Reflections on public bioethics: a view from the trenches

For many reasons, and more than its predecessors, the President's Council on Bioethics has been the subject of much public attention and heated controversy. But little of that attention and controversy has been informed by knowledge of the Council's mission, its ways of working, and, most importantly, its actual work. This essay describes the Council's mission, discusses its public ways of working, and reviews the five major works produced during the Council's first term. In all its activities, the Council has sought to develop a richer bioethics, one that recognizes and tries to do justice to the deep issues of our humanity raised by the age of biotechnology. Believing that these issues are properly matters to be discussed and governed by the polity as a whole, the Council also has sought to contribute to a genuinely public or political bioethics, beyond the rule of "experts," scientific and bioethical.     

Experts in science: a view from the trenches

In this paper I analyze four so-called “principles of expertise”; that is, good epistemic practices that are normatively motivated by the epistemological literature on expert judgment. I highlight some of the problems that the four principles of expertise run into, when we try to implement them in concrete contexts of application (e.g. in science committees). I suggest some possible alternatives and adjustments to the principles, arguing in general that the epistemology of expertise should be informed both by case studies and by the literature on the use of experts in science practice.     

The early history of behavior modification of stuttering: A view from the trenches

The attitudes of 644 employers toward stuttering were studied through the use of a questionnaire which required the respondents to indicate their strenght-of- agreement to seven attitudinal statements concerning stuttering. While rejecting the suggestion that stuttering interferes with job performance, the employers agreed that stuttering decreases employability and interferes with promotion possibilities. It was concluded that although stuttering may not typically interfere with job performance, it is a significant vocationally handicapping problem.     

Self-Tracking: Reflections from the BodyTrack Project

Based on the author’s experiences the practice of self-tracking can empower individuals to explore and address issues in their lives. This work is inspired by examples of people who have reclaimed their wellness through an iterative process of noticing patterns of ups and downs, trying out new ideas and strategies, and observing the results. In some cases, individuals have realized that certain foods, environmental exposures, or practices have unexpected effects for them, and that adopting custom strategies can greatly improve quality of life, overcoming chronic problems. Importantly, adopting the role of investigator of their own situation appears to be transformative: people who embarked on this path changed their relationship to their health situation even before making discoveries that helped lead to symptom improvement. The author co-founded the BodyTrack project in 2010 with the goal of empowering a broader set of people to embrace this investigator role in their own lives and better address their health and wellness concerns, particularly those with complex environmental or behavioral components. The core of the BodyTrack system is an open source web service called Fluxtream (https://fluxtream.org) that allows users to aggregate, visualize, and reflect on data from myriad sources on a common timeline. The project is also working to develop and spread peer coaching practices to help transfer the culture and skills of self-tracking while mentoring individuals in how to self-assess their own situation and guide the process for themselves.     

Reflections on the clinical implications of symbolism

We start by stressing the idea that the process itself of constructing the symbol in its different components and its vicissitudes is centrally important to contemporary psychoanalysis as symbols are essential for thinking and for storing emotional experiences in our memory and for conveying our affects to others and to ourselves. Our implicit idea is that internal attacks are not directed only at the internal objects, but also include attacks on the structure or forms of the mental representations before and while they become constituted in symbols. It is by this means that destructive impulses invade the processes of symbolic construction. Symbols can lose their plasticity and thus silence the emotions and therefore cut off the patient from their meanings. Our clinical material allows us to increase our understanding of how the formal qualities of symbols operate in mental life, and how they can interfere in the capacity to work through emotional experiences. Finally, our reflections based on the analysis of a patient with difficulty in relating with the meanings of the symbols he produced will highlight the importance of the analyst's reverie along the process of formulating an interpretation. This paper is also part of a development in the study of the process of reverie.     

Creating Creativity: Reflections from Fieldwork

The present article addresses the question of ‘When can we say something is creative?’ and, in answering it, takes a critical stand towards past and present scientific definitions of creativity. It challenges an implicit assumption in much psychological theory and research that creativity exists as an ‘objective’ feature of persons or products, universally recognised and independent of social agreement and cultural systems of norms and beliefs. Focusing on everyday life creative outcomes, the article includes both theoretical accounts and empirical examples from a research exploring creativity evaluations in the context of folk art. In the end, a multi-layered perspective of creativity assessment emerges, integrating dimensions such as newness and originality, value and usefulness, subjective reception and cultural reception of creative products. Implications for how we understand and study creativity are discussed.     

Translating Neuroethics: Reflections from Muslim Ethics

Muslim ethics is cautiously engaging developments in neuroscience. In their encounters with developments in neuroscience such as brain death and functional magnetic resonance imaging procedures, Muslim ethicists might be on the cusp of spirited debates. Science and religion perform different kinds of work and ought not to be conflated. Cultural translation is central to negotiating the complex life worlds of religious communities, Muslims included. Cultural translation involves lived encounters with modernity and its byproduct, modern science. Serious ethical debate requires more than just a mere instrumental encounter with science. A robust Muslim approach to neuroethics might require an emulsion of religion and neuroscience, thought and body, and body and soul. Yet one must anticipate that Muslim debates in neuroethics will be inflected with Muslim values, symbols and the discrete faith perspectives of this tradition with meanings that are specific to people who share this worldview and their concerns.     

Cancer and the body: Reflections from a Lacanian perspective

This paper discusses psychotherapeutic work with cancer patients using a Lacanian approach to illness. In the first part of the paper, some of Lacan's notions of the body are discussed. In the second half, Lacan's understanding of the body is used to show how an appreciation of Lacan's work might enhance clinical/psychotherapeutic work with cancer patients.     

Feminist Reflections from the Wheat Fields

No abstract available for this article.     

Reflections of a reluctant clinical ethicist: Ethics consultation and the collapse of critical distance

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them — but rarely both. It may be that professional ethics is most effective when it plays the role of stranger rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its strangeness in the medical milieu even as it assumes a more prominent role within the medical center.     

The Finnish Luther: Reflections from a Buddhist Perspective

Abstract : The author argues that the debate regarding the “Finnish Luther” can be illuminated by the rhetoric of merit of Shinran, the founder of the Jōdoshinshū sect of Japanese Buddhism. Tuomo Mannermaa and his colleagues have argued that Luther's doctrine of justification has more in common with the Orthodox doctrine of theosis than the theology of forensic justification of subsequent Lutheran theologians. In faith, the sinner undergoes an existential transformation due to the ontological indwelling of Christ. Both Luther and Shinran begin with similar starting points: the unbridgeable chasm between the sinner and the savior. In Shinran, this sets in motion an affirmation of the existential transformation of the sinner. Shinran's Buddhist rhetoric of merit, therefore, lends plausibility to this interpretation of Luther.