Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

Learning and memory are inextricably intertwined. The capacity for learning presupposes an ability to retain the knowledge acquired through experience, while memory stores the background knowledge against which new learning takes place. During the dark years of radical behaviorism, when the concept of memory was deemed too mentalistic to be a proper subject of scientific study, research on human memory took the form of research on verbal learning (Anderson, 2000; Schwartz & Reisberg, 1991).

Conscious recollection appears to be governed by seven principles: elaboration, organization, time‐dependency, cue‐dependency, encoding specificity, schematic processing, and reconstruction. However, these same principles may not apply to unconscious, or implicit, memory. Implicit memory is most commonly reflected in priming effects which occur in the absence of conscious recollection. Dissociations between explicit and implicit memory have been observed in patients suffering various sorts of brain damage, in other forms of amnesia, in behavioral performance of neurologically intact subjects, and in brain‐imaging studies (...) of memory. The most popular interpretation of these dissociations holds that explicit and implicit memory are mediated by separate and independent brain systems. However, there are also compelling interpretations in terms of dual processes operating on the contents of a single memory system. (shrink)

Introduction Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether (...) mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.Objectives To explore mental health clinicians’ views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.Materials and Methods In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient’s previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.Conclusions Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice. (shrink)

We used a retrospective survey to model the patterns of appraisal, motivation, and coping that uniquely correspond with 12 positive emotions (affection/love, amusement, awe, challenge/det...

Deep neural networks (DNNs) have had extraordinary successes in classifying photographic images of objects and are often described as the best models of biological vision. This conclusion is largely based on three sets of findings: (1) DNNs are more accurate than any other model in classifying images taken from various datasets, (2) DNNs do the best job in predicting the pattern of human errors in classifying objects taken from various behavioral datasets, and (3) DNNs do the best job in predicting (...) brain signals in response to images taken from various brain datasets (e.g., single cell responses or fMRI data). However, these behavioral and brain datasets do not test hypotheses regarding what features are contributing to good predictions and we show that the predictions may be mediated by DNNs that share little overlap with biological vision. More problematically, we show that DNNs account for almost no results from psychological research. This contradicts the common claim that DNNs are good, let alone the best, models of human object recognition. We argue that theorists interested in developing biologically plausible models of human vision need to direct their attention to explaining psychological findings. More generally, theorists need to build models that explain the results of experiments that manipulate independent variables designed to test hypotheses rather than compete on making the best predictions. We conclude by briefly summarizing various promising modeling approaches that focus on psychological data. (shrink)

Jennifer McKitrick offers an opinionated guide to the philosophy of dispositions. In her view, when an object has a disposition, it is such that, if a certain type of circumstance were to occur, a certain kind of event would occur. Since this is very common for this to be the case, dispositions are an abundant and diverse feature of our world.

Philosophers of language have tended to focus on examples that are not politically significant in any way. We spend a lot of time analyzing natural kind terms: We think hard about “water” and “pain” and “arthritis.” But we don’t think much about the far more politically significant kind terms (natural or social—it's a matter for dispute) like “race,” “sex,” “gender,” “woman,” “man,” “gay,” and “straight.” In this essay, I will try to show, using the example of “woman,” that it's worth (...) thinking about terms like these, for at least three reasons: (1) There are some interesting puzzles. (2) Politically significant terms matter to people's lives— and it's worth spending at least some of our energy thinking about things that matter in this way. (3) Most importantly, interesting methodological issues emerge at the intersection of philosophy of language and politics. (shrink)

The authors discuss findings from a qualitative research project concerning applied ethics that was undertaken at a general family counseling agency in southern Ontario. Interview data suggested that workers need to dialogue about ethical dilemmas, but that such dialogue demands a high level of risk taking that feels unsafe in the organization. This finding led the researchers to examine their own sense of "breaking rules" by suggesting an intersubjective view of ethics that requires a "safe space" for ethical dialogue. The (...) authors critique the individualistic tendency of professional ethics as an effect of power that is tied to the history of professionalism, and discuss the role of bureaucracies in diminishing a central role for ethics in helping services. The authors call for elaboration of critical perspectives on ethics in order to promote the centrality of ethics in the helping professions. (shrink)

To determine whether dispositions are causally relevant, we have to get clear about what causal relevance is. Several characteristics of causal relevance have been suggested, including Explanatory Power, Counterfactual Dependence, Lawfullness, Exclusion, Independence, and Minimal Sufficiency. Different accounts will yield different answers about the causal relevance of dispositions. However, accounts of causal relevance that are the most plausible, for independent reasons, render the verdict that dispositions are causally relevant.

Upward mobility through the path of higher education has been an article of faith for generations of working-class, low-income, and immigrant college students. While we know this path usually entails financial sacrifices and hard work, very little attention has been paid to the deep personal compromises such students have to make as they enter worlds vastly different from their own. Measuring the true cost of higher education for those from disadvantaged backgrounds, Moving Up without Losing Your Way looks at the (...) ethical dilemmas of upward mobility—the broken ties with family and friends, the severed connections with former communities, and the loss of identity—faced by students as they strive to earn a successful place in society. -/- Drawing upon philosophy, social science, personal stories, and interviews, Jennifer Morton reframes the college experience, factoring in not just educational and career opportunities but also essential relationships with family, friends, and community. Finding that student strivers tend to give up the latter for the former, negating their sense of self, Morton seeks to reverse this course. She urges educators to empower students with a new narrative of upward mobility—one that honestly situates ethical costs in historical, social, and economic contexts and that allows students to make informed decisions for themselves. -/- A powerful work with practical implications, Moving Up without Losing Your Way paves a hopeful road so that students might achieve social mobility while retaining their best selves. (shrink)

Contemporary theories of universals have two things in common: first, they are unable to account for necessary connections between universals that form a structure. Second, they leave teleology out of their accounts of instantiation. These facts are not unrelated; the reason why contemporary theories have such trouble is they neglect the ancient idea that universals are ends at which nature aims. If we want a working theory of universals, however, we must return to this idea. Despite its unpopularity among realists, (...) teleology is not a disposable eccentricity, and its dismissal is not an improvement on ancient views. (shrink)

In this paper, I write about nurses of colour who have made significant contributions to nursing, yet are actively ignored in traditional nursing textbooks related to colonized thinking. One consequence of this is that when we think about comparing the disparities of the past to the present day, we see that we have not made much of a difference. The disparity is still huge. I call on all of us as nurses to challenge ourselves to think beyond the box of (...) colonized thought to what we know is true. (shrink)

Rowley and Berman (2000) are tackling the right questions in their article. Three critical questions, in essence, are asked: What is corporate social performance (CSP)? What does it mean (i.e., CSP measures)? And, where does the future lie with CSP? In answering these questions, they are creating a CSP research agenda for the 21st Century. While agreeing, to a large extent, with their new set of questions, this paper questions their rationale for what is currently wrong with CSP and focuses (...) on extending future research directions. Specifically, this paper suggests that existing research in related disciplines can help accelerate our understanding of CSP. Marketing (i.e., customer-organization relations) and human relations (i.e., employee-organization relations) literatures, for example, already critically examine the conditions under which various organizational practices, policies, and procedures flourish. These boundary spanning functions provide newinsights that can lead to a broader, richer, and more systematic understanding of the complex CSP construct. (shrink)

This special issue of Science, Technology, & Human Values assembles papers that consider relations among science, ethics, and justice. The papers are drawn from a 2011 National Science Foundation-sponsored workshop that brought together interdisciplinary scholars to consider, incorporate, and attend to the meanings, uses, and social consequences of ethical questions and justice ideals in technoscientific projects. The papers included in this special issue examine key areas that emerged from this workshop, including public participation, the production of knowledge, what counts as (...) consent, ownership of biomaterials, and others. Together, the papers raise questions about new directions and articulations of power, justice, and inequalities in science and technology studies. (shrink)

In this study we analyze the overlapping perspectives of legitimacy theory, institutional theory, resource dependence theory, and stakeholder theory. Our purpose is to explore how these theories can inform and be built upon by one another. Through our analysis we provide a broader theoretical understanding of these theories that may support and promote social and environmental accounting research. This article starts with a detailed analysis of legitimacy theory by bringing some recent critical discussions on legitimacy and corporations in the management (...) literature into accounting research. The notion forwarded by legitimacy theory then serves as an overarching concept to examine the relationship between and among theories. We conclude that two theoretical considerations are important for future social and environmental accounting research. First, it must be acknowledged that some business entities initiate social activities based on direct interactions with stakeholders, whereas others may also undertake similar activities to manage their societal level of legitimacy. Second, from analyzing the perspectives of legitimacy theory, institutional theory, resource dependence theory, and stakeholder theory, it is possible to reach compatible interpretations of business social phenomena, and the selection and application of these theories should depend upon the focus of study. (shrink)

One of the most important aspects of Grice’s theory of conversation is the drawing of a borderline between what is said and what is implic- ated. Grice’s views concerning this borderline have been strongly and influentially criticised by relevance theorists. In particular, it has become increasingly widely accepted that Grice’s notion of what is said is too lim- ited, and that pragmatics has a far larger role to play in determining what is said than Grice would have allowed. (See for (...) example Bezuidenhuit 1996; Blakemore 1987; Carston 1991; Recanati 1991, 1993, 2001; Sperber and Wilson 1986; Wilson and Sperber 1981.) In this paper, I argue that the rejection of Grice has moved too swiftly, as a key line of objection which has led to this rejection is flawed. The flaw, we will see, is that relevance theorists rely on a misunderstanding of Grice’s project in his theory of conversation. I am not arguing that Grice’s versions of saying and implicating are right in all details, but simply that certain widespread reasons for rejecting his theory are based on misconceptions. (shrink)

climate are both linked to an organization's ability to retain healthcare professionals and increase their level of job satisfaction, leaders have a corollary responsibility to address moral distress. We recommend that leaders should provide access to ethics education and resources, offer interventions such as ethics debriefings, establish ethics committees, and/or hire a bioethicist to develop ethics capacity and to assist with addressing healthcare provider moral distress....

Although we think 1 of the basic purposes of journalism is to provide information vital to enhancing citizen autonomy, we also see this goal as being in direct tension with the power news media hold and wield, power that may serve to undercut, rather than enhance, citizen autonomy. We argue that the news media are ethically constrained by proceduralism, resulting in journalists asserting power inappropriately at the individual level, and unwittingly surrendering moral authority institutionally and globally. Anonymity, institutionalization, and routinization (...) cloak power relationships among citizens, journalists and the institutions of which they are a part, ultimately inculcating these distinctly Western values in the global community. (shrink)

While there is a growing body of work on moral issues and global governance in the fields of global justice and international relations, little work has connected principles of global health justice with those of global health governance for a theory of global health. Such a theory would enable analysis and evaluation of the current global health system and would ethically and empirically ground proposals for reforming it to more closely align with moral values. Global health governance has been framed (...) as an issue of national security, human security, human rights, and global public goods. The global health governance literature is essentially untethered to a theorized framework to illuminate or evaluate governance. This article ties global health justice and ethics to principles for governing the global health realm, developing a theoretical framework for global and domestic institutions and actors. (shrink)

Sibley et al. (2008) report a recurrent neural network model designed to learn wordform representations suitable for written and spoken word identification. The authors claim that their sequence encoder network overcomes a key limitation associated with models that code letters by position (e.g., CAT might be coded as C‐in‐position‐1, A‐in‐position‐2, T‐in‐position‐3). The problem with coding letters by position (slot‐coding) is that it is difficult to generalize knowledge across positions; for example, the overlap between CAT and TOMCAT is lost. Although we (...) agree this is a critical problem with many slot‐coding schemes, we question whether the sequence encoder model addresses this limitation, and we highlight another deficiency of the model. We conclude that alternative theories are more promising. (shrink)

Dugald Stewart claims that conjectural history is ‘the peculiar glory of the latter half of the eighteenth century’. Yet it is hard to see why, in his view, conjectural histories are not merely confabulated just-so stories. This paper examines Stewart's views about the epistemic and moral value of conjectural history.

IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.ResultsFirst person accounts of psychiatric diagnosis and mental health care (shown here to represent 'counter stories' to (...) the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities.ConclusionTo honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. (shrink)

This paper examines ways in which current moral values are influenced by earlier patterns of thinking carried forward in root metaphors whose meanings were often framed by the analogues settled upon in the past by thinkers who were influenced by the silences and prejudices of their culture. It is argued that such tacitly inherited metaphors reproduce the myth of the individual as a moral agent and that this both is ecologically unsustainable and undermines other important ways of understanding the individual. (...) In various ways the form of critical thinking to which it gives rise stands in the way of individuals exercising what Gregory Bateson refers to as their ?ecological intelligence? in a manner that properly takes account of the interdependent nature of cultural and natural ecologies. It is argued that if in the West (at least) a shift could be made to relying on ?ecology? as the dominant root metaphor the whole system of Western moral values would undergo a radical change to one better suited to a current Western environmental situation. (shrink)

Proponents of “the affective appeal” :787–812, 2014; Zagzebski in Philos Phenomenol Res 66:104–124, 2003) argue that we can make progress in the longstanding debate about the nature of moral motivation by appealing to the affective dimension of affective episodes such as emotions, which allegedly play either a causal or constitutive role in moral judgements. Specifically, they claim that appealing to affect vindicates a version of Motivational Internalism—roughly, the view that there is a necessary connection between moral judgment and motivation—that is (...) both more empirically respectable and less theoretically controversial than non-affective versions. We here argue that the affective appeal fails: versions of Internalism which appeal to affect are neither more empirically supported, nor clearly less controversial, than versions of Internalism which make no such appeal. Although affect doubtless has an important role to play in explaining moral motivation, we are sceptical that establishing any such role advances the debate. (shrink)

In this paper, I draw a parallel between the stability of physical systems and that of economic ones, such as the US financial system. I argue that the use of equilibrium assumptions is central to the analysis of dynamic behavior for both kinds of systems, and that we ought to interpret such idealizing strategies as footholds for causal exploration and explanation. Our considerations suggest multi-scale modeling as a natural home for such reasoning strategies, which can provide a backdrop for the (...) assessment and prevention of financial crises. Equilibrium assumptions are critical elements of the epistemic scaffolding that make up multi-scale models, which we should understand as a means of constructing explanations of dynamic behavior. (shrink)

The current qualitative study investigated prevalence and types of academic integrity violations in psychology graduate students and solicited student recommendations for how academic institutions, professors, and peers may act to discourage or prevent its occurrence. Students were recruited through email lists and asked to participate in an online study with a series of open-ended questions assessing integrity violations and prevention recommendations. Results revealed academic integrity violations were relatively infrequent and most were of relatively low severity. Common antecedents to integrity violations (...) included inadequate preparation, task difficulty, and external stressors such as health ailments that interfered with preparation. Most violators reported engaging in a rational decision making process, weighing the pros and cons of cheating, and most did not reveal the violation to anyone. The majority of violations resulted in no negative consequences to the student and 44 % reported they would do it again. Students recommended better dissemination of integrity policies, greater oversight of graduate students, harsher punishments for violations, and consistent reporting of violations as prevention strategies. Results highlight how academic dishonesty in psychology graduate students may be a product of multiple time and resource demands, coupled with low self-efficacy to meet or negotiate these demands. Despite reports of external pressures being the top reason for academic integrity violations, few recommendations focused on decreasing external pressures as a mechanism to curb cheating. (shrink)

The proper object of global health governance should be the common good, ensuring that all people have the opportunity to flourish. A well-organized global society that promotes the common good is to everyone’s advantage. Enabling people to flourish includes enabling their ability to be healthy. Thus, we must assess health governance by its effectiveness in enhancing health capabilities. Current GHG fails to support human flourishing, diminishes health capabilities and thus does not serve the common good. The provincial globalism theory of (...) health governance proposes a Global Health Constitution and an accompanying Global Institute of Health and Medicine that together propose to transform health governance. Multiple lines of empirical research suggest that these institutions would be effective, offering the most promising path to a healthier, more just world. (shrink)

One of the ethical issues that has been raised recently regarding emerging neurotherapies is that people will be coerced explicitly or implicitly in the workplace or in schools to take cognitive enhancing drugs. This article builds on this discussion by showing how the law may pressure people to adopt emerging neurotherapies. It focuses on a range of private law doctrines that, unlike the criminal law, do not come up very often in neuroethical discussions. Three doctrines—the doctrine of mitigation, the standard (...) of care in negligence, and child custody determinations in family law—are addressed to show how the law may pressure people to consent to treatment by offering a choice between accepting medical treatment and suffering a legal disadvantage. The doctrines considered in this article apply indirect pressure to submit to treatment, unlike court-ordered medical treatment, which applies direct pressure and is not addressed here. The outcome of this discussion is to show that there is a greater range of social pressures that may encourage the uptake of novel neurotherapies than one might initially think. Once treatments that were developed and offered with therapeutic benefits in mind become available, their existence gives rise to unintended legal consequences. This certainly does not mean we should cease developing new therapies that may be of tremendous benefit to patients, but it does raise some questions for physicians and for legal policy-makers. How should physicians, who are required by medical ethical principles to obtain valid consent to treatment, react to a patient’s reluctant consent that is driven by legal pressure? From the legal policy perspective, are our legal doctrines satisfactory or should they be changed because, for example, they unduly promote the collective interest over individual freedom to reject medical treatment or because they channel us toward economically efficient treatments to the detriment of more costly but potentially superior approaches of dealing with behavioural problems? (shrink)

During an Australian qualitative and empirical study looking at lesbian, gay, bisexual, and transgender client's experiences of counseling, and counselor's experiences of working with minority clients, a large body of unsolicited data emerged related to experiences of religious-based homophobia. Analysis of the data suggests that a lifelong process of posttraumatic recovery for many lesbian, gay, bisexual, and transgender people follows prior experiences of religious-based homophobia. This paper discusses the sociological debate related to how counselors find themselves at the crossroad between (...) a healthy lifestyle model of homosexuality based in well established contemporary professional ethics versus long standing religious-based attitudes and constraints toward homosexuality. This intersection of conflicting beliefs generates a controversial social and political environment in which counselors must make a basic decision to either support minority clients according to ethical guidelines or to side with socially conservative constructs that, rightly or wrongly, rely largely on Western religious traditions. (shrink)