Megan Kitts

People living with endometriosis, a disease in which tissue similar to the lining of the uterus grows elsewhere in the body, often experience prolonged diagnostic journeys because of symptom variability, normalisation of period pain and other symptoms, and lack of awareness of the condition. In this article, we analyse the endometriosis diagnostic journey through the lens of epistemic injustice. Drawing on in‐depth interviews with 52 people living with endometriosis in the United States, we introduce the concept of diagnostic buck‐passing to characterise the phenomenon wherein individuals who seek treatment for their symptoms end up stuck in a cycle of seeing different providers across ranging specialities, which ultimately delays their diagnosis. We describe diagnostic buck‐passing and the conditions that give rise to its emergence, grounding our conceptualisation in endometriosis diagnosis. Utilising concepts of undone science and wilful ignorance, we demonstrate how endometriosis diagnosis becomes a site of hermeneutical injustice due to a long history of underinvestment in women's health research and resultant knowledge gaps in clinical care.

In this paper, we discuss a concern about moral testimony in the context of clinical ethics consultation. We argue that deference to moral testimony complicates the notion of moral answerability. By moral answerability, we mean roughly the notion of being the appropriate target for demands for moral justification regarding a belief or action and being eligible for a variety of moral responses. In cases of deference to moral testimony, it is unclear whether it is the testifier or the deferring agent who is morally answerable for the testimony-based belief and any requisite action performed on the basis of said belief. We discuss the implications of this idea for the practice of clinical ethics consultation. We explore whether the ethicist or the consultee is answerable for beliefs formed and actions performed as outcomes of the consultation. We outline the various considerations for holding each party answerable and ultimately propose a joint answerability account according to which both the ethicist and the consultee are answerable for moral responses, but to different degrees depending on the context.

When patients are unable to make decisions for themselves, medical teams often turn to surrogate decision makers to help identify what the patient would have wanted. Unless a patient has designated a surrogate, teams must rely on statutory hierarchies that often prioritize legal and biological ties. When cases arise in which patients do not want their legal surrogate to be their medical decision maker, they must take steps to exclude that person. Unfortunately, people often are not aware of this until they are unable to make complex medical decisions for themselves. While much has been said about the capacity to appoint surrogates, comparatively little has been said about excluding surrogates. In current practice, a patient’s decision to exclude a surrogate would not be respected when they do not have capacity. It is our view that this blanket inclusion of surrogates can be seriously harmful and potentially violating. Our goals in this article are twofold. First, we aim to carve out the decision to exclude a surrogate as distinct from the decision to appoint one. Second, we argue that respecting an incapacitated patient’s exclusion to some degree is morally appropriate. We will conclude by offering suggestions about how to respect the preference to exclude while considering the risks that may come with exclusion.

As a growing number of embryos collect in fertility clinics, it is imperative to evaluate the permissibility of available options for genetic parents and fertility institutions. Much of the discussion on appropriate treatment of embryos has focused on the circumstances under which it is permissible to destroy embryos for instrumental purposes, and thus has little application to the fertility context. I aim to develop a new account of the value of embryos whereby embryos have final value in virtue of their relationship to persons that could exist. I call this symbolic value. To establish this value, I first show that corpses have this same symbolic value in virtue of their relationship to prior persons, and then show that the cases of corpses and embryos are relevantly similar. Because of this value, we ought to treat embryos in particular respectful ways. It is currently common practice in the United States to simply discard extra embryos that exist as a result of in vitro fertilization. I argue it is generally impermissible to simply discard embryos because it is an act of disrespect and does not treat them in accordance with their value.