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.

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.

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..

: Mothers serve as an important layer of the health-care system, with special responsibilities 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

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Studying Human Behavior: How Scientists Investigate Aggression and Sexuality by Helen LonginoRebecca KuklaReview: Helen Longino, Studying Human Behavior: How Scientists Investigate Aggression and Sexuality, University of Chicago Press, 2013In Studying Human Behavior: How Scientists Investigate Aggression and Sexuality, Helen Longino meticulously examines a wide variety of research programs devoted to studying human behavior, specifically aggression and sexual orientation. She teases apart the methodologies of the various approaches, examining their epistemic structure, the assumptions they must hold fixed, the research questions they enable and those they necessarily occlude, their underlying ontologies, the interests that motivate them, the ideological investments they help buttress, and the practical and political uses they serve. By the end of the book she has made clear that the so-called ‘nature-nurture’ debates invoke a hopelessly simplistic and distorting dualism when it comes to any interesting question about the etiology of a behavior. This is a readable, informative, rigorous, and elegantly organized new work from a leading scholar who has had a major hand in turning the interplay among science, ethics, and social interests into a topic of rigorous philosophical study.In the first part of the book, Longino devotes a chapter or substantial section to each major methodological approach to studying aggression and sexual orientation, including (using her labels): quantitative behavioral genetics, social-environmental approaches, molecular behavioral genetics, neurobiological approaches, and several ‘integrative’ approaches (such as developmental systems theory) that focus on the interactions and dynamics between causal factors over time rather than trying to isolate one causal contribution. She also briefly discusses human ecology, which takes the unit of study to be the behavior of a population, studied in its material environment, rather than the behavior of an individual.Longino shows elegantly how each of these research programs is equipped to reveal certain specific kinds of truths about behavior, while making other important dimensions of the phenomena invisible. Many of her examples are technical and detailed, but I can recap a few relatively simple and powerful examples: (1) Behavioral researchers have no shared understanding of what an ‘environment’ is or which features of it we need [End Page E-97] to measure. Whatever operationalization of ‘environment’ is used within a study or set of studies, this operationalization is not itself scientifically validated, but merely presupposed (33). Thus how much of a behavior shows up in a study as due to the ‘environment’ depends on just what we measure. On the behavioral genetic approach this will include everything other than genes, but on, say, the neurobiological approach this will be everything other than neural structure. But these are quite different senses of ‘environment’ with different scopes, and there’s no good reason to think they are easily commensurable. (2) ‘GxExN’ researchers use techniques to study the etiology of behavior that were developed expressly for studying disorders (112). This work thus presupposes that we can understand whatever behavior is under study on the disorder model, and will yield no well-formed results to the extent that this model does not fit. But it is at best non-obvious that a disorder model is unproblematic when it comes to aggression or—especially!—sexual orientation. (3) Most of the research programs Longino covers treat the behaving individual as the unit of analysis and study, as opposed to, for example, human ecologists’ focus on whole populations. But as she demonstrates, this affects what kinds of causes we can study, because patterns at the population level may not be detectable using the kinds of measures that can be manipulated at the individual level. Furthermore, some kinds of behaviors may require more than one participant to exist at all; for instance, the very same thing that counts as an aggressive act within one interaction may be a peaceful act in another (175).Longino does a lovely job of showing what sorts of social interests are served and buttressed by which kinds of research. For example, social-environmental approaches will, in virtue of their methodology, focus on social factors that are manipulable, and this makes them particularly amenable to generating suggestions for social interventions. Such research thus better serves the ends of those who are looking to implement...

We can understand objectivity, in the broadest sense of the term, as epistemic accountability to the real. Since at least the 1986 publication of Sandra Harding’s The Science Question in Feminism, so-called standpoint epistemologists have sought to build an understanding of such objectivity that does not essentially anchor it to a dislocated, ‘view from nowhere’ stance on the part of the judging subject. Instead, these theorists have argued that a proper understanding of objectivity must recognize that different agential standpoints offer different access to objective truths, with some standpoints holding better epistemic potential than others. As Harding puts it, standpoint epistemology calls for “a critical evaluation of which social situations tend to generate the most objective knowledge claims” so as to identify those standpoints that “produce empirically more accurate descriptions and theoretically richer explanations” (1991, 142, 149). Which standpoints enable the most objectivity with respect to a particular inquiry is, for the standpoint theorists, always an empirical at least as much as a conceptual question; it requires attention to the actual, material relationship between knowers, knowledge practices, and objects known. Standpoint epistemology was developed primarily by self-identiªed feminist epistemologists. Virtually all developments of standpoint episte-.

Moral perception, as the term is used in moral theory, is the perception of normatively contoured objects and states of affairs, where that perception enables us to engage in practical reason and judgment concerning these particulars. The idea that our capacity for moral perception is a crucial component of our capacity for moral reasoning and agency finds its most explicit origin in Aristotle, for whom virtue begins with the quality of perception. The focus on moral perception within moral theory has made a comeback in the last few decades, especially in the hands of self-proclaimed neo-Aristotelians such as John McDowell, Martha Nussbaum, and Nancy Sherman. For these writers, our perceptual capacities are not static, and the laborious honing of our perceptual skills is a crucial moral task. On this picture, as Nancy Sherman puts it, “How to see becomes as much a matter of inquiry as what to do.”Moral particularists—including but not restricted to the neo-Aristotelians—have emphasized the centrality of moral perception to moral agency and judgment, as a corrective to moral theories that treat deliberation in terms of universal principles as the privileged keystone of moral agency.

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

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.

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..

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.

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