Danielle Wenner

We argue for two claims in this paper. First, we argue that existing taxonomies of ideal and non-ideal theory must be expanded. While non-ideal theory is often thought to be transitional in nature - that is, theorizing how agents in structurally unjust circumstances should act so as to bring about a more just state of affairs - we show that some non-ideal theory is in fact static. Static non-ideal theory attempts to guide the actions of individuals while taking background structural injustice as a kind of fixed point, or as a "backdrop" against which individuals can try to ethically interact. Second, we argue that notwithstanding the intentions of theorists, static non-ideal theory often serves ideological purposes by functioning to reinforce the (unjust) status quo. Throughout, we use theoretical debates about exploitation as illustrative of the phenomenon under discussion.

Within bioethics as well as in broader clinical practice, support for transgender and gender‐questioning adolescent access to pubertal suppression has often relied heavily on the desire to prevent risky, self‐destructive, and suicidal behavior. We argue that framing justifications for access to puberty suppression in this way can actually be harmful to both individual patients as well as to the broader trans population. This justification for access to care makes such access precarious, limits its scope, and introduces perverse incentives to the patient population that is being served. We go on to offer an alternative, positive defense of access to puberty‐blocking treatment for transgender youth grounded in the child's right to an open future. We argue that decisions related to pubertal suppression are both importantly weighty and potentially irreversible, and show why this justification is preferable to so‐called “informed consent” approaches.

This paper illustrates some concerns about ideal theory by problematizing deliberative democracy. Deliberative democrats argue that inclusive deliberation conducted among equals who offer reasons in support of positions can confer legitimacy on democratic political outcomes. However, this argument is predicated on idealized assumptions about the ability and willingness of deliberators to interact in ways that either generate epistemically superior outcomes or ensure equal access to deliberation. The chapter argues that these assumptions fail to withstand scrutiny, and that this failure undermines the legitimacy-conferring status of deliberation. Moreover, in failing to account for the ways existing injustices can influence group decision-making, deliberation may also serve to entrench and even propagate those injustices. This suggests that an account of deliberative democracy capable of grounding claims to legitimacy must begin from a standpoint more fully informed about the ways cultural, personal, social, and economic differences can impact the process and outcome of deliberative decision-making.

The global impact of Dobbs v. Jackson Women’s Health Organization and the backlash towards reproductive justice that it represents warrant a global feminist response informed by broad theoretical and geopolitical lenses. We consider how a solidaristic, transnational feminist movement might learn from Latin American feminist movements that have been successful in uniting broad coalitions in the fight for reproductive justice as situated within far-reaching political goals. The success of such a global movement must be decolonial and must contend with the fact that overlapping realities of global inequality, severe poverty, extractivism, and western-backed violence are fundamentally implicated in reproductive justice.

A growing proportion of clinical research funded by pharmaceutical companies, high-income country research agencies, and not-for-profit funders is conducted in low- and middle-income settings. Disparities in wealth and access to healthcare between the populations where new interventions are often tested and those where many of them are ultimately marketed raise concerns about exploitation. This chapter examines several ethical requirements frequently advanced as mechanisms for protecting research subjects in underserved communities from exploitation and evaluates the effectiveness of those mechanisms as responses to exploitation worries. It goes on to highlight where the conceptual frameworks relied upon by research ethicists must be improved if we are to fully understand the nature of the moral claims and obligations that arise in research conducted in underserved communities.