Nurse and sociologist Jamie Smith reflects on an event held by the Centre for Nursing Philosophy at UC Irvine on Speculative ethics and care
In October 2023, our emerging research group made up of nurses, sociologists and activists hosted a thought-provoking event on speculative ethics in healthcare. Bringing together scholars from nursing, technology studies, and religious studies, the event sparked discussion on how speculative ethics can help us reimagine (health)care.
The dominant framework for health-related ethics is biomedical ethics, which relies on four key principles: autonomy (making decisions over our own health), non-maleficence (healthcare providers should do no harm), beneficence (acting in or for the benefit of the patient), and justice (equitable access to care and resource distribution). Whilst important, the biomedical approach can be rigid and narrowly focused, overlooking broader ethical questions and the circumstances from which they arise. At our event, we explored speculative ethics as an alternative.
What is Speculative Ethics?
Speculative ethics draws on feminist, critical posthumanist, and Indigenous knowledges to pay attention to care, relationality, and pluralism.
Speculative ethics diverges from the abstract, principle-based approach of biomedical ethics by foregrounding care and relationships (de La Bellacasa, 2017). It also draws on feminist theory, which recognises that ethics emerges through hands-on caring processes, not just top-down rules and guidelines (Braidotti, 2015; Lloyd, 2020). Speculative ethics sees care as an ongoing practice of nurturing mutual flourishing, aligning with feminism’s emphasis on interconnection and contextual nuance.
Critical posthumanism challenges the Western liberal notion of a unified, coherent, rational self at the centre of ethical deliberation (Braidotti, 2019). Instead, it proposes that the human self extends beyond the individual body, entangled with other beings and technologies in complex networks. This resonates with Indigenous worldviews that reject atomistic individualism and see the human, natural, and spiritual worlds as profoundly interrelated (Haraway, 2016). Reflecting these theoretical view points, speculative ethics also values pluralism, recognizing that diverse cultures and knowledge systems can produce multiple valid ontologies-or ways of being- simultaneously. There is no single “correct” worldview.
Lastly, speculative ethics focuses on situated, embodied knowledge. It rejects the colonial notion of a detached, neutral vantage point from which to make ethical pronouncements. Rather, ethics emerges from embedded locations, shaped by particular relationships and contexts.
In other words, speculative ethics integrates central concerns from feminist, Indigenous, and posthumanist thought to reimagine ethical care as a situated, relational practice responsive to marginalized perspectives and multiple ways of knowing. This provides a critical counterpoint to mainstream biomedical ethics.
Speculative approaches make explicit the politics involved in how technologies, such as machine learning, are designed and deployed. As Goda Klumbytė explained, applying speculative ethics to machine learning involves asking “what if” questions, expanding the possibilities of algorithmic systems beyond profit-driven motives. Using examples from healthcare, Goda discussed patient care pathways in evidence-based practice and algorithm logic, where decisions around care are developed from big data sets . She discussed how both the patient and the healthcare provided (from these data sets) are framed in an idealistic way that systematically excludes diversity in favour of profitable outcomes.
Brianne Donaldson spoke about how applying a metaphysical lens to the ethics of care, and questioning the fundamental characteristics of existing healthcare systems, reveals healthcare’s false binaries : mind/body and individual/community. She argued that we should move away from fixed binaries and instead recognise the constant becoming inherent in life, embracing the confused and speculative potential in all things. Brianne highlighted the contrast between biomedical ethics and what it means to situate people in their relational care networks.
Though unable to participate due to an unforeseen conflict, Zakiyyah Iman Jackson’s work inspired how we framed race and embodiment in ethics. As Jess Dillard-Wright summarised, Jackson probes how ideals of autonomy and self-determination emerge from anti-black logics of what constitutes a “human”.
In the discussion that followed, participants grappled with how to shift contemporary nursing ethics beyond its roots in white empiricism and cis-heteropatriachy. We considered that since speculative ethics foregrounds the situated, messy, collective processes of care, it enables us to ask “whose lives matter?” and recognise that multiple ontologies (ways of being) can co-exist.
Speculative ethics has radical implications for healthcare. It means relinquishing the pretence of neutrality or objectivity. It enables us to challenge the status quo, pushing us to imagine – and then build – other worlds, worlds where care work builds justice, fulfilment and collective flourishing. It requires centring marginalised communities and their visions of health and wellbeing. And it demands care for the planet itself.
We will continue the dialogue with a series of reading groups and writing workshops focused on developing the affirmative potential for speculative ethics in the context of care. This effort will culminate in a special issue in Nursing Philosophy in 2025. All are welcome. Please join us!
About the author
Jamie B. Smith works as a nurse, lecturer and research associate at Charité Universitätsmedizin Berlin and The University of Edinburgh. He studied psychology as an undergraduate, before training
as a nurse and earning his Master’s degrees in both Nursing and Sociology. His PhD at the
University of Edinburgh explored nursing and institutional power using critical posthuman theory. He can be found on Twitter @Mrhornesmith.
Braidotti, R. (2015). Posthuman feminist theory.
Braidotti, R. (2019). Posthuman knowledge (Vol. 2). Cambridge: Polity Press.
de La Bellacasa, M. P. (2017). Matters of care: Speculative ethics in more than human worlds (Vol. 41). U of Minnesota Press.
Haraway, D. J. (2016). Staying with the trouble: Making kin in the Chthulucene. Duke University Press.
Lloyd, G. (2020). Part of Nature: Self-Knowledge in Spinoza’s” Ethics”. Cornell University Press.