In this article I clarify the relationship between the use of involuntary antipsychotic medication and a delusional person’s freedom of thought in the light of three different views of freedom, namely, freedom as negative freedom, freedom as having an autonomous mind and freedom as capability. It is not clear how freedom of thought as a psychotic person’s human right should be understood and protected in practice. Therefore, further discussion is needed. These different ways of understanding a patient’s freedom of (...) thought also encourages to consider individual situations, hear the patient’s voice and work both multiprofessionally and across disciplines. (shrink)

Because many involuntarily childless people have equal interests in benefitting from assisted reproductive technologies like in vitro fertilization as a mode of treatment, we have normative reasons to ensure inclusive access to such interventions for as many of these people as is reasonable and possible. However, the prevailing eligibility criterion for access to assisted reproductive technologies—'infertility'—is inadequate to serve the goal of inclusive access. This is because the prevailing frameworks of infertility, which include medical and social infertility, fail to (...) precisely capture and unify the relevance of certain involuntarily childless experiences as warranting assisted reproductive technology (ART) treatment. I argue that the least we can do for those who have an interest in accessing ARTs is to conceptualize involuntarily childless experiences in dialogue with interactionist and ecological models of disability, to outline a unified and more inclusive eligibility criterion. (shrink)

RD, a 32-year-old male, was admitted to the hospital with hypoxic COVID pneumonia–a potentially life-threatening condition characterized by dangerously low levels of oxygen in the body- during one of the pandemic’s surges. While RD’s age gave the clinical team hope for his prognosis, his ability to recover was complicated by his being unvaccinated and having multiple comorbidities, including diabetes and obesity. His condition worsened to the point that he required extracorporeal membrane oxygenation (ECMO), a machine that maintains the functioning of (...) a person’s heart and lungs. -/- Given its scarcity–only 264 of the over 6,000 hospitals in the United States offer ECMO, according to the Extracorporeal Life Support Organization–as well as its high cost and the inadequate supply of staff required to maintain it, ECMO primarily serves as a bridge to support critically ill patients until they can receive an organ transplant or implanted medical device. For RD, ECMO was started to support him until he could be evaluated for, and possibly receive, a bilateral lung transplant. Despite its intended use as a treatment of last resort, some patients can remain on ECMO for weeks or months. And some are awake, alert, and capable of medical decision-making. -/- RD was one such patient. However, the transplant evaluation committee ruled out RD’s candidacy for bilateral lung transplantation, based on his poor potential for recovery and a lack of family and friends to provide post-transplant support. This determination raised the prospect of continued ECMO treatment being a bridge to nowhere. But RD was comfortable on ECMO and wanted to remain in the ICU. The ICU intensivist contacted the ethics consult service with questions about whether continued ECMO support was medically and ethically inappropriate. (shrink)

Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients' refusal of consent by incorporating time limits on involuntary treatment. When these are absent, as in the provisions for long term care which have recently come into force, the justification for compulsory treatment and supervision becomes (...) more obviously problematic. Second, Anglo-American law does not normally allow the preventive detention of someone who may be dangerous but has not actually committed any crime. The justification for detaining a possibly dangerous user of mental health services without his or her consent can only be based on risk assessment, but this raises issues of moral luck. Is the psychiatrist who decides not to take out a supervision order for a possibly dangerous patient with an initial psychotic diagnosis morally at fault if that person harms someone in the community, or himself? Or is the psychiatrist merely unlucky? (shrink)

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with irrational (...) beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and (...) human rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural and (...) gender issues; rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)

Despite extensive evidence for its effectiveness, ECT remains the subject of fierce opposition from those contesting its benefits and claiming extreme harms. Alongside some reflections on my experiences of this treatment, I examine the case against ECT, and find that it appears to rest primarily on unsubstantiated claims about major ethical violations, rather than clinical factors such as effectiveness and risk.

This dissertation seeks to examine the validity of the justification commonly offered for a coercive(1) psychiatric intervention, namely that the intervention was in the ‘best interests’ of the subject and/or that the subject posed a danger to others. As a first step,it was decided to analyse justifications based on ‘best interests’ [the ‘Stage 1’ argument] separately from those based on dangerousness [the ‘Stage 2’ argument]. Justifications based on both were the focus of the ‘Stage 3’ argument. Legal and philosophical analyses (...) of coercive psychiatric interventions generally regard such interventions as embodying a benign paternalism occasioning slight, if any, ethical concern. Whilst there are some dissenting voices even at the very heart of academic and professional psychiatry, the majority of psychiatrists also appear to share such views. The aim of this dissertation is to show that such a perspective is mistaken and that such interventions raise philosophical and ethical questions of the profoundest importance.(2) The philosophical well-spring of the Stage 1 dissertation argument lay in an observation made by Philippa Foot (3) that the “… right to be let free from unwanted interference” is one of the most fundamental and distinctive rights of persons, a right which takes precedence over any “… action we would dearly like to take for his sake.” This – in conjunction with the recognition that some coercive psychiatric interventions are of a gravity as to result in the personhood of the subject being severely damaged if not destroyed – suggested that the concept of personhood play a central role in the formulation of the dissertation argument. For ease of analysis it was presumed that the term ‘person’ could be defined by a set of necessary and sufficient conditions of which ‘minimum levels of rationality’ and ‘ability to communicate’ were the only conditions relevant to the formulation of justifications for coercive psychiatric interventions. This presumption was explicated into a number of postulates which enabled the construction of a rigorous foundation on which to develop the dissertation argument. This argument then sought to determine whether psychiatric assessments of irrationality were accurate and reliable. In furtherance of this analysis it was necessary to examine the reliability of psychiatric determinations in other areas of claimed expertise namely diagnosis, treatment and assessment of dangerousness. This ‘crossing of the disciplinary threshold’ brought to light the dearth of studies on psychiatric misdiagnosis and iatrogenic harm. A variant of the Precautionary Principle was developed to enable the extent of such harms to be estimated. The not insignificant levels of psychiatric misdiagnosis and iatrogenic harm and erroneous assessments of dangerousness which were thus found are of considerable relevance to any ethical analysis of the justification for coercive psychiatric intervention and serve to undermine simple paternalistic justifications. ---- (1)The term ‘coercive’ (rather than ‘non-consensual’) is used to indicate an intervention carried out against the explicit and contemporaneous objections of the subject (2)Not least because the number of individuals detained in Irish psychiatric hospitals is of a comparable order of magnitude to the number detained in Irish prisons subsequent to a criminal conviction. (3) See Foot (1977), p.102. (shrink)

In recent decades, it has been argued that the modern concept of forgiveness is absent from Aristotle’s conception of συγγνώμη as it appears in his Rhetoric and Nicomachean Ethics. In this paper, I argue that Aristotle’s view is more modern than it might appear. I defend the idea that Aristotle’s treatment of συγγνώμη, when seen in conjunction with his theory of ethical decision, involuntary action, and character alteration, commits him to a cognitive and emotional theory of forgiveness that (...) is both well-grounded and thoroughly modern. I go on to claim that Aristotle’s view of συγγνώμη helps to solve at least four controversial problems about the nature of forgiveness raised by modern philosophers: how one can forgive a wrong without condoning it, whether forgiveness is a duty, whether moral luck requires us to forgive more widely, and whether forgiveness ought to be unconditional. (shrink)

In this paper, I examine three mutually inconsistent claims that are commonly attributed to Hume: all beliefs are involuntary; some beliefs are subject to normative appraisal; and that ‘Ought implies Can’. I examine the textual support for such ascription, and the options for dealing with the puzzle posed by their inconsistency. In what follows I will put forward some evidence that Hume maintains each of the three positions outlined above. I then examine what I call the ‘prior voluntary action’ (...) solution. I argue that this position in any form fails to account for synchronic rationality. I then raise more specific objections depending on how we disambiguate the position, which can be read as either granting beliefs derivative voluntariness, or as denying their normative significance; the former version is inconsistent with Hume’s treatment of natural abilities, while the latter falls to a regress given Hume’s thesis regarding the inability of actions and passions to be subject to epistemic normativity. I then propose to reject instead for two reasons: first, the weakness of textual support for such an ascription; secondly, Hume’s explicit recognition of the irrelevance of involuntariness to normative evaluation in the moral case. (shrink)

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant information—in (...) this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

In this paper I argue that self-respect constitutes an important value, and further, serves as an important basis for equality. I also argue that under conditions of inequality-producing segregation, voluntary separation in schooling may be more likely to provide the resources necessary for self respect. Accordingly, I defend a prima facie case of voluntary separation for stigmatized minorities when equality – as equal status and treatment – is not an option under either the terms of integration or involuntary (...) segregation. (shrink)

Barbara Fried described John Rawls’s response to libertarianism as “the unwritten theory of justice.” This paper argues that while there is no need for a new theory of justice to address the libertarian challenge, there is a need for an additional chapter. Taking up Fried’s suggestion that the Rawlsian response would benefit from a revised list of primary goods, I propose to add employment to the list, thus leading to adoption of a full employment principle in the original position that (...) ensures that anyone who wants to work will be able to do so. I argue that although Rawls famously proposed government as employer of last resort, he never integrated that comment into his theory, which lacks a full employment principle and says nothing about the injustice of involuntary unemployment in its ideal theory. I first refute the received view of Rawls’s treatment of employment as required by its importance for citizens’ self-respect, then show that in fact, the full employment assumption is the result of the role of general equilibrium theory in Rawls’s model of a well-ordered society, and indicate why developments in economic theory and economic policy support the proposed revision. (shrink)

Aphantasia is a condition that is often characterized as the impaired ability to create voluntary mental images. Aphantasia is assumed to selectively affect voluntary imagery mainly because even though aphantasics report being unable to visualize something at will, many report having visual dreams. We argue that this common characterization of aphantasia is incorrect. Studies on aphantasia are often not clear about whether they are assessing voluntary or involuntary imagery, but some studies show that several forms of involuntary imagery (...) are also affected in aphantasia (including imagery in dreams). We also raise problems for two attempts to show that involuntary images are preserved in aphantasia. In addition, we report the results of a study about afterimages in aphantasia, which suggest that these tend to be less intense in aphantasics than in controls. Involuntary imagery is often treated as a unitary kind that is either present or absent in aphantasia. We suggest that this approach is mistaken and that we should look at different types of involuntary imagery case by case. Doing so reveals no evidence of preserved involuntary imagery in aphantasia. We suggest that a broader characterization of aphantasia, as a deficit in forming mental imagery, whether voluntary or not, is more appropriate. Characterizing aphantasia as a volitional deficit is likely to lead researchers to give incorrect explanations for aphantasia, and to look for the wrong mechanisms underlying it. (shrink)

According to what McMahan and Savulescu (2024) call the “popular position”, embryo selection is less ethically problematic than gene editing (other things being equal). The Two-Tier View, defended by McMahan and Savulescu, implies that the popular position is mistaken. The authors treat gene editing of embryos similarly to standard cases of medical treatments that promise expected benefits for the (subsequent) person even though gene editing also may create risks of harmful side effects for her. McMahan and Savulescu assume that if (...) gene editing is (successfully) done, it is better for the person who developed from the beneficently edited embryo. And, if the editing had not been done, although it was possible, that would have been worse for the same person in question. Thus, the comparator must always be a possible, even if unlikely, world in which she would have existed. That is why gene editing, in their view, resembles medical treatments. Therefore, assuming that standard medical treatments are not more ethically problematic than embryo selection, they conclude that (in general) gene editing should also be treated as not more problematic than embryo selection. In this paper, I am taking one step further than McMahan and Savulescu in questioning the central assumptions in the bioethical debates about new reproductive technologies. In the previous work, we argued that the very distinction between person-affecting and identity-affecting interventions is based on a questionable form of material-origin essentialism (Żuradzki and Dranseika 2022). Here, I argue that the bipartite distinction between person-affecting and impersonal reasons, as used by McMahan and Savulescu, insufficiently represents different possible counterfactual comparisons between real and merely possible outcomes. In particular, I argue that the evaluation of gene editing requires counterfactual comparisons to situations in which the benefited person might or might not exist. Such evaluation requires an additional class of reasons, let me call them “semi-person-affecting,” that cannot be reduced to either person-affecting or impersonal ones. This aspect of gene editing makes it dissimilar to standard cases of medical treatments. (shrink)

This paper proposes that the question “What should I believe?” is to be answered in the same way as the question “What should I do?,” a view I call Equal Treatment. After clarifying the relevant sense of “should,” I point out advantages that Equal Treatment has over both simple and subtle evidentialist alternatives, including versions that distinguish what one should believe from what one should get oneself to believe. I then discuss views on which there is a distinctively (...) epistemic sense of should. Next I reply to an objection which alleges that non-evidential considerations cannot serve as reasons for which one believes. I then situate Equal Treatment in a broader theoretical framework, discussing connections to rationality, justification, knowledge, and theoretical vs. practical reasoning. Finally, I show how Equal Treatment has important implications for a wide variety of issues, including the status of religious belief, philosophical skepticism, racial profiling and gender stereotyping, and certain issues in psychology, such as depressive realism and positive illusions. (shrink)

Sentences containing definite descriptions, expressions of the form ‘The F’, can be formalised using a binary quantifier ι that forms a formula out of two predicates, where ιx[F, G] is read as ‘The F is G’. This is an innovation over the usual formalisation of definite descriptions with a term forming operator. The present paper compares the two approaches. After a brief overview of the system INFι of intuitionist negative free logic extended by such a quantifier, which was presented in (...) (Kürbis 2019), INFι is first compared to a system of Tennant’s and an axiomatic treatment of a term forming ι operator within intuitionist negative free logic. Both systems are shown to be equivalent to the subsystem of INFι in which the G of ιx[F, G] is restricted to identity. INFι is then compared to an intuitionist version of a system of Lambert’s which in addition to the term forming operator has an operator for predicate abstraction for indicating scope distinctions. The two systems will be shown to be equivalent through a translation between their respective languages. Advantages of the present approach over the alternatives are indicated in the discussion. (shrink)

The workshop took place in Leuven, Belgium, and was hosted by the KU Leuven's Centre for Logic and Analytic Philosophy. The workshop’s theme was the syntactical treatment of (alethic, epistemic, etc.) modalities. The standard view on modalities nowadays is that they are operators. Syntactic theories, however, treat modalities as predicates, and thus have to assume a background theory which is sufficiently strong to encode its own formulas (usually, one works with some system of arithmetic and Gödel coding). As a (...) consequence, such theories suffer from paradoxes of self-referentiality. For example, just as the liar sentence states of itself that it is false, the knower sentence states of itself that it is unknown. Kaplan and Montague (1960: 'A paradox regained', Notre Dame J. Formal Logic, vol. 1, pp. 79–90) famously showed that any sufficiently strong theory that contains the knower is inconsistent. (shrink)

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is (...) in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research (...) suggests that practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

Prof. Cohen and I answer six questions: (1) Why do we lock people up? (2) How can involuntary civil commitment be reconciled with people's constitutional right to liberty? (3) Why don't we treat homicide as a public health threat? (4) What is the difference between legal and medical approaches to mental illness? (5) Why is mental illness required for involuntary commitment? (6) Where are we in our efforts to understand the causes of mental illness?

This essay focuses on theories of creativity from six historical figures, while noting comparisons to several others. In Ancient Greece: (i) Plato advances the thesis that the poet is a passive vessel inspired by a muse. (ii) Aristotle replies with the antithesis that the poet creates through skilled activity. (iii) Longinus provides the synthesis. Plato is right that poets are passively inspired with original ideas – though the source is natural genius instead of some muse. But Aristotle is also right (...) that the poet must actively employ skill. In early modern Europe: (iv) Margaret Cavendish argues that through creativity women can enjoy some freedom and happiness despite oppression. (v) Alexander Gerard and Immanuel Kant both inherit the Longinian synthesis. Gerard says we form original ideas through remote associations. (vi) Kant notices that although the genius must be passive in the origination of ideas, she must also be active in the very same process, because she merits acclaim for her originality. Kant designs his theory of genius to resolve this Paradox of Creative Agency. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how (...) clinicians use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Casgevy, the world’s first approved CRISPR-based cell therapy, has been priced at $2.2 million per patient. Although this hefty price tag was widely anticipated, the extremely high cost of this and other cell and gene therapies poses a major ethical issue in terms of equitable access and global health. In this Perspective, we argue that lowering the prices of future CRISPR therapies is an urgent ethical imperative. Although we focus on Casgevy as a case study, much of our analysis can (...) be extrapolated to the controversies over affordable access to other gene and cell therapies. First, we explain why this first-of-its-kind CRISPR therapy might be so expensive. We then analyze the ethical issues of equity and global health of early CRISPR treatments. Next, we discuss potential solutions to lower the prices of CRISPR gene therapies. We conclude that the approval of CRISPR transforms our obligations of justice and compels us to bring future gene therapies to the maximum possible number of patients with serious genetic diseases at affordable prices. (shrink)

Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies. Policies regarding who can access ART and with what support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem (...) to suppose. Instead, we propose that debates about appropriate state responses should consider the various implications for health and broader well-being that may be associated with difficulties starting a family. We argue that the harms and disruption to valued life projects of subfertility-related suffering may provide a stronger basis for justifying state support in this context. Further, we suggest that, whilst ART may alleviate some of the harm resulting from subfertility, population-level considerations can indicate a broader range of interventions aimed at tackling different sources of subfertility-related harm, consistent with broader public health aims. (shrink)

The fact that Gilbert Ryle and J.L. Austin seem to disagree about the ordinary use of words such as ‘voluntary’, ‘involuntary’, ‘voluntarily’, and ‘involuntarily’ has been taken to cast doubt on the methods of ordinary language philosophy. As Benson Mates puts the worry, ‘if agreement about usage cannot be reached within so restricted a sample as the class of Oxford Professors of Philosophy, what are the prospects when the sample is enlarged?’ (Mates, Inquiry 1:161–171, 1958, p. 165). In this (...) chapter, we evaluate Mates’s criticism alongside Ryle’s and Austin’s specific claims about the ordinary use of these words, assessing these claims against actual examples of ordinary use drawn from the British National Corpus (BNC). Our evaluation consists in applying a combination of methods: first aggregating judgments about a large set of samples drawn from the corpus, and then using a clustering algorithm to uncover connections between different types of use. In applying these methods, we show where and to what extent Ryle’s and Austin’s accounts of the use of the target terms are accurate as well as where they miss important aspects of ordinary use, and we demonstrate the usefulness of this new combination of methods. At the heart of our approach is a commitment to the idea that systematically looking at actual uses of expressions is an essential component of any approach to ordinary language philosophy. (shrink)

Following the precedent set by Dorthe Berntsen’s 2009 book, Involuntary Autobiographical Memory, this paper asks whether the mechanisms responsible for involuntarily recollected memories are distinct from those that are responsible for voluntarily recollected ones. Berntsen conjectures that these mechanisms are largely the same. Recent work has been thought to show that this is mistaken, but the argument from the recent results to the rejection of Berntsen’s position is problematic, partly because it depends on a philosophically contentious view of voluntariness. (...) Berntsen herself shares this contentious view, but the defenders of her position can easily give it up. This paper explains how and why they should. (shrink)

The fact that Gilbert Ryle and J.L. Austin seem to disagree about the ordinary use of words such as ‘voluntary’, ‘involuntary’, ‘voluntarily’, and ‘involuntarily’ has been taken to cast doubt on the methods of ordinary language philosophy. As Benson Mates puts the worry, ‘if agreement about usage cannot be reached within so restricted a sample as the class of Oxford Professors of Philosophy, what are the prospects when the sample is enlarged?’ (Mates 1958, p. 165). In this chapter, we (...) evaluate Mates’s criticism alongside Ryle’s and Austin’s specific claims about the ordinary use of these words, assessing these claims against actual examples of ordinary use drawn from the British National Corpus (BNC). Our evaluation consists in applying a combination of methods: first aggregating judgments about a large set of samples drawn from the corpus, and then using a clustering algorithm to uncover connections between different types of use. In applying these methods, we show where and to what extent Ryle’s and Austin’s accounts of the use of the target terms are accurate as well as where they miss important aspects of ordinary use, and we demonstrate the usefulness of this new combination of methods. At the heart of our approach is a commitment to the idea that systematically looking at actual uses of expressions is an essential component of any approach to ordinary language philosophy. (shrink)

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender (...) affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong. (shrink)

This article describes a case of a teenager with early complex trauma due to chronic domestic violence. Cannabis use triggered auditory hallucinations, after which the teenager was diagnosed with an acute schizophrenia-like psychotic disorder. Antipsychotic medication did not fully resolve symptoms. Eventually the teenager chose to self-medicate with LSD in order to resolve a suicidal condition. The teenager carried out six unsupervised LSD sessions, followed by an extended period of almost daily use of inhaled low-dose DMT. Psychotic symptoms were mostly (...) resolved after approximately one year. Subsequent cannabis use caused a transient relapse. -/- While his psychosis may have been due to cannabis use in the presence of a genetic predisposition, LSD and DMT did not promote psychotic symptoms in this case, and resolved the suicidal condition in one session. Additional high-dose LSD sessions and low-dose DMT sessions appeared to resolve the symptoms related to the early complex trauma. Alternatively, if psychosis is understood as a massive defense system resulting from early complex trauma, and if his psychotic symptoms were partially due to such trauma, psychedelics appeared to transcend this defense system, providing access to traumatic memories in order to allow for an integrative treatment effect. -/- Information was acquired from medical record excerpts provided by the patient, a semi-structured retrospective video interview, and follow-up interviews a year later. The present case suggests a need for further studies on the relationship between psychedelics and psychotic disorders, the feasibility of supervised vs unsupervised settings for various situations, and alternative therapeutic models for utilizing the hyperaware-hypersensitive state induced by psychedelics. With regard to self-treatment, a harm reduction approach should be adopted. Low-risk psycholytic self-treatment protocols could be developed for future use in public health care systems. (shrink)

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, (...) that is, individuals who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being. (shrink)

Primarily, this article emphasises that while conducting research, especially one involving human subjects, researchers are expected to comply with applicable global and national ethical standards. Should a researcher fail to do so, he/she stands the risk of breaching research ethics, and this is capable of rendering his/her research unacceptable. Accordingly, this article, making reference to relevant ethical theories, critically examines and analyses the actions of a researcher who set out to investigate treatment recommendations for diarrhoea. Ultimately, a number of (...) ethical pitfalls in the stated research are x-rayed and some recommendations for subsequent studies are provided in this paper. (shrink)

Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted (...) a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases. (shrink)

I defend a certain claim about rationing in the context of HIV/AIDS, namely, the 'priority thesis' that the state of a developing country with a high rate of HIV should provide highly active anti-retroviral treatment (HAART) to those who would die without it, even if doing so would require not treating most other life-threatening diseases. More specifically, I defend the priority thesis in a negative way, by refuting two influential and important arguments against it inspired by the Kantian principle (...) of respect for persons. The 'equality argument' more or less maintains that prioritizing treatment for HIV/AIDS would objectionably treat those who suffer from it as more important than those who do not. The 'responsibility argument' says, roughly, that to ration life-saving treatment by prioritizing those with HIV would wrongly fail to hold people responsible for their actions, since most people infected with HIV could have avoided the foreseeable harm of infection. While it appears that a Kantian must think that one of these two arguments is sound, I maintain that, in fact, respect for persons grounds neither the equality nor responsibility argument against prioritizing HAART and hence at least permits doing so. If this negative defence of the priority thesis succeeds, then conceptual space is opened up for the possibility that respect for persons requires prioritizing HAART, which argument I sketch in the conclusion as something to articulate and defend in future work. (shrink)

This paper offers a critical survey and analysis of empirical studies on creativity, with emphasis on how imagination plays a role in the creative process. It takes as a foil the romantic view that, given features like novelty, incubation, and insight, we should be skeptical about the prospects for naturalistic explanation of creativity. It rebuts this skepticism by first distinguishing stages or operations in the creative process. It then works through various behavioral and neural studies, and corresponding philosophical theorizing, that (...) concern the preparation, generation, insight, and evaluation stages of creative processes. The result is not a complete explanation of creativity, but it identifies an explanatory path towards such an explanation, including the features of creativity that motivate that skepticism. (shrink)

Schizophrenia is often associated with other physical and mental problems. Generalized anxiety disorder is notably one of the comorbid disorders which is often linked to schizophrenia. The association of polythematic delusions and of ideas resulting from generalized anxiety disorder complicates the exercise of the corresponding cognitive therapy, for the resulting ideas are most often inextricably intertwined. In what follows, we endeavour to propose a methodology for the differential treatment of polythematic delusions inherent to schizophrenia when combined with ideas originating (...) from generalized anxiety disorder. We propose, with regard to the corresponding content of delusions, an analysis which allows under certain conditions, to separate the content associated with polythematic delusions and the one that relates to generalized anxiety disorder, in order to facilitate the exercise of the corresponding cognitive therapy. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force (...) here. As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

Science is the basis for managing the affairs of life and human activities, and living without knowledge is a form of wandering and a kind of loss. Using scientific methods helps us understand the foundations of choice, decision-making, and adopting the right solutions when solutions abound and options are numerous. Operational research is considered the best that scientific development has provided because its methods depend on the application of scientific methods in solving complex issues and the optimal use of available (...) resources in various fields, private and governmental work in peace and war, in politics and economics, in planning and implementation, and in various aspects of life. Its basic essence is to use the data provided for the issue under study to build a mathematical model that is the optimal solution. It is the basis on which decision makers rely in managing institutions and companies, and when operations research methods meet with the neutrosophic teacher, we get ideal solutions that take into account all the circumstances and fluctuations that may occur in the work environment over time. One of the most important operations research methods is the linear programming method. Which prompted us to reformulate the linear models, the graphical method, and the simplex method, which are used to obtain the optimal solution for linear models using the concepts of neutrosophic science. In this research, and as a continuation of what we presented previously, we will reformulate the modified simplex algorithm that was presented to address the difficulty that we were facing when applying the direct simplex algorithm. It is the large number of calculations required to be performed in each step of the solution, which requires a lot of time and effort. (shrink)

One of the most important theories in linear programming is the dualistic theory and its basic idea is that for every linear model has dual linear model, so that solving the original linear model gives a solution to the dual model. Therefore, when we solving the linear programming model, we actually obtain solutions for two linear models. In this research, we present a study of the models. The neutrosophic dual and the binary simplex algorithm, which works to find the optimal (...) solution for the original and dual models at the same time. The importance of this algorithm is evident in that it is relied upon in several operations research topics, such as integer programming algorithms, some nonlinear programming algorithms, and sensitivity analysis in linear programming. (shrink)

Ketamine is a well-known and widely available general anesthetic from the 1960s that, in sub-anesthetic doses, has been adopted in a limited manner for the treatment of acute suicidality and treatment-resistant depression. Its short onset time and short duration of action make it feasible for use at outpatient clinics. In the US, it has a long history of off-label use and was officially approved for depression treatment in 2019. In Finland, it has been administered to selected hospitalized (...) patients in the public healthcare system since 2010 and became available at a private outpatient clinic very recently. In Norway, it has been administered off-label at a private clinic for approximately 500 patients since mid-2010s and at a public clinic for approximately 300 patients since 2020, with plans on opening more clinics in 2024. In the US, the treatment has been administered to hundreds of thousands of patients. -/- The retrospective ethnographic inquiry part of this study features a Finnish woman in her twenties who suffered from treatment-resistant depression, rooted in her insecure childhood and having been bullied at school, as well as income insecurity and excessive workload in adulthood. Eventually, she was violently raped, which induced an obvious post-traumatic stress disorder and exacerbated her depression, incapacitating her. In the course of approximately five years, she was prescribed ten different anti-depressive medications and seventeen other medications, including various antipsychotic medications and lithium. These failed to provide an anti-depressive effect but resulted in 'massive' adverse effects instead, including 60% weight gain and psychotic hallucinations. Eventually, esketamine spray treatment at a private outpatient clinic resolved her depression in a single session. A weekly re-administration process was ongoing. -/- In this case, repeated esketamine administration alleviated depression by producing accumulating corrective emotional experiences without the need to re-experience previous traumatizing events. In a few months to a year, the transient but accumulating anti-depressive effect typically leads to the resolution of depression in most cases, if the patients' living conditions no longer constantly re-traumatize them. It is necessary to adopt ketamine more widely as an emergency measure while more effective, non-addictive alternatives and complements are prepared for adoption. The cost of this specific pilot program implementation was unscalable, but costs can be reduced by approximately 90% by modifying the implementation details. Ketamine and its more effective alternative, 5-MeO-DMT, can serve a major role in facilitating a rebirth of public and private mental healthcare systems, with treatment efficacy multiplied and treatment costs simultaneously reduced. (shrink)

d organic compounds that pose serious risks to aquatic ecosystems and human health. This study investigates the application of biochar as an effective treatment medium for textile wastewater. Biochar, a carbon-rich material produced through pyrolysis of organic matter, offers high surface area, porosity, and adsorption properties. We evaluated the efficacy of biochar in removing dyes and heavy metals from simulated textile effluent under varying conditions of contact time, pH, and biochar dosage. Results indicated that biochar significantly reduced dye concentration (...) and metal ions, with optimal removal rates achieved at specific pH levels and higher biochar amounts. Mechanistic studies suggested that adsorption, electrostatic interactions, and ion exchange were the primary removal processes. This research highlights the potential of biochar not only as a sustainable solution for textile effluent treatment but also as a means to recycle organic waste, contributing to a circular economy. Further investigations into the regeneration and reuse of biochar in wastewater treatment are recommended to enhance its practical applicability. (shrink)

There is no doubt that custard apple diseases are among the important reasons that destroy the Custard Apple plant and its agricultural crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases is a good step to provide the appropriate and correct treatment. Determining the treatment with high accuracy depends on the method used to correctly diagnose the disease, expert systems can greatly help in avoiding damage to these plants. The expert system (...) correctly diagnoses Custard Apple disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: A specialized syllable language system was established for the diagnosis of Custard Apple plant disease. (shrink)

Central elements of Roman Catholic treatment ethics include: 1) that rejection of treatment with the intent of hastening death (even for a good end) is ethically equivalent to active euthanasia with the same intent; 2) a distinction between morally obligatory “ordinary” treatment and morally optional “extraordinary treatment”; 3) that the quality of the patient’s life is not be a legitimate basis for rejecting treatment; and 4) that extraordinary treatment is not forbidden, but optional, and (...) that it is the patient or the patient’s legal surrogate–not the doctor– who has the right to choose or reject it. Despite these principles, even in a cultural climate fully sympathetic to Catholic treatment ethics, it is appropriate as a legal matter to maintain the doctrine of informed consent under which it is possible for patients or their surrogates to reject life-preserving treatment, including for unethical reasons. It is normally impossible to enforce in practice in the external forum a differentiation between rejection of treatment for ethically acceptable and ethically unacceptable reasons. By contrast, in cases of direct killing, such as assisting suicide, the intent to cause death is unmistakable (as opposed to accepting an increased risk of death as a foreseeable but unintended consequence of pursuing a good end). In a pluralistic society Catholic ethics cannot be legislatively enforced on the ground that they are compelled by Catholic teaching. However, the basic principles of Catholic treatment ethics may be justified based on logic and widely accepted norms of human equality independently of revelation or ecclesiastical authority. Particularly in protecting the right of individuals to choose and obtain life-saving medical treatment regardless of their “quality of life,” and in suicide prevention, secular law can and should be congruent with key aspects of Catholic health care ethics. (shrink)

Semanticists face substitution challenges even outside of contexts commonly recognized as opaque. Jennifer M. Saul has drawn attention to pairs of simple sentences - her term for sentences lacking a that-clause operator - of which the following are typical: -/- (1) Clark Kent went into the phone booth, and Superman came out. (1*) Clark Kent went into the phone booth, and Clark Kent came out. -/- (2) Superman is more successful with women than Clark Kent. (2*) Superman is more successful (...) with women than Superman. -/- She challenges us to explain why the upper and lower sentences in each pair differ, or at least appear to differ, in their truth-values and hence truth-conditions. This appearance of substitution failure is inherently puzzling. Moreover, it is taken by Saul to generate a dilemma for anyone hostile to direct reference accounts of that-clause constructions. Direct reference theorists regard the appearance of substitution failure in that-clause contexts as mere appearance, to be dealt with pragmatically rather than semantically. -/- Critics of such accounts need to say something about simple-sentence cases. If they choose to allow that intuitions of substitution failure can be over-ridden and explained away pragmatically in simple-sentence cases but not in that-clause cases, they lay themselves open to the charge of operating a double standard. But if they do not choose this option, they must offer a semantic explanation of apparent substitution failure in simple-sentence cases - no easy task, it turns out. Other respondents to Saul's challenge have sought to provide elaborate semantic treatments. In contrast, this paper proposes a far simpler pragmatic explanation of intuitions of substitution failure in simple sentences, an explanation that deploys no more resources than are to be found in Grice's 'Logic and Conversation'. Ironically, this proposal turns out to be incompatible with a direct reference perspective. So if it is, as I maintain, the most plausible treatment of simple-sentence cases available, Saul's initial thought gets turned around 180 degrees: the phenomenon she has drawn attention to ends up representing a challenge to supporters of direct reference theories. (shrink)

The article analyses the concept of indirect discrimination, arguing first that existing conceptualisations are unsatisfactory and second that it is best understood as equal treatment that is disadvantageous to the discriminatees because of their group-membership. I explore four ways of further refining the definition, arguing that only an added condition of moral wrongness is at once plausible and helpful, but that it entails a number of new problems that may outweigh its benefits. Finally, I suggest that the moral wrongness (...) of indirect discrimination is best accounted for in terms of the harm it does to discriminatees, and sketch three ways in which it may do so. I conclude that the analysis provides both a clearer understanding of the concept of indirect discrimination as well as indirect support for a harm-based account of the wrongness of discrimination, while suggesting that our moral obligations qua non-discrimination may be more extensive than is frequently assumed. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision (...) on the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

Social structure of our society decides the actions that are allowed by any individual human being. All the actions of an individual are characterized into voluntary or involuntary actions, which decides the behaviour of society towards that individual for that action. In this paper it has been shown that the characterization of action into these two categories is fundamentally flawed.

According to some critics, if biology is a kind of reverse engineering for the nature, it is quite poorly prepared for the task. Thus, the issue is more likely with its ontology. Multiple hypotheses and conjectures found in papers on methodological issues claim that living systems should be viewed as complex networks of signal-transmitting paths, both neural and non-neural, that feature modularity and feedback circuits and are prone to emergent properties and increasing complexity. If so, we are on the eve (...) of a new stage in computer models development where not only computers are used to emulate life, but life itself is construed as a complex network of interacting natural computers. (shrink)

Normal interpersonal treatment is often based on the existence of the rational nature of both the agent and the target of the treatment, and their relationship is reciprocal and mutual. However, when the rational person confronts the irrational person, such as the mentally retarded or vegetative person, the reciprocal relationship cannot be maintained because the targeted person loses his or her rational capacity. But this inequality does not deprive the object of action of the right to be treated (...) rationally, because people treat the irrationally disabled not according to the principle of reason but according to the principle of emotion - specifically, the principle of love. The principle of love often disregards the specific conditions of the object of treatment and still treats them reasonably. Thus, the emotional principle has a broader application in interpersonal treatment. (shrink)