BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

The Belgian health care system has a few features that may havecontributed to the rising costs of health care: patients' freechoice of physicians, large clinical freedom of physicians, essentiallya fee-for-service remuneration for medical specialists in which the feesare agreed between insurance funds and physicians. The increased medicalconsumption and costs have prompted the state and insurance companies totake measures that limit the professional autonomy of the physicians.Access to medical education, free until 1997, is now restricted. Themedical profession is organized in the (...) Order of Physicians that hasestablished a code of professional ethics that has moral but not legalforce. So far, there is no special legislation for thepatient–physician relationship, though laws on specific issueslike organ transplantation contain duties for physicians. In recentyears a debate is taking place on patients' rights, of which informedconsent is central and gaining importance in medico-legal publications.An analysis of (ethical and legal) regulations concerning thewithholding or withdrawal of treatment by physicians demonstrate thatthe profession still enjoys a large clinical autonomy, though duediscussion with the patient has become more explicitly required. Therespect for professional autonomy is not primarily due to any formalpower that the Order of Physicians would have, but is rather grounded inthe generally high quality of the patient–physician relationshipthat in ethical terms is considered essentially as a confidencerelationship rather than a contractual relationship. (shrink)

BackgroundThe ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity (...) they are trained to.MethodsWe surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days.Results525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient’s (210 answers, 40%) and relative’s communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in “at risk” hospital settings.ConclusionSelf-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life. (shrink)

In this article, I set out Suárez's conception of the demon's obstinacy. For Suárez, the demons’ obstinacy is a divine punishment. It is the result of the free and awful choice to turn away from God that the demons have decided to make, the main consequence of which is the loss of the freedom to will and to do the good. Taking up Aquinas’s conception, Suárez considers that the demonic nature is irredeemably corrupt and obstinate in evil. Demons (...) are provided only with a miserable freedom, consisting of the possibility to choose between different evils. Perpetually sinful and eternally constrained to remain so, they are condemned to wretchedness, to complacency in evil, and to the unremitting torments of hell. (shrink)

For epistemic subjects like us, updating our credences incurs epistemic costs. Expending our limited processing power and working memory to properly update our credences by some information can come at the cost of not responding to other available information. It is thus desirable to flesh out and compare alternative ways of taking information into account in light of cognitive shortcomings like our own. This paper is a preliminary attempt to do so. I argue that it is better, in a range (...) of circumstances and from the point of view of expected credal accuracy, for epistemic subjects like us not to update on available information that bears on propositions for which substantial evidence has been gathered than it is to update on information as it presents itself. In order to clarify the argument, and enable comparisons between information-response policies more generally, I develop a queue-theoretic model of learning for subjects with cognitive limitations. The model characterizes how policies for responding to information interact with a subject’s limitations to yield confidences. Finally, I discuss implications of the discussion for work on confidence, outright belief, and the relationship between those two states. The comparison of information-response policies helps to explain how some of the “biases” revealed by psychological research might be cognitively valuable, clarify views that take outright belief to be a kind of epistemic plan that resists reconsideration, and assuage certain “demandingness” worries for the hypothesis that we are credal reasoners. (shrink)

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of (...) contracts, the development of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)

This article focuses on two very different thinkers from different periods of time, an early hedonist who belonged to Socrates’ circle and lived until the middle of the fourth century BCE and the late Stoic who ruled the Roman Empire in the second century CE. Despite all substantial divergences – for instance, on the value of pleasure – Aristippus the Elder and Marcus Aurelius shared an interest in presentism, broadly construed as a focus on the present and its primacy, and (...) engaged themselves in exercises regarding the experience of the present. Moreover, in developing their respective positions and the exercises they prescribed, we shall uncover and foreground their essentially therapeutic character. (shrink)

The aim of this paper is to make the case for the obstinacy thesis. This is the thesis that proper names like ‘Hitler’, demonstratives like ‘this’, pure indexicals like ‘I’, and natural kind terms like ‘water’ and ‘gold’, are obstinately rigid terms. An obstinately rigid term is one that refers to the object that is its actual referent with respect to every possible world (hence, a fortiori, even with respect to worlds where that object does not exist). This form (...) of rigidity is stronger than the usual Kripkean one and has been notoriously explored by David Kaplan (Kaplan 1989a: 492-3; Kaplan 1989b: 569-71). Yet, the obstinacy thesis seems implausible to many philosophers and is worth substantive argument. For convenience, we focus our attention on proper names; but most of our remarks could be easily generalized to other unstructured singular terms. We shall take for granted Saul Kripke’s semantical doctrine that proper names are rigid in the general sense of the term and argue that their rigidity should take the specific form of obstinacy rather than persistence. (shrink)

In this essay, I propose an analysis of Quine’s example ’Giorgione was so-called because of his size’, grounded on the idea of an obstinate demonstrative. In the first sections, I discuss the advantages and drawbacks of the demonstrative and logophoric treatments of ‘so called’, I highlight certain parallelisms with Davidson’s paratactic view of quotation, and I introduce independent considerations in favor of the idea of an obstinate demonstrative. In the second half of my essay, I apply this notion to Quine’s (...) example, and I discuss its consequences with respect to the principle of substitutivity of coreferential singular terms. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

An epochal archaeology of the labor power that has been cultivated in the human body over the last two thousand years. If Marx's opus Capital provided the foundational account of the forces of production in all of their objective, machine formats, what happens when the concepts of political economy are applied not to dead labor, but to its living counterpart, the human subject? The result is Alexander Kluge and Oskar Negt's History and Obstinacy, a groundbreaking archaeology of the labor (...) power that has been cultivated in the human body over the last two thousand years. Supplementing classical political economy with the insights of fields ranging from psychoanalysis and phenomenology to evolutionary anthropology and systems theory, History and Obstinacy reaches down into the deepest strata of unconscious thought, genetic memory, and cellular life to examine the complex ecology of expropriation and resistance. First published in German 1981, and never before translated into English, this epochal collaboration between Kluge and Negt has now been edited, expanded, and updated by the authors in response to global developments of the last decade to create an entirely new analysis of "the capitalism within us.". (shrink)

The distinction between therapeutic and non-therapeutic research is a familiar one in research ethics. This chapter argues that the term “therapeutic research” is a misnomer. I consider two broad types of ostensibly therapeutic research: controlled trials, and innovative/experimental treatments. I argue that in the former case the term therapeutic research is a misnomer because no reasonable researcher can expect patients/subjects to derive any therapeutic advantage from being entered into an ethically conducted controlled trial. In (...) the latter case, while accepting that there may well be a reasonable expectation of therapeutic benefit from innovative treatments, I argue that the decision whether it is in the interests of a given patient to receive a given treatment is properly made on purely clinical grounds. There is no special feature of the research situation, in either of these types of case, which serves to ensure that participation, qua research subject, is in a patient’s interests. (shrink)

Christian Smith has described the religious attitudes of American youth and many adults as Moralistic Therapeutic Deism. In this formulation the word “therapeutic” does much work, and is meant to indicate that the goal of life is to be happy, to which end religion is instrumental. Martha Nussbaum has argued that Hellenistic schools of philosophy were therapeutic and instrumental in much the same way, and that this is a possible mode of philosophy even today. Appealing to the (...) historical investigations of Pierre Hadot and Giovanni Reale, this paper shows that Neoplatonism was an even more successful form of therapeutic philosophy, a fact which Augustine recognized and to which he responded in his therapeutic masterpiece Confessions, through his depiction of his mother as a sage. This suggests that Catholicism can be powerful when presented therapeutically, which might be a more appropriate mode for evangelism in our therapeutic age. (shrink)

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a (...) conversation with a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

This paper develops and defends a new account of therapeutic trust, its nature and its constitutive norms. Central to the view advanced is a distinction between two kinds of therapeutic trust – default therapeutic trust and overriding therapeutic trust – each which derives from a distinct kind of trusting competence. The new view is shown to have advantages over extant accounts of therapeutic trust, and its relation to standard (non-therapeutic) trust, as defended by Hieronymi, (...) Frost-Arnold, and Jones. (shrink)

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of (...) class='Hi'>therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

Therapeutic touch, a healing technique based upon the laying‐on of hands, has found wide acceptance in the nursing profession despite its lack of scientific plausibility. Its acceptance is indicative of a broad antiscientific trend in nursing. Adherents of this movement use the jargon of postmodern philosophy to justify their enthusiasm for a variety of mystically based techniques, citing such postmodern critics of science as Derrida and Michel Foucault as well as philosophical forerunners Heidegger and Husserl. Between 1997 and 1999, (...) 94 articles in nursing journals referred to postmodernism, according to a database search. This paper criticizes the postmodern movement for abandoning the biological underpinnings of nursing and for misreading philosophy in the service of an antiscientific world‐view. It is also suggested that nursing can retain its tradition of ‘caring’ without abandoning the scientific method. (shrink)

: "Therapeutic misconception" has been misconstrued, and some of the newer, mistaken interpretations are troublesome. They exaggerate the distinction between research and treatment, revealing problems in the foundations of research ethics and possibly weakening informed consent.

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)

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of ‘misunderstandings’ that research participants may have. In this paper, we describe a new concept—therapeutic appropriation. Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an (...) opportunity to enhance patients' clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining (...) and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

Although the therapeutic misconception (TM) has been well described over a period of approximately 20 years, there has been disagreement about its implications for informed consent to research. In this paper we review some of the history and debate over the ethical implications of TM but also bring a new perspective to those debates. Drawing upon our experience of working in the context of translational research for rare childhood diseases such as Duchenne muscular dystrophy, we consider the ethical and (...) legal implications of the TM for parental consent to research. In this situation, it is potentially the parent who is vulnerable to TM. In our analysis we not only consider the context of informed consent for research but also the wider environment in which the value of research is promoted, more broadly through the media but also more specifically through the communication strategies of patient organizations. All dissemination about developments in research for health runs the risk of portraying an overly optimistic view of the promise of biotechnological solutions and has the potential to encourage a ‘collective’ TM. In this paper we consider the challenge that TM presents to parents as well as explore the ethical and legal responsibilities of researchers to ensure an appropriately informed consent: compatible with a hopeful disposition of parents who consent for the their children whilst avoiding a blind and misleading optimism. (shrink)

Is it possible to approach quantum theory in a 'therapeutic' vein that sees its foundational problems as arising from mistaken conceptual presuppositions? The book explores the prospects for this project and, in doing so, discusses such fascinating issues as the nature of quantum states, explanation in quantum theory, and 'quantum non-locality'.

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and (...) the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process. (shrink)

Clinical trials play a crucial role in generating evidence about healthcare interventions and improving outcomes for current and future patients. For individual trial participants, however, there are inevitably trade‐offs involved in clinical trial participation, given that trials have traditionally been designed to benefit future patient populations rather than to offer personalised care. Failure to understand the distinction between research and clinical care and the likelihood of benefit from participation in clinical trials has been termed the ‘therapeutic misconception’. The evolution (...) of the clinical trials landscape, including greater integration of clinical trials into healthcare and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience. Using cancer clinical trials as an exemplar, we describe how methodological changes in early‐ and late‐phase clinical trial designs, as well as changes in the design and delivery of healthcare, impact upon the therapeutic misconception. We suggest that this provides an impetus to re‐examine the ethics of clinical research, particularly in relation to trial access, participant selection, communication and consent, and role delineation. (shrink)

The unexpected roles of the microbiota in cancer challenge explanations of carcinogenesis that focus on tumor-intrinsic properties. Most tumors contain bacteria and viruses, and the host’s proximal and distal microbiota influence both cancer incidence and therapeutic responsiveness. Continuing the history of cancer–microbe research, these findings raise a key question: to what extent is the microbiota relevant for clinical oncology? We approach this by critically evaluating three issues: how the microbiota provides a predictive biomarker of cancer growth and therapeutic (...) responsiveness, the microbiota’s causal role(s) in cancer development, and how therapeutic manipulations of the microbiota improve patient outcomes in cancer. Clarifying the conceptual and empirical aspects of the cancer-associated microbiota can orient future research and guide its implementation in clinical oncology. (shrink)

Objectives: Clinical trials in humans in Germany—as in many other countries—must be approved by local research ethics committees . The current study has been designed to document and evaluate decisions of chairpersons of RECs in the problematic field of non-therapeutic research with minors. The authors’ purpose was to examine whether non-therapeutic research was acceptable for chairpersons at all, and whether there was certainty on how to decide in research trials involving more than minimal risk.Design: In a questionnaire, REC (...) chairpersons had to evaluate five different scenarios with non-therapeutic research. The scenarios described realistic potential research projects with minors, involving increasing levels of risk for the research participants. The chairpersons had to decide whether the respective projects should be approved.Methods: A total of 49 German REC chairpersons were sent questionnaires; 29 questionnaires were returned. The main measurements were approval or rejection of research scenarios.Results: Chairpersons of German RECs generally tend to accept non-therapeutic research with minors if the apparent risk for the participating children is low. If the risk is clearly higher than “minimal”, the chairpersons’ decisions differ widely.Conclusion: The fact that there seem to be different attitudes of chairpersons to non-therapeutic research with minors is problematic from an ethical point of view. It suggests a general uncertainty about the standards of protection for minor research participants in Germany. Therefore, further ethical and legal regulation of non-therapeutic research with minors in Germany seems necessary. (shrink)

The doctrines of therapeutic nihilism and administrative nihilism are both based on the belief that the norms of activity are intrinsically linked to the structure of the body. Just as there is a vis medicatrix naturae in the individual organism, which renders any intervention of the therapist vain, there would be a vis medicatrix rei publicae in the social body, which makes the intervention of the legislator in economic life pointless and even dangerous. However, such a symmetry is not (...) quite as clear as it appears at first. It has also been upheld that the real parallel is not between therapeutic and administrative nihilism, but between therapeutic nihilism and statism. In this view, government is less comparable to a therapist than to the nervous system, and just as a well regulated organism is a one with an extensive nervous system, a well regulated society is one with a strong State.We intend to retrace the historical origin of these two schemas of correspondence, which has his roots in the celebrated controversy in the 1870’s between Herbert Spencer and Thomas Henry Huxley. We examine the causes of this apparent paradox, which sometimes views the doctrine of administrative nihilism, and sometimes the opposing doctrine of statism, as being the equivalent in politics of therapeutic nihilism in medicine. In our opinion, an important part of the explanation must be sought in the variations of the field of extension, which is implicitly given to the concept of vis medicatrix, or –as we now usually call this notion– that of Self-regulation. (shrink)

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

Dissecting Bioethics, edited by Tuija Takala and Matti Hayry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly appreciated. To submit a paper or to discuss (...) a suitable topic, contact Tuija Takala [email protected].:This article examines some of the assumptions and implications associated with the Belmont era context in which the concept of therapeutic misconception was forged. We argue that the justification of therapeutic misconception should be reconsidered based on less paternalistic and more participatory models of research. Finally, we identify conceptual and practical approaches that might better reflect contemporary research practice. (shrink)

I argue that a variety of physical disabilities, and neurological and psychiatric disorders can be understood in terms of changes to the subject’s affordance space. Understanding disorders in this way also has some implications for therapy. On the basis of a phenomenological- and pragmatist-inspired enactivism I propose an affordance-based approach to therapy with a focus on changing physical, social, and cultural environments, and I consider the role of virtual and mixed realities in this context.

Since its inception in the 1900s, the concept of countertransference has been mired in controversy. Psychoanalytic literature is divided on its utility, significance and its clinical value in psychotherapy. While some psychotherapists have advocated for the importance of therapists’ expertise in the comprehension and processing of countertransference dynamics in the treatment of sexually abused children, others see no value in competency in countertransference in trauma treatment of sexually abused children. The purpose of this article is to explore whether countertransference is (...) a useful therapeutic tool, or a hindrance in the treatment of sexually abused children. A qualitative paradigm, particularly interpretative phenomenology, was employed in this research to make meaning of the therapists’ experiences. The analysis of the results revealed the following five main themes that were supported by 18 superordinate themes. These themes reveal that therapists treating sexually abused children experience a myriad of feelings, including a) feeling emotionally overwhelmed, b) anger toward perpetrators and the need to protect and rescue their patients, c) the importance of social support and self-healing, d) feelings of empathy and identification with the client, and e) erotic countertransference. These findings reveal two contradictory findings. Firstly, they tell of variable utilisation of countertransference among participants and, secondly, they highlight a lack of application of countertransference in the treatment of sexually abused children. The implications of the current study are that there is a need to both highlight the importance of countertransference as a therapeutic tool and to incorporate it in the treatment of sexually abused children. (shrink)

I argue that in recent years, the therapeutic ethos and the ideal of authenticity have become aligned with distinctively neo-liberal notions of personal responsibility and self-reliance. This situation has radically exacerbated the threat to political community that Charles Taylor saw in the ‘ethics of authenticity’. I begin by tracing the history of the therapeutic ethos and its early (Rieff, Lasch, MacIntyre) and late (Furedi) critics. I then discuss Charles Taylor’s argument that the culture of self-fulfillment generated by the (...) therapeutic ethos harbors an important moral ideal, namely, the ethic of authenticity. Pace Taylor, I argue that authenticity has now become thoroughly instrumentalized in the service of the guiding political rationality of neo-liberalism. I make this case through a discussion of its uptake in managerial techniques and practices and also in popular culture. (shrink)

The theme of the philosopher as therapist dominates Nietzsche's entire opus, from his earliest writings to the Zarathustra period and beyond. Nietzsche wishes to hasten the coming and future sanctification of a new type of synthetic human being, and his entire teaching is shaped by his own struggles against illness.Yet few Nietzsche scholars have paid this crucial therapeutic element of his thought sufficient attention. This collection of essays by leading scholars in the field is composed around the Nietzschean insight, (...) which has its roots in the Hippocratic tradition of ancient medicine, that beliefs, behaviours, ideals and patterns of striving are not things for which individuals or even cultures are responsible. Rather, they are symptoms of what an individual or culture is, which symptoms require diagnostic interpretation and evaluation. The book identifies three principal approaches in Nietzsche's philosophy: diagnostic, prognostic and therapeutic. Each essay takes up this essential insight into Nietzsche's therapeutic philosophy from a different perspective and collectively they reveal an array of insightful approaches to self-induced enhancement, for both individuals and cultures. (shrink)

ABSTRACTBased on the case of Rosa, a nine‐year‐old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an (...) ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity. (shrink)

Introduction:Despite being considered as a contravention under some countries’ legislation, the therapeutic use of Cannabis sativa has been growing in Brazil, due to the promising results observed in many pathologies. Such a scenario has fostered the need to deepen discussions on the subject and possibly revise legislation governing the substance use and access.Objectives:Identify the types of stigma related to the therapeutic use of Cannabis and describe the strategies people use to overcome stigma.Methods:This integrative review was carried out in (...) the databases PubMed, Scopus, CINAHL, MEDLINE, PsycINFO, Web of Science, and Cochrane Library, with 565 articles being retrieved. Triads’ cross-check were done, first maintaining the “cannabis” and “therapeutic use” pair, added by “stigma,” “bioethics,” “ethics,” “social consequences,” and “legal consequences.” The final selection resulted in six articles.Ethical Consideration:However, the ethical issues that pervade and regulate decisions on this subject must be considered.Results:Different dimensions and types of stigma related to the therapeutic use of Cannabis have been identified. The bioethical principle of autonomy was an expression of citizenship and human rights, mitigating internal conflicts related to self-stigma and the effects of external stigma on the person’s life.Conclusion:It was possible to identify the types of stigma related to the therapeutic use of Cannabis is an internal dimension represented and an external dimension, represented and to identify strategies adopted to face this stigma: skills training group for users, elaboration of laws and specific programs to clarify the therapeutic use of Cannabis with a greater social scope, and support for family members. Thus, contributing to the building of people’s autonomy in a broader context of decision-making autonomy and executive autonomy will provide the development of people’s capacity to perform complex tasks of self-management and, consequently, to continue promoting and preserving their decision-making process and their capacity to plan and perform tasks associated with managing their lives and their treatments. (shrink)