The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as (...) well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics. (shrink)
The view we defend is that in virtue of its nature, disgust is not fit to do any moral or social work whatsoever, and that there are no defensible uses for disgust in legal or political institutions. We first describe our favoured empirical theory of the nature of disgust. Turning from descriptive to normative issues, we address the best arguments in favour of granting disgust the power to justify certain judgements, and to serve as a social tool, respectively. Daniel Kahan (...) advances a pair of theses that suggest disgust is indispensable (Moral Indispensability Thesis), and so has an important part to play in the functioning of a just, well-ordered society (Conservation Thesis). We develop responses and show how they rebut the arguments given in support of each thesis. We conclude that any society free of social disgust would be more just, reasonable and compassionate. (shrink)
Peer commentary on: Blumenthal-Barby, J. S. (2016). Biases and heuristics in decision making and their impact on autonomy. The American Journal of Bioethics, 16(5), 5-15.
Dominant views about the nature of health and disease in bioethics and the philosophy of medicine have presumed the existence of a fixed, stable, individual organism as the bearer of health and disease states, and as such, the appropriate target of medical therapy and ethical concern. However, recent developments in microbial biology, neuroscience, the philosophy of cognitive science, and social and personality psychology (Ickes...
This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must (...) be reoriented. Our main claim is that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians’ biased behavior as a result of interaction with the medical industry. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Substantiating this claim will involve elaboration on two points. First, we will retrace the history of policies regarding gift giving between the medical profession and the medical industry and highlight how most policies assume a rationalistic view of moral agency. Reliance on this view of agency is best illustrated by past attempts to address gift giving in terms of conflicts of interest. Second, we will introduce and motivate an alternate view of moral agency emerging from recent literature in social psychology on implicit social cognition. We will show that proper consideration of implicit social cognition paints a picture of human psychology at odds with the rationalistic model assumed in discussions of COIs. With these two pieces on the table we will be able to show that, without fully appreciating the social-psychological mechanisms of implicit cognition, policy-makers are likely to overlook significant aspects of how gifts influence doctors. (shrink)
Questions of individuality are traditionally predicated upon recognizing discrete entities whose behavior can be measured and whose value and agency can be meaningfully ascribed. We consider a series of challenges to the metaphysical concept of individuality as the ground of the self. We argue that an ecological conception of individuality renders ascriptions of autonomy to selves highly improbable. We find conceptual resources in the work of environmental philosopher Arne Naess, whose distinction between shallow and deep responses helps us rethink the (...) notion of individuality and, thus, assess whether the conceptual and normative coherence of human autonomy could, at least partially, be salvaged. (shrink)
Peer commentary on: Goering, S., Klein, E., Dougherty, D. D., & Widge, A. S. (2017). Staying in the loop: Relational agency and identity in next-generation DBS for psychiatry. AJOB Neuroscience, 8(2), 59-70.
In a near-future world of bionics and biotechnology, the main ethical and political issue will be the definition of who we are. Could biomedical enhancements transform us to such an extent that we would be other than human? Habermas argues that any genetic enhancement intervention that could potentially alter ‘human nature’ should be morally prohibited since it alters the child’s nature or the very essence that makes the child who he is. This practice also commits the child to a specific (...) life project or, in any case, it puts specific restrictions on his freedom to choose a life of his own. Ultimately, genetic enhancement jeopardizes the very foundations of moral equality. I contend that Habermas’ argument is based either on a series of presuppositions that imply a gross misunderstanding of evolution or the relevant factual information cocerning the action we are about to morally assess is not empirically supported. Hence, the argument from human nature is based on a series of false or problematic assumptions, and, as such, it fails to play the normative role intended by Habermas. (shrink)
Questions of individuality are traditionally predicated upon recognizing discrete entities whose behavior can be measured and whose value and agency can be meaningfully ascribed. We consider a series of challenges to the metaphysical concept of individuality as the ground of the self. We argue that an ecological conception of individuality renders ascriptions of autonomy to selves highly improbable. We find conceptual resources in the work of environmental philosopher Arne Naess, whose distinction between shallow and deep responses helps us rethink the (...) notion of individuality and, thus, assess whether the conceptual and normative coherence of human autonomy could, at least partially, be salvaged. (shrink)
The study of anarchism as a philosophical, political, and social movement has burgeoned both in the academy and in the global activist community in recent years. Taking advantage of this boom in anarchist scholarship, Nathan J. Jun and Shane Wahl have compiled twenty-six cutting-edge essays on this timely topic in New Perspectives on Anarchism.
Biodiversity has become one of the most important conservation values that drive our ecological management and directly inform our environmental policy. This paper highlights the dangers of strategically appropriating concepts from ecological sciences and also of uncritically inserting them into conservation debates as unqualified normative landmarks. Here, I marshal evidence from a cutting-edge research program in microbial ecology, which shows that if species richness is our major normative target, then we are faced with extraordinary ethical implications. This example challenges our (...) well-received beliefs about biodiversity and it invites us to critically rethink the nature of this concept so that a more robust understanding of biodiversity and of its role in conservation policy could emerge. (shrink)
It has often been said that deconstruction leaves Derrida with nothing positive to say about politics. Critics of Derrida think that the application of deconstruction to politics fails because it overlooks the distinctiveness of political structures. By framing this paper from a case study into the theory of aporias in law and politics and back to the question of apartheid, I argue for a way in which Derrida’s deconstruction is at play both only on a theoretical level and also on (...) a practical level as a corrective to a given political situation. (shrink)
Public attitudes concerning cognitive enhancements are significant for a number of reasons. They tell us about how socially acceptable these emerging technologies are considered to be, but they also provide a window into the ethical reasons that are likely to get traction in the ongoing debates about them. We thus see Conrad et al’s project of empirically investigating the effect of metaphors and context in shaping attitudes about cognitive enhancements as both interesting and important. We sketch what we suspect is (...) a central theme that runs through these public attitudes, but that Conrad el al’s paper elides. We were disappointed that they did not more directly explore the efficacy of frames and metaphors associated with the values of authenticity and self-expression. This seems like a missed opportunity. Based on the premise that individualistic values enjoy centrality in Western and especially North American culture (e.g. Taylor 1989), we hypothesize that metaphors and frames informed by those values will be especially effective in shaping public attitudes. That is, when various kinds of novel enhancement are described as allowing people to more fully express themselves, or as helping people overcome obstacles to being authentic and true to their inner sense of themselves, those enhancements will be considered justified, and their use more likely to be viewed as socially acceptable by the public. We support our contention by drawing on work by Elliott (2004, 2011, c.f. Kadlac 2018), and discuss how this study, and others modeled on it, might shed light on our hypothesis. (shrink)
It has become increasingly clear that there is a vast array of microorganisms on and in the human body, known collectively as the human microbiome. Our microbiomes are extraordinarily complex, and this complexity has been linked to human health and well-being. Given the complexity and importance of our microbiomes, we struggle with how to think about them. There is a long list of competing metaphors that we use to refer to our microbiomes, including as an “organ” containing our “second genome,” (...) as a “symbiont” in the human “holobiont,” and as an ecological “community” in the human “ecosystem,” among others. Each of these makes different assumptions about the fundamental biology of the human-microbe system, with important implications for how we choose to study microbiomes, and the therapies we envision for correcting microbiome-linked disorders. We believe that it is time to move beyond metaphors, and we propose a scientifically pluralist approach that focuses on characterizing fundamental biological properties of microbiomes such as heritability, transmission mode, rates of dispersal rates, and strength of local selection. Such an approach will allow us to break out of the confines of narrow conceptual frameworks, and to guide the exploration of our complexity as chimeric beings. (shrink)
This paper argues that the practical reach and ethical impact of the One Health paradigm is conditional on satisfactorily distinguishing between interconnected and interdependent factors among human, non-human, and environmental health. Interconnection does not entail interdependence. Offering examples of interconnections and interdependence in the context of existing One Health literature, we demonstrate that the conversations about One Health do not yet sufficiently differentiate between those concepts. They tend to either ignore such distinctions or embrace bioethically untenable positions. We conclude that (...) careful conceptual differentiation can prevent One Health stakeholders either from overreaching or under-reaching the practical and ethical boundaries of this developing paradigm. (shrink)
Debates about obesity in bioethics tend to unfold in predictable epicycles between individual choices and behaviours and the oppressive socio-economic structures constraining them. Here, we argue that recent work from two cutting-edge research programmes in microbiology and social psychology can advance this conceptual stalemate in the literature. We begin in section 1 by discussing two promising lines of obesity research involving the human microbiome and relationship partners. Then, in section 2, we show how this research has made viable novel strategies (...) for fighting obesity, including microbial therapies and dyad-level interventions. Finally, in section 3, we consider objections to our account and conclude by arguing that attention to the most immediate features of our biological and social environment offers a middle ground solution, while also raising important new issues for bioethicists. (shrink)
