Volume 20, Issue 3, March 2020, Page 73-74.

Psychedelics such as psilocybin reliably produce significantly altered states of consciousness with a variety of subjectively experienced effects. These include certain changes to perception, cognition, and affect,1 which we refer to here as the acute subjective effects of psychedelics. In recent years, psychedelics such as psilocybin have also shown considerable promise as therapeutic agents when combined with talk therapy, for example, in the treatment of major depression or substance use disorder.2 However, it is currently unclear whether the aforementioned acute subjective (...) effects are necessary to bring about the observed therapeutic effects of psilocybin and other psychedelics. This uncertainty has sparked a lively—though still largely hypothetical—debate on whether psychedelics without subjective effects (“nonsubjective psychedelics” or “non-hallucinogenic psychedelics”) could still have the same therapeutic impact, or whether the acute subjective effects are in fact necessary for this impact to be fully realized.3,4,5. (shrink)

Definition of the problem The reform of German guardianship law coming into force in 2023 will remove the term “well-being” from the law. This is intended to emphasise that the legal guardian should be guided by the subjective wishes of the person rather than by an objective understanding of well-being. This article analyses the understanding of well-being underlying the reformed guardianship law in comparison to common conceptions of well-being in philosophy and medical ethics, aiming to promote interdisciplinary understanding between ethics (...) and law. Arguments The justification for the reform emphasises that the law is based on a subjective understanding of well-being. However, this understanding does not correspond to philosophical subjective theories of well-being, according to which only things that a person desires can contribute to her well-being. In contrast, the guardianship law assumes that the fulfilment of certain wishes can lead to objective harm to the person and thus impair her well-being. Negative consequences for the objective well-being of a person are only relevant insofar as they indicate a limit to following current wishes that are based on a natural will and are not an expression of self-determination. Conclusion While the term “well-being” is removed from reformed guardianship law, the law implicitly contains an understanding of well-being comparable to a hybrid conception of well-being from a medical ethics perspective. According to this conception, fulfilment of a person’s wishes generally contributes to her well-being, although certain objective criteria are also taken into consideration. (shrink)

Definition of the problem The reform of German guardianship law coming into force in 2023 will remove the term “well-being” from the law. This is intended to emphasise that the legal guardian should be guided by the subjective wishes of the person rather than by an objective understanding of well-being. This article analyses the understanding of well-being underlying the reformed guardianship law in comparison to common conceptions of well-being in philosophy and medical ethics, aiming to promote interdisciplinary understanding between ethics (...) and law. Arguments The justification for the reform emphasises that the law is based on a subjective understanding of well-being. However, this understanding does not correspond to philosophical subjective theories of well-being, according to which only things that a person desires can contribute to her well-being. In contrast, the guardianship law assumes that the fulfilment of certain wishes can lead to objective harm to the person and thus impair her well-being. Negative consequences for the objective well-being of a person are only relevant insofar as they indicate a limit to following current wishes that are based on a natural will and are not an expression of self-determination. Conclusion While the term “well-being” is removed from reformed guardianship law, the law implicitly contains an understanding of well-being comparable to a hybrid conception of well-being from a medical ethics perspective. According to this conception, fulfilment of a person’s wishes generally contributes to her well-being, although certain objective criteria are also taken into consideration. (shrink)

Pickering, Newton-Howes, and Young argue that a person should be considered incapable of making a specific decision if that decision is judged by onlookers to be seriously harmful to the dec...

The interests of a patient are not only related to objective ideas about health, but are also determined by the patient’s own view of the good. To act in the best interests of a patient requires co...

This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are: (1) The obligation to protect patients against COVID-19 spread; (2) The obligation to maintain professional competence and remain available for patients; (3) Clinicians’ role and place in society in relation to COVID-19; (4) The obligation to encourage societal vaccination uptake. These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a (...) duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional’s ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians. (shrink)

Volume 20, Issue 3, March 2020, Page 68-70.

Volume 20, Issue 3, March 2020, Page 75-77.

Volume 20, Issue 3, March 2020, Page 63-65.

Volume 20, Issue 3, March 2020, Page 65-68.

Volume 20, Issue 3, March 2020, Page 79-81.

Volume 20, Issue 3, March 2020, Page 85-87.

Volume 20, Issue 3, March 2020, Page 81-83.

This article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on and produces uncertain knowledge and (...) evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making. (shrink)

Definition of the problemThe medical-ethical principle of beneficence is directed towards the well-being of patients. In clinical practice, the focus is often on the relief of pain, the elimination of symptoms and the restoration of bodily functioning. However, the significance of these health-related aspects for the overall well-being of patients also depends on individual values, desires, and life plans.ArgumentationAn overemphasis on the subjective perspective of patients on their well-being would admittedly lead to a strong substantial convergence of the two medical-ethical (...) principles of beneficence and respect for autonomy. In addition, it would not be compatible with some of the guiding principles of the medical profession. A mere objective perspective on patient well-being conversely carries the danger of imposing values on individual patients that they do not share. Consequently, actions that are intended to benefit patients instead harm them.ConclusionThrough a more detailed analysis of the relationship between health-related and overall well-being, this paper shows that health is only a relative value in our overall well-being. Basic health-related goods like a sound cardiovascular system or fully functioning lungs have special standing because they are seen as valuable independently of individual preferences and life plans, which means they are of objective value. (shrink)

The principle of autonomy is widely recognized to be of utmost importance in bioethics; however, we argue that this principle is often misapplied when one fails to distinguish two different contexts in medicine. When a particular patient is offered treatment options, she has the ultimate say in whether to proceed with any of those treatments. However, when deciding whether a particular intervention should be regarded as a form of medical treatment in the first place, it is the medical community who (...) has the ultimate say. Some argue that particular interventions should be allowed by virtue of the fact that they are autonomously requested. But making such an argument fails to distinguish between these two contexts and misapplies the principle of autonomy, ultimately having the potential to instigate problematic changes in the practice of medicine. (shrink)

Volume 20, Issue 3, March 2020, Page 88-90.

Volume 20, Issue 3, March 2020, Page 83-85.

Volume 20, Issue 3, March 2020, Page 77-79.