Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

Technology is not just a tool but an amalgam of conceptual, institutional, and interactional issues that occupy the space of technical reason. In this space, parents' identity is becoming narrowed according to a limited conception in which the place of caring is in danger of being lost. Parents are increasingly required to adopt knowledge on parent ing instead of adapting it to their child's needs. By use of the Heideggerian idea of Enframing, I argue that educational experts and practitioners need (...) to undo parent ing from this technological straitjacket. It needs to be recognised that being a parent is about ac knowledging that caring for your children is about questioning the borders of Enframing rather than accepting its boundaries uncritically. I argue that experts, in order to provoke parents to care, ought to create space for ethical questions on how the Information and Communication Technology we once managed has come to manage us. (shrink)

Since the introduction of Prozac (fluoxetine), a number of so‐called selective serotonin reuptake inhibitors (SSRIs) have been developed and introduced. These mood enhancers are being presently prescribed for people whose problems are not recognized mental illnesses. It is probable that in the near future the combination of data from advanced biochips and brain imaging will accelerate the development of neurotechnology. So‐called neuroceuticals, used for therapy and enhancement, and to improve different aspects of mental health, will be efficient neuromodulators. The scientific, (...) ethical, and social issues raised by mood enhancement and alteration of personal resilience require further exploration. The chapter talks about the notion of personal autonomy, cosmetic psychopharmacology, power for autonomous, and moral accountability in this context. It suggests that empirical research should also cover psychological and sociological research into perceptions and experiences of individuals who have used these drugs. (shrink)

Definition of the problem: The development and use of drugs aimed at a positive influence on the cognitive decline in patients suffering from Alzheimer's disease raises a number of ethical issues. Arguments: Among other things, these issues are concerned with the significance of these drugs for the patient's subjective well-being and quality of life and with aspects of informed consent to the use of these drugs, particularly in connection with their use in scientific medical research. Conclusion: The value and significance (...) of antidementia drugs depends not only on their effect on cognitive decline, but also on their wider significance for patients' quality of life and their primary carers. The subjective experience of those directly involved deserves more attention in research and practice. (shrink)

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim (...) is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism. (shrink)

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim (...) is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism. (shrink)

This paper explores the use of advance directives in clinical dementia research. The focus is on advance consent to participation of demented patients in non-therapeutic research involving more than minimal risks and/or burdens. First, morally relevant differences between advance directives for treatment and care, and advance directives for dementia research are discussed. Then attention is paid to the philosophical issue of dementia and personal identity, and the implications for the moral authority of research advance directives. Thirdly, a number of practical (...) shortcomings of advance directives for non-therapeutic dementia research are explored and attention is paid to the role of proxies. It is concluded that upon a closer look the initial attractiveness of advance directives for dementia research is lessened, and that it is doubtful whether these instruments can compensate for the lack of subject consent in case of non-therapeutic dementia research involving more than minimal risks and/or burdens for the incompetent demented subject. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 23-24, August 2011.

This article discusses ethical issues which are raised as a result of the introduction of economic evidence in mental health care in order to rationalise clinical practice. Cost effectiveness studies and guidelines based on such studies are often seen as impartial, neutral instruments which try to reduce the influence of non-scientific factors. However, such rationalising instruments often hide normative assumptions about the goals of treatment, the selection of treatments, the role of the patient, and the just distribution of scarce resources. (...) These issues are dealt with in the context of increased control over clinical practice by third parties. In particular, health insurers have a great interest in economic evidence in clinical care settings in order to control access to and quality of health care. The authors conclude that guideline setting and cost effectiveness analysis may be seen as important instruments for making choices in health care, including mental health care, but that such an approach should always go hand in hand with a social and political debate about the goals of medicine and health care. This article is partly based on the results of a research project on the normative aspects of guideline setting in psychiatry and cardiology which was conducted under the guidance of the Royal Dutch Medical Association. (shrink)

Mackenzie and Watts (2011) discuss the role of emotions in decision-making capacity (DMC) for medical treatment decisions. They are concerned that “the rights of the neurodiverse are at risk as the...

Genomic and neuro-scientific research into the causes and course of antisocial behaviour triggers bioethical debate. Often, these new developments are met with reservation, and possible drawbacks and negative side-effects are pointed out. This article reflects on these scientific developments and the bioethical debate by means of an exploration of the perspectives of one important stakeholder group: juveniles convicted of a serious crime who stay in a juvenile justice institution. The views of juveniles are particularly interesting, as possible applications of current (...) and future scientific findings are considered to be most effective if applied early in life. Based on their statements we come to the following provisional conclusions. Concerns about labelling and stigmatization are recognized and widely shared. Possible effects on one's identity are acknowledged too. Yet, a possible biological underpinning of one's antisocial behaviour is not considered to result in the development of a criminal identity. Nonetheless, psychopharmacological interventions are experienced as endangering one's current self. Concerns regarding the refusal of responsibility and the blaming of one's genes or brain can be put into perspective. Instead, participants emphasize the motive of own choice as underlying their criminal behaviour. Moreover, bioethical debate should pay attention to the role of parents of children at risk and the parent-child relationship in families at-risk. We argue that the short-term and long-term interests of children at risk, as well as their interests and those of society at large, may conflict. In order to deal appropriately with newly arising dilemmas, a normative framework needs to be developed. (shrink)

This article investigates what Hans Blumenberg has in mind when he characterizes his own philosophical activity as a „metaphorology”. An adequate understanding of Blumenberg's work has to consider the author's fundamental change of perspective concerning the relationship between metaphorical and conceptual language. First, metaphorology is considered as an auxiliary discipline of the „history of concepts” as it was developed in the Archiv für Begriffsgeschichte and the Historisches Wörterbuch der Philosophie . Even at this stage, however, Blumenberg already respects metaphors as (...) „basic constituents of philosophical language” which can never be recuperated adequately and completely by conceptual language. In this context, he proposes to comprehend the „truth” of a metaphor as „pragmatic”. Gradually, Blumenberg gives up the priority of the concept and announces his „theory of unconceivability” , which has its starting point in the assumption that reality transcends whatever can be predicated in a clear and distinct way. Blumenberg, however, stresses the predicability of the „mystical” with his notion of „metaphorics of break-up” . Although Blumenberg rejects every form of essentialism in his thinking of man and reality, his view on the functioning of metaphors has its foundation in some anthropological and ontological assumptions, with the central notion of man as a „being of lack who tries to overcome his unability to adapt to reality, by a rhetorical, i.e. indirect and functional relationship to reality. Blumenberg's metaphorology stands midway between pragmatics and metaphysics. It is more than pragmatics because it also implies a statement on the character of reality. It is less than metaphysics because these statements precisely bring into the open the vanity of conceptual language. Therefore, we propose to characterize Blumenberg's philosophy as a kind of „negative metaphysics”. (shrink)

This article presents an overview ofregulations, guidelines and societal debates ineight member states of the EC about a)embryonic and fetal tissue transplantation(EFTT), and b) the use of human embryonic stemcells (hES cells) for research into celltherapy, including `therapeutic' cloning. Thereappears to be a broad acceptance of EFTT inthese countries. In most countries guidance hasbeen developed. There is a `strong' consensusabout some of the central conditions for `goodclinical practice' regarding EFTT.International differences concern, amongstothers, some of the informed consent issuesinvolved, and the (...) questions whether anintermediary organisation is necessary, whetherthe methods of abortion may be influenced bythe possible use of EFT, and whether EFTTshould only be used for the experimentaltreatment of rare disorders. The potential useof hES cells for research into cell therapy hasgiven a new impetus to the debate about (human)embryo research. The therapeutic prospects withregard to the retrieval and research use of hEScells appear to function as a catalyst for theintroduction of less restrictive regulationsconcerning research with spare embryos, atleast in some European countries. It remains tobe seen whether the prospect of treatingpatients suffering from serious disorders withtransplants produced by therapeutic cloningwill decrease the societal and moral resistanceto allowing the generation of embryos for`instrumental' use. (shrink)

The cloister of the Poor Clares St.-Elisabethsdal in Boxtel, in the present-day province of Brabant, the Netherlands, is one of the monasteries created during the new wave of Observant Clarissan monastic foundations in the Northern Low Countries between ca. 1460 and 1513. It was established after Wamel, Haarlem, Veere, Delft, Brielle, Gouda and Alkmaar.1 But it was not the first Clarissan settlement in what is currently the Netherlands. More than a century before, Willem van den Bossche, lord of Erp, enabled (...) through his last will d.d. 28 augustus 1335 the foundation of a convent of Poor Clares in the town of 's-Hertogenbosch,2... (shrink)

Coercion and pressure in mental healthcare raise moral questions. This article focuses on moral questions raised by the everyday practice of pressure and coercion in the care for the mentally ill. In view of an example from literature—the story of Ulysses and the Sirens—several ethical issues surrounding this practice of care are discussed. Care giver and patient should be able to express feelings such as frustration, fear and powerlessness, and attention must be paid to those feelings. In order to be (...) able to evaluate the intervention, one has to be aware of the variety of goals the intervention can aim at. One also has to be aware of the variety of methods of intervention, each with its own benefits and drawbacks. Finally, an intervention requires a context of care and responsibility, along with good communication and fair treatment before, during and after the use of coercion and pressure. (shrink)

Universities are regarded as key institutions in the knowledge economy. Traditionally, the concept of scientific progress has been linked with an ideal of free and open dissemination of scientific information.At present, however, there is a growing strain to cash in the commercial potential created by academic research, and to regard academic knowledge as targets for opportunities for creating income. The major question is how to reconcile the traditional academic mission of knowledge production and science sharing with the current trend towards (...) knowledge protection and appropriation through patenting. In balancing the sharing and shielding of knowledge, two major sets of measures should be contemplated.A first set of measures aims at safeguarding individual and collective research from the harm patents might have on research practice and scientific conduct, and at cautiously watching potential conflicts of interest. The appointment of an ombudsperson for science, a mandatory system of whistle blowing, a code of conduct, and a set of conflict-of-interest guidelines are explored as helpful instruments in this regard.A second set of tools aims at designing institutional strategies to balance the ethos of sharing and profit maximalisation through patents. Public patents, open access patents, and two-tiered patent license strategies are examined in order to find a new balance in the growing conflict between private and public knowledge with which contemporary universities are faced. (shrink)

The issue of benefits in international clinical research is highly controversial. Against the background of wide recognition of the need to share benefits of research, the nature of benefits remains strongly contested. Little is known about the perspectives of research populations on this issue and the extent to which research ethics discourses and guidelines are salient to the expectations and aspirations existing on the ground. This exploratory study contributes to filling this void by examining perspectives of people in low-income South (...) African communities on benefits in international clinical research. Twenty-four individuals with and without experience of being involved in clinical research participated in in-depth interviews. Respondents felt that ancillary care should be provided to clinical research participants, while a clinical study conducted in particular community should bring better health to its members through post-trial benefits. Respondents' perspectives were grounded in the perception that the ultimate goal of international clinical research is to improve local health. We argue that perspectives and understandings of the respondents are shaped by local moral traditions rather than clinical research specificities and require attention as valid moral claims. It is necessary to acknowledge such claims and cultural worlds from which they emerge, thus building the foundation for equal and embracing dialogue to bridge different perspectives and handle contradicting expectations. (shrink)

The discussion concerning the patenting of academic knowledge is already closed for many people. It has become a type of credo, solemnly intoned at all levels: universities must commercially valorize the knowledge that they generate as extensively as possible.The public means that are reserved for universities can never increase at the same rate as the mounting costs for highly specialized research. So universities, if they want to work at the top level, must increasingly appeal to private resources. Universities are increasingly (...) forced to aim at contract research, sponsorships, commercialised service, the patenting of technical findings, and spin-offs: Cash for knowledge!The pressure for the unfettered commercialisation of academic knowledge does not only come from within the universities. The message also comes from the politicians and those who are committed to economic prosperity. They argue that the commercialisation of intellectual property contributes to new employment because it makes new industrial developments possible and reinforces the competitiveness of ventures. They make it seem that universities form the motor of the knowledge economy.In a country without considerable natural resources and with extremely high personnel costs, innovation is of vital importance. Few convictions are equally as expressly avowed at so many differing forums. The direction of the march seems clear.It was once different. The knowledge that was acquired, deepened, preserved, and transmitted within the universities was not for sale. In fact, its sale could present difficulties because academic knowledge has never answered to the properties of a marketable thing. Use does not deplete knowledge and if you consider it your mission to bring to light knowledge, you do not want to exclude anyone from making use of it.Academic knowledge could thus not be an object of trade, at least so long as nobody was intent on keeping that knowledge secret, and so long as nobody appealed to regulations, whereby one could restrict the legal use of that knowledge. Today neither of these strategies are taboo within academic centres. The patenting of all forms of qualifying knowledge is even encouraged.A patent assumes, on the one hand, that one makes public the knowledge upon which a technique rests, while one, on the other hand, can grant use of that technique exclusively to who one gives a licence, whether or not for a fee. This system is put forth as attractive for all parties. The researchers can keep up with technical details, and the entrepreneur can commercialise the finding. Everyone is happy.Or perhaps not? Are there reasons to be concerned that universities must increasingly submit themselves to the laws of the market? Are there arguments for evaluating academic performance differently than the performance of entrepreneurs? Must one regret that knowledge is commercialised as much as possible?The proponents of the commercial orientation point out that all kinds of new incentives will give a new impetus to the old academic system and will increase the relevance of academic research. They seem to dismiss resistance to the renewal as a nostalgic outpouring of a privileged group that used to have it too good, a group that for too long knew to retreat too safely back into a series of unworldly problems.The opponents of the economically oriented approach fear that the proper character of the academic mission will be lost. They fear that the loss of academic autonomy will make the specific function that a university fulfils within society impossible. In what sense?In our society, there is not one type of sphere, and there is not one valid set of standards, the basis upon which performances are evaluated, functions are judged, or objectives commended. There are strongly divergent spheres and each have their own specific function. The laws that apply in one sphere do not necessarily have authority in another sphere, and the standards that apply in one sort of relationship often have little or no meaning in another relationship.Each sphere recognises its own standards and answers to its own system of exchange for compensation, approval, and recognition. What applies in the sphere of law does not necessarily apply in the sphere of someone’s personal friendships, or is not applicable among family members. What applies in trade does not necessarily apply in the sphere of art.Even more, things go wrong when the autonomy of these spheres is not respected. Within the domain of art, love and friendship, monetary laws are not valid, at least in a healthy situation. That is not to say that the rules that apply within the free market would be wrong or unethical – far from it. It seems self evident that these laws are valid under the condition that they apply in the environment to which they belong, and that one respects these limits.This applies for all spheres. It would be unjust if one would apply the standards of friendship to the spheres of jurisprudence or education. Manifestly, it seems self evident not to define justice as a univocal principle that must be extended with the same consistency in every type of sphere. Rather, it is just to respect the individual character of the normative relationship that applies in the diverse spheres of life, and to prevent one sphere from colonising another.Justice assumes that one prevents the political sphere from stipulating what must be said, or concealed, within the academic sphere. Academics must answer alone to that which is expected of them within the academic sphere. Political pressure may exert no influence on this. Why cannot one say the same about economic pressure?Do we run the risk that the economic sphere will colonise the academic sphere just as the economic sphere previously colonised the sphere of media? What must one imagine in this supposed risk? In what sense should economic laws threaten the academic sphere?In the academic sphere, it is traditional to follow one’s own interests and investigate anything whatsoever without having to ask if this knowledge is useful for something or how the fruits of this research fit within the economic context. The academic search for a better understanding of everything has an unconditional character.The manner in which researchers evaluate the performance of each other seldom has to do with the economic effects that their findings have, but with their reliability, the meticulousness with which they were checked, the scrupulousness with which the sources were collected, and the honesty with which they were communicated. The function of the academic is to collect and refine knowledge, and to bring to light the truth.By doing so, universities offer a type of foot-hold within society. They make it possible that a place exists where one can be obedient to what lets itself appear most truthfully today. Nobody has to fear, at least as long as the autonomy of the academic sphere is respected, that the communication of a particular subject was rhetorically coloured in function of a commercial interest, was applied according to the wishes of the sponsor, was brought into conformity with what was agreed upon by the financiers, or answered to the demands of a patent.It is possible that the influence of the commercial sphere shall be less dramatic than pessimistic academics imagine, but nothing indicates the opposite. Today we are giving a new strategy power, and nobody knows how the magician’s apprentice will bring it off.This forms the context of the questions that we shall try to answer together this number of Ethical Perspectives, and we will restrict our discussion to patents. We are aware that the discussion about patents illuminates just one part of the problems, which have to do with the relation of the worlds of academia and commerce. But there is a reason for confining oneself to an aspect of this problematic relationship. If one were to broaden the scope of inquiry further, one would risk missing the complexity of the subject matter already covered, and be consigned to a far too general and aimless debate.We have brought together a number of specialists, jurists, ethicists, and people with practical experience with the field. They shall introduce us into the problematic, confront us with their points of view, and help to answer our questions: Are there moral limits to the patenting of academic knowledge? Is patenting always the most efficient strategy? Does not perhaps the university sell its soul if it gradually leaves itself subject to the laws of the market?We will begin by asking how in particular a university should proceed with the patenting of knowledge. Modern universities were inspired by the ideals of the Enlightenment, which was characterised by the open distribution of unselfishly pursued knowledge.The privatisation and commercialisation of knowledge would seem to conflict with this traditional vision. Jürgen Mittelstrass and Bart Pattyn provide a theoretical and historical basis for protecting the autonomy of university research from the corrupting aspects of the market economy.But, are there reasons for giving up the traditional outlook? Few or no universities have not chosen to patent discoveries, but how is one to proceed within the framework of the university, once one has obtained patent protection? Can one pursue a policy of using these protected intellectual rights to secure the fruits of knowledge for financially weaker groups, or do circumstances compel the universities to be exclusively driven by market forces?Those are the kinds of questions that Gilles Capart and Geertrui Van Overwalle of the KU Leuven will deal with.Sigrid Sterckx of the university of Ghent will answer the question: can patents be morally justified?Paul Belleflamme of the Université Catholique de Louvan La Neuve writes concerning the economic evidence of patents, and the real effect of incentives. Are there any economic facts that can demonstrate the effectiveness of patenting?Then we give the floor to Christopher May of the University of Lancaster, who looks at the question of how universities have to deal with the global information society. (shrink)

The use of coercive measures in mental health care is an issue of ongoing concern (Cf. Fisher 1994; Janssen et al. 2008; Paterson and Duxbury 2007; Prinsen and Van Delden 2009; Widdershoven and Berghmans 2007; Wynn 2006). On the one hand, coercive interventions seem to infringe the patient’s right to self-determination (principle of autonomy). However, professionals are also committed to providing the care they deem necessary (principle of beneficence). In other words, professionals in mental health care are often caught (...) between the two (opposing) ideals of beneficence and autonomy. In medical practice, the right of self-determination is operationalized in the principle of informed consent. A medical physician is .. (shrink)