Applying Nonideal Theory to Bioethics Living and Dying in a Nonideal World

This book offers new essays exploring concepts and applications of nonideal theory in bioethics. Nonideal theory refers to an analytic approach to moral and political philosophy (especially in relation to justice), according to which we should not assume that there will be perfect compliance with principles, that there will be favorable circumstances for just institutions and right action, or that reasoners are capable of being impartial. Nonideal theory takes the world as it actually is, in all of its imperfections. Bioethicists have called for greater attention to how nonideal theory can serve as a guide in the messy realities they face daily. Although many bioethicists implicitly assume nonideal theory in their work, there is the need for more explicit engagement with this theoretical outlook. 

A nonideal approach to bioethics would start by examining the sociopolitical realities of healthcare and the embeddedness of moral actors in those realities. How are bioethicists to navigate systemic injustices when completing research, giving guidance for patient care, and contributing to medical and public health policies? When there are no good options and when moral agents are enmeshed in their sociopolitical viewpoints, how should moral theorizing proceed? What do bioethical issues and principles look like from the perspective of historically marginalized persons? These are just a few of the questions that motivate nonideal theory within bioethics. This book begins in Part I with an overview of the foundational tenets of nonideal theory, what nonideal theory can offer bioethics, and why it may be preferable to ideal theory in addressing moral dilemmas in the clinic and beyond. In Part II, authors discuss applications of nonideal theory in many areas of bioethics, including reflections on environmental harms, racism and minority health, healthcare injustices during incarceration and detention, and other vulnerabilities experienced by patients fromclinical and public health perspectives. The chapters within each section demonstrate the breadth in scope that nonideal theory encompasses, bringing together diverse theorists and approaches into one collection.

Elizabeth Victor is Associate Professor of Philosophy and Liberal Studies at William Paterson University where she also serves on the Institutional Review Board. She received her Ph.D. in philosophy from the University of South Florida. Her research focuses on feminist bioethics, agency theory, the concept of vulnerability in different institutional contexts, and how to address implicit bias in clinical contexts. She is the author of Vulnerability and incarceration: Evaluating protections for prisoners in research (Lexington Books 2019). Her recent work has appeared in Hastings Center Report, Journal of Medical Ethics, Nursing Ethics, Journal of Clinical Ethics, Journal of Bioethical Inquiry, International Journal of Feminist Approaches to Bioethics, and Science and Engineering Ethics.

Laura Guidry-Grimes is an assistant professor in the Department of Medical Humanities and Bioethics at the University of Arkansas for Medical Sciences, and she is a clinical ethicist at UAMS and Arkansas Children’s Hospital. In her position as a clinical ethicist, she provides consultation on complex cases, reviews and develops policies, offers ethics education, addresses moral distress, and contributes to ethical climate of the institution. She also teaches students across the health professions, and she frequently partners with the Division of Diversity, Equity, and Inclusion. She received her Ph.D. in philosophy at Georgetown University. She worked on projects for the Kennedy Institute of Ethics, Presidential Commission for the Study of Bioethical Issues, and Pan American Health Organization. Her research focuses on psychiatric ethics, disability bioethics, and vulnerability in clinical contexts. She recently co-authored Basics of Bioethics, Fourth Edition with Robert M. Veatch (Routledge, 2020).