M B Mahowald. Oxford University Press, 2000, US$39.95 (hb), pp 314. ISBN 0–19–512110–4

• Mahowald MB. Genes
• Women
• Equality

Far too often it is still assumed that if feminist bioethics has any role to play, its contribution lies purely in reproductive ethics. Mary Mahowald's Genes, Women, Equality should dispel that delusion once and for all, along with a second illusion: that the new genetics is gender-neutral.

Mahowald is not a bioethical Luddite: she is not concerned to attack the new genetics, but to make good the failure of bioethicists and scientists to explore the differential impact of the new genetics on women. Specific implications for women of advances in genetics in different fields form the bulk of the book, with chapters on genetic counselling; genetics research; allocation of genetic services; culture and sex selection; misattributed paternity and cystic fibrosis; sickle cell disease and carrier testing; breast cancer susceptibility testing; preimplantation genetic diagnosis and abortion; genomic alternation; genetically linked alcoholism, employment and insurance testing, and human cloning.

This last chapter is a prime example of the need for Mahowald's sort of analysis: how often is it recognised that even therapeutic cloning and stem cell research, such as was recently approved by the UK parliament, affect women differently from men? The obvious reason is that large numbers of enucleated eggs will be required, and that enucleated eggs come from women, taken in a painful and difficult procedure. But as Mahowald mildly notes, so far as the further step of human cloning goes: “Interestingly, while some bioethicists expressed concerns about the impact of human cloning on cloned individuals, none, to my knowledge, indicated that there were gender differences to worry about as well” (281–2).

These practical chapters show Mahowald's clinical knowledge to good advantage (although a philosopher, she is professor in the college, the Department of Obstetrics and Gynecology, the Committee on Genetics and the MacLean Center for Clinical Medical Ethics at the University of Chicago.) Her analysis is particularly clear here, and in other “reprogenetics” chapters, especially in the distinction she draws between genetic, gestational, and lactational motherhood. She rightly draws our attention to a fourth form of motherhood which can also now occur: the provision of enucleated eggs, into which another set of genes is inserted. Which of these is “real” motherhood?

There are also a series of “mid-level theory” chapters, such as that on Disabilities, feminism and caregiving, which is informed by the split in feminist thought between disability rights feminists such as Adrienne Asch, who distrust genetic screening and correlated abortion on the grounds that they discriminate against the disabled, and other feminists such as Christine Overall,¹ or Mahowald herself, who distinguish between the legitimate abortion of fetuses with disabilities and advocacy for disabled people (and their carers, usually women). The analysis in both the “specific issues” and the “mid-level” chapters will be of enormous use to both practitioners and academics.

Mahowald also attempts to provide a normative foundation for the two less theoretical sorts of chapters, particularly in her chapter 4, Gender justice in genetics. Here she employs what she terms a feminist standpoint approach or egalitarian feminist model, which directs our attention towards power imbalances. Where inequalities result from rectifiable social power imbalances rather than unalterable and value-neutral differences, the standpoint of the less powerful group should be privileged over that of the more powerful, in this model. “Some differences entail inequalities; others are merely associated with them” (74). Inequalities which persist by mere association, such as the continued association of women with caregiving, are more easily rectifiable; biological differences, such as the fact that it is women who give birth, are harder to remedy, but we should try to minimise their impact. Certainly we should not allow necessary biological inequality to become an excuse for avoidable social inequality, but that is what some aspects of the new genetics risk doing.

The feminist standpoint model is frequently contrasted with a conservative libertarian model, as the theoretical overview which has so far dominated in the new genetics. While I agree with this part of Mahowald's analysis, I am less convinced that the liberal feminist model is always wrong, even though I do not count myself a liberal feminist. There is a certain risk of demonisation of the liberal feminist view, which Mahowald does not always avoid; it is not the same as libertarianism. On the whole, however, this is a vital book for anyone interested in the new genetics—yes, even for those who don't actually think they are also interested in feminism.