Philosophy

States tend to be the centerpieces of International Relations theory, as they are commonly considered the primary actors of international relations. As such, states are commonly analyzed as intentional beings that act on their own reasons, based on their own beliefs and desires. This treatment of states as intentional entities leads naturally to a treatment of states as responsible agents that must stand accountable for what they have done. It is on such a basis that retrospective moral and legal judgments are made of states; for example, when reparations debt

The speed and effectiveness of current approaches to research translation are widely viewed as disappointing given small gains in real population health outcomes despite huge investments in basic and translational science. We identify critical value questions-ethical, social, economic, and cultural-that arise at moments throughout the research pathway. By making these questions visible, and promoting discussion of them with diverse stakeholders, we can facilitate handoffs along the translational pathway and increase uptake of effective interventions. Who is involved with those discussions will determine which research projects, populations, and methods get prioritized. We argue that some upfront investment in community and interdisciplinary engagement, shaped by familiar questions in ethics, social justice, and cultural knowledge, can save time and resources in the long run because interventions and strategies will be aimed in the right direction, that is, toward health improvements for all.

As a philosopher interested in biomedical ethics, I find recent advances in genetic technologies both fascinating and frightening. Future technologies for genetic therapies and elimination of clearly deleterious genes offer us the ability to get rid of the cause of much human suffering, seemingly at its physiological root. But memories of past eugenics programs gone horribly awry (whether we speak of Hitler's program, California sterilization laws and practices of the 1920s, or even contemporary practices, such as attempts to work out deals that exchange sterilization for early prison release) must make cautious our initial optimism for these generally well-intentioned programs. Most often the scientist proceeds in research with the best of intentions, but that does not make all scientific investigation worth pursuing.

In this paper, I look at several examples that demonstrate what I see as a troubling tendency in much of mainstream bioethics to discount the views of disabled people. Following feminist political theorists who argue in favour of a stance of humility and sensitive inclusion for people who have been marginalized, I recommend that bioethicists adopt a presumption in favour of believing rather than discounting the claims of disabled people. By taking their claims at face value and engaging with disabled people in open dialogue over impairment and disadvantage, bioethicists may take to heart an important lesson about human fragility and resilience.

Women's agency-their ability to make conscious choices and to act on them-is a central consideration in feminist theories of cosmetic surgery. Several key issues in this longstanding debate are how much external or coercive influence women experience (or acknowledge) in their choice to pursue surgery, whether they are aware of sexist ideology more so than non-recipients, and whether their choice to pursue surgery exemplifies a strong sense of self worth. To test this agency hypothesis, we draw on survey data from a volunteer sample of 202 adult women ages 19-86 years from the southern California region in the U.S. to compare cosmetic surgery recipients to non-recipients across these key sociocultural and personal domains. Results reveal that cosmetic surgery recipients were more likely to have friends who had undergone cosmetic surgery, endorsed more covert sexist beliefs, exhibited greater media usage, and had higher household incomes, than non-recipients. Recipients also evidenced lower ratings in global self-esteem than nonrecipients. These findings challenge some of the notions attendant to agency claims, and engage with conceptions of autonomy introduced in the feminist philosophical literature.

A twenty-person working group convened to discuss the ethical and policy considerations of the controversial intervention called "growth attenuation," and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.

Because novel neurotechnologies may alter human identity and society in profound ways, we advocate for the early integration of ethics into neurotechnology. We recommend developing and adopting a set of guidelines, like the Belmont Report on human subject research, as a framework for development and use of brain-related technologies.

Disability scholars have argued that the disadvantage of disability is caused primarily by social factors and calls out for social change as a matter of justice. But what about psychiatric disability? While noting several factors that make psychiatric disability a special casethe mentally ill individuals unreliability of judgment and instability of functioningSara Goering argues that much is gained by viewing mental illness through the lens of social oppression and workingtoward recognition of individuals with mental illness as equal members of the human community

IMPORTANCE Developing more and better diagnostic and therapeutic tools for central nervous system disorders is an ethical imperative. Human research with neural devices is important to this effort and a critical focus of the National Institutes of Health Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative. Despite regulations and standard practices for conducting ethical research, researchers and others seek more guidance on how to ethically conduct neural device studies. This article draws on, reviews, specifies, and interprets existing ethical frameworks, literature, and subject matter expertise to address 3 specific ethical challenges in neural devices research: analysis of risk, informed consent, and posttrial responsibilities to research participants. OBSERVATIONS Research with humans proceeds after careful assessment of the risks and benefits. In assessing whether risks are justified by potential benefits in both invasive and noninvasive neural device research, the following categories of potential risks should be considered: those related to surgery, hardware, stimulation, research itself, privacy and security, and financial burdens. All 3 of the standard pillars of informed consent-disclosure, capacity, and voluntariness-raise challenges in neural device research. Among these challenges are the need to plan for appropriate disclosure of information about atypical and emerging risks of neural devices, a structured evaluation of capacity when that is in doubt, and preventing patients from feeling unduly pressured to participate. Researchers and funders should anticipate participants' posttrial needs linked to study participation and take reasonable steps to facilitate continued access to neural devices that benefit participants. Possible mechanisms for doing so are explored here. Depending on the study, researchers and funders may have further posttrial responsibilities. CONCLUSIONS AND RELEVANCE This ethical analysis and points to consider may assist researchers, institutional review boards, funders, and others engaged in human neural device research.

Many feminist moral philosophers in recent times have argued that com-plete reliance on the principle of impartiality in moral theory is epistemo-logically and emotionally impossible and therefore theoretically unjustified.1 Complete impartiality is impossible to achieve ...

Medicine published a case about a six-year-old girl with profound developmental disabilities who was given estrogen patches to reduce her final height.1 The article also offered an ethical justifica-tion for growth attenuation, as this kind of interven-tion is known: it would let her ...

Many feminist moral philosophers in recent times have argued that complete reliance on the principle of impartiality in moral theory is epistemologically and emotionally impossible and therefore theoretically unjustified. 1 Complete impartiality is impossible to achieve because we cannot pull off "the God trick," 2 and anyway it overlooks the moral relevance of our relationships and corresponding emotions. Other moral philosophers have come to similar conclusions, although sometimes for rather different reasons. 3 They point out the difficulty in finding fulfillment or even in sustaining a self, with individual projects, attachments, and plans, in a system that requires complete moral impartiality. As John Cottingham notes, "Friends and loved ones are special to us; we do not, and should not, assess their interests from the cold detached standpoint of the impartial observer, for to do so would be a repudiation of love. No ethical system worth its salt will attempt to require such impartiality from us in these contexts, on pain of making human fulfillment unattainable." 4 Most philosophers agree, in practice if not in principle. We do give ourselves, our friends, and our family at least some special treatment, and intuitively we believe that we must be justified in doing so. Finally, as Marilyn Friedman notes in her work on friendship, "Ordinary people, fortunately, have held this view for quite some time." 5 But what are the implications of such a rejection of moral impartiality? Presumably we don't want to give it up entirely, for fear of inviting all kinds of discrimination and bias back into the moral world under the guise of selfsustaining, emotionally rich, epistemologically practical partiality. Can one, for instance, rightly claim moral legitimacy for building a life project around racism and sexism (indulging in partiality toward one's own race and sex)? Surely we want to find some limit for the range of acceptable partiality. Cottingham accepts what he calls "philophilic partialism" (partiality to loved ones, including friends and family) and suggests that he would also accept some kind of wider partialism (e.g., toward an interdependent clan or community). These forms of partiality, he argues, help us to flourish as human beings, and indeed are constitutive of such flourishing. He rejects partiality for one's own race or sex 6 on the basis that "all the evidence. .. suggests that abandoning racial and sexual partialities leads to richer, more fulfilling human relationships and institutions, an increase in respect for persons, a

Novel neurotechnologies, like deep brain stimulation and brain-computer interface, offer great hope for treating, curing, and preventing disease, but raise important questions about effects these devices may have on human identity, authenticity, and autonomy. After briefly assessing recent narrative work in these areas, we show that agency is a phenomenon key to all three goods and highlight the ways in which neural devices can help to draw attention to the relational nature of our agency. Drawing on insights from disability theory, we argue that neural devices provide a kind of agential assistance, similar to that provided by caregivers, family, and others. As such, users and devices participate in a kind of co-agency. We conclude by suggesting the need for developing relational agency-competencies-skills for reflecting on the influence of devices on agency, for adapting to novel circumstances ushered in by devices, and for incorporating the feedback of loved ones and others about device effects on agency.