There are three lines of argument in defence of coercive treatment of patients with mental disorders: arguments regarding (1) societal interests to protect others, (2) the patients' own health interests, and (3) patient autonomy. In this paper, we analyse these arguments in relation to an idealized case, where a person with a mental disorder claims not to want medical treatment for religious reasons. We also discuss who should decide what in situations where patients with mental disorders deny treatment on seemingly (...) rational grounds.We conclude that, in principle, coercive treatment cannot be defended for the sake of protecting others. While coercive actions can be acceptable in order to protect close family and others, medical treatment is not justified for such reasons but should be given only in the interest of patients. Coercive treatment may be required in order to promote the patient's health interests, but health interests have to waive if they go against the autonomous interests of the patient. We argue that non-autonomous patients can have reasons, rooted in their deeply-set values, to renounce compulsory institutional treatment, and that such reasons should be respected unless it can be assumed that their new predicaments have caused them to change their views. (shrink)

A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and (...) defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism. (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.

There is no subject at the interface of law, psychiatry and medical ethics which is more controversial than psychosurgery. The divergent views of the treatment begin with its definition. The World Health Organisation1 and others2 define psychosurgery as the selective surgical removal or destruction of nerve pathways or normal brain tissue with a view to influencing behaviour. However, proponents of psychosurgery demur on the basis that the `modern' treatment is concerned predominantly with emotional illness, without any specific effect upon behaviour. (...) The alternative definition offered is `the surgical treatment of certain psychiatric illnesses by means of localised lesions placed in specific cerebral sites.3It is difficult entirely to accept this definition because, as examined below, scientific psychiatry is not yet in a position to directly treat psychiatric illness solely through surgical intervention. There is no reliable theoretical relationship between particular cerebral sites (which are normal and healthy) and an identifiable psychiatric illness or symptomatology. Given this state of psychiatric understanding, it is misleading to suggest fine distinctions between generalised alteration of behaviour or mood and treatment of an illness. Highly divergent practices and theories (relating to the multiplicity of conditions treated, surgical methods adopted and areas of the brain operated upon) further undermine exaggerated claims that psychosurgery can scientifically `treat' specific illness through precise surgical intervention. Nonetheless, contemporary psychosurgery does not contain quite the same `broadbrush' approach of its ancestors and it can lay some legitimate claim as an effective empirical treatment in narrowly limited circumstances. Major ethical problems still, however, arise and these will be discussed in this article. (shrink)

Postmortem research on the brains of American tackle football players has revealed the presence of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated head trauma. Repeated concussion is a risk factor for CTE, raising ethical concerns about the long-term effects of concussion on athletes at risk for football-related concussion. Of equal concern is that youth athletes are at increased risk for lasting neurocognitive and developmental deficits that can result in behavioral disturbances and diminished academic performance. In this (...) article, we consider evidence of the effects of concussion in youth athletes, and discuss ethical duties to youth athletes and how these duties might be satisfied, given the intrinsic risks of football. Finally, we evaluate potential strategies for reducing concussions in junior football, and recommend the optimal strategy for reducing brain injury to an acceptable level while still making available the benefits of football participation for youth athletes. (shrink)

Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson’s disease for the last 20 years. In terms of clinical ethics, it is worth asking whether the use of DBS may have unanticipated negative effects similar to those associated with other types of psychosurgery. Clinical studies of epileptic patients who have undergone an anterior temporal lobectomy have identified a range of side effects and complications in a number of domains: psychological, (...) behavioural, affective and social. In many cases, patients express difficulty adjusting from being chronically ill to their new status as ‘treated’ or ‘seizure free’. This postoperative response adjustment has been described in the literature on epilepsy as the ‘Burden of Normality’ (BoN) syndrome. Most of the discussion about DBS postoperative changes to self is focused on abnormal side effects caused by the intervention (ie, hypersexuality, hypomania, etc). By contrast, relatively little attention is paid to the idea that successfully ‘treated’ individuals might experience difficulties in adjusting to becoming ‘normal’. The purpose of this paper is (1) to articulate the postoperative DBS psychosocial adjustment process in terms of the BoN syndrome, (2) to address whether the BoN syndrome illustrates that DBS treatment poses a threat to the patient’s identity, and (3) to examine whether the current framework for rehabilitation after DBS procedures should be updated and take into account the BoN syndrome as a postoperative self-change response. (shrink)

In their paper “Deflating the neuroenhancement bubble”, more precisely in their section entitled “How New is Neuroenhancement?”, Lucke and colleagues argue that neuroenhancement is nothing new to our epoch by demonstrating that the use of psychoactive stimulants in the 19th and 20th centuries was already common. The purpose of our comment is to show that the current bubble surrounding neuroenhancement in particular, and enhancement in general, is a recasting of an even older speculative engagement that can be traced back from (...) the 16th to the 18th centuries. As a consequence, there is a high risk that bioethicists might not have captured or found new conceptual challenges related to current enhancement debate. As well, by ignoring issues related to ancient debate, we argue that modern bioethicists risk spending effort on speculative ethics. (shrink)

As palliative care develops across many of the countries of Europe, we find that it continues to raise important ethical challenges. Palliative care practice requires ethical sensitivity and understanding. At the same time the very existence of palliative care calls for ethical explanation. Ethics and palliative care meet over some vital issues: 'the good death', sedation at the end of life, requests for euthanasia, futile treatment, and the role of research. Yet palliative care appears uncertain about its goals and there (...) is evidence that its ethical underpinnings are changing. Likewise, the moral problems of palliative care are only partly served by the four 'principles' of modern bioethics. This innovative book, with contributions by clinicians, ethicists, philosophers and social scientists, provides the first ever picture of palliative care ethics in the European context. It will be of interest to those involved in the delivery and management of palliative care services, as well as to students and researchers. (shrink)

Deep brain stimulation (DBS) is optimistically portrayed in contemporary media. This already happened with psychosurgery during the first half of the twentieth century. The tendency of popular media to hype the benefits of DBS therapies, without equally highlighting risks, fosters public expectations also due to the lack of ethical analysis in the scientific literature. Media are not expected (and often not prepared) to raise the ethical issues which remain unaddressed by the scientific community. To obtain a more objective portrayal of (...) DBS in the media, a deeper collaboration between the science community and journalists, and particularly specialized ones, must be promoted. Access to databases and articles, directly or through science media centers, has also been proven effective in increasing the quality of reporting. This article has three main objectives. Firstly, to explore the past media coverage of leukotomy, and to examine its widespread acceptance and the neglect of ethical issues in its depiction. Secondly, to describe how current enthusiastic coverage of DBS causes excessive optimism and neglect of ethical issues in patients. Thirdly, to discuss communication models and strategies to enhance media and science responsibility. (shrink)