Abstract: This working paper focuses on the question whether there is a therapeutic imperative that, in specific situations, would oblige us to perform genome editing at the germline level in the context of assisted reproduction. The answer to this central question is discussed primarily with reference to specific scenarios where preimplantation genetic diagnosis (PGD) does not represent an acceptable alternative to germline genome editing based on either medical, or ethical, or – from the perspective of the potential parents (...) – moral or religious grounds. This article deals with four different types of case constellations that result from these possible reasons against PGD as well as from the necessity or dispensability of a subsequent “control PGD.” These cases are discussed based on hypotheses concerning contextual factors and theoretical assumptions. In conclusion, we point out that if our assumptions are correct, there is probably no therapeutic imperative for genome editing at the germline level. We draw this rationale from the fact that germline interventions are likely not person-affecting. However, we caution the reader that our result is preliminary and needs to be more carefully examined in future work in light of the bioethical debate and potential objections. -/- // Abstract: Im Zentrum dieses Working Papers steht die Frage, ob es einen therapeutischen Imperativ geben kann, der uns, in bestimmten Situationen, verpflichten würde, eine Genomeditierung (genome editing) auf Keimbahnebene im Rahmen der assistierten Befruchtung vorzunehmen. Die Antwort auf diese zentrale Frage wird insbesondere mit Bezug auf Fälle diskutiert, in denen das Verfahren der Präimplantationsdiagnostik (PID) keine aus entweder medizinischen oder ethischen oder – aus Sicht der potentiellen Eltern – moralischen bzw. religiösen Gründen akzeptable Alternative zu einem Keimbahneingriff darstellt. Die möglichen Gründe gegen die PID sowie die Erforderlichkeit oder Verzichtbarkeit einer nachfolgenden «Kontroll-PID» ergeben vier verschiedene Fallkonstellationen, denen sich der Beitrag zuwendet. Auf Grundlage von Hypothesen zu kontextuellen Faktoren und theoretischen Annahmen diskutieren wir diese Fälle. Im Ergebnis verweisen wir darauf, dass es, wenn unsere Annahmen zutreffen, vermutlich keinen therapeutischen Imperativ zum genome editing auf Keimbahnebene gibt. Dies begründet sich daraus, dass der Keimbahneingriff vermutlich nicht als personenbezogen (person-affecting) zu bezeichnen ist. Wir weisen jedoch darauf hin, dass unser Ergebnis vorläufig ist und unter Berücksichtigung der bioethischen Debatte und möglicher Einwände genauer geprüft werden muss. -/- // Résumé: Ce Working Paper se concentre sur la question de l’existence d’un impératif thérapeutique qui, dans des situations spécifiques, nous obligerait à réaliser une édition du génome au niveau de la lignée germinale dans le cadre de la procréation assistée. Afin de répondre à cette question centrale nous développons quatre scénarios spécifiques dans lesquels le diagnostic préimplantatoire (DPI) ne représente pas une alternative acceptable à l’édition du génome germinal pour des raisons médicales, éthiques ou – du point de vue des futurs parents – morales ou religieuses. Cet article traite de quatre constellations différentes de cas résultant des raisons mises en avant pour s'opposer au DPI ainsi que de la nécessité ou de l’inutilité d’un ultérieur « DPI de contrôle » Ces cas sont discutés sur la base d’hypothèses portant sur les facteurs contextuels et sur les présupposés théoriques. En conclusion, nous soulignons que si nos hypothèses sont correctes, il n’y a probablement aucun impératif thérapeutique justifiant l’édition du génome au niveau de la lignée germinale. Nous arrivons à cette conclusion parce qu’une intervention au niveau de la lignée germinale n’est probablement pas susceptible d’affecter la personne. Cependant, nous mettons en garde le lecteur sur le fait que notre conclusion est préliminaire et qu’elle doit être examinée avec soin dans des futurs travaux instruits par le débat bioéthique et par les éventuelles objections. (shrink)

This article sets forth the argument that Christian ministry in Africa must become socially and culturally informed and constructed or else it will not touch the African soul and thus remain superficial. Black African people aspire above everything else to experience fullness of life and wellbeing here and now, as demonstrated by their greetings that are actually an enquiry into each other's health and an expression of the wish for the other's good health and wellbeing. The mainline churches that operate (...) in Africa should embrace the scripturally sound Christian healing ministry in obedience to Christ's commission to preach the gospel and heal the sick, if they are to prosper. Hence, this article discusses the following eight points, namely, good health and healing as Africans' important aspiration, healing as the work of God and thus of the church, the imperative of serious consideration of and respect for the African worldview, membership decline and mainline churches' loss of influence, rethinking church in African Christianity, the need for the black African church to adopt a therapeutic or healing community ecclesial model in order to position itself strategically to cater for the holistic needs of African church members and surrounding communities, the rationale of the healing ministry in today's Reformed Church in Africa and the recommended healing ministry. The article closes with a few concluding statements and advice. (shrink)

Pediatric participation in non-therapeutic research that poses greater than minimal risk has been the subject of considerable thought-provoking debate in the research ethics literature. While the need for more pediatric research has been called morally imperative, and concerted efforts have been made to increase pediatric medical research, the importance of protecting children from undue research risks remains paramount.United States research regulations are derived largely from the deliberations and report of the National Commission for the Protection of Human Subjects (...) of Biomedical and Behavioral Research. The authors of this report specifically designated children as a vulnerable population and suggested additional protections, most of which became U.S. law. One of the more contested sets of regulations surrounds non-therapeutic research, e.g., research that does not offer the potential for direct benefit to participants. Federal regulations allow local Institutional Review Boards to approve non-therapeutic research posing a minor increase above minimal risk when it involves children who have the disease or medical condition that the research addresses. (shrink)

This article presents a critical discursive analysis around the concept of menstrual health in a series of texts published in book format and in social networks in the last five years (2019-2023) by different activists and menstrual educators in Argentina. In a reading itinerary that goes from the singular to the collective, I identify the configuration of an experiential episteme that redefines the menstruating body as informational and multidimensional, which enables that, in addition to a physiological dimension, its role in (...) different social, political, cultural, environmental and economic contexts is vindicated. I place these examples in the context of the neoliberal precariousness that installs the therapeutic-managerial culture as a moral imperative, while at the same time it challenges certain subjectivities with relative privilege —white, urban, trained and educated women— to dispute and strain meanings. (shrink)

It is well established that demographic representation in clinical research is important for understanding the safety and effectiveness of novel therapeutics and vaccines in diverse patient populations. In recent years, the National Institutes of Health and Food and Drug Administration have issued guidelines and recommendations for the inclusion of women, older adults, and racial and ethnic minorities in research. However, these guidelines fail to provide an adequate explanation of why racial and ethnic representation in clinical research is important. This article (...) aims to both provide the missing arguments for why adequate representation of racial and ethnic minorities in clinical research is essential and to articulate a number of recommendations for improving diversity going forward.Appropriate racial and ethnic representation and fair inclusion help (1) increase the generalisability of clinical trial results, (2) equitably distribute any benefits of clinical research and (3) enable trust in the research enterprise. (shrink)

The government-sponsored Tuskegee syphilis study had a huge impact on U.S. research ethics and policy. Study investigators regarded subjects as “mere means” to their research ends, which led to a variety of ethical violations. Investigators used deception so that subjects would see participation as therapeutic — researchers promoted the therapeutic misconception because this advanced study objectives. The research would produce important information, and this justified lying to research subjects.Today we see this sort of intentional deception as unjustified no (...) matter how important a study might be. But what do we make of the claim that the syphilis study had value? As James Jones reported, its objectives were to test the prevailing views that syphilis affected blacks and whites differently, and that the disease was less harmful to blacks than whites. U.S. Public Health Service researchers and officials assumed the study had sufficient value to justify not only deceiving subjects, but also depriving them of safe and effective treatment. (shrink)

The usual conception of transcendence is as the success of a process or practice of mediation, meditation, transmutation, salvation, supplication, application or implication. Blanchot's unusual transcendence escapes the inevitable ruin of such achievements by arriving in the form of the failure of immanence. Although it is impossible to describe that failure explicitly, it can be approached apophatically. Following an impossible imperative to see the whole, immanence generates inadvertent transcendence “thus exposing the essential ambiguity of transcendence and the impossibility that (...) this ambiguity be measured according to truth or legitimacy.” ( Writing of the Disaster p.65). The demanding process of bringing enough ambiguity into play in order to elucidate the failure of immanence and demonstrate a glimpse of an unavowable transcendence shall be undertaken through an assemblage of fragments from The Writing of the Disaster , interpreted as instructions for constructing and interrogating a temporary singularity. (shrink)

On 25 April 2002, the German Parliament has passed a strict new law referring to stem cell research. This law took effect on July 1, 2002. The so-called embryonic Stem Cell Act ( Stammzellgesetz — StZG ) permits the import of embryonic stem (ES) cells isolated from surplus IvF-embryos for research reasons. The production itself of ES cells from human blastocysts has been prohibited by the German Embryo Protection Act of 1990, with the exception of the use of ES cells (...) which exist already. The debate on the legitimate use of ES cells escalated, after the main German research funding agency, the Deutsche Forschungsgemeinschaft (DFG), unexpectedly published new guidelines recommending are stricted use of human ES cells for research. Meanwhile, the debate has ethically dividedsociety, political parties, government and church members into a group supporting and a group rejecting ES cell research. The arguments in favour of such a research can be summarized as arguments derived from a new ethics ofhealing calling for a therapeutic imperative, whereas the arguments against can be summarized as arguments violating the fundamental principle of human dignity as they imply the destruction of human embryos. This article willtry to present and evaluate various ethical arguments founded on the latest biological and medical data on the potential use of stem cell technologies. It will finally come to the conclusion that ES cell research is opposed to human dignity, since the procedures of isolating ES cells require the destruction and instrumentalization of human embryos. Human embryos are human beings at a very early stage of their development, fully possessing the ability of completing their development. At this very early stage, human embryos are extremely dependent and fragile, and thus vulnerable corporealities. Vulnerability and human dignity demand the protection of the embryo's corporeal integrity. Hence, this essay will try to propagate research with adult stem(AS) cells, a procedure which does not require the destruction of human embryos; with regard to the necessary plasticity, it should be emphasized that AS cells very much resemble ES cells. (shrink)

Talk of matters ethical is, in the psychotherapeutic context, typically relegated to therapy’s preconditions and setting, i.e., to its ‘frame’. What goes on within that frame, i.e., therapeutic action itself, gets theorised in psychological rather than ethical terms. An explanation for this is the frequent therapeutic imperative to extirpate self-directed moralising. Moralising, however, constitutes but a phoney pretender to the ethical life. A true ethical sensibility instead shows itself in such moments of life as involve our offering (...) humane recognition to one another and to ourselves. Being offered such recognition not only allows a patient to internalise it as a remoralising dignity or healthy pride. It also enables the patient to know herself by animating within herself a range of virtue concepts—courage, probity, repentance, etc.—which can then function as regulative ideals for a well-functioning psyche. Inchoate anxiety now takes shape as intelligible guilt. Repentance and the repair of damaged relationships now replace blame’s repression or projection. Conscience now becomes a motor for therapeutic change. In such ways, ethical concern constitutes not merely the frame but the living flesh of the therapeutic project. (shrink)

The six papers in the 2014 clinical ethics number of the Journal get us back to the basics in the work of clinical ethics and clinical ethicists: getting clear about concepts that should be used in achieving deliberative clinical ethics. The papers explore the concepts of the best interests of the patient, health and disease understood in their proper relationship to autonomy in our species, the therapeutic obligation, and the therapeutic imperative. The final paper appraises the systematic (...) review, a scholarly tool for tracking the basic concepts of clinical ethics in the literature. (shrink)

The U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials , which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted (...) baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act. (shrink)

It is tempting to argue that Kantian moral philosophy justifies prohibiting both human germ-line genetic engineering and non-therapeutic genetic engineering because they fail to respect human dignity. There are, however, good reasons for resisting this temptation. In fact, Kant’s moral philosophy provides reasons that support genetic engineering—even germ-line and non-therapeutic. This is true of Kant’s imperfect duties to seek one’s own perfection and the happiness of others. It is also true of the categorical imperative. Kant’s moral philosophy (...) does, however, provide limits to justifiable genetic engineering. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy's Role in Psychopathology Back to Jaspers and an Appeal to Grow PracticalThe author reports no conflicts of interest.In "Philosophy's role in theorizing psychopathology," Gibson presents a defense of the continued relevance of philosophy to psychopathology, and a non-exhaustive framework for the role of philosophy in this domain (Gibson, 2024). I find it hard to disagree that psychopathology is soaked in philosophy from its origins, and that to try (...) and dry it out would be both unwise and impossible.In this commentary, I go back to Karl Jaspers' account of the role of philosophy in his General Psychopathology. In doing so, I do not find that Gibson adds anything new, but instead gives us a well-illustrated reminder that philosophy "is operative within every living science" (Jaspers, 1997, p. 770).Situated Psychopathological TheorizingGibson addresses a broad 'we' who might be engaged with psychopathological theorizing. This seems to encompass three main settings, from which examples are drawn.1. Everyday and regulative social practices (ordinary and legal setting).2. Empirically driven disciplines which work with psychopathological constructs (academic setting).3. Psychiatry and psychotherapy (clinical setting).In my view, it is a mistake not to map the terrain where psychopathological theorizing is situated. In each setting psychopathological theorizing has its own set of aims and constraints. In the ordinary setting, the aim might be to know whether to blame a loved one for their action. In the legal setting it might be to decide whether treatment or punishment is appropriate. In the clinical setting, the aim is usually a therapeutic assessment, and moral stance taking is often best kept at bay. In the academic setting, we might want to ensure our concepts are reliable and valid, opening them up to investigation using objective scientific methods. [End Page 13]Beyond what can be said in the most general terms, the role of philosophy will look different in these different situations.Understanding Is Not (Just) a Philosophical ToolUnderstanding is a mode of knowing that is concerned with the particular, rather than the general, and accessed inter-relationally, relying on tacit knowledge and empathetic imagination. Gibson introduces the concept as an elementary form of social intuition, used in ordinary life to make sense of social relations and other people's behaviors and reactions. I agree with Gibson, drawing on Strawson, that Understanding is a mode of knowledge that involves the subject of enquiry as a participant (Strawson, 1982). There is a moral imperative to take this stance, which drives us to value the expansion of what we are able to understand of other people's mental states. This at least partly motivates the agenda when we theorize about psychopathology.At times throughout his argument, Gibson seems to be arguing for the role of Understanding in psychopathological theorizing, in place of his explicit aim of arguing for the role of philosophy. However it is not at all clear that this replacement can be made. Accepting the picture drawn, Understanding is not any more the expertise or domain of the philosopher than the author, police officer, or sociologist. We are surely not meant to take Understanding as a uniquely philosophical tool, but rather a mode of knowing available to all social agents, integral to social reasoning in ordinary life and in the human studies.What philosophy can distinctively do is point to and defend the existence of forms of intersubjective and tacit knowledge within human studies such as psychopathology. For Jaspers, Understanding can be a scientific tool, albeit one that reminds us that knowledge in psychopathology is not all of one kind. One role for philosophy therefore is to help us to "distinguish the different modes of knowing," so that we might "order knowledge into a comprehensive whole" (Jaspers, 1997, p. 769). This is akin to the 'synthetic' role that Gibson proposes.Philosophy and ScienceJaspers defines scientific knowledge broadly as knowledge with "general validity, convincing insights (which can be proved), clarity of method, and the possibility for a meaningful discussion" (Jaspers, 1997, p. 768).We do not get such a definition from Gibson, but in the sections of... (shrink)

This book argues the case for a foundationalist ethics centrally based on an empirical understanding of human nature. For Maxine Sheets-Johnstone, “an ethics formulated on the foundations of anything other than human nature, hence on anything other than an identification of pan-cultural human realities, lacks solid empirical moorings. It easily loses itself in isolated hypotheticals, reductionist scenarios, or theoretical abstractions—in the prisoner’s dilemma, selfish genes, dedicated brain modules, evolutionary altruism, or psychological egoism, for example—or it easily becomes itself an ethical (...) system over and above the ethics it formulates,” such as the deontological ethics of Kantian categorical imperatives, the utilitarianism of Bentham and Mill, or the ethics of care. Taking her cue from Hume, especially his _Treatise on Human Nature_, where he grounds “the moral sense” in human nature seen as always in tension between the natural tendencies of selfish acquisitiveness and sympathy for others, Sheets-Johnstone pursues her phenomenological investigation of the natural basis of human morality by directing her attention, first in Part I, to what is traditionally considered the dark side of human nature, and then, in Part II, to the positive side. The tension between the two calls for an interdisciplinary therapeutic resolution, which she offers in the Epilogue by arguing for the value of a moral education that enlightens humans about their own human nature, highlighting both the socialization of fear and the importance of play and creativity. (shrink)

Background Human brain organoids are a valuable research tool for studying brain development, physiology, and pathology. Yet, a host of potential ethical concerns are inherent in their creation. There is a growing group of bioethicists who acknowledge the moral imperative to develop brain organoid technologies and call for caution in this research. Although a relatively new technology, brain organoids and their uses are already being discussed in media literature. Media literature informs the public and policymakers but has the potential (...) for utopian or dystopian distortions. Thus, it is important to understand how this technology is portrayed to the public. Methods To investigate how brain organoids are displayed to the public, we conducted a systematic review of media literature indexed in the Nexis Uni database from 2013–2019. News and media source articles passing exclusion criteria (_n_ = 93) were scored to evaluate tone and relevant themes. Themes were validated with a pilot sample before being applied to the dataset. Thematic analysis assessed article tone, reported potential for the technology, and the scientific, social, and ethical contexts surrounding brain organoids research. Results Brain organoid publications became more frequent from 2013 to 2019. We observed increases in positively and negatively toned articles, suggesting growing polarization. While many sources discuss realistic applications of brain organoids, others suggest treatment and cures beyond the scope of the current technology. This could work to overhype the technology and disillusion patients and families by offering false hope. In the ethical narrative we observe a preoccupation with issues such as development of artificial consciousness and “humanization” of organoid-animal chimeras. Issues of regulation, ownership, and accuracy of the organoid models are rarely discussed. Conclusions Given the power that media have to inform or misinform the public, it is important this literature provides an accurate and balanced reflection of the therapeutic potential and associated ethical issues regarding brain organoid research. Our study suggests increasing polarization, coupled with misplaced and unfounded ethical concern. Given the inhibitory effects of public fear or disillusion on research funding, it is important media literature provides an accurate reflection of brain organoids. (shrink)

In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed 'resource-poor settings'- to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of (...) bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the 'resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning 'outcome gap' between rich and poor. (shrink)

In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed ‘resource‐poor settings’– to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of (...) bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease‐burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics.Here we call for the ‘resocialising’ of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning ‘outcome gap’ between rich and poor. (shrink)

This paper discusses how to apply a collective decision model of the principle of voluntary informed consent in African communitarian culture, in a culturally sensitive way, in order to protect research candidates from potential exploitations and abuses. Dismissing cultural and ethical skepticism surrounding the global application of the principle of voluntary informed consent, the paper ultimately concludes that international collaboration on diagnostic and therapeutic medical research in Africa, especially HIV vaccine trials, is a moral imperative.

Given the contemporary ambivalent standpoints toward the future of artificial intelligence, recently denoted as the phenomenon of Singularitarianism, Gregory Bateson’s core theories of ecology of mind, schismogenesis, and double bind, are hereby revisited, taken out of their respective sociological, anthropological, and psychotherapeutic contexts and recontextualized in the field of Roboethics as to a twofold aim: the proposal of a rigid ethical standpoint toward both artificial and non-artificial agents, and an explanatory analysis of the reasons bringing about such a polarized outcome (...) of contradictory views in regard to the future of robots. Firstly, the paper applies the Batesonian ecology of mind for constructing a unified roboethical framework which endorses a flat ontology embracing multiple forms of agency, borrowing elements from Floridi’s information ethics, classic virtue ethics, Felix Guattari’s ecosophy, Braidotti’s posthumanism, and the Japanese animist doctrine of Rinri. The proposed framework wishes to act as a pragmatic solution to the endless dispute regarding the nature of consciousness or the natural/artificial dichotomy and as a further argumentation against the recognition of future artificial agency as a potential existential threat. Secondly, schismogenic analysis is employed to describe the emergence of the hostile human–robot cultural contact, tracing its origins in the early scientific discourse of man–machine symbiosis up to the contemporary countermeasures against superintelligent agents. Thirdly, Bateson’s double bind theory is utilized as an analytic methodological tool of humanity’s collective agency, leading to the hypothesis of collective schizophrenic symptomatology, due to the constancy and intensity of confronting messages emitted by either proponents or opponents of artificial intelligence. The double bind’s treatment is the mirroring “therapeutic double bind,” and the article concludes in proposing the conceptual pragmatic imperative necessary for such a condition to follow: humanity’s conscience of habitualizing danger and familiarization with its possible future extinction, as the result of a progressive blurrification between natural and artificial agency, succeeded by a totally non-organic intelligent form of agency. (shrink)

Psychiatric research is advancing rapidly, with studies revealing new investigative tools and technologies that are aimed at improving the treatment and care of patients with psychiatric disorders. However, the ethical framework in which such research is conducted is not as well developed as we might expect. In this paper we argue that more thought needs to be given to the principles that underpin research in psychiatry and to the problems associated with putting those principles into practice. In particular, we comment (...) on some of the difficulties posed by the twin imperatives of ensuring that we respect the autonomy and interests of the research subject and, at the same time, enable potentially beneficial psychiatric research to flourish. We do not purport to offer a blueprint for the future; we do, however, seek to advance the debate by identifying some of the key questions to which better answers are required. (shrink)

BackgroundThe EU’s 2006 Paediatric Regulation aims to support authorisation of medicine for children, thus effectively increasing paediatric research. It is ethically imperative to simultaneously establish procedures that protect children’s rights.MethodThis study endeavours (a) to evaluate whether a template consent form designed by the Standing Working Group of the German-Research-Ethics-Committees (AKEK) adequately informs adolescents about research participation, and (b) to investigate associated phenomena like therapeutic misconception and motives for research participation. In March 2016 a questionnaire study was conducted among (...) 279 pupils (mean age 13.1 years) of a secondary school in northern Germany.ResultsA majority of participants showed a general good understanding of foundational research ethics concepts as understood from the AKEK consent form. Nevertheless, our data also suggests possible susceptibility to therapeutic misconception. Own health concerns and pro-social considerations were found to be significant motivational factors for participating in research, while anticipation of pain lessens likelihood of participation. Advice from trusted others is an important decisional influence, too. Furthermore, data security was found to be a relevant aspect of adolescents’ decision-making process.ConclusionBearing in mind adolescents’ generally good understanding, we infer the lack of knowledge about medical research in general to be one source of therapeutic misconception. To further improve the quality of consent we propose a multi-staged approach whereby general research education is completed before an individual becomes a patient or potential participant. To the best of our knowledge this is the first German questionnaire-study addressing issues of informed consent in a large under-age sample. (shrink)

ObjectiveHopelessness and depression are strongly associated with suicidality. Given that physical and psychological outcomes can be altered with hope, hope is a therapeutic goal of increasing importance in the treatment of brain tumor patients. Moreover, it is not yet understood which factors affect the perception of hope in brain tumor patients. In addition, it remains uncertain whether lower-grade brain tumor patients suffer less from psycho-oncological distress than higher-grade brain tumor patients.MethodsNeuro-oncological patients were examined perioperatively with the Distress Thermometer and (...) the Herth Hope Index. In addition, psychological comorbidities and an assessment of general psycho-oncological distress were recorded.ResultsSixty-six brain tumor patients were included. No differences between higher- and lower-grade brain tumor patients were observed for general psycho-oncological distress and hope. However, higher-grade brain tumor patients showed a significantly higher level of depression and more negative expectations regarding therapeutic success. The extent of depression correlated negatively with hope.ConclusionUnexpectedly, higher-grade brain tumor patients remained as hopeful as lower-grade brain tumor patients despite the devastating diagnosis, higher levels of depression, and a worse expectation of therapeutic success. Conversely, lower-grade brain tumor patients experience as much psycho-oncological distress as patients with a higher-grade brain tumor, underpinning the imperative need for comprehensive psycho-oncological screening. For all brain tumor patients, considering hope is important to avoid suicides resulting from hopelessness and depression. (shrink)

This article provides an analysis of the relationships between IVF and therapeutic cloning, as they played out in the UK Human Fertilisation and Embryology Authority consultation of 2006: Donating Eggs for Research: Safeguarding Donors. We develop an account of current developments in IVF and cloning which foregrounds the role of mediation in structuring the discursive context in which they are constituted. We foreground the imperative of choice and the promise of cures as key features of this context. We (...) also argue that the intercorporeal exchanges of IVF are materially restructured in relation to cloning research, despite their represented similitude in the consultation document. The discourse of choice in relation to reproductive technologies has become entrenched over the last twenty years. In relation to therapeutic cloning, it has been coupled with, and strengthened by, the discourse of cures. In examining relations between IVF and cloning with specific attention to both mediating imaginaries, and intercorporeal exchanges, we develop an analysis that displaces the rhetoric of choice and cures. This makes visible the limited subject positions available, and the limited possibilities for responding critically to the consultation. Identifying women as the gendered subjects of this consultation and placing intercorporeality at the centre of our analysis illuminates the interdependency of women undergoing IVF, cloning science and the governance of embryo research in the UK. (shrink)

Individualized care and equality of care remain two imperatives for formulating any scientifically and morally informed public health policy. Yet both continue to be elusive goals, even in the age of genomics, proteomics, and evidence-based medicine. Nonetheless, with the rapid growth and improvement of human biotechnologies, the need to individualize therapies while allocating medical care equally may result partly from our biological constitution. Human beings are all unique, and their biological differences significantly influence variability in disease causation and therapeutic (...) response to treatments. However, because humans have equal moral worth, there is no ethically justifiable reason to establish an a .. (shrink)

This article reviews four areas of pediatric research in which we have identified questionable levels of allowable risk, exceeding those foreseen by the Commission. They are the following: the categorization of increasingly risky interventions as minimal risk in a variety of protocols; the increasing number of applications for federal panel review of research not otherwise approvable because of higher projected risk levels; research on asymptomatic at risk children; and the inclusion of children and adolescents in placebo-controlled trials for participants of (...) all ages without performing subgroup analysis. While embracing the imperative to include children in research is an encouraging step towards providing the pediatric population with effective medical care and finally eradicating the therapeutic orphan, we must ensure that this research does not become overly permissive. (shrink)

Deep brain stimulation is part of state-of-the-art treatment for medically refractory Parkinson’s disease, essential tremor or primary dystonia. However, there are multiple movement disorders that present after a static brain lesion and that are frequently refractory to medical treatment. Using Holmes tremor as an example, we discuss the effectiveness of currently available treatments and, performing simulations using a Markov Chain approach, propose that DBS with iterative parameter optimization is expected to be more effective than an approach based on sequential trials (...) of pharmacological agents. Since, in DBS studies for HT, the thalamus is a frequently chosen target, using data from previous studies of lesion connectivity mapping in HT, we compared the connectivity of thalamic and non-thalamic targets with a proxy of the HT network, and found a significantly higher connectivity of thalamic DBS targets in HT. The understanding of brain networks provided by analysis of functional connectivity may thus provide an informed framework for proper surgical targeting of individual patients. Based on these findings, we argue that there is an ethical imperative to at least consider surgical options in patients with uncommon movement disorders, while simultaneously providing consistent information regarding the expected effectiveness and risks, even in a scenario of surgical-risk aversion. An approach based on n-of-1 DBS trials may ultimately significantly improve outcomes while informing on optimal therapeutic targets and parameter settings for HT and other disabling and rare movement disorders. (shrink)

In Section One the automatic ratification of existing law as immediately self-validating is shown to undermine the very purpose of law - the surpassing of arbitrariness and of Czar-like ukases. In Sections Two and Three there is an attempt to explore the justification or grounding that can be given for the existing laws and civil disobedience, respectively. In both cases, the justification has been given in terms of fundamental human dignity which should never be violated by empirical laws. Only when (...) such a violation does occur can civil disobedience be justified. Therefore, the rationale for, and motivation of, both a legal system and civil disobedience are the same.However, one does not so easily resolve the opposition between the two. For the law itself is proclaimed apodictically, without the reservation that one may with impunity break the law and commit an act of civil disobedience whenever the law violates one's conscience. Otherwise, we do not have a rule of law but instead anarchy. For, as Jesus has said and Abraham Lincoln paraphrased it: “A kingdom divided against itself will not stand.” The law cannot declare that it is legal to break the law without incapacitating itself. The law must punish its violators to be a valid law; without powers of enforcing sanctions against violators the law is no law.However, we must not consider for this reason that those who are responsible for making, interpreting, and enforcing the law and those who are civilly disobedient are working at cross purposes. Both are concerned with justice. The civilly disobedient individual is concerned with improving the existing legal system. He envisions his role as therapeutic rather than destructive. He believes that the ideal of justice is being violated in some way in the existing laws. He therefore makes of himself a martyr, bearing witness to the truth, and hoping thereby to educate and enlighten and to move men of good will - in short, to effect a change in the law.Before an individual who respects the rule of law should be willing to be civilly disobedient he must be convinced of the violation of basic human rights in the law. He also must consider whether civil disobedience is the most effective means of producing the desired change. But beyond the pragmatic consideration of the most effective means to produce the desired end, there is also the question of what is most meaningful and suitable for him personally in living in conformity with the categorical imperative. Discussions of civil disobedience which limit themselves to questions of practical consequences do a great disservice to such actions. For, must we not admire those who resisted Hitler, even though they realized that their actions were futile in terms of changing the law and might even mean their deaths?In a free society, dedicated to the rule of law, all citizens are concerned with justice. Those entrusted with the responsibility of enforcing the law obviously must do just that, so that violators of the law have to be punished. However, when legislators and judges notice that some of the most perspicacious and conscientious individuals are openly violating existing laws in the name of a higher law, they should also make a serious reappraisal of their positions, looking to see whether they may not have become morally insensitive or careless. Indeed, the real value of a free society is its flexibility and tolerance of dissent, even that of civil disobedience, which can serve to dramatize forcefully, deep-seated convictions concerning the injustice of certain laws on the books. It is true that fanatics from time immemorial have been willing to sacrifice much in the name of their cause. But whenever one finds that there is an individual who is willing to sacrifice much without the hope of personal advantage and who is also willing to provide arguments in defense of his position, society would do well to listen to his words and actions.Without the constant delving scrutiny and criticism of existing laws, there cannot be true legal responsibility. Therefore, the civilly disobedient individual, who is willing to put his head on the block in order to abrogate unjust laws, is in fact the legally responsible individual par excellence. (shrink)

Over the past ten to fifteen years, medical interventions, therapeutic approaches and scientific studies involving mindfulness meditation have gained traction in areas such as clinical psychology, psychotherapy, and neuroscience. Simultaneously, mindfulness has had a very strong public appeal. This article examines some of the ways in which the medical and scientific meaning of mindfulness is communicated in public and to the public. In particular, it shows how experts in the field of mindfulness neuroscience seek to communicate to the public (...) at large the imperative of brain fitness for the promotion of health, wellbeing and happiness. The study identifies claims being made in popular outlets that, by and large, bypass traditional mass media, such as self-help books, websites and online videos. By treating this material as a form of personalized science communication, this article contributes to the body of literature that understands science communication as a continuum and the boundary between science and popularized science as the outcome of human negotiations. The study finds that processes of personalization help to build bridges between scientific findings and their supposed application, that they infuse science with subjective meaning, and turn expert communication with the public into a moral vocation. (shrink)

The purpose of this dissertation is to identify some of the most pressing problems in the dominant contemporary approach to research ethics, and to devise an alternative approach that avoids these problems. I contend that the fundamental ethical values invoked in human research are often appealed to in contradictory or ambiguous ways, or in ways that do not adequately capture or do not show an adequate understanding of the specific ethical concerns of human research. One significant problem in this domain (...) is that values for ethical research are often unreflectively imported from medical therapy, producing ill-suited guidelines that cannot capture the different ethical situations that arise in the context of research. Furthermore, ethical guidelines in this area are often not developed with a sufficient understanding of the deep philosophical issues that they invoke. I suggest that we can address these problems through examining the fundamental ethical concerns of research on a philosophical level. This method will reveal severe problems with the approach to two of the ethical values underlying research; beneficence and respect for autonomy (or respect for persons). Once the nature of these problems has been revealed, and with reference to ethical problems that typically arise in the domain of research, I construct a coherent philosophical foundation for research ethics, which both avoids these deep-seated problems and better captures the ethical issues that arise in the domain of human research. I argue that we need to radically depart from the values of beneficence and autonomy/respect for persons as they are currently understood in the guidelines. We need an idea of beneficence that is clearly distinct from that which is used in the therapeutic medical context from which this notion is currently drawn. I also contend that we need to move away from autonomy as a central value in research ethics. I posit an alternative choice-based approach to informed consent which is concerned both with respecting agents’ freedom of choice, and also with their wellbeing, as providing a good means of protecting and promoting the interests of the individual research subject. Although these two imperatives are often thought to clash on a fundamental level, I will show that, in research ethics, they can be reconciled with minimal conflict. Though this represents a departure from the ethics of medical therapy, this approach is far more suited to the context of research. This theoretical basis for informed consent can help to clarify the ethical problems that are specific to this domain and provide us with relevant ethical guidance in research ethics. (shrink)

Background: Magnetic resonance spectroscopic imaging is a neuroimaging technique that may be useful for non-invasive mapping of brain temperature over a large brain volume. To date, intra-subject reproducibility of MRSI-based brain temperature has not been investigated. The objective of this repeated measures MRSI-t study was to establish intra-subject reproducibility and repeatability of brain temperature, as well as typical brain temperature range.Methods: Healthy participants aged 23–46 years were scanned at two time points ~12-weeks apart. Volumetric MRSI data were processed by reconstructing (...) metabolite and water images using parametric spectral analysis. Brain temperature was derived using the frequency difference between water and creatine for 47 regions of interest delineated by the modified Automated Anatomical Labeling atlas. Reproducibility was measured using the coefficient of variation for repeated measures, and repeatability was determined using the standard error of measurement. For each region, the upper and lower bounds of Minimal Detectable Change were established to characterize the typical range of TCRE values.Results: The mean global brain temperature over all subjects was 37.2°C with spatial variations across ROIs. There was a significant main effect for time [F = 37.0, p < 0.0001] and for brain region [F = 2.66, p < 0.0001]. The time*brain region interaction was not significant [F = 0.80, p = 0.83]. Participants' TCRE was stable for each ROI across both time points, with ROIs' COVrep ranging from 0.81 to 3.08% ; majority of ROIs had a COVrep <2.0%.Conclusions: Brain temperature measurements were highly consistent between both time points, indicating high reproducibility and repeatability of MRSI-t. MRSI-t may be a promising diagnostic, prognostic, and therapeutic tool for non-invasively monitoring brain temperature changes in health and disease. However, further studies of healthy participants with larger sample size and numerous repeated acquisitions are imperative for establishing a reference range of typical brain TCRE, as well as the threshold above which TCRE is likely pathological. (shrink)

Several authors have recently argued that the content of pains (and bodily sensations more generally) is imperative rather than descriptive. I show that such an account can help resolve competing intuitions about phantom limb pain. As imperatives, phantom pains are neither true nor false. However, phantom limb pains presuppose falsehoods, in the same way that any imperative which demands something impossible presupposes a falsehood. Phantom pains, like many chronic pains, are thus commands that cannot be satisfied. I conclude (...) by showing that some of the negative psychological consequences of chronic pain are a direct consequence of their imperative nature. (shrink)

I show how, contrary to recent claims, so-called embedded imperatives are better analyzed in terms of mixed quotation. To this end I extend the presuppositional analysis of mixed quotation to include quotations of constructions.

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)

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)

Stoltenberg, G. Freies und imperatives Mandat.--Kaltefleiter, W. und Veen, H.-J. Von der Demokratie zur Delegiertenherrschaft.--Bromme, P. Meinungsfreiheit in der parlamentarischen Demokratie.

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)

The study used a thematic analysis to examine student and faculty responses to two qualitative questions focused on their perceptions of the consequence of incivility and solutions that would embed civility expectations as a key element to professional role socialization in higher education. Participants included students and faculty across multiple academic programs and respondent subgroups at a regional university in the southern United States. A new adapted conceptual model using Clark’s in _Nursing Education Perspectives_, _28_(2), 93–97 ( 2007, revised 2020) (...) Conceptual Model for Fostering Civility in Nursing Education and Daniel Goleman’s in _Emotional intelligence: Why it can matter more than IQ_. Bantam Books ( 1995 ) Emotional Intelligence domains was used as the framework for this study to give meaning and context to its findings. For this group of respondents, the study found that seventy percent of faculty and students agree that incivility has the largest impact on the emotional intelligence domain of self-management, which includes negative emotional outcomes, loss of respect, negative professional and student outcomes, poor academic outcomes, attrition, and less success. Leadership in higher education will strengthen their institutions by using a relational approach centered on communication skill-building to ensure that faculty have been socialized to the importance of civil professional behavior and that stakeholders collectively explore and agree on the meaning and organizational integration of civility. (shrink)

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)

Some arguments include imperative clauses. For example: ‘Buy me a drink; you can’t buy me that drink unless you go to the bar; so, go to the bar!’ How should we build a logic that predicts which of these arguments are good? Because imperatives aren’t truth apt and so don’t stand in relations of truth preservation, this technical question gives rise to a foundational one: What would be the subject matter of this logic? I argue that declaratives are used (...) to produce beliefs, imperatives are used to produce intentions, and beliefs and intentions are subject to rational requirements. An argument will strike us as valid when anyone whose mental state satisfies the premises is rationally required to satisfy the conclusion. For example, the above argument reflects the principle that it is irrational not to intend what one takes to be the necessary means to one’s intended ends. I argue that all intuitively good patterns of imperative inference can be explained using off-the-shelf formulations of our rational requirements. I then develop a formal-semantic theory embodying this view that predicts a range of data, including free-choice effects and Ross’s paradox. The resulting theory shows one way that our aspirations to rational agency can be discerned in the patterns of our speech, and is a case study in how the philosophy of language and the philosophy of action can be mutually illuminating. (shrink)

More than forty years have passed since Congress, in response to the Civil Rights Movement, enacted sweeping antidiscrimination laws in the Civil Rights Act of 1964, the Voting Rights Act of 1965, and the Fair Housing Act of 1968. As a signal achievement of that legacy, in 2008, Americans elected their first African American president. Some would argue that we have finally arrived at a postracial America, butThe Imperative of Integration indicates otherwise. Elizabeth Anderson demonstrates that, despite progress toward (...) racial equality, African Americans remain disadvantaged on virtually all measures of well-being. Segregation remains a key cause of these problems, and Anderson skillfully shows why racial integration is needed to address these issues. Weaving together extensive social science findings--in economics, sociology, and psychology--with political theory, this book provides a compelling argument for reviving the ideal of racial integration to overcome injustice and inequality, and to build a better democracy. -/- Considering the effects of segregation and integration across multiple social arenas, Anderson exposes the deficiencies of racial views on both the right and the left. She reveals the limitations of conservative explanations for black disadvantage in terms of cultural pathology within the black community and explains why color blindness is morally misguided. Multicultural celebrations of group differences are also not enough to solve our racial problems. Anderson provides a distinctive rationale for affirmative action as a tool for promoting integration, and explores how integration can be practiced beyond affirmative action. -/- Offering an expansive model for practicing political philosophy in close collaboration with the social sciences, this book is a trenchant examination of how racial integration can lead to a more robust and responsive democracy. (shrink)

Naturalism, as Binmore understands the term, is characterized by a scientific stance on moral behavior. Binmore claims that a naturalistic account of morality necessarily goes with the conviction “that only hypothetical imperatives make any sense”. In this paper it is argued that this claim is mistaken. First, as Hume’s theory of promising shows, naturalism in the sense of Binmore is very well compatible with acknowledging the importance of categorical imperatives in moral practice. Moreover, second, if Binmore’s own theory of moral (...) practice and its evolution is correct, then the actual moral practice does-and in fact must-incorporate norms, which have the form of a categorical imperative. Categorical imperatives are part of social reality and, therefore, any (normative) moral theory that adequately reflects moral practice must also include categorical imperatives. (shrink)

Christian Smith has described the religious attitudes of American youth and many adults as Moralistic Therapeutic Deism. In this formulation the word “therapeutic” does much work, and is meant to indicate that the goal of life is to be happy, to which end religion is instrumental. Martha Nussbaum has argued that Hellenistic schools of philosophy were therapeutic and instrumental in much the same way, and that this is a possible mode of philosophy even today. Appealing to the (...) historical investigations of Pierre Hadot and Giovanni Reale, this paper shows that Neoplatonism was an even more successful form of therapeutic philosophy, a fact which Augustine recognized and to which he responded in his therapeutic masterpiece Confessions, through his depiction of his mother as a sage. This suggests that Catholicism can be powerful when presented therapeutically, which might be a more appropriate mode for evangelism in our therapeutic age. (shrink)