Autonomy is a core concept for medical decision-making in the United States. Yet as issues of social justice have been increasingly appreciated by American bioethicists, so has the difficulty of reconciling autonomy with unjust contexts. Bioethicists have turned to the feminist concept of relational autonomy to address these issues, but there is disagreement over its implementation. This paper aims to clarify the relationship between unjust circumstances and respect for autonomy by analyzing the utility of relational autonomy for medical decision-making in nonideal social contexts.
Between 1987 and 1995, the Kennedy Institute of Ethics held a number of training courses specifically addressing German physicians and scholars engaged in the establishment of medical ethics in West Germany. These courses were linked to the annual Intensive Bioethics Course the institute had been organizing since 1975. During the 1980s, the perspective of bioethical training began to shift toward an international audience. Through the fundraising skills and organizational efforts of Hans-Martin Sass, a German philosopher and senior research scholar at the institute, the focus eventually shifted toward the situation in Germany, where interest in bioethics was emerging but infrastructure and knowledge were lacking. Based on extensive archival research in the US and Germany, this paper retraces the history of German participation in the Kennedy Institute's bioethical training courses and analyzes the impact this experience had on the institute's outlook as well as on the development of German medical ethics.
Respecting individual liberty is a foundational principle of both liberal democratic theory and public health ethics. It is not always clear, however, what role liberty should play in evaluating restrictive public health policies such as those implemented by governments during the COVID-19 pandemic. During the pandemic, a number of scholars argued that an appeal to individual liberty provides a strong argument against restrictive policies such as stay-at-home orders, school and business closures, and gathering restrictions-which we will collectively refer to as "lockdowns." This paper argues that while individual liberty is an important consideration, it does not, on its own, provide a strong argument against pandemic lockdowns. To show as much, we survey some of the most promising and prominent liberty-based arguments against lockdowns. We argue that such arguments either fail or are incomplete. Before concluding, we draw on this discussion to suggest a different liberty-based frame for evaluating pandemic policies. This approach would focus more on what functions liberties are meant to fulfill and whether lockdowns can be designed to preserve those functions-even if they restrict liberty.
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.
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.
There are many proposals in the literature on how to "manage values." Many of these proposals have in common the assumption that the relevant values in science can be "packaged for transfer": they can be put in an envelope for scientists to hand to stakeholders or policymakers, or for members of the public or ethical experts to hand to scientists. The central aim of this paper is to argue that packaging values for transfer is a practical impossibility. The central argument of the paper concerns the best stance to take on how values in science should be conceptualized. Specifically, I argue that we need to return to a decision-theoretic definition of values (as, I argue, is strongly suggested by a close reading of Rudner, Jeffrey, and Hempel.) Further, I argue for a picture of these values that is nonpsychologistic, stance relative, and always and everywhere entangled with credences. I call my account of the nature of values in science the Putnam-Hempel account. Unfortunately, the Putnam-Hempel account forces us to see that any proposal that depends on packaging values for transfer will ultimately suffer from great difficulties.
Scientists have to make trade-offs between different types of error risks when making methodological decisions. It is now widely recognized (and not disputed in this article) that in doing so they must consider how serious the consequences of each error would be. The fact that they must also consider the potential benefits of getting it right is not equally recognized (and explicitly rejected by Heather Douglas). In this article, I argue that scientists need to do both when managing epistemic risks. At the same time, I acknowledge that in some cases it intuitively seems as if considering the consequences of possible errors carries greater moral weight. I explain this intuition by arguing that in these cases the contrast between the seriousness of mistakes and the benefits of getting it right can be linked to the moral asymmetry between action and omission. I examine various reasons that might justify a stronger weighting of the consideration of the consequences of errors in light of the action-omission asymmetry. I conclude that for all but some exceptional cases, such asymmetrical consideration is not called for.
Generally speaking, BPD is a cognitive-affective disposition that shapes one's conception and experience of herself, and also her experiences of interrelationality. Many BPD symptoms relating to affect regulation are spurred by psychosocial complications that can then exacerbate psychosocial complications in future relationships. One consequence of affective dysregulation due to abuse-induced trauma can be persistent interpersonal breakdowns. Such breakdowns can be caused by the inability of two differently affectively disposed persons to harmonize according to what person each needs based on a set of supposedly shared norms and expectations. Attempting to identify specific ethical issues related to affective disruptions in interrelational harmonizing requires that one pull together the embodied experiences of BPD and the effects of those experiences on interpersonal relationships and then position that distinctive dynamic within an ethico-epistemological framework. I believe that one critical trigger for BPD affective dysregulation comes from the role of abuse-induced trauma in the cultivation of the BPDer's body memory. I offer a description of this phenomenology, which I ground in the philosophy of embodied cognition. The relationship between trauma and the embodied memory matters to ethical conversations about BPD because it is crucial to see how trauma that manifests as a specific kind of affective disposition can influence the ethical harmonizing of interpersonal interactions.I write this analysis from my own first-person experience of someone diagnosed with severe BPD.
In this paper, I examine the life and works of Enlightenment philosopher Jean-Jacques Rousseau (1712-1778) through the lenses of madness, neurodivergence, and disability. While many scholars readily think of Rousseau as eccentric, overly emotional, and "melancholic," they do not attempt to situate him as explicitly disabled, or to interpret his work as informed by madness.Using my own disabled, autistic, and mad identity as a point of potential reparative reading and kinship (although not as a direct diagnostic analogue or an uncritical approach), I argue that reading Rousseau explicitly as disabled, and further as experiencing traits consistent with modern descriptions of mental disability, opens up a new way of looking at his philosophical and musical works. By applying disabled, neurodivergent, and mad lenses to Rousseau. I provide a framework to understand the tensions between authenticity and falsehood, belief in mankind and misanthropy, and understanding and misunderstanding in his work.
Many technologies that are purportedly developed to improve the lives of disabled people reflect an ableist ideology that devalues rather than supports disabled bodyminds. In this paper we attribute this tendency to a neurotypical form of perception that obscures disabled people's moral visibility, understood as their visibility as richly expressive and interaction-worthy sense-making individuals. Relying heavily on examples drawn from scholarship on and community with augmentative and alternative communication technology (AAC tech)-that is, communication technology designed for and used by nonspeaking people-we take the expressive bodies and voices of disabled people as well as technology's role in forming expressivity and voice as important loci for redressing neurotypical ableist perceptions widely embedded in practices of engineering and science. Through our AAC tech discussion, we map different modes and degrees of moral (in)visibility, offering this mapping as an analytic resource for technologists committed to anti-ableist technology. Additionally, we also trace how technologies can be used and tinkered with in ways that can open up more (neuro)expansive, diversity-embracing ways of perceiving disabled lives. Ultimately, our account aims to motivate technologists to embrace such an expansive approach. We conclude by tentatively indicating some ways in which this approach can be operationalized in engineering and science practices.
Theories of neurodivergence which describe divergent neurotypes as pathological, that is, as stemming from a dysfunction, represent the status quo for many institutions and caregivers. I seek to disrupt the "pathology paradigm" through a critique of the relevant notions of "function" and "dysfunction" and an examination of some oppressive therapeutic interventions promoted by the pathology paradigm. I advance an alternative analysis of neurodivergence, the "lack of fit" analysis, which aims to examine the particular ways that neurodivergent people experience a lack of fit with their environments. The "lack of fit" analysis is intended to promote self-determination through the development of adaptive relationships and collaborative interventions.
One of the central aims of mental healthcare should be to increase a person's autonomous agency. In a mental healthcare context, it is often argued that mental healthcare should maximize a person's autonomy so they can make autonomous choices about their treatment. My argument in this paper is broader: mental healthcare should increase autonomous agency so that a person can exercise direction over their life and live a life of meaning. Mental healthcare can and ought to increase autonomous agency by helping the person achieve both internal and external conditions of autonomy. Mental healthcare can fulfill these conditions by reducing mental illness symptoms and thus enhancing competence and voluntariness, increasing the capacity for reflective endorsement by examining the influence of social norms, enabling normative authority through the development of self-worth, and connecting individuals with services that can provide multiple good options to choose from.
Recently, neurodiversity scholars published a letter to the editor of Autism arguing that Judy Singer should not be cited as coiner of neurodiversity; rather, the term should be attributed to earlier neurodiverse forums online. I make a similar argument for neuroqueer. Neuroqueer is typically attributed to one of the letter's authors: Nick Walker (2015). Archival information, however, demonstrates that the term was developed in neuroqueer community conversations on the NeuroQueer blog (2013-2016) and, even earlier, on the alt.support. autism Usenet forum (2003). Walker's claim to coinage, then, obscures the collective origins of the concept and erases neuroqueer people from their own story. In retracing these historiographical steps, I pursue two theoretical questions. First, what can this broader history illuminate about the concept, theory, and practice of neuroqueer? Second, what might an explicitly neuroqueer citation politics look like? If not a single-origin story, then what?
