Kennedy Institute of Ethics Journal最新文献

Disability scholars generally categorize staring as a stigmatizing action that has negative psychosocial impacts on disabled people. Yet, interestingly, staring is also oftentimes understood as natural, understandable, and is even encouraged in different contexts. In this paper, I first articulate the diverse ways staring is experienced and conceptualized by drawing from general sociological, queer, and disability theories, and I demonstrate that staring itself is a value-neutral action. I argue that staring is experienced particularly negatively by disabled communities because (1) staring that occurs within inaccessible environments reinforces societal sentiments that disabled individuals are unwanted and unvalued, and (2) disabled individuals often lack control over whether and how they are stared at; thus, when staring occurs in a physically inaccessible context, staring perpetuates a loss of control over social experiences. I conclude by articulating how participatory planning as an alternative approach to inclusive design can attenuate the harmful impacts staring has on disabled individuals.

Climate change and worsening environmental degradation remain the greatest threat of our time. How to address the environmental crisis ethically and equitably is one of the most important questions facing the global community. Conceptions of environmental justice and ecological justice are key sources of guidance on this matter. Yet these conceptions are ill equipped to guide global action. They identify four core dimensions of environmental justice and ecological justice: distribution, recognition, inclusion, and well-being. In this paper, I argue that different ontological (e.g., holism) and experiential (e.g., colonization and coloniality) starting points in the Global South identify additional dimensions-harmony and power-and additional aspects of the recognition dimension that are largely missing from dominant multivalent concepts. I next offer three epistemic reasons why excluding the additional dimensions and aspects from our conception of environmental justice and ecological justice is problematic. I then apply relevant theory from the Global North and South to propose how the power, harmony, and recognition dimensions might be understood or reimagined. I demonstrate that a broadened environmental justice and ecological justice concept identifies certain issues voiced by people from the Global South as injustices, where current mainstream concepts do not. I conclude by considering important objections to the ideas proposed in the paper.

Double-blind, randomized, controlled trials (DB-RCT), if designed and conducted well, are widely considered the gold standard in medical research for purposes of establishing causal efficacy. Their logic is compelling: by balancing out all confounding variables through the research design, DB-RCTs are thought to reveal whether a proposed treatment-by virtue of its characteristic constituents-causes therapeutic effects. Many studies on psychedelic-assisted therapy (PAT) follow this ostensible gold standard and use a DB-RCT design. But several authors have already noted that conducting psychedelic DB-RCTs is particularly challenging: due to the psychoactive effects of psychedelics, participant awareness of condition assignment is likely; this awareness may then interact with response expectancy and experimenter behavior, introducing systematic bias into the trial. For this reason, these authors have suggested ways to rescue DB-RCTs for PAT. This paper takes a different direction. It argues that we should abandon the DB-RCT design as the assumed gold standard in PAT research, because its logic is largely undermined by the intervention(s) in question, and the design in its standard form neglects potentially important aspects of PAT (i.e., extrapharmacological factors and their interaction(s) with the psychedelic). Abandoning DB-RCT opens the door to a more holistic study of PAT, in which DB-RCTs are still useful for certain ends but are considered to produce results that are not per se superior but complementary to those of other research designs.

• Contributors

Michiel De Proost is a postdoctoral researcher at the Department of Philosophy and Moral Sciences at Ghent University and is affiliated with the Bioethics Institute Ghent and the METAMEDICA consortium.

Benjamin Chin-Yee is a hematologist in the Division of Hematology, Western University, Canada, and a doctoral student in the Department of History and Philosophy of Science at the University of Cambridge. His research interests span philosophy of medicine, values in science, and the ethics of scientific and clinical communication.

Ilvie Prince is a doctoral candidate at Leibniz University Hannover. Her work focuses on the complex relationship between ethics and epistemology in medicine, with a particular interest in medical practices that challenge established concepts and methods.

Megan A. Dean is an assistant professor in the Philosophy Department at Michigan State University and the North American coordinator of Culinary Mind: Center for Philosophy of Food. She works in feminist bioethics with a focus on the ethics of eating.

Jonathan Ichikawa is a professor and department head in philosophy at the University of British Columbia. His research interests center around epistemology, feminist philosophy, ethics, and the philosophy of language, especially the points at which those philosophical subfields interact with one another.

Several suggestions have been made to embolden and reorient the concept of solidarity given the emergence of data-driven medicine. Recently, the European Union introduced a new consent model for so-called data altruism to motivate people to make their data available for purposes such as scientific research or improving public services. Others have introduced the alternative concept of data solidarily, which assumes that people's interests in data sharing result from a collective commitment to assist others. What those perspectives have in common is a focus on top-down organizational structures to deal with data-driven medicine. In this article, I offer an alternative reading of data solidarity, drawing on anarchist theory that highlights the disposition of mutual aid as a broader characteristic of solidarity. I begin by briefly indicating how the existing approaches to data solidarity in healthcare remain legalistic and state-centered without thoroughly considering socially critical notions of solidarity that highlight the impact of structural injustices. I then sketch out how an anarchist understanding of mutual aid could inform the conceptualization of solidarity. Finally, I focus on two implications for the practice of data-driven medicine: (1) current proposals of data altruism seem to engender a form of reversed charity; and (2) data solidarity practices could arise from the bottom-up through spontaneous order and direct action.

Generalizations in medical research can be informative, but also misleading. Building on recent work in the philosophy of science and ethics of communication, I offer a novel analysis of common generalizations in clinical trials as generics in natural language. Generics, which express generalizations without terms of quantification, have attracted considerable attention from philosophers, psychologists, and linguists. My analysis draws on probabilistic and contextual features of generics to diagnose how these generalizations function and malfunction across communicative contexts in medicine. Given a high risk of misinterpretation ("slippage"), I recommend avoidance of generic claims about medical interventions in public contexts, exemplified by clinical trials and medical research more generally. Generics should only be used with vigilance in private contexts, exemplified by the physician–patient encounter. My analysis provides tools to support vigilance when communicating with generics, suggests new norms for public science communication, and raises deeper questions in the ethics of clinical communication.

Reviewed by:

• Green Light Ethics: A Theory of Permissive Consent and its Moral Metaphysics by Hallie Liberto
• Jonathan Ichikawa (bio)

Hallie Liberto's Green Light Ethics offers a framework for conceptualizing permissive consent. The book is a philosopher's work of philosophy. Although it touches on non-ideal social realities, especially sexism, it is most centrally a contribution to a quite abstract literature in normative ethics, following in the tradition of scholars like David Owens, Heidi Hurd, Alan Wertheimer, and Tom Dougherty—it may have a few too many Φs and abstractions to be accessible to and comfortable for many people outside the analytic philosophical tradition. The central approach to permission and consent is general—not specific to sexual consent—although some discussions are specific to sex.

I have always appreciated and learned from Liberto's work on this topic, and I was excited to read her new book. As I'd hoped, it exhibits fresh and interesting moral and philosophical instincts, and advances plausible and interesting ideas. I did feel, however, that it was sometimes more difficult than one might hope to identify exactly what those ideas are. At key points, I found myself wanting more precision or explanation. I am not the kind of philosopher who shuns abstraction—I value both the concrete/non-ideal and the theoretical/abstract. And I'm not afraid of all those Φs. But as I see it, the point of writing in that mode—the reason it can be worth the cost in accessibility and style—is the ability to express and examine complex ideas with a high degree of precision. As I was reading this book, I found that much of my own intellectual contribution centered around attempts to interpret Liberto's ideas and technicalities before I was in a good position to learn from them. This was a bit of a shame, because there are intriguing ideas in this book, well worthy of consideration. I'll give my own reconstruction of a few of them below, along with some critical engagement.

1. domain authority

Liberto posits that there are certain domains over which people hold a special kind of moral authority, which she calls "domain authority" (38). Someone would wrong you if they acted in your domains outside of your normative control. For example, you have domain authority over sexual contact with your body; any actions by others within that domain must [End Page 429] be in accordance with your moral control, or they are violative. Liberto typically uses the following abbreviations to discuss domain authority: S is a person who may or may not be g

Since the invention of hormonal contraceptives, there has been disagreement between users and providers about the existence of side effects and their implications for care. The lack of consideration for cisgender women, and other people who may become pregnant, has often been explained by sexist bias in the philosophy of medicine. My goal is to contribute additional elements to this discussion. I will argue that there are structurally embedded assumptions about the responsibilities and goals of medicine that open the door to this sexism in the first place. While we tend to accept that contraception is part of medicine for pragmatic reasons, we do not exhibit the same form of pragmatism when it comes to dealing with side effects. This is an unjustified double standard that fails to recognize the goals of contraception and the fact that it relies on medical expertise to achieve them.