Mercer Gary

Conversations about dependency must balance competing concerns too often consolidated into opposing narratives. On the one hand, our cultural premium on autonomy casts dependency as a weakness and a tragedy, if not a moral failing. On the other hand, efforts to resist this dominant narrative reframe dependency as the rule and not the exception. Extending this delicate balancing act to emerging modalities of dementia care poses additional questions. What should we make of apparently increasing levels of dependence on technology, as opposed to on humans? Confronting both the technophobic and technophilic extremes at once––alongside the polarized views of dependency that underlie them––provides us with clearer resources for reformulating narratives about technology in dementia care. What we need is an account of dependence that recognizes its ubiquity and moral significance while also acknowledging that it requires work that is widely devalued and that can exacerbate vulnerabilities.

Direct‐to‐consumer (DTC) telehealth is presented by marketers as a mere conduit for self‐care capable of circumventing the frustrations and injustices of existing healthcare systems. If self‐care is both lauded as a key tool of resistance for the marginalized and rejected as a hollow marketing tactic, how should we respond to technologies seeking to promote self‐care? What can they tell us about where self‐care is a valuable pursuit and where it becomes a social threat? I pursue these questions by examining the tensions between ethically meaningful care for the self and pernicious self‐responsibilization in two different uses of DTC telehealth: ‘men's health’ services for the treatment of erectile dysfunction and gender‐affirming care services for queer and trans people. Drawing on opposing views of self‐care, I argue that particular self‐care projects like DTC telehealth are ethically viable where they resist, rather than bolster, projects of domination and where they support, rather than undermine, caring relationships.

On January 30, 2020, the World Health Organization declared a Public Health Emergency of International Concern (PHEIC) over what would quickly become known as SARS-CoV- 2 or COVID- 19. This emergency status was officially ended in the United States in May 2023 amidst much dissent and debate. Although emergency conditions resulting from COVID- 19 will likely wax and wane over the coming years, there is good reason to think that the incidence of severe global pandemics will increase over the next century, as will declarations of emergency. The declaration of an emergency calls for urgent action, but it just as urgently demands careful reflection. Official “emergency” status licenses unparalleled executive intervention, completely reorganizing the lives of those who live under its decree. Such official recognition, however, is heavily dependent on the social context in and from which the emergency arises. Highlighting which circumstances rise to the level of an official emergency clarifies our reigning assumptions about what threshold of active harm—and in relation to which groups of people—demands immediate intervention.

White progressives in the United States are currently experiencing two profound reckonings that typically are assumed to be unrelated. On one hand, the Dobbs verdict overturned the assumption that the right to choose with respect to abortion is too socially entrenched, juridically settled, or politically sacred to be denied. On the other hand, climatological conditions for possibly having a comfortable existence are increasingly under threat in locales in which residents have come to expect to enjoy secure lives and livelihoods. This article highlights what Indigenous communities across the United States already know well. Namely, threats to reproductive freedom and climate crisis are neither new nor separable. Both phenomena have common colonial roots that continue to proliferate, each a result of the disruption and destruction of Indigenous kinship assemblages. Indeed, in aiming to remediate their current reckonings, white progressives routinely (if unthinkingly) support forms of settler-state violence that perpetuate reproductive and climate injustice in Indigenous communities. The authors appeal to white progressives, notably including white feminists, to embrace the proposition that their reckonings cannot be properly understood nor successfully addressed without prioritizing Indigenous futurity. They call for centering forms of Indigenous feminist praxis that facilitate robust Indigenous coalitions of anti-colonial resistance.

Disability Justice in Public Health Emergencies is the first book to highlight contributions from critical disability scholarship to the fields of public health ethics and disaster ethics. It takes up such contributions with the aim of charting a path forward for clinicians, bioethicists, public health experts, and anyone involved in emergency planning to better care for disabled people—and thereby for all people—in the future. Across 11 chapters, the contributors detail how existing public health emergency responses have failed and still fail to address the multi-faceted needs of disabled people. They analyze complications in the context of epidemic and pandemic disease and emphasize that vulnerabilities imposed upon disabled people track and foster patterns of racial and class domination. The central claim of the volume is that the ethical and political insights of disability theory and activism provide key resources for equitable disaster planning for all. The volume builds upon the existing efforts of disability communities to articulate emergency planning priorities and response measures that take into account the large body of qualitative and quantitative research on disabled people’s health, needs, and experiences. It is only by listening to disabled people’s voices that we will all fare better in future public health emergencies.

As many scholars have noted, the concept of “dignity” has historically been defined in several ways, creating conflict and confusion when the concept is invoked in the present. The concept has also been historically exclusive of various groups of individuals; some contemporary accounts still do not understand certain individuals with disabilities as possessing dignity. I examine the strength of three strands of dignity definitions and determine whether any groups are unjustifiably excluded due to disability status. Eva Kittay puts forward a theory that purports to include all humans which, although promising, is vulnerable to critique. I offer revisions of Kittay’s account that address the charge of over-inclusion. However, I note the lingering issues with my revision, particularly that even the best version of Kittay’s account requires the acceptance of some sort of speciesism.

The Routledge Handbook of Feminist Bioethics, edited by Wendy A. Rogers et al., presents a thorough, contemporary understanding of feminist bioethics, linking feminist efforts to other critical approaches in the field of bioethics. A more demanding standard for feminist scholarship is set by engaging gender at its intersections with race, class, sexuality, and ability––intersections that require bioethicists to attend to issues like incarceration and transmisogynistic violence that are less frequently tackled in the field. Editors and contributors alike in this volume show that long‐standing feminist conceptual interventions, especially those regarding the significance of relationality and epistemic marginalization, provide key tools for a coalition of critical approaches to bioethics.

Contemporary critical approaches to bioethics increasingly present themselves as “relational,” though the meaning of relationality and its implications for bioethics seem to be many and varying. I argue that this confusion is due to a multiplicity of relational approaches originating from distinct theoretical lineages. In this article, I identify four key differences among commonly referenced relational approaches: the scope and nature of relationships considered, the extent of the determining influence on individual selfhood, and the integrity of individual selfhood. Importantly, these four differences carry consequences for the usage of relational approaches within academic and clinical bioethics. I show that these differences attach to multiple objects of critique within mainstream bioethics and imply distinct metaethical commitments. Although I issue a cautionary note about combining relational approaches from distinct lineages, I close by suggesting that many such approaches may have their use, drawing on Susan Sherwin's sense of bioethical theories as lenses.

This commentary responds to “Home Care in America: The Urgent Challenge of Putting Ethical Care into Practice,” by Coleman Solis and colleagues, in the May‐June 2023 issue of the Hastings Center Report. More specifically, we respond to the authors’ call for “inquiry into the nature, value, and practice” of home care. We argue that the most urgently needed normative reset for thinking about care work is the replacement of dominant individualistic thinking with systemic thinking. Deepening a focus on the social, economic, and historical forces that shape the state of contemporary care work will help bioethicists to argue more effectively for improvements to working conditions. In turn, better working conditions will ease the oppositional stance between caregivers and receivers that has been set up by the current system, enabling all parties involved to better pursue the feminist ethical ideal of care.

Care has become a popular topic of conversation in the context of Covid‐19. But what will it take for the value of care to be realized when the use of “care” in corporate slogans inspires cynicism or when conflicting appeals to care dilute the concept's meaning? In this brief essay, Hastings Center postdoctoral fellow Mercer Gary suggests that building helpfully on the current interest in care as an ethical value and a form of work requires strengthening the conditions that make care possible. Two projects on which Gary is collaborating at The Hastings Center concern supporting older adults in aging in place, with one demonstrating the necessity of stable housing and the other highlighting how the labor of informal care providers is often assumed, but not provided for, in aging‐in‐place initiatives.

Introduction: The humanities enrich and transform the practice of medicine. What remains to be seen, however, is how best to integrate humanities into the medical curriculum to optimize both educational and patient-related outcomes. The present study considers the structure of an innovative student-driven humanities curriculum and seeks to understand its strengths and limitations, as well as make recommendations for improvement. Methods: The Penn State College of Medicine, University Park Regional Campus uses an inquiry-based approach to education, whereby students are responsible for creating learning objectives in four core pillars of exploration: Foundational Science, Clinical Science, Health Systems Science, and Health Humanities. This study explores student-derived humanities learning objectives (HLO) across four years of the curriculum. Results: 420 HLOs met criteria for analysis and were coded as instrumental (developing direct clinical skill), non-instrumental (non-skill based), or both. Of these, 125 (30%) were instrumental, 239 (57%) were non-instrumental, and 56 (13%) were coded as both. Most instrumental HLO centered around communication skills. Non-instrumental HLO most commonly focused on bearing witness and critiquing a particular experience within a social and/or political context. Conclusions: Findings from this study contribute to the development of a humanities curriculum in a student-directed learning program. Non-instrumental HLO lacked a theoretical framework to guide student’s investigations to a deeper level of analysis. Student-directed learning offers many strengths, but can be enhanced through external direction from humanities trained faculty, particularly given that many medical students have a limited humanities background.

In its institutionalized form, disability studies has historically drawn from political activism in the United States and the United Kingdom, particularly struggles that sought rights and recognition through the development of a social understanding of disability in opposition to the mainstream medical model.1 Recent work that expands the geographic scope of disability studies beyond these contexts has spurred debate about the challenges such a move poses to the foundations of the field. This essay responds to the field’s transnational turn by interrogating recent work by Nirmala Erevelles, Jasbir Puar, and Robert McRuer that displaces the white, wealthy, and Western contexts that have grounded the landmark achievements of disability studies. At issue here are the category struggles that emerge when a concept confronts the conditions and limits of its own migration.

Philosophy Compass, Volume 17, Issue 4, April 2022. In a moment where needs for care are acute and their provision precarious, feminist care ethics has gained new relevance as a framework for understanding and responding to necessary interdependence. This article reviews and evaluates two long-standing critiques of care ethics in light of this recent research. First, I assess what I call the pluralist feminist critique, or the dispute over the ability of care ethics to address the needs and histories of a range of marginalized subjects. I identify two forms of this critique: the first disputes the biased starting points shaping the development of the theory, and the second concerns the weaponization of care in support of domination. Although these critiques are well-established, I draw attention to recent responses that move care theory in generative directions. I argue that the pluralist feminist critique demands both self-critical transformation in dialog with other feminist schools of thought and a robust account of care ethics' normative authority. I then take up critiques those levied by mainstream ethicists concerned with care theory's adequacy as an ethical approach. I show that recent work on normative authority, conceptual uniqueness, and the grounding of responsibility must be engaged before care theory can be dismissed as “under-theorized.” In articulating these two sets of critiques and evaluating recent rebuttals to them, I argue for a pluralist feminist theory of care within which strands informed by varying philosophical schools and methods can coexist.

“Care robots” offer technological solutions to increasing needs for care just as economic imperatives increasingly regulate the care sector. Ethical critiques of this technology cannot succeed without situating themselves within the crisis of social reproduction under neoliberal capitalism. What, however, constitutes “care” and its status as a potential critical resource, and how might care robots damage this potential? Although robots might threaten norms of care, I argue that they are by no means necessarily damaging. Critiques of care robots must not entrench exclusionary images of the ideal carer. Instead, critical reflection on their use should trouble dominant paradigms of care.

The crisis of Covid‐19 has forced us to notice two things: our human interdependence and American society's tolerance for what Nancy Krieger has called “inequalities embodied in health inequities,” reflected in data on Covid‐19 mortality and geographies. Care is integral to our recovery from this catastrophe and to the development of sustainable public health policies and practices that promote societal resilience and reduce the vulnerabilities of our citizens. Drawing on the insights of Joan Tronto and Eva Feder Kittay, we argue that the ethics of care offers a critical alternative to utilitarian and deontological approaches and provides a street‐ready framework for integration into public health deliberations to anchor public policy and investments concerning the recovery and future well‐being of America's citizens and society.