Our Editor’s Pick for our September 2018 issue is Lauren Freeman and Saray Ayala López’s paper, “Sex Categorization in Medical Contexts: A Cautionary Tale.” In this paper, Freeman and Ayala López question the completely standard practice of sorting patients into male and female (and in unusual, ‘abnormal’ cases, ‘other’) as a first step in providing medical care. The authors carefully analyze the empirical and normative effects of this practice and argue that it leads to suboptimal care, as well as having damaging social and psychological effects. They argue that there is no need for such a sorting, and that health care providers can and should focus on more proximate sexed dimensions of their patients, such as having ovaries, having a penis, caring about presenting as feminine, and so forth. This paper brings a crucial public debate into the heart of medical practice, and its consequences are far-reaching.
Category: Editor’s Pick
Our Editor’s Pick for our June 2018 issue is Tommy J. Curry and Ebony A. Utley’s paper, “She Touched Me: Five Snapshots of Adult Sexual Violations of Black Boys.” In this painful and nuanced paper, Curry and Utley argue compellingly that Black boys are especially vulnerable to sexual violation. Ironically, this special vulnerability is grounded in our cultural framing of Black masculinity in a way that makes Black boys seem impervious to sexual violation, almost as a matter of conceptual necessity. Through five case studies, Curry and Utley show that the boys themselves are not given the social tools to understand their own violation or how to protect themselves from it. They are also not provided with appropriate sexual education, in part because they are seen as already-sexual and not in need of training in self-protection. Curry and Utley’s paper is both heartbreaking and important.
Before reading this issue’s Editor’s Pick, readers should understand that it may be difficult to read for some, as it contains descriptions of sexual violation within relationships of gross power inequality, and under conditions of enormous vulnerability.
Our Editor’s Pick for our March 2018 issue is “Ethical Guidelines for Genetic Research on Alcohol Addiction and Its Applications,” by Audrey R. Chapman, Adrian Carter, Jonathan M. Kaplan, Kylie Morphett, and Wayne Hall. In this important paper, Chapman and her coauthors examine the ethical issues surrounding genetic research on alcohol addiction. The authors take on this multiply complicated issue, where difficult questions arising out of genetic research combine with the urgent ethical issues alcoholism and other addictions raise, and conclude that “genetic testing is not yet ready for use in the prediction of alcohol dependence liability.” With ever-improving genetic technology and renewed public attention to the social issues addiction raises, this paper takes up questions that are of immediate practical significance.
Our Editor’s Pick for our December 2017 issue is Joe Stramondo’s paper, “Disabled By Design: Justifying and Limiting Parental Authority to Choose Future Children with Pre-Implantation Genetic Diagnosis.” In this fascinating paper, Stramondo takes up the increasingly visible question of when and whether eugenic steps to create a disabled child—for instance, to select an embryo with Achondroplasia or genetic deafness—can be morally permissible. Stramondo rejects some extreme views and argues that “future parents are not morally required to use PGD to select some vision of an objectively “best” child, but should be permitted to use PGD to select embryos according to their own conception of the good life, even if that conception of the good life includes disability.” This paper takes up important questions, provides nuanced analysis, and challenges our intuitions about what it means to care properly for the well-being of our future children.
Our Editor’s Pick for September 2017 is Yechiel Michael Barilan’s paper, “The Role of Doctors in Hunger Strikes.” Barilan provides “a critical examination of the social history of prisoners’ hunger strikes, the philosophy of nonviolence, and the debate on its medicalization.” As he notes in the paper, three paradigms dominate the existing literature on hunger strikes. These are: the “communicative,” the “extreme violence,” and the “psychiatric” paradigms. Barilan argues that another paradigm is needed, and in his paper develops the “wounded combatant” paradigm, “according to which hunger strikers are like enemy soldiers who are injured in battle.”
Our Editor’s Pick for December 2016 is Bertha A. Manninen’s paper, “Sustaining a Pregnant Cadaver for the Purpose of Gestating a Fetus: A Limited Defense.” Manninen argues that “there are times it is morally permissible to keep a brain-dead pregnant woman on life support” for the “sole purpose of allowing her fetus to gestate until it is able to be born as healthy as possible.” She then goes on to argue that this claim is compatible with a pro-choice perspective on abortion.
Our Editor’s Pick for September 2016 is Jing-Bao Nie and Ruth Fitzgerald’s article, “Connecting the East and the West, the Local and the Universal: The Methodological Elements of a Transcultural Approach to Bioethics.” Nie and Fitzgerald argue that scholars working in transcultural bioethics have “seriously problematic methodological habits in approaching cultural differences,” such as “radically dichotomizing the East and the West, the local and the universal.” In light of this, Nie and Fitzgerald’s paper seeks to develop new methodologies for transcultural bioethics.
Our Editor’s Pick for June 2016 is Brian Earp’s groundbreaking article, “Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on ‘FGM.’” Earp tackles the ethics of female genital cutting or “mutilation” (an ethically loaded term). This is a difficult topic that brings on board gender inequity, the integrity of the body, the value of cultural traditions, sexuality, colonialism, ethnocentrism, and other fraught axes of reflection.
This issue of KIEJ also features three commentaries on Earp’s article by Richard Schweder, Jamie Nelson, and Robert Darby that you may read here.
The Editor’s Pick for March 2016 is Franklin Miller and Marco Annoni’s paper, “Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic Approach.” This paper challenges one of the most fundamental metaethical pillars of traditional bioethics: the distinction between therapy and communication about therapy. Traditionally, we think that protecting autonomy requires communication about therapeutic possibilities before any therapy can begin; imposing therapy before obtaining informed consent may be beneficent, but it constitutes a paternalistic violation of autonomy. Miller and Annoni examine “therapeutic communication”: communication that enhances placebo effects in virtue of its manipulation of patient expectations. Placebo studies “demonstrate that the way in which health professionals communicate, disclose, frame, and contextualize information to patients may modulate symptoms across an array of highly prevalent conditions.” Thus “communication by clinicians has the power to turn diagnoses and prognoses into parts of the treatment.” Hence there is not always a neat distinction between communication and therapy, or between beneficence and autonomy considerations. This is a crucial challenge to the nearly universally presupposed division of ethical labor in medical care.
The editor’s pick for the September 2015 issue is “Enhancement and Obsolescence: Avoiding an ‘Enhanced Rat Race’” by Robert Sparrow. Sparrow identifies a social concern about making enhancements that increase productivity (including cognitive and physical enhancements) widely available: if these enhancements are not “upgradable” or are only upgradable at extravagant cost, we might end up with a situation in which every few years, a new crop of young adults renders their elders literally obsolete. His portrayal of the technological possibility of obsolescent people is powerful. This “enhanced rat race” would, Sparrow argues, intensify the competitive, class-divided, socially stratified, stressful character of capitalist culture at its worst. An important philosophical byproduct of his argument is that there are significant ethical distinctions between upgradable and permanent enhancements, as well as previously unnoticed ethical issues that arise if we make enhancements available to those with sufficient personal resources.