According to a dominant view of stigma, a person is stigmatized within a community if sufficiently many people within that community hold a bad view of her. I call this the 'Bad View Model'. In this paper, I argue against the Bad View Model on the grounds that such beliefs are neither necessary nor sufficient for stigma, and that the account cannot explain the distinctive phenomenology of stigma, including certain vulnerabilities to shame. I then develop an alternative (...) that explains these features of stigma, which I call the 'Shaming Model'. On this view, a person is stigmatized within a community if she is shamed by members of that community, and this is explained by their belief that she has deviated from some social norm and/or standard. (shrink)

How should we interpret the popular objection that stigmatised subjects are not treated as individuals? The Eidelson View claims that stigma, because of its connection to stereotypes, violates an instance of the general requirement to respect autonomy. The Self-Presentation View claims that stigma inhibits the functioning of certain morally important capacities, notably the capacity for self-presentation. I argue that even if we are right to think that stigma violates a requirement to respect autonomy, this is insufficient to (...) account for the full weight of the charge that stigmatised subjects are not treated as individuals. We need the Self-Presentation View to explain a special threat to agency. I then address the worry that focusing on a concern with being treated as individuals opens the door to the suggestion that treating as superior can be just as morally troubling as stigma. This objection is fatal for the Eidelson View. But the Self-Presentation View has a number of resources for deflating the worry. We should not exclude the possibility of a moral symmetry between some cases of stigma and some cases of treating as superior. Rather, we should provide a nuanced account of the circumstances in which either phenomenon is detrimental for self-presentation. (shrink)

In this paper, I discuss stigma, understood as a category which includes acknowledged, enacted degradation, discreditation and discrimination. My discussion begins with an analysis of HIV stigma, as discussed in a social media post on Twitter. I then analyse a fictionalized clinical stigma scenario. These two analyses are undertaken to highlight aspects of the conceptual anatomy and interactional dynamics of stigma and by extension shame. Brief social media declarations and short, fictionalized clinical interactions are rich with (...) information which helps us understand how stigma—degradation, discreditation and discrimination—is operationalized in interaction. (shrink)

Rawlsian liberals face the challenge of providing reasons to oppose stigma that do not appeal to a rejection of controversial stigmatic attitudes, but rather to political values that are undermined by stigma. One prominent strategy (the Self-Respect Strategy) appeals to the threat stigma poses to self-respect. Another strategy (the Hierarchy Strategy) appeals to the dependence of stigmas on social hierarchies, which are taken to be intrinsically problematic. I argue that the Self-Respect Strategy needs further resources in order (...) to answer important questions about which stigmas are most morally and politically urgent. The Hierarchy Strategy confronts the obstacle, for the purposes of political justification, of sustaining a highly contentious interpretation of the value of equality. In my view, Rawlsian liberals should jettison this underlying normative concern with hierarchy when making the case for opposing stigmas, and instead use considerations of hierarchy to identify some of the most pronounced threats that stigma poses to self-respect. In this way, considerations of hierarchy can help supply the explanatory resources that the Self-Respect Strategy needs. (shrink)

Hermeneutical injustice means being unjustly prevented from making sense of one’s experiences, identity or circumstances and/or communicating about them. The literature focusses almost exclusively on whether people have access to adequate conceptual resources. In this paper, we discuss a different kind of hermeneutical struggle caused by stigma. We argue that in some cases of hermeneutic injustice people have access to hermeneutical resources apt to understand their identity but reject employing these due to the stigma attached to the identity. (...) We begin with a reinterpretation of one of the cases discussed in the literature, Edmund White’s novel A Boy’s Own Story. We argue that in this case hermeneutic resources are available but are rejected due to the stigma attached to homosexuality. We then present two analogous kinds of cases: alcohol addiction and being the victim of intimate partner violence. Here, too, hermeneutic injustice occurs because of the stigma attached to an identity rather due to unavailability of resources. We close by suggesting that these cases may, additionally, involve the wrong of ‘Tightlacing’: by meddling with their self-conception, stigma can manipulate individuals into a view of themselves that licenses inappropriate demands on them and makes them complicit in the erasure of their identities. (shrink)

Relational egalitarians oppose social hierarchy. Or, more precisely, they oppose intolerable social hierarchy. Stigma is often included among those unequal forms of relating that relational egalitarians ought to oppose, but there are circumstances in which stigmatizing behaviors or group identities might be strategically important for opposing social inequalities. Working through different responses to this puzzle, in this paper I advance the view that stigma is neutral, such that relational egalitarians should only oppose forms of it that are unwarranted.

The concept of organizational stigma has received significant attention in recent years. The theoretical literature suggests that for a stigma to emerge over a category of organizations, a “critical mass” of actors sharing the same beliefs should be reached. Scholars have yet to empirically examine the techniques used to diffuse this negative judgment. This study is aimed at bridging this gap by investigating Goffman’s notion of “stigma-theory”: how do stigmatizing actors rationalize and emotionalize their beliefs to convince (...) their audience? We answer this question by studying the stigma over the finance industry since 2007. After the subprime crisis, a succession of events put the industry under greater scrutiny, and the behaviors and values observed within this field began to be publicly questioned. As an empirical strategy, we collected opinion articles and editorials that specifically targeted the finance industry. Building on rhetorical analysis and other mixed methods of media content analysis, we explain how the stigmatizing rhetoric targets the origins of deviant organizational behaviors in the finance industry, that is, the shareholder value maximization logic. We bridge the gap between rhetorical strategies applied to discredit organizations and ones used to delegitimize institutional logics by drawing a parallel between these two literatures. Taking an abductive approach, we argue that institutional contradiction between field and societal-level logics is sufficient, but not necessary to generate organizational stigma. (shrink)

I offer a preliminary examination on the importance of narrative for helping to overcome the issue of stigma surrounding mental illness, specifically schizophrenia. I maintain that engaging with first-person accounts of schizophrenia allows caregivers, and the broader general public, to better understand the phenomenological lived experiences of persons living with this mental health challenge and to better understand the experience of dealing with stigma. In doing so, I maintain that both caregivers and the public can begin developing more (...) accepting views of schizophrenia and begin to support those who need it the most. (shrink)

Challenges to psychiatric stigma fall between a rock and a hard place. Decreasing one prejudice may inadvertently increase another. Emphasising similarities between mental illness and ‘ordinary’ experience to escape the fear-related prejudices associated with the imagined ‘otherness’ of persons with mental illness risks conclusions that mental illness indicates moral weakness and the loss of any benefits of a medical model. An emphasis on illness and difference from normal experience risks a response of fear of the alien. Thus, a ‘likeness-based’ (...) and ‘unlikeness-based’ conception of psychiatric stigma can lead to prejudices stemming from paradoxically opposing assumptions about mental illness. This may create a troubling impasse for anti-stigma campaigns. (shrink)

This paper explains how discrimination and COVID-19 related stigmas are intertwined. When people stigmatize COVID-19 victims, they act in ways for which the victims suffer status loss and discrimination. As a result, they do not enjoy participatory parity in various aspects of their life making COVID-19 related stigmatization a deplorable instance of discrimination. But a society already fraught with discrimination is a breeding ground of stigmatization often because of people’s fear and anxiety about their life once they become a patient (...) of a disease like COVID-19. (shrink)

As social and interdependent beings, we have responsibilities to each other. One of them is to recognize each other appropriately. When we fail to meet this responsibility, we often stigmatize. In this paper, I argue that the COVID-19-related stigmatization is a variation of the lack of recognition understood as an orientation to our evaluative features. Various stereotypical behaviors regarding COVID-19 become stigmatized practices because of labeling, stereotyping, separation, status loss and discrimination, and power. When people stigmatize COVID-19 victims, they orient (...) themselves to their evaluative quality of being vulnerable to the SARS-CoV-2 virus by internalizing the victims as dangerous, understanding them as separable, and being motivated to act with them differently. All this causes the COVID-19 victims to lose status and suffer discrimination for which they do not experience participatory parity in different facets of their lives, rendering the COVID-19-related stigmatization an appalling example of misrecognition. (shrink)

This work explores structural isomorphisms: identical relational patterns operating across distinct substrates. Beginning with the botanical term stigma (the receptive surface of a flower’s pistil), it traces the same relational configuration through social stigmatization and religious stigmata.

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research suggests that (...) practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

Investigators increasingly need high quality face photographs that they can use in service of their scholarly pursuits—whether serving as experimental stimuli or to benchmark face recognition algorithms. Up to now, an index of known face databases, their features, and how to access them has not been available. This absence has had at least two negative repercussions: First, without alternatives, some researchers may have used face databases that are widely known but not optimal for their research. Second, a reliance on databases (...) comprised only of young white faces will lead to science that isn't representative of all the people whose tax contributions, in many cases, make that research possible. The “Face Image Meta-Database” (fIMDb) provides researchers with the tools to find the face images best suited to their research, with filters to locate databases with people of a varied racial and ethnic backgrounds and ages. Problems of representation in face databases are not restricted to race and ethnicity or age – there is a dearth of databases with faces that have visible differences (e.g., scars, port wine stains, and cleft lip and palate). A well-characterized database is needed to support programmatic research into perceivers' attitudes, behaviors, and neural responses to anomalous faces. The “ChatLab Facial Anomaly Database” (CFAD) was constructed to fill this gap, with photographs of faces with visible differences of various types, etiologies, sizes, locations, and that depict individuals from various ethnic backgrounds and age groups. Both the fIMDb and CFAD are available from cliffordworkman[dot]com/resources/. (shrink)

Die Einführung der HIV-Prophylaxe PrEP ist ein Beispiel für demokratische Biopolitik und macht Hoffnung auf eine Beendigung von Sexnegativität und Stigmatisierung, findet Dr. Karsten Schubert.

Cultural stigma and medical pathologization have long shaped scientific and social perceptions of menstruation, limiting both research and clinical attention. This paper outlines three major sources of negative perceptions and examines their influence on scientific discourse and cultural attitudes. To counter these biases and misconceptions, evolutionary accounts of menstruation are explored, which emphasize its crucial role in human physiology and reproduction. Two evolutionary approaches to adaptation are compared: one adopts a functionalist stance that assigns specific functions to traits. While (...) this perspective offers a naturalized and positive understanding of menstruation, it remains insufficient to capture the phenomenon’s full complexity. In response, the paper draws on a second approach, organismal and relational, which emphasizes whole-organism adaptation within developmental and ecological contexts. This contrast is also reflected in evolutionary medicine, where organismal approaches support integrative views of disease patterns. Revisiting late 20th-century debates on whether menstruation is adaptive or a byproduct, the paper presents key elements of the alternative organismal-relational perspective. This framework makes it possible to distinguish three broad categories of menstrual pathologies and supports the claim that organismal evolutionary perspectives offer a richer understanding of menstrual health. (shrink)

This article critically examines how anti-fat biases have been introduced into environmental bioethics, particularly in discussions of climate change. Fat bodies are often linked to environmental harm based on the flawed assumption that they consume more resources and produce higher greenhouse gas emissions. The authors argue that such claims rely on mistaken assumptions, which ultimately result in the disproportionate blaming of already oppressed individuals, reinforcing weight stigma, and exacerbating fat people’s vulnerability to various harms—especially within communities of color. Framing (...) fatness as an environmental burden is thus both empirically unfounded and unjust. (shrink)

Epidemiological crisis during recrudescence of pandemic like COVID-19 may stir fear and anxiety leading to prejudices against people and communities, social isolation and stigma. Such behavioral change may wind up into increased hostility, chaos and unnecessary social disruptions. A qualitative exploratory approach was utilized to conduct an extensive review of secondary literature. The case-studies were gathered from academic literature like articles, opinions and perspective pieces published in journals and in grey literature like publications in humanitarian agencies and media reports. (...) Grey literature was included in the scope as the COVID-19 situation is still evolving. I discuss some of the mechanisms of stigmatization and how social connectedness and empathetic understandings can be a way out of negative stereotyping and discrimination met out to the sufferer of the communicable diseases as COVID-19. Empathetic understanding paves a way to approach a problem from the perspective of ‘we’ not limiting one only to ‘I’. The moment when we make an approach from ‘I’ to ‘We’ actually then we embark on a journey of illness to wellness. Keywords: COVID-19, pandemic, stigma, discrimination, mental health, empathy, India, Face-to-face communication, social distancing, suicide. (shrink)

In this commentary, I will consider the implications of the argument made by Christopher Stratman (2020) in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, that virtually everything we already know about unintended pregnancies, abortion and adoption does not (...) prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion then there is unlikely to be any radical transformation of the practice of abortion. Second, abortion is already associated with stigma and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the fetus to the human subject of the artificial womb—the gestateling. Therefore, creating a new category of killing—gestaticide—and this would only reorient the debate rather than end it. (shrink)

Jennifer Blumenthal-Barby (2024) has called for bioethics to end talk about personhood, asserting that such talk has the tendency to confuse and offend. It will be argued that this has only limited application for (largely) private settings. However, in other settings, theorizing about personhood leaves a gap in which there is the risk that the offending concept will get uptake elsewhere, and so the problem Blumenthal-Barby nominates may not be completely avoided. In response to this risk, an argument is presented (...) in support of the idea that the role of philosophers and bioethicists, far from ending talk of personhood, ought to be to clarify the concept, and to do so in nuanced ways, given its application for specific kinds of impairments. The case of dementia is used to illustrate this in the context of person-centered care. Ironically, given the stigma attached to dementia, far from the need to end talk of personhood, bioethicists are needed to rescue the concept and clarify its role. (shrink)

Human and its associated Acquired Immunodeficiency Syndrome (AIDS) have negatively affected many lives and altered many homes. HIV-related stigma is a major obstacle to HIV prevention and the well-being of people living with HIV (PLWH) in many developing nations, including Ghana. Since the first reported case in March 1986, the government of Ghana has put in place many measures to prevent its spread and increase access to treatment and health care, yet stigma and discrimination remain a barrier to (...) achieving these goals. Many people perceive the disease as a death sentence. Due to certain socio-cultural factors, the disease is sometimes perceived as a punishment for immoralities, hence fuelled certain behaviours (stigmatisation and discrimination) exhibited against people living with HIV/AIDS (PLWHA). Using a mixed data analysis, qualitative and quantitative research approach, this research examines the impact of HIV/AIDS and how it affects the life of PLWHA from 2000-2023, focusing on the Tafo and Pankrono communities in the Asante Region of Ghana. This will provide a comprehensive understanding of the effect of HIV on the lives of people living with it. The study discussed media and government policies in shaping HIV/AIDs as a discourse, cultural and societal factors that influence the perception, impact of stigma and discrimination on prevention efforts and access to support services, governmental policy frameworks. Primary contacts, such as HIV-positive clients, the youth, hospital personnel, and data managers, were interviewed, and statistical analysis was also conducted to obtain the number of people who have tested for HIV over the years; these responses and the statistical data were duly analysed. It could be said that the efforts and measures put in place by health personnel and the government to curb or reduce stigma and discrimination, so far, have yielded positive results or are relatively good. Despite these efforts to reduce stigma-related issues, factors such as societal norms, beliefs, and traditions, misconceptions about the disease continue to be a barrier to addressing stigma and discrimination affecting PLWHA. (shrink)

Willpower is a metaphor that is widespread in both common usage and expert literature across disciplines. This paper looks into willpower as a ‘metaphor we live by’, analyzing and exploring the consequences of the tacit information content of the willpower metaphor for agentive self-understanding and efficacy. In addition to contributing to stigma associated with self-control failures, the metaphor causally contributes to self-control failures by obscuring available self-control strategies and instructing agents to superfluous self-control efforts.

Addictive behavior sometimes involves harmful moral transgressions for which the addicted individual may be blamed. However, blame may motivate addiction stigma, which has its own harmful consequences, including failures to provide or seek out treatment and recovery resources. Minimizing blame and stigma, while acknowledging the moral dimension of addictive behavior, thus recommends itself as a worthy public health objective. The disease and choice models of addiction both face difficulties in reducing stigma, the latter because harmful choices are (...) considered culpable. By challenging the widely held libertarian conception of human agency, an explicitly deterministic understanding of the genesis and expression of addiction, including voluntary choices, can help keep reactive attitudes to wrongdoing in check. This will mitigate the perceived blameworthiness of addicted individuals, thus reducing stigma and increasing the chances of finding compassionate and effective care. Such an approach to addiction will recognize the need for moral accountability but not include punitive attitudes and policies justified by belief in libertarian agency. (shrink)

The brain disease model of addiction is widely endorsed by agencies concerned with treating behavioral disorders and combatting the stigma often associated with addiction. However, both its accuracy and its effectiveness in reducing stigma have been challenged. A proposed alternative, the “choice” model, recognizes the residual rational behavior control capacities of addicted individuals and their ability to make choices, some of which may cause harm. Since harmful choices are ordinarily perceived as blameworthy, the choice model may inadvertently help (...) justify stigma. This paper seeks to fully naturalize the choice model by highlighting the determinants of voluntary action and thus increase its potential for destigmatizing addiction. In light of a deterministic understanding of behavior, it is unreasonable to suppose that addicted individuals could have made different choices in becoming addicted and in subsequent situations. To the extent that stigma is motivated by the supposition that addicted individuals could have chosen otherwise in actual situations, a deterministic understanding of addictive behavior promises to mitigate blame and stigma. (shrink)

This study addresses the socioemotional consequences of visible pigmentary disorders such as vitiligo and melasma, a problem that profoundly affects individuals' quality of life. The relevance of this research lies in the growing need to understand how these dermatological conditions influence self-esteem, social interacti-ons, and psychological well-being, especially in diverse cultural contexts. Although existing literature has explored these impacts, it lacks approaches that integrate the uncertainty and subjectivity inherent in human experiences. To fill this gap, a PRISMA-based systematic review was (...) conducted, analyzing articles from PubMed, Scielo, and Scopus (2015–2025), and the neutrosophic OWA-TOPSIS method was employed, which combines weighted aggregation and prioritization to manage ambiguous data. The findings highlight low self-esteem and social stigma as the most significant consequences, along with anxiety and depression also being prevalent. This research contributes by introducing an innovative methodology that captures the uncertainty in psychosocial data, offering a solid basis for designing effective psychosocial interventions. It also provides practical tools for healthcare professionals, promoting a comprehensive approach to visible pigmentary disorders that transcends the dermatological dimension. (shrink)

Ryan and Savulescu recently offered an ethical analysis of the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, we continue the discussion and argue that their framework insufficiently addresses structural inequalities and the broader political context of obesity treatment. Positioning pharmaceutical drugs as a solution to socially produced health problems narrows moral decision-making, causing structural approaches to appear less urgent and less important. We criticise the individualistic conception of autonomy commonly invoked to justify pharmaceutical choice, arguing that (...) a proper definition of autonomy requires attention to social contexts—stigma, discrimination and economic inequality—that shape treatment decisions. We call for a broader ethical framework—one that interrogates structural injustices and reimagines health interventions beyond individual treatment—asking: is the problem our bodies or unregulated markets and environments that produce ill health in them? (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing (...) mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

Nonliteral uses of mental illness terms abound. Common examples include criticizing a person’s mood swings by saying “you’re bipolar”, hyperbolically exclaiming that a particularly difficult college exam “gave me PTSD”, or responding to a compliment about the cleanliness of one’s home by saying “I just have OCD.” There has been some pushback in recent years, both socially and within the philosophical literature, against using mental illness terms nonliterally to imply something negative about the subject. The focus so far has been (...) on the pejorative nature of the utterances. Nonliteral uses which imply something positive about the subject have all but gone ignored. One might think that these positive uses are innocent, perhaps even helpful in combatting stigma. On the contrary, as I argue in this paper, all nonliteral uses of mental illness terms are harmful, and they are harmful for the same reason. I argue that they contribute to what I call hermeneutic hijacking. Hermeneutic hijacking occurs when a term’s literal meaning is eclipsed by a nonliteral usage in a way that prevents the original term from functioning as it should. Though people have recognized the harm of pejoration, they have overlooked the way that nonliteral uses of mental illness terms, even absent pejoration, cause hermeneutic injustice. (shrink)

This study investigates the influence of evaluative judgments, specifically regarding an individual's moral character, on judgments of health and disease. Though it might seem that assessments judgments of health and disease should be impervious to evaluative judgments, two hypotheses suggest that health and disease judgments might be influenced by evaluative judgments: the "naturalization hypothesis" which centers on our inclination to assign blame, and the "pathologization hypothesis" rooted in the belief of a just world. These hypotheses lead to opposing predictions about (...) how someone with a perceived negative moral character might have their condition categorized. Employing a fictional vignette and the methodologies of experimental philosophy, our research provides evidence in favor of the "pathologization hypothesis." While this phenomenon likely carries real-world implications, especially in healthcare, it also has potential for offering insights into the dynamics of medicalization and stigma. (shrink)

Background The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older (...) persons. Results 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration We registered our systematic review in the PROSPERO network under CRD42021248543. (shrink)

[This piece is written for those working in communication studies and in healthcare writ large, with the aim of bringing insights from disability studies and philosophy of disability to bear on discussion concerning disability in those fields.] Despite being assailed for decades by disability activists and disability studies scholars spanning the humanities and social sciences, the medical model of disability—which conceptualizes disability as an individual tragedy or misfortune due to genetic or environmental insult—still today structures many cases of patient–practitioner communication. (...) Synthesizing and recasting work done across critical disability studies and philosophy of disability, I argue that the reason the medical model of disability remains so gallingly entrenched is due to what I call the “ableist conflation” of disability with pain and suffering. In an effort to better equip healthcare practitioners and those invested in health communication to challenge disability stigma, discrimination, and oppression, I lay out the logic of the ableist conflation and interrogate examples of its use. I argue that insofar as the semiosis of pain and suffering is structured by the lived experience of unwelcome bodily transition or variation, experiences of pain inform the ableist conflation by preemptively tying such variability and its attendant disequilibrium to disability. I conclude by discussing how philosophy of disability and critical disability studies might better inform health communication concerning disability, offering a number of conceptual distinctions toward that end. (shrink)

Autism is a psychopathological condition around which there is still much prejudice and stigma. The discrepancy between third-person and first-person accounts of autistic behavior creates a chasm between autistic and neurotypical (non-autistic) people. Epistemic injustice suffered by these individuals is great, and a fruitful strategy out of this predicament is much needed. I will propose that through the appropriation and implementation of methods and concepts from phenomenology and ecological-enactive cognitive science, we can acquire powerful tools to work towards greater (...) epistemic justice for autistic individuals. I will use the resources found in the skilled intentionality framework, integrated with various phenomenological theories. From these approaches, we can view autistic impairments and disability relationally and how epistemic enablement and disablement form. Phenomenology and its methods help us learn more about the perceptual and social experiences of autistic individuals. The voices of the autistics themselves will be of the greatest importance here. I will show that, through restructuring our landscape of affordances and with a greater phenomenological understanding of the autistic inner world, we can devise new strategies that afford greater epistemic enablement and epistemic justice. (shrink)

Xenotransplantation has the potential to alter the U.S. transplant system in profound ways. However, this emerging “spare parts” solution spearheaded by biotechnology companies raises concerns about its impact on the organ shortage, healthcare systems, population health, and health inequalities. We contend that xenotransplantation may have limited benefits in improving health, could prove prohibitively expensive for many, and may divert resources away from proven public health measures. Additionally, it carries the risk of perpetuating stigma. Xenotransplantation may thereby exacerbate existing healthcare (...) inequities across racial, ethnic, socio‐economic, and geographic lines. To mitigate these risks, we contend that public health expert input is integral for xenotransplant policy development and outreach and that this underscores the importance of federal government investment in transplant infrastructure. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The (...) system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

Räsänen and Ahola-Launonen recently offered a commentary on an ethical analysis I co-authored with Julian Savulescu on the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, I continue the discussion by engaging their concerns about the narrow framing of our analysis with respect to the structural determinants of health and the conditions of autonomy, as well as the role of race, class and gender in shaping stigma and access to treatment. I argue that Räsänen and Ahola-Launonen’s (...) critique and the conclusion they draw are largely in alignment with our paper and that the absence in our account of a more expansive conception of autonomy and a broader discussion of race, class and gender are fair criticisms. In what follows, I add nuance to these dimensions and caution against critiques of unjust structures that risk reproducing injustice by inadvertently denying the agency, self-respect and inclusion of marginalised groups. (shrink)

This article analyses how child victims of abuse may be subjected to hermeneutical injustice. I start by explaining how child victims are hermeneutically marginalised by adults’ social and epistemic authority, and the stigma around child abuse. In understanding their abuse, I highlight two epistemic obstacles child victims may face: (i) lack of access to concepts of child abuse, thereby causing victims not to know what abuse is; and (ii) myths of child abuse causing misunderstandings of abuse. When these epistemic (...) obstacles cause the child victims to fail to see themselves as being abused and/or to get adults to recognise that they are being abused, I argue that this constitutes hermeneutical injustice. While some may justify obstructing epistemic access to concepts of abuse on the grounds of parental rights and protection of children’s innocence, I reply that both grounds are unjust in light of children’s basic rights and the fact that children can easily be taught such concepts in a child-appropriate manner. The case of child abuse prompts important reflections on existing epistemic injustice literature, particularly on the ways in which hermeneutical injustice materialises, the epistemic responsibilities of institutional bodies and individuals, and the interrelationship between testimonial and hermeneutical injustice. (shrink)

Recent studies demonstrating epigenetic and developmental sensitivity to early environments, as exemplified by fields like the Developmental Origins of Health and Disease (DOHaD) and environmental epigenetics, are bringing new data and models to bear on debates about race, genetics, and society. Here, we first survey the historical prominence of models of environmental determinism in early formulations of racial thinking to illustrate how notions of direct environmental effects on bodies have been used to naturalize racial hierarchy and inequalities in the past. (...) Next, we conduct a scoping review of postgenomic work in environmental epigenetics and DOHaD that looks at the role of race/ethnicity in human health (2000–2021). Although there is substantial heterogeneity in how race is conceptualized and interpreted across studies, we observe practices that may unwittingly encourage typological thinking, including: using DNA methylation as a novel marker of racial classification; neglect of variation and reversibility within supposedly homogenous racial groups; and a tendency to label and reify whole groups as pathologized or impaired. Even in the very different politico-economic and epistemic context of contemporary postgenomic science, these trends echo deeply held beliefs in Western thinking which claimed that different environments shape different bodies and then used this logic to argue for essential differences between Europeans and non-Europeans. We conclude with a series of suggestions on interpreting and reporting findings in these fields that we feel will help researchers harness this work to benefit disadvantaged groups while avoiding the inadvertent dissemination of new and old forms of stigma or prejudice. (shrink)

The dispute about the role of class in understanding the life situations of people of color has tended to be overpolarized, between a class reductionism and an “it's only race” position. Class processes shape racial groups’ life situations. Race and class are also distinct axes of injustice; but class injustice informs racial injustice. Some aspects of racial injustice can be expressed only in concepts associated with class (e.g., material deprivation, inferior education). But other aspects of racial injustice or other harms, (...) such as racial discrimination or stigma, are not reducible to class concepts and cannot be fully addressed through class-focused policies. Overall, any attempt to fully secure racial justice for a racial group will require a combination of race-focused and class-focused policies. Anti-racist outlooks often neglect or downplay either the normative or the explanatory significance of class, or both—for example, by overlooking or downplaying the dignitary harms of class and the material harms of race; missing the historical dimension of class injustice; masking class by a narrowing of the complex normative structure of racial disparities; or not recognizing that a class-focused initiative (like raising the minimum wage) can address substantial racial justice concerns, even though not all of them. “Systemic racism” terminology recognizes class explanatorily but suppresses it normatively. Charles Mills's influential notion of “white supremacy,” while a powerful tool for conceptualizing and illuminating racial injustice, can also contribute to minimizing or masking the justice-related impact of class, as do some of Mills's specific discussions of class in various writings. (shrink)

Particularistic pejoratives (PPs) mock individuals based on their personal attributes yet lack a precise definition. This paper seeks to refine our understanding of PPs by examining their derogatory profiles across three dimensions: descriptiveness, intensity, and slurring potential. I propose a four-way taxonomy and argue that current frameworks fail to account for PPs beyond "all-purpose" terms like _jerk_ or _bastard_. To address this, I develop a pragmatic explanation of how PPs derogate by leveraging social stigmas and expectations. Finally, I argue that (...) slurs form a subset of PPs associated with dominance hierarchies, advancing our understanding of the mechanisms underlying verbal harm. (shrink)

Semaglutide (Wegovy), a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has attracted global attention for its appetite-suppressing and weight-loss effects. Approved by the U.S. FDA in 2022 for adolescents aged 12 and older, it has since been authorized in several other countries. Despite this, its use among youth remains limited, with ongoing concerns about its long-term safety, efficacy, and suitability during periods of growth and development. Advocates see Wegovy as an important tool for addressing pediatric obesity and its psychological burdens, while (...) critics caution against widespread use in such a vulnerable population. -/- This paper examines an underexplored ethical dimension of Wegovy’s use in children: its impact on mental health. We argue that Wegovy may offer mental health benefits for children—such as reducing weight stigma, improving self-esteem, and avoiding invasive interventions such as bariatric surgery. However, these potential benefits are constrained by barriers to access, supply shortages, risks of misuse, and the possibility of reinforcing stigma and class-based discrimination. -/- In light of these considerations, we argue that while Wegovy offers promising health benefits for children, its long-term effects on growth, development, and mental health remain uncertain, warranting further study before definitive policy decisions are made. If future evidence confirms its value, it is our view that access should be equitable and accompanied by reforms to reduce stigma, regulate prescribing, and prevent misuse. Until then, clinicians should prescribe cautiously, ensuring clear medical need and implementing safeguards against risks such as weight regain, treatment interruption, and bias in care. (shrink)

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative approach (...) to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs. (shrink)

Reasoning that leads to delusions—especially in schizophrenia—appears beyond the bounds of sense, profoundly inaccessible. By analyzing empirical research on reasoning that supports delusions in schizophrenia, I demonstrate that such reasoning can be made intelligible at the personal level. Specifically, I propose that these empirical findings can be positively characterized as reflecting a distinctive epistemic style—a unique implementation of reason rather than its absence. Delusion-supporting reasoning in schizophrenia can be understood as expressing epistemic values and preferences characteristic of a maverick epistemic (...) personality. As such, it is substantially intelligible in light of these underlying values. Further, I argue that the presence of this epistemic style in individuals with schizophrenia can itself be understood in light of their anomalous experiences and social exclusion. This view contributes to reducing stigma and provides new resources for theorizing non-standard interactions with evidence within the neurodiversity paradigm. (shrink)

This conceptual paper advocates for the recognition of neurodiversity within South African education policy as integral to the realisation of inclusive education. Current policy discourses marginalise neurodivergent communities by conflating neurodiversity with disability, reproducing deficit-based framings that neglect intersectional realities. This underrepresentation has negative consequences for the participation and recognition of neurodivergent learners, particularly those with autism and attention-deficit/hyperactivity disorder. We argue that policy reform is essential to reframe neurodiversity as difference, rather than disability. Drawing on the cultural model and (...) intersectionality theory, this study undertakes a qualitative analysis of post-apartheid education policy documents and relevant scholarly literature. The analysis critically interrogates how neurodiversity is framed, the extent of its representation, and the implications of prevailing deficit-oriented conceptualisations for inclusive education in South Africa. Findings reveal that neurodiversity is largely absent from existing policies, and when referenced, it is mischaracterised through medicalised discourses that reinforce stigma. Such framings erase strengths-based perspectives, perpetuate negative perceptions of autism and attention-deficit/hyperactivity disorder, and constrain institutional capacity to develop inclusive practices responsive to South Africa’s socio-cultural context. We call for Afrocentric, intersectional, and community-driven policy reform. Reframing neurodiversity as human diversity would align with UNESCO’s Salamanca Statement, enhance institutional inclusivity, and improve the educational experiences of neurodivergent learners across schools and universities in South Africa. (shrink)

Philosophical speculation about how psychiatric externalism might function in practice has yet to fully consider the multitude of externalist psychiatric systems that exist beyond the bounds of modern psychiatry. Believing that anthropology can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighboring borderlands. First, the paper describes the Akha set of medicinal, ritual, and (...) shamanic practices, analyzing issues of stigma and medical pluralism within it. Second, it makes the case that the Akha realize a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha re-frames psychiatric illness as a ‘problem in living,’ which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a takeaway for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness. (shrink)

Calls to break silence pervade public discourse on mental health. Silence can of course be harmful if it results from stigma and prevents people from getting the support they need. Such socially imposed, harmful silence should be broken. But we need to stop talking as though all silence in mental illness is like that. Although such oversimplification lends itself to punchy campaign slogans, it does not reflect the lived experience of patients. More importantly, it can inadvertently harm people already (...) in severe distress. (shrink)

Existing human rights models were designed for an era of visible violence and identifiable perpetrators. In the twenty-first century, harm increasingly occurs through digital, bureaucratic, and institutional systems that diffuse responsibility. This paper introduces the Human Rights+ Framework, an expanded model integrating three interdependent concepts: Invisible Harm (injury escaping recognition due to technological mediation or stigma), Harm Attribution Gaps (diffusion of responsibility for harm across complex systems), and Institutional Harm (damage generated by systems failing to act on known injustices). (...) Drawing on autoethnographic experience within coerced cyber-labour networks and comparative institutional analysis, the study demonstrates how structural, digital, and procedural opacity sustain impunity. Building on Galtung’s structural violence and Sen’s capability approach, the framework reconceptualizes rights as protections against all preventable constraints on human flourishing—including those enacted by algorithms and institutions. The paper concludes with policy mechanisms for narrowing harm-attribution gaps and establishing anticipatory accountability in AI and governance. (shrink)

Sex work is highly gendered, with 80 percent of sex workers being female, and the vast majority of buyers of sex being male. It is often taken for granted that this is how it is, and implicit in much of the debate around sex work is the assumption that it is inherently gendered. In this paper, I question this assumption, drawing on sociological research to challenge arguments which purport that it is inconceivable that women would ever want to pay for (...) sex, or that sex work would exist under conditions of gender equality. I argue that gendered sexual norms likely are a significant reason for why sex work is so gendered, but sex work would probably continue to exist under conditions of gender equality, due to the diversity in motivations people have for buying and selling sex. Acknowledging that sex work is not inherently gendered is important for (at least) two reasons. First, it is probable that the gendered nature of sex work contributes to the stigma and bad treatment that sex workers, particularly female ones, face. Secondly, if sex work is not inherently gendered, this will have implications for how we should think about it, morally, practically, and legally. (shrink)

This paper proposes a structural theory of selfhood, identity, and desire grounded in Judgemental Philosophy. We argue that identity—including aspects like gender, ethnicity, nationality, and sexual orientation—is not a fixed essence or biological given, but rather an emergent structure constituted through the successful operation of the Judgemental Triad (Constructivity, Coherence, Resonance). Identity exists and is validated where meaning can be symbolically formed (Constructivity), integrated consistently (Coherence), and most crucially, returned meaningfully through intersubjective loops (Resonance). Analyzing disputes surrounding non-normative identities and (...) desires, we contend that ethical conflicts often stem not from inherent immorality or biological inaccuracy, but from structural failures, particularly the blockage or denial of Resonance (misrecognition, stigma, silencing). We conclude that ethical recognition requires moving beyond mere tolerance to actively enabling the structural conditions for resonant attribution, affirming that true identity lies where judgement—and thus meaning—can return. (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical (...) issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)