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as their passive research tools; they propose alternate conceptions of research as a collegial activity in which subjects and investigators negotiate the terms of participation to achieve a shared commitment to the success of the activity.12 Research is not separate from other practices of society, and it is certainly not automatically immune from the poisonous effects of bias. If clinical research is to respond fully to the demands of justice, investigators will need to develop ways to be more inclusive and less elitist in all stages of their studies. They might, for example, adapt models of participatory democracy, in which those who have a stake in the research help to formulate priorities. In order to begin to counteract the disadvantage that oppression creates for its victims, members of oppressed groups should, whenever possible, be included, not only as subjects, but also as investigators and active participants in the deliberations.

NOTES

1.  

I shall not provide any evidence for this belief since the literature is filled with detailed analysis of the systematic ways in which women are disadvantaged economically, socially, legally, politically, physically, and culturally. The account of oppression underlying my interpretation of the empirical data about women's disadvantaged status and choices as constituting oppression has been provided by Iris Marion Young, Justice and the Politics of Difference (Princeton: Princeton University Press, 1990). Young identifies five conditions as characterizing oppression, whether they appear singly or in combination: exploitation, marginalization, powerlessness, cultural imperialism, and violence.

2.  

See, for example, Barbara Ehrenreich and Deirdre English, For Her Own Good: 150 Years of the Experts' Advice to Women (Garden City, N.Y.: Anchor Books, 1979); Elizabeth Fee, ed., Women and Health: The Politics of Sex in Medicine (Farmindgale, N.Y.: Bayood, 1983); Sue Fisher, In the Patient's Best Interest: Women and the Politics of Medical Decisions (New Brunswick, N.J.: Rutgers University Press, 1986); Cesar A. Periles and Lauren S. Young, eds., Too Little, Too Late: Dealing with the Health Needs of Women in Poverty (New York: Harrington Park Press, 1988); Alexandra Dundas Todd, Intimate Adversaries: Cultural Conflict Between Doctors and Women Patients (Philadelphia: University of Pennsylvania Press, 1989); Evelyn C. White, ed., The Black Women's Health Book: Speaking for Ourselves (Seattle: Seal Press, 1990).

3.  

This argument is spelled out in greater detail in Susan Sherwin, No Longer Patient: Feminist Ethics and Health Care (Philadelphia: Temple University Press, 1992).

4.  

Several examples of such exclusions are provided by Rebecca Dresser, ''Wanted: Single, White Male for Medical Research,'' Hastings Center Report 22(1):24–29, 1992.

5.  

Nazi studies on concentration camp prisoners and the Tuskegee Syphilis Study are two of the most notorious examples in this category.

6.  

See Sherwin, No Longer Patient, pp. 159–165.

7.  

Gena Corea, The Hidden Malpractice: How American Medicine Mistreats Women, updated edition (New York: Harper Colophon Books, 1985), pp. 130–188.



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