lot of people, which was the understanding that our notions of not only justice, but also autonomy and beneficence and the other key ingredients as we conceived of as bioethics then were largely shaped from an administrative, male point of view, not an on-the-ground relational kind of dimension of the ethics. But there are different ways of understanding these concepts. This is not to categorize by gender, but her empirical findings point to relational thinking in general, and how the situatedness of people within a specific context really matters for ethics. And when ethics doesn't pay attention to that, when it administers in the abstract, as it were, as a judge in a courtroom, rather than as a person on the ground trying to figure out what's going on here, we impoverish ethics. The way to enrich it is to include more voices, more perspectives, more methodologies, and a far more relational and interactional understanding about what ethics is, why it works, and how people are persuaded and convinced of things.

This has had a tremendous impact for me in terms of my understanding of bioethics consultation and in my own teaching, because I began to realize it is the patients and their families and the physicians and nurses trying to care for them that matters, and what their interactions are like. And in teaching, I wasn’t teaching ethics, I was teaching students. And it is what the students were thinking and doing and how they were progressing that was really the measure of any success one might have in this field.

So, feminist approaches really opened things up for me, tremendously, and I think for a lot of people, and now we see that impact on the field, and who is doing bioethics – more women, more people from minoritized backgrounds – and who are in bioethics doing really important, cutting-edge work. I think that feminist approaches are a kind of standard in the field now as far as I can see, and this shows up in the book.

It shows up in your chapter with Takunda Matose on a really enriched notion of vulnerability for incarcerated persons. It shows up in Nancy Tuana’s chapter in terms intersectionality

and the intersection of multiple vulnerabilities and what that does in relation to climate change and the people affected by it. It shows up in a little more subtle way in Nancy King’s  essay on othering in which we’re invited to understand some of the textures of othering and where it comes from, and it's out of the same kind of cloth of a deepened sense of relationality.

It shows up in Johnathan Flowers' essay [on citational tyranny in bioethics and the erasure of disability scholarship from bioethics] for sure, in terms of the discussion of disability and disenfranchisement, and the lack of accreditation [of certain frameworks or scholars] as a preemptive move in bioethics, which I think is much wider than just disability. And I think also, in terms of Lisa Parker's essay, with the emphasis there on the way in which identity-forming feelings, which is such a very powerful notion, that is really true that feelings actually ground our sense of identity. This is all a product of opening up the bioethics conversation to a broader range of people and accrediting what they can contribute.

We really had this conversation! A screen grab of a Zoom meeting between Larry, a white male with white hair and glasses sitting at his desk talking on the screen with a blurred background, and Elizabeth, a white female with short brown hair and glasses listening reflectively to his remarks with light pink walls and kid art in the background.

Elizabeth:  As you're saying this, I'm also reflecting on how many times feminist scholars, feminist thinking, feminist lineages, appear throughout the chapters, some overtly – for example, in my own chapter on bioethics and incarceration we at one point name check that we are drawing on intersectional feminist methodologies, among other things – but also concepts like intersectionality, or relational approaches, appear across many chapters. Feminist methods really thread throughout. Maybe that is just a reflection of the people we are in conversation with in general, and in this collection, but I wonder if the ways feminist methods and scholars appear across the collection permit us to say anything broader about the place of feminist approaches to bioethics in the field more generally these days?

Larry: Well, I think it used to be a distal relationship. It was out there; it was something that was curious and interesting. And now I think it's very proximate. It is part of the fabric of how people think, and when people aren't thinking in that way, they look archaic now.

Elizabeth:  Is there anything you're especially hoping readers take from the book?

Larry:  I hope they'll take away the fact that there's an awful lot of very important work to do, and that the work of bioethics is actually just beginning for the current environment. If we don't pay attention to these questions, it's not clear who will.

Elizabeth:  So, there is a call to action?

Larry:  Yes, that's right. There's more work to do in bioethics than I ever imagined when I first got interested in this field, and far more than we've ever had previously, because the questions now are more complicated, they're more nuanced in terms of the methodologies one has to use to make any progress.

Elizabeth:  Thanks, Larry, for sharing your thoughts with us, and I'm excited to see this book out in the world.

Larry R. Churchill, PhD, is Professor of Medical Ethics Emeritus, Vanderbilt University Medical Center. He was previously the chair of the department of social medicine at the University of North Carolina at Chapel Hill. Dr. Churchill is a member of National Academy of Medicine and a Fellow of The Hastings Center as well as the author of seven books. His work has been featured in popular media such as USA Today, The New York Times, Bill Moyers’ Journal, and the Alex Gibney documentary Money-Driven Medicine.  

Elizabeth Lanphier, PhD, MS, HEC-C, is a philosopher and clinical ethicist. She is a co-editor of the IJFAB blog.

All views expressed in this interview of those of the speakers and do not represent those of IJFAB, or any institution with which the speakers are presently affiliated or have been in the past