Comment: In this short, seminal piece, Keisha Ray argues that bioethics needs to address issues of health and well-being of Black individuals. She applies Beauchamp and Childress’s famous four principles of bioethics to a particular issue: the disproportionate maternal mortality rate of Black women in the United States. Ray argues bioethics must incorporate the lens of Black bioethics, if the discipline is to remain relevant.

Comment: Wilson et al. argue that intersectionality is an important concept in clinical practice. They clarify the concept and distinguish their call for intersectionality from nearby claims. For instance, they argue that intersectionality goes beyond mere cultural competence that healthcare providers are already trained in, at least to some degree. Their paper is anchored around two fictionalized case studies, which they use to make vivid and explain their central claims. They end by responding to objections, including the very idea of intersectionality itself.

Comment: Yearby argues that appeals to racial categories—social, but especially biological—in medicine harm people from all races, including those from dominant racial groups, like Whites. Yearby first gives evidence for the claim that there is no biological reality to race. She then argues that the continued use of racial categorization in medicine—for instance, as a basis for different standards of care—leads to worse outcomes for all. For example, because Whites are often the de facto standard group in healthcare, their worse health outcomes are sometimes overlooked. Yearby ends by making suggestions for improving the categorization of people in healthcare.

Comment: In this excerpt from her book, Beasts of Burden, Taylor resists the way that animals and intellectual disabled people are often framed in terms of one another. She argues that this does a disservice to both groups. Animals are not voiceless, as they are often constructed. And their comparison to disabled people in the (in)famous argument from marginal cases should not be accepted. Perhaps most importantly, the argument opens for discussion the worth of disabled people’s lives. But this is not something that should be open for discussion, especially given the marginalization of disabled people.

Comment: Wieseler draws on resources developed by feminists and disability theorists to critique the practice of philosophical bioethics (bioethics done by philosophers). In particular, she argues that philosophical bioethics involves and perpetuates ableism. Among its many problems, this ableism is epistemically fraught. It interferes with disabled people’s ability to participate in various kinds of knowledge production. Wieseler uses a lot of technical terms—like epistemic exploitation, epistemic imperialism, and willful hermeneutical ignorance—but she explains everything clearly and the payoff is worthwhile. Wieseler uses these concepts to develop a powerful and thought-provoking critique of bioethical practice with respect to disability. The concepts are also useful in broader contexts, as we’ll see in section 3.

Comment: Stramondo critiques triage protocols that were put into place, or at least proposed, during the COVID-19 pandemic. Stramondo argues that protocols that prioritize quality of life involve ableist commitments. While chance-of-survival protocols might do better here, he argues that they are also vulnerable to creeping ableism. Stramondo’s paper is valuable not only for its perspective on triage protocols, but also for highlighting some crucial theoretical contributions by philosophers of disability and by bioethicists. Stramondo also argues not to cede too much ground to fatalism in thinking about triage protocols; bioethicists should also, and perhaps primarily, resist the framing of triage as inevitable, rather than a product of various privileged interests.

Comment: Moral distress is, roughly, when a healthcare worker is institutionally constrained to act against their best moral judgement. A typical example is a nurse being prevented from giving care they deem morally required because they are hierarchically constrained by the orders of a physician. Moral distress has been much discussed in nursing ethics, but is almost entirely absent from broader bioethics syllabi and conversations. This paper examines moral distress through a lens of feminist care ethics. In doing so, it draws lessons that apply very broadly throughout professional ethics.

Comment: Ashley draws on their own experiences as a trans person, as well as that of the trans community more broadly, to argue against assessment and referral requirements for hormone-replacement therapy (HRT). Ashley argues instead for an informed consent model, on which providers of HRT are not gatekeepers of transness, but facilitators of thoughtful decision-making.

Comment: Priest argues that the state should provide puberty-blocking treatment (PBT) for trans youth, even if their parents are not supportive. Priest’s argument is important partly because it avoids the issue of whether adolescents and children can give properly informed consent. This is a point that some of Priest’s critics seem to have missed (see, for example, Laidlaw et al. 2019. “The Right to Best Care for Children Does Not Include the Right to Medical Transition”, and Harris et al. 2019. “Decision Making and the Long-Term Impact of Puberty Blockade in Transgender Children”). Priest’s conclusion is founded instead on a principle of harm avoidance.