Quill Kukla

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.

Discussions of uptake in the philosophy of language focus our attention on what role other people have in fixing the import, success, influence and social life of a speech act. The general idea in most discussions of uptake, despite their differences and disagreements, is whether and how an audience is cooperative or uncooperative when a speaker plays a critical role in how speech acts function. This essay is primarily concerned with “refusals”, or uncooperative uptakes. The essay analyzes the varieties of refusal; when refusal is possible why it might be challenging and when it is ethical. It examines how and when the uptake of a speech act can constitute the pragmatic form and force of the original speech act.

I argue that the concept of disease serves such radically different strategic purposes for different kinds of stakeholders that coming up with a unified philosophical definition of disease is hopeless. Instead, I defend a radically pluralist, pragmatist account of when it is appropriate to mobilize the concept of disease. I argue that it is appropriate to categorize a condition as a disease when it serves legitimate strategic goals to at least partially medicalize that condition, and when the condition is pathological from inside the epistemology and metaphysics of medicine. While some conditions, like pancreatic cancer, are legitimate diseases from all stakeholders’ points of view and in any context, and while other conditions, like homosexuality, are not diseases from any legitimate point of view, there is a range of interesting, messy cases—including Deafness, autism, pre-hypertension, infertility, and ADHD, for example—whose disease status is irreducibly context-dependent and under contest.

When I say “I know Sarah,” or “I know Berlin,” what sort of knowledge am I claiming? Such knowledge of a particular is, I claim, not reducible to either propositional knowledge-that or to traditional physical know-how. Mere, bare knowledge by acquaintance also does not capture the kind of knowledge being claimed here. Using knowledge of a place as my central example, I argue that this kind of knowledge-of, or “objectual knowledge” as it is sometimes called, is of a distinctive epistemological sort. It is a genre of inherently first-personal aesthetic knowledge, but it also, like know-how, involves active skill. I end by exploring a couple of classic problems in aesthetic epistemology, applied to the case of knowledge-of as active aesthetic knowledge.

When I say “I know Sarah,” or “I know Berlin,” what sort of knowledge am I claiming? Such knowledge of a particular is, I claim, not reducible to either propositional knowledge-that or to traditional physical know-how. Mere, bare knowledge by acquaintance also does not capture the kind of knowledge being claimed here. Using knowledge of a place as my central example, I argue that this kind of knowledge-of, or “objectual knowledge” as it is sometimes called, is of a distinctive epistemological sort. It is a genre of inherently first-personal aesthetic knowledge, but it also, like know-how, involves active skill. I end by exploring a couple of classic problems in aesthetic epistemology, applied to the case of knowledge-of as active aesthetic knowledge.

City Living is about urban spaces, urban dwellers, and how these spaces and people make, shape, and change one another. More people live in cities than ever before: more than 50% of the earth's people are urban dwellers. As downtown cores gentrify and globalize, they are becoming more diverse than ever, along lines of race, ethnicity, socioeconomic class, sexuality, and age. Meanwhile, we are in the early stages of what seems sure to be a period of intense civil unrest. During such periods, cities generally become the primary sites where tensions and resistance are concentrated, negotiated, and performed. For all of these reasons, understanding cities and contemporary city living is pressing and exciting from almost any disciplinary and political perspective. Quill R Kukla offers the first systematic philosophical investigation of the nature of city life and city dwellers. The book draws on empirical and ethnographic work in geography, anthropology, urban planning, and several other disciplines in order to explore the impact that cities have on their dwellers and that dwellers have on their cities. It begins with a philosophical exploration of spatially embodied agency and of the specific forms of agency and spatiality that are distinctive of urban life. It explores how gentrification is enacted and experienced at the level of embodied agency, arguing that gentrifying spaces are contested territories that shape and are shaped by their dwellers. The book then moves to an exploration of repurposed cities, which are cities materially designed to support one sociopolitical order, but in which that order collapsed, leaving new dwellers to use the space in new ways. Through detailed original ethnography of the repurposed cities of Berlin and Johannesburg, Kukla makes the case that in repurposed cities, we can see vividly how material spaces shape and constrain the agency and experience of dwellers, while dwellers creatively shape the spaces they inhabit in accordance with their needs. The book concludes with a reconsideration of the right to the city, asking what would be involved in creating a city that enabled the agency and flourishing of all its diverse inhabitants.

In this issue's lead article, "Adolescent Medical Transition is Ethical: An Analogy with Reproductive Health," Florence Ashley argues that insofar as we accept that abortion and birth control can be ethical interventions for adolescents, so, by analogy, should we treat interventions such as puberty blockers that aid in gender transition as ethical. None of these interventions treat illness or pathology, but rather they operate on healthy bodies, not in order to cure, but in order to help patients live in line with their fundamental self-conception and to realize their embodied goals. Parenting, pregnancy, and gender all go to the heart of our embodied identities and sense of self, they point out. Moreover, Ashley...

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) by Sarah RichardsonQuill KuklaQuill Kukla, review of Sarah Richardson's The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021)I had been eagerly anticipating the release of Sarah Richardson's meticulously researched The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) for several years, and I was not disappointed. A leading feminist scholar of the history and philosophy of science, Richardson traces the scientific history of the idea that pregnant people's bodies control the future health, character, and well-being of their offspring. She also explores how this science is translated into social messaging and shaped by social ideology. Richardson delves into the details of the methodology, motivations, results, and communication of the science of maternal influences. She reveals a history of shaky results, contested methods, and socially loaded messaging, unified by a sustained interest in framing maternal bodies as sites of risk and responsibility for birth outcomes.A central narrative of the book is that the perceived location and mechanism through which pregnant bodies control fetal development keeps shifting around; over time, scientists have located this maternal influence in the uterine environment, the cytoplasm, the methylation of DNA, maternal nutrition, and even in the emotions, thoughts, and imagination of the mother, among other locations.1 Each time a version of the maternal influence hypothesis re-emerges, targeting a different bodily location and mechanism, it comes along with similar social messaging: pregnant people are distinctively responsible for the 'quality' of their children; their bodies are distinctive sites of risk, in need of social management; and their influence can be understood and controlled independent of the context in which they live. Given how many times this scientific hypothesis and its accompanying social messaging has died and been reborn, it is hard not to conclude, with Richardson, that background ideology compels us to keep searching for new stories that take this same form. The idea that pregnant people's bodies are understood as decontextualized and heightened sites of risk and responsibility for birth outcomes, in need of systematic discipline (both self-discipline and social discipline) in order to ensure their production of proper offspring, is one that has been explored [End Page e-1] in quite a bit of depth within feminist theory and reproductive ethics over the last thirty years. To name just a few, Barbara Duden's Disembodying Women: Perspectives on Pregnancy and the Unborn (1993), Deborah Lupton's "Risk and the Ontology of Pregnant Embodiment" (1999), Lisa Mitchell's Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (2001), and my own Mass Hysteria: Medicine, Culture, and Mothers' Bodies (2005) are all works firmly within this tradition. What is new about Richardson's book is not the development and exploration of this cultural narrative and imaginary, but rather her rigorous and skillful analysis of the science that has grown out of and undergirded it. Richardson is a masterful writer, who makes scientific details comprehensible and fascinating. Her historical and epistemological analyses of exactly what shaped the science at each stage, what each scientific iteration did and didn't manage to show, and how these different scientific movements were translated into public messaging, is sharp and compelling. Richardson shows us the inner workings of how scientific programs build momentum; how scientists make methodological decisions; and how results feed into ongoing research programs. From this book, we also develop a rich sense of just how much uncertainty is baked into the science of human development, and how both scientific and public excitement about a given research program are mostly independent of the success and security of the science that comes out of it. The book traces 150 years of the history of the science of maternal influences, culminating in the current focus on epigenetics—which, like various past maternal influence theories, has ignited our broader social imagination. Epigenetics, roughly, is the study of molecular changes outside our DNA that control how genes express themselves. Environmental stimuli (such as stress) can cause changes in methylation, and thereby influence the expression of the genome: "Epigenetic markers that help determine whether a...

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...

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...

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...