The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values and (...) value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)
Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case sketches illustrate how bioethics can contribute to the analysis and public policy discussion of medicalization.
While 90 percent of participants in a 2005 Gallup poll indicated that they would donate an organ if asked, only 40 percent of Americans have registered to do so, according to 2012 data from Donate Life America; likely even fewer have shared their donation wishes with loved ones. Undoubtedly, the single biggest reason for the discrepancy between the number of potential transplants and the number actually performed is our failure to talk with loved ones about our wishes regarding organ donation. (...) Although many resources already exist to hold these conversations, we can do more, and the emergence of social media provides an intriguing new opportunity. Two years ago, Organize.org set out to create the first nationwide organ donation registry in the United States. (shrink)
Research ethics consultation is increasingly recognized as a potentially valuable mechanism for addressing the depth and breadth of ethical issues that arise in research related to human health and well-being. However, fundamental questions remain, including: What is “research ethics consultation”? And what is its justification beyond the purposes already served by existing entities? We examine how a research ethics consultation service may differ from or complement the role of an institutional review board by offering a definition of research ethics consultation (...) and by exploring the potential scope of a consultation service in terms of types of clients served, questions addressed, and advice provided at various stages of the research process. We then consider the relationship between research ethics consultation services and IRBs, as well as the issues that may arise between them, including possible conflicts of interest. (shrink)
A defence of the possibility of amoralism is important to discussions about the foundations of ethics and the justification of morality. I argue against Michael Smith's attempt to show, through a defence of internalism, that amoralism is incoherent. I argue first, that a de dicto reading of the externalist's explanation of changes in motivation which are pursuant upon changes in judgement is not objectionable or implausible as Smith contends; and second, that internalism cannot account for the effort of the will (...) required to make such changes in motivation. I also argue that the internalism/externalism debate can be diffused by considering the epistemic difficulties associated with identifying motivating states and by rejecting the notion that motivation can be understood in terms of psychlogical states. (shrink)
Ethics is the emphasis of our first-year Introduction to Clinical Medicine-1 course. Introduction to Clinical Medicine-1 uses problem-based learning to involve groups of seven to nine students and two facilitators in realistic clinical cases. The cases emphasize ethics, but also include human behaviour, basic science, clinical medicine, and prevention learning issues. Three cases use written vignettes, while the other three cases feature standardized patients. Groups meet twice for each case. In session one, students read the case introduction, obtain data from (...) the written case or standardized patient, identify the case's ethical problems, formulate learning issues, discuss ways to resolve the moral conflicts, and assign research responsibilities. In session two, students discuss their assigned learning issues and specify and justify clinical actions to address the case's ethical dilemmas. Following three cases, groups write an essay discussing what they learned and describing how they would approach and resolve the case's learning issues. (shrink)
Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. The series will aim to build links between the sciences and humanities in psychiatry. Our ability to decipher mental disorders depends to a unique extent on both the sciences and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', and the humanities provide insight into its 'meanings' and helps with our 'understanding'. Psychiatry, (...) if it is to develop as a balanced discipline, must draw on input from both of these spheres. Nature (for causes) and Narrative (for meanings) will help define the series as a whole by touching on a range of issues relevant to this 'border country'. With contributions from an international star-studded cast, representing the field of psychiatry, psychology and philosophy, this volume will set the scene for this new interdisciplinary field. This will be of interest to all those with practical experience of mental health issues, whether as providers or as users/consumers of services, as well as to philosophers, social scientists, and bioethicists. (shrink)
A recent literature review of commentaries and ‘state of the art’ articles from researchers in psychiatric genetics (PMG) offers a consensus about progress in the science of genetics, disappointments in the discovery of new and effective treatments, and a general optimism about the future of the field. I argue that optimism for the field of psychiatric molecular genetics (PMG) is overwrought, and consider progress in the field in reference to a sample estimate of US National Institute of Mental Health funding (...) for this paradigm for the years 2008 and 2009. I conclude that the amounts of financial investment in PMG is questionable from an ethical perspective, given other research and clinical needs in the USA. (shrink)
While much discussion in bioethics, philosophy of science, and philosophy of medicine concerns the proper handling and uses of value considerations, there has been little discussion about how to identify or recognize values in medical/scientific discourse. This article presents a heuristic method for identifying values in such discourses. Values are defined as descriptions or conditions that guide human action and are praise- or blameworthy. Values manifest themselves in discourses in one or more of three dimensions: linguistic, causal, and descriptive; each (...) with distinctive “subtypes”. By recognizing the various ways that values manifest in discourses, a “values scholar” can ask relevant questions of the discourse and thereby come to recognize potential evaluative meanings in the discourse. Numerous examples are provided from the author's own research program. Strengths, limitations, and paths to developing the model are briefly discussed. (shrink)
An important issue raised and resolved in St. Anselm’s Proslogion is the compatibility between justice and mercy as divine attributes. In this paper I argue that Anselm’s discussion of divine justice and mercy is an exploration of God’s nature as quo maius cogitari non potest, and that his discussion contributes to a better understanding of the complicated relationship between God and creatures—including the creatures attempting to know or argue about God. It seems at first that God’s mercy must be in (...) contradiction with God’s justice. On the basis of a more adequate way of framing the issue, however—one that requires reference to other parts of the Proslogion and is supported by the Monologion—we can grasp, though not fully comprehend, the harmony between divine justice and divine mercy. (shrink)
I offer ten arguments to demonstrate why student plagiarism is unethical. In sum, plagiarism may be theft; involve deception that treats professors as a mere means; violate the trust upon which the professor-student relationship depends; be unfair to other students in more than one way; diminish the student’s education; indulge vices such as indolence and cowardice; foreclose access to the internal goods of the discipline; diminish the value of a university degree; undercut creative self-expression and acceptance of epistemic limitations; and (...) undermine the vital interpersonal component of higher education. Plagiarism warrants severe penalties that effectively combat the student’s presumptive competitive strategy for individual success. (shrink)
The concept of vice-wrongful or criminal conduct-poses a metaphysical clash with the non-moral values of impairment, injury, and incapacity that drive illness/disorder concepts. Nevertheless, vice and disorder concepts have interpenetrated psychiatry past and present through practical social-service interactions between the mental health, adult and juvenile criminal justice, and intellectual disability systems. This chapter will unpack and briefly review the philosophical issues, including considerations of moral and legal responsibility, diagnostic constructs, and the medicalization of vice in contemporary psychiatry.
Currently there is little guidance given to teachers in selecting focal issues for socio-scientific issues -based teaching and learning. As a majority of teachers regularly collaborate with other teachers, understanding what factors influence collaborative SSI-based curriculum design is critical. We invited 18 secondary science teachers to participate in a professional development on SSI-based instruction and curriculum design. Through intentional design, we studied how these teachers formed curriculum design teams and how they selected focal issues for SSI-based curriculum units. We developed (...) substantiative grounded theory to explain these processes. Key findings include how teachers’ tensions and agential moves worked in tandem in the development of a safe and shared place to share discontentment and generate opportunities to form design teams and select issues. Teacher passion and existing resources are factors as influential as considerations for issue relevance. Implications for teacher professional development and research are included. (shrink)
I argue that to see certain textual practices as instances of plagiarism depends upon prior assumptions about the nature of authorship and originality. I introduce key ideas from Kant's essay "On the Unauthorized Publication of Books" as a clue to the modern notion of authorship and from Foucault's "What Is an Author?" which offers a postmodern deconstruction of the author. I explain how the current proliferation of student plagiarism can be viewed as a radical departure from both of these views, (...) pointing toward a future in which the creation of text is un-authored, anonymous, collective but non-collaborative, and dynamic. I suggest that faculty attitudes about plagiarism represent, in part, a failure to understand the changing economic, technological, and textual practices that are guiding students and administrators. Nonetheless, I maintain that plagiarism is unethical, even as I call for philosophers to rethink how our discipline might respond to these changing practices. (shrink)
This essay introduces a thematic issue focused on the contributions to clinical ethics and the philosophy of medicine by Richard M. Zaner. We consider the apparent divorce of Zaners philosophical roots from his recent narrative immersions into the blooming, buzzing confusions of clinical-moral lifeworlds. Our considerations of the Zanerian context and origins of the clinical encounter introduce the fundamental questions faced by Zaner and his commentators in this issue, questions about the role of ethics consultants, moral authority, and clinical truths.
The DSM-IV, like its predecessors, will be a major influence on American psychiatry. As a consequence, continuing analysis of its assumptions is essential. Review of the manuals as well as conceptually-oriented literature on DSM-III, DSM-III-R, and DSM-IV reveals that the authors of these classifications have paid little attention to the explicit and implicit value commitments made by the classifications. The response to DSM criticisms and controversy has often been to incorporate more scientific diversity into the classification, instead of careful inquiry (...) and assessment of the principal values that drive the nosologic process. Implications for psychiatric science and future DSM classifications are discussed. (shrink)
In 2015, the U.S. Supreme Court ruled in favor of same-sex marriage in Obergefell v. Hodges. Although I concur that same-sex couples should have the right to marry if anyone does, I argue that civil marriage is an unjust institution. By examining the claims employed in the majority opinion, I expose the Court’s romanticized, patriarchal view of marriage. I critique four central claims: that marriage is central to individual autonomy and liberty; that civil marriage is uniquely valuable; that marriage “safeguards” (...) children and families; and that marriage is fundamental to civil society. (shrink)