While we might associate ‘the unconscious’ with repression and the psychodynamic theories of Freud, 1 it has a more general sense and application that mean it is an important concept for contemporary ethics. Paying attention to the significance of associations, beliefs, presumptions and emotions that we have, but are not consciously attending to, is important for a more nuanced understanding of autonomy. Unconscious bias is an important issue for health education and clinical ethics, while beliefs and desires that are not (...) yet fully formed can be very important issues in therapy with younger people. The _Journal of Medical Ethics_ has published a number of papers over recent years that discuss the ways we frame clinical interactions and make decisions in the light of the unconscious. The recognition that we all have implicit, or unconscious biases should be acknowledged in health education and learning opportunities for addressing it created.... (shrink)

The central concerns of Hutchison’s paper are the under-representation and unequal pay of women in surgery and the role that subtle gender biases play in explaining these phenomena. My comments focus on how well executed and important this work is and also why we need more of it to fully understand the gravity of the situation for women in surgery and how it compares with similar situations for women in other fields.

This paper argues that a major contribution to women’s under-representation and the gender pay gap in surgery is the interaction and aggregation of many small wrongs, or as they have come to be called in the literature, microinequities. Further, the paper argues that existing strategies do not adequately address the problems faced by women surgeons and cannot do so without an understanding of those wrongs as microinequities. Insights from the literature on ethics and microinequities are thought to be able to (...) inform new strategies.1 The study identifies four different kinds of gender bias: workplace discrimination, epistemic injustice, stereotyped roles and objectification. The different kinds of gender bias interact with one another and add up in ways that pose serious setbacks to the careers of women surgeons. In addition to being small wrongs, microinequities share other features. They are cumulative; they interact with one other; they are often invisible; and they are implicit or unintended. My comments are going to focus on the response to microinequities, …. (shrink)

In this paper, I expand our framework for epistemic injustice by shifting focus from epistemic evaluations of individuals in information exchange to epistemic evaluations of individuals engaging their know-how in performance. I call the injustice to individuals qua knowers-how performative injustice, and I argue that performative injustice has distinct features worth understanding apart from varieties of epistemic injustice devoted to information exchange. I develop an account of the performative authority that is unfairly evaluated in cases of performative injustice and show (...) how, in some cases, cognitive penetration can affect observers’ evaluations. Finally, I show how stereotype threat may short circuit what would otherwise be cases of performative injustice, which in turn reveals the significance of its systemic manifestations. (shrink)