Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

Humanitarian health care practitioners working outside familiar settings, and without familiar supports, encounter ethical challenges both familiar and distinct. The ethical guidance they rely upon ought to reflect this. Using data from empirical studies, we explore the strengths and weaknesses of two ethical models that could serve as resources for understanding ethical challenges in humanitarian health care: clinical ethics and public health ethics. The qualitative interviews demonstrate the degree to which traditional teaching and values of clinical health ethics seem insufficient (...) for addressing all the realities of health care practice during humanitarian missions. They equally suggest that greater good orientations of public health ethics can thwart the best intentions of health care professionals wanting to attend to the interests of individual patients. Even though neither is complete on its own for helping guide health professionals on field missions, taken together these models have much to offer. At the same time, the narratives of the humanitarian health care workers illustrate how some of the crucial differences between public health ethics and clinical ethics generate tensions in humanitarian health practice. We offer an analysis of some of the complexities this creates for humanitarian health care ethics, and consider ways of adjudicating between the two models. (shrink)

This paper presents a normative analysis of restrictive measures in response to a pandemic emergency. It applies to the context presented by the Corona virus disease 2019 global outbreak of 2019, as well as to future pandemics. First, a Millian-liberal argument justifies lockdown measures in order to protect liberty under pandemic conditions, consistent with commonly accepted principles of public health ethics. Second, a wider argument contextualizes specific issues that attend acting on the justified lockdown for western liberal democratic states, as (...) modeled on discourse and accounted for by Jürgen Habermas. The authors argue that a range of norms are constructed in societies that, justifiably, need to be curtailed for the pandemic. The state has to take on the unusual role of sole guardian of norms under emergency pandemic conditions. Consistently with both the Millian-liberal justification and elements of Habermasian discourse ethics, they argue that that role can only be justified where it includes strategy for how to return political decisionmaking to the status quo ante. This is because emergency conditions are only justified as a means to protecting prepandemic norms. To this end, the authors propose that an emergency power committee is necessary to guarantee that state action during pandemic is aimed at re-establishing the conditions of legitimacy of government action that ecological factors have temporarily curtailed. (shrink)

Moral theory has generally focused on resolving ethical dilemmas by identifying ethically sound options. Whether the focus is on consequences, duties, principles or virtues, ethical cases are often approached in ways that assume morally sound solutions can be found and followed. Such ‘ideal morality’ assumes that moral goodness is always possible, leaving people confident they have done the right thing. Such an approach becomes inadequate in disaster settings where any good solution is often difficult to see. This paper examines recent (...) work on nonideal moral theory as a useful model for disaster bioethics. This approach views moral dilemmas as situations where no choice is ideal and every option involves some element of unavoidable wrongdoing. Rather than straining for ideal answers, this approach acknowledges that sometimes the lesser of two evils is the best that can be done. Such situations inevitably lead to feelings of regret or guilt, commonly encountered in discussions of disaster bioethics. This paper explores the practical implications of nonideal approaches for disaster responders working in tragic situations. (shrink)

Care theorists often think of care as involving “caring-about”—concern or attentiveness—and “caring-for”—acting to nurture, look after, or meet needs. One problem for any theory of care is the scope of our obligations to care in both of those senses; in particular, our capacities for “caring-about” often outrun our capacities for “caring-for.” Accounts of care as potentially global in scope may ascribe overwhelming obligations to moral agents; however, we are often tempted to avoid or ignore situations that may call for a (...) caring response. I suggest that some Kantian ideas may help to strike a reasonable balance. (shrink)

Feminists have noted the injustice of the institution of marriage and the asymmetric power dynamics within gender-structured marriages. Recently, feminists have found an unexpected supporter of this struggle against marriage in some liberal political theorists. I argue that this new wave of interest in the wrongness of marriage within liberalism reveals shortcomings from a feminist perspective. While some liberals fail to realise that instead of being disestablished, the institution of marriage should be radically reformed, others do not recognise that such (...) a reform should be theorised by starting from our non-idealised conditions of gender inequality and from an analysis of how the institution of marriage intersects with other spheres of gender injustice. This article provides recommendations for the radical reform of marriage by following some methodological premises of feminist theory. To illustrate how the reform of marriage should be theorised, it focuses on the intersection between the sphere of gender injustice represented by immigration and that of marriage. (shrink)

Open Access: This essay argues that Claudia Card numbers among important contributors to nonideal ethical theory, and it advocates for the worth of NET. Following philosophers including Lisa Tessman and Charles Mills, the essay contends that it is important for ethical theory, and for feminist purposes, to carry forward the interrelationship that Mills identifies between nonideal theory and feminist ethics. Card's ethical theorizing assists in understanding that interrelationship. Card's philosophical work includes basic elements of NET indicated by Tessman, Mills, and (...) others, and further offers two important and neglected elements to other nonideal ethical theorists: her rejection of the “administrative point of view,” and her focus on “intolerable harms” as forms of “extreme moral stress” and obstacles to excellent ethical lives. The essay concludes that Card's insights are helpful to philosophers in developing nonideal ethical theory as a distinctive contribution to, and as a subset of, nonideal theory. (shrink)

Morally speaking, what should one do when one is morally uncertain? Call this the Moral Uncertainty Question. In this paper, I argue that a non-ideal moral theory provides the best answer to the Moral Uncertainty Question. I begin by arguing for a strong ought-implies-can principle---morally ought implies agentially can---and use that principle to clarify the structure of a compelling non-ideal moral theory. I then describe the ways in which one's moral uncertainty affects one's moral prescriptions: moral uncertainty constrains the set (...) of moral prescriptions one is subject to, and at the same time generates new non-ideal moral reasons for action. I end by surveying the problems that plague alternative answers to the Moral Uncertainty Question, and show that my preferred answer avoids most of those problems. (shrink)

Lipsey and Lancaster's "general theory of second best" is widely thought to have significant implications for applied theorizing about the institutions and policies that most effectively implement abstract normative principles. It is also widely thought to have little significance for theorizing about which abstract normative principles we ought to implement. Contrary to this conventional wisdom, I show how the second-best theorem can be extended to myriad domains beyond applied normative theorizing, and in particular to more abstract theorizing about the normative (...) principles we should aim to implement. I start by separating the mathematical model used to prove the second-best theorem from its familiar economic interpretation. I then develop an alternative normative-theoretic interpretation of the model, which yields a novel second best theorem for idealistic normative theory. My method for developing this interpretation provides a template for developing additional interpretations that can extend the reach of the second-best theorem beyond normative theoretical domains. I also show how, within any domain, the implications of the second-best theorem are more specific than is typically thought. I conclude with some brief remarks on the value of mathematical models for conceptual exploration. (shrink)

This Thesis reconsiders the prospects for an approach to global justice centring on the proposal that every human being should possess a certain bundle of goods, which would include certain members of a distinctive category: the category of capabilities. My overall aim is to present a clarified and well-developed framework, within which such claims can be made. To do this, I visit a number of regions of normative and metanormative theorising. I begin by introducing the motivations for the capability approach, (...) and clarifying some of its most distinctive features. Next, I focus on Martha Nussbaum's version of the approach, and identify several problems therein. The most important concerns epistemology, and especially the challenges that constructivist theories pose. The middle part of the Thesis presents an alternative, based on the work of John McDowell, which I argue has superior prospects. Then, I turn to two further problems: that of making sense of the universalistic aspirations of cosmopolitanism, and that of integrating the microscopic prescriptions of ethics with the macroscopic analyses of political philosophy. Using the Aristotelian interpretation of its core framework that I have developed, I conclude that the capability approach can provide compelling answers to important questions about global justice. (shrink)

In Against Purity, Alexis Shotwell takes up a multiplicity of tasks with respect to what I think of as non-ideal ethical theory. In what follows, I trace the relationship of her work to that of non-ideal theorists whose work influences mine. Then, more critically, I probe her analysis of gender voluntarism in Chapter 5, “Practicing Freedom: Disability and Gender Transformation,” partly to better understand what she takes it to be, and partly to advance a cautious defense of some of the (...) moral functions of individualistic performances of gender voluntarism that non-ideal theory leads me to value. I conclude that my interest in retaining a positive account of individualistic gender voluntarism as a form of resistance to a hostile world is due to my tendency to take non-ideal theory as a recommendation for some pessimism, whereas Shotwell’s similar commitments turn out to inform her more optimistic philosophy. (shrink)

My commentary deals with the fourth chapter of Against Purity, entitled “Consuming Suffering,” where Shotwell invites us to imagine what an alternative to ethical individualism might look like in practice. I am particularly interested in the analogy she develops to help pull us into the frame of what she calls a “distributed” or “social” approach to ethics. I will argue that grappling with this analogy can help illuminate three challenges confronting those of us seeking a genuine alternative to ethical individualism: (...) first, that of recognizing that and how certain organizational forms work to entrench an individualistic orientation to the world; second, that of acknowledging the inadequacy of alternatives to individualism that are merely formal in character; and third, that of avoiding the creation of organizational forms that foster purism at the collective level. (shrink)