The primary means for psychotherapy interaction is language. Since talk-in-interaction is accomplished and rendered interpretable by the systematic use of linguistic resources, this study focuses on one of the central issues in psychotherapy, namely agency, and the ways in which linguistic resources, person references in particular, are used for constructing different types of agency in psychotherapy interaction. The study investigates therapists' responses to turns where the client complains about a third party. It focuses on the way therapists' responses distribute experience (...) and agency between the therapist and the client by comparing responses formulated with the zero-person to responses formulated with a second person singular pronoun that refers to the client. The study thus approaches agency as situated, dynamic and interactional: an agent is a social unit whose elements are distributed in the therapist-client interaction. The data consist of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis, and the method of analysis is conversation analysis and interactional linguistics. The main findings are that therapists use the zero-person for two types of responses: affiliating and empathetic responses that distribute the emotional experience between the client and the therapist, and responses that invite clients to interpret their own experiences, thereby distributing control and responsibility to the clients. In contrast, the second person references are used for re-constructing the client's past history. The conclusion is that therapists use the zero-person for both immediate emotional work and interpretative co-work on the client's experiences. The study suggests that therapists' use of the zero-person does not necessarily attribute “weak agency” to the client but instead might strengthen the clients' agency in the sense of control and responsibility in the long term. (shrink)

Suggesting that underlying some violent behavior is an unhealthy identification of one's self with one's behavior, such that there is no reflective space between the acting self and unwanted or violent action, Alexandra Pârvan echoes many contemporary psychotherapeutic models in suggesting that a central goal of psychotherapy for perpetrators and recipients of violence should be to encourage clients to distance the acting self from the self's experience and behavior. Pârvan observes that this is already a feature of "attachment-informed psychotherapy," but (...) she argues that "the distinction between self and action can only be effectively established from outside strictly psychological perspectives" (p.... (shrink)

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in (...) which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

Conversational artificial intelligence (CAI) presents many opportunities in the psychotherapeutic landscape—such as therapeutic support for people with mental health problems and without access to care. The adoption of CAI poses many risks that need in-depth ethical scrutiny. The objective of this paper is to complement current research on the ethics of AI for mental health by proposing a holistic, ethical, and epistemic analysis of CAI adoption. First, we focus on the question of whether CAI is rather a tool or (...) an agent. This question serves as a framework for the subsequent ethical analysis of CAI focusing on topics of (self-) knowledge, (self-)understanding, and relationships. Second, we propose further conceptual and ethical analysis regarding human-AI interaction and argue that CAI cannot be considered as an equal partner in a conversation as is the case with a human therapist. Instead, CAI’s role in a conversation should be restricted to specific functions. (shrink)

A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users’ sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic (...) agency may be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people’s contributions as epistemic agents in the clinical encounter. (shrink)

The feeling of acting voluntarily is a fundamental component of human behavior and social life and is usually accompanied by a sense of agency. However, this ability can be impaired in a number of diseases and disorders. An important example is apraxia, a disturbance traditionally defined as a disorder of voluntary skillful movements that often results from frontal-parietal brain damage. The first part of this article focuses on direct evidence of some core symptoms of apraxia, emphasizing those with connections to (...) agency and free will. The loss of agency in apraxia is reflected in the monitoring of internally driven action, in the perception of specifically self-intended movements and in the neural intention to act. The second part presents an outline of the evidences supporting the functional and anatomical link between apraxia and agency. The available structural and functional results converge to reveal that the frontal–parietal network contributes to the sense of agency and its impairment in disorders such as apraxia. The current knowledge on the generation of motor intentions and action monitoring could potentially be applied to develop therapeutic strategies for the clinical rehabilitation of voluntary action. (shrink)

How exactly do mental disorders affect one’s agency? How might therapeutic interventions help patients regain or improve their autonomy? Do only some disorders excuse morally inappropriate behavior, such as theft or child neglect? Or is there nothing about having a disorder, as such, that affects whether we ought to praise or blame someone for their moral success or failure? Our volume gathers together empirically-informed philosophers who are well equipped to tackle such questions. Contributors specialize in free will, agency, and (...) responsibility, but they are informed by current scientific and clinical approaches to a wide range of psychopathologies, including autism, addiction, Tourette syndrome, personality disorders, depression, dementia, phobias, schizophrenia, and obsessive-compulsive disorder. These conditions exhibit a diverse array of symptoms that can contribute quite differently to being blameworthy or praiseworthy. (shrink)

In ‘A politics of reminding: Khoisan resurgence and environmental justice in South Africa’s Sarah Baartman district’, Burnett et al. scrutinize the memory activism of the Gamtkwa Khoisan Council, which is part of the wider ‘Khoisan resurgence’ sweeping across post-apartheid South Africa. Although the authors missed important nuances, they also pointed out flaws in the way I used Niezen’s ‘therapeutic history’ [Niezen, R. (2009). The rediscovered self: Indigenous identity and cultural justice. McGill-Queen’s Press] in my work to account for why (...) Khoisan activists turn to the past. I therefore not only respond to their criticism, but also revise aspects of my theoretical framework. Therapeutic history is not divorced from material concerns. Nor is it representative of all engagements with the past by indigenous people or simply the opposite of academic history. Instead, by drawing on my ethnographic fieldwork and theorizing alongside the Khoisan, I show how it captures emic discourses on the past that entangle notions of indigenous identity, healing, and history in order to resist settler colonialism and its oppressive etic histories. While the concept of therapeutic history has its limitations, it effectively highlights indigenous people’s agency in the face of settler colonialism in South Africa and elsewhere. (shrink)

Effective agency, according to contemporary Kantians, requires a unity of purpose both at a time, in order that we may eliminate conflict among our motives, and over time, because many of the things we do form part of longer-term projects and make sense only in the light of these projects and life plans. Call this the unity of agency thesis. This thesis can be regarded as a normative constraint on accounts of personal identity and indeed on accounts of what it (...) is to have the life of a person in the broad, rather than narrowly biological sense. It is also a fundamental condition of social life that persons within society fulfill a range of longitudinal roles: parenthood is one such obvious example, as are teachers, health professionals, engineers, artists, and many others. The fulfillment of these and other valuable social roles requires that agents have the capacity to rationally conceive of themselves as engaged in these roles and subject to the demands of them. To be unable to fulfill any such longitudinal social roles is to have a life deficient in value. The unity of agency is thus, we argue, something we rationally strive for, and something to be morally promoted. Psychiatric states that undermine the unity of agency are morally and rationally disvaluable. Using the example of dissociation, we explain how one such state may have this undermining or disruptive effect on the unity of agency. The therapeutic ends for psychiatry in conditions involving such states are thus seen more globally as the restoration of effective agency, that is, unified agency. (shrink)

The aim of this project to expose the reasons behind the pandemic of misinformation (henceforth, PofM) by examining the enabling conditions of epistemic agency and the emerging technologies that threaten it. I plan to research the emotional origin of epistemic agency, i.e. on the origin of our capacity to acquire justification for belief, as well as on the significance this emotional origin has for our lives as epistemic agents in our so-called Misinformation Age. This project has three objectives. First, I (...) plan to expose the degree to which epistemic agency is made possible by an under-researched species of emotion called epistemic feelings. Perhaps, the most epistemically significant is the feeling of confidence. In particular, epistemic feelings make epistemic agency possible by making errors in reasoning salient or the potential lack thereof. -/- Second, in order to diagnose the reasons for PofM, I will analyze the emotional basis of epistemic agency in the context of emerging technologies. Epistemic feelings ought to be construed as motivators of epistemic acts, specifically acts following exposure to misinformation spread by social media. For example, a recent study found that subjects on YouTube have a 6.3% probability in five clicks to go from watching innocuous videos to misogynistic videos. Accordingly, one prominent view holds that social media algorithms lead subjects down the proverbial rabbit hole, producing content that elicits strong emotional reactions. -/- But under-researched is the degree to which these emotions are intertwined with epistemic feelings, so that subjects are likely to misjudge the information as correct due to being primed to do so by processing the AI's suggested media. Thus, when this technology is used in epistemic practices, the result is invariably epistemically bad behavior because of how this manner of producing content motivates epistemic acts through the production of erroneous feelings of confidence, which result from the perceived ease of cognitive processing: the content is easy to process and so, the subject confidently misjudges, it is true. As of yet, an account of this cognitive and emotional decision-making process has not been used to analyze how emerging technologies are threatening epistemic agency, and thus our wellbeing as knowers. -/- Finally, I plan to develop therapeutics for PofM by outlining how to reform our collective epistemic practices. Thus, this project complements existing research in virtue epistemology, specifically by articulating the challenges to cultivating epistemic virtues and warding off the vices of the mind. In summation, the project aims to account for how emerging technologies are committing a form of epistemic injustice through the exploitation of cognitive biases and the production of erroneous epistemic feelings, with the overarching goal being a framework for convalescing from the pandemic of misinformation plaguing our age. (shrink)

Within common mental health treatments there exists a paradox, in which personal agency over a problem appears to increase by disownership of the problem. I endeavor to explain this paradox and by doing so, shed light on the relationships among identity, psychopathology, and therapeutic agency. The work of the philosopher Harry Frankfurt, with emphasis on his concept of externality, is used as the model for unraveling the paradox of agency.

Memory modification technologies (MMTs)—interventions within the memory affecting its functions and contents in specific ways—raise great therapeutic hopes but also great fears. Ethicists have expressed concerns that developing and using MMTs may endanger the very fabric of who we are—our personal identity. This threat has been mainly considered in relation to two interrelated concerns: truthfulness and narrative self‐constitution. In this article, we propose that although this perspective brings up important matters concerning the potential aftermaths of MMT utilization, it fails (...) to tell the whole story. We suggest that capturing more tangible potential consequences of MMT use, namely, its psychological ramifications is crucial both in ethical considerations and in making decisions regarding the permissibility of such interventions. To this end, we first examine what current MMTs are capable of and what are the prospects of emerging MMTs. Subsequently, we outline the relationship between memory and personal identity; specifically, we indicate that concepts of self‐defining memories and narrative identity are crucial to considering how MMTs may influence one's psychological functioning. On this basis, we analyze potential consequences of narrative disruption that may be the result of the use of MMTs; more precisely, we consider its potential effects on mental health, well‐being, and personal agency, and outline the ethical dilemmas that decision‐makers face in this context. We conclude by considering the broader cultural context that may have influence on policymaking regarding permissibility of memory modification interventions. (shrink)

Connecting human minds to various technological devices and applications through brain-computer interfaces (BCIs) affords intriguingly novel ways for humans to engage and interact with the world. Not only do BCIs play an important role in restorative medicine, they are also increasingly used outside of medical or therapeutic contexts (e.g., gaming or mental state monitoring). A striking peculiarity of BCI technology is that the kind of actions it enables seems to differ from paradigmatic human actions, because, effects in the world (...) are brought about by devices such as robotic arms, prosthesis, or other machines, and their execution runs through a computer directed by brain signals. In contrast to usual forms of action, the sequence does not need to involve bodily or muscle movements at all. A motionless body, the epitome of inaction, might be acting. How do theories of action relate to such BCI-mediated forms of changing the world? We wish to explore this question through the lenses of three perspectives on agency: subjective experience of agency, philosophical action theory, and legal concepts of action. Our analysis pursues three aims: First, we shall discuss whether and which BCI-mediated events qualify as actions, according to the main concepts of action in philosophy and law. Secondly, en passant, we wish to highlight the ten most interesting novelties or peculiarities of BCI-mediated movements. Thirdly, we seek to explore whether these novel forms of movement may have consequences for concepts of agency. More concretely, we think that convincing assessments of BCI-movements require more fine-grained accounts of agency and a distinction between various forms of control during movements. In addition, we show that the disembodied nature of BCI-mediated events causes troubles for the standard legal account of actions as bodily movements. In an exchange with views from philosophy, we wish to propose that the law ought to reform its concept of action to include some, but not all, BCI-mediated events and sketch some of the wider implications this may have, especially for the venerable legal idea of the right to freedom of thought. In this regard, BCIs are an example of the way in which technological access to yet largely sealed-off domains of the person may necessitate adjusting normative boundaries between the personal and the social sphere. (shrink)

This article examines the therapeutic self-transformation process in a self-help group in Russia. Drawing on participant observation and interviews, and engaging with debates on therapeutic technologies and the transformation of gender relations, it explores how the self-help group shapes how participants come to understand and act upon themselves. It shows that the process of self-transformation is profoundly gendered, problematising femininity and identifying it as an object of therapeutic intervention. Rather than collectively contesting gendered power and disadvantage, participants (...) are invited to cultivate traditional notions of femininity and masculinity and learn to draw pleasure from them. We argue that this message may be appealing to women because it speaks to their lived experience of exhaustion and precarity, and offers them the prospect of overcoming it through a mythologised heteronormative order. It offers solace and a potential escape route where room for political agency is limited and feminist discourse heavily vilified. Yet the article also shows that participants do not merely internalise the ideological messages of the group, but engage with them in contradictory and ambivalent ways. (shrink)

Agro-ecological innovations aim at promoting sustainable agricultural practices that have long term benefits. However, farmers rarely adopt beneficial innovations in agro-ecology despite expressing an understanding of the benefits and a desire to do so. It has been argued that the farmers lack sufficient knowledge to implement complex innovations. We believe that in many cases such knowledge is necessary, but is ultimately insufficient for complex innovation adoption. We argue that in addition to knowledge and a desire to adopt an innovation, many (...) farmers require a collaborative relation with an ally. We call this method the Alliance Approach to innovation. This approach is modeled after the therapeutic Alliance Approach at work in cognitive and behavioral sciences. We argue that using the Alliance Approach will not only prove effective in helping farmers adopt complex agro-ecology innovations, but also a better fit for the human centered development of capability approach human development, as it is likely to enhance both the well-being and agency of the farmers. (shrink)

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between 1 to (...) 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing. (shrink)

Stimulants have been shown to be safe and effective for reduction of the symptoms of attention deficit hyperactivity disorder. Despite much debate, however, there has been little empirical evidence as to whether stimulants affect authenticity and moral agency in children. Singh presents evidence that stimulants do not undercut children's' sense of self and increase their experience of agency. These findings are consistent with laboratory evidence that stimulant drugs in therapeutic doses improve cognitive control over thought and behavior.

Definition of the problem Refugees show a high prevalence of mental health burden. Catering to the need for mental health services is made difficult by access barriers. These barriers consist of structural factors as well as culturally different attitudes towards mental health, mental illness, and therapeutic interventions. One option to overcome these access barriers and to provide mental healthcare services in an appropriate manner is seen in digital interventions. In the form of interactive websites or smartphone apps, these interventions (...) have proven to be effective in mental healthcare. There are also promising examples of successful use of these technologies with refugees. However, the ethical aspects of digital interventions for refugees have scarcely been studied yet. Arguments Aim of this paper is to tackle this research desiderate. The instrument of the ethical analysis to be conducted is the concept of agency. According to the concept of agency, persons have to be seen as actors capable of acting based on their own resources and competencies. Agency is the guiding principle here for analyzing the opportunities and risks of digital interventions for refugees. In addition, I will attempt to point out prospects for an agency-based application of digital interventions. Conclusion The ethical analysis could be used as the blueprint for developing therapeutic concepts that contribute to the improvement of mental healthcare services for refugees from an ethical perspective. (shrink)

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the Department of (...) Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

In this paper I bring up some ideas on how to search for religious healing through criticism to the concepts of "belief" and "symbolic efficiency". With this purpose, its presented a brief overview of the imbrication between cure and religion in the Brazilian religious field, indicating the vitality of this relationship in the contemporary context, followed by two episodes of healing narrative in which I was personally involved. In the end, I argue that contrary to what the concept of belief (...) might suggest, therapeutic efficacy does not constitute “a discourse on" intervention on the bodies and on the world, but on the practical conditions for mobilizing the truth. The concept of belief does not constitute a good tool for understanding the diversity of implicated mediators of assemblages of healing, nor enables us to understand the intricacies of religious-therapeutic effectiveness. In anthropology, similar critique has also been made to the concept of symbolic efficacy as a conceptual tool for understanding transformations not only of "souls," but also of bodies. (shrink)

Contemporary educational goals place increasing emphasis on conferring recognition and building self-esteem for people deemed to be marginalised and vulnerable. Such goals coalesce with the language, symbols and practices of therapy inscribed within a broader 'therapeutic ethos'. The paper relates these trends to broader cultural demoralisation about people's potential for human agency and evaluates their effects on educational debates. A therapeutic ethos in education appears benign and empowering. Yet, the paper argues that it produces a diminished view of (...) people and low expectations about people's capacity for resilience and autonomy. One effect is to encourage an alignment between the values and activities of education and welfare. This both legitimises and extends institutional and government influence over people's psychological and emotional states. The paper explores these trends and evaluates their implications for educational ideas about human agency. (shrink)

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the (...) connections between mechanistic processes and more fundamental reasons for medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates. (shrink)

This paper examines the concept of confidentiality and the quality of the relationship between young people experiencing mental health problems and social workers supporting them. The nature of a therapeutic intervention brings into focus the rigidities and complexities in adhering to agency and professional guidelines on confidentiality. The paper highlights the tensions and ethical dilemmas in making decisions about risk and whether, when, and how to breach confidentiality.

This contribution discusses competencies needed for regulating systems with properties of multi-causality and non-linear dynamics (therapeutic, economical, organizational, socio-political, technical, ecological, etc.). Various research communities have contributed insights, but none has come forward with an inclusive framework. To advance the debate, I propose to draw from dynamic systems theory (DST) and “4E” (embodied, embedded, enactive, and extended), cognition approaches, which offer a set of perspectives to understand what expert regulators in real-life settings do. They define the regulator's agency as (...) skillfully imposing constraints on a target system and hereby creating context-sensitive openings for self-organizing dynamics, rather than “controlling” the system. Adept regulators apply multi-pronged and multi-timescale constraints to achieve nuanced effects. Among other things, their skill set includes scarcely noted enactive processual competencies for “emergence management”, which the intellectualistic and insufficiently ecologically situated accounts of the complex problem solving literature omit. To capture the nature of system regulation, I advocate treating regulation dynamics and target system dynamics “symmetrically” by grounding regulator competencies in concepts from complexity theory. (shrink)

The number of police departments carrying Narcan keeps increasing at a fast pace throughout the U.S., as it is considered an effective measure to fight the opioid epidemic. However, there have been strong oppositions to the idea of the police Narcan use. Still, in 2018, the nation is debating about it. Though not clearly visible to the public, there are important ethical arguments against the police Narcan use which necessarily involve understanding of the ethical roles and responsibilities of police as (...) the law enforcement agency and apprehension of the moral status of a non-therapeutic opioid use. The authors of the paper investigate, primarily, the existing ethical controversies surrounding the police Narcan use while touching upon the issue of the decriminalizing drug policy in the U.S. The authors conclude that the police can carry and administer Narcan without self-contradiction and that the policymakers’ investigation on the drug decriminalization policy should begin with the understanding of the “common morality” of the American public, the ethical view shared and practiced by the greatest number of people. (shrink)

Throughout the sources that have come down to us from the Roman period of the Stoic school, we find an important number of therapeutical practices that can be clearly linked to other schools and can be consequently seen to constitute the common ground that enables the idea that there is a general Hellenistic approach to the problem of philosophy as therapy. I will argue that a subset of those strategies, which I will refer to as repetition, ascetic and visualization practices, (...) can be better understood as part of an approach to the problem of comprehension, a new approach which, contrary to what may seem at first glance, is fully consistent with the intellectualist conception of human agency defended by both Early and Roman Stoics. I will further suggest that this new approach to the notion of comprehension may be interpreted as an expression of dissatisfaction with the Early Stoic excessively abstract approach to the problem of knowledge. (shrink)

This article evaluates New Zealand’s Medicines Amendment Bill 2011. This Bill is currently before Parliament and will amend the Medicines Act 1981. On June 20, 2011, the Australian and New Zealand governments announced their decision to proceed with a joint scheme for the regulation of therapeutic products such as medicines, medical devices, and new medical interventions. Eventually, the joint arrangements will be administered by a single regulatory agency: the Australia New Zealand Therapeutic Products Agency. The medicines regulations in (...) Australia and New Zealand will be updated as part of this process. The Medicines Amendment Bill addresses some of the well-recognised deficiencies in the Medicines Act 1981. However, a comprehensive overhaul of the Act is not being undertaken. I argue that repealing and replacing the Medicines Act 1981 would be preferable and advisable, given the number of legal difficulties with the Act and, in particular, where it does not align with equivalent current international law. (shrink)

Feticide, the practice of terminating the life of an otherwise viable fetus in utero, has become an increasingly common practice in obstetric centres around the globe, a concomitant of antenatal screening technologies. This paper examines this expanding practice in light of the concept of human dignity. Although it is assumed from the outset that even viable human fetuses are not persons and as such do not enjoy full membership in the moral community, it is argued that the fact that these (...) are nevertheless human fetuses affords them prima facie moral status. Thus even those who accept a liberal position with regard to therapeutic abortion, should be concerned about these more recent developments. Indeed, how we treat viable human fetuses has implications for our prospective treatment of other human non-persons and could undermine the common human dignity we all share. (shrink)

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

Therapeutic strategies capable of inducing and enhancing prosthesis embodiment are a key point for better adaptation to and acceptance of prosthetic limbs. In this study, we developed a training protocol using an EMG-based human-machine interface that was applied in the preprosthetic rehabilitation phase of people with amputation. This is a case series with the objective of evaluating the induction and enhancement of the embodiment of a virtual prosthesis. Six men and a woman with unilateral transfemoral traumatic amputation without previous (...) use of prostheses participated in the study. Participants performed a training protocol with the EMG-based HMI, composed of six sessions held twice a week, each lasting 30 mins. This system consisted of myoelectric control of the movements of a virtual prosthesis immersed in a 3D virtual environment. Additionally, vibrotactile stimuli were provided on the participant’s back corresponding to the movements performed. Embodiment was investigated from the following set of measurements: skin conductance response, crossmodal congruency effect, ability to control the virtual prosthesis, and reports before and after the training. The increase in the skin conductance response in conditions where the virtual prosthesis was threatened, recalibration of the peripersonal space perception identified by the crossmodal congruency effect, ability to control the virtual prosthesis, and participant reports consistently showed the induction and enhancement of virtual prosthesis embodiment. Therefore, this protocol using EMG-based HMI was shown to be a viable option to achieve and enhance the embodiment of a virtual prosthetic limb. (shrink)

This article examines the Buddhist idea of anātman, ‘no- self ’ and pudgala, ‘the person’ in relation to the notion of ‘self ’ emerging from contemporary cognitive science. The Buddhist no-self doctrine is enriched by the cognitive scientist’s understanding of the multiple facets of selfhood, or structures of experience, and the causative action of a functional self in the world. A proper understanding of the Buddhist concepts of anātman and pudgala proves critical to mindfulness-based therapeutic interventions: this is as (...) the ‘person’, as constituted by various structures of selfhood, including—the ecological, interpersonal, extended, private, narrative, relational and conceptual selves—which may be disrupted by traumatic events which disorder one’s experience of time, defence, relationality, memory, resource and agency. In the absence of this understanding, the no-self doctrine might encourage a sort of bypass, in which traumatic facets of selfhood are overlooked in the quest for spiritual liberation. With a proper understanding of the function served by the Buddhist concepts of no-self and ‘person’, psychotherapeutic work may be situated as a necessary ‘preliminary practice’ for meditative exploration of deeper transpersonal domains and soteriological goals. (shrink)

Though widely derided by popular psychologists and self-help writers as an emotionally toxic and destructive response, blame has many defenders among contemporary moral philosophers. Blaming wrongdoers has been thought to express deep commitment to moral values and norms, to be intimately bound up with practices of holding others responsible, and to be an important exercise of moral agency. In this paper I push against the grain of such defenses of blame just enough to articulate what seems right in the more (...) popular lines of critique. I distinguish between blame as a reactive attitude and blaming as a speech act, and argue that some disagreement over the value of blame can be explained by the fact that blaming, as a speech act, takes several distinct forms. Critiques of blame, I suggest, properly target what we might call judgmental or strongly verdictive blaming, the sort of blaming that passes judgment on the wrongdoer him- or herself, and treats him or her as deserving of the blamer’s hostile or “punishing” reactions. This kind of blaming, I argue, tends to foreclose engagement in further moral dialogue with wrongdoers, an effect that is particularly destructive in therapeutic contexts. In such contexts, it is often more appropriate—and more constructive—to hold others answerable without blaming them in the strongly verdictive sense. I argue, moreover, that strongly verdictive blame may be similarly destructive outside of straightforwardly therapeutic contexts, and I challenge the idea that there is in any case a sharp or clear dividing line between therapeutic and non-therapeutic responses to wrongdoers. Holding answerable in a non-judgmental mode is a response that may have a therapeutic dimension, but it nonetheless engages a wrongdoer as a moral peer and partner in moral dialogue. This account of non-judgmental answerability, I suggest, captures much of what moral philosophers have taken to be valuable about blame, while accommodating the insights of those who criticize its more toxic forms. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics (...) revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

My first experience as a clinician was in a Therapeutic Community for service users with personality disorder. As well as having personality disorder, many of the Community members also suffered from related conditions, such as addiction and eating disorders. Broadly speaking, these conditions are what we might call ‘disorders of agency’. Core diagnostic symptoms or maintaining factors of disorders of agency are actions and omissions: patterns of behaviour central to the nature or maintenance of the condition. For instance, borderline (...) personality disorder is diagnosed in part via deliberate self-harm and attempted suicide, reckless and impulsive behaviour, substance use, violence, and outbursts of anger; addiction is diagnosed via maladaptive patterns of drug consumption; eating disorders involve eating too much or too little. If a service user is to improve let alone recover from these disorders, they must change the diagnostic or maintaining pattern of behaviour (cf. Pearce and Pickard, 2010). For instance, service users with borderline personality disorder must stop self-harming; addicts need to quit using drugs or alcohol; anorexics must eat. (shrink)

Theories in both contemporary psychotherapy and ancient philosophy associate deprivation with wrongdoing and suffering, but operate with different understandings of deprivation. The article will focus on two concepts of deprivation, one psychological and the other one ontological, as advanced by Bowlby in attachment theory, and Augustine of Hippo. In attachment theory deprivation is something one suffers as a result of the others’ actions ; it has neuropsychological effects, it relates to violent behaviour later in life, and it is therapeutically treated (...) mainly by emotional sensory work directed at attaining self-regulation. Understanding deprivation as Augustine does introduces a distinctive philosophical view on formation and can inform a type of reflective-behavioural work centred on forming impaired volitional and emotional capacities, and on reclaiming agency and responsibility both for what can be called self-deprivation and for ways to counter deprivation in offenders and victims. (shrink)

A growing number of technologies are currently being developed to improve and distribute thinking and decision-making. Rapid progress in brain-to-brain interfacing and swarming technologies promises to transform how we think about collective and collaborative cognitive tasks across domains, ranging from research to entertainment, and from therapeutics to military applications. As these tools continue to improve, we are prompted to monitor how they may affect our society on a broader level, but also how they may reshape our fundamental understanding of agency, (...) responsibility, and other key concepts of our moral landscape.In this paper we take a closer look at this class of technologies – Technologies for Collective Minds – to see not only how their implementation may react with commonly held moral values, but also how they challenge our underlying concepts of what constitutes collective or individual agency. We argue that prominent contemporary frameworks for understanding collective agency and responsibility are insufficient in terms of accurately describing the relationships enabled by Technologies for Collective Minds, and that they therefore risk obstructing ethical analysis of the implementation of these technologies in society. We propose a more multidimensional approach to better understand this set of technologies, and to facilitate future research on the ethics of Technologies for Collective Minds. (shrink)

The collection and dissemination of data on human and nonhuman organisms has become a central feature of 21st-century biology and has been endorsed by funding agencies in the United States and Europe as crucial to translating biological research into therapeutic and agricultural innovation. Large molecular data sets, often referred to as “big data,” are increasingly incorporated into digital databases, many of which are freely accessible online. These data have come to be seen as resources that play a key role (...) in mediating global market exchange, thus achieving a prominent social and economic status well beyond science itself. At the same time, calls to make all such data publicly and freely available have garnered strength and visibility, most prominently in the form of the Open Data movement. I discuss these developments by considering the conditions under which data journey across the communities and institutions implicated in globalized biology and biomedicine, and what this indicates about how Internet-based communication and the use of online databases affect scientific research and its role within contemporary society. (shrink)

At the end of life, pain management is commonly a fundamental part of the treatment plan for patients where curative measures are no longer possible. However, the increased recognition of opioid diversion for secondary gain coupled with efforts to treat patients in the home environment towards the end of life creates the potential for ethical dilemmas in the palliative care management of terminal patients in need of continuous pain management. We present the case of an end-stage patient with rectal cancer (...) who required a continuous residential narcotic infusion of fentanyl for pain control due to metastatic disease. His functional status was such that he had poor oral intake and ability to perform other activities of daily living, but was able to live at home with health agency nursing care. The patient presented to this institution with a highly suspect history of having lost his fentanyl infusion in a residential accident and asking for a refill to continue home therapy. The treating physicians had concerns of diversion of the infusion medication by caregivers and were reluctant to continue the therapeutic relationship with the patient. This case exemplifies the tension that can exist between wanting to continue with palliative care management of an end-stage patient and the fear of providers when confronted by evidence of potential diversion of opioid analgesic medications. We elucidate how an ethical framework based on a combination of virtue and narrative/relationship theories with reference to proportionality can guide physicians to a pragmatic resolution of these difficult situations. (shrink)

By examining first-person descriptions of thought insertion I show that thought insertion is a complex and heterogeneous phenomenon. People experiencing this phenomenon have huge difficulty explaining what it is like due to the bizarre nature of the experience. Through careful analysis of first-person descriptions I identify some of the characteristics of thought insertion. I then briefly examine some of the philosophical literature regarding agency, ownership and thought insertion and conclude that the standard account of the basic characteristics of thought insertion (...) is inadequate when we consider the phenomenon as it is experienced. First person descriptions suggest that thought insertion is characterised by a lack of personal ownership and not simply by a loss of agency or authorship. This is an important factor that should inform research and therapeutic intervention. We cannot hope to arrive at appropriate therapeutic intervention or identify underlying neuronal mechanisms for the experience if we cannot say what the experience actually is. I further suggest that more analysis of first-person description is required for an improved account of the phenomenology of thought insertion. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

This article is one of the author’s serial writings to assimilate Ricoeur’s three-fold ethical investigation into various areas of human acts of forgetting, including 1) the therapeutic or pathological area, 2) the pragmatic area, dealing with individual and group’s self-identity in relation to time and otherness, and 3) the more explicitly ethical-political (social and institutional) area, in a wide context. Corresponding to the second area of the Ricoeurian three-fold investigation, this paper probes the ethical dimension of the Zhuangzian forgetfulness (...) of personal identity in relation to time and otherness. It first examines textual materials of the Zhuangzi to navigate on the narrative meanings of forgetting oneself or personal identity, and then delves into three domains of Zhuangzian conception on the forgetting of one’s fixed identity. Finally, it elaborates on the Zhuangzian notion of relational autonomy or agency that underlies the practice of forgetfulness of oneself or personal identity. (shrink)

Nanomedicine plays a prominent role among emerging technologies. The spectrum of potential applications is as broad as it is promising. It includes the use of nanoparticles and nanodevices for diagnostics, targeted drug delivery in the human body, the production of new therapeutic materials as well as nanorobots or nanoprotheses. Funding agencies are investing large sums in the development of this area, among them the European Commission, which has launched a large network for life-sciences related nanotechnology. At the same time (...) government agencies as well as the private sector are putting forward reports of working groups that have looked into the promises and risks of these developments. This paper will begin with an introduction to the central ethical themes as identified by selected reports from Europe and beyond. In a next step, it will analyse the most frequently invoked ethical concerns–risk assessment and management, the issues of human identity and enhancement, possible implications for civil liberties (e.g. nanodevices that might be used for covert surveillance), and concerns about equity and fair access. Although it seems that the main ethical issues are not unique to nanotechnologies, the conclusion will argue against shrugging them off as non-specific items that have been considered before in the context of other biomedical technologies, such as gene therapy or xenotransplantation. Rather, the paper will call on ethicists to help foster a rational, fair and participatory discourse on the different potential applications of nanotechnologies in medicine, which can form the basis for informed and responsible societal and political decisions. (shrink)

When does benefiting from others’ wrongdoing effectively make one a moral accomplice in their evil deeds? If stem cell research lives up to its therapeutic promise, this question (which has previously cropped up in debates over fetal tissue research or the use of Nazi research data) is likely to become a central one for opponents of embryo destruction. I argue that benefiting from wrongdoing is prima facie morally wrong under any of three conditions: (1) when the wrongdoer is one’s (...) agent; (2) when acceptance of benefit directly encourages the repetition of the wrongful deed (even though no agency relationship is involved); and (3) when acceptance of a benefit legitimates a wrongful practice. I conclude by showing that, because of the ways in which most embryonic stem cell lines come into being, people who oppose embryo destruction may use human embryonic stem cells without incurring moral blame. (shrink)

In everyday life we take it for granted that we have conscious control of some of our actions and that the part of us that exercises control is the conscious mind. Psychosomatic medicine also assumes that the conscious mind can affect body states, and this is supported by evidence that the use of imagery, hypnosis, biofeedback and other 'mental interventions' can be therapeutic in a variety of medical conditions. However, there is no accepted theory of mind/body interaction and this (...) has had a detrimental effect on the acceptance of mental causation in science, philosophy and in many areas of clinical practice. Biomedical accounts typically translate the effects of mind into the effects of brain functioning, for example, explaining mind/body interactions in terms of the interconnections and reciprocal control of cortical, neuroendocrine, autonomic and immune systems. While such accounts are instructive, they are implicitly reductionist, and beg the question of how conscious experiences could have bodily effects. On the other hand, non-reductionist accounts have to cope with three problems: (1) The physical world appears causally closed, which would seem to leave no room for conscious intervention. (2) One is not conscious of one's own brain/body processing, so how could there be conscious control of such processing? (3) Conscious experiences appear to come too late to causally affect the processes to which they most obviously relate. This paper suggests a way of understanding mental causation that resolves these problems. It also suggests that 'conscious mental control' needs to be partly understood in terms of the voluntary operations of the preconscious mind, and that this allows an account of biological determinism that is compatible with experienced free will. (shrink)

The debate over moral bioenhancement has incrementally intensified since 2008, when Persson and Savulescu, and Douglas wrote two separate articles on the reasons why enhancing human moral capabilities and sensitivity through technological means was ethically desirable. In this article, we offer a critique of how Persson and Savulescu theorize about the possibility of moral bioenhancement, including the problem of weakness of will, which they see as a motivational challenge. First, we offer a working definition of moral bioenhancement and underscore some (...) of the challenges in determining whether moral bioenhancement, as conceptualized by Persson and Savulescu, falls into the category of enhancement or constitutes a type of therapeutic intervention. Second, we provide a critical analysis of the way Persson and Savulescu pathologize human behavior in relation to what they see as the main threat to the survival of the human species: weak moral motivation. Next, we critique the claim that the use of genetic manipulation and drug treatment will increase moral motivation. We argue that Persson and Savulescu mischaracterize the nature of human moral psychology because moral motivation includes affective and cognitive dimensions. The type of interventions they envision focus almost exclusively on the former. In the final two sections, we outline three main criticisms of moral bioenhancement and offer a more robust account of moral psychology and moral development than what Persson and Savulescu recommend, through the lens of Aristotle’s work on virtue ethics. Ultimately, we argue that what Persson and Savulescu, and Douglas consider as moral bioenhancement is a misnomer because they do not fully account for the complexity of moral agency. (shrink)

In crisis situations, the authority of the nurse is legitimised by legal powers and professional knowledge. Crisis stakeholders include those who directly use services and their families, and a wide range of health, social service and justice agencies. Alternative strategies such as therapeutic risk taking from the perspective of socially inclusive recovery policy coexist in a sometimes uneasy relationship with mental health legislation. A critical discourse analysis was undertaken to examine mental health policies and guidelines, and we interviewed service (...) users, families, nurses and the police about experiences of accessing services. For those who attempt to access services early in crisis, as is suggested to lead to a better outcome, provision of services and rights appear to be reversed by an attempt to exclude them through practices that screen them out, rather than prioritising a choice in access. (shrink)

This article addresses the need for discourse and dialogue on ethics in the fields of Animal Assisted Therapy in general and Equine-assisted Therapy specifically. Utilizing animals as partners in a therapeutic process requires major cultural paradigm shifts regarding intelligence and emotion and consideration of the ethical implications for the care and agency of these animals. There is a paucity of literature and very little is known about the impact that therapy has on animals. This study suggests that this blind (...) spot may be the result of the legacy of underlying, post-Christian, Western scientific beliefs about human-animal relationships. Practitioners in the field tend to fall into the broad categories of ‘utilitarians’ or ‘stewards’. The author, an EAT practitioner from Native American cultural healing tradition, offers suggestions on the ways in which Native American constructs about animals may provide valuable alternatives to commonly-held Western viewpoints creating opportunities for deeper, more authentic relationships, reciprocity and a greater understanding of horse-human relationships. (shrink)

Nanomaterials have the promise of revolutionizing current treatment and diagnosis of diseases, which has led to 33 nanotherapeutics drugs currently on the market and many more in various stages of clinical trials. With an increasing number of products available and in development, along with the unique, emergent properties of the nanoparticle therapeutics themselves, regulatory agencies are now faced with decisions regarding the regulation of such novel technologies. Regulatory guidance, particularly in pre-clinical stages, has the potential to facilitate quick and safe (...) development of these novel materials, but new regulation beyond what is currently in place must be justified in a clear and distinctive toxic response. Herein, we examine literature that compares and correlates in vivo and in vitro nanotoxicity studies to gain a deeper understanding of the modes of nanoparticle toxicity. Additionally, this comparison aims to identify clear and unique toxicity responses caused by nanoparticles, which informs our perspective on pre-clinical nanotherapeutic oversight. (shrink)