Quill R Kukla

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process.

Philosophers have often posited a foundational calling voice, such that hearing its call constitutes subjects as responsive and responsible negotiators of normative claims. I give the name ldquo;transcendental conscience to that which speaks in this founding, constitutive voice. The role of transcendental conscience is not – or not merely – to normatively bind the subject, but to constitute the possibility of the subject's being bound by any particular, contentful normative claims in the first place. I explore the ontological and temporal status of transcendental conscience, using Heidegger's account of conscience in Being and Time as my textual touchstone. I ask what performative structure the call of conscience might have that would enable it to constitute normative responsiveness, and I raise some temporal conundrums surrounding this structure. I argue that it is incoherent to attempt to give a literal, chronological account of the origin of normative grip and response. I suggest that we can best understand the founding calls of conscience, not as literal events occurring in regular time, but as events that can only show up retrospectively, as occurring in an ever-receding, unlocalizable past, and that these calls can only be figured mythically and metaphorically. Appropriating a Derridean term, I claim that the voice of transcendental conscience must be that of a lsquo;ghost, whose call binds us by haunting us – a haunting that is no less transcendentally necessary for its inability to be translated into a literal historical event.

The summer issue of the Kennedy Institute of Ethics Journal highlights a range of controversial issues that will incite spirited disagreement amongst our readers. These five papers each take up complex contemporary ethical challenges and develop creative strategies to resolve them. Together they represent our continued commitment to publishing theoretically rigorous, empirically informed, and practically relevant work in bioethics.In “HPV and the Ethics of CDC’s Vaccination Requirements for Immigrants,” Mark Navin offers a timely defense of immunization mandates for migrants, extending the contentious debates taking place in the United States to the domain of immigration justice. Navin begins by critiquing the..

: The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to non-therapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range of research contexts and types—including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle

Several accounts of representation in cognitive systems have recently been proposed. These look for a theory that will establish how a representation comes to have a certain content, and how these representations are used by cognitive systems. Covariation accounts are unsatisfactory, as they make intelligent reasoning and cognition impossible. Cummins' interpretation-based account cannot explain the distinction between cognitive and non-cognitive systems, nor how certain cognitive representations appear to have intrinsic meaning. Cognitive systems can be defined as model-constructers, or systems that use information from interpreted models as arguments in the functions they execute. An account based on this definition solves many of the problems raised by the earlier proposals

In this book, Paul Redding argues both that Hegel’s thought is making a resurgence in some quarters of analytic philosophy, and that such a resurgence is well-deserved and will bear future fruit. He begins with Bertrand Russell’s story of analytic philosophy as born out of a rejection of Hegelian thought, and traces the development of an alternative path through analytic philosophy that moves through Frege, Wittgenstein, Sellars, and Evans, and finds its fullest contemporary form in Brandom and McDowell. This alternative path, he claims, has important historical roots in Hegel, although not in Russell’s caricatured version of him.Redding reads Hegel as the direct inheritor of Kant and Aristotle, especially with respect to logic, the role of the singular in thought, and the nature of evaluative judgment, and he argues that Hegel gives us the materials with which to overcome Sellars’ myth of the given productively. He also gives extended readings of Hegel’s principle of determinate negation and rejection of the principle of non-contradiction, as well as of the ontology of Hegelian Spirit as the unity of substance and subject, all designed to reveal these components of Hegelian thought as productive resources for analytic philosophers

As a culture, we have a tendency to measure motherhood in terms of a set of signal moments that have become the focus of special social attention and anxiety; we interpret these as emblematic summations of women's mothering abilities. Women's performances during these moments can seem to exhaust the story of mothering, and mothers often internalize these measures and evaluate their own mothering in terms of them. "Good" mothers are those who pass a series of tests—they bond properly during their routine ultrasound screening, they do not let a sip of alcohol cross their lips during pregnancy, they give birth vaginally without pain medication, they do not offer their child an artificial nipple during the first six months, they feed their children maximally nutritious meals with every bite, and so on. This reductive understanding of mothering has had counterproductive effects upon health care practice and policy, encouraging measures that penalize mothers who do not live up to cultural norms during signal moments, while failing to promote extended narratives of healthy mothering.

I argue that interpretivists ought to broaden and enrich the constitutive standards of interpretability and epistemic agency that they have inherited from classic Davidsonian theory. Drawing heavily upon John Haugeland’s recent account of objective truth- telling, I claim that in order to be an interpretable epistemic agent at all, a being must have various kinds of practical commitments that cannot be reduced to combinations of beliefs and desires.On the basis of this claim, I argue that radical interpreters must appeal to many commitments held by their interpretees other than assents to observation sentences and commitments to sincerity; hence the interpretive tools available in the Davidsonian toolbox are insufficient. I suggest that we ought to take the behaviors manifesting the various commitments that constitute epistemic agency as straightforwardly available from a third-personal observational perspective, and thus as no threat to the basic spirit of interpretivism.At the same time, I claim that these behaviors cannot be individuated in non-normative, physicalist terms, so my account should indeed pose a threat to naturalists of a certain stripe. I end by revisiting and moderately revising Davidson's notorious deflation of the problem of radical skepticism.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, not evidence.

This quarter’s issue of the Kennedy Institute of Ethics Journal is unusual, because it hosts a symposium focused Brian Earp’s provocative and groundbreaking article, “Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on ‘FGM.’” Along with Earp’s article, we are presenting critical responses by Richard Shweder, Robert Darby, and Jamie Nelson. Earp tackles the ethics of female genital cutting or “mutilation”. This is a difficult topic that brings on board gender inequity, the integrity of the body, the value of cultural traditions, sexuality, colonialism, ethnocentrism, and other fraught axes of reflection. Earp argues against the common view that all...

Fertile grounds for theoretical inquiry can be found in the oddest corners. Contemporary television programming provides viewers with several talk shows of the grotesque, as I will call them, in which the aim of each episode is to put some monstrous human phenomenon on display with the help of a host and a participating studio audience. In this paper I will try to support the unlikely claim that these talk shows, which include The Jerry Springer Show and Sally Jesse Raphael (among others), provide remarkably fruitful foci for theoretical attention. My plan is to give a reading of the ideological structure of talk shows of the grotesque. In particular, my interest lies in a relatively recent strand of ideological theory that has treated questions concerning the nature and reproduction of ideology as serious ontological questions: questions that go to the heart of our philosophical understanding of subjectivity, autonomy, and the metaphysics of belief and other intentional attitudes. Here I take the work of Louis Althusser, Judith Butler, and Slavoj i ek as paradigmatic and seminal representatives of this type of theorizing. My eye, in this paper, will be turned toward showing how the contemporary talk show of the grotesque provides us with a case study through which we can productively interrogate this new theoretical turn in our understanding of ideology. After spending a substantial amount of time laying down some theoretical groundwork, during which I take a selective and usurious tour through recent theories of ideology, performativity, and the constitution of subjectivity, I will analyze the talk show phenomenon by dividing it into four levels of participatory activity: those of the host, the guests, the studio audience, and the television audience. I will argue..

Mothers serve as an important layer of the health-care system, with special responsi-bilities to care for the health of families and nations. In our social discourse, we tend to treat maternal “choices” as though they were morally and causally Self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers’ caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. I give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets.

Epistemologists generally think that genuine warrant that is available to anyone must be available to everyone who is exposed to the relevant causal inputs and is able and willing to properly exercise her rationality. The motivating idea behind this requirement is roughly that an objective view is one that is not bound to a particular perspective. In this paper I ask whether the aperspectivality of our warrants is a precondition for securing the objectivity of our claims. I draw upon a Sellarsian account of perception in order to argue that it is not; rather, inquirers can have contingent properties and perspectives that give them access to forms of rational warrant and objective knowledge that others do not have. The universal accessibility of reasons, on my account, is not a precondition for the legitimacy of any actual warrant, but rather a regulative ideal governing inquiry and communication.

Three years ago, as my fortieth birthday disappeared into the far distance in my rearview mirror, driven by a combination of vanity and fear of my own mortality and decrepitude, I committed to getting in shape.I’ve always been fairly active: I have always walked a lot, commuted by bike when that was plausible, avoided driving whenever possible, and just generally been high energy. But a childhood full of failure at team sports and a lack of innate gifts in the coordination department scared me off for decades from formal physical activity. Indeed, I was convinced that I hated working out—that I would always hate it, no matter what, and that it would always take a tremendous and ongoing act of sheer will power to do...

This issue of the Kennedy Institute of Ethics Journal continues two conversations that have been developing in this journal over the last few years, and introduces a new and timely one. Kevin Elliot and Paul Mushak’s paper, “Structured Development and Promotion of a Research Field: Hormesis in Biology, Toxicology, and Environmental Regulatory Science,” continues an ongoing debate in this journal over the role of values in shaping scientific methodology and communication, and how this role should be managed at the level of policy. We inaugurated this discussion in our June 2012 special issue on Science, Expertise, and Democracy, and have followed up with multiple articles on science and values. David..

When Sandra Harding called for an epistemology of science whose systematic attention to the gendered Status of epistemic agents renders it ‘less partial and distorted’ than ‘traditional’ epistemologies, some commentators recoiled in horror. Propelled by ‘a mad form of the genetic fallacy’ they said, she descends ‘the slide to an arational account of science.’ On a less melodramatic reading, feminist epistemologies such as Harding's advocate not irrationalism, but senses of rationality more expanded than those which they associate with ‘traditional’ epistemology.

Ghostwriting scandals are pervasive in industry-funded biomedical research, and most responses to them have presumed that they represent a sharp transgression of the norms of scientific authorship. I argue that in fact, ghostwriting represents a continuous extension of current socially accepted authorship practices. I claim that the radically collaborative, decentralized, interdisciplinary research that forms the gold standard in medicine is in an important sense unauthored, and that this poses a serious problem in applied social epistemology. It is no easy matter to find procedural or architectural solutions that can secure epistemic trust and accountability for collaborative publishing in biomedicine.

The Routledge Companion to Bioethics is a comprehensive reference guide to a wide range of contemporary concerns in bioethics. The volume orients the reader in a changing landscape shaped by globalization, health disparities, and rapidly advancing technologies. Bioethics has begun a turn toward a systematic concern with social justice, population health, and public policy. While also covering more traditional topics, this volume fully captures this recent shift and foreshadows the resulting developments in bioethics. It highlights emerging issues such as climate change, transgender, and medical tourism, and re-examines enduring topics, such as autonomy, end-of-life care, and resource allocation.

Wilfrid Sellars's iconic exposé of the ‘myth of the given’ taught us that experience must present the world to us as normatively laden, in the sense that the contents of experience must license inferences, rule out and justify various beliefs, and rationalize actions. Somehow our beliefs must be governed by the objects as they present themselves to us. Often this requirement is cashed out using language that attributes agent-like properties to objects: we are described as ‘accountable to’ objects, while objects ‘hold us’ to standards, and so forth. But such language is either deeply anti-naturalistic or trades on a set of metaphors in need of a literal translation. We offer an explanation of how the material features of the world, as received in experience, can rationally constrain our beliefs and practices—one that makes no recourse to this imagery. In particular, we examine the structure of ostensive practices (that is, practices of directing one another's attention to objects and features of the world) and the distinctive role they play in making us jointly beholden to how things actually are

This paper discusses a crisis of accountability that arises when scientific collaborations are massively epistemically distributed. We argue that social models of epistemic collaboration, which are social analogs to what Patrick Suppes called a “model of the experiment,” must play a role in creating accountability in these contexts. We also argue that these social models must accommodate the fact that the various agents in a collaborative project often have ineliminable, messy, and conflicting interests and values; any story about accountability in a massively distributed collaboration must therefore involve models of such interests and values and their methodological and epistemic effects

Bioethicists have, of course, always been concerned with death: we have asked when should we allow it to happen without trying to stave it off any longer; whether is it ever acceptable for doctors to hasten or cause it; how can we make death a dignified and relatively humane experience for the dying and for their loved ones; and how we can and cannot treat human remains. We discussed all of these classic ethical issues even when death itself seemed to be a fairly straightforward, all-or-nothing concept: life and death were natural, biological states, and people were either alive, with a beating heart and a working brain, or they were dead, and everything in them had stopped. But over the last several...