Events in 2020 have sparked a reimagination of how both individuals and institutions should consider race, power, health, and marginalization in society. In a response to these developments, we exa...

Like many fields, bioethics has been constrained to thinking to race in terms of colorblindness, the idea that ideal deliberation would ignore race and hence prevent bias. There are practical and ethically significant problems with colorblind approaches to ethical deliberation, and important reasons why race is ethically relevant. Future discourse needs to understand how and why race is relevant in bioethics.

Like many fields, bioethics has been constrained to thinking to race in terms of colorblindness, the idea that ideal deliberation would ignore race and hence prevent bias. There are practical and e...

Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. (...) We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies. (shrink)

Epistemic injustice is a kind of injustice that arises when one’s capacity as an epistemic subject is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have (...) a certain epistemic privilege, healthcare professionals have a pro tanto epistemic duty to attend to and/or solicit reports of patients’ first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it. (shrink)

Damon Tweedy is a psychiatrist, lawyer, and writer. He's also Black. While in his first year as a medical student at Duke University, one of his professors approached him in the classroom and asked why the light bulb in the room hadn't been changed, as requested. Tweedy realized that his professor assumed he was a maintenance worker, not a student. Tweedy never took up this incident with the professor, nor did the professor ever apologize. Tweedy recounts that his best "revenge" (...) would be to excel in the class, which he ultimately did. At the end of the semester, upon learning that Tweedy received the second highest grade of over one hundred students, this professor invited him to work as a research assistant in his... (shrink)

Despite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, (...) gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine. (shrink)

Definition of the problem Few concepts in recent ethical debates have enjoyed as much popularity as the concept of discrimination. However, a comparative discussion of the concept, including its conceptual nuances and its ethical significance for health care, has so far been lacking. The aim of this paper is to develop a nuanced understanding of discrimination based on the philosophical and sociological literature against the background of ethically relevant medical and nursing scenarios. Methods Using practical examples from health care, we (...) discuss direct, indirect, and statistical discrimination; we examine the importance of intentions and the role of collective actors. In addition, we analyze which social groups may experience discrimination and the respective importance of forms of epistemic injustice. Conclusions We argue that despite its complexity, the concept offers significant added value because it allows us to highlight forms of disadvantage that go beyond the violation of individual specific rights or interests. As a knowledge-based system of great societal influence, health care exhibits some characteristics that can foster discrimination. Acknowledging this fact is essential in order to effectively address discrimination. (shrink)

The concept of person‐centeredness has become in many instances the standard of health care that humanises services and ensures that the patient/client is at the centre of care delivery. Rejecting a purely biomedical explanation of dementia that led to a loss of self, personhood in dementia could be maintained through social interaction and communication. In this article, we use the insights of queer theory to contribute to our current understanding of the care of those with dementia. We critically discuss the (...) concepts of person and personhood that have become the cornerstone values of person‐centred care for persons with dementia (PWD). Some critics, using queer theory as a theoretical approach, contend that person‐centred care often (unwittingly) reproduces heteronormative roles in trying to sustain life histories. In doing so, they argue, regendering of PWD is sometimes enforced by care providers who try to safeguard this biographical continuity. Cultural theorist Linn Sandberg also mentions that other axes of domination such as race and class are not conceptualised in person‐centeredness approaches, and neither are power asymmetries. Thus, in our article, we revisit the concept of person‐centred care as a first step in proposing another way to think about ‘beings with dementia’ (to avoid the term person). Believing that queer theorists have fallen short in questioning the idea of person or personhood as such, we will build on and broaden Sandberg's critique by demonstrating that queer and crip theory can be understood as a fundamental critique of the (Western) subject and processes of subjectivation. We argue that dementia can be conceptualised as a radical break not only with gendered roles and embodiments, but with many of the norms that make us recognisable subjects. Conceptualising dementia in this way turns it into what Sandberg called an ‘emancipatory space’ and not merely a pathology. (shrink)

Philosophers working in bioethics often hope to identify abstract principles and universal values to guide professional practice, relying on ideals of objectivity and impartiality, and on the power of rational (individual, autonomous) deliberation. Such a focus has made it difficult to address issues arising from group‐based, sociohistorical differences like race and ethnicity. This essay offers a survey of some of the major issues concerning race in the field of bioethics. These issues include a long history of racialized abuse in medical (...) and scientific research, reproductive injustice and abuse against women of color, and persistent racial and ethnic disparities in U.S. health and health care. The essay also argues that the field of bioethics as a whole would be improved by taking the experience of racial minorities into account in all its theorizing. Philosophers can aid in this task by expanding their theoretical focus beyond questions of individual rights to questions of social justice, beyond informed consent to community collaboration, and beyond cultural competency to both structural competency and cultural humility. (shrink)

Feminist ethics and medical ethics are critical of contemporary moral theory in several similar respects. There is a shared sense of frustration with the level of abstraction and generality that characterizes traditional philosophic work in ethics and a common commitment to including contextual details and allowing room for the personal aspects of relationships in ethical analysis. This paper explores the ways in which context is appealed to in feminist and medical ethics, the sort of details that should be included in (...) the recommended narrative approaches to ethical problems, and the difference it makes to our ethical deliberations if we add an explicitly feminist political analysis to our discussion of context. It is claimed that an analysis of gender is needed for feminist medical ethics and that this requires a certain degree of generality, i.e. a political understanding of context. (shrink)

Mobile applications (apps) have gained significant popularity as a new intervention strategy responding to violence against women and girls. Despite their growing relevance, an assessment from the perspective of public health ethics is still lacking. Here, we base our discussion on the understanding of violence against women and girls as a multidimensional, global public health issue on structural, societal and individual levels and situate it within the theoretical framework of structural injustice, including epistemic injustice. Based on a systematic app review (...) we previously conducted, we evaluate the content and functions of apps through the lens of structural injustice. We argue that technological solutions such as apps may be a useful tool in the fight against violence against women and girls but have to be situated within the broader frame of public health that considers the structural dimensions of such violence. Ultimately, the concerns raised by structural injustice are—alongside key concerns of safety, data privacy, importance of human supportive contact, and so forth—crucial dimensions in the ethical assessment of such apps. However, research on the role and relevance of apps as strategies to address the structural and epistemic dimensions of violence remains scarce. This article aims to provide a foundation for further discussion in this area and could be applicable to other areas in public health policy and practice. (shrink)

Empirische Ethik ist ein relativ neues Vorgehen in der Ethikforschung, das vor allem in der Medizinethik angewandt wird. Dieser Beitrag bespricht die kennzeichnenden Charakteristika der empirischen Ethik und unterscheidet zwischen generalistischer und kontextualistischer empirischer Ethik. Zuerst werden verschiedene Beispiele beider Arten von empirischer Ethik vorgestellt, danach werden für beide Ansätze mögliche Schwachpunkte diskutiert. Die Schlussfolgerung des Beitrages besteht darin, dass das Entstehen der empirischen Ethik eine positive Entwicklung ist. Empirische Ethik sollte jedoch als eine Ergänzung der traditionellen philosophischen Medizinethik betrachtet (...) werden, und nicht als die bessere Alternative. (shrink)

Menschen mit psychischer Erkrankung sterben statistisch gesehen früher als die Allgemeinbevölkerung. Ein Grund hierfür ist, dass sie eine schlechtere somatische Gesundheitsversorgung erhalten. Wir argumentieren, dass ableistische Netzwerke sozialer Bedeutung zu einer Abwertung der epistemischen Kompetenz von Menschen mit psychischer Erkrankung führen. Diese Abwertung kann mit dem Konzept der testimonialen Ungerechtigkeit erfasst werden. Testimoniale Ungerechtigkeit bezeichnet das ungerechtfertigte Herabstufen der Glaubwürdigkeit einer*s Sprecher*in aufgrund eines Vorurteils gegen ihre*seine soziale Identität. Wir analysieren ethische und epistemische Folgen testimonialer Ungerechtigkeit als wichtige Ursachen der (...) schlechteren Gesundheitsversorgung von Menschen mit psychischer Erkrankung. Testimoniale Ungerechtigkeit kann zu medizinischen Behandlungsfehlern führen und für Betroffene schwerwiegende gesundheitliche Folgen nach sich ziehen. Zudem kann sie zu einem Vertrauensverlust von Menschen mit psychischer Erkrankung in das Gesundheitssystem führen. Daher trägt testimoniale Ungerechtigkeit zur strukturellen Diskriminierung von Menschen mit psychischer Erkrankung bei. Vor diesem Hintergrund diskutieren wir, wie die somatische Gesundheitsversorgung unter ethischen Gesichtspunkten verbessert werden kann. (shrink)

Quantitative research has called attention to the burden associated with informal caregiving in home nursing arrangements. Less emphasis has been placed, however, on care recipients’ subjective feelings of being a burden and on caregivers’ willingness to carry the burden in home care. This article uses empirical material from semi‐structured interviews conducted with older people affected by multiple chronic conditions and in need of long‐term home care, and with informal and professional caregivers, as two groups of relevant others. The high burden (...) of home‐care arrangements is unanimously stressed by all three groups involved in the triangle of care. An empirical‐ethical investigation of what can be legitimately expected from family members and informal caregivers, informed by Frith's symbiotic empirical ethics approach, was undertaken. Key tenets from the special goods theory and nursing professionalism are used as analytical tools. The study concludes that the current situation may hinder professional development and can reinforce feelings of being a burden to relevant others. (shrink)

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable (...) of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health. (shrink)

Empirische Ethik ist ein relativ neues Vorgehen in der Ethikforschung, das vor allem in der Medizinethik angewandt wird. Dieser Beitrag bespricht die kennzeichnenden Charakteristika der empirischen Ethik und unterscheidet zwischen generalistischer und kontextualistischer empirischer Ethik. Zuerst werden verschiedene Beispiele beider Arten von empirischer Ethik vorgestellt, danach werden für beide Ansätze mögliche Schwachpunkte diskutiert. Die Schlussfolgerung des Beitrages besteht darin, dass das Entstehen der empirischen Ethik eine positive Entwicklung ist. Empirische Ethik sollte jedoch als eine Ergänzung der traditionellen philosophischen Medizinethik betrachtet (...) werden, und nicht als die bessere Alternative. (shrink)

ZusammenfassungEthische Fragen der Pflegepraxis haben sich in den letzten Jahren zugespitzt. Sie sind häufig verbunden mit einer grundsätzlichen Sorge um eine kompetente und verantwortliche Pflege, die den Bedürfnissen von Patient*innen gerecht wird. Forschungen aus drei Jahrzehnten zeigen, dass strukturelle Beschränkungen, Konflikte mit Kolleg*innen, Patient*innen und Angehörigen sowie eine Managementorientierung und die Unsichtbarkeit der Pflegearbeit, Ursachen für die grundsätzlichen Sorgen sind. Sie führen zu moralischem Stress, fehlenden Beziehungen und einer Fragmentierung der Pflege. Teilweise reagieren Pflegende widerständig, indem sie beispielsweise die Regeln (...) beugen und eine passive „wait and see“ Position einnehmen. Einige Pflegende erheben ihre Stimme und suchen ein Klinisches Ethikkomitee auf. Klinische Ethikkomitees bieten eine Möglichkeit, die komplexen ethischen Fragen der Pflegepraxis zu thematisieren. Allerdings verweisen die Studien aus drei Dekaden auf einen Mangel der Thematisierung. Die Analyse der Ursachen lässt die Schlussfolgerung zu, demokratischen Lernprozessen Raum zu geben. (shrink)

Die medizinischen Interventionen bei Intersexualität basieren auf den vorherrschenden gesellschaftlichen Geschlechtsnormen, die das intersexuelle Kind als behandlungsbedürftige Abweichung sehen. Aus diesem Blickwinkel wird unter „Heilung“ die erfolgreiche Integration des intersexuellen Individuums in ein eindeutig abgegrenztes Geschlecht verstanden, das durch eine medizinische Behandlung hergestellt wird. Dabei wird einerseits vorausgesetzt, dass unbehandelte intersexuelle Individuen nicht erfolgreich „heilen“ können, und andererseits, dass behandelte Individuen medizinische Interventionen als „Heilungsmaßnahmen“ erleben. Die Exploration der medizinischen Fachliteratur und der Berichte aus erster Hand sowohl von behandelten als (...) auch von unbehandelten Menschen mit Intersexualität lassen diese Vorannahmen fragwürdig erscheinen. In der Literatur wird nämlich belegt, dass als grundlegende Mittel, die tatsächlich bei diesen Menschen zu einer „Heilung“ führen, zentrale Werte wie Selbstakzeptanz der Andersartigkeit, Überwindung der Isolation durch Austausch mit anderen in ähnlichen Situationen und Wahrhaftigkeit von Bedeutung sind. Dies würde bedeuten, dass eine medizinische Intervention zur Überwindung der sozialen Ausgrenzung in Fällen von Intersexualität möglicherweise nicht die effektivste „Heilungsmaßnahme“ ist. Die medizinische Behandlung muss vielmehr darauf ausgerichtet werden, die Reaktion auf Intersexualität zu überwinden, als diesen Zustand selbst als pathologisch anzusehen. (shrink)

In diesem Beitrag sollen Iris Marion Youngs gerechtigkeitstheoretische Überlegungen zu Unterdrückungsformen und Mechanismen ihrer Stabilisierung zur Analyse der Situation der Pflege in Deutschland und der politischen Diskurse darüber fruchtbar gemacht werden. Ausgehend von Youngs These, dass das bloße Postulat formal gleichberechtigter Teilhabe unterschiedlicher Gruppen an politischen Meinungsbildungs- und Entscheidungsprozessen nicht automatisch auch zu deren gleichberechtigter und wirksamer Interessensvertretung führt, werden resultierende gesellschaftliche Ungerechtigkeiten, von denen Pflegende und die Pflege betroffen sind, den „Fünf Formen der Unterdrückung“ ihrer gleichnamigen Theorie zugeordnet. Diese (...) Unterdrückungsformen werden erläutert und auf die aktuelle Situation der Pflege hin interpretiert. Im Fazit wird der Bezug zum Thema gerechter Partizipation und damit ihre Bedeutung für die aktuellen pflegepolitischen Diskurse in sozial- und gerechtigkeitstheoretischer Perspektive betont. Die Analysen Youngs können zum Verständnis politischer Prozesse und zu deren bewussten Mitgestaltung durch Pflegende beitragen. Konsequenzen ergeben sich insbesondere für die Pflegepädagogik, da auf dieser Basis ein kritisches pflegepolitisches und professionelles Selbstverständnis gefördert werden kann. (shrink)

BackgroundThe bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other.MethodsBased on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices’ relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and (...) reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice.ResultsFirst, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy. (shrink)

This essay examines dominant notions of reproductive identity in feminist bioethics from a queer-crip perspective by considering the “reproductive situation” in Germany of people who are classified as disabled and people who are classified as queer. I analyze the ways in which such people are excluded from the understandings of reproductive identity that figure prominently in German feminist bioethics, and argue that feminist bioethics in Germany, which has become a well-established part of important bioethical institutions, reflects many, if not most, (...) of the neo-eugenic developments that characterize more recognizably mainstream bioethics. I also show that feminist bioethics constitutes the reproductive subject as nondisabled, intelligibly gendered, and heterosexual. (shrink)

Die Medikamentenversorgung während der Schwangerschaft stellt für die zu behandelnden Frauen und die behandelnden Ärzte gleichermaßen ein Problem dar. Eine „evidence based“ Therapie wirft allerdings die schwierigen Fragen auf, ob und inwiefern Arzneimittelforschung an schwangeren Frauen gerechtfertigt sein könnte und, wenn ja, unter welchen Bedingungen. In meinem Beitrag stelle ich die aktuelle Situation hinsichtlich Forschung und Therapie während der Schwangerschaft dar. Es folgt eine Darstellung von Ergebnissen aus Gesprächen, die mit schwangeren und frisch entbundenen Frauen geführt wurden. Abschließend werden die (...) Kernkonflikte der Debatte diskutiert, und es wird aufgezeigt, dass Arzneimittelforschung an schwangeren Frauen dringend geboten ist. Nur in einer geringen Anzahl von Studientypen ergeben sich tatsächlich problematische Fragen, zu deren Lösung verschiedene Argumentationslinien aufgezeigt werden. (shrink)

Zwischen Medizinethik und Behindertenbewegung besteht Uneinigkeit darüber, ob von einer Diskriminierung von behinderten Menschen durch biomedizinische Verfahren, wie der Pränatal- und der Präimplantationsdiagnostik, gesprochen werden kann. Dieser Konflikt beruht u. a. darauf, dass sich gesellschaftspolitische und ethische Argumente oft auf unterschiedlichen Ebenen bewegen. Während in der Ethik danach gefragt wird, ob durch die genannten Verfahren unmittelbar individuelle Rechte von Menschen mit Behinderungen verletzt werden, scheint es der Behindertenbewegung um die Verletzung des kollektiven Anspruches auf kulturelle Anerkennung zu gehen. Mit der (...) Unterscheidung verschiedener Anerkennungsverhältnisse in zwischenmenschlichen Beziehungen beabsichtigt der Beitrag, einen Rahmen für das Verständnis der Anliegen der Behindertenbewegung bereitzustellen. Daran anschließend wird eine Ethikkonzeption skizziert, die geeignet ist, die Argumente der Behindertenbewegung für eine konstruktive ethische Diskussion fruchtbar zu machen. (shrink)

Prenatal genetic analysis complicates problems of decision-making during pregnancy. After a brief summary of the new situation the article resumes the argumentation within the German feminist and the German church debate. The author proposes some activities for churches and theological arguments to support women's reproductive rights as well as the ebryos' right to live.