Book Review

Medicine and the Family: A feminist perspective

N Engl J Med 1996; 334:60January 4, 1996

Article

Medicine and the Family: A feminist perspective
(Families and Health.) By Lucy M. Candib. 360 pp. New York, BasicBooks, 1995. $38. ISBN: 0-465-02374-6

Few physicians, whether male or female, identify themselves as feminists, and many perceive feminism as an angry critique of men that few of their patients support. If family physician Lucy M. Candib is correct, however, doctors should be feminists, and feminism might more correctly be described as requiring precisely the type of care that physicians aspire to give and their patients would like to receive.

Medicine and the Family: A Feminist Perspective offers no explicit definition of feminism. But throughout her book Candib implicitly defines the term by applying the critical perspective that is central to various versions of feminism and that calls for the inclusion of women's experience in developing an adequate understanding of patients and efforts to overcome oppressive influences in the lives of women. These goals, she argues, are essential to the caring mandate of physicians.

“Medical texts,” according to Candib, “continue to rely on a model of development based on men.” After demonstrating this reliance through an examination of theories of infant, child, and adult development, she criticizes family systems theory for reinforcing sexual stereotypes and explores how these have led to the inadequate treatment of health issues raised by sexual violence and domestic battering.

Candib's proposal for rectifying the flaws of “masculinist” medicine is not only feminist but also feminine. The feminine component is based on the newly rejuvenated ethic of care developed by Carol Gilligan, Nel Noddings, and Sarah Ruddick, and in M.F. Belenky's account of “women's ways of knowing.” The feminist component identifies the potential of an ethic of care for exploiting women whose care-giving role has been disesteemed and unrewarded. Within this framework, health care is surely not to be equated with medical treatment, but neither is it to be equated with self-denying altruism.

Many physicians would agree with Candib's critique of a contract model of the relationship between physician and patient and of the emphasis on patient autonomy that prevails in health care practice and in contemporary bioethics. They may remain uneasy, however, with her endorsement of self-disclosure on the part of physicians to their patients and her claim that a patient's own assessment of the impact of her therapy is “as valid a measure in her direct care as any other measure available to me, and may be better.” Her strategy for avoiding both the liabilities of care and the perils of paternalism is vague but valid: the goal of therapy is to empower the patient.

In a manner consistent with feminist methodology, the author draws amply on her own experience, both professional and personal. In a manner consistent with traditional scientific methods, she uses pertinent research in a critical manner. In a manner consistent with feminist and feminine methodology, she exhibits a rich sense of context by incorporating relevant insights from social science and philosophy into her interpretation and critique of clinical practice. The result is highly readable, informative, and provocative. Candib may even persuade some clinicians that feminism is essential rather than tangential to their caring role.

Mary Briody Mahowald, Ph.D.
University of Chicago, Chicago, IL 60637