Sara Goering

UW, Philosophy, Department Member

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Trustworthiness matters: Building equitable and ethical science

Cell

Mapping the Dimensions of Agency

AJOB Neuroscience

Abstract Neural devices have the capacity to enable users to regain abilities lost due to disease... more Abstract Neural devices have the capacity to enable users to regain abilities lost due to disease or injury – for instance, a deep brain stimulator (DBS) that allows a person with Parkinson’s disease to regain the ability to fluently perform movements or a Brain Computer Interface (BCI) that enables a person with spinal cord injury to control a robotic arm. While users recognize and appreciate the technologies’ capacity to maintain or restore their capabilities, the neuroethics literature is replete with examples of concerns expressed about agentive capacities: A perceived lack of control over the movement of a robotic arm might result in an altered sense of feeling responsible for that movement. Clinicians or researchers being able to record and access detailed information of a person’s brain might raise privacy concerns. A disconnect between previous, current, and future understandings of the self might result in a sense of alienation. The ability to receive and interpret sensory feedback might change whether someone trusts the implanted device or themselves. Inquiries into the nature of these concerns and how to mitigate them has produced scholarship that often emphasizes one issue – responsibility, privacy, authenticity, or trust – selectively. However, we believe that examining these ethical dimensions separately fails to capture a key aspect of the experience of living with a neural device. In exploring their interrelations, we argue that their mutual significance for neuroethical research can be adequately captured if they are described under a unified heading of agency. On these grounds, we propose an “Agency Map” which brings together the diverse neuroethical dimensions and their interrelations into a comprehensive framework. With this, we offer a theoretically-grounded approach to understanding how these various dimensions are interwoven in an individual’s experience of agency.

Can Precollege Philosophy Help Academic Philosophy’s Diversity Problem? in advance

Precollege Philosophy and Public Practice

There is a significant lack of diversity in philosophy, including an underrepresentation of women... more There is a significant lack of diversity in philosophy, including an underrepresentation of women and people of color, and a dearth of philosophy programs that offer classes exploring philosophy outside the Western canon. This problem is further compounded by institutional racism, sexism, and ableism within philosophy pedagogy and practice and the perception that philosophy is an abstract subject suitable only for academically advanced students. If philosophy were made more accessible to a diverse group of students before they entered college, would it be possible to recruit more individuals from underrepresented groups into the field? In 2018, PLATO and the APA surveyed their members about their first exposure to philosophy. It was clear that early experiences—conversations with friends and family, books in grade school, and classes in high school—were pivotal moments that generated interest in philosophy. In this paper we describe some of these experiences and suggest that P4C pro...

Integrating Equity Work throughout Bioethics

The American Journal of Bioethics, 2021

As members of a neuroethics research group funded by the NIH, we echo the call from Fabi and Gold... more As members of a neuroethics research group funded by the NIH, we echo the call from Fabi and Goldberg (2022) for greater funding parity between the ethics of specialized medical technologies and broader, population health ethics, especially as they relate to issues of race, racism and health disparities. We appreciate the need for people trained in bioethics to devote more attention to entrenched forms of injustice and their effects inside and outside of medicine (e.g., Wilson 2021; Danis et al. 2016; Hoberman 2016), and for active measures to be taken to diversify the practitioners of bioethics (Ray 2020; Danis et al. 2016). With the shared aim of addressing and ameliorating structural inequalities and inequities, we advocate for the position that funding directed to projects investigating the ethics of emerging technologies should also investigate and attend to health/healthcare disparities, structural oppression, and legacies of injustice that will inevitably affect and be affected by the technologies in question (Benjamin 2019). Bioethics questions related to the well-funded, or as the authors argue, overfunded, areas of inquiry (e.g., genomics, AI, neurotechnology) must engage with issues of race/racism, gender/ sexism, disability/ableism, etc. For example, discussions of AI ethics must include attention to algorithmic bias, diversity of training sets, researcher characteristics, and assumptions about problem formulation and use if we are to have any chance of avoiding a reinscription and retrenchment of existing injustices and stereotypes (e.g., Buolamwini and Gebru 2018; Chase 2020). Similar issues arise in neurotechnology development (Brown and Fink 2020) and go well beyond issues of fair access to future technology, to include questions about problem formulation, measurement, normative assumptions about the standard user, representation in human subjects research, and procedural justice (Thompson 2019; Goering and Klein 2020). These are examples Fabi and Goldberg acknowledge and support. Their key concern is with the lack of sufficient funding of research into social determinants of health as compared to these technologies, a disparity we too advocate addressing. However, in making their argument, Fabi and Goldberg sometimes seem to frame issues regarding research on structural inequalities grounded in racism and research into developing technologies dichotomously. Our goal is to push back on this either/or framing. They write: “The importance of research into future ethical challenges that may come into existence as technologies advance should not, however, outweigh bioethical inquiry into the unjust distribution of existing health and health-promoting resources.” Pitting one against the other risks oversimplifying the interplay between these two research aims and overlooking the important collaborative work that neuroethics and genetic ethics must take on in the space between them. We contend that scientists, clinicians, technologists, and bioethicists must ensure that neural and genetic technologies are developed and distributed justly. Further, at least some of those technologies are already part of the existing health resources. Addressing structural inequalities requires continued consideration of the collaborative and productive spaces between the ethics of public health, social determinants of health, and developing technologies. In our view, it is important to motivate people working in both areas to attend to issues of structural injustice, race/gender/disability oppression, health inequities, and other “social impacts” of their work. Just how that

Neurotechnology ethics and relational agency

Philosophy Compass, 2021

Novel neurotechnologies, like deep brain stimulation and brain-computer interface, offer great ho... more 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.

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Others' Contributions to an Individual's Narrative Identity Matter

AJOB Neuroscience, 2017

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BCI Mediated Action and Responsibility: Questioning the Distinction Between Recreation and Necessity

AJOB Neuroscience, 2020

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Perspectives

Questions: Philosophy for Young People, 2002

Doing Philosophy with Young Students

Questions: Philosophy for Young People, 2001

Embedding Ethics in Neural Engineering

A Guide to Field Philosophy, 2020

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Transforming Genetic Research Practices with Marginalized Communities: A Case for Responsive Justice

Hastings Center Report, 2008

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Choosing Our Friends: Moral Partiality and the Value of Diversity

Journal of Social Philosophy, 2003

Many feminist moral philosophers in recent times have argued that complete reliance on the princi... more 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

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Introduction to the Special Section: Feminist Approaches to Neurotechnologies

IJFAB: International Journal of Feminist Approaches to Bioethics

Navigating Growth Attenuation in Children with Profound Disabilities Children's Interests, Family Decision-Making, and Community Concerns

Hastings Center …, 2010

Medicine published a case about a six-year-old girl with profound developmental disabilities who ... more

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The Summer Philosophy Institute of Colorado: Building Bridges

Teaching Philosophy, 1997

Choosing our friends: Moral partiality and the value of diversity

Journal of social philosophy, 2003

Many feminist moral philosophers in recent times have argued that com-plete reliance on the princ... more

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Race-based medicine and justice as recognition: Exploring the phenomenon of Bidil

In the United States, health disparities have been framed by categories of race. Racial health di... more In the United States, health disparities have been framed by categories of race. Racial health disparities have been documented for cardiovascular disease, cancer, diabetes, HIV/AIDS, and numerous other diseases and measures of health status. Although such disparities can be read as symptoms of disparities in healthcare access, pervasive social and economic inequities, and discrimination, some have suggested that the disparities might be due, at least in part, to biological differences based on race. Or, to be more precise, if race itself has no determined biological meaning, race may nonetheless be a proxy that collects a group of individuals who share certain physiological or genotypic features that affect health.

Trading Vulnerabilities: Living with Parkinson’s Disease before and after Deep Brain Stimulation

Cambridge Quarterly of Healthcare Ethics

Implanted medical devices—for example, cardiac defibrillators, deep brain stimulators, and insuli... more Implanted medical devices—for example, cardiac defibrillators, deep brain stimulators, and insulin pumps—offer users the possibility of regaining some control over an increasingly unruly body, the opportunity to become part “cyborg” in service of addressing pressing health needs. We recognize the value and effectiveness of such devices, but call attention to what may be less clear to potential users—that their vulnerabilities may not entirely disappear but instead shift. We explore the kinds of shifting vulnerabilities experienced by people with Parkinson’s disease (PD) who receive therapeutic deep brain stimulators to help control their tremors and other symptoms of PD.

Recommendations for Responsible Development and Application of Neurotechnologies

Neuroethics

and preventing bias, and (4) the adoption of public guidelines for safe and equitable distributio... more

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“Why Should Adamancy of an Uninformed View Give Moral Weight?”

The American Journal of Bioethics

Sara Goering

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