Anita Silvers

Justice through Trust: Disability and the “Outlier Problem” in Social Contract Theory*

Viewed as a bargain among equals for reciprocal advantage, social contract theory has been criticized as ignoring outliers such as persons with disabilities. Critics such as Martha Nussbaum have contended that the idea of a social contract must be abandoned in favor of other ways of modeling justice. This article contends that the problem lies in modeling social contract justifications as bargaining for mutual advantage. The insight of social contract theory rests on the importance of respect for individuals with differing conceptions of their good. Reconceptualizing contract theory in terms of building trust relationships fosters inclusiveness and respect.

The OHRP and SUPPORT - Another view

A group of physicians, bioethicists, and scholars in allied fields agrees with the Office for Human Research Protections about the informed-consent documents in SUPPORT.

The Blackwell guide to medical ethics

Notes on Contributors. Introduction: Rosamond Rhodes (Mount Sinai School of Medicine), Leslie P. Francis (University of Utah) and Anita Silvers (San Francisco State University). Part I: Individual Decisions About Clinical Issues. I.1: Patient Decisions. 1. Autonomy, the Good Life and Controversial Choices: Julian Savulescu (University of Oxford). 2. Individual Responsibility and Reproduction: Rachel A. Ankeny (University of Sydney). 3. Patient and Family Decisions about Life-Extension and Death: Felicia Nimue Ackerman (Brown University). I.2: Individual Decisions of Physicians and Other Health Care Professionals. 4. The Professional Responsibilities of Medicine: Rosamond Rhodes (Mount Sinai School of Medicine). 5. Truth telling: Roger Higgs (Emeritus, Kings College, London). 6. Medical Confidentiality: Kenneth Kipnis (University of Hawaii at Manoa). 7. Patient Competence and Surrogate Decision-Making: Dan W. Brock (Harvard Medical School). 8. Ending Life: F.M. Kamm (Harvard University). 9. Discrimination in Medical Practice: Justice and the Obligations of Health Care Providers to Disadvantaged Patients: Leslie P. Francis (University of Utah). 10. Institutional Practices, Ethics, and the Physician: Mary V. Rorty (Stanford University), Ann E. Mills (University of Virginia), and Patricia H. Werhane (DePaul University). Part II: Legislative and Judicial Decisions About Social Policy. II.2: Liberty. 11. Reproductive Choice: Rebecca Bennett (University of Manchester) and John Harris (University of Manchester). 12. Public Policy and Ending Lives: Evert van Leeuwen (Vrije Universiteit Medisch Centrum), and Gerrit Kimsma (Vrije Universiteit Medisch Centrum). 13. Drug Legalization: Douglas N. Husak (Rutgers University). 14. Selling Organs, Gametes, and Surrogacy Services: Janet Radcliffe Richards (University College, London). 15. The Patient as Victim and Vector: The Challenge of Infectious Disease for Bioethics: Margaret P. Battin (University of Utah), Leslie P. Francis (University of Utah), Jay A. Jacobson (University of Utah), Charles B. Smith (Emeritus, University of Utah). 16. Uses of Science in Medical Ethics: Glenn McGee (Albany Medical College) and Dyrleif Bjarnadottir. 11.2: Justice. 17. Allocation of Scarce Resources: Paul Menzel (Pacific Lutheran University). 18. Just Caring: The Challenges of Priority-Setting in Public Health: Leonard M. Fleck (Michigan State University). 19. Justice and the Financing of Health Care: Stephen R. Latham (Quinnipiac University). 20. Judgment and Justice: Evaluating Health Care for Chronically Ill and Disabled Patients: Anita Silvers (San Francisco State University). 21. Justice in Research on Human Subjects: David R. Buchanan (National Cancer Institute, Bethesda), and Franklin G. Miller (National Institutes of Health, Bethesda). 22. Ethics of Disclosure Following a Medical Injury: Time for Reform?: Troyen Anthony Brennan (Emeritus, Harvard Medical School). 23. Pre-existing Conditions: Genetic Testing, Causation and the Justice of Medical Insurance: Robert T. Pennock (Michigan State University). Index

Human Rights and Genetic Discrimination: Protecting Genomics’Promise For Public Health

We argue in this article for a much broader approach, an equality-based protection similar to the bans against race and sex discrimination. In doing so, we identify some problems that have made current prohibitions against disability discrimination less effective than was originally hoped, and we show that the prevailing approach to protection against genetic discrimination is subject to a similar weakness. In particular, we show that neither existing federal law banning disability discrimination nor proposed federal genetic discrimination law protects asymptomatic individuals with genetic anomalies who pursue prophylactic or mitigating measures. The diseases associated with these anomalies may never be expressed or, if expressed, may not manifest as unmitigatable functional impairments. Yet genetic anomalies may be used as proxies to disqualify their possessors from opportunity, as biological properties associated with race and female sex have been used in the past. We therefore advocate a novel civil rights paradigm that safeguards individuals from being discriminated against on the basis of genetic identity, as they now are protected from discrimination based on their identities in respect to race and sex.

Pedagogy and Polemics: Are Art Educators Qualified to Teach Visual Culture?.

he visual dimension of a culture consists of the meanings and values that images characteristic of the culture construct and convey. All cultures have a visual dimension. Some cultures embrace certain images (for instance, images of lavishly clothed women) but reject others (for instance, images of extravagantly nude women) for religious or other reasons. Some cultures ban graven images altogether for religious or other reasons. Cultures in the latter category usually contain a visual dimension nonetheless. For example, Islam bans graven images, yet calligraphy in Islamic culture has been developed to an admirable degree. Islamic culture enjoys a rich visual dimension that is dominated by design rather than images. Islamic societies also differ regarding how categorically the ban against graven images is applied.

Better Than New! Ethics for Assistive Technologists

What are the fundamental values that should guide the practice of assistive technologists? This essay examines two sources that appear to inform current understandings of the ethics of assistive technology: medical ethics and engineering ethics. From medical ethics comes the notion that assistive technology should aim to restore its users to normal functioning, making them like new. Engineering ethics, on the other hand, recommends enhancing users’ functionality, even if functioning is not achieved in a species typical way. From this engineering perspective, it is permissible and even desirable for assistive technology to make its users function even better than new. Thus enhancing functionality is a central value in assistive technology. Professionals in the field have the ability, and the responsibility as well, to address and counter societal suspicion of artificially enhanced functioning achieved through technology. Consequently, assistive technology professionals should fight against discrimination that excludes people with disabilities, whose functioning depends on prostheses and other products of technology, from the mainstream of social life.

An Essay on Modeling: The Social Model of Disability

From its first exposition almost half a century ago, the social model of disability has been aimed at altering both theory and practice, bringing about profound changes in people’s understanding of disability, and in the daily lives of disabled people as well. The social model’s foil, and on some accounts its antithesis, is the medical model of disability. Both models treat disability as a locus of difficulties. While the medical model takes disability to be a problem requiring medical intervention—and as both the prerogative and the responsibility of medical professionals to fix—the social model understands disability as a political problem calling for corrective action by citizen activists who alter other people’s attitudes and reform the practices of the state. These two conceptualizations of disability have been treated as competitors, as if one must prevail over and eradicate the other in thinking about who disabled people are and what should be said and done in regard to them.

Predictive Genetic Testing: Congruence of Disability Insurers' Interests with the Public Interest

This article argues that, under existing jurisprudence, the disability insurance business will be harmed, not benefited, from broad access to the results of genetic testing identifying people with higher than species-typical genetic propensities for illness.

No Basis for Justice: Equal Opportunity, Normal Functioning, and the Distribution of Healthcare

despite the feeling that there is not the luxury of developing good process in the midst of a crisis. I think bioethics has a role here. Daniels suggests that health policy should be informed by political philosophy, by the sort of valuable analysis that he himself provides. Yet facilitating this would require creating real links between philosophers and those making healthcare rationing decisions. In Canada, for example, a set of collaborative projects has begun to forge those links between people with expertise in bioethics and health law at Dalhousie University and policy makers (and others) at the Nova Scotia Department of Health, the QEII Health Sciences Centre, the IWK Health Centre, and the Nova Scotia Hospital (Kenny et al. 2000). While the mandate of these collaborations extends beyond making good rationing decisions, our ability to bring philosophical analysis to bear on rationing decisions and decision-making processes has been successful and appreciated. More broadly, by designing or redesigning various processes, these collaborations are helping government and healthcare organizations make lasting changes to the way they do things, so that high ethical standards can be maintained.

Cloudy Crystal Balls Do Not “Gray” Babies Make

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