To what extent should we focus on implicit bias in order to eradicate persistent social injustice? Structural prioritizers argue that we should focus less on individual minds than on unjust social structures, while equal prioritizers think that both are equally important. This article introduces the framework of transactive memory into the debate to defend the equal priority view. The transactive memory framework helps us see how structure can emerge from individual interactions as an irreducibly social product. If this is right, (...) then debiasing interventions are structural interventions. One upshot is that the utility of the individual versus structural distinction is not apparent for the purposes of intervention. (shrink)

This paper presents the early findings of research into the experiences of pain for those who live with chronic pain and engage in BDSM (bondage and discipline, domination and submission, sadism and masochism), explored using a critical crip approach rooted in crip theory and feminist disability studies. The research took the form of a series of interviews with eight disabled people living with chronic pain who experience pain in their BDSM practices, developing a narrative of experiences. The majority of those (...) living with chronic pain, or who have diagnoses of chronic illnesses causing chronic pain, are women. Chronic pain is frequently assumed to be similar to acute pain; however, thinking through pain in terms of normativity and able-bodymindedness reveals the ableist structures that underpin normative attitudes towards pain and those who are in pain. Pain is understood as dehumanising—and thus the person living with chronic pain is understood as not human, abnormal, and disabled. The disabled body, the body in pain, is a horrifying object of abjection, and the non-disabled observer assumes that to be in pain is to suffer; therefore, living with chronic pain is understood as an ontological impossibility and must be stopped. BDSM is a series of practices forming a space in which the people living with chronic pain in this study are able to engage with their somatic experience in ways that do not expect normalcy, while being disabled and living with chronic pain gives them space to explore non-normative sexual practices. (shrink)

Women are over-represented within alternative medicine, both as consumers and as service providers. In this paper, I show that the appeal of alternative medicine to women relates to the neglect of women’s health needs within scientific medicine. This is concerning because alternative medicine is severely limited in its therapeutic effects; therefore, those who choose alternative therapies are liable to experience inadequate healthcare. I argue that while many patients seek greater autonomy in alternative medicine, the absence of an evidence base and (...) plausible mechanisms of action leaves patients unable to realize meaningful autonomy. This seems morally troubling, especially given that the neglect of women’s needs within scientific medicine seems to contribute to preferences for alternative medicine. I conclude that the liberatory credentials of alternative medicine should be questioned and make recommendations to render scientific medicine better able to meet the needs of typical alternative medicine consumers. (shrink)

Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone’s words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of (...) narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient’s gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as “testimonial injustice,” the prima facie harm experienced by individuals whose credibility is undermined by others’ prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling. (shrink)

Among those who discuss America's opioid crisis, it is popular to claim that we know what we, as a society, ought to do to solve the problem—we simply don't want it badly enough. We don't lack knowledge; we lack the will to act and to fund the right policies. In fact, I've heard two versions of this. Among those who focus on prescription opioids, it is clear that we ought to stop prescribing so many powerful opioid painkillers. And among my (...) public health colleagues focusing on illicit drug use, it is clear that we ought to expand addiction treatment and harm‐reduction services. The problem, however, is that the second claim is not obvious (and, indeed, is denied by many Americans), and the first claim probably isn't even true (at least, not in so crude a form). In short, the opioid crisis presents not only a problem of political will but also one of ethics. It will take work to discover or justify our normative claims in this arena. (shrink)

Members of the lay public are turning increasingly to the internet to answer health-related questions. Some authors suggest that the widespread availability of online health information has dislodged medical knowledge from its traditional institutional base and enabled a growing role for alternative or previously unrecognized health perspectives and ‘lay health expertise’. Others have argued, however, that the organization of information retrieved from influential search engines, particularly Google, has merely intensified mainstream perspectives because of the growing consolidation of the internet with (...) traditional, commercial media sources. In this paper we describe an analysis of ‘first page’ results retrieved through Google searches about several common health concerns, each of which has been the subject of controversy as a result of uncertain aetiology, diagnoses, outcomes and/or contested approaches to treatment. Our findings suggest that the online search tactics used by most lay health information seekers produce sources of information that, for the most part, reflect mainstream biomedical discourses, often linked to commercial interests, rather than a plurality of voices that offer a variety of perspectives and resources. We discuss the implications for health-interested internet searchers who fail to look beyond the ‘first page’. (shrink)

In this paper, I argue that women who experience fibromyalgia may find themselves in a double bind. They may feel the need to describe their pain as extreme weakness or violence to convince health care providers and loved ones of the severity of it, but having to describe themselves repeatedly in these ways may be internalized and lead to a diminished sense of agency, especially in a culture that already systematically denigrates the strength and credibility of women.

Dans les discussions concernant la sous-représentation des femmes dans le domaine de la philosophie professionnelle, ceux et celles qui sont sceptiques quant à l’explication par la discrimination suggèrent souvent que les différences de genre dans les intérêts constituent une autre hypothèse possible. Certain.e.s croient que si les intérêts différents des femmes expliquaient la sous-représentation, les interventions suggérées par l’hypothèse de la discrimination ne seraient pas nécessaires, voire seraient risquées. Je maintiens qu’on doit considérer la façon dont les stéréotypes exerceraient une (...) influence sur les intérêts, et que ce faisant, on peut offrir une évaluation plus équilibrée des risques découlant des interventions proposées. (shrink)

We are grateful to everyone who took the time to offer such insightful comments with regard to the protection–inclusion dilemma in research oversight. Nearly all respondents agreed that this dilemm...

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician–patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that (...) are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients—in this case, pregnant women—become what I call “epistemic peers.”. (shrink)

The reception of Elaine Scarry’s landmark text, The Body in Pain, focuses in part on exploring how pain might be understood as beneficial or therapeutic. Childbirth is often cited as the paradigmatic instance of this kind of beneficial pain. This essay examines conceptualizations of labour pain in biomedical, natural childbirth and reproductive justice movements that explore the limits of Scarry’s description of pain as ‘unshareable’. Political struggles over pain in childbirth centre on the legibility of pain in labour. Feminist and (...) natural childbirth activists have developed an understanding of pain at birth as central to maternal subjectivity, where pain is a biopolitical force and its management a means of self-transformation. Alongside calls for reproductive justice, the essay considers how the visibility and expressivity of labour pain could contribute to what Imogen Tyler and Lisa Baraitser term a new ‘natal politics’ that addresses concerns for the disproportionate injury and death experienced by Black birth givers. (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)

I argue that epistemic injustice manifests not only in the content of our concepts, but in the spaces between them. Others have shown that epistemic injustice arises in the form of “testimonial injustice,” where an agent is harmed because her credibility is undervalued, and “hermeneutical injustice,” where an agent is harmed because some community lacks the conceptual resources that would allow her to render her experience intelligible. I think that epistemic injustice also arises as a result of prejudiced and harmful (...) defects in the inferential architecture of both scientific practice and everyday thinking. Drawing on lessons from the philosophy of science, I argue that the inferential architecture of our epistemic practices can be prejudiced and wrongful, leading to a variety of epistemic injustice that I am calling “inferential injustice.” This type of injustice is fully structural; it inheres in our epistemic practices themselves rather than as a direct result of an individual’s action. For this reason, cases of inferential injustice are importantly different from extant cases of epistemic injustice and are especially hard to track. We need a better understanding of inferential injustice so that we can avoid and ameliorate cases such as the ones I present here. (shrink)

Journal of Social Philosophy, EarlyView.

Who was truly capable of experiencing pain? In this article, I explore ideas about the distribution of bodily sensitivity in patients from the early nineteenth century to 1965 in Anglo-American societies. While certain patients were regarded as “truly hurting,” other patients’ distress could be disparaged or not even registered as being “real pain.” Such judgments had major effects on regimes of pain-alleviation. Indeed, it took until the late twentieth century for the routine underestimation of the sufferings of certain groups of (...) people to be deemed scandalous. Often the categorizations were contradictory. For instance, the humble status of workers and immigrants meant that they were said to be insensitive to noxious stimuli; the profound inferiority of these same patients meant that they were especially likely to respond with “exaggerated” sensitivity. How did physicians hold such positions simultaneously? Pain-assignation claimed to be based on natural hierarchical schemas, but the great Chain of Feeling was more fluid than it seemed. (shrink)

This paper aims to problematize pregnancy and support the development of a safe alternative method of gestation. Our arguments engage with the health risks of gestation and childbirth, the value assigned to pregnancy, as well as social and medical attitudes toward women’s pain, especially in labor. We claim that the harm caused by pregnancy and childbirth provides a prima facie case in favor of prioritizing research on a method of extra corporeal gestation.

This essay explores the contemporary experiences of women who live with pain, given the complex responses they encounter within Western medical systems, including pervasive stigma, bias, clinician disbelief, and poor health outcomes. In response to these realities, as highlighted within recent literature and exemplified in a first-person account provided by the paper’s author, this essay explores the Christian practice of the Stations of the Cross as a faithful response to women living with pain. The Stations provide a distinctive Christian practice (...) that invites women living with pain, as well as their clinicians and loved ones, into faithful care marked by prayer, solidarity, and hospitable listening. Practicing the Stations provides one faithful response that Christian clinicians and those who live with pain might engage in the clinic and beyond. (shrink)