Polemicists and disciplinary puritans commonly make a sharp distinction between the normative, “prescriptive,” philosophical work of bioethicists and the empirical, “descriptive” work of anthropologists and sociologists studying medicine, healthcare, and illness. Though few contemporary medical anthropologists and sociologists of health and illness subscribe to positivism, the legacy of positivist thought persists in some areas of the social sciences. It is still quite common for social scientists to insist that their work does not contain explicit normative analysis, offers no practical recommendations (...) for social reform or policy making, and simply interprets social worlds. (shrink)

Contemporary liberal democracies contain multiple cultural, religious, and philosophical traditions. Within these societies, different interpretive communities provide divergent models for understanding health, illness, and moral obligations. Bioethicists commonly draw upon models of moral reasoning that presume the existence of shared moral intuitions. Principlist bioethics, case-based models of moral deliberation, intuitionist frameworks, and cost-benefit analyses all emphasise the uniformity of moral reasoning. However, religious and cultural differences challenge assumptions about common modes of moral deliberation. Too often, bioethicists minimize or ignore the (...) existence of multiple traditions of moral inquiry. Careful consideration of the presence of multiple horizons for moral deliberation generates challenging questions about the capacity of bioethicists to effectively resolve complex cases and social policy disputes. (shrink)

For many individuals, religious traditions provide important resources for moral deliberation. While contemporary philosophical approaches in bioethics draw upon secular presumptions, religion continues to play an important role in both personal moral reasoning and public debate. In this analysis, I consider the connections between religious traditions and understandings of morality, medicine, illness, suffering, and the body. The discussion is not intended to provide a theological analysis within the intellectual constraints of a particular religious tradition. Rather, I offer an interpretive analysis (...) of how religious norms often play a role in shaping understandings of morality. While many late 19th and early 20th century social scientists predicted the demise of religion, religious traditions continue to play important roles in the lives of many individuals. Whether bioethicists are sympathetic or skeptical toward the normative claims of particular religious traditions, it is important that bioethicists have an understanding of how religious models of morality, illness, and healing influence deliberations within the health care arena. (shrink)

Bioethicists recognize the conflicts of interest that can arise for clinicians and scientists. However, few scholars exploring the moral dimensions of medicine and the sciences publicly address potential conflicts of interest concerning their own research. Increasingly, however, bioethicists will be confronted with difficult choices in which opportunities to obtain funding will sometimes conflict with the pursuit of critical, rigorous scholarship conducted without regard for corporate interests.

Scientists, bioethicists, and policy makers are currently engaged in a contentious debate about the scientific prospects and morality of efforts to increase human longevity. Some demographers and geneticists suggest that there is little reason to think that it will be possible to significantly extend the human lifespan. Other biodemographers and geneticists argue that there might well be increases in both life expectancy and lifespan. Bioethicists and policy makers are currently addressing many of the ethical, social, and economic issues raised by (...) life extension research. However, the emphasis on philosophical argument supporting or condemning efforts to increase human longevity means that much less attention is currently being given to the factors that might play a role in generating interest in efforts to increase human longevity. This analysis considers three factors that might play a role in heightening public interest in efforts to develop biomedical technologies capable of retarding or reversing aging processes. While discussions of life extension research can seem quite futuristic and impractical, there are some powerful existential factors that might well generate considerable public support for life extension strategies if effective biomedical interventions emerge. Rather than providing philosophical justifications supporting or condemning efforts to increase human longevity, this essay seeks to promote a better understanding of the factors generating contemporary interest in prolonging life and postponing death. (shrink)

Countries throughout Asia promote themselves as leading destinations for international travelers seeking inexpensive healthcare. India, Indonesia, Malaysia, Singapore, the Philippines, and Thailand are all trying to attract greater numbers of what their promotional campaigns call “medical tourists.” Government tourism initiatives, hospital associations, medical tourism companies, and individual hospitals advertise hip and knee replacements, spinal surgery, cosmetic surgery, and other medical procedures. In contrast to most nations marketing treatments to international patients, the Philippines differentiates itself by selling “all inclusive” kidney transplant (...) packages. Patients from other countries travel to the Philippines and receive kidneys purchased from poor individuals. (shrink)

: Many bioethicists assume that morality is in a state of wide reflective equilibrium. According to this model of moral deliberation, public policymaking can build upon a core common morality that is pretheoretical and provides a basis for practical reasoning. Proponents of the common morality approach to moral deliberation make three assumptions that deserve to be viewed with skepticism. First, they commonly assume that there is a universal, transhistorical common morality that can serve as a normative baseline for judging various (...) actions and practices. Second, advocates of the common morality approach assume that the common morality is in a state of relatively stable, ordered, wide reflective equilibrium. Third, casuists, principlists, and other proponents of common morality approaches assume that the common morality can serve as a basis for the specification of particular policies and practical recommendations. These three claims fail to recognize the plural moral traditions that are found in multicultural, multiethnic, multifaith societies such as the United States and Canada. A more realistic recognition of multiple moral traditions in pluralist societies would be considerably more skeptical about the contributions that common morality approaches in bioethics can make to resolving contentious moral issues. (shrink)

Last year I published a short article urging bioethicists to carefully examine the question of what ought to constitute the canonical issues topics and questions driving research and teaching in bioethics. Why some subjects dominate the field whereas other topics are regarded as matters for scholars in other disciplines is a question that has intrigued me for nearly a decade. How are the boundaries of bioethics established? What factors influence research agendas and the creation of bioethics curricula? How do funding (...) agencies, editors, and leading scholars shape the field of bioethics? These questions are increasingly receiving scrutiny from Charles Bosk, Raymond De Vries, and other researchers as they explore the sociology of bioethics and the “construction” of the “ethical enterprise.". (shrink)

Anthropologists and sociologists offer numerous critiques of bioethics. Social scientists criticize bioethicists for their arm-chair philosophizing and socially ungrounded pontificating, offering philosophical abstractions in response to particular instances of suffering, making all-encompassing universalistic claims that fail to acknowledge cultural differences, fostering individualism and neglecting the importance of families and communities, and insinuating themselves within the “belly” of biomedicine. Although numerous aspects of bioethics warrant critique and reform, all too frequently social scientists offer ungrounded, exaggerated criticisms of bioethics. Anthropological and sociological (...) critiques of bioethics are hampered by the tendency to equate bioethics with clinical ethics and moral theory in bioethics with principlist bioethics. Also, social scientists neglect the role of bioethicists in addressing organizational ethics and other “macro-social” concerns. If anthropologists and sociologists want to provide informed critiques of bioethics they need to draw upon research methods from their own fields and develop richer, more informed analyses of what bioethicists say and do in particular social settings. (shrink)

Cultural models of health, illness, and moral reasoning are receiving increasing attention in bioethics scholarship. Drawing upon research tools from medical and cultural anthropology, numerous researchers explore cultural variations in attitudes toward truth telling, informed consent, pain relief, and planning for end-of-life care. However, culture should not simply be equated with ethnicity. Rather, the concept of culture can serve as an heuristic device at various levels of analysis. In addition to considering how participation in particular ethnic groups and religious traditions (...) can shape moral reasoning, bioethicists need to consider processes of socialization into professional cultures, organizational cultures, national civic culture, and transnational culture. From the local world of the community clinic or oncology unit to the transnational workings of human rights agencies, attentiveness to the concept of culture can illuminate how patients, family members, and health care providers interpret illness, healing, and moral obligations. (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they neglect issues (...) of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

When journalists and health researchers address the subject of patients in the United States undergoing unproven stem cell–based interventions, they have historically crafted narratives about "stem cell tourism" to facilities located in such countries as China, India, Mexico, Panama, and Thailand. These latter nations often are depicted as jurisdictions where clinics providing access to SCBIs operate without meaningful oversight, relevant regulations are nonexistent or have significant loopholes, and regulatory bodies are underfunded, understaffed, corrupt, or otherwise unable to provide effective oversight (...) (Caul-field et al. 2009;... (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they neglect issues (...) of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer‐reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article (...) identifies and describes twenty‐six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer‐reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of ‘medical tourism’ will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. (shrink)

Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the common morality of society supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared common sense. Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple (...) cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation. (shrink)

Peer review is an important component of scholarly research. Long a black box whose practical mechanisms were unknown to researchers and readers, peer review is increasingly facing demands for accountability and improvement. Numerous studies address empirical aspects of the peer review process. Much less consideration is typically given to normative dimensions of peer review. This paper considers what authors, editors, reviewers, and readers ought to expect from the peer review process. Integrity in the review process is vital if various parties (...) are to have trust, or faith, in the credibility of peer review mechanisms. Trust in the quality of peer review can increase or diminish in response to numerous factors. Five core elements of peer review are identified. Constitutive elements of scholarly peer review include: fairness in critical analysis of manuscripts; the selection of appropriate reviewers with relevant expertise; identifiable, publicly accountable reviewers; timely reviews, and helpful critical commentary. The F.A.I.T.H. model provides a basis for linking conceptual analysis of the core norms of peer review with empirical research into the adequacy and effectiveness of various processes of peer review. The model is intended to describe core elements of high-quality peer review and suggest what factors can foster or hinder trust in the integrity of peer review. (shrink)

The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care. This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and/or avoiding wait times for care in the patient’s home country. This practice raises numerous ethical concerns, including potentially exacerbating health inequities in destination and source countries and disrupting (...) continuity of care for patients. In this report, we synthesize conference presentations and present three lessons from the conference: 1) Medical tourism research has the potential for cross- or inter-disciplinarity but must bridge the gap between researchers trained in ethical theory and scholars unfamiliar with normative frameworks; 2) Medical tourism research must engage with empirical research from a variety of disciplines; and 3) Ethical analyses of medical tourism must incorporate both individual and population-level perspectives. While these lessons are presented in the context of research on medical tourism, we argue that they are applicable in other areas of research where global practices, such as human subject research and health worker migration, are occurring in the face of limited regulatory oversight. (shrink)

Peer review is an important component of scholarly research. Long a “black box” whose practical mechanisms were unknown to researchers and readers, peer review is increasingly facing demands for accountability and improvement. Numerous studies address empirical aspects of the peer review process. Much less consideration is typically given to normative dimensions of peer review. This paper considers what authors, editors, reviewers, and readers ought to expect from the peer review process. Integrity in the review process is vital if various parties (...) are to have trust, or faith, in the credibility of peer review mechanisms. Trust in the quality of peer review can increase or diminish in response to numerous factors. Five core elements of peer review are identified. Constitutive elements of scholarly peer review include: fairness in critical analysis of manuscripts; the selection of appropriate reviewers with relevant expertise; identifiable, publicly accountable reviewers; timely reviews, and helpful critical commentary. The F.A.I.T.H. model provides a basis for linking conceptual analysis of the core norms of peer review with empirical research into the adequacy and effectiveness of various processes of peer review. The model is intended to describe core elements of high-quality peer review and suggest what factors can foster or hinder trust in the integrity of peer review. (shrink)

J. Angelo Corlett’s response to Leigh Turner defends the current practice of anonymous refereeing in scholarly journals. In reply to him: a slightly refined proposal for signed referees’ reports, with temporarily blind refereeing, would restore to the process of publication, in philosophy at least, the sense of responsibility for rational debate, cooperation, mutual criticism, and simple courtesy which is expected among colleagues in public academic relations, and would also allow more credit for the difficult task for refereeing. Personal (...) observation of the quality of referees’ reports suggests that a gathering of anecdotal evidence would show the need for reform. (shrink)

In some recent articles, Dr. Leigh Turner [Doffing the Mask: Why Manuscript Reviewers Ought to Be Identifiable,” Journal of Academic Ethics, 1 (2003), pp. 41–48; “Promoting F.A.I.T.H. in Peer Review: Five Core Attributes in Effective Peer Review,” Journal of Academic Ethics, 1 (2003), pp. 181–188.] makes some rather critical observations regarding the processes of peer-review in academic journals. I shall note them in turn, note wherein I concur and wherein I disagree, and discuss some of Turner's suggestions (...) to resolve such difficulties. It is hoped that my comments on Turner's much-appreciated points will engage readers of this august and well-edited journal to take more seriously Turner's arguments for the sake of the betterment of academic research. (shrink)

Conceptual integration—“blending”—is a general cognitive operation on a par with analogy, recursion, mental modeling, conceptual categorization, and framing. It serves a variety of cognitive purposes. It is dynamic, supple, and active in the moment of thinking. It yields products that frequently become entrenched in conceptual structure and grammar, and it often performs new work on its previously entrenched products as inputs. Blending is easy to detect in spectacular cases but it is for the most part a routine, workaday process that (...) escapes detection except on technical analysis. It is not reserved for special purposes, and is not costly.In blending, structure from input mental spaces is projected to a separate, “blended” mental space. The projection is selective. Through completion and elaboration, the blend develops structure not provided by the inputs. Inferences, arguments, and ideas developed in the blend can have effect in cognition, leading us to modify the initial inputs and to change our view of the corresponding situations.Blending operates according to a set of uniform structural and dynamic principles. It additionally observes a set of optimality principles. (shrink)

Conceptual integration—“blending”—is a general cognitive operation on a par with analogy, recursion, mental modeling, conceptual categorization, and framing. It serves a variety of cognitive purposes. It is dynamic, supple, and active in the moment of thinking. It yields products that frequently become entrenched in conceptual structure and grammar, and it often performs new work on its previously entrenched products as inputs. Blending is easy to detect in spectacular cases but it is for the most part a routine, workaday process that (...) escapes detection except on technical analysis. It is not reserved for special purposes, and is not costly.In blending, structure from input mental spaces is projected to a separate, “blended” mental space. The projection is selective. Through completion and elaboration, the blend develops structure not provided by the inputs. Inferences, arguments, and ideas developed in the blend can have effect in cognition, leading us to modify the initial inputs and to change our view of the corresponding situations.Blending operates according to a set of uniform structural and dynamic principles. It additionally observes a set of optimality principles. (shrink)

This paper examines a particularly egregious example of a NIMBY claim and considers three proposals for explaining what about that claim might be ethically problematic: The NIMBY claimant is being selfish or self-serving; The NIMBY claim cannot be morally justified, because respecting everyone's NIMBY claims leaves communities worse off; and if policymakers were to defer to people's NIMBY claims, they would end up perpetuating environmental injustices. We argue that these proposals fail to explain why there is anything wrong with the (...) NIMBY claim per se. (shrink)

This paper develops responses to several critics who commented on an earlier paper that we published in this journal. In that paper, we argued that there is nothing necessarily wrong with NIMBY claims or those who make them. The critics raised some important issues, such as whether “NIMBY” is essentially a pejorative term; the possibility that NIMBY claimants are saying something deep about the noncomparability of places; what exactly it means for policy makers to defer to a NIMBY claim; the (...) relationship between NIMBY and environmental justice claims; and whether there is any principled way to distinguish good from bad NIMBY claims. We explore these issues further, and in the course of responding to the critics, we develop some further reasons for skepticism about the prospects for distinguishing good from bad NIMBY claims in a principled way. (shrink)

This article considers the ‘creative education’ of influential Aotearoa/new Zealand art educator Elwyn Richardson, which is based on what he calls the ‘discovery method’: the ‘concentrated study of material from [students’] own surroundings’. Through a game that his students play with tyres, we explore the role that tools play in Richardson’s classroom and in the imaginary ‘worlding’ of his students’ play. By taking the ‘early world’ of the children’s development to be a product of the tools through which they describe (...) it, we reveal Richardson’s educative process to be essentially technological. His idea of the whole child who emerges through a process of experience and observation—of ‘emotion recollected in tranquillity’, in the well-known phrase of Wordsworth cited by Richardson—conflates the nature of the child and nature of the ‘natural’ world. By this act of ‘natural settlement’ not untypical of settler narratives in Aotearoa/new Zealand, the child’s—and, by implication, other settlers’—relation to the world of nature is naturalized. Instead, we would argue that the child’s relation to nature is altogether unnatural: it is imprinted by the technological means through which she explores the world and makes it her own—and by which she is made over. The ‘tyre-child’ is no child of nature, but a child of technology, for whom creative errors—acts of ‘mis-taking’ like the ones Richardson’s children make in playing with tyres—reveal an imaginary capacity at once theoretical and unsettling. (shrink)

Robin Nunn has argued that we should stop using the terms ‘placebo’ and ‘placebo effect’. I argue in support of Nunn’s position by considering the logic of why we perform placebo comparisons. Like all comparisons, placebo comparison is just a case of comparing one thing with another, but it is a mistake, I argue, to think of placebo comparison as a case where something is compared to ‘a placebo’. Rather, placebo comparison should be understood as a situation which sets-up the (...) treatment and control groups in a particular way; not as a case involving objects or procedures called ‘placebos’ employed in order to control for ‘placebo effects’. (shrink)

Does Henry Thoreau have a positive politics? Depending on how one conceives of politics, answers will vary. Hannah Arendt famously portrayed Thoreau's commitment to the sanctity of individual conscience as distinctly unpolitical. More recent commentators grant that Thoreau has a politics, but they characterize it as profoundly negative in character. This essay argues that Thoreau indeed sponsors a positive politics-a politics of performing conscience. The performance of conscience before an audience transforms the invocation of consciencefrom a personally political act into (...) a publicly political one. The aim of the performance is to provoke one's neighbors into a process of individual self-reform that will make them capable of properly vigilant democratic citizenship and conscientious political agitation. I establish this claim through a sustained reading of a relatively neglected text that deserves wider attention in political theory: Thoreau's 1859 lecture defending insurrectionary activities by radical abolitionist John Brown. (shrink)