自闭症个体道德推理的心理机制及其脑机制

社交障碍是自闭症个体主要的临床症状之一,对他们的道德推理状况进行研究有助于我们解释这一现象.研究表明,自闭症个体在进行道德推理时和常人之间有所不同,而道德推理任务中经常包含有心理理解和移情方面的信息,提示我们自闭症个体的心理推理和移情能力可能是影响他们道德推理的内在心理机制.自闭症个体能够区分道德违背和习俗违背,但是他们经常判断不是故意造成的伤害是有意的.他们对伤害者的情绪线索也不太敏感,不能理解他人的感受,这种移情能力和道德推理能力之间的表现是相关的.此外,自闭症个体对道德推理的解释和言语发展水平之间也存在关联,他们经常通过重复故事情节、引述具体后果来解释道德推理,而缺乏对抽象道德规则的描述.脑成像研究表明,自闭症个体进行道德推理时在眶额叶皮质、杏仁核、脑岛、额下回、前扣带回、内侧前额叶皮质、默认网络模式、右颞顶联合区等部位的激活程度与常人存在着显著差异,这些部位同时也是心理理论或移情能力的重要脑区.自闭症个体在句子加工任务中言语功能联合区的激活程度也与常人存在差异,这可能是他们在对道德推理进行解释时存在困难的内部原因.未来研究需要考察心理理论、移情和言语能力对自闭症道德推理的交互作用,并采取非言语的方式对自闭症个体的道德推理进行研究,同时可通过脑损伤技术和激素水平的分析对影响他们道德推理的生理机制进行更加全面的考察.     

REFLECTIONS ON ‘AUTISTIC INTEGRITY’

Autism, particularly its moderate to severe forms, has prompted considerable scientific study and clinical involvement because the associated behaviours imply disconnections with valued features of a ‘good’ life, such as close relationships, enjoyment, and adaptability. Proposed causes of autism involve potent philosophical concepts including consciousness, identity, mind, and relationality. The concept of autistic integrity is used by Barnbaum in The Ethics of Autism: Among Them, But Not of Them to help provide moral justification to stop efforts to cure adults with autism, especially if the cause is presumed to be a lack of a theory of mind. 1 This article has two goals: (1) to apply four familiar definitions or characterizations of integrity to the case of moderate to severe autism, and (2) to examine whether autistic integrity does provide the moral justification Barnbaum seeks.     

Moral philosophy and public policy: the case of NRTs

In this paper, I will express some reservations about the usefulness of moral philosophy for the analysis of public policy issues.... My question is whether taking morality seriously requires taking moral philosophy seriously. This paper focuses on one particular public policy context -- namely, government commissions into new reproductive technologies, such as Britain's Warnock Committee, Australia's Waller and Michael Committees, Canada's Baird Commission, and many others.... Moral philosophers are sometimes asked to participate in these commissions, either as Commissioners, staff, or expert advisers. How can moral philosophers contribute to the analysis of public policy recommendations on NRTs? A survey of the literature suggests that there are two main views on this question, one of which is ambitious, the other more modest. The ambitious view says that moral philosophers should attempt to persuade Commissioners to adopt the right comprehensive moral theory (e.g. adopt a deontological theory, rather than utilitarianism or contractarianism), and then apply this theory to particular policy questions. The more modest view shies away from promoting a particular moral theory, given that the relative merits of different moral theories are a subject of dispute even amongst moral philosophers. Instead, it says that moral philosophers should attempt to ensure that the Commission's arguments are clear and consistent. On this view, philosophers should focus on identifying conceptual confusions or logical inconsistencies within the Commission's arguments without seeking to influence its choice of the underlying theory.     

Foundations, frameworks, lenses: the role of theories in bioethics

I explore the implications of the foundation metaphor for understanding the role of moral theories in ethics and bioethics and argue that its disadvantages outweigh its advantages. I then consider two other metaphors that might be used instead, those of frameworks and lenses. I propose that the metaphor of lenses is most promising in providing methodological guidance for drawing on moral theories when deliberating about bioethical problems.     

Wrongness,Responsibility, and Conscientious Refusals in Health Care

In this article, I address what kinds of claims are of the right kind to ground conscientious refusals. Specifically, I investigate what conceptions of moral responsibility and moral wrongness can be permissibly presumed by conscientious objectors. I argue that we must permit HCPs to come to their own subjective conclusions about what they take to be morally wrong and what they take themselves to be morally responsible for. However, these subjective assessments of wrongness and responsibility must be constrained in several important ways: they cannot involve empirical falsehoods, objectionably discriminatory attitudes, or unreasonable normative beliefs. I argue that the sources of these constraints are the basic epistemic, relational, and normative competencies needed to function as a minimally decent health‐care professional. Finally, I consider practical implications for my framework, and argue that it shows us that the objection raised by the plaintiffs in Zubik v. Burwell is of the wrong sort.     

Medical professionalism and the social contract

Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.     

AFRICAN AND WESTERN MORAL THEORIES IN A BIOETHICAL CONTEXT

The field of bioethics is replete with applications of moral theories such as utilitarianism and Kantianism. For a given dilemma, even if it is not clear how one of these western philosophical principles of right (and wrong) action would resolve it, one can identify many of the considerations that each would conclude is relevant. The field is, in contrast, largely unaware of an African account of what all right (and wrong) actions have in common and of the sorts of factors that for it are germane to developing a sound response to a given bioethical problem. My aim is to help rectify this deficiency by first spelling out a moral theory grounded in the mores of many sub-Saharan peoples, and then applying it to some major bioethical issues, namely, the point of medical treatment, free and informed consent, standards of care and animal experimentation. For each of these four issues, I compare and contrast the implications of the African moral theory with utilitarianism and Kantianism, my overall purposes being to highlight respects in which the African moral theory is distinct and to demonstrate that the field should take it at least as seriously as it does the Western theories.     

Constructivist Models of Mind, Contemporary Psychoanalysis, and the Development of Culture Theory

Researchers in a number of fields, including contemporary psychoanalysis, are contributing to the development of a dynamic model of mind that acknowledges the contributions of biology and social experience to the construction of human consciousness and subjectivity. In this paper, I examine this emerging model of mind and I discuss its implications for the development of Culture theory. I argue that theories of culture must reflect the fluidity and complexity of the psychological states that underlie the culture process, and I suggest that even highly conventional models of action, thought, and feeling are rarely, if ever, internalized, appropriated, or reproduced without some degree of modification, refashioning, and personalization. I propose person-centered ethnography as one of the methods by which we can explore the complex relations among culture, mind, and behavior, [constructivist models of mind, contemporary psychoanalysis, culture theory, self and subjectivity, person-centered ethnography]     

Duty or dream? Edwin G. Conklin's critique of eugenics and support for American individualism

This paper assesses ideas about moral andreproductive duty in American eugenics duringthe early twentieth century. While extremeeugenicists, including Charles Davenport andPaul Popenoe, argued that social leaders andbiologists must work to prevent individuals whowere ``unfit' from reproducing, moderates,especially Edwin G. Conklin, presented adifferent view. Although he was sympathetic toeugenic goals and participated in eugenicorganizations throughout his life, Conklinrealized that eugenic ideas rarely could meetstrict scientific standards of proof. Withthis in mind, he did not restrict his eugenicvision to hereditary measures. Relying onhis experience as an embryologist, Conklininstead attempted to balance more extremeeugenic claims – that emphasized the absolutelimits posed by heredity – with his own view of``the possibilities of development.' Throughhis critique he argued that most human beingsnever even begin to approach their hereditarypotential; he moderated his own eugenicrhetoric so that it preserved individualopportunity and responsibility, or what hasoften been labeled the American Dream.     

The two faces of revenge: moral responsibility and the culture of honor

Retributive emotions and behavior are thought to be adaptive for their role in improving social coordination. However, since retaliation is generally not in the short-term interests of the individual, rational self-interest erodes the motivational link between retributive emotions and the accompanying adaptive behavior. I argue that two different sets of norms have emerged to reinforce this link: (1) norms about honor and (2) norms about moral responsibility and desert. I observe that the primary difference between these types of retribution motivators lies in where the normative focus is placed after an offense. In the first form of retribution, the normative focus is on the offended party. In the second, it is on the offender. Next, I show how each class of norms is well tailored to the particular features of the environment in which these forms of retributive behavior emerge. Finally, I consider some philosophical implications of these observations. I suggest that my account, if correct, would pose tough challenges for contemporary philosophical theories of moral responsibility and punishment.

An African theory of bioethics: reply to MacPherson and Macklin

In a prior issue of Developing World Bioethics, Cheryl Macpherson and Ruth Macklin critically engaged with an article of mine, where I articulated a moral theory grounded on indigenous values salient in the sub-Saharan region, and then applied it to four major issues in bioethics, comparing and contrasting its implications with those of the dominant Western moral theories, utilitarianism and Kantianism. In response to my essay, Macpherson and Macklin have posed questions about: whether philosophical justifications are something with which bioethicists ought to be concerned; why something counts as 'African'; how medicine is a moral enterprise; whether an individual right to informed consent is consistent with sub-Saharan values; and when thought experiments help to establish firm conclusions about moral status. These are important issues for the field, and I use this reply to take discussion of them a step or two farther, defending my initial article from Macpherson's and Macklin's critical questions and objections.     

WHAT IS IT TO BE A DAUGHTER? IDENTITIES UNDER PRESSURE IN DEMENTIA CARE

This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person’s well‐being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of the moral issues in the care for people with dementia is centred on responsibilities; how do people conceive and determine their responsibilities towards one another? To investigate this issue we use the theoretical perspective of Margaret Walker. She states that ideas about identity play a crucial role in patterns of normative expectations with regard to the distribution of responsibilities in daily practices of care. The results of this study show how the identity of a family‐member is put under pressure and changes during her loved one’s illness that leads to difficulties and misunderstandings concerning the issue of responsibility. These results offer an insight into the complexities of actual practices of responsibility and highlight the importance for those caring for people with dementia of attending carefully to how they see themselves and how they see other people involved (Who am I? Who do I want to be for the other?). Answers to such questions show what people expect from themselves and from one another, and how they, at any rate, are distributing responsibilities in a given situation. Professional caregivers should take into account that family members might have different ideas about who they are and consequently about what their responsibilities are.     

Concepts of Animal Welfare in Relation to Positions in Animal Ethics

When animal ethicists deal with welfare they seem to face a dilemma: On the one hand, they recognize the necessity of welfare concepts for their ethical approaches. On the other hand, many animal ethicists do not want to be considered reformist welfarists. Moreover, animal welfare scientists may feel pressed by moral demands for a fundamental change in our attitude towards animals. The analysis of this conflict from the perspective of animal ethics shows that animal welfare science and animal ethics highly depend on each other. Welfare concepts are indispensable in the whole field of animal ethics. Evidence for this can be found by analyzing the structure of theories of animal ethics and the different ways in which these theories employ welfare concepts. Furthermore, the background of values underneath every welfare theory is essential to pursue animal welfare science. Animal ethics can make important contributions to the clarification of underlying normative assumptions with regard to the value of the animal, with regard to ideas about what is valuable for the animal, and with regard to the actions that should follow from the results of animal welfare science.     

The choice between people: 'common sense' morality, and doctors

Kamm is concerned with explaining how "common sense" morality might be used in deciding about the distribution of scarce medical resources. Drawing an analogy between redirection of possible harms or threats and the allocation of health resources, she first explores how an ordinary moral agent, not a physician, might act. Using what Kamm calls the principle of irrelevant utilities (PIU), a moral agent might decide between contestants for a particular good based on "sobjectivism" (Sob), the author's term for a combination of the objective and subjective points of view. Kamm explores decision making using three versions of Sob that weigh interests and rights, equivalences, and aggregation of costs (losses). She concludes that, while ordinary moral agents functioning as social agents may act according to objective aggregated costs, physicians should be concerned with equivalents and individuals when allocating resources.     

The moral complexity of sperm donation

Sperm donation is a widely accepted and increasingly common practice. In the standard case, a sperm donor sells sperm to an agency, waives his parental rights, and is absolved of parental responsibility. We tend to assume that this involves no problematic abandonment of parental responsibility. If we regard the donor as having parental responsibilities at all, we may think that his parental responsibilities are transferred to the sperm recipients. But, if a man creates a child accidentally, via contraception failure, we tend to assume that the man does indeed have parental responsibilities. Assessing these contrasting conclusions requires a theory of parental responsibility. I analyse prevalent theories of what makes someone parentally responsible and show that none of these theories can withstand scrutiny. I propose a new theory of parental responsibility, which, I argue, is more plausible than the alternatives. My theory of parental responsibility is based on our ownership and control over hazardous materials, namely, our gametes. I show that neither my theory, nor the theories I reject, can support our contrasting intuitions. I conclude that sperm donors are fathers, with parental responsibility. I argue that the alternative conclusion, that neither sperm donors nor accidental fathers are parentally responsible for their resulting offspring, is less plausible. I then consider whether parental responsibility can be transferred and argue that it is far from clear that it can. Finally, I address objections and consider some practical implications of these views.     

Profiles of executive function in parents and siblings of individuals with autism spectrum disorders

Delineation of a cognitive endophenotype for autism is useful both for exploring the genetic mechanisms underlying the disorder and for identifying which cognitive traits may be primary to it. This study investigated whether first-degree relatives of individuals with autism spectrum disorders (ASDs) demonstrate a specific profile of performance on a range of components of executive function (EF), to determine whether EF deficits represent possible endophenotypes for autism. Parents and siblings of ASD and control probands were tested on EF tasks measuring planning, set-shifting, inhibition and generativity. ASD parents showed poorer performance than control parents on a test of ideational fluency or generativity, and ASD fathers demonstrated a weakness in set-shifting to a previously irrelevant dimension. ASD siblings revealed a mild reduction in ideational fluency and a weakness in non-verbal generativity when compared with control siblings. Neither ASD parents nor siblings displayed significant difficulties with planning or inhibition. These results indicated that the broad autism phenotype may not be characterized primarily by impairments in planning and cognitive flexibility, as had been previously proposed. Weaknesses in generativity emerged as stronger potential endophenotypes in this study, suggesting that this aspect of EF should play a central role in cognitive theories of autism. However, discrepancies in the EF profile demonstrated by parents and siblings suggest that factors related to age or parental responsibility may affect the precise pattern of deficits observed.     

Power, blame, and accountability: Medicaid managed care for mental health services in New Mexico

I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize the public-private "partnership" between the state and its managed care contractors to illuminate the complexities of exacting state oversight in a medically underserved, rural setting. Second, I discuss the strategic deployment of accountability discourse by members of this partnership to limit use of expensive services by Medicaid recipients. Third, I focus on transportation for Medicaid recipients to show how market triumphalism drives patient care decisions. Providers and patients with the least amount of formal authority and power are typically blamed for system deficiencies.     

Parental virtue: a new way of thinking about the morality of reproductive actions

In this paper I explore the potential of virtue ethical ideas to generate a new way of thinking about the ethical questions surrounding the creation of children. Applying ideas from neo‐Aristotelian virtue ethics to the parental sphere specifically, I develop a framework for the moral assessment of reproductive actions that centres on the concept of parental virtue. I suggest that the character traits of the good parent can be used as a basis for determining the moral permissibility of a particular reproductive action. I posit three parental virtues and argue that we can see the moral status of a reproductive action as determined by the relationship between such an action and (at least) these virtues. Using a case involving selection for deafness, I argue that thinking in terms of the question ‘would a virtuous parent do this?’ when morally assessing reproductive action is a viable and useful way of thinking about issues in reproductive ethics.     

City of purposes: free life and libertarian activism in London

This essay looks at the ideas and practice of libertarian activists in London. It focuses on the value placed on purposefulness, and on the city as the terrain for a free life. These libertarians' activism is explored through an engagement with the centrality of ‘freedom’ in the emergent anthropology of ethics, and by reference to alternative theories of power or action. In particular, attention falls on the challenge of representing subjects who seem to embody and profess overly familiar theories of individual freedom and responsibility. The essay is meant as a contribution to political and urban anthropology, and the ethnography of Britain.     

Values at stake: autonomy, responsibility, and trustworthiness in relation to genetic testing and personalized nutrition advice

Personalized nutrition has the potential to enhance individual health control. It could be seen as a means to strengthen people’s autonomy as they learn more about their personal health risks, and receive dietary advice accordingly. We examine in what sense personalized nutrition strengthens or weakens individual autonomy. The impact of personalized nutrition on autonomy is analyzed in relation to responsibility and trustworthiness. On a societal level, individualization of health promotion may be accompanied by the attribution of extended individual responsibility for one’s health. This constitutes a dilemma of individualization, caused by a conflict between the right to individual freedom and societal interests. The extent to which personalized nutrition strengthens autonomy is consequently influenced by how responsibility for health is allocated to individuals. Ethically adequate allocation of responsibility should focus on prospective responsibility and be differentiated with regard to individual differences concerning the capacity of adults to take responsibility. The impact of personalized nutrition on autonomy also depends on its methodological design. Owing to the complexity of information received, personalized nutrition through genetic testing (PNTGT) is open to misinterpretation and may not facilitate informed choices and autonomy. As new technologies, personalized nutrition and PNTGT are subject to issues of trust. To strengthen autonomy, trust should be approached in terms of trustworthiness. Trustworthiness implies that an organization that develops or introduces personalized nutrition can show that it is competent to deal with both the technical and moral dimensions at stake and that its decisions are motivated by the interests and expectations of the truster.