COVID-19 elicited a rapid emergence of new mutual aid networks in the US, but the practices of these networks are understudied. Using qualitative methods, we explored the empirical ethics guiding US-based mutual aid networks' activities, and assessed the alignment between principles and practices as networks mobilized to meet community needs during 2020-21. We conducted in-depth interviews with 15 mutual aid group organizers and supplemented these with secondary source materials on mutual aid activities and participant observation of mutual aid organizing efforts. We analyzed participants' practices in relation to key mutual aid principles as defined in the literature: 1) solidarity not charity; 2) non-hierarchical organizational structures; 3) equity in decision-making; and 4) political engagement. Our data also yielded a fifth principle, "mutuality," essential to networks' approaches but distinct from anarchist conceptions of mutualism. While mutual aid networks were heavily invested in these ethical principles, they struggled to achieve them in practice. These findings underscore the importance of as an intersection between ethical principles and practices, and the challenges that contemporary, and often new, mutual aid networks responding to COVID-19 face in developing praxis during a period of prolonged crisis. We develop a theory-of-change model that illuminates both the opportunities and the potential pitfalls of mutual aid work in the context of structural inequities, and shows how communities can achieve justice-oriented mutual aid praxis in current and future crises.

In this paper, I discuss bipolar disorder (BD) and identity. My general goal is to argue that working on BD and identity from a philosophical, interdisciplinary perspective has promise to be beneficial for empirical research on the topic, for people with BD, and for philosophical treatment of identity. I first argue that both people with BD and empirical researchers on the topic of BD and identity implicitly understand "identity" as it is understood in (some areas of) philosophy. Namely, as identity in the characterization sense and, often, specifically as practical identity. I call this conception of identity "characterization-identity". If this is the case, then empirical researchers have more data to work with when trying to understand why people with BD experience particular difficulties with identity: they can appeal to the extant work on characterization-identity. Having argued that the researchers and people with BD understand "identity" in this way, I move to making the case that, insofar as we have a sound account of characterization-identity, this method of research has the potential to be mutually beneficial: (1) Work on characterization-identity can explicate the empirical work on, and first-hand experience of, BD and difficulty with identity. (2) The empirical work and first-hand accounts suggest a desideratum for a good account of identity. And (3) the interdisciplinary treatment of the topic could generate therapeutic interventions for people with BD.

Theories of neurodivergence which describe divergent neurotypes as pathological, that is, as stemming from a dysfunction, represent the status quo for many institutions and caregivers. I seek to disrupt the "pathology paradigm" through a critique of the relevant notions of "function" and "dysfunction" and an examination of some oppressive therapeutic interventions promoted by the pathology paradigm. I advance an alternative analysis of neurodivergence, the "lack of fit" analysis, which aims to examine the particular ways that neurodivergent people experience a lack of fit with their environments. The "lack of fit" analysis is intended to promote self-determination through the development of adaptive relationships and collaborative interventions.

One of the central aims of mental healthcare should be to increase a person's autonomous agency. In a mental healthcare context, it is often argued that mental healthcare should maximize a person's autonomy so they can make autonomous choices about their treatment. My argument in this paper is broader: mental healthcare should increase autonomous agency so that a person can exercise direction over their life and live a life of meaning. Mental healthcare can and ought to increase autonomous agency by helping the person achieve both internal and external conditions of autonomy. Mental healthcare can fulfill these conditions by reducing mental illness symptoms and thus enhancing competence and voluntariness, increasing the capacity for reflective endorsement by examining the influence of social norms, enabling normative authority through the development of self-worth, and connecting individuals with services that can provide multiple good options to choose from.

The neurodiversity movement has long advocated for "Nothing about us without us" or the necessity of including neurominoritized people, such as Autistics, in the production of public policies, social discourses, academic knowledge, and scientific research about neurominoritized profiles, including autism. Similarly, the scientific and academic communities are increasingly recognizing the importance for participatory research to be not only ethical but also emancipatory. Yet the call for "Nothing about us without us" is still too often ignored, inaccurately understood, or imperfectly applied, in ways that can be jarring and disrespectful at best, and violent and traumatic at worst. Drawing on my experience as an Autistic woman, academic, and self-advocate who has participated in studies on autism, I develop a proposal for how the principle of "Nothing about us without us," understood as reclaiming epistemic authority and agency, might best be implemented in emancipatory research with Autistic adults. Specifically, I turn to two frameworks that have so far been developed independently of each other, yet that prove to be particularly fruitful when used together in this context: namely, the frameworks of design justice and of epistemic injustice. Drawing on both frameworks, I identify four principles of justice so that participatory autism research can be conducted in both an ethical and an emancipatory manner that heeds the neurodiversity movement's call for "Nothing about us without us" - namely, the principles of thorough involvement, of nonnormative communication, of trust-building, and of accountability.

This article analyzes the meaning of solidarity for bioethics and healthcare. Drawing on the anthropology of embodiment, it argues that solidarity arises upon relations of care for our vulnerable bodies and transforms it into our common democratic project. Its main focus is, therefore, not on distribution, which is the purpose of justice, but on the recognition and democratic inclusion of persons who-due to the vulnerable condition of their bodies-are still deprived of full participation in the public sphere. By reorienting caring relationships around the horizontal axis, solidarity obliges us to treat a person who is cared for not only as a passive recipient of healthcare goods, but as a fellow citizen and a partner in the process of care. It is argued that the model of narrative citizenship, by establishing discursive equality between a patient and a physician, can contribute to greater inclusion of vulnerable individuals into our societies.

Several suggestions have been made to embolden and reorient the concept of solidarity given the emergence of data-driven medicine. Recently, the European Union introduced a new consent model for so-called data altruism to motivate people to make their data available for purposes such as scientific research or improving public services. Others have introduced the alternative concept of data solidarily, which assumes that people's interests in data sharing result from a collective commitment to assist others. What those perspectives have in common is a focus on top-down organizational structures to deal with data-driven medicine. In this article, I offer an alternative reading of data solidarity, drawing on anarchist theory that highlights the disposition of mutual aid as a broader characteristic of solidarity. I begin by briefly indicating how the existing approaches to data solidarity in healthcare remain legalistic and state-centered without thoroughly considering socially critical notions of solidarity that highlight the impact of structural injustices. I then sketch out how an anarchist understanding of mutual aid could inform the conceptualization of solidarity. Finally, I focus on two implications for the practice of data-driven medicine: (1) current proposals of data altruism seem to engender a form of reversed charity; and (2) data solidarity practices could arise from the bottom-up through spontaneous order and direct action.

There are many proposals in the literature on how to "manage values." Many of these proposals have in common the assumption that the relevant values in science can be "packaged for transfer": they can be put in an envelope for scientists to hand to stakeholders or policymakers, or for members of the public or ethical experts to hand to scientists. The central aim of this paper is to argue that packaging values for transfer is a practical impossibility. The central argument of the paper concerns the best stance to take on how values in science should be conceptualized. Specifically, I argue that we need to return to a decision-theoretic definition of values (as, I argue, is strongly suggested by a close reading of Rudner, Jeffrey, and Hempel.) Further, I argue for a picture of these values that is nonpsychologistic, stance relative, and always and everywhere entangled with credences. I call my account of the nature of values in science the Putnam-Hempel account. Unfortunately, the Putnam-Hempel account forces us to see that any proposal that depends on packaging values for transfer will ultimately suffer from great difficulties.

Scientists have to make trade-offs between different types of error risks when making methodological decisions. It is now widely recognized (and not disputed in this article) that in doing so they must consider how serious the consequences of each error would be. The fact that they must also consider the potential benefits of getting it right is not equally recognized (and explicitly rejected by Heather Douglas). In this article, I argue that scientists need to do both when managing epistemic risks. At the same time, I acknowledge that in some cases it intuitively seems as if considering the consequences of possible errors carries greater moral weight. I explain this intuition by arguing that in these cases the contrast between the seriousness of mistakes and the benefits of getting it right can be linked to the moral asymmetry between action and omission. I examine various reasons that might justify a stronger weighting of the consideration of the consequences of errors in light of the action-omission asymmetry. I conclude that for all but some exceptional cases, such asymmetrical consideration is not called for.

Efficiency is often overlooked as an ethical value and seen as ethically relevant chiefly when it conflicts with other values, such as equality. This article argues that efficiency is a rich and philosophically interesting concept deserving of independent normative examination. Drawing on a detailed healthcare case study, we argue that making assessments of efficiency involves value-laden, deliberative judgments about how to characterize the functioning of human systems. Personal and emotional resources and ends are crucial to system functioning but are often discounted in favor of a relatively narrow set of financial inputs and institutional or procedural outputs. Judgments about efficiency tend to advantage (or disadvantage) different parties, depending on the resources and ends considered. Different constructions of efficiency can therefore promote or neglect the perspectives and interests of differently placed actors. Models of efficiency do not merely embody contestable ethical standpoints but-put to use-can unwittingly reify and reproduce them.

This essay applies an ethical analysis of the Jewish religious rite of hatafat dam brit to the ongoing debate on child genital cutting. Recent scholarship on the ethical and legal status of "de minimis" or "symbolic" involuntary genital cutting practices features disagreement over what, if anything, grounds their wrongfulness given that they are (relatively) physically superficial. Hatafat dam brit ("the drawing of covenantal blood") is even less physically intrusive than the most minor of the other practices commonly debated (e.g., "ritual nicking" of the vulva) yet still, as I will show, elicits moral concern-including from within the practicing religious community. As a type of genital cutting ritual that does not, in fact, modify the body, hatafat dam brit challenges those on both sides of the debate to clarify the basis for their moral objection or approval. I argue that debates about involuntary genital cutting of minors should focus on the ethics of these practices considered as (sexually) embodied interpersonal interactions, rather than as body modifications.

Generally speaking, BPD is a cognitive-affective disposition that shapes one's conception and experience of herself, and also her experiences of interrelationality. Many BPD symptoms relating to affect regulation are spurred by psychosocial complications that can then exacerbate psychosocial complications in future relationships. One consequence of affective dysregulation due to abuse-induced trauma can be persistent interpersonal breakdowns. Such breakdowns can be caused by the inability of two differently affectively disposed persons to harmonize according to what person each needs based on a set of supposedly shared norms and expectations. Attempting to identify specific ethical issues related to affective disruptions in interrelational harmonizing requires that one pull together the embodied experiences of BPD and the effects of those experiences on interpersonal relationships and then position that distinctive dynamic within an ethico-epistemological framework. I believe that one critical trigger for BPD affective dysregulation comes from the role of abuse-induced trauma in the cultivation of the BPDer's body memory. I offer a description of this phenomenology, which I ground in the philosophy of embodied cognition. The relationship between trauma and the embodied memory matters to ethical conversations about BPD because it is crucial to see how trauma that manifests as a specific kind of affective disposition can influence the ethical harmonizing of interpersonal interactions.I write this analysis from my own first-person experience of someone diagnosed with severe BPD.

Many technologies that are purportedly developed to improve the lives of disabled people reflect an ableist ideology that devalues rather than supports disabled bodyminds. In this paper we attribute this tendency to a neurotypical form of perception that obscures disabled people's moral visibility, understood as their visibility as richly expressive and interaction-worthy sense-making individuals. Relying heavily on examples drawn from scholarship on and community with augmentative and alternative communication technology (AAC tech)-that is, communication technology designed for and used by nonspeaking people-we take the expressive bodies and voices of disabled people as well as technology's role in forming expressivity and voice as important loci for redressing neurotypical ableist perceptions widely embedded in practices of engineering and science. Through our AAC tech discussion, we map different modes and degrees of moral (in)visibility, offering this mapping as an analytic resource for technologists committed to anti-ableist technology. Additionally, we also trace how technologies can be used and tinkered with in ways that can open up more (neuro)expansive, diversity-embracing ways of perceiving disabled lives. Ultimately, our account aims to motivate technologists to embrace such an expansive approach. We conclude by tentatively indicating some ways in which this approach can be operationalized in engineering and science practices.

In this paper, I examine the life and works of Enlightenment philosopher Jean-Jacques Rousseau (1712-1778) through the lenses of madness, neurodivergence, and disability. While many scholars readily think of Rousseau as eccentric, overly emotional, and "melancholic," they do not attempt to situate him as explicitly disabled, or to interpret his work as informed by madness.Using my own disabled, autistic, and mad identity as a point of potential reparative reading and kinship (although not as a direct diagnostic analogue or an uncritical approach), I argue that reading Rousseau explicitly as disabled, and further as experiencing traits consistent with modern descriptions of mental disability, opens up a new way of looking at his philosophical and musical works. By applying disabled, neurodivergent, and mad lenses to Rousseau. I provide a framework to understand the tensions between authenticity and falsehood, belief in mankind and misanthropy, and understanding and misunderstanding in his work.

Recently, neurodiversity scholars published a letter to the editor of Autism arguing that Judy Singer should not be cited as coiner of neurodiversity; rather, the term should be attributed to earlier neurodiverse forums online. I make a similar argument for neuroqueer. Neuroqueer is typically attributed to one of the letter's authors: Nick Walker (2015). Archival information, however, demonstrates that the term was developed in neuroqueer community conversations on the NeuroQueer blog (2013-2016) and, even earlier, on the alt.support. autism Usenet forum (2003). Walker's claim to coinage, then, obscures the collective origins of the concept and erases neuroqueer people from their own story. In retracing these historiographical steps, I pursue two theoretical questions. First, what can this broader history illuminate about the concept, theory, and practice of neuroqueer? Second, what might an explicitly neuroqueer citation politics look like? If not a single-origin story, then what?

Generalizations in medical research can be informative, but also misleading. Building on recent work in the philosophy of science and ethics of communication, I offer a novel analysis of common generalizations in clinical trials as generics in natural language. Generics, which express generalizations without terms of quantification, have attracted considerable attention from philosophers, psychologists, and linguists. My analysis draws on probabilistic and contextual features of generics to diagnose how these generalizations function and malfunction across communicative contexts in medicine. Given a high risk of misinterpretation ("slippage"), I recommend avoidance of generic claims about medical interventions in public contexts, exemplified by clinical trials and medical research more generally. Generics should only be used with vigilance in private contexts, exemplified by the physician-patient encounter. My analysis provides tools to support vigilance when communicating with generics, suggests new norms for public science communication, and raises deeper questions in the ethics of clinical communication.

Ethics can be envisioned as a process where human beings move from a more passive stance in their moral lives to a more active one, in which the moral aspects of their lives become the basis of a project to best live one's life. Participatory research and methods would appear essential to ethics in this light, yet they remain rather marginally used in bioethics. In this article, I argue that participatory research methods are particularly compelling means of ethical enactments because of their ability-when carried out properly-to help promote self-actualization. Although I cannot review in detail the vast array of participatory research undertaken in management, education, communication, and so on, I pinpoint the advantages of this orientation to research, especially in light of a pragmatist and deliberative form of ethics that aims to help understand and enact human flourishing. These advantages include: (1) the co-understanding and co-reconstruction of problem situations and responses; (2) the importance attributed to meaning and intersubjectivity; (3) mutual learning (moral co-learning); (4) empowerment for effective eudemonistic change; and (5) opening the evaluation of outcomes to human flourishing. I also explain that these attributes of participatory research and methods do not preclude the use of non-participatory methods and approaches in ethics.