This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

In her excellent and comprehensive article, Friesen argues that utilising personal responsibility in healthcare is problematic in several ways: it is difficult to ascribe responsibility to behaviour; there is a risk of prejudice and bias in deciding which behaviours a person should be held responsible for; it may be ineffective at reducing health costs. In this short commentary, I will elaborate the critique of personal responsibility in health but suggest one way in which it could be used ethically. In doing (...) so, I will introduce the concepts of reasonable risk and golden opportunity. I previously argued that it is both difficult to disentangle responsibility and that we risk prejudice and bias in singling out behaviours that are socially disapproved of.1 So I am sympathetic to Friesen’s concerns. I also discussed another way in which ascribing personal responsibility for health is problematic which Friesen does not discuss and which, in my view, is the most concerning and further supports her arguments. It represents a back door assault on liberalism and neutrality towards concepts of the good life. Even if one were to accurately and in an unbiased way divine the personal contribution to disease, the greatest problem would remain: those who voluntarily take on risk would be penalised. That is, such a system would be risk-averse. Those lives which avoided risk would be prioritised, while those who chose to take on risky activities in their conception of the good life would be penalised. Yet risk is necessary, both for the good life, and social progress. Columbus, Edmund Hilary, Florence Nightingale, Ernest Hemingway and countless monumental figures in human history took risks in order to achieve something great. Should we aim for a society of trembling, teetotalling health nuts? Surely that prospect is horrific. It is horrific because it elevates health …. (shrink)

Published in the American Journal of Bioethics.

It is always awkward when someone asks me informally what I’m working on and I answer that I’m trying to figure out what gender is. For outside a rather narrow segment of the academic world, the term ‘gender’ has come to function as the polite way to talk about the sexes. And one thing people feel pretty confident about is their knowledge of the difference between males and females. Males are those human beings with a range of familiar primary and (...) secondary sex characteristics, most important being the penis; females are those with a different set, most important being the vagina or, perhaps, the uterus. Enough said. Against this background, it isn’t clear what could be the point of an inquiry, especially a philosophical inquiry, into “what gender is”. (shrink)

What’s important about ‘coming out’? Why do we wear business suits or Star Trek pins? Part of the answer, we think, has to do with what we call agential identity. Social metaphysics has given us tools for understanding what it is to be socially positioned as a member of a particular group and what it means to self-identify with a group. But there is little exploration of the general relationship between self-identity and social position. We take up this exploration, developing (...) an account of agential identity—the self-identities we make available to others. Agential identities are the bridge between what we take ourselves to be and what others take us to be. Understanding agential identity not only fills an important gap in the literature, but also helps us explain politically important phenomena concerning discrimination, malicious identities, passing, and code-switching. These phenomena, we argue, cannot be understood solely in terms of self-identity or social position. (shrink)

In this peer commentary on Maura Priest's "Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm", I argue against the "mismatch" model of trans identity. On this model, which is prevalent in institutional and medical contexts, to be trans is to have one's gender identity "mismatch" with one's sexed body.

We want to know what gender is. But metaphysical approaches to this question solely have focused on the binary gender kinds men and women. By overlooking those who identify outside of the binary–the group I call ‘genderqueer’–we are left without tools for understanding these new and quickly growing gender identifications. This metaphysical gap in turn creates a conceptual lacuna that contributes to systematic misunderstanding of genderqueer persons. In this paper, I argue that to better understand genderqueer identities, we must recognize (...) a new type of gender kind: critical gender kinds, or kinds whose members collectively destabilize one or more pieces of dominant gender ideology. After developing a model of critical gender kinds, I suggest that genderqueer is best modeled as a critical gender kind that destabilizes the ‘binary axis’, or the piece of dominant gender ideology that says that the only possible genders are the binary, discrete, exclusive, and exhaustive kinds men and women. (shrink)

Chinese translation courtesy of Zhuanxu Xu. We want to know what gender is. But metaphysical approaches to this question solely have focused on the binary gender kinds men and women. By overlooking those who identify outside of the binary–the group I call ‘genderqueer’–we are left without tools for understanding these new and quickly growing gender identifications. This metaphysical gap in turn creates a conceptual lacuna that contributes to systematic misunderstanding of genderqueer persons. In this paper, I argue that to better (...) understand genderqueer identities, we must recognize a new type of gender kind: critical gender kinds, or kinds whose members collectively resist dominant gender ideology. After developing a model of critical gender kinds, I suggest that genderqueer is best modeled as a critical gender kind that stands in opposition to `the binary assumption', or the prevalent assumption that the only possible genders are the binary, discrete, exclusive, and exhaustive kinds men and women. (shrink)