Mit den Fortschritten im Bereich der psychiatrisch-genetischen Forschung gehen auch intensive Diskussionen bezüglich der daraus erwachsenden Implikationen einher. Hoffnungen wie Befürchtungen gegenüber der neuen Technologie und deren Folgen werden gleichermaßen zum Ausdruck gebracht. Über die Einstellung der Bevölkerung und insbesondere der Patienten mit affektiven oder schizophrenen Erkrankungen und ihrer Angehörigen in Deutschland war bisher allerdings wenig bekannt. Daher führten wir im Rahmen des Deutschen Humangenomprojektes erstmals eine Studie durch, um die Einstellungen und ihre beeinflussenden Faktoren zu erfassen. Wir entwickelten einen (...) Fragebogen zur Erfassung der Erwartungen, Hoffnungen und Befürchtungen sowie der die Einstellung beeinflussenden Faktoren. Hiermit wurde eine repräsentative Stichprobe von 3077 Personen aus der Allgemeinbevölkerung am Telefon befragt. Weiterhin wurden mit 316 Patienten und 163 Angehörigen persönliche standardisierte Interviews anhand des Fragebogens durchgeführt. Die Mehrzahl der Befragten hatte eine positive Einstellung zu psychiatrisch-genetischer Forschung, äußerte jedoch gleichzeitig ethische Bedenken. Übereinstimmend waren die Befragten der Ansicht, dass Informationen aus genetischen Untersuchungen vertraulich behandelt werden sollten. Kleine, aber signifikante Unterschiede zwischen den Gruppen zeigten sich bezüglich der Einstellung zu präsymptomatischer genetischer Diagnostik. Unsere Ergebnisse weisen auf eine Ambivalenz der Befragten gegenüber der psychiatrisch-genetischen Forschung und Untersuchung hin: Neben einer überwiegend positiven Einstellung wurden auch moralische Bedenken geäußert. (shrink)

The discussions about subject and validation in our late modernity tend to oscillate between the "weak" self of postmodernity ("empty" or "rhetorical") and neo-Cartesian versions trying, as they do, to recover a discredited foundation. Correspondingly, the solutions advanced range from calls for a "New Enlightenment" (in the face of the resurgence of myth and "the irrational") to attempts to "re-enchant the world" (in the face of the growing threat of an impersonal instrumental Reason).The present study seeks to respond theologically to (...) such a situation from the perspective of God's action in and towards the world by engaging two prominent philosophical/theological figures who continue to inform such discussions today, namely, Georg Friedrich Hegel and Paul Ricoeur. The upshot of this response points to a view of rationality that follows the drama of God's engagement with the world, thus involving both dying and resurrection, ascesis and abundance, suffering witness and eucharistic communion. (shrink)

_The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness, second edition_ examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, and more. It is also an outstanding introduction to philosophy of mind from the perspective of mental disorder. Revised and updated throughout, this _second edition_ includes new discussions of grief and psychopathy, the problems of the psychophysical basis of disorder, the nature of selfhood, and clarification of the relation between rationality and (...) mental disorder. Each chapter explores a central question or problem about mental disorder, including: what is mental disorder and can it be distinguished from neurological disorder? what roles should reference to psychological, cultural, and social factors play in the medical/scientific understanding of mental disorder? what makes mental disorders undesirable? Are they diseases? mental disorder and the mind–body problem is mental disorder a breakdown of rationality? What is a rational mind? addiction, responsibility and compulsion ethical dilemmas posed by mental disorder, including questions of dignity and self-respect. Each topic is clearly explained and placed in a clinical and philosophical context. Mental disorders discussed include clinical depression, dissociative identity disorder, anxiety, religious delusions, and paranoia. Several non-mental neurological disorders that possess psychological symptoms are also examined, including Alzheimer’s disease, Down’s syndrome, and Tourette’s syndrome. Containing chapter summaries and suggestions for further reading at the end of each chapter, _The Disordered Mind, second edition_ is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. (shrink)

This article is a review of the literature on the subject of how nurses who provide palliative care are affected by ethical issues. Few publications focus directly on the moral experience of palliative care nurses, so the review was expanded to include the moral problems experienced by nurses in the care of the terminally ill patients. The concepts are first defined, and then the moral attitudes of nurses, the threats to their moral integrity, the moral problems that are perceived by (...) nurses, and the emotional consequences of these moral problems are considered in turn. The results show that the moral behaviour of nurses, which is theoretically grounded in commitment to care and to the patient, appears to be shaped by specific processes that lead to engagement or to mental and behavioural disengagement in morally difficult situations. Nurses often appear to fail to recognize the moral dimensions of the problems they experience and also to lack the skills they need to resolve moral problems adequately. Although the findings show that several elements that are beyond the control of nurses, owing to their lack of autonomy and authority, influence their moral experience, intrinsic factors such as feelings of insecurity and powerlessness have a profound effect on nurses’ perceptions and attitudes in the face of moral problems. The moral problems perceived by these nurses are related to end-of-life issues, communication with patients, the suffering of patients, and the appropriateness of the medical treatment. (shrink)

It is not only overtly probabilistic illatives like ‘makes it certain that’ but also apparently non-probabilistic ones like ‘therefore’ that have probabilistic import. Illatives like ‘therefore’ convey the meaning that the premise confers on the conclusion a probability not only greater than 0 but also greater than 1/2. But because they do not say whether that probability is equal to or less than 1, these illatives are appropriately called ‘neutral’.

A benchmark volume for an emerging field where mental disorders serve as the springboard for philosophical insights.

George McClure offers here a far-reaching analysis of the role of consolation in Italian Renaissance culture, showing how the humanists' interest in despair, and their effort to open up this realm in both social and personal terms, signaled a shift toward a heightened secularization in European thought. Analyzing works by fourteenth-and fifteenth-century writers, from Petrarch to Marsilio Ficino, McClure examines the treatment of such problems as bereavement, fear of death, illness, despair, and misfortune. These writers, who evinced a belief (...) in the legitimacy of secular sadness, tried to forge a wisdom that in their view dealt more realistically with the art of living and dying than did the disputations of scholastic philosophy and theology. Arguing that consolatory concerns helped spur the revival of classical schools of psychological thought, McClure reveals that the humanists sought comfort from once-neglected troves of Stoic, Peripatetic, Epicurean, Platonic, and Christian thought. He contends that the humanists' pursuit of solace and their duty as consolers provided not only a forum but perhaps also an incentive for the articulation of prominent Renaissance themes concerning immortality, the dignity of man, and the sanctity of worldly endeavor. Originally published in 1990. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Background: Caring for terminally ill patients is a meaningful task, however the patient’s suffering can be a considerable burden and cause of frustration.Objectives: The aim of this study is to describe the experiences of general practitioners in The Netherlands in dealing with a request for euthanasia from a terminally ill patient.Methods: The data, collected through in-depth interviews, were analysed according to the constant comparative method.Results: Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described (...) as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without “intentionally hastening a patient’s death on his request”. The other GPs explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient’s request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient’s suffering through euthanasia and their personal values.Conclusion: Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient’s suffering and to promote a peaceful death. (shrink)

Too little attention has been paid by philosophers to the cognitive and epistemic dimensions of emotional disturbances such as depression, grief, and anxiety and to the possibility of justification or warrant for such conditions. The chief aim of the present paper is to help to remedy that deficiency with respect to depression. Taxonomy of depression reveals two distinct forms: depression (1) with intentionality and (2) without intentionality. Depression with intentionality can be justified or unjustified, warranted or unwarranted. I argue that (...) the effort of Aaron Beck to show that depressive reasoning is necessarily illogical and distorted is flawed. I identify an essential characteristic of that depression which is a mental illness. Finally, I describe the potential of depression to provide credal contact with important truths. (shrink)

The Disordered Mind, Third Edition is a wide-ranging introduction to the philosophy of mental disorder or illness. It examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, compassionate treatment, and more. Revised and updated throughout, the third edition includes enhanced discussions of the distinction between mental health and illness, selfhood and delusions about the self, impairments of basic psychological capacities in mental disorder and the distinct roles that mental causation and neural mechanisms play in (...) mental illness. The book is organized around four questions: What is a mental disorder or illness? What makes mental disorder something bad? What are various mental disorders and what do they tell us about the mind? What is mental health and how may it be restored? Numerous disorders are discussed including: addiction, agoraphobia, delusion, depression, dissociative identity disorder, obsession-compulsion, schizophrenia, and religious scrupulosity, among others. Several neurological disorders are examined. Various problems associated with DSM-5 and with psychiatric diagnosis are explored. Including chapter summaries and suggestions for further reading at the end of each chapter, The Disordered Mind presupposes no special background in philosophy, and as such will be of interest to those in related disciplines such as psychology, psychiatry and mental health, and professions such as nursing and social work. (shrink)

In response to Evelyn Pluhar'sWho Can Be Morally Obligated to Be a Vegetarian? in this journal issue, the author has read all of Pluhar's citations for the accuracy of her claims and had these read by an independent nutritionist. Detailed analysis of Pluhar's argument shows that she attempts to make her case by consistent misappropriation of the findings and conclusions of the studies she cites. Pluhar makes sweeping generalizations from scanty data, ignores causal explanations given by scientists, equates hypothesis with (...) fact, draws false cause conclusions from studies, and in one case claims a conclusion opposite of what the scientist published. Such poor reasoning cannot be the basis of an argument for moral vegetarianism. A broader search of the literature and attention to reviews and textbooks in nutrition shows that each of Pluhar's claims is suspect or incorrect. Pluhar has not undermined my central claims: even if animals have certain rights and well-planned vegetarian diets are safe in complex industrialized societies, these diets cannot be so regarded if the presuppositions of high levels of wealth, education, and medical care do not exist; and, women, children, the aged and some ill persons are at greater risk on restrictive vegan diets. Thus, any duty of moral vegetarianism is not categorical but provisional in nature. (shrink)

The paper describes the refusal of the liberal community to assert the right of persons accused of mental illness to be free of coercive psychiatric intrusion. It suggests that the penchant for benevolent governmental intrusion into other social problems may be at fault and recommends that intervention be abandoned in favor of a return to human autonomy as a basis of the concept of freedom.

In lieu of an abstract, here is a brief excerpt of the content:George J. Leonard EMERSON, WHITMAN, AND CONCEPTUAL ART The widespread abandoning of the art object at the end of the 1960s was taken as something radically, even frighteningly, new, by critics and artists alike. Objects, concept artist Joseph Kosuth was asserting by 1969, are "irrelevant" to art. Though an artist might choose, as in the past, to "employ" objects, "all art is finally conceptual." In fact it was (...) now time that the object, nothing more than the "physical residue" of the artist's mental activity, was dispensed with.1 "We / open our eyes and ears seeing life / each day excellent as it is," John Cage chanted: "This / realization no longer needs art...."2 Aestheticians as disparate as Murray Krieger and Harold Rosenberg reacted to this "transfiguration of the commonplace," as Arthur Danto has called it. Danto has gained a wide scholarly audience for his ideas about the 1960s as "the end of art," or at least as the beginning of "post-historical art."3 We know from such works as Renato Poggioli's TL· T^ry oftL· Avant-Garde that, in this century, particular movements have routinely declared themselves to be art's climax.4 Critics like Jacques Barzun and artists like Amedee Ozenfant had been saying for years that art was exhausted. Yet conceptualism's attack on the object struck most critics as something both alarming and new: Irving Sandler wrote in a special edition of the College Art Association's Art Journal devoted to the problem that it demolished "every notion of what art should be,"5 and Murray Krieger feared that this "leap beyond Pop Art" would "complete the obliteration of the realm of art, its objects, its museums...."6 But the conceptualist attacks on the art object were, in fact, not new. One can find attacks as scathing in Emerson and Whitman; so scathing, that criticism has rarely taken them seriously. The attacks the concep297 298Philosophy and Literature tualists mounted in the 1960s were only the culmination ofan intellectual tendency which appeared throughout the West one hundred and sixty years before. It has long been a scholarly commonplace that after 1800 an "intellectual tendency"—as M. H. Abrams finallytermed it—extolling the possibilities of this world emerged in all parts of Western culture. When itappears in literature we nowusually call it, withAbrams, Natural Supernaturalism; or, with Harold Bloom, the "visionary company." Man, Wordsworth decreed, can and must learn to find "Paradise" in "the common day."7 Surprisingly litde work has been done on what happened when this intellectual tendency, Natural Supernaturalism, confronted the art object. Emerson and Whitman can stand for many who were necessarily ill at ease with the idea of art objects as elite objects superior to the common things it was their mission to extol. Wordsworth works before these two; Ruskin develops similar ideas into greater complexity; but since Emerson writes clear expository prose and avoids fanciful terminology, he makes a good place to enter this dark wood. Let us begin with some straightfor-ward, overdue interdisciplinary history, reading Emerson on the art object, noticing similar passages in Whitman, and noting where Emerson has reworked Hegel for his own ends. For Emerson objects are but thought's "inert effect," as for the concept artist Kosuth they would be but the "physical residue" of the artist's activity. Emerson and Kosuth, opposite Shakespeare, do not applaud the art process as the giving to an airy nothing a local habitation and a name; rather they disdain the stuff as petrifactions, as dead mud footprints left by living thoughts diat have raced away.8 In his essay "Circles," Emerson derides our admiration for a work of architecture, directing us to the "litde waving hand" that built it, for "that which builds is better than that which is built." By the same logic, the invisible thoughts which truly wrought the object were even better than the hand and "nimbler."9 When such passages are discussed at all, they are usually considered Platonic,10 but, in his essay "Art," Emerson envisions a use for art objects Plato would have blinked at. For the time being, art objects have a particular "office" to fill. That office, Emerson wrote in... (shrink)

The mainstream approach to the understanding of pain continues to be governed by the biomedical paradigm and the dualistic Cartesian ontology. This Volume brings together essays of scholars of literature, philosophy and history on the many enigmatic shades of pain-experience, mostly from an anti-Cartesian perspective of cultural ontology by scholars of literature, philosophy and history. A section of the essays is devoted to the socio-political dimensions of pain in the Indian context. The book offers a critical perspective on the reductive (...) conceptions of pain and argue that non-substance ontology or cultural ontology supports a more humane and authentic understanding of pain. The general ontological features of the self in pain and culturally imbued dimensions of pain-experience are, thus, brought together in a rare blend in this Volume. The essays dwell on the importance of understanding what cultural, social and political forces outside our control do to our pain-experience. They show why such understanding is necessary, both to humanely deal with pain, and to rectify erroneous approaches to pain-experience. They also explore the thoroughly ambivalent spaces between pain and pleasure, and the cathartic and productive dimensions of pain. The essays in this Volume investigate pain-experiences through the fresh lenses of history, gender, ethics, politics, death, illness, self-loss, torture, shame, dispossession and denial. (shrink)

Valuations are ubiquitous. We may be for or against genetically modified food; we find some politicians irresponsible; we prefer Beethoven to rock ‘n’ roll or vice versa; some enjoy bird-watching while others find it boring; and we may think that we have to tighten up on green-house gas emissions. Valuing is pervasive and often we are not even aware that we are valuing. However, many of our valuations are ill grounded and rationally defective. They are frequently based on misinformation, sloppy (...) thinking, prejudice, and are biased in many ways as psychological research shows. For this reason there is widespread agreement among phi-losophers that we need an account of substantive valuational rationality, both for the theory of practical reasoning and for ethics as well. My main object in this paper is to outline such an account and to present a principle that allows a non-technical rational criticism of valuations. (shrink)

Philosophical psychopathology lies at the intersection of philosophy and psychiatry. The name is new. The field is not. This paper surveys work in the field since about 1980. Special attention is given to work on two topics: mental illness semantics and the metaphysics of disorders of self-consciousness.

As the world moves into the 21st century, business managers face new and daunting challenges to their legitimacy. Those who run the world’s 72,0000 multinational firms and their 828,000 subsidiaries face special difficulties.1 These firms constitute a global economy that has produced much that is useful, including wondrous technologies and great wealth for many. Nevertheless, one in five of the world’s six billion people lives in extreme poverty, surviving on less than $1 a day. Half the world lives on less (...) than $2. In spite of roughly $1 trillion that has been spent to fight poverty around the globe in the last 50 years and vastly increased trade and investment, most people in Latin America, the Middle East and Central Asia are poorer today than they were ten years ago, and most Africans were better off 40 years ago.2 Environmental degradation increases, as do disease and violations of human rights. Unreasonable as it may be to blame business for the world’s ills, the blame sticks, because the ills — like multinationals — transcend national boundaries and are in many ways beyond the power of existing governments to affect. And global government has yet to evolve. Furthermore, the governments of many countries lack either the will or the ability to reduce poverty within their jurisdictions, meaning that if MNCs do not do it, it won’t be done.3 In addition to the undesirable costs of the globalisation they have helped to create, managers are concerned also with the greed, crime and scandal in their own ranks. So it is appropriate to help them inspect the assumptions that have been used to justify their power and authority, and to consider whether those assumptions need renovation. This I shall do in Part I of this essay. In Part II I shall seek a historical perspective, because in many ways the criticism of business and globalisation today echoes the debate in the 1930s about which economic system was best, communism, socialism or capitalism. Capitalism, we suppose, has won, but if so, what is it? Is it the same everywhere — in China, Japan, Europe, Mexico, the United States, and elsewhere? If not, is the very word not misleading? (shrink)

Not everyone finds a in suffering. Indeed, even those who do subscribe to this interpretation recognize the responsibility of each individual to show not only sensitivity and compassion but render assistance to those in distress. Pharmacologic hypnosis, morphine intoxication, and terminal sedation provide their own type of medical to the terminally ill patient suffering unremitting pain. More and more states are enacting legislation that recognizes this need of the dying to receive relief through regulated administration of controlled substances. Wider legislative (...) recognition of this need would go far toward allowing physicians, in the exercise of their reasonable medical judgment, to administer a range of narcotics and barbiturates to the terminally ill without fear of legal sanctions. Sadly, social attitudes and governmental concerns about the spread of drug addiction provide an undeniable policy nexus that impedes unduly a rational approach or exception for the treatment of pain experienced by the dying. (shrink)

This paper explores and reflects upon the literature and several mini case studies to recommend a change of focus for the linking management and development of community participants and community organisations. This change of focus looks at complexity and patterns that arise from the multitude of social interactions; the support and development of individuals and the effect this can have on an organisation’s wellbeing; and the effect a community organisation can have on that of the individual. To gain insight into (...) wellbeing, people need to be aware of their mind, body and energy and how they affect others. There is evidence that terminally ill people who have found new beliefs have experienced a spontaneous remission of disease. Humanity evolves in the same way as we control our destiny. We can learn to love, respect, trust, and commit to each other and work in harmony, or we can foster disharmony resulting in failure and negative feelings. As the economy changes, community organisations are under threat of extinction. Just as species and humanity evolve, we suggest that community organisations need to evolve to ensure wellbeing. (shrink)

Battin et al examined data on deaths from physician-assisted suicide in Oregon and on PAS and voluntary euthanasia in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it—namely, that there is for the most part ‘no evidence of heightened risk’ to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference (...) to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS. (shrink)

The philosophy of medicine and psychiatry has considered the defining of disease, illness, and disorder an important project for over three decades. Within this literature, accounts based on adaptive "functions" have been prominent, particularly in the DSM nosology. In response to this trend, Jerome Wakefield has presented a view of mental disorder as "harmful dysfunction." In this view, "harm" contributes the value-element to disorder concepts, while "dysfunction" implies a value-free foundation as long as the latter is grounded in evolutionary biology. (...) In a critical review of Wakefield's and others' functionalist arguments for disorder concepts, we make four major points. We recommend a shift away from the definition of value-free disorder concepts, instead emphasizing the analysis of the logical features and the value commitments in nosological categories. (shrink)

Phaedo of Elis was well-known as a writer of Socratic dialogues, and it seems inconceivable that Plato could have been innocent of intertextuality when, excusing himself on the grounds of illness, he made him the narrator of one of his own: the "Phaedo". In fact the psychological model outlined by Socrates in this dialogue converges with the evidence we have (especially from fragments of the Zopyrus) for Phaedo's own beliefs about the soul. Specifically, Phaedo seems to have thought that non-rational (...) desires were ineliminable epiphenomena of the body, that reason was something distinct, and that the purpose of philosophy was its 'cure' and 'purification'. If Plato's intention with the "Phaedo" is to assert the separability and immortality of reason (whatever one might think about desire and pleasure), then Phaedo provides a useful standpoint for him. In particular, Phaedo has arguments that are useful against the 'harmony-theorists' (and are the more useful rhetorically speaking since it is only over the independence of reason that Phaedo disagrees with them). At the same time as allying himself with Phaedo, however, Plato is able to improve on him by adding to the demonstration that reason is independent a proof that it is actually immortal. (shrink)

The impressive volume before us started out as an attempt to write “the history of epistemology since Kant, the way Carnap would have written it had he been Hegel.” Coffa began his project in 1981 while a fellow at the Center for Philosophy of Science in Pittsburgh and had finished a “good penultimate draft” when he suddenly died, after a brief illness, on 30 Dec., 1984. The title alludes to Edmund Wilson’s classic study of revolutionary ideology, To the Finland Station. (...) This is no accident and would be presumptuous in a lesser work. The two studies cover roughly the same period, from the late eighteenth century to the first part of the present one, and they are both sparkling narratives that boldly project a large picture and then fill it in with canny detail. Coffa begins with Kant, the villain of the piece, and ends with a group of thinkers “in the neighborhood of Vienna” who came to terms with the restrictive framework they had inherited from Kant, finally overcoming it in favor of a new philosophy in which meaning, rather than mind, played the central role. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Criminal Law, Pain Relief, and Physician Aid in DyingFaye Girsh, Ed.D., Executive DirectorMadam:The article by Cantor and Thomas on “Pain Relief, Acceleration of Death, and Criminal Law” (KIEJ, June 1996) was a tortured attempt to develop criteria for the humane and compassionate physician who tries to serve the needs of a patient in unremitting pain. There are three areas that merit comment.The authors dealt with pain medications that might (...) have the undesirable side effect of causing death. They did not mention tolerance, which usually occurs in a patient with chronic pain and which would require exceedingly high doses to be effective. They did not mention barbiturates, which are preferable to opiates in causing death and which are used increasingly by compassionate physicians to answer the pleas of their suffering patients, but for which there is no excuse about alleviating pain. Would the criminal law just call the prescription of a lethal dose of barbiturates a reckless act and require conviction? Fortunately, juries, as the authors point out, do not balance these formulas on the head of a pin. When they see the circumstances under which these doctors do help their patients, they choose to nullify the law and would ignore the suggestions made in this article.The authors refer to the “consent” of the patient. They do not mention that these doctors are operating with more than consent; they are administering these medications because suffering patients are begging them to put them out of their pain and the indignities of the dying process. The article discusses the process as though it were the same as consent to elective surgery. These patients—with AIDS, cancer, and hopeless neurological degeneration—are not simply agreeing to a procedure; they are desperately seeking a way out. If the criminal law were to develop criteria for physician aid in dying, certainly one of them should be the active, witnessed, repeated request of such a patient for a certain, quick, painless, gentle death.The third point is that physicians do not face prosecution when administering no treatment to a patient whose life could be saved with treatment but who chooses not to receive it. This has been upheld by the U.S. Supreme Court; no criteria for suffering, alternatives, terminality, justifiability, or unbearability are required. The doctor can stand by while the patient dies what may be a protracted, difficult death, but it is within the law. What matters in this situation is the decision of the patient to refuse treatment, and that is absolute. How ironic that the patient who cannot refuse treatment must, with his or her doctor, jump through all these hoops to achieve a peaceful death.One worries that the physician who must balance the risk of “risky pain relief” against the accusation of recklessness will err in the direction of allowing [End Page 103] the patient to bear the pain rather than help with a dose of analgesics that might be considered beyond the stipulated “risk.”Why don’t we just be honest about it? Allow dying or hopelessly ill patients to make the decision about what they want by passing a carefully defined law allowing euthanasia rather than balancing the risk and trying to determine the “purpose” of the physician’s ministrations. We protect some patients from themselves while allowing others almost complete autonomy to make the choice of ending their lives. The authors were right in saying that proponents of rational laws consider this sheer hypocrisy.Faye Girsh, Executive DirectorHemlock Society U.S.A. Denver, COFaye Girsh misconceives our article’s objective as an “attempt to develop criteria” for the humane physician. Our goal in writing the paper was to analyze the current criminal law framework in the hope of sharpening debate and engendering normative critiques. We readily acknowledge tensions in the current legal framework and would support changes in that framework.Copyright © 1997 The Johns Hopkins University Press... (shrink)

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not been (...) inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. (...) Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice. (shrink)

There is growing interest in contact tracing apps for pandemic management. It is crucial to consider ethical requirements before, while, and after implementing such apps. In this paper, we illustrate the complexity and multiplicity of the ethical considerations by presenting an ethical framework for a responsible design and implementation of CT apps. Using this framework as a starting point, we briefly highlight the interconnection of social and political contexts, available measures of pandemic management, and a multi-layer assessment of CT apps. (...) We will discuss some trade-offs that arise from this perspective. We then suggest that public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely undermine public trust, and as such, risk impeding general effectiveness. (shrink)

Psychiatry is unique in medicine in being on the border between science and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', while the humanities provide insight into its 'meanings' and helps with our 'understanding'. The new interdisciplinary field of 'philosophy of psychiatry' has developed to explore the range of issues relevant to this border country. The Oxford Textbook of Philosophy and Psychiatry is a unique textbook which provides a detailed introduction to (...) the field, a framework for study and skill development, and an overview of current research. It focuses on case studies in 5 key topic areas. Each case study is supported by selected readings from both philosophy and mental health, thinking skills exercises, self-test questions, key learning points and detailed guides to further reading. (shrink)

Schizophrenia has been investigated predominately from psychological, psychiatric and neurobiological perspectives. This book is unique in examining it from a philosophical point of view. It should appeal to every reader who wants to better understand this major mental illness, providing unique insights into the 'experience' of schizophrenia.

Inflammatory bowel disease is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient’s personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged (...) 16–76 years. An increase in the domain overvigilance and inhibition score had a significant effect, with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme and dependence/incompetence, vulnerability to harm and illness and subjugation schemas. The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme’s intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition. (shrink)

Both spiritual experiences and mindfulness as a psychological variable have been identified as components of wellbeing and health. As there is uncertainty about their relationship, we have investigated the impact of spiritual experiences and mindfulness as well as their interaction on distress in chronically ill patients. The unidimensional Daily Spiritual Experiences Scale, the multidimensional Exceptional Experiences Questionnaire, the Freiburg Mindfulness Inventory, and the Brief Symptom Inventory were administered to 109 chronically ill patients. Fifty-eight patients reported regular and frequent spiritual or (...) contemplative practice from different traditions over an average of 14.7 years. Patients with regular spiritual practice reported more positive spiritual experiences, were more mindful and less distressed. A stepwise linear regression analysis revealed that the EEQ subscale “negative spiritual experiences” was the most important single predictor for psychological distress. In contrast, both the EEQ subscale “positive spiritual experiences” as well as the DSES that also captures positives daily encounters with a transcendental realm or entity did not account for a significant amount of variance in distress. Further analysis of the regression model, confirmed that NSE was still the largest predictor for distress and that mindfulness and the interaction between mindfulness and NSE were the most important buffers protecting individuals from distress. Thus, mindfulness seems not only to be a clinically important protective factor for buffering generic distress, but particularly for distress derived from NSEs. This suggests that in addition to directly facilitating well-being and health by means of positive spiritual experiences, at least some form of regular spiritual or meditative techniques seem to endow an individual with a certain degree of resilience against negative spiritual experiences that is likely a consequence of increased mindfulness. If these findings are vindicated by further studies, spiritual experiences should not be conceived and measured as univariate but rather multivariate constructs. (shrink)

The fourteen authors in this collection used phenomenology and hermeneutics to conduct deep inquiry into perplexing and wondrous events in their work and personal lives. These seasoned scholar-practitioners gained remarkable insight into areas such as health care and illness, organ donation, intercultural communications, high-performance teams, artistic production, jazz improvisation, and the integration of Tai Chi into education. All authors were transformed by phenomenology's expanded ways of seeing and being.