2. LITERATURE REVIEW
2.5 Feminist Alternatives to Principled Autonomy: Relational Models
2.5.1 Relational Autonomy: Feminist Models
here that developing and applying notions of relational autonomy in ethics does not amount to replacing traditional notions of autonomy with alternative conceptions drawn from this feminist ethic of care, among other feminist propositions. In the afterglow of Gilligan‟s (1982) work on the differences between men and women‟s moral identities, many feminists warned against the potential ramifications of reifying these differences, arguing that this might serve to reinforce the oppression of women, entrenching them in the very same emotional, irrational, marginalized roles to which they had been assigned by Western patriarchal society. Sherwin (1992b), for example, cautions that articulating a feminine ethic which assigns to women values of care and emotional responsiveness risks reinforcing those characterizations of women that patriarchal society has traditionally used to justify women‟s relegation to the private sphere and their subordination to men. “Renouncing autonomy (altogether) would defeat feminist efforts to achieve justice and foster social change” (Donchin, 2000a, p. 189). This reflects yet another recurring feminist theme: a resistance to the dichotomous, dualistic, divisive modes of thinking that are typical of the philosophical tradition – dichotomies such as abstract/concrete,
reason/emotion, universal/particular, subjective/objective, knowledge/experience, public/private, theory/practice, and mind/body (Code et al., 1988). Thus in this study, as in many other feminist works, the care and justice approaches which offer differing perspectives on autonomy are viewed not as antagonistic but as symbiotic approaches that, together, can generate a richer understanding of the principle of autonomy.
Wary of unwittingly advocating any absolute alternatives to autonomy, the alternatives presented here follow the call for a poststructuralist feminist ethic that displaces, rather than replaces autonomy (Shildrick, 1997). It is hoped that the ideas explored here will initiate further
investigation into and debate around richly gender- and culture-conscious perceptions of autonomy that will complement, indeed supplement, conventional, male-oriented approaches.
This can be achieved, as we have seen, by looking to feminist ethics to provide a critical voice from women‟s perspectives. Like the perceptual shift invoked by ambiguous gestalt figures, the ethical reasoning of men and women demonstrates a similarly ambiguous shift, so that their perspectives are cast as different but complementary frames or visions of the same situation, depending on the dimensions of relationship in which they are grounded (Gilligan, 1987). By focusing on relational autonomy in this way, this study takes up one of the fundamental
principles of feminist thought by explicitly steering clear of splitting the principle of autonomy into a masculine autonomy and a feminine autonomy. Instead, the two poles of yet another dichotomy implicit in Western thought are presented, not as alternatives in opposition to one another, but as complementary perspectives in symbiosis.
There is further danger in the dichotomous thinking inherent in the Western tradition. Once individuals have been assigned to one side of the autonomy/connection duality, for instance, other assumptions are automatically made. Implicit in the idea that women are relational by nature and men autonomous, is the assumption that women are not autonomous and men are not relational (Berlin & Johnson, 1989). As a result, those masculine values traditionally associated with autonomy – isolation, independence, competition, and self-sufficiency – are removed from what is perceived as women‟s reality. Such associations are transformed when autonomy and relatedness are no longer conceived as bipolar characteristics but as integral parts of healthy maturity. Berlin and Johnson (1989) outline a new form of autonomy that allows for a
commitment to oneself and one‟s relationships, to being a whole self within relationships. This
two-stranded commitment highlights the ability of a new, tuned-in autonomy to be realized within relationship while simultaneously “underscoring the absence of both freedom and warmth when caregiving takes place from a submissive position” (Berlin & Johnson, 1989, p. 94). Their argument is strongly for not abandoning autonomy, but for using the valuable contributions from Gilligan and other care theorists to re-focus notions of autonomy on the importance of
relationships and caring, connectedness and empathy. The primary goal is to reclaim and revise the concept of autonomy so that both autonomy and relatedness can co-exist in mature selves.
Elaborating further on the concept of relational autonomy, feminists have drawn attention to the ways in which the development and preservation of autonomy is inherently social. Selves-in- relation are both pre- and co-requisites of autonomy. Friedman (1998) highlights the social nature of autonomy as follows: To acquire the very capacity for autonomy requires the self- reflection borne from socialization; maintaining autonomy involves interacting in the social world, relating to others in particular ways; and sustaining autonomy requires socially created meanings whereby an individual recognizes and evaluates herself and her goals and values in relation to those around her. Social identities, social selves, and social contexts intersect to shape relational autonomy, thereby focusing conceptions of individual autonomy, and of moral,
political, and bioethical agency, through the lens of the intersubjective and social dimensions of selfhood and identity (Mackenzie & Stoljar, 2000). Developing this situated notion of relational autonomy, Holler (2001) puts forward as an alternative a “whole-system ethic” that is
“necessarily ontological,” maintaining that the illusions of separation and of self-interest apart from other-interest in conventional notions of autonomy “threaten the very existence of the
living community” (Holler, 2001, p. 220). Holler points out that there is evidence for the ontological primacy of relationship prior to isolation in our existence.
“Unlike the autonomous man, who thinks that his self is entirely separable from others, the autokoenomous woman realizes that she is a self inextricably related to other selves” (Tong, 1997, p. 94). Another alternative to the traditionally individualistic conceptions of autonomy in the ethical mainstream has been proposed by Hoagland (1988). Her alternative, autokoenomy represents the self-in-community and captures the sense of being free from dominance without necessitating self-domination (Sherwin, 1992b). One advantage of these alternative conceptions of autonomy is that they support richer and more acceptable notions of persons and, as a result, they support more comprehensive understandings of what counts as ethical problems. By
recognizing that individuals are “situated within a web of relationships and contexts from which their decisions cannot be separated,” responsibility for choices and actions extends to the
contribution that society makes – allowing for conceptions of autonomy that do not reinforce unacceptable ideology (Ells, 2001, p. 423). This is particularly significant when considering that principles of autonomy are applied in contexts where consent is required from disadvantaged or vulnerable populations by privileged groups of researchers. The task becomes one of balancing autonomy with community solidarity, both in ontological thought and epistemological action (Code, 1987) to ensure that principles applied in research ethics are as ethical in practice as they are in theory.
Keller (1997) outlines the alternative model of autonomy proposed by Meyers (1987, 1989), which takes the relational self, situated in an ethic of care, as its starting point. Meyers‟ account
also severs traditional notions of autonomy from individualistic assumptions by building into autonomy the idea that the self is socially constituted and, therefore, the way that individuals experience and think about the world is a function of the relationships in which they are
involved. However, this alternative does not eliminate the importance of autonomy in the caring individual‟s self concept. Self-respect is a central component of Meyers‟ theory, whereby
autonomy and self-respect are each necessary for the realization of the other – they are reciprocal and mutually reinforcing. Meyers‟ relational autonomy is built on models of friendship. She looks at how women relate to one another, how they maintain and reinforce their sense of self- respect through seeking out other‟s care and support and engaging in discussions with others when making major decisions. Autonomy is also enhanced through this dialogical process, Meyers argues, as it not only helps to solidify the relationships in which individuals develop their self-respect, but also can help the individual to make decisions which are more autonomous.
Conceiving of autonomy as a dialogical process helps to distinguish which aspects of autonomy can be shared and which must be exercised by the autonomous person alone;…it explains how a person can be very much connected to others and still be autonomous; it illustrates how friendship (and mutually respectful researcher-participant relationships) can enhance the autonomy competency, and thereby the self-respect, of someone who can be minimally autonomous to begin with; and it issues one last challenge to the individualistic conception of autonomy by conceiving autonomy as an intersubjective activity (Keller, 1997, p. 161).
Towards this end, many feminists acknowledge the central place that autonomy has in bioethical theory, while emphasizing that it must be scourged of its individualistic presumptions and reformulated as a concept which recognizes the centrality of relational experiences in human agency. This, they argue, will offer a conception of patient autonomy that is better suited to the practical work of bioethics than the dominant principlist model (Donchin, 2001). Common to
these alternative models is the emphasis on relationship. Much of the work in this area has been advanced by Donchin (2001), who has explored the alternative metaphors of mothering and of friendship put forward by earlier feminist theorists as more appropriate for application in health care contexts, and presented the sisterhood model which, she argues, overcomes some of the potential flaws of the previous two approaches. Donchin (2000a) presents a more inclusive understanding of autonomy that offers solutions to controversial ethical dilemmas like physician- assisted suicide that the limited perspective of the dominant individualistic conception misses.
Donchin (2000b) has also shown how prevailing accounts of autonomy which do not take the complex interplay between individual autonomy and biological and social relationships into account are ill-equipped to offer guidance in, for example, genetic decision making. She proposes the development of a strong relational model of autonomy which recognizes that
“autonomy is not solely an individual enterprise, and that respect for the autonomy of others requires collaboration, long-term reciprocity, and equitable balancing of power relationships”
(Mackenzie & Stoljar, 2000, p. 26). Dodds (2000) has also developed a more relational approach to autonomy. Like Donchin, Dodds argues that autonomy is narrowly conceptualized as
informed consent in the bioethical literature, which, in turn, limits the options available in health care contexts and restricts ethical decision-making. Dodds presents relational autonomy as a more appropriate option for ethical recourse in clinical contexts.