The doctrines of therapeutic nihilism and administrative nihilism are both based on the belief that the norms of activity are intrinsically linked to the structure of the body. Just as there is a vis medicatrix naturae in the individual organism, which renders any intervention of the therapist vain, there would be a vis medicatrix rei publicae in the social body, which makes the intervention of the legislator in economic life pointless and even dangerous. However, such a symmetry is not quite (...) as clear as it appears at first. It has also been upheld that the real parallel is not between therapeutic and administrative nihilism, but between therapeutic nihilism and statism. In this view, government is less comparable to a therapist than to the nervous system, and just as a well regulated organism is a one with an extensive nervous system, a well regulated society is one with a strong State.We intend to retrace the historical origin of these two schemas of correspondence, which has his roots in the celebrated controversy in the 1870’s between Herbert Spencer and Thomas Henry Huxley. We examine the causes of this apparent paradox, which sometimes views the doctrine of administrative nihilism, and sometimes the opposing doctrine of statism, as being the equivalent in politics of therapeutic nihilism in medicine. In our opinion, an important part of the explanation must be sought in the variations of the field of extension, which is implicitly given to the concept of vis medicatrix, or –as we now usually call this notion– that of Self-regulation. (shrink)

The Therapeutic Process attempts to present an informative, sequential, well-defined, and clinically rich guide to the process of psychodynamic psychotherapy. The book was specifically designed to have broad appeal and value, for the beginning clinician to more experienced clinician, or the clinician who also teaches students of psychoanalytic psychotherapy. For the beginning clinician, the book has many illustrative examples, and terms are well defined. For the long-time clinician, the book attempts to put clearly into words, what many of us have (...) thought all along. This book arose from a series of lectures that were part of a course for the psychiatric residents at UCLA Neuropsychiatric Institute and Hospital, as well as from the instruction of many therapists from other mental health disciplines. The challenge in the initial instruction of psychoanalytic psychotherapy is always to be able to introduce fundamental concepts and convey the importance of a solid theoretical background, while concurrently addressing the clinician's pressing desire and often immediate requirement to understand the clinical process. Novel heuristic models are described and illustrated in clinical vignettes, in order to quickly bring together clinical and theoretical terms with the practice and process of psychotherapy. (shrink)

The focus of this article is to offer an account of how the development of one’s intellectual character has therapeutic value in the attempt to overcome self-deception. Even stronger, the development of intellectual character has necessary therapeutic value in regard to self-deception. This account proceeds by first consulting the predominant psychological theory of virtuous character offered by contemporary virtue ethicists and virtue epistemologists. A motivational/dispositional account of self-deception is then offered and connected to the former account of intellectual character. By (...) connecting these two sets of literature the therapeutic value of intellectual virtue is displayed. The problem of self-diagnosis is then presented as well as intellectual character as a necessary therapeutic measure to assure agents that they are not self-deceived. (shrink)

From a theoretical standpoint, the problem of human suffering can be understood as one formulation of the classical problem of evil, which calls into question the compatibility of the existence of a perfect God with the extent to which human beings suffer. Philosophical responses to this problem have traditionally been posed in the form of theodicies, or justifications of the divine. In this article, I argue that the theodical approach in analytic philosophy of religion exhibits both morally and epistemically harmful (...) tendencies and that philosophers would do better to shift their perspective from the hypothetical “God’s-eye view” to the standpoint of those who actually suffer. By focusing less on defending the epistemic rationality of religious belief and more on the therapeutic effectiveness of particular imaginings of God with respect to suffering, we can recover, (re)construct, and/or (re)appropriate more virtuous approaches to the individual and collective struggle with the life of faith in the face of suffering. (shrink)

In analysing the position adopted by the United Kingdom over therapeutic cloning, this paper will endeavour to examine the question of regulation, its necessity and extent. This will be achieved through considering different models of relevant theoretical discourse before, in applying that discourse to identified systems of regulation, the advantages and pitfalls of each system will be assessed in the hope of reaching a solution appropriate to the sensitive, yet dynamic, needs of the issue.

_Therapeutic Approaches in Psychology_ is a simple introduction to the many psychological therapies in use today, including cognitive-behavioural, humanistic and psychodynamic approaches.

Therapeutic touch, a healing technique based upon the laying‐on of hands, has found wide acceptance in the nursing profession despite its lack of scientific plausibility. Its acceptance is indicative of a broad antiscientific trend in nursing. Adherents of this movement use the jargon of postmodern philosophy to justify their enthusiasm for a variety of mystically based techniques, citing such postmodern critics of science as Derrida and Michel Foucault as well as philosophical forerunners Heidegger and Husserl. Between 1997 and 1999, 94 (...) articles in nursing journals referred to postmodernism, according to a database search. This paper criticizes the postmodern movement for abandoning the biological underpinnings of nursing and for misreading philosophy in the service of an antiscientific world‐view. It is also suggested that nursing can retain its tradition of ‘caring’ without abandoning the scientific method. (shrink)

En la actualidad, aún se desconoce el verdadero alcance de la vasta cultura de Lope de Vega, pues, aunque se sabe que fue un gran lector, que legó más de 1500 libros, sus títulos se han perdido a lo largo de la historia. No obstante, en sus obras trasciende una serie de textos que contribuyeron a su formación. En el presente trabajo se analiza La Arcadia, considerada la novela pastoril más erudita del Siglo de Oro, desde la perspectiva de los (...) agentes terapéuticos. En esta obra se mencionan remedios de procedencia herbal, de procedencia mineral y también de procedencia animal. Los resultados confirman que Lope de Vega pudo utilizar una serie de textos científicos en sus citas sobre la materia terapéutica. Entre ellos cabe destacar a Andrés Laguna y su Dioscórides y Plinio el Viejo, cuya Historia Natural pudo haber consultado como fuente primaria, a través de alguna traducción comentada, como la de Gerónimo de Huerta o a través de alguna otra obra basada en ella, como el opúsculo de Constantino Castriota, pues, en este último caso, se encuentran párrafos muy similares y, en algunos casos, casi literales. Nowadays, the true extent of the vast culture of Lope de Vega is still largely unknown. Although it is known that he was a great reader, who bequeathed more than 1500 books, his titles have been lost throughout history. However, a series of texts that contributed to his education become known in his works. In the present paper, La Arcadia, considered the most erudite pastoral romance of Spanish Golden Age, is analyzed from the therapeutic perspective. Remedies of herbal origin, of mineral origin and also of animal origin are mentioned in this novel. The results achieved confirm that Lope de Vega was able to use a series of scientific texts in his quotations on the therapeutic subject. Among them, it is worth mentioning Andres Laguna, and Pliny the Elder, whose Natural History could have been consulted as a primary source, through some commented translation, such as that of Geronimo de Huerta, or through some other work based on it, like Constantino Castriota's opuscule. In the latter case, there are very similar and, in some cases, almost literal paragraphs. (shrink)

This paper develops and defends a new account of therapeutic trust, its nature and its constitutive norms. Central to the view advanced is a distinction between two kinds of therapeutic trust – default therapeutic trust and overriding therapeutic trust – each which derives from a distinct kind of trusting competence. The new view is shown to have advantages over extant accounts of therapeutic trust, and its relation to standard (non-therapeutic) trust, as defended by Hieronymi, Frost-Arnold, and Jones.

The distinction between therapeutic and non-therapeutic research is a familiar one in research ethics. This chapter argues that the term “therapeutic research” is a misnomer. I consider two broad types of ostensibly therapeutic research: controlled trials, and innovative/experimental treatments. I argue that in the former case the term therapeutic research is a misnomer because no reasonable researcher can expect patients/subjects to derive any therapeutic advantage from being entered into an ethically conducted controlled trial. In the latter case, while accepting that (...) there may well be a reasonable expectation of therapeutic benefit from innovative treatments, I argue that the decision whether it is in the interests of a given patient to receive a given treatment is properly made on purely clinical grounds. There is no special feature of the research situation, in either of these types of case, which serves to ensure that participation, qua research subject, is in a patient’s interests. (shrink)

: "Therapeutic misconception" has been misconstrued, and some of the newer, mistaken interpretations are troublesome. They exaggerate the distinction between research and treatment, revealing problems in the foundations of research ethics and possibly weakening informed consent.

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in which (...) only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

Although the therapeutic misconception (TM) has been well described over a period of approximately 20 years, there has been disagreement about its implications for informed consent to research. In this paper we review some of the history and debate over the ethical implications of TM but also bring a new perspective to those debates. Drawing upon our experience of working in the context of translational research for rare childhood diseases such as Duchenne muscular dystrophy, we consider the ethical and legal (...) implications of the TM for parental consent to research. In this situation, it is potentially the parent who is vulnerable to TM. In our analysis we not only consider the context of informed consent for research but also the wider environment in which the value of research is promoted, more broadly through the media but also more specifically through the communication strategies of patient organizations. All dissemination about developments in research for health runs the risk of portraying an overly optimistic view of the promise of biotechnological solutions and has the potential to encourage a ‘collective’ TM. In this paper we consider the challenge that TM presents to parents as well as explore the ethical and legal responsibilities of researchers to ensure an appropriately informed consent: compatible with a hopeful disposition of parents who consent for the their children whilst avoiding a blind and misleading optimism. (shrink)

Adolescents are often an overlooked clinical population. Among school-based practitioners, there is a natural inclination to focus the delivery of mental health services, assessment measures, and intervention plans on younger children, and there is a strong research base to support these programs. On the other hand, the waiting rooms of most practitioners in private practice are filled with young and middle-age adults, couples, or families with young children. Because most therapists do not specialize in working with teens, who might make (...) up only a small portion of their overall caseload, there is a need for high quality, easily implemented activities to help engage with adolescent clients.This book provides an overview of the principles of therapeutic storytelling, developmental issues of adolescents and young adulthood, and their strengths-based model, before moving into a series of chapters devoted to specific issues. Commonly encountered topics such as sexuality, parent & peer relationships, substance abuse, violence & gangs, bereavement, and cultural and religious issues are covered within the chapters. (shrink)

Background and Purpose: Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. Participants and methods: A single-centre opinion survey of (...) healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Results: Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor’s family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient’s care. But more than 75% of respondents think that the advance patient’s consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. Conclusion: The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families’ support. But they ask to require previously expressed patient’s consent and family’s approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are then (...) discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

In the course of the long 18th century, medical theory and theories underwent profound changes. These in turn reflected discontinuities and often conflicting assumptions and premises, engendering divergent concepts of physiology and pathology. However, most theoretical considerations were only very inconsistently and partially reflected in therapeutic practice, which continued to be governed by experience with traditional and known medicinals and by patient expectations regarding provider practices. Additional factors in therapeutic decision making were economic considerations and preferences for particular therapies in (...) certain social and religious networks. The present volume deals with some aspects of this complex relationship between medical theory and therapeutic practice, using a transatlantic perspective. Individual essays reflect the current state of historical research in Germany, the US and Great Britain. (shrink)

La comprensión de la muerte varía según la época, la cultura, la religión y la edad. Con anterioridad al desarrollo que la ciencia médica ha experimentado desde finales del siglo XIX, en la mayoría de las culturas y religiones había una aceptación de la muerte y se consideraba como parte del ciclo vital de la persona donde se trascendía a una forma celestial y puramente sobrenatural. Los avances científicos de la medicina han venido a cambiar esta situación. La muerte se (...) empezó a ver como un enemigo y dio comienzo a una lucha encarnizada entre ambas. El concepto de "muerte natural" se sustituyó por el de "muerte intervenida," dando origen a numerosas cuestiones relacionadas con la toma de decisiones y actuaciones a realizar en pacientes ingresados y en situación terminal. En este trabajo se realiza una reflexión teórica que tiene como objetivo el análisis bioético acerca de las diferencias entre los aspectos religiosos y culturales relacionados con la práctica de la limitación del esfuerzo terapéutico. The understanding of death varies according to time, culture, religion, and age. Previous to the development that medical sciences has undergone since the end of the XIX Century, in most cultures and religions there have been an acceptation of death and considered as part of the person vital cycle in which one would transcend to a celestial and purely supernatural form. The scientific advances in medicine have emerged to change this situation. Death began to be seen as an enemy and gave rise to an enraged struggle between both of them. The concept of natural death was changed into intervened death, which originated numerous related questions with decision and action taking to be performed in hospitalized patients and those in terminal situation. In this work a theoretical reflection is performed whose objective is the bioethical analysis on the differences among religious and cultural aspects related to the practice of therapeutic effort limitation. (shrink)

Use of the imagination is a key aspect of successful psychotherapeutic treatments. Psychotherapy helps clients get in touch with, awaken, and learn to trust their creative inner life, while therapists use their imaginations to mentalise the suffering other and to trace the unconscious stirrings evoked by the intimacy of the consulting room. Working from this premise, in _The Therapeutic Imagination_ _Jeremy Holmes_ argues unashamedly that literate therapists make better therapists. Drawing on psychoanalytic and literary traditions both classical and contemporary, Part (...) I shows how poetry and novels help foster therapists’ understanding of their own imagination-in-action, anatomised into five phases: attachment, reverie, logos, action and reflection. Part II uses the contrast between secure and insecure narrative styles in attachment theory and relates these to literary storytelling and the transformational aspects of therapy. Part III uses literary accounts to illuminate the psychiatric conditions of narcissism, anxiety, splitting and bereavement. Based on Forster’s motto, ‘Only Connect’, Part IV argues, with the help of poetic examples, that a psychiatry shorn of psychodynamic creativity is impoverished and fails to serve its patients. Clearly and elegantly written, and drawing on the author’s deep knowledge of psychoanalysis and attachment theory and a lifetime of clinical experience, _Holmes _convincingly links the literary and psychoanalytic canon. _The Therapeutic Imagination _is a compelling and insightful work that will strike chords for therapists, counsellors, psychoanalysts, psychiatrists and psychologists. (shrink)

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a conversation with (...) a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining and multi-level (...) models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

An ethnographic field study about the informed consent process in investigational drug trials for seriously ill persons with hepatitis C suggests that nurses and physicians referred to these trials as giving treatment, even though they involved placebos. Interview data and informed consent documents contained frequent references to the term `treatment trial' or `treatment'. Although these findings were unexpected and not the original focus of our study, we consider them in the light of an extensive literature on the `therapeutic misconception' that (...) has been described among physicians and patients with AIDS and other serious illnesses. We also suggest that certain organizational and professional characteristics of nursing and medicine reinforce this tendency to refer to the trials as treatment. Implications for further research are provided. (shrink)

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of ‘misunderstandings’ that research participants may have. In this paper, we describe a new concept—therapeutic appropriation. Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an opportunity to enhance patients' (...) clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them. (shrink)

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of contracts, the development (...) of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)

Is it possible to approach quantum theory in a 'therapeutic' vein that sees its foundational problems as arising from mistaken conceptual presuppositions? The book explores the prospects for this project and, in doing so, discusses such fascinating issues as the nature of quantum states, explanation in quantum theory, and 'quantum non-locality'.

Dissecting Bioethics, edited by Tuija Takala and Matti Hayry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly appreciated. To submit a paper or to discuss (...) a suitable topic, contact Tuija Takala [email protected].:This article examines some of the assumptions and implications associated with the Belmont era context in which the concept of therapeutic misconception was forged. We argue that the justification of therapeutic misconception should be reconsidered based on less paternalistic and more participatory models of research. Finally, we identify conceptual and practical approaches that might better reflect contemporary research practice. (shrink)

This article describes the pilot projectShadows&Light Within: Untold Stories—a two-phase, multi-partner community-based project that explores the hypothesis that Autobiographical Therapeutic Performance can help traumatized individuals to improve executive functioning. A group of 10 individuals ranging in age from 32 to 69, with lived experiences at the intersection of trauma, mental health, and the court system, were paired with theater mentor-coaches for a 10-month creative group process, in which they shaped their stories into autobiographical performance pieces, through movement, improvisation, story-telling, and (...) self-discovery. In the second phase of the project, their stories were merged into a theater production, weaving movement, song, and voice, and performed by an ensemble of experienced actors from the community. Pre- and post-interviews and self-report standardized measures of executive functioning were used to assist in establishing criteria and direction for future research. The results suggest that the individuals involved in this pilot may have improved executive functioning and acquired more ability to engage in human service programs designed to increase job readiness and enhance adaptive living skills. (shrink)

This article focuses on two very different thinkers from different periods of time, an early hedonist who belonged to Socrates’ circle and lived until the middle of the fourth century BCE and the late Stoic who ruled the Roman Empire in the second century CE. Despite all substantial divergences – for instance, on the value of pleasure – Aristippus the Elder and Marcus Aurelius shared an interest in presentism, broadly construed as a focus on the present and its primacy, and (...) engaged themselves in exercises regarding the experience of the present. Moreover, in developing their respective positions and the exercises they prescribed, we shall uncover and foreground their essentially therapeutic character. (shrink)

(2002). Therapeutic Beneficence and Patient Recruitment in Randomized Controlled Clinical Trials. The American Journal of Bioethics: Vol. 2, No. 2, pp. 35-36.

Non-therapeutic ventilation of potential organ donors would increase the supply of kidneys for transplantation. There are no major ethical objections to it. The means of permitting it are forbidden by laws with an ethical basis. A law permitting it would need an ethical basis. Introducing a third legal method of diagnosing death would be unethical. Expanding the power of the advance directive to permit procedures involving minimal harm would be ethical but not helpful. Extending the power of proxies to permit (...) specific non-therapeutic procedures which caused or risked minimal harm to incompetent patients is the best way forward. (shrink)

Objectives: Clinical trials in humans in Germany—as in many other countries—must be approved by local research ethics committees . The current study has been designed to document and evaluate decisions of chairpersons of RECs in the problematic field of non-therapeutic research with minors. The authors’ purpose was to examine whether non-therapeutic research was acceptable for chairpersons at all, and whether there was certainty on how to decide in research trials involving more than minimal risk.Design: In a questionnaire, REC chairpersons had (...) to evaluate five different scenarios with non-therapeutic research. The scenarios described realistic potential research projects with minors, involving increasing levels of risk for the research participants. The chairpersons had to decide whether the respective projects should be approved.Methods: A total of 49 German REC chairpersons were sent questionnaires; 29 questionnaires were returned. The main measurements were approval or rejection of research scenarios.Results: Chairpersons of German RECs generally tend to accept non-therapeutic research with minors if the apparent risk for the participating children is low. If the risk is clearly higher than “minimal”, the chairpersons’ decisions differ widely.Conclusion: The fact that there seem to be different attitudes of chairpersons to non-therapeutic research with minors is problematic from an ethical point of view. It suggests a general uncertainty about the standards of protection for minor research participants in Germany. Therefore, further ethical and legal regulation of non-therapeutic research with minors in Germany seems necessary. (shrink)

ABSTRACTBased on the case of Rosa, a nine‐year‐old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an ample (...) use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity. (shrink)

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

This essay contends that God created humanity as His co-creators to bring Him glory with one’s entire being, including imagination and creativity. Throughout Scripture, YHWH is depicted as the artistic Creator of all that is beautiful, true, and transcendent. The Bible attests the creation of humanity in the imago Dei--sharing God’s innate creativity--and divine gifting of Spirit-inspired artisans utilizing their talents for God’s glory. Yet, over the centuries, “art” was oft misunderstood and grossly neglected in Christ’s church. Philip Ryken explains (...) how medieval skeptics began removing and destroying art believed to violate the Decalogue. Imbalanced suspicions toward art in Christendom still persist, despite the positive, inspirational effects of icons in Catholic and Orthodox traditions and scientific research that shows the therapeutic value of art across a broad spectrum of mental and physical challenges, including isolation and depression. Makoto Fujimura posits that Christian creatives possess a common faith as “border-walkers,” and can affect phoenix-like positive cultural and ecclesial change by reintroducing beauty as a visible “sermon” into a fragmented, post-pandemic world. (shrink)

I argue that in recent years, the therapeutic ethos and the ideal of authenticity have become aligned with distinctively neo-liberal notions of personal responsibility and self-reliance. This situation has radically exacerbated the threat to political community that Charles Taylor saw in the ‘ethics of authenticity’. I begin by tracing the history of the therapeutic ethos and its early (Rieff, Lasch, MacIntyre) and late (Furedi) critics. I then discuss Charles Taylor’s argument that the culture of self-fulfillment generated by the therapeutic ethos (...) harbors an important moral ideal, namely, the ethic of authenticity. Pace Taylor, I argue that authenticity has now become thoroughly instrumentalized in the service of the guiding political rationality of neo-liberalism. I make this case through a discussion of its uptake in managerial techniques and practices and also in popular culture. (shrink)

ArgumentThis essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, and clinicians. (...) It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called “bacteriological medicine,” tuberculin, in 1890. (shrink)

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and (...) the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process. (shrink)