• Medical Ethics and the Land Ethic
    In Deborah C. Poff & Alex C. Michalos (eds.), Encyclopedia of Business and Professional Ethics, Springer Verlag. pp. 1320-1325. 2021.
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    Understanding the autonomy of adults with impaired capacity through dialogue
    with Simon Bell, Daniel Blackburn, Jon Dickson, Markus Reuber, and Traci Walker
    Journal of Medical Ethics 49 (7): 493-494. 2023.
    Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not jus…Read more
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    The hermeneutics of symptoms
    with Markus Reuber
    Medicine, Health Care and Philosophy 25 (3): 395-412. 2022.
    The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms ar…Read more
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    Health justice in the Anthropocene: medical ethics and the Land Ethic
    Journal of Medical Ethics 46 (12): 791-796. 2020.
    Industrialisation, urbanisation and economic development have produced unprecedented improvements in human health. They have also produced unprecedented exploitation of Earth’s life support systems, moving the planet into a new geological epoch, the Anthropocene—one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role—the environmental threats that will shape human health in this century represent a ‘perf…Read more
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    Does clinical ethics need a Land Ethic?
    Medicine, Health Care and Philosophy 22 (4): 531-543. 2019.
    A clinical ethics fit for the Anthropocene—our current geological era in which human activity is the primary determinant of environmental change—needs to incorporate environmental ethics to be fit for clinical practice. Conservationist Aldo Leopold’s essay ‘The Land Ethic’ is probably the most widely-cited source in environmental philosophy; but Leopold’s work, and environmental ethics generally, has made little impression on clinical ethics. The Land Ethic holds that “A thing is right when it t…Read more
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    Liberal individualism, relational autonomy, and the social dimension of respect
    International Journal of Feminist Approaches to Bioethics 8 (1): 37-66. 2015.
    The principle of respect for autonomy in clinical ethics is frequently linked to bioethics’ neglect of community-level ethical considerations. I argue that the latter is not an inevitable consequence of the former; rather, that neglect results from a common interpretation of respect for autonomy in solely synchronic and individual terms. A relational understanding of autonomy reveals the way in which respect inescapably involves diachronic and social dimensions. When these are acknowledged, the …Read more
  •  71
    Authenticity and autonomy in deep-brain stimulation
    Journal of Medical Ethics 40 (8): 563-566. 2014.
    Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy , and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for au…Read more
  •  83
    Medicalization and epistemic injustice
    Medicine, Health Care and Philosophy 18 (3): 341-352. 2015.
    Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate signif…Read more
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    In a recent paper, Hugh McLachlan argues from a deontological perspective that the most ethical means of distributing scarce supplies of an effective vaccine in the context of an influenza pandemic would be via an equal lottery. I argue that, even if one accepts McLachlan's ethical theory, it does not follow that one should accept the vaccine lottery. McLachlan's argument relies upon two suppressed premises which, I maintain, one need not accept; and it misconstrues vaccination programmes as cli…Read more
  •  21
    Autonomy as Ideology: Towards an Autonomy Worthy of Respect
    The New Bioethics 21 (1): 56-70. 2015.
    Recent criticism of the role of respect for autonomy in bioethics has focused on that principle's status as ‘dogma’ or ‘ideology’. I suggest that lying beneath many applications of respect for autonomy in medical ethics are some influential dogmas — propositions accepted, not as explicit premises or as a consequence of reasoned argument, but simply because moral problems are so frequently framed in such terms. Furthermore, I will argue that rejecting these dogmas is vital to secure and protect a…Read more
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    Relational Autonomy and the Ethics of Health Promotion
    Public Health Ethics 8 (1): 50-62. 2015.
    Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are …Read more
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    Diagnosis by Documentary: Professional Responsibilities in Informal Encounters
    with Markus Reuber
    American Journal of Bioethics 16 (11): 40-50. 2016.
    Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional–patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such “informal” encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to profess…Read more