It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Abstract It would be puzzling if the morally best agents were not so good after all. Yet one prominent account of the morally best agents ascribes to them the exact motivational defect that has famously been called a “fetish.” The supposed defect is a desire to do the right thing, where this is read de dicto . If the morally best agents really are driven by this de dicto desire, and if this de dicto desire is really a fetish, then (...) the morally best agents are moral fetishists. This is puzzling. I resolve the puzzle by showing that on a proper understanding of the interaction between de dicto and de re moral motivation, it is not only not fetishistic, but quite possibly desirable, to be motivated by a de dicto desire to do the right thing. My argument relies partly on an appeal to a non-buck-passing account of moral rightness, according to which rightness is itself an additional reason-giving property over and above the right-making properties of an action. If this account of moral rightness is correct, then we would expect the morally best agents to exhibit de dicto moral motivation. However, since their de dicto desire acts in concert with de re desires, there is no reason to consider it a fetish. Content Type Journal Article Pages 1-19 DOI 10.1007/s11098-011-9825-z Authors Vanessa Carbonell, Philosophy Department, University of Cincinnati, P.O. Box 210374, Cincinnati, OH 45221-0374, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116. (shrink)

I argue for the existence of a ‘ratcheting-up effect’: the behavior of moral saints serves to increase the level of moral obligation the rest of us face. What we are morally obligated to do is constrained by what it would be reasonable for us to believe we are morally obligated to do. Moral saints provide us with a special kind of evidence that bears on what we can reasonably believe about our obligations. They do this by modeling the level of (...) sacrifice a person can realistically bear. Exposure to moral saints thus ‘ratchets-up’ our obligations by combating a type of ignorance that would otherwise defeat those obligations. (shrink)

The moral community is a social community, and as such it is vulnerable to social problems and pathologies. In this essay I identify a particular way in which participation in the moral community can be constrained by social factors. I argue that features of the social world—including power imbalances, oppression, intergroup conflict, communication barriers, and stereotyping—can make it nearly impossible for some members of the moral community to hold others responsible for wrongdoing. Specifically, social circumstances prevent some marginalized people from (...) engaging in what Stephen Darwall calls “felicitous moral address” (Darwall 2006). We should think of some members of the moral community as having “second-class moral citizenship” in ways that parallel second-class political citizenship. The injustice of second-class moral citizenship can be understood by drawing an analogy with Miranda Fricker’s notion of “epistemic injustice” (Fricker 2007). Fricker’s account of how people can be undermined in their capacity as knowers can be extended to show how people can be undermined in their capacity as makers of moral claims, which can be called “claimant injustice”. (shrink)

Susan Wolf famously claimed that the life of the moral saint is unattractive from the “point of view of individual perfection.” I argue, however, that the unattractive moral saints in Wolf’s account are self-defeating on two levels, are motivated in the wrong way, and are called into question by real-life counter-examples. By appealing to a real-life case study, I argue that the best life from the moral point of view is not necessarily unattractive from the individual point of view.

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system activity; (...) and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

Malicious moral envy is an aversive reaction to a rival’s moral properties or accomplishments, accompanied by a tendency to level-down the target by morally tarnishing or sabotaging them. In this essay I give an account of malicious moral envy, showing how it is a sub-type of envy more generally. I describe Donald Trump’s behaviors toward Barack Obama and Anthony Fauci as a case study of malicious moral envy. I argue that malicious moral envy is puzzling, first because it is self-defeating, (...) and then—more interestingly—because it betrays an ambivalence about morality and moral requirements. I explore how malicious moral envy relates to other issues in the literature on moral ambivalence, including moral exemplars, moral saints, admirable immorality, and the pathologizing of moral outliers. Ultimately I suggest that mild forms of malicious moral envy may play an important role in helping agents navigate the socially complex and constantly changing landscape of moral requirements. (shrink)

Knowledge is necessary for certain moral obligations. In learning something new, one sometimes triggers a moral obligation. This paper argues that the existence of these knowledge-based obligations poses a problem for the view that we are not only free to choose the course of our own lives, including our careers and personal projects, but also free to change our minds and quit at any time to pursue something else. For if our choice of life path has generated knowledge-based moral obligations (...) that we must fulfill, then it is apparently not true that we can quit at any time. To resolve this tension, this paper proposes a relatively demanding set of conditions under which it is permissible to swap one career or life project for another. The resulting compromise reconciles the moral force of knowledge-based obligations with the basic freedom to choose less-than-optimal careers and projects. It also highlights the distinctive role played by knowledge and expertise in generating the intractable problem of morality’s demandingness. (shrink)

The purpose of this essay is to make the case that the ethical issues raised by the current U.S. practice of direct-to-consumer prescription drug advertising are worthy of study in philosophy courses, and to provide instructors with some ideas for how they might approach teaching the topic, despite the current relative scarcity of philosophical literature published on it. This topic presents a unique opportunity to cover ground in ethics, critical thinking, and scientific literacy simultaneously. As a case study, the practice (...) of DTC advertising is both theoretically rich and universally relevant to students’ lives. The nature of these ads—numerous, diverse, visually and thematically entertaining—makes them delicious fodder for in-class activities, small group work, discussion-based learning, creative projects, and customizable essay topics. I offer a set of suggestions for approaching the study of DTC drug ads that is informed by my own experience doing so in bioethics courses. Ultimately, including this topic on your syllabus not only contributes to students’ philosophical skills and knowledge, but also helps them become better informed as citizens and potential “consumers” of health care. (shrink)