According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the (...) brain — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

This paper explores the position that moral enhancement interventions could be medically indicated in cases where they provide a remedy for a lack of empathy, when such a deficit is considered pathological. In order to argue this claim, the question as to whether a deficit of empathy could be considered to be pathological is examined, taking into account the difficulty of defining illness and disorder generally, and especially in the case of mental health. Following this, Psychopathy and a fictionalised (...) mental disorder are explored with a view to consider moral enhancement techniques as possible treatments for both conditions. At this juncture, having asserted and defended the position that moral enhancement interventions could, under certain circumstances, be considered medically indicated, this paper then goes on to briefly explore some of the consequences of this assertion. First, it is acknowledged that this broadening of diagnostic criteria in light of new interventions could fall foul of claims of medicalisation. It is then briefly noted that considering moral enhancement technologies to be akin to therapies in certain circumstances could lead to ethical and legal consequences and questions, such as those regarding regulation, access, and even consent. (shrink)

In Making Things Happen, James Woodward influentially combines a causal modeling analysis of actual causation with an interventionist semantics for the counterfactuals encoded in causal models. This leads to circularities, since interventions are defined in terms of both actual causation and interventionist counterfactuals. Circularity can be avoided by instead combining a causal modeling analysis with a semantics along the lines of that given by David Lewis, on which counterfactuals are to be evaluated with respect to worlds in which their (...) antecedents are realized by miracles. I argue, pace Woodward, that causal modeling analyses perform just as well when combined with the Lewisian semantics as when combined with the interventionist semantics. Reductivity therefore remains a reasonable hope. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, (...) and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

To be effective, a medical intervention must improve one's health by targeting a disease. The concept of disease, though, is controversial. Among the leading accounts of disease-naturalism, normativism, hybridism, and eliminativism-I defend a version of hybridism. A hybrid account of disease holds that for a state to be a disease that state must both (i) have a constitutive causal basis and (ii) cause harm. The dual requirement of hybridism entails that a medical intervention, to be deemed effective, must target either (...) the constitutive causal basis of a disease or the harms caused by the disease (or ideally both). This provides a theoretical underpinning to the two principle aims of medical treatment: care and cure. (shrink)

The problem of mental causation is discussed by taking into account some recent developments in the philosophy of science. The problem is viewed from the perspective of the new interventionist theory of causation developed by Woodward. The import of the idea that causal claims involve contrastive classes in mental causation is also discussed. It is argued that mental causation is much less a problem than it has appeared to be.

Causal selection is the task of picking out, from a field of known causally relevant factors, some factors as elements of an explanation. The Causal Parity Thesis in the philosophy of biology challenges the usual ways of making such selections among different causes operating in a developing organism. The main target of this thesis is usually gene centrism, the doctrine that genes play some special role in ontogeny, which is often described in terms of information-bearing or programming. This paper is (...) concerned with the attempt of confronting the challenge coming from the Causal Parity Thesis by offering principles of causal selection that are spelled out in terms of an explicit philosophical account of causation, namely an interventionist account. I show that two such accounts that have been developed, although they contain important insights about causation in biology, nonetheless fail to provide an adequate reply to the Causal Parity challenge: Ken Waters's account of actual-difference making and Jim Woodward's account of causal specificity. A combination of the two also doesn't do the trick, nor does Laura Franklin-Hall's account of explanation (in this volume). We need additional conceptual resources. I argue that the resources we need consist in a special class of counterfactual conditionals, namely counterfactuals the antecedents of which describe biologically normal interventions. (shrink)

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and (...) in each case we discuss the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass. (shrink)

Background If trials of therapeutic interventions are to serve society's interests, they must be of high methodological quality and must satisfy moral commitments to human subjects. The authors set out to develop a clinical - trials compendium in which standards for the ethical treatment of human subjects are integrated with standards for research methods. Methods The authors rank-ordered the world's nations and chose the 31 with >700 active trials as of 24 July 2008. Governmental and other authoritative entities of (...) the 31 countries were searched, and 1004 English-language documents containing ethical and/or methodological standards for clinical trials were identified. The authors extracted standards from 144 of those: 50 designated as ‘core’, 39 addressing trials of invasive procedures and a 5% sample of the remainder. As the integrating framework for the standards we developed a coherent taxonomy encompassing all elements of a trial's stages. Findings Review of the 144 documents yielded nearly 15 000 discrete standards. After duplicates were removed, 5903 substantive standards remained, distributed in the taxonomy as follows: initiation, 1401 standards, 8 divisions; design, 1869 standards, 16 divisions; conduct, 1473 standards, 8 divisions; analysing and reporting results, 997 standards, four divisions; and post-trial standards, 168 standards, 5 divisions. Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research. (shrink)

Feminist theorists have shown that knowledge is embodied in ways that make a difference in science. Intemann properly endorses feminist standpoint theory over Longino’s empiricism, insofar as the former better addresses embodiment. I argue that a pragmatist analysis further improves standpoint theory: Pragmatism avoids the radical subjectivity that otherwise leaves us unable to account for our ability to share scientific knowledge across bodies of different kinds; and it allows us to argue for the inclusion, not just of the knowledge produced (...) from marginalised bodies, but of the marginalised themselves. (shrink)

What words we use, and what meanings they have, is important. We shouldn't use slurs; we should use 'rape' to include spousal rape (for centuries we didn’t); we should have a word which picks out the sexual harassment suffered by people in the workplace and elsewhere (for centuries we didn’t). Sometimes we need to change the word-meaning pairs in circulation, either by getting rid of the pair completely (slurs), changing the meaning (as we did with 'rape'), or adding brand new (...) word-meaning pairs (as with 'sexual harassment'). A problem, though, is how to do this. One might worry that any attempt to change language in this way will lead to widespread miscommunication and confusion. I argue that this is indeed so, but that's a feature, not a bug of attempting to change word-meaning pairs. The miscommunications and confusion such changes cause can lead us, via a process I call transformative communicative disruption, to reflect on our language and its use, and this can be further, rather than hinder, our goal of improving language. (shrink)

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

What can we do—and what should we do—to fight against bias? This final chapter introduces empirically-tested interventions for combating implicit (and explicit) bias and promoting a fairer world, from small daily-life debiasing tricks to larger structural interventions. Along the way, this chapter raises a range of moral, political, and strategic questions about these interventions. This chapter further stresses the importance of admitting that we don’t have all the answers. We should be humble about how much we still (...) don’t know and dedicate efforts to gathering as much knowledge as possible. Even so, we know enough now to start making a difference, and this chapter ultimately aims to chip away at the gap between our abstract commitments to treat people fairly and our lived habits and experiences, which continue to be shaped by implicit and explicit prejudices and stereotypes about race, gender, and other social categories. (shrink)

In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. Methods: (...) This systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers. (shrink)

This introduction concerns the place that Indian philosophical literature should occupy in the history of philosophy, and the challenge of championing pre-modern modes of inquiry in an era when philosophy, at least in the anglophone world and its satellites, has in large measure become a highly specialized and technical discipline conceived on the model of the sciences. This challenge is particularly acute when philosophical figures and texts that are historically and culturally distant from us are engaged not only exegetically but (...) also with a view to recruiting their topics and arguments for contemporary philosophical debates. (shrink)

This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives (...) system—which I have previously defended, and a brief recap of social-scientific research on the allocation of scarce medical resources. Following these overviews, I examine different ways in which public preferences could matter to the ethics of allocation. Last, I suggest some ways in which social scientists could learn from ethics as they conduct research into public preferences regarding the allocation of scarce medical resources. (shrink)

This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can help ensure that scarce resources (...) such as tissue samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs. (shrink)

In “Ontologies Relevant to behaviour change interventions: A Method for their Development” Wright, et al. outline a step by step process for building ontologies of behaviour modification – what the authors call the Refined Ontology Developmental Method (RODM) – and demonstrate its use in the development of the Behaviour Change Intervention Ontology (BCIO). RODM is based on the principles of good ontology building used by the Open Biomedical Ontology (OBO) Foundry in addition to those outlined in (Arp, Smith, and (...) Spear 2015). BCIO uses as its top-level ontology Basic Formal Ontology (BFO). The methods outlined in Wright, et al. are a valuable contribution to the field, especially the use of formal mechanisms for literature annotation and expert stakeholder review, and the BCIO will certainly play an important role in the extension of OBO Foundry ontologies into the behavioural domain. (shrink)

In the present review we focus on what we take to be some remaining issues with the Behaviour Change Intervention Ontology (BCIO). We are in full agreement with the authors’ endorsement of the principles of best practice for ontology development In particular, we agree that an ontology should be “logically consistent and having a clear structures [sic], preferably a well-organised hierarchical structure,” and that “Maximising the new ontology’s interoperability with existing ontologies by reusing entities from existing ontologies where appropriate” is (...) critically important (Wright et al., 2020, p. 17). Our remaining concerns with BCIO relate directly to these two principles. First, we identify a number of issues with some of the classifications and definitions in BCIO that seem to be in tension with the just-mentioned principle . Second, we note some reservations about the reuse of certain classes in BCIO, namely from the Gazetteer (GAZ), the Ontology of Medically Related Social Entities (OMRSE), and the Information Artifact Ontology (IAO). While the latter principle of “reuse” is important, it is also important not to let the reuse of existing classes (or their corresponding definitions) compromise the logical integrity or the realist nature of one’s ontology. (shrink)

Public health scholars and public health officials increasingly worry about health-related misinformation online, and they are searching for ways to mitigate it. Some have suggested that the tools of digital influence are themselves a possible answer: we can use targeted, automated digital messaging to counter health-related misinformation and promote accurate information. In this commentary, I raise a number of ethical questions prompted by such proposals—and familiar from the ethics of influence and ethics of AI—highlighting hidden costs of targeted digital messaging (...) that ought to be weighed against the health benefits they promise. (shrink)

The effective altruism movement aims to save lives in the most cost-effective ways. In the future, technology will allow radical life extension, and anyone who survives until that time will gain potentially indefinite life extension. Fighting aging now increases the number of people who will survive until radical life extension becomes possible. We suggest a simple model, where radical life extension is achieved in 2100, the human population is 10 billion, and life expectancy is increased by simple geroprotectors like metformin (...) or nicotinamide mononucleotide by three more years on average, so an additional 750 million people survive until “immortality”. The cost of clinical trials to prove that metformin is a real geroprotector is $65 million. In this simplified case, the price of a life saved is around eight cents, 10 000 times cheaper than saving a life from malaria by providing bed nets. However, fighting aging should not be done in place of fighting existential risks, as they are complementary causes. (shrink)

Mindfulness-based interventions (MBIs) are being actively implemented in a wide range of fields – psychology, mind/body health care and education at all levels – and there is growing evidence of their effectiveness in aiding present-moment focus, fostering emotional stability, and enhancing general mind/body well-being. However, as often happens with popular innovations, the burgeoning interest in and appeal of mindfulness practice has led to a reductionism and commodification – popularly labelled ‘McMindfulness’ – of the underpinning principles and ethical foundations of (...) such practice which threatens to subvert and militate against the achievement of the original aims of MBIs in general and their educational function in particular. It is argued here that mindfulness practice needs to be organically connected to its spiritual roots if the educational benefits of such practice are to be fully realised. (shrink)

The present study aimed to develop effective moral educational interventions based on social psychology by using stories of moral exemplars. We tested whether motivation to engage in voluntary service as a form of moral behavior was better promoted by attainable and relevant exemplars or by unattainable and irrelevant exemplars. First, experiment 1, conducted in a lab, showed that stories of attainable exemplars more effectively promoted voluntary service activity engagement among undergraduate students compared with stories of unattainable exemplars and non-moral (...) stories. Second, experiment 2, a middle school classroom-level experiment with a quasi-experimental design, demonstrated that peer exemplars, who are perceived to be attainable and relevant to students, better promoted service engagement compared with historic figures in moral education classes. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of (...) the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

While structural equations modeling is increasingly used in philosophical theorizing about causation, it remains unclear what it takes for a particular structural equations model to be correct. To the extent that this issue has been addressed, the consensus appears to be that it takes a certain family of causal counterfactuals being true. I argue that this account faces difficulties in securing the independent manipulability of the structural determination relations represented in a correct structural equations model. I then offer an alternate (...) understanding of structural determination, and I demonstrate that this theory guarantees that structural determination relations are independently manipulable. The account provides a straightforward way of understanding hypothetical interventions, as well as a criterion for distinguishing hypothetical changes in the values of variables which constitute interventions from those which do not. It additionally affords a semantics for causal counterfactual conditionals which is able to yield a clean solution to a problem case for the standard ‘closest possible world’ semantics. (shrink)

Multiple drug resistant strains of HIV and continuing difficulties with vaccine development highlight the importance of psychologi- cal interventions which aim to in uence the psychosocial and emo- tional factors empirically demonstrated to be significant predictors of immunity, illness progression and AIDS mortality in seropositive persons. Such data have profound implications for psychological interventions designed to modify psychosocial factors predictive of enhanced risk of exposure to HIV as well as the neuroendocrine and immune mechanisms mediating the impact of (...) such factors on disease progression. Many of these factors can be construed as unconscious mental ones, and psychoanalytic self-psychology may be a useful framework for conceptualizing psychic and immune de- fence as well as bodily and self-integration in HIV infection. Al- though further prospective studies and cross-cultural validation of research are necessary, existing data suggest that psychoanalytic insights may be useful both in therapeutic interventions and evaluative research which would require an underlying epistemology of the complementarity of mind and matter. (shrink)

Interventions that modify a person’s motivations through chemically or physically influencing the brain seem morally objectionable, at least when they are performed nonconsensually. This chapter raises a puzzle for attempts to explain their objectionability. It first seeks to show that the objectionability of such interventions must be explained at least in part by reference to the sort of mental interference that they involve. It then argues that it is difficult to furnish an explanation of this sort. The difficulty (...) is that these interventions seem no more objectionable, in terms of the kind of mental interference that they involve, than certain forms of environmental influence that many would regard as morally innocuous. The argument proceeds by comparing a particular neurointervention with a comparable environmental intervention. The author argues, first, that the two dominant explanations for the objectionability of the neurointervention apply equally to the environmental intervention, and second, that the descriptive difference between the environmental intervention and the neurointervention that most plausibly grounds the putative moral difference in fact fails to do so. The author concludes by presenting a trilemma that falls out of the argument. (shrink)

The current debate on closed-loop brain devices (CBDs) focuses on their use in a medical context; possible criminal justice applications have not received scholarly attention. Unlike in medicine, in criminal justice, CBDs might be offered on behalf of the State and for the purpose of protecting security, rather than realising healthcare aims. It would be possible to deploy CBDs in the rehabilitation of convicted offenders, similarly to the much-debated possibility of employing other brain interventions in this context. Although such (...) use of CBDs could in principle be consensual, there are significant differences between the choice faced by a criminal offender offered a CBD in the context of criminal justice, and that faced by a patient offered a CBD in an ordinary healthcare context. Employment of CBDs in criminal justice thus raises ethical and legal intricacies not raised by healthcare applications. This paper examines some of these issues under three heads: autonomy, human rights, and accountability. (shrink)

Research suggests that interventions involving extensive training or counterconditioning can reduce implicit prejudice and stereotyping, and even susceptibility to stereotype threat. This research is widely cited as providing an “existence proof” that certain entrenched social attitudes are capable of change, but is summarily dismissed—by philosophers, psychologists, and activists alike—as lacking direct, practical import for the broader struggle against prejudice, discrimination, and inequality. Criticisms of these “debiasing” procedures fall into three categories: concerns about empirical efficacy, about practical feasibility, and about (...) the failure to appreciate the underlying structural-institutional nature of discrimination. I reply to these criticisms of debiasing, and argue that a comprehensive strategy for combating prejudice and discrimination should include a central role for training our biases away. (shrink)

This chapter serves as an introduction to the edited collection of the same name, which includes chapters that explore digital well-being from a range of disciplinary perspectives, including philosophy, psychology, economics, health care, and education. The purpose of this introductory chapter is to provide a short primer on the different disciplinary approaches to the study of well-being. To supplement this primer, we also invited key experts from several disciplines—philosophy, psychology, public policy, and health care—to share their thoughts on what they (...) believe are the most important open questions and ethical issues for the multi-disciplinary study of digital well-being. We also introduce and discuss several themes that we believe will be fundamental to the ongoing study of digital well-being: digital gratitude, automated interventions, and sustainable co-well-being. (shrink)

Both philosophical and practical analyses of global justice issues have been vitiated by two errors: a too-high emphasis on the supposed duties of collectives to act, and a too-low emphasis on the analysis of causes and risks. Concentrating instead on the duties of individual actors and analysing what they can really achieve reconfigures the field. It diverts attention from individual problems such as poverty or refugees or questions on what states should do. Instead it shows that there are different duties (...) for political leaders, intelligence operatives, opinion leaders and citizens in devising, urging and implementing such plans as transfers of aid with accountability, military interventions in rogue states and limited intakes of refugees. With collectivist excuses for inaction such as sovereignty out of the way, it is possible to take a cautiously optimistic view of the possibility of forceful and morally responsible interventions in the range of major global problems. (shrink)

The overwhelming majority of those who theorize about implicit biases posit that these biases are caused by some sort of association. However, what exactly this claim amounts to is rarely specified. In this paper, I distinguish between different understandings of association, and I argue that the crucial senses of association for elucidating implicit bias are the cognitive structure and mental process senses. A hypothesis is subsequently derived: if associations really underpin implicit biases, then implicit biases should be modulated by counterconditioning (...) or extinction but should not be modulated by rational argumentation or logical interventions. This hypothesis is false; implicit biases are not predicated on any associative structures or associative processes but instead arise because of unconscious propositionally structured beliefs. I conclude by discussing how the case study of implicit bias illuminates problems with popular dual-process models of cognitive architecture. (shrink)

While ideal interventions are acknowledged by many as valuable tools for the analysis of causation, recent discussions have shown that, since there are no ideal interventions on upper-level phenomena that non-reductively supervene on their underlying mechanisms, interventions cannot—contrary to a popular opinion—ground an informative analysis of constitution. This has led some to abandon the project of analyzing constitution in interventionist terms. By contrast, this paper defines the notion of a horizontally surgical intervention, and argues that, when combined (...) with some innocuous metaphysical principles about the relation between upper and lower levels of mechanisms, that notion delivers a sufficient condition for constitution. This, in turn, strengthens the case for an interventionist analysis of constitution. (shrink)

Harms of medical interventions are systematically underestimated in clinical research. Numerous factors—conceptual, methodological, and social—contribute to this underestimation. I articulate the depth of such underestimation by describing these factors at the various stages of clinical research. Before any evidence is gathered, the ways harms are operationalized in clinical research contributes to their underestimation. Medical interventions are first tested in phase 1 ‘first in human’ trials, but evidence from these trials is rarely published, despite the fact that such trials (...) provide the foundation for assessing the harm profile of medical interventions. If a medical intervention is deemed safe in a phase 1 trial, it is tested in larger phase 2 and 3 clinical trials. One way to think about the problem of underestimating harms is in terms of the statistical ‘power’ of a clinical trial—the ability of a trial to detect a difference of a certain effect size between the experimental group and the control group. Power is normally thought to be pertinent to detecting benefits of medical interventions. It is important, though, to distinguish between the ability of a trial to detect benefits and the ability of a trial to detect harms. I refer to the former as power-B and the latter as power-H. I identify several factors that maximize power-B by sacrificing powerH in phase 3 clinical trials. If a medical intervention is approved for general use, it is evaluated by phase 4 post-market surveillance. Phase 4 surveillance of harms further contributes to underestimating the harm profile of medical interventions. At every stage of clinical research the hunt for harms is shrouded in secrecy, which further contributes to the underestimation of the harm profiles of medical interventions. (shrink)

?Love hurts??as the saying goes?and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could ?cure? an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses?and misuses?of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

The neurosciences not only challenge assumptions about the mind’s place in the natural world but also urge us to reconsider its role in the normative world. Based on mind-brain dualism, the law affords only one-sided protection: it systematically protects bodies and brains, but only fragmentarily minds and mental states. The fundamental question, in what ways people may legitimately change mental states of others, is largely unexplored in legal thinking. With novel technologies to both intervene into minds and detect mental activity, (...) the law should, we suggest, introduce stand alone protection for the inner sphere of persons. We shall address some metaphysical questions concerning physical and mental harm and demonstrate gaps in current doctrines, especially in regard to manipulative interferences with decision-making processes. We then outline some reasons for the law to recognize a human right to mental liberty and propose elements of a novel criminal offence proscribing severe interventions into other minds. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either (...) good or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients’ ability to give informed consent to treatment. This ‘deception’ claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments, rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of psychotherapy (...) have a duty to ‘go open’ to patients about the role of common factors in therapy ; to not ‘go open’ is supposed to unjustly restrict patients’ autonomy. This paper makes two related arguments against the ‘go open’ claim. While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners ‘go open’ about therapeutic common factors in psychotherapy, and clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to ‘go open’ should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works. (shrink)

Philosophers of science have insisted that evidence of underlying mechanisms is required to support claims about the effects of medical interventions. Yet evidence about mechanisms does not feature on dominant evidence-based medicine “hierarchies.” After arguing that only inferences from mechanisms (“mechanistic reasoning”)—not mechanisms themselves—count as evidence, I argue for a middle ground. Mechanistic reasoning is not required to establish causation when we have high-quality controlled studies; moreover, mechanistic reasoning is more problematic than has been assumed. Yet where the problems (...) can be overcome, mechanistic reasoning can and should be used as evidence. (shrink)

Inner speech travels under many aliases: the inner voice, verbal thought, thinking in words, internal verbalization, “talking in your head,” the “little voice in the head,” and so on. It is both a familiar element of first-person experience and a psychological phenomenon whose complex cognitive components and distributed neural bases are increasingly well understood. There is evidence that inner speech plays a variety of cognitive roles, from enabling abstract thought, to supporting metacognition, memory, and executive function. One active area of (...) controversy concerns the relation of inner speech to auditory verbal hallucinations in schizophrenia, with a common proposal being that sufferers of AVH misidentify their own inner speech as being generated by someone else. Recently, researchers have used artificial intelligence to translate the neural and neuromuscular signatures of inner speech into corresponding outer speech signals, laying the groundwork for a variety of new applications and interventions. (shrink)

Standing is a peculiar norm, allowing for deflecting that is rejecting offhand and without deliberation interventions such as directives. Directives are speech acts that aim to give directive-reasons, which are reason to do as the directive directs because of the directive. Standing norms, therefore, provide for deflecting directives regardless of validity or the normative weight of the rejected directive. The logic of the normativity of standing is, therefore, not the logic of invalidating directives or of competing with directive-reasons but (...) of ‘exclusionary permission’. That is, standing norms provide for permission to exclude from practical deliberation directive-reasons if given without the requisite standing, regardless of their normative weight. As such, standing is a type of second-order norm. Numerous everyday practices involve the deflection of directives, such as pervasive practices of deflecting hypocritical and officious directives. Of various possible models, the one that best captures the normative structure of these practices of deflection is the standing model. Accordingly, the normativity of standing is pervasive in our everyday practices. Establishing that standing, although a neglected philosophical idea, is a significant and independent normative concept. (shrink)

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

We argue that the fragility of contemporary marriages—and the corresponding high rates of divorce—can be explained (in large part) by a three-part mismatch: between our relationship values, our evolved psychobiological natures, and our modern social, physical, and technological environment. “Love drugs” could help address this mismatch by boosting our psychobiologies while keeping our values and our environment intact. While individual couples should be free to use pharmacological interventions to sustain and improve their romantic connection, we suggest that they may (...) have an obligation to do so as well, in certain cases. Specifically, we argue that couples with offspring may have a special responsibility to enhance their relationships for the sake of their children. We outline an evolutionarily informed research program for identifying promising biomedical enhancements of love and commitment. (shrink)

I consider the developmental origins of the socially extended mind. First, I argue that, from birth, the physical interventions caregivers use to regulate infant attention and emotion (gestures, facial expressions, direction of gaze, body orientation, patterns of touch and vocalization, etc.) are part of the infant’s socially extended mind; they are external mechanisms that enable the infant to do things she could not otherwise do, cognitively speaking. Second, I argue that these physical interventions encode the norms, values, and (...) patterned practices distinctive of their specific sociocultural milieu. Accordingly, not only do they enhance and extend the infant’s cognitive competence. They also entrain the infant to think and act in culturally appropriate ways. These physical interventions are thus arguably the earliest examples of social practices that scaffold the infant’s cognitive development and shape the development of their cultural education. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients (...) about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients. (shrink)

In the debates regarding the ethics of human enhancement, proponents have found it difficult to refute the concern, voiced by certain bioconservatives, that cognitive enhancement violates the autonomy of the enhanced. However, G. Owen Schaefer, Guy Kahane and Julian Savulescu have attempted not only to avoid autonomy-based bioconservative objections, but to argue that cognition-enhancing biomedical interventions can actually enhance autonomy. In response, this paper has two aims: firstly, to explore the limits of their argument; secondly, and more importantly, to (...) develop a more complete understanding of autonomy and its relation to cognitive enhancement. By drawing a distinction between the capacity for autonomy and the exercise and achievement of autonomy and by exploring the possible effects of cognitive enhancement on both competence and authenticity conditions for autonomy, the paper identifies and explains which dimensions of autonomy can and cannot, in principle, be enhanced via direct cognitive interventions. This allows us to draw conclusions regarding the limits of cognitive enhancement as a means for enhancing autonomy. (shrink)

This chapter addresses the claim that, as new types of neurointervention get developed allowing us to enhance various aspects of our mental functioning, we should work to prevent the use of such interventions from ever becoming the “new normal,” that is, a practice expected—even if not directly required—by employers. The author’s response to that claim is that, unlike compulsion or most cases of direct coercion, indirect coercion to use such neurointerventions is, per se, no more problematic than the pressure (...) people all find themselves under to use modern technological devices like computers or mobile phones. Few people seem to believe that special protections should be introduced to protect contemporary Neo-Luddites from such pressures. That being said, the author acknowledges that separate factors, when present, can indeed render indirect coercion to enhance problematic. The factors in question include lack of safety, fostering adaptation to oppressive circumstances, and having negative side effects that go beyond health. Nonetheless, the chapter stresses that these factors do not seem to be necessary correlates of neuroenhancement. (shrink)

In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Disorders, asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and respond similarly to (...) the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications. The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as "oppositional defiance disorder" and pathological gambling. -/- Contributors George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar. (shrink)