Adaptive preferences in medicine: a subjectivity-first account

In this paper, I argue for a subjectivity-first account of health-related adaptive preferences (HRAPs). Rather than evaluating preferences in isolation, this approach shifts normative attention to how a subject's lived orientation and the world they inhabit mutually shape one another long before a clinical encounter. On this view, the normative task is to understand how HRAPs become intelligible to a subject under non-ideal conditions by focusing on two dimensions of subject formation: the ecosystemic, which concerns the patterned norms and material conditions that structure what appears viable, and the configurational, which concerns how subjects interpret and navigate these pressures within their lived orientation. Together, these dimensions explain how HRAPs emerge in ways that avoid collapsing into either paternalism or relativism.