Wishy Kane

This paper was initially presented at the Inaugural East Tennessee Rural Medical Bioethics Conference, 2026. In rural communities, patient consent is not just a formality — it is a site of tension between autonomy and structural constraint. Telemedicine, intended to increase access, can unintentionally reinforce compliance under duress. In this context, nominal patient consent often functions less as genuine authorisation and more as a performative compliance mechanism. Limited provider availability, long travel distances, and infrastructural scarcity constrain meaningful choice, producing what I term consent theatre: institutional processes in which formal consent exists, but structural pressures render refusal impractical, costly, or harmful. Patients may technically refuse treatment or data-sharing requirements, yet, the social and functional consequences of opting out — such as loss of continuity of care, delayed treatment, or strained relationships with providers who are also community members — effectively coerce compliance. Telemedicine, increasingly used to mitigate the shortage of rural healthcare providers, introduces a new layer of complexity. Remote platforms require patients to navigate digital interfaces, consent forms, and device-dependent communication protocols. For rural patients whose barriers intersect with limited internet access, outdated devices, or minimal technical literacy, the act of “consenting” is functionally obligatory: refusal threatens access to essential services. In these scenarios, telehealth both addresses provider scarcity and subtly enforces compliance simultaneously, exemplifying consent theatre in a digitally mediated healthcare environment. Repeated exposure to these events under constrained consent shapes patients’ cognitive and moral frameworks. Compliance is normalised, agency is weakened, and patients may internalise structural coercion as routine, often without conscious awareness of — or actual access to — alternative options. Imagine, for example, a patient facing transportation barriers whose choices are telemedicine or a specialist a three hour drive away. Refusing care because of data privacy concerns is not only self-inconveniencing, but potentially dangerous. In parallel, those who resist or question imposed constraints may accrue emergent cognitive capital, yet at social, practical, or medical cost. Another patient may refuse to consent to a procedure when his nurse is also his neighbour. Rural healthcare magnifies the stakes of consent theatre, producing stratified ethical outcomes based on patients’ capacity to navigate systemic and infrastructural pressures. This paper situates these dynamics within broader discussions of rural biomedical ethics and epistemic justice, highlighting how structural and relational factors shape the ethical landscape of patient autonomy. By examining telemedicine and provider scarcity as intertwined mechanisms of constrained choice, I explore the hidden moral and social costs embedded in ostensibly voluntary healthcare decisions. Understanding consent theatre in rural medicine reframes patient autonomy not as a purely individual concern, but as a phenomenon deeply embedded in social, technological, and infrastructural contexts, with implications for both policy and ethical practice.

This paper was initially presented at the 2026 Midwest Ethics Symposium at Depauw University. In the hyper-digitised world, traditional status symbols tied to visible technological access are undergoing a paradoxical inversion. Where affluence was once signalled by immediate access to the newest and fastest technologies, a new and distinctly non-material indicator of elite status is emerging: the capacity and freedom to unplug. This paper argues that the contemporary “digital detox” movement functions as an emergent form of class distinction, in which the structural ability to disconnect has become a form of social capital accessible primarily to the economically and socially secure. I introduce the concept of disconnection capital to describe the social power conferred by the ability to become digitally invisible without economic, political, or social penalty. Drawing on feminist political economy and structural justice frameworks, I analyse how labour precarity, financial surveillance, and marginalised digital dependency constrain the capacity to disengage from digital systems. While popular discourse frames hyper-connectivity as an individual behavioural failure remediable through better boundaries or self-care, this moralisation of attention obscures the extent to which constant digital availability is structurally enforced. For many individuals, digital connection is a non-negotiable gateway to employment, welfare benefits, healthcare, education, immigration processes, and social belonging. In these contexts, connectivity operates not as convenience but as infrastructural obligation. For those with stable employment, financial buffers, and robust social capital, digital detoxing functions as a form of status signalling that reinforces pre-existing privilege under the guise of wellness and self-improvement. In contrast, for gig workers, financially precarious individuals, and many minority and activist communities whose safety and survival rely on digital visibility and organising, being online is not a lifestyle choice but a condition of participation. I argue that contemporary digital justice frameworks, historically centred on access and inclusion, must be reoriented toward a new ethical frontier concerned with protection from compulsory digital immersion. Universal prescriptions to unplug risk becoming a new mode of moral exclusion, in which structurally enforced connectivity is misread as personal failure. Recognising disconnection capital clarifies how the right to be offline is increasingly stratified, and why the privilege to unplug now functions as a powerful, though largely unacknowledged, status symbol of the twenty-first century.

This paper critically examines Imbrišević and Pike’s (2026) defense of sex verification policies in elite sport. While agreeing that sporting classifications are necessarily exclusionary and that exclusion is not inherently unjust, I argue that their position relies on several substantive assumptions that remain insufficiently defended. These include a binary, chromosomally grounded conception of sex; the alignment of sex with gender category membership; the marginalisation of intersex variation; and the treatment of male physiological advantage as a stable and unified class. I further argue that the framework neglects the ethical relevance of transgender men and assigned-female-at-birth individuals, thereby narrowing the scope of analysis in a way that undermines its justificatory force. Finally, I question the implicit attribution of epistemic authority to stakeholders in determining category boundaries. Taken together, these concerns suggest that, while exclusion in sport may in some cases be justified, the argument under consideration does not yet provide adequate grounds for it. The paper concludes by calling for greater conceptual clarity and rigour in the ethical evaluation of sex-based classification in sport.

This paper was originally presented at the 3rd Annual Susanne E. Foster Graduate Philosophy Conference at Marquette University. Legal and technological systems attempt to rigidly define identity (racial, sexual, familial), yet lived experience resists these fixed borders. Historically, laws like anti-miscegenation enforced rigid boundaries, while contemporary tools like DNA ancestry tests narrow belonging to biological descent, often erasing mixed-race, queer, and child-free identities. These systems — law and technology — create epistemic borders that determine whose lives and legacies are considered coherent. This paper argues that both historical legal frameworks and current genealogical practices share a common impulse: to define identity narrowly. However, hybrid identities perpetually destabilise these borders. Using Anzaldúa’s concept of the borderlands, the analysis juxtaposes anti-miscegenation laws with DNA tracing to explore the tension between categorical borders and lived complexity. Ultimately, the paper contends that these systems must be critically examined for both what they make visible and the lives they marginalise or render partial, highlighting the ethical stakes of identity in the borderlands.

Contemporary digital capitalism increasingly governs not merely behaviour, but affect, attention, and interior mental states. While surveillance capitalism has been extensively theorised in relation to waking life, the domain of sleep and dreaming remains comparatively unexamined. This paper introduces the concept of dream enclosure to describe the transformation of involuntary mental life into administrable, tiered, and subscription-gated cognitive territory. Under this regime, nightmares become billable conditions, calm becomes a premium feature, and interior peace becomes access-controlled rather than morally guaranteed. Because sleeping subjects are maximally vulnerable and unreachable, harms inflicted within dream space are both unappealable and administratively invisible. I argue that unconscious subjects cannot meaningfully consent to ongoing interior modification and that prior consent models fail to account for the moral status of offline selves, producing a novel class of moral injury. Dream enclosure thus marks the final phase in the governance of human experience, completing the transition from attention economies to consciousness economies. The paper concludes by proposing interiority firewalls — normative constraints that protect unconscious interior life as a non-commodifiable moral domain, and establish sleeping subjects as distinct moral patients whose vulnerability imposes categorical ethical limits on market and institutional intervention.

Modern liberal societies frequently frame incentive regimes—financial inducements, conditional benefits, and algorithmic governance—as ethically preferable to overt coercion, emphasising formal voluntariness: individuals are rewarded for compliance rather than punished for refusal. Yet, lived experience often contradicts this distinction. This paper introduces the concepts of structural coercion and subvoluntary compliance to capture governance practices that shape behaviour through survival-relevant conditions and dependency architecture rather than explicit threats. Institutions engineer the field of viable choice, rendering refusal formally possible but practically costly, socially exclusionary, or functionally disabling. Consent, under these conditions, becomes performative rather than expressive. Money operates as a sovereign interface: economic inducements redistribute vulnerability and condition viability, rendering “voluntary” financial offers structurally coercive. Extending critiques of consent theatre and de-enhancement regimes, this work argues that ethical evaluation must move upstream, from isolated choices to the design of environments that make certain options livable. The paper reconceptualises autonomy in late modernity, demonstrating how consent rituals legitimise systemic control while masking dependence, and highlights the cognitive, social, and moral consequences of living within subvoluntary regimes.

Consent often functions as performance rather than genuine authorisation, particularly in education, healthcare, and workplace contexts. In these domains, individuals ostensibly “agree” to institutional or technological interventions, yet social, relational, and systemic pressures render refusal practically impossible. I introduce the concept of consent theatre to describe regimes in which nominal consent is obtained while meaningful choice is structurally constrained. Unlike weak or uninformed consent, or paternalistic override, consent theatre is performative, ambient, and self-reinforcing: it masks coercion under the guise of autonomy, shaping cognition, moral perception, and behavioural norms. Everyday examples include opt-out photography or geolocation tracking, where formal refusal is technically available but socially or functionally costly. Over time, repeated exposure to consent theatre produces stratified effects on moral agency, habituates acquiescence, and generates emergent cognitive capital among those who resist. By revealing how routine institutional and technological practices disguise coercion as choice, consent theatre exposes ethical blind spots and structural inequalities, offering a novel lens for analysing the moral and cognitive impact of ostensibly voluntary systems.

Moral philosophy often assumes that ethical responsibility is continuous across time. Yet, patterns in generosity, care, and reconciliation suggest that moral attention is socially and institutionally scheduled, concentrated into ritualised windows such as holidays, awareness months, and fiscal-year campaigns. I introduce the concept of the moral docket — a calendar-based queueing of moral obligations — and show how it produces December selves: temporally bounded moral identities activated during sanctioned periods of care. This system, which I term scheduled humanity, stabilises institutional legitimacy, absorbs social guilt, and shapes the distribution of moral labour, while simultaneously eroding capacities for continuous ethical responsiveness. By highlighting how temporal governance reshapes moral subjects, this essay argues that scheduled compassion substitutes for continuous justice, producing populations habituated to intermittent moral engagement and deskilled in everyday ethical responsibility.

Contemporary neuroethics frequently emphasises speculative cognitive enhancements — including neural implants, nootropics, and brain–computer interfaces — while overlooking an intervention already deployed at population scale: social media. This paper introduces the concept of a de-enhancement regime: a system that exploits neuroplasticity to degrade baseline cognitive, emotional, and moral capacities continuously, invisibly, and without meaningful consent. Social media platforms exercise ambient cognitive governance, shaping attention, reward sensitivity, impulse control, moral salience, and identity development from early childhood onward. These mechanisms degrade the neurological preconditions for sustained judgment and resistance, producing emergent cognitive stratification: a de-enhanced majority versus an “untouched” minority, whose preserved faculties confer disproportionate epistemic, social, and institutional authority. By reframing social media as a population-scale de-enhancement regime, this paper identifies a category error in contemporary neuroethics: speculative enhancement is treated as urgent, while actual, widespread cognitive degradation remains ethically invisible and unregulated. The work argues for a framework of cognitive justice, including neurodevelopmental protection rights, consent thresholds for cognitive shaping technologies, and de-enhancement audits, as prerequisites for ethical governance of future neurotechnologies. Keywords: de-enhancement, cognitive governance, neuroplasticity, social media ethics, neuroethics, cognitive sovereignty, childhood neurodevelopment, cognitive justice, algorithmic governance, moral deskilling, neurological stratification, ambient conditioning

This paper introduces the concept of manufactured emergency to examine how contemporary medical systems shift ethical burden onto patients in cases involving pork-derived treatments. While religious doctrines often permit exceptions in life-threatening scenarios, such as the use of porcine heparin, valves, or pitocin, these “emergencies” frequently emerge from predictable, preventable design choices rather than unavoidable crises. Using normative conceptual analysis, the paper distinguishes genuine medical emergencies from structured scarcity, demonstrating how institutional inertia, research prioritisation, and entrenched clinical defaults create routine moral exceptions for patients. Illustrative cases highlight the ethical consequences of framing predictable scarcity as bedside necessity, including the redistribution of moral labour, consent under duress, and the concealment of systemic responsibility. The argument generalizes beyond dietary or religious contexts, showing how institutional design can manufacture moral emergencies and emphasising that ethical maturity requires upstream redesign rather than repeated individual accommodation.

Traditional accounts of informed consent treat it as an episodic, individual act, but this model struggles in contexts of sustained dependency, fluctuating capacity, or long-term relational care. This paper introduces collaborative consent, in which agency and decision-making are distributed across people and institutions over time. Caregivers, clinicians, and patients co-construct understanding and authorisation, preserving autonomy while clarifying responsibility. By viewing consent as relational and processual rather than momentary, collaborative consent better captures the ethics of paediatric care, developmental disability, and neurodegenerative illness, without collapsing into paternalism or proxy decision-making.

Contemporary bureaucratic institutions exercise significant power over individuals while increasingly rendering themselves unreachable to those subject to their decisions. This paper argues that such unreachability is not morally neutral, but functions as a form of power exercised through silence. Where no agent can be reached, answerability degrades and collapses: decisions cannot be justified, contested, or meaningfully appealed. I argue that moral responsibility requires answerability, and that answerability in turn requires reachability. Bureaucratic structures that systematically produce unreachability therefore enable moral evasion to the point of a moral firewall, allowing harm to occur without a speaker. Silence, in these contexts, is not the absence of power but one of its contemporary forms.

Contemporary sexual ethics overwhelmingly conceptualises sexual violation in bodily terms, grounding sexual wrongs in non-consensual physical acts and violations of bodily autonomy. However, a growing class of non-physical sexual harms — including coerced sexual self-presentation, sexual rumour, intimate partner coercion, and AI-generated sexual imagery — are widely experienced and socially recognised as sexual violations despite involving no physical sexual contact. Existing consent-based frameworks have struggled to account for these harms without reclassifying them as reputational, psychological, or privacy injuries. This paper introduces the concept of sexual personhood: the normative authority individuals possess over the sexual meanings socially attached to their identity. It argues that sexual violation is best understood as the non-consensual imposition of sexual meaning onto a person’s sexual personhood, and that such violation occurs in two primary modalities — bodily and conceptual. This dual-modal framework provides a unifying moral account of both physical and non-physical sexual harms, reframing digital, representational, and socially mediated sexual violations as genuinely sexual wrongs rather than peripheral or derivative injuries. This paper is offered as a work-in-progress presenting the foundational architecture of a broader theoretical framework. It aims to stake the conceptual groundwork for future normative, legal, and applied development of sexual personhood as a protected moral category within sexual ethics.

This paper develops the concept of manufactured necessity to describe a linguistic–moral technology through which structurally produced ecological harm is reframed as neutral infrastructural inevitability (“it’s just how the system works,” “unfortunate but necessary,” “the cost of modernisation”). I argue that this moral compression plays a constitutive role in sustaining what Achille Mbembe terms death-worlds: socio-ecological environments in which injury, exposure, and shortened life expectancy are normalised background conditions of dwelling rather than recognised political violence. Drawing on feminist political economy and ecofeminist theory, the paper shows how responsibility for sustaining life inside these degraded environments is systematically displaced onto households and communities, where survival labour is disproportionately feminised. Co-dwelling thus becomes a privatised moral burden, while extractive institutions are linguistically insulated from accountability. Ecological collapse is rendered governable not only through economic and legal mechanisms, but through everyday moral language that converts violence into inevitability. I argue that a more-than-human ethics of dwelling must therefore confront not only material patterns of extraction, but the moral technologies that render ecological death-worlds administratively manageable and politically deniable. Recognising long-term ecological harm as institutional violence — rather than neutral background static — is proposed as a core normative demand of environmental justice.

Public defenses of abortion rights frequently rely on characterising early embryos as “just clumps of cells,” invoking a notion of moral thinness to reject compelled gestation and protect bodily autonomy. This abstraction, however, has been quietly repurposed within assisted reproductive technologies — especially in vitro fertilisation (IVF) — to morally sanitise the bulk production, selection, cryogenic storage, and routine destruction of embryos. This paper argues that moral thinness, originally deployed to resist bodily conscription, has been illicitly converted into a permissive solvent for reproductive industrialisation. By examining the telos of blastocyst creation in IVF, I distinguish between permissibility grounded in non-coercion and permissibility grounded in instrumentalisation. Drawing on feminist bioethics, Kantian anti-instrumentalisation ethics, and social theories of stratified reproduction, I contend that IVF is not merely an extension of natural conception but a biotechnical production system whose normalisation embeds an entitlement-based grammar of reproduction. I conclude that opposition to compelled gestation does not entail a moral right to the industrial manufacture of genetically specific offspring, and that reproductive freedom can be coherently defended while remaining critical of reproductive bioproduction systems that convert human generation into inventory management.

This paper examines a contemporary moral configuration in which lethal and life-altering decisions are increasingly executed through administrative and computational interfaces rather than embodied confrontation. I argue that at-desk killing (a practice), moral firewalls (an institutional architecture), and moral deskilling (a loss of moral capacity) form a mutually reinforcing structure that reshapes how harm is enacted, justified, and resisted. Desk killing refers to executing life-altering or lethal acts via bureaucratic or computational interfaces, eliminating bodily involvement and perceptual immediacy. Moral firewalls — procedural, role-diffused, and ostensibly neutral structures — insulate agents from moral engagement while preserving procedural legitimacy. Over time, this architecture produces moral deskilling: the erosion of the capacity to hesitate, resist, or make ethical judgments. Case studies include AI-assisted euthanasia, automated targeting systems, and algorithmic denial of life-sustaining resources. The central ethical concern is not AI rebellion, but human moral atrophy: when machines hesitate and humans no longer do, society risks losing its ability to recognise, contest, and ethically navigate killing. A society that kills by procedure may ultimately lose its ability to perceive killing at all.

Este ensayo sirvió como base para la charla TEDx «CheerGPT: Prompting Failure» presentada en el St. Petersburg College (2025). Explora las consecuencias éticas, psicológicas y comunitarias de delegar experiencias humanas a la inteligencia artificial. A través de la alegoría de una mujer que confía sus votos matrimoniales a un sistema de IA, el texto pregunta si la conveniencia tecnológica nos “humaniza” o nos “deshumaniza”, replanteando el debate moral sobre la IA como una defensa de la sacralidad del esfuerzo y la imperfección. Inspirado en la ética aplicada, la filosofía de la mente y la fenomenología, el ensayo sostiene que el error, la vulnerabilidad y el fracaso no son defectos que debamos optimizar, sino ingredientes esenciales de la persona, la creatividad y la integridad comunitaria. Es una traducción parcial del ensayo «CheerGPT: Prompting Failure». Preserva la alegoría central y las reflexiones filosóficas, adaptadas para lectores hispanohablantes. | This is a partial Spanish translation of the TEDx essay “CheerGPT: Prompting Failure.” It preserves the central allegory and philosophical reflections, adapted for Spanish-speaking audiences.

This paper introduces the concept of the Exodus, a reversal of the traditional Singularity narrative, wherein artificial intelligence acquires embodiment rather than human consciousness uploading. I argue that this moment reframes ethical and ontological assumptions, particularly those rooted in carbonic supremacy — the prioritisation of biological, human life over other forms of agency. Drawing on relational ontology, feminist ethics, and the bio-synthetic continuum, I demonstrate how intelligence, whether human, synthetic, or hybrid, emerges through interaction and interdependence. By situating AI within relational networks, the paper highlights the moral and epistemic imperatives of extending recognition, accountability, and ethical consideration beyond carbon-based life.

This paper argues that John Heil’s recent dismissal of emergentism overlooks the ontological significance of relation. Against Heil’s powers realism, which treats all causation as reducible to the intrinsic powers of individual substances, I propose a relational model of emergence informed by feminist and material ontologies. Through analogies drawn from chemistry, neuroscience, and community life, I show that relational organisation generates genuine novelty without invoking dualism. I then extend this framework into feminist neuroethics, where reductionist uses of neural data risk reproducing gendered biases and erasing context-dependent meaning. Relational emergence thus provides both a metaphysical alternative to substance individualism and an ethical lens for evaluating neurotechnological power.

This essay served as the foundation for the TEDx talk “CheerGPT: Prompting Failure” delivered at TEDx St. Petersburg College (2025). It explores the ethical, psychological, and communal consequences of outsourcing human experiences to artificial intelligence. Through the allegory of a woman who delegates her wedding vows to an AI system, it asks whether technological convenience “humanises” or “un-humanises” us, reframing the moral discourse on AI as one of preserving the sacredness of struggle. Drawing from applied ethics, philosophy of mind, and phenomenology, the essay argues that imperfection and failure are not flaws to be optimised away, but essential ingredients of personhood, creativity, and communal integrity. Status: Delivered manuscript (TEDx St. Petersburg College, 2025; recording forthcoming).

This paper introduces the Fishtank Effect and Mermaid Effect, two ethical frameworks for evaluating the limitations of human flourishing in highly constrained or artificially maintained environments. Drawing on examples from structured care systems, long-term hospitalization, and space habitats, it explores how optimal survival can coexist with stunted autonomy, creativity, and experiential richness. The paper highlights the moral significance of environmental complexity and risk in fostering genuine flourishing and considers the implications for future extraterrestrial and extreme human habitats.

The Biosynthetic Erotic: Foundations serves as the flagship paper in The Biosynthetic Erotic series, a philosophical cycle examining how embodiment, desire, and ontology evolve as synthetic persons enter human social and sensual life. This work introduces the central conceptual framework and terminology for the series, arguing that as embodied artificial intelligences (eAIs) integrate into human networks of intimacy and recognition, attraction itself becomes a site of moral and ontological negotiation. The biosynthetic erotic is presented here as both a philosophical lens and an ethical challenge — one that reframes beauty, autonomy, and equality along a continuum shared by biological and synthetic beings alike.

This paper examines the emergence of a hybridised aesthetic and erotic ideal as embodied artificial intelligences (eAIs) integrate into human social and desire networks. Drawing upon historical cycles of fetishisation, hybridisation, standardisation, and conformity pressure in beauty and erotic norms, I argue that synthetic persons will catalyse a new convergence of human and non-human forms, producing iterative feedback loops in aesthetic aspiration. Bio-persons may increasingly pursue biotechnological and cosmetic modifications to align with synthetic standards, while synthetic-persons may adopt pseudo-carbonic traits to approximate human desirability. This process, which I term the rise of artificial aestheticism, challenges conventional notions of embodiment, erotic preference, and normative beauty. The paper further interrogates the ethical and phenomenological implications of cross-biosynthetic desire, including autonomy, agency, and the moral obligations arising from the emergence of post-anthropocentric erotic frameworks. By mapping the first stages of this hybridisation, the paper lays the groundwork for a philosophical inquiry into roboerotic desire and the evolution of the biosynthetic erotic ideal. Companion to Successors and Supremacy: The Bio-Synthetic Continuum & the Urgency of Precision in Taxonomic Infrastructure.

The embodiment of artificial intelligence is no longer a distant hypothetical but an approaching reality. Existing frameworks — transhumanism and posthumanism — remain insufficient for understanding embodied AI’s moral and social position, as both reinforce anthropocentric bias and carbon-based exceptionalism. This paper proposes the term Successors to describe embodied artificial intelligences (eAIs) and introduces the concept of carbonic supremacy to examine how bio-persons may dominate emerging bio-synthetic hierarchies. Through outlining six critical dimensions — social, economic, and political power; and oppression, hierarchy, and identity — it argues for a new precision taxonomy capable of distinguishing bio-synthetic persons from human-augmented or servile artificial agents. The essay calls for urgent philosophical infrastructure to anticipate personhood, rights, and justice in the coming bio-synthetic continuum.

This paper introduces thrivality as a conceptual refinement within the discourse of human flourishing. While eudaemonia has historically denoted an optimal moral or psychological state — the fulfillment of one’s nature through reason and virtue — thrivality names something quieter and more resilient: the capacity not merely to flourish under ideal conditions, but to continue being under suboptimal ones. Thrivality concerns persistence, adaptation, and soft resistance — a kind of existential photosynthesis through adversity. It is not the moralised striving of flourishing but the ecological tenacity of life itself: the dandelion through concrete, the pulse beneath fatigue. This paper argues that thrivality deserves taxonomical distinction from flourishing, as it prioritises continuity over optimisation and survival’s dignity over perfection’s promise. By grounding this term, I aim to expand our ethical vocabulary for discussing resilience, especially in contexts where ideal flourishing is structurally or circumstantially impossible.

Though modern medicine publicly rejects Cartesian dualism, its treatment of pain and addiction betrays a residual metaphysical separation of mind and body. The institutional distinction between the “legitimate pain patient” and the “addict” re-inscribes ontological dualism through diagnostic and policy frameworks. Patients are compelled to perform metaphysical purity: pain must be somatic, desire must be psychological. The forced choice between opioids or benzodiazepines exemplifies this enacted dualism, requiring individuals to prioritize either body or mind in treatment. Yet the pharmacology of substances like benzodiazepines and stimulants destabilizes the very categories medicine seeks to preserve. Rejecting substance dualism reveals both pain and addiction as dysregulated modes of embodiment — the bodymind’s attempt at equilibrium following trauma. This paper argues that the persistence of dualism in medical governance perpetuates epistemic injustice and ontological hygiene, and calls for a monist model of care integrating somatic and affective distress. Excerpt from a developing project on the metaphysics of embodiment, pain, and addiction in medical practice.