Diversity Reading List

Abstract: This paper examines the roles of culture in the principles of biomedical ethics. Drawing on examples from African, Navajo and Western cultures, the paper maintains that various elements of culture are indispensable to the application of the principles of biomedical ethics.

Abstract: In this paper I argue that the genetic manipulation of sexual orientation at the embryo stage could have a detrimental effect on the subsequent person's later capacity for autonomous agency. By focussing on an example of sexist oppression I show that the norms and expectations expressed with this type of genetic manipulation can threaten the development of autonomous agency and the kind of social environment that makes its exercise likely.

Abstract: In this paper we argue that society should make available reliable information about parenting to everybody from an early age. The reason why parental education is important (when offered in a comprehensive and systematic way) is that it can help young people understand better the responsibilities associated with reproduction, and the skills required for parenting. This would allow them to make more informed life-choices about reproduction and parenting, and exercise their autonomy with respect to these choices. We do not believe that parental education would constitute a limitation of individual freedom. Rather, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny.

Summary: A compelling argument for the morality of limitations on procreation in lessening the harmful environmental effects of unchecked population. We live in a world where a burgeoning global population has started to have a major and destructive environmental impact. The results, including climate change and the struggle for limited resources, appear to be inevitable aspects of a difficult future. Mandatory population control might be a possible last resort to combat this problem, but is also a potentially immoral and undesirable violation of human rights. Since so many view procreation as an essential component of the right to personal happiness and autonomy, the dominant view remains that the government does not have the right to impose these restrictions on its own citizens, for the sake of future people who have yet to exist. Sarah Conly is first to make the contentious argument that not only is it wrong to have more than one child in the face of such concerns, we do not even retain the right to do so. In One Child, Conly argues that autonomy and personal rights are not unlimited, especially if one's body may cause harm to anyone, and that the government has a moral obligation to protect both current and future citizens. Conly gives readers a thought-provoking and accessible exposure to the problem of population growth and develops a credible view of what our moral obligations really are, to generations present and future.

Abstract: This book brings together a diverse group of American Indian thinkers to discuss traditional and contemporary philosophies and philosophical issues. The essays presented here address philosophical questions pertaining to knowledge, time, place, history, science, law, religion, nationhood, ethics, and art, as understood from a variety of Native American standpoints. Unique in its approach, this volume represents several different tribes and nations and amplifies the voice of contemporary American Indian culture struggling for respect and autonomy. Taken together, the essays collected here exemplify the way in which American Indian perspectives enrich contemporary philosophy.

Publisher’s Note: Viola Cordova was the first Native American woman to receive a PhD in philosophy. Even as she became an expert on canonical works of traditional Western philosophy, she devoted herself to defining a Native American philosophy. Although she passed away before she could complete her life’s work, some of her colleagues have organized her pioneering contributions into this provocative book. In three parts, Cordova sets out a complete Native American philosophy. First she explains her own understanding of the nature of reality itself—the origins of the world, the relation of matter and spirit, the nature of time, and the roles of culture and language in understanding all of these. She then turns to our role as residents of the Earth, arguing that we become human as we deepen our relation to our people and to our places, and as we understand the responsibilities that grow from those relationships. In the final section, she calls for a new reverence in a world where there is no distinction between the sacred and the mundane. Cordova clearly contrasts Native American beliefs with the traditions of the Enlightenment and Christianized Europeans. By doing so, she leads her readers into a deeper understanding of both traditions and encourages us to question any view that claims a singular truth. From these essays—which are lucid, insightful, frequently funny, and occasionally angry—we receive a powerful new vision of how we can live with respect, reciprocity, and joy

Abstract: As yet, there is no enactive account of social cognition. This paper extends the enactive concept of sense-making into the social domain. It takes as its departure point the process of interaction between individuals in a social encounter. It is a well-established finding that individuals can and generally do coordinate their movements and utterances in such situations. We argue that the interaction process can take on a form of autonomy. This allows us to reframe the problem of social cognition as that of how meaning is generated and transformed in the interplay between the unfolding interaction process and the individuals engaged in it. The notion of sense-making in this realm becomes participatory sense-making. The onus of social understanding thus moves away from strictly the individual only.

Abstract: Patient competence is an essential element of every doctor-patient relationship. In this paper I provide a case report involving an older Korean man in a Hawaiian hospital who refused treatment on the basis of mistaken facts or beliefs about his doctors and treatment. I discuss the case as it relates to competency and extends it to informed consent, autonomy and paternalism. I suggest and argue firstly, that the older Korean man is not fully competent, and secondly, that if he is not fully competent, then soft and weak paternalism may be justified in his case and in cases similar to his.

Abstract: Summary (from Introduction of Autonomy and Mental Disorder, Radoilska ed.): In 'Mental disorder and the value(s) of autonomy', Jane Heal identifies and critically examines a form of thought which is implicit in discussions about what we, as a society, owe to people with mental disorder. This form of thought builds upon intuitions which link respect for a person with respect for a person's autonomy. In light of these intuitions, the issue of how to treat a person with mental disorder may seem to revolve around the question whether or not this person has the capacity for autonomy. However, Heal argues, inquiries that share this logical form are methodologically inappropriate and potentially unhelpful in answering either of the questions they put together: what we owe to people with mental disorder and what is involved in autonomy as a capacity. The reason for this is twofold. Firstly, the apparent consensus about autonomy as a capacity for self-determination that ought to be protected from interference by a corresponding right to self-determination is too shallow to ground a coherent course of action in terms of respect for autonomy. Even if we work with the assumption that autonomy is part of the Enlightenment project, we face an important dilemma since we have to choose between a Kantian or rationality oriented and a Millian or well-being oriented take on the nature and significance of autonomy. Secondly, even if we were to reach a substantive consensus on the concept of autonomy, it would arguably require an intricate array of mental capacities, outside the reach of at least some people with mental disorder. Getting clearer on what autonomy is will not help us find out what it means to treat these people respectfully.

Abstract: John Harris recently argued that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement that aim to make the enhancement recipients less likely to “fall,” including moral education, are detrimental to moral agency. In this article, I present a new moral agency–based critique against the moral bioenhancement program envisaged by Persson and Savulescu. I argue that the irresistible influences exerted by the bioenhancement program harm our capabilities for conducting accurate self-reflection and forming decisions that truly express our will, subsequently undermining our moral agency.

Publisher’s Note: Publisher: Truth, Trust and Medicine investigates the notion of trust and honesty in medicine, and questions whether honesty and openness are of equal importance in maintaining the trust necessary in doctor-patient relationships. Jackson begins with the premise that those in the medical profession have a basic duty to be worthy of the trust their patients place in them. Yet questions of the ethics of withholding information and consent and covert surveillance in care units persist. This book boldly addresses these questions which disturb our very modern notions of a patient's autonomy, self-determination and informed consent.

Abstract: 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.

Publisher's Note: Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.

Publisher's Note: Two centuries after they were published, Kant's ethical writings are as much admired and imitated as they have ever been, yet serious and long-standing accusations of internal incoherence remain unresolved. Onora O'Neill traces the alleged incoherences to attempts to assimilate Kant's ethical writings to modern conceptions of rationality, action and rights. When the temptation to assimilate is resisted, a strikingly different and more cohesive account of reason and morality emerges. Kant offers a "constructivist" vindication of reason and a moral vision in which obligations are prior to rights and in which justice and virtue are linked. O'Neill begins by reconsidering Kant's conceptions of philosophical method, reason, freedom, autonomy and action. She then moves on to the more familiar terrain of interpretation of the Categorical Imperative, while in the last section she emphasizes differences between Kant's ethics and recent "Kantian" ethics, including the work of John Rawls and other contemporary liberal political philosophers

Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.