Bruce Jennings

The social sciences playa variety of multifaceted roles in the policymaking process. So varied are these roles, indeed, that it is futile to talk in the singular about the use of social science in policymaking, as if there were one constant relationship between two fixed and stable entities. Instead, to address this issue sensibly one must talk in the plural about uses of dif ferent modes of social scientific inquiry for different kinds of policies under various circumstances. In some cases, the influence of social scientific research is direct and tangible, and the connection between the find ings and the policy is easy to see. In other cases, perhaps most, its influence is indirect-one small piece in a larger mosaic of politics, bargaining, and compromise. Occasionally the findings of social scientific studies are explicitly drawn upon by policymakers in the formation, implementation, or evaluation of particular policies. More often, the categories and theoretical models of social science provide a general background orientation within which policymakers concep tualize problems and frame policy options. At times, the in fluence of social scientific work is cognitive and informational in nature; in other instances, policymakers use social science primarily for symbolic and political purposes in order to le gitimate preestablished goals and strategies. Nonetheless, amid this diversity and variety, troubling general questions persistently arise.

hope of obtaining a comprehensive and coherent understand ing of the human condition, we must somehow weave together the biological, sociological, and psychological components of human nature and experience. And this cannot be done indeed, it is difficult to even make sense of an attempt to do it-without first settling our accounts with Darwin, Marx, and Freud. The legacy of these three thinkers continues to haunt us in other ways as well. Whatever their substantive philosophical differences in other respects, Darwin, Marx, and Freud shared a common, overriding intellectual orientation: they taught us to see human things in historical, developmental terms. Phil osophically, questions of being were displaced in their works by questions of becoming. Methodologically, genesis replaced teleological and essentialist considerations in the explanatory logic of their theories. Darwin, Marx, and Freud were, above all, theorists of conflict, dynamism, and change. They em phasized the fragility of order, and their abiding concern was always to discover and to explicate the myriad ways in which order grows out of disorder. For these reasons their theories constantly confront and challenge the cardinal tenet of our modern secular faith: the notion of progress. To be sure, their emphasis on conflict and the flux of change within the flow of time was not unprecedented; its origins in Western thought can be traced back at least as far as Heraclitus.

This article defends ‘relational theorizing’ in bioethics and public health ethics and describes its importance. It then offers an interpretation of solidarity and care understood as normatively patterned and psychologically and socially structured modes of relationality; in a word, solidarity and care understood as ‘practices.’ Solidarity is characterized as affirming the moral standing of others and their membership in a community of equal dignity and respect. Care is characterized as paying attention to the moral being of others and their needs, suffering, and vulnerability. The wager of relational theorizing in health care and public health is that substantive ethical visions of solidarity and care will provide support for more just and egalitarian health care and public health policies.

Aging brings about the ordeal of coping. Younger people also cope, but for those in old age, the ordeal is so often elegiac, forced upon the self by changing functions within the body and by the outside social world, with its many impediments to the continuity of former roles, pursuits, and self‐identities. Coping with change can be affirming, but when what is being forgone seems more valuable than what lies ahead, it is travail. For most, the coping is managed more moderately by a sense of resignation. This is especially true for those who survive into profound old age, when one is viewed as if being old is one’s essential identity and nature. We must recognize and affirm difference and change without stigmatizing or losing sight of the specific capabilities and circumstances of the individual. This is what I think the often‐used, but less often clearly defined, notion of a “person‐centered” orientation should signify.Individuals age, but so do societies, not simply because they have a large population over age sixty‐five, but in the sense that societies as a whole are also buffeted by significant disruption in orders of meaning. Aging has a public as well as a private manifestation, a social as well as a personal embodiment, and how it is paid attention to in culture, politics, and policy makes a great difference to how aging is concretely experienced in human lives. In this essay, I explore how the moral imagination nurtured by the practices of solidarity and care—and nurturing them in turn—can come of age—and how these practices can take their rightful place in an ethically mature political culture.

Many working in bioethics today are engaging in forms of normative interpretation concerning the meaningful contexts of relational agency and institutional structures of power. Using the framework of relational bioethics, this article focuses on two significant social practices that are significant for health policy and public health: the practices of solidarity and the practices of care. The main argument is that the affirming recognition of, and caring attention paid to, persons as moral subjects can politically motivate a society in three respects. The recognition of solidarity and the attention of care can prompt progressive change toward a democratic willingness: (a) to provide for equal respect for rights and dignity; (b) to provide the social resources and services needed for just health and well‐being; and (c) to focus its creativity and wealth on the actualization of potential flourishing of each and all. Solidarity is discussed as a morally developmental stance that moves from standing up for another, standing up with another, and standing up as another. Care is discussed as a morally developmental stance that moves from the attentive rehabilitation of another, attentive companionship with and for another, and attentive commitment to another.

We are living in what is widely considered the sixth major extinction. Most ecologists believe that biodiversity is disappearing at an alarming rate, with up to 150 species going extinct per day according to scientists working with the United Nations Convention on Biological Diversity. Part of the reason the loss signified by biological extinction feels painful is that it seems irremediable. These creatures are gone, and there's nothing to be done about it. In recent years, however, the possibility has been broached that, just possibly, something can be done, in at least some cases. Human ingenuity, a contributing factor in the extinction crisis, might achieve their “de‐extinction”—in at least some cases, and with sometimes significant qualifications about whether the original species had been “recreated” and whether it could resume its original place in the environment. De‐extinction is an entry point into a larger set of questions about how biotechnological tools can support, coexist with, or undermine the goals of conservation and about the very meaning of conservation. Are we beings in control of the world or beings who prosper by accommodating ourselves to webs of symbiotic interdependencies? Are we creators or creatures, or both—and if both, then how can we achieve the balance between them that might be called humility? The interplay of perfecting and accommodating is not unique to human beings—perhaps it characterizes all forms of life on Earth—but with humans, these modes of being are distinctive, and our technology greatly expands their scale and effects. It is such questions that the ten essays in this special report explore.

We are living in what is widely considered the sixth major extinction. Most ecologists believe that biodiversity is disappearing at an alarming rate, with up to 150 species going extinct per day according to scientists working with the United Nations Convention on Biological Diversity. Part of the reason the loss signified by biological extinction feels painful is that it seems irremediable. These creatures are gone, and there's nothing to be done about it. In recent years, however, the possibility has been broached that, just possibly, something can be done, in at least some cases. Human ingenuity, a contributing factor in the extinction crisis, might achieve their “de‐extinction”—in at least some cases, and with sometimes significant qualifications about whether the original species had been “recreated” and whether it could resume its original place in the environment. De‐extinction is an entry point into a larger set of questions about how biotechnological tools can support, coexist with, or undermine the goals of conservation and about the very meaning of conservation. Are we beings in control of the world or beings who prosper by accommodating ourselves to webs of symbiotic interdependencies? Are we creators or creatures, or both—and if both, then how can we achieve the balance between them that might be called humility? The interplay of perfecting and accommodating is not unique to human beings—perhaps it characterizes all forms of life on Earth—but with humans, these modes of being are distinctive, and our technology greatly expands their scale and effects. It is such questions that the ten essays in this special report explore.

This article reflects on the implications of the concept of health and the questions it poses for moral philosophy, psychology, and the panoply of professions that are involved in the practices of care and in the ethics of individual rights, dignity, and autonomy. Significant among these questions is what we call “the predicament of agency.” The predicament involves the ethical tensions—arising within the broad concept of health and flourishing, but also in concrete everyday practices and relationships—between supporting individual health outcomes and supporting health and flourishing through respect for autonomy and self-direction. Three ways of addressing the predicament of agency are discussed: by reinterpreting the nature and requirements of autonomy (a) by appeal to reason, (b) by designing or curating contextual conditions influencing choice (often called “choice architecture” or “nudging”) in ways that constrain autonomy but do not violate its core value, and (c) by appeal to relational judgment and reflective professional practice. The article argues that each of these lines of thought is important, but none is a panacea, and none is free from conceptual confusions and ethical pitfalls of its own. The relational approach is the most promising in pointing beyond the predicament of agency—not so much by resolving it as by showing how it can be worked through without either turning our back on caring or turning caring into management and manipulation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

To the Editor: The sensitive discussion by Courtney Campbell and Jessica Cox on hospice care and physician-assisted death (“Hospice and Physician-Assisted Death: Collaboration, Compliance, and Complicity,” September-October 2010) is a model blend of ethical analysis, empirical study, and policy assessment in bioethics. The legalization of physician aid in dying has raised important ethical issues for hospice that go to the broader question of its evolving mission and its place in the landscape of end-of-life care in our society. Hospice began, one might say, as a philosophy of care of the dying that formed a countercultural movement. It offered a systematic and holistic approach to care involving not ..

This essay examines the goals of care and the exercise of guardianship authority in the long-term care of persons with Alzheimer's disease and other forms of chronic, progressive dementia. It counters philosophical views that deny both agency and personhood to individuals with Alzheimer's on definitional or analytic conceptual grounds. It develops a specific conception of the quality of life and offers a critique of hedonic conceptions of quality of life and models of guardianship that are based on a hedonic legal standard of “best interests.” As an alternative, it proposes a conception of quality of life based on the notions of “semantic agency” and “memorial personhood.”

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature

The further development of public health ethics will be assisted by a more direct engagement with political theory. In this way, the moral vocabulary of the liberal tradition should be supplemented—but not supplanted—by different conceptual and normative resources available from other traditions of political and social thought. This article discusses four lines of further development that the normative conceptual discourse of public health ethics might take. The relational turn. The implications for public health ethics of the new ‘ecological’ or ‘relational’ interpretation that is emerging for concepts such as agency, self-identity, autonomy, liberty and justice. Governing the health commons. The framework of collective action problems is giving way to notions of democratic governance and management of common resources. The concept of membership. Membership is specified by the notions of equal respect and parity of voice and agency. The concept of mutuality. Mutuality is specified by the notions of interdependent concern and care.