REFRAMING ETHICS EDUCATION: WHY PROFESSIONAL RESPONSIBILITY REQUIRES STRUCTURAL COMPETENCY By Jeramy S. Neefus A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Philosophy – Doctor of Philosophy 2024 ABSTRACT This dissertation presents structural competency as a response to three interrelated problems. First, ethics education is at a crisis of relevance, with widespread complaints among educators that students do not regard ethics as important. Second, ethics does not take oppression to be theoretically significant, and only rarely addresses major movements like Black Lives Matter or #MeToo as isolated case studies. Third, a reactionary conservative campaign against diversity, equity, and inclusion (DEI) initiatives is gaining momentum, especially at academic institutions. As a theoretical and pedagogical model, structural competency holds that addressing structural oppression is necessary for responsible professional practice. As such, it should be treated as a required competency in professional training. While mirroring cultural competency in many ways, the shift from culture to structures as the focus of the competency makes it much more effective in discussing systemic oppression. Structural competency solves the first problem of relevance by remedying the deficiency of ignoring oppression in the second. In centering structural oppression as a necessary topic for professional ethics, structural competency takes up moral problems that many experience as pressing questions of right and wrong but have long been excluded from ethics. Simultaneously, structural competency provides a strategic response for the attacks on DEI by repositioning attention to oppression as a necessary component of professional preparation. Chapter One surveys ethics education literature to make the case that professional ethics education is both facing a crisis of relevance and failing to address structural oppression. Chapter Two identifies necessary features for a working understanding of structural oppression as intersectionality, starting from lived experiences, the centrality of race and colonialism, structures as adaptive and dynamic, and a complex understanding of agency. The importance of these features is illustrated positively in women of color feminist accounts of structural oppression from Patricia Hill Collins and Elena Ruíz and negatively in accounts that fall into the trappings of white feminism from Nancy Hartsock, Iris Marion Young, and Miranda Fricker. On the way to articulating a view of structurally sensitive professional responsibility, Chapter Three examines the subject of moral responsibility, searching for an account that can explain responsibilities in relation to structural oppression. A relational understanding of responsibility is needed because successfully accounting for structural oppression requires acknowledging relationships as a legitimate source of moral requirements. Major accounts of moral responsibility, including rights and duties, blameworthiness, liability, and Young’s social connection model, ultimately discount relationships as a source of moral requirements. Instead, they rely on the Kantian premise that the self-legislating subject is the only legitimate source of moral requirements, because imposition of requirements from an external source violates individual autonomy. Chapter Four presents the structural competency model as it is situated in the health care ethics literature before developing a generalized adaptation that can be applied to a variety of fields. Chapter Five offers guidelines for incorporating structural competency into ethics courses and professional degree programs and analyzes how structural competency can function to sidestep many of the current attacks on DEI. Ultimately, this project approaches ethics education from the starting point of regarding structural oppression as theoretically significant and offers resources for making the changes that this approach demands. Copyright by JERAMY S. NEEFUS 2024 To Suzanne. v ACKNOWLEDGEMENTS Many thanks to Lisa Schwartzman, Michael O’Rourke, Sean Valles, and Robyn Bluhm for serving on my committee. Special thanks to Elena Ruíz and Kyle Powys Whyte for serving on committee previously and providing invaluable support, wisdom, and encouragement. I am particularly grateful to Shelbi, Ayanna, AY, Jared, Jess, Julia, Jeffrey, Cat, Eva, Kristin, Shaila, and Mercer for all the ways that each of you saved my life and taught me better ways to live. To my chosen family and especially to my partner, thank you for sticking with me and bringing me so much joy. Teamwork makes the dream work. vi TABLE OF CONTENTS INTRODUCTION .......................................................................................................................... 1 Chapter Summaries ..................................................................................................................... 3 CHAPTER ONE: A Critique of Professional Ethics Education – Why Professional Responsibility Requires Attention to Structural Oppression .......................................................... 9 I. What is a Profession? .............................................................................................................. 9 II. Survey of Professional Ethics Education Literature and Practice ........................................ 19 III. The Gap in Professional Ethics Education .......................................................................... 36 IV. Why Professional Responsibility Requires Addressing Structures of Oppression ............. 43 V. Conclusion ............................................................................................................................ 45 CHAPTER TWO: What Every Account of Structural Oppression Needs – Lessons from Women of Color Feminisms and White Feminism .................................................................................... 46 I. Necessary Elements for an Account of Structural Oppression .............................................. 47 II. Lessons from Women of Color Feminisms .......................................................................... 50 III. Failures of White Feminism ................................................................................................ 59 IV. Conclusion........................................................................................................................... 74 CHAPTER THREE: The Moral Demands of Structural Oppression: Towards a Relational Theory of Responsibility ........................................................................................................................... 75 I. Sources of Moral Requirements ............................................................................................ 76 II. Responsibility as Relational ................................................................................................. 83 III. Traditional Accounts of Responsibility ............................................................................... 89 IV. The Social Connection Account of Responsibility ............................................................. 99 V. Professional Responsibility for Structural Oppression ........................................................112 VI. Conclusion .........................................................................................................................114 CHAPTER FOUR: How Structural Competency Can Incorporate Attention to Structural Oppression into Professional Ethics Education ...........................................................................115 I. The Origins of the Structural Competency Model in Medical Ethics ..................................115 II. From Medicine to Broader Health Education .................................................................... 123 III. Beyond the Health Professions ......................................................................................... 126 IV. Structural Competency in Relation to Professional Ethics Education and Cultural Competency ............................................................................................................................ 131 V. Features of My Generalized Structural Competency Model .............................................. 136 VI. Conclusion ........................................................................................................................ 140 CHAPTER FIVE: Guidelines for Incorporating Structural Competency into Professional Ethics Education Curricula .................................................................................................................... 141 I. Learning Outcomes.............................................................................................................. 141 II. Delivery Formats ................................................................................................................ 148 III. Student Engagement ......................................................................................................... 152 IV. Assessment ........................................................................................................................ 154 vii V. Political Context ................................................................................................................. 156 VI. Conclusion ........................................................................................................................ 163 CONCLUSION ........................................................................................................................... 165 BIBLIOGRAPHY ....................................................................................................................... 169 viii INTRODUCTION Over the past 15 years as I have studied and taught ethics, many social movements have erupted in the United States. As particularly egregious instances of police brutality and murder were caught on video, uprisings in response called attention to the systemic violence underpinning the entire system of policing, from its origin in patrols aiming to recapture runaway enslaved Black people to its current role in the prison-industrial complex. The #MeToo movement drew attention to pervasive and normalized sexual violence. Lakota resistance to construction of the Dakota Access Pipeline across sacred land on the Standing Rock Reservation showed the intersection of Indigenous sovereignty and environmental justice. Most recently, mass protests have emerged against the genocide Israel is waging against Palestine with the full support and funding of the US government. Each of these movements raises to the forefront of the national consciousness tremendously consequential questions of right and wrong, demanding that we consider our responsibilities in relation to the injustices being protested. And yet the field of ethics has remained largely silent on these issues. I found myself asking how it could be that a discipline dedicated to carefully considering moral questions of right and wrong would ignore such pressing moral issues. At the same time, I found ethics education literature to be preoccupied with the problem of the relevance of ethics. Professionals both inside and outside the academy complained that students did not regard the ethics instruction they received as relevant or practical to real life outside the ivory tower. The solutions posited for this crisis of relevance tended to be anemic reorganizing of existing tools within the canon or isolated case studies of current events tacked- on as examples for applying the same principles and theories. I had a hunch that taking 1 oppression seriously would do wonders for ethics’ relevance crisis, so I began exploring what it would look like for ethics to take structural oppression seriously. This search eventually led me to structural competency, an emerging theoretical and pedagogical model situated in the health care ethics literature that posed awareness of structural oppression as a necessary competency for responsible professional practice. The potential usefulness of this model was immediately apparent, but it had only been deployed within health care or health care adjacent contexts. This literature did not include much analysis of structural oppression itself, jumping directly to analysis of the ways that oppression generates health disparities and manifests within health contexts. Adapting this model for general application would require deeper theoretical grounding, examining structural oppression at a higher level and making the case that it was relevant and necessary for responsible practice in any profession. Connecting structural oppression and professional responsibility led to a search for an account of responsibility that had the capacity to make sense of responsibilities in relation to oppressive structures. The main approaches to moral responsibility lack that capacity. Iris Marion Young’s social connection model represents an improvement with its aim of explaining responsibility specifically in relation to structural harms but is limited by serious flaws in its conceptions of both structural oppression and responsibility. Ultimately, a relational approach to responsibility is needed to make sense of responsibility for structural oppression, including professional responsibility. Part of this work involved distinguishing structural competency from other approaches with similar content. Structural competency differs from cultural competency and diversity, equity, and inclusion (DEI) both in terms of content and positioning or institutional location. In the years since I began articulating the unique space for structural competency, reactionary 2 conservatives launched a political war against DEI programs with a particular focus on state- funded educational institutions, in several cases completely disallowing any DEI programs not specifically required for accreditation.1 These developments made repositioning discussion of structural oppression as a necessary professional competency more relevant and pressing than anticipated. Chapter Summaries Chapter One addresses professional ethics education, which aims to prepare students to practice in their fields as responsible practitioners. However, professional ethics education largely fails to reckon with the reality and importance of oppressive structures like racism, sexism, or ableism. In ignoring these important moral dimensions affecting the decisions they will make in their professional practice, ethics education is failing to adequately prepare students to be responsible professionals. I understand professions as involving specialized training, regardless of level of education, and having influence on the social world in the course of operating in one’s professional role. A survey of the current state of ethics education demonstrates its failure to take oppression seriously. Feminist perspectives are typically included as an afterthought, tacked on the end using outdated content. Race is rarely addressed, and when disability is discussed, it rarely features work by disabled scholars. The Beauchamp and Childress “Four Principles” approach is very influential. Another common format is setting out three kinds of theory: deontological, consequentialist, and virtue ethics. These approaches are premised on an individualist ontology and ignore structural and systemic problems. When collective goods and problems are discussed, it tends to be exclusively in terms of individual choices or laws and policies. 1 “How Will Utah’s 2024 Diversity, Equity and Inclusion Law Impact Campus?”; “Regents Direct Iowa’s Public Universities to Cut DEI Programs Not Needed for Compliance.” 3 At the same time, ethics educators are facing a crisis of relevance. Students do not regard the traditional approaches as being relevant to their experiences and future practice, and abounding scandals in the news are taken as evidence that ethics education has not been effective in preventing such misconduct. Much discussion has been devoted to shifting the presentation of the existing canon in various ways to improve outcomes, but the literature has not connected the problem of relevance with the failure to address oppression. Ultimately, I contend that the structural competency model offers solutions to both of these interrelated problems for ethics education. Chapter Two develops a working understanding of structural oppression to be deployed in the next chapter’s discussion of responsibility, presenting five elements necessary for an account of structural oppression. Intersectionality provides a methodology for recognizing the inextricably interlocking nature of oppressive structures. The lived experiences and material realities of the oppressed must be the starting point for theorizing rather than something to be abstracted away from in a mistaken pursuit of objectivity. Centering colonialism and race within intersectional analysis is necessary to decenter the oppressive formations that have built the academy and society to benefit white people by punishing and excluding people of color. The dynamic and adaptive nature of oppressive structures, evolving to maintain concentrations of power, cannot be ignored. Lastly, a nuanced understanding of agency is required to make sense of agential decision-making within the constraints of oppressive structures without obscuring or discounting conditions for responsibility. The importance of these elements is illustrated positively in women of color feminisms and negatively in white feminist accounts. While women of color feminisms are not a monolith, there are points of convergence, and my examination of the work of Patricia Hill Collins and 4 Elena Ruíz highlights the previously-identified elements as such points. Conversely, white feminist failures to adequately theorize structural oppression serve as cautionary tales for what can go wrong when some or all of the five elements are missing. White feminism refers to methodological practices of centering the experiences and perspectives of a few privileged white women and then universalizing those experiences, excluding issues important to women of color. This section examines the work of Nancy Hartsock, Miranda Fricker, and Iris Marion Young, showing how each of these accounts falls into the white feminist pitfall of excluding crucial intersections of race and colonialism and thereby fail to present satisfactory accounts of structural oppression. Chapter Three presents relational responsibility as the result of my search for an account of moral responsibility that has the capacity to address structural oppression as understood in Chapter Two. Successfully reckoning with structural oppression requires recognizing relationships themselves as legitimate sources of moral requirements. A source of moral requirements is the component of a larger account of moral responsibility that explains in virtue of what something is obligatory. Accounts of responsibility build on sources of moral requirements to map out comprehensive systems for explaining attribution of and interaction among moral responsibilities. The most recognized sources of moral requirements are voluntary action and agential nature. Major accounts of moral responsibility rely exclusively on the agential nature or voluntary action sources of moral requirements, and the key to their inability to account for structural oppression is this reliance. Both voluntary action and agential nature rely on the same Kantian view of the subject as self-legislating that I find implausible. Association is an undertheorized source of moral requirements that recognizes relationships themselves as legitimate grounds of obligation, reflecting feminist epistemology’s insights on social 5 embeddedness. This facilitates a relational account of responsibility that can successfully explain responsibilities in relation to structural oppression. Anishanaabe conceptions of responsibility are presented as an example of an existing relational account of responsibility. A survey of major accounts of moral responsibility shows how each fails to explain responsibilities in relation to structural oppression. The moral landscape imagined by the rights and duties account simply does not have a place for oppressive structures in its mapping of correlative rights and duties. Strawsonian blameworthiness largely assesses the appropriateness of blame attributions on the basis of mental states like intentionality, and this focus limits its ability to explain responsibility apart from intentionality or in relation to the larger scale of oppressive structures. The liability model attributes responsibility based on findings of singular fault for causing a past, discrete harm. Iris Marion Young argues that the isolating nature of responsibility in this model cannot explain responsibilities in relation to structural oppression as a singular party to blame. Young’s social connection model was intended to explain responsibility for structural oppression where the liability model could not, but I show that the social connection account fails at this by excluding colonialism, denying relationships as a legitimate source of moral requirements, arbitrarily discounting historical injustice, and artificially limiting responsibility. The chapter concludes with a discussion of how relational responsibility can be applied to the specific topic of professional responsibilities in relation to structural oppression, mapping categories of relationships to professional positions such as professional affiliations, governing law and policy, and communities that the profession has harmed in the past. Chapter Four adapts structural competency from health care ethics literature for general application to professional ethics. Helena Hansen, Dorothy Roberts, and Jonathan Metzl created 6 the structural competency model and sparked a flurry of publishing on the topic in health care ethics literature. Metzl and Hansen define structural competency as: “the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases…also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health.”2 Given that their work builds off extensive research about the social determinants of health, this definition is specific to health care education. The process of extending structural competency to many health and medical subfields is well underway, but the only example of taking structural competency beyond health is a single paper on the topic of higher education student affairs. To adapt this model for application to other fields, I identify three key features of structural competency as engagement governing professional bodies, interdisciplinarity, and intersectionality. As I understand it, the central thesis of the structural competency model is the necessity of addressing structural oppression as it manifests in a particular field for responsible professional practice in that field. Chapter Five offers practical guidance on implementing a structural competency model in professional ethics education programs. In addition to identifying a set of learning outcomes, I assess the advantages of delivery formats including intensive workshops, a series of shorter workshops, presentation as a module in existing ethics courses, integration into multiple courses across a curriculum, and a standalone college course. Also discussed are strategies for student engagement and assessment. The chapter concludes with analysis of the current political context 2 Metzl, Jonathan M., and Hansen, Helena, 2014, “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality,” Social Science & Medicine, Structural Stigma and Population Health 7 affecting the feasibility of implementing structural competency training. Strong backlash against DEI and “Critical Race Theory” (CRT) is calcifying in the form of state laws sweeping the US discouraging or banning education about racial inequality at public educational institutions. Structural competency may be able to sidestep some of these limitations by situating its necessity under the umbrella of ethics competencies. Professional ethics education’s failure to attend to structural oppression is an abrogation of its own professional responsibility to prepare students for moral decision making in their professional practice. Structural competency represents a path forward for effective and relevant ethics education that focuses directly on interlocking oppressive structures and operates from a relational understanding of responsibility. 8 CHAPTER ONE: A Critique of Professional Ethics Education – Why Professional Responsibility Requires Attention to Structural Oppression Professional ethics education aims to inculcate responsible behaviors in students destined for professional fields. Teaching ethics aims at transformed and improved ethical decision making, in this case focused on decisions made in one’s role as a member of a profession. As it stands now, professional ethics education largely fails to reckon with the reality and importance of oppressive structures like ableism and sexism. I take this to be a failure of professional responsibility. A student cannot be adequately prepared for ethical decision making in their field if they are not taught about very real and influential things that exist and affect the spaces they will occupy as professionals. In this chapter, I contend that professional ethics education is incomplete without discussion of structural oppression. First, I will discuss what I mean by profession. Next, I will offer a brief survey of the state of professional ethics education, drawing attention to the dearth of content addressing structures of oppression. I will then identify important gaps in the professional ethics education literature, arguing that it not only neglects to discuss issues of identity, power, and oppression, but professionalism itself is also used as a tool of active discrimination. Lastly, I will argue that professional responsibility requires teaching students about structural oppression. I. What is a Profession? The professions have evolved over the years, and the question of what it takes to qualify as a member of the category is endlessly contested. Paradigmatic professions like medicine and law gain universal consensus on their qualifications. More recently, engineering and business have attained widespread recognition as professions. Many consider the professions to include education, social work, journalism, library science, clergy, nursing, exercise science, and agriculture. But what is a profession? Many definitions have emerged out of different scholarly 9 approaches, offering broader or narrower conceptions. In this section, I summarize commonly accepted criteria for professions, present the current legal definition of profession in the US context, and discuss several philosophical approaches before articulating my definition. A. Common Criteria Across disciplines and decades, many definitions of profession include similar elements. These frequently-appearing criteria can offer a picture of the conventional notion of a profession. In a survey of approaches to defining profession, Alan Tapper and Stephan Millett identified the following themes: “an ideal of service and responsibility to the public good; virtue on the part of professionals; and a special sort of fiduciary obligation."3 Wade Robison offers a more specific list, arguing that the five “integral parts of” a profession are special knowledge, special skills, training in a particular way of thinking, adopting a special set of moral relations, and serving a social purpose.4 From the nursing field, Renee McLeod-Sordjan writes, "Professionalism entails a commitment to society that demonstrates scientific knowledge, accountability, and responsibility."5 These definitions offer a brief snapshot of the many definitions in the literature. The four key elements that appeared repeatedly are: 1. Intellectual training and higher education 2. Social prestige and higher pay 3. Heightened moral responsibilities, adopted voluntarily and articulated in a code of ethics 4. Service to society and moral ideals The first criterion is rooted in the history of professions emerging out of fields that required university training. Law, clergy, and medicine all involve very specialized and technical 3 Tapper and Millett, “Revisiting the Concept of a Profession,” 4. 4 Robison, “Professional Norms,” 188–89. 5 McLeod-Sordjan, “Evaluating Moral Reasoning in Nursing Education,” 474. 10 training.6 A more recent definition conceives of professions as “employing dangerous (or potent) knowledge in pursuit of a public good by people of good character who behave ethically in the use of that knowledge."7 This emphasizes that the professions use specialized and powerful knowledge which must be carefully obtained, through higher education. The second criterion notes the social benefits of professional status. Echoing many others, Stephan Barker reports, "We find, however, a good deal of agreement that when an occupation is called a profession, approval is being expressed of according prestige and high pay to those in that occupation."8 The status and financial incentives associated with professions illustrate why many occupations strive towards professional status. Michael Davis notes that achieving this status happens through a process: "an occupation 'professionalizes' by organizing as a profession, that is, by adopting special standards."9 Increased levels of organization and codification lends credence to a field and can be appealed to for a basis of higher status and raising prices for higher income. The third criterion gets at the moral dimension of professions. With the specialized knowledge noted in the first criterion comes heightened responsibility.10 This responsibility goes above and beyond the regular demands of morality. Stephan Barker emphasizes that these responsibilities are voluntarily taken on. Much like making a promise incurs moral duties that one did not have before, joining a profession is an exercise of autonomy in taking on greater moral responsibility. Barker distinguishes these responsibilities from duties that may come up in an employment contract, connecting the obligations to the nature of the profession itself.11 These 6 Kelly, Professional Ethics, 4–5. 7 Tapper and Millett, “Revisiting the Concept of a Profession,” 16. 8 Barker, “What Is a Profession?,” 74. 9 Davis, “Licensing, Philosophical Counselors, and Barbers,” 233. 10 Maxwell, Professional Ethics Education: Studies in Compassionate Empathy. 11 Barker, “What Is a Profession?,” 88–89. 11 heightened moral responsibilities are typically articulated in a profession’s code of ethics. Indeed, the code of ethics plays a central role in distinguishing professions. Tapper and Millet identify a code of ethics as a necessary, “formal element” of the concept of a profession.12 Lee Loevinger concurs, “a code of ethics is inherent in the concept of a profession."13 Jean Preer argues that the “evolution of ethical standards is a central element in the professionalization of librarianship."14 The fourth criterion is articulated in a number of different ways in the literature, but most definitions appeal to some element of service to society, working for the public good, serving moral ideals, or universal human goods. The root “profess” harkens back to the practice of medical doctors reciting the Hippocratic Oath, publicly declaring their commitment to values serving the community.15 Loevinger notes, "It is significant that commitment to public service is one of the characteristics which distinguishes a profession from all other types of occupations.”16 Tapper and Millett emphasize this criterion in their argument against considering hairdressing to be a profession, claiming that “as there appears to be no required ethical ideal of service.”17 The sentiment is that some central, universal human good must be invoked to qualify, like medicine serves health. B. The Legal Definition In the United States, the federal government has weighed in on the nature of professions in labor law over the years. In 1896, the Supreme Court first ruled on the nature of professions, ruling that a chemist counted as a professional. Later rulings extended professional recognition to 12 Tapper and Millett, “Revisiting the Concept of a Profession,” 15. 13 Loevinger, “Enforcing Ethical Standards of Professional Associations,” 157. 14 Preer, Library Ethics, 1. 15 Cruess, Johnston, and Cruess, “Profession,” 76. 16 Loevinger, “Enforcing Ethical Standards of Professional Associations,” 157. 17 Tapper and Millett, “Revisiting the Concept of a Profession,” 15. 12 architects and engineers.18 The 1938 Fair Labor Standards Act (FLSA) established the Wage and Hour Division within the Department of labor, and this unit defines professions in contrast with occupations. The demarcation is primarily used to determine which employees are covered by overtime pay protections, since the law exempts professionals from these protections. The current standards identify two classes of professionals: learned professionals and creative professionals. Learned professionals are understood as follows: "Professional work is therefore distinguished from work involving routine mental, manual, mechanical, or physical work. A professional employee generally uses the advanced knowledge to analyze, interpret, or make deductions from varying facts or circumstances. Advanced knowledge cannot be attained at the high school level."19 Similarly, creative professionals are distinguished from more “menial” labor: "This requirement distinguishes the creative professions from work that primarily depend on intelligence, diligence, and accuracy. Exemption as a creative professional depends on the extent of the invention, imagination, originality, and talent exercised by the employee."20 The legal framing of professions does reflect much of the popular understanding of professions, identifying higher education and specialized, technical use of knowledge and judgment as key differentiating factors between professions and occupations. C. Philosophical Definitions 18 Loevinger, 158. 19 U.S. Department of Labor Wage and Hour Division, “Fact Sheet #17D: Exemption for Professional Employees Under the Fair Labor Standards Act (FLSA).” 20 U.S. Department of Labor Wage and Hour Division. 13 While much of the literature about the nature of professions focuses on historical, legal, or conventional approaches to defining professions, philosophers have offered more conceptual analysis. This section will explore Marxist, social contract, and conversational accounts of profession. A Marxist analysis of the nature of profession focuses on the functions of economic power. Anne Witz argues that a profession is an "occupational monopoly over the provision of certain skills and competencies in a market for services."21 Witz traces the history of how medical doctors used their professional clout as a “strategy of exclusionary closure"22 to maintain power over and control the emerging occupation of nursing. Tracing similar functions of professionalism in other industries illustrates the way that profession is bound up in class structure. An analysis of the nature of professions would be incomplete without “grounding the rise of professionalism within the historical and structural parameters of competitive, monopoly, and welfare capitalism."23 While a number of theorists understand the professions as a kind of social contract, Cruess, Johnson, and Cruess present this idea very directly. They write, "Under the terms of the contract, professions are granted status, privileges, and financial rewards on the understanding that they will be devoted to service, will guarantee competence, be moral in their endeavors, and address society's concerns."24 This social contract is not necessarily explicit, often relying on tacit consent of the professional to the increased moral demands in virtue of accepting the benefits. The social status conferred on professionals is not inherent, but rather is contingent 21 Witz, “Patriarchy and Professions,” 675. 22 Witz, 676. 23 Witz, 676. 24 Cruess, Johnston, and Cruess, “Profession,” 75. 14 upon good behavior.25 This incentivizes the professions to include robust ethics training in their training programs. Employing a Socratic, conversational approach, Michael Davis offers the most inclusive definition of profession found in my survey of the literature. He contends that a profession is: “[A] number of individuals in the same occupation voluntarily organized to earn a living by openly serving a certain moral ideal in a morally permissible way beyond what law, market, and morality would otherwise require.”26 Davis’s iterative approach to defining professions reflects several of the common criteria for professions, but his definition diverges at some interesting points. Next I will analyze the key elements of this definition and critique some points to construct my own definition. First, Davis explicitly includes earning a living as a necessary component of a profession, a consideration that most definitions take as an unspoken assumption. Davis argues that despite having specialized training and ethical standards, “notaries public do not form a profession because the fee for their service has been set so low that no one can earn a living as a notary."27 This criterion reflects the conventions that Davis’s iterative process is in conversation with, but it is not clear that there is anything essential or necessary about earning a living. The economic structure of a society at a particular point in time is a contingent fact; there is nothing necessary about earning a living. Consider the rise of universal basic income as a model that a growing number of localities28 have begun implementing. In this type of economic system, basic living conditions are provided for, so no one is required to earn a living. If a whole society 25 Cruess, Johnston, and Cruess, 76. 26 Davis, “Is Higher Education a Prerequisite of Profession?” 142. 27 Davis, “Licensing, Philosophical Counselors, and Barbers,” 234. 28 Mayors for Guaranteed Income is an organization of dozens of mayors across the United States implementing or advocating for some kind of guaranteed income programs in their localities. 15 implemented universal basic income, this criterion would imply that professions would cease to exist. Second, Davis argues that professions must be morally permissible. The inclusion of this criterion is chiefly motivated by the idea that a profession that is not morally permissible cannot impose binding moral obligations or responsibilities. For instance, Davis rules out the possibility of a group of assassins organizing as a profession, even if they adopted a code of ethics, because murder is wrong.29 However, Davis does not offer any standard for determining moral permissibility. The analysis gestures toward broad, commonly accepted moral norms. But this does not reckon with the relationship between moral and legal permissibility, or the possibility of widespread prejudice coloring the permissibility of a profession. How would this criterion regard sex work? Sex work, while highly stigmatized, is important work. Without a clearer explanation of how to understand the moral permissibility criterion in practice, it seems unnecessary. The third necessary element of professions that Davis offers is service to a moral ideal, which he understands as follows: “A moral ideal is a state of affairs in which, though not morally required, is one that everyone (that is, every rational person at his rational best) wants everyone else to approach, all else equal, wanting that so much that he is willing to reward, assist, or at least praise such conduct if that is the price for others to do the same"30 To illustrate this point, Davis differentiates between a mere mercenary and a soldier, identifying service to one’s country as a moral ideal that soldiers serve which goes beyond the economic terms of the employment contract.31 Another example of the kind of moral ideal he has in mind is “the truth about nature,” which he connects to scientists.32 29 Davis, “Licensing, Philosophical Counselors, and Barbers,” 230–31. 30 Davis, “Is Higher Education a Prerequisite of Profession?,” 142. 31 Davis, “Licensing, Philosophical Counselors, and Barbers,” 232. 32 Davis, 231. 16 The next criterion that Davis includes is voluntarily taking on moral demands above and beyond the norm.33 Employment contracts explicitly offer benefits in exchange for obligations, but professional responsibility goes beyond this source of moral burden. Davis explains, "claiming membership in a profession necessarily adds to one's moral obligations, just as promising does, and so opens one to moral criticism for failure to live up to those added obligations, just as promising does."34 Joining the profession is to voluntarily take on increased moral responsibilities. "The moral authority of a professional code rests on each member's (voluntary) consent, either express (for example, by oath) or (more often) implied by considerations of fairness (voluntarily taking the benefits of profession)"35 Davis’s choice to categorize professional responsibilities as a separate type of moral responsibilities specific only to the particular profession follows the trend in much of the literature. His position seems to imply that the relevant responsibilities for occupations are fully encompassed by the combination of the employment contract and basic, everyday moral requirements. This approach does not explore the social dimensions of workplace roles beyond contractual and very abstract (professional) ideals. Lastly, Davis also acknowledges the role of education in defining a profession. However, he does not believe that higher education is necessary. Rather, "what education a profession needs to be a profession is a function both of the underlying occupation and of the moral ideal served."36 Davis argues that arbitrary higher education criteria in definitions of professions are “morally destructive”37 because they disallow “lowly” occupations such as barbers and garbage 33 Davis, 231–32. 34 Davis, “Is Higher Education a Prerequisite of Profession?,” 143. 35 Davis, 140. 36 Davis, 146. 37 Davis, 145. 17 collectors based on prejudice. He points out that carpentry does serve a derivative universal human good, which he identifies as safe and quality construction. Davis strongly believes that less prestigious fields should not be ruled out of consideration as professions based on the level of formal education required for the position. D. My Definition of Profession My approach to understanding professions errs on the side of inclusion rather than exclusion. The three criteria I will offer for distinguishing professions are: (1) Specialized training, regardless of education level; (2) Having influence on the social world in one’s occupational role; (3) Discussion of the moral dimensions of social influence in occupation role as part of the specialized training. The specialized training referenced in (1) need not involve higher education. For instance, many customer service and construction jobs do not require higher education, but these jobs are highly skilled and involve technical training. This understanding of professions dignifies labor and recognizes the moral dimensions of oft-devalued forms of labor. My second criterion is where my view departs from the framing in most of the literature surveyed here. I reject the notion that the source of professional responsibilities is a voluntary choice or implicit social contract. Rather, responsibilities arise from roles and apply within the scope of one’s behavior in that role. Jobs do not exist in a vacuum, so any role will have a social context and societal impact of some kind. This embeddedness in the social world is the criterion that qualifies professions for considerations of professional responsibility. Power and influence in one’s professional role entail ethical impact and require responsible exercise of one’s role. Professions do not have a special, separate kind of moral status giving rise to completely distinct 18 moral questions. Rather, the moral nature of professional responsibilities is rooted in the particularity of the professional role and one’s behavior in that social context. II. Survey of Professional Ethics Education Literature and Practice Assessing the state of professional ethics education is difficult because each profession’s ethics education tends to be quite insular. In this section, I survey what is being taught in professional ethics education, followed by an examination of common worries, problems, and challenges for professional ethics education. I conclude the section with a detailed analysis of one of the most influential models of ethics education in the health care field, Beauchamp and Childress’s Four Principles approach. A. What is Taught in Professional Ethics Education In 1980, The Hastings Center published a landmark report that essentially set the agenda for ethics education in the United States for the next few decades. In The Teaching of Ethics in Higher Education, The Hastings Center made authoritative recommendations about what should be taught in professional ethics education. The report states, "We recommend, therefore, that courses in professional ethics at the graduate level include the following emphases: (1) personal ethical dilemmas that will be faced by professionals; (2) the ethical choices and judgments involved in selecting, defining, and analyzing concrete problems, and in weighing, judging, or recommending particular broad policies and patterns of conduct; (3) an analysis of the value dimensions, and implicit biases, of the methodologies and practices of particular disciplines."38 38 Hastings Center, The Teaching of Ethics in Higher Education, 34–35. 19 These recommendations sparked a marked increase in ethics content in various professional training programs. Over the years, particular professions reflected the recommendations of this report as they issued their own standards for accreditation of professional degree-granting programs. In 2004, the Association to Advance Collegiate Schools of Business (AACSB) updated its accreditation standards to include ethics content: "The institution or the business programs of the institution must establish expectations for ethical behavior by administrators, faculty, and students."39 The standards required that undergraduate programs contain content about ethical understanding and reasoning skills, and masters programs should address “ethical and legal responsibilities in organizations and society.”40 Similarly, in 2003 the engineering accreditation board updated its requirements to explicitly address ethical responsibility. Up to that point, it was widely assumed that the only moral training needed was professors modeling good behavior.41 These recommendations and standards certainly encouraged professional programs to incorporate more ethics content into their curricula. However, it is not enough to simply note that there is more ethics. The next section will examine what kinds of approaches to ethics have become most influential. The models and theoretical approaches that dominate professional ethics education represent a narrow range of perspectives, closely following the traditional canon in Western philosophy. In a survey of ethics instructors at top universities, Thomas Cooper found that 70% use original canonical ethics writings as their primary reading document. 42 Only 30% of those 39 Ethics Education Task Force, “Ethics Education in Business Schools,” 20. 40 Ethics Education Task Force, 21. 41 Bird, “Integrating Ethics Education at All Levels: Ethics as a Core Competency,” 125–27. 42 Cooper, “Learning From Ethicists, Part 2,” 39. 20 surveyed used case studies, often as the main avenue for addressing current events and "hot" topics.43 There is widespread agreement in the literature that most professional ethics education follows the model of teaching a few key theories or principles and then applying them. Lisa Kretz writes, "The most common approach to teaching ethics in North American university settings is to teach ethical theory, or - given developments in applied ethics - to teach the application of ethical theory to a specified subset of problems."44 Daniel Hartner concurs, "it is now plainly standard practice for textbooks and courses in professional ethics to insert a chapter or unit that sketches crude outlines of these theories before encouraging students to use some or all of them, or to simply bear them in mind when trying to address complex moral problems, or even combine them."45 Leslie Sekerka argues that ethics programs based on only two frameworks, consequentialism and deontology, dominate the field.46 Several other survey articles found that professional ethics training relied on identifying and applying universal principles or rules. 47,48 Business schools have made significant progress in including ethics content in recent years, but gaps remain. As of 2007, eighty-four percent business schools require a course that addresses at least one of ethics, corporate social responsibility, and sustainability,49 and undoubtedly the number has grown in the years since this survey. However, only twenty-five percent require a standalone ethics course.50 This low number likely reflects attempts to integrate 43 Cooper, 63. 44 Kretz, “Teaching Being Ethical,” 154. 45 Hartner, “What Is the Proper Content of a Course in Professional Ethics?,” 162. 46 Sekerka, “Organizational Ethics Education and Training,” 78. 47 Bowden and Surma, “Codes of Ethics,” 21. 48 Grant, Arjoon, and McGhee, “Reconciling Ethical Theory and Practice,” 46. 49 Christensen et al., “Ethics, CSR, and Sustainability Education in the ‘Financial Times’ Top 50 Global Business Schools,” 351. 50 Christensen et al., 351. 21 ethics across the curriculum, a strategy that has had mixed results.51 Overall, the trend appears to be superficial attention to ethics with declining robust engagement. Carolyn Nicholson and Michelle DeMoss write, "although ethics education is given lip service, it is declining as MBA programs proliferate."52 In a survey of curriculum managers across different areas of business, they found that those responsible for the curriculum reported less ethics education than they believed to be necessary for business professionals.53 In a survey of bestselling business textbooks, Mark Baetz and David Sharp found lots of thoughtful case studies presenting important ethical issues, but very little conceptual background for analyzing the situations.54 Few of these texts actually acknowledged the existence of ethical theories.55 When ethical theory is addressed, there is a strong reliance on “master-principle theories”56 and codes of ethics. Edward O’Boyle and Luca Sandona note that the current business ethics literature uses three primary theories to teach ethics: deontology, consequentialism, and more recently, virtue ethics.57 More recently, a number of schools have been incorporating Mary Gentile’s Giving Voice to Values approach to supplement ethics education.58 The premise of this approach is that “individuals can develop and practice scripts for addressing ethical dimensions of business decisions. Through practice, they gain confidence in their ability to analyze and respond to situations arising at the workplace."59 This approach assumes that most business professionals have strong moral standards and simply lack the confidence to speak up and share their personal values at critical 51 Baetz and Sharp, “Integrating Ethics Content into the Core Business Curriculum,” 59–60. 52 Nicholson and DeMoss, “Teaching Ethics and Social Responsibility,” 214. 53 Nicholson and DeMoss, 217. 54 Baetz and Sharp, 57. 55 Baetz and Sharp, 55. 56 Grant, Arjoon, and McGhee, 47. 57 O’Boyle and Sandonà, “Teaching Business Ethics Through Popular Feature Films,” 329–30. 58 Gentile, Educating for Values-Driven Leadership. 59 Gonzalez-Padron et al, 255. 22 decision points. The Giving Voice to Values approach has become quite popular, but critics caution that it can at best supplement other ethics education content.60 Similar themes of insufficient content and lack of theoretical diversity appear in the professional ethics education literature for professions other than business as well. In health care ethics, Tapper and Millett note that much of the literature relies on Beauchamp and Childress’s principlism.61 “In the dental field, eighty percent of dental schools offer a standalone ethics course,62 but little curriculum time is devoted to ethics instruction in US dental schools...just over 0.5 percent of the mean curriculum clock hours reported for dental education programs."63 Mark Winston complains that library and information science professional training “includes limited discussion of ethical decision making."64 Social work accreditation standards require ethics to be addressed in curriculum, but it does not specify anything beyond mere inclusion, leaving content and methods undetermined. 65 Laura Kaplan’s survey found that ethics education for social workers usually involves memorizing a list of social work values, examining decision trees, and referencing the field’s code of ethics.66 In engineering, Joseph Heckert observes that many influential textbooks only address micro level ethics issues and leave out macro, profession-wide considerations.67 Agricultural science only touches on ethics at the margin, if at all, according to Robert Zimdahl.68 In teacher education, surprisingly little ethics content appears. A recent review of curricula at 156 religious schools found that only nine percent of teacher education programs 60 Gonzalez-Padron, et al. 61 Tapper and Millett, 2. 62 Lantz, Bebeau, and Zarkowski, “The Status of Ethics Teaching and Learning in U.S. Dental Schools,” 1298. 63 Lantz, Bebeau, and Zarkowski, 1304. 64 Winston, “Ethical Leadership and Ethical Decision Making,” 234. 65 Kaplan, “Moral Reasoning of MSW Social Workers and the Influence of Education,” 508. 66 Kaplan, 518. 67 Herkert, “Ways of Thinking about and Teaching Ethical Problem Solving,” 375. 68 Zimdahl, “Teaching Agricultural Ethics,” 231. 23 offered an ethics course at all.69 While the numbers may be better in secular programs, Bryan Warnick and Sarah Silverman note that by and large, teacher education missed the movement to incorporate more ethics into the curriculum. When ethics does arise, the content typically relies on a Strike and Soltis text from 1985, case studies, and appeals to the NEA code of ethics.70 Notably, the many surveys of professional ethics education had very little to say about diversity as it relates to professional moral development. One engineering ethics paper suggested that cultural sensitivity should be addressed in engineering ethics courses because engineering graduate programs have a large number of international students.71 Baetz and Sharp noted that one case study in their survey addressed diversity as an ethical dilemma because it could affect corporate performance and image.72 Within business ethics, there have been some attempts to reinterpret stakeholder theory from a feminist ethics of care, but these interpretations in the academic discourse rarely make it to textbooks.73 There is even less engagement with non- Western approaches. The only example my survey found was Bernie D’Angelo Asher’s 2017 paper arguing for incorporating an Afro-communitarian ethic in business contexts.74 Most professional educational institutions recognize that they must include some kind of ethics component in their programs, but the extent, intellectual diversity, and quality of the ethics instruction is often lacking. B. Common Problems and Challenges for Professional Ethics Education There is fairly widespread agreement that most professional ethics education needs to be better. The literature extensively discusses a variety of challenges in teaching ethics to 69 Warnick and Silverman, “A Framework for Professional Ethics Courses in Teacher Education,” 273. 70 Warnick and Silverman, 275. 71 Li and Fu, “A Systematic Approach to Engineering Ethics Education,” 341. 72 Baetz and Sharp, 59. 73 Asher, “Afro-Communitarian Ethics,” 131. 74 Asher, 131. 24 professionals, and frequent scandals in different fields are referenced as a problem that current programs must improve to address. Since ethics is recognized as a core element of a profession, existing and aspiring professions have a vested interest in connecting ethical standards to their public image. Gallup does yearly surveys of the United States public to assess the level of perceived ethical standards in various fields. In the most recent survey, nurses got the highest rating, with eighty-five percent believing them to have high ethical standards. The numbers drop considerably to sixty-six percent for engineers, sixty-five percent for medical doctors, forty-nine percent for college teachers, twenty-eight percent for journalists, twenty-two percent for lawyers, twenty percent for business executives, fourteen percent for stockbrokers, and thirteen percent for advertisers.75 It is significant that the majority of the professions included in the survey fail to earn even fifty percent confidence in their ethical standards. Many of the articles in the professional ethics education literature present their interventions or suggested changes in response to ethics scandals. The urgency for improving ethics education is grounded in the many public cases of misconduct. For instance, drug and doping scandals in sports are cited as a reason to figure out how to improve the training of exercise science professionals.76 Many criticize higher education for failing to include enough ethics education to prevent fiscal scandals and collapses.77 Jun Gu and Christina Neesham note that these various scandals are important to prevent not only because of the impact to the profession, but also because of broader impacts on society and the environment.78 Mark Winston cites the “myriad examples of high-profile cases of ethical abuses, from many corporate cases to 75 Reinhart, “Nurses Continue to Rate Highest in Honesty, Ethics.” 76 Millett, Budiselik, and Maiorana, “Teaching Ethics in Exercise Science,” 288. 77 Martinov-Bennie and Mladenovic, “Investigation of the Impact of an Ethical Framework and an Integrated Ethics Education on Accounting Students’ Ethical Sensitivity and Judgment,” 190; Fletcher-Brown et al., “A Longitudinal Study of the Effectiveness of Business Ethics Education,” 10; Waples et al., “A Meta-Analytic Investigation of Business Ethics Instruction,” 133. 78 Gu and Neesham, “Moral Identity as Leverage Point in Teaching Business Ethics,” 527. 25 those in higher education, the public sector, sports, and so on”79 as a motivation for his survey and meta-analysis of professional ethics education practices. The 1980 Hastings Center report identified a number of general worries about ethics education that continue to appear in the more recent literature. The Hastings Center reports, "In essence, then, the teaching of ethics in almost all professional schools can be characterized as follows: it is seen as at best a secondary or tertiary function of the schools; those who teach such courses are likely to be seen either as outside, or only barely on the fringe of, the main purposes of the schools; and those attempting to introduce ethics courses can normally expect considerable disinterest or resistance."80 The report recommends that those who teach professional ethics should have at least one year of academic training in ethics or philosophy as a measure to improve the quality of the ethics education offered.81 By 2012, McGraw et al. reported that the majority of ethics instructors across different fields do not have training in philosophy.82 The problems identified by the Hastings Center remain. In a 2017 assessment, Patricia Grant et al. express “serious concerns” about the “adequacy of the contemporary approach to ethics education and training."83 Many fields have incorporated ethics courses into their curriculum, but mandatory ethics courses remain relatively rare.84 These more general issues in ethics education lead into more specific problems. 79 Winston, “Ethical Leadership and Ethical Decision Making,” 231. 80 Hastings Center, The Teaching of Ethics in Higher Education, 37. 81 Hastings Center, 82. 82 McGraw et al., “Who Teaches Ethics?,” 130. 83 Grant, Arjoon, and McGhee, 60. 84 Maxwell and Schwimmer, 355. 26 One of the most persistent and pressing concerns in the literature is how to educate for action. Most ethics material focuses on moral reasoning and judgment, and ethicists consistently lament that this training does not translate into more ethical practice.85 If ethics education does not have an impact on actual decision-making outside of the classroom, it is not doing its job. Lisa Kretz, arguing that the majority of professional ethics education focuses on reasoning to the detriment of focus on behavior and action,86 powerfully expresses the urgency of this problem: "One need only look so far as the current radically inequitable distributions of wealth, education, and health care, the continuation of imperialism and slavery under the umbrella of economic welfare, and the environmental holocaust to recognize how pressingly moral action is needed. Discovering how to inspire students to be active participants in the move toward more ethical ways of being, I hope, will become a central, explicit, publicly recognized goal of those who study and teach ethics. I take it that bridging the space between moral cognition and moral action will be a necessary element for doing so."87 Gu and Neesham agree that decision making needs far more attention in ethics education, and their work suggests that taking an approach that focuses on moral identity formation could help connect theory in the classroom to decisions made outside the academy.88 They connect this to findings in moral psychology indicating that “rule prescription is often too general, inflexible, and removed from the personal experiences of individuals to motivate them into engagement."89 William Frey identifies emotion as a gap in the cognitive skills that ethics training covers, 85 Sekerka, Leslie E., 91. 86 Kretz, “Teaching Being Ethical,” 152. 87 Kretz, 158. 88 Gu and Neesham, 532. 89 Gu and Neesham, 529. 27 arguing that cultivating moral emotions is necessary for translating ethics into action.90 The move to add virtue ethics as a third theoretical approach to consequentialism and deontology has been strongly motivated by the hope that virtue ethics’ focus on dispositions and habits will translate into more practical, actionable moral guidance. Similarly, in business ethics, the Giving Voice to Values approach has become popular due to its focus on practicing scripts to build confidence in taking action to speak up about one’s values in the workplace. Much like ethicists ’worry that their courses do not seem relevant to their students, a challenge facing ethics education is that ethics courses are often alienating. Beyond passivity and irrelevance, some aspects of ethics education can actively turn students away. Peta Bowden and Anne Surma argue that using codes of ethics in professional ethics education can have “alienating effects.”91 Employing authoritative codes can “have the effect of smothering”92 student engagement or personal reflection on values and actions. While a focus on compliance with official standards may be more practical, it can alienate students from engaging. Michael Clifford shares Bowden and Surma’s concern. He argues that “moral theory is for the majority of students very abstract and speculative, not at all the exercise in practical reason that moral theorists as diverse as Aristotle and Kant understood it to be. As such, students routinely find moral theory alienating and even intimidating.”93 Interestingly, none of the discussions of student alienation in the literature addressed the whiteness and maleness of the canon of assigned texts and theorists in these courses. Business ethics has its own set of problems and challenges in training future professionals. A recent study “found that 63% of undergraduate business majors self-reported 90 Frey, “Teaching Responsibility,” 325. 91 Bowden and Surma, “Codes of Ethics,” 26. 92 Bowden and Surma, 23. 93 Clifford, “Moral Literacy,” 126. 28 Internet-based cheating in the past year.”94 Ethics educators in the business field face an uphill battle. The AACSB standards for accreditation do require education on topics in ethics and ethical reasoning skills, but the official standards do not contain “particular stipulations pertaining to how this education is delivered or assessed.”95 Accounting is another subfield where there have been consistent calls for more and better ethics education over the years, according to Irene Gordon.96 In the advertising subfield, a 2020 study discovered that moral reasoning abilities declined for advertisers the longer they worked in the industry.97 These findings corroborate the public’s very low estimation of the ethical standards of various business professions in the Gallup poll. Another problem with business ethics is that "classical interpretations of stakeholder theory and its application to business organisations have largely been undertaken from Western masculinist perspectives."98 Numerous authors express concerns about failures in medical ethics education. Rosamond Rhodes, discussing the widespread influence of Beauchamp and Childress’s Four Principles model, argues "Medical ethics is supposed to serve as a moral compass. Others call upon the field to be edifying and to provide guidance. Instead, medical ethics frequently muddies the waters and points people in the wrong direction."99 She identifies the Four Principles model as the primary example of “not so good” medical ethics. A comprehensive review of the medical ethics literature “documents a persistent mismatch between the issues taught to medical students in required bioethics curricula and texts and the dilemmas students typically face in their clinical 94 Gordon, “Lessons to Be Learned,” 29. 95 Waples et al, 134. 96 Gordon, 32. 97 Schauster et al., “Advertising Primed,” 4. 98 Asher, “Afro-Communitarian Ethics,” 130. 99 Rhodes, Rosamond, "Good and Not So Good Medical Ethics," 72. 29 experiences."100 This mismatch is a serious problem, both for the relevance of the ethics training and for the lack of guidance being offered to practitioners on the actual moral dilemmas they face. Michael Millstone argues that medical ethics education has largely failed to address “the realities and ethical significance of the organizational and policy changes brought about by post- industrial medicine.”101 Several fields have struggled to incorporate formal ethics education into their professional training because, traditionally, ethics and moral behavior is just implied in the nature of the profession. Maxwell and Schwimmer argue that teacher education has been slow to incorporate direct instruction in ethics because it “runs counter to a cherished notion, as widespread among teacher candidates as teacher educators, that there is little more to being an ethical professional than simply being a 'nice person.'"102 When the accreditation board for engineering updated its requirements to include discussion of ethical responsibility, there was some significant pushback because, to that point, most engineering faculty believed that modeling good behavior as professors was sufficient to convey the profession’s moral standards.103 The agricultural sciences have also been slow to address ethics education because of the positive moral association with farming in the imaginary of much of the American public. Zimdahl explains, "When one believes one's profession has been granted virtue by the public there is no compelling need to explore the source of the grant or the ethical foundation of the profession. The profession has what most strive for."104 100 Millstone, “Teaching Medical Ethics to Meet the Realities of a Changing Health Care System,” 214. 101 Millstone, 214. 102 Maxwell and Schwimmer, “Professional Ethics Education for Future Teachers,” 364. 103 Bird, “Integrating Ethics Education at All Levels: Ethics as a Core Competency,” 125–27. 104 Zimdahl, “Teaching Agricultural Ethics,” 239. 30 Another challenge facing ethics education is assessment. Measuring moral progress or ethical development can be quite difficult. Assessing changes in moral reasoning is easier than tracking changes in decision-making or behavior beyond the classroom, so most assessment has focused on the former. University pressure to prove the efficacy of ethics education ironically leads many ethics instructors to restrict their content to more abstract content that does not translate well to practice in hopes of meeting assessment demands. In what many consider to be a breakthrough in ethics assessment, James Rest created the Defining Issues Test (DIT) in 1979. Twenty years later, Rest and a team of researchers revised the DIT, publishing the DIT-2 in 1999. The DIT is based on Rest’s Four Component Model, which conceives of moral behavior in terms of moral judgment, moral sensitivity, motivation, and character.105 The aim of the DIT, and now the DIT-2, is to locate the respondent on the moral development path."106 Rest proudly claims to base his approach on Lawrence Kohlberg’s and John Rawls’ work,107 focusing on cognition108 and tracing moral development through three developmental schemas: “personal interest, maintaining norms, and postconventional.”109 Critics have raised several challenges to the DIT and DIT-2. Howard Curzer et al. offer extensive criticism of the DIT-2 before offering an alternative assessment tool. They point out that deontology is at the top of the moral development scheme, and they argue that "surveys should not hold respondents to a standard which a substantial percentage of experts reject."110 The DIT-2 measures moral progress based on a target that is actively and widely contested. The assessment literature often acknowledges that Kohlberg’s theory of moral development faced 105 Curzer et al., “Do Ethics Classes Teach Ethics?,” 369. 106 Curzer et al. 107 Rest et al., “A Neo-Kohlbergian Approach to Morality Research,” 381. 108 Rest et al., 382. 109 Rest et al., “DIT2,” 648. 110 Curzer et al., “Do Ethics Classes Teach Ethics?,” 370. 31 considerable challenges from Carol Gilligan’s 1982 In a Different Voice.111 However, Rest and other defenders of the DIT-2 have largely dismissed feminist criticism over the overall neo- Kohlbergian framework. This dismissal is based on the argument that “sex (gender) accounts for less than 0.5% of the variance of the DIT.”112 Women perform just as well as men on the DIT, so feminist criticisms are irrelevant. Another cause for concern about the reliance on the DIT and DIT-2 appears in Rest’s discussion of why his team decided to update the DIT and create the DIT-2. Some practical details like changing references to the Vietnam War from present to past tense are fairly neutral. However, another problem in the DIT that the DIT-2 fixes is that in the DIT, "the term Orientals was used to refer to Asian Americans."113 The response glosses over the use of a very offensive term rather than taking the opportunity for deeper reflection on what biases may be reflected in other aspects of the theory. All in all, Rest dismisses the concerns raised by various critics, appealing to the fact that over 400 peer-reviewed articles employ the DIT and DIT-2. He takes this to fully document the validity of the approach.114 The literature reporting ethics assessment results is a mixed bag. There is some evidence that ethics courses may improve moral reasoning, at least according to the DIT-2’s concept of moral development, but there is little evidence that this translates to lasting changes beyond the classroom. Warnick and Silverman report empirical research suggesting that ethics courses can make a positive difference in improving moral reasoning.115 Nonna Martinov-Bennie and Rosina Mladenovic conducted assessments which suggest that “the integrated ethics education component has a positive impact on students' ethical sensitivity."116 Articles reporting assessment 111 Gilligan, In a Different Voice: Psychological Theory and Women’s Development. 112 Rest et al., “A Neo-Kohlbergian Approach to Morality Research,” 311. 113 Rest et al., “DIT2,” 647. 114 Rest et al., 646. 115 Warnick and Silverman, “A Framework for Professional Ethics Courses in Teacher Education,” 274. 116 Martinov-Bennie and Mladenovic, “Investigation of the Impact of an Ethical Framework and an Integrated Ethics Education on Accounting Students’ Ethical Sensitivity and Judgment,” 195. 32 results in various particular professional fields abound, with mixed results. One example in business ethics comes from Ethan Waples et al. Their study reports that “business ethics instruction, as reported in the literature, is at best minimally effective in enhancing ethics among students and business people.”117 At the very least it is clear that the professional ethics education literature does not contain significant evidence of ethics education being particularly successful. C. Assessing Beauchamp and Childress’s Four Principles Framework The traditional canon still wields immense power in ethics education. Feminist perspectives are typically included as an afterthought. Race is rarely addressed, and when disability is discussed, it rarely features work by disabled scholars. The Beauchamp and Childress “Four Principles” approach is very influential, especially in health care contexts. Tom L. Beauchamp and James F. Childress published the first edition of Principles of Biomedical Ethics in 1979,118 establishing the Four Principles framework. This text quickly dominated the health ethics education field as a standard, accessible approach to medical ethics. As of 2019, the text is in its eighth edition.119 In this section, I survey the framework and identify significant lacunae with respect to oppressive structures. Beauchamp and Childress identify four key principles which should be balanced against each other in guiding ethical decision-making: respect for autonomy, nonmaleficence, beneficence, and justice. A wide range of theoretical approaches converge on two necessary conditions for autonomy: “(1) liberty (independence from controlling influences) and (2) agency (capacity for intentional action).”120 Beauchamp and Childress argue that a threshold level of understanding 117 Waples et al., “A Meta-Analytic Investigation of Business Ethics Instruction,” 146. 118 Beauchamp and Childress, Principles of Biomedical Ethics, 1979. 119 Beauchamp and Childress, Principles of Biomedical Ethics, 2019. 120 Beauchamp and Childress, Principles of Biomedical Ethics, 2001, 58. 33 and freedom from constraint is what is required for someone to be considered autonomous. Full information and complete independence from external influence is a standard rarely met, and as such should not be used to judge the majority of life, which does not meet that high bar. Autonomy should not be nearly impossible to achieve.121 The principle of respect for autonomy imposes both a negative obligation to not impose controlling constraints on autonomous actors and a positive obligation to disclose information needed for informed decision-making.122 The principle of nonmaleficence issues a demand against harming others. As a negative obligation, i.e. do not harm, it is generally understood to be more stringent than positive obligations (like beneficence).123 There is much discussion about the extent of these obligations, however. Ongoing debates consider the nature of causation, what constitutes harm, and how to approach quality of life judgements. Although the term often has a connotation of voluntariness, Beauchamp and Childress understand beneficence as a positive moral obligation to benefit other persons.124 While some acts of general beneficence are ideal, there are other situations where providing benefits to specific others is morally required, like rescuing someone from a dangerous situation where the rescue does not significantly endanger the actor. Beneficence differs from nonmaleficence in that its requirements do not always need to be followed in an unbiased manner, and failure to meet the moral demand is rarely a reason for legal consequences.125 Beneficence does not mandate heavy paternalism; rather, this principle must be balanced against autonomy. 121 Beauchamp and Childress, 59. 122 Beauchamp and Childress, 64. 123 Beauchamp and Childress, 115. 124 Beauchamp and Childress, 166. 125 Beauchamp and Childress, 168. 34 In articulating their principle of justice, Beauchamp and Childress survey several theories of justice to glean insights. Most agree that a formal principle of justice requires that equals receive equal treatment and unequals receive unequal treatment. Yet this standard is not substantive, so the authors focus more narrowly on how health care resources should be allocated. A minimum threshold for justice requires recognition of “an enforceable right to a decent minimum of health care.”126 They do not specify the content of a decent minimum. The Four Principles framework includes fairly minimal and poorly analyzed discussions of effects of structures of oppression. When injustice related to social identity is discussed, it is reduced to a liberal, individualistic matter. For example, in discussing statistics regarding gender disparities in lung cancer and cardiac disease diagnoses, Beauchamp and Childress discuss the cause of this solely in terms of provider bias.127 Provider bias is certainly a part of the story, but their analysis overlooks significant causal mechanisms behind these disparities. Further, the Four Principles framework closes off theoretical space for oppressive structures. Beauchamp and Childress firmly endorse a narrow scope of possible moral demands: “The requirement that persons must seriously disrupt their life plans in order to benefit those who are sick, undereducated, or starving exceeds the limits built into common-morality obligations.”128 This appeal to common-sense morality as a ceiling for moral demands refuses space for considering whole social structures and systems to be unjust and in need of radical transformation. The rights and obligations system of morality they employ is certainly popular in moral and political philosophy, but it does not include much theoretical space for addressing whole structures of injustice because it tends to reduce moral demands down to an individualist 126 Beauchamp and Childress, 272. 127 Beauchamp and Childress, 239. 128 Beauchamp and Childress, 169. 35 ontology. For example, their analysis of health care access does not even consider the possibility that capitalism could be part of the problem or could be anything but inevitable. When they do discuss justice in health care access, they write, “the primary economic barrier to health care access in many countries…is the lack of adequate insurance.”129 By preemptively assuming that society is not deeply unjust to begin with, this orienting assumption closes off many possibilities of attending to injustices. Overall, the Four Principles framework does not provide an ethics education that is suitably attentive to oppressive structures. The framework does include some discussion of justice in relation to medical institutions and policies and individual patient health, but the discussion relies on a conception of justice that does not include structural oppression. III. The Gap in Professional Ethics Education In my survey of the professional ethics education literature, only three articles out of seventy referenced racial or gender discrimination as theoretically significant for ethics. A handful considered examples and case studies about diversity. None addressed disability, sexual orientation, or gender identity. The history of discrimination based on race, gender, and ability is inextricable from the history of professions, and the ongoing disparities and forms of discrimination that manifest in society and in workplaces in particular is undeniable. Current movements like the #MeToo movement highlight how pervasive sexual harassment and abuse are in the workplace, and ongoing conversations about racial equity resurge in popularity as the news covers police violence. When race is acknowledged, it is often reduced to cultural difference.130 While some discussion of gender discrimination has emerged in professional ethics 129 Beauchamp and Childress, 240. 130 Li and Fu, “A Systematic Approach to Engineering Ethics Education,” 341. This represents one of the few references to racial difference in the professional ethics literature was an engineering ethics piece that argued for including cultural sensitivity training because engineering has large numbers of international students. 36 education literature in response to the #MeToo movement,131 these discussions are still largely treated as case studies that do not speak to the basic ethical frameworks for approaching professional ethics. One positive example of such a study is Michelle Mello and Reshma Jagsi’s “Standing Up Against Gender Bias and Harassment – A Matter of Professional Ethics.” They argue that “health professionals have a moral duty to practice...intervening as bystanders in response to sexual harassment and gender bias, and that this obligation should be described in codes of medical professional ethics and supported with institutional training."132 They compare the responsibility to intervene in cases of gender discrimination to the more widely recognized duty to intervene upon observing an impaired medical practitioner.133 There are too many examples to count of how oppression shows up in professional contexts. For instance, the Covid-19 pandemic has highlighted the capabilities of workplaces to improve accessibility and make accommodations that disabled people have been demanding for years, revealing the corporate argument that it was just too difficult to be a lie. Major League Baseball recently faced public pressure to take its all-star game out of Georgia when the state implemented a new racially discriminatory voter restriction law.134 Similarly, when North Carolina passed a restrictive anti-trans law, companies including PayPal, Adidas, and Deutsche Bank pulled business from the state. The cost to the North Carolina economy was estimated to be close to $4 billion.135 These events clearly demonstrate the relevance of various kinds of discrimination to professional ethics, yet textbooks and courses do little to engage with these 131 Holroyd-Leduc and Straus, “#MeToo and the Medical Profession,” 33; Diener and Small, “#Metoo and Lessons in Stakeholder Responsibility,” 4; Clarke, “Organizational Failure to Ethically Manage Sexual Harassment,” 3; Tusinski Berg, “The Ethics of Exploring Gender Issues in a Time of #Metoo,” 1; Zacharias, “Learning from Me Too,” 4. 132 Mello and Jagsi, “Standing Up against Gender Bias and Harassment — A Matter of Professional Ethics,” 1385. 133 Mello and Jagsi, 1386. 134 Gonzalez, “MLB Moves All-Star Game over Ga. Voting Law.” 135 Dalesio and Drew, “AP Exclusive: ‘Bathroom Bill’ to Cost North Carolina $3.76B | AP News.” 37 subjects. At most, these topics are incorporated as case studies or isolated scenarios, never as bigger phenomena that impact ethical theorizing. The trend of applying principles from a handful of white men in the ethics canon continues. But these issues are not just case studies. Oppression is relevant to how we approach moral questions in the first place. The theories and tools for making sense of moral issues in the workplace must have the resources to address structures of oppression. Ignoring discrimination in society is a serious problem, yet the professional ethics education literature has a more sinister gap. Professionalism itself is often actively weaponized as a tool for discrimination. In wake of the Civil Rights Act of 1964, discrimination against Black people in employment shifted to focus on “unprofessional” natural hairstyles. In 1976, an appeals court ruled that afros are protected under Title VII of the Civil Rights. However, in 1981, the courts ruled that braids were not a protected hairstyle because braids are not “an immutable racial characteristic” like the afro.136 The status of Black hairstyles other than afros is still uncertain in U.S. federal law. In recent years, a number of states and cities have passed nondiscrimination laws and ordinances that ban discrimination on the basis of hairstyles or textures, including California; New York; New Jersey; Cincinnati, Ohio; and Durham, North Carolina.137138 The standards of professionalism have also been used against LGBTQ educators, whose sexual orientations or gender identities are often considered inappropriate to bring up in schools. Coming out can be in tension with being professional. In recent years, the courts have extended legal protections for sexual orientation and gender identity, but covert discrimination continues.139 In the legal profession, women still face social pressure and sometimes 136 Griffin, “How Natural Black Hair at Work Became a Civil Rights Issue.” 137 Belsha, “How Hair Discrimination Bans Are Affecting Students and Schools.” 138 Padilla, “New Jersey Is Third State to Ban Discrimination Based on Hair.” 139 Biegel, The Right to Be Out. 38 requirements from judges to wear skirts.140 One of the biggest ways that professionalism masks hidden biases is the focus on “fit” in hiring processes. A 2016 survey found that eighty-four percent of employers focused on cultural fit in determining whether an applicant was a good candidate for a job.141 In practice, “fit” is often a proxy for finding a candidate whose identities do not challenge those of existing staff. Racial, gender, and disability discrimination is often at work in assessments of whether an applicant would do well in the professional culture of an organization. Individuals with names that do not “sound white” face barriers in the job search process. Further, even once hired, the “foreign” sounding names can cause problems in internal company systems. For example, upon joining the Screen Actors Guild, Gabe González was told he could not register his name correctly because “á” is a special character that their systems could not handle.142 The impact of this is that Gabe’s name will be spelled incorrectly in any professional capacities in which the SAG is involved. I could not find any reference to the problem of professional standards as tools of active discrimination in the professional ethics education literature. Not only is professional ethics education neglecting to address a very relevant topic, but it is also willfully ignoring active harm being done in the name of professionalism itself. One objection that might be raised against my position is that I have made a category error in identifying this as a gap in professional ethics. The phenomena I describe belongs to the category of diversity and inclusion initiatives, not professional responsibility. This objection assumes that similar phenomena cannot be addressed in multiple ways. Why should structures of 140 Cooper, “The Appearance of Professionalism,” 1. 141 Gray, “The Bias of ‘Professionalism’ Standards.” 142 Gabe González [@gaybonez], “Joining SAG and Was Told I Can’t Spell My Name Correctly (González) Because ‘á’ Is a ‘Special Character’ in Their System. The Folks I Spoke to Were Lovely, but It’s Nuts I Can’t Register My ‘Professional’ Name the Way It Should Be Spelled.” 39 oppression not be addressed in multiple formats and locations? This objection does not deny that the phenomena I have described have moral weight and practical relevance to professional practice. My argument is that these criteria are sufficient for relevance to professional ethics. Many workplace dilemmas are categorized as diversity problems, when in fact deep structural injustices are at play. A robust ethics training that considers structures of oppression may provide professionals better tools to deal with them. Another possible objection to be leveled against my argument is that even if widespread discrimination is relevant to professional ethics, new theoretical approaches to ethics are not necessary. Supplementing the existing ethics training and its narrow canon with cultural competency training will sufficiently fill the gap. Cultural competency is a widely recognized and employed framework for addressing difference in health care ethics and teacher education, for example. In response, I contend that an additive approach of merely importing the cultural competency framework will not solve the problem I have identified. While the cultural competency approach has significant influence, it has significant limitations. Cultural Competency emerged as the primary pedagogical model for preparing health professionals to work with racial and ethnic minorities. The Department of Health and Human Services (HHS) created the Office of Minority Health (OMH) in 1986 to begin addressing the concerns raised by the Heckler Report.143 This report drew attention to serious health care disparities facing minority populations. Medical institutions in the United States began taking steps towards addressing this problem and cultural competence emerged as the primary pedagogical tool to address these disparities. Various training modules and programs were implemented in medical educational institutions, and the OMH established the Center for 143 Think Cultural Health, “Health Equity Timeline.” 40 Linguistic and Cultural Competence in Health Care (CLCCHC) to consolidate and facilitate these endeavors in 1995. The cultural competency framework has achieved enough recognition and institutional importance to be included in medical school accreditation standards.144 Cultural competency is also widely used in other professional fields including education, social work, and library science. Rebecca Hester defines cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations.”145 This model emerged with the premise that training more culturally-sensitive healthcare providers would improve clinical interactions.146 These programs originally adapted material from cross- cultural trainings in order to address health care barriers faced by refugees and immigrants.147 The HHS describes the intention behind cultural competence training: “Practicing cultural competence to honor diversity means understanding the core needs of your target audience and designing services and materials to meet those needs strategically.”148 This training typically takes a three-pronged approach: developing attitudes, knowledge, and skills. Cross-cultural work requires dispositional attunements in the form of humility, sensitivity, respect, and curiosity. The knowledge element involves learning about sociocultural contexts and perspectives, ideally in a way that avoids generalizations and stereotyping. Lastly, the skill element gives professionals an opportunity to practice clinical communication techniques that incorporate the lessons of the attitude and knowledge elements.149 By focusing on 144 Hester, “The Promise and Paradox of Cultural Competence,” 281. 145 Hester, 281. 146 Kleinman and Benson, “Anthropology in the Clinic,” 1673. 147 Gregg and Saha, “Losing Culture on the Way to Competence,” 542. 148 Office of Population Affairs, “Cultural Competence.” 149 Hester, “The Promise and Paradox of Cultural Competence,” 285–86. 41 the sociocultural context of the patient, cultural competence training aims to equip professionals with attitudes, knowledge, and skills to effectively interact with minority patients or clients. The cultural competency framework does not adequately reckon with oppressive structures. Cultural difference is not an effective proxy for structural oppression. The cultural competency framework does not use the language of oppressive structures as such in its analysis of injustice and wrongs. It discusses racism and sexism as unjust phenomena, but the framework employed generally understands these as rooted in bias or prejudice. The solution to misguided beliefs is learning more about different cultures or populations. This model of response reveals an understanding of phenomena like racism and sexism that is individualist rather than structural. The cultural competency framework does include extensive indirect discussion of oppressive structures. The framework was developed as a response to health disparities for vulnerable or minority populations, so the literature includes extensive discussion of how social identities are connected to barriers to healthcare access. The HHS Cultural Competence webpage includes a section about the social determinants of health.150 However, the framework has been widely criticized for not effectively responding to these health disparities. “Very few studies have been able to link a reduction in health care disparities to culture competence training.”151 One of the most significant problems is that racial disparities cannot be reduced to culture.152 Hester argues, “The use of culture as a proxy for race erases the political and historical forces that have ascribed racial characteristics to and informed the social position of particular populations.”153 150 Office of Population Affairs, “Cultural Competence.” 151 Hester, “The Promise and Paradox of Cultural Competence,” 288. 152 Lee and Farrell, “Is Structural Competency a Backdoor to Racism?” 153 Hester, “The Promise and Paradox of Cultural Competence,” 284. 42 Several critics note that cultural competency often reduces culture to a set of information, which misses the dynamic nature of culture and tends to reinforce stereotypes.154 Overall, the cultural competency framework fails to adequately address various forms of oppression because structural oppression is not reducible to cultural difference. While cultural competency does leave open some theoretical space for the existence of oppressive structures, it presumes a basically just society. Adding cultural competency to existing ethics education would not be sufficient to address the pervasive ways that structures of oppression manifest in professional situations. A theoretical framework that directly engages with structural oppression is needed. IV. Why Professional Responsibility Requires Addressing Structures of Oppression The previous section identified a crucial gap in the professional ethics education literature. Justice and injustice are conceived of in an individualistic rights-based manner that ignores the systemic ways that oppression operates. This existing approach leaves out a huge range of moral content that is very relevant to how one operates as a professional in society. This section will offer a positive argument for discussing structures of oppression in ethics education. Specifically, I argue that professional responsibility requires that ethics education addresses structures of oppression. At the very least, professional responsibility should mean not causing active harm in one’s professional roles. Structures of oppression exist in society, causing ongoing harm. Widespread oppression, disadvantage, and discrimination are undeniable and morally significant. Chapter Two will offer feminist epistemology’s articulation of how these are structures. The professional’s work is not isolated from society; rather, professionals engage in spaces marked by structures of oppression as a regular part of their professional role. Since 154 Gregg and Saha, “Losing Culture on the Way to Competence”; Kleinman and Benson, “Anthropology in the Clinic”; Tervalon and Murray-García, “Cultural Humility Versus Cultural Competence.” 43 professionals cannot avoid interacting with structures of oppression in their professional roles, their professional responsibilities must include considerations of structural oppression. Their actions as professionals will be marked by very real power dynamics, whether they notice this or not. Professional responsibility involves recognizing the moral dimensions of one’s professional behavior. Positionality in relation to structures of oppression is a moral dimension of professional action, because one’s actions and interactions as a professional have moral valence in relation to morally relevant things. Thus, professional responsibility requires understanding how these structures mediate and affect the moral impact of professional behavior. Professional responsibility, on the part of ethics educators, requires that professional ethics education start addressing this relevant and missing topic. Perhaps a too-gracious stance is that ethics education has not dealt with this because structural oppression is mostly discussed outside the field, which requires interdisciplinary work. The existing tools ethics uses for making sense of our responsibilities in relation to moral demands are inadequate to make sense of this kind of wrong. However, professional ethics education already employs interdisciplinarity in integrating ethics material into the content of particular professional fields. This should mean that professional ethics educators will not be resistant to looking at work in fields beyond “ethics” for morally relevant content, like the work on structures in sociology, women’s studies, African and American studies, and the like. Additionally, while the ethical frameworks dominating the field lack the capacity to make sense of moral responsibility in relation to structures, this problem calls for better theory rather than sidestepping. Chapter Three will articulate an improved approach to responsibility that does have the conceptual tools to make sense of moral demands in relation to structures of oppression. 44 V. Conclusion Most professional ethics training does not address structures of oppression. The professional ethics education literature recognizes many challenges for ethics education. In Chapter Four, I illustrate how many of these challenges and problems can be mitigated by a structural competency approach. In the next chapters I articulate in greater depth what I mean by both structural oppression and by responsibility, setting up my discussion of how a structural competency approach can help professional ethics education meet its responsibility to teach future professionals about structures of oppression. 45 CHAPTER TWO: What Every Account of Structural Oppression Needs – Lessons from Women of Color Feminisms and White Feminism This chapter is about structures of oppression, but it does not contain an argument for their existence or importance. The fact that oppression is deeply rooted in the systems shaping and governing all levels of daily life is a starting point for this project. As Chapter One argues, this fact is morally significant and crucially relevant to professional ethics and professional responsibility. Consequently, addressing structural oppression is necessary for professional ethics education, but professional ethics education has largely failed to incorporate attention to structural oppression. My larger argument builds toward structural competency as a model that can successfully deliver that necessary attention to structural oppression in professional ethics education. The aim of this chapter is articulate an operative conception of oppressive structures that can be used to identify responsibilities in relation to those oppressive structures, setting up Chapter Three’s more extensive examination of the topic of responsibility. This chapter argues for the necessity of several elements of a successful account of oppressive structures before examining and contrasting the accounts provided by women of color feminisms and white feminism. Women of color feminisms, while not a monolith, converge in significant ways in their analysis of structural oppression. This work offers a positive account of the importance of my necessary elements. In contrast, white feminist accounts of structural oppression fall short in significant ways, and examining these failures will serve to provide a negative argument for my necessary elements by illustrating what goes wrong when they are missing. The five necessary elements I explore in this chapter are intersectionality, starting from lived experiences, the centrality of race and coloniality, structures as adaptive and dynamic, and a complex understanding of agency. 46 I. Necessary Elements for an Account of Structural Oppression Many familiar categories of oppression include coloniality, race, gender, ability, sexual orientation, gender identity, and class. But what does it mean to say that these forms of oppression are structures? Structures offer a way of analyzing the organization and function of systems, institutions, or other larger-scale phenomena. Structural analyses are common in the natural sciences, having gained influence through systems theory. In that usage, structures function to explain controlling and defining relationships amongst entities under scientific scrutiny, specifying connections to governing natural laws. In the social sciences and the humanities, structures are often used to map and explain relationships among people and institutions. Elena Ruíz y Flores traces these understandings of structures back to Aristotle’s writings on matter, causation, and necessity. She argues that these notions of structure can be understood as a mechanical paradigm, where structures are intended to “produce predictive knowledge that explained how parts related to wholes.”155 This predictive function leads to structures often being seen as neutral explanatory frameworks that do not, in themselves, have or reproduce values. Such a neutral view of structures will not work for an account of oppressive structures. Oppression is decidedly not neutral, and the account of the structures that shape the manifestation and operation of oppression in the world are not either. A neutral view will also not accomplish what my project needs in terms of explaining relationships in a way that will build with responsibility to provide guidance on how to respond to oppression in professional settings. This section identifies five necessary elements for a working account of oppressive structures for my project. It is beyond the scope of this chapter to articulate a full theory or account of 155 Ruíz y Flores, “Women of Color Structural Feminisms,” 168–69. 47 oppressive structures, but these five elements are features that will be operative in the remainder of my project as I explore responsibility in relation to oppressive structures, how that responsibility manifests in professional settings, and how the structural competency model provides a useful framework for addressing those professional responsibilities in ethics education. The five necessary elements for my working understanding of oppressive structures are as follows: intersectionality, starting from lived experiences, the centrality of race and coloniality, structures as adaptive and dynamic, and a complex understanding of agency. First, a successful account of structural oppression must be intersectional. Oppressive structures interlock and intersect such that they cannot be analyzed separately or abstracted from each other. Oppression is not one-note, nor is it additive. A working understanding of structural oppression needs to reflect the inextricable linkages and compounding factors that are evident in the lived experiences of those subject to colonial domination. Second, the understanding of structural oppression must start from the lived experiences and material realities of the oppressed. Too often, philosophical endeavors start by abstracting far away from material conditions in a misguided pursuit of objectivity. This leads to many of the most relevant injustices and wrongs being excluded from theory. As Elena Ruíz and Nora Berenstain remind us, ideal theory functions to obscure colonialism, and even non-ideal theory still operates within the obscuring abstractive parameters set by ideal theory.156 Moving beyond that dualism to a place of starting from material conditions is necessary.157 Third, accounts of structural oppression cannot ignore the centrality of race and colonialism. This is in keeping with the Black feminist tradition from which intersectionality 156 Ruíz and Berenstain, “Critical Race Structuralism and Non-Ideal Theory.” 157 Ruíz and Berenstain note, “Colonialism is a historical difference that make a theoretical difference, full stop” (6, emphasis original); and, “Non-ideal theory simply does not get to the materiality of physical lands at the level necessary to be of pragmatic and practical value in Indigenous contexts” (8). 48 arises. Part of what it means for oppressive structures to be interlocking is that one category of oppression or another cannot be separated out. Racial oppression is a unifying and organizing principle behind so much of the construction and organization of Western society. Analysis that considers class, gender, and disability while excluding race may be examining different aspects of oppression, but it is not properly intersectional. Centering race and colonialism in intersectional analysis is necessary corrective for reckoning with ongoing oppressive formations that have built the academy and society to benefit white people by punishing and excluding people of color. Feminist theory, which tends to reduce to white feminism, is not sufficient to understand and address the complexities of colonial power relations. Starting from the lived experiences of women of color is methodologically necessary. Fourth, the adaptive and dynamic nature of oppressive structures must be included. Oppressive structures are not neutral or passive; they continuously evolve and adjust for attacks on power. Elena Ruíz y Flores argues this point with a plethora of examples of how racist structures have evolved in response to challenges, finding ways to double down and retain the same power relations with slightly shifted arrangements.158 Efforts to resist and dismantle oppressive structures, then, cannot assume a permanent, static framework which can be straightforwardly taken apart. Analysis of oppressive structures must include attention to their constant evolution as they are reproduced. Strategic moves should account for the tendency of the system to “correct” to maintain oppressive power relations. Fifth, an effective account of structural oppression needs a complex understanding of agency for responsibility attribution. Just as structures are not passive sets of relationships, the many people and things that make up structures are not passive either. The active daily decisions 158 Ruíz y Flores, “Women of Color Structural Feminisms.” 49 of people, organizations, and institutions reproduce structures and reinscribe their power relations on an ongoing basis. The continued existence of oppressive structures depends on the participation of actors at all levels of systems and institutions, and recognizing the agency in this ongoing participation is crucial for understanding structures of oppression. A later example in this chapter will explore how obscuring agency is a tactic for avoiding responsibility, and Chapter Three will more fully explore the topic of responsibilities to fight oppression. The five elements presented in this section are not intended to serve as a complete theory of oppressive structures, but I do contend that any account of structural oppression is incomplete without them. The following sections will provide positive and negative arguments for the importance of these elements, with women of color feminisms showing the way and white feminisms demonstrating what goes wrong when elements are missing from an account of oppressive structures. II. Lessons from Women of Color Feminisms Women of color feminisms are a rich, diverse tradition of social-political thought. Although not recognized by the Western academy, women of color have been theorizing and responding to oppression for as long as they have been experiencing it.159 As an umbrella term, women of color feminisms encompasses widely diverging traditions and communities. Naturally, it is not a monolith. Elena Ruíz y Flores argues that it would be a mistake to try to identify a singular position or theory coming out of women of color feminisms. Rather, points of convergence can be identified where many thinkers align and overlap.160 This section examines examples of accounts of structural oppression that offer arguments for the importance of the necessary elements identified in the previous section. 159 Berenstain, “White Feminist Gaslighting,” 743. 160 Ruíz y Flores, “Women of Color Structural Feminisms,” 178. 50 A. Patricia Hill Collins First published in 1990, Black Feminist Thought is a landmark text. Patricia Hill Collins pulls together work by Black feminists through the years and offers an interpretative framework to establish a distinct academic field of study. An epistemic understanding of structures of oppression pervades the work. Kristie Dotson comments, “The erasure of black women’s lives, plights, triumphs, and thought is a staple realization in US Black feminist thought. What many black feminist theorists have in common is the idea that these erasures are, in part, caused by epistemological problems or problems with respect to knowledge.”161 Collins pursues three objectives in Black Feminist Thought. First, she presents several core themes that have consistently appeared in Black feminist thought, surveying and synthesizing the works of many Black women intellectuals.162 Second, she presents an analysis of oppression incorporating intersectionality and the matrix of domination.163 Third, she develops a Black feminist epistemic framework out of that analysis of oppression.164 Collins identifies the primary purpose of Black feminist thought as empowering “African-American women within the context of social injustice sustained by intersecting oppressions.”165 Understanding these structures is necessary for resistance, and the epistemology she uses throughout the text and explicitly describes towards the end offers methodological guidance. One of the features of Black feminist thought is that theory and practice are inextricable.166 As a social justice project, Black feminist thought embraces change and evolution in response to new mechanisms of oppression,167 and coalition building with others facing 161 Dotson, “Inheriting Patricia Hill Collins’s Black Feminist Epistemology,” 2323. 162 Patricia Hill Collins, Black Feminist Thought, 17. 163 Patricia Hill Collins, 18. 164 Patricia Hill Collins, 18. 165 Patricia Hill Collins, 22. 166 Patricia Hill Collins, 31. 167 Patricia Hill Collins, 39. 51 similar oppressions is crucial.168 Collins surveys Black women’s writings about labor and the family, sexual politics, and the construction of Black womanhood. Collins challenges additive conceptions of oppression, articulating an account that explains the intersecting nature of structures of oppression in creating the matrix of domination. Attention to intersecting oppression is at the core of Black feminist discussion of themes like family, motherhood, work, and sexual politics.169 The subjugation of Black women means that Black women speak from a distinct standpoint. Collins distinguishes this understanding of standpoint from additive conceptions, which imply that axes of oppression are separable. “One implication of some uses of standpoint theory is that the more subordinated the group, the purer the vision available to them.”170 Collins rejects this, arguing that the search for a most oppressed point of view falls back into positivism’s search for universality. In fact, the various structures which all construct a particular social position generate a unique and partial standpoint.171 “Intersectional paradigms remind us that oppression cannot be reduced to one fundamental type, and that oppressions work together in producing injustice.”172 Collins uses the term matrix of domination to refer to “how these intersecting oppressions are actually organized,”173 observing that different forms of oppression will involve different intersections and formations of power. Still, the unique subjugations faced at different social positions all involve “structural, disciplinary, hegemonic, and interpersonal domains of power.”174 Collins identifies controlling images as an important mechanism of the matrix of domination in the oppression of US Black women. “Domination always involves attempts to 168 Patricia Hill Collins, 38. 169 Patricia Hill Collins, 251. 170 Patricia Hill Collins, 270. 171 Patricia Hill Collins, 270. 172 Patricia Hill Collins, 18. 173 Patricia Hill Collins, 18. 174 Patricia Hill Collins, 18. 52 objectify the subordinate group.”175 Collins describes and analyzes four of these controlling images: the mammy, the matriarch, the welfare queen, and the jezebel.176 These controlling images construct Black womanhood as less than fully human. “Denying Black women status as fully human subjects by treating us as the objectified Other within multiple binaries demonstrates the power that binary thinking, oppositional difference, and objectification wield within intersecting oppressions.”177 US Black women writers have consistently resisted these constructions and labored to develop positive self-presentations.178 Collins’ epistemic framework is deeply intertwined with her understanding of structural oppression. Although the chapter on Black feminist epistemology lands towards the end of her book, Collins explains that her epistemology underwrites her overall methodology in explicating the particular structural formation of oppression faced by US Black women. The intersectional approach and emphasis on US Black women’s unique standpoint set up her epistemology. Collins explicitly identifies Black feminist thought as working from an oppressed position: “Black feminist thought can best be viewed as subjugated knowledge.”179 She approaches epistemology as a field that is structured by power, specifically identifying the control elite white men wield over structures of knowledge production.180 Dominant knowledge validation processes have been built around the interests of white men, resulting in the exclusion of Black women from positions of epistemic authority. Black women, however, still generated knowledge, relying instead on “alternative knowledge validation processes,” which academic disciplines dismiss out of hand.181 Black women instead used “music, literature, daily conversations, and 175 Patricia Hill Collins, 71. 176 Patricia Hill Collins, 72–84. 177 Patricia Hill Collins, 71. 178 Patricia Hill Collins, 93. 179 Patricia Hill Collins, 251. 180 Patricia Hill Collins, 251. 181 Patricia Hill Collins, 254. 53 everyday behavior as important locations for constructing a Black feminist consciousness.”182 The structures of oppression explain why Black feminist voices have been missing in academic studies of epistemology. Dotson takes up Collins’ analysis in her discussion of testimonial quieting and testimonial smothering, building out more complex analysis of the mechanisms by which Black women are ignored and preemptively silenced in the academy.183 Collins also points out that intimate familiarity with “the dynamics of intersecting oppressions has been essential to U.S. Black women’s survival.”184 Collins identifies several criteria for credibility in a US Black feminist epistemology. The first is lived experience. Materiality, history, and personal connection are necessary. Lived experience includes a social component, as survival under oppressive structures requires community. “Connectedness rather than separation is an essential component of the knowledge validation process.”185 Second, the call and response tradition of dialogue replaces white men’s antagonistic debate process for generating knowledge.186 Third, Collins insists that the Black feminist epistemology she articulates has an ethic of caring built in. Knowledge is both political and ethical. “[T]he ethic of caring suggests that personal expressiveness, emotions, and empathy are central to the knowledge validation process.”187 In a dialogic approach, emotion is not just appropriate but necessary: “Emotion indicates that a speaker believes in the validity of an argument.”188 Emotion communicates having a personal stake, and material, personal connection and experience is crucial. This criterion of emotion also mandates that knowing well requires 182 Patricia Hill Collins, 251–52. 183 Dotson, “Tracking Epistemic Violence, Tracking Practices of Silencing,” 242–50. 184 Patricia Hill Collins, Black Feminist Thought, 257. 185 Patricia Hill Collins, 260. 186 Patricia Hill Collins, 261. 187 Patricia Hill Collins, 263. 188 Patricia Hill Collins, 263. 54 “developing the capacity for empathy.”189 Dotson highlights the ways in which Collins’ epistemology is working on a structural level towards third-order change. Dotson defines this as “recognizing, and, possibly, enabling the ability to alter operative, instituted social imaginaries, in which organizational schemata are situated.”190 Overall, Collins’ conception of structure requires an intersectional approach to epistemology. Her criteria for credibility are built out of her analysis of mechanisms of structural oppression. The importance of lived experience, community dialogue, the ethic of caring, and emotion are tools for resisting controlling images and for communicating solidarity with oppressed social positions. B. Elena Ruíz In “Women of Color Structural Feminisms,” Elena Ruíz y Flores191 articulates a framework for women of color feminist views of structure. She is careful to flag that women of color feminisms are not a monolith, but they do share opposition to colonial domination.192 Her goal is to identify points of convergence which can serve for strategic resistance to structures of oppression. In contrast to the value-neutral conception of structures, women of color theorizing starts from structures as tied to colonial power relations. Specifically, Ruíz y Flores argues that “colonial power relations are functionalized through social structures.”193 Structures are how oppressive power formations are deployed and actualized. Coulthard defines colonial power relations as: 189 Patricia Hill Collins, 263. 190 Dotson, “Conceptualizing Epistemic Oppression,” 119. 191 Elena Ruíz has published under several names, including Elena Flores Ruíz and Elena Ruíz y Flores. In this paper, I refer to her in general using the name on her most recent publication except when referencing a specific article published under a different name. 192 Ruíz y Flores, “Women of Color Structural Feminisms,” 178. 193 Ruíz y Flores, 172. 55 “characterized by dominations; that is, …a relationship where power - in this case, interrelated discursive and nondiscurisve facets of economic, gendered, racial, and state power - has been structured into a relatively secure or sedimented set of hierarchical social relations that continue to facilitate the dispossession of Indigenous peoples of their land and self-determining authority.”194 The prominence of domination in these understandings of structure paves the way for clear analysis of responsibility and wrongs. This contrasts with how Farmer’s work deploys the concept of structural violence: while behavioral violence always has a responsible aggressor that can be identified, structural violence is used for more complex relationships where the responsible party cannot be identified. Articulating this view, Farmer writes “Neither culture nor pure individual will is at fault.”195 Ruíz y Flores argues that this use of the idea of structural violence has been built on whitewashed conceptions of structure specifically in order to “deflect identification of the relations it maintains - to misidentify and ghost colonial structures in the operation of oppressive social processes.”196 A theory of structures should not obscure oppressive relationships and responsibilities. According to Ruíz y Flores, women of color structural feminisms can be traced in centuries of intersectional anti-colonial work, both academic and activist. The specific term of structure has not prominently figured in the written herstories due to its problematic Eurocentric associations, but Ruíz y Flores argues that structure can be a strategically useful concept for resistance efforts when it is not rooted in deflectionary and scapegoating epistemic formulations.197 Still, there are abundant examples of theories of structure seen at work in 194 Coulthard, Red Skin, White Masks, 6–7. 195 Farmer, Infections and Inequalities, 79. 196 Ruíz y Flores, “Women of Color Structural Feminisms,” 174–75. 197 Ruíz y Flores, 185. 56 women of color accounts of specific forms of oppression as structural in nature. Angela Davis argues that: “slavery should be seen as a concerted system of organized domination that requires the existence of a distinct structure…that fundamentally links capitalist economic systems, agricultural production, and specialist techniques of violence…to produce asymmetric profit for white settler populations and their descendants.”198 In contrast to a view of structure that treats oppressive systems as merely an inert set of relations, Ruíz y Flores shows how slavery adaptively responded to challenges, self-replicating its structure in dynamic response to new conditions to maintain relations of domination.199 A limited view of what structures curtails the ability of a theory of structure to track dynamic lived experiences. Ruíz y Flores explains that starting from lived experiences of oppression is necessary, and it illustrates ways that the material impacts of colonial power relations can “exceed system determinations (as in intergenerational knowledge, transgenerational memory, and dream life).”200 Ruíz y Flores ultimately identifies four key characteristics of women of color structural feminisms. The first is the idea that oppression is never a one-time phenomenon. Rather, oppressive structures are a system of organized domination which cannot be reduced to individual actors or events.201 Personal intentions are not particularly relevant to the persistence of white supremacy. Second, Ruíz y Flores argues that women of color feminisms strongly reject 198 Davis, Women, Race & Class, 7. 199 Ruíz y Flores, “Women of Color Structural Feminisms,” 176. 200 Ruíz y Flores, 177–78. 201 Ruíz y Flores, 183. 57 “value-free views of structures,” or neutral objective frameworks.202 The reason for this is that neutrality functions to “exonerate cultural traditions from culpability in organizing systems of domination against women of color.”203 The agency and complicity of settlers and those benefiting from and reproducing relations of domination must not be obscured or elided.204 Ruíz y Flores’s third point is that structures are “oriented processes of functionalization that operate within a system of social transformations aimed at stabilizing colonial relations.”205 Structures are not passive; they do something! Specifically, structures dynamically respond and adapt to disruptions in their power in order to preserve colonial relationships. In a dynamic world, change is inescapable, but oppressive structures actively absorb and accommodate new inputs in order to preserve existing domination and violent oppression. Ruíz y Flores contrasts this type of adaptation with biological models of responsiveness, which tend toward balancing ecosystems. Oppressive structures adapt to preserve violence and harm women of color.206 Fourth and finally, Ruíz y Flores emphasizes that women of color feminisms offer “a specific analysis of power as intersectional oppressions.”207 The view of structural oppression presented by Ruíz y Flores has much in common with the analysis by Patricia Hill Collins. This makes sense, as Ruíz y Flores is providing a high-level summary of points of convergence among many specific women of color feminist positions, including citations of Collins. Her identification of four shared characteristics is a helpful blueprint for addressing structural oppression without providing a complete account. 202 Ruíz y Flores, 183. 203 Ruíz y Flores, 183. 204 Ruíz y Flores, 184. 205 Ruíz y Flores, 184. 206 Ruíz y Flores, 184–85. 207 Ruíz y Flores, 185. 58 III. Failures of White Feminism While positive lessons can be gleaned from women of color feminisms, white feminist accounts of structural oppression serve as cautionary tales. A common misconception regarding white feminism is that the label refers to any and all white people who are feminists. However, white feminism is not a composite term such that it applies to anyone who is white and a feminist. As argued by Nora Berenstain, white feminism is a practice or methodology.208 Berenstain describes white feminism as being made up of “methodological practices of centering and decentering.”209 Cate Young further expounds who and what are being centered and decentered in white feminism: “White feminism is a set of beliefs that allows for the exclusion of issues that specifically affect women of color. It is ‘one size fits all’ feminism, where middle class white women are the mold that others must fit. It is a method of practicing feminism, not an indictment of every individual white feminist, everywhere, always.”210 In offering an account of gender oppression, white feminism excludes intersections of race and colonialism while presenting itself as universal. If other structures of oppression are acknowledged at all, they are treated as afterthoughts rather than theoretically significant. Berenstain identifies this posturing of theory for a narrow range as universally applicable as a form of gaslighting.211 Since white feminism describes practices rather than identities, the white 208 Berenstain, “White Feminist Gaslighting,” 738. 209 Berenstain, 738. 210 Young, “This Is What I Mean When I Say ‘White Feminism.’” 211 Berenstain, “White Feminist Gaslighting,” 735. 59 feminist approach to theorizing oppression is not limited to white people. Young notes that women of color can practice white feminism too.212 This section examines several examples of white feminist accounts of structural oppression with particular attention to the ways these accounts are missing crucial elements of an account of oppressive structures and the impacts of those exclusions. A. Nancy Hartsock In 1983, Nancy C. M. Hartsock published an essay that went on to become a founding text for feminist standpoint theory. In “The Feminist Standpoint: Developing the Ground for a Specifically Feminist Historical Materialism,” Hartsock lays out a historical materialist account of gender oppression and epistemology. Along with Sandra Harding and Donna Haraway, Hartsock is considered one of the most influential figures in standpoint theory.213 This section summarizes her understanding of standpoint theory, explains her Marxian understanding of oppressive structures, and identifies how her understanding of structural oppression functions in her broader project. Hartsock begins by identifying the political goal of her project: developing “an important epistemological tool for understanding and opposing all forms of domination – a feminist standpoint.”214 She uses Marx’s project as a starting point, but focuses on the epistemic insights rather than his metatheory.215 Hartsock analyzes the sexual division of labor as the basis for a feminist standpoint, replacing traditional Marxist class analysis with gender: “just as Marx’s understanding of the world from the standpoint of the proletariat enabled him to go beneath bourgeois ideology, so a feminist standpoint can allow us to understand patriarchal institutions 212 Young, “This Is What I Mean When I Say ‘White Feminism.’” 213 Grasswick, “Feminist Social Epistemology.” 214 Hartsock, “The Feminist Standpoint,” 283. 215 Hartsock, 284. 60 and ideologies as perverse inversions of more human social relations.”216 Hartsock identifies five criteria for her technical definition of a standpoint: “(1) Material life (class position in Marxist theory) not only structures but sets limits on the understanding of social relations. (2) If material life is structured in fundamentally opposing ways for two different groups, one can expect that the vision of each will represent an inversion of the other, and in systems of domination the vision available to the rulers will be both partial and perverse. (3) The vision of the ruling class (or gender) structures the material relations in which all parties are forced to participate, and therefore cannot be dismissed as simply false. (4) In consequence, the vision available to the oppressed group must be struggled for and represents an achievement… (5) …the adoption of a standpoint exposes the real relations among human beings as inhuman, points beyond the present, and carries a historically liberatory role.”217 Examining the institutionalized sexual division of labor in Western class societies, Hartsock shows how the position of women meets these criteria and thus generates a standpoint. Women find themselves more tied to the material world than men, engaging in more subsistence work through the “double day” and their bodily investments in motherhood.218 She also employs psychoanalysis to illustrate the hierarchical dualisms which function in gender oppression. The exchange abstraction of class shares a number of dualisms with masculine abstraction: “the 216 Hartsock, 284. 217 Hartsock, 285. 218 Hartsock, 292–94. 61 separation and opposition of social and natural worlds, of abstract and concrete, of permanence and change, the effort to define only the former of each pair as important, the reliance on counterfactual assumptions.”219 Hartsock’s standpoint theory features a Marxian understanding of structures of oppression. Oppression plays out in material conditions, which are organized by dominating structures. The dominating group employs various mechanisms to oppress the subordinate group; for Hartsock’s purposes this means institutionally exploiting women’s sexual labor. Structures are constructed, and they play out materially: “The Marxian category of labor…can help to avoid the false characterizing of the situation of women as either ‘purely natural’ or ‘purely social.’”220 We see an important element of Hartsock’s conception of structure in the description of her second standpoint criterion. She understands the social positions on top and on bottom of an oppressive structure to be in an inverse relation. Further, “the female experience…forms a basis on which to expose abstract masculinity as both partial and fundamentally perverse.”221 As the inverse, then, the feminist standpoint is complete and not perverse. Hartstock also analyzes the mechanisms by which the structure oppresses, focusing on the hierarchical dualisms built into the dominating group’s picture of the world. For the masculine abstraction, these binaries include death and life, permanence and change, and abstract and concrete. The binary construction carves the world up in a particular way, and then the masculine abstraction mandates a preference for the former of all these pairings. This works out materially in disadvantaging things connected to the latter of the pairings, which happens to overlap with the social position of women.222 219 Hartsock, 298. 220 Hartsock, 283. 221 Hartsock, 299. 222 Hartsock, 299. 62 This conception of structure directly motivates Hartsock’s epistemic project. From the very beginning, she emphasizes the need to achieve a feminist standpoint as a tool to resist the oppressive structure. This political conception also motivates her distinction between a perspective and a standpoint. A perspective is passive and can follow from the mere existence of a social position. However, the feminist standpoint is “neither self-evident nor obvious;”223 rather, it involves political work. Achieving a standpoint exposes the operative structures in society as oppressive and unnecessary.224 The position of the oppressed creates more potential insight than dominant groups have access to. Thus, the political commitments in Hartsock’s conception of structure play out in how she explains the feminist standpoint. However, Hartsock chooses to exclude axes of oppression other than gender and class in her analysis. Hartsock deliberately chooses to ignore the experiences of women of color and lesbians in her analysis of what all women experience, and she appeals to Marx to defend her decision: “I propose to lay aside the important differences among women across race and class boundaries and instead search for central commonalities. I take some justification from the fruitfulness of Marx’s similar strategy.”225 This erasure and marginalization is a significant flaw in Hartsock’s account. She accepts “the danger of making invisible the experience of lesbians or women of color”226 as an acceptable risk, given her assumption that “there are some things common to all women’s lives in Western class societies.”227 Hartsock’s truncation of other oppressions is also in tension with some of her other own commitments. Her project starts from the belief that “material life structures understanding,”228 and differences in material conditions 223 Hartsock, 303. 224 Hartsock, 285. 225 Hartsock, 290. 226 Hartsock, 290. 227 Hartsock, 290. 228 Hartsock, 287. 63 mean differences in perspective. “Each division of labor, whether by gender or class, can be expected to have consequences for knowledge”229 (emphasis added). On Hartsock’s own account, then, the understanding available to women of color or lesbians must be different from that of women in general. Ironically, Hartsock falls into the same trap of ignoring other axes of oppression that she finds Marx guilty of in his class analysis. Additionally, Hartsock’s view of structural oppression discourages critical self-reflection and growth on the part of those holding the oppressed perspective. She presents an inverse relationship between the positions of the oppressed and the oppressors. Hartsock identifies the masculine abstraction standpoint as “both partial and fundamentally perverse.”230 This leads her to regard the feminist standpoint as complete and nonproblematic, a position which does not encourage reflection and room for improvement. Hartsock’s belief in this position in her claim that the feminist standpoint “provides an ontological base for developing a nonproblematic social synthesis.”231 This mirrors Marx’s understanding of the proletariat as “the only class which has the possibility of creating a classless society.”232 Hartsock’s move to universalize the feminist position and represent it as innocent and complete makes the same error that Collins criticizes in her rejection of the additive conception of oppression in favor of an interlocking view of structures. B. Miranda Fricker Miranda Fricker’s Epistemic Injustice sparked a flurry of philosophical publishing. Fricker connected questions of power and identity to epistemology in a way that was presented 229 Hartsock, 286. 230 Hartsock, 287. 231 Hartsock, 303. 232 Hartsock, 284. 64 as groundbreaking without recognizing and acknowledging the extensive work in this area done by women of color in other disciplines. Fricker proposes epistemic injustice as an important new category of justice for philosophical analysis. Wronging someone in their capacity as a knower is not a wrong that can be reduced to other forms of justice (i.e. distributive). Fricker limits this category to two kinds: testimonial injustice and hermeneutical injustice.233 For six out of the seven chapters, Fricker analyzes testimonial injustice, which occurs when a speaker “receives a credibility deficit owing to identity prejudice in the hearer.”234 Identity prejudice involves pernicious social stereotypes. While some stereotypes are merely benign images which “express an association between a social group and one or more attributes,”235 false or negative associations can cause harm. Fricker prescribes a virtue of testimonial justice as the proper way to work against testimonial injustice. Fricker contends that the proper way to correct against harmful stereotypes and prejudices is by inculcating a virtue, which she defines as “a matter of one’s credibility judgments being unprejudiced.”236 Hermeneutical injustice is defined as “the injustice of having some significant area of one’s social experience obscured from collective understanding owing to a structural identity prejudice in the collective hermeneutical resource.”237 The harm of this injustice lies in both disadvantaged access to collective sense-making tools, but also in the construction of one’s own selfhood.238 Fricker first acknowledges structures in her introduction, saying “the root cause of epistemic injustice is structures of unequal power and the systemic prejudices they generate.”239 233 Fricker, Epistemic Injustice, 1. 234 Fricker, 29. 235 Fricker, 38. 236 Fricker, 93–94. 237 Fricker, 155. 238 Fricker, 168. 239 Fricker, 7–8. 65 Structures are how power is distributed unequally. In most of her analysis, she does not use language of structures, preferring to talk in terms of power and prejudice. Fricker does not offer a definition of structure, but she defines power as “a socially situated capacity to control others’ actions.”240 Her central definition of testimonial injustice, “identity-prejudicial credibility deficit,”241 does not reference or theoretically engage with structures. In later chapters she acknowledges that structures play a role in cases of pre-emptive testimonial injustice, where “the speaker is silenced by the identity prejudice that undermines her credibility in advance. Thus purely structural operations of identity power can control whose would‐be contributions become public, and whose do not.”242 Her definition of hermeneutical injustice does involve structure: “hermeneutical injustice is caused by structural prejudice in the economy of collective hermeneutical resources.”243 Fricker briefly discusses Nancy Hartsock’s historical materialist understanding of structure in order to specify that she is using the epistemological sense of the term, not the material or ontological sense.244 So, while structures do play a role in her account, they do not play a central role in Fricker’s analysis. Additionally, it is worth noting that Fricker does not provide a clear conception of structures. Her use of the term implies an understanding of structure as meaning merely an arrangement of social relations. Fricker’s understanding of structure underpins two key limitations of her approach. First, structure is used as a scapegoat to avoid distributing responsibility for epistemic injustice too widely. Fricker uses the term structure to explain cases where a wrong is done but there is not a 240 Fricker, 4. 241 Fricker, 4. 242 Fricker, 130. 243 Fricker, 1. 244 Fricker, 147. 66 particular agent who is responsible. Rather, the structure of power is the cause. Structures for her are important for teasing out agency: “in purely structural operations of power, it is entirely appropriate to conceive of people as functioning more as the ‘vehicles’ of power than as its paired subjects and objects, for in such cases the capacity that is social power operates without a subject—the capacity is disseminated throughout the social system.”245 This opposition of agency and structures is echoed again in her discussion of hermeneutical injustice: “No agent perpetuates hermeneutical injustice – it is a purely structural notion.”246 Fricker asserts that “identity power often takes a purely structural form.”247 This is important because it is part of how her project absolves most people of agential or causal responsibility in connection with this kind of injustice. Testimonial injustice is caused by identity-prejudice, and hermeneutical injustice is caused by structural prejudice. She is careful to bracket off individual moral connection to these structures of power and the effects they have, focusing on the positive efforts of virtue development rather than rule formation or blame assignment. Fricker’s analysis offers guidance to individuals seeking to minimize prejudice in their lives and its epistemic effects, but this virtue solution does not target the structural causes of the injustice. It functions as an excusing condition of how to avoid moral contamination in an unjust world. Dotson criticizes Fricker on this point, observing that she seems to believe that “epistemic injustice cannot be conceptualized so that it is too easy to commit. The reality is that epistemic injustice is very easy to commit. In fact, it is extraordinarily difficult to avoid it.”248 Using structure to limit responsibility makes epistemic injustice harder to address and, consequently, is a significant flaw 245 Fricker, 11. 246 Fricker, 159. 247 Fricker, 16. 248 Dotson, “A Cautionary Tale,” 37. 67 of Fricker’s theory. The next chapter will more fully explore the topic of responsibility, but for the purposes of this chapter, it is important to note that a conception of structural oppression which functions to shield the powerful and those benefitting from oppression from responsibility is insufficient. Second, Fricker advocates a virtue-based response to epistemic injustice, a solution which completely ignores structural dimensions. The virtue of testimonial justice is a call for individuals to actively work toward being less prejudiced. This solution ignores material conditions shaping epistemic injustices and reduces a structural problem to individual action. Fricker has very little to say about how to address hermeneutical injustice,249 suggesting that individuals should develop the virtue of hermeneutical justice to “realize that the speaker is struggling with an objective difficulty and not a subjective failing.”250 Again, an individual developing this virtue may contribute less to epistemic injustices, but this response does not remotely reckon with solutions to the structural dimensions of epistemic injustice. Altogether, Fricker’s passive and thin account of structure drives some key weaknesses in her account of epistemic injustice. Structure as mere arrangement allows Fricker to conceptualize epistemic injustice as something that individuals are rarely responsible for, since they can avoid blame by developing individualist virtues. Fricker’s conception of structural injustice exemplifies white feminism’s false universalizing and shielding of white supremacy. C. Iris Marion Young In several landmark texts, Iris Marion Young presented a theory of responsibility that was intended to account for structural injustice and reckon with the influence of power through social 249 Fricker devotes an entire chapter to the virtue of testimonial justice, and just four pages to the virtue of hermeneutical justice. 250 Fricker, Epistemic Injustice, 169. 68 structures. This intention sets her work apart from much of the philosophical canon she converses with. However, her account of structural oppression ultimately falls into the pitfalls of white feminism. Young defines structural injustice as what happens when: “[S]ocial processes put large groups of persons under systematic threat of domination or deprivation of the means to develop and exercise their capacities, at the same time that these processes enable others to dominate or to have a wide range of opportunities for developing and exercising capacities available to them.”251 This passage draws out several important elements of her view. First, Young presents a process- oriented view of structures, which she distinguishes from the conception of structure used in Rawlsian political philosophy. Rawls introduces his project with the claim that the basic structure of society is the subject of justice. Young argues that Rawls considers the structure to be a part of society. In contrast, she conceives of structure in terms of process: “structural social processes concern the whole of a society looked at from a specific point of view.”252 Structures exist, then, “only in actions”253 when examined from a certain point of view. Second, Young distinguishes the type of injustice created by social-structural processes from other categories of justice. She contends that structural injustice is a fundamentally different kind of wrong than historical injustices or the bad actions of political institutions or individuals.254 Young argues, “Structural injustice occurs as a consequence of many individuals and institutions acting to pursue their particular goals and interests, for the most part within the 251 Young, Responsibility for Justice, 2011, 52. 252 Young, 142. 253 Young, 53. 254 Young, 44. 69 limits of accepted rules and norms.”255 What is different about structural injustices is that they are “embedded in unquestioned norms, habits, and symbols, in the assumptions underlying institutional rules and the collective consequences of following those rules.”256 Young emphasizes that individuals participating in social processes that have negative outcomes generally do not intend the negative outcomes of structural injustice. This lack of intent is an important distinguishing characteristic for Young in building the case against a liability form of responsibility for structural injustice. Third, Young insists that her model of structural injustice does not allow for tracing causal links between individual actions and direct harms. The liability model of responsibility requires connecting individual actions linearly to specific outcomes, but “with structural injustice…we cannot trace this kind of connection.”257 Social-structural processes mediate between individual actions and harmful outcomes, obscuring the lines tracing causation to particular actors.258 “The actions of particular persons do not contribute to injustice for other persons directly, moreover, but rather indirectly, collectively, and cumulatively through the production of structural constraints on the actions of many.”259 Young notes that everyone who participates in society also contributes to structural processes. Since everyone is responsible for the ongoing reproduction of social-structural processes, Young contends that it does not make sense to try to isolate out specific actors who are responsible for such large-scale outcomes.260 The social connection model is what Young offers as an alternative to the liability model of responsibility to account for structural injustice. Chapter Three examines this model in greater 255 Young, 52. 256 Young, Justice and the Politics of Difference, 41. 257 Young, Responsibility for Justice, 2011, 96. 258 Young, 100. 259 Young, 96. 260 Young, 105–6. 70 detail, but for the purposes of this chapter it suffices to say that Young views this type of responsibility as shared, meaning that “it can therefore be discharged only through collective action.”261 Shared responsibility requires a political response to work together to change social- structural processes to make them more just. Young does not seem to believe that responsibility under the social connection model calls individuals to evaluate their actions and change their behaviors and decisions in relation to large-scale injustices in society. The call is to contribute to collective, political changes in society and to reflect on unconscious attitudes and associations.262 Despite its attempt to wrestle with responsibility for large-scale injustices in society, the model that Young presents ends up exemplifying several pitfalls of white feminism. This section examines the failures of Young’s view of structural injustice, while further examination of the social connection model of responsibility is contained in the next chapter. A significant issue with Young’s view of structural injustice is its ahistorical nature. Young repeatedly distinguishes the harms produced by social processes from both historical wrongs and the types of wrongs which can be traced to specific institutions, like state actors. Her view is forward-looking, because “the injustices produced through structures have not reached a terminus, but rather are ongoing.”263 Elena Ruíz points out that Young presents “historical” injustices like slavery as not relevant to our shared responsibilities moving forward because none of the perpetrators or those directly harmed by slavery are still alive.264 Young’s process-oriented model truncates off “historical” wrongs from current injustices, refusing to theorize the connections between these wrongs of the past with current injustices in society. 261 Young, 105. 262 Young, Justice and the Politics of Difference, 151. 263 Young, Responsibility for Justice, 2011, 109. 264 Ruíz, Structural Violence, 94. 71 Young’s ahistoricity connects to what I consider the largest failure of her view: the failure to account for colonialism. Throughout, Young usually refers to her subject as structural injustice rather than structural oppression, which in some ways signifies the positioning of her project in dialogue with mainstream philosophical theories of justice rather than the perspectives of oppressed peoples. Indeed, this word choice covers for the elision of one of the most central and consequential oppressive structures shaping society. An ahistorical account will not be able to make sense of the ongoing nature of colonialism and its evolutions and adaptation to preserve oppressive power relations. Young repeatedly emphasizes that structural injustices are intended by no one, but historical records of colonization are rife with intentionality.265 Another problem with Young’s account is the way that it shields and supports harmful institutions. One of the important features of colonial oppression is setting up the basic rules and norms of society to operate in a way that extracts from and harms people of color to enrich white settlers. Young’s discussion of structural injustice repeatedly emphasizes that it arises from many people blamelessly “following the rules” in society. Unjust outcomes are treated like a bug rather than a feature of these rules. Young’s account does not seriously call into question “following the rules,” because her solutions require people to work together within the rules and existing institutions to try to make things somewhat better.266 This prescription relies on an assumption that justice can be found through existing political institutions in the United States. As Ruíz argues, this assumption is another glaring point where Young ignores colonialism.267 What justice for the United States’ genocide and theft from Indigenous peoples can be found in the same institutions that committed the atrocities? Ruíz argues that Young’s model functions to 265 Ruíz, 100–101. 266 Young, Responsibility for Justice, 2011, 96. 267 Ruíz, Structural Violence, 78. 72 shield and deflect responsibility for oppression. Young’s version of shared responsibility fails to distinguish between people harmed by the ongoing reproduction of colonial structures and those actively benefiting from their ongoing existence, lumping everyone who participates in society together with the same shared responsibility. Ruíz notes, “In Young’s framework, everyone is implicated and yet no one is individually to blame.”268 Not only are the oppressed just as responsible as those benefiting from oppression, but Young also demands that the oppressed participate in existing political institutions. Further, the shared responsibility is specifically to strengthen the institutions which are causing harm: “Our forward-looking responsibility consists in changing the institutions and processes so that their outcomes will be less unjust.”269 As Ruíz identifies, mandated support for and participation in some of the very institutions doing harm to oppressed populations is another form of structural violence.270 Again, the next chapter will examine the social connection model of responsibility in more detail. For this chapter, it is important to note that what Young conceives of as the solution to structural injustice ends up perpetuating more of the same. Young’s engagement with the idea of structural injustice is a marked improvement from Fricker’s choice to largely ignore the structural level, but it still falls into many of the same functions of white feminist theory. Any account of structural oppression ought to at the very least be able to account for the major structures of oppression, yet Young both ignores and truncates the possibility of considering colonialism in her view. 268 Ruíz, 69. 269 Young, Responsibility for Justice, 2011, 111. 270 Ruíz, Structural Violence, 78. 73 IV. Conclusion While I have not offered a full account of the nature of structures of oppression, this chapter offers several elements that every account of structural oppression needs: intersectionality, starting from lived experiences, the centrality of race and coloniality, structures as adaptive and dynamic, and a complex understanding of agency. Accounts of structural oppression from Collins and Ruíz illustrate the importance of these elements, while models from Hartsock, Fricker, and Young show what happens when elements are missing. The next chapter examines responsibility in relation to oppressive structures, building toward a view of specifically professional responsibility in relation to structural oppression. The following chapters present the structural competency model as a tool for identifying and responding to the demands of professional responsibility in practice. 74 CHAPTER THREE: The Moral Demands of Structural Oppression: Towards a Relational Theory of Responsibility This chapter focuses on finding an account of moral responsibility that addresses structural oppression to serve as the basis for understanding professional responsibility for structural oppression. This figures into Chapter Four’s presentation of structural competency as a successful way to incorporate professional responsibility for structural oppression into professional ethics education. The analysis of features of structural oppression in Chapter Three leads to the search for a theory of responsibility that can account for those features. This chapter posits that taking structural oppression seriously requires a different approach to moral responsibility than the major accounts in the ethics literature offer. What is needed to account for structural oppression is an account of moral responsibility that recognizes relationships as a legitimate and independent source of moral requirements. One part of every account of moral responsibility is what it considers to be a source or ground of moral requirements. The most recognized sources of moral requirements are voluntary action and agential nature. Different accounts build upon these sources of moral requirements in various ways as they flesh out comprehensive systems to explain attribution of moral responsibilities. I contend that the major accounts of moral responsibility all rely exclusively upon voluntary action and/or agential nature as the source(s) of moral requirements, and this reliance is key to their failure to account for structural oppression. Both voluntary action and agential nature rely on the same Kantian view of the subject that I find implausible. I take up association as an undertheorized source of moral requirement, rejecting the standard move in the literature to treat it as derivative of and reducible to voluntary action or agential nature. The relationships we find ourselves always already embedded in are themselves generative of responsibilities. While I do not have the space to build out a complete relational account of moral responsibility, I will begin 75 sketching how one would work and how it would successfully address structural oppression. I will also present Anishanaabe conceptions of responsibility as an example of an existing relational account of responsibility before applying the relational approach to responsibilities to professional responsibility in particular. I. Sources of Moral Requirements The quest to understand moral requirements has been a longstanding fascination for philosophers, constituting a distinct tradition from discussions of virtue or other supererogatory actions. What is a moral requirement? In the most basic sense, it is something that someone has to do. Moral requirements are prescriptions such that failing to follow the prescription would be morally wrong. Robert Goodin explains them as “prescriptions of the general form: A ought to see to it that X, where A is some agent and X some state of affairs.”271 Accounts of moral requirements are endeavors in answering this question more thoroughly. I take accounts of moral responsibility to be systematic explanations of how moral requirements work. Providing such accounts includes discussion of the source or ground of the moral requirements to answer the question of in virtue of what things are required. Accounts generally include analysis of the structure of relationships amongst various moral requirements in building out a picture of how these requirements work. This chapter will go on to assess several accounts of moral requirements on how successfully they address structural oppression, but first some groundwork must be laid. I will next examine one necessary component of all accounts of moral requirements, namely, the source or ground of the moral requirement. I believe this element is crucial to whether the accounts surveyed below succeed or fail at addressing structural oppression in the pictures they present of how moral requirements work. 271 Goodin, “Responsibilities.,” 50. 76 The literature on moral requirements identifies three independent sources of moral requirement: voluntary action, agential nature, and association. Before I examine each of these sources of moral requirement, some comments situating the literature on this topic are in order. Much of the initial literature on the nature and source of moral requirements traces back to the longstanding debate between deontological and consequentialist theories of ethics. In more recent years, the discussion is largely situated in discussions about political obligation. To answer the question of why or how the state may require things of its citizens, theorists explore the range of options for grounding a moral requirement. They come to the question “In virtue of what something can be a moral requirement?” from the more specific question of in virtue of what citizens can be morally obligated to obey the state. Explanations range from hypothetical consent to fair play to natural duties that agents have in virtue of their agency. A major influence in this literature is John Rawls’ contractarian view, which has its roots in the deontological, neo-Kantian tradition, but a larger trend in this literature is the move to presents accounts that do not require allegiance to a particular theory of ethics. Generally, it is a point in favor of an account if it does not require adherence to a particular theory of ethics to be persuasive, as it will have broader appeal. Most accounts, then, even if situated within the tradition of a particular ethical theory, will endeavor to show that their account is not inconsistent with other theories. In practice, this often leads to accounts of moral requirements carefully articulating how their approach is consistent with central Kantian principles like individual autonomy and inviolability. In this way, the Kantian view of the subject and of moral agency has tremendous influence on the scope of moral imagination regarding legitimate sources of moral requirements. Kant’s famous conception of morality as self-legislating from an autonomous, rational agent shows up in the assumption pervading the literature on moral requirements that any constraints 77 on an agent must ultimately come from the agent themself. If moral requirements are understood as constraints, then imposition of requirements from an external source is regarded as a violation of individual autonomy. This is not to say that morality is up to the whim of the individual or that external demands cannot be made; rather, it means that the ground legitimizing the demands must connect back to the agent themself. Robert Nozick argues this point in his critique of Rawls’ liberal political theory: “Side constraints upon action reflect the underlying Kantian principle that individuals are ends and not merely means; they may not be sacrificed or used for the achieving of other ends without their consent. Individuals are inviolable.”272 Assigning responsibilities or moral requirements to an agent that do not ultimately derive from the agent is an unjust violation of the individual.273 This conception of the individual as a self-legislating moral agent can be seen in the way the topic of the source of moral requirements is framed; it is often presented as a question of how moral requirements are acquired. Framing the question in this way assumes that the natural state of the agent is to be prior to and without moral requirements. Any moral requirement must then justify its obligatoriness in terms of its relationship to individual autonomy. Actions come from the agent, so requirements arising from actions are grounded in the individual. Similarly, justification of natural duties is grounded in the very agency of the subject such that not following the requirement would be rationally inconsistent. The two methods of showing that moral requirements issue from the agent themself are appeals to voluntary action and agential nature. I will examine each of these sources or grounds of moral requirements next with an eye toward my goal of taking up association as a legitimate, independent source of moral requirements that need not reduce to voluntary action or agential 272 Nozick, Anarchy, State, and Utopia, 30–31. 273 Nozick, 33. 78 nature, where relationships themselves ground and generate responsibilities, including responsibilities in relation to structural oppression. First, holding people responsible for their voluntary actions is a paradigmatic function of moral judgment. Voluntary actions can generate moral requirements either by an agent explicitly taking on a requirement or more generally through acting in ways that can have foreseeable moral entanglements. For instance, if Able adopts a dog, they consent to take on care duties through the voluntary choice of adoption. The influence of voluntary action over the scope of western philosophical moral imagination can be traced to a number of culprits. In The Nichomachean Ethics, Aristotle identified control over one’s actions as one of the two necessary conditions for holding someone morally responsible.274 In The Groundwork of the Metaphysics of Morals, Kant famously postulated autonomy as the source of morality.275 While reactions to the Kantian position varied, the impact of his position is seen in the continuing centrality of voluntary choices in discussion of moral responsibility. John Rawls considers voluntariness to be one of the two sources of moral requirements, alongside agential nature.276 He goes on to explain that obligations “arise as a result of our voluntary acts; these acts may be the giving of express or tacit understandings, such as promises and agreements, but they need not be, as in the case of accepting benefits.”277 The fair play account of political obligation is another example of appealing to tacit consent to explain how receiving benefits from the state generates obligations to the state. The appeal to consent is intended to ward off objections from the inviolability of individual autonomy. Robert Nozick famously argues against this principle, contending that it would allow us to impose obligations on others by merely conferring benefits. Nozick’s critique 274 Ross and Brown, The Nicomachean Ethics, 38. 275 Bennett, Saunders, and Stern, Groundwork for the Metaphysics of Morals. 276 Rawls, A Theory of Justice., 94. 277 Rawls, 97. 79 comes down to the idea that this type of obligation fails to respect individual autonomy and consent, as a person’s choice in the matter is not considered. Outside of the Kantian tradition, voluntary action as a necessary condition for attributing moral responsibility is more often taken for granted than argued for. In the literature on responsibility for historical injustice, for instance, philosophers commonly assert that it would be wrong to assign moral responsibility to someone for something that they did not do and could not have prevented.278 The second ground of moral requirements is agential or human nature. This form of moral requirements is often referred to in terms of natural duties. Rawls again figures prominently in identifying agential nature as a paradigmatic source of moral requirement.279 He explains natural duties in contrast to voluntary action: “it is a characteristic of natural duties that they apply to us without regard to our voluntary acts….Thus we have a natural duty not to be cruel, and a duty to help another, whether or not we have committed ourselves to these actions.”280 Rather, he considers natural duties to be what morality demands of moral agents in virtue of their agency.281 Diane Jeske similarly explains natural duties as what moral agents intrinsically owe other moral agents in virtue of shared agential features.282 Such features are presented differently in different accounts, but generally identify features like rationality or decision-making capacity. The agential features specified typically stem from the same Kantian conception of the subject as a self-legislating, autonomous moral agent. In this way, the agential nature source avoids the criticism that it disregards autonomy, as its demands trace back not to specific exercises of autonomy, but to the nature of the autonomous agent itself. One of the most 278 Perez, Freedom from Past Injustices; Radzik, “Collective Responsibility and Duties to Respond”; Webb, “What Is Unjust Enrichment?” 279 Rawls notes that his use of the distinction between obligation and natural duties comes from the work of from H.L.A. Hart, C.H. Whiteley, and R.B. Brandt (A Theory of Justice, footnote 28). 280 Rawls, A Theory of Justice., 98. 281 Rawls, 98. 282 Jeske, “Special Relationships and the Problem of Political Obligations.” 80 widely recognized natural duties is the duty of easy rescue, where rescuing a helpless other from danger would impose minimal cost to oneself. Other natural duties identified by Rawls include the duty to not harm or injure others, a duty to respect others, and the duty of justice.283 The duty of justice plays a significant role in Rawls’ project, which understands as a mandate that individuals “comply with and do our share in justice institutions when they exist and apply to us…and to assist in the establishment of just arrangements when they do not exist.”284 The methodology for identifying something as a natural duty involves, first, connecting the duty to some aspect of moral agency. Next, failure to discharge the duty is shown to be inconsistent with some part of the nature of a moral agent. For instance, the duty of easy rescue is presented as something that any agent would reasonably hope another would perform for them if they needed rescue. This universalizing standard, reminiscent of the first formulation of Kant’s categorical imperative,285 functions to show the rational inconsistency of failing to recognize the natural duty. Association is a third and highly contested source of moral requirements. The basic idea is that one’s associations can be sources of moral requirements. Examples of duties that are sometimes described as associative include duties to family or duties based on group membership. It is not controversial to observe that moral requirements are associated with various types of connections or associations. What is contested is whether association itself can independently ground moral obligations. In practice, association is often further dissected to identify some voluntary action or aspect of agential nature as the source of the moral requirements in question. If a person has made a choice to join a group, the responsibilities 283 Rawls, A Theory of Justice., 114, 337. 284 Rawls, A Theory of Justice., 334. 285 Bennett, Saunders, and Stern, Groundwork for the Metaphysics of Morals. 81 associated with group membership can be traced to the action of joining. Cases where a person is tacitly or involuntarily associated can sometimes be explained in terms of natural duties or agential nature. For instance, Christopher Wellman argues that duties to family can be reduced to explanation in terms of natural duties.286 The political obligation literature includes discussion of association as a possible source of obligation to the state alongside consent and natural duties.287 Ronald Dworkin writes, “political association, like family and friendship and other forms of association more local and intimate, is itself pregnant of obligation.”288 Criticisms of this formulation of political obligation focus on objections from voluntariness and the inviolability of individuals. When associative theorists respond to voluntarist objections, they end up identifying something deeper grounding the association like some kind of hypothetical consent or natural duty, essentially conceding that association is not an independent source of moral requirement.289 If the validity of associative claims only holds if traced back to consent or agential nature, it is ultimately derivative of these sources of moral requirements. The source or ground of moral requirements will play an important role in the accounts of moral requirements presented in the following sections. Accounts of moral responsibility offer more systematic explanations of how moral requirements work in practice. Taking up the associative source of moral requirements, I will argue for a relational understanding of responsibility as providing the conceptual tools needed to address responsibilities for structural oppression. Then I assess several significant accounts of moral responsibility, contending that each ends up relying on the voluntary action or agential nature sources of moral requirement and so fails to sufficiently address structural oppression. 286 Wellman, “Associative Allegiances and Political Obligations.” 287 Dagger and Lefkowitz, “Political Obligation.” 288 Dworkin, Law’s Empire, 206. 289 Wellman, “Relational Facts in Liberal Political Theory,” 553. 82 II. Responsibility as Relational My view is that relationships are a legitimate ground of responsibility apart from voluntary action or agential nature, and relational responsibility is necessary for making sense of responsibilities in relation to structural oppression. While building out a comprehensive account of relational responsibility is beyond the scope of this project, I will discuss several important elements that should be included in such an account that takes structural oppression seriously, starting with relationships as a source of moral requirements and moving on to address directedness, orientation toward outcomes, temporality, and blame before concluding this section with a brief discussion of Anishanaabe conceptions of relational responsibility as an example of an existing relational account. Association as an independent, legitimate source of moral requirements is undertheorized. While it does have some proponents in the political obligation literature, attempts to respond to voluntarist critique ultimately weaken the position and concede too much. The underlying influence of the Kantian view of the autonomous, self-legislating moral subject sets the terms of the debate, and the associative position does not stand much of a chance once it grants this premise. However, that premise need not be granted. Although it remains wildly influential, I see the Kantian view of the moral subject as implausible. Methodologically, placing individual autonomy as supreme and prior and sorting out justification of moral constraints on the subject from that starting point is incompatible with theorizing and practice of many marginalized and oppressed peoples. One of the key insights of women of color feminisms noted in Chapter 2 was the importance to starting from material realities. Feminist social theory and epistemology have pointed out the material reality of social embeddedness.290 We always already 290 Code, Ecological Thinking; Haraway, “Situated Knowledges”; “Whose Science?”; hooks, Yearning. 83 find ourselves enmeshed in complex relational networks. We do not exist as subjects prior to relationships; moral agents are not extricable from these interconnections. Applying these feminist insights to the source of moral requirements leads to recognition of responsibility suffused throughout relational networks. Relationships among humans, animals, the environment, and oppressive structures are all capable of independently generating responsibilities. A common distinction made in accounts of moral responsibility is orientation toward outcomes versus orientation toward agents. This distinction relates to success conditions for a responsibility being fulfilled or not. Later examples will include accounts where success in meeting moral requirements is measured in reference to qualities or choices of the agent themself, while outcome-oriented accounts evaluate success in terms of whether certain outcomes are realized. Goodin notes that, while this distinction between results and internal qualities often maps onto the longstanding feud between deontology and consequentialism, accounts using these orientations are not so clearly cut into those camps,291 for results and intentions or actions are not mutually exclusive moral considerations. A structurally sensitive relational account of responsibility will place greater emphasis on outcomes in assessing success, but individual action and intention are not irrelevant or meaningless. A consideration related to the orientation of success conditions is whether success is measured in a binary or scalar manner. Goodin associates binary success conditions with duties, while scalar success conditions correspond to responsibilities.292 His description of duties as either met or failed seems to ignore the category of imperfect duties, but I do follow his endorsement of responsibilities as having scalar success conditions. Many responsibilities have 291 Goodin, “Responsibilities.,” 50. 292 Goodin, 53. 84 receding targets, meaning that the ideal outcome may not be attainable, but movement towards the target can still be evaluated in a scalar fashion. Goodin writes, “since responsibilities admit of more or less complete fulfilment, it makes perfectly good sense to…ask not whether A has discharged his responsibilities but rather to what extent he has done so.”293 I take it that scalar assessment is a good fit for addressing the complexities of relationships to and under the conditions of structural oppression. The work of resisting oppression is never done, so a binary success condition does not make much sense. However, there is something to the binary failure condition that could be incorporated into a scalar view as a threshold. There is value in being able to point out that an institution has not even begun to work towards meeting its responsibilities in relation to a particular injustice. Another important aspect of accounts of moral responsibility is the treatment of temporality. This is often represented as a distinction between backward-looking and forward- looking accounts, where the orientation refers to that for which responsibility is being assigned. Backward-looking accounts identify past actions, events, or circumstances and assess responsibility for them, usually in order to assign blame or corrective penalties. Forward-looking accounts generally start with present circumstances and explore what should be done moving forward to improve them. Much discussion of distributive justice is forward-looking, while the topic of reparations, for instance, is backward-looking. The appropriateness and relevance of blame generally functions as the differentiating consideration between these temporal orientations. While the connection between blameworthiness and causal responsibility will be explored further when I discuss the blameworthiness account later, it is important to note that the close association between blame and responsibility plays a pivotal role in objections to 293 Goodin, 55. 85 responsibility for historic and structural injustices. Relational responsibility does not require such a tight association, as we can be responsible for something in virtue of our relationship to it, not just in virtue of causal contributions to an outcome or blameworthiness. This is not to say that blame is irrelevant, but rather to reject its appropriateness as a condition of being responsible. Consider my responsibility as a white American for chattel slavery. I undoubtedly have responsibilities arising from my relationship to that past injustice and its ongoing existence in white supremacist structures. It is obvious that I did not personally cause slavery, and in that sense of course cannot be blamed for it. However, that this sort of blame is not appropriate in no way takes away my relational responsibilities. Further, if I neglect these relational responsibilities, I am blameworthy for that failure. I believe this example illustrates how blame can be appropriate in discussions of responsibility for historic injustice without falling into the absurd position of saying that someone born in the 1990s somehow caused slavery. I believe the emphasis on causal connection to states of affairs in the blameworthiness literature ignores other kinds of connections and relationships that are practically and theoretically important. Relational accounts of moral responsibility are well-suited to address responsibilities for structural oppression. Some of the five necessary elements in an account of structural oppression identified in Chapter 2 can already be seen at work in relational responsibility. Relational responsibility starts from lived, material experience in its identification of social embeddedness as the starting point for understanding moral subjects rather than disembodied Kantian autonomy. The scalar evaluation of success is better suited to structures as adaptive and dynamic than binary success conditions focused on the qualities of the agent. Similarly, relational responsibility presents a more complex understanding of agency than the Kantian voluntarist tradition. The rejection of the Kantian voluntarist tradition itself is a step toward centering race 86 and coloniality, and an account that emphasizes all forms of interconnected relationships has the capacity to track intersections amongst oppressive structures. A more comprehensive account of relational responsibility would detail the connections between social positions and oppressive structures. A specific type of relationship I would like to highlight here is the relationship between an individual and an oppressive structure. As I will argue later, a significant limitation of Iris Marion Young’s social connection account of responsibility is that it does not render oppressive structures as something individuals can have a relationship to. One dimension of this relationship is the relation of extraction and benefit. A primary function of white supremacy is extracting from people of color to benefit white people. The benefits conferred by whiteness are an important aspect of any white person’s relationship to white supremacy, shaping and grounding responsibilities to resist oppressive structures and work towards liberation. This relationship to the structure of white supremacy also shapes relationships and thus responsibilities between individual white and Black people. Before moving on to illustrating the deficiencies of accounts of moral responsibility that do not acknowledge relationships as a legitimate, independent source of moral requirements, I would like to point to Anishanaabe conceptions of relational responsibility as an example of an existing account that takes the same approach as mine, albeit largely disregarded by western philosophy. Themes of responsibility as relational appear in many Indigenous traditions. As a person of settler descent working at an institution located on occupied Anishanaabe land, I bear a responsibility to recognize the theoretical sophistication of this tradition that long predates my work. Speaking from his embeddedness in Anishnaabe intellectual traditions, Kyle Powys Whyte offers the following articulation of responsibility: “Responsibilities refer to the reciprocal (though not necessarily equal) attitudes and patterns of behavior that are expected by and of 87 various parties by virtue of the different roles that each may be understood to be accountable for in a relationship.”294 Interdependence and kinship networks organize the Anishnaabe way of life and structure relationships and responsibilities. Relational responsibilities extend beyond the human realm as well. Deborah McGregor explains, “An Anishnaabe understanding of environmental justice considers relationships not only among people but also among all our relations (including all living things and our ancestors).”295 Women share a special relationship with water in that both are givers of love, and so they have responsibilities to each other. Similarly, relational responsibilities determine what western scientists would think of as resource management. Leanne Simpson shares, “Our relationship with the fish nations meant that we had to be accountable for how we used this ‘resource.’”296 This kind of interdependence goes beyond traditional western categories of moral consideration. Brenda Child observes that these relationships with nations of the animal world “allowed for a dynamic, ever-evolving reciprocity from multiple Ojibwe communities as they moved around the Great Lakes region.”297 In addition to including living beings like fish nations, Whyte notes that the cycles of interdependence are not bound by linear time in the same way. Ancestors and future generations are included in the web of human relationships that create responsibilities.298 This section has endeavored to demonstrate both that relationships are a legitimate source of moral responsibilities and that relational responsibility has the conceptual capacities to address structural oppression. While this is not a fully fleshed-out account, the commentary offered will 294 Whyte, “Food Sovereignty, Justice, and Indigenous Peoples: An Essay on Settler Colonialism and Collective Continuance,” 356. 295 McGregor, “Honouring Our Relations: An Anishnaabe Perspective on  Environmental Justice,” 28. 296 Simpson, “Looking after Gdoo-Naaganinaa,” 33–34. 297 Child, “Women of the Great Lakes and Mississippi: Everything Was Very  Systematic,” 29. 298 Whyte, “Settler Colonialism, Ecology, and Environmental Injustice,” 128–30. 88 help to illuminate the failures of the other accounts of moral responsibility surveyed in the next sections, especially the ways in which those accounts make it more difficult to perceive the impact and importance of structural oppression. III. Traditional Accounts of Responsibility This section examines three significant accounts of moral requirements, assessing each on its capacity to make sense of moral requirements in relation to structural oppression. While the accounts differ in many ways, they share a reliance on the voluntary action and agential nature sources of moral requirements and thus the Kantian view of the moral subject as self- legislating. These features contribute to the accounts’ failure to make sense of responsibilities related to structural oppression. The three accounts examined here are rights and duties, blameworthiness, and the liability model. A. Rights and Duties The rights and duties account of moral obligation is the most influential model, with many philosophers believing that morally required action can be fully explained in terms of rights and duties. Duties are most relevant to my analysis of moral obligations, but rights and duties are usually analyzed together as correlatives. Both deontological and consequentialist theories offer accounts of rights and duties. While the moral ground and justification of the prescriptions differs, both share a basic approach to conceptualizing right action. Much current literature about rights and duties seeks to offer understandings that are compatible with both deontic and consequentialist frameworks. I will focus on what these accounts share in common rather than their differences. Analyzing the structure of rights and duties offers a better understanding of what they are. Wesley Hohfeld’s articulation of the relationships between rights and duties in legal theory has 89 undergirded rights discourse for the past century.299 Hohfeld identifies four components of a right that form its structures: the privilege, the claim, the power, and the immunity.300 Different arrangements between these components form the structure of different kinds of rights. For example, a privilege-right denotes something for which an actor does not have a duty not to do. Powers relate to the ability to change the status of other claims or privileges. If someone invites a person into an otherwise forbidden area, they have given that person a privilege to enter the area. For my purposes, I am most interested in claims as correlative with duties. Hohfeld understands a claim as a situation where Y has a claim that Z x if and only if Z has a duty to Y to x. For instance, Alpha has a right that Bravo pay them if and only if Bravo has a duty to Alpha to pay them. This biconditional relationship between most rights (or claims) and duties is widely recognized. Joel Feinberg argued that to have a right is to have “a valid claim.”301 A claim is held against another. In cases of more general human rights, it is thought that those claims are held against the state if a specific target of the claim cannot be otherwise identified. The distinctions between different ways of acquiring obligations map onto the rights and duties framework. The voluntary action source applies to interpersonal agreements, contracts, business, and more. The duties acquired by various actions are fairly simple to trace to the claims. In these cases, the duty is clearly directed to the holder of the claim. The directedness of duties is key to their enforceability. Without a claimant to demand that the duty to them be fulfilled, it can be more difficult to argue that a particular moral action is truly required. Another category of rights and duties are those attributed to agential nature. These can include both positive and negative rights. Negative rights are the right to have others refrain from something, 299 Hohfeld, Fundamental Legal Conceptions as Applied in Judicial  Reasoning. 300 Wenar, “Rights.” 301 Feinberg and Narveson, “The Nature and Value of Rights,” 257. 90 while positive rights are entitlements - a right to something. Negative rights are often considered simpler or less demanding, while positive rights are generally thought to require a state to bear the correlative duty. In the Kantian tradition, a perfect duty is one that is enforceable; that is, there is specific enough directedness and clarity between the claimant and the bearer of the duty for the claimant to hold the bearer of the duty accountable if they fail to fulfil the duty. Imperfect duties are more difficult to enforce because they allow greater discretion in the manner of their discharge. George Rainbolt explains imperfect duties in terms of the discretion allowed the agent in fulfilling the requirement: “I can meet my obligation to give to charity by giving different amounts at different times to any one of many groups.”302 Still, circumstances can increase the perfection of a particular claim to the point of reaching the threshold of enforceability. For instance, a general duty of charity is attributed to agential nature, but does not identify a specific correlative claimant in its general form. However, particular circumstances may present a claimant who can successfully appeal to that duty to charity as enforceable. Some relevant circumstances would be the cost or impact to the bearer of the duty, the presence of others against whom the claim could be made, and the urgency of the matter on the part of the claimant. An example of this process may be helpful. The imperfect duty of mutual aid allows agents significant discretion in determining how to discharge the duty. However, in certain emergency circumstances, the more general imperfect duty of mutual aid may at times be perfected into a duty of easy rescue. If Asher happens upon a toddler drowning face-down in a puddle, their imperfect duty of mutual aid is perfected on the directedness dimension to target that particular drowning toddler in need of rescue, so long as the rescue can be completed without unreasonable costs. It would be unreasonable for Asher to decline to rescue the toddler because their shoes 302 Rainbolt, “Perfect and Imperfect Obligations.” 91 might get wet; however, if the toddler was instead drowning far out in a deep lake and Asher did not know how to swim, rescuing the toddler might cost Asher their life. In that case, the rescue would remain morally praiseworthy, but the high cost may prevent the action from being required. However, the imperfect duty of mutual aid would still be perfected to require some response on Asher’s part, like calling for help. Thus, natural duties can be perfected into directed duties by circumstantial factors. A significant limitation of the rights and duties account is its lack of capacity to address structural oppression in its picture of right action. Oppressive structures simply do not have a place in the landscape described by correlative rights and duties. Interpersonal or contractual duties operate at one level, and claims without a clear, singular target for their directedness are assigned to the state to address. This landscape does not have explanatory tools to parse the duties of actors to address large-scale injustices in society. If a duty to work to rectify oppression was to be named, it would fit in the category of an imperfect and undirected duty, meaning that it would be unenforceable, undermining how required it really is. It is unsurprising that the rights and duties account does not have the resources to address structural oppression. At best, its development did not have oppressive structures in mind, and a good case can be made that it was developed at least in part to justify and obscure white supremacist European colonization, so it makes sense that it lacks conceptual resources for opposing and dismantling such oppressive structures. B. Blameworthiness The blameworthiness account of moral responsibility emphasizes the process of holding agents morally accountable, discussing how and when to attribute blame to agents on the basis of their behavior. P.F. Strawson’s landmark 1962 essay “Freedom and Resentment” launched 92 extensive discourse about when and how to hold agents to be worthy of blame. He famously understands responsibility in terms of fitting reactive attitudes.303 The responding literature consistently makes a distinction between causal responsibility and personal or agential responsibility. Michael Zimmerman clarifies the moral responsibility which blameworthiness literature focuses on is “retrospective moral responsibility.”304 Forward-looking duties are not in the scope; rather, assignment of evaluative attitudes based on past events is at issue. To be appropriately judged worthy of blame is to be responsible, and responsibility implies blameworthiness. Identifying appropriate targets for blame features importantly in the blameworthiness framework. Kurt Baier’s account of blameworthiness features strict limits on its assignment which are on par with standards in the literature: “Nobody can have responsibility for some past occurrence ascribed to him unless that occurrence can be attributed to a failure in his responsibility to society, that is, his failure in a task he could have performed and knew he was required to perform; he cannot be held responsible for it except by persons to whom he was responsible for his failure.”305 Interestingly, this standard shares the directedness associated with duties in the rights and duties framework. Mental states also figure centrally in most accounts of appropriate blame assignment. H.L.A. Hart observes that all the excusing conditions for legal responsibility are mental states (e.g. duress, insanity),306 and Michael McKenna extends this to moral responsibility 303 Strawson, “Freedom and Resentment.” 304 Zimmerman, “Varieties of Moral Responsibility,” 46. 305 Baier, “Types of Responsibility,” 120. 306 Hart, “Acts of Will and Responsibility,” 31. 93 as well.307 Gunnar Bjornsson builds off of Strawson’s quality of will concept to argue that blameworthiness is indexed to “the extent to which the agent cares about how well things go…compared to what can be properly morally demanded of her.”308 Larry May and Linda Radzick argue that the quality of will component can be extended to hold actors responsible for attitudes or prejudices they hold.309 Much like the rights and duties approach, the blameworthiness account is limited in its ability to make sense of structural oppression. Much of the blameworthiness framework’s attention is paid to excusing conditions for minimizing or avoiding blame. Blame has a negative cast and is to be avoided, so likewise responsibility is to be avoided. This leads to moves to innocence and denial of participation in large-scale injustices. The blameworthiness literature shares an assumption that the scope of appropriate blaming is limited by common sense morality. Among others, Bjornsson argues that a desideratum for an account of blame is that it must match our natural, ordinary understanding of blameworthiness, and “accounts postulating discontinuities need strong justification.”310 This appeal does not specify to whom “our” refers. This prima facie rejection of accounts of right action which require more of agents than certain authors’ intuitions imagine to be appropriate is ill-suited to reckon with a society where oppression is abundant. The actual range of injustices and moral problems in society lie beyond the scope of the world imagined by these theorists. 307 McKenna, “Moral Responsibility: A Conceptual Map,” 3. 308 Björnsson, Robichaud, and Wieland, “Explaining (Away) the Epistemic Condition on Moral Responsibility,” 152. 309 May, Sharing Responsibility; Radzik, “Collective Responsibility and Duties to Respond.” 310 Björnsson, Robichaud, and Wieland, “Explaining (Away) the Epistemic Condition on Moral Responsibility,” 89. 94 C. Liability The liability model is how Iris Marion Young describes traditional accounts of moral requirements taken together. Young articulates the account with the purpose of illustrating its limitations in addressing structural oppression, but she does not view this as a weakness or problem with the account itself, just a limitation in the scope of its application. Young opens her discussion of the liability model by noting its success in making sense of wrongs attributable to individual interactions and to “that which is attributable to the specific actions or policies of states or other powerful institutions.”311 However, she argues that the liability model cannot explain moral obligations related to large-scale injustices. Young describes the liability model as one that assigns responsibility based on findings of singular fault for a discrete, past harm.312 This conception of the liability model encompasses both the rights and duties and blameworthiness models of accounting for moral obligations. Central features of the liability model Young analyzes include its focus on linear causality, and the isolating and absolving functions of liability attribution. Young emphasizes the centrality of causal responsibility for harm in the liability model: “Practices of assigning responsibility in law and everyday moral life first try to locate ‘who dunnit’; for a person to be held responsible for a harm, we must be able to say that he or she caused it. Causal responsibility is not sufficient for finding an agent blameworthy or at fault, but it is usually necessary.”313 Young notes repeatedly that on the liability approach, “it is necessary to connect a person’s deed linearly to the harm for which we seek to assign responsibility.”314 Not only must a direct causal 311 Young, Responsibility for Justice, 2011, 45. 312 Young, 97. 313 Young, 95. 314 Young, 96. 95 connection be identifiable, but also the causal relationship much be sufficiently strong. Young explains this as a “but for” condition: “It should be the case that if I had not done what I did, then the harm would not have occurred, or would not have occurred to the same extent.”315 Mere contribution to harmful outcomes cannot ground attributions of liability; rather, the relationship must involve a necessary or sufficient causal relation to the outcome. Young further explains that the goal of assigning responsibility on the liability model is distinguishing those who are guilty from those who are blameless, which she takes to be an isolating practice. Backward-looking approaches like the liability model have the goal of “identifying particular agents as the liable ones.”316 She contends that “the logic of blame says that those to whom it is appropriately applied bear a singular responsibility for events or circumstances, even as a group.”317 Assigning responsibility on this account has the effect to “implicitly absolve others.”318 Thus, the isolating function of liability attributions is just as much about shielding the blameless from the moral taint of responsibility as it is about seeking corrective or compensatory action from the guilty. Young argues that these aspects of the liability model are reasons why the liability model cannot be extended to explain responsibilities in relation to structural injustice. For her process- based view of structural injustice, Young argues that complex social processes mediate between individual action and negative outcomes, making it impossible to trace a direct line between actions and outcomes. “On the whole, however, it is not possible to identify how the actions of one particular individual, or even one particular collective agent…has directly produced harm to 315 Young, 101. 316 Young, 98. 317 Young, 117. 318 Young, 109. 96 other specific individuals.”319 Liability attributes do not make sense in this context. “None ought to be blamed for that outcome…because the specific actions of each cannot be causally disentangled from structural processes to trace a specific aspect of the outcome.”320 With a few exceptions like negligence, intentionality is generally required to move from identifying direct causal connection to a harm to blame for that harm. Young’s definition of structural injustice emphasizes that the negative outcomes are not intended by the individual actors participating in social processes. “Many large-scale social processes in which masses of individuals believe they are following the rules, minding their own business, and trying to accomplish their legitimate goals can be seen to result in undesirable unintended consequences when looked at structurally” (emphasis added).321 She cites this lack of intentionality paired with the difficultly in tracing linear connections to harms as the “primary reason the liability model does not apply to issues of structural injustice.”322 If the masses are following “normally accepted rules and practices” that result in some harms when considered from a structural point of view, it does not make sense to use the liability model.323 In Justice and the Politics of Difference, Young critiques the liability model for making assumptions that reduce moral life to the realm of intentional action.324 On her view, structural injustice is caused by large-scale unintentional actions mediated by structural-social processes to result in harmful outcomes. The liability model cannot make sense of this as injustice since it cannot directly connect individual intentional action with the resulting harms. She argues that a new conception of responsibility is required for moral philosophy to pay sufficient attention to structural injustices which “are 319 Young, 96. 320 Young, 100. 321 Young, 63. 322 Young, 100. 323 Young, 100. 324 Young, Justice and the Politics of Difference, 150. 97 embedded in unquestioned norms, habits, and symbols, in the assumptions underlying institutional rules and the collective consequences of following those rules.”325 The other significant limitation of the liability model’s application to structural injustice identified by Young is the isolating nature of blame. All individuals who participate in social- structural processes have some kind of connection to the harms of structural injustice, so trying to isolate particular actors to hold singularly responsible and blameworthy turns into a game of whack-a-mole.326 Young contends, “A blame language can be inappropriate and unproductive in the context of issues of structural injustice because it tends to divide people between powerful wrongdoers and those who are innocent, whether as victims or bystanders. This often oversimplifies the causes of injustice and renders most people passive.”327 If everyone is involved in the production of the injustice, it does not seem fair to isolate only a few actors to bear the singular responsibility. Additionally, a natural response to attributions of liability and blame is defensiveness. Young notes that this is appropriate in legal contexts, where parties must defend themselves in court. However, in the context of addressing injustices caused by structural-social processes, “the language of blame…often impedes discussion that will end in collective action, because it expresses a spirit of resentment, produces defensiveness, or focuses people more on themselves than on the social relations they should be trying to change.”328 The question of the productivity of certain emotional reactions is a practical one. Young emphasizes the ongoing nature of structural injustices as the results of structural-social processes in explaining why blame is not helpful. Young argues that blame is more appropriate for past events 325 Young, 41. 326 Young, Responsibility for Justice, 2011, 100. 327 Young, 116. 328 Young, 114. 98 that have concluded, or for policies that can be attributed to particular organizations. Since blaming is essentially backward-looking, “it focuses debate on the past, rather than on what can be changed in the present.”329 Young concludes that these limitations of the liability model demand development of an alternative “conception of responsibility that does not assume blame, fault, or liability as the primary way of assigning responsibility.”330 While this sets up her positioning of the social connection model in contrast with the liability model, Young is careful to clarify that she is not arguing against the liability model as a whole. She writes, “I do not aim to replace or reject the liability model. I am claiming instead that the liability model is appropriate in some contexts but not all.”331 The features she identifies as making the liability model unfit to explain responsibility for structural injustice are understood as limitations, not flaws or failures. IV. The Social Connection Account of Responsibility Iris Marion Young’s social connection account of responsibility does better than the traditional accounts at addressing social embeddedness, but still falls short of recognizing relationships as themselves independent sources of moral requirements. The shift in focus towards the importance of connections and relationships in explaining responsibilities is certainly an improvement over the traditional views, but Young ultimately tries to explain the importance of connections using the same limited mechanics underlying the voluntary action and agential nature sources of moral requirements. Young developed the social connection account of responsibility with the goal of providing a model that accounts for structural injustice. She articulates the social connection 329 Young, 117. 330 Young, 40–41. 331 Young, 100. 99 model of responsibility against what she terms the liability model of traditional ethics, which encompasses both the rights and duties and blameworthiness frameworks. As discussed in the previous chapter, Young understands structural injustice in terms of social-structural processes. She writes, “Many large-scale social processes in which masses of individuals believe they are following the rules, minding their own business, and trying to accomplish their legitimate goals can be seen to result in undesirable unintended consequences when looked at structurally.”332 This section examines Young’s analysis of the limitations of the liability model and her account of the social connection model before assessing the limitations of Young’s attempt to reckon with responsibilities in relation to structural oppression. The alternative view of responsibility Young presents is known as the social connection model, which is framed as offering “a more active relation between individuals, social-structural processes, and responsibility.”333 Young explains that the “social connection model finds that all those who contribute by their actions to structural processes with some unjust outcomes share responsibility for the injustice.”334 What is it that this responsibility demands? Young writes, “Being responsible in relation to structural injustice means that one has an obligation to join with others who share that responsibility in order to transform the structural processes to make their outcomes less unjust.”335 This conception of responsibility is intended to address structural injustice in the ways that the liability model cannot. In contrast to the backward-looking nature of the personal responsibility assigned by the liability model, the social connection model is a form of political responsibility. Young explains, “The meaning of political responsibility is forward-looking. One has the responsibility always 332 Young, 63. 333 Young, 40. 334 Young, 96. 335 Young, 96. 100 now, in relation to current events and in relation to their future consequences.”336 This distinction between personal and political responsibility Young models after Hannah Arendt’s use of the distinction.337 Arendt believes that personal responsibility and its attributions of guilt and blame does not work to explain large-scale wrongs. Her analysis of German responsibility for the Holocaust introduces political responsibility as a collective form of obligation.338 While Arendt presents the basis of this collective responsibility as membership in a nation, Young argues that mere membership in a group is not sufficient to ground responsibility attribution.339 She describes it as “a mystification” to attribute responsibility to people based on mere association “and not because of anything at all that they have done or not done.”340 The ground of political responsibility ultimately comes back to the actions of moral agents for Young, who identifies the ground as participation in structural-social processes.341 She writes, “Responsibility in relation to injustice thus derives from not living under a common constitution, but rather from participating in the diverse institutional processes that produce structural injustice.”342 This is not to say that she thinks action is sufficient to explain that responsibility, but repeatedly describing the ground as participation invokes action as a necessary condition. Although political responsibility depends on individual actions, Young argues that it “is strictly collective. One has this responsibility as part of a group.”343 The shared nature of political responsibility is contrasted against the isolating nature of liability. In practice, what it means for political responsibility to be shared is that “it can therefore be discharged only through collective 336 Young, 92. 337 Young, 76. 338 Arendt, “Collective Responsibility,” 43. 339 Young, Responsibility for Justice, 2011, 87. 340 Young, 79. 341 Young, 87. 342 Young, 105. 343 Young, 89. 101 action.”344 Young references Larry’s May’s work on shared responsibility as a helpful starting point,345 but argues that his account is too backward-looking to apply to ongoing structural injustices.346 The harms produced by structural injustices are ongoing and happening in the present, so a forward-looking version of responsibility is needed to direct efforts at improving present conditions. Young does clarify that her conception of shared responsibility should account for difference in social position.347 The specific actions required by shared responsibility vary: “More should be expected, for example, of persons who are relatively privileged in the structural processes.”348 Young contends that the shared nature of political responsibility avoids the pitfalls of defensiveness that blame-based liability evokes. “Political responsibility is not about doing something by myself, however, but about exhorting others to join me in collective action.”349 The social connection model presents a view of responsibility that aims to call in rather than separate out. The political nature of this responsibility involves a call to organize with others in the public sphere to transform the structural-social processes which are causing harm to “reduce and eliminate the injustice they cause.”350 Blame elicits defensiveness, which is counterproductive to organizing coordinated efforts at transforming the present.351 Not only is shared responsibility necessary to avoid unproductive emotional reactions to blame attribution, but Young also argues that change to structural-social processes is only possible through collective action. “These processes can be altered only if many actors from diverse positions within the social structures 344 Young, 85. 345 May, Sharing Responsibility. 346 Young, Justice and the Politics of Difference, 151. 347 Young, Responsibility for Justice, 2011, 109–10. 348 Young, 181. 349 Young, 93. 350 Young, 110. 351 Young, 117. 102 work together to intervene in them to try to produce other outcomes.”352 Interventions to address these processes often involve interacting with government institutions, but Young also has in mind “public communicative engagement with others for the sake of organizing our relationships and coordinating our actions more justly.”353 Young repeatedly indicates that the target of such collective action should be rehabilitation or reform of processes and institutions which are causing harm. The social connection model mandates that people work together to “reform those institutions to reduce their unjust effects.”354 Doing this work requires individual agents to forge relationships of solidarity, which Young defines as a relationship between people from different backgrounds “who decide to stand together, for one another.”355 While Young provides an insightful analysis of the limitations of the liability model in addressing structural injustice, the social connection model of responsibility ends up having significant limitations of its own. The limitations in the social connection model that I will examine include the role of history, the exclusion of colonialism, the reliance on action as the ground of moral requirement, and artificially limiting responsibility. As Chapter 2 has already argued, Young’s process-based conception of structural injustice truncates significant varieties of structural oppression by how it treats history. I argued that Young’s model is ahistorical because it renders history as irrelevant to the responsibility itself that is generated by participation in social-structural processes. Young does not take her view to be ahistorical; she specifically notes that it “is not plausible to argue…that a relationship to the past is irrelevant to this project.”356 Young discusses history at various points, even 352 Young, 111. 353 Young, 112. 354 Young, 180. 355 Young, 120. 356 Young, 181. 103 devoting an entire chapter in Responsibility for Justice to the topic of historic injustice. However, the role that Young carefully carves out for history is separate from the source of responsibility and the nature of the injustice being addressed. “History matters in the social connection model, but not in order to reproach, punish, or demand compensating damages.”357 The topic of historic injustice is inherently backward-looking, which Young associates exclusively with the liability model. However, assigning responsibility on the liability model only works if perpetrators and/or victims or their direct beneficiaries are still alive and clearly identifiable.358 Young considers reparations for the historic injustice of slavery. “On the whole it does not make sense, I will argue, to use the language of blame, guilt, indebtedness, or compensation to talk about the responsibilities of Americans today, and particularly white Americans, may have in relation to the historic injustice of slavery.”359 Reparations are generally conceived of as compensatory damages, which falls under the purview of the liability model. Young argues that very few agents still exist who have the direct causal connection to slavery that could ground liability. She grants that a few longstanding corporations may be held accountable in this way,360 but she rejects the idea that the U.S. government could still be liable. “If reparations claims are valid, the U.S. government is not the agent which is liable for the wrong and from which damages should be assessed.”361 Young recognizes that slavery was the policy of the U.S. government, but she contends that it has discharged its liability by abolishing slavery and making some “explicit reforms aimed at providing some remedy”362 like passing the civil rights 357 Young, 173. 358 Young, 173–74. 359 Young, 174. 360 Young, 175–76. 361 Young, 177. 362 Young, 177. 104 legislation and Fair Housing Act.363 If the government is not liable, individual agents are not either. “Because it is not possible to trace a linear causal relationship between the actions of these persons and these particular aspects of the harm, however, it is not appropriate to apply a liability model of responsibility.”364 Young concludes that these ontological and practical difficulties in applying to liability model to historic injustice make it inappropriate to explain responsibility for historical injustices like slavery. What Young offers instead is the forward-looking outlook of the social connection model. Reparations as compensation for a past wrong do not make sense, so the focus must shift to the practical question of reducing the injustices that exist currently. The social connection model enjoins members of society to aim at “social transformation and policy reform,”365 reshaping social-structural processes “to reduce their unjust effects.”366 Young states, “The remedies for racialized structural injustice in the United States concern institutional reform and investment, rather than payment construed as compensation to some present persons for wrongs done directly to other persons before they were born.”367 So what role does history have to play in Young’s view? While history is not relevant to the source of social connection’s responsibility, Young does grant reflecting on history does have 363 Young contends that the popular imagination simply does not have accounts tracing the continuities between slavery and the present through racialized policy over the years: “an account of the continuity of contemporary racialized structures with the legacy of Reconstruction, Jim Crow, and racial discrimination in housing, education, and employment in northern cities is not currently part of the popular historical imagination.” (Responsibility for Justice, 185). Is this another epistemic injustice or prioritizing only those accounts that have received uptake and not recognizing the extensive work of women of color feminists in documenting the operation and evolution of oppressive structures? That such an account is not part of the “popular historical imagination” does not mean that it does not exist, yet Young repeatedly doubles down on the claim that it is impossible to trace those connections! In another place where she is discussing privilege, Young says that we have to “acknowledge its continuities with historical injustice” (Responsibility for Justice, 187). It is not clear what she means by continuity in the face of her reject of the possibility of tracing causal connections, and it is also not clear what work acknowledgment is doing. 364 Young, Responsibility for Justice, 2011, 175. 365 Young, 179. 366 Young, 180. 367 Young, 185. 105 several practical benefits for collective organizing in the present. Discussing historic injustices can help “differently positioned members of a society to nurture respectful relations with one another now.”368 She also recognizes that examining the workings of unjust processes in the past can help us “understand our role” in present social-structural processes.369 Young identifies the most crucial function of history as follows: “The most important reason for the social connection model of responsibility is to be concerned with historic injustice is in order to understand present injustice as structural.”370 Understanding the injustices resulting from processes in the present as structural leads to the need for shared responsibility that can only be discharged through collective action. Essentially, Young is once again stating that history matters only insofar as it helps us work together more effectively in the present. By allowing only a practical use for history, Young truncates “historical” injustice from theoretical significance. Young’s rejection of the theoretical significance of history leads to the social connection model not being able to conceptualize or account for significant dimensions of structural oppression. Elena Ruíz analyzes the failures of the social connection model to address white supremacy and colonialism. As widely recognized in the literature on colonialism, settler colonialism is not a past injustice, but rather an ongoing event.371 Similarly, Ruíz notes that Young presents slavery as a “past historical wrong rather than as a structural injustice that is part of a continuum of ongoing structured disadvantage rooted in the system of white supremacy.”372 Where racial disparities exist in the present distribution of wealth and well-being, those disparities can only be addressed in terms of forward-looking solutions to general socioeconomic 368 Young, 181. 369 Young, 109. 370 Young, 185. 371 Wolfe, “Settler Colonialism and the Elimination of the Native,” 387–409. 372 Ruíz, Structural Violence, 74. 106 injustice.373 Cutting off history from the analysis “yields a picture of structures as arbitrary historical interrelations between different elements (and interactive levels) of a social system without their goal-oriented functions.”374 Ruíz emphasizes that white supremacy and colonialism “are designed to reproduce dispossession, death, and social disparities in order to accumulate wealth and concentrate it in dynastic chains of transmission.”375 Ruíz further argues that Young ends up identifying the injustice of social-structural processes as residing in those processes rather than the outcomes: “Young places structural injustice here in the power of social processes to produce inequality, not in the specific populations that historically have been, and continue to be, consistently and asymmetrically disadvantaged by such processes.”376 This decentering of the material impacts of oppressive structures to those harmed by them also functions to justify the focus on reforming processes to improve them rather than on material outcomes. Young understands reforming social-structural processes to involve “calls for pushing authoritative and coercive political institutions in directions that remedy injustice, where they exist, and bringing them into being where they do not.”377 Ruíz identifies this demand for the oppressed to bolster the very institutions that are instrumental in their oppression as itself a form of structural violence.378 Young’s choice to name her theory of responsibility the social connection model is a bit misleading about the source of that responsibility. Social connection conveys a sense that relationships will be important in explaining responsibility, but in practice Young still relies on the same ground of responsibility as the liability model by treating action or consent as necessary 373 Ruíz, 74. 374 Ruíz, 86. 375 Ruíz, 100–101. 376 Ruíz, 75. 377 Young, Responsibility for Justice, 2011, 168. 378 Ruíz, Structural Violence, 78. 107 conditions. I argue that the failure to connect social connections to the actual ground of responsibility for structural injustice is a limitation of her view. Young introduces her project as one that aims to “theorize a more active relation between individuals, social-structural processes, and responsibility.”379 Young repeatedly says that social connection is a different kind of responsibility than the liability model, but the difference in kind does not extend to a difference in the ground or source of that responsibility. What she means by a difference in kind is that social connection is forward-looking rather than backward-looking because the intentionality required for blaming is not present in the case of injustice resulting from social-structural processes. However, Young makes clear in a number of places that responsibility for structural injustice is grounded in actions. She writes, “The social connection model finds that all those who contribute by their actions to structural processes with some unjust outcomes share responsibility for the injustice”380 (emphasis added).381 Young underlines this point in her rejection of Arendt’s notion of collective responsibility based on group membership thus: “It is a mystification to say that people bear responsibility simply because they are members of a political community, and not because of anything at all that they have done or not done.”382 Young agrees, then, with the liability model’s assumption that it is wrong to attribute responsibility without connecting it to some concrete action performed by agents. Social connection’s responsibility is distinguished from liability based on the role of intent. Since agents do not intend the harmful effects of social processes in their actions of 379 Young, Responsibility for Justice, 2011, 40. 380 Young, 96. 381 Elsewhere Young writes, “The social connection model of responsibility says that individuals bear responsibility for structural injustice because they contribute by their actions to the processes that produce unjust outcomes…. Responsibility in relation to injustice thus derives from not living under a common constitution, but rather from participating in the diverse institutional processes that produce structural injustice” (emphasis added) (Responsibility for Justice, 105). 382 Young, Responsibility for Justice, 2011, 79. 108 participating in institutions and markets, it is inappropriate to assign blame looking backward. The role of intentionality also appears in two other points that Young’s account emphasizes. First, Young consistently describes structural injustice as arising from the cumulative effect of people “following the rules” and operating within widely-accepted norms.383 The description of participating in structural-social processes as following the rules is what backs the claim that the harms of these processes are not intended. Rather, agents intend only the realization of what Young considers as their legitimate projects and interests. Second, Young’s repeated assertion that it is impossible to trace direct enough causal links between individual actions of participating in society and the specific harmful outcomes of social structural processes384 functions as an argument against the application of negligence or willful ignorance. If links could be traced between specific unintentional actions and specific harms, a negligence appeal to liability could be constructed. If the agent could have and should have known better the effects of their actions, they could have responsibility for those effects. While it is obvious that tracing connections between very distant points in the web of global capitalism can be very difficult, this does not imply that it is impossible to trace any connections through social-structural processes. Young’s choice to generalize from a difficult case to all cases ends up treating social-structural processes like a black box. The input of individual legitimate 383 For instance, “Structural injustice is produced and reproduced by thousands or millions of persons usually acting within institutional rules and according to practices that most people regard as morally acceptable” (Responsibility for Justice, 95). “Many large-scale social processes in which masses of individuals believe they are following the rules, minding their own business, and trying to accomplish their legitimate goals can be seen to result in undesirable unintended consequences when looked at structurally” (Responsibility for Justice, 63). “Structural injustice occurs as a consequence of many individuals and institutions acting to pursue their particular goals and interests, for the most part within the limits of accepted rules and norms” (Responsibility for Justice, 52). 384 For instance, “Because it is not possible for any of us to identify just what in our own actions results in which aspects of the injustice that particular individuals suffer” (Responsibility for Justice, 110). “The problem with structural injustice is that we cannot trace this kind of connection. It is not difficult to identify persons who contribute to structural processes. On the whole, however, it is not possible to identify how the actions of one particular individual, or even one particular collective agent…has directly produced harm to other specific individuals” (Responsibility for Justice, 96). 109 actions goes into the black box of collective social-structural processes and somehow results in structural injustices that no one intended or could have prevented. The mystification of social- structural processes ignores the extensive work by women of color feminists mapping the mechanisms of oppressive structures like white supremacy and settler colonialism. Another limitation of Young’s social connection model is that, despite Young’s stated goal of spreading more responsibility around,385 the account functions to shield those benefitting from structural oppression from responsibility while holding those harmed by oppressive structures equally responsible for those structures. While Young’s account certainly spreads more responsibility than a scenario where no responsibility is assigned for structural injustice, I follow Ruíz’s argument that Young fails to address morally relevant differences between the oppressed and those benefitting from oppression. Young understands responsibility for structural injustice to be essentially shared because the social-structural processes that result in unjust outcomes for some are reproduced by everyone participating together in society. While the specific demands of this responsibility vary person to person, Young insists that “To say that responsibility is shared means that we all bear it personally in a form that we should not try to divide and measure.”386 This is what it means for shared responsibility to be political rather than personal – it must not be subdivided out, but rather discharged exclusively through collective organizing. Still, Young does acknowledge some room for difference in her model, arguing that differing social positions are relevant to the specifics of how particular agents go about discharging their collective duty. “That we share responsibility in this way as contributors does not imply, however, that we should not distinguish degrees and kinds of responsibility in 385 Young, Responsibility for Justice, 2011, 179. 386 Young, 124. 110 reasoning about how to take forward-looking action to discharge the responsibility.”387 Young notes that shared responsibility is more open-ended in what it requires that liability, which is narrowly focused on correcting a past and completed wrong. There are many ways to pursue social transformation, and the specific actions required by this responsibility vary based on particular circumstances. Young’s discussion here mirrors the way that imperfect duties work in the rights and duties model, where a general imperfect duty can be perfected to the point of requiring specific actions by various circumstances. Young acknowledges differences in social position as relevant circumstances that affect how someone should go about discharging their shared responsibility.388 “More should be expected, for example, of persons who are relatively privileged in the structural processes.”389 It is worth noting that Young appeals to positionality and relationships as relevant only to the practical application of responsibility rather than to the nature of that responsibility itself. It would be unfair to say that Young does not recognize some room for difference, but she carefully segregates it from the source or ground of responsibility in the first place. Ruíz contends that this puts Young in the position of arguing for the oppressed bearing an identical and equal type of responsibility to those reaping the benefits of oppression. Ruíz states that the social connection model ends up “indirectly coassigning responsibility for colonial violence and settler wealth extractivism to survivors of colonialism.”390 Indeed, Young believes this to be a strength of her position! “Those who can properly be argued to be victims of structural injustice can also be called to a responsibility they share with others to engage in 387 Young, 124. 388 Young, 144. 389 Young, 181. 390 Ruíz, Structural Violence, 77. 111 actions directed at transforming those structures.”391 She believes that this flattening of difference so that all members of society bear the same kind of responsibility for structural injustice will avoid unproductive reactions of defensiveness on the part of white people who are called to action. Indeed, Young devotes a whole chapter to the strategies that are often used to avoid responsibility, explaining how her shared responsibility for structural injustice bypasses these reactions.392 It is ironic that Young prioritizes accommodating privileged objections to having responsibility over acknowledging morally relevant differences in position between those more harmed by oppressive structures and those benefiting from them. Major accounts of moral responsibility fail to adequately account for responsibilities in relation to structural oppression, even those few that focus on social connections and large-scale injustices. This highlights the need for a different approach to responsibility where moral requirements stem from relationships themselves. V. Professional Responsibility for Structural Oppression Applying a relational approach to professional responsibility in particular starts from the definition of profession presented in Chapter One. A profession is a type of work that requires specialized training, regardless of formal education level, and exerts social influence in the course of doing its work. A voluntarist explanation of the source of professional responsibility would appeal to the choice to enter a profession as consent to take on whatever was morally required by the nature of the profession. In contrast, a relational approach takes professional responsibility to stem from the many types of relationships in which the position is situated. By moving into the space of that position, the individual stands in the many relationships of that position in addition to their prior personal responsibilities. Thus, understanding one’s 391 Young, Responsibility for Justice, 2011, 113. 392 Young, 154. 112 professional responsibility involves mapping out these many kinds of relationships held by a particular professional position. Although the mapping process will look different in each profession, there are a few common categories that provide helpful starting points for the process. More formal professions have institutions, governing bodies, and professional organizations, while less formal ones still have networks, associations, and conventions connecting people in similar lines of work. The history of a profession is another focal point for identifying relationships, both of the field today with its past iterations and of the field with other professions, institutions, and communities. Of particular importance is examination of the history of professional or institutional wrongs, which shape the impact of current practice in that profession and how professional operations are interpreted, especially by communities harmed by those wrongs. Such relationships to historic injustice generate responsibilities, not in the sense of blame for their having happened, but in generating moral requirements to do differently in the present. For instance, the history of redlining in a community is important for a real estate agent to be conscious of to avoid unconsciously reproducing its patterns moving forward. All lines of work involve positions situated in a web of relationships, so all will have relational responsibilities. While a dock worker in a port does not wield the same level of social power in the course of doing their job as a physician, their work still has a tremendous impact on the world. For example, dock workers around the world have organized strikes and protests to stop shipments of weapons to Israel for use in the ongoing genocide it is waging against Palestine.393 393 Heyman, “Dock Workers”; News, “Pro-Palestinian Protestors Block Tacoma Port to Halt Suspected Weapons Shipment to Israel.” 113 VI. Conclusion Beholden as they are to the voluntary action and agential nature sources of moral requirements rooted in the Kantian self-legislating subject, traditional accounts of moral responsibility simply do not have the resources to explain responsibilities for structural oppression. Responsibility as grounded in relationships starts from recognition of social embeddedness as itself generative of moral demands and constraints. A relational understanding of responsibility offers tools needed to understand and explain responsibility for structural oppression. This applies to professional responsibility for structural oppression as well. Looking ahead, the next chapters will present structural competency as an approach to professional ethics education that builds out the theoretical and practical framework addressing these professional responsibilities in relation to oppressive structures in specific professional fields. 114 CHAPTER FOUR: How Structural Competency Can Incorporate Attention to Structural Oppression into Professional Ethics Education In this chapter, I will present structural competency and explain how this conceptual framework can incorporate due attention to structural oppression into professional ethics education and mitigate the failures identified in Chapter One. The structural competency approach is an emerging model for attending to structural considerations in ethics education. Based in health care ethics literature, this model considers dealing with structural oppression as it manifests in a particular field as a basic competency for professionals in that field. In this chapter I will review the origins of the structural competency model in medical ethics. Next, I examine structural competency’s expanding influence to health education more broadly. After that, I analyze and assess the sole example to date of adapting the structural competency model beyond health education to other fields. Next, I analyze the relationship structural competency holds to the professional ethics landscape and to cultural competency. Lastly, I argue for my generalized adaptation of structural competency, articulating three key features of the model which serve as a template for developing learning outcomes in Chapter Five. I. The Origins of the Structural Competency Model in Medical Ethics Helena Hansen, Dorothy E. Roberts, and Jonathan Metzl created the structural competency model and published a number of works on the topic in medical ethics literature. Metzel and Hansen published a seminal article laying out this new approach in early 2014.394 An article by Roberts and Metzl followed close after in late 2014 connecting the new approach to the long history of Black feminist work on structural racism in medicine. Roberts, author of the influential 1997 book Killing the Black Body: Race, Reproduction, and the Meaning of 394 Metzl and Hansen, “Structural Competency.” 115 Liberty,395 illustrates how the structural competency framework makes the case in a new way for the need for medical professionals to engage with structural racism. A flurry of publications quickly carried forward the work of these twin founding texts. This section will examine each founding article in turn to pull out key aspects of the structural competency model as it was introduced in the medical field. “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality” appeared in Social Science & Medicine in February 2014. Authors Metzl and Hansen coined the term structural competency, which they define as: “The trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases…also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health.”396 Metzl and Hansen identify the set of skills that comprise structural competency, illustrate the importance of those skills, and argue for their incorporation in medical education as a necessary competency for effective practitioners. To locate structural competency within the many competencies medical professionals are expected to develop, Metzl and Hansen present structural competency in relation to cultural competency, describing it as “an evolving discourse that redefines cultural competency in structural terms.”397 The definition is careful to frame structural competency as a solution to a significant gap in the current cultural competency approach. Metzl and Hansen write, “stigma in 395 Roberts, Killing the Black Body. 396 Metzl and Hansen, “Structural Competency.” 397 Metzl and Hansen, 129. 116 clinical encounters needs to be addressed in the institutions and social conditions that produce the markers of exclusion that we call stigma, as well as in on-the-ground encounters.”398 Here Metzl and Hansen identify that structural competency operates on a different level of intervention than cultural competency: structural and systemic rather than cultural and interpersonal. This is not to dismiss the importance of addressing bias and stigma in interpersonal clinical encounters. Rather, illuminating a missing dimension of analysis makes space for tools like structural competency to directly address the gap, incorporating more necessary resources to address the broader landscape of the injustices at work. Instead of offering a definition of structure, Metzl and Hansen describe some of what structural analysis invokes, including the physical infrastructure serving a community, environmental context, diagnostic and bureaucratic frameworks, and even assumptions embedded in linguistic practices. The central metaphor for structure in their definition of structural competency is that of a stream; upstream, higher-level inputs have downstream effects, which may seem distant from each other, but are causally connected in a way that can be tracked. The analogy to water quality is especially appropriate in discussing health effects. Just as contaminated water can be traced upstream to the source of contamination, health disparities in a community can be traced upstream to social and structural determinants like failing infrastructure, poverty, or redlining. The skill set prescribed by structural competency is about tracking the connections between health conditions that appear at the clinical level to systemic factors up the causal stream. In introducing their five core competencies, Metzl and Hansen call out interdisciplinarity 398 Metzl and Hansen, 129. 117 as central to their methodology, invoking academic work on structure from a variety of disciplines. The five core competencies are as follows: 1. Recognizing the structures that shape clinical interactions. 2. Developing an extra-clinical language of structure. 3. Rearticulating ‘cultural’ presentations in structural terms. 4. Observing and imagining structural intervention. 5. Developing structural humility.399 Metzl and Hansen explain the first competency by illustrating how structural thinking would track influences “from beyond the exam-room walls”400 on a case study of a clinical interaction. This may involve attention to insurance policies, the economics of pharmaceuticals, and government regulations and incentives, among many others. The second competency seeks to expand medical education’s attention to unpacking the “social” in the social determinants of health. Too often, Metzl and Hansen argue, medical professionals aware of social determinants of health end up treating the social as “a monolithic or immutable force that functions beyond the reach of medical imagination or expertise.”401 This competency gives medical professionals tools to make sense of the complex social systems and failures that lead to complex social and health problems. This leads into the third competency, applying the expanded sense-making tools to reframe “cultural” presentations in structural terms. This can allow medical professionals to see how “cultural” barriers often arise as a manifestation of larger structural forces. The fourth competency, focused on structural intervention, turns from understanding to action. Once medical professionals have developed the skill of identifying decisions, policies, or moments 399 Metzl and Hansen, “Structural Competency.” 400 Metzl and Hansen, 132. 401 Metzl and Hansen, 135. 118 upstream that have health impacts, they can begin to make structural interventions to address those inputs at the source. Historical examples can provide roadmaps and strategies. Metzl and Hansen offer an example of medical students who created a social enterprise program to deliver food to minority and low-income patients who live in food deserts after they noticed that the food deserts contributed to patient “noncompliance” with the directive to take medication after eating. The fifth competency clarifies the nature of the set of competencies. Metzl and Hansen are very clear that structural competency is not mastery of all structures of oppression and their impacts on professional practice. The skill of tracking downstream effects back to upstream inputs inherently requires recognition of the complexity of the structures operating in society. Structural humility acknowledges the limitations of analysis, noting that there is always more to learn and structures are always themselves evolving. Structural competency skills are necessary, but they are a starting point rather than an end in themselves. In September 2014, Metzl and Roberts published “Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge” in the American Medical Association Journal of Ethics.402 Roberts joins Metzl to connect interdisciplinary work on structural racism in fields like law, public health, history, and sociology403 with the emerging framework of structural competency. Metzl and Roberts describe the goal of structural competency as “increasing clinician recognition of the health-related influences of institutions, markets, and health care delivery systems.”404 While increased attention to race-based health disparities is important, it can go awry without structural context. Metzl and Roberts write, 402 Metzl and Roberts, “Structural Competency Meets Structural Racism.” 403 Metzl and Roberts, 675. 404 Metzl and Roberts, 675. 119 “Locating medical approaches to racial diversity solely in the bodies, backgrounds, or attitudes of patients and doctors, therefore, leaves practitioners unprepared to address the biological, socioeconomic, and racial impacts of upstream decisions on structural factors such as expanding health and wealth disparities.”405 Thus, structural competency offers tools to navigate the complexities of race in clinical encounters, while scholarship on race offers interdisciplinary insights to structural competency. Metzl and Roberts explore three historical case studies to illustrate the explanatory and analytical resources that structural competency can bring to complex scenarios: the overdiagnosis of schizophrenia, the unhealthy diet, and the punitive treatment of women who use drugs during pregnancy. The first case examines the dramatic rise in schizophrenia diagnoses for Black men in the 1960s-1980s. When it was discovered that Black men were diagnosed with paranoid schizophrenia five to seven times more often than white men, medical professionals assumed the disparity was due to cross cultural miscommunications.406 However, initiatives to reduce bias to resolve the disparities were not successful. Where interpersonal-level explanations failed, tracing structural influences upstream provides insight. Metzl and Roberts note that the second edition of the Diagnostic and Statistical Manual (DSM), published in 1968, adjusted the diagnostic criteria for schizophrenia. Rather than being cast as a state of regressive emotional disharmony, the DSM-II included indicators like hostility, aggression, and anger.407 Cultural tropes of Black men as aggressive and violent aligned with these altered diagnostic criteria. Metzl and Roberts 405 Metzl and Roberts, 674. 406 Metzl and Roberts, 676. 407 Metzl and Roberts, 676. 120 conclude that the overdiagnosis was not just due to biased doctors or changes in the symptoms of patients; rather, it “reflected a series of structural shifts in the framing of mental illness that incorporated racially and politically inflected terminology.”408 Next, the second case study discusses “compliance” with prescribed diets. Medical professionals frequently applied the idea of noncompliance to members of minority groups or those in lower socio-economic classes. As late as the early 2000s, dieticians listed “the African- American diet” as a risk factor for disease.409 Without a structural lens, interventions focused on changing individual choices or cultural attitudes. Metzl and Roberts show that incorporating the broader socioeconomic context opens up more possibilities for interventions. For example, accessible grocery stores, public transportation, and infrastructure like sidewalks have a significant impact on how possible a “healthy” diet is in a particular area. These upstream structural factors are as much a part of diet noncompliance as is individual choice, and failing to factor them in paints an incomplete picture. The third case study addresses the punitive treatment of women using drugs during pregnancy. Metzl and Roberts describe how a health problem, substance use during pregnancy, was criminalized through The Interagency Policy at the Medical University of South Carolina. Started in 1989, the policy allowed for medical professionals to conduct drug tests on pregnant patients without their consent at the hospital, which served a poor, minority population.410 Those who tested positive were charged with neglect or distributing drugs to a minor. Similar policies were adopted in at least 30 states and were enforced almost exclusively against Black women. The Supreme Court later ruled that such policies unconstitutionally violated the right against a 408 Metzl and Roberts, 678. 409 Metzl and Roberts, 678. 410 Metzl and Roberts, 679. 121 warrantless search.411 The authors cite Roberts’ work on reproductive justice to identify the structural dimensions of the criminalization of this health problem. Roberts traces disparaging myths about “bad” Black mothers as far back as slavery, noting modern riffs on the mythology in the form of Ronald Reagan’s war on “welfare queens.”412 These myths shaped public perception of Black mothers’ culpability for their health challenges and encouraged harsh, criminalizing responses. Roberts identifies another structural factor affecting this case study, citing studies which report that medical professionals were far more likely to report Black patients using drugs during pregnancy than white patients. Further, warrantless drug testing was far more likely to be conducted at public hospitals serving low-income and minority populations than at private hospitals serving more affluent white populations.413 The narrative of “bad” Black mothers carelessly endangering their babies quickly breaks down when contextualized with structural influences like racial stereotyping and selection bias. Metzl and Roberts note that these case studies illustrate how interventions targeted at improving cross cultural communication “will overlook the potentially pathologizing impact of structural factors set in motion long before patients or doctors enter exam rooms.”414 They conclude that structural competency offers a way to apply a more nuanced understanding of the relationships between individual- and population-level forces impacting health outcomes. Metzl and Hansen’s article presents the structural competency model, carves out theoretical space for it in the medical education landscape, and offers core competencies. Metzl and Roberts’ article incorporates the interdisciplinary approach required for structural analysis, 411 Metzl and Roberts, 679. 412 Metzl and Roberts, 680. 413 Metzl and Roberts, 681. 414 Metzl and Roberts, 681. 122 illustrates in-depth examples of how to conduct structural analysis, and establishes the inextricability of race in the set of structures impacting health. II. From Medicine to Broader Health Education At first, structural competency was taken up and applied in medical contexts such as pre- med college programs, medical school residencies, and medical specializations like immunology,415 epidemiology,416 reproductive health,417 and emergency medicine.418 More recently, a burgeoning field of scholarship is taking structural competency further to health fields beyond the medical school pipeline, including nursing,419 dental schools,420 pharmacy programs,421 dermatology,422 psychology423 and psychiatry,424 agricultural health,425 and LGBTQIA+ health.426 Given that the structural competency model emerged from social determinants of health research, it makes sense that most applications of the model have remained within the health sphere. Beyond the numerous papers researching and applying the model to different health fields and subfields, structural competency is increasingly being incorporated into health education programs. In this section, I present three examples of its successful integration with 415 Udemgba et al., “Toolkit for Developing Structural Competency in Health Disparities in Allergy and Immunology Training and Research.” 416 Martínez-Hernáez and Bekele, “Structural Competency in Epidemiological Research.” 417 Downey and Gómez, “Structural Competency and Reproductive Health.” 418 Salhi et al., “Toward Structural Competency in Emergency Medical Education”; Willging et al., “Structural Competency in Emergency Medicine Services for Transgender and Gender Non-Conforming Patients”; Zeidan et al., “A Structural Competency Framework for Emergency Medicine Research.” 419 Woolsey and Narruhn, “Structural Competency”; Torres, “An Evaluation of a Structural Competency Training for School Nurses”; Orr and Unger, “The TOLERance Model for Promoting Structural Competency in Nursing.” 420 Alarcon et al., “Bringing Structural Competency to the Forefront of Dental Education.” 421 Avant and Gillespie, “Pushing for Health Equity through Structural Competency and Implicit Bias Education”; Hsia et al., “Implementation and Evaluation of a 10-Week Health Equity Curriculum for Pharmacy Students.” 422 Lester and Taylor, “Incorporating Structural Competency Into Dermatologic Curricula—Reply.” 423 Hunt, “On the Need for Structurally Competent Counselling and Psychotherapy.” 424 Rohrbaugh et al., “Allying with Our Neighbors to Teach Structural Competence”; Bailey, “Psychiatric Formulation and the Structural Determinants of Mental Health.” 425 Bendixsen, Ramos, and Holmes, “Structural Competency and Agricultural Health and Safety.” 426 Johnson, “Tipping Points and Shifting Expectations”; Donald et al., “Queer Frontiers in Medicine.” 123 health education programs: an interdisciplinary pre-health major at Vanderbilt University, a residency track within the Yale University Department of Psychiatry, and a California family medicine residency program facilitated by the Structural Competency Working Group. First, at Vanderbilt University, an interdisciplinary pre-health program called Medicine, Health, and Society (MHS) was reformulated around structural competency as an orienting framework beginning in 2013. The undergraduate major weaves together traditional medical education with interdisciplinary course offerings including sociology, critical race theory, urban planning, anthropology, economics, epigenetics, and other fields.427 Metzl et al. developed an assessment tool, the Structural Foundations of Health Survey, to comparatively assess outcomes of a major centered on structural competency and traditional premedical tracks. Metzl et al. offered the survey to seniors graduating from the revised MHS program, as well as seniors graduating from traditional premedical tracks.428 The data suggested that students graduating from the interdisciplinary pre-health program demonstrated more advanced skills in identifying and tracking how structures influence health outcomes, and the level of skill demonstrated rose in proportion to the number of courses taken within the program.429 Metzl et al. report, “MHS students showed enhanced ability to diagnose issues such as structural determinants of health and structural stigma while at the same time also demonstrating deeper self-critical understandings of the ‘cultural’ components of cultural competency.”430 The MHS program is significant as a successful program integrated into the offerings of a R1 institution. 427 Metzl, Petty, and Olowojoba, “Using a Structural Competency Framework to Teach Structural Racism in Pre- Health Education.” 428 Metzl, Petty, and Olowojoba, 192–93. 429 Metzl, Petty, and Olowojoba, 199. 430 Metzl, Petty, and Olowojoba, 199. 124 Second, the Department of Psychiatry at Yale University developed the Yale Structural Competency Curriculum Initiative (YSCCI) as a training seminar offered to all psychiatry residents in their second year of the program.431 The faculty leading the Psychiatry residency program began developing the seminar due to their belief that “residents also needed to understand the barriers patients faced when attempting to be healthy.”432 The seminar focused on the neighborhood level, aiming to illustrate for residents the structural barriers to health that can manifest in neighborhoods and encourage critical thinking about ways to support overcoming those barriers.433 After finding that several cohorts participated in the neighborhood-focused seminar without interacting with people living in their assigned neighborhoods, Rohrbaugh et al. report that the seminar evolved. The leadership reoriented the experience so that residents could “learn about the neighborhoods through the perspectives of individuals living in the neighborhood.”434 The revised version of the seminar takes place on three non-consecutive days over the course of one semester. An evening team building exercise broke the ice and helped residents gain confidence in using language describing health disparities, their consequences, and social identifiers. The second part involved small groups spending a day immersed in a New Haven neighborhood with residents of those neighborhoods as guides. The community members participating shared their experiences, bringing the landscape to life.435 The seminar is capped off with a session in which the small groups discuss their experiences and prepare brief presentations about the structural barriers that stood out in their assigned neighborhood.436 Program leadership conducts focus groups with both residents and the participating community members after the 431 Rohrbaugh et al., “Allying with Our Neighbors to Teach Structural Competence,” 160. 432 Rohrbaugh et al., 160. 433 Rohrbaugh et al., 160. 434 Rohrbaugh et al., 160. 435 Rohrbaugh et al., 162. 436 Rohrbaugh et al., 163. 125 seminar to assess and further hone the seminar.437 Rohrbaugh et al. report that the seminar successfully educates residents about community structures, resources, and barriers.438 Third, the Structural Competency Working Group (SCWG) has developed structural competency trainings for medical professionals based on Metzl and Hansen’s work. Based in Oakland, California, SCWG is a collective of academics and medical professionals that actively offers structural competency trainings to medical professionals in the Bay Area.439 In 2016, the group published the results of a successful pilot program with a cohort in residency for family medicine. Three years later, Neff et al.440 published their revised training curriculum alongside more extensive assessment of the learning outcomes. As of October 2019, the group had run the four-hour training over 75 times.441 Chapter Five will examine the SCWG’s work in more depth as a model for applications of my generalized model of structural competency. These three examples of health education programs incorporating structural competency demonstrate the successful expansion and implementation of structural competency approaches. III. Beyond the Health Professions A 2023 article by Whitman and Jayakumar442 represents the first extension of structural competency beyond health fields, in this case to higher education and student affairs. The approach Whitman and Jayakumar take to adapting the structural competency model and applying it to a non-health field is quite illuminating, and a close examination of their approach will offer insights on my endeavor to broaden structural competency out beyond specific health contexts. 437 Rohrbaugh et al., 164. 438 Rohrbaugh et al., 166. 439 Neff et al., “Structural Competency,” 2. 440 Neff et al., “Structural Competency.” 441 Neff et al., 3. 442 Whitman and Jayakumar, “Structural Competency.” 126 Whitman and Jayakumar situate their project in the ongoing history of racial oppression in U.S. institutions of higher education. They write, “The legacy of U.S. chattel slavery persists through ongoing projects as well as institutional infrastructures.”443 Critical race theory (CRT) guides this adaptation of structural competency to higher education, which focuses on “building capacities toward understanding structural racism [to] enable more effective student affairs practices in support of BIPOC students thriving.”444 Whitman and Jayakumar note that structural competency’s ability to increase “recognition of the upstream decisions that make higher education institutions inaccessible, hostile, and inequitable for BIPOC students”445 is valuable for both student affairs professionals and university administration. After discussing the limitations of cultural competency in higher education, Whitman and Jayakumar discuss how structural competency could be integrated into established student affairs competencies. The Professional Competency Areas for Student Affairs Educators, set by professional organizations and used to determine accreditation for graduate programs in student affairs, cover a range of content areas and include a separate social justice competency.446 Whitman and Jayakumar critique this segregation of discussion of oppression from other competencies like history, ethics, policy, and assessment, noting that: “BIPOC students are not only marginalized in higher education at diversity trainings or social justice events, but also through structural forces: the policies, institutions, infrastructure, and the hegemonic beliefs embedded in our economic, social, and political systems, with which our students interact every day.”447 443 Whitman and Jayakumar, 2. 444 Whitman and Jayakumar, 3. 445 Whitman and Jayakumar, 3. 446 Whitman and Jayakumar, 4–5. 447 Whitman and Jayakumar, 5. 127 Structural forces of racial oppression pervade every area addressed by the student affairs competencies, so discussion of those topics on their own is incomplete. They argue for structural competency as the core of the ten student affairs competencies, illustrating the relationship with structural competency as the center of a flower and the ten existing student affairs competencies as petals surrounding the core.448 As Whitman and Jayakumar adapt Metzl and Hansen’s core competencies from medicine to student affairs, they emphasize the centrality of race. “Cultivating structural competency is not possible without centering race and racism.”449 While cultural competency encourages individual-level strategies and responses, structural competency illuminates how “BIPOC student vulnerabilities are often connected to structural violence.”450 Structural competency fosters skills in recognition and assessment of structural vulnerability. This is tremendously practical for student affairs professionals, who have the role of being “primary institutional agents tasked with identifying and intervening when a student can benefit from additional services offered by the campus and external community.”451 Whitman and Jayakumar adapt each of Metzl and Hansen’s competencies through a CRT lens, and I posit that CRT functions in their student affairs adaptation as the social determinants of health function in the medical version of structural competency. Each is a well-established theoretical tool in its respective field, offering structural competency extensive material to operationalize in a new way for professionals. The first competency identified by Metzl and Hansen is about identifying ways that structures shape clinical encounters. For student affairs, Whitman and Jayakumar identify CRT as a conceptual tool that assists in tracking racial oppression upstream from individual student 448 Whitman and Jayakumar, 5. 449 Whitman and Jayakumar, 6. 450 Whitman and Jayakumar, 6. 451 Whitman and Jayakumar, 6. 128 experiences.452 The skill they identify to be developed with this first competency is being able to recognize “how racialized structures shape student-practitioner relations and interactions.”453 Metzl and Hansen’s second competency focuses on understanding structure beyond the clinic. Whitman and Jayakumar apply this to student affairs by appealing to interdisciplinary work on CRT that offers analysis of intersecting oppressions.454 They write, “Cultivating racial literacy in student affairs practitioners means they will be better poised to develop an extra-clinical (or in our case, extra-student affairs) language of structure, centered on racial justice.”455 The third competency which Metzl and Hansen identify involves reframing “cultural” factors in structural terms. Whitman and Jayakumar identify reformulating cultural presentations that rely on deficit assumptions as the key to adapting this competency to student affairs, pushing practitioners to look beyond pathologized behaviors to the structural roots of student actions.456 Metzl and Hansen’s fourth competency moves to identifying interventions at a structural level rather than individual or cultural level. In student affairs, Whitman and Jayakumar take this to mean the skill of reimagining “structural interventions that resist white norms, are not top down, and are connected to BIPOC students’ lived experiences and community-based knowledge.”457 They conceptualize the interventions student affairs professionals can collaborate on as harm reduction efforts to mitigate negative impacts of racial oppression on students in the present while working towards longer-term change to upstream problems.458 The fifth competency that Metzl and Hansen articulate promotes structural humility, which Whitman and Jayakumar tailor to higher education by prescribing that practitioners 452 Whitman and Jayakumar, 7. 453 Whitman and Jayakumar, 8. 454 Whitman and Jayakumar, 9. 455 Whitman and Jayakumar, 9. 456 Whitman and Jayakumar, 9. 457 Whitman and Jayakumar, 10. 458 Whitman and Jayakumar, 10. 129 develop “structural humility toward an ongoing critical race praxis.”459 They highlight that structures of racial oppression are always changing. “White supremacy will re-create and re- imagine race when it is challenged, to preserve a racial hierarchy that protects whiteness and the privileges it comes with.”460 Cultivating awareness of racial injustices must be an ongoing practice. Whitman and Jayakumar then extend Metzl and Hansen’s framework to add a sixth competency centered on structural intersectionality. Informed by CRT and Black feminist scholarship, structural intersectionality centers race “while adding other forms of oppression- informed identity formations” to the analysis.461 Intersecting oppressive structures like class, gender, or cis-normativity compound the marginalizations students experience. Overall, Whitman and Jayakumar’s adaptation of structural competency from the health literature to student affairs is quite successful. Mirroring the ways in which research on social determinants of health functions in the medical version of structural competency, the CRT lens functions in student affairs to identify “the social determinants behind postsecondary education inequities.”462 The CRT lens also maintains the centrality of race in Metzl, Hansen, and Roberts’ work. Whitman and Jayakumar innovated by directly engaging with the professional competencies prescribed by the professional organizations in their field, articulating the specific relationship structural competency should have to those existing competencies. The health education formulations of structural competency tend to speak more broadly and less specifically, so direct engagement with the standards of accreditation for a specific field is not present. However, this move to directly integrate structural competency with the institutions 459 Whitman and Jayakumar, 10. 460 Whitman and Jayakumar, 10. 461 Whitman and Jayakumar, 11. 462 Whitman and Jayakumar, 12. 130 prescribing professional requirements is astute and impactful. One aspect of Whitman and Jayakumar’s adaptation that strikes me as less successful is their choice to tack on structural intersectionality as an extra competency at the end. The intersectionality of oppressive structures is a fundamentally important aspect of understanding the operation and impact of structures in the world. Intersections of oppressive formations are always already present in the world compounding and amplifying each other’s effects. Much as Whitman and Jayakumar suggest that structural competency should be at the center of all of the student affairs competencies, I suggest that their argument would be more effective with structural intersectionality at the core of the competencies they adapt. IV. Structural Competency in Relation to Professional Ethics Education and Cultural Competency This section further analyzes the relationship of structural competency to the current landscape of professional ethics education in general and to cultural competency in particular. In focusing on structures of oppression, structural competency addresses a crucial topic that is largely missing from professional ethics education and clumsily hinted at in cultural competency. Structural competency can address many of the challenges facing professional ethics education at large. Chapter One identified five challenges bedeviling professional ethics education; here I show how structural competency can mitigate or resolve each issue. First, there is the standing problem that ethics is usually tertiary or sidelined in professional education. Structural competency positions its associated skill-building as a necessary competency for responsible professional practice. This centralizes focus on the moral dimensions of the workplace and oppressive structures that shape and produce social formations. Second, ethics educators have worried about how to educate for action for years, and professional ethics is a location of particular concern on this point. It may seem counterintuitive that structural 131 competency can address this concern with its focus on large-scale structures of oppression and upstream inputs quite distant from interpersonal encounters. However, structural competency offers a relentlessly practical orientation. Incorporating structural levels of analysis opens the door to multiple levels of intervention on structural wrongs, highlighting the many points of oppressive structures manifestations as opportunities for action. The second feature of my model will address this further. Third, many students find ethics as taught in professionalization contexts alienating. Structural competency’s examination of the very practical impacts of institutions, policies, and decisions in a field serves to make ethics personal. Shining light on particular oppressive systems and formations in a field is a step towards recognition of those often erased or underrepresented. Fourth, many professionals report a mismatch between what is taught in their required ethics courses or modules and what kinds of dilemmas they actually encounter as practitioners. Ethical theories and principles can come across as too abstract to connect with the complex moral landscape of the workplace. Structural competency offers tools to connect practical dilemmas to larger structures in society, opening up more possible levels of intervention and response to various scenarios. Fifth, ethics education has a significant gap in that it barely mentions discrimination on the basis of race, sex, ability, or other identities. Ethics education at large has not even addressed the gaps that cultural competency was designed to ameliorate. Structural competency goes even further to center interlocking structures of oppression in its picture of professional ethics. Regarding the relationship of structural competency to cultural competency, my view diverges from the position expressed in the original writings of Metzl, Hansen, and Roberts. These authors present the relation between the two models as additive. Metzl and Hansen write, “Again, the aim here is not to ‘replace’ culture or eschew discussions about cultural values 132 between patients and doctors.”463 Metzl and Roberts describe the problem with cultural competency as overlooking relevant factors, for which structural competency can add explanation.464 Metzl, Hansen, and Roberts are careful to avoid rejecting cultural competency or minimizing its usefulness within a limited range, instead focusing on the theoretical space it fails to address, namely, attention to structures. Structural competency was created to directly address this gap, providing tools and skills for professionals to engage with the upstream influences that impact and shape the environment in which they work. Their critiques of cultural competency focus on the idea that it should not be stretched to try to address all kinds of difference or discrimination, but it provides useful tools for interpersonal communication. According to Metzl and Hansen, “[i]n no way does this approach obviate” the importance of the intercultural communication skills cultural competency champions.465 Thus, Metzl, Hansen, and Roberts seem to regard cultural competency as useful for addressing challenges in communicating across difference on an individual level, emphasizing structural competency’s role as filling the gap in addressing the structural level. I argue that an additive view of the relationship between structural competency and cultural competency underestimates the transformative potential of structural competency, which, when properly understood and implemented, subsumes cultural competency. On this point I disagree with Metzl, Hansen, and Roberts. While Metzl, Hansen, and Roberts do acknowledge some of the critiques and limitations of cultural competency, they hesitate to reject it. This may be a strategic or political move as part of the introduction of a new model, aimed at building consensus without alienating proponents of cultural competency who may recognize the 463 Metzl and Hansen, “Structural Competency,” 9. 464 Metzl and Roberts, “Structural Competency Meets Structural Racism,” 8. 465 Metzl and Hansen, “Structural Competency,” 14. 133 utility of a structural competency approach. Such framing may be useful in certain contexts, but it does not hold up on a theoretical level. The additive relation hinges on the sufficiency of cultural competency for addressing the individual, interpersonal level of communication challenges across difference. Based on my assessment of the failings of cultural competency in Chapter One, I echo many others in arguing that cultural competency is not successful even at the individual level. Interlocking oppressive structures permeate every dimension of professional practice, including the individual level of interpersonal interactions. Cultural competency cannot fully address the interpersonal challenges of communicating across difference precisely because difference is not reducible to culture. Cultural competency may help in identifying when difference is in play in interpersonal challenges, but its culture-focused formulation misleads the response. The immediate leap to culture as an explanatory tool encourages attributing things to certain cultures in a way that tends toward stereotyping and can contribute to harmful myths. It can also lead providers to, upon encountering a communication challenge with a patient, to think of culture as a shared set of traits that may be driving behavior while there are other influences shaping behavior that may well be more relevant. To further illustrate the difference structural competency makes in practice compared to cultural competency, I return to the example Metzl and Roberts analyzed of compliance with a healthy diet. In the scenario, a provider is concerned about a working-class Black patient’s lack of compliance with the recommended healthy diet. How would cultural competency and structural competency lead to different outcomes in this case? A provider taking a cultural competency approach looks to “the African-American diet” to explain the lack of compliance with the recommendation. By attributing the “failure” to culture, cultural competency does remove some of the stigma or blame from the patient themself. Unfortunately, it does so at the 134 expense of attributing the negative quality of promoting unhealthy eating to the patient’s culture. Not blaming the patient for lack of compliance is a positive outcome from cultural competency, but it does not provide a useful path forward for treatment. Blaming the patient’s culture may alienate the patient, and the assessment of the patient’s culture may be incorrect or inapplicable to the patient’s actual lived experience of making dietary decisions. A provider with only cultural competency to guide them in this instance might suggest that the patient try using an air fryer instead of eating deep fried chicken as a way of building a bridge to what they assume is an important part of the patient’s culture while still promoting a healthier option. The patient may be rightly offended by the stereotyping and cultural assumptions at play in this suggestion and frustrated by the provider’s attempt to offer advice to them as a member of a cultural group rather than inquiring about their specific obstacles and challenges. Metzl and Roberts astutely apply structural competency to the scenario to identify poverty and lack of infrastructure like sidewalks, public transit, and grocery stores as more relevant and active factors influencing the patient’s diet. The structural constraints on the patient, shaped by decades of racist policies and economic exploitation, dramatically reduce the patient’s ability to successfully follow the provider’s recommendation. But how does this analysis actually help the provider to help the patient? It certainly can help the provider avoid the faux pax of assuming lack of compliance is due to an assumed cultural trait or tradition. It can facilitate the move away from blaming the patient that cultural competency attempts, and instead accurately ascribes blame to the structures of oppression constraining the patient’s options and resources. Recognition of such obstacles can be a way to build trust with a patient. Structural competency leads a provider to ask the patient different questions to understand their specific obstacles to healthy behavior. This may look like nonjudgmental questions about where they get their food, 135 what resources are available in their neighborhood, or how much time they have for preparing meals. This can open up space to discuss small shifts that feel accessible within a limited ecosystem. Patients are often overwhelmed by how impossible fully complying with the recommendation seems in their circumstances, and this can lead to shutting down and closing off of creativity. Taking the time to consider what resources are available may open up small opportunities, allowing the patient to experience agency in decisions about their health where they generally feel constrained by their circumstances. For the provider, this also means shifting perspective on compliance and how that is tracked in patient records. Instead of viewing compliance as a binary condition where the patient either complies or does not comply, it may look like identifying small steps towards a larger goal. It also prioritizes effort over outcomes for measuring compliance with provider recommendations. In practice it should decenter the power structure of compliance away from being a categorization that an authority can weaponize against a patient in the form of refusing referrals, tests, or exploring options until compliance with the original prescription is achieved. Metzl and Roberts offer the example of several health providers working together to set up a delivery program for healthy food to areas without much access. While that level of organizing is commendable, it will not be feasible for all providers, but the interpersonal shifts I have identified can change how a provider approaches any situation where a patient is not taking the steps the provider recommends. V. Features of My Generalized Structural Competency Model My project is the philosophical endeavor of abstracting back from the very concrete formulation of structural competency embedded within the health professions, identifying key features of the model and then using them to generate a basic template for structural competency that can be widely applied to other fields. The central features of a generalized structural 136 competency model offer a blueprint for filling in relevant specifics for the particular fields to which structural competency is adapted. In this section, I articulate the three key features of my generalized structural competency model and briefly present my learning outcomes, which will be further developed in Chapter Five. The first feature of my approach is adopted from Whitman and Jayakumar’s application of structural competency to student affairs: adaptations of structural competency to a particular field should engage with the competencies prescribed by the relevant professional authorities. For student affairs, this meant connecting structural competency to core competencies determined by accrediting bodies for higher educational programs, but this feature need not be limited to higher education. Recall the criteria I proposed for identifying professions in Chapter One: 1) Specialized training, regardless of education level; 2) Having influence on the social world in one’s occupational role; and 3) Discussion of the moral dimensions of social influence in the occupational role as part of the specialized training. Any line of work can have an organizing or governing body that specifies expected competencies and standards of care, and professional responsibilities arise from one’s embeddedness in the social world in their professional role. This feature ensures that structural competency adaptations engage with current best practices or expectations in the field. It paves the way not only for structural competency to make sense to individual practitioners, but also for institutions within a field to adopt and incorporate structural competency into their standards. The second feature of the generalized structural competency model is interdisciplinarity. As a form of professional ethics education, structural competency follows a long tradition of interdisciplinary engagement with specific professional fields. Scholarship on structures ranges across numerous disciplines, and presenting a coherent picture of how structures operate in the 137 world requires engagement with work from Black feminist thought, Indigenous studies, Critical Race Theory, history, sociology, economics, gender studies, and more. Some disciplines have the advantage of already-established frameworks that incorporate these interdisciplinary influences. For instance, student affairs benefits from extensive work on Critical Race Theory recognized as relevant to the field. Whitman and Jayakumar’s project appears less interdisciplinary than much of the health-related structural competency iterations precisely because CRT already has uptake within the discipline, allowing them to more directly operationalize that scholarship in a new way. When such interdisciplinary conceptual frameworks are available internally to a particular field, structural competency should employ those tools, as internal resources can often garner uptake more easily. However, fields which do not have significant internal literature on social determinants of conditions of the field can draw on the external interdisciplinary body of work on structure and begin the process of weaving that work into the field. The work of illustrating what structures are and how they produce downstream effects can certainly be more challenging without internal conceptual tools like the social determinants of health. Still, the relevance of structural competency to a specific field need not be expressed in theoretical and academic terms. Structures show up in direct, observable ways in all areas of life, and anyone can learn the skills of tracking upstream inputs to downstream effects. While the particulars of how structures affect a mechanic or a physician differ, the structural level is no less present in one or the other, and structural competency provides a more complete picture of the moral dimensions of the workplace. Rounding out the three features of my generalized structural competency model is intersectionality. Black feminist scholarship on the interlocking nature of oppression is at the heart of structural competency. The forces shaping individual experiences cannot be isolated 138 from each other, and Black feminist work on structure demands attention to the connections while centering race. Structural competency would not exist without Roberts’ work on reproductive justice and systems targeting the health of Black women. This feature takes up the in-depth examination of Black feminist conceptions of structure from Chapter Two. It is also worth noting that discussing intersectionality and structural competency together can help address a common misconception about intersectionality. Some have critiqued intersectionality as only addressing individual social identities.466 This is a misunderstanding of intersectionality, which centrally engages with structures. Unfortunately, this misconception has become a mainstream understanding of the concept. Presenting intersectionality in conjunction with structural competency can help to correct these widespread misunderstandings and emphasize the central focus intersectionality places on analyzing systems of oppression and power. To sum up, my generalized model of structural competency features intersectionality, interdisciplinarity, engagement with existing professional standards, and identification of the gap in professional preparation which structural competency addresses. These features feed into the following set of adaptable learning outcomes for structural competency, which will be analyzed in Chapter Five: 1. Identify and understand interlocking structures of oppression. 2. Identify how oppressive structures operate in relevant institutions and policies. 3. Identify how oppressive structures influence individuals and their material circumstances. 4. Generate strategies for responding to oppressive structures in professional settings. 5. Generate strategies for responding to oppressive structures outside professional settings. 6. Explain and practice structural humility. 466 Downing, “The Body Politic.” 139 VI. Conclusion In conclusion, the structural competency framework addresses the challenges facing professional ethics by incorporating attention to structural oppression. From its origin in medical ethics, structural competency has developed as an evolution of cultural competency and been adapted to a variety of health fields and even beyond the health professions to higher education and student affairs. This chapter analyzes the relationship between structural and cultural competency before abstracting toward a generalized model of structural competency which can be applied to a variety of professional fields. 140 CHAPTER FIVE: Guidelines for Incorporating Structural Competency into Professional Ethics Education Curricula This chapter offers guidelines for implementing a structural competency model in professional ethics education curricula. Metzl and Hansen have created outcomes for training in medical ethics, and I adapt their work for professional ethics education in general. Section I presents learning outcomes, Section II describes delivery formats, Section III addresses student engagement, Section IV discusses assessment, and Section V considers the political context. I. Learning Outcomes Identifying learning outcomes is crucial for creating an effective educational program. Learning outcomes provide standards to evaluate student progress, as well as benchmarks for assessing the program itself. The learning outcomes presented in this section build on learning outcomes adapted from Jonathan Metzl and Helena Hansen and used by the Structural Competency Working Group. My generalized learning outcomes expand beyond the health professions for broader use and include an example of applying the general set to a specific professional field. In their groundbreaking paper “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality,” Jonathan Metzl and Helena Hansen laid out the paradigm of structural competency for medical education. They define structural competency as: “[T]he trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases…also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health.”467 467 Metzl and Hansen, “Structural Competency,” 5. 141 For this medically-focused definition, they proposed five core competencies: 1. Recognizing that structures shape clinical interactions.468 2. Developing an extra-clinical language of structure.469 3. Rearticulating “cultural” presentations in structural terms.470 4. Observing and imagining structural intervention.471 5. Developing structural humility.472 This set of five competencies is not framed precisely as a set of learning outcomes, but can be easily translated to that format. The Structural Competency Working Group (SCWG) developed structural competency trainings for health professionals based on Metzl and Hansen’s work. Based in Oakland, California, SCWG is a collective of academics and medical professionals that actively offers structural competency trainings to medical professionals in the Bay Area.473 SCWG understands structure as follows: “In this context, structural refers to social and economic policies; laws regulating the distribution of health and social resources; and social stratification based on race, ethnicity, religious affiliation, immigration status, ability, gender identity, sexual orientation, and so on.”474 Adapting the definition of structural competency provided in Metzl and Hansen’s essay, SCWG operates with this definition: “we define structural competency as the capacity for health professionals to recognize and respond to health and illness as the downstream effects of 468 Metzl and Hansen, 6. 469 Metzl and Hansen, 7. 470 Metzl and Hansen, 9. 471 Metzl and Hansen, 11. 472 Metzl and Hansen, 12. 473 Neff et al., “Structural Competency,” 2. 474 Neff et al., 2. 142 broad social, political, and economic structures.”475 SCWG first published its learning outcomes in a review of the first three years of conducting trainings. 1. 2. 3. 4. 5. Identify the influences of structures on patient health. Identify the influences of structures on the clinical encounter. Generate strategies to respond to the influences of structures in the clinic. Generate strategies to respond to the influences of structures beyond the clinic. Describe structural humility as an approach to apply in and beyond the clinic.476 Neff et al. reported two significant themes from assessment data collected one month after the trainings (n=32). Participants indicated that the training influenced “their attitudes and their clinical practice in the weeks after the training,” improving their ability to build relationships and partnerships with patients.477 Second, participants felt overwhelmed by their “increased recognition of structural influences on health,” asking for more practical strategies and ideas for taking action.478 Three years later, Neff et al.479 published their revised training curriculum alongside more extensive assessment of the learning outcomes. As of October 2019, the group had run the four- hour training over 75 times.480 Evaluation for the training included “both process and knowledge assessment components”481 and employed qualitative, written-response, and open-ended questions.482 Overall, the results show students demonstrating measurable progress and success in meeting these outcomes. Neff et al. noted three primary themes in the data (n=275). First, 475 Neff et al., 3. 476 Neff et al., “Teaching Structure,” 430–31. 477 Neff et al., 431–32. 478 Neff et al., 432. 479 Neff et al., “Structural Competency.” 480 Neff et al., 3. 481 Neff et al., 5. 482 Neff et al., 5. 143 “participants valued the training’s focus on application of the structural competency framework in real-world clinical, community, and policy contexts.”483 Second, participants that had clinical experience indicated that “the training helped them reframe how they think about patients, away from blaming and other possible misconceptions.”484 Third, “participants reported feeling reconnected to their original motivations for entering the health professions.”485 In response to the earlier feedback of some participants leaving the training feeling overwhelmed, SCWG revised the third module of the curriculum to offer more practical steps for moving forward. Neff et al. report that “findings from our evaluation of subsequent sessions suggest that these modifications helped participants feel more empowered and less distressed upon completing the training.”486 The learning outcomes developed and tested by the SCWG are a proven foundation to build on. While focused on health professions, the format of the outcomes can be adapted for a general professional audience. I offer the following generalized set of learning outcomes. This set can then be edited for more specific details of a particular profession. 1. 2. 3. Identify and understand interlocking structures of oppression. Identify how oppressive structures operate in relevant institutions and policies. Identify how oppressive structures influence individuals and their material circumstances. 4. Generate strategies for responding to oppressive structures in professional settings. 483 Neff et al., 6. 484 Neff et al., 6. 485 Neff et al., 6. 486 Neff et al., 7. 144 5. Generate strategies for responding to oppressive structures outside professional settings. 6. Explain and practice structural humility. The first learning outcome should familiarize students with the fact that structures of oppression intersect; they cannot be understood apart from each other. Many professionals may doubt the very existence of these structures, so first understanding their interconnected existence and impact in society is a prerequisite to analyzing the structures’ impact on specific professional contexts. On the other hand, many other students have personal experiences of oppression. These students can still gain further insight regarding the interlocking nature of structures of oppression, since there will always be types of oppression that are beyond the lived experience of a particular individual. This learning outcome should also illustrate the ways that the interlocking systems of oppression respond dynamically to changing circumstances. Historical analysis is required to trace the interactions and evolutions of the oppressive structures. This first learning outcome is not included in the SCWG’s set of learning outcomes. However, careful attention to interlocking structures of oppression is a pervasive throughline of its curriculum. For my purposes of developing a generalized set of outcomes that can be adapted for specific fields with more detailed curricula following, it is important to specifically identify the interlocking nature of oppressive structures as a foundational concept. The second learning outcome encourages students to track the mechanisms by which oppressive structures operate in the institutions and policies of their profession. This institutional-level view narrows the focus from the general, society-level scope presented in the first outcome. This outcome aims to make students aware of the political nature of the institutions, organizations, and policies that organize their professions. Examining the history of 145 institutions is again vital for identifying the ways oppressive structures shape the professional context. Tracking harms and wrongs caused by oppressive structures at the very foundations of relevant institutions is necessary for the generative work of outcomes four and five. The third learning outcome further narrows the scope down to impacts on individuals and their material circumstances. This outcome works to disrupt assumptions and narratives about people’s material conditions that do not account for the reality of structural oppression. This outcome equips students to recognize the ways structural oppression affects people and to avoid incorrectly blaming individual choices for structural impacts. The fourth learning outcome shifts the focus from theory to application and to response to the content of the first three outcomes. As students reflect on how to incorporate attention to oppressive structures in their habits and practices, they start learning how to push back against these structures. This requires studying models and strategies that have worked in the past, and brainstorming how to incorporate them into the students’ particular contexts. Identifying concrete actions that can be taken and practical strategies for addressing oppressive structures in daily professional life is a crucial step. The fifth learning outcome broadens the generative task to contexts beyond direct, individual interactions. The focus moves from interpersonal interactions to the larger community setting. This requires attention to institutional and policy considerations that have direct and indirect impacts on the relevant professional sphere. Just as oppressive structures are not limited to the workplace, the responsibility to resist them extends to broader community, political, and societal contexts. The sixth learning outcome is aimed at transforming student dispositions and behaviors. A frequent theme in ethics education literature is how to teach students ethical behavior. Many 146 criticisms of ethics training for professionals express concern that ethics education is limited to knowledge acquisition, and that learning about ethical principles and theories will not create more ethically responsible professionals. Action-oriented outcomes are considered to be very important in ethics education literature. Beginning to practice the virtue of structural humility is a long-term process. This outcome highlights that dealing with oppressive structures is not just mastery of facts; it requires awareness of positionality and commitment to personal transformation. To illustrate how my generalized learning outcomes can be tailored to specific professional fields, I offer a version adapted for the field of library science used in my work in an academic library. 1. 2. Identify and understand interlocking structures of oppression. Identify how oppressive structures operate in the American Library Association, the Library Bill of Rights, and political and institutional governance of libraries. 3. Identify how oppressive structures materially impact significant demographics of library patrons, including unhoused populations, children, low-income individuals, non-native English speakers, and people of color. 4. Generate strategies for responding to oppressive structures in professional contexts like the policies for professional organizations, institutional rules about access to public spaces, and approaches to fines and fee structures. 5. Generate strategies for responding to relevant oppressive structures beyond the walls of the library, like advocacy for diversity in publishing, resisting book 147 bans or “Don’t Say Gay” and anti-Critical Race Theory legislation, and reference support for incarcerated individuals not served by public libraries. 6. Explain and practice structural humility. This applied set of learning outcomes identifies important features of the library profession throughout. An even more detailed set of learning outcomes could be fine-tuned to address the differences between the context of public libraries and academic libraries, but this set covers elements that the library profession shares in common. II. Delivery Formats Structural competency training can be delivered in a number of formats. The five addressed here are intensive workshops, a series of shorter workshops, a module or unit in an ethics course, modules integrated across a program of study, and a standalone ethics course. Intensive workshops are the most established and successful method. In the healthcare profession, the Structural Competency Working Group uses this format exclusively. This approach covers three modules over four hours. For the SCWG, instruction time includes presentation of information from the facilitators, group activity work, and individual reflection and writing.487 The activity work is crucial to the pedagogy because it allows practice and application of the skills being developed. An example of an exercise used by the SCWG is the arrow diagram exercise. This exercise introduces a case study of a patient in an emergency room, directing participants to identify stigmatizing language in the case, which was adapted from clinical encounters. The facilitator then provides further background on the life experiences of the patient, and participants map out the trajectory of the patient’s life that brought them to the 487 Structural Competency Working Group, “Training Curriculum: Background Information,” in Structural Competency: A Framework for Recognizing and Responding to Social, Political, and Economic Structures to Improve Health, https://structcomp.org/wp-content/uploads/2023/06/A.-Manual-Background-Info.docx.pdf. 148 emergency room along an arrow diagram. Then the participants work together to identify structural influences along the trajectory that contributed to the current situation.488 The second delivery method is a series of shorter workshops. This was the method selected for my work with the University of North Carolina Chapel Hill Libraries as part of the Engaged Philosophy Internship Program at Michigan State University. This format is a series of three, one-hour workshops. The series mirrors the three modules in the intensive workshop format, distilling the content down into shorter delivery. A benefit of this approach is that the series can be more easily incorporated into the existing flow and scheduling of businesses or organizations. Additionally, since the workshops are spaced out, it allows participants more time to reflect and digest the content between sessions, which can have a deeper impact. The challenge of this format is that not as much content can be covered, and participants will have less time to practice and apply their new skills. There is potential for this to be mitigated by ongoing application workshops, providing professionals opportunities to gather and apply the skills they have learned to a case study about a current issue in the field or organization. Ongoing workshops would only be open to those who have completed the initial three workshop series. The feasibility of this depends on organizational culture and the amount of uptake the structural competency approach achieves in the workplace. These workshops could fit into ongoing professional license renewal requirements, which often include ethics components. Many professionals complain that existing ethics courses or workshops have very little bearing on their actual day-to-day work,489 so structural competency presents an interesting opportunity to make existing requirements more useful. 488 Neff et al, Appendix L, Participant Workbook. 489 Millstone, “Teaching Medical Ethics to Meet the Realities of a Changing Health Care System,” 214. 149 The third delivery format is located in college training for future professionals as a module or unit in an ethics course. As discussed in Chapter One, the vast majority of ethics education in colleges does not address issues of structural oppression, and when these matters do arise, it is almost always as case studies. In these scenarios, structural oppression is rarely presented as theoretically significant for how students should approach and think about ethics. The most common format includes units on deontological ethics, consequentialist ethics, and virtue ethics, with feminist care ethics occasionally included. Beauchamp and Childress’s Four Principles approach is another popular unit. Structural competency can be incorporated into ethics classes in a similar manner. A college syllabus and classroom is a markedly different context from workshops in the workplace. Often, these courses will have a bit more emphasis on the theoretical side of things. The unit would still include activities, participatory work, and application; however, these aspects would make up less of the time than they do in the workshops. Another difference is the ability to assign required readings. Workshops, when they do have assigned reading, keep it short and tight due to the context. In the college classroom, a structural competency unit can delve into the literature about structural competency as well as literature that addresses structural issues in the particular professional field at hand. Academic work also allows for more long-form assessment, which is both useful for the students in internalizing the skills and useful for meta-reflection on the effectiveness of the module. The fourth delivery format is structural competency integrated into multiple college courses across a curriculum. This method could be incorporated into existing Ethics Across the Curriculum (EAC) programs. A version of this delivery format has been implemented in an interdisciplinary pre-health major at Vanderbilt University called Medicine, Health, and Society (MHS). After rapid growth in the first few years of the major, MHS faculty reworked the major 150 to put structural competency at the core of the program.490 While the majority of premed students at Vanderbilt continued in traditional premedical majors, the existence of an alternative centered around structural competency created opportunity for comparative assessment. While the assessment tools used to accomplish this task will be discussed in a later section, it is worth noting that the study resulted in findings that MHS graduates “identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors and first-term freshmen.”491 The study also found that the analytical skills in identifying nuanced understandings of structural bases for various outcomes rose “in direct proportion to the number of MHS courses taken.”492 The fifth delivery format, also located in college training for future professionals, takes the form of a standalone ethics course. In contrast to the previous example of a unit within an ethics course, a standalone course allows for deeper engagement with the topic of structural competency. Having more time to explore the context, delve into the details, and practice applying the principles to real-life examples can improve retention. It also affords the opportunity to more closely examine the historical context of a profession and the intricacies of the ways that oppressive structures interlock and evolve. A point against this approach is the relative difficulty in adding a course in many university contexts, which can be mitigated by introducing the course as an entry under a special topics heading. However, the corresponding challenge of this course as an elective is generating interest and maximizing impact by reaching a significant number of future professionals. Ideally, a standalone course could be added to the requirements or limited electives for a professional program. This would address the problem of 490 Metzl, Petty, and Olowojoba, “Using a Structural Competency Framework to Teach Structural Racism in Pre- Health Education,” 191. 491 Metzl, Petty, and Olowojoba, 199. 492 Metzl, Petty, and Olowojoba, 199. 151 exposing students to training that is necessary for their professional practice. Ruth et al.493 tested the efficacy of a standalone structural competency course. The course was an upper-level pre- health course students could select as an elective, and the content was designed around the core competencies identified by Metzl and Hansen. Assessment was conducted via pre-tests and post- tests at the beginning and end of the course (n=27) evaluating student ability to identify structural inequalities. Ruth et al. “were able to detect pre-/post-test differences in the number of times students identified structural reasons for the disparities,”494 with the post-test mean being statistically significantly higher than the pre-test mean.495 This study suggests that a standalone course can be an effective delivery method for structural competency training. While it is significantly more difficult to create a standalone course and add it to program requirements, the challenge of implementation matches the potential payoff. III. Student Engagement Structural competency training necessarily requires significant student engagement. While the training can take different formats, interaction and conversation feature prominently in all of them. This section considers factors that impact student engagement, including the facilitator’s role in different contexts, difficult student emotions, and a practical orientation. Different contexts require different approaches to implementing structural competency training. For instance, the role I would play running a structural competency training for a corporation would be markedly different from the role as a guest lecturer in a business ethics class. Sometimes structural competency training will fit best as an instruction module in a classroom or in a professional seminar, but the format should fitr the organization’s particular 493 Ruth et al., “Structural Competency of Pre-Health Students.” 494 Ruth et al., 332. 495 Ruth et al., 335. 152 needs. Sometimes the particular need would be for a facilitated workshop. A necessary step in practicing this kind of engaged philosophy, for my project in particular, will be taking professional facilitation training. While academics often develop some of the skills necessary for effective facilitation through teaching college courses, there are some important differences.496 Pedagogical and interpersonal approaches differ in varying contexts. One important difference between the roles of a facilitator and an instructor is authority. Generally speaking, the instructor role is structured more hierarchically than facilitation. Facilitation functions more horizontally, taking leadership in guiding conversations and holding space for communication. Instruction relies on expertise, which is structured around different levels or types of knowledge held by those in different positions. This positionality difference is crucial to bear in mind when crafting approaches to training. Presuming an instructor’s authority while inhabiting a facilitation role will create friction or undermine the success of the collaborative exploration. An inevitable feature of teaching structural competency is that the content will elicit a range of emotional reactions from participants or students. This can range from the feelings of being overwhelmed or discouraged identified as a challenge by Neff et al.497 to antagonistic or defensive responses. Examining the structural foundations of various large-scale problems and injustices is challenging and emotional work, and students may respond to their discomfort with denial, defensiveness, pessimism, or outright hostility. Managing these situations requires careful planning and clear boundaries. It is essential to establish firm ground rules about safety and respect up front to lay the groundwork for constructive communication.498 For instance, misgendering and holocaust denial are harmful and not compatible with respectful dialogue. 496 Luguetti, Oliver, and Parker, “Facilitation as an Act of Love.” 497 Neff et al., “Teaching Structure,” 432. 498 Garcia, Crifasi, and Dessel, “Oppression Pedagogy.” 153 Some content in itself is offensive, not just tone or delivery, and that content will not be tolerated. Any training that addresses issues related to structural competency runs the risk of subjecting marginalized participants to harm when ignorant or hostile colleagues make objectionable comments. The facilitator’s responsibility is to manage discussion in a productive way so that marginalized participants are not placed in the position of defending their experiences or educating those who benefit from their oppression. In addition to setting boundaries for safety, it is helpful to be clear about the scope of what is being addressed. In a professional context, there are many difficult realities that have to be grappled with for one to work effectively and responsibly. Structural competency training is neither a space to debate opinions nor a quest for facts; rather, it is space to understand the realities of historically built-in disparities in the infrastructure and daily processes of professional life. This practical orientation can be used to deflect some resistance and skepticism. The company cannot make its employees believe certain things or hold particular personal opinions, but it can mandate competence in professionally relevant content, including content about the ways that oppression shapes and appears in professional life. IV. Assessment Assessment of structural competency is like other ethics education in that it is challenging to assess. In the health context, Petty, Metzl, and Keeys499 created an assessment tool for measuring structural competency in the MHS pre-health curriculum at Vanderbilt University. The instrument, The Structural Foundations of Health Survey ©, starts with baseline knowledge questions based on the Association of American Medical Colleges “Core Competencies for 499 Petty, Metzl, and Keeys, “Developing and Evaluating an Innovative Structural Competency Curriculum for Pre- Health Students.” 154 Entering Medical Students.”500 It also includes a section adapting the Attributional Complexity Scale501 with questions measuring what types of factors are used to explain behavior. Next, it features open-ended questions about factors that influence health, testing whether students could generate responses addressing social determinants of health unprompted.502 It concludes with several case studies, assessing “ability to analyze physician-patient encounters, health disparities, and media using the tools of structural competency.”503 Graduating seniors from the MHS major completed the survey as part of their final exams, and premed students not in the major were recruited through an announcement to Vanderbilt’s Health Professions Advisory Office email list with a link to an anonymous online survey.504 The mix of close- and open-ended questions tests for a range of abilities and provides both quantitative and qualitative data. Ruth et al. adopted aspects of the tool from Petty et al. in their assessment for a standalone structural competency college course, presenting open-ended questions about vignettes in a pre- and post-test.505 The Structural Foundations of Health Survey © is tailored specifically to the academic context, but contains fertile material for adaptation to other delivery formats. The SCWG utilizes an assessment tool incorporating both process and knowledge testing components in a qualitative format.506 The evaluation survey is administered at the end of the four-hour session. Unlike the assessment tools utilized by Metzl et al. and Petty et al., SCWG uses exclusively qualitative data, which is analyzed through directed thematic analysis, which codes repeated terms and concepts to generate important themes.507 500 Petty, Metzl, and Keeys, 461. 501 Navarro, “Attributional Complexity Scale (ACS).” 502 Petty, Metzl, and Keeys, “Developing and Evaluating an Innovative Structural Competency Curriculum for Pre- Health Students,” 463. 503 Petty, Metzl, and Keeys, 463. 504 Petty, Metzl, and Keeys, 463. 505 Ruth et al., “Structural Competency of Pre-Health Students,” 334. 506 Neff et al., “Structural Competency,” 5. 507 Neff et al, 6. 155 For my purposes, I am developing a general assessment tool template that can be easily adapted for use in particular fields. The assessment will be more effective if it is specifically tailored to the specific context; an instrument designed for accountants will not capture the progress of librarians as well. Since structural competency is designed to be applicable to all professional fields, I chose to start with a template rather than generate individual instruments for every potential field. This template will easily translate into the language and context of specific professional areas. The template is based on my generalized learning objectives. It is optimized for workshop series delivery formats, but with small adjustments it can function for other delivery formats. V. Political Context It is worth commenting on the political context of implementing the model proposed in this dissertation. I write during a wave of powerful backlash against “Critical Race Theory” (CRT), which opponents take to be any critical discussion of race, gender, sexuality, or oppression. The backlash, while grossly misrepresenting the nature of CRT, has successfully generated significant political restrictions on education systems across the United States, some of which would prevent structural competency programs from being utilized. It is important to be clear that the backlash against CRT is not actually about CRT. Critical Race Theory is an academic, legal theory developed in the 1970s as a way to examine how racial inequality is embedded in legal and political systems.508 Whitman and Jayakumar explain, “Across fields, CRT is a movement focused not only on naming how racism is situated as an always present and foundational construct that organizes U.S. institutions and everyday life, but also on challenging and transforming racist structures.”509 The representations by 508 Delgado and Stefancic, “Critical Race Theory,” 490. 509 Whitman and Jayakumar, “Structural Competency,” 7. 156 supporters of anti-CRT legislation do not come close to accurately representing any part of the theory. In fact, accurately representing CRT would not achieve the purpose for which the theory is being invoked. Adebayo Oluwayomi explains, “[T]he arguments made…are about controlling public discourse and the devising of false narratives to achieve nefarious political ends…. [A]ttacks on CRT can be understood as part of a larger ideological effort to delegitimize historically accurate presentations of race and racism in American history; to thwart attempts by members of marginalized groups to participate fully in civic life and to retain political power.”510 CRT is being used as a straw man against which to generate conservative hysteria. While CRT is not always named specifically in the laws that have been implemented, it is frequently invoked as a boogeyman in the rhetoric surrounding the introduction, promotion, and justification of these laws. As the attacks span higher and lower education across the United States, further examination of the content being restricted and how it relates to my project is warranted. The catalyst for this surge of restrictions came in September 2020 with Executive Order 13950, in which President Donald Trump prohibited federal contractors from employing professional training influenced by “race-based ideologies.”511 It defined and prohibited “race or sex stereotyping,” which it took to mean “ascribing character traits, values, moral and ethical codes, privileges, status, or beliefs to a race or sex, or to an individual because of his or her race or sex.”512 “Race or sex scapegoating” is defined as “assigning fault, blame, or bias to a race or sex, or to members of a race or sex because of their race or sex.”513 The restrictions went even 510 Oluwayomi, “Not for the Faint of Heart,” 7. 511 Samuels, Samuels, and Haas, “Legislate to (Un)Educate.” 512 Executive Order 13950, Combating Race and Sex Stereotyping. 513 Executive Order 13950. 157 farther for trainings intended for members of the military, prohibiting teaching of “divisive concepts,” defined as: “(1) one race or sex is inherently superior to another race or sex; (2) the United States is fundamentally racist or sexist; (3) an individual, by virtue of his or her race or sex, is inherently racist, sexist, or oppressive, whether consciously or unconsciously; (4) an individual should be discriminated against or receive adverse treatment solely or partly because of his or her race or sex; (5) members of one race or sex cannot and should not attempt to treat others without respect to race or sex; (6) an individual’s moral character is necessarily determined by his or her race or sex; (7) an individual, by virtue of his or her race or sex, bears responsibility for actions committed in the past by other members of the same race or sex; (8) any individual should feel discomfort, guilt, anguish, or any other form of psychological distress on account of his or her race or sex; or (9) meritocracy or traits such as hard work ethic are racist or sexist, or were created by a particular race to oppress another race.”514 Although this executive order was revoked by President Joseph Biden in January 2021,515 dozens of bills inspired by and modeled on the order sprung up in state legislatures around the country. Between January 2021 and June 2023, 44 states saw bills or initiatives meant to restrict teaching 514 Executive Order 13950. 515 The White House, “Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.” 158 about critical race theory, racism, or sexism. These efforts were successful in 18 states: Idaho, Oklahoma, Montana, Tennessee, Iowa, New Hampshire, South Carolina, Alabama, Texas, North Dakota, Virginia, Mississippi, South Dakota, Kentucky, Georgia, Florida, Arkansas, and Utah.516 516 Schwartz, “Map.” 159 Figure 1. Anti-CRT State Law or Rule Elements Compared to 11 Elements of Executive Order 13950 160 The framing of these laws varies by state. In New Hampshire, the section of the larger bill that enacted these restrictions was named “Right to Freedom from Discrimination in Public Workplaces and Education.”517 In Virginia, Glenn Youngkin’s executive order specifically prohibits “inherently divisive concepts,” naming Critical Race Theory as one of the these in the very title of the order. Iowa’s law refers to the set as “specific defined concepts.”518 In the past year, the mobilization against CRT has evolved to target diversity, equity, and inclusion (DEI) more broadly. Since the Supreme Court effectively outlawed the use of affirmative action in college admissions with its 2023 decision in Harvard and SFFA v. UNC,519 more than 100 bills have been introduced by Republican lawmakers across 30 state legislatures to limit and restrict DEI programs,520 with 14 successfully becoming law.521 States with laws targeting DEI now include Idaho, North Dakota, Wyoming, Iowa, Utah, Kansas, Texas, Indiana, Tennessee, Alabama, North Carolina, and Florida.522 The specific restrictions in these laws vary, including targets of DEI staff and offices, required DEI training, diversity statements, and affirmative action in hiring and admissions. There is some overlap in the states where this second wave of legislation has succeeded with states that implemented CRT-related laws, as shown in Figure 2. 517 New Hampshire House Bill 2. 518 Iowa House File 802, An Act Providing for Requirements Related to Racism or Sexism Trainings at, and Diversity and Inclusion Efforts By, Governmental Agencies and Entities, School Districts, and Public Postsecondary Educational Institutions. 519 “Divided Supreme Court Outlaws Affirmative Action in College Admissions, Says Race Can’t Be Used.” 520 “Map.” 521 “DEI Legislation Tracker.” 522 “DEI Legislation Tracker.” 161 Figure 2. Map of Anti-CRT and Anti-DEI Legislation in the US as of May 2024 This political landscape creates a context of intimidation, especially affecting administrators and decision makers in the field of education. There is a very practical potential cost to any unit considering taking up models that engage in what reactionaries might deem “Critical Race Theory.” The misrepresentation of CRT is deliberate and the framing is intentionally vague to have the maximum silencing effect. Unclear legislation prompts responses from local school boards, boards of regents, colleges, and units within colleges to preemptively self-censor to avoid being challenged or sued. The self-censorship is incentivized by the threat of legal action, fines, or just costly litigation that most school districts simply cannot afford. Structural competency falls into the pool of approaches that this backlash targets. Structural competency directly addresses structural oppression, especially racism and white supremacy. Any conservative investigation into the content of a structural competency curriculum would show that it contains the threatening “divisive concepts.” 162 While reactionary politics should not drive our research agendas, they do constrain strategic choices. One advantage structural competency has in the anti-oppression training space, given this context, is that it does not name particular structures in its label. This means structural competency may fly under the radar of some less sophisticated attacks on “Critical Race Theory.” Most of the laws proposed or adopted focus on categories of discrimination or naming groups of people rather than identifying structures. Overall, the broader discourse and backlash is still focusing on language of diversity, “cultural marxism,” and “Critical Race Theory” without addressing the language of structures. This removes one level of barriers to uptake within college administrations. The move to locate structural competency in professional ethics is also strategic and designed to sidestep some of this sort of reactionary political opposition. More sophisticated attacks which evaluate content more thoroughly would still end up targeting structural competency, but simpler initiatives targeting equity work could be avoided. This positioning of structural competency not only bears reactionary laws and state policies in mind, but also considers the self-censoring and preemptive silencing that the specter or possibility of such laws and political attacks can inspire. Framing structural competency as a professional ethics project is less likely to set off alarm bells for cautious administrators. My hope is that structural competency can smuggle valuable education past reactionary censorship. VI. Conclusion In conclusion, professional ethics education must remedy its failure to attend to structural oppression. My structural competency model is a way to accomplish that end. It focuses directly on interlocking structures of oppression, and operates from a concept of responsibility that is better suited to deal with moral problems beyond individualism. These features of my structural 163 competency model make it more effective and address some common concerns about the success of professional ethics education. 164 CONCLUSION This project has a dual theoretical and practical nature, setting up much work to be done on both fronts. On the applied side of things, applying a structural competency approach to fields beyond health could be a lifetime of work on its own. Having demonstrated the promise of structural competency, I hope to see it implemented across disciplines and levels of professional training, from education programs to professional organizations to accreditation and licensure standards. On the theoretical front, Chapter Three barely scratched the surface of the attention needed to the topic of responsibility. Rather than presenting a comprehensive relational account of responsibility, I identified how relational responsibility differs from traditional accounts of responsibility. What is considered a legitimate source of moral requirements is a key determiner of an account’s ability to address structural oppression. Anishanaabe conceptions of responsibility were referenced as an example of existing frameworks exhibiting this relational understanding of responsibility, but piecing together a full account of relational responsibility was beyond the scope of this project. This leaves the exciting work of exploring full accounts of relational responsibility for the future. Of course, this pursuit will be necessarily interdisciplinary and transdisciplinary in recognition of many schools of thought and perspectives beyond the disciplinary walls of philosophy that already embody and practice relational responsibility. While there is much of interest coming out of this project, it also important to avoid overstating what structural competency can do. Structural competency itself does not liberate or decolonize anything. Implementation in training programs functions to reform existing institutions with the goal of improving outcomes. Harm reduction of this sort can do a lot of good, but there will be those who seek to coopt structural competency into reinforcing and bolstering institutions that should not be saved. The professional responsibility structural 165 competency demands in some cases will be abolition of the profession. A structurally competent police department is not possible. Beyond its use in professional ethics education, structural competency can serve as a standard for assessing institutions and professionals for failures to meet their responsibilities. As a diagnostic tool, structural competency can serve more radical endeavors in communicating institutional and professional failures in a new way, explicitly identifying failures to address structural oppression as failures of professional responsibility. Turning this evaluatory function of structural competency inward on ethics education itself is the crescendo of a long journey for me. For as long as I have been interested in understanding responsibility for injustice, I have been dissatisfied with ethics’ ability to offer any meaningful guidance on the topic. In writing a master’s thesis that argued we have responsibilities to work toward rectifying injustices in virtue of our benefiting from them, I found the source of moral requirements to be a sticking point for the limitations of traditional theories of responsibility, but I could not yet see a resolution. Finding Iris Marion Young’s work on the social connection model of responsibility came as a tremendous relief to me, at least at first. Finally I had found a philosopher writing about both responsibility and structural injustice. My relief in having a touchpoint within the philosophical canon to work from made me complacent and prevented me from interrogating Young’s work. I am deeply grateful to Elena Ruíz for challenging me to look closer and see how Young needed to be interrogated. Though unmooring at first, this challenge encouraged me to do better philosophical work. Chapters Two and Three are indebted to this closer examination, which uncovered deep inadequacies and active harm in Young’s work. This experience reinforced for me the importance of looking to the practical and applied commitments of a theorist as indicative and determining of theoretical commitments. Young’s positions on reparations and Indigenous 166 sovereignty run counter to the ethos she cultivated around her social connection model of responsibility. Following her surprisingly bad conclusions back to the key assumptions and theoretical moves that led to those conclusions illuminated the specific ways that the theory fails. Chapter Two highlights the necessity of starting from the experiences and material realities of the oppressed when addressing structural oppression, and I find it striking that this approach can function almost as a reductio ad absurdum when applied to critiques of existing theory. Certain conclusions are unacceptable in the face of the material experiences of oppression, and that rejection of the conclusion spurs interrogation of the supporting premises. Higher education has been the site of much tumult and contention since I started working on this dissertation in 2021. My argument that professional ethics education cannot continue ignoring structural oppression has only strengthened in relevance over the years. Positioning structural competency as the solution and locating it within professional training rather than diversity, equity, and inclusion (DEI) programs has only become more and more significant as various laws and policies have swept the nation targeting attempts to reckon with structural oppression within higher education. As DEI programs are being defunded, eliminated, or rebranded, structural competency is poised to sidestep some of these limitations by making structural oppression the focus of core professional competency rather than an added topic tacked on outside of professional responsibility itself. Interestingly, in some ways structural competency converges with conservative criticism of standalone DEI programs in holding that they are not compelling as an added-on requirement. The conservative solution to this critique is to eliminate DEI programs and make any requirements optional. Structural competency moves in an opposite direction. It is not that DEI is not important or necessary, but rather that structural oppression is so central and fundamental that it demands integration into the conception of 167 professional responsibility itself. Historical injustices and their continuing impacts, for instance, cannot be separated from professional ethics. Ultimately, structural competency shows that oppression is relevant to every job, institution, and organization. Applying the standard of structural competency to the field of ethics education shows that professional ethics training is failing its responsibility to adequately prepare students for moral decision-making in their fields. Ethics education needs structural competency to meet its own responsibilities and to solve its relevance crisis. 168 BIBLIOGRAPHY Alarcon, Bertha O., Lucian O’Connor, Sean Rowan, Bradley S. Henson, Anne E. Doan Van, Paul Simeteys, and Marisa K. Watanabe. “Bringing Structural Competency to the Forefront of Dental Education.” Journal of Dental Education 86, no. 9 (2022): 1083–89. https://doi.org/10.1002/jdd.13020. AP News. “Divided Supreme Court Outlaws Affirmative Action in College Admissions, Says Race Can’t Be Used,” June 29, 2023. https://apnews.com/article/supreme-court- affirmative-action-college-race-f83d6318017ec9b9029b12ee2256e744. Arendt, Hannah. “Collective Responsibility.” In Amor Mundi: Explorations in the Faith and Thought of Hannah Arendt, edited by S. J. James W. Bernauer, 43–50. Dordrecht: Springer Netherlands, 1987. https://doi.org/10.1007/978-94-009-3565-5_3. Asher, Bernie D’Angelo. “Afro-Communitarian Ethics: Implications for Small-Business Stakeholder Relationships.” Business & Professional Ethics Journal 36, no. 2 (2017): 129–55. https://doi.org/10.5840/bpej201742654. Avant, Nicole D., and Gordon L. Gillespie. “Pushing for Health Equity through Structural Competency and Implicit Bias Education: A Qualitative Evaluation of a Racial/Ethnic Health Disparities Elective Course for Pharmacy Learners.” Currents in Pharmacy Teaching and Learning 11, no. 4 (April 1, 2019): 382–93. https://doi.org/10.1016/j.cptl.2019.01.013. Baetz, Mark C., and David J. Sharp. “Integrating Ethics Content into the Core Business Curriculum: Do Core Teaching Materials Do the Job?” Journal of Business Ethics 51, no. 1 (April 2004): 53–62. https://doi.org/10.1023/B:BUSI.0000032343.68115.dd. Baier, Kurt. “Types of Responsibility.” In The Spectrum of Responsibility. New York: St. Martin’s Press, 1991. Bailey, Allison M. “Psychiatric Formulation and the Structural Determinants of Mental Health.” Academic Psychiatry 44, no. 6 (December 1, 2020): 804–5. https://doi.org/10.1007/s40596-020-01307-9. Barker, Stephen F. “What Is a Profession?” Professional Ethics, A Multidisciplinary Journal 1, no. 1/2 (April 1, 1992): 73–99. https://doi.org/10.5840/profethics199211/22. Beauchamp, Tom L, and James J. Childress. Principles of Biomedical Ethics. 1st ed. New York: Oxford University Press, 1979. ———. Principles of Biomedical Ethics. 5th ed. New York: Oxford University Press, 2001. ———. Principles of Biomedical Ethics. 8th ed. New York: Oxford University Press, 2019. 169 Belsha, Kalyn. “How Hair Discrimination Bans Are Affecting Students and Schools.” Chalkbeat, January 16, 2020. https://www.chalkbeat.org/2020/1/16/21121830/states-and-cities-are- banning-hair-discrimination-here-s-how-that-s-affecting-schools/. Bendixsen, Casper G., Athena K. Ramos, and Seth M. Holmes. “Structural Competency and Agricultural Health and Safety: An Opportunity to Foster Equity within Agriculture.” Journal of Agromedicine 28, no. 1 (January 2, 2023): 45–52. https://doi.org/10.1080/1059924X.2022.2148148. Bennett, Immanuel Kant Christopher, Joe Saunders, and and Robert Stern. Groundwork for the Metaphysics of Morals. Oxford World’s Classics. Oxford, New York: Oxford University Press, 2020. Berenstain, Nora. “White Feminist Gaslighting: HYPATIA-A JOURNAL OF FEMINIST PHILOSOPHY.” HYPATIA-A JOURNAL OF FEMINIST PHILOSOPHY 35, no. 4 (January 1, 2020): 733–58. https://doi.org/10.1017/hyp.2020.31. Biegel, Stuart. The Right to Be Out: Sexual Orientation and Gender Identity in America’s Public Schools, Second Edition a Book by Stuart Biegel, 2018. https://bookshop.org/p/books/the- right-to-be-out-sexual-orientation-and-gender-identity-in-america-s-public-schools- second-edition-stuart-biegel/9841023. Bird, Stephanie J. “Integrating Ethics Education at All Levels: Ethics as a Core Competency.” In Emerging Technologies and Ethical Issues in Engineering : Papers From a Workshop, 125–30. The National Academies Press, 2004. Björnsson, Gunnar, Philip Robichaud, and Jan Willem Wieland, eds. “Explaining (Away) the Epistemic Condition on Moral Responsibility.” In Responsibility: The Epistemic Condition, 0. Oxford University Press, 2017. https://doi.org/10.1093/oso/9780198779667.003.0008. Bowden, Peta, and Anne Surma. “Codes of Ethics: Texts in Practice.” Professional Ethics, A Multidisciplinary Journal 11, no. 1 (February 1, 2003): 19–36. https://doi.org/10.5840/profethics20031111. Child, Brenda J. “Women of the Great Lakes and Mississippi: Everything Was Very  Systematic.” In Holding Our World Together: Ojibwe Women and the Survival Of Community., 1–30. New York: Penguin, n.d. Christensen, Lisa Jones, Ellen Peirce, Laura P. Hartman, W. Michael Hoffman, and Jamie Carrier. “Ethics, CSR, and Sustainability Education in the ‘Financial Times’ Top 50 Global Business Schools: Baseline Data and Future Research Directions.” Journal of Business Ethics 73, no. 4 (2007): 347–68. https://doi.org/10.1007/s10551-006-9211-5. Clarke, Heather M. “Organizational Failure to Ethically Manage Sexual Harassment: Limits to #metoo.” Business Ethics: A European Review 29, no. 3 (2020): 544–56. https://doi.org/10.1111/beer.12282. 170 Clifford, Michael. “Moral Literacy.” Teaching Ethics 11, no. 2 (2011): 125–41. https://doi.org/10.5840/tej201111211. Code, Lorraine. Ecological Thinking: The Politics of Epistemic Location. Studies in Feminist Philosophy. Oxford, New York: Oxford University Press, 2006. Cooper, Elizabeth B. “The Appearance of Professionalism.” Florida Law Review 71 (n.d.). Cooper, Thomas. “Learning From Ethicists, Part 2: How Ethics Is Taught at Leading Institutions in the Pacific Region.” Teaching Ethics 17, no. 1 (July 18, 2017): 23–91. https://doi.org/10.5840/tej201771147. Cornell University Press. “Whose Science? Whose Knowledge? By Sandra Harding | Paperback.” Accessed May 12, 2024. https://www.cornellpress.cornell.edu/book/9780801497469/whose-science-whose- knowledge/. Coulthard, Glen Sean. Red Skin, White Masks : Rejecting the Colonial Politics of Recognition. Indigenous Americas. Minneapolis : University of Minnesota Press, 2014. Cruess, Sylvia R., Sharon Johnston, and Richard L. Cruess. “‘Profession’: A Working Definition for Medical Educators.” Teaching and Learning in Medicine 16, no. 1 (2004): 74–76. https://doi.org/10.1207/s15328015tlm1601_15. Curzer, Howard J., Sabrina Sattler, Devin G. DuPree, and K. Rachelle Smith-Genthôs. “Do Ethics Classes Teach Ethics?” Theory and Research in Education 12, no. 3 (2014): 366– 82. https://doi.org/10.1177/1477878514545209. Dagger, Richard, and David Lefkowitz. “Political Obligation.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2021. Metaphysics Research Lab, Stanford University, 2021. https://plato.stanford.edu/archives/sum2021/entries/political- obligation/. Dalesio, Emery P., and Jonathan Drew. “AP Exclusive: ‘Bathroom Bill’ to Cost North Carolina $3.76B | AP News.” Accessed March 19, 2024. https://apnews.com/article/e6c7a15d2e16452c8dcbc2756fd67b44. Davis, Angela Y. (Angela Yvonne). Women, Race & Class. First Vintage Books edition. New York : Vintage Books, 1983. Davis, Michael. “Is Higher Education a Prerequisite of Profession?” International Journal of Applied Philosophy 13, no. 2 (October 1, 1999): 139–48. https://doi.org/10.5840/ijap199913216. ———. “Licensing, Philosophical Counselors, and Barbers: A New Look at an Old Debate about Professions.” The International Journal of Applied Philosophy 24, no. 2 (2010): 225–36. https://doi.org/10.5840/ijap201024220. 171 Delgado, Richard, and Jean Stefancic. “Critical Race Theory: Past, Present, and Future.” Current Legal Problems 51, no. 1 (January 1, 1998): 467–91. https://doi.org/10.1093/clp/51.1.467. Diener, Keith William, and Emmanuel Small. “#Metoo and Lessons in Stakeholder Responsibility.” Business and Society Review 124, no. 4 (2019): 449–65. https://doi.org/10.1111/basr.12185. Donald, Cameron A., Sayantani DasGupta, Jonathan M. Metzl, and Kristen L. Eckstrand. “Queer Frontiers in Medicine: A Structural Competency Approach.” Academic Medicine: Journal of the Association of American Medical Colleges 92, no. 3 (March 2017): 345–50. https://doi.org/10.1097/ACM.0000000000001533. Dotson, Kristie. “A Cautionary Tale: On Limiting Epistemic Oppression.” Frontiers: A Journal of Women Studies 33, no. 1 (2012): 24–47. ———. “Conceptualizing Epistemic Oppression.” Social Epistemology 28, no. 2 (April 3, 2014): 115–38. https://doi.org/10.1080/02691728.2013.782585. ———. “Inheriting Patricia Hill Collins’s Black Feminist Epistemology.” Ethnic and Racial Studies 38, no. 13 (October 21, 2015): 2322–28. https://doi.org/10.1080/01419870.2015.1058496. ———. “Tracking Epistemic Violence, Tracking Practices of Silencing.” Hypatia 26, no. 2 (2011): 236–57. Downey, Margaret Mary, and Anu Manchikanti Gómez. “Structural Competency and Reproductive Health.” AMA Journal of Ethics 20, no. 3 (March 1, 2018): 211–23. https://doi.org/10.1001/journalofethics.2018.20.3.peer1-1803. Downing, Lisa. “The Body Politic: Gender, the Right Wing and ‘Identity Category Violations.’” French Cultural Studies 29, no. 4 (November 1, 2018): 367–77. https://doi.org/10.1177/0957155818791075. Dworkin, Ronald. Law’s Empire. First Edition. Cambridge, Mass.: Belknap Press of Harvard University Press, 1986. Ethics Education Task Force. “Ethics Education in Business Schools.” The Association to Advance Collegiate Schools of Business: AACSB International, 2004. Executive Order 13950. Combating Race and Sex Stereotyping (2020). https://www.federalregister.gov/documents/2020/09/28/2020-21534/combating-race-and- sex-stereotyping. Farmer, Paul. Infections and Inequalities : The Modern Plagues. [Updated edition with a new preface]. Berkeley : University of California Press, 2001. 172 Feinberg, Joel, and Jan Narveson. “The Nature and Value of Rights.” The Journal of Value Inquiry 4, no. 4 (1970): 243–60. https://doi.org/10.1007/BF00137935. Fletcher-Brown, Donna, Anthony F. Buono, Robert Frederick, Gregory Hall, and Jahangir Sultan. “A Longitudinal Study of the Effectiveness of Business Ethics Education: Establishing the Baseline.” Journal of Academic Ethics 10, no. 1 (2012): 45–56. https://doi.org/10.1007/s10805-012-9149-4. Frey, William J. “Teaching Responsibility: Pedagogical Strategies for Eliciting a Sense of Moral Responsibility.” Teaching Ethics 15, no. 2 (2015): 317–36. https://doi.org/10.5840/tej20158422. Fricker, Miranda. Epistemic Injustice: Power and the Ethics of Knowing. Oxford University Press, 2007. https://doi.org/10.1093/acprof:oso/9780198237907.001.0001. Gabe González [@gaybonez]. “Joining SAG and Was Told I Can’t Spell My Name Correctly (González) Because ‘á’ Is a ‘Special Character’ in Their System. The Folks I Spoke to Were Lovely, but It’s Nuts I Can’t Register My ‘Professional’ Name the Way It Should Be Spelled.” Tweet. Twitter, April 1, 2021. https://twitter.com/gaybonez/status/1377678623910531072. Garcia, Betty, Elizabeth Crifasi, and Adrienne B. Dessel. “Oppression Pedagogy: Intergroup Dialogue and Theatre of the Oppressed in Creating a Safe Enough Classroom.” Journal of Social Work Education 55, no. 4 (October 2019): 669–83. https://doi.org/10.1080/10437797.2019.1567414. Gentile, Mary C. Educating for Values-Driven Leadership: Giving Voice to Values across the Curriculum. First edition. Principles of Responsible Management Education (PRME) Collection. New York, New York (222 East 46th Street, New York, NY 10017): Business Expert Press, 2013. Gilligan, Carol. In a Different Voice: Psychological Theory and Women’s Development. Cambridge, MA: Harvard University Press, 1982. Gonzalez, Alden. “MLB Moves All-Star Game over Ga. Voting Law.” ESPN.com, April 2, 2021. https://www.espn.com/mlb/story/_/id/31183822/mlb-moving-all-star-game-atlanta- georgia-voting-law. Goodin, Robert E. “Responsibilities.” Philosophical Quarterly 36 (1986): 50. Gordon, Irene M. “Lessons to Be Learned: An Examination of Canadian and U.S. Financial Accounting and Auditing Textbooks for Ethics/Governance Coverage.” Journal of Business Ethics 101, no. 1 (2011): 29–47. https://doi.org/10.1007/s10551-010-0706-8. Grant, Patricia, Surendra Arjoon, and Peter McGhee. “Reconciling Ethical Theory and Practice: Toward Developing a Business Ethics Pedagogical Model.” Business & Professional Ethics Journal 36, no. 1 (2017): 41–65. https://doi.org/10.5840/bpej2016113046. 173 Grasswick, Heidi. “Feminist Social Epistemology.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2018. Metaphysics Research Lab, Stanford University, 2018. https://plato.stanford.edu/archives/fall2018/entries/feminist-social-epistemology/. Gray, Aysa. “The Bias of ‘Professionalism’ Standards.” Stanford Social Innovation Review, June 4, 2019. https://ssir.org/articles/entry/the_bias_of_professionalism_standards. Gregg, Jessica, and Somnath Saha. “Losing Culture on the Way to Competence: The Use and Misuse of Culture in Medical Education.” Academic Medicine: Journal of the Association of American Medical Colleges 81, no. 6 (June 2006): 542–47. https://doi.org/10.1097/01.ACM.0000225218.15207.30. Griffin, Chanté. “How Natural Black Hair at Work Became a Civil Rights Issue.” JSTOR Daily, July 3, 2019. https://daily.jstor.org/how-natural-black-hair-at-work-became-a-civil-rights- issue/. Gu, Jun, and Cristina Neesham. “Moral Identity as Leverage Point in Teaching Business Ethics.” Journal of Business Ethics 124, no. 3 (2014): 527–36. https://doi.org/10.1007/s10551- 013-2028-0. Haraway, Donna. “Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective.” Feminist Studies 14, no. 3 (1988): 575–99. https://doi.org/10.2307/3178066. Hart, H. L. A. “Acts of Will and Responsibility.” In Punishment and Responsibility. Oxford: University Press, 2008. https://doi.org/10.1093/acprof:oso/9780199534777.003.0004. Hartner, Daniel F. “What Is the Proper Content of a Course in Professional Ethics?” Teaching Philosophy 41, no. 2 (July 17, 2018): 151–73. https://doi.org/10.5840/teachphil201851186. Hartsock, Nancy C. M. “The Feminist Standpoint: Developing the Ground for a Specifically Feminist Historical Materialism.” In Discovering Reality: Feminist Perspectives on Epistemology, Metaphysics, Methodology, and Philosophy of Science, edited by Sandra Harding and Merrill B. Hintikka, 283–310. Synthese Library. Dordrecht: Springer Netherlands, 1983. https://doi.org/10.1007/0-306-48017-4_15. Hastings Center, ed. The Teaching of Ethics in Higher Education: A Report. The Teaching of Ethics 1. Hastings-on-Hudson, N.Y: Hastings Center, Institute for Society, Ethics, and the Life Sciences, 1980. Herkert, Joseph R. “Ways of Thinking about and Teaching Ethical Problem Solving: Microethics and Macroethics in Engineering.” Science and Engineering Ethics 11, no. 3 (2005): 373– 85. https://doi.org/10.1007/s11948-005-0006-3. Hester, Rebecca J. “The Promise and Paradox of Cultural Competence.” HEC Forum 24, no. 4 (December 2012): 279–91. https://doi.org/10.1007/s10730-012-9200-2. 174 Heyman, Jack. “Dock Workers: Block Military Cargo to Israel Against the Genocidal War on Palestinians in Gaza!” CounterPunch.org, February 21, 2024. https://www.counterpunch.org/2024/02/21/dock-workers-block-military-cargo-to-israel- against-the-genocidal-war-on-palestinians-in-gaza/. Hohfeld, Wesley Newcombe. Fundamental Legal Conceptions as Applied in Judicial  Reasoning. New Haven: Yale University Press, 1919. Holroyd-Leduc, Jayna M., and Sharon E. Straus. “#MeToo and the Medical Profession.” CMAJ : Canadian Medical Association Journal 190, no. 33 (August 20, 2018): E972–73. https://doi.org/10.1503/cmaj.181037. hooks, bell. Yearning: Race, Gender, and Cultural Politics. 2nd edition. Routledge, 2014. “How Will Utah’s 2024 Diversity, Equity and Inclusion Law Impact Campus? - @theU.” Accessed May 12, 2024. https://attheu.utah.edu/law-politics/how-will-utahs-2024- diversity-equity-and-inclusion-law-impact-campus/. Hsia, Stephanie L., Aubrey Landsfeld, Kelly Lam, and Rupa Lalchandani Tuan. “Implementation and Evaluation of a 10-Week Health Equity Curriculum for Pharmacy Students.” American Journal of Pharmaceutical Education 85, no. 9 (October 2021): 8579. https://doi.org/10.5688/ajpe8579. Hunt, Joanne. “On the Need for Structurally Competent Counselling and Psychotherapy: Neoliberal Ideology, Disability and the Psy Disciplines.” Counselling and Psychotherapy Research 23, no. 3 (2023): 598–602. https://doi.org/10.1002/capr.12649. Iowa House File 802. An Act Providing for Requirements Related to Racism or Sexism Trainings at, and Diversity and Inclusion Efforts By, Governmental Agencies and Entities, School Districts, and Public Postsecondary Educational Institutions (2021). Iowa Public Radio. “Regents Direct Iowa’s Public Universities to Cut DEI Programs Not Needed for Compliance,” November 16, 2023. https://www.iowapublicradio.org/education/2023- 11-16/regents-direct-iowas-public-universities-to-cut-dei-programs-not-needed-for- compliance. Jeske, Diane. “Special Relationships and the Problem of Political Obligations.” Social Theory and Practice 27, no. 1 (2001): 19–40. https://doi.org/10.5840/soctheorpract200127119. Johnson, Austin H. “Tipping Points and Shifting Expectations: The Promise of Applied Trans Studies for Building Structural Competency.” Bulletin of Applied Transgender Studies 1, no. 1–2 (June 13, 2022): 163–77. https://doi.org/10.57814/98we-xm94. Kaplan, Laura E. “Moral Reasoning of MSW Social Workers and the Influence of Education.” Journal of Social Work Education 42, no. 3 (2006): 507–24. https://doi.org/10.5175/JSWE.2006.200404129. 175 Kelly, Terrence. Professional Ethics: A Trust-Based Approach. Accessed March 19, 2024. https://rowman.com/ISBN/9781498513630/Professional-Ethics-A-Trust-Based- Approach. Kleinman, Arthur, and Peter Benson. “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It.” PLoS Medicine 3, no. 10 (October 2006): e294. https://doi.org/10.1371/journal.pmed.0030294. Kretz, Lisa. “Teaching Being Ethical.” Teaching Ethics 15, no. 1 (January 5, 2015): 151–72. https://doi.org/10.5840/tej201515112. Lantz, Marilyn S., Muriel J. Bebeau, and Pamela Zarkowski. “The Status of Ethics Teaching and Learning in U.S. Dental Schools.” Journal of Dental Education 75, no. 10 (2011): 1295– 1309. https://doi.org/10.1002/j.0022-0337.2011.75.10.tb05174.x. Lee, Agnes S, and Michelle Farrell. “Is Structural Competency a Backdoor to Racism?” Anthropology News, March 2006, 9–10. Lester, Jenna C., and Susan C. Taylor. “Incorporating Structural Competency Into Dermatologic Curricula—Reply.” JAMA Dermatology 157, no. 12 (December 1, 2021): 1517. https://doi.org/10.1001/jamadermatol.2021.1899. Li, Jessica, and Shengli Fu. “A Systematic Approach to Engineering Ethics Education.” Science and Engineering Ethics 18, no. 2 (2012): 339–49. https://doi.org/10.1007/s11948-010- 9249-8. Loevinger, Lee. “Enforcing Ethical Standards of Professional Associations.” Professional Ethics 5, no. 1/2 (March 1, 1996): 157–66. https://doi.org/10.5840/profethics199651/21. Luguetti, Carla, Kimberly L. Oliver, and Melissa Parker. “Facilitation as an Act of Love: A Self- Study of How a Facilitator’s Pedagogy Changed Over Time in the Process of Supporting a Community of Learners.” Journal of Teaching in Physical Education 40, no. 2 (June 1, 2020): 207–14. https://doi.org/10.1123/jtpe.2019-0193. Martínez-Hernáez, Ángel, and Deborah Bekele. “Structural Competency in Epidemiological Research: What’s Feasible, What’s Tricky, and the Benefits of a ‘Structural Turn.’” Global Public Health 18, no. 1 (January 2023): 2164903. https://doi.org/10.1080/17441692.2023.2164903. Martinov-Bennie, Nonna, and Rosina Mladenovic. “Investigation of the Impact of an Ethical Framework and an Integrated Ethics Education on Accounting Students’ Ethical Sensitivity and Judgment.” Journal of Business Ethics 127, no. 1 (2015): 189–203. https://doi.org/10.1007/s10551-013-2007-5. Maxwell, Bruce. Professional Ethics Education: Studies in Compassionate Empathy. 1st ed. Berlin: Springer Netherlands, 2008. 176 Maxwell, Bruce, and Marina Schwimmer. “Professional Ethics Education for Future Teachers: A Narrative Review of the Scholarly Writings.” Journal of Moral Education 45, no. 3 (2016): 354–71. https://doi.org/10.1080/03057240.2016.1204271. May, Larry. Sharing Responsibility. Chicago: University of Chicago Press, 1992. McGraw, David K., Daphyne Thomas- Saunders, Morgan Benton, Jeffrey Tang, and Amanda Biesecker. “Who Teaches Ethics? An Inquiry into the Nature of Ethics as an Academic Discipline.” Teaching Ethics 13, no. 1 (April 1, 2012): 129–40. https://doi.org/10.5840/tej201213135. McGregor, Deborah. “Honouring Our Relations: An Anishnaabe Perspective on  Environmental Justice.” In Speaking for Ourselves: Environmental Justice in Canada, 27–41. Vancouver: University of British Columbia Press, 2009. McKenna, Michael. “Moral Responsibility: A Conceptual Map.” In Conversation and Responsibility. New York: Oxford University Press, 2012. McLeod-Sordjan, Renee. “Evaluating Moral Reasoning in Nursing Education.” Nursing Ethics 21, no. 4 (June 2014): 473–83. https://doi.org/10.1177/0969733013505309. Mello, Michelle M., and Reshma Jagsi. “Standing Up against Gender Bias and Harassment — A Matter of Professional Ethics.” New England Journal of Medicine 382, no. 15 (April 9, 2020): 1385–87. https://doi.org/10.1056/NEJMp1915351. Metzl, Jonathan M., and Helena Hansen. “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality.” Social Science & Medicine (1982) 103 (February 2014): 126–33. https://doi.org/10.1016/j.socscimed.2013.06.032. Metzl, Jonathan M., JuLeigh Petty, and Oluwatunmise V. Olowojoba. “Using a Structural Competency Framework to Teach Structural Racism in Pre-Health Education.” Social Science & Medicine, The role of Racism in Health Inequalities: Integrating Approaches from Across Disciplines, 199 (February 1, 2018): 189–201. https://doi.org/10.1016/j.socscimed.2017.06.029. Metzl, Jonathan M., and Dorothy E Roberts. “Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge.” AMA Journal of Ethics 16, no. 9 (2014): 674–90. https://doi.org/10.1001/virtualmentor.2014.16.9.spec1-1409. Millett, Stephan, William Budiselik, and Andrew Maiorana. “Teaching Ethics in Exercise Science.” Teaching Ethics 15, no. 2 (October 1, 2015): 287–301. https://doi.org/10.5840/tej20158320. Millstone, Michael. “Teaching Medical Ethics to Meet the Realities of a Changing Health Care System.” Journal of Bioethical Inquiry 11, no. 2 (June 2014): 213–21. https://doi.org/10.1007/s11673-014-9520-9. 177 Navarro, Michael. “Attributional Complexity Scale (ACS).” In The Sourcebook of Listening Research, 191–97. John Wiley & Sons, Ltd, 2017. https://doi.org/10.1002/9781119102991.ch13. NBC News. “Map: See Which States Have Introduced or Passed Anti-DEI Bills,” March 2, 2024. https://www.nbcnews.com/data-graphics/anti-dei-bills-states-republican- lawmakers-map-rcna140756. Neff, Joshua, Seth M. Holmes, Kelly R. Knight, Shirley Strong, Ariana Thompson-Lastad, Cara McGuinness, Laura Duncan, et al. “Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities.” MedEdPORTAL : The Journal of Teaching and Learning Resources 16 (n.d.): 10888. https://doi.org/10.15766/mep_2374-8265.10888. Neff, Joshua, Kelly R. Knight, Shannon Satterwhite, Nick Nelson, Jenifer Matthews, and Seth M. Holmes. “Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians.” Journal of General Internal Medicine 32, no. 4 (April 1, 2017): 430–33. https://doi.org/10.1007/s11606-016-3924-7. New Hampshire House Bill 2 (2021). https://legiscan.com/NH/text/HB2/2021. News, Danny Schmidt, KOMO. “Pro-Palestinian Protestors Block Tacoma Port to Halt Suspected Weapons Shipment to Israel.” KOMO, November 6, 2023. https://komonews.com/news/local/port-of-tacoma-protest-palestinian-israel-hamas-gaza- strip-war-aid-united-states-washington-seattle-oakland-bay-area-san-francisco- demonstrators-block-entrance-pierce-county-middle-east-cease-fire-maritime- trespassing-laws-jewish-federal-building. Nicholson, Carolyn Y., and Michelle DeMoss. “Teaching Ethics and Social Responsibility: An Evaluation of Undergraduate Business Education at the Discipline Level.” Journal of Education for Business 84, no. 4 (March 1, 2009): 213–18. https://doi.org/10.3200/JOEB.84.4.213-218. Nozick, Robert. Anarchy, State, and Utopia. New York: Basic Books, 1974. O’Boyle, Edward J., and Luca Sandonà. “Teaching Business Ethics Through Popular Feature Films: An Experiential Approach.” Journal of Business Ethics 121, no. 3 (2014): 329–40. https://doi.org/10.1007/s10551-013-1724-0. Office of Population Affairs. “Cultural Competence.” US Department of Health and Human Services, 2018. https://www.hhs.gov/ash/oah/resources-and-training/tpp-and-paf- rxesources/cultural-competence/index.html. Oluwayomi, Adebayo. “Not for the Faint of Heart: Becoming an Antiracist Philosopher in a Society Polarized by Critical Race Theory.” Eidos. A Journal for Philosophy of Culture 6, no. 3 (December 31, 2022): 5–23. https://doi.org/10.14394/eidos.jpc.2022.0022. 178 Orr, Zvika, and Shifra Unger. “The TOLERance Model for Promoting Structural Competency in Nursing.” Journal of Nursing Education 59, no. 8 (August 2020): 425–32. https://doi.org/10.3928/01484834-20200723-02. Padilla, Mariel. “New Jersey Is Third State to Ban Discrimination Based on Hair.” The New York Times, December 20, 2019, sec. U.S. https://www.nytimes.com/2019/12/20/us/nj-hair- discrimination.html. Patricia Hill Collins. Black Feminist Thought : Knowledge, Consciousness, and the Politics of Empowerment. Perspectives on Gender (New York, N.Y.) ; New York : Routledge, 1991. Perez, Nahshon. Freedom from Past Injustices: A Critical Evaluation of Claims for Inter- Generational Reparations. 1st edition. Edinburgh: Edinburgh University Press, 2012. Petty, JuLeigh, Jonathan M. Metzl, and Mia R. Keeys. “Developing and Evaluating an Innovative Structural Competency Curriculum for Pre-Health Students.” Journal of Medical Humanities 38, no. 4 (December 1, 2017): 459–71. https://doi.org/10.1007/s10912-017-9449-1. Preer, Jean L. Library Ethics. Westport, Conn: Libraries Unlimited, 2008. Radzik, Linda. “Collective Responsibility and Duties to Respond.” Social Theory and Practice 27, no. 3 (2001): 455–71. Rainbolt, George. “Perfect and Imperfect Obligations.” Philosophical Studies: An International Journal for Philosophy in the Analytic Tradition 98, no. 3 (2000): 233. Rawls, John. A Theory of Justice. Cambridge, Mass: Belknap Press of Harvard University Press, 1971. Reinhart, RJ. “Nurses Continue to Rate Highest in Honesty, Ethics.” Gallup.com, January 6, 2020. https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty- ethics.aspx. Rest, James R., Darcia Narvaez, Stephen J. Thoma, and Muriel J. Bebeau. “A Neo-Kohlbergian Approach to Morality Research.” Journal of Moral Education 29, no. 4 (2000): 381–95. https://doi.org/10.1080/713679390. ———. “DIT2: Devising and Testing a Revised Instrument of Moral Judgment.” Journal of Educational Psychology 91, no. 4 (1999): 644–59. https://doi.org/10.1037/0022- 0663.91.4.644. Roberts, Dorothy E. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. Twentieth Anniversary Edition. Vintage Books, 1997. Robison, Wade. “Professional Norms” 16, no. 2 (2016). 179 Rohrbaugh, Robert M., Billy Bromage, John A. Encandela, Virginia T. Spell, Bridgett Williamson, and Walter S. Mathis. “Allying with Our Neighbors to Teach Structural Competence: The Yale Department of Psychiatry Structural Competency Community Initiative (YSCCI).” In Structural Competency in Mental Health and Medicine: A Case- Based Approach to Treating the Social Determinants of Health, edited by Helena Hansen and Jonathan M. Metzl, 159–66. Cham: Springer International Publishing, 2019. https://doi.org/10.1007/978-3-030-10525-9_13. Ross, Aristotle Translated by David, and Edited by Lesley Brown, eds. The Nicomachean Ethics. New Edition, New to this Edition:, New Edition, New to this Edition: Oxford World’s Classics. Oxford, New York: Oxford University Press, 2009. Ruíz, Elena. Structural Violence: The Makings of Settler Colonial Impunity. Oxford, New York: Oxford University Press, 2024. Ruíz, Elena, and Nora Berenstain. “Critical Race Structuralism and Non-Ideal Theory.” In The Routledge Handbook of Non-Ideal Theory, edited by Hilkje Hänel and Johanna Müller. Routledge. Accessed February 12, 2024. https://philarchive.org/rec/RUZCRS. Ruíz y Flores, Elena. “Women of Color Structural Feminisms.” In The Palgrave Handbook of Critical Race and Gender, edited by Shirley Anne Tate and Encarnación Gutiérrez Rodríguez, 167–88. Cham: Springer International Publishing, 2022. https://doi.org/10.1007/978-3-030-83947-5_9. Ruth, Alissa, Cindi SturtzSreetharan, Alexandra Brewis, and Amber Wutich. “Structural Competency of Pre-Health Students: Can a Single Course Lead to Meaningful Change?” Medical Science Educator 30, no. 1 (March 1, 2020): 331–37. https://doi.org/10.1007/s40670-019-00909-9. Salhi, Bisan A., Jennifer W. Tsai, Jeffrey Druck, Jacqueline Ward-Gaines, Melissa H. White, and Bernard L. Lopez. “Toward Structural Competency in Emergency Medical Education.” AEM Education and Training 4, no. S1 (2020): S88–97. https://doi.org/10.1002/aet2.10416. Samuels, Gregory, Amy Samuels, and Brandon J. Haas. “Legislate to (Un)Educate.” Curriculum & Teaching Dialogue 25, no. 1 (January 2023): 51–68. Schauster, Erin, Patrick Ferrucci, Tandoc Edson, and Tara Walker. “Advertising Primed: How Professional Identity Affects Moral Reasoning.” Journal of Business Ethics: JBE 171, no. 1 (June 2021): 175–87. https://doi.org/10.1007/s10551-020-04429-0. Schwartz, Sarah. “Map: Where Critical Race Theory Is Under Attack.” Education Week, June 11, 2021, sec. Policy & Politics, States. https://www.edweek.org/policy-politics/map-where- critical-race-theory-is-under-attack/2021/06. Sekerka, Leslie E. “Organizational Ethics Education and Training: A Review of Best Practices and Their Application.” International Journal of Training and Development 13, no. 2 (2009): 77–95. https://doi.org/10.1111/j.1468-2419.2009.00319.x. 180 Simpson, Leanne. “Looking after Gdoo-Naaganinaa: Precolonial Nishnaabeg Diplomatic and Treaty Relationships.” Wicazo Sa Review 23, no. 2 (2008): 29–42. Strawson, Peter Frederick. “Freedom and Resentment.” Proceedings of the British Academy 48 (1962): 187–211. Tapper, Alan, and Stephan Millett. “Revisiting the Concept of a Profession.” In Conscience, Leadership and the Problem of “Dirty Hands,” 13:1–18. United Kingdom: Emerald Group Publishing Limited, 2015. https://doi.org/10.1108/S1529-209620150000013001. Tervalon, Melanie, and Jann Murray-García. “Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.” Journal of Health Care for the Poor and Underserved 9, no. 2 (1998): 117– 25. https://doi.org/10.1353/hpu.2010.0233. The Chronicle of Higher Education. “DEI Legislation Tracker,” March 29, 2024. https://www.chronicle.com/article/here-are-the-states-where-lawmakers-are-seeking-to- ban-colleges-dei-efforts. The White House. “Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.” The White House, January 21, 2021. https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive- order-advancing-racial-equity-and-support-for-underserved-communities-through-the- federal-government/. Think Cultural Health. “Health Equity Timeline.” Think Cultural Health. Accessed March 19, 2024. https://thinkculturalhealth.hhs.gov/clas/health-equity-timeline. Torres, Rachel. “An Evaluation of a Structural Competency Training for School Nurses.” Doctoral Projects, May 1, 2023. https://doi.org/10.31979/etd.djmn-xu3g. Tusinski Berg, Kati. “The Ethics of Exploring Gender Issues in a Time of #Metoo.” Journal of Media Ethics 34, no. 1 (January 2, 2019): 52–56. https://doi.org/10.1080/23736992.2019.1618049. Udemgba, Chioma, Akilah A. Jefferson, Jessica Stern, and Paneez Khoury. “Toolkit for Developing Structural Competency in Health Disparities in Allergy and Immunology Training and Research.” The Journal of Allergy and Clinical Immunology. In Practice 10, no. 4 (April 2022): 936–49. https://doi.org/10.1016/j.jaip.2022.02.009. U.S. Department of Labor Wage and Hour Division. “Fact Sheet #17D: Exemption for Professional Employees Under the Fair Labor Standards Act (FLSA).” U.S. Department of Labor, 2019. https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/fs17d_professional.pdf. Waples, Ethan P., Alison L. Antes, Stephen T. Murphy, Shane Connelly, and Michael D. Mumford. “A Meta-Analytic Investigation of Business Ethics Instruction.” Journal of Business Ethics 87, no. 1 (2009): 133–51. https://doi.org/10.1007/s10551-008-9875-0. 181 Warnick, Bryan R., and Sarah K. Silverman. “A Framework for Professional Ethics Courses in Teacher Education.” Journal of Teacher Education 62, no. 3 (May 2011): 273–85. https://doi.org/10.1177/0022487110398002. Webb, Charlie. “What Is Unjust Enrichment?” Oxford Journal of Legal Studies 29, no. 2 (July 1, 2009): 215–43. https://doi.org/10.1093/ojls/gqp008. Wellman, Christopher Heath. “Associative Allegiances and Political Obligations.” Social Theory and Practice 23, no. 2 (1997): 181–204. ———. “Relational Facts in Liberal Political Theory: Is There Magic in the Pronoun ‘My’?” Ethics 110, no. 3 (2000): 537–62. https://doi.org/10.1086/233323. Wenar, Leif. “Rights.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta and Uri Nodelman, Spring 2023. Metaphysics Research Lab, Stanford University, 2023. https://plato.stanford.edu/archives/spr2023/entries/rights/. Whitman, Kenyon Lee, and Uma Mazyck Jayakumar. “Structural Competency: A Framework for Racial Justice Intervention in Student Affairs Preparation and Practice.” Education Sciences 13, no. 1 (January 2023): 75. https://doi.org/10.3390/educsci13010075. Whyte, Kyle. “Food Sovereignty, Justice, and Indigenous Peoples: An Essay on Settler Colonialism and Collective Continuance.” In Oxford Handbook of Food Ethics. New York: Oxford University Press, 2018. ———. “Settler Colonialism, Ecology, and Environmental Injustice.” Environment and Society 9, no. 1 (September 1, 2018): 125–44. https://doi.org/10.3167/ares.2018.090109. Willging, Cathleen, Lara Gunderson, Daniel Shattuck, Robert Sturm, Adrien Lawyer, and Cameron Crandall. “Structural Competency in Emergency Medicine Services for Transgender and Gender Non-Conforming Patients.” Social Science & Medicine 222 (February 1, 2019): 67–75. https://doi.org/10.1016/j.socscimed.2018.12.031. Winston, Mark D. “Ethical Leadership and Ethical Decision Making: A Meta-Analysis of Research Related to Ethics Education.” Library & Information Science Research 29, no. 2 (2007): 230–51. https://doi.org/10.1016/j.lisr.2007.04.002. Witz, Anne. “Patriarchy and Professions: The Gendered Politics of Occupational Closure.” Sociology (Oxford) 24, no. 4 (1990): 675–90. https://doi.org/10.1177/0038038590024004007. Wolfe, Patrick. “Settler Colonialism and the Elimination of the Native: Journal of Genocide Research.” Journal of Genocide Research 8, no. 4 (December 2006): 387–409. https://doi.org/10.1080/14623520601056240. Woolsey, Colleen, and Robin Narruhn. “Structural Competency: A Pilot Study.” Public Health Nursing 37, no. 4 (2020): 602–13. https://doi.org/10.1111/phn.12756. 182 Young, Cate. “This Is What I Mean When I Say ‘White Feminism.’” BattyMamzelle, January 10, 2014. https://www.cate-young.com/battymamzelle/2014/01/This-Is-What-I-Mean-When- I-Say-White-Feminism.html-a386a-8fcnm-4mgwa-bz4nj-3mc3f-jk2mf-a5e5m-6wty8- rapaw-9t6yt-4bmem-xeym3-hbzfs-cemaz. Young, Iris Marion. Justice and the Politics of Difference. Princeton, N.J. : Princeton University Press, 1990. ———. Responsibility for Justice. Oxford Political Philosophy. New York : Oxford University Press, 2011. ———. Responsibility for Justice. Oxford Political Philosophy. New York: Oxford University Press, 2011. Zacharias, Rachel L. “Learning from Me Too.” Hastings Center Report 48, no. 4 (2018): inside back cover-inside back cover. https://doi.org/10.1002/hast.860. Zeidan, Amy, Brian Salhi, Anika Backster, Erica Shelton, Alycia Valente, Basmah Safdar, Ambrose Wong, et al. “A Structural Competency Framework for Emergency Medicine Research: Results from a Scoping Review and Consensus Conference.” Western Journal of Emergency Medicine 23, no. 5 (September 2022): 650–59. https://doi.org/10.5811/westjem.2022.6.56056. Zimdahl, Robert L. “Teaching Agricultural Ethics.” Journal of Agricultural & Environmental Ethics 13, no. 3–4 (2000): 229–229. https://doi.org/10.1023/A:1009596732445. Zimmerman, Michael J. “Varieties of Moral Responsibility.” In The Nature of Moral Responsibility: New Essays, edited by Randolph Clarke, Michael McKenna, and Angela M. Smith, 0. New York: Oxford University Press, 2015. https://doi.org/10.1093/acprof:oso/9780199998074.003.0003. 183