Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.
Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.
Sharpe
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Office of the Dean of Research, Georgetown University Medical Center, Washington, DC 20007.
D000293:Adolescent; D000328:Adult; D026686:Beneficence; D002648:Child; D002675:Child, Preschool; D032982:Contracts; D026689:Ethical Analysis; D028663:Ethical Theory; D004992:Ethics, Medical; D005260:Female; D005610:Freedom; D006801:Humans; D007223:Infant; D008297:Male; D035863:Moral Development; D028681:Moral Obligations; D009014:Morals; D026684:Personal Autonomy; D028723:Personhood; D010817:Physician-Patient Relations; D012737:Sex Factors; D012935:Social Justice