Quill Rebecca Kukla

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices.

Our lead article in this issue of the Kennedy Institute of Ethics Journal, Jonathan Kaplan’s “Self-Care as Self-Blame Redux: Stress as Personal and Political,” opens up an entirely new and clearly important topic for bioethicists: the concept and role of ‘self-care.’ Advice for ‘self-care’ is everywhere, and often this advice takes the form of a kind of moral imperative: we owe ourselves self-care and have a responsibility to care for ourselves. Meanwhile, typical suggested self-care practices focus on individual behaviors and purchases, rather than social interventions. Moreover, they very often require quite a bit of time, money, organization, and energy to complete. These include yoga classes, meditation, diet...

It is the great honor of the Kennedy Institute of Ethics Journal to present this special issue celebrating the career and bioethical contributions of LeRoy Walters. Professor Walters is the former Director of the Kennedy Institute of Ethics, which he has been affiliated with since its inception in 1971 until his recent retirement from his position as Joseph P. Kennedy, Sr. Professor of Christian Ethics. Trained as a philosopher and a theologist, LeRoy Walters was also a lifelong political activist, fighting for social justice and protections for the vulnerable. He was also a visionary who played a substantial role in creating and building the field of bioethics, and in bridging the divide between academia and the...

This issue's lead article, Alison Reiheld's "Rightly or For Ill: The Ethics of Individual Memory," takes up a topic that is manifestly deserving of philosophical analysis, and routinely important in our private and public interactions, and yet as far as I know it has never before received systematic treatment: the ethics of memory. That is, Reiheld asks, when are we morally blameworthy or praiseworthy for remembering, forgetting, or encoding a memory in a specific way, and what are the ethical principles that should govern our practices of remembering and forgetting? As Reiheld points out, this set of questions only makes sense once we understand remembering and forgetting as constructive activities involving...

The goal of this paper is to give an account of the pragmatic and social function of slurs, taken as speech acts. I develop a theory of the distinctive illocutionary force and pragmatic structure of slurs. I argue that slurs help to produce subjects who occupy social identities carved out by pernicious ideologies, and that they do this whether or not anyone involved intends for the slur to work that way or has any particular feelings or conscious thoughts associated with using or being targeted by the slur. I offer an Althusser‐inspired account of what an ideology is, as well as of the mechanisms by which slurs can serve to cue and strengthen ideologies. A slur, I argue, is a kind of interpellation, which reduces its target to a generic identity and derogates and subordinates its target. I explore how slurs and ideologies work in tandem to constitute and fortify one another. I end by applying my account to see how well it fits and helps illuminate three quite different, especially complex slurs.

This quarter’s issue of the Kennedy Institute of Ethics Journal dives deeply into questions concerning who is the proper target of medical interventions, and under what circumstances. Mary Jean Walker and James Franklin’s article, “An Argument Against Drug Testing Welfare Recipients,” and Maggie Taylor’s “Too Close to the Knives: Children’s Rights, Parental Authority, and Best Interests in the Context of Elective Pediatric Surgeries” both ask hard questions about when medical interventions can be imposed without consent, purportedly in order to secure non-medical, social benefits for their recipients. Lauren Freeman and Saray Ayala López’s “Sex Categorization in Medical Contexts: A Cautionary Tale,” questions who...

I explore how we negotiate sexual encounters with one another in language and consider the pragmatic structure of such negotiations. I defend three theses: Discussions of consent have dominated the philosophical and legal discourse around sexual negotiation, and this has distorted our understanding of sexual agency and ethics. Of central importance to good-quality sexual negotiation are sexual invitations and gift offers, as well as speech designed to set up safe frameworks and exit conditions. Sexual communication that goes well does not just prevent harm; it enables forms of agency, pleasure, and fulfillment that would not otherwise be possible.

This issue of the Kennedy Institute of Ethics Journal contains a couple of papers that may be difficult to read for some: one concerning the sexual violation of young Black boys and one on the Guatemalans who were intentionally infected with sexually transmitted diseases and sexually abused in the hands of the United States government and other US-based institutions. I’m honored and proud to be publishing these papers in the journal; both dive headfirst into formidably painful topics of enormous social and ethical importance. However, readers should understand before reading these papers that they contain descriptions of sexual violation within relationships of gross power inequality...

I explore how gender can shape the pragmatics of speech. In some circumstances, when a woman deploys standard discursive conventions in order to produce a speech act with a specific performative force, her utterance can turn out, in virtue of its uptake, to have a quite different force—a less empowering force—than it would have if performed by a man. When members of a disadvantaged group face a systematic inability to produce a specific kind of speech act that they are entitled to perform—and in particular when their attempts result in their actually producing a different kind of speech act that further compromises their social position and agency—then they are victims of what I call discursive injustice. I examine three examples of discursive injustice. I contrast my account with Langton and Hornsby's account of illocutionary silencing. I argue that lack of complete control over the performative force of our speech acts is universal, and not a special marker of social disadvantage. However, women and other relatively disempowered speakers are sometimes subject to a distinctive distortion of the path from speaking to uptake, which undercuts their social agency in ways that track and enhance existing social disadvantages.

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...

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.

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

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.

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...

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.

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..

: 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

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.

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

Pragmatism has enjoyed a major resurgence in Anglo-American philosophy over the course of the last decade or two, and Robert Brandom’s work – particularly his 1994 tome Making it Explicit (MIE) – has been at the vanguard of this resurgence (Brandom 1994).2 But pragmatism comes in several surprisingly distinct flavours. Authors such as Hubert Dreyfus find their roots in certain parts of Heidegger and in phenomenologists such as Merleau-Ponty, and they privilege embodied, preconceptual skills as opposed to discursive practices as the basic sites of meaning and agency (Dreyfus 1991; Dreyfus 1992; Todes 2001). With strong inheritances from Dewey and Wittgenstein, Richard Rorty has championed a pragmatism whose core emphasis is on the rejection of transcendental truth and high metaphysical theorizing (Rorty 1982), and this anti-theoretical banner has been taken up by several prominent ethicists, among others. For his part, Brandom, who purports to offer a systematic theory of language and meaning grounded on a foundation of pragmatic normative relationships between speakers, looks back instead to Sellars and Quine for his stripe of pragmatism. Near the start of MIE, he writes: The explanatory strategy pursued here is to begin with an account of social practices, identify the particular structure they must exhibit in order to qualify as specifically linguistic practices, and then consider what different sorts of semantic contents those practices can confer on states, performances, and expressions caught up in them in suitable ways. (Brandom 1994, xiii) Despite his professed pragmatism, Brandom is no foe of high theory or metanarratives, and he is vastly more interested in language and theoretical reason than in the rest of human bodily activity. For Brandom, inferentially articulated discourse forms an autonomous domain of normativity, while our bodily encounters with the world in perception and in action serve as language entry and exit points respectively..