Quill Kukla

This issue of the Kennedy Institute of Ethics Journal offers essays about risk, social values, and how to act in the face of risk, especially when our risk assessments are socially freighted. It is made up of two clusters of related papers.The first cluster consists of two papers that explore the ways in which our risk assessments are shaped by moral panic around HIV, and its accompanying legacy of fear, homophobia, and stigma. These papers take up ethical and social dimensions of PrEP and of blood donation in the face of social and medical policies based on risk distortions.The second cluster of papers is a back-and forth exchange in response to...

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.

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...

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...

It is with great pleasure and a sense of urgency that we present this KIEJ double issue on ethical issues raised by the COVID-19 pandemic. The sheer range of ethical concerns raised by the pandemic, combined with the speed with which these problems emerged, is staggering and unprecedented in our generation. We have tried to give space to papers that raise immediately pressing ethical issues that have not received much discussion in popular media. Topics range from fundamental questions about how we set up our public health infrastructure, to ethical issues in scientific communication and the translation of science into policy, to the impact of the pandemic on people with intellectual disabilities, to the ethics of...

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-.

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...

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.

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

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.

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.

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

Our autonomy can be compromised by limitations in our capacities, or by the power relationships within which we are embedded. If we insist that real consent requires full autonomy, then virtually no sex will turn out to be consensual. I argue that under conditions of compromised autonomy, consent must be socially and interpersonally scaffolded. To understand consent as an ethically crucial but nonideal concept, we need to think about how it is related to other requirements for ethical sex, such as the ability to exit a situation, trust, safety, broader social support, epistemic standing in the community, and more.

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...

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 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