Through a fieldwork study of the practice of methadone substitution at a French addiction clinic, the classic ‘theory of action’ is criticized and an alternative one proposed. A sketch of the debates among French drug specialists, drug users and legislators shows the pertinence for these practitioners of such a theoretical question; further, the ethnographic data suggest that they can be seen as actually trying out an alternative to this ‘theory of action’.

Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt (...) to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non-consensual. We argue that non-consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non-consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices. (shrink)

Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies. Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification (...) for current policies of forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries. (shrink)

Concerns that cash payments to people who inject drugs (PWID) to reimburse research participation will facilitate illicit drug purchases have led some ethical authorities to mandate department store/supermarket vouchers as research reimbursement. To examine the relative efficacy of the two forms of reimbursement in engaging PWID in research, clients of two public opioid substitution therapy clinics were invited to participate in a 20–30 min, anonymous and confidential interview about alcohol consumption on two separate occasions, 4 months apart. Under (...) the crossover design, at Time 1, clients of Clinic 1 were offered $A20 cash as reimbursement, while clients of Clinic 2 were offered an $A20 voucher; at Time 2, the form of reimbursement was reversed. Using clinic records to determine the denominator (number of clients dosed), we found that compared with clients offered a voucher, a significantly higher proportion of clients who were offered cash participated in the survey (58% (139/241) vs 74% (186/252); χ2=14.27; p=0.0002). At first participation, respondents most commonly reported planning to purchase food/drinks/groceries (68%), cigarettes (21%) and transport/fuel (11%) with their payments, with those reimbursed in cash more likely to report planning to fund transport/fuel (19% vs 1%; p<.01) and less likely to report planning to purchase food/drinks/groceries (62% vs 76%; p=0.02). Just three out of 155 cash participants reported planning to purchase illicit drugs with their payment. Results demonstrate that modest cash payments enhanced recruitment of this group, an important consideration given the challenges of delineating the parameters of a population defined by illegal activity, seemingly without promoting excessive additional drug use. (shrink)

The increased incidence of morbidity and mortality due to Clostridium difficile infection, had led to the emergence of fecal microbial transplantation (FMT) as a highly successful treatment. From this, a 32 strain stool substitute has been derived, and successfully tested in a pilot human study. These approaches could revolutionize not only medical care of infectious diseases, but potentially many other conditions linked to the human microbiome. But a second revolution may be needed in order for regulatory agencies, society and medical (...) practitioners to accept and utilize these interventions, monitor their long term effects, have a degree of control over their use, or at a minimum provide guidelines for donors and recipients. (shrink)

Certamente, desde que o ser humano existe, a vida nunca esteve isenta de manipulação técnica. Todavia, formas recentes de biotecnologia vão mais longe, tendendo a tornar indiscernível as distinções clássicas entre crescimento natural e produção artificial. Ars sive natura, este poderia ser o novo slogan. Neste sentido, em oposição à bioética corrente que tenta compensar o monismo tecnológico através de um dualismo prático, discutiremos a idéia de que, quando age sobre o Outro (Fremdeneinwirkung), a biotecnologia nunca é puramente técnica, sendo (...) imediatamente prática, ética e política. Por outro lado, confrontada com novos desafios tecnológicos, a fenomenologia necessita assumir certas características de fenomenotecnologia; ações não são nunca meramente práticas. Uma tal combinação entre fenomenologia e fenomenotecnologia abre especiais perspectivas no que diz respeito ao trato da questão da vida humana. Primeiramente, descreveremos o eu corporal como gerador de sua própria história, na medida que evidencia graus de identidade e se constitui como altamente vulnerável. Em segundo lugar, distinguiremos entre a atitude técnica, restrita ao fato de que algo se modifica, e a atitude terapêutica, que se dirige a alguém que sofre: o paciente. A seguir, ultrapassaremos os limites do enquadramento clínico ao considerar novas conquistas no que diz respeito à produção da vida (por exemplo, clonagem e manipulação genética). Antes de simplesmente argumentar pró ou contra, temos de indagar o que significa produzir um eu vivo. Neste contexto, o tempo da poiesis será contrastado com o do pathos. Examinaremos o lugar desde o qual um ser vivo ou pessoal pode ser definido como alguém em si, e pretendemos tencionar simultaneamente o caráter paradoxal de atribuição de um eu ao Outro (Fremdezuschreibung), que assemelha-se ao paradoxo de ter a experiência do Outro como Outro (Fremderfahrung). Pois a pré-história e a pós-história de um alguém específico, incluindo nascimento e morte, é apenas acessível a nós em termos de substituição. Reduzidos a conjuntos de células, seres humanos seriam liberados de tudo isto. Restaria algo sobre o que falamos, mas de modo algum alguém falando a nós. PALAVRAS-CHAVE – Biotecnologia. Terapia. Fenomenologia. Fenomenotecnologia. ABSTRACT Certainly, as long as human beings exist, life has never been exempt from technical manipulations. However, recent forms of biotechnology go further, tending to blur the classical distinction between natural growth and artificial production. Ars sive natura, that may be the new slogan. Now, in opposition to current bioethics which try to compensate the technological monism by means of a practical dualism, we will argue that by acting upon the Other (Fremdeinwirkung) biotechnology is never purely technical, it is immediately practical, ethical and political. On the other side, faced with new technological challenges, phenomenology needs certain features of phenomenotechnology; actions are never merely practical. Such an intertwining of phenomenology and phenomenotechnology opens up special perspectives in dealing with the issue of human life. Firstly, we will describe the bodily self as generating its own history, as showing grades of selfhood and as being highly vulnerable. Secondly, we will distinguish between the technological attitude, restricted on something to be changed, and the therapeutic attitude, addressed to somebody suffering, namely the patient. In the end, we cross the limits of the clinical frame by considering new attempts of life production (e.g. cloning and gene manipulation). Before simply arguing pro and con we have to ask what does it mean to produce a living self. In this context the time of poiesis will be contrasted with the time of pathos. We will examine the place from where a living or personal being may be defined as somebody in itself, and we will simultaneously stress the paradoxical character of ascribing the status of a self to the Other (Fremdzuschreibung), which resembles the paradox of experiencing the Other as an Other (Fremderfahrung). At last, the pre-history and the post-history of a oneself, including birth and death, is only accessible for us by means of substitution. Reduced to cell ensembles, human beings would get rid of all that. There would be left something we speak about, but by no means somebody speaking to us. KEY WORDS – Biotechnology. Therapy. Phenomenology. Phenomenotecnology. (shrink)

Obwohl die Substitutionsbehandlung nachweislich den Gesundheitszustand opiatabhängiger Patienten verbessern und die Beschaffungskriminalität reduzieren kann, bestehen enge gesetzliche Regelungen, die die Therapiefreiheit der behandelnden Ärzte stark begrenzen: So werden durch das Betäubungsmittelgesetz und die zugehörigen Verordnungen nicht nur das Behandlungsziel (Abstinenz) sondern auch notwendige Therapiebausteine definiert, die darauf ausgerichtet sind, die Therapietreue des Patienten zu kontrollieren. Deutsche Ärzte, die die strengen Auflagen nicht strikt befolgten, wurden zu Gefängnisstrafen verurteilt. Wie der Artikel zeigt, fördern die bestehenden Gesetze eine „kontrollierende“ statt einer motivierenden (...) ärztlichen Behandlung, ohne wichtige Ziele, wie den Schutz der Allgemeinheit vor einer illegalen Verbreitung illegaler Opioide, vollständig zu erreichen. Zusammenfassend zeigt der Artikel, dass eine stärker am Wohl der Patienten ausgerichtete Substitutionsbehandlung (einschließlich notwendiger Kontrolluntersuchungen) mit hoher Wahrscheinlichkeit auch die Öffentlichkeit wirksamer vor den potenziellen Gefahren einer illegalen Verbreitung von gefährlichen Opioiden schützt als die Befolgung abstrakter, restriktiver gesetzlichen Normen. (shrink)

The 20th century saw a profound change to the model of humanity commonly accepted in the West. At the start of the century the tripartite model of personhood included the components of mind, body and soul, or the physical, mental and moral/spiritual aspects of being. By the end of the century, this had changed to physical, mental and emotional. This substitution of 'emotional' for 'moral' has had profound effects, not the least on teaching. The effects have included alterations to (...) the content of education, including the introduction of programs to preserve/promote children's self esteem, and interest in topics such as 'emotional intelligence'. Also affected, however, has been how teaching itself is conceptualised. This paper will consider some of these effects and their consequences for teaching and teachers. (shrink)

Although many philosophers have, throughout history, regarded themselves as answering the skeptic, the question arises whether answering the skeptic is the thing to do. If not, the question becomes how else to respond to her. Wittgenstein-inspired stances are, in general, therapeutic. In this article I focus on the problem of other minds in order to analyze and compare the different shapes such therapeutic stances may have. I begin by showing how crucial resisting the temptation to answer the skeptic was for (...) John McDowell’s early formulations of disjunctivism in the 1980s. In his article “Criteria, Defeasibility, and Knowledge” I identify substantial positions such as the rejection of highest common factor views, the diagnosis of the connection between such highest common factor views and an conception of appearances, as well as the proposal of a non-Cartesian, or modest, approach to indistinguishability for a subject. Whatever his success in these other enterprises, McDowell continues to regard both the temptation to answer the skeptic and a substitute therapeutic stance as epistemologically motivated. But if skepticism is more than an intellectual conundrum, as maintained by Stanley Cavell, the source of such temptation has to be considered in a completely different light. (shrink)

Sedlakova and Trachsel (2023) discuss the ethical concerns associated with employing what they term conversational artificial intelligence as therapist substitutes. Given their apprehensions, they...

Meat consumption has long been a staple in China, but its environmental and social impacts have prompted the development of a market for meat substitutes. However, the question remains whether meat substitutes can coexist with traditional food culture in the context of sustainable development. To address this issue, the researchers used a mixed methods approach to examine the factors influencing Chinese consumers' purchase intentions for meat substitutes. This study conducted an online survey to explore the demographic characteristics of Chinese consumers (...) who are more likely to purchase meat substitutes. The online survey focused on environmental factors such as greenhouse gas emissions (GHGs), animal welfare, energy efficiency, and waste. Differences in the intention to purchase meat substitutes across various groups were compared using a Chi-square test. The results showed that women were more likely to buy meat alternatives for environmental sustainability, over half of the vegetarians were willing to purchase plant-based meat to reduce GHG emissions, and over a quarter of younger respondents were ready to buy cultured meat to minimize waste. Nearly a third of higher-income earners were willing to purchase cultured meat to protect animal welfare. Furthermore, the study conducted in-depth interviews with experts from various industries to explore consumer perceptions of meat alternatives. Text analysis revealed factors that motivate or discourage consumers from purchasing meat alternatives, such as traditional Chinese medicine, food therapy, masculinity, and other socio-cultural factors. The study highlights the complex interplay of cultural, environmental, and social factors that shape Chinese consumers' attitudes toward meat alternatives, providing new insights into the future of sustainable meat. (shrink)

This paper discusses the meaning that interactive software agents and robots have in the context of mental therapy. This theoretical discussion is undertaken from a psychological and sociological perspective. It investigates what happens when interactive agents are introduced into current social situations. Methods of mental therapy vary from therapeutic conversation between clients and human therapists to interaction between clients and therapeutic animals such as dogs. This paper focuses on applications of interactive software agents and robots that substitute as (...) autonomous artifacts behaving like humans for human therapists. In addition, some implications and policies for applications of interactive software agents and robots in mental therapy are discussed. (shrink)

The question of whether it is permissible to deactivate a pacemaker at the end of life has been addressed in medical journals but rarely in ethics journals. The ethics of pacemaker deactivation is especially challenging because of the disparate ways the devices are viewed by both medical professionals and patients. Some consider pacemakers replacement therapy, and some consider them substitutive therapy. If they are the former, then deactivation would not be permitted, since a replacement device is considered a (...) part of the body, akin to a new heart. Some ask whether pacemakers are natural or artificial; if pacemakers are artificial, deactivation would be permissible. Another factor is whether a patient is pacemaker dependent. Some medical experts decide the issue of deactivation on the basis of patient autonomy. Others weigh in on whether pacemakers are ordinary or extraordinary means of care. This paper examines each proposal and concludes tentatively that pacemaker deactivation is not permissible at the end of life. National Catholic Bioethics Quarterly 15.1 : 39–51. (shrink)

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and in each case we discuss (...) the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass. (shrink)

Novel therapies resulting from regenerative medicine and tissue engineering technology may offer new hope for patients with injuries, end-stage organ failure, degenerative disorders and many other clinical issues. Currently, patients suffering from diseased and injured organs are treated with transplanted organs. However, there is a shortage of donor organs that is worsening yearly as the population ages and new cases of organ failure increase. Scientists in the field of regenerative medicine and tissue engineering are now applying the principles of cell (...) transplantation, material science, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased and injured tissues. In addition, the stem cell field is a rapidly advancing part of regenerative medicine, and new discoveries in this field create new options for this type of therapy. For example, new types of stem cells, such as amniotic fluid and placental stem cells, that can circumvent the ethical issues associated with embryonic stem cells have been discovered. The process of somatic cell nuclear transfer and the creation of induced pluripotent cells provide still other potential sources of stem cells for cell-based tissue engineering applications. While stem cells are still in the research phase, some therapies arising from tissue engineering endeavors that make use of autologous, adult cells have already entered the clinical setting, indicating that regenerative medicine holds much promise for the future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in a (...) controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (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)

One objection to enhancement technologies is that they might lead us to live inauthentic lives. Memory modification technologies (MMTs) raise this worry in a particularly acute manner. In this paper I describe four scenarios where the use of MMTs might be said to lead to an inauthentic life. I then undertake to justify that judgment. I review the main existing accounts of authenticity, and present my own version of what I call a “true self” account (intended as a complement, rather (...) than a substitute, to existing accounts). I briefly describe current and prospective MMTs, distinguishing between memory enhancement and memory editing . Moving then to an assessment of the initial scenarios in the light of the accounts previously described, I argue that memory enhancement does not, by its very nature, raise serious concerns about authenticity. The main threat to authenticity posed by MMTs comes, I suggest, from memory editing. Rejecting as inadequate the worries about identity raised by the President’s Council on Bioethics in Beyond Therapy , I argue instead that memory editing can cause us to live an inauthentic life in two main ways: first, by threatening its truthfulness, and secondly, by interfering with our disposition to respond in certain ways to some past events, when we have reasons to respond in such ways. This consideration allows us to justify the charge of inauthenticity in cases where existing accounts fail. It also gives us a significant moral reason not to use MMTs in ways that would lead to such an outcome. (shrink)

Paul E. Meehl and B. F. Skinner, two of the foremost psychological theorists of the 20th century, overlapped at the University of Minnesota in the early 1940s when Skinner was a faculty member and Meehl was a graduate student. Though Skinner was well aware of, and influenced by, early 20th century physiology, he eschewed reductionism, developing his analysis of behavior without reference to concepts at another level of analysis. Meehl's theoretical approach transcended levels of analysis, drawing upon data and concepts (...) from genetics, neuroscience, and psychology. In this paper the functional components of Meehl's (1990) "Toward an Integrated Theory of Schizotaxia, Schizotypy, and Schizophrenia" paper are re-formulated substituting autism as the condition of interest. Skinner's and Meehl's theoretical frameworks are integrated with recent findings in genetics and neuroscience in an attempt to better understand the reasons why Intensive Early Behavior Therapy (IEBT) provided to children with Autism Spectrum Disorders produces enduring improvements in social, language, and cognitive functioning. (shrink)

Congenital nystagmus in infants and young children can lead to early blindness. Previous neuroimaging studies have demonstrated that EB is accompanied by alterations in brain structure and function. However, the effects of visual impairment and critical developmental periods on brain functional connectivity at rest have been unclear. Here, we used the voxel-wise degree centrality method to explore the underlying functional network brain activity in adolescents with EB. Twenty-one patients with EBs and 21 sighted controls underwent magnetic resonance imaging. Differences between (...) the two groups were assessed using the DC method. Moreover, the support vector machine method was used to differentiate patients with EB patients from the SCs according to DC values. Compared with the SCs, the patients with EB had increased DC values in the bilateral cerebellum_6, cerebellum vermis_4_5, bilateral supplementary motor areas, and left fusiform gyrus; the patients with EB had decreased DC values in the bilateral rectal gyrus and left medial orbital frontal gyrus. The SVM classification of the DC values achieved an overall accuracy of 70.45% and an area under the curve of 0.86 in distinguishing between the patients with EB and the SCs. Our study may reveal the neuromechanism of neuroplasticity in EB; the findings provide an imaging basis for future development of restorative visual therapies and sensory substitution devices, and future assessments of visual rehabilitation efficacy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to Byrnes and FurtonMark T. Brown, Ph.D.In “Moral Complicity in Induced Pluripotent Stem Cell Research” (MCIPS) (Brown 2009), I sketched the moral complicity implications of alternative national stem cell policies with respect to direct reprogramming techniques that appear to result in pluripotent stem cells derived from skin cells, hair cells, and possibly other somatic cells. This aspect of the stem cell debate was considered from the perspective of (...) those who are pro embryo life and who attribute to human embryos a complete set of basic human rights, including a stringent right to life; and from the perspective of advocates of embryonic stem cell research who do not recognize full moral equivalence between human embryos and human children and who do not ascribe to human embryos an inviolable right to life. The moral complicity concerns of embryonic stem cell research advocates focus upon the scope of medical beneficence with respect to patients whose quality of life and personal autonomy are negatively impacted by the interval between the time when they might have gotten effective medical treatment through unimpeded stem cell science and the time at which stem cell science constrained by pro embryo life moral complicity concerns arrives at a similar destination. The moral complicity concerns of embryo life proponents focus upon noncooperation in past and future destruction of human embryos in order to derive in vitro embryonic stem cell lines.Among the policy alternatives considered were proposals that would be responsive to the possibility that induced pluripotent stem cells (iPSC) at some point may provide a source of stem cell lines that would substitute for human embryonic stem [End Page 206] cell (hESC) lines in cell replacement therapy. If functional equivalence between iPSC lines and hESC lines for cell replacement purposes were confirmed, a national stem cell research policy might be crafted that could accommodate the central moral complicity concerns both of persons who are embryo life advocates and of advocates of embryonic stem cell research. Policy alternatives considered in MCIPS included those based upon the assumption that currently existing embryonic stem cell lines are sufficient to conduct iPSC/hESC functional equivalence studies and policy options based upon the assumption that currently existing hESC lines fall short of what would be required for methodologically sound validation studies. The moral complicity implications for those who are embryo life advocates of both sets of policies were outlined, as were the moral complicity implications of alternative policies for embryonic stem cell research advocates. Since moral complicity concerns are one factor that those who formulate national stem cell policy should consider, MCIPS was an attempt to provide some guidance to policymakers with respect to how alternative policies accommodate or fail to accommodate the moral complicity concerns of various constituencies.In a 2008 article, Malcolm Byrnes (2008, p. 286) appears to consider both empirical assumptions regarding the sufficiency of existing stem cell lines for meaningful functional equivalence studies, and for that reason I drew upon his paper to frame the moral complicity implications for advocates of embryo life of national stem cell policy based upon either assumption. In his paper, Byrnes refers both to stem cell scientists who “suggest” that the hESC lines approved by President Bush in 2001 are sufficient and to stem cell scientists who believe that more hESC lines are needed. Based on my reading of his paper, I erroneously included Byrnes in the group who were willing to consider new hESC derivations in order to complete functional equivalence studies. However, my description of the moral complicity implications for advocates of embryo life of policies that enable new hESC derivations was an exercise in contingency planning, and certainly not intended as “a condemnation” of Byrnes (2009, p. 203). Similarly, what Byrnes (2009, p. 204) sees as “ironic” is simply a description later in my paper of policy options based upon an alternative factual assumption.Byrnes’s position seems to be that existing hESC lines are sufficient to conduct iPSC/hESC functional equivalence studies and that no additional hESC lines should be derived. Although it appears that I did mischaracterize Byrnes’s view of the permissibility of deriving additional hESC lines for equivalence studies, I think my interpretation was... (shrink)

Clinical emergencies necessitate immediate action to avert the danger to the patient's life or health. Emergency patients might be in greatest need of novel therapies, and even presumed willing to assume some risk, but research into emergency conditions should be conducted under commonly accepted principles that fulfil the scientific, ethical, and legal criteria. Such criteria already exist in the US, but are still under development in Europe.This article introduces criteria upon which trials in emergency settings may be ethically and legally (...) justified in Europe. Based on both legal texts and professional guidelines, the author has established seven conditions for emergency research, of which informed consent and its substitutes, as well as the conditions of direct benefit requirement and necessity, are considered most problematic and therefore analysed more closely. Other conditions include absence of alternative methods, scientific validity, and approval by an ethics committee. (shrink)

Unrepresented patients are individuals who lack decision makingcapacity and have no family or friends to make medical decisions for them. This population is growing in number in the United States, particularly within emergency and intensive care settings. While some bioethical discussion has taken place in response to the question of who ought to make decisions for these patients, the issue of how surrogate medical decisions ought to be made for this population remains unexplored. In this paper, we argue that standard (...) applications of surrogate decision making principles in health care are not well suited to many unrepresented patients with long-term mental health diagnosis. We argue that when applied to this population, the substituted judgment standard, designed to preserve patient preferences and values, may lead to the exclusion of their preferences. We argue further that the application of the best interest standard runs the risk of leading to harmful cases of overtreatment or undertreatment. We offer an alternative interpretation of the best interest principle that is better able to promote the well-being of unrepresented patients, especially for those who lack capacity because of mental disorders. This alternative is based on the practices and principles of harm reduction and includes three components: emphasis on considering the expressed preferences of unrepresented patients, a focus on reducing harm as well as the delivery of clinical benefits, and a recognition of the importance of promoting trust. (shrink)

As soon as Rabbi Shneur Zalman of Liadi (the Baal HaTanya) formulated his method of self-mastery, more than two hundred years ago, it spread like wildfire. Within a few years, thousands had knocked on his door to get "therapy" with individually tailored advice for various emotional challenges. The Tanya was compiled over a twenty-year period to present a comprehensive framework that would serve as a substitute for a face-to-face encounter and last for generations to come. Rabbi Shneur Zalman's method (...) sees a person as locked in a lifelong internal struggle. The mission of life is to win the struggle in the present moment. This optimistic attitude toward the human psyche - and the claim that at any moment one can be victorious in the day's struggles - has captivated hearts for centuries and is here available to the modern reader in a down-to- earth presentation. Winning Every Moment enables the reader to develop an intimate spiritual conversation with the great master of Jewish psychology. Through this soul conversation with the Baal HaTanya, you are invited to know yourself and your inner powers. (shrink)

Touch is the first sense to develop in the womb, yet often it is overlooked. The Senses of Touch examines the role of touching and feeling as part of the fabric of everyday, embodied experience. -/- How can we think about touch? Problems of touch and tactility run as a continuous thread in philosophy, psychology, medical writing and representations in art, from Ancient Greece to the present day. Picking through some of these threads, the book ‘feels’ its way towards writing (...) and thinking about touch as both sensory and affective experience. -/- Taking a broadly phenomenological framework that traces the tactility from Aristotle through the Enlightenment to the present day, it examines the role of touch across a range of experiences including aesthetics, digital design, visual impairment and touch therapies. The Senses of Touch thereby demonstrates the varieties of sensory experience, and explores the diverse range of our ‘senses’ of touch. (shrink)

First published in 1977, Emotion, Thought and Therapy is a study of Hume and Spinoza and the relationship of philosophical theories of the emotions to psychological theories of therapy. Jerome Neu argues that the Spinozists are closer to the truth; that is, that thoughts are of greater importance than feelings in the classification and discrimination of emotional states. He then contends that if the Spinozists are closer to the truth, we have the beginning of an argument to show (...) that Freudian or analytic therapies make philosophic sense. Throughout the book, careful attention is paid to modern discussions in philosophy of mind and psychology, and materials from anthropology and other relevant disciplines are considered. At the centre of the discussion is the notion of ‘thought-dependence’. Therapies for psychological disorders are placed along a spectrum in accordance with the role they assign to thoughts. The Spinozist view of the emotions can be seen as at the extreme thought end of a corresponding spectrum of theories of the emotions. The book suggests that this stream may help explain the spectrum of therapeutic theories and the possibilities that exist for psychological development and change. This book will be of interest to students of philosophy, psychology and counselling. (shrink)

Therapists and related theorists and practitioners of mental health tend to hold one of two broad views about how to help patients. On the one hand, some maintain that, or at least act as though, the basic point of therapy is to help patients become clear about what they want deep down and to enable them to achieve it by overcoming mental blockages. On the other hand, there are those who contend that the aim of therapy should instead (...) be to psychologically enable patients to live objectively desirable lives, say, ones that involve developing their inherent talents or exhibiting an authentic/strong/integrated self. In this chapter, I argue that neither of these prominent approaches is complete. Contra the former, sometimes what patients want deep down is not something to promote, and, against the latter, it can sometimes be reasonable for patients to want to sacrifice their own objective interests and for therapists to assist them in this regard. I argue that the category of meaningfulness does well at accounting for these counterexamples to the two dominant approaches, while capturing the kernels of truth in them. The proper aim of therapy, I suggest, is to enable patients to live meaningfully. (shrink)

We show that, contrary to conventional wisdom, Frege’s distinction between sense and reference does not reconcile a classical logic of identity with apparent counterexamples to it involving proper names embedded under propositional attitude verbs.

In this report, the phenomenology of two blind users of a sensory substitution device – “The vOICe” – that converts visual images to auditory signals is described. The users both report detailed visual phenomenology that developed within months of immersive use and has continued to evolve over a period of years. This visual phenomenology, although triggered through use of The vOICe, is likely to depend not only on online visualization of the auditory signal but also on the users’ previous (...) (albeit distant) experience of veridical vision (e.g. knowledge of shapes and visual perspective). Once established, the sensory substitution mapping between the auditory and visual domains is not confined to when the device is worn and, thus, may constitute an example of acquired synaesthesia. (shrink)

Assessing the risk-benefit ratio has always been considered key in designing clinical trials. These benefits can be diverse and may include social value and psychological benefits. When it comes to...

According to proponents of the sensorimotor contingency theory of perception (Hurley & Noë 2003, Noë 2004, O’Regan 2011), active control of camera movement is necessary for the emergence of distal attribution in tactile-visual sensory substitution (TVSS) because it enables the subject to acquire knowledge of the way stimulation in the substituting modality varies as a function of self-initiated, bodily action. This chapter, by contrast, approaches distal attribution as a solution to a causal inference problem faced by the subject’s perceptual (...) systems. Given all of the available endogenous and exogenous evidence available to those systems, what is the most probable source of stimulation in the substituting modality? From this perspective, active control over the camera’s movements matters for rather different reasons. Most importantly, it generates proprioceptive and efference-copy based information about the camera’s body-relative position necessary to make use of the spatial cues present in the stimulation that the subject receives for purposes of egocentric object localization. (shrink)

The aim of this paper is to study the n-variable fragment of first order logic from a modal perspective. We define a modal formalism called cylindric mirror modal logic, and show how it is a modal version of first order logic with substitution. In this approach, we can define a semantics for the language which is closely related to algebraic logic, as we find Polyadic Equality Algebras as the modal or complex algebras of our system. The main contribution of (...) the paper is a characterization of the intended ‘mirror cubic’ frames of the formalisms and, a consequence of the special form of this characterization, a completeness theorem for these intended frames. As a consequence, we find complete finite yet unorthodox derivation systems for the equational theory of finite-dimensional representable polyadic equality algebras. (shrink)

Seidenfeld (Seidenfeld, T. [1988a], Decision theory without 'Independence' or without 'Ordering', Economics and Philosophy 4: 267-290) gave an argument for Independence based on a supposition that admissibility of a sequential option is preserved under substitution of indifferents at choice nodes (S). To avoid a natural complaint that (S) begs the question against a critic of Independence, he provided an independent proof of (S) in his (Seidenfeld, T. [1988b], Rejoinder [to Hammond and McClennen], Economics and Philosophy 4: 309-315). In reply (...) to my (Rabinowicz, W. [1995], To have one's cake and eat it too: Sequential choice and expected-utility violations, The Journal of Philosophy 92: 586-620), in which I argue that the proof is invalid, Seidenfeld (Seidenfeld, T. [2000], Substitution of indifferent options at choice nodes and admissibility: A reply to Rabinowicz, Theory and Decision 48: 305–310 this issue) submits that I fail to give due consideration to one of the underlying assumptions of his derivation: it is meant to apply only to those cases in which the agent's preferences are stable throughout the sequential decision process. The purpose of this note is to clarify the notion of preference stability so as meet this objection. (shrink)

How we narrate our lives can affect us, for good or ill. Our narrative practices make an undeniable difference to our psychosocial well-being. All so-called "talking cures" – including traditional psychoanalytic and psychodynamic approaches to therapy and newer techniques – are motivated by this insight about the power of personal narratives. All therapies of the discursive ilk make use of narratives, in one way or another, as a means of enabling individuals to frame, or reframe, and to manage their (...) life circumstances in richer or new ways.Narrative Therapy, an important sub-class of talking therapies, breaks faith with more traditional psychodynamic approaches in adopting a... (shrink)

Pt. I. Philosophy and cognitive-behavioral therapy (CBT) -- Ch. 1. The "philosophical origins" of CBT -- Ch. 2. The beginning of modern cognitive therapy -- Ch. 3. A brief history of philosophical therapy -- Ch. 4. Stoic philosophy and psychology -- Ch. 5. Rational emotion in stoicism and CBT -- Ch. 6 Stoicism and Ellis's rational therapy (REBT) -- Pt. II. The stoic armamentarium -- Ch. 7. Contemplation of the ideal stage -- Ch. 8. Stoic mindfulness (...) of the "here and now" -- Ch. 9. Self-analysis and disputation -- Ch. 10. Autosuggestion, premeditation, and retrospection -- Ch. 11. Preditatio malorum and mental rehearsal -- Ch. 12. Stoic fatalism, determination, and acceptance -- Ch. 13. The view from above and stoic metaphysics. (shrink)

The purpose of the study is to analyze the processes of implementing the import substitution policy, based on the use of techniques and methods of influencing participants in market relations used by public authorities, which make it possible to identify its strengths and weaknesses and build the author's vision of directions for its stabilization. The authors focus on the prevailing opinion on the phased implementation of the import substitution policy, as well as on its application as a retaliatory (...) measure to the current sanctions regimes. The analysis of scientific sources on the issues under study allows us to draw a conclusion about its special status as a tool for the development of territories. The scientific novelty of the article lies in the author's position of the reasons for the reduction in the production of the main import-substituting food products, as well as changes in the import supply of food products. As a result, the authors expressed the need to change the approaches used to stimulate the production of food products based on the principles of innovation and science. (shrink)

What if a blind person could 'see' with her ears? Thanks to Sensory Substitution Devices (SSDs), blind people now have access to out-of-reach objects, a privilege reserved so far for the sighted. In this paper, we show that the philosophical debates have fundamentally been mislead to think that SSDs should be fitted among the existing senses or that they constitute a new sense. Contrary to the existing assumption that they get integrated at the sensory level, we present a new (...) thesis according to which they are not sensory, and get vertically integrated on the top of existing sensory abilities, from which they should be theoretically distinguished. (shrink)

Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has (...) been initiated entails a claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to (...) consent to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified. (shrink)

This is a study of the way in which Levinas approaches the experience of human expression from two perspectives: firstly, as a pre-thematic or pre-cognitive “experience,” which requires that he revisit Husserl's pre-objective intentionality and explore the relationship between the upsurge of sensation and its “intentionalization” as consciousness self-temporalizing. Thereafter, Levinas must contend with the implications of his own writing, which includes his claims for the face. This implies that he must grapple with criticism to the effect that he is (...) providing a hermeneutics of face-to-face encounters. Levinas acknowledges that his writing is a “dramatique des phénomènes” and not a phenomenology of actions. How, then, to avoid charges of arbitrary description? How to step outside the primordiality of “the phrase” or the conceptualization that threatens claims to “pure” phenomenology? This is really what is at stake in Levinas's second great work. In this essay, I explore the role that “substitution” plays in weaving together conceptuality and phenomenality. I contrast this with other forms of “dramatization,” from narrative witnessing, to minimalist sculpture. (shrink)