The use of placebo in clinical practice has been the topic of extensive debate in the bioethics literature, with much scholarship focusing on concerns regarding deception. While considerations of placebo without deception have largely centred on open-label placebo, this paper considers a different kind of ethical quandary regarding placebo without an intent to deceive—one where the provider believes a treatment is effective due to a direct physiological mechanism, even though that belief may not be supported by rigorous scientific evidence. This (...) is often the case with complementary and alternative medicine (CAM) techniques and also with some mainstream therapies that have not proven to be better than sham. Using one such CAM technique as a case study—electroencephalography (EEG) neurofeedback for attention-deficit/hyperactivity disorder (ADHD)—this paper explores the ethics of providing therapies that may have some beneficial effect, although one that is likely due to placebo effect. First, we provide background on EEG neurofeedback for ADHD and its evidence base, showing how it has proven to be equivalent to—but not better than—sham neurofeedback. Subsequently, we explore whether offering therapies that are claimed to work via specific physical pathways, but may actually work due to the placebo effect, constitute deception. We suggest that this practice may constitute unintentional deception regarding mechanism of action. Ultimately, we argue that providers have increased information provision obligations when offering treatments that diverge from standard of care and we make recommendations for mitigating unintentional deception. (shrink)

Direct-to-consumer (DTC) genetic tests (GT) enable consumers to access a wide range of GT, without involving a healthcare professional, promoting an increasing disassociation of genetics from the clinical context. This study explores, through semi-structured interviews, the experiences and attitudes of European clinical geneticists towards DTCGT. Our results indicate that the participants have limited experience of consultations with patients regarding such tests. The majority of participants stated that consumers purchased tests out of curiosity and sought a general interpretation of test results (...) by a healthcare professional. Most respondents were skeptical of the quality of tests, especially regarding their clinical utility. The participants supported the importance of medical supervision and genetic counseling in this context. Finally, most respondents considered it their duty to accept consultations concerning DTCGT results. However, due to concerns over limited time and potential downstream costs, some participants supported that a prioritization system based on guidelines would be necessary. (shrink)

Electroencephalography (EEG) neurofeedback is a type of biofeedback that purportedly teaches users how to control their brainwaves. Although neurofeedback is currently offered by thousands of providers worldwide, its provision is contested, as its effectiveness beyond a placebo effect is unproven. While scholars have voiced numerous ethical concerns about neurofeedback—regarding opportunity cost, physical and psychological harms, financial cost, and informed consent—to date these concerns have remained theoretical. This pilot study aimed to provide insights on whether these issues were supported by empirical (...) data from the experiences of neurofeedback users. Semi-structured telephone interviews were conducted with individuals who had used EEG neurofeedback for themselves and/or for a child. The majority of respondents (N = 36) were female (75%), white (92%), and of higher socioeconomic status relative to the U.S. population. Among adult users (n = 33), most (78.8%) resorted to neurofeedback after having tried other therapies, and were satisfied with the treatment (81.8%). The majority paid for neurofeedback out-of-pocket (72.7%) and considered it to be good value for money (84.8%). More than half (57.6%) considered neurofeedback to be a scientifically well-established therapy. However, of those, 78.9% were using neurofeedback for indications not adequately supported by scientific evidence. Concerns regarding opportunity cost, physical and psychological harms, and financial cost are not substantiated by our findings. Our results partially support concerns regarding insufficient understanding of limitations. This study underlines the disconnect between some of the theoretical concerns raised by scholars regarding the use of non-validated therapies and the lived experiences of users. (shrink)

Neurotherapies for diagnostics and treatment—such as electroencephalography (EEG) neurofeedback, single-photon emission computerized tomography (SPECT) imaging for neuropsychiatric evaluation, and off-label/experimental uses of brain stimulation—are continuously being offered to the public outside mainstream healthcare settings. Because these neurotherapies share many key features of complementary and alternative medicine (CAM) techniques—and meet the definition of CAM as set out in Kaptchuk and Eisenberg—here we refer to them as “alternative neurotherapies.” By explicitly linking these alternative neurotherapy practices under a common conceptual framework, this paper (...) draws attention to, and critically considers, the cross-cutting ethical and legal issues related to the provision of these services. The first section of this paper provides an updated empirical overview of uses of SPECT neuropsychiatric evaluations, EEG neurofeedback, and experimental/off-label forms of brain stimulation. Next, drawing on CAM bioethics scholarship, we highlight the pertinent ethical issues in the alternative neurotherapy context, including the truthful representation of evidence base, marketing to vulnerable populations, potential harms, provider competency, and conflicts of interest. Finally, we consider the principal legal issues at stake for the provision of alternative neurotherapies in the U.S., namely those related to licensing and scope-of-practice considerations. We conclude with recommendations for future research in this domain. (shrink)

In this paper I examine which is the most appropriate moral theory for dealing with disaster bioethics contexts. It is pointed out that, contrary to what is usually believed, moral theories of right action cannot actually guide us in such difficult situations. Instead, it is claimed that a virtue ethics theory of an Aristotelian version, which gives emphasis not only on the virtuous person but also on the relevant developmental process of becoming virtuous, can provide us with the right theoretical (...) framework for coping with the problems which the victims of such disastrous situations face. (shrink)

Presenting the first critical analysis of Carl Schmitt's _The Nomos of the Earth_ and how it relates to the epochal changes in the international system that have risen from the collapse of the ‘Westphalian’ international order. There is an emerging recognition in political theory circles that core issues, such as order, social justice, rights, need to be studied in their global context. Schmitt’s international political thought provides a stepping stone in these related paths, offering an alternative history of international relations, (...) of the genesis, achievements and demise of the ‘Westphalian system.’ Writing at a time when he believed that the spatial, political and legal order—the nomos of the earth—had collapsed, he highlighted the advent of the modern state as the vehicle of secularization, tracing how this interstate order was able to limit and ‘rationalize and humanize’ war. Providing a large number of case studies including: global terrorism, humanitarian intervention and US hegemony, this book will give further impetus to, and expand, the nascent debate on the significance of Schmitt’s legal and political thought for international politics. _The International Political Thought of Carl Schmitt_ will be of interest to students and scholars of international relations, law and history. (shrink)

In response to varied processes of globalization, the cosmopolitan perspective has rightly insisted that discussion of global ethics ought to be taken seriously. This article agrees with cosmopolitan theorists in calling for the implementation of a perspective that can address the other outside of narrow communal determinations. Yet it also advances a critique of their reliance on legalist instruments such as human rights, contending that the bestowal of human rights does not necessarily or directly lead to an ethics of inclusiveness. (...) While the attribution of universal humanity to all may appear as an appropriate means of extending ethical regardedness to all others, this does not immediately follow from such a legalist gesture. Any attempts to articulate a truly global ethics must begin by questioning the distinct communal sensibilities which, by the very fact of their distinctiveness, always already contain within them a ‘xenophobic’ element that cannot be transcended solely by the bestowal of human rights or other such instruments. This article, therefore, discusses a different kind of ‘cosmopolitan’ disposition, one which is based on the recovery of an ethical selfhood that understands itself as an opening to otherness. For this task, it explores the phenomenological analyses of German philosopher Martin Heidegger and specifically his examination of how communication can be cultivated through hearing and silence. (shrink)

In response to varied processes of globalization, the cosmopolitan perspective has rightly insisted that discussion of global ethics ought to be taken seriously. This article agrees with cosmopolitan theorists in calling for the implementation of a perspective that can address the other outside of narrow communal determinations. Yet it also advances a critique of their reliance on legalist instruments such as human rights, contending that the bestowal of human rights does not necessarily or directly lead to an ethics of inclusiveness. (...) While the attribution of universal humanity to all may appear as an appropriate means of extending ethical regardedness to all others, this does not immediately follow from such a legalist gesture. Any attempts to articulate a truly global ethics must begin by questioning the distinct communal sensibilities which, by the very fact of their distinctiveness, always already contain within them a ‘xenophobic’ element that cannot be transcended solely by the bestowal of human rights or other such instruments. This article, therefore, discusses a different kind of ‘cosmopolitan’ disposition, one which is based on the recovery of an ethical selfhood that understands itself as an opening to otherness. For this task, it explores the phenomenological analyses of German philosopher Martin Heidegger and specifically his examination of how communication can be cultivated through hearing and silence. (shrink)

Offering the first full assessment of Heidegger’s philosophy in the fields of International Studies and International Political Theory, this important volume provides a fresh intervention into the debate on globalization from a critical theory perspective.

Introduction The present volume contains the proceedings of the First International Conference on Medical Ethics which took place in Nicosia, from the 24th ...

Nagappan, Kalokairinou, and Wexler (2021) raised a serious ethical question: Are off-label practices or direct-to-consumer medical devices offered to public exempted from clinical or research gover...