Kennedy Institute of Ethics Journal最新文献

• Editor’s Note
• Quill Kukla, Editor-in-Chief

This 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 existe

Social robots are increasingly being deployed to address social isolation and loneliness, particularly among older adults. Clips on social media attest that individuals availing themselves of this option are pleased with their robot companions. Yet, some people find the use of social robots to meet fundamental human emotional needs disturbing. This article clarifies and critically evaluates this response. It sets forth a framework for loneliness, which characterizes one kind of loneliness as involving an affective experience of lacking human relations that provide certain social goods. Next, the article discusses social robots and critically reviews the literature on the ethics of using them in light of this loneliness characterization. Third, we present a normative argument connecting the philosophical critique of loneliness-as-absence with the design and deployment of social robots. Finally, we draw out the implications of our analysis for public health and for interrogating the aims of commercial companies who make social robots.

COVID-19 elicited a rapid emergence of new mutual aid networks in the US, but the practices of these networks are understudied. Using qualitative methods, we explored the empirical ethics guiding US-based mutual aid networks' activities, and assessed the alignment between principles and practices as networks mobilized to meet community needs during 2020-21. We conducted in-depth interviews with 15 mutual aid group organizers and supplemented these with secondary source materials on mutual aid activities and participant observation of mutual aid organizing efforts. We analyzed participants' practices in relation to key mutual aid principles as defined in the literature: 1) solidarity not charity; 2) non-hierarchical organizational structures; 3) equity in decision-making; and 4) political engagement. Our data also yielded a fifth principle, "mutuality," essential to networks' approaches but distinct from anarchist conceptions of mutualism. While mutual aid networks were heavily invested in these ethical principles, they struggled to achieve them in practice. These findings underscore the importance of mutual aid praxis as an intersection between ethical principles and practices, and the challenges that contemporary, and often new, mutual aid networks responding to COVID-19 face in developing praxis during a period of prolonged crisis. We develop a theory-of-change model that illuminates both the opportunities and the potential pitfalls of mutual aid work in the context of structural inequities, and shows how communities can achieve justice-oriented mutual aid praxis in current and future crises.

• Contributors

Dr. Emma C. Gordon is a Lecturer in Applied Ethics at the University of Glasgow and Head of Interdisciplinary Research at the COGITO Epistemology Research Centre. Her main research interests are in bioethics, medical ethics, epistemology, and the philosophy of technology. Her book, Human Enhancement and Well-Being, is forthcoming with Routledge in 2023.

Anne-Marie Gagné-Julien is a postdoctoral fellow at the Biomedical Ethics Unit at McGill University. She is also affiliated with the Centre de recherche en éthique (CRE, Montréal) and École normale supérieure (Paris). She holds a PhD in philosophy of science and psychiatry from the Université du Québec à Montréal (UQAM). Her research interests lie at the intersection of the philosophy and ethics of psychiatry, feminist philosophy of science, and epistemic injustices.

Nabina Liebow is the Director of the College of the Arts and Sciences Leadership and Ethical Development Program at American University. She is also a Professorial Lecturer in the Department of Philosophy and Religion at American University.

Megan A. Dean is assistant professor of Philosophy at Michigan State University. She works in feminist bioethics with a focus on the ethics of eating.

Neşe Devenot, PhD is a Postdoctoral Associate at the University of Cincinnati's Institute for Research in Sensing, an Affiliate Scholar at The Ohio State University's Center for Psychedelic Drug Research & Education, and a Research Fellow with Psymposia. Dr. Devenot works at the intersection of health humanities, psychedelic bioethics, neuroethics, and comparative literature. Their research examines changes to self-concept alongside the function of metaphor and other literary devices in narrative accounts of psychedelic experiences.

Aidan Seale-Feldman, PhD, is an Assistant Professor of Medical Anthropology at the University of Notre Dame. For the past decade, she has conducted ethnographic research in the Nepal Himalayas on disaster, mental health, and the translation of affliction between Indigenous and psychiatric worlds. Dr. Seale-Feldman's current work explores the imagined possibilities of psychedelic medicine as a solution to America's "mental health crisis."

Elyse Smith, M.A., is a doctoral student in medical and environmental anthropology at the University of Connecticut. Her scholarship examines environmental ethics and human health, Indigenous sovereignty, the bioethics of psychedelic medicine, and evidence-based approaches to drug policy that are grounded in a decolonial, trauma-informed, human rights perspective. Her research explores psychedelic community integration and harm reduction-based socialized care frameworks, which diverge from the burgeoning clinical model of psychedelic medicine access and regulation.

In the last two decades it has become increasingly common to advocate for a complete ban on the sale of cigarettes. One reason in favor of such a ban is egalitarian: differences in the prevalence of smoking between socioeconomic groups go a long way in explaining health inequality, and a complete ban might be effective in reducing this inequality. However, a complete ban might also be objectionable on egalitarian grounds if issued with a discriminatory intent or if it is selectively paternalistic. This article argues that a complete ban is likely to be guilty of both, especially when one of its aims is to reduce unequal rates of smoking between groups. A complete ban on the sale of cigarettes thus exhibits a curious feature: in aiming to reduce inequality it threatens to be inegalitarian. This is characteristic of a wider class of public health policies that deserves further attention by egalitarians.

Autistic adults suffer from an alarmingly high and increasing unemployment rate. Many companies use pre-employment personality screening tests. These filters likely have disparate impacts on neurodivergent individuals, exacerbating this social problem. This situation gives rise to a bind. On the one hand, the tests disproportionately harm a vulnerable group in society. On the other, employers think that personality test scores are predictors of job performance and have a right to use personality traits in their decisions. It is difficult to say whether these negative disparate impacts are a case of wrongful discrimination. Nevertheless, we will show that pre-employment personality tests prey on several features of autism in an unfair way, and for this reason, we suggest the contours of some regulation that we deem necessary.

This study describes the results of a social analysis of mutual aid solidarity during Nigeria's #EndSARSprotests against Special Anti-Robbery Squad (SARS) brutality in Nigeria. The results reveal that the protests achieved success with the assistance of mutual aid solidarity networks. Yet there is a dearth of literature exploring the reasons for this accomplishment. Nigeria is a country where everything done usually has a religious coloration and interpretation; however, the 2020 mutual aid solidarity in the #EndSARS protests proved otherwise. Using in-depth interviews, data were elicited from 20 youths, including participants and observers during the #EndSARS mutual aid solidarity protests. Using a phenomenological approach, this study found that the mutual aid support group transcended traditional geopolitical, gender, and religious barriers, and youth and the elderly participated in the protest. Further results show that the 2020 #End-SARS mutual aid solidarity brought about an accountable and transparent civil society, including the financial disbanding of the Nigerian Police Force, the SARS unit responsible for extrajudicial killings. The findings also indicate that Nigerian politicians are the real problem, not religion. Recommendations are discussed.