Abstract
What is reflexivity, anyway?
Throughout history, the concept of ‘know thyself’ has exerted a lasting moral influence within philosophical and sociological discourses. Reflexivity, along with its closely related concept of ‘(self)reflection’, encompasses a wide range of interpretations and applications. This diversity arises from its use across various fields of inquiry and intellectual traditions. Reflexivity holds a central role in the works of various philosophers in distinct ways. While dominant theories and scholarship on reflexivity often cite Greek philosophers and analytical and continental traditions – reflecting the contemporary politics of knowledge production, especially in English and written modes – I want to emphasize that reflexive philosophical practices and thoughts have been integral to knowledge production across all regions and cultures, and influenced each other traditions (for instance, see these works: Asante, 2000; Dasgupta, 1932; Sarukkai, 2022). This recognition demands that we examine the limits of narrow historical understanding of reflexivity and embrace richer, more nuanced accounts of reflexivity in knowing, being and doing, as well as the boundaries we often either constrain ourselves within or strive to liberate.
Additionally, without attempting to oversimplify, I want to briefly share the diverse understandings of reflexivity among scholars, shaped by their varied contexts and situatedness. For example, for Nietzsche (1929), reflexive practice is more transformative, recognizing that all philosophy is essentially a confession. He emphasizes the concept of ‘self-overcoming’, where individuals must continually reflect on and transcend societal values. It is an active process of re-evaluating values and creating new ones, urging individuals to challenge traditional moralities. Merleau-Ponty (1962), offers an embodied understanding of reflexive practice. He emphasizes that self-awareness is not merely intellectual but grounded in sensory, lived experience, with the body’s interactions with the world shaping perception and making it central to self-reflection. Collins (1999) emphasizes the importance of self-valuation in understanding one’s work, particularly from multiple intersectional perspectives. She argues that individuals, especially those from marginalized communities, must actively engage in the process of defining and valuing their own experiences and contributions. This approach challenges dominant narratives that often overlook or misrepresent the voices of marginalized groups. For, Walker (2007), in her call for an alternative moral epistemology, challenge’s traditional moral philosophy by arguing for a more reflective approach to understanding moral representations. She asserts that for moral philosophy to be genuinely reflective, it must engage with questions previously deemed ‘philosophically inappropriate’, such as the rhetoric and politics that shape ethical discourse.
For social researchers such as Giddens (1992), Bourdieu (1992), Schutz (1970) and Garfinkel (1967), reflexivity is engaged with in terms of how academic communities shape social reality through the construction of topics and methods. However, they invoke reflexivity for different purposes. Giddens, for instance, examines the subject-object divide and the distinction between experts and laypeople, emphasizing reflexivity’s significance in modernity and its role in understanding societal values and norms. For Schutz, reflexivity focusses on the representation of everyday life, meanings and ways of knowing, while Garfinkel, who rejects categorizing everyday theorizing in social life and social research, views reflexivity as the starting point for analysis and contextualization. For Bourdieu, reflexivity is essential to producing a realistic and responsible social science. Critical theorists and feminist philosophers highlight how reflexivity becomes significant for situated knowledge discourses, as it is crucial to the process of knowing (Haraway, 1988; Harding, 2003, 2004). Employing critical reflexivity lies at the heart of critical, anticolonial, decolonial and Indigenous methodologies and scholars engage with the intertwined relationship between experiences, emotions, affects, place, space and their methods, methodologies and overall epistemologies and ontologies (Kandasamy and McDonnell, 2025; Archibald, 2008; Code, 1991; hooks, 1984; Kovach, 2015; Canaan et al., 1983; Tuck and Yang, 2014; Tuhiwai Smith, 2021; Walker, 2007; Guru and Sarukkai, 2018). For example, Moreton-Robinson (2017) and Tuhiwai Smith, 2021 centres relationality as a core presupposition of indigenous research, and relationship of self, other and world in knowing, being and doing is interconnected.
Reflexivity, whether explicit or implicit, has been central to many scholars and intellectual traditions. It involves recalling, reflecting on, making sense of and sharing experiences, narratives, emotions and ways of understanding ourselves and relational knowledge about the self, others and the world. Reflexivity requires us to pay attention to how the self is embedded in our representations and theorizing of the world through grand narratives or texts, as well as in the relationships between self and other in any inquiry of the world. As a concept, reflexivity carries multiple interpretations and goals from epistemological, political and ontological perspectives (Abdelnour and Abu Moghli, 2021; Deer, 2013; Pillow, 2003). Various philosophical, sociological and methodological paradigms interpret and practice reflexivity in distinct ways. In qualitative health research, several theoretical and methodological approaches emphasize and practice reflexivity to enhance understanding (England, 1994; Finlay, 2002; Finlay and Gough, 2003). At its core, reflexivity discourses challenge dominant positivist epistemological frameworks, where knowledge is considered ‘value-neutral’.
Many critical scholars emphasize the importance of contemplative and reflective practices in social justice projects to remind oneself and others of the intentions of our work in creating a just world. A key focus of reflective practices is to centre and privilege marginalized voices and ways of being, thinking and doing. Such practices have a liberatory force, challenging the status quo. hooks 1 (2014) calls on social justice theorists and scholars working at the margins to ‘destroying dualism, eradicating systems of domination’ (p. 163) through reflective and transformative practices. Despite the diversity of interpretations and practices of reflexivity, they all acknowledge the intertwined nature of ‘knowledge out there’ and ‘self-knowledge’. For those familiar with standpoint epistemologies and situated knowledge epistemologies, reflexivity is central, as it emphasizes that knowledge production involves ‘being engaged’ from/with identities, social locations and embeddedness. For instance, Selgas (2004) highlights that reflexivity helps us ‘talk of agents of knowledge, who are embodied, social and meaning positions, nonisomorphic and moving among diverse narrative territories… they need connections and the coming together of different standpoints, and they will fulfil this condition better than the dominant (but also fragmented and multidimensional) standpoint. Identities are thus not only constructed and performative, but also impossible to reduce to a single social marker of oppression (gender, race or class) because these markers are variously interlocked’(p.304).
In this paper, I do not intend to cover the rich and diverse scholarship on reflexivity across varied disciplines. Instead, my aim is to briefly unpack the prevailing dominant discourse on reflexivity within bioethics and critically analyse its dominant interpretations through the metaphor of thin and thick reflexivity, while proposing a way forward for critical scholars interested in researching morality and ethics. First, I explore what practising reflexivity demands of researchers, drawing on two approaches from my previous work, and discuss their implications for ongoing methodological and epistemological debates in bioethics. I argue that reflexivity is an ethical, epistemological and political practice that demystifies the knowledge production, process and politics of knowing. Specifically, I illustrate that if we take reflexivity seriously, we must question thin reflexivity and consider its implications for knowledge production and complicity in upholding the status quo. For researchers, especially those in disciplines such as applied ethics, practising thick reflexivity demands that we consider what we are theorizing for, what our epistemic claims, to whom, why and what role the self plays in the politics of knowing. Especially, it demands that, we can’t and shouldn’t escape the suffering and struggle of epistemic authority we hold when representing moral realities. We must make ourselves responsible to the epistemic communities we are part of – not the elite or privileged, but those on whose behalf we are speaking. In the third section, based on the preceding analysis, I briefly demonstrate how embracing thick reflexivity could shape the ethics and politics of theorization in applied ethics/health ethics and its practice.
Through the metaphors of thin and thick reflexivities
For critical researchers, the concept of reflexivity is nothing new, and it is often employed to varying degrees as both a methodological and analytical tool. As briefly discussed in the earlier section, reflexivity challenges positivist paradigms such as ‘truth as correspondence’ and ‘knowledge as representation’, which assume a clear division between subject and object, subjective and objective, theory and data/practice, and between fact and value. Adopting reflexive practices involves critiquing these divisions, which are artificial and overlook the complex interplay between knowledge and values. Recent discussions in bioethics emphasize reflexive practices (Dunn and Ives, 2009; Ives, 2014; Ives and Dunn, 2010; Ives et al., 2016; Murray and Holmes, 2013), yet its application in research and theorization, as I would explain later, in my observation, has led to a distinction between ‘thin’ and ‘thick’ conceptions of reflexivity within the scholarly literature. In some cases, practices of reflexivity are adopted in a limited way, often reduced to tick-box exercises or brief positionality statements and with an emphasis on bias or conflict of interest that is not critically examined in relation to broader research paradigms and philosophical commitments. I view these practices as situated on the lower end of the spectrum of thin reflexivity.
The distinction between ‘thin’ and ‘thick’ conceptions of reflexivity offers a framework for understanding how reflexivity operates at different levels of depth within scholarly literature. A thin conception of reflexivity is often procedural or instrumental. It acknowledges the need for researchers to reflect on their positionality into narrow statements – mostly, who they are or positioned within social categories – but often limits such reflection to a checklist of considerations without reflecting or practising reflexivity across theorizing or analysis. Thin reflexivity is commonly employed to demonstrate or signal methodological rigour, transparency, accountability or virtue. For instance, researchers may disclose their identities, biases or potential conflicts of interest as a way of demonstrating accountability to their audience. However, this approach often leaves unexamined the deeper ontological and epistemological assumptions underpinning the research process and relation to selves itself. Thin reflexivity often emphasizes focussing on surface-level engagement without critically addressing first-order or second-order questions. This approach tends to uphold the status quo or reinforce existing epistemic habits, avoiding deeper reflection or meaningful critique. For instance, as first-order questions,
To truly honor the complexity of situated moral knowledge, one must embrace acknowledge
Thick reflexivity reminds us of the taken-for-granted notions, of resisting the dominance of thin, universalizing narratives and of honoring the complexity of situated knowledge. It is an acknowledgment that knowledge is always partial. This deeper approach interrogates the broader sociocultural, political and historical contexts that shape research practices, as well as the power dynamics inherent in the production and dissemination of knowledge. As I see, thick reflexivity thus has a subversive function and becomes a practice for unlearnings and relearnings: it challenges the self-evidence of dominant paradigms and calls into question the significance of frameworks and values that claim to represent an unproblematic reality we often take it for granted. These practices do not aim to offer definitive or fixed answers but instead remains open to revision and reinterpretation. It requires researchers to embrace uncertainty, suffering and the possibility of discomfort, acknowledging that values, theories and principles may need to be re-examined. For instance, challenge positivist and realist assumptions while remaining cautious of excessive romanticized relativism or Eurocentric universalism. Thus it is not merely a way to enhance ‘methodological rigour’ or ‘bias’ or ‘conflict of interest’ but as a transformative practice that interrogates the relationship between the self and the social world-knowing, being and doing. While thin reflexivity may suffice for addressing procedural concerns or demonstrating methodological transparency in neoliberal practices of writing, thick reflexivity engages more deeply with the ontological and epistemological foundations of politics of knowing. By questioning what it means to know and how we come to know, thick reflexivity not only critiques existing frameworks but also opens up possibilities for more situated and transformative forms of inquiry.
Unpacking reflexivity: A critical lens on bio/global health ethics
In bio/global health ethics, there is a growing concern among scholars about critically examining the epistemic, normative and political assumptions that underpin the discipline’s prevailing knowledge practices (Abimbola, 2023; Bond et al., 2021; Carter, 2018; Garden, 2015; Mukandi, 2021; Naidu et al., 2024a, 2024b; Pratt and de Vries, 2023; Scully, 2019; Zeiler and De Boer, 2020; Emmerich, 2015), even though explicit engagement with reflexivity is not explored in all these discourses, except few. I see this reflective process encompasses critiques of positivist scholarship as well as ‘apolitical’ and unjust knowledge production and political practices which are central to thick reflexivity. Some have engaged with critical reflections on the discipline to varying degrees, particularly in relation to the decolonization of bioethics and the project of provincializing the field (Viana, 2024; Fayemi and Macaulay-Adeyelure, 2016; Banerjee, 2022, Chattopadhyay et al, 2017). While the scholarship on the decolonization of ‘any discipline’, including bioethics, has been growing, we must remain critical of how these terms can sometimes serve to sustain or be complicit in maintaining the status quo, under the guise of superficially ‘bringing diversity’. Given the history of bio/global health ethics as disciplines, shaped by dominant Euro-American normativity and the continued imperial and colonial legacies – through mechanisms such as funding or the establishment of ‘standards’ and priorities that dictate which epistemological projects gain prominence, for which regions and by whom – and considering the ways in which the discipline itself (rather than its practices or topics) often holds little relevance for many Global South regions, it is even more crucial to practice thick reflexivity as researchers. This is particularly important when attempting to provincialize disciplines like bioethics, avoiding romanticized portrayals of local values, norms and contexts and instead critically examining the historical and ongoing oppressive structures embedded in moral and political discourses within different contexts.
There is often an explicit or implicit reliance on the lineage of empiricists and rationalists, leading to the continued theorization and development of frameworks. While some approaches account for context, they often lack close attention to self-reflection in relation to knowledge production, instead relying on abstraction and decontextualization in the quest for moral certainty and universal truths. In dominant Euro-American moral philosophy, the history and conceptualization of reflexivity can be traced back to two key trajectories: the centring of the individual as the locus of reasoning, and the consideration of context, material conditions and relationships in the politics of knowledge – shaping the ‘what, ‘how’ and ‘why’ of knowing. In much of bioethics, which often centres scholars from the USA, UK, Australia and Europe due to the discipline’s origins, nearly 24 years have passed since Arthur Kleinman (1999), who is from USA, explicitly called for reflexive practice in bioethics in his 2000 paper, Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? A Quandary for ‘The New Bioethics’. This was closely followed by Hedgecoe’s (2004) Critical Bioethics: Beyond The Social Science Critique of Applied Ethics, in which he emphasized reflexivity and critical bioethics – a social research approach influenced by Renee Fox, Barry Hoffmaster and Charles Bosk. While social approaches are part of (bio)ethics discourses globally, the past 40 years have seen bioethics research take a so-called ‘empirical turn’ (Borry et al., 2005; Hurst, 2010) incorporating both qualitative and quantitative methods to explore and intervene in the ethical dimensions of healthcare and medicine.
Many critical scholars and qualitative health researchers in bioethics, though not always explicitly mention thick reflexivity, engage with and adopt it to varying degrees while engaging with knowledge and politics (Murray and Holmes, 2013; Scully, 2019). Murray and Holmes (2013) emphasize language, speech and embodiment become part of ‘ethical analysis of contextualization’ and question the binaries. While they emphasize reflexivity as central to normative analysis, they frame their work as pre-normative – a stance that, as I understand it, remains unclear in its implications for the politics of knowledge production. Scully (2019) engages with bioethicist’s responsibilities while engaging with questions of activism/advocacy. Some scholars draw on concepts from feminist epistemology, phenomenology and critical theory, such as ‘situated knowledge’ and ‘positionality’ though their engagement with the politics of knowing and critical reflexivity discourse remains less explicit. Influenced by critical theorists and feminist epistemology, some in bioethics are fundamentally committed to situate the intertwined aspect of theory and practice through sociological, phenomenological and philosophical lenses. Embracing this theoretical position means adopting reflexivity and rejecting the notion of value-neutrality in knowledge production. For others, reflexivity addresses issues such as ‘bias’ and ‘conflict of interest’ in relation to the researcher’s positionality. These scholars employ reflexivity as both a methodological and theoretical tool to integrate theory and practice. For instance, Ives (2014) has championed a ‘reflexive turn’ in bioethics, emphasizing the importance of balancing perspectives and advocating for ‘a genuine suspension of disciplinary or ideological commitments’ (p. 213). Ives and Dunn (2010) view reflexivity as a ‘managing tool’, aiding authors or speakers in ‘managing the inevitable subjectivity in the process of philosophical bioethical analysis and revealing potential bias and conflicts of interest in public and political engagement’ (p. 262). Framing it as ‘suspension’ or ‘managing tool’ reduces it to a procedural exercise aimed at mitigating bias and assumes subjectivity can be contained or neutralized rather than understood as a fundamental and inescapable part of knowing and transformative practice that interrogates power and epistemic frameworks. This depoliticized view risks reinforcing the status quo by failing to critically engage with deeper, systemic issues in politics of knowing. For those of us working within a critical constructivist paradigm and a phenomenological approach, the term ‘bias’ in the practice of reflexivity suggests an inclination towards positivist or post-positivist frameworks. This perspective risks reverting to a binary understanding of subjectivity/objectivity, which situated epistemologies seek to resist. The emphasis of reflexivity in these discourses is precisely to challenge such binaries and to acknowledge the researcher’s active role in politics of knowing.
As a ‘managing tool’ and the language of ‘bias’ is becoming dominant in recent bioethics debates (Hofmann, 2023). This focus raises critical questions for practice of reflexivity: what does ‘bias’ imply in this context? Is it a lack of ‘objectivity’, a threat to the study’s ‘reliability’ or ‘credibility’ or does it involve ethical or political considerations? Acknowledging reflexivity in one’s work implies rejecting the concept of objective standards as entities that exist independently of human thought and practice. This perspective brings the interplay of power, knowledge and practice to the forefront of bioethics discourse. Under this paradigm, it is not only the interpretation of ‘facts’ that is shaped by power dynamics, but also the criteria for what is deemed valid knowledge. As a result, the traditional notion of ‘truth as representation’ in relation to ‘facts’ loses its significance. Hedgecoe (2004), while challenging the monolithic assumptions of social research paradigms, describes reflexivity not just as an individual’s self-awareness but as central to the nature of knowledge production. He emphasizes the importance of authors and speakers being mindful of their personal contexts, advocating for the use of ‘sociological imagination’ and the integration of social research into bioethics. In this literature, the focus is on the ‘author’ or ‘spokesperson’, promoting reflexivity as a methodological tool that facilitates ‘integrated’ bioethics attuned to real-world social contexts.
It compels us to scrutinize the very concept of ‘integration’ and ‘objective standards’ used to assess competing knowledge claims, particularly in light of the field’s ongoing ‘reflexive turn’ and ‘empirical turn’. Understanding that these standards are constructs shaped by a community of researchers and practitioners – and acknowledging the influence of political, historical and social contexts on knowledge production – requires recognizing the political and normative dimensions inherent in scholarly research.
Advocates for reflexivity in bioethics often imply, rather than explicitly articulate, its necessity, which risks reducing this historically and conceptually rich concept to a mere ‘tick-box’ exercise, statements or procedural formality. Such an approach could undermine the full potential of reflexivities. As I observe in fact-value discourse and through sociological debates and qualitative health research, bioethics has grappled with an ‘identity crisis’ since its inception – an issue that has persisted and evolved, particularly with the discipline’s ‘empirical turn’ and ‘reflexive turn’. I would see that these shifts have/should lead bioethics to reflect on and investigate itself as a subject. In the ongoing debates around empirical bioethics, standard-setting exercises (Ives et al., 2018) and reviews of empirical bioethics methodologies (Davies et al., 2015), there are inherent gatekeeping practices that determine what counts – and what does not count – as ‘empirical bioethics methods and methodologies’. Simultaneously, these discussions invoke the values of trans, multi, inter and post-disciplinary narratives, creating a tension between inclusionary rhetoric and exclusionary practices. Then, I see, the discourse of reflexivity becomes a crucial opportunity for the discipline to engage in self-reflection and evaluation, especially given its increasing fragmentation into distinct academic ‘sects’, ‘tribes’ or ‘schools’. While the existence of such ‘tribes’ within bioethics may be debatable, the discipline has undeniably undergone significant growth, branching into super-specialties and sub-specialties that align with the demands of a neoliberal healthcare and academic system. In this context, engaging with concepts like reflexivity offers both promise and challenges for a multidisciplinary field like bio/global health ethics.
The current focus on reflexivity in bio/global health ethics scholarship often emphasizes self-reflection and the positionality of researchers or authors, bias and conflict of interest, while sometimes overlooking or underestimating the deeper epistemological, theoretical and political commitments in doing ethics research. Rightly, a few scholars are beginning to question the performative nature of positionality statements and their roots in modernity and colonial knowledge practices (Gani and Khan, 2024). The increasing trend of making performative positionality statements – without acknowledging the larger value commitments – turns this practice into a colonial and imperial one, merely often signalling racial, ethnic and/or gender differences or social categories without considering what these mean for the knowledge produced or theorized. This tendency underscores the need for proponents of reflexivity in any domain, here bioethics, to engage more thoroughly with these fundamental aspects of knowing. At present, the dominant ‘thin’ form of reflexivity does not sufficiently challenge or critical of underlying assumptions of knowing the social world. This highlights a significant gap in reflexivity literature, especially from epistemic, political and normative perspectives within bioethics. It’s important to recognize the diverse philosophical approaches to reflexivity – such as those of critical theorists, phenomenologists, constructivists or pragmatists (noting that these schools are not always mutually exclusive). In this context, unpacking what the ‘reflexive turn’ truly signifies for bioethics and its potential impact on the subject-object or fact-value divide becomes essential. Evaluating the outcomes of this ‘reflexive turn’ is crucial.
The understanding that moral and ethical concepts and theories are not mere representations of an external ‘world out there’ or a ‘view from nowhere’, independent of the observer, is fundamental. This realization establishes a profound link between epistemology – concerned with what is considered meaningful or reliable knowledge – and politics, which encompasses the values, concerns, needs and interests of a community. Viewing reflexivity as both an epistemic and political endeavor has significant implications for the field of bioethics. Like any social research, bioethics is characterized by a diversity of paradigms, especially as we borrow and learn from other diverse disciplines, each with its own terminology, values and orientation towards distinct political projects. In the next section, I will focus on two approaches I have employed in my work, examining instances of practices of reflexivity and their broader implications, particularly when scholars use interpretative methods and methodologies.
Centring experiential and situated knowledges: Critical constructivist and phenomenological approaches
When engaging with reflexivity, critical scholars are not critiquing just ‘bias’, which is often employed in bioethics discipline; we are engaging with a deeply entrenched ethical-political-epistemic paradigm, philosophical and political assumptions. This approach essentially blurs the traditional distinctions between subject (such as researchers and participants) and object (including the study, participants and theory), and ‘known, to be known and knower’. As a result, the researcher’s presence becomes an integral part of how the world is described, interpreted, understood and experienced. This shift recognizes the significant role researchers play in both the production and evaluation of knowledge. It leads us to question what counts as ‘reliable’, ‘credible’ or ‘trustworthy’ knowledge. Which standards are applied, and why? Thus, we must critically examine the kind of knowledge that becomes accepted as ‘truth as representation’ and account for the socio-historical and political contexts in which it is produced.
Critical scholars emphasize the interplay between representations of social realities and the socio-economic and political conditions that render ‘reality’ as a given. Many critical scholars, including myself, experience an epistemological and existential crisis, questioning the ‘reliability’ of knowledge and the politics of ‘evidence’. This crisis leads to an embrace of the historicity of knowledge, reflexivity and humility. As bioethics researchers, such an understanding of reflexivity shifts our focus from merely exploring the essence and nature of moral knowledge to emphasizing the historical, political and sociological analysis of the conditions in which knowledge is produced and its significance to politics of knowing. I position my works within interpretive framework and critical theory approach as it usually incorporates attention to researchers’ reflexivity and intersecting positionalities, identities and selves and weaves them into the way we theorize and the way we want to vision and liberate marginalized voices, and I believe this understanding adds on an ontological sensibility; here I mean, it sheds light on ways of being in the world, ways we want to live, as inherently part of what it means to construct knowledge. To elucidate how different epistemological and ontological standpoints offered by various schools or theories lead to unique bioethics projects, let me share some examples from by earlier works where I employed critical constructivist methodology and phenomenological approach.
My doctoral study, influenced by situated knowledge epistemologies, as a critical philosophical ethnographic project (Subramani, 2018, 2019b, 2022, 2025), employed constructivist grounded theory approach (Charmaz, 2006), recognizing that knowledge is not neutral or objective but shaped through our interactions, identities, histories and power relations. The conception of ‘passive patient’ in Indian healthcare settings is not just a theoretical and conceptual construct; it is a lived experience, one that I, like many others, have felt deeply in moments of vulnerability and care (Subramani, 2018, 2019b, 2022). Even though, almost 7 years ago, I lacked the vocabulary or language I have now (which we are constantly unlearning and learning), I maintained a reflexive stance throughout my doctoral research process, continually interrogating how my own social position and personal experiences influenced my work through reflexive moments (Subramani, 2019a). My identities have been shifting, and also very well aware that identities and categories we embody are not static. I come from the Badaga hill tribe, a community whose indigenous identity is contested within India’s state’s political discourse and constitutionally categorized as ‘Backward Community’. Raised in a lower-caste and class background, with phases of poverty, I have some intimate knowledge of what it means to navigate spaces marked by gender, ethnic, caste, class and racial discrimination. I am not suggesting I have an epistemic authority because of my marginalized identities and lived experiences, but I certainly have partial knowledge and experience being on the margins and reflecting on self and once categories we embody would situate my knowledge construction and production process and provides a critical perspective towards dominant moral and social practices. My experience of everyday indignities, often due to social categories I live by, along with many I had with medical authorities and hospitals – both public and private – have made me acutely aware of how gender, class, caste, language and able-bodiedness, shape how we access healthcare and experiences of care in South India. It is through this lens of embodied knowledge that I engaged with the underlying assumptions of respect, autonomy, and informed consent in law and clinical practice (Subramani, 2025).
Throughout the process, my personal experiences and social categories I live by continually shapes and reshapes the knowledge I produce or how I theorize within dominant bioethics discourse. These embodied experiences deeply influenced not only the way I approached my fieldwork but also how I came to understand the broader theoretical, methodological and ethical questions central to my work. For example, in the government/public hospital, where wards are shared spaces with little privacy, I initially conducted interviews in the presence of nurses. I took it for granted the architecture and power relationships and became complicit in the very structure and methods of ethnography. The responses I received were guarded, shaped by the dynamics of surveillance in these settings. Over time, I realized the importance of conducting interviews in more ‘nurse away’ spaces, and ‘rigid power dominant wards’ and times to minimize the influence of hierarchical power structures, allowing for a more honest conversation. I am not an ‘objective outsider’; I am part of the social fabric that I seek to study. My own epistemic and affective anxieties with experiences of caste-class-gender are deeply part of me, resurfaced as I stood hesitantly outside a private hospital room, unsure whether I should knock the door and disturb the patient’s privacy. This hesitation marked a critical moment in my understanding of how identity, privacy, respect and self-respect are negotiated differently in public and private spaces, including hospital settings, shaped not only by the very architecture but also by the class-caste-gender and social positions of the patients themselves. The hospital architecture along with institutional ethos itself seemed to guide and frame the interactions I witnessed and experienced. The open wards, devoid of privacy, revealed much about the everyday functioning of the hospital, but also about the implicit messages patients received about their moral worth in different settings.
I observed how everyday indignities, shame and humiliation, became normalized at varying degrees in different hospitals by healthcare professionals. For instance, there was little space for everyday dignities in a hierarchal setting where beds were crammed side by side, separated only by thin curtains or sometimes nothing at all. Public patients are often not seen as morally worthy, while private patients are viewed as troublemakers. Either way, the archetype of the patient in India does not accommodate the concept of the ‘active patient’, which is inherently assumed or taken for granted in bioethics discourse. Here, privacy felt like an afterthought, and respect for patients was often denied or compromised by often justifications such as overwhelming demands placed on healthcare workers and lack of time in these overburdened spaces. But these attitudes and behaviours are sustained and normalized due to institutional ethos structured by colonial legacies and upper-caste-class-gendered hierarchies. I have discussed elsewhere in detail how these experiences make us question the way we think about concepts such as respect, autonomy and informed consent, which are central to bioethics discourse but shaped by its dominant, decontextualized, dominant Anglo-American values and archetypes of patients (Subramani, 2025). Reflexive practices not only address first-order questions seriously but also engage with second-order questions, subverting established notions and challenging the ways we theorize within historical, political and social context, and produce knowledge through reflexive methods and methodologies.
During my postdoctoral work in Zurich, Switzerland, which focussed on the moral phenomenon of (dis)respect while accessing healthcare by migrant women in Zurich, Switzerland. I adopted a critical constructivist framework coupled with a moral phenomenological-sociological approach to explore the phenomenon. Let me share an example to share one of the reflexive moments, to capture how the experience of being-with the ‘other’ as ‘other’, and its significance for theoretical and epistemological understanding, and finally conclude with making sense of these aspects and how it contributes to normative discourse and demystifies the theorization, as well as how reflexivity is also a political practice. Similar to my doctoral work, which involved continual processes of unlearning and learnings, I have been deeply influenced by critical theorists in this work (Ahmed, 2013a, 2013b; Fanon, 1952; hooks, 2006, 2009; hooks and Hall, 2017; Yancy, 2008; Young, 2008). Both personally and professionally, I often choose to embrace the margins, while acknowledging being anxious, as it anchors me in freedom, openness and reflexivity, while producing knowledge. As a researcher who has been reflecting on topics such as microinequities (Subramani, 2018), moral habitus (Subramani, 2022), embodiment in public health ethics discourse (2024), and the experiential dimension of respect for persons (Subramani and Biller-Andorno, 2022), and ways I know and experience the work, I became highly aware of my body as an ‘Other’ during my first year in Zurich due to instances of discrimination in public spaces and within the university system (Subramani, 2024). These experiences, along with particular ‘reflexive moments’ when I encountered and witnessed public hate crimes and policing behaviours, led me to seek a deeper understanding of migrants’ healthcare experiences and their relevance to moral identity and moral self.
Drawing from my personal struggle to establish a sense of belonging, I began attending meet-ups in Zurich, seeking to connect with and build a social community. My approach predominantly relied on purposive sampling and snowballing methods to identify and engage participants. The data collection process took place in various settings, including walks, shared journeys on public transportation, coffee meetings and cooking together. In some cases, interviews were conducted at the participants’ homes, public parks or my own home, based on their preferred locations. Given that some of these interviews occurred during the ongoing COVID-19 pandemic, I offered flexibility by scheduling interviews at times and in ways that suited the participants best. Many participants favoured walking as a method of engagement, which I consider to be an exceptional means of understanding one’s life and experiences. It is a profound way to communicate about experiences, as it allows us to connect in an embodied manner, sharing feelings and corporeal presence while moving.
A key theme of my research, based on my own reflexive accounts and experiences as immigrants, is awareness of one’s own body as the ‘Other’, that is being conscious of being the ‘Other’ through the embodied experience. For instance, a recurring experience while crossing traffic signals is awareness of the ‘othering’ gaze. We (I & informants) have both experienced ‘Othering’, whether through glances, shouts or gestures that made someone feel judged and we are quite aware of how the body is perceived as an Other. My epistemological and ontological framework allows me to position my ‘self’ in research and power of paying attention to my body and emotions when I moved to Zurich, Switzerland 6 months prior to COVID-19. I was normalized to discrimination based on caste, gender, colour and class within Southern Indian society, but I wasn’t familiar with discrimination in the ‘dominant white space’, while the experiences are no different. Some experiences in Zurich made me acutely aware of my ‘body’ – a strangely familiar yet unfamiliar – as my body was reduced to nothing more than a ‘coloured Ausländer’. While experiences of being called as
Seema identifies herself as Kurdish ethnicity, is a cisgender woman in her mid-30s, is a first-generation immigrant and works part-time as a waitress in a restaurant. Here’s an account of our interaction, when I went to pick Seema up, she was elegantly dressed, wearing boots and carrying a potted plant. We exchanged greetings, and I escorted her to my home. As we entered my living room, which also served as my kitchen, I noticed Seema’s keen observation – the change in my footwear. She inquired whether she should remove her boots, to which I reassured her that it was not necessary and she could come in with her boots on. However, Seema chose to remove her boots, expressing, ‘I don’t want to disrespect your values’. I reiterated that there was no issue whatsoever, and we proceeded with our conversation while preparing dosa and chicken curry together. As our conversation flowed, we explored into discussions about our notions of home, cooking, belonging and our connections to specific foods and memories that held experiences of belonging. After our lunch, I sought Seema’s permission to begin audio recording for the study. When I began questioning her about her experiences as a migrant in Zurich, Seema steered the conversation towards how individuals relate to each other, or sometimes fail to do so, when encountering people from different cultures. She repeatedly emphasized why she felt a strong commitment to respecting others, sharing, ‘Many people here see me differently. I have been living here since I was 11 years old, and even though I am a Swiss citizen now, they still see me as an auslander… you know, I speak Swiss German, but still when I go shopping or meet with office people, they talk to me as if they don’t understand me, as if I’m an outsider’ (her voice pitched, and she appeared visibly disturbed). Nevertheless, she expressed her conscious awareness of other cultures and her determination to ensure that she did not disrespect mine, which led her to remove her boots despite her discomfort. She also revealed her right foot, where two toes had been amputated due to a fire accident and recounted her healthcare experiences, particularly a recent incident with Swiss healthcare professionals regarding custom-fitted shoes for her feet. She elaborated on how her needs were often disregarded, and her presence remained unacknowledged during multiple appointments.
Through Seema’s experience, I have illustrated the way in which our embodied presence and shared vulnerability shed light on the performance of identities and bodies in the our interactions, spaces of belonging and connecting. It also underscores the significance of the moral and cultural spaces within our body-selves. For example, Seema’s vulnerability in sharing her fire incident and the removal of her boots to acknowledge my space are indicative of her way of showing respect and recognition during our encounter and connecting. I theorized that this encounter epitomizes the intersubjective space and the practice of an ethics of belonging, where encounters with ‘others’ are imbued with recognition. Also, based on this analysis, I critiqued the liberal understanding of cosmopolitanism, which upholds the ‘universal subjectivity’ where we are all ‘the same’ stripped of identities, needs to wrestle with the subjectivity of the ‘Other’, where moral emotions and embodied experiences need to be accounted for in order to practice cosmopolitanism…and argued “when emotions and body politics become central through migrants’ experiences, they become political agents who practice cosmopolitanism through the ethics of belonging and not just passive ‘strangers’ who are owed duties by well-meaning, detached so called cosmopolitans” (Subramani, 2024).
As I weave together critical insights through reflexive practices, from my doctoral and postdoctoral work, I continually return to one core question: What does it mean to truly respect persons within a culture so deeply marked by disrespect? In my works, in centring self-respect, recognition and everyday dignities, I strive not to treat it as an abstract ideal but as a lived, embodied practice of liberation within intersubjective spaces – one grounded and situated. This is not just about generating knowledge; it is about healing the structures that withhold recognition and respect from those who need it most and who practice. Thus, I show here that practising reflexivity directs us to focus on the embodied intersubjectivity of research processes and demystify and show potentiality to subvert the epistemological process, and value and political commitments in normative discourse. I hope I have illustrated with few examples here that knowledge and reality are constructed; actions, interpretations and representations of reality and knowledge are co-created. For scholars utilizing a critical constructivist and phenomenological framework to explore moral realities, reflexivity prompts questions about how subjective meanings transform into ‘objective facticities’, and how change can be fostered after representing or better explaining social reality and its power structures. This understanding necessitates a careful consideration of the socio-political context of knowledge production, especially in the current climate of evidence-based research movement and the evolving ‘standardization’ for conducting and evaluating empirical inquiry in bioethics. In the next concluding section, by taking forward the analysis so far, I will reemphasize that practising reflexivity is inherently ethical, epistemological and political practice in the ongoing knowledge production discourse.
Practising reflexivity: Epistemic, ethical and political practice
As a critical social theorist working in health ethics space deeply influenced by critical theorists and epistemologists who engage with the politics of knowledge, power, experience and epistemic practices, I have come to realize that all knowledge, including moral knowledge, is situated. This means that we, as researchers, are not passive vessels of knowledge, but active agents whose understanding is embodied and rooted in specific social and historical contexts. This is central to many epistemological frameworks, including anti-colonial, Indigenous, feminist and critical theories (Archibald, 2008; Kovach, 2015; Tuck and Yang, 2014; Tuhiwai Smith, 2021). These frameworks challenge the traditional Cartesian paradigm of truth and reason, particularly the rigid dichotomy between subject and object, data and theory, and fact and value. For me, this understanding has reshaped how I approach normative discourse and ethics research, which is not about ‘discovering’ meanings or ‘integrating’ empirical data with normative theory as though they are separate and value-neutral entities.
When I observe discussions about so called “empirical bioethics”, it often revolves around the idea of ‘integration’ – integrating social inquiry with normative inquiry. But from my perspective, this assumption that data and theory are two different things is deeply problematic as it assumes inherent dichotomous understanding of social and moral realities. Drawing on the framework of situated knowledges, they are not neutral artifacts waiting to be integrated; theory/data are shaped by values, norms and political commitments, produced by those who develop and contribute to social, moral and political realities. Theories/concepts/data are not discovered in some pure, untouched form; they are constructed through research processes that involve numerous choices – choices about what to understand, measure, how to categorize and who to study. These choices are not innocent; they reflect specific values and can reinforce particular commitments within particular social, cultural and political contexts. So, when I think about reflexivity in empirical bioethics, it’s not just about asking whether we are biased or conflicted or writing brief positionality statements; it’s about asking deeper questions:
Some bioethics scholars have critiqued the standardization and its implication (Carter, 2018; Cribb, 2018). In addition, continuing and contributing to such conversations, I am wary of empirical bioethics as a mere methodological exercise, as thin reflexivity, as a space where we simply integrate empirical data with normative theory as though they are distinct and separate entities. Beyond thin reflexivity – beyond concerns of bias or conflicts of interest – thick reflexivity resists the push towards over-specialization that reinforces academic territorialism. It becomes an ethical-epistemological-political practice that asks us to take responsibility for the knowledge we produce and be accountable within the current politics of knowing and being in these academic spaces or while translating them. Embracing the margins, as hooks (2014) often writes about, has grounded me in openness, practices of reflexivity and humility, particularly in how I produce and construct knowledge. But as much as this reflexivity has been intellectually enriching, it has also come with challenges. The ambivalence of being a postcolonial ‘product’ and now a migrant scholar – privileged in certain Global South contexts yet occupying spaces of relative marginalization in white-dominant Global North settings – often leaves me grappling with how, when and why to invoke identities and lived experiences in epistemological and political conversations. My lived experiences, having lived with multiple marginalization and in-betweenness, have shaped my ongoing unlearnings on how I see the world, how I experience, how I theorize, how I write and why I write and to whom.
Conclusion: Commitment and responsibility
As shown in earlier sections, reflexivity is deeply anchored in the nexus of epistemology, politics and ethics. It becomes particularly pertinent for scholars engaged in politically engaged research projects, which is literally every social research (including ethics projects). Reflexivity thus evolves into a political endeavor, where the commitment and responsibility to ethical and political values in knowledge production is both acknowledged and critically examined. Practising thick reflexivity from a relational and interpretative perspective of social and moral worlds positions us, as researchers, as both participants in the meaning-making process and political agents in our projects. This practice is inherently epistemic, ethical and political. It re/presents the researcher’s commitment and responsibility to capturing and shaping the politics of knowing. By emphasizing thick reflexivity, which is inherently critical, one key takeaway – both for myself and for others who practice or wish to practice it – is its epistemological and political distinction from ‘thin’ practices. Critical reminder when we read works such as this and those who engage in such detached exercises exercises (see works like those of Perry Hendricks and others who engage in similar ‘oughts’ and ‘arguments.’). 2 Thick reflexivity resists complicity in upholding positivist, decontextualized, disembodied and absolutist approaches, as well as the language of obfuscation, when contributing to moral knowledge discourse. It offers a way forward, envisioning and fostering radical imagination in how we know and in our practices of knowing. As critical scholars, we attempt to understand that ethical theory is always directed towards a specific audience and designed to achieve particular objectives. This understanding, drawn from earlier analyses, suggests that the production of knowledge is never neutral or ‘innocent’. For example, the growing trend towards standardizing ‘empirical bioethics methods’ within the evidence-based research movement cannot be ignored – it’s the ‘elephant in the room’. Engaging with this issue inevitably brings up questions of politics and ethics that need to be addressed. Thus, we must consider its broader implications for knowledge production, particularly in works that engage with concepts of justice, equity, solidarity or other ethical theories. This reflection is crucial for understanding how our research practices and theoretical frameworks influence, and are influenced by, our ethical and political stances. Recognizing that researchers have a privileged position in terms of what, how and for whom they write and acknowledging this privilege, especially when challenged by the subjects of study, leads to a reflexive recognition of the performative nature of writing and research methodologies that conform to certain academic norms. Thus, embracing and practising reflexivity is a craft that underscores the ethical and political implications of theorizing and any research.
Sometimes, or often, writing self-narratives or positioning in academia seems like a ‘marketing job’ where one might risk performing a coherent self. I see practising reflexivity as essential for understanding how and why these performances of our multiple selves take shape and are sustained within academic spaces. If the practice doesn’t help us embrace the uncertainty and our multiple selves in knowing the world, then its significance is lost. Reflexivity most of the times then becomes as commitment and as a responsibility. This arises from the limits of continual reflexivity in practice, where it risks sometimes becoming non-relational and overly individualistic. Practising reflexivity can be constrained by the retrospective nature of understanding actions, experiences and events. In many cases, as shown earlier with some examples, the illuminating power of reflexivity is only realized after the fact or as ongoing experience. Some scholars have tried to address the complexity and challenges through steps, methods and approaches to practices, these approaches mirror the complexity of doing research and producing knowledge in neoliberal academic systems. However, one cannot overlook the values that sustain knowledge production and the need for active practice of thick reflexivity. This active practice involves moving from tick-box exercises to discursive knowledge, examining the components of agency (i.e. the ability to account for actions and act within specific conditions) and focussing on practice-positioned relations. Reflexivity, therefore, extends beyond individual self-awareness and becomes deeply relational, positioning individuals and groups and knowledge productions within the politics of broader historical, cultural and sociopolitical contexts.
Learning from critical scholars (hooks, 1991; Kovach, 2015), I would argue that making sense of the world is what theorizing is. Describing, naming and theorizing are part of what we do as meaning-making and evaluative beings. Whenever we theorize, we claim something about the world. An ethical theory can be an intricate explanation or a complex analysis, a sophisticated philosophy or a sociological reality or even a specific language or political position. Practising reflexivity in ethics research embodies a performative aspect of social inquiry, as research methods don’t just create representations of moral realities but also shape the very moral realities, we/they depict. This goes beyond a mere epistemological concern – that is, evaluating the conditions under which bioethics knowledge is produced – to encompass a political dimension. Consider the metaphor of weaving with one coloured thread to create a cloth, where our ‘use of certain methods’ needs to be recognized as performative within given conditions and contexts and the potential for other coloured threads exists. This argument holds normative, ontological and political assumptions, as well as epistemic and ethical implications. In my earlier work, I explored how practising reflexivity serves to ‘demystify knowledge construction’ (Subramani, 2019). However, it is crucial to recognize that thick reflexivity involves more than our positionalities and identities. In the context of critical philosophy, where practising reflexivity is indispensable, engaging in thick reflexivity not only challenges the status quo but also entails a process of embracing uncertainty and suffering. Through this transformation, we become—like dragonflies—capable of seeing beyond surface appearances. Thick reflexivity acknowledges the interplay between doing, knowing and becoming, while demystifying the processes of knowledge production and the representation of social and moral realities. To conclude, it demands that we recognize the non-innocence of our knowledge production and the ways in which we represent moral and political realities, both within and at the margins of various fields/disciplines.
Footnotes
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Author biography