In “Materialized Oppression in Medical Tools and Technologies”, we show how oppression can be inscribed in medical devices. We consider oximeters and spirometers, drawing heavily on the work of anthropologist Amy Moran-Thomas and historian Lundy Braun. Both devices encode racial biases: oximeters because they do not correct for race, and spirometers because they do. We zoom out from these particular devices to examine a wide range of tools and technologies, and we build a theoretical framework that covers not only race (...) but other axes of oppression: gender, ability, class, etc. -/- We are inspired by the peer commentaries and the guest editorial, and we are grateful to the contributors for engaging with our work and sharing their expertise. Their responses to our target article advance our understanding in three directions. First, a set of responses contextualize our framework within the histories of medicine, bioethics, and science and technology studies. Second, a set of responses provide additional examples of oppressive medical tools and technologies: not only material artifacts like oximeters and spirometers, but also spatial environments like inpatient psychiatric units, and cognitive niches comprised of digital technologies like electronic medical records and medical data classifications. Third, a set of responses propose countermeasures: operationalizing anti-oppressive practices for device design and testing; mapping the complex causal relationships involved in real-world problems; and repairing the harms done by materialized oppression through racism-conscious praxis. We reply to these three sets of responses—respectively, the “past, present, and future” of oppressive medical objects and spaces—in what follows. (shrink)

Background The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals’ lifeworlds and need to be considered in implant care and in the course of technical developments. Methods This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical (...) research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data. Results Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability. Conclusions Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in “lived experiences” may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design. (shrink)

In analyzing oppressive systems like racism, social theorists have articulated accounts of the dynamic interaction and mutual dependence between psychological components, such as individuals’ patterns of thought and action, and social components, such as formal institutions and informal interactions. We argue for the further inclusion of physical components, such as material artifacts and spatial environments. Drawing on socially situated and ecologically embedded approaches in the cognitive sciences, we argue that physical components of racism are not only shaped by, but also (...) shape psychological and social components of racism. Indeed, while our initial focus is on racism and racist things, we contend that our framework is also applicable to other oppressive systems, including sexism, classism, and ableism. This is because racist things are part of a broader class of oppressive things, which are material artifacts and spatial environments that are in congruence with an oppressive system. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Some of the most pressing contemporary social problems result from the amalgamation of a mass of actions that are not intentionally coordinated. Although these essentially aggregative harms are foreseeable, it is unclear what moral duties individuals have with regards to them. This paper offers a new analysis of these problems and uses a nonideal contractualist approach to argue in favour of two kinds of duties for individuals. Collectivization duties that require individuals to act responsively with a view to ensuring that (...) there are effective governance agents that reliably, fairly, and efficiently prevent these outcomes in the long-term and duties of restraint that require individuals to avoid action of a kind that is likely to come together with other actions to cause serious EAH in the immediate future when restraint with regards to actions of this kind could help prevent the outcome from occurring. (shrink)

Medical devices with built-in bias can both result from, and contribute to, harmful systemic racial oppression—a point that Liao and Carbonell (2023) argue convincingly in the target article of thi...

Women are under-represented in surgery, especially in leadership and academic roles, and face a gender pay gap. There has been little work on the role of implicit biases in women’s under-representation in surgery. Nor has the impact of epistemic injustice, whereby stereotyping influences knowledge or credibility judgements, been explored. This article reports findings of a qualitative in-depth interview study with women surgeons that investigates gender biases in surgery, including subtle types of bias. The study was conducted with 46 women surgeons (...) and trainees of the Royal Australasian College of Surgeons. Maximum variance sampling strategies ensured a comprehensive set of perspectives. Data were analysed using iterative thematic analysis to document and classify forms of gender bias experienced by the participants, including implicit bias and epistemic injustice. It found four types of bias affecting women surgeons: workplace factors such as access to parental leave and role models; epistemic injustices—unfair assessments of women surgeons’ credibility by patients and colleagues; stereotyped expectations that they will carry out more of surgery’s carework, such as meeting the emotional needs of patients and objectification. Implicit biases arose in each category. Given that many of the biases identified in this study are small, are harmless on their own and are not necessarily under anyone’s conscious control, important questions arise regarding how they cause harm and how to address them. I draw on theoretical work on cumulative harm to answer these questions. (shrink)

Liao and Carbonell argue that medical devices are often not merely biased, but rather materialize oppression through the perpetuation of oppression into the present and future (Liao and Carbonell 2...