Readers of this book are sure to view the ethics of incentives in a new light.

This book provides an analysis of the debate surrounding cultural diversity, and attempts to reconcile the seemingly opposing views of "ethical imperialism," the belief that each individual is entitled to fundamental human rights, and cultural relativism, the belief that ethics must be relative to particular cultures and societies. The author examines the role of cultural tradition, often used as a defense against critical ethical judgments. Key issues in health and medicine are explored in the context of cultural diversity: the physician-patient (...) relationship, disclosing a diagnosis of a fatal illness, informed consent, brain death and organ transplantation, rituals surrounding birth and death, female genital mutilation, sex selection of offspring, fertility regulation, and biomedical research involving human subjects. Among the conclusions the author reaches are that ethical universals exist, but must not be confused with ethical absolutes. The existence of ethical universals is compatible with a variety of culturally relative interpretations, and some rights related to medicine and health care should be considered human rights. Illustrative examples are drawn from the author's experiences serving on international ethical review committees and her travels to countries in Africa, Asia, and Latin America, where she conducted educational workshops and carried out out her own research. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Correctly understood, teleosemantics is the claim that “representation” is a function term. Things are called “representations” if they have a certain kind of function or telos and perform it in a certain kind of way. This claim is supported with a discussion and proposals about the function of a representation and of how representations perform that function. These proposals have been retrieved by putting together current descriptions from the literature on neural representations with earlier explorations of the features common to (...) most things we are inclined to call representations as these were assessed in Millikan. Of interest is the degree to which these independent sources converge. I conclude that there is no need to employ any new or technical sense of the term “representation” for it to play an important role in neuroscience. (shrink)

Incentives are typically conceived as a form of trade, and so voluntariness appears to be the only ethical concern. As a consequence, incentives are often considered ethically superior to regulations because they are voluntary rather than coercive. But incentives can also be viewed as one way to get others to do what they otherwise would not; that is, as a form of power. When incentives are viewed in this light, many ethical questions arise in addition to voluntariness: What are the (...) responsibilities of the powerful in using incentives? Can incentives be manipulative or exploitative, even if people are free to refuse them? Like all other forms of power, incentives can be abused. This paper develops criteria for distinguishing their legitimate from their illegitimate uses, viz. legitimacy of purpose, voluntariness, and effect on character. The criteria are then applied to three cases: plea bargaining, recruiting medical research subjects, and motivating children to learn. Thinking of incentives in terms of.. (shrink)

The Office for Human Research Protections was correct in determining that the consent forms for the National Institutes of Health -sponsored SUPPORT study were seriously flawed. Several articles defended the consent forms and criticized the OHRP's actions. Disagreement focuses on three central issues: how risks and benefits should be described in informed consent documents; the meaning and application of the concept of “standard of care” in the context of research; and the proper role of OHRP. Examination of the consent forms (...) reveals that they failed to disclose the reasonably foreseeable risks of the experimental interventions in the study, as well as the potential for differences in the degree of risk between these interventions. Although the concept of “standard of care” may be helpful in determining the ethical acceptability of other aspects of research, such as clinical equipoise, it is not helpful in discussing consent requirements. (shrink)

Why does #RepealedThe8th matter for feminist legal studies? The answers seem obvious in one sense. Feminism has long constituted itself through the struggle for sexual and reproductive justice, and Irish feminism has contributed a significant ‘legal win’ with the landslide vote of approval for lifting abortion restrictions in the referendum on the 25th May 2018. That win comes at a global moment when populist legal engagement is doing significant damage in countries that regard themselves as world leaders, and beyond. #RepealedThe8th (...) offers Ireland, and the world, the actuality that the popular vote, and everything that contributes to it, could be something else. Repeal shows how legal tools like the vote may be made into an expression of care for reproductive lives. This expression is important in recognizing pregnant people as knowing agents who are best placed to decide, and in seeking to do justice to those who contribute to everyday reproductive life. But repeal, like the many who brought it into being, has multiple meanings. #RepealedThe8th matters because it is a moving process of socio-legal translation, which draws on a collective energy, ‘repeal energy’, to turn the travesty that was the Eighth Amendment and all it represents into a search for the rest of reproductive life. In opening up the meaning of the vote, much like feminists elsewhere have opened up the meaning of the strike, Irish feminists have turned public mourning over past mistreatment into a series of reproductive connections. This is not a strategy that can be rolled out. Figuring out #RepealedThe8th will take many tellings. Rather we need to give repeal, and repealers, room to breathe and rest. We need to feel our way through repeal’s production of legal change so that this success is not reduced to some generic transferable set of legal instructions. I begin by reflecting on repeal as a process of feminist socio-legal translation, which shows us how legal change comes about through the motivation of collective joy, the mourning of damaged and lost lives, the sharing of legal knowledge, and the claiming of the rest of reproductive life. (shrink)

Paradigm intensional contexts result from the unmarked use of referential expressions as “self‐signs”, signs that refer to themselves as tokens, types, or members of Sellarsian “dot‐quoted” kinds. Self‐signing (but unquoted) linguistic expressions are more difficult to recognize than non‐linguistic self‐signs such as the color of a felt pen's casing that represents the color of ink inside. I will discuss non‐linguistic self‐signing, then examine self‐signing in quotation, in “said that …” contexts and in “believes that … ” contexts. The phenomenon of (...) intensionality may reduce to a kind of equivocation, a matter of notation rather than a necessary feature of language. (shrink)

Rhodes seeks to defend her ‘conclusion that everyday ethics and medical ethics [are] incompatible’.1 She challenges ‘views that medical ethics is nothing more than common morality applied to clinical matters’.1 Beauchamp and Childress explicate the term ‘common morality’ at length.2 Nowhere do they claim that medical ethics is ‘nothing more than common morality applied to clinical matters’. Here is what they do say: “The origin of the norms of the common morality is no different in principle from the origin of (...) the norms of a particular morality for a medical or other profession … The primary difference is that the common morality has authority in all communities, whereas particular moralities are authoritative only for specific groups”.2 This critique discusses the seven examples Rhodes uses to illustrate her main point: that common morality and medical ethics are radically different. I contend that common morality accounts for the purported differences she cites. In ordinary life, people can simply mind their own business, whereas physicians have a duty to act in their professional setting. On this view, common morality cannot explain the moral obligation people have to prevent easily avoidable harm to others. A bystander …. (shrink)

“Teleosemantics and Pushmi-Pullyu Representations” (call it “TP-PR,” this journal 2014 79.3, 545–566) argues that core teleosemantics, particularly as defined in Millikan (Language, thought and other biological categories, MIT Press, Cambridge, 1984, J Philos 86(6):281–297, 1989, White queen psychology and other essays for Alice, MIT Press, Cambridge, 1993, Philosophical perspectives, Ridgeview Publishing, Alascadero, 1996, Varieties of meaning, MIT Press, Cambridge, 2004–2008), seems to imply that all descriptive representations are at the same time directive and that directives are at the same time (...) descriptive, hence that all representations are pushmi-pullyu representations. A pushmi-pullyu representation is at once indicative and imperative, telling both what the case is and what to do about it. The usefulness at all of the notion of a pushmi-pullyu representation is then questioned. I have recently found several new papers, dissertations, discussions, in which TP-PR is treated as definitive. However, the conclusions of TP-PR rest on misunderstandings of my position, so although the date is late, clarification seems still to be in order. I will indicate a few significant corrections that need to be made to TP-PR’s description of my position (originally called “biosemantics”) and explain central features of biosemantics that are omitted in TP-PR’s description of basic teleosemantics and which are incompatible with the main argument and conclusions of TP-PR. I will try to clarify and explain the value of the notion of a pushmi-pullyu representation. (shrink)

Where we once spoke in military terms, we now often wield the language of the market: health care is a “product” and we are its “providers” and “consumers.” The market metaphor constrains in various ways our vision of the goals we pursue in making health policy, of the options available to us in pursuing them, indeed—because policy implies a certain view of moral agency—of the way we relate to each other.

A truly global bioethics involves cooperation and collaboration among countries. Most of the articles published in bioethics journals address a problem that exists in one or more countries, but the articles typically do not discuss solutions that require collaboration or cooperation. COVAX is one example of proposed international cooperation related to the current COVID-19. pandemic. Yet it is evident that nations have been proceeding on their own with little, if any collaboration. Despite international research ethics guidance from the World Health (...) Organization, an article published under WHO auspices violates an ethical principle rejecting “double standards” in the conduct of global research. The COVID pandemic provides an opportunity for countries to learn from the recent lack of international cooperation and employ a multi-national strategy in future global health crises. (shrink)

Locke often writes that our knowledge is the perception of the agreement or disagreement of ideas. For example, he refers to “our Knowledge consisting in the perception of the Agreement, or Disagreement of any two Ideas” in the second chapter of the Essay's book on knowledge. Similarly, at the beginning of this book he characterizes knowledge as “the perception of the connexion and agreement, or disagreement and repugnancy of any of our Ideas”. Since commentators remark on this formula so frequently, (...) one would expect that major questions about its interpretation would have been settled long ago. But not so. Controversy still prevails about Locke's intent, and especially about his assumption that the knowledge of the existence of real things counts as an instance of the perception of the agreement or disagreement of ideas.Scholars have put forward two sorts of problems about the attempted assimilation of knowledge of real existence to Locke's formula. (shrink)

What, normatively speaking, are the grounds of rational choice? This paper defends ‘comparativism’, the view that a comparative fact grounds rational choice. It examines three of the most serious challenges to comparativism: 1) that sometimes what grounds rational choice is an exclusionary-type relation among alternatives; 2) that an absolute fact such as that it’s your duty or conforms to the Categorial Imperative grounds rational choice; and 3) that rational choice between incomparables is possible, and in particular, all that is needed (...) for the possibility of rational choice is that one alternative is not worse than the others. Each challenge is questioned. If comparativism is correct, then no matter what normative theory you favor, your answer to the question, ‘What makes my choice rational?’ must be comparative in form. In this way, comparativism provides a framework for normative theorizing. (shrink)

This editorial explains the themes of the forthcoming FLaK seminar and how those themes draw on the collective and individual contributions of the articles, interviews and commentaries presented in this issue. At FLaK, we propose to think with others about the kind of ‘kitchen table’ that FLS might provide into the future. How might feminist legal studies—the approach and the journal—best use its food, equipment, techniques, time, space, mood, energy and commitment? How shall FLS scholars and associates make the most (...) of what we have in a room that can sometimes be confining and confusing, yet also exciting and sustaining? How do others engage with the processes and products of our kitchen table? In considering these issues and more, we propose to draw reflexively on feminist legacies of praxis, internationalism and openness, as we stock up and critically reflect on decolonizing techniques, legal know-how, protest and publishing practices. (shrink)

“Teleosemantics and Pushmi-Pullyu Representations” (call it “TP-PR,” this journal 2014 79.3, 545–566) argues that core teleosemantics, particularly as defined in Millikan (Language, thought and other biological categories, MIT Press, Cambridge, 1984, J Philos 86(6):281–297, 1989, White queen psychology and other essays for Alice, MIT Press, Cambridge, 1993, Philosophical perspectives, Ridgeview Publishing, Alascadero, 1996, Varieties of meaning, MIT Press, Cambridge, 2004–2008), seems to imply that all descriptive representations are at the same time directive and that directives are at the same time (...) descriptive, hence that all representations are pushmi-pullyu representations. A pushmi-pullyu representation is at once indicative and imperative, telling both what the case is and what to do about it. The usefulness at all of the notion of a pushmi-pullyu representation is then questioned. I have recently found several new papers, dissertations, discussions, in which TP-PR is treated as definitive. However, the conclusions of TP-PR rest on misunderstandings of my position, so although the date is late, clarification seems still to be in order. I will indicate a few significant corrections that need to be made to TP-PR’s description of my position (originally called “biosemantics”) and explain central features of biosemantics that are omitted in TP-PR’s description of basic teleosemantics and which are incompatible with the main argument and conclusions of TP-PR. I will try to clarify and explain the value of the notion of a pushmi-pullyu representation. (shrink)

In the current research landscape, there are increasing demands for research to be innovative and cutting-edge. At the same time, concerns are voiced that as a consequence of neoliberal regimes of research governance, innovative research becomes impeded. In this paper, I suggest that to gain a better understanding of these dynamics, it is indispensable to scrutinise current demands for innovativeness as a distinct way of ascribing worth to research. Drawing on interviews and focus groups produced in a close collaboration with (...) three research groups from the crop and soil sciences, I develop the notion of a project-innovation regime of valuation that can be traced in the sphere of research. In this evaluative framework, it is considered valuable to constantly re-invent oneself and take ‘first steps’ instead of ‘just’ following up on previous findings. Subsequently, I describe how these demands for innovativeness relate to and often clash with other regimes of valuation that matter for researchers’ practices. I show that valuations of innovativeness are in many ways bound to those of productivity and competitiveness, but that these two regimes are nevertheless sometimes in tension with each other, creating a complicated double bind for researchers. Moreover, I highlight that also the project-innovation regime as such is not always in line with what researchers considered as a valuable progress of knowledge, especially because it entails a de-valuation of certain kinds of long-term epistemic agendas. I show that prevailing pushes for innovativeness seem to be based on a rather short-sighted temporal imaginary of scientific progress that is hardly grounded in the complex realities of research practices, and that they can reshape epistemic practices in potentially problematic ways. (shrink)

Response to Emily A. Largent, Franklin G. Miller and Steven Joffe, A Prescription for Ethical Learning, Hastings Center Report, 43, s1, (S28-S29), (2013).

Neither the George Washington University embryo splitting experiment nor the technique of embryo splitting itself has ethical flaws. The experiment harmed or wronged no one, and the investigators followed intramural review procedures for the experiment, although some might fault them for failing to seek extramural consultation or for not waiting until national guidelines for research on preembryos were developed. Ethical objections to such cloning on the basis of possible loss of individuality, possible lessening of individual worth, and concern about potential (...) harm to the resulting children are discussed and challenged, as are objections to the creation of embryos for the purpose of genetic diagnosis. Many of the ethical questions raised by the George Washington experiment are similar to those posed by existing reproductive technologies that allow the simultaneous production of several embryos. A multidisciplinary group should consider whether regulation of cloning is needed, and laws should be enacted to prohibit a commercial market for all frozen embryos. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

The contributors to this issue focus on legal internationalism, including hybrid mixes with nationalist forms. They have provoked us as editors to think more about these sites and forms of engagement. Sankey shows how civic participation in the ECCC has played a key role in surfacing the gendered harms of separation and starvation. Turan highlights the problems with ICC exclusion of the experience of men and boys from sexual violence. Peroni expresses her hesitations over the Istanbul Convention given an association (...) between assumed vulnerability and migrant women, while admiring its uncoupling of violence and culture. Cruz’s interview with Wendy Brown contextualizes and expands on these themes as they consider, with other participants, the future of feminist theory in the context of neo-liberal capturing of rights and legal space. Thinking more about internationalism and commitment in this context also helps us hold a mirror up to ourselves as we reflect more critically on our own naming of FLS as an ‘international’ journal. Together these contributions, and the reviews of new work, play a role in fleshing out an editorial commitment to enacting the journal as a living thing that ‘hangs together somehow’ even as it is known differently in different places. (shrink)

The goal of this article is to explore how a social justice framework can help illuminate the role that consent should play in health and science policy. In the first section, we set the stage for our inquiry with the important case of Henrietta Lacks. Without her knowledge or consent, or that of her family, Mrs. Lacks’s cells gave rise to an enormous advance in biomedical science—the first immortal human cell line, or HeLa cells.

In this study we compared the ethical attitudes of a group of experienced, predominantly female, registered nurses (n = 67) with those of a group of final year, mixed sex, medical students (n = 125). The purpose was to determine the basis of differences in attitudes that could lead to ethical disagreements between these two groups when they came to work together. A questionnaire developed to explore ethical attitudes was administered and the responses of the two groups were compared using (...) t-tests. Because of the preponderance of females among the nurses an analysis of variance of the gender-adjusted scores for each group was also carried out. On comparing the responses, the nurses differed significantly from the medical students in a number of ethical domains. A potential source of conflict between these two groups is that the nurses were inclined to adopt the perspective of patients but the medical students identified with their profession. When corrected for the effects of gender, the differences persisted, indicating that it was discipline that determined the differences. We recommend that students of nursing and medicine receive ethics education together, and that more open dialogue between doctors and nurses with respect to their different ethical viewpoints is needed in the work setting. This article will be of interest to educators of students of medicine and nursing, as well as to doctors and nurses who are eager to improve their professional relations and thereby improve patient care. (shrink)

Deacon’s target article is a welcome contribution not only on “biological information” but, more generally, on representation in cognitive science. Some kind of explanation and justification for use of the terms “representation” and “interpretant” for primordial autogen system would be helpful. A connection between the notions of “information” and “representation” can be elaborated more in this respect.

Brentano was surely mistaken, however, in thinking that bearing a relation to something nonexistent marks only the mental. Given any sort of purpose, it might not get fulfilled, hence might exhibit Brentano's relation, and there are many natural purposes, such as the purpose of one's stomach to digest food or the purpose of one's protective eye blink reflex to keep out the sand, that are not mental, nor derived from anything mental. Nor are stomachs and reflexes "of" or"about" anything. A (...) reply might be, I suppose, that natural purposes are "purposes" only in an analogical sense hence "fail to be fulfilled" only in an analogical way. They bear an analogy to things that have been intentionally designed by purposive minds, hence can fail to accomplish the purposes they analogically have. As such they also have only analogical "intentionality". Such a response begs the question, however, for it assumes that natural purposes are not purposes in the full sense exactly because they are not. (shrink)

Since the last issue of Feminist Legal Studies, we editorial board members have had lots of conversations about comfort, displacement and alienation. As we developed the programme for #FLaK2016 we thought about it as a kind of pulling ourselves out of our comfort zone, if academic events and journals ever have a comfort zone. Drawing on a mix of feminist live performance methods and a science and technology studies-type curiosity for objects of experimentation, we tried out a kitchen table method (...) of hosting a live research conversation with activists, artists and academics over two days. But we had not fully anticipated the way that the Brexit result would contribute to and complicate discomfort. A fuller analysis of FLaK awaits a later moment, but here we pick out this one aspect of our gathering—feelings of discomfort – as they animate the contributions to this issue in interesting ways. (shrink)