Addiction is increasingly described as a “chronic and relapsing brain disease”. The potential impact of the brain disease model on the treatment of addiction or addicted individuals’ treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females (...) and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about “diseased brains” will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons. (shrink)

Using this case, Lavazza and Reichlin (2018) explored the ethical dilemmas associated with decision making in people with Alzheimer’s disease (AD), specifically when their new preferences conflict...

Digital mental health can be understood as the in situ quantification of an individual’s data from personal devices to measure human behavior in both health and disease (Huckvale, Venkatesh and Chr...

The authors comments on several articles on addiction. Research suggests that addicted individuals have substantial impairments in cognitive control of behavior. The authors maintain that a proper study of addiction must include a neurobiological model of addiction to draw the attention of bioethicists and addiction neurobiologists. They also state that more addiction neuroscientists like S. E. Hyman are needed as they understand the limits of their research. Accession Number: 24077921; Authors: Carter, Adrian 1; Email Address: adrian.carter@uq.edu.au (...) Hall, Wayne 1; Affiliations: 1: The University of Queensland, Brisbane, Australia; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Subject: NEUROBIOLOGISTS; Subject: NEUROSCIENTISTS; Number of Pages: 3p. (shrink)

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence (...) that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis. (shrink)

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal (...) research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a cure of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction. (shrink)

Lewis’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of neuroplasticity. His (...) view is consistent with epidemiological evidence of addicted individuals ‘maturing out’ and recovering from addiction. We do however hold some reservations about Lewis’ model. We do not think that his analysis of the neurobiological evidence is clearly different from that of the BDMA or that his neurodevelopmental model provides a more rigorous interpretation of the evidence than the BDMA. We believe that our understanding of the neurobiology of drug use is too immature to warrant the major role given to it in the BDMA. Our social research finds very mixed support for the BDMA among addicted people and health professionals in Australia. Lewis’ account of addiction requires similar empirical evaluation of its real-world implications. (shrink)

Brian Earp and colleagues argue that the major harms associated with the use of illicit drugs largely arise from, or are at least exacerbated by, the fact that their use attracts criminal pe...

The 30th anniversary of the first DBS surgery of the subthalamic nucleus (STN) for Parkinson’s disease was celebrated in Grenoble this June. Since this initial surgery, the application of DBS has e...

Developments in the field of neuroscience, according to its proponents, offer the prospect of an enhanced understanding and treatment of addicted persons. Consequently, its advocates consider that improving public understanding of addiction neuroscience is a desirable aim. Those critical of neuroscientific approaches, however, charge that it is a totalising, reductive perspective–one that ignores other known causes in favour of neurobiological explanations. Sociologist Nikolas Rose has argued that neuroscience, and its associated technologies, are coming to dominate cultural models to the extent (...) that 'we' increasingly understand ourselves as 'neurochemical selves'. Drawing on 55 qualitative interviews conducted with members of the Australian public residing in the Greater Brisbane area, we challenge both the 'expectational discourses' of neuroscientists and the criticisms of its detractors. Members of the public accepted multiple perspectives on the causes of addiction, including some elements of neurobiological explanations. Their discussions of addiction drew upon a broad range of philosophical, sociological, anthropological, psychological and neurobiological vocabularies, suggesting that they synthesised newer technical understandings, such as that offered by neuroscience, with older ones. Holding conceptual models that acknowledge the complexity of addiction aetiology into which new information is incorporated suggests that the impact of neuroscientific discourse in directing the public's beliefs about addiction is likely to be more limited than proponents or opponents of neuroscience expect. (shrink)

There is a growing recognition that the ongoing use of investigational neural implants requires continued access to clinical expertise and specialized healthcare (e.g., Hendriks et al., 2019). Howe...

Earl (2019) argues that the current uniform restriction of innovative practice limits clinicians’ ability to provide optimal treatment and stunts progress in medicine. We agree that it is important...

Impaired control over drug use is a defining characteristic of addiction in the major diagnostic systems. However there is significant debate about the extent of this impairment. This qualitative study examines the extent to which leading Australian addiction neuroscientists and clinicians believe that addicted individuals have control over their drug use and are responsible for their behaviour. One hour semi-structured interviews were conducted during 2009 and 2010 with 31 Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with (...) clinical experience and 15 with no clinical experience). Although many addiction neuroscientists and clinicians described uncontrolled or compulsive drug use as characteristic of addiction, most were ambivalent about whether or not addicted people could be said to have no control of their drug use. Most believed that addicted individuals have fluctuating levels of impaired control over their drug use but they nonetheless believed that addicted persons were responsible for their behaviour, including criminal behaviour engaged in to fund their drug use. Addiction was not seen as exculpating criminal behaviour but as a mitigating factor. (shrink)

Peterson et al. (2023) identify two potential uses of psychedelic drugs in Alzheimer’s disease and related disorders (AD/ADRD). The first is to treat depression and anxiety that commonly occur afte...

The American Journal of Bioethics, Volume 12, Issue 2, Page 12-14, February 2012.

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 163-188.

The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease can lead to the development of neuropsychiatric symptoms. These can include harmful changes in mood and behaviour that alienate family members and raise ethical questions about personal responsibility for actions committed under stimulation-dependent mental states. Qualitative interviews were conducted with twenty participants following subthalamic DBS at a movement disorders centre, in order to explore the meaning and significance of stimulation-related neuropsychiatric symptoms amongst a purposive sample of persons (...) with PD and their spousal caregivers. Interview transcripts underwent inductive thematic analysis. Clinical and experiential aspects of post-DBS neuropsychiatric symptoms were identified. Caregivers were highly burdened by these symptoms and both patients and caregivers felt unprepared for their consequences, despite having received information prior to DBS, desiring greater family and peer engagement prior to neurosurgery. Participants held conflicting opinions as to whether emergent symptoms were attributable to neurostimulation. Many felt that they reflected aspects of the person’s “real” or “younger” personality. Those participants who perceived a close relationship between stimulation changes and changes in mental state were more likely to view these symptoms as inauthentic and uncontrollable. Unexpected and troublesome neuropsychiatric symptoms occurred despite a pre-operative education programme that was delivered to all participants. This suggests that such symptoms are difficult to predict and manage even if best practice guidelines are followed by experienced centres. Further research aimed at predicting these complications may improve the capacity of clinicians to tailor the consent process. (shrink)

In recent decades, researchers have attempted to prospectively identify individuals at high risk of developing psychosis in the hope of delaying or preventing psychosis onset. These psychosis risk individuals are identified as being in an ‘At-Risk Mental State’ (ARMS) through a standardised psychometric interview. However, disclosure of ARMS status has attracted criticism due to concerns about the risk–benefit ratio of disclosure to patients. Only approximately one quarter of ARMS patients develop psychosis after three years, raising concerns about the unnecessary harm (...) associated with such ‘false-positive’ results. These harms are especially pertinent when identifying psychosis risk individuals due to potential stigma and discrimination in a young clinical population. A dearth of high-quality evidence supporting interventions for ARMS patients raises further doubts about the benefit accompanying an ARMS disclosure. Despite ongoing discussion in the bioethical literature, these concerns over the ethical justification of disclosure to ARMS patients are not directly addressed in clinical guidelines. In this paper, we aim to provide a unified disclosure strategy grounded in principle-based analysis for ARMS clinicians. After considering the ethical values at stake in ARMS disclosure, and their normative significance, we argue that full disclosure of the ARMS label is favoured in the vast majority of clinical situations due to the strong normative significance of enhancing patients' understanding. We then compare our framework with other approaches to ARMS disclosure and outline its limitations. (shrink)

Why are some patients with Parkinson's disease unhappy about the outcome of deep brain stimulation (DBS)? Meccaci and Haselager (2014) attempt to answer this question by analyzing the seminal case...

The misuse of alcohol inflicts a major toll on individual users, their families, and the wider society. This includes disruptions of family life, violence, absenteeism and problems in the workplace, child neglect and abuse, and excess morbidity and mortality. The World Health Organization estimates that alcohol ranks eighth among global risk factors for death and is the third leading global risk factor for disease and disability. In the United States, alcohol dependence affects four to five percent of the population at (...) any given time. Alcohol dependence also exacts a significant financial toll.... (shrink)

Suppositional theories of conditionals take apparent similarities between supposition and conditionals as a starting point, appealing to features of the former to provide an account of the latter. This paper develops a novel form of suppositional theory, one which characterizes the relationship at the level of semantics rather than at the level of speech acts. In the course of doing so, it considers a range of novel data which shed additional light on how conditionals and supposition interact.

Abstract: Might knowledge normatively govern conversations and not just their discrete constituent thoughts and (assertoric) actions? I answer yes, at least for a restricted class of conversations I call aimed conversations. On the view defended here, aimed conversations are governed by participatory know-how - viz., knowledge how to do what each interlocutor to the conversation shares a participatory intention to do by means of that conversation. In the specific case of conversations that are in the service of joint inquiry, the (...) view defended is that interlocutors (A, B, ... n) must intentionally inquire together into whether p, by means of an aimed conversation X, only if A,B, ... n know how to use X to find out together whether p. The view is supported by considerations about instrumental rationality, shared intentionality, the epistemology of intentional action, as well as linguistic data. (shrink)

For readers looking for insights into key issues linking current Eastern and Western views on the arts, aesthetics, and philosophy, Unsettled Boundaries offers fresh and insightful perspectives on current issues as seen by leading Chinese and Western scholars. Represented in the volume are previously unpublished essays of Nöel Carroll, Garry Hagberg, Richard Shusterman, and Jason Wirth alongside writings of Chinese peers Gao Jianping, Peng Feng, Liu Yuedi, Wang Chunchen and Cheng Xiangzhan. The essays in this volume draw attention to evolving (...) cultural and philosophical connections linking the cultures of East and West, while taking note of important differences in the respective cultures. These connections draw upon both traditional Confucian ideas and Chinese Marxist-Leninist aesthetics as well as western pragmatism, somaesthetics, and Wittgenstein-based analytic philosophy. Alongside these philosophical currents, are reflections on issues linking globalization to contemporary Balinese, Chinese, and Japanese arts, by Curtis Carter, Stephen Davies, Garry Hagberg, and Mary Wiseman. (shrink)

Our understanding of what exactly needs protected against in order to safeguard a plausible construal of our ‘freedom of thought’ is changing. And this is because the recent influx of cognitive offloading and outsourcing—and the fast-evolving technologies that enable this—generate radical new possibilities for freedom-of-thought violating thought manipulation. This paper does three main things. First, I briefly overview how recent thinking in the philosophy of mind and cognitive science recognises—contrary to traditional Cartesian ‘internalist’ assumptions—ways in which our cognitive faculties, and (...) even our beliefs, can be materially realised by as well as stored non-biologically and extracranially. Second, and taking brain-computer interface technologies (BCIs) and the associated possibility of ‘extended’ beliefs as a reference point, I propose and defend a sufficient condition on freedom-of-thought violating (extended) thought manipulation. On the view proposed, the right not to have one’s thoughts or opinions manipulated is violated if one is (i) caused to acquire non-autonomous propositional attitudes (acquisition manipulation) or (ii) caused to have otherwise autonomous propositional attitudes non-autonomously eradicated (eradication manipulation). The implications of this view are then illustrated through four thought experiments, which map on to four distinct ways—what I call Type 1-Type 4 manipulation—in which, and with reference to the view defended, one’s freedom of thought is plausibly violated. (shrink)

A growing body of empirical evidence suggests that folk knowledge attribution practices regarding some epistemological thought experiments differ significantly from the consensus found in the philosophical literature. More specifically, laypersons are likely to ascribe knowledge in the so-called Authentic Evidence Gettier-style cases, while most philosophers deny knowledge in these cases. The intuitions shared by philosophers are often used as evidence in favor (or against) certain philosophical analyses of the notion of knowledge. However, the fact that these intuitions are not universal, (...) as non-philosophers do not sympathize with verdicts made by philosophers, is problematic and requires some explanation. Recently, a promising theoretical approach emerged that could be used to explain away unexpected folk knowledge attributions. According to the protagonist projection hypothesis, when subjects answer questions about some hypothetical scenario, their judgments might result from adopting the cognitive perspective of the protagonist in the given scenario. Previous experimental findings suggest protagonist projection might be responsible for problematic knowledge attributions in Gettier-style cases. This paper reports data collected in an experiment which focused on five different Authentic Evidence Gettier-style scenarios and investigated the impact of protagonist projection on folk knowledge ascriptions in such cases. The results bring some support to the protagonist projection hypothesis, but do not allow to explain away a substantial number of problematic folk knowledge attributions. (shrink)

Francis Ysidro Edgeworth’s unduly neglected monograph New and Old Methods of Ethics (1877) advances a highly sophisticated and mathematized account of social well-being in the utilitarian tradition of his 19th-century contemporaries. This article illustrates how his usage of the ‘calculus of variations’ was combined with findings from empirical psychology and economic theory to construct a consequentialist axiological framework. A conclusion is drawn that Edgeworth is a methodological predecessor to several important methods, ideas, and issues that continue to be discussed in (...) contemporary social well-being studies. (shrink)

A common objection to Sosa’s epistemology is that it countenances, in an objectionable way, unsafe knowledge. This objection, under closer inspection, turns out to be in far worse shape than Sosa’s critics have realised. Sosa and his defenders have offered two central response types to the idea that allowing unsafe knowledge is problematic: one response type adverts to the animal/reflective knowledge distinction that is characteristic of bi-level virtue epistemology. The other less-discussed response type appeals to the threat of dream scepticism, (...) and in particular, to the idea that many of our everyday perceptual beliefs are unsafe through the nearness of the dream possibility. The latter dreaming response to the safety objection to Sosa’s virtue epistemology has largely flown under the radar in contemporary discussions of safety and knowledge. We think that, suitably articulated in view of research in the philosophy and science of dreaming, it has much more going for it than has been appreciated. This paper further develops, beyond what Sosa does himself, the dreaming argument in response to those who think safety (as traditionally understood) is a condition on knowledge and who object to Sosa’s account on the grounds that it fails this condition. The payoffs of further developing this argument will be not only a better understanding of the importance of insights about dreaming against safety as a condition on knowledge, but also some reason to think a weaker safety condition, one that is relativised to SSS (i.e., skill/shape/situation) conditions for competence exercise, gets better results all things considered as an anti-luck codicil on knowledge. (shrink)

Since the early seventeenth century of Bacon, Gallileo and Descartes, the relations between science and religion as well as mind and body have remained volatile fault lines of conflict. The controversies surrounding these relations are as alive and pressing now as at any point over the course of the past four centuries. Adrian Johnston's transcendental materialism offers a new theoretical approach to these issues. Arming himself with resources provided by German idealism, Marxism, psychoanalysis, the life sciences and contemporary philosophical (...) developments, Johnston formulates an account of subjectivity that, although being both materialist and naturalist, does full justice to human beings as irreducible to natural matter alone. At the same time he argues against relapses into idealisms, dualisms and spiritualisms. Adventures in Transcendental Materialism elaborates Johnston's position through critical engagements with some of today's most important thinkers including Slavoj Žižek, Alain Badiou, Catherine Malabou, Jean-Claude Milner, Martin Hägglund, William Connolly, and Jane Bennett"--Back cover. (shrink)