Quill Kukla

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.

Maps provide us with an easily recognizable version of the new demarcation problem: On the one hand, we are all familiar with graphics and maps that unacceptably distort our perceptions without being technically inaccurate or fictive; indeed there are whole websites groups devoted to curating such images for fun. On the other hand, there are multiple unavoidably value-laden choices that must be made in the production of any map. Producing a map requires choosing everything from the colors and thicknesses of the lines, the scale, the projection system, the categories and parameters represented, and much more. There is no neutral default for any of these choices, and all of them shape what information the map communicates. All the visual choices involved in producing a map enable some information to be conveyed at the cost of hiding or distorting other information, as map makers themselves routinely acknowledge and discuss. Hence there are no straightforward answers to questions about the line between distortion and legitimate representational choices. I explore three distinctive kinds of epistemic risks in map-making that generate special versions of the demarcation problem, which I dub aesthetic risk, categorization risk, and simplification risk. I argue that in each case, even good maps – maps that are accurate and epistemically valuable – have the potential to mislead us. I end by looking at maps that offer special epistemic benefits by making clear their own lack of value-neutrality while still being accurate and epistemically fecund.

In lieu of an abstract, here is a brief excerpt of the content:Editor’s NoteQuill Kukla, Editor-in-ChiefThis issue of the Kennedy Institute of Ethics Journal contains two essays and one dialogue, all of which concern ethical and epistemological issues that arise at the meeting point of our cognitive and mental lives and technology.In the first piece, two leading bioethicists with expertise in neurotechnology, James Giordano and Joseph J. Fins, discuss a wide range of complex problems surrounding people with disorders of consciousness that make their mental states opaque to observers. It is especially difficult to know how to respectfully care for and interact with such people, since we cannot directly communicate with them and our technological methods for discerning whether and how they are conscious are nascent and unreliable. People with these disorders challenge our norms for decision-making and patient care, including end of life care. It is easy for doctors, who may only sporadically have contact with people with these disorders, to be unaware of their consciousness altogether. Because caring for people with these sorts of consciousness disorders is typically technologically intense, such care also raises difficult questions concerning resource allocation. Giordano and Fins discuss these and a wide range of other issues in depth. Their discussion of how the tools of disability studies and disability rights advocacy can and should be applied when it comes to people with whom we cannot communicate is particularly powerful. As Fins points out, the important principle, “Nothing about us without us,” cannot be honored in the case of people whose voices and experiences we cannot discern; this slogan presupposes communicative abilities. Fins and Giordano challenge us to revisit our concepts of accessibility and inclusion in ways that might let them be adapted to the needs of people with consciousness disorders.Phoebe Friesen and Anna Swartz—in “The First Smart Pill: Digital Revolution or Last Gasp?”—offer a critical social history of Abilify MyCite, a version of the popular antipsychotic drug Abilify, which contains a small sensor that digitally tracks when patients take the medication, thereby enabling compliance information to be shared with health care professionals. Friesen and Swartz show in detail the ways in which the story [End Page ix] of this drug’s use and uptake were fundamentally shaped by marketing pressures and financial incentives. Even though we do not actually have good evidence that the drug provides benefits that normal Abilify does not provide, nor that it increases compliance, Abilify MyCite was marketed as a success story. Bioethicists who were paid consultants for Otsuka, the maker of the drug, offered shallow analyses that justified the drug’s existence, focusing primarily on compliance and safety while skimming over deep ethical issues concerning privacy, surveillance, and the targeting of minority populations. Friesen and Swartz conclude that “MyCite was merely another move made in order to capitalize on the enormous success of Abilify that was slipping away from an increasingly desperate company.” Their discussion provides a fascinating case study in the production of medical knowledge and the complex ways it is controlled and shaped by financial interests, as well as driven by an optimistic enthusiasm for technological fixes in the medical and bioethical communities.Finally, Zohar Lederman and Nancy Jecker—in their essay, “Social Robots to Fend Off Loneliness?”—take up the ethically and existentially fascinating question of when and whether robots can and should be used to mitigate human loneliness. As they point out, loneliness is an urgent public health concern, particularly among older people and other vulnerable groups, but it has received very little bioethical attention. They show that one cannot give a fine-grained answer to the question of what role robots might play in helping with loneliness unless one dives into the nature and varieties of loneliness. This is a deep philosophical project, and the essay argues that loneliness comes in different varieties, many of which essentially concern deficiencies in human-human interactions that serve a wide variety of purposes for us, only some of which can be fulfilled by nonhuman robots. Lederman and Jecker raise fascinating questions about whether deception is integral to the kind of help that robots can in fact offer for fending off loneliness, and whether that would in turn...

In Games: Agency as Art, Thi Nguyen has given us a deep and compelling picture of agency as much more layered, volatile, environment-dependent and discontinuous than it appears in most philosophical accounts. Games ‘inscribe … forms of agency into artifactual vessels’.1 1 When we play a game, we take up a form of agency, including a set of motivations, values and goals, which has been artificially provided by the game. Our purpose in playing, in the kinds of gameplay that interest Nguyen, is to have the aesthetic experience of first-personally exercising the kind of agency sculpted by the game. As we move in and out of gameplay, we take up and drop values, motives, and goals that are provided to us by the game. Games can expand our autonomy and the richness of life by allowing us to practice different forms of agency, taking on different ends for the aesthetic experience of striving to meet them. While I am on board with these central moves of Nguyen’s book, in this essay I will argue that the situation is substantially messier than Nguyen portrays it as being. Game play, I will claim, is inextricably embedded and entangled in its larger social, material and cultural context. Conversely, I will argue, everyday life is routinely sculpted in ways Nguyen claims are distinctive of games.