Quill Kukla

: 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.

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.

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...

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.

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..

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.

All five articles in this issue consider, in different ways, what it takes to respect an individual’s humanity; each one offers a broader conception of human regard than is standard in the practical ethics literature. Respectively, they explore how truth-telling, providing appropriate treatment for those with substance use disorders, enabling real reproductive choice and control, and providing meaningful access to the internet all form important parts of what it takes to treat people as fully human and to care for their well-being. All are grounded not just in abstract rights arguments, but in attention to the empirical and social conditions of...

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...

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.

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...

It gives me great pleasure to introduce the December 2013 issue of the Kennedy Institute of Ethics Journal—our ninety-second!—and to introduce myself as the new Editor-in-Chief of the journal. For almost a quarter of a century, from its special vantage point in Washington, D.C., and at Georgetown University’s Joseph and Rose Kennedy Institute of Ethics, the KIEJ has served as a leading source for practically engaged, policy-relevant philosophical work in bioethics, broadly construed. Under the expert stewardship of Robert Veatch and Carol Spicer, the journal built a top-quality research legacy. It is with pride and anticipation that I take the helm.While I am committed to honoring and building on our past, I am ..

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.

In lieu of an abstract, here is a brief excerpt of the content:Editorial NoteRebecca Kukla, PhD, Editor in ChiefThis spring is an exciting time at the Kennedy Institute of Ethics Journal. We are rolling out our new series of online reviews of books in bioethics, practical ethics, and the ethical, social, and legal dimensions of science and medicine. These in-depth reviews will be written by leading figures in the discipline, and will be published in online issue supplements, with pre-publication versions available on our website or by e-mail subscription. We are very enthusiastic about this new initiative and hope that our reviews will become crucial tools and sources of inspiration for everyone interested in the field of bioethics, broadly construed. We hope that you will make use of and enjoy this new source of ethical conversation and information.Our spring issue represents our current attempt here at the journal to broaden the discipline’s conception of what counts as a bioethical issue.In our lead article, David DeGrazia brings the currently emotional debates over gun control policy within the purview of bioethics. Violence and policies concerning violent weapons are crucial health issues, and yet bioethicists have done little to bring their tools and insights to this domain. DeGrazia’s paper thus breaks new ground. He defends a moderate gun control policy, and argues that from the point of view of public health, it is morally inexcusable not to tighten gun regulations in the United States, regardless of which moral framework we employ.Our second two papers—“Resolving the Conflict: Some Clarifications of Vulnerability in Health Care” (by Anglea Martin, Nicholas Tavaglione, and Samia Hurst) and “Beneficence, Justice, and Health Care” (by J. Paul Kelleher)—both take rich philosophical concepts that usually find their home within research ethics and resituate them within the domain of patient care. Martin and her co-authors give a close analysis of the notion of vulnerability. They seek meaningful ways of identifying specific, morally pressing vulnerabilities among patients, given that all patients are to some extent vulnerable. Kelleher creatively revisits the much-discussed notion [End Page vii] of beneficence, arguing that duties of beneficence are sometimes grounded in justice-based duties. This pushes against the tradition of thinking of justice as a consideration that comes into play only at the population level.The final paper, Howard Brody’s “Chauncey Leake and the Development of Bioethics in America,” brings a new methodological approach to the journal. This is a historical paper examining the intellectual and social role that Leake played in the development of the discipline of bioethics. Leake’s advocacy for the integration of philosophy and medical expertise in bioethics became a hallmark of the field; yet Leake himself is mostly forgotten. Brody examines both his contribution and the reasons for his relative invisibility. This kind of intellectual history enriches and grounds ethical analysis in crucial ways, but it is too rarely integrated into bioethical conversations. [End Page viii]Rebecca Kukla, Editor in ChiefKennedy Institute of Ethics JournalCopyright © 2014 The Johns Hopkins University Press...

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.

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..