Editorial Note

This issue of the Kennedy Institute of Ethics Journal brings you challenging new work on underexplored topics as well as the continuation of an important conversation the journal has been hosting over the past half-year.

In “Risks, Benefits, Complications and Harms: Neglected Factors in the Current Debate on Non-therapeutic Circumcision,” Robert Darby offers a vivid critique of our current justifications for routine male circumcision. His critique focuses less on the practice itself than on how we have discussed the ethics of circumcision. He argues that our analyses of the ‘risks and benefits’ of the procedure have focused on narrowly medical concerns, and made invisible the layered symbolic, personal, and psychological significance of the foreskin and the attendant harms that may result from removing it without consent. He covers some of the fascinating social history of our attitudes towards circumcision, and develops an extended and effective analogy with mastectomy: while our current practices recognize and incorporate the potentially powerful personal significance of the female breast to identity and gender, our circumcision practices have no such sensitivity. This paper can be difficult to read, as it can be a challenge to confront a clear-headed critique of a procedure that many readers underwent or had performed on their sons with little reflection.

Bridget Pratt and Adnan Hyder’s “Applying a Global Justice Lens to Health Systems Research Ethics” examines the impact of health systems research on less resource-rich countries, and ask what specific duties health systems researchers have to promote global justice. Pratt and Hyder use a health capabilities framework to think through researchers’ duties, and to analyze how we can set priorities, build states’ capacities to ensure health capabilies, and ensure post-study benefits. Typically, bioethical discussions of researchers’ duties focus entirely on clinician-researchers and clinical research. This skews the discussion, since clinicians have distinctive duties of care and distinctive relationships to their patients. More generally, the field of bioethics has traditionally been limited by a myopic, socially decontextualized focus on doctor-patient relationships; overcoming this limitation has been a major theme in bioethics over the past few years, and is an important mission of this journal. Pratt and Hyder’s piece provides an important corrective.

“Governing the Post Mortem Procurement of Human Body Material for Research,” by Kristof Van Assche and his colleagues, explores the ethics of how we get people to donate their bodies and tissues for research. While opt-in consent is standard in the United States and many other countries, Van Assche, et al. argue that donation should be the presumptive default choice, from which citizens can opt out. They argue for an imperfect duty to make one’s body available for research after death, based in duties to avoid free-riding and help maintain public goods. In a nuanced move, they also argue that for some citizens, donation will not be a low-cost option; it may involve serious infringements on privacy and integrity, for instance. Furthermore, the path from donations for research to the rescue of particular human lives is indirect. Hence there is no straightforward or universal duty of easy rescue involved, but only a conditional and defeasible one. For this reason, the authors argue that conscripted donation would be ethically inappropriate.

Finally, Sofia Jeppson’s “Obesity and Obligation” continues a conversation about the ethics of regulating obese bodies that the journal began in our September, 2014 special issue (24.3), and continued in the December, 2014 issue (24.4) with paired papers by Matteo Bonotti and Michele Loi on food labeling. Jeppson argues that even if we grant that being obese is unhealthy and overall undesirable, obese people do not have an obligation to sustain weight loss. Hence our widespread social rhetoric of blaming and shaming the obese is morally inappropriate. Jeppson deftly combines empirical and conceptual arguments to show that sustained weight loss is so difficult for many people that it cannot plausibly count as something they ‘can’ do, and hence it is not a contender for something they ‘ought to do.’ She also argues that for some people, even if they could lose weight and keep it off, doing so...