Kennedy Institute of Ethics Journal最新文献

Contextualist treatments of clashes of intuitions can allow that two apparently conflicting claims can both be true. But making true claims is far from the only thing that matters-there are often substantive normative questions about what contextual parameters are appropriate to a given conversational situation. This paper foregrounds the importance of the social power to set contextual standards and how it relates to injustice and oppression, introducing a phenomenon I call "contextual injustice," which has to do with the unjust manipulation of conversational parameters in context-sensitive discourse. My central example applies contextualism about knowledge ascriptions to questions about knowledge regarding sexual assault allegations, but I will also discuss parallel dynamics in other examples of context-sensitive language involving politically significant terms, including gender terms. The discussion further illustrates some of the deep connections between language, epistemology, and social justice.

People with Alzheimer's dementia experience significant neuropsychological decline, and this seems to threaten their sense of self. Yet they continue to have regard for their moral standing, especially from the feedback they receive from others in relation to such things as pride in their work, retaining a valued role, or acting out of a sense of purpose. This continuing self-regard is based on a self-image which often persists through memory loss. I will argue that in care settings the self-image ought to be assumed to remain intact. Treating a person with Alzheimer's dementia supportively and respectfully as the person with a certain role or identity-say as scientist, musician, janitor, parent, or friend-fosters an environment in which they are best able to retain what I call moral self-orientation. The latter notion is central to the well-being of social persons, and so it takes on special significance for people with dementia because, although their remembering selves are fragmenting, their self-image persists. Normative aspects of the self-image, I argue, require a social framework of support to sustain the self-image.

We explore conceptions of responsibility and integrity in global health research and practice as it is being carried out in the academic setting. Our specific motivation derives from the recent publication of a study by a clinical research team involving the delivery of mental health care services in a Ghanaian prayer camp. The study was controversial on account of the prayer camp's history of human rights abuses and therefore was met with several high-profile critiques. We offer a more charitable evaluation of the Joining Forces study. Our analysis has three primary goals. First, we respond to criticism suggesting that the Joining Forces research team needed to maintain some form of morally "clean hands" in relation to the human rights abuses at Mount Horeb prayer camp. We argue that, for academic global health practitioners working under severe resource constraints, what is reasonable and responsible to pursue is a complex proposition without a one-size-fits-all ethical answer. Second, we offer an explanation for why the Joining Forces study team designed the project as they did in spite of their obvious vulnerability to ethical concern. We argue that the Joining Forces study was a morally risky, but ethically earnest effort to reach a neglected patient population and promote behavior change in prayer camp staff. Third, we identify an open ethical question born of the researchers' commitment to pragmatism that, to our knowledge, has not been previously addressed in published discussion of the Joining Forces project. Namely, was the incomplete disclosure of information to prayer camp staff defensible? We close with a broader reflection on the notion of moral integrity in the pursuit of the salutary aims of global health.

In this paper, I analyze the phenomenon of child cultural body modification (CCBM). I describe the practice, discuss philosophical, sociological, and anthropological arguments about the parental motivations, and evaluate an influential justification based on the children's putative cultural benefit of undergoing CCBM. I propose an alternative view of bodily integrity based on the value of body agency, the ability of individuals to generate meaning in their world through conscious, voluntary, and purpose-driven usage of their own bodies.

Medical professionals routinely offer prenatal genetic testing services to their expecting patients. Some bioethicists believe that when these professionals promote the use of such testing for abortion on grounds of disability, they express a devaluing message to and about extant disabled people. Supporters of this expressivist objection further maintain that, in expressing such a message, medical professionals reinforce negative attitudes about extant disabled people and thereby further stigmatize them. But while the expressivist objection has received quite a bit of support from disability rights theorists-in part because of its intuitive appeal-its current formulation suffers from various shortcomings that render it implausible. By invoking tools from the philosophy of language, I present the expressivist objection*: an improved and distinctive formulation of the expressivist objection that preserves some of its core insights. According to this improved formulation, the promotion of prenatal testing for selective abortion can at least sometimes be wrong.

This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of Autism Spectrum Disorder (ASD). However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis (ABA), which is widely taken to be far-and-away the best "treatment" for ASD, manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but often exacerbate them. Warnings of the perils of ABA are not original to us-autism advocates have been ringing this bell for some years. However, their pleas have been largely unheeded, and ABA continues to be offered to and quite frequently pushed upon parents as the appropriate treatment for autistic children. Our contribution is to argue that, from a bioethical perspective, autism advocates are fully justified in their concerns-the rights of autistic children and their parents are being regularly infringed upon. Specifically, we will argue that employing ABA violates the principles of justice and nonmaleficence and, most critically, infringes on the autonomy of children and (when pushed aggressively) of parents as well.