RT Journal Article SR Electronic T1 Notes on substantance in orthodox theory: a reply to Badano JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 275 OP 276 DO 10.1136/medethics-2018-105030 VO 45 IS 4 A1 William R Smith YR 2019 UL http://jme.bmj.com/content/45/4/275.abstract AB Gabriele Badano offers three criticisms of my challenge to the orthodox family of theories of legitimacy in bioethics. First, I assumed an ‘oversimplified version of the orthodoxy’. Second, I failed to appreciate its domain of application. Third, I only addressed the ways in which orthodox theorists incorporate substance as an ‘afterthought’—and, even then, only by rehashing Gopal Sreenivasan’s argument. Here, I respond to each, taking up the first and third before ending with reflections on the second. The first underestimates the insight that criticism of the simplified version provides to that of the more complex relatives. The third misunderstands the relationship between my view and Sreenivasan’s and neglects an entire argument of my paper. The second fails in light of these two, but raises interesting questions about how the method I suggest might be extended to other domains.