In Games: Agency as Art, Thi Nguyen has given us a deep and compelling picture of agency as much more layered, volatile, environment-dependent and discontinuous than it appears in most philosophical accounts. Games ‘inscribe … forms of agency into artifactual vessels’.1 1 When we play a game, we take up a form of agency, including a set of motivations, values and goals, which has been artificially provided by the game. Our purpose in playing, in the kinds of gameplay that interest (...) Nguyen, is to have the aesthetic experience of first-personally exercising the kind of agency sculpted by the game. As we move in and out of gameplay, we take up and drop values, motives, and goals that are provided to us by the game. Games can expand our autonomy and the richness of life by allowing us to practice different forms of agency, taking on different ends for the aesthetic experience of striving to meet them. While I am on board with these central moves of Nguyen’s book, in this essay I will argue that the situation is substantially messier than Nguyen portrays it as being. Game play, I will claim, is inextricably embedded and entangled in its larger social, material and cultural context. Conversely, I will argue, everyday life is routinely sculpted in ways Nguyen claims are distinctive of games. (shrink)

Consider a recent expression of such traditionalism.

I explore how gender can shape the pragmatics of speech. In some circumstances, when a woman deploys standard discursive conventions in order to produce a speech act with a specific performative force, her utterance can turn out, in virtue of its uptake, to have a quite different force—a less empowering force—than it would have if performed by a man. When members of a disadvantaged group face a systematic inability to produce a specific kind of speech act that they are entitled (...) to perform—and in particular when their attempts result in their actually producing a different kind of speech act that further compromises their social position and agency—then they are victims of what I call discursive injustice. I examine three examples of discursive injustice. I contrast my account with Langton and Hornsby's account of illocutionary silencing. I argue that lack of complete control over the performative force of our speech acts is universal, and not a special marker of social disadvantage. However, women and other relatively disempowered speakers are sometimes subject to a distinctive distortion of the path from speaking to uptake, which undercuts their social agency in ways that track and enhance existing social disadvantages. (shrink)

Our autonomy can be compromised by limitations in our capacities, or by the power relationships within which we are embedded. If we insist that real consent requires full autonomy, then virtually no sex will turn out to be consensual. I argue that under conditions of compromised autonomy, consent must be socially and interpersonally scaffolded. To understand consent as an ethically crucial but nonideal concept, we need to think about how it is related to other requirements for ethical sex, such as (...) the ability to exit a situation, trust, safety, broader social support, epistemic standing in the community, and more. (shrink)

City Living is about urban spaces, urban dwellers, and how these spaces and people make, shape, and change one another. More people live in cities than ever before: more than 50% of the earth's people are urban dwellers. As downtown cores gentrify and globalize, they are becoming more diverse than ever, along lines of race, ethnicity, socioeconomic class, sexuality, and age. Meanwhile, we are in the early stages of what seems sure to be a period of intense civil unrest. During (...) such periods, cities generally become the primary sites where tensions and resistance are concentrated, negotiated, and performed. For all of these reasons, understanding cities and contemporary city living is pressing and exciting from almost any disciplinary and political perspective. Quill R Kukla offers the first systematic philosophical investigation of the nature of city life and city dwellers. The book draws on empirical and ethnographic work in geography, anthropology, urban planning, and several other disciplines in order to explore the impact that cities have on their dwellers and that dwellers have on their cities. It begins with a philosophical exploration of spatially embodied agency and of the specific forms of agency and spatiality that are distinctive of urban life. It explores how gentrification is enacted and experienced at the level of embodied agency, arguing that gentrifying spaces are contested territories that shape and are shaped by their dwellers. The book then moves to an exploration of repurposed cities, which are cities materially designed to support one sociopolitical order, but in which that order collapsed, leaving new dwellers to use the space in new ways. Through detailed original ethnography of the repurposed cities of Berlin and Johannesburg, Kukla makes the case that in repurposed cities, we can see vividly how material spaces shape and constrain the agency and experience of dwellers, while dwellers creatively shape the spaces they inhabit in accordance with their needs. The book concludes with a reconsideration of the right to the city, asking what would be involved in creating a city that enabled the agency and flourishing of all its diverse inhabitants. (shrink)

When I say “I know Sarah,” or “I know Berlin,” what sort of knowledge am I claiming? Such knowledge of a particular is, I claim, not reducible to either propositional knowledge-that or to traditional physical know-how. Mere, bare knowledge by acquaintance also does not capture the kind of knowledge being claimed here. Using knowledge of a place as my central example, I argue that this kind of knowledge-of, or “objectual knowledge” as it is sometimes called, is of a distinctive epistemological (...) sort. It is a genre of inherently first-personal aesthetic knowledge, but it also, like know-how, involves active skill. I end by exploring a couple of classic problems in aesthetic epistemology, applied to the case of knowledge-of as active aesthetic knowledge. (shrink)

When I say “I know Sarah,” or “I know Berlin,” what sort of knowledge am I claiming? Such knowledge of a particular is, I claim, not reducible to either propositional knowledge-that or to traditional physical know-how. Mere, bare knowledge by acquaintance also does not capture the kind of knowledge being claimed here. Using knowledge of a place as my central example, I argue that this kind of knowledge-of, or “objectual knowledge” as it is sometimes called, is of a distinctive epistemological (...) sort. It is a genre of inherently first-personal aesthetic knowledge, but it also, like know-how, involves active skill. I end by exploring a couple of classic problems in aesthetic epistemology, applied to the case of knowledge-of as active aesthetic knowledge. (shrink)

I argue that the concept of disease serves such radically different strategic purposes for different kinds of stakeholders that coming up with a unified philosophical definition of disease is hopeless. Instead, I defend a radically pluralist, pragmatist account of when it is appropriate to mobilize the concept of disease. I argue that it is appropriate to categorize a condition as a disease when it serves legitimate strategic goals to at least partially medicalize that condition, and when the condition is pathological (...) from inside the epistemology and metaphysics of medicine. While some conditions, like pancreatic cancer, are legitimate diseases from all stakeholders’ points of view and in any context, and while other conditions, like homosexuality, are not diseases from any legitimate point of view, there is a range of interesting, messy cases—including Deafness, autism, pre-hypertension, infertility, and ADHD, for example—whose disease status is irreducibly context-dependent and under contest. (shrink)

Traditional moral explorations of sexual violation are dyadic: they focus on the relationship between the perpetrator and the victim, considered in relative isolation. We argue that the moral texture of sexual violation and its fallout only shows up once we see acts of sexual violation as acts that occur within an ecosystem. An ecosystem is made up of dwellers and an environment embedded in a broad, thick, interdependent, and relatively stable web of norms, practices, environments, material and institutional structures. We (...) argue that many of the important and interesting harms wrought by sexual violation can only be understood as ecological harms. To illustrate this, we focus on sexual violations that occur within a specific type of ecosystem, namely an academic department with a graduate program. We examine the possible damaging effects of sexual violation on the ecology of a department. We also consider what makes an ecosystem resilient and relatively able to self-repair, and how sexual violation within an ecosystem may weaken its self-repairing resources. We show that looking at sexual violation through this ecological lens lets us identify harms that are otherwise obscured or difficult to locate. (shrink)

We would like to thank […] for their thoughtful engagement with our paper. In the end, we do not think that they have demonstrated substantive tensions in our view, but explaining why this is so gi...

I explore how we negotiate sexual encounters with one another in language and consider the pragmatic structure of such negotiations. I defend three theses: Discussions of consent have dominated the philosophical and legal discourse around sexual negotiation, and this has distorted our understanding of sexual agency and ethics. Of central importance to good-quality sexual negotiation are sexual invitations and gift offers, as well as speech designed to set up safe frameworks and exit conditions. Sexual communication that goes well does not (...) just prevent harm; it enables forms of agency, pleasure, and fulfillment that would not otherwise be possible. (shrink)

This paper discusses a crisis of accountability that arises when scientific collaborations are massively epistemically distributed. We argue that social models of epistemic collaboration, which are social analogs to what Patrick Suppes called a “model of the experiment,” must play a role in creating accountability in these contexts. We also argue that these social models must accommodate the fact that the various agents in a collaborative project often have ineliminable, messy, and conflicting interests and values; any story about accountability in (...) a massively distributed collaboration must therefore involve models of such interests and values and their methodological and epistemic effects. (shrink)

Discussions of uptake in the philosophy of language focus our attention on what role other people have in fixing the import, success, influence and social life of a speech act. The general idea in most discussions of uptake, despite their differences and disagreements, is whether and how an audience is cooperative or uncooperative when a speaker plays a critical role in how speech acts function. This essay is primarily concerned with “refusals”, or uncooperative uptakes. The essay analyzes the varieties of (...) refusal; when refusal is possible why it might be challenging and when it is ethical. It examines how and when the uptake of a speech act can constitute the pragmatic form and force of the original speech act. (shrink)

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in (...) epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

The goal of this paper is to give an account of the pragmatic and social function of slurs, taken as speech acts. I develop a theory of the distinctive illocutionary force and pragmatic structure of slurs. I argue that slurs help to produce subjects who occupy social identities carved out by pernicious ideologies, and that they do this whether or not anyone involved intends for the slur to work that way or has any particular feelings or conscious thoughts associated with (...) using or being targeted by the slur. I offer an Althusser‐inspired account of what an ideology is, as well as of the mechanisms by which slurs can serve to cue and strengthen ideologies. A slur, I argue, is a kind of interpellation, which reduces its target to a generic identity and derogates and subordinates its target. I explore how slurs and ideologies work in tandem to constitute and fortify one another. I end by applying my account to see how well it fits and helps illuminate three quite different, especially complex slurs. (shrink)

Mass Hysteria examines the medical and cultural practices surrounding pregnancy, new motherhood, and infant feeding. Late eighteenth century transformations in these practices reshaped mothers' bodies, and contemporary norms and routines of prenatal care and early motherhood have inherited the legacy of that era. As a result, mothers are socially positioned in ways that can make it difficult for them to establish and maintain healthy and safe boundaries and appropriate divisions between public and private space.

Ghostwriting scandals are pervasive in industry-funded biomedical research, and most responses to them have presumed that they represent a sharp transgression of the norms of scientific authorship. I argue that in fact, ghostwriting represents a continuous extension of current socially accepted authorship practices. I claim that the radically collaborative, decentralized, interdisciplinary research that forms the gold standard in medicine is in an important sense unauthored, and that this poses a serious problem in applied social epistemology. It is no easy matter (...) to find procedural or architectural solutions that can secure epistemic trust and accountability for collaborative publishing in biomedicine. (shrink)

Wilfrid Sellars's iconic exposé of the ‘myth of the given’ taught us that experience must present the world to us as normatively laden, in the sense that the contents of experience must license inferences, rule out and justify various beliefs, and rationalize actions. Somehow our beliefs must be governed by the objects as they present themselves to us. Often this requirement is cashed out using language that attributes agent-like properties to objects: we are described as ‘accountable to’ objects, while objects (...) ‘hold us’ to standards, and so forth. But such language is either deeply anti-naturalistic or trades on a set of metaphors in need of a literal translation. We offer an explanation of how the material features of the world, as received in experience, can rationally constrain our beliefs and practices—one that makes no recourse to this imagery. In particular, we examine the structure of ostensive practices (that is, practices of directing one another's attention to objects and features of the world) and the distinctive role they play in making us jointly beholden to how things actually are. (shrink)

Maps provide us with an easily recognizable version of the new demarcation problem: On the one hand, we are all familiar with graphics and maps that unacceptably distort our perceptions without being technically inaccurate or fictive; indeed there are whole websites groups devoted to curating such images for fun. On the other hand, there are multiple unavoidably value-laden choices that must be made in the production of any map. Producing a map requires choosing everything from the colors and thicknesses of (...) the lines, the scale, the projection system, the categories and parameters represented, and much more. There is no neutral default for any of these choices, and all of them shape what information the map communicates. All the visual choices involved in producing a map enable some information to be conveyed at the cost of hiding or distorting other information, as map makers themselves routinely acknowledge and discuss. Hence there are no straightforward answers to questions about the line between distortion and legitimate representational choices. I explore three distinctive kinds of epistemic risks in map-making that generate special versions of the demarcation problem, which I dub aesthetic risk, categorization risk, and simplification risk. I argue that in each case, even good maps – maps that are accurate and epistemically valuable – have the potential to mislead us. I end by looking at maps that offer special epistemic benefits by making clear their own lack of value-neutrality while still being accurate and epistemically fecund. (shrink)

As a culture, we have a tendency to measure motherhood in terms of a set of signal moments that have become the focus of special social attention and anxiety; we interpret these as emblematic summations of women's mothering abilities. Women's performances during these moments can seem to exhaust the story of mothering, and mothers often internalize these measures and evaluate their own mothering in terms of them. "Good" mothers are those who pass a series of tests—they bond properly during their (...) routine ultrasound screening, they do not let a sip of alcohol cross their lips during pregnancy, they give birth vaginally without pain medication, they do not offer their child an artificial nipple during the first six months, they feed their children maximally nutritious meals with every bite, and so on. This reductive understanding of mothering has had counterproductive effects upon health care practice and policy, encouraging measures that penalize mothers who do not live up to cultural norms during signal moments, while failing to promote extended narratives of healthy mothering. (shrink)

Mothers serve as an important layer of the health-care system, with special responsi-bilities to care for the health of families and nations. In our social discourse, we tend to treat maternal “choices” as though they were morally and causally Self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers’ caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. I (...) give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

The Routledge Companion to Bioethics is a comprehensive reference guide to a wide range of contemporary concerns in bioethics. The volume orients the reader in a changing landscape shaped by globalization, health disparities, and rapidly advancing technologies. Bioethics has begun a turn toward a systematic concern with social justice, population health, and public policy. While also covering more traditional topics, this volume fully captures this recent shift and foreshadows the resulting developments in bioethics. It highlights emerging issues such as climate (...) change, transgender, and medical tourism, and re-examines enduring topics, such as autonomy, end-of-life care, and resource allocation. (shrink)

: The standard bioethics account is that respecting patient autonomy means ensuring patients make their own decisions. In fact, respecting patient autonomy often has more to do with the overall shape and meaning of patients' health care regimes, and sometimes, at least, patients will very reasonably defer to medical authority.

Epistemologists generally think that genuine warrant that is available to anyone must be available to everyone who is exposed to the relevant causal inputs and is able and willing to properly exercise her rationality. The motivating idea behind this requirement is roughly that an objective view is one that is not bound to a particular perspective. In this paper I ask whether the aperspectivality of our warrants is a precondition for securing the objectivity of our claims. I draw upon a (...) Sellarsian account of perception in order to argue that it is not; rather, inquirers can have contingent properties and perspectives that give them access to forms of rational warrant and objective knowledge that others do not have. The universal accessibility of reasons, on my account, is not a precondition for the legitimacy of any actual warrant, but rather a regulative ideal governing inquiry and communication. (shrink)

The standard bioethics account is that respecting patient autonomy means ensuring that patients make their own decisions, and that requires that they give informed consent. In fact, respecting autonomy often has more to do with the overall shape and meaning of their health care regimes. Ideally, patients will sometimes take control of their health care but sometimes defer to medical authority. The physician's task is, in part, to inculcate patients into the appropriate good health care regimes.

Philosophers have often posited a foundational calling voice, such that hearing its call constitutes subjects as responsive and responsible negotiators of normative claims. I give the name ldquo;transcendental conscience to that which speaks in this founding, constitutive voice. The role of transcendental conscience is not – or not merely – to normatively bind the subject, but to constitute the possibility of the subject's being bound by any particular, contentful normative claims in the first place. I explore the ontological and temporal (...) status of transcendental conscience, using Heidegger's account of conscience in Being and Time as my textual touchstone. I ask what performative structure the call of conscience might have that would enable it to constitute normative responsiveness, and I raise some temporal conundrums surrounding this structure. I argue that it is incoherent to attempt to give a literal, chronological account of the origin of normative grip and response. I suggest that we can best understand the founding calls of conscience, not as literal events occurring in regular time, but as events that can only show up retrospectively, as occurring in an ever-receding, unlocalizable past, and that these calls can only be figured mythically and metaphorically. Appropriating a Derridean term, I claim that the voice of transcendental conscience must be that of a lsquo;ghost, whose call binds us by haunting us – a haunting that is no less transcendentally necessary for its inability to be translated into a literal historical event. (shrink)

This issue of the Kennedy Institute of Ethics Journal offers essays about risk, social values, and how to act in the face of risk, especially when our risk assessments are socially freighted. It is made up of two clusters of related papers.The first cluster consists of two papers that explore the ways in which our risk assessments are shaped by moral panic around HIV, and its accompanying legacy of fear, homophobia, and stigma. These papers take up ethical and social dimensions (...) of PrEP and of blood donation in the face of social and medical policies based on risk distortions.The second cluster of papers is a back-and forth exchange in response to... (shrink)

In this issue's lead article, "Adolescent Medical Transition is Ethical: An Analogy with Reproductive Health," Florence Ashley argues that insofar as we accept that abortion and birth control can be ethical interventions for adolescents, so, by analogy, should we treat interventions such as puberty blockers that aid in gender transition as ethical. None of these interventions treat illness or pathology, but rather they operate on healthy bodies, not in order to cure, but in order to help patients live in line (...) with their fundamental self-conception and to realize their embodied goals. Parenting, pregnancy, and gender all go to the heart of our embodied identities and sense of self, they point out. Moreover, Ashley... (shrink)

All five articles in this issue consider, in different ways, what it takes to respect an individual’s humanity; each one offers a broader conception of human regard than is standard in the practical ethics literature. Respectively, they explore how truth-telling, providing appropriate treatment for those with substance use disorders, enabling real reproductive choice and control, and providing meaningful access to the internet all form important parts of what it takes to treat people as fully human and to care for their (...) well-being. All are grounded not just in abstract rights arguments, but in attention to the empirical and social conditions of... (shrink)

It is with great pleasure and a sense of urgency that we present this KIEJ double issue on ethical issues raised by the COVID-19 pandemic. The sheer range of ethical concerns raised by the pandemic, combined with the speed with which these problems emerged, is staggering and unprecedented in our generation. We have tried to give space to papers that raise immediately pressing ethical issues that have not received much discussion in popular media. Topics range from fundamental questions about how (...) we set up our public health infrastructure, to ethical issues in scientific communication and the translation of science into policy, to the impact of the pandemic on people with intellectual disabilities, to the ethics of... (shrink)

Epistemologists generally think that genuine warrant that is available to anyone must be available to everyone who is exposed to the relevant causal inputs and is able and willing to properly exercise her rationality. The motivating idea behind this requirement is roughly that an objective view is one that is not bound to a particular perspective. In this paper I ask whether the aperspectivality of our warrants is a precondition for securing the objectivity of our claims. I draw upon a (...) Sellarsian account of perception in order to argue that it is not; rather, inquirers can have contingent properties and perspectives that give them access to forms of rational warrant and objective knowledge that others do not have. The universal accessibility of reasons, on my account, is not a precondition for the legitimacy of any actual warrant, but rather a regulative ideal governing inquiry and communication. (shrink)

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not (...) seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (shrink)

This volume explores the relationship between Kant's aesthetic theory and his critical epistemology as articulated in the Critique of Pure Reason and the Critique of the Power of Judgment. The essays, written specially for this volume, explore core elements of Kant's epistemology, such as his notions of discursive understanding, experience, and objective judgment. They also demonstrate a rich grasp of Kant's critical epistemology that enables a deeper understanding of his aesthetics. Collectively, the essays reveal that Kant's critical project, and the (...) dialectics of aesthetics and cognition within it, is still relevant to contemporary debates in epistemology, philosophy of mind, and the nature of experience and objectivity. The book also yields important lessons about the ineliminable, yet problematic place of imagination, sensibility and aesthetic experience in perception and cognition. (shrink)

: Mothers serve as an important layer of the health-care system, with special responsibilities to care for the health of families and nations. In our social discourse, we tend to treat maternal "choices" as though they were morally and causally self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers' caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. (...) I give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

When Sandra Harding called for an epistemology of science whose systematic attention to the gendered Status of epistemic agents renders it ‘less partial and distorted’ than ‘traditional’ epistemologies, some commentators recoiled in horror. Propelled by ‘a mad form of the genetic fallacy’ they said, she descends ‘the slide to an arational account of science.’ On a less melodramatic reading, feminist epistemologies such as Harding's advocate not irrationalism, but senses of rationality more expanded than those which they associate with ‘traditional’ epistemology.

: The way patients make health care decisions is much more complicated than is often recognized. Patient autonomy allows both that patients will sometimes defer to clinicians and that they should sometimes be active inquirers, ready to question their clinicians and do some independent research. At the same time, patients' active inquiry requires clinicians' support.

: The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to non-therapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range (...) of research contexts and types—including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle. (shrink)