- Editor's Note June 2022
In this issue's lead article, "Adolescent Medical Transition is Ethical: An Analogy with Reproductive Health," Florence Ashley argues that insofar as we accept that abortion and birth control can be ethical interventions for adolescents, so, by analogy, should we treat interventions such as puberty blockers that aid in gender transition as ethical. None of these interventions treat illness or pathology, but rather they operate on healthy bodies, not in order to cure, but in order to help patients live in line with their fundamental self-conception and to realize their embodied goals. Parenting, pregnancy, and gender all go to the heart of our embodied identities and sense of self, they point out. Moreover, Ashley argues, in the case of abortion and birth control, our primary justification for providing these interventions is autonomy-based, so we do not feel the need to prove that they also have mental health or other health benefits; it is sufficient that they are demonstrably not associated with serious harm. They argue that gender transition should be held to the same bar, since the reasons for allowing it are also autonomy-based, and that we already have the data to show that it meets this bar. As Ashley argues, we can consistently object to all three interventions, and many people do of course. But insofar as we are comfortable using medicine to enhance autonomy rather than to treat pathology sometimes, the case for using it to aid gender transition in adolescents is as strong as the case for using it to aid their reproductive control.
This paper is of the utmost importance right now, as access to appropriate medical care for trans adolescents is under direct and terrifying attack in multiple jurisdictions. Unfortunately, so, of course, is access to abortion, with access to contraception perhaps lagging not far behind, given their similar legal histories and constitutional statuses. But trans kids and their families have been under especially direct attack at the state level, and so Ashley's clear and compelling analysis of the ethics of their provision is a vital document. [End Page vii]
Boaz Miller and Meital Pinto's article, "Epistemic Equality: Distributive Epistemic Justice in the Context of Justification," continues the tradition at the journal of publishing cutting-edge work at the interface of ethics and the epistemology and social organization of science. While recent years have seen a flourishing emergent discourse concerning epistemic justice for individuals, Miller and Pinto treat epistemic justice as fundamentally a problem of distributive justice, and ask how epistemic inclusion should be distributed across society for both ethical and epistemological purposes. They argue that on both fronts, we need to systematically include marginalized groups, non-experts, and stakeholders in our epistemic activities. This means more than allowing them to be taken seriously as testifiers; it means including them in the full range of epistemic activities and negotiations. Miller and Pinto argue that an epistemologically responsible just distribution of epistemic inclusion should not proceed on an individual-by-individual basis. Rather, justice and collective knowledge are best achieved by focusing on which groups we need to include. The primary goal of their proposals is to organize our epistemic activities so that the rich and powerful cease to have an outsized ability to distort our beliefs and manufacture uncertainty.
Finally, in "White Ignorance in Pain Research: Racial Differences and Racial Disparities," Phoebe Friesen and Nada Gligorov explore the connection between the well-known fact that non-White (and especially Black) people systematically receive less and lower quality pain treatment from doctors, and the much less explored fact that they also experience more pain. Friesen and Gligorov argue compellingly that we have pointedly overlooked the possible causal links between these two facts, choosing instead to either ignore racialized pain, or to individualize it, attributing it to the emotions or dispositions of particular racialized patients. They point out the various ways in which experiences of pain are affected not just by personal attitudes and dispositions, but by external cues and context, background conditions of trust, and other situational factors. It is not surprising, given our empirical knowledge about how pain and pain intensity work, that...