A recent systematic review of Machine Learning (ML) approaches to health data, containing over 100 studies, found that the most investigated problem was mental health (Yin et al., 2019). Relatedly, recent estimates suggest that between 165,000 and 325,000 health and wellness apps are now commercially available, with over 10,000 of those designed specifically for mental health (Carlo et al., 2019). In light of these trends, the present chapter has three aims: (1) provide an informative overview of some of (...) the recent work taking place at the intersection of text mining and mental health so that we can (2) highlight and analyze several pressing ethical issues that are arising in this rapidly growing field and (3) suggest productive directions for how these issues might be better addressed within future interdisciplinary work to ensure the responsible development of text mining approaches in psychology generally, and in mental health fields, specifically. In Section 1, we review some of the recent literature on text-mining and mental health in the contexts of traditional experimental settings, social media, and research involving electronic health records. Then, in Section 2, we introduce and discuss ethical concerns that arise before, during, and after research is conducted. Finally, in Section 3, we offer several suggestions about how ethical oversight of text-mining research might be improved to be more responsive to the concerns mapped out in Section 2. (shrink)

According to proponents of the extended mind, bio-external resources, such as a notebook or a smartphone, are candidate parts of the cognitive and mental machinery that realises cognitive states and processes. The present chapter discusses three areas of ethical concern associated with the extended mind, namely mental privacy, mental manipulation, and agency. We also examine the ethics of the extended mind from the standpoint of three general normative frameworks, namely, consequentialism, deontology, and virtue ethics.

This article argues that existing approaches to programming ethical AI fail to resolve a serious moral-semantic trilemma, generating interpretations of ethical requirements that are either too semantically strict, too semantically flexible, or overly unpredictable. This paper then illustrates the trilemma utilizing a recently proposed ‘general ethical dilemma analyzer,’ GenEth. Finally, it uses empirical evidence to argue that human beings resolve the semantic trilemma using general cognitive and motivational processes involving ‘mental time-travel,’ whereby we simulate different possible pasts and futures. (...) I demonstrate how mental time-travel psychology leads us to resolve the semantic trilemma through a six-step process of interpersonal negotiation and renegotiation, and then conclude by showing how comparative advantages in processing power would plausibly cause AI to use similar processes to solve the semantic trilemma more reliably than we do, leading AI to make better moral-semantic choices than humans do by our very own lights. (shrink)

The extended mind thesis maintains that the functional contributions of tools and artefacts can become so essential for our cognition that they can be constitutive parts of our minds. In other words, our tools can be on a par with our brains: our minds and cognitive processes can literally ‘extend’ into the tools. Several extended mind theorists have argued that this ‘extended’ view of the mind offers unique insights into how we understand, assess, and treat certain cognitive conditions. In this (...) chapter we suggest that using AI extenders, i.e., tightly coupled cognitive extenders that are imbued with machine learning and other ‘artificially intelligent’ tools, presents both new ethical challenges and opportunities for mental health. We focus on several mental health conditions that can develop differently by the use of AI extenders for people with cognitive disorders and then discuss some of the related opportunities and challenges. (shrink)

This article identifies and examines a tension in mental health researchers’ growing enthusiasm for the use of computational tools powered by advances in artificial intelligence and machine learning (AI/ML). Although there is increasing recognition of the value of participatory methods in science generally and in mental health research specifically, many AI/ML approaches, fueled by an ever-growing number of sensors collecting multimodal data, risk further distancing participants from research processes and rendering them as mere vectors or collections of data (...) points. The imperatives of the “participatory turn” in mental health research may be at odds with the (often unquestioned) assumptions and data collection methods of AI/ML approaches. This article aims to show why this is a problem and how it might be addressed. (shrink)

Well before the COVID-19 pandemic, proponents of digital psychiatry were touting the promise of various digital tools and techniques to revolutionize mental healthcare. As social distancing and its knock-on effects have strained existing mental health infrastructures, calls have grown louder for implementing various digital mental health solutions at scale. Decisions made today will shape the future of mental healthcare for the foreseeable future. We argue that bioethicists are uniquely positioned to cut through the hype surrounding digital (...) mental health, which can obscure crucial ethical and epistemic gaps that ought to be considered by policymakers before committing to a digital psychiatric future. Here, we describe four such gaps: The evidence gap, the inequality gap, the prediction-intervention gap, and the safety gap. (shrink)

The observation that a crisis of confidence regarding Psychiatry exists is a notion shared even among psychiatrists themselves. Psychiatry has a checkered history and its alliance with the pharmaceutical industry, aka Big-Pharma, continues to reinforce a need for healthy skepticism. Why? Mainly, an over-reliance on the questionable expertise and authority afforded psychiatry as the specialists of mental health. I contend that the authority of psychiatry is misplaced and too often harmful. Since the criteria required to justify and satisfy psychiatric (...) expertise is not fully established as can be substantiated by compelling reasons to rethink its authority as a reliable profession in its current form. Psychiatric expertise is not particularly scientific and this is especially dangerous in a sector that prescribes mind-altering drugs. There are a number of identified criteria that would otherwise substantiate psychiatric expertise and whilst partially existent, are nonetheless deficient. These major yet deficient aspects of psychiatric practice concern diagnostic problems – reliability and verification of diagnoses and accurate testable validity of diagnoses - mainly due to an absence of identifiable underlying biomarkers ordinarily related to disease or biological conditions. Psychiatrists often fail to distinguish between reactive-depression (reaction to external event or circumstance) and endogenous-depression (biological) resulting, in part, from incorrectly distinguishing between conditions constitutive of ‘trait’ (endogenous) and of those of ‘state’ (e.g. reactive depression; adverse effects from medication, etc.). (shrink)

As COVID-19 spread, clinicians warned of mental illness epidemics within the coronavirus pandemic. Funding for digital mental health is surging and researchers are calling for widespread adoption to address the mental health sequalae of COVID-19. -/- We consider whether these technologies improve mental health outcomes and whether they exacerbate existing health inequalities laid bare by the pandemic. We argue the evidence for efficacy is weak and the likelihood of increasing inequalities is high. -/- First, we review (...) recent trends in digital mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities. (shrink)

The dissertation is mainly concerned with the following question: How can we be responsible for our attitudes? Traditional formulations of the philosophical problem underlying this question see it as a conflict between responsibility and the absence of voluntary control. I interpret it, by contrast, as a problem about the responsibility that we have for being (ir)rational. To illuminate this responsibility, I engage in discussions about the normative status of object-given reasons for attitudes, present a novel case against pragmatism about reasons (...) for attitudes, and propose that we can understand our responsibility for being (ir)rational by grounding the normative force of reasons for attitudes in our practice of holding each other answerable for our (ir)rationality. Properly distinguishing the direct answerability we have for our attitudes from the indirect accountability that we have for managing our attitudes allows us to see that not all kinds of responsibility presuppose control. Rather, attitudes for which we are directly answerable are within the space of reasons without always being within our control. (shrink)

Climate change, pollution, and deforestation have a negative impact on global mental health. There is an environmental justice dimension to this challenge as wealthy people and high-income countries are major contributors to climate change and pollution, while poor people and low-income countries are heavily affected by the consequences. Using state-of-the art data mining, we analyzed and visualized the global research landscape on mental health, climate change, pollution and deforestation over a 15-year period. Metadata of papers were exported from (...) PubMed®, and both relevance and relatedness of terms in different time frames were computed using VOSviewer. Co-occurrence graphs were used to visualize results. The development of exemplary terms over time was plotted separately. The number of research papers on mental health and environmental challenges is growing in a linear fashion. Major topics are climate change, chemical pollution, including psychiatric medication in wastewater, and neurobiological effects. Research on specific psychiatric syndromes and diseases, particularly on their ethical and social aspects is less prominent. There is a growing body of research literature on links between mental health, climate change, pollution, and deforestation. This research provides a graphic overview to mental healthcare professionals and political stakeholders. Social and ethical aspects of the climate change-mental health link have been neglected, and more research is needed. (shrink)

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood (...) data collection technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

This collection presents six case studies on the ethics of mental health research, written by scientific researchers and ethicists from around the world. We publish them here as a resource for teachers of research ethics and as a contribution to several ongoing ethical debates. Each consists of a description of a research study that was proposed or carried out and an in-depth analysis of the ethics of the study.

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, I discuss (...) two potential problems surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships. (shrink)

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. This paper firstly highlights the relevance of a process-based approach to ethics when accessing highly sensitive data and then discusses the ethical considerations and potential challenges regarding the accessing of public data from Digital (...) class='Hi'>Mental Health services. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users’ expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research in an ethical manner that includes vulnerable young people as research participants. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users’ control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and ‘read more’ options. (shrink)

One of the most prominent ethical concerns regarding emerging neurotechnologies is mental privacy. This is the idea that we should have control over access to our neural data and to the information about our mental processes and states that can be obtained by analyzing it. A key issue is whether this information needs more stringent protection than other kinds of personal information. I will articulate and support the view, underlying recent regulatory frameworks, that mental privacy requires a (...) special treatment because of its relation to relevant aspects of personal identity. It has been suggested that this approach could be supported by the idea that mental privacy constitutes a fundamental psychological dimension of privacy. The connection between this psychological view of privacy and identity can be traced back to Irwin Altman’s idea that privacy is an interpersonal boundary regulation process. However, it is not clear whether this notion of privacy can be associated with a conception of identity that is relevant in contemporary neuroethics. I will suggest that the narrative and relational approach to identity, a prominent view in recent ethical discussions of neurotechnology, lines up with key aspects of Altman’s proposal. I suggest that if mental privacy is an essential component of identity, the latter could be affected by technological mind-reading. (shrink)

Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

Is it wrong to distract? Is it wrong to direct others’ attention in ways they otherwise would not choose? If so, what are the grounds of this wrong – and, in expounding them, do we have to at once condemn large chunks of contemporary digital commerce (also known as the attention economy)? In what follows, I attempt to cast light on these questions. Specifically, I argue – following the pioneering work of Jasper Tran and Anuj Puri – that there is (...) a right to attention, and that its existence underlies some of our claims regarding the wrongness of distractions. However, I depart from both these authors in two respects: first, I present a new way of deriving the right to attention, grounding it in the more fundamental right to mental integrity. Second, I remain agnostic on whether the contemporary business practices of capturing attention in exchange for a variety of digital products and services are plagued by routine violations of the right. (shrink)

This chapter asks two questions about the ethics of expectations: one about the nature of expectations, and one about the wrongs of expectations. On the first question, expectations involve a rich constellation of attitudes ranging from beliefs to also include imaginings, hopes, fears, and dreams. As a result, sometimes expectations act like predictions, like your expectation of rain tomorrow, sometimes prescriptions, like the expectation that your students will do the reading, sometimes like proleptic reasons like the hope that your (...) mentee will flourish, and sometimes expectations are peremptory in that they carry the force of moral law. Turning to the second question, given the multiple roles played by expectations it shouldn’t be surprising that there are also multiple ways expectations can be wrong to hold. Sometimes they wrong as beliefs do, e.g., doxastic wronging, and sometimes they result in alienation because of who holds that expectation of us. The upshot of this chapter is that getting clear on these potential ways expectations can wrong not only delivers an ethics of expectations that mirrors familiar discussions of the ethics of belief, but an ethics of expectations further opens the door for taking seriously an ethics of mental attitudes more generally. (shrink)

Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of themselves as (...) treating an illness. Instead, they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as (...) friends and lovers. There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

This paper is devoted to defending philosophical studies of mind, especially traditional ones. In my view, human mentality is a dialogue with myself, which has a social aspect that is never explained nor predicted by scientific studies. We firstly derive this picture from Descartes’ classical argmuments (§§2-3), and then develop it in the context of Kantian ethics (§4). Some readers think this combination arbitrary. However, these two philosophers agree on mind/body dualism (§5), and further, the fact that the dialogue (...) is often made in an ethical situation leads us to Kantian ethics. We shall draw this developed picture within the format of modern practical syllogisms (§§5-13). Finally, we shall refer to Nick Zangwill’s normative essentialism for the completion of our whole picture (§§7-8). (shrink)

Is a universal meaning of life (MoL) possible? In this paper I argue for an affirmative answer: Starting out from the MoL's initial definition as "the active and successful pursuit of the ultimate end in life (UEiL)" and another initial definition of the UEiL, I first introduce four UEiL and MoL categories. In the context of their discussion, I add the elements of non-physical relation and universal scope to the definitions of UEiL and MoL (sect. 2). After those more general (...) aspects, the discussion turns to the specifics of mental evolution and evolvedness. In this respect, the concept of traditional organic or physicalistic evolution is expanded to one of 'holistic evolution,' a distinction between holistic evolutionary process, the UEiL of mental evolution and the virtue of mental evolvedness is established, and the definition of as well as the chain of arguments for this paper's universalistic 'mental evolution account' of the MoL is rounded off (sect. 3). (shrink)

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical settings, in the (...) following sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

What is the scope of our conscious mental agency, and how do we acquire self-knowledge of it? Both questions are addressed through an investigation of what best explains our inability to form judgemental thoughts in direct response to practical reasons. Contrary to what Williams and others have argued, it cannot be their subjection to a truth norm, given that our failure to adhere to such a norm need not undermine their status as judgemental. Instead, it is argued that we (...) cannot form judgements at will because we subjectively experience them as responses to epistemic reasons, and because this is incompatible with our experiential awareness of direct mental actions, such as instances of imagining. However, this latter awareness does not extend to indirect agency, which relies on epistemic or causal processes as means. Judging may therefore still count as an indirect action - just like, say, breaking a window by throwing a stone. (shrink)

I argue for a possible Buddhist theory of free will that combines Frankfurt's hierarchical analysis of meta-volitional/volitional accord with elements of the Buddhist eightfold path that prescribe that Buddhist aspirants cultivate meta-volitional wills that promote the mental freedom that culminates in enlightenment, as well as a causal/functional analysis of how Buddhist meditative methodology not only plausibly makes that possible, but in ways that may be applied to undermine Galen Strawson's impossibility argument, along with most of the other major arguments (...) for free will skepticism. (shrink)

In this paper, we defend three claims about what it will take for an AI system to be a basic moral patient to whom we can owe duties of non-maleficence not to harm her and duties of beneficence to benefit her: (1) Moral patients are mental patients; (2) Mental patients are true intentional systems; and (3) True intentional systems are systematically flexible. We suggest that we should be particularly alert to the possibility of such systematically flexible true intentional (...) systems developing in the areas of exploratory robots and artificial personal assistants. Finally, we argue that in light of our failure to respect the well-being of existing biological moral patients and worries about our limited resources, there are compelling moral reasons to treat artificial moral patiency as something to be avoided at least for now. (shrink)

Attempts to provide a thoroughly naturalized reading of the doctrine of karma have raised important issues regarding its role in the overall economy of the Buddhist soteriological project. This paper identifies some of the most problematic aspects of a naturalized interpretation of karma: (1) the strained relationship between retributive action and personal identity, and (2) the debate concerning mental causation in modern reductionist accounts of persons. The paper explores the benefits of a phenomenological approach in which reductionist accounts of (...) karma are replaced with accounts that interpret virtuous and compassionate actions as emergent properties of consciousness that can be further enhanced through socialization. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field do not allow for the representation of concepts in terms of typical traits. However, the need of representing concepts in terms of (...) typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific mental disorders. On this respect, we favor a hybrid approach to the representation of psychiatric concepts, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual spaces. (shrink)

Introduction: representationalismMost theorists of cognition endorse some version of representationalism, which I will understand as the view that the human mind is an information-using system, and that human cognitive capacities are representational capacities. Of course, notions such as ‘representation’ and ‘information-using’ are terms of art that require explication. As a first pass, representations are “mediating states of an intelligent system that carry information” (Markman and Dietrich 2001, p. 471). They have two important features: (1) they are physically realized, and so (...) have causal powers; (2) they are intentional, in other words, they have meaning or representational content. This presumes a distinction between a representational vehicle—a physical state or structure that has causal powers and is responsible for producing behavior—and its content. Consider the following characterization of a device that computes the addition functionReaders will recognize the similarity t. (shrink)

Recently, mental strength education requires to change in a way that establishes a military value system suitable for a liberal democracy while facing the need to strengthen mental strength in response to unpredictable security situations. The key to fulfilling these twofold objectives lies in the fact that there is a positive correlation between the enhancement of a soldier’s democratic awareness and intangible force. Therefore, it is of great importance to emphasize the concept of ‘citizen in uniform’ as one (...) of the central military values. However, this concept has one problem before its use in military mental strength in which the orders of the military status and the orders of the civic seem heterogeneous and even conflicting. This study aims to dissolve the internal tension of this concept through a new philosophical interpretation of citizens in uniform, freedom, people and state, thereby providing the foundation for establishing for establishing new military values and enhancement of mental force. To this end, it examines the explanation of the current curriculum regarding these concepts first and diagnoses its several problems (II). The current curriculum presents a brief explanation of the compatibility of civil rights and military obligations but does not resolve the conflict between the two. A new understanding of them is possible by introducing Hegelian insights in Philosophy of Rights (III). From Hegel's point of view, freedom is not the mere absence of coercion but a capacity for self-determination. Freedom is difficult to realize wholly at the level of an isolated individual, and it calls for an ethical community to give it a specific form. A state that is the best entity in humanity is the supreme unit that defines individual freedom and identity. Then it naturally derives that national defense is one of the supreme missions directly related to the freedom and identity of its people. A re-description of the contents of the curriculum based on these insights can conceptually resolve the aforementioned problem and even strengthen its arguments (IV). The state and the people are in a more essential correlation than previously depicted, and liberal democratic values such as freedom, human rights and welfare are proved as constitutive of a state itself. The superiority of liberal democracy, which the current textbook attempts to prove, also becomes transparent. Finally, military duties do not conceptually conflict with civil freedom but are considered as a form of it. (shrink)

The paper presents a positive argument for a version of metaphysically light ethical non-naturalism from the nature of mental states such as desires. It uses as its premise the time-honoured, and recently rediscovered, doctrine of the guise of the good, whereby it is essential to desire that the object of desire be conceived as good or as normatively favoured under some description. The argument is that if the guise of the good is a correct theory of desire, then a (...) certain version of non-naturalism is better placed than other meta-ethical views to make sense of it. First I define ethical non-naturalism and the guise of the good, providing also an initial defence of the latter. Then I briefly survey some historical precedents and proceed to the argument. For each major meta-ethical view I consider I offer reasons why combining them with the guise of the good leads to consequences that are or should be unwelcome by the guise of the good. At the end of this elimination process a form of relatively metaphysically light non-naturalism will emerge as the view that best fits with the guise of the good. (shrink)

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five (...) key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

Memory modification technologies (MMTs)—interventions within the memory affecting its functions and contents in specific ways—raise great therapeutic hopes but also great fears. Ethicists have expressed concerns that developing and using MMTs may endanger the very fabric of who we are—our personal identity. This threat has been mainly considered in relation to two interrelated concerns: truthfulness and narrative self‐constitution. In this article, we propose that although this perspective brings up important matters concerning the potential aftermaths of MMT utilization, it fails to (...) tell the whole story. We suggest that capturing more tangible potential consequences of MMT use, namely, its psychological ramifications is crucial both in ethical considerations and in making decisions regarding the permissibility of such interventions. To this end, we first examine what current MMTs are capable of and what are the prospects of emerging MMTs. Subsequently, we outline the relationship between memory and personal identity; specifically, we indicate that concepts of self‐defining memories and narrative identity are crucial to considering how MMTs may influence one's psychological functioning. On this basis, we analyze potential consequences of narrative disruption that may be the result of the use of MMTs; more precisely, we consider its potential effects on mental health, well‐being, and personal agency, and outline the ethical dilemmas that decision‐makers face in this context. We conclude by considering the broader cultural context that may have influence on policymaking regarding permissibility of memory modification interventions. (shrink)

Cases of severe and enduring Anorexia Nervosa (SEAN) rightly raise a great deal of concern around assessing capacity to refuse treatment (including artificial feeding). Commentators worry that the Court of Protection in England & Wales strays perilously close to a presumption of incapacity in such cases (Cave and Tan 2017, 16), with some especially bold (one might even say reckless) observers suggesting that the ordinary presumption in favor of capacity ought to be reversed in such cases (Ip 2019). -/- Those (...) of us who worry that such trends and proposals amount to (or at least pose a serious threat of) wrongful discrimination on the grounds of disability nevertheless feel the pull of judging many SEAN service users to be incapacitous with respect to decisions regarding (perhaps amongst other things) treatments involving feeding, artificial or otherwise. But it is difficult to get to grips with exactly what their incapacity consists in. Many such service users seem able to understand, retain, use and weigh information, and express a decision (i.e. they seem, prima facie, to satisfy the ‘MacArthur’ criteria). At the very least, they do not, generally. (shrink)

(First paragraphs.) — The notion of “mental time” refers to the experience and awareness of time, including that of past, present, and future, and that of the passing of time. This experience and awareness of time raises a number of puzzling questions. How do we experience time? What exactly do we experience when we experience time? Do we actually experience time? Or do we infer time from something in, or some aspect of our experience? And so forth. These and (...) many related questions in the “philosophy of mental time”, the topic of this special issue of the Annals of the Japan Association for Philosophy of Science, are not purely philosophical questions. Or at least, they are not likely to be satisfactorily answered by philosophers alone. Rather, they also need the input of neuroscientists, psychologists, physicists, linguists, and others. And conversely, answers to these questions may have implications outside the scope of philosophy. The papers in this special issue illustrate this inherent multi- or interdisciplinarity of the philosophy and science of mental time. In this theme introduction, we want to give a few more examples to illustrate this interdisciplinarity, but also to point out that much of the field is still wide open—that is, these illustrations raise more questions than answers. (shrink)

How can we be responsible for our attitudes if we cannot normally choose what we believe, desire, feel, and intend? This problem has received much attention during the last decades, both in epistemology and in ethics. Yet its connections to discussions about reasons and rationality have been largely overlooked. Responsibility for Rationality is the first book that connects recent debates on responsibility and on rationality in a unifying dialectic. It achieves four main goals: first, it reinterprets the problem of (...) responsibility for attitudes as a problem about the normativity of rationality; second, it breaks the stalemate between rationalist and voluntarist accounts of mental responsibility by defending a hybrid view; third, it provides novel support to recent accounts of the normativity of rationality by arguing that epistemic reasons and other ‘right-kind’ reasons are genuine normative reasons; fourth, it sets the foundations and the research agenda for an ‘ethics of mind’, including an illustration of how to approach applied issues in epistemology within the presented framework. After spelling out connections between responsibility and rationality (part I), the book engages in debates in normative epistemology (part II) and brings them to bear on the broader field of an ethics of mind (part III). -/- Full draft of current version available on request, comments welcome! (shrink)

Although Descartes’ characterization of the mind has sometimes been seen as too ‘moral’ and too ‘intellectualist’ to serve as a modern notion of consciousness, this article re-establishes the idea that Descartes’ way of doing metaphysics contributed to a novel delineation of the sphere of the mental. Earlier traditions in moral philosophy and religion certainly emphasized both a dualism of mind and body and a contrast between free intellectual activities and forcibly induced passions. Recent scholastic and neo-Stoic philosophical traditions, moreover, (...) drew attention to the disparity between the material and the immaterial, as well as to the possibility of a retreat into the personal realm of one’s own mind. Yet none of these moral and religious assessments of the relation between mind and body were motivated by the purely epistemological interest that we find in Descartes in setting apart a world of consciousness from the world of physics. The present article explains how Descartes made use of specific theological and moral philosophical theories in his own analysis of mental faculties; how he changed the orientation of metaphysics itself in the direction of a phenomenology of the mental; how he never returned to the naive idea of offering a dualist foundation for ethics; and how his mechanicism may have motivated his epistemological transformation of the science of metaphysics. In all these various ways, Descartes inaugurated an understanding of human mental life on the basis of physiological rather than metaphysical considerations, a view of psychology that is related to the experience of human individuals, and a naturalistic characterization of the mind in terms of a domain of consciousness rather than of moral conscience. (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research (...) results. Ethical issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)

This dissertation examines the idea of _ethical revaluation_ — taking things we normally see as good for our flourishing and seeing them as neutral or bad, and vice versa — in the Mahāyāna Buddhist thinker Śāntideva. It shows how Śāntideva’s thought on the matter is more coherent than it might otherwise appear, first by examining the consistency of Śāntideva’s own claims and then by applying them to contemporary ethical thought. In so doing, it makes four significant contributions. Śāntideva claims that (...) property and relationships are bad for us because they promote attachment, and that others’ wrongdoing is good for us because it allows us to generate patient endurance. Yet he also urges his readers to give property to others, and to prevent their wrongdoing. Is he caught in contradiction? The dissertation argues that he is not, because giving to others is not intended to benefit them materially, but rather to produce beneficial mental states in them, and preventing wrongdoing is intended to benefit the wrongdoer and not the victim. In both cases, Śāntideva emphasizes individual action in a way that makes social or political action more difficult to justify. The dissertation’s first contribution is to show how this interpretation of Śāntideva contrasts notably with standard presentations of Mahāyāna ethics. Its second contribution is to refute claims that Buddhists have no normative ethics. Śāntideva’s resolutions of these apparent contradictions also have relevance for contemporary ethical thought. Martha Nussbaum argues against an ethical revaluation similar to Śāntideva’s, on the grounds that such a revaluation makes it contradictory to argue for providing goods to others, preventing others’ wrongdoing or engaging in political action. Śāntideva’s views show that ethical revaluation is a more sustainable position than these criticisms of Nussbaum’s would imply; if it is to be rejected, it must be rejected on other grounds. To show this point is the dissertation’s third contribution. The fourth contribution is methodological; by finding similarities of concern and differences of opinion between Śāntideva and a contemporary thinker, it helps bridge the gap between normative and comparative religious ethics. (shrink)

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section 2, we consider (...) whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

This chapter locates our overall approach within the dialectic of contemporary philosophical debates and provides an overall framework for discussion. First, I introduce the problem of mental normativity. I show how this problem poses a prima facie threat to the common assumption in epistemology and metaethics that beliefs and other attitudes are governed by robust normative requirements. Secondly, I motivate philosophical inquiry about an ethics of mind by tracing this field back to recent debates in the ethics (...) of belief. I characterize the ethics of mind as being concerned with two main questions: 1. How can we be responsible for our attitudes? 2. What attitudes should we have? Finally, I give an overview over the structure of the book and summarize the chapters. (shrink)

A patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff (...) confronted with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community. At present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real-world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction. I start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision-making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution. A major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus. The said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves. In conclusion, the proposed framework represents the first comprehensive proposal regarding the decision-making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS. (shrink)

The tendency to draw mind-brain dichotomies and evaluate mental disorders dualistically arises in both laypeople and mental health professionals, leads to biased judgments, and contributes to mental health stigmatization. This paper offers a theory identifying an underlying source of these evaluations in social practice. According to this theory, dualistic evaluations are rooted in two mechanisms by which we represent and evaluate the beliefs of others in folk psychology and theory of mind: the doxastic conception of mental (...) disorders and doxastic voluntarism. Tracing these origins contributes to our understanding of mental state representation in cognitive science and philosophy of psychiatry, the concept of belief in philosophy of mind, and may help improve patient experience and treatment in light of social stigmatization and bias toward mental illness. (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)

According to ethical neo-expressivism, all declarative sentences, including those used to make ethical claims, have propositions as their semantic contents, and acts of making an ethical claim are properly said to express mental states, which (if motivational internalism is correct) are intimately connected to motivation. This raises two important questions: (i) The traditional reason for denying that ethical sentences express propositions is that these were thought to determine ways the world could be, so unless we provide an analysis of (...) ethical terms in terms of natural properties, are we not committed to the Moorean conclusion that ethical sentences describe sui generis “nonnatural” ways the world could be? (ii) If we reject the claim that motivational attitudes constitute any part of the semantics of ethical sentences, are we not committed to denying the intuition behind motivational internalism after all? This chapter argues for negative answers to both of these questions. (shrink)

I will argue that a person is causally responsible for believing what she does. Through inference, she can sustain and change her perspective on the world. When she draws an inference, she causes herself to keep or to change her take on things. In a literal sense, she makes up her own mind as to how things are. And, I will suggest, she can do this voluntarily. It is in part because she is causally responsible for believing what she does (...) that there are things that she ought to believe, and that what she believes can be to her credit or discredit. I won’t pursue these ethical matters here, but will focus instead on the metaphysics that underpin them. (shrink)

It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN) High Commissioner for Human Rights, article 12 of the UN Convention on the Rights of (...) Persons with Disabilities (CRPD) presents a wholesale rejection of the competence model. The High Commissioner here adopts the interpretation of article 12 proposed by the Committee on the Rights of Persons with Disabilities. On this interpretation, CRPD article 12 renders it impermissible to deny persons with mental disabilities the right to make treatment decisions on the basis of impaired decision-making capacity and demands the replacement of all regimes of substitute decision-making by supported decision-making. In this paper, we explicate six adverse consequences of CRPD article 12 for persons with mental disabilities and propose an alternative way forward. The proposed model combines the strengths of the competence model and supported decision-making. (shrink)

I offer a preliminary examination on the importance of narrative for helping to overcome the issue of stigma surrounding mental illness, specifically schizophrenia. I maintain that engaging with first-person accounts of schizophrenia allows caregivers, and the broader general public, to better understand the phenomenological lived experiences of persons living with this mental health challenge and to better understand the experience of dealing with stigma. In doing so, I maintain that both caregivers and the public can begin developing more (...) accepting views of schizophrenia and begin to support those who need it the most. (shrink)

Abstract: In this article, we explore what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this conduct in (...) a detached sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing. (shrink)