I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting (at least) those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections.

In this paper I propose minimal criteria for a successful theory of the mechanisms of motivation (i.e. how motivational mental states perform their characteristic function), and argue that extant philosophical accounts fail to meet them. Further, I argue that a predictive processing (PP) framework gives us the theoretical power to meet these criteria, and thus ought to be preferred over existing theories. The argument proceeds as follows-motivational mental states are generally understood as mental states with the power to initiate, guide, and control action, though few existing theories of motivation explicitly detail how they are meant to explain these functions. I survey two contemporary theories of motivational mental states, due to Wayne Wu and Bence Nanay, and argue that they fail to satisfactorily explain one or more of these functions. Nevertheless, I argue that together, they are capable of giving a strong account of the control function, which competing theories ought to preserve (all else being equal). I then go on to argue that what I call the 'predictive theory' of motivational mental states, which makes use of the notion of active inference, is able to explain all three of the key functions and preserves the central insights of Wu and Nanay on control. It thus represents a significant step forward in the contemporary debate.

I argue that Schmidt et al, while correctly diagnosing the serious racial inequity in current ventilator rationing procedures, misidentify a corresponding racial inequity issue in alternative ‘unweighted lottery’ procedures. Unweighted lottery procedures do not ‘compound’ (in the relevant sense) prior structural injustices. However, Schmidt et al do gesture towards a real problem with unweighted lotteries that previous advocates of lottery-based allocation procedures, myself included, have previously overlooked. On the basis that there are independent reasons to prefer lottery-based allocation of scarce lifesaving healthcare resources, I develop this idea, arguing that unweighted lottery procedures fail to satisfy healthcare providers’ duty to prevent unjust population-level health outcomes, and thus that lotteries weighted in favour of Black individuals (and others who experience serious health injustice) are to be preferred.

This paper argues that we ought to rethink the harm-reduction prioritization strategy that has shaped early responses to acute resource scarcity (particularly of intensive care unit beds) during the COVID-19 pandemic. Although some authors have claimed that “[t]here are no egalitarians in a pandemic,” it is noted here that many observers and commentators have been deeply concerned about how prioritization policies that proceed on the basis of survival probability may unjustly distribute the burden of mortality and morbidity, even while reducing overall deaths. The paper further argues that there is a general case in favor of an egalitarian approach to medical rationing that has been missed in the ethical commentary so far; egalitarian approaches to resource rationing minimize wrongful harm. This claim is defended against some objections and the paper concludes by explaining why we should consider the possibility that avoiding wrongful harm is more important than avoiding harm simpliciter.

In a recent article, 1 Eric C. Ip argues that the decision reached in the case of Re E (Medical Treatment: Anorexia), heard by the Court of Protection for England and Wales, was ethically and legally correct.Ip agrees with the two main decisions reached in Re E:1. E lacked the capacity to refuse life-sustaining treatment (including artificial feeding) both at the time of the proposed treatment and when she gave her advance directive.2. E's best interests were served by imposing life-sustaining treatment on her against her will, as well as by the development of a further treatment plan.He also makes a more general ethico-legal proposal in light of his arguments for those conclusions:3. If their capacity to refuse life-saving nutrition, either contemporaneously or as an advance directive, is impugned, patients with anorexia nervosa should be assumed to be incapacitous 2 with respect to such decisions, with the service user having to meet a 'high standard of proof' 3 in order to overturn this assumption.