This dissertation is motivated by the hunch that current treatments of methodology in bioethics rest on inaccurate and one-sided pictures of the social practices of moral reasoning, in part because of their general avoidance of questions about the constitution of the we that reasons about moral issues. These approaches uncritically take the perspective of the doctor or administrator and unduly focus on one aspect of moral reasoning—its purported goal of producing definitive judgments. These limitations rarely produce considerations that are useful and usable by most people who face moral dilemmas concerning health care decisions, especially people who do not find medical institutions to be empowering places.In this dissertation I contribute to the painting of a different picture—one that provides more usable resources for dealing with the problems that confront people in a morally messy world. I by no means claim artistic originality here. This alternative picture has been painted in several different shades and variations by many others. Though each variation places a different gloss on the relationship between ethical theory and practice, all share a commitment to modeling ethics on the variety of actual social practices in which moral reasoning occurs. I focus on a naturalized and feminist variation on this theme. More specifically, this variation combines politically critical and socially reflexive analysis with a commitment to starting moral reflection from the actual moral experiences of human beings—most often from the experiences of people excluded from mainstream moral discourse on account of their social position (e.g., gender, race, class, or disability status). In this dissertation, I aim at the modest task of clarifying the details of the portion of this picture relevant to moral reasoning in bioethics.I begin with a critical examination of dominant methodologies in bioethics and outline their problems in terms of their inability to accommodate the significance for moral agents of three kinds of social positioning: the positioning of agents (1) in institutions, (2) along axes of social oppression, and (3) as temporally, culturally, and psychologically constrained human beings. I then introduce naturalized moral epistemology as a potential antidote to the idealizing assumptions remaining in dominant methodologies. In the second chapter, I develop the application of naturalized moral epistemology to bioethics by naturalizing the notion of the common morality. I develop three mutually reinforcing interpretations of a naturalized common morality: the common morality as (1) shared ecological predicament, as (2) shared evaluative space, and (3) as external coherence. The third chapter looks more deeply into theoretical issues for the naturalized approach, namely into the problem of locating normativity in a natural world. This chapter also provides a clear expression of the difference between the feminist naturalism developed in this dissertation and the scientific naturalism that is more well-known in the literature. In the fourth chapter, I confront a common objection to naturalized approaches—the charge of moral relativism—and show how naturalizing does not lead to relativism. This sets the dissertation up for the final chapter in which I show naturalizing in action by presenting a naturalized approach to the topic of medical cultural competence.
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