Kathryn Hinsch makes a good point at the Women’s Bioethics Project blog:

Much of the “assisted death” debate gets reduced to two questions: “Do people have a right to commit suicide?” and “Should we allow physicians to assist in hastening death?” But before we tangle with those tough public policy questions, it is important to ask “how might people’s different life circumstances impact the issue?”

Looking at these questions from a gender perspective will be imperative as we move forward in crafting new laws. There are some key facts that make a woman’s end-of-life decision quite different from a man’s—women on average live longer than men. Additionally, women are more likely to be impoverished, receive inferior health care, experience poorer pain relief, and are two times as likely to suffer from depression as men. Women, who have often lost their life partner by the time they face debilitating disease, may feel a stronger cultural pressure not to be a burden on their families. All these factors must be considered when crafting a policy to allow “physician assisted death.”

Looking at gender implications is just one step in a thorough public policy analysis of this issue. We also must look at the implications of physician assisted death for disabled, poor, and minority populations. From some groups, the fear that death with dignity could quickly lead to duty to die is not an unfounded fear and something we must be vigilant to prevent.

She’s right that it’s traditional to boil bioethics issues down into clashes of abstract principles. Feminist philosophers in particular have been invaluable in demanding “thick descriptions” of cases, to situate them in a fuller human context and identify the systematic inequities and pressures that impinge on the people affected. Just as career opportunities turned into the double burden of a full-time job plus sole responsibility for homemaking, for many women, the “empowerment” of autonomy may merely mean the reduction of support systems in the healthcare setting if the real burdens people face are not kept in mind.

As someone who is partial both to strong autonomy rights and to the “airy principlist” approach to ethical problems, this is a useful reminder that principles do not play out in real lives the same way for everyone. The practical impact of general principles must always be the touchstone for practical policymaking.