Peer commentary on: Goering, S., Klein, E., Dougherty, D. D., & Widge, A. S. (2017). Staying in the loop: Relational agency and identity in next-generation DBS for psychiatry. AJOB Neuroscience, 8(2), 59-70.

Dominant views about the nature of health and disease in bioethics and the philosophy of medicine have presumed the existence of a fixed, stable, individual organism as the bearer of health and disease states, and as such, the appropriate target of medical therapy and ethical concern. However, recent developments in microbial biology, neuroscience, the philosophy of cognitive science, and social and personality psychology (Ickes...

An increasing number of contemporary voices in both bioethics and environmental ethics have grown dissatisfied with the schisms, abysses, and raging torrents that continue to flow between those two...

Beneath important ethical questions about the impacts of de-extinct species on ecosystems and the potential harms to individual organisms lies a more fundamental assumption; namely, that the thing being "de-extinct-ed" is indeed a member of previously existing species. This is the ontological assumption: that genetic make-up of the individual is both a necessary and sufficient condition for species membership. Questioning this ontological assumption poses an even more critical challenge for de-extinction. Genes a member of a species do not make. They (...) represent a mere necessary condition. Sufficiency entails a broad set of ecological connections, inside and out. In this commentary on Kasperbauer’s target article, I argue for the primacy of ontology in the ethical analysis of de-extinction. (shrink)

In this commentary on an article by Jennifer Blumenthal-Barby (AJOB 16:5-15, 2016), we discuss how external influences on decisions affect personal autonomy. Specifically, we introduce the idea of “pre-authorization” as an evaluative stance by which an individual gives a certain agent preferential access to influencing her decision-making processes. Influences arising from pre-authorized agents may then be seen as promoting, rather than infringing upon, autonomy. While the idea that an external influence can be autonomy-promoting may be inconsistent with individualistic conceptions of (...) autonomy, it aligns well with more relational conceptions that recognize the social milieu in which decisions are made. We suggest that pre-authorization provides a framework for thinking about how relational accounts of autonomy might work mechanistically. (shrink)

Peer commentary on: Blumenthal-Barby, J. S. (2016). Biases and heuristics in decision making and their impact on autonomy. The American Journal of Bioethics, 16(5), 5-15.

Who is the autonomous moral agent? The individual? The exemplary/typical knowing, acting, suffering, or thriving human being? Such questions in diverse modalities, originating in multiple circumsta...

The Covid‐19 crisis has underscored the importance of the collection and analysis of clinical and research data and specimens for ongoing work. The federal government recently completed a related revision of the human subjects research regulations, founded in the traditional principles of research ethics, but in this commentary, we argue that the analysis underpinning this revision overemphasized the importance of informed consent, given the low risks of secondary research. Governing the interests of a community is different from governing the interests (...) of individuals, and here we suggest that, moving forward, the analyses of the risks of secondary research protocols be assessed from the perspective of the former. (shrink)

Jonathan Beever and Nicolae Morar’s (2016) article “The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine” and its accompanying commentaries in the American Journal of Bioethics—though insightful, innovative, and provocative—overlook key interlocutors necessary for any discussion of whether the mid-twentieth-century biomedical principle of autonomy should be revised or revoked. The conversation sparked by “The Porosity of Autonomy” will remain both incomplete and politically untenable so long as there is no meaningful engagement with persons/communities who appeal to (...) the principle of patient autonomy in order to articulate and challenge the conditions of their oppression. (shrink)

The environmental movement has brought attention to the reality that we are not only connected to the natural world, but the ways in which we transform nature have a significant impact on our well-...

Healthism and ableism intertwine through an imperative of normalcy and the ensuing devaluing of those who fail to meet societally dominant norms and expectations around “normal” health. This paper tracks the effect of that imperative of normalcy through current research into gut microbiome therapies, using therapies targeting fatness and autism as examples. The complexity of the gut microbiome ought to encourage us to rethink our conception of ourselves and our embeddedness in the world; instead, the microbiome is transformed into one (...) more tool for controlling unruly bodies and minds. (shrink)

This paper argues that the practical reach and ethical impact of the One Health paradigm is conditional on satisfactorily distinguishing between interconnected and interdependent factors among human, non-human, and environmental health. Interconnection does not entail interdependence. Offering examples of interconnections and interdependence in the context of existing One Health literature, we demonstrate that the conversations about One Health do not yet sufficiently differentiate between those concepts. They tend to either ignore such distinctions or embrace bioethically untenable positions. We conclude that (...) careful conceptual differentiation can prevent One Health stakeholders either from overreaching or under-reaching the practical and ethical boundaries of this developing paradigm. (shrink)

A clinical ethics fit for the Anthropocene—our current geological era in which human activity is the primary determinant of environmental change—needs to incorporate environmental ethics to be fit for clinical practice. Conservationist Aldo Leopold’s essay ‘The Land Ethic’ is probably the most widely-cited source in environmental philosophy; but Leopold’s work, and environmental ethics generally, has made little impression on clinical ethics. The Land Ethic holds that “A thing is right when it tends to preserve the integrity, stability, and beauty of (...) the biotic community. It is wrong when it tends otherwise.” I argue that a Land Ethic helps to re-frame problems in clinical ethics that more common philosophical approaches struggle to handle, and that it can be incorporated into clinical ethics without succumbing to “environmental fascism”. I motivate viewing problems in clinical ethics from the perspective of the ‘integrity of the biotic community’, then illustrate how this perspective can offer guidance where more commonly-invoked theories—such as consequentialism and Kantian-inspired approaches—struggle, using antimicrobial resistance in nosocomial infection as a case study. The Land Ethic equips us to understand human values as arising within and inseparable from a social-ecological context, and by treating communities as valuable in themselves rather than just through the aggregate welfare of their individual participants, we can avoid problems with the ‘repugnant conclusion’ and utility monster that plague utilitarian accounts. (shrink)