# introduction

Bioethicists have increasingly had to tackle issues that involve advocacy or activism. As ethical frameworks evolve, especially amid political hostility and institutional instability, we are asked to consider: what does it mean to act ethically across borders? What is the role of the bioethicist in contexts characterised by systemic and structural injustice? The strained Canada-US relationship, marked by trade disputes and polemic rhetoric, adversely affects access to cross-border healthcare, resource allocation, and partnerships. Current political tensions and the loss of US funding present issues beyond these borders and are an opportunity to explore the role of the bioethicist. This commentary takes its inspiration from *Ethics in Practice*, a podcast series exploring how researchers follow their moral compass in day-to-day work (1). The podcast is an open-access platform showcasing diverse narratives from health and research professionals, including critiques of biases and institutional constraints. It acts as an archive of moral conviction and action; we use here excerpts from various episodes to explore the bioethicist’s role in social justice.

This podcast grew from the understanding that most people develop their notions of goodness long before encountering bioethics (2). Their family, location, and personal experiences play formative roles in shaping the core values by which they navigate the complexity of medicine and health research later on (2). With this premise, *Ethics in Practice* shifts away from the canonical principles of autonomy, beneficence, non-maleficence, and justice to focus on ethical behaviour in everyday life, particularly when it poses an internal conflict or dissonance. The content plan was shaped by our experiences as early career researchers and insights from a survey shared across our networks. Each episode’s topic guide was co-developed with the guests to ensure relevance, and community value. Over five episodes, ten health and research professionals shared personal stories and insights on themes of epistemic pluralism, fieldwork, teaching bioethics, systems change in health, and reckoning with wrongdoing and injustice.
# Broken Systems, Organizational Silence, and Silencing
        Individuals

Bioethicists work within a complex environment that can involve conducting research on ethical issues, teaching and educating others about bioethics, developing institutional policies and guidelines, serving on ethics committees, and providing consultation and advice on ethical dilemmas. It is necessary to critically examine this environment in light of the current political climate. Our discussions with the podcast guests revealed that they are less troubled by moral dilemmas in their research than by the challenges of being ethical in “violent systems,” as described by Anna Dowrick, a Senior Researcher from the University of Oxford:

> A lot of people get burnt out through research, through this type of research, which is also true when people are out doing activism, and any job like this. Yes, it’s all part of the oppression, all part of the violence of these systems. But then, we’re part of it too. And that’s why I always think of these as political issues, because I’m not just a passive observer
> — 3

Health and research professionals may need to independently explore how power and injustice affect health because their ethics education does not cover these topics. Mario Vaz, a retired Professor from St John’s Medical College, highlighted that institutional dynamics affect both ethics instruction and the willingness to address these issues:

> Some of the ethical issues that people face are actually related to systemic issues within the institution that they work for, and it is difficult for them to speak out openly because, of course, they’re worried about their jobs and how they will be perceived
> — 4

The field of bioethics faces challenges due to a collective silence among practitioners regarding how its own systems perpetuate the injustices they aim to address. We heard stories of how those who presented an alternative view were questioned or dismissed, even by fellow bioethicists, often limiting the field’s ability to respond to real-world complexities. This silence has ethical implications (5). As Michael Certo recently observed, we must ask whether the risks of speaking out against unjust policies outweigh the dangers of allowing them to continue unchallenged (5). Amar Jesani, an independent consultant, researcher, and teacher from India, stressed the dual importance of both structure and agency in addressing these issues:

> Institutionalisation is required, but at the same time you require checks and balances on the institutionalisation. If they are not there, the standard of ethics does not go up. So, that is how I said that inside as well as outside, you will have to keep working both ways if you are concerned about the larger goal of bioethics
> — 6

Bioethics often operates within institutional boundaries, while meaningful change is often brought about by those working at the margins of or outside formal structures altogether. It is this tension, between internal critique and external pressure, that ethical progress occurs. This dynamic highlights the importance of maintaining a generative balance between procedural ethics, bioethics as a discipline, and ‘everyday’ ethics as it is practiced by individuals within the system and outside it.
# Recognizing the Architecture of Exclusion

The withdrawal of US funding has sent shock waves through the global health research and humanitarian communities, but arbitrary displays of power are not new. There are several communities across the world for whom this is a persistent reality. They have navigated shifting geopolitical power and could offer valuable lessons on how to mitigate these effects. However, bioethics often overlooks these diverse perspectives due to its alignment with institutional authority, disciplinary limitations, and reluctance to engage in political critique. While some bioethicists critique systemic injustices, fewer acknowledge their own complicity or that of their institutions. This moment requires a reawakening, urging bioethicists to say plainly when “the king is naked” and to openly challenge injustices, even if it disrupts comfort or consensus. The current political climate poses threats to diversity, equity, inclusion, and accessibility (DEIA), but bioethics must also reflect on its internal issues. Despite advocating for justice and care, the field’s institutions often remain exclusive, hierarchical, and slow to embrace epistemic and methodological diversity (7). On our podcast, Christina Lee, a Research Associate at the University of Sheffield, shared her experiences as a disabled woman of colour in academic spaces:

> As a disabled person, I’ve always been afraid of roads and I wanted to use that metaphor to express the sense of vulnerability that disabled people in academia often experience, particularly if you are a disabled woman or a disabled woman of colour
> — 8

The backlash against DEIA initiatives has also been driven by fears of “reverse discrimination”. This frames these efforts as unfair to certain groups, especially white individuals, while questioning their effectiveness and legality (9). Bioethicists might view this as a problematic situation; however, this could also compel the field to confront the deep institutional racism that persists within it (10). Bioethics has fallen short in confronting the unequal distribution of power within academic institutions (11). As a result, institutions seem to be responsive while failing to adequately tackle the underlying causes of discrimination in bioethics and, more broadly, in academia as a whole (11). Moreover, there is a need to recognise the interconnectedness of human, animal, and planetary health, as discussed by Nicole Redvers, Associate Professor and Director of Indigenous Planetary Health at Western University, who reminded us of the need to integrate diverse knowledge systems, including decolonial, Indigenous, and environmental bioethics:

> I witnessed very clearly not only the lack of accessible services, but also the lack of trustworthiness between Indigenous peoples and what was seen to be colonial governments because, of course, Canada was a colonised country. But layered on that was the great environmental changes that have been happening and are still happening in the sub-Arctic and Arctic with strong climate-change impacts. The environmental provisions that many indigenous communities rely on — the hunting, the fishing, the gathering — are becoming more difficult with the changing climate
> — 8
# We’re All in This Together

Social justice centres fairness, equity, and human rights, closely aligning with bioethics. However, as our podcast conversations revealed, movements for social justice require collective effort, and often originate outside of bioethics, a field which tends to prioritise individualism and neutrality over direct political critique. As has been noted by our guests, calls for attention to significant social issues like racism in healthcare did not originate from bioethics but from external advocates (6). Bioethicists, such as Fletcher and colleagues, have called for a shift towards social justice, and have highlighted the need for the field to address its limitations and engage more with external movements to promote equity and accountability (12). Instead of framing ethics as individual virtue, or institutional compliance, our podcast guests point toward a broader, more relational role for the bioethicist: one rooted in solidarity and attentive to the ethical labour of researchers and practitioners who may not identify as bioethicists yet engage deeply with moral complexity in their everyday work.

Solidarity involves acting in response to specific events or concerns and providing support amidst differing views (13). Effective solidarity acknowledges epistemic humility and diverse perspectives within the bioethics community and emphasizes mutual obligations (9). The challenges we face are local, national, and global. To tackle them requires collaboration and a greater allowance for reasoning and disagreement in bioethics. This “space for reasoning and disagreement” should allow individuals to express views and engage in constructive debate, thereby encouraging respect, active listening, and openness to alternative perspectives. Scholars have explored solidarity in multiple dimensions: as lived experience, as political, as collective action against injustice, and as transformative and emancipatory (14). The podcast is an invitation for bioethicists in the US, Canada, and elsewhere to engage in cross-border solidarity even, or especially, when that means challenging our own knowledge and value systems.

Addressing challenges within health and research systems, where competition often overshadows collaboration, can be quite difficult. There are limited opportunities for practitioners to engage in more personal discussions on the burden and desire to be ethical in an increasingly unethical world. This is why we have come to recognise our podcast as a moral space for reflection and dialogue between guests that hail from very different backgrounds, country, community, experience, and seniority. We hope the podcast encourages creative projects in bioethics because there is no prescribed way of standing up to power. We need to explore new vehicles for storytelling that capture the mess and imperfection of practicing ethics, such as the podcast. With a healthy disregard for convention, these media can also offer an alternative way of framing bioethics as a collective effort to ensure that our institutions are not only designed to prevent harm but to strive towards the higher ideals of equity and justice.
# Conclusion

Bioethics cannot expect to advocate for moral space if it remains unwilling to interrogate the power structures and exclusions within its own field. Calls for justice and equity in bioethics ring hollow if the discipline itself reproduces the very forms of structural racism, elitism, and epistemic exclusion it claims to challenge. Bioethicists must model the kind of institutional introspection and structural change it often calls for in others. As political divisions grow and institutional failures mount, the need for courageous, relational ethics is more urgent than ever. This reflection does not offer answers, but a further provocation: How might we centre spaces in bioethics for social justice, disagreement and dialogue, solidarity, diverse knowledge systems, and diverse project-engagements that offer alternative narratives on what it means to be ethical? How might we reimagine bioethics not only as a set of ideals, but as a plural and lived practice? Bioethics must adopt a bolder stance if it intends to create significant and enduring change. In the face of intense political debates and systemic injustices, we are urged to support one another not only in theory but also through our practice.

## Références

1Ethics in Practice. Podcast.

2Black and Brown in Bioethics. Bioethics and Global Health: In Search of Common Ground. 12 Sept 2023.

3Episode 2: The ethics of being there: fieldwork, doubt and meaning. Ethics in Practice podcast. 15 May 2025

4Episode 3: The quiet optimism of teaching bioethics. Ethics in Practice podcast. 15 May 2025

5Certo M. How bioethicists can respond to the moment by learning from the past. Hastings Bioethics Forum. 4 Apr 2025.

6Episode 4: Building, challenging, and transforming systems in bioethics. Ethics in Practice podcast. 23 May 2025

B, de Vries J. Where is knowledge from the global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics. 2023;49(5):325-34.

8Episode 1: An invitation to re-imagine health, research, and bioethics. Ethics in Practice podcast. 8 May 2025

M. What is ‘reverse racism’ — and what’s wrong with the term? The Conversation. 11 Jul 2023.

VN. Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health. 1997;87(11):1773-8.

K, Johal HK, Swana M. Bolder bioethics: demanding a gold standard in REDI recommendations. American Journal of Bioethics. 2024;24(10):26-9.

F, Thomas SP, Lapite FC, Ray K. Bioethics must exemplify a clear path toward justice: a call to action. American Journal of Bioethics. 2022;22(1):14-6.

13Inouye M. On solidarity. Boston Review. Summer 2023.

14The EthicsLab. Solidarity embodied and enacted. University of Cape Town. 5 Mar 2025.