Steering into the Curves: Using Diagnosis to Support the Dignity and Autonomy of Trans Youth.

This response to Kariyawasam and Rai affirms their critique of the pathologization of trans youth but forecasts a foreseeable negative outcome of their proposed elimination of diagnosis as a prerequisite to gender-affirming care (GAC) - the risk of removing GAC entirely from the medical sphere and compromising the wellbeing of those transgender individuals for whom GAC is deeply affirming. We suggest an ethical framework of GAC that expands past a focus on autonomy to incorporate a principle of respect for persons that affirms the dignity and diversity of trans youth - recognizing the need to facilitate both medical assistance and social change.

Speaking Volumes: The Encyclopedia of Bioethics and Racism.

This essay takes as its starting point the claim that addressing anti-Black racism is essential to the work of bioethics in the United States. The essay examines whether and how racism has been addressed in the field's central reference work, the Encyclopedia of Bioethics, throughout its four editions-in 1978, 1995, 2004, and 2014. With consideration of each edition's stated purpose and editorial framing, we find that the subject of racism is obscured by the Encyclopedia's inattention to African American approaches to bioethics, to racism as a bioethics issue, and specifically, to racism as a matter of justice. This essay suggests questions for guiding reflection necessary for giving racism its due in the field of bioethics.

Respect for Communities in Health Justice.

Health justice seeks, both conceptually and in practice, to strengthen community engagement and empowerment as an integral means of addressing health disparities. In this essay, we explore the nature of communities and their roles in health care/public health. We propose that an ethical principle of respect for communities is a requisite part of health justice. It is this respect for communities that ethically grounds health justice's calls for greater community engagement and empowerment. Conceptions of health justice, we claim, will gain ethical power and coherence as this principle is more clearly recognized and further developed.

Communities Matter.

Given the enduring inequities in US health and health care, it is no surprise that particular communities are bearing the disproportionate brunt of the Covid-19 pandemic and our responses to it. Many ethical aspects of the pandemic involve diverse communities bound by race, ethnicity, disability, income, residence, age, and more. How does bioethics engage these communities in theory and in practice? Only faintly, despite Covid-19's relentless reminder that communities matter morally. This article sketches initial directions for developing a community-inclusive bioethics, one that understands communities as critical moral participants in the work of bioethics as well as in health and health care.

Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act.

The U.S. 2010 Patient Protection and Affordable Care Act (ACA) exempts members of health care sharing ministries (HCSMs) from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption's less than clear legislative justification, their potential influence on the ACA's policy and ethical success, and their salience to current religious liberty debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States' three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: (1) the charity versus insurance status of these ministries; (2) the conflation of two ACA religious exemptions; (3) the tension between the values of religious liberty and of justice; (4) the potential undermining of ACA policy goals; and (5) the questionable compliance of health care sharing ministries with ACA exemption requirements. An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here.

Farm labor, reproductive justice: Migrant women farmworkers in the US.

Little is known about the reproductive health of women migrant farmworkers in the US. The health and rights of these workers are advanced by fundamental human rights principles that are sometimes conceptually and operationally siloed into three approaches: reproductive health, reproductive rights, and reproductive justice. I focus on the latter framework, as it lends critical attention to the structural oppression central to poor reproductive health, as well as to the agency of communities organizing and leading efforts to improve their health. I review what is known about these women's reproductive health; identify three realms of reproduction oppression affecting their reproductive health: labor/occupational conditions, health care, and social relations involving race, immigration and fertility; and then highlight some current efforts at women farmworker-directed change. Finally, I make several analytical observations that suggest the importance of the reproductive justice framework to broader discussions of migrant worker justice and its role in realizing their right to health.

Still missing: undocumented immigrants in health care reform.

The health care reform signed by President Obama in March 2010 mirrors the Clinton reform proposal of 1993 in that both excluded undocumented immigrants from federal insurance coverage. In both cases substantive discussion of their possible inclusion was stifled by political timidity. This paper begins with a brief descriptive overview of undocumented immigrants in the U.S. and their health care and insurance coverage. It highlights the most common moral, economic, and public health arguments made for and against the inclusion of undocumented immigrants in the 2010 health care reform. The paper then asserts that undocumented immigrants are part of the U.S. health care community and urges health care workers to become more active participants in this policy arena.

Blood donation, deferral, and discrimination: FDA donor deferral policy for men who have sex with men.

U.S. Food and Drug Administration (FDA) policy prohibits blood donation from men who have had sex with men (MSM) even one time since 1977. Growing moral criticism claims that this policy is discriminatory, a claim rejected by the FDA. An overview of U.S. blood donation, recent donor deferral policy, and the conventional ethical debate introduce the need for a different approach to analyzing discrimination claims. I draw on an institutional understanding of injustice to discern and describe five features of the MSM policy and its FDA context that contribute to its discriminatory effect. I note significant similarities in the 1980s policy of deferring Haitians, suggesting an historical pattern of discrimination in FDA deferral policy. Finally, I point to changes needed to move toward a nondiscriminatory deferral policy.

Health care as a community good. Many dimensions, many communities, many views of justice.

We often speak of health care as a social good. What kind of good it is--and what justice requires of us in making it available to the members of society--depends on how society understands it. Yet the value of health care may be understood in many different ways within society.