In this paper I provide a speech act analysis of microaggressions. After adopting a notion of microaggressions found in the political philosophy literature, I provide an account of both the illocutionary force and perlocutionary effects of microaggressions. I show that there are two parts to microaggressions’ illocutionary force: (i) the general Austinian linguistic conventions; (ii) socio-political conventions that change the speech act into a microaggression. Despite the varied speech acts that can count as microaggressions, I identify a unique perlocutionary effect (...) common to all, perlocutionary frustration, in which the recipient of a microaggression is frustrated or inhibited from addressing the harms that microaggressions cause. The recipient is not necessarily silenced insofar as they are prevented from performing certain illocutionary acts. Instead, the illocutionary acts do not have their intended perlocutionary effects. (shrink)

Misgendering is perceived as the use of incorrect pronouns and gender categories when addressing Transgender and Gender Non-Conforming people. This common habit is widely observed in reports, surveys and assessments, where the pressures to comply with a binary understanding of gender are high and alternative options for self-identification are not frequently offered. The present study reads misgendering as a manifestation of epistemic injustice, and uses resources from Science, Technology and Society Studies in order to highlight the importance of situated perspectives (...) on the matter. After being analysed as a commonplace microaggression, misgendering is conceptualised as an act of structural hermeneutical marginalisation that is not usually intentional but product of society’s lack of sensibility towards gender diversity. Finally, a reparative approach against misgendering is offered through the Gender Fair Language model, which involves relational and situated contributions in order to prevent already marginalised people and experiences from being further excluded. (shrink)

In this paper, I argue that purely quantitative understandings of Aristotle's concept of "the mean" are oversimplified, and I make this argument by analyzing the particular emotion of anger. Anger, I contend, helps to complicate the purely quantitative understanding of the mean, insofar as, I argue, the amount of anger experienced is not the morally salient feature in determining whether or not the anger is virtuous. Rather, anger is one example of an emotion or trait for which other, non-quantitative parameters (...) of the mean are more salient, giving us a more nuanced understanding of what the mean is. Anger is virtuous not when it is in the right measurable degree, but rather when it is directed at the proper target. In this way, the virtue-making property of anger is distinctly qualitative. Examining anger provides insight into the concept of the mean and its role in Aristotle's ethics, and also helps to shed light on contemporary debates about political anger. (shrink)

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

How can we tell whether an incident counts as a microaggression? How do we draw the boundary between microaggressions and weightier forms of oppression, such as hate crimes? I address these questions by exploring the ontology and epistemology of microaggression, in particular the constitutive relationship between microaggression and systemic social oppression. I argue that we ought to define microaggression in terms of the ambiguous experience that its victims undergo, focusing attention on their perspectives while providing criteria for distinguishing microaggression.

At first glance, hate speech and microaggressions seem to have little overlap beyond being communicated verbally or in written form. Hate speech seems clearly macro-aggressive: an intentional, obviously harmful act lacking the ambiguity (and plausible deniability) of microaggressions. If we look back at historical discussions of hate speech, however, many of these assumed differences turn out to be points of similarity. The harmfulness of hate speech only became widely acknowledged after a concerted effort by critical race theorists, feminists, and other (...) activists. Before the 1990s, slurs were widely considered socially acceptable behavior: mere jokes that weren’t intended to be harmful. Authors like Richard Delgado, Mari Matsuda, and Charles Lawrence pushed back against this dismissal. In this chapter, I show that their arguments for the serious harmfulness of hate speech prefigure and provide support for current debates about the serious harmfulness of microaggressions. Exploring resonances with the 1980s hate speech debate will allow us to explain why microaggressions fall below the cutoff for legal liability but remain apt targets for moral blame. (shrink)

How do we know that what has happened to us is a microaggression? I claim in this chapter that our understanding about how we perceive microaggression is grounded in the cultivation and critical reflection about experiences of people who occupy marginalized social locations. My aim is to explore the nature of epistemic harms of microaggression in order to highlight how they diminish the microaggressed’s ability to generate and participate in making knowledge claims. I differentiate between the primary (direct) harm of (...) microaggressive acts, and the secondary epistemic harms that occur in the aftermath of the microaggression, particularly when the microaggressed attempts to convey their experience to others. I conclude with an analysis of the two secondary harms in hopes that it helps us explore a possible avenue of resistance to the epistemic harms of microaggression. (shrink)

Scientists, philosophers, and policymakers disagree about how to define microaggression. Here, we offer a taxonomy of existing definitions, clustering around (a) the psychological motives of perpetrators, (b) the experience of victims, and (c) the functional role of microaggression in oppressive social structures. We consider conceptual and epistemic challenges to each and suggest that progress may come from developing novel hybrid accounts of microaggression, combining empirically tractable features with sensitivity to the testimony of victims.

Invalidation from healthcare practitioners is an experience shared by many patients, especially those marginalized or living with contested conditions (e.g., chronic pain, fibromyalgia, etc.). Invalidation can include not taking someone’s testimony seriously, imposing one’s thoughts, discrediting someone’s emotions, or not perceiving someone’s testimony as equal and competent. Epistemic injustices, that is, the disqualification of a person as a knower, are a form of invalidation. Epistemic injustices have been used as a theoretical framework to understand invalidation that occurs in the patient-healthcare (...) provider relationship. However, to date, the different recommendations to achieve epistemic justice have not been listed, analyzed, nor compared yet. This paper aims at better understanding the state of the literature and to critically review possible avenues to achieve epistemic justice in healthcare. A systematic and critical review of the existing literature on epistemic justice was conducted. The search in four databases identified 629 articles, from which 35 were included in the review. Strategies to promote epistemic justice that can be applied to healthcare are mapped in the literature and sorted in six different approaches to epistemic justice, including virtuous, structural, narrative, cognitive, and partnership approaches, as well as resistance strategies. These strategies are critically appraised. A patient partnership approach based on the Montreal Model, implemented at all levels of healthcare systems, seems promising to promote epistemic justice in healthcare. (shrink)

Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation. More specifically, clinical ethics needs both theoretical tools to analyze and practical strategies to address structural discrimination within clinical ethics consultations. (...) Intersectionality, a concept developed in Black feminist scholarship, is increasingly considered in bioethical theory. It stresses how social structures and practices determine social positions of privilege and disadvantage in multiple, mutually co-constitutive systems of oppression. This article aims to investigate how intersectionality can contribute to addressing structural discrimination in clinical ethics consultations with a particular focus on mental healthcare. To this end, we critically review existing approaches for clinical ethics consultants to address structural racism in clinical ethics consultations and extend them by intersectional considerations. We argue that intersectionality is a suitable tool to address structural discrimination within clinical ethics consultations and show that it can be practically implemented in two complementary ways: 1) as an analytic approach and 2) as a critical practice. (shrink)

Zusammenfassung Im internationalen Diskurs sind feministische Perspektiven auf die Medizinethik bereits etabliert. Demgegenüber scheinen diese bislang nur vereinzelt in den deutschsprachigen medizinethischen Diskurs eingebracht zu werden. In diesem Artikel untersuchen wir, welche feministischen Perspektiven im deutschsprachigen medizinethischen Diskurs vertreten sind, und schlagen weitere Ansätze für eine feministische Medizinethik vor. Zu diesem Zweck zeichnen wir mittels einer systematisierten Literaturrecherche feministische Perspektiven im deutschsprachigen medizinethischen Diskurs seit der Etablierung der Medizinethik als eigenständiger institutionalisierter Disziplin nach. Wir analysieren, welche Themen bereits innerhalb der (...) Medizinethik aus einer feministischen Perspektive untersucht worden sind, und identifizieren Leerstellen. Basierend auf der Literaturrecherche, unseren eigenen Vorarbeiten sowie der Zusammenarbeit in der Arbeitsgruppe in der Akademie für Ethik in der Medizin „Feministische Perspektiven in der Bio- und Medizinethik“ stellen wir drei Thesen vor, die aus unserer Sicht einer Weiterentwicklung des deutschsprachigen medizinethischen Diskurses dienen können. Die erste These bezieht sich auf die Ziele feministischer Medizinethiken und besagt, dass diese (epistemische) Gerechtigkeit anstreben. Die zweite These stellt zentrale Eigenschaften von feministischen Medizinethiken als kritisch und kontext-sensibel heraus. In der dritten These diskutieren wir Intersektionalität und Postkolonialismus als theoretische Ansätze, die zu einer epistemisch gerechten, kritischen und kontext-sensiblen Medizinethik beitragen können. Wir argumentieren, dass feministische Perspektiven grundständig verankert werden sollten. Der Artikel schließt mit einem Ausblick auf die Arbeit der im letzten Jahr gegründeten Arbeitsgruppe in der Akademie für Ethik in der Medizin „Feministische Perspektiven in der Bio- und Medizinethik“. (shrink)

RésuméCet article met en évidence trois pratiques épistémiques qui, prises ensemble, créent des conditions qui aggravent le problème de « l'effacement de la bisexualité ». Bien que les personnes bisexuelles constituent une portion significative de la communauté LGBTQ+, leurs identités et leurs expériences sont régulièrement effacées, autant au sein des communautés queer que dans la société au sens large. Cet article soutient que nous avons une obligation à la fois épistémique et morale de nous préoccuper des conditions épistémiques créées pour (...) les personnes bisexuelles, et de travailler pour rendre ces conditions plus justes. Plus précisément, je souligne l'influence néfaste de l'injustice testimoniale, de l’étouffement testimonial et des micro-agressions épistémiques sur la capacité des personnes bisexuelles à défier et à résister à leur propre effacement. (shrink)

This paper defends the claim that pragmatic encroachment—the idea that knowledge is sensitive to the practical stakes of believing—can explain a distinctive kind of epistemic injustice: the injustice that occurs when prejudice causes someone to know less than they otherwise would. This encroachment injustice, as we call it, occurs when the threat of being met with prejudice raises the stakes for someone to rely on her belief when acting, by raising the level of evidential support required for knowledge. We explain (...) this notion of encroachment injustice, connect it to the empirical literature on implicit bias, and defend it against important objections. (shrink)

Journal of Political Philosophy, EarlyView.

A recent flurry of philosophical research on microaggression suggests that there are various practical and moral reasons why microaggression may be objectionable, including that it can be offensive, cause epistemic harms, express demeaning messages about certain members of our society, and help to reproduce an oppressive social order. Yet little attention has been given to the question of whether microaggression is also epistemically objectionable. This paper aims to further our understanding of microaggression by appealing to recent work on moral encroachment—the (...) idea that knowledge is sensitive to the moral stakes of believing—to argue that microaggression can be irrational in a distinctively epistemic sense, as it can involve relying on an epistemically unwarranted belief. This view suggests that the notion of epistemic justification may come apart from the notion of epistemic blame. (shrink)

The traumatic stress experienced by our black healthcare colleagues is often overlooked. This work contextualizes workplace racism, identifies some interpersonal barriers limiting anti-racist growth, and calls for solidarity.

McLeod's Conscience in Reproductive Health Care offers a number of valuable contributions to the literature, both within and beyond reproductive care. In this commentary, I begin by discussing two potential applications of her argument that healthcare professionals—specifically, those "who are charged with gatekeeping access to healthcare services" —have a fiduciary duty of loyalty to prioritize the interests of their patients over their own. Then, I turn to a couple of concerns one might raise about extending this fiduciary duty to pharmacists (...) who function as gatekeepers of reproductive services. Finally, I pose some questions about the ways in which McLeod conceives of the harms and wrongs of... (shrink)

Alongside clinical practice, medical schools now confront mounting reasons to examine nontraditional approaches to ethics. Increasing awareness of systems of oppression and their effects on the experiences of trainees, patients, professionals, and generally on medical care, is pushing medical curriculum into an unfamiliar territory. While there is room throughout medical school to take up these concerns, ethics curricula are well-positioned to explore new pedagogical approaches. Feminist ethics has long addressed systems of oppression and broader structures of power. Some of its (...) established concepts can offer distinct value as medical climates change and adapt in response to increased awareness of the experiences of marginalized individuals and populations. In this essay, we offer a set of concepts from feminist ethics that have a fundamental role to play in medical school curriculum: relationality, relational autonomy, and epistemic justice. Though these concepts are not exhaustive, they can be taught in tandem with the concepts that have historically grounded ethics education in medical school, such as autonomy and beneficence. Ultimately, we contend that these concepts hold particular value in ethics curriculum insofar as they diversify mainstream ethical approaches, directly address the pervasiveness of systems of oppression in medicine, and recognize the voices and concerns that may be marginalized in standard approaches. (shrink)

Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety (...) as a field of practice. We argue that dignitary harms in health care are—at least sometimes—preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality. (shrink)

Definition of the problemFeminist approaches to medical ethics are well established in international discourses. By contrast, in the German-speaking medical ethical discourse, they still seem to be rather marginal. In this article, we analyze which feminist perspectives are prominent in German medical ethics and suggest new approaches.ArgumentsWe present our results from a systematized review of the literature, in which we identify existing feminist approaches within the German-speaking medical ethics discourse as well as research gaps. Based on the review, our preliminary (...) research and discussions in the working group “Feminist perspectives in bio and medical ethics”, we defend three hypotheses aimed at advancing the German feminist medical ethical discourse. We posit that (1) feminist medical ethics aim at (epistemic) justice, (2) feminist medical ethics are critical and context-sensitive, and (3) intersectional and postcolonial approaches within feminist medical ethics may contribute to epistemically just, critical, and context-sensitive medical ethics.ConclusionWe argue that feminist perspectives should be implemented as a fundamental perspective in medical ethics because they can bring together key dimensions such as epistemically just, critical, context-sensitive, intersectional, and postcolonial thinking. (shrink)

As the other entries in this section have surely made clear, Carolyn McLeod's outstanding monograph, Conscience in Reproductive Health Care: Prioritizing Patient Interests, is fertile ground for fruitful philosophical analyses of issues pertaining to conscience, trust, autonomy, and more, all of which are sure to be of great interest and benefit to scholars in areas such as bioethics, health policy, and feminist ethics. Conscience in Reproductive Health Care provides a compelling response to a timely bioethical dilemma: What do we do (...) when healthcare providers refuse certain health services to patients on grounds of conscience? McLeod contends that healthcare providers, in light of their fiduciary... (shrink)

This dissertation offers a robust philosophical examination of a phenomenon that is morally, socially, and politically significant – microaggressions. Microaggressions are understood to be brief and routine verbal, behavioral, or environmental indignities that, whether intentional or unintentional, convey hostility toward or bias against members of marginalized groups. Microaggressions are rooted in stereotypes and/or bias (whether implicit or explicit) and are connected to broader systems of oppression. Microaggressions are philosophically interesting, since they involve significant ambiguity, questions about speech and communication, and (...) the ability for our speech to encode and transmit bits of meaning. Microaggressions prompt reflection about the nature of blameworthiness and responsibility, especially for unintended acts and harms. They involve questions about how we perceive and treat one another, and whether or not people are treated as true equals in our social and political worlds. For all of these reasons, microaggressions are a critical area in need of philosophical reflection, specifically reflection in feminist philosophy, philosophy of language, moral philosophy, and social and political philosophy. This dissertation seeks to advance the philosophy of microaggressions through three distinct aims: a conceptual aim (chapters 2 and 3), an epistemological aim (chapters 1 and 2), and a moral aim (chapters 4 and 5). The conceptual aim involves clarifying how we should understand and categorize microaggressions. The epistemological aim involves identifying some of the epistemological assumptions undergirding discussions of microaggressions in the literature, including assumptions made by critics of microaggression theory, and arguing for an alternative epistemological framework for theorizing about microaggressions. The moral aim involves better understanding the harms of microaggressions, including their role in reinforcing structures of oppression and unjust social hierarchy. Taken together, these chapters make some progress on the conceptual, epistemological, and moral questions that microaggressions generate, and which philosophers have not yet adequately analyzed. It thus offers a meaningful contribution to the conversations philosophers are beginning to have about the morally and politically salient phenomenon of microaggressions. (shrink)

The role of microaggressions has gained increasing philosophical attention in recent years. However, microaggressions only tell part of the story. An often-overlooked component of inequality is the uneven and unjust distribution of microaffirmations. In this paper, I give a new definition of microaffirmations as signals that a recipient belongs to some valued or high-status class. Microaffirmations can—but need not—lead individuals to gain a sense of confidence, belonging, and merit. I then explain the harms of microaffirmations, arguing that when microaffirmations are (...) distributed inequitably, they can have larger ramifications for injustice, harming some vulnerable groups more than others. In addition, microaffirmations can lead individual actors to make choices based on who gives them microaffirmations and where they receive them, and thus can have outsized influence over the direction of an individual’s life because individuals tend to migrate to where they feel valued, appreciated, and included. I then turn to solutions to the problems I raise. I argue we should attend to and attempt to rectify inequalities in microaffirmations because doing so can help ensure not just the absence of negative attention, but also that the presence of positive attention is flowing in a just and equitable way. (shrink)