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  • Editorial Note
  • Rebecca Kukla

This quarter’s issue of the Kennedy Institute of Ethics Journal dives deeply into questions concerning who is the proper target of medical interventions, and under what circumstances. Mary Jean Walker and James Franklin’s article, “An Argument Against Drug Testing Welfare Recipients,” and Maggie Taylor’s “Too Close to the Knives: Children’s Rights, Parental Authority, and Best Interests in the Context of Elective Pediatric Surgeries” both ask hard questions about when medical interventions can be imposed without consent, purportedly in order to secure non-medical, social benefits for their recipients. Lauren Freeman and Saray Ayala López’s “Sex Categorization in Medical Contexts: A Cautionary Tale,” questions who should receive medical interventions in a more conceptually basic sense: they are not asking when someone should get an intervention, but rather, how should we conceive of the people who are potential patients? Is it medically helpful to conceive of patients as male and female, as opposed to as bearers various more fine-grained gendered features? And finally, in “Bioethics and the Hypothesis of Extended Health,” Nicolae Morar and Joshua August Skorburg again question who should receive medical treatment, but for them the question is a metaphysically fundamental one. They ask where the boundaries of the self—considered as a subject of health and an object of medical attention—lie, and argue for an ecological and extended understanding of the metaphysics of patients.

In this issue’s featured article, “Sex Categorization in Medical Contexts: A Cautionary Tale,” Freeman and Ayala López question the completely standard practice of sorting patients into male and female (and in unusual, ‘abnormal’ cases, ‘other’) as a first step in providing medical care. The sexual binary has come under heavy criticism, for both its descriptive stability and for its normative effects, from biology, gender theory, philosophy, sociology, psychology, activist discourses, and elsewhere. However, it is built into our health care institutions and standards that we presume that patients should be categorized by sex. Freeman and Ayala López carefully analyze the empirical and normative effects of this [End Page ix] assumption. They argue that it leads to suboptimal care, as well as having damaging social and psychological effects. They argue that there is no need for such a sorting, and that health care providers can and should focus on more proximate sexed dimensions of their patients, such as having ovaries, having a penis, caring about presenting as feminine, and so forth. This paper brings a crucial public debate into the heart of medical practice, and its consequences are far-reaching.

“Too Close to the Knives: Children’s Rights, Parental Authority, and Best Interests in the Context of Elective Pediatric Surgeries,” by Maggie Taylor, examines elective surgeries for children who will presumptively be competent to make their own medical decisions eventually. Taylor argues that in considering children’s best interest, we typically value their interest in making self-determining decisions. Elective surgeries for children (such as those fixing a cleft palate, inserting cochlear implants, or amputating or lengthening limbs) vary in terms of whether they are preventing imagined future psychosocial harm or addressing current psychosocial harm, as well as in terms of whether they take away or provide options that could otherwise be chosen later on. She argues that caretakers should only choose elective surgeries on children not old enough to consent when they are addressing a current harm; when they are minimizing the foreclosing of the child’s future options as best they can; and when they have taken the value of their self-determination into account.

In “An Argument Against Drug Testing Welfare Recipients,” Mary Jean Walker and James Franklin argue that programs that make welfare benefits contingent on drug testing cannot reasonably be expected to meet their aims, and are disproportionately costly and burdensome given their expected benefits; hence they are ethically unacceptable. They argue that recreational drug users are not likely to benefit from such programs, and that there are more effective and less punitive ways of helping those with serious drug dependencies. It is common to critique such programs on the grounds that they are disrespectful and demeaning to their targets, or because they generally enhance systematic...


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