In early June, when the Vatican denounced Sister Margaret Farley’s book, Just Love: A Framework for Christian Sexual Ethics, I took notice. As a recent graduate of Yale Divinity School (where I studied ethics), I’ve been influenced by Farley’s scholarship and work, even though she was professor emeritus by the time I arrived on campus. The experiences I had in New Haven—participating in a hospital ethics committee of which she was a founding member, interning at the Yale Interdisciplinary Center for Bioethics where she served as co-director for almost a decade, reading her writings that spotted the library shelves, and listening to stories of her academic mentoring around dinner tables with Yale classmates and friends—have shaped my understanding of ethics in countless ways.
So when a news headline involving Farley’s name broke, I advanced Just Love to the top of my summer reading list, making me one of the many who have turned a condemned book into a bestseller. As a bioethicist, I am interested in reading Farley’s book because I feel that one of her self-proclaimed goals—to help “people think through their questions about human sexuality”—offers instruction to my own field of bioethics, a discipline in which issues involving gender and sexuality remain under-explored.
As a learner of bioethics, I am conscious of the fact that most of the course lectures and conversations discussing ethics and gender/sexuality that I have been involved with have centered on the subject of HIV/AIDS. To be sure, there is good reason why so much attention has been paid to this illness and the ethical dilemmas surrounding its rise on the global scene. At the same time, my own clinical experiences, as well as my awareness of other patient and clinician experiences, leads me to conclude that expanding the bioethical dialogue about issues of sexuality and gender is necessary.
One example comes from my own practice as a nurse in the newborn intensive care unit. In this setting, I worked with several parents of infants born with ambiguous external genitalia. I saw these parents flounder when asked by jubilant and well-meaning family visitors, “Is it a boy or a girl?” The truth is, they didn’t know the answer to this question and they weren’t quite sure how to respond. Sometimes, after further medical testing, the road to clarifying this question was clear and straightforward. At other times, assigning a child’s sex was less clear and more ethically complex. In these instances, medical teams would often turn to parents and ask them to make the final determination regarding the sex of their child. At the time of my involvement in these cases, I didn’t have the ethical training that is helpful when guiding such parents through their decision-making process. Today, I might be able to help to a greater degree, but I still have more to learn.
Ethical issues that arise in the care of the LGBT population also need more exploration. Evidence points to the fact that LGBT individuals do not receive the same quality of services as those in the general population. In addition, services that are provided to LGBT individuals may not address their specific health care needs.
Another issue that is likely to arise more and more is that of recognizing LGBT individuals as surrogate decision-makers. A surrogate decision-maker is often a spouse or another family member – someone close to the patient who knows his or her wishes. The law in New York State, where I currently practice, recognizes domestic partners (which would include LGBT partners) as surrogate decision makers; however, not all states do. While a LGBT partner may be the ethically appropriate person for health care teams to consult with, especially if this surrogate has maintained regular contact with the patient and knows his or her health values/preferences or the moral/religious beliefs that would inform the patient’s health values/preferences, it may be impossible for the health care team to empower this person as a surrogate decision maker if the law states otherwise.
Although I personally see application for Just Love in the field of bioethics, I recognize that Farley did not set out to accomplish this task. But Farley does offer norms that can be applied to just expressions of human sexuality, including do no unjust harm, free consent of partners, mutuality, equality, commitment, fruitfulness, and social justice. Farley’s seventh norm—social justice— encompasses the way in which communities (both civic and religious) should respond toward gendered people who make up society, including gays, lesbians, and transgendered persons. If one accepts Farley’s premise—that social justice is one norm characterizing just expressions of human love—it seems fitting for bioethicists to ponder and apply this principle to the domain of health care (and all who are recipients of health care) in much greater depth.
Melissa Kurtz is a bioethics fellow at the Montefiore-Einstein Center for Bioethics. Prior to becoming a bioethics fellow, Melissa practiced as a neonatal intensive care nurse, last at Yale-New Haven Hospital, New Haven, CT.