This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

This paper imagines what the liberatory possibilities of (full) ectogenesis are, insofar as it separates woman from female reproductive function. Even before use with human infants, ectogenesis productively disrupts the biological paradigm underlying current gender categories and divisions of labour. I begin by presenting a theory of women’s oppression drawn from the radical feminisms of the 1960s, which sees oppression as deeply rooted in biology. On this view, oppressive social meanings are overlaid upon biology and body, as artefacts of culture (...) and history. I then argue that ectogenesis should be pursued to replace two modes of assisted gestation that can be seen as outgrowths of oppressive assumptions about women's function, ectogenesis should be pursued to replace two modes of assisted gestation. These are gestational surrogacy and uterine transplant, which arise partly from gendered, pronatalist, and geneticist norms. These practices are supported by assumptions about women’s identity and value. Pursuing technologies such as ectogenesis, which weaken the presumed link between biology and gender, is beneficial to (trans-inclusionary radical) feminist aims, as part of a broad project of challenging dominant power relations resting on and maintaining gender categories. By allowing the conceptual separation of female reproductive function from ‘woman’, ectogenesis raises questions about how we determine who counts in this gender identity, and also how we value those who claim the identity ‘woman’. I conclude that ectogenesis has the potential to challenge traditional patriarchal family structures, and thence all other male-dominated structures (of work, education, cultural production), allowing a reimagining of the family and society in more radical ways than we have yet achieved. (shrink)

In their analysis of how much fetal genetic information prospective parents should be able to access, Bayefsky and Berkman determine that parents should only be able to access information th...

Journal of Social Philosophy, EarlyView.

In the paper “An archeology of corruption in medicine”, Miles Little, Wendy Lipworth, and Ian Kerridge present an account of corruption and describe its prevalent forms in medicine. In presenting an individual-focused account of corruption found within “social entities”, Little et al. argue that these entities are corruptible by nature and that certain individuals are prone to take advantage of the corruptibility of social entities to pursue their own ends. The authors state that this is not preventable, so the way (...) to remedy corruption is via management and, where necessary, punishment. This commentary will briefly lay out the key features and functions of corruption as presented by Little et al., before providing a critical discussion that will focus on whether corruptibility is a necessary feature of social entities. I will propose that it is not a necessary feature, though it may frequently arise where individualistic values are unchecked. Corruption can be prevented within social entities by enhancing structures that direct toward virtue and which promote and reward cooperation instead of competition. (shrink)

A few years ago, the New York City Department of Health introduced a public health campaign entitled “Cut Your Portions, Cut Your Risk”, a series of posters in which images of food in increasingly large portion sizes appear. In one example, three packets of french fries are featured; in another, cheeseburgers are shown. In a red box in each, the text, in large, all-capital letters in English and Spanish, reads “Portions have grown,” and, below this, in all capitals, “so has (...) obesity, which can lead to many health problems” or “so has type 2 diabetes, which can lead to amputations.” Beneath the food, the posters admonish, again in all-capital... (shrink)

In this commentary on Brown and colleagues’ paper, entitled ‘Against Moral Responsibilisation of Health: Prudential Responsibility and Health Promotion’, I highlight the tension between individual responsibility—even when this is prudential and not moral—and systemic factors that impact people's health. Brown and colleagues and I agree that individuals are frequently held inappropriately responsible for health-related behaviours or diseases that have become associated with the so-called ‘lifestyle’ diseases. We further agree that health is an instrumental value to people, allowing them to achieve (...) their goals or plans. However, while Brown and colleagues argue that health promotion is justified in providing education campaigns that highlight the pragmatic reasons people have for improving their health-related behaviours, I argue that this amounts to the same inaction on systemic issues as holding individuals morally responsible. Further, without action on systemic issues such as the social determinants of health, some people lack the kinds of future-oriented pragmatic reasons that Brown and colleagues place at the centre of their argument. Rather, for some groups, the pragmatic thing is to enjoy current pleasures even if unhealthy, rather than to forego them for the sake of health in a mythical future. (shrink)

There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology have gained prominence on the political agenda. The relationship between the social determinants of health and behavioural science in health policy has not hitherto been explored. Given the (...) on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures. (shrink)

In this article, I focus on two problematic aspects of British health-promotion campaigns regarding feeding children, particularly regarding breastfeeding and obesity. The first of these is that health-promotion campaigns around “lifestyle” issues dehumanize mothers with their imagery or text, stemming from the ongoing undervaluing and objectification of mothers and women. Public health-promotion instrumentalizes mothers as necessary components in achieving its aims, while at the same time undermining their agency as persons and interlocutors by tying “mother” to particular images. This has (...) a double effect: first, it excludes mothers who do not fit the campaign picture of a mother; second, it encloses those who do fit the picture into an objectified image of motherhood that is defined by and subject to the dominant white, heteropatriarchal gaze. The second problem is that campaigns place unjustified demands on mothers, which stem from a misinterpretation of the maternal duty to benefit. I argue that nutrition-related health concerns regarding children are improperly framed as individual failures of maternal duty, rather than as failures of a system to function correctly. These arguments ultimately support shifting the focus of responsibility for issues around childhood nutrition away from mothers and back toward policymakers. (shrink)

Elizabeth A. McGibbon and Josephine B. Etowa, Anti-racist health care practice, Toronto: Canadian Scholars’ Press, 2009, reviewed by Kathryn L. Mackay.

This thesis aims to determine whether international gestational surrogacy contracts are exploitative, and whether they should be prohibited. I chose a group of women working as surrogates at Kaival Maternity Home and Surgical Hospital, in Anand, Gujarat, India as a study group. After examining their life circumstances, I argue that these women live in unjust circumstances caused by institutional sexism and poverty. I critically assess arguments launched against surrogacy, organ trade, and prostitution and find that none of these are sufficient (...) for demonstrating that contracts involving the sale of the body are necessarily exploitative. I find that surrogacy is exploitative because of a complex set of social conditions. Further, the contracts are beneficial to both the woman acting as surrogate and to the couple hiring her. I conclude that international gestational surrogacy is exploitative yet mutually beneficial, and prohibiting surrogacy would be harmful unless accompanied by drastic social change. (shrink)

In the case discussion, ‘Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level’ , Mah and Timming state that menu labelling would ‘place requirements for information disclosure on private sector food businesses, which, as a policy instrument, is arguably less intrusive than related activities such as requiring changes to the food content’. In this commentary on Mah and Timming’s case study, I focus on discussing how menu-labelling policy permits governments to avoid addressing the heart (...) of the problem, which is high-calorie, high-sodium restaurant food. Menu labelling policy does not address food content in a way that is meaningful for change, instead relying on individuals to change their behaviour given new information. Besides having questionable efficacy, this raises concerns about moralizing food choices. (shrink)

In this case discussion, Barnhill and Devine collect and present a significant amount of recent research on the various reasons why people struggle to succeed in weight loss programmes. Specifically, the authors focus on what they call ‘behavioural weight loss interventions’, which are ‘research, clinical or public health efforts to promote individual healthy eating and physical activity behaviours’. As defined, this is a very broad category of interventions and presumably includes all kinds of dieting and weight loss programmes or promotion (...) efforts short of private or independently chosen programmes. The authors argue, in a nutshell, that these clinical, research, and public health interventions have low efficacy, and while they may have some health or other benefits, the balance of evidence presented shows that they harm people in multiple ways. (shrink)

The COVID-19 pandemic has changed the world. The depth and breadth of changes are still unfolding. What is the place of feminist bioethics in this new world? It's important to point out that COVID-19 is only one of a few major catastrophes we are facing as humans. The ongoing and worsening effects of climate change, along with the paltry efforts of politicians to address it, are an urgent concern. Humanitarian crises caused by climate change, by COVID-19, or crises unrelated to (...) either but surely worsened by both, are also... (shrink)

In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihlén Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: first, about the nature of collectives as moral agents, in response to Nihlén Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher.

One thousand women. Ten years. Diana Greene Foster’s epic Turnaway Study, and its namesake book, followed a thousand women who sought abortions across the United States for a decade after they were or were not successful in ending unwanted pregnancies to document how their lives changed. The result is a book rich in detail, full of facts about abortion in the United States—and somewhat more generally—that perhaps many of us knew or suspected but few could find in print. These facts (...) include why some women do not realize until the second trimester that they are pregnant, why women seek abortions later in their pregnancies, or... (shrink)

In the paper “An archeology of corruption in medicine”, Miles Little, Wendy Lipworth, and Ian Kerridge present an account of corruption and describe its prevalent forms in medicine. In presenting an individual-focused account of corruption found within “social entities”, Little et al. argue that these entities are corruptible by nature and that certain individuals are prone to take advantage of the corruptibility of social entities to pursue their own ends. The authors state that this is not preventable, so the way (...) to remedy corruption is via management and, where necessary, punishment. This commentary will briefly lay out the key features and functions of corruption as presented by Little et al., before providing a critical discussion that will focus on whether corruptibility is a necessary feature of social entities. I will propose that it is not a necessary feature, though it may frequently arise where individualistic values are unchecked. Corruption can be prevented within social entities by enhancing structures that direct toward virtue and which promote and reward cooperation instead of competition. (shrink)

Elizabeth A. McGibbon and Josephine B. Etowa’s co-authored book Anti-racist Health Care Practice exposes and addresses systemic racism in the Canadian health-care system. McGibbon and Etowa directly confront racism in health provision and Canadian society, and provide a discussion of racism and related issues (gender, class) that does not hold back criticisms. The system of racial oppression and its sustenance by white privilege is presented to the reader in a clear and straightforward way, making it impossible for the reader to (...) deny or misunderstand his or her role in the power structures of Canadian (or American) society. The book is directed primarily at medical practitioners, as well as educators and policy .. (shrink)

In this article, the authors introduce the concept of a “queer counter-mythology.” They do so by discussing a speculative song they wrote as an enactment of research-creation. Research-creation names an interdisciplinary scholarly praxis where artist-scholars create the artefacts they want to think-with, rather than analysing existing cultural productions. The song discussed in this article, “Cosmic Beavers,” proposes a queer counter-mythology that reimagines the historical, colonial archive by foregrounding the stories of giant, trans-dimensional beavers who shred Lewis and Clark and use (...) them to reinforce their Time-Dam. Drawing on this song, as well as queer theories of time and anti-colonial thinkers, the authors suggest that artistic interventions invoke speculative lures that, while not changing history, can complicate state-sanctioned archives and narratives of the past and future: they frame this intervention as a queer counter-mythology. (shrink)

The philosophy of utility.--The happiness of nations.--Democracy and efficiency.--The utility of man.

In this introductory essay, I describe feminist ethics as a kind of approach to morality that says we ought to pay attention to the facts on the ground and empirical information in order to know whether and how a moral problem is a gendered problem. One of the best accounts of feminist ethics is by Hilde Lindemann, who wrote that feminist ethics aims “to understand, criticize, and correct how gender operates within our moral and social beliefs and practices.” She doesn’t (...) define feminism as a theory about women, and neither do I. The term 'feminist' has more to do with the sources of this approach to ethics than the ultimate goals of such theorists; women were influential and early advocates of the view that sometimes a moral problem is a problem because it is gendered. (shrink)

Kok?Chor Tan argues for a conception of Liberal Cosmopolitanism that seeks to reconcile ideals of global justice and national partiality. I provide two objections to his luck egalitarian model of global justice: first, it fails to provide adequate space for legitimate cultural variation with respect to the understanding of and valuing of natural resources; and second, that its account of ideas of collective responsibility is restricted to a point at which it becomes unrecognizable and inefficacious. I conclude with some reflections (...) on the implications of my analysis for the more general question of whether or how national partiality and global justice can be reconciled. (shrink)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (...) (whether traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

Christians share a common concern for the earth. Evangelicals emphasize creation care; mainline Protestants embrace the green movement; the Catholic Church lists "10 deadly environmental sins;" and the Eastern Orthodox Patriarch has declared climate change an urgent issue of social and economic justice. This textbook examines seven contemporary environmental challenges through the lens of classical Christian virtues. Authors Kathryn Blanchard and Kevin O'Brien use these classical Christian virtues to seek a "golden mean" between extreme positions by pairing each virtue (...) with a pernicious environmental problem. Students are thus led past political pitfalls and encouraged to care for other creatures prudently, to develop new energy sources courageously, to choose our food temperately, to manage toxic pollution justly, to respond to climate change faithfully, to consider humanity's future hopefully, and to engage lovingly in advocacy for God's earth. Readers will emerge from this text with a deeper understanding of contemporary environmental problems and the fundamentals of Christian virtue ethics. (shrink)

The Catholic Tradition requires the faithful to form and follow their conscience. This is the case even with the recognition that consciences can be malformed and one can make errors in practical judgments. Water Shaping Stone examines various aspects of this tradition regarding conscience by using, among other sources, twentieth-century magisterial documents, theologians' works, and Scripture. Kathryn Lilla Cox argues that while the Magisterium retains teaching authority, and a responsibility to help form consciences through its teaching, focusing only on (...) the Magisterium leads to incomplete formation. A more holistic vision of conscience formation means considering the formation of the moral agent to be a multifaceted process that draws on, for example, teaching, prayer, rituals, Scripture, practices, and virtues, along with relationships with the Triune God and communities of accountability. This vision of conscience formation retains the magisterial teaching authority while acknowledging discipleship as the theological basis for making and assessing practical judgments of conscience. (shrink)

The methodological device of or, as sometimes euphemistically labeled, does not enjoy much support among institutional review boards (IRBs) and a large portion of scholars in bioethics. The reasons for this have been documented sufficiently, beginning with the now-paradigmatic attack on the well-known study by Milgram and the unsavory study of Laud Humphries on male homosexual activities in public restrooms. But are the current attitudes interfering with some worthwhile approaches to data gathering that seem to have no other methodology of (...) equal effectiveness? (shrink)

There is conflicting experimental evidence about whether the “stakes” or importance of being wrong affect judgments about whether a subject knows a proposition. To date, judgments about stakes effects on knowledge have been investigated using binary paradigms: responses to “low” stakes cases are compared with responses to “high stakes” cases. However, stakes or importance are not binary properties—they are scalar: whether a situation is “high” or “low” stakes is a matter of degree. So far, no experimental work has investigated the (...) scalar nature of stakes effects on knowledge: do stakes effects increase as the stakes get higher? Do stakes effects only appear once a certain threshold of stakes has been crossed? Does the effect plateau at a certain point? To address these questions, we conducted experiments that probe for the scalarity of stakes effects using several experimental approaches. We found evidence of scalar stakes effects using an “evidence seeking” experimental design, but no evidence of scalar effects using a traditional “evidence-fixed” experimental design. In addition, using the evidence-seeking design, we uncovered a large, but previously unnoticed framing effect on whether participants are skeptical about whether someone can know something, no matter how much evidence they have. The rate of skeptical responses and the rate at which participants were willing to attribute “lazy knowledge”—that someone can know something without having to check—were themselves subject to a stakes effect: participants were more skeptical when the stakes were higher, and more prone to attribute lazy knowledge when the stakes were lower. We argue that the novel skeptical stakes effect provides resources to respond to criticisms of the evidence-seeking approach that argue that it does not target knowledge. (shrink)