Quill R Kukla

How can we conceptualize and promote agential choices in a complicated social world—one in which institutional, cultural, and marketing pressures convey values and norms that may not be in the best interest of individual patients? In this issue of the Kennedy Institute of Ethics Journal, Eric Racine and his colleagues explore this difficult question in the context of “preclinical” Alzheimer’s disease and complementary and alternative medicines. This is an especially murky and vexed context in which to think about patient agency, for at least two reasons. First...

This season’s issue includes two articles on a quickly expanding topic in bioethics: the ethics of enhancement. There are many kinds of enhancement both actual and imagined: we can enhance people’s physical, aesthetic, cognitive, or moral capacities, for instance; individuals might choose particular enhancements, parents might choose them for their future children, or states might institute them at the widespread population level; the enhancements might be technologically complex or take the form of low-tech education and training; they might be permanent genetic features or swappable technological prosthetics; and so forth. Many discussions of the ethics of enhancement are concerned..

This work seeks to take seriously the common philosophical claim that individual subjects are constituted by their social world. A detailed understanding this claim requires an analysis of what is involved in being a subject, of the nature of 'the social', and of the possible constitutive relationships between these. I begin with a critical history of the idea that subjects are norm-followers, and that social groups constitute individuals by demanding their conformity to norms. I trace this 'conformity theory' through the thought of Rousseau, Hegel, Mead, and Althusser, to its manifestation in contemporary continental and Anglo-American philosophy. I criticize this theory for being unable to sufficiently accommodate creativity and social resistance. I go on to develop an account of subjects as not only norm-followers but also sense-makers, who have identities in virtue of their engagement in narrative dramas. Such subjects are socially constituted in at least two ways: through their 'dialogical' interactions with particular others , and through their position in a public culture which determines what counts as a meaningful possibility for action. This understanding of subjectivity allows me to develop a new account of the nature of social groups--such as groups based on gender, class and nationality--which provides an alternative to the conformity theory. Social groups contribute to individual identities not only by imposing norms, but also by providing sense-making resources, in the form of literary and artistic traditions as well as the actual lives and dramas of members. My account allows us to understand creativity and social resistance as enabled by subjects' membership in social groups, and it reveals how the internal diversity of a group can strengthen rather than compromise its role in individual identities. I end with a discussion of the political implications of my work

This volume explores the relationship between Kant's aesthetic theory and his critical epistemology as articulated in the Critique of Pure Reason and the Critique of the Power of Judgment. The essays, written specially for this volume, explore core elements of Kant's epistemology, such as his notions of discursive understanding, experience, and objective judgment. They also demonstrate a rich grasp of Kant's critical epistemology that enables a deeper understanding of his aesthetics. Collectively, the essays reveal that Kant's critical project, and the dialectics of aesthetics and cognition within it, is still relevant to contemporary debates in epistemology, philosophy of mind, and the nature of experience and objectivity. The book also yields important lessons about the ineliminable, yet problematic place of imagination, sensibility and aesthetic experience in perception and cognition.

Mass Hysteria examines the medical and cultural practices surrounding pregnancy, new motherhood, and infant feeding. Late eighteenth century transformations in these practices reshaped mothers' bodies, and contemporary norms and routines of prenatal care and early motherhood have inherited the legacy of that era. As a result, mothers are socially positioned in ways that can make it difficult for them to establish and maintain healthy and safe boundaries and appropriate divisions between public and private space

The pragmatic texture of second-person calls such as requesting, ordering, inviting, and entreating is complex. None of these speech acts are interchangeable. All are appropriate in some contexts and inappropriate in others, and all can be enabled or precluded by specific power relations. We argue that one cannot understand either the origin or the structure of many of our ethically significant normative statuses and relationships without attending to how they are instituted and modified by calls and the uptake they receive. Our model also enables us to give a close analysis of various forms of defiance and transgression.

Practical ethics is a peculiar field; it has no agreed-upon methods or foundations and takes a wide variety of forms. Its relationship to traditional “pure” philosophical ethics is contested and inconsistent. Since its beginnings, the Kennedy Institute of Ethics has been at the forefront of methodological reflections on the nature, grounding, and appropriate standards for practical ethics. Institute scholars such as Tom Beauchamp, Robert Veatch, and Henry Richardson have been among the most influential philosophers engaged in such metaethical conversations. Correspondingly, the Kennedy Institute of Ethics Journal has hosted some of the most vigorous debates in this subfield. In this issue of the journal, we..

Many recent theorists have argued that the self is socially constituted, or “decentered” by its social world. With surprising consistency, and in various ways, this decentered self has been gendered feminine, by feminists and non‐feminists alike. In this paper I explore whether there is any special link between femininity and decenteredness. I distinguish between two different ways that the self might be decentered – by its position within a cultural order, or by its interactions and relations with particular others. I then ask whether either of these potential forms of decenteredness bear a specific connection to femininity, and I try to spell out several such connections that are suggested by contemporary feminist theoretical writings. I argue that most of these cannot be made plausible or coherent. However, I conclude that there are some senses in which feminine selves are especially decentered, although it appears that the link depends upon women's disempowered social position, and not upon anything to do with femininity as a distinctive identity.

Truth-telling is a project that is both gripping and problematic for Rousseau, as he is both captured by an ideal of telling as complete, undistorted discernment, documentation and communication, and also haunted by the fear that telling can never be this innocent. For Rousseau, as for Kant, telling does not leave the told untouched; rather, telling gives us a type of contact with objects that is marked and mediated by the process of telling itself, and hence the possibility of immediately grasping objects through telling is forever lost to us. The drive to capture things in themselves, which originates, according to Kant, in a formal principle of reason, shows up in Rousseau's writings as a nostalgia that governs and animates inquiry. I will read Rousseau, and the traumas of truth-telling he articulates, as important pretexts for Kant's critical epistemology. Rousseau discloses tensions that infect his truth-telling practices. Kant seeks to neutralize these tensions, not by dissolving them, but rather by translating them into the terms of transcendental philosophy and thus showing how they can be defused and rendered harmless in their empirical form, so as to secure the possibility of proper truth-telling.

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

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..

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

: 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

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.