EPUB and EPDF available Open Access under CC-BY-NC-ND licence. We tend to hold people responsible for their choices, but not for what they can’t control: their nature, genes or biological makeup. This thought-provoking collection redefines the boundaries of moral responsibility. It shows how epigenetics reveals connections between our genetic make-up and our environment. The essays challenge established notions of human nature and the nature/nurture divide and suggest a shift in focus from individual to collective responsibility. Uncovering the links between our (...) genetic makeup, environment and experiences, this is an important contribution to ongoing debates on ethics, genetics and responsibility. (shrink)

Neo‐Aristotelian ethical naturalism purports to show that moral evaluation of human action and character is an evaluation of natural goodness—a kind of evaluation that applies to living things in virtue of their nature and based on their form of life. The standard neo‐Aristotelian view defines natural goodness by way of generic statements describing the natural history, or the ‘characteristic’ life, of a species. In this paper, I argue that this conception of natural goodness commits the neo‐Aristotelian view to a problematic (...) anti‐individualism that results in the wrong assessment of individuals with uniquely adaptive adjustments. I then offer an alternative account of natural goodness that avoids this problem. Instead of relying on generic statements about a species, my account defines natural goodness based on counterfactual conditionals describing the modal properties of a single individual. I argue that this modal‐explanatory account gives a conception of natural goodness that is more intuitively plausible and better suited to capture the diversity and plasticity distinctive of life. (shrink)

[This piece is written for those working in social gerontology and aging studies, with the aim of bringing insights from disability studies and philosophy of disability to bear on enduring debates in those fields.] The guiding question of humanistic age-studies—What does it mean to grow old?—cannot be answered without reflecting on disability. This is not simply because growing old invariably means becoming impaired in various ways, but also because the discriminations and stigmas involved in ageism are often rooted in ableism. (...) We here draw on research in the philosophy of disability as well as the interdisciplinary field of disability studies to explore the relationship between ageism and ableism. (shrink)

The article introduces readers to the study of disability, both with respect to the interdisciplinary field of disability studies and the field of philosophy of disability. We then offer an overview of three central areas of philosophical inquiry where feminist work in philosophy and disability has made significant contributions: (1) metaphysics and ontology, (2) epistemology and phenomenology, and (3) ethical, social, and political philosophy.

The view that it is better for life to be created free of disability is pervasive in both common sense and philosophy. We cast doubt on this view by focusing on an influential line of thinking that manifests it. That thinking begins with a widely-discussed principle, Procreative Beneficence, and draws conclusions about parental choice and disability. After reconstructing two versions of this argument, we critique the first by exploring the relationship between different understandings of well-being and disability, and the second (...) by more briefly focusing on the idea of a significant reason. By placing these results against the broader historical and ongoing contexts in which the lives of those with disabilities have been deemed of inferior quality, we conclude with a call for greater humility about disability and well-being in thought and practice. (shrink)

Disabled people face obstacles to participation in epistemic communities that would be beneficial for making sense of our experiences and are susceptible to epistemic oppression. Knowledge and skills grounded in disabled people's experiences are treated as unintelligible within an ableist hermeneutic, specifically, the dominant conception of disability as lack. My discussion will focus on a few types of epistemic oppression—willful hermeneutical ignorance, epistemic exploitation, and epistemic imperialism—as they manifest in some bioethicists’ claims about and interactions with disabled people. One of (...) the problems with the epistemic phenomena with which I am concerned is that they direct our skepticism regarding claims and justifications in the wrong direction. When we ought to be asking dominantly situated epistemic agents to justify their knowledge claims, our attention is instead directed toward skepticism regarding the accounts of marginally situated agents who are actually in a better position to know. I conclude by discussing disabled knowers’ responses to epistemic oppression, including articulating the epistemic harm they have undergone as well as ways of creating resistant ways of knowing. (shrink)

As reproductive genetic technologies advance, families have more options to choose what sort of child they want to have. Using preimplantation genetic diagnosis (PGD), for example, allows parents to evaluate several existing embryos before selecting which to implant via in vitro fertilization (IVF). One of the traits PGD can identify is genetic deafness, and hearing embryos are now preferentially selected around the globe using this method. Importantly, some Deaf families desire a deaf child, and PGD–IVF is also an option for (...) them. Selection for genetic deafness, however, encounters widespread disapproval in the hearing community, including mainstream philosophy and bioethics. In this paper I apply Elizabeth Barnes’ value-neutral model of disability as mere-difference to the case of selecting for deafness. I draw on evidence from Deaf Studies and Disability Studies to build an understanding of deafness, the Deaf community, and the circumstances relevant to reproductive choices that may obtain for some Deaf families. Selection for deafness, with deafness understood as mere-difference and valued for its cultural identity, need not necessitate impermissible moral harms. I thus advocate that it is sometimes morally permissible to select for deafness in one’s child. (shrink)

Despite the growing interest and supporting evidence for person-centered care, there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the (...) application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care. (shrink)

This paper argues that there are reasons to believe that there is no single concept or category which demarcates all individuals who have a disability from those individuals who do not. The paper begins by describing that I call ‘a Unified Concept View of Disability’ and the role that such a view plays in debates about the nature of disability. After considering reasons to think that our concept of disability is not unified in the way that the Unified Concept View (...) assumes, I outline what a non-unified approach to disability might look like. The paper concludes by considering implications of rejecting the Unified Concept View of disability. (shrink)

Accounts of adaptive preferences are of two kinds: well-being accounts fully theorized for their own sake and political accounts theorized to facilitate the political project of reducing oppression and marginalization. Given their practical role, the latter are often less fully theorized, and are therefore less robust to theoretical criticism. In this paper, I first draw on well-being accounts to identify the well-theorized elements that political accounts should want to adopt in order to strengthen their project and avoid common criticisms. Second, (...) I appeal to the political project to show the shortcomings of the well-being accounts on which I draw. (shrink)

© Swanson 2017How Propaganda Works is a brilliant, rich, and wide-ranging exploration of the interactions between ideology, inequality, democracy and propaganda. Read as a piece of analytic political philosophy, it is radical, arguing for bold theses about democracy: legitimate democratic deliberation, Stanley contends, requires not only political equality but also substantive material equality. Read as a piece of analytic epistemology and philosophy of language, it is more modest, but nevertheless very compelling, extending well-established work in fascinating but methodologically conservative ways. (...) In particular, on Stanley’s view ‘the truth-conditional, cognitivist picture … gives us an elegant account of what happens when communication fails, due to propagandistic manipulation’. Stanley is thus not trying to think outside the box so much as trying to move or expand the box, using familiar, proven tools to make the job easier. The book generously rewards careful study and thought, and any short summary... (shrink)

In this paper, I argue that disabled people have a right to assistive technology, but this right cannot be grounded simply in a broader right to health care or in a more comprehensive view like the capabilities approach to justice. Both of these options are plagued by issues that I refer to as the problem of constriction, where the theory does not justify enough of the AT that disabled people should have access to, and the problem of overextension, where the (...) theory cannot adequately identify an upper limit on the AT that people have a right to. As an alternative to these justificatory frameworks, I argue that disabled people are owed access to AT at the expense of nondisabled people as a matter of compensatory justice. That is, I defend the position that disabled people are owed AT as part of due compensation for the harms they experience from being disadvantaged by society’s dominant cooperative scheme and the violation of their right to equality of opportunity that such disadvantage entails. I also propose a method for identifying an upper limit to what this right to AT requires. In this way, I argue that compensatory justice avoids both the problem of constriction and the problem of overextension. (shrink)

This article discusses the role that algorithmic thinking and management play in health care and the kind of exclusions this might create. We argue that evidence‐based medicine relies on research and data to create pathways for patient journeys. Coupled with data‐based algorithmic prediction tools in health care, they establish what could be called health care algorithmics—a mode of management of healthcare that produces forms of algorithmic governmentality. Relying on a critical posthumanist perspective, we show how healthcare algorithmics is contingent on (...) the way authority over bodies is produced and how predictive health care algorithms can reproduce inequalities of the worlds from which they are made, centreing possible futures on existing normativities regulated through algorithmic biopower. In contrast to that, we explore posthuman speculative ethics as a way to challenge understanding of ‘ethics’ and ‘care’ in healthcare algorithmics. We suggest some possible avenues towards working speculative ethics into health care while still being critically attentive to algorithmic modes of management and prediction in health care. (shrink)

Elizabeth Barnes’s recently proposed value-neutral model for disability provoked a familiar storm of oft-made objections from philosophers who appear committed to equating being disabled with being intrinsically or inescapably disadvantaged. Their narrow framing of the options for disabled people is influenced, I suggest, by purposes to which “disability” (on my analysis, a term of art) now is put. But there are both epistemic and moral reasons to refrain from importing the normative narrowness imposed by these purposes into our philosophical investigation (...) of disability. Barnes’s ontological account opens up our framing options. Developing a full institutional theory of disability that both rests on and extrapolates from a social ontology of disablement is a promising direction for exploration at the intersect of metaphysics and public policy in the new field of Philosophy and Disability. (shrink)

If it is within our power to provide a significantly better world for future generations at a comparatively small cost to ourselves, we have a strong moral reason to do so. One way of providing a significantly better world may involve replacing our species with something better. It is plausible that in the not‐too‐distant future, we will be able to create artificially intelligent creatures with whatever physical and psychological traits we choose. Granted this assumption, it is argued that we should (...) engineer our extinction so that our planet's resources can be devoted to making artificial creatures with better lives. (shrink)

One way to determine whether a mental condition should be considered a disorder is to first give necessary and sufficient conditions for something to be a disorder and then see if it meets these conditions. But this approach has been criticized for begging normative questions. Concerning autism (and other conditions), a neurodiversity movement has arisen with essentially two aims: (1) advocate for the rights and interests of individuals with autism, and (2) de-pathologize autism. We argue that denying autism’s disorder status (...) could undermine autism’s exculpatory role in cases where individuals with autism are charged with a crime. Our argument raises a dilemma for the neurodiversity movement: advocating for the rights and interests of individuals with autism may require viewing autism as a condition that can be inherently disabling (at least for some individuals). If this is right, autism’s disorder status might be maintained (again, at least for some individuals) without deriving this result from any general account of disorder. (shrink)

In this paper, I ask whether there is a defensible philosophical view according to which everybody is beautiful. I review two purely aesthetical versions of this claim. The No Standards View claims that everybody is maximally and equally beautiful. The Multiple Standards View encourages us to widen our standards of beauty. I argue that both approaches are problematic. The former fails to be aspirational and empowering, while the latter fails to be sufficiently inclusive. I conclude by presenting a hybrid ethical–aesthetical (...) view according to which everybody is beautiful in the sense that everybody can be perceived through a loving gaze. I show that this view is inclusive, aspirational and empowering, and authentically aesthetical. (shrink)

Journal of Social Philosophy, EarlyView.

This article develops a detailed, empirically driven analysis of the nature of the transition costs incurred in becoming disabled. Our analysis of the complex nature of these costs supports the claim that it can be wrong to cause disability, even if disability is just one way of being different. We also argue that close attention to the nature of transition costs gives us reason to doubt that well-being, including transitory impacts on well-being, is the only thing that should determine the (...) wrongness of causing or removing disability. Non-welfare considerations also defeat the claim that it is always wrong to cause disability. The upshot of these conclusions is that closer attention to the nature of transition costs supports disabled people who strenuously contest the assumption that their well-being is lower than nondisabled people. It also suggests that, in addition, disabled people should contest their opponents’ narrow account of how we should make ethical decisions regarding causing or failing to prevent disability. (shrink)

The treatment-enhancement distinction is often used to delineate acceptable and unacceptable medical interventions. It is likely that future assistive and augmenting technologies will also soon develop to a level that they might be considered to provide users, in particular those with disabilities, with abilities that go beyond natural human limits, and become in effect an enhancing technology. In this paper, we describe how this process might take place, and discuss the moral implications of such developments. We argue that such developments (...) are morally acceptable and indeed desirable. (shrink)

The dominant view in bioethics is that embryo selection is in general morally preferable to gene editing because the latter involves risks that are absent in the former. What is less widely appreci...

There is broad agreement that humans can be wronged independently of their incurring any harm, that is, when their welfare is not affected. Examples include unnoticed infringements of privacy, ridiculing unaware individuals, or disregarding individuals’ autonomous decision-making in their best interest. However, it is less clear whether the same is true of animals—that is, whether moral agents can wrong animals in situations that do not involve any harm to the animals concerned. In order to answer this question, I concentrate on (...) the illustrative case of treating animals in a demeaning yet harmless way that would be disrespectful if humans were concerned. I discuss whether such actions are permissible or unjustifiably discriminatory from a moral point of view. I conclude that moral agents cannot directly wrong animals without harming them and thus do not owe it to a particular animal to refrain from such actions. However, if the actions increase the likelihood that animal abuse will occur, this presents a strong indirect reason against performing them. Thus, the reasons for refraining from such actions are merely indirect rather than direct. (shrink)

In the United States, Protestant Christian identity is the dominant religious identity. Protestant Christian identity confers status privileges, yet also creates objectionable status inequalities. Historical and contemporary evidence includes the unfair treatment of Mormons, Native Americans, Muslims, and other religious minorities. Protestant Christian supremacy also plays a significant role in bolstering anti LGBTQ prejudice, xenophobia, and white supremacy. Ways that Protestant Christian identity correlates with objectionable status inequalities are often neglected in contemporary political philosophy. This paper aims to make a (...) modest contribution towards filling that gap. Some forms of inequality linked to Protestant Christian supremacy can be characterized as domination and oppression. Other instances include barriers to fair equality of opportunity for self-determination. Adapting ideas from egalitarian political philosophy I propose an analysis of objectionable status inequality rooted in Protestant Christian supremacy. Alan Patten’s defense of an egalitarian principle for assessing the effects of law and policy is helpful for this task. (shrink)

In any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of...

I attempt to adjudicate the disagreement between those who seek to reconceptualize disability as mere difference and their opponents. I do so by reviewing a central conviction motivating the resistance, concerning the relationship between disability and well-being. I argue that the conviction depends on further considerations about the costs and extent of change involved in accommodating individuals with a particular disability trait. I conclude by considering three pay-offs of this clarification.

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should spend hundreds (...) of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

Some disability activists argue that disability is merely a difference. It is often objected that this view has unacceptable implications, implying, for example, that it is permissible to cause disability. In reply, Elizabeth Barnes argues that viewing disability as a difference needn’t entail such implications and that seeing such implications as unacceptable is question-begging. We argue that Barnes misconstrues this objection to the mere difference view of disability: it’s not question-begging to regard its implications as unacceptable, and the grounds that (...) Barnes offers for potentially blocking some of these implications fail to explain our conviction that it’s impermissible to cause disability. (shrink)

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...) are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (shrink)

Does disability make a person worse off? I argue that the best answer is yes AND no, because we can be worse off in two conceptually distinct ways. Disabilities usually make us worse off in one way (typified by facing hassles) but not in the other (typified by facing loneliness). Acknowledging two conceptually distinct ways to be worse off has fundamental implications for philosophical theories of well-being. (This paper won the APA’s Routledge, Taylor & Francis Prize in 2017.).

This article defends the use of fanciful examples within the method of wide reflective equilibrium. First, it characterizes the general persuasive role of described cases within that method. Second, it suggests three criteria any example must meet in order to succeed in this persuasive role; fancifulness has little or nothing to do with whether an example is able to meet these criteria. Third, it discusses several general objections to fanciful examples and concludes that they are objections to the abuse of (...) described cases; they identify no special problem with fanciful examples. (shrink)

We often find ourselves in situations where it is up to us to make decisions on behalf of others. How can we determine whether such decisions are morally justified, especially if those decisions may change who it is these others end up becoming? In this paper, I will evaluate one plausible kind of justification that may tempt us: we may want to justify our decision by appealing to the likelihood that the other person will be glad we made that specific (...) choice down the line. Although it is tempting, I ultimately argue that we should reject this sort of appeal as a plausible justification for the moral permissibility of our vicarious decisions. This is because the decisions that we make on behalf of another may affect the interests and values that that person will hold in the future. As I will show, this complicates the justificatory relationship between present decisions and future attitudes, since the latter can depend on the former. This is not to say that the predicted future attitudes of others can play no significant role in justifying our decisions on others’ behalf. Rather, appealing to the future attitudes in our moral justifications may play an important role in our practical thinking but only when we consider the future attitudes of all relevant possible futures. (shrink)

Inflicting harm is generally preferable to inflicting death. If you must choose between the two, you should generally choose to harm. But prenatal harm seems different. If a mother must choose between harming her fetus or aborting it, she may choose either, at least in many cases. So it seems that prenatal harm is particularly objectionable, sometimes on a par with death. This paper offers an explanation of why prenatal harm seems particularly objectionable by drawing an analogy to the all-or-nothing (...) problem. It then argues that this analogy offers independent support for the ‘voluntarist’ view that at least some parental role obligations are grounded in the choice to be a parent. (shrink)

In this paper I offer a close reading of Aristotle’s argument in the Nicomachean Ethics 3.5.1114a31–b25 and try to show that despite considerable interpretive difficulties, some clear structure can nevertheless be discerned. While Aristotle’s main concern in this passage is to refute the so-called asymmetry thesis – the thesis that virtue is voluntary, but vice is not – there is much more in it than just a dialectical encounter. Aristotle wants to respond to a more general objection, which has as (...) its target the voluntariness of both virtue and vice, and which is provoked by some of his ideas in EN 3.4 and 3.5. Further, I will try to show why Aristotle thinks that we are only co-causes of our dispositions. In my opinion, his reasons have nothing to do with compatibilist or incompatibilist considerations as they are commonly understood in modern philosophy. In particular, he does not want to argue that nature is aitios of our dispositions just as ourselves are. Rather, we are co-causes of our dispositions because we are causal origins of actions without which a certain good, which is the final cause of our actions and of our dispositions, cannot be achieved. Finally, I will try to show that Aristotle’s discussion implies that there is no more to the responsibility for dispositions than there is to the responsibility for actions. (shrink)

Value and responsibility are two central concepts in philosophy and bioethics. The articles that comprise this issue of The Journal of Medicine and Philosophy engage topics of moral injury, madness, transhumanism, cognitive enhancement, and the woman’s responsibility to assist her fetus. Clearly diverse in matter, these subject articles univocally present fruitful ground for engagement with contemporary questions that impact society today. The ability to cure or to enhance, to treat or to terminate through advances in medical technology are all actions (...) that come with personal and social responsibility for their consequences. By approaching each article through the dual lens of value and responsibility, the reader is challenged to think seriously about the values we hold as human persons and the responsibility we take to pursue and protect these values. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering from body (...) integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting ‘classical’ amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world. (shrink)

The problem of justified harm is the problem of explaining why it is permissible to inflict harm for the sake of future benefits in some cases but not in others. In this paper I first motivate the problem by comparing a case in which a lifeguard breaks a swimmer’s arm in order to save her life to a case in which Nazis imprison a man who later grows wiser as a result of the experience. I consider other philosophers’ attempts to (...) explain why the lifeguard’s action was permissible but the Nazis’ action was not. After arguing that principles having to do with consent, expected utility, and the types of harms and benefits at issue do not fully solve the problem, I argue for a causal solution to the problem. The causal solution includes both a causal account of harming and a distinction between causes and mere conditions. It then distinguishes between the lifeguard and Nazi cases with following principle: A harmful action that causes greater benefits can sometimes be justified by those benefits, but a harmful action that does not cause greater benefits cannot be justified by any subsequent benefits that the action, itself, does not cause. (shrink)

I argue that it is permissible for pregnant women to expose their unborn children to risks and injury. I begin with the premise that abortion is permissible. If so, then just as a pregnant woman may permissibly prevent an unborn child from experiencing any future wellbeing, she also may permissibly provide her child relatively poorer prospects for wellbeing. Therefore, it is permissible for pregnant women to take risks and cause prenatal injury. This argument has revisionary implications for policies that prevent (...) medical research and drug use during pregnancy. It also explains why moralistic criticism of pregnant women is unwarranted. (shrink)

According to Jerome Wakefield’s harmful dysfunction analysis of medical disorder, the inability of some internal part or mechanism to perform its natural function is necessary, but not sufficient, for disorder. HDA also requires that the part dysfunction be harmful to the individual. I consider several problems for HDA’s harm criterion in this article. Other accounts on which harm is necessary for disorder will suffer from all or almost all of these problems. Comparative accounts of harm imply that one is harmed (...) when one is made worse off, that is, worse off than one otherwise would have been. Non-comparative accounts imply that one is harmed when one is put into some kind of condition or state that is, in some way, bad in itself. I argue that whether harm is construed comparatively or non-comparatively, HDA’s harm criterion is problematic. I tentatively conclude that an analysis of medical disorder should not make use of the concept of harm. (shrink)

Disability is often defined as deviation from putative norms of physical, cognitive, or affective function. This definition is normatively laden, causing people with disabilities to be thought of as “different” and treated with pity. We address the predominant theme of this issue on “Disability Identity”: defining and imposing the category of “disability” and attempting to overcome it through medical intervention. The issue culminates in a call for courageous humility as the proper response to encounters with disability, providing medical professionals with (...) the disposition to resist medicine’s inherent drive to fix what is perceived to be broken—that which strays from the norm. We hope that this issue might act as a clarion call to medical professionals to reevaluate how they see and interact with “disability” as a category, and ultimately with people with disabilities, especially with respect to what may be owed to persons with disabilities from society. (shrink)