Background: The use of therapeutic untruths raises a number of ethical issues, which have begun to be explored to some extent, particularly in dementia care services, where their use has been found to be high. Little is known, however, about their use by health professionals working in learning disability services. Research question: The study aimed to explore the frequency of use of therapeutic untruths by student learning disability nurses, and by their colleagues; how effective the students perceived them (...) to be as a means of responding to behaviours that challenge; and their level of comfort with using them. Research design: A correlational design was used to gather data from an online version of the Best Interest Scale, adapted for a learning disability context. Participants were 30 learning disability student nurses studying at a university in the North-East of England. Ethical considerations: The study was reviewed and received ethical approval from the first author’s university ethics committee. Findings: Overall, 96% of participants reported using therapeutic untruths. ‘Omission’ was the most frequently used type of therapeutic untruths, the most effective and the type that the students felt most comfortable using. Frequency of use of therapeutic untruths correlated significantly and positively with perceived effectiveness and the level of comfort that the students felt when using them, for all types of therapeutic untruths. Conclusion: The use of therapeutic untruths by the student nurses was consistent with that found in research in dementia care services in the United Kingdom and abroad. Further research to explore the generalisability of the results to the wider context of learning disability services is needed. The study highlights that there may be a need for more formal guidance and educational input to student nurses in the use of therapeutic untruths with people with a learning disability. (shrink)

In this study of advertisements appearing in medical periodicals and by direct mail advertising to general practitioners, Dr. Stimson, a sociologist, concludes that from what is intended to provide therapeutic information hardly any therapeutic information is provided. He reminds the reader of the safeguards which surround all drug advertising by law and by the code of practice of the Association of the British Pharmaceutical Industry but these safeguards do not appear to control real or potential sins of (...) class='Hi'>omission. Frequently in these advertisements the literature relating to the drug is quoted but Dr. Stimson found that it was difficult to trace all the papers quoted in different types of medical library. (Some references quoted were to unpublished papers but surely the blame should be shared in this situation?) Dr. Stimson also gives a vivid and fascinating glimpse of what he calls the 'images and stereotypes' of the patients who, it is claimed, would benefit from the drug being advertised. Certainly most general practitioners must be aware that when they prescribe that image is displaced by an individual but the portrait gallery is indeed depressing. However, to balance these advertisements drug companies issue data sheets which must be more informative than advertisements and conform to regulations in their format. Unfortunately data sheets are only issued every 15 months whereas the 'average general practitioner is potentially exposed to 1,300 advertisements every month'. In other words, the data sheet and not the advertisement should be the guideline but it arrives too infrequently to offset the lack of therapeutic information contained in advertisements. (shrink)

The principle of the child's right to an open future was first proposed by the legal philosopher Joel Feinberg and developed further by bioethicist Dena Davis. The principle holds that children possess a unique class of rights called rights in trust—rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity. Parents should not, therefore, take actions that permanently foreclose on or pre-empt the future options of their children, but leave them the greatest (...) possible scope for exercising personal life choices in adulthood. Davis particularly applies the principle to genetic counselling, arguing that parents should not take deliberate steps to create physically abnormal children, and to religion, arguing that while parents are entitled to bring their children up in accordance with their own values, they are not entitled to inflict physical or mental harm, neither by omission nor commission. In this paper, I aim to elucidate the open future principle, and consider whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. I argue that the principle is highly applicable to non-therapeutic circumcision, and conclude that non-therapeutic circumcision would be a violation of the child's right to an open future, and thus objectionable from both an ethical and a human rights perspective. (shrink)

Many people have moral qualms about embryo research, feeling that embryos must deserve some kind of protection, if not so much as is afforded to persons. This paper will show that these qualms serve to camouflage motives that are really prudential, at the cost of also obscuring the real ethical issues at play in the debate concerning embryo research and therapeutic cloning. This in turn leads to fallacious use of the Actions/Omissions Distinction and ultimately neglects the duties that we (...) have towards future persons. (shrink)

Many people have moral qualms about embryo research, feeling that embryos must deserve some kind of protection, if not so much as is afforded to persons. This paper will show that these qualms serve to camouflage motives that are really prudential, at the cost of also obscuring the real ethical issues at play in the debate concerning embryo research and therapeutic cloning. This in turn leads to fallacious use of the Actions/Omissions Distinction and ultimately neglects the duties that we (...) have towards future persons. (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)

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims (...) about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy, to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. (shrink)

Although the positive outcomes achieved in home‐visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse–family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic (...) of techne. After describing how a scientific–clinical gaze misrepresents teen mothers and contributes to a rational–technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life‐world. Dialogical understanding also disrupts the scientific–clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers’ long‐term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know‐how that ‘strays’ from protocol‐driven care is addressed. (shrink)

John Haugeland aimed throughout his career to determine what it is for an entity to count as having intelligence or thought, and at each stage he developed the idea from the phenomenological tradition that genuine thought requires intentionality. His most mature essay to do this, “Authentic Intentionality,” shows how the intentional directedness of thought requires that thinkers understand themselves as responsive to entities they think about, that they be committed to maintaining the socially shared forms of understanding of those entities, (...) and yet that they be self-critically open to the possibility of needing to revise or reject those forms of understanding. In this essay I argue that, while Haugeland’s account of intentionality sheds much light on empirical thought (thought directed at different kinds of things in the world), it doesn’t address what it takes for thought to intend or think its own form—and so it fails to describe the kind of transcendental thought of which the account itself is an instance. Building on Haugeland’s own rich picture of self-understanding, I show how we can remedy this omission, and that when we do, we see that transcendental thought is performed by each of us as concrete individuals and yet takes place from a perspective outside of, and thus free from, the normative demands and existential situations of our empirical lives. It is thus of at most therapeutic use in them, even as it is valuable for its own sake as an exercise of our finite freedom. (shrink)

Analyses of factual causation face perennial problems, including preemption, overdetermination, and omissions. Arguably, the thorniest, are cases of omissive overdetermination, involving two independent omissions, each sufficient for the harm, and neither, independently, making a difference. A famous example is Saunders, where pedestrian was hit by a driver of a rental car who never pressed on the (unbeknownst to the driver) defective (and, negligently, never inspected) brakes. Causal intuitions in such cases are messy, reflected in disagreement about which omission mattered. (...) What these analyses mistakenly take for granted, is that at issue is the 'efficacy' of each omission. I argue, on the contrary, the puzzle of omissive overdetermination favors taking the act/omission distinction seriously. Factual causation, properly understood precludes omissions (i.e. omissions are not causal). Of course, the law also attaches liability to omissions, but this works differently from liability for real causes (e.g. omissions have a duty requirement, they also respond differentially to difference-making considerations). The manner in which liability attaches for omissions differs from that of straightforward causal liability, and is entirely dependent on the underlying causal structure. Attention to that structure (e.g. that the driver's hitting the pedestrian with his car is what actually caused the injury) sheds light on which omissions matter (e.g. driver's failure to press on the brakes) and why (because that failure removes a defense the driver would have to liability for the accident he caused). Other cases, where the parties' connection is entirely omissive (e.g. two physicians fail to detect independently lethal conditions), come out differently (tracking moralized elements). The analysis offered makes better sense of both why omissive determination cases are puzzling and how to resolve them. (shrink)

Philosophers have already recognized the importance of causal preemption involving “positive” events. First, preemption with positive events raises problems for counterfactual theories of causation. Second, theories of moral and legal responsibility rely heavily on the concept of causation, so accurately assessing responsibility in preemption cases requires correctly assessing their causal structure. However, philosophers have not discussed preemption involving “negative” events or omissions. This paper argues that cases of preemptive omissions exist and have important implications for theories of causation and for (...) moral and legal responsibility. Of theoretical importance, the alterations made to counterfactual theories of causation to address preemption with positive events do not seem to work for accommodating preemptive omissions. Of practical importance, there have been actual legal cases involving preemptive omissions, and at least one such case was, this paper contends, decided incorrectly on erroneous causal grounds. This paper identifies what must happen for preemptive omissions to obtain. It then argues for the existence of preemptive omissions by constructing a series of cases and drawing structural parallels between preemption cases with positive events and cases with omissions. It ultimately presents a formula for generating preemptive omissions and examines both why “traditional” methods of generating preemption fail for omissions and why the proposed method avoids such concerns. (shrink)

This paper gives a framework for understanding causal counterpossibles, counterfactuals imbued with causal content whose antecedents appeal to metaphysically impossible worlds. Such statements are generated by omissive causal claims that appeal to metaphysically impossible events, such as “If the mathematician had not failed to prove that 2+2=5, the math textbooks would not have remained intact.” After providing an account of impossible omissions, the paper argues for three claims: (i) impossible omissions play a causal role in the actual world, (ii) causal (...) counterpossibles have broad applications in philosophy, and (iii) the truth of causal counterpossibles provides evidence for the nonvacuity of counterpossibles more generally. (shrink)

Philosophical theories of agency have focused primarily on actions and activities. But, besides acting, we often omit to do or refrain from doing certain things. How is this aspect of our agency to be conceived? This book offers a comprehensive account of omitting and refraining, addressing issues ranging from the nature of agency and moral responsibility to the metaphysics of absences and causation. Topics addressed include the role of intention in intentional omission, the connection between negligence and omission, (...) the distinction between doing and allowing, and the distinction in law between act and omission. (shrink)

I present and develop the view that omissions are de re possibilities of actual events. Omissions do not literally fail to occur; rather, they possibly occur. An omission is a tripartite metaphysical entity composed of an actual event, a possible event, and a contextually specified counterpart relation between them. This view resolves ontological, causal, and semantic puzzles about omissions, and also accounts for important data about moral responsibility for outcomes resulting from omissions.

Imagine you and your friend Pierre agreed on meeting each other at a café, but he does not show up. What is the difference between a friend’s not showing up meeting? and any other person not coming? In some sense, all people who did not come show the same kind of behaviour, but most people would be willing to say that the absence of a friend who you expected to see is different in kind. In this paper, I will spell (...) out this difference by investigating laypeople’s conceptualisation of absences of actions in four experiments. In languages such as German, French, Italian, or Polish, people consider a friend’s not coming an omission. Any other person’s not coming, in contrast, is not considered an omission at all, but just a mere nothing. This use of the term omission differs from the usage in English, where ‘omission’ refers to all kinds of absences. In addition, ‘omission’ is not even an everyday term, but invented by philosophers for the sake of philosophical investigation. In other languages, ‘omission’ is part of an everyday vocabulary. Finally, I will discuss how this folk concept of omission could be made fruitful for philosophical questions. (shrink)

We take ourselves to be able to omit to perform certain actions and to be at times responsible for these omissions. Moreover, omissions seem to have effects and to be manifestations of our agency. So, it is natural to think that omissions must be events. However, very few people writing on this topic have been willing to argue that omissions are events. Such a view is taken to face three significant challenges: (i) omissions are thought to be somehow problematically negative, (...) (ii) it is unclear where the event of an omission would be located, and (iii) if we accept any omissions as events, it seems like there would be far too much causation involving them. In this paper, I develop a novel view of omissions as events and as actions that provides answers to these challenges. (shrink)

Unwitting omissions pose a challenge for theories of moral responsibility. For commonsense morality holds many unwitting omitters morally responsible for their omissions (and for the consequences thereof), even though they appear to lack both awareness and control. For example, some people who leave dogs trapped in their cars outside on a hot day (see Sher 2009), or who forget to pick something up from the store as they promised (see Clarke 2014) seem to be blameworthy for their omissions. And yet, (...) if moral responsibility requires awareness of one’s omission and of its moral significance, as well as control, then it would appear that the unwitting protagonists of these cases are not, in fact, morally responsible for their omissions. In this paper, we consider, and ultimately reject, a number of influential views that try to solve this problem, including skepticism about responsibility for such omissions, a view we call the “decision tracing” view that grounds responsibility for such omissions in previous exercises of conscious agency, and “attributionist” views that ground responsibility for such omissions in the value judgments or other aspects of the agents’ selves. We propose instead a new tracing view that grounds responsibility for unwitting omissions in past opportunities to avoid them, where having such opportunities requires general awareness of the risk of such an omission, but not an exercise of agency, in contrast to the decision tracing view. We argue that the view can better accommodate cases, and fits well with the most plausible conception of the kind of control required for responsibility. (shrink)

In previous work I have argued that talk about negative events should not be taken at face value: typically, what we are inclined to think of as a negative event (John’s failure to go jogging) is just an ordinary, positive event (his going to the movie instead); it is a positive event under a negative description. Here I consider more closely the difficulties that arise in those cases where no positive event seems available to do the job, as with putative (...) cases of causation by omission. In particular, I elaborate on Helen Beebee’s idea that not all causal explanations are reports of causation. When we mention John’s failure to turn off the gas as an explanans of why there was an explosion, we do not say what caused the explosion. We do not mention any of the relevant causes. We just remark that one sort of event that was supposed to occur, and whose occurrence would have prevented the explosion, did not in fact occur. (shrink)

It is argued that intentionally omitting requires having an intention with relevant content. And the intention must play a causal role with respect to one’s subsequent thought and conduct. Even if omissions cannot be caused, an account of intentional omission must be causal. There is a causal role for one’s reasons as well when one intentionally omits to do something.

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)

The statement that we are currently failing to address some of humanity’s greatest challenges seems uncontroversial—we are not doing enough to limit global warming to a maximum of 2 °C and we are exposing vulnerable people to preventable diseases when failing to produce herd immunity. But what singles out such failings from all the things we did not do when all are unintended? Unlike their individualist counterparts, collective inaction and omission have not yet received much attention in the literature. (...) collective inaction, I argue, can be attributed to a group of agents where a collective action x that the agents did not perform was collectively feasible at time t where each agent in that group had sufficient reason to contribute to performing x or others had a reasonable expectation that they would perform x. I show that, perhaps surprisingly, we can speak of collective inaction even where only one member of the group fails to act. However, where large and dispersed groups of agents are concerned, there is often no meaningful way of attributing collective failings. Still, I contend that the failure to close the global emissions gap and—in some cases—to generate herd immunity are indeed on us. (shrink)

It is widely held that one can be responsible for doing something that one was unable to avoid doing. This paper focuses primarily on the question of whether one can be responsible for not doing something that one was unable to do. The paper begins with an examination of the account of responsibility for omissions offered by John Martin Fischer and Mark Ravizza, arguing that in many cases it yields mistaken verdicts. An alternative account is sketched that jibes with and (...) explains judgments about a variety of omissions cases, including intentional omissions as well as simple failures to act. (shrink)

This paper warns of two threats to moral responsibility that arise when accounting for omissions, given some plausible assumptions about how abilities are related to responsibility. The first problem threatens the legitimacy of our being responsible by expanding the preexisting tension that luck famously raises for moral responsibility. The second threat to moral responsibility challenges the legitimacy of our practices of holding responsible. Holding others responsible for their omissions requires us to bridge an epistemic gap that does not arise when (...) holding others responsible for their actions—one that we might often fail to cross. (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)

Moore is one of the many law theorists who doubt that omissions can operate as factors in the causation of events and that in cases in which potential agents remain passive in spite of an obligation to intervene ascriptions of responsibility are justified exclusively by non-causal factors. The paper argues that this is an uneasy and essentially unstable position. It also shows that Moore himself, in Causation and Responsibility, does not consistently follow his exclusion of a causal role of (...) class='Hi'>omission in the context of casuistic analysis. Though Moore is to be praised for the clear stance he takes on the issue of negative causality, an analysis of the reasons given for the negation of causality by omission shows that these do not carry enough weight to compensate the sacrifice in theoretical coherence made by the special treatment of negative responsibility in cases in special obligations. It is proposed, instead, that the fact that responsibility for omissions is, as a rule, weaker than that for positive acts is better explained by non-causal factors such as the significant, though incomplete, correlation of the active-passive distinction with a number of normatively relevant factors and the greater social significance of moral and legal rules against active over against passive forms of wrongdoing. (shrink)

Literature on testimonial injustice and ways that perpetrators might combat it have flourished since Miranda Fricker’s ground-breaking work on testimonial injustice. Less attention has been given, however, to the role of bystanders. In this paper, I examine the accountability that bystanders may have for their omissions to redress testimonial injustice. I argue that bystander accountability applies in cases where it is opportune for bystanders to intervene, and if they are also sufficiently equipped and able to redress the testimonial injustice. Moreover, (...) I recommend that we move beyond virtue responsibilism for ameliorative thinking about testimonial injustice. (shrink)

This book empirically investigates the social practice of ascribing moral responsibility to others for the things they failed to do, and it discusses the philosophical relevance of this practice.0In our everyday life, we often blame others for things they failed to do. For instance, we might blame our neighbour for not watering our plants during our vacation. Interestingly, the attribution of blame is typically accompanied by the attribution of causal responsibility. We do not only blame our neighbour for not watering (...) our plants, but we do so because we believe that not watering the plants caused them to dry up and die. In this book, I investigate how we make moral and causal judgments about omissions. I discuss different philosophical perspectives on this matter, and I outline to what extent the actual social practice is in line with philosophical theories. (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)

In this paper I discuss a recent exchange of articles between Hugh McLachlan and John Coggon on the relationship between omissions, causation, and moral responsibility. My aim is to contribute to their debate by isolating a presupposition I believe they both share and by questioning that presupposition. The presupposition is that, at any given moment, there are countless things that I am omitting to do. This leads both McLachlan and Coggon to give a distorted account of the relationship between causation (...) and moral or (as the case may be) legal responsibility and, in the case of Coggon, to claim that the law’s conception of causation is a fiction based on policy. Once it is seen that this presupposition is faulty, we can attain a more accurate view of the logical relationship between causation and moral responsibility in the case of omissions. This is important because it will enable us, in turn, to understand why the law continues to regard omissions as different, both logically and morally, from acts, and why the law seeks to track that logical and moral difference in the legal distinction it draws between withholding life-sustaining measures and euthanasia. (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)

Omissions are metaphysically puzzling: Are they something or are they nothing? This paper develops and defends the constitution view of omissions, according to which a correct analysis of a person’s omission has the form “S omitted to X by Y-ing,” where her Y-ing is what constitutes her not-X-ing. The paper explains why the constitution view should be preferred to other views of omissions and defends the view against objections.

The omission effect, first described by Spranca and colleagues, has since been extensively studied and repeatedly confirmed. All else being equal, most people judge it to be morally worse to actively bring about a negative event than to passively allow that event to happen. In this paper, we provide new experimental data that challenges previous studies of the omission effect both methodologically and philosophically. We argue that previous studies have failed to control for the equivalence of rules that (...) are violated by actions and omissions. Once equivalent norms are introduced, our results show that the omission effect is eliminated, even if the negative outcome of the behavior is foreseen and intended by the agent. We show that the omission effect does not constitute a basic, moral disposition but occurs exclusively in complex moral situations. Building on these empirical results, we cast doubt onto two influential explanations of the omission effect, the Causal Relevance Hypothesis and the Overgeneralization Hypothesis, and provide a novel explanation of the phenomenon. Furthermore, we discuss various ramifications of the interplay between our understanding of omissions and legal systems. (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)

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)

Among the objections to the implementation of what I will call "genome editing in human reproduction" is that it does not address any unmet medical need, and therefore fails to meet an important criterion for introducing an unproven procedure with potentially adverse consequences. To be clear: what I mean by GEHR is the use of any one of a number of related biological techniques, such as the CRISPR-Cas9 system, deliberately to modify a functional sequence of DNA in a cell of (...) a human embryo, so that the modified sequence is replicated in the cells of a resulting child and may, without further intervention, be passed on to that child's biological descendants. It is... (shrink)

The Counterfactual Comparative Account of Harm says that an event is overall harmful for someone if and only if it makes her worse off than she otherwise would have been. I defend this account from two common objections.

In some contexts, not saying S generates a conversational implicature: that the speaker didn’t have sufficient reason, all things considered, to say S. I call this an omissive implicature. Standard ways of thinking about conversational implicature make the importance and even the existence of omissive implicatures somewhat surprising. But I argue that there is no principled reason to deny that there are such implicatures, and that they help explain a range of important phenomena. This paper focuses on the roles omissive (...) implicatures play in Quantity implicatures—in particular, in solving the symmetry problem for scalar implicatures—and on the political and social importance of omissions where apologies, objections, or other communicative acts are expected or warranted. (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)

In the UK, female genital mutilation is unlawful, not only when performed on minors, but also when performed on adult women. The aim of our paper is to examine several arguments which have been advanced in support of this ban and to assess whether they are sufficient to justify banning female genital mutilation for competent, consenting women. We proceed by comparing female genital mutilation, which is banned, with cosmetic surgery, towards which the law has taken a very permissive stance. We (...) then examine the main arguments for the prohibition of the former, assessing in each case both (a) whether the argument succeeds in justifying the ban and, if so, (b) whether a parallel argument would not also support a ban on the latter. We focus on the following arguments. Female genital mutilation should be unlawful because: (1) no woman could validly consent to it; (2) it is an oppressive and sexist practice; (3) it involves the intentional infliction of injury; (4) it causes offence. Our view is that arguments (3) and (4) are unsound and that, although arguments (1) and (2) may be sound, they support not only a ban on female genital mutilation, but also one on (some types of) costmetic surgery. Hence, we conclude that the present legal situation in the UK is ethically unsustainable in one of the following ways. Either the ban on female genital mutilation is unjustified because arguments (1) and (2) are not in fact successful; or the law's permissive attitude towards cosmetic surgery is unjustified because arguments (1) and (2) are in fact successful and apply equally to female genital mutilation and (certain forms of) cosmetic surgery. The people of the countries where female genital mutilation is practised resent references to ‘barbaric practices imposed on women by male‐dominated primitive societies’, especially when they look at the Western world and see women undergoing their own feminization rites intended to increase sexual desirability: medically dangerous forms of cosmetic plastic surgery, for instance …. (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)

This article utilizes recent Western approaches to the ethical inquiry into human activities of forgetting, especially the approach represented by Ricoeur’s work on memory and forgetting and their ethical functioning. The three areas of Ricoeur’s investigation includes the therapeutic/pathological area; pragmatic area, which deals with the issue of individual and group’s self-identity in relation to time and otherness; and the more explicitly ethical area. These three divisions are useful to start with, but Ricoeur’s work shows some narrowness in neglect (...) of positive, productive and healthy forgetting, which has been deemed significant by the Zhuangzi. This paper is the first of the author’s serial writings to apply Ricoeur’s three areas of forgetting to investigate the forgetfulness of the Zhuangzi, and examines therapeutic forgetting and its ethical dimension only. (shrink)

People generally accept that there is causation by omission—that the omission of some events cause some related events. But this acceptance elicits the selection problem, or the difficulty of explaining the selection of a particular omissive cause or class of causes from the causal conditions. Some theorists contend that dependence theories of causation cannot resolve this problem. In this paper, we argue that the appeal to norms adequately resolves the selection problem for dependence theories, and we provide novel (...) experimental evidence for it. (shrink)

When taken too far, certain well-intentioned ethical guidelines can become transformed into artificial boundaries that serve as destructive prohibitions and thereby undermine clinical effectiveness. Rigid roles and strict codified rules of conduct between therapist and client can obstruct a clinician's artistry. Those anxious conformists who go entirely by the book, and who live in constant fear of malpractice suits, are unlikely to prove significantly helpful to a broad array of clients. It is my contention that one of the worst professional/ethical (...) violations is to permit current risk-management principles to take precedence over humane interventions. (shrink)

The research is developed with the use of deductive and descriptive analytical methods used to obtain information on doctrine and jurisprudence and to establish and describe specific situations in the field of Ecuadorian Medical Law respectively. The main objective is to provide scientific and doctrinal tools to understand guilt in cases of omissive conduct in Ecuadorian medical practice, as well as its comparison with other countries such as Colombia, Mexico, Cuba and Argentina, the results of the research show that the (...) doctrine in the relationship to the categories of Omission, Guilt, Guarantor Position and Permitted Risk is broad and is based on scientific-doctrinal advances of the Normative Conception of Guilt comprised between 1995 and 2022. To establish useful criteria and conclusions, the discussion focuses on defining what is considered “guilty” in the context of Medical Law, highlighting the importance of elements such as the objective duty, the harmful result and the analysis of the concomitant circumstances, emphasizing the importance of considering the context and development of the facts in cases of omissive conduct in medicine and not only the result. In relation to omissions in criminal law, a distinction is made between proper and improper and finally, it concludes by suggesting the modification of article 146 of the Organic Integral Criminal Code to guarantee due process and a effective judicial protection in matters related to health in Ecuador, specifically with regard to causality in cases of omissive conduct. (shrink)

Despite the remarkable achievements of novel targeted anti‐cancer drugs, most therapies only produce remission for a limited time, resistance to treatment, and relapse, often being the ultimate outcome. Drug resistance is due to highly efficient adaptive strategies utilized by cancer cells. Exogenous and endogenous stress stimuli are known to induce first‐line responses, capable of re‐establishing cellular homeostasis and determining cell fate decisions. Cancer cells may also mount second‐line adaptive strategies, such as the mutator response. Hypermutable subpopulations of cells may expand (...) under severe selective stress, thereby accelerating the emergence of adapted clones. As with first‐line protective responses, these strategies appear highly conserved, and are found in yeasts and bacteria. We hypothesize that evolutionarily conserved programs rheostatically regulate mutability in fluctuating environments, and contribute to drug resistance in cancer cells. Elucidating the conserved genetic and molecular mechanisms may present novel opportunities to increase the effectiveness of cancer therapies. (shrink)