Med Health Care Philos [JOURNAL]
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200 papers
Clarifying the muddle: towards a comprehensive taxonomy of cognitive biases in medicine.
Amoretti MC, Lalumera E
Med Health Care Philos · 2026 Apr · PMID 41954853 · Publisher ↗
Cognitive biases are widely discussed in the medical literature as systematic deviations from rational judgment and as significant contributors to diagnostic error. However, the prevailing view of cognitive biases as inh...
Cognitive biases are widely discussed in the medical literature as systematic deviations from rational judgment and as significant contributors to diagnostic error. However, the prevailing view of cognitive biases as inherently epistemically detrimental may be challenged by recent research highlighting their potential utility. In this paper, we argue that the impact of cognitive biases in medicine depends not only on their internal cognitive structure, but also on the ecological characteristics of the medical environments in which they operate. We develop a conceptual framework that distinguishes between three types of cognitive biases: (1) those that are epistemically reliable (and practically useful) in so-called "safe cognitive environments", where ecological informational structures reliably support the use of "fast and frugal" heuristics; (2) those that are practically useful in "pragmatically permeable contexts" such as emergency care or public health, where time pressure, uncertainty, or resource constraints justify decisions that are epistemically suboptimal but action-guiding; and (3) those that are neither epistemically nor pragmatically defensible, and thus constitute clear targets for mitigation. By offering this taxonomy, we aim to clarify when and why cognitive biases hinder or support medical reasoning and practical actions. Our analysis also emphasizes the need to reframe some traditional assumptions in medical epistemology and education. Rather than attempting to eliminate all cognitive biases, we advocate for a more nuanced, context-sensitive, and ecologically informed approach in medicine. We conclude by outlining the implications of this framework for improving diagnostic accuracy, professional training, and institutional practices in healthcare.
Vulnerability as a normative concept: reviving the scepticism.
Soofi H
Med Health Care Philos · 2026 Apr · PMID 41934545 · Publisher ↗
Appeals to vulnerability are widespread in bioethics, yet they continue to face criticism. One line of critique concerns their normative force, with two major sceptical claims dominating the debate. The strong version ho...
Appeals to vulnerability are widespread in bioethics, yet they continue to face criticism. One line of critique concerns their normative force, with two major sceptical claims dominating the debate. The strong version holds that vulnerability alone carries little or no normative force. The moderate version grants some role but denies that it has the same normative force as concepts such as wrong or wronging. I revisit these claims in light of Catriona Mackenzie’s rejoinder, which shifts the focus from relational or situational vulnerability to its ontological sense, framed as a morally salient feature of humanity. While Mackenzie’s account is novel, it faces challenges from the needs‑theory literature she draws on, where dependence appears a more direct basis for grounding obligations related to vital needs. I examine Mackenzie’s favoured argumentative strategy of intertwining dependence and ontological vulnerability, and I argue that even if one accepts intertwinement in functional co‑constitution sense, this would not by itself establish vulnerability as a foundational obligation‑grounding concept. I then consider possible avenues for vulnerability defenders. I argue that the option of identifying another transitive intra‑conceptual relation between dependence and vulnerability is not readily available. A second option is to claim that ontological vulnerability is foundational not through a transitive relation from dependence but because both are morally salient. I argue that the stronger sense of moral salience implies obligation‑grounding, making the argument circular; and that the weaker sense, understood as mere moral relevance, leaves the account open to the very sceptical challenge it aims to resist.
Color and health inequities.
Ten Have H, Gordijn B
Med Health Care Philos · 2026 Jun · PMID 41934544 · Publisher ↗
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Is there a judgment here? Why medicine cannot endure decision-making without a judging subject in the age of AI.
Matsui M
Med Health Care Philos · 2026 Apr · PMID 41920434 · Publisher ↗
Artificial intelligence is increasingly integrated into medical decision-making, often framed as a supportive tool that enhances accuracy while leaving final judgment to clinicians. This paper argues that such framing ob...
Artificial intelligence is increasingly integrated into medical decision-making, often framed as a supportive tool that enhances accuracy while leaving final judgment to clinicians. This paper argues that such framing obscures a deeper structural shift: medical action may proceed without any judgment ever occurring. AI systems do not judge; they generate outputs through statistical transduction. Clinicians, under institutional and legal pressures, may relay these outputs without regenerating them as their own reasons. When neither AI nor clinician generates judgment, decisions are enacted without a judging subject. While judgment without a judging subject may be sustainable elsewhere, medicine renders this absence unsustainable. Medical practice is characterized by irreversibility, case-specificity, meaning-demand, and relational accountability-features that presuppose judgment as a human act. Even clinically correct outcomes do not guarantee that patients will recognize a decision as right for them. When judgment disappears, informed consent persists only as a procedural ritual, simulating understanding without grounding it. To make this absence explicit, the paper introduces Metaqualia Theory (MTQ), distinguishing patient experience (Q), technical transduction (T), and judgment as meaning-generating endorsement (M). This leads to a prior ethical question: Is there an M here? This question precedes concerns about explainability and helps clarify the conditions under which consent and responsibility remain meaningful. The analysis suggests that when AI outputs are not regenerated as human judgment, their role in medical practice raises structural limits that cannot be addressed by transparency alone.
Moral distress: sometimes, there is no fix.
Brown C, Solbakk JH
Med Health Care Philos · 2026 Mar · PMID 41854996 · Publisher ↗
Since Andrew Jameton introduced the term “moral distress” (MD) in 1984, the idea has gained enormous attention in the healthcare literature. We offer a critical, narrative review of the understandings of MD that have bee...
Since Andrew Jameton introduced the term “moral distress” (MD) in 1984, the idea has gained enormous attention in the healthcare literature. We offer a critical, narrative review of the understandings of MD that have been proposed, with an eye towards their scope and corresponding ability to speak to the moral vulnerability inherent in human life. Jameton’s understanding of MD is narrow in the sense that it requires the presence of institutional constraints (e.g., hierarchies or hospital policies) that prevent a healthcare professional from doing what they take to be morally right. Other theorists have suggested that internal constraints (e.g., lack of moral courage) can engender MD as well, and still others have suggested that neither kind of constraint is necessary, as MD can arise from moral conflicts and moral uncertainty in addition to constraints. We criticize understandings of MD that emphasize institutional and/or internal constraints, as they exclude cases in which MD does not arise from any flaw or shortcoming and so for which there is no fix. However, we also criticize understandings of MD that look beyond constraints in general, as they lose sight of MD’s distinguishing feature as a moral experience, namely the anguished or panicked sense that one is constrained from doing what one takes to be morally required. We suggest that the corrective involves acknowledging a third kind of constraint: human constraints, or constraints that arise from the human condition rather than any kind of flaw or shortcoming.
Responsibility and disrespect: reply to Tsiakiri.
Ehlert A, Björk J
Med Health Care Philos · 2026 Mar · PMID 41849070 · Publisher ↗
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Towards a medical ethics of suffering: ontological and practical foundations.
García-Rico E, de la Sota AE, Daza AO … +2 more , Muñoz FL, Garcia L
Med Health Care Philos · 2026 Jun · PMID 41849069 · Publisher ↗
This paper proposes a radical reconfiguration of medical ethics by placing suffering-not as a clinical symptom or ancillary datum, but as an ontological category-at the center of ethical deliberation. In the face of a fr...
This paper proposes a radical reconfiguration of medical ethics by placing suffering-not as a clinical symptom or ancillary datum, but as an ontological category-at the center of ethical deliberation. In the face of a fragmented and technified clinical practice, we argue that suffering is the only truly universal human experience, irreducible to cultural, linguistic, or ideological variations. As such, it offers a potent, immanent foundation for a non-relative ethics in medicine. Drawing on the philosophical contributions of Heidegger, Levinas, Jonas, Jaspers, Butler, and Schopenhauer, we develop a model of medical ethics rooted in the shared and asymmetrical vulnerability that suffering reveals. Rather than abstract principles or procedural deontology, this model emphasizes narrative, responsibility, and hospitality as structural dimensions of the clinical act. We contend that medicine must move from being a problem-solving technique to becoming a space of presence, attention, and recognition-where suffering is not erased but welcomed. The clinical encounter is thus reimagined as a site of ontological unveiling, where the physician's role is not merely to diagnose or intervene, but to bear witness, to accompany, and to share in the exposure of the other. This ethics of suffering entails epistemological shifts (through narrative and phenomenology), spatial transformations (via architecture of care), and institutional reforms (integrating patients' voices and lived experience). Ultimately, we propose suffering not as a failure of health, but as the ethical ground from which a truly human medicine must begin.
Cure as medicine's constitutive aim: a defence of the refined curative thesis.
Ncube L
Med Health Care Philos · 2026 Jun · PMID 41807766 · Full text
Medicine has persisted for thousands of years despite frequent therapeutic failures. What explains its persistence despite its failure to cure? I contend that the Inquiry thesis's view - seeing medicine's "core business"...
Medicine has persisted for thousands of years despite frequent therapeutic failures. What explains its persistence despite its failure to cure? I contend that the Inquiry thesis's view - seeing medicine's "core business" as prediction and understanding - rests on an unhelpful conceptual distinction between main goal and core business, along with an implausible "No Bullshit" premise. Instead, I support the refined Curative Thesis (RCT): medicine is united by a teleological (constitutive) aim to help the sick through socially organised and accountable interventions, even when cures are uncertain. Using conceptual analysis and analogies from comedy, mining, and policing, I demonstrate that professions can survive repeated failures in their main goals, revealing a symmetry: prediction and explanation often fail as well. This work is innovative in three ways: it discards "core business" as a defining tool, introduces a teleological boundary that accommodates epistemic diversity, and redefines prediction and understanding as instrumental goods intrinsic to medicine. It also relates RCT to other recent curative-focused and related accounts, such as Smart (Synthese 201(6):194, 2023); Varga (Science, medicine, and the aims of inquiry, Cambridge University Press, Cambridge, 2024); Stegenga (Care and cure, University of Chicago Press, Chicago, 2018), clarifying their significance.
Physicians' ethical responsibilities in relation to the climate and further environmental crises: a review of academic publications.
Timmermann C, Wabnitz KJP, Schlögl-Flierl K … +1 more , Wild V
Med Health Care Philos · 2026 Jun · PMID 41796424 · Full text
The climate and further environmental crises have motivated calls for the medical profession to act by taking on additional responsibilities. These calls to assume responsibilities towards environmental protection and to...
The climate and further environmental crises have motivated calls for the medical profession to act by taking on additional responsibilities. These calls to assume responsibilities towards environmental protection and to systematically consider the health impacts of these crises greatly vary in their scope and demandingness. Through a review of journal publications, we have mapped the various calls for physicians to take on responsibilities in relation to these crises as individuals and as a professional group. These professional responsibilities, obligations or duties were grouped in four broad categories of physicians' roles as (i) medical practitioners, (ii) medical scientists, (iii) facility (co-)managers, and (iv) citizens. In sum, these responsibilities go beyond actions within the individual patient-physician relationship and setting, demanding from physicians to get involved within their institution, their community, engage with policy-makers, and also concern themselves with the health effects of environmental changes also on distant others, such as people in other parts of the world and future generations.
Chronic pain and unrecognized grief: epistemic barriers to personal and social recognition.
McCarroll CJ, Lin YT, Koesling D … +1 more , Bozzaro C
Med Health Care Philos · 2026 Jun · PMID 41796423 · Full text
What is it to grieve? What is the nature of grief? An intuitive and straightforward answer to these questions, one that will be familiar to all of us, is that grief is an emotional reaction to the death of a close loved...
What is it to grieve? What is the nature of grief? An intuitive and straightforward answer to these questions, one that will be familiar to all of us, is that grief is an emotional reaction to the death of a close loved one. Grief is intimately connected to bereavement. However, grief can arise in situations beyond the death of a significant other and is revealed to be a much more complex and heterogeneous experience. People can grieve over all sorts of losses. What makes our response to these losses one of grief? We can understand all these losses as involving a loss of life possibilities, which impacts one's practical identity and who one takes oneself to be. Importantly, a close examination of the phenomenology of chronic pain helps illuminate the ways in which it also involves the kind of losses that we can grieve over. The losses involved in experiences of chronic pain impact one's practical identity in ways that can lead to grief. This chronic pain grief remains largely unrecognized, however. We outline four epistemic barriers to recognizing the grief involved in experiences of chronic pain.
Recognizing epistemic injustice in healthcare: a case for methodological pluralism.
Færge S, Muldtofte L, Ustrup M … +2 more , Mikkelsen AKK, Speyer H
Med Health Care Philos · 2026 Mar · PMID 41792545 · Publisher ↗
Nielsen et al. (2025) recently presented a critique of the current scholarship on epistemic injustice in healthcare, emphasizing the absence of robust empirical evidence, the conceptual difficulty of establishing criteri...
Nielsen et al. (2025) recently presented a critique of the current scholarship on epistemic injustice in healthcare, emphasizing the absence of robust empirical evidence, the conceptual difficulty of establishing criteria for identification, and the risk of theoretical misapplication of Miranda Fricker's original framework. While the call for nuance and careful theoretical articulation might be worthwhile, the framing of their critique risks reinforcing precisely the patterns of epistemic exclusion that the concept of epistemic injustice is meant to expose. The implication that epistemic injustice must be operationalized and empirically validated in large-scale quantitative studies before it can be acknowledged as clinically and ethically significant may inadvertently replicate a longstanding hierarchy of knowledge in which certain forms of suffering become "real" only once translated into quantifiable data. In this response, we aim to advance the scholarly debate by questioning the argumentative basis of Nielsen et al.'s claim that fundamental scientific, conceptual, and theoretical flaws undermine the field of epistemic injustice in healthcare. We propose instead approaching epistemic injustice with social objectivity and methodological pluralism; the concept should not be dismissed for lacking quantification or standardization, but rather recognized for its complexity and significance in improving equity, care, and clinical encounters.
Epistemic disadvantage and looping breaks: a reply to Gauld et al.
Alcalay R
Med Health Care Philos · 2026 Jun · PMID 41790407 · Full text
While Gauld et al. correctly argue that warranted clinical exclusion of patient narratives need not constitute epistemic injustice, this paper introduces epistemic disadvantage, a coextensive but distinct category of har...
While Gauld et al. correctly argue that warranted clinical exclusion of patient narratives need not constitute epistemic injustice, this paper introduces epistemic disadvantage, a coextensive but distinct category of harm. Drawing on its three conditions, I show how epistemic harm persists even when exclusions are non-prejudicial and justified, contributing to clinical ethical obligations.
Humanization by depersonalization: historical contexts of the detainees' hospital during the war in Gaza.
Barilan YM
Med Health Care Philos · 2026 Jun · PMID 41790406 · Publisher ↗
Following the massacre on October 7th, 2023, Israel built a field hospital to care for wounded prisoners who were among the perpetrators of that massacre. Since Israel's ground invasion of Gaza, the facility has been car...
Following the massacre on October 7th, 2023, Israel built a field hospital to care for wounded prisoners who were among the perpetrators of that massacre. Since Israel's ground invasion of Gaza, the facility has been caring for captured "unlawful combatants". The hospital, which operated for nearly a year is made historically unique by its civilian, voluntary and makeshift structure of care on the medical side, along with the severe security measures imposed upon the patients-detainees. Based on extensive interviews with team members and related documents, this paper narrates the creation of this field hospital in its first five months of operation, its routines of care and key ethical challenges, from the perspective of its healthcare professionals, the hospital's ethics committee and the Israel Ministry of Health. Caregivers are constantly torn between their professional standards and natural empathy, on the one hand, and, on the other, a strong need to distinguish their Hamas patients from all others, including heinous criminals and other Palestinian detainees captured outside the context of the war in Gaza. The hospital team members try to restrain their empathy, usually seeking professional limits between compassion and inhumanity. The second part of the article offers reflections on the peculiarities of the field hospital and the special care ethics developed there, from the perspectives of the biopsychosocial model and the sociological distinction between "bare life" and "political life". Prison medicine, unlawful combatants, Geneva Convention, biopsychosocial model.
Bringing theoretical conceptions in psychiatry to epistemic justice.
Biturajac M
Med Health Care Philos · 2026 Jun · PMID 41787205 · Publisher ↗
Pathocentric epistemic injustice is a form of epistemic injustice that affects ill persons. In this paper I deal with pathocentric epistemic injustice in psychiatry that impacts persons with psychiatric conditions. There...
Pathocentric epistemic injustice is a form of epistemic injustice that affects ill persons. In this paper I deal with pathocentric epistemic injustice in psychiatry that impacts persons with psychiatric conditions. There are several sources of such epistemic injustice, ranging from the agential level to the structural, institutional and even to the theoretical level of healthcare and medicine. In this paper I explore theoretical conceptions as sources of pathocentric epistemic injustice in psychiatry. Specifically, I focus on the notion that the naturalistic conception of health is an epistemically unjust theoretical conception when it exclusively privileges the epistemic resources of biomedical sciences. Supposing this claim is correct, this paper tries to offer a way of ameliorating the pathocentric epistemic injustice caused by the naturalistic conception of health. I argue that the first step of the ameliorative project lies in emphasis and acknowledgement of the concepts that embody the patient perspective, such as harm, well-being and suffering. While these concepts are found in the theoretical sphere of psychiatry, they are underdeveloped and lack proper attention. Furthermore, while elaborating on these concepts is necessary, it is not sufficient for epistemic justice in psychiatry. Thus, I introduce the idea of epistemic pillars of psychiatry - scientific research, clinical work and patient's perspective. Epistemic justice in psychiatry does not rely on any one these elements, rather it rests on the collaboration, compromise and mutual recognition of these spheres. It lies in harmony of the three pillars of psychiatry, rather than in either element being the dominant one.
Can health technologies be "care optimizers"? A normative evaluation of digital health technologies in light of postphenomenological reflections.
Onder O, Ilkilic I
Med Health Care Philos · 2026 Jun · PMID 41784921 · Full text
The integration of new technologies such as artificial intelligence (AI) into healthcare has initiated profound changes in clinical practice, reshaping not only clinical workflows but the relational structure of care its...
The integration of new technologies such as artificial intelligence (AI) into healthcare has initiated profound changes in clinical practice, reshaping not only clinical workflows but the relational structure of care itself. Among the most significant developments is the transformation of the traditional doctor–patient dyad into a doctor–patient–technology triad. Philosophical studies of technology, especially postphenomenological research, argue that technologies should not be understood as neutral tools but as mediators of perception and action. Building on this perspective, we argue that ethical evaluation must move beyond description toward a normative orientation for understanding how such mediation reshapes care relations. To this end, we draw on postphenomenological theory of technological mediation in relation to contemporary clinical practices and develop a normative evaluative framework grounded in patient wellbeing, understood as an emergent, relational quality of care. Rather than deriving evaluative categories from a single tradition, the framework integrates insights from quality-of-care scholarship and care-ethical perspectives, informed by relational accounts of clinical practice. It operationalizes this orientation across five domains (care quality, patient-centeredness, decision-making, access and communication, and care practices) understood as relational sites where technological mediation can enhance or compromise care. Using clinical decision support systems (CDSS) as an analytically demanding test case, we introduce the concept of the care optimizer as a descriptive-normative category identifying technologies that structure the conditions under which care unfolds. By anchoring evaluation in patient wellbeing and situating technological mediation within a normative horizon, the framework translates postphenomenological insights into ethically actionable guidance and aims to ensure that digital health innovations reinforce, rather than undermine, the moral commitments of medicine.
Aesthetic injustice in healthcare: exploring testimonial and hermeneutical forms.
Adams J
Med Health Care Philos · 2026 Jun · PMID 41774347 · Full text
This paper introduces and develops the concepts of aesthetic testimonial injustice and aesthetic hermeneutical injustice, arguing that understanding the aesthetic dimensions of human experience, specifically those concer...
This paper introduces and develops the concepts of aesthetic testimonial injustice and aesthetic hermeneutical injustice, arguing that understanding the aesthetic dimensions of human experience, specifically those concerning physical appearance, is central to justice in healthcare practice. Drawing on Miranda Fricker's framework of epistemic injustice, the paper provides a bridge between emerging literature on aesthetic injustice, which is often focused on lookism and appearance-based discrimination, and accounts that emphasize the recognition of individuals as aesthetic subjects. The concept of aesthetic testimonial injustice relates to the unjust discrediting of a person's aesthetic testimony regarding their own body, often due to biases related to attractiveness, age or disability. Aesthetic hermeneutical injustice, by contrast, pertains to the structural disadvantage faced by individuals who lack the interpretive resources to make sense of or communicate their aesthetic experience as it pertains to bodily appearance, particularly in healthcare contexts. Using examples from prosthetics design, nursing care and disorders of visual perception, the paper shows how healthcare systems can marginalize patients' aesthetic values and perceptions, thereby undermining their dignity and agency. It concludes by calling for a deeper understanding of aesthetics in bioethics, suggesting that respecting patients as embodied aesthetic agents can enhance ethical healthcare delivery and counter systemic injustice. The concepts of aesthetic testimonial injustice and aesthetic hermeneutical injustice thus expand bioethical discourse by highlighting the moral significance of aesthetic experience in healthcare contexts.
Postmortem reproduction: the bioethics of reproductive wills.
Villalba A, Mut S, Pedelini L
Med Health Care Philos · 2026 Jun · PMID 41762353 · Publisher ↗
The rapid advancement of assisted reproductive technologies has not only expanded the possibilities of human reproduction but also introduced crucial ethical and legal challenges, particularly in the case of posthumous c...
The rapid advancement of assisted reproductive technologies has not only expanded the possibilities of human reproduction but also introduced crucial ethical and legal challenges, particularly in the case of posthumous conception. Existing legal frameworks, such as the one-year limit on using cryopreserved sperm in some European countries, often fail to address the emotional and practical needs of surviving partners, exposing significant gaps in current policies. This paper argues that reproductive autonomy should extend beyond death, ensuring that individuals' explicit wishes regarding the use of their gametes or embryos are respected. To bridge this regulatory and ethical gap, we propose the development of reproductive wills, a legal mechanism designed to safeguard postmortem reproductive autonomy. By allowing individuals to specify their reproductive intentions in advance, reproductive wills provide a structured approach to balancing personal autonomy with the rights and interests of surviving partners and potential offspring.
Are you weary of illness? Coping and existential positioning in life with myasthenia gravis.
Missel M, Witting N, Beck M
Med Health Care Philos · 2026 Jun · PMID 41729403 · Full text
This article explores what it means to position oneself existentially in relation to illness weariness in myasthenia gravis. Grounded in phenomenology and informed by autoethnographic principles, the study examines how t...
This article explores what it means to position oneself existentially in relation to illness weariness in myasthenia gravis. Grounded in phenomenology and informed by autoethnographic principles, the study examines how the body's changing disposition shapes lived meaning and coping in chronic illness. Phenomenological vignettes serve as experiential entry points, followed by reflective interpretation inspired by Havi Carel, Maurice Merleau-Ponty, Drew Leder, and Kay Toombs. Two experiential themes emerge. First, When the body doesn't always follow one's lead anymore shows how myasthenia gravis disrupts habitual rhythm and bodily trust. Bodily hesitation and the oscillation between resistance and responsiveness give rise to illness weariness-an existential modality distinct from physical fatigue or mood. Within this terrain, uncompromisingness appears as a quiet, existential stance; a refusal to let illness fully determine the direction of one's life, expressed through a persistent insistence on participation and dignity. Second, Physical activity and relational support as existential coping practices demonstrates how movement and relationship sustain existential positioning. Physical activity becomes an existential practice through which hope, orientation, and embodied rhythm are maintained, not by erasing illness weariness but by placing it alongside an uncompromising insistence on participation. At the same time, relational support, here exemplified by an attuned neurologist, serves as a subtle relational nudge that grounds and strengthens the will to continue. The study conceptualizes illness weariness and uncompromisingness as a continuum of existential responses shaped by bodily fluctuation and relational context. These insights extend beyond myasthenia gravis and point to the importance of existential attentiveness and relational continuity in clinical care.
Is bioethics a discipline? Beyond methodological reductionism.
Gomez-Virseda C, Andreoli L, Jegan R
Med Health Care Philos · 2026 Jun · PMID 41721188 · Publisher ↗
Is bioethics a discipline? This question has accompanied the field since its emergence, revealing persistent tensions about what defines a discipline and what bioethics is expected to achieve. This article revisits the d...
Is bioethics a discipline? This question has accompanied the field since its emergence, revealing persistent tensions about what defines a discipline and what bioethics is expected to achieve. This article revisits the debate through the lens of conceptual analysis. While engaging critically with Bjørn Hofmann's argument-representative of a narrow, method-focused view of disciplinarity-we propose a broader and more dynamic account. In the pars destruens, we show that Hofmann's criteria rely on an overly restrictive conception of disciplines, one that is inconsistent with current practices. In the pars construens, we adopt Krishnan's comprehensive framework to demonstrate how bioethics meets six core elements of disciplinarity: a particular object of research, a body of specialized knowledge, structuring theories and concepts, shared terminology and technical language, specific research methods, and institutional manifestations. We argue that bioethics' pluralism and normative orientation are not signs of epistemic immaturity, but appropriate responses to the complexity of its subject matter. Rather than undermining its status, these features affirm bioethics as a discipline in its own right-one that bridges philosophical reflection and practical engagement in contemporary medicine and healthcare.
White by default: conceptual and methodological limits of binary white logic in global health equity research.
Malinowska JK
Med Health Care Philos · 2026 Jun · PMID 41718935 · Full text
This article examines the conceptual and methodological limitations of how the category “White” is interpreted and used in health equity research. I argue that such studies often rely on a binary White logic – a framewor...
This article examines the conceptual and methodological limitations of how the category “White” is interpreted and used in health equity research. I argue that such studies often rely on a binary White logic – a framework that organises ethnoracial comparisons around a dichotomy between people racialised as White and Non-White Others. Within this logic, the White category is treated as a homogeneous reference group that reliably signals uniform protection from racism and access to White privilege. This assumption operates both statistically and epistemically, with profound implications for how health disparities are measured and understood. Although this framework reflects broad ethnoracial dynamics rooted in White supremacism, it has serious shortcomings. One relevant but underexplored consequence is that it tends to biologise and essentialise Whiteness. It also obscures complex, context-specific processes of racialisation and marginalises groups that do not fit prevailing classificatory practices. I demonstrate that the uncritical use of the White category – as a default homogenous comparator category – in global health equity research reproduces epistemic injustice and misrepresents complex dynamics of racialisation, thereby concealing medically relevant experiences of representatives of such groups. I focus on people racialised as Eastern Europeans, whose ambiguous positioning within global ethnoracial hierarchies – often termed Off-White – renders them largely invisible in scholarship, despite evidence of racism affecting their health. To produce more accurate and socially responsible science, I call for a shift away from binary White logic towards more thoughtful, precise, and contextually appropriate uses of ethnoracial categories – and other proxies for racism – in research on racism and health.
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