Gilbert et al. have raised important questions about the empirical grounding of neuroethical analyses of the apparent phenomenon of Deep Brain Stimulation ‘causing’ personality changes. In this paper, we consider how to make neuroethical claims appropriately calibrated to existing evidence, and the role that philosophical neuroethics has to play in this enterprise of ‘evidence-based neuroethics’. In the first half of the paper, we begin by highlighting the challenges we face in investigating changes to PIAAAS following DBS, explaining how different trial (...) designs may be of different degrees of utility, depending on how changes to PIAAAS following DBS are manifested. In particular, we suggest that the trial designs Gilbert et al. call for may not be able to tell us whether or not DBS directly causes changes to personality. However, we suggest that this is not the most significant question about this phenomenon; the most significant question is whether these changes should matter morally, however they are caused. We go on to suggest that neuroethical analyses of novel neuro-interventions should be carried out in accordance with the levels of evidence hierarchy outlined by the Centre for Evidence-Based Medicine, and explain different ways in which neuroethical analyses of changes to PIAAAS can be evidence-based on this framework. In the second half of the paper, we explain how philosophical neuroethics can play an important role in contributing to mechanism-based reasoning about potential effects on PIAAAS following DBS, a form of evidence that is also incorporated into the CEBM levels of evidence hierarchy. (shrink)
Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)
Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.
Background -/- Innovative neurosurgical treatments present a number of known risks, the natures and probabilities of which can be adequately communicated to patients via the standard procedures governing obtaining informed consent. However, due to their novelty, these treatments also come with unknown risks, which require an augmented approach to obtaining informed consent. -/- Objective -/- This paper aims to discuss and provide concrete procedural guidance on the ethical issues raised by serious unexpected complications of novel deep brain stimulation treatments. -/- (...) Approach -/- We illustrate our analysis using a case study of the unexpected development of recurrent stereotyped events in patients following the use of deep brain stimulation (DBS) to treat severe chronic pain. Examining these unexpected complications in light of medical ethical principles, we argue that serious complications of novel DBS treatments do not necessarily make it unethical to offer the intervention to eligible patients. However, the difficulty the clinician faces in determining whether the intervention is in the patient's best interests generates reasons to take extra steps to promote the autonomous decision making of these patients. -/- Conclusion and recommendations -/- We conclude with clinical recommendations, including details of an augmented consent process for novel DBS treatment. (shrink)
Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)
Oriental scholars discuss the concept of corporate personalitywithout any reference to Islamic law. A leading proponent of this view isJoseph Schacht; a western scholar of jurisprudence who contended that Islamicjurisprudence is limited to individual personality and devoid of corporate laws,hence, contractual agreements between corporations has no basis in Islamiclaw. Several scholars and researcher have responded with sufficient literatureon the status of an artificial person in Islamic law, but there are still issues withthe legal implication of corporate personality in the event (...) of financial distress.This study aims to explore Islamic threshold on fundamental principles ofcorporate personalities and its contemporary applications in the situation offinancial trouble. The study will employ the analytical approach in describingthe essential characteristics of a corporation as inherent in Islamic law throughinterpolation from the natural person and the possibility of adapting the existingconventional bankruptcy laws. This study employs an analytical approach to Islamic literature and regular related works. The study found out that eventhough the concept of financial distress has basis in Islamic law, it remainscomplicated as it entails insolvency, bankruptcy and interdiction in a debtorcreditorrelationship. Overall, further efforts need to be done to put theseconcepts into contemporary and applicable perspectives without violatingIslamic fundamental principle of justice and fair dealings. (shrink)
There has been an increase of discussion and focus on matters of theological significance in the area of youth ministry. An area that remains neglected concerns the professional youth worker in Southern Africa. This focus on professional youth work has gained a great amount of urgency from the office of the presidency of Southern Africa, who in collaboration with the Commonwealth desk have prioritised the focus on youth work in South Africa. Unfortunately, the focus on the professional youth worker, the (...) career youth pastor, within the church in Southern Africa fails to receive a similar amount of attention. The article will highlight the need to pursue a theological articulation around the office of the career youth pastor by building a practical theological argument for the office of career youth pastor. The article will address a case study of a mainline evangelical denomination regarding its theological articulation of the career youth pastor. (shrink)
As a form of da’wah, the grave pilgrimage has didactic function. Some didactic values contained in the pilgrimage of the grave are the exemplary to the charismatic figures, the transformation of remembering death as a spirit of the good deed, the building of social capital, the medium of gratitude, and of order and obedience. One of the challenges faced in Indonesian education is the rampant violence done by students and parents to teachers. This problem can not be solved only through (...) the application of the concept of humanistic education. Therefore, the author offers the concept of humanistic religious education. This concept contains the use of some didactic values of the grave pilgrimage to complement the weaknesses of the concept of humanistic education. The use of didactic value is motivated by the reason that the grave pilgrimage is the religious practice that is easily accessible to the public from all social classes, except for those who reject it. Some of the companion values of the concept of humanistic education are the sacralization of the function of the teacher, the transformation of remembering death for charity and commitment to order and obedience. The sacralization of teachers is necessary to awaken parents and students that violence to teachers can lead to quality for perpetrators of violence. The concept of charity should be maintained in education to encourage the awareness of parents and students to not only need to respect the teacher during the learning process, but also to continue after the student completes his education. Commitment to obeying the order is necessary so that the parents and the student do not resort to violence to the teacher when the teacher carries out his disciplinary duties. (shrink)