Routine infant circumcision is one of the most common surgical procedures performed in the U.S. Despite its broad societal acceptance, the practice is not without controversy. The stories included in this symposium offer rich insight into the diverse set of attitudes, values, and beliefs related to the practice of circumcision. They additionally offer insight into the complex web of personal, interpersonal, and social dynamics that inform the circumcision choices parents make for their children, the reasons parents make them, and how (...) others can influence decisional choices. More broadly, these narratives raise important ethical questions mirrored today in broader contemporary bioethical and public discourse on the scope and limits of parental authority to make decisions for their children, power dynamics in medical decision making, and the ethics of healthcare activism. In this commentary, I discuss three sets of themes related to the ethics of circumcision running through the symposium narratives, comment on the ethical tensions and questions which emerge from each set of themes, gently problematize some of the rhetoric surrounding the ethical permissibility of circumcision, and gesture towards the future of bioethical inquiry on circumcision discourse. (shrink)

This article explores the relationship between gender, technology, language, and how infants and children born with disorders of sexual development are shaped into intelligible members of the community. The contemporary medical model maintains that children ought to be both socially and surgically assigned and reared as one particular gender. Gender scholar Suzanne Kessler rejects this position and argues for the acceptance of greater genital variability through the use of language. Using a Heideggerian lens, the main question I seek to answer (...) in this article is: does Kessler’s approach succeed in its aim to better treat individuals born with disorders of sexual development? I argue that Kessler is successful in offering practical solutions for persons with intersexed conditions to exist and flourish as intelligible members of the community, but that her project ultimately relies on power to “challenge forth” greater acceptance of genital variance. Building on the work of Kessler and Heidegger, I argue that a better approach to making intelligible the existence of an infant born with a disorder of sexual development is not to rely on the manipulation of language, but to instead reinvigorate a sense of the sacred in response to having an intersex condition. (shrink)

The concept of scale is useful in analyzing both the strengths and limitations of community food security programs that attempt to link issues of ecological sustainability with social justice. One scalar issue that is particularly important but under-theorized is the scale of social reproduction, which is often neglected in production-focused studies of globalization. FoodShare Toronto's good food box (GFB) program, engages people in the politics of their everyday lives, empowering them to make connections between consumption patterns and broader political-economic, cultural, (...) and political-ecological issues. Community food security (CFS) projects such as the GFB are currently limited in their scope and reach and have been criticized for their inability to deliver food to a larger segment of marginalized, hungry people. A central dilemma for CFS projects is how to engage the majority of urban consumers who still eat “inside the box” of the industrial food system. We argue that the concept of scale helps clarify how CFS projects must “scale out” to other localities, as well as “scale up” to address structural concerns like state capacity, industrial agriculture, and unequal distribution of wealth. This requires the state and the third sector to recognize the importance of multi-scaled food politics as well as a long-term pedagogical project promoting ecological sustainability, social responsibility, and the pleasures of eating locally. (shrink)

Steve Baker’s Artist/Animal focuses on a collection of interviews with contemporary artists whose work engages with nonhuman animal life. The text centralizes artists+ voices regarding their interpretations and interactions with animals and their art. Through a mix of both interviews and posthumanist theory, Baker provides context for artists who use animals in their work, either figuratively or literally, or both. Against reactivity and moralizing, Baker+s thesis concentrates on the key importance of attention in relation to art.

Maximize Expected Choiceworthiness (MEC) is a theory of decision-making under moral uncertainty. It says that we ought to handle moral uncertainty in the way that Expected Value Theory (EVT) handles descriptive uncertainty. MEC inherits from EVT the problem of fanaticism. Roughly, a decision theory is fanatical when it requires our decision-making to be dominated by low-probability, high-payoff options. Proponents of MEC have offered two main lines of response. The first is that MEC should simply import whatever are the best solutions (...) to fanaticism on offer in decision theory. The second is to propose statistical normalization as a novel solution on behalf of MEC. This paper argues that the first response is open to serious doubt and that the second response fails. As a result, MEC appears significantly less plausible when compared to competing accounts of decision-making under moral uncertainty, which are not fanatical. (shrink)

Two decades ago, in 1994, in the context of the 4th EU Framework Programme, ELSA was introduced as a label for developing and funding research into the ethical, legal and social aspects of emerging sciences and technologies. Currently, particularly in the context of EU funding initiatives such as Horizon2020, a new label has been forged, namely Responsible Research and Innovation. What is implied in this metonymy, this semantic shift? What is so new about RRI in comparison to ELSA? First of (...) all, for both labels, the signifier was introduced in a top-down manner, well before the concept that was signified by it had acquired a clear and stable profile. In other words, the signifier preceded the research strategies actually covered by these labels. Moreover, the newness of RRI does not reside in its interactive and anticipatory orientation, as is suggested by authors who introduced the term, but rather in its emphases on social-economic impacts. (shrink)

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein (...) the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

According to comparativist theories of quantities, their intrinsic values are not fundamental. Instead, all the quantity facts are grounded in scale-independent relations like "twice as massive as" or "more massive than." I show that this sort of scale independence is best understood as a sort of metaphysical symmetry--a principle about which transformations of the non-fundamental ontology leave the fundamental ontology unchanged. Determinism--a core scientific concept easily formulated in absolutist terms--is more difficult for the comparativist to define. After settling on the (...) most plausible comparativist understanding of determinism, I offer some examples of physical systems that the comparativist must count as indeterministic although the relevant physical theory gives deterministic predictions. Several morals are drawn. In particular: comparativism is metaphysically contingent if true, and it is most natural for a comparativist to accept an at-at theory of motion. (shrink)

Poor Eliza -- Pax Americana : the case of Show boat -- National brands, national body : Imitation of life -- Uncle Sam needs a wife : citizenship and denegation -- Remembering love, forgetting everything else : Now, voyager -- "It's not the tragedies that kill us, it's the messes" : femininity, formalism, and Dorothy Parker -- The compulsion to repeat femininity : Landscape for a good woman and The life and loves of a she-devil.

I argue against pessimistic readings of the Buddhist tradition on which unawakened beings invariably have lives not worth living due to a preponderance of suffering (duḥkha) over well-being.

A fundamental goal of research in neuroscience is to uncover the causal structure of the brain. This focus on causation makes sense, because causal information can provide explanations of brain function and identify reliable targets with which to understand cognitive function and prevent or change neurological conditions and psychiatric disorders. In this research, one of the most frequently used causal concepts is ‘mechanism’ — this is seen in the literature and language of the field, in grant and funding inquiries that (...) specify what research is supported, and in journal guidelines on which contributions are considered for publication. In these contexts, mechanisms are commonly tied to expressions of the main aims of the field and cited as the ‘fundamental’, ‘foundational’ and/or ‘basic’ unit for understanding the brain. Despite its common usage and perceived importance, mechanism is used in different ways that are rarely distinguished. Given that this concept is defined in different ways throughout the field — and that there is often no clarification of which definition is intended — there remains a marked ambiguity about the fundamental goals, orientation and principles of the field. Here we provide an overview of causation and mechanism from the perspectives of neuroscience and philosophy of science, in order to address these challenges. (shrink)

The desire to minimize the number of individual new entities postulated is often referred to as quantitative parsimony. Its influence on the default hypotheses formulated by scientists seems undeniable. I argue that there is a wide class of cases for which the preference for quantitatively parsimonious hypotheses is demonstrably rational. The justification, in a nutshell, is that such hypotheses have greater explanatory power than less parsimonious alternatives. My analysis is restricted to a class of cases I shall refer to as (...) additive. Such cases involve the postulation of a collection of qualitatively identical individual objects which collectively explain some particular observed phenomenon. Especially clear examples of this sort occur in particle physics. 1 Introduction 2 Particle physics: a case study 3 Three kinds of simplicity 4 Explanatory power 5 Explanation and non-observation 6 Parsimony and scientific methodology 7 Conclusions. (shrink)

The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, (...) which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medical ethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names. (shrink)

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

Slurring language has had a lot of recent interest, but the focus has been almost exclusively on racial slurs. Gendered pejoratives, on the other hand—terms like “slut,” “bitch,” or “sissy”—do not fit into existing accounts of slurring terms, as these accounts require the existence of neutral correlates, which, I argue, these gendered pejoratives lack. Rather than showing that these terms are not slurs, I argue that this challenges the assumption that slurs must have neutral correlates, and so that a new (...) approach to thinking about the meaning of slurring terms is required. (shrink)

In the last two decades few topics in philosophy of science have received as much attention as mechanistic explanation. A significant motivation for these accounts is that scientists frequently use the term “mechanism” in their explanations of biological phenomena. While scientists appeal to a variety of causal concepts in their explanations, many philosophers argue or assume that all of these concepts are well understood with the single notion of mechanism. This reveals a significant problem with mainstream mechanistic accounts– although philosophers (...) use the term “mechanism” interchangeably with other causal concepts, this is not something that scientists always do. This paper analyses two causal concepts in biology–the notions of “mechanism” and “pathway”–and how they figure in biological explanation. I argue that these concepts have unique features, that they are associated with distinct strategies of causal investigation, and that they figure in importantly different types of explanation. (shrink)

That testimony is one of the principle bases on which many people hold their religious beliefs is hard to dispute. Equally hard to dispute is that our world contains an array of mutually incompatible religious traditions each of which has been transmitted down the centuries chiefly by way of testimony. In light of this latter it is quite natural to think that there is something defective about holding religious beliefs primarily or solely on the basis of testimony from a particular (...) tradition. The present chapter takes up the question of what that defect consists in. I first consider whether religious diversity entails that a religious believer’s testimony-based beliefs are not formed in a suitably epistemically reliable manner even conditional upon the truth of her religion. After casting doubt on this thought I turn to look at the idea that testimony-based beliefs are subject to defeaters in light of awareness of religious diversity, and I suggest that many such beliefs are not obviously so. According to my diagnosis the problem, rather, is that believers who base their religious beliefs just on testimony will be very unlikely to have reflective (that is, second-order) knowledge even if they possess first-order knowledge, and I explain why this is a notable shortcoming. (shrink)

_Twenty-First Century Inequality & Capitalism: Piketty, Marx and Beyond_ is a collection of critical essays on the economist’s iconic 2014 book, from the perspective of critical theory, global political economy or public sociology, mostly drawn from the Marxist tradition.

THE TITLE W. used the title 'Philosophische Untersuchungen, Versuch einer Umar- beitung' as the heading of his 1936 revision of Br. B. in Vol. ...

The idea that introspection is transparent—that we know our minds by looking out to the world, not inwards towards some mental item—seems quite appealing when we think about belief. It seems that we know our beliefs by attending to their content; I know that I believe there is a café nearby by thinking about the streets near me, and not by thinking directly about my mind. Such an account is thought to have several advantages—for example, it is thought to avoid (...) the need to posit any extra mental faculties peculiar to introspection. In this paper I discuss recent attempts to extend this kind of outwards-looking account to our introspective knowledge of desire. According to these accounts, we know our desires by attending to what in the world we judge to be valuable. This, however, does not deal satisfactorily with cases where my value judgments and introspective knowledge of my desires come apart. I propose a better alternative for the proponent of transparency, but one that requires giving up on the supposed metaphysical advantages. (shrink)

This article considers the contemporary effective altruism (EA) movement from a classical Indian Buddhist perspective. Following barebones introductions to EA and to Buddhism (sections one and two, respectively), section three argues that core EA efforts, such as those to improve global health, end factory farming, and safeguard the long-term future of humanity, are futile on the Buddhist worldview. For regardless of the short-term welfare improvements that effective altruists impart, Buddhism teaches that all unenlightened beings will simply be reborn upon their (...) deaths back into the round of rebirth (samsāra), which is held to be undesirable due to the preponderance of duhkha (unsatisfactoriness, dis-ease, suffering) over well-being that characterizes unenlightened existence. This is the samsāric futility problem. Although Buddhists and effective altruists disagree about what ultimately helps sentient beings, section four suggests that Buddhist-EA dialogue nonetheless generates mutually-instructive insights. Buddhists – including contemporaries, such as those involved in Socially Engaged Buddhism – might take from EA a greater focus on explicit prioritization research, which seeks knowledge of how to do the most good we can, given our finite resources. EA, for its part, has at least two lessons to learn. First, effective altruists have tended to assume that the competing accounts of welfare converge in their practical implications. The Buddhist conception of the pinnacle of welfare as a state free from duhkha and, correspondingly, the Buddhist account of the path that leads to this state weigh against this assumption. Second, contrasting Buddhist with effective altruist priorities shows that descriptive matters of cosmology, ontology, and metaphysics can have decisive practical implications. If EA wants to give a comprehensive answer to its guiding question – “how can we do the most good?” – it must argue for, rather than merely assume, the truth of secular naturalism. (shrink)

The expression ‘nonreductive materialism’ refers to a variety of positions whose roots lie in attempts to solve the mind-body problem. Proponents of nonreductive materialism hold that the mental is ontologically part of the material world; yet, mental properties are causally efficacious without being reducible to physical properties.s After setting out a minimal schema for nonreductive materialism (NRM) as an ontological position, I’ll canvass some classical arguments in favor of (NRM).1 Then, I’ll discuss the major challenge facing any construal of (NRM): (...) the problem of mental causation, pressed by Jaegwon Kim. Finally, I’ll offer a new solution to the problem of mental causation. (shrink)

Kaplan and Craver claim that all explanations in neuroscience appeal to mechanisms. They extend this view to the use of mathematical models in neuroscience and propose a constraint such models must meet in order to be explanatory. I analyze a mathematical model used to provide explanations in dynamical systems neuroscience and indicate how this explanation cannot be accommodated by the mechanist framework. I argue that this explanation is well characterized by Batterman’s account of minimal model explanations and that it demonstrates (...) how relationships between explanatory models in neuroscience and the systems they represent is more complex than has been appreciated. (shrink)

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

Dispositional ascriptions do not entail the counterfactuals we might expect, as interfering factors may be poised to prevent the disposition from manifesting in its very stimulus conditions. Such factors are commonly called finks and masks. It is thought, however, that finks and masks cannot be intrinsic to the disposition bearer; if an intrinsic property of the object would prevent a particular response in certain conditions, the object fails to have the corresponding disposition. I argue that we should accept intrinsic finks (...) and masks if we think there are finks and masks at all, and also if we maintain that paradigmatic dispositions are intrinsic. This last point is particularly problematic for the claim that there cannot be intrinsic finks and masks, for if paradigmatic dispositions are not intrinsic then the central argument for the impossibility of intrinsic finks and masks is undermined. (shrink)

According to mainstream philosophical views causal explanation in biology and neuroscience is mechanistic. As the term ‘mechanism’ gets regular use in these fields it is unsurprising that philosophers consider it important to scientific explanation. What is surprising is that they consider it the only causal term of importance. This paper provides an analysis of a new causal concept—it examines the cascade concept in science and the causal structure it refers to. I argue that this concept is importantly different from the (...) notion of mechanism and that this difference matters for our understanding of causation and explanation in science. (shrink)

_Twenty-First Century Inequality & Capitalism: Piketty, Marx and Beyond_ is a collection of critical essays on the economist’s iconic 2014 book, from the perspective of critical theory, global political economy or public sociology, mostly drawn from the Marxist tradition.

This article explores the question of the role of religion in the public square through the lens of Richard Rorty’s more general public–private distinction. When we note his various positions over the years on the role of religion in the public square we observe a shift that yields a more favorable public role for religion so long as it limits itself to social action and refrains from making knowledge-claims that serve as tools of the powerful. But if, according to Rorty, (...) religion per se is no longer the problem, then what becomes of his efforts to endorse a more general public–private distinction? The argument set forth assesses the inadequacies and limitations of Rorty’s assumptions about the public–private split and suggests another way of framing the issue that will prove productive in debates concerning the role of religion in the public square. (shrink)

In this paper, I identify a form of epistemic insensitivity that occurs when someone fails to make proper use of the epistemic tools at their disposal in order to bring their beliefs in line with epistemically relevant evidence that is available to them. I call this kind of insensitivity agential insensitivity because it stems from the epistemic behavior of an individual agent. Agential insensitivity can manifest as a failure to either attend to relevant and available evidence, or appropriately interpret evidence (...) that is attended to. The concept of agential insensitivity allows us to conceptualize the kind of not-knowing involved in forms of ignorance that are cultivated and maintained by individual agents, especially when this ignorance is enabled or encouraged by social structures. I use the skepticism about racial disparities in policing practices that is displayed by many white Americans as a lens for exploring this connection. Understanding agential insensitivity thus provides insight into both social and epistemic phenomena. (shrink)

While there is now considerable anxiety about whether the psychological theory presupposed by virtue ethics is empirically sustainable, analogous issues have received little attention in the virtue epistemology literature. This paper argues that virtue epistemology encounters challenges reminiscent of those recently encountered by virtue ethics: just as seemingly trivial variation in context provokes unsettling variation in patterns of moral behavior, trivial variation in context elicits unsettling variation in patterns of cognitive functioning. Insofar as reliability is a condition on epistemic virtue, (...) we have reason to doubt that human beings possess the cognitive materials required for epistemic virtue, and thereby reason to think that virtue epistemology is threatened by skepticism. We conclude that while virtue epistemology has resources for addressing this challenge, exploiting these resources forces tradeoffs between empirical and normative adequacy. (shrink)

In his article ‘Divine hiddenness and the demographics of theism’ (Religious Studies, 42 (2006), 177-191) Stephen Maitzen develops a novel version of the atheistic argument from divine hiddenness according to which the lopsided distribution of theistic belief throughout the world’s populations is much more to be expected given naturalism than given theism. I try to meet Maitzen’s challenge by developing a theistic explanation for this lopsidedness. The explanation I offer appeals to various goods that are intimately connected with the human (...) cognitive constitution, and in particular, with the way in which we depend upon social belief forming practices for our acquisition of much of our knowledge about the world – features about us that God would value but that also make probable a lopsided distribution of theistic belief, or so I argue. (shrink)

This book debates competing approaches to ethical decision-making for members of the armed forces of liberal-democratic states. In this volume, four prominent thinkers propose and debate competing approaches to ethical decision-making for military personnel. Deane-Peter Baker presents and expounds the 'Ethical Triangulation' model, an ethical decision-making method he has employed through much of his career as an applied military ethicist. Rufus Black advocates for a natural law-based approach, one which has heavily influenced the framework formally adopted by the Australian (...) Defence Force. Roger Herbert outlines the 'Moral Deliberation Roadmap', the moral reasoning framework recently adopted by the US Naval Academy. Iain King then sets out a model of quasi-utilitarian decision-making developed in several post-conflict settings and refined at the UK's Royal College of Defence Studies. After the opening chapters in which each author outlines their favoured decision-making approach, the four contributors then evaluate each other's proposals, often critically. Philosopher David Whetham offers some concluding thoughts in which he summarises areas of agreement between the authors, identifies key areas of difference, and suggests directions for future research. This book will be of great interest to students of military ethics, the ethics of war, moral philosophy, and International Relations, as well as military professionals. (shrink)

This book draws on the hermeneutics of Hans-Georg Gadamer to inform a feminist perspective of social identities. Lauren Swayne Barthold moves beyond answers that either defend the objective nature of identities or dismiss their significance altogether. Building on the work of both hermeneutic and non-hermeneutic feminist theorists of identity, she asserts the relevance of concepts like horizon, coherence, dialogue, play, application, and festival for developing a theory of identity. This volume argues that as intersubjective interpretations, social identities are vital (...) ways of fostering meaning and connection with others. Barthold also demonstrates how a hermeneutic approach to social identities can provide critiques of and resistance to identity-based oppression. (shrink)

Deliberation often begins with the question ‘What do I want to do?’ rather than the question of what one ought to do. This paper takes that question at face value, as a question about which of one’s desires is strongest, which sometimes guides action. The paper aims to explain which properties of a desire make that desire strong, in the sense of ‘strength’ relevant to this deliberative question. Both motivational force and phenomenological intensity seem relevant to a desire’s strength; however, (...) accounting for the strength of a desire in these terms opens up significant indeterminacy about what we want. The paper argues that this indeterminacy is often resolved simply by posing the question ‘What do I want to do?’ to oneself: there is reason to believe that one’s answer will play a verdictive role, partially determining what the agent most wants. Self-reflective beliefs can play a self-fulfilling role, and surprisingly this seems to follow from basic platitudes about the belief-desire model. (shrink)

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the ethical defensibility (...) of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)