The relation between the notions of (medical) invasiveness and (actual or potential) harm has not been systematically discussed nor theoretically grounded, despite its importance to clinical-ethical practice. This paper aims to clarify the notion of invasiveness beyond the traditional notion of invasiveness as breaking skin or inserting mechanical objects into the body. The traditional notion of invasiveness is challenged by counterexamples. Three approaches to the notion of disorder applied here are: deviation from what is common; deviation from what is considered (...) ideal; and disruption of self-organization. Assuming that more extreme measures are related to more harm, all three approaches to the notion of disorder suggest that invasiveness is proportional if not identical to harm, and show no clear relation to the traditional notion of invasiveness. In conclusion, the notion of invasiveness may best be eliminated from medical terminology, replacing it with a detailed understanding of the notion of harm. (shrink)

This study examines the ends of medical intervention and argues that mainstream contemporary medicine assumes that appropriate ends may be discovered (i.e., naturalism), rather than created or decided upon (i.e., conventionalism). The essay then applies these considerations to the problem of the demarcation of the normal from the pathological. I argue that the common formulations of this dispute commit a fallacy, as they characterize the "normal" as a state of the organism and not as an ongoing process within it. Such (...) a process may be characterized as self-creation and self-repair. Such considerations support the conclusion that normality may be regarded as a regulative idea, rather than as an end-state, and as part of the ends of medical intervention, depending upon choice and context. (shrink)

Dialogical ethics are a procedural alternative to substantive ethics such as consequentialism, deontology, principlism, casuistry, virtue ethics and care ethics. Dialogical ethics are procedural in that they do not establish goods in advance, unlike substantive ethics, but rather determine goods through a procedure enacted by the actual parties involved (although some substantive notion of justice may still be required); and they are dialogical in that the procedure is that of dialogue, involving both empathic critical discussion and negotiation. A fundamental tenet (...) of dialogical ethics may be the use of appropriate rules of order regulating dialogue among the parties involved. Some of the central characteristics of such rules of order are that they are reciprocally regulated by dialogue, that they override other ethical considerations, and that they institute empathic critical discussion and negotiation within the ethical dialogue. Dialogical bioethics are the application of dialogical ethics to ethical problems in medicine. The approach of dialogical bioethics has proven fruitful for resolving bioethical problems such as that of medical futility, where approaches of substantive ethics have reached an impasse. There is room for further study of special challenges within dialogical bioethics, such as the incompetence of some involved parties, conflicts of interests of third parties, and the cost-effectiveness of this ethical approach. (shrink)

Biological psychiatry has been dominated by a psychopharmacologically-driven neurotransmitter dysfunction paradigm. The objective of this paper is to explore a reductionist assumption underlying this paradigm, and to suggest an improvement on it. The methods used are conceptual analysis with a comparative approach, particularly using illustrations from the history of both biological psychiatry and molecular biology. The results are that complete reduction to physicochemical explanations is not fruitful, at least in the initial stages of research in the medical and life sciences, (...) and that an appropriate (non-reducible) integrative principle - addressing a property of the whole system under study - is required for each domain of research. This is illustrated in Pauling's use of a topological integrative principle for the discovery of the functioning of proteins and in Watson and Crick's use of the notion of a genetic code as an integrative principle for the discovery of the structure of genes. The neurotransmitter dysfunction paradigm addresses single molecules and their neural pathways, yet their interactions within the CNS as a whole seem most pertinent to mental disorders such as schizophrenia. The lack within biological psychiatry of an integrative principle addressing a property of the CNS as a whole may be responsible for the empirical failure of orthomolecular psychiatry, as well as for the central role that serendipity has played in the study of mental disorders, which is dominated by the neurotransmitter paradigm. The conclusion is that research in biological psychiatry may benefit from using, at least initially, some integrative principle(s) addressing a property of the CNS as a whole, such as connectionism or a hierarchical notion. (shrink)

A meta-ethical analysis demonstrates that care ethics is a grounded in a distinct mode of moral reasoning. This is comprised primarily of the rejection of principles such as impartiality, and the endorsement of emotional or moral virtues such as compassion, as well as the notion that the preservation of relations may override the interests of the individuals involved in them. The main conclusion of such a meta-ethical analysis is that such meta-ethical foundations of care ethics are not sound. Reasonable alternatives (...) for care ethics may be its formulation as an additional principle within an established principlist framework, or the move to a dialogical ethics, where the good to be acted upon is not decided in advance but rather critically discussed and established within the encounter of the parties involved. (shrink)

Informed consent to breaking (or waiving) bad news is an important yet neglected topic. It is distinct from informed consent to diagnosis and to treatment, and may be logically and ethically sound, provided patients are competent and that no considerable harm may be caused to others by breaking or waiving bad news to patients. This requires a differential assessment procedure in order to balance patient autonomy, benefit and justice towards others, preferably exploring patients’ values, expectations and needs with them, so (...) that an acceptable decision can be made on whether to act on their consent to breaking or waiving bad news, or to ignore it and act on informed consent by proxy. Future study should attempt to provide a detailed characterization of procedures for attaining informed consent to breaking or waiving bad news, and to test their success in establishing ethically sound health care. (shrink)

It is only in the past 20 years that the concept of 'recovery' from mental health has been more widely considered and researched. This book is unique in addressing philosophical issues - including conceptual challenges and opportunities - raised by the notion of recovery of people with mental illness.

Human rights protect the conditions of a minimally decent life of which mental health is an indispensable element. Adequate care for mental health is thus recognized as part of the human right to health. However, for populations living far from urban centers, adequate in-person (mental) health care is often extremely costly and thus not provided. Digital mental health care options have become an effective alternative to in-person treatment. Benefitting from these new digital opportunities, though, requires sufficient access to the internet. (...) Because everyone has a human right to adequate health care, and digital mental health care is now an effective option for progressively realizing this human right for people who live in remote regions, these people also have to be understood to have a right to access to the internet. This right to internet access creates duties for public authorities and the international community to create the required digital infrastructure and (where needed) to cover the costs of internet access where this is the only feasible way of delivering, or progressively realizing, the mental health care that is indispensable for having the opportunity to lead minimally decent lives. (shrink)

Bioethics uses various theories, methods and institutions for its decision-making. Lately, a dialogical, i.e., dialogue-based, approach has been argued for in bioethics. The aim of this paper is to explore some of the decision-making processes that may be involved in this dialogical approach, as well as related pitfalls that may have to be addressed in order for this approach to be helpful, particularly in clinical ethics. Using informal logic, an analysis is presented of the notion of dialogue and of the (...) stages of dialogical decision-making, and then processes and related pitfalls associated with these stages in the context of clinical ethics are examined. The results of this exploration are expected to facilitate the implementation and empirical testing of dialogical bioethics. (shrink)

This article aims to clarify the notion of a psychiatric disability. The article uses conceptual analysis, examining and applying established definitions of (general) disability to psychiatric disabilities. This analysis reveals that disability as inability to perform according to expectations or norms is related to impairment as deviation from the (statistical) norm, while disability as inability to achieve (personal) goals is related to impairment as deviation from the (personal) ideal. These two views of impairment and disability are distinct from the self-organization (...) view of impairment as disrupted self-creation or disrupted self-repair and of disability as disrupted whole person self-compensation (in relation to an impairment). All these three views of disability pertain to psychiatric disability. Although there is nothing necessarily psychiatric about psychiatric disability other than the psychiatric impairment related to it, the life course and life circumstances typical of many people with (severe) psychiatric disorders may lead to disability and may thus confer some (psychiatric) specificity on this disability. This analysis may facilitate research on specific psychiatric disabilities and a broader scope for psychiatric rehabilitation. (shrink)

BackgroundEthics consultations are established in contemporary health care. Informal ethics consultations often occur and are possibly beneficial, yet they have not been empirically studied. We sought to describe features of informal ethics consultations and to identify facilitators and disruptors of patient participation in such ethics consultations.MethodsWe used a mixed methods (quantitative and qualitative) evaluation design and conveniently sampled 64 sequential informal ethics consultations over a period of 3 years in two academic health care centers in one city in Canada. Data (...) were collected by the two participating ethicists. We used statistical description for the quantitative data and thematic analysis for the qualitative data.ResultsPatients participated in only two (3%) of the informal ethics consultations. Factors that disrupted patient participation in ethics consultations were related to patients’ issues (mental impairments), family issues (family withholding information from the patient), and team members’ issues (efficiency considerations).ConclusionInformal ethics consultations may be used for ethics capacity building of health care providers rather than for engagement with addressed patients. Further research on informal ethics consultations is required, including in different sites. (shrink)

abstract Ethicists such as Peter Singer argue that consciousness and self‐consciousness are the principal considerations in discussing the use of animals by humans, such as in medical experiments. This paper raises an additional consideration to factor into this ethical discussion. Ethics deal with the intentional impact of subjects on each other. This assumes a meta‐representational ability of subjects to represent states of mind of others, which may be termed other‐consciousness. The moral weight of other‐consciousness is manifest in the notion of (...) responsibility, where humans lacking in other‐consciousness (such as individuals with autism) may not be held responsible for their harmful actions towards others. As responsibility implies not only duties but also rights and more generally high moral status, it follows that other‐consciousness grants high moral status, other things being equal — recognizing that other factors grant moral status too. Other‐consciousness also increases the capacity for suffering, both due to increased freedom (and consequently increased possibility of restriction of freedom) and to increased empathy (with suffering of others). Hence, the more an animal is other‐conscious, the more it deserves high moral status and the more it can suffer, other things being equal, and consequently, the less it should be used for human purposes. Further study is required to elucidate to what extent animals used by humans, such as in medical experiments, particularly primates and other highly evolved mammals, are other‐conscious. (shrink)

Deviant forms of human thought may provide insight into epistemic standards, such as rationality. A comparative analysis of paranoia and reinforced dogmatism suggests that reinforced dogmatism, such as pseudo-science a-la-Popper, demonstrates a primary epistemic lack of critical rationality, that is, of testability, whereas paranoia demonstrates a lack of range of alternative statements leading secondarily to a lack of testability. This reflects the importance to both epistemology and psychiatry of epistemic standards in addition to testability, such as relevance to problems, and (...) emphasizes the distinction of the context of introduction from the contexts of discovery and of justification. Key Words: context of introduction • paranoia • reinforced dogmatism • relevance • testability. (shrink)

Contemporary biological psychiatry is in a seemingly inchoate state. I assert that this state of biological psychiatry is due to its violation of an epistemological criterion of rationality, i.e., the relevance criterion; that is, contemporary biological psychiatry is irrational as it adopts a conception irrelevant to the psychobiological domain. This conception is mechanistic. The irrationality of biological psychiatry is manifest as the dominance of neurochemical explanations of psychopharmacological correlations, resulting in predictive sterility and, correspondingly, in the dominance of serendipity. I (...) suggest a rationalization of biological psychiatry through a conception relevant to the psychobiological domain. This conception is hierarchical. Keywords: criterion of relevance, epistemology, hierarchical conception, mechanistic conception, rationality CiteULike Connotea Del.icio.us What's this? (shrink)

Medical assistance in dying (MAiD) is scheduled to be legalized in Canada as of March 2024 for individuals with mental disorder/illness as their sole underlying medical condition (MAiD MD-SUMC). As guidelines are being developed for the safe and consistent provision of MAiD MD-SUMC, sufficient consideration must be given to the interpretation of ambiguous terminology in current legislation, and to ensuring sound use of acceptable ethics principles in these interpretations.

Jakovljevic and Crnčevic review the concept of comorbidity in relation to mental disorders, which is timely. Yet they seem to ignore a longstanding and important notion of comorbidity, highlighted in psychiatry particularly by Sigmund Freud. The ignored notion is that of compensatory comorbidity. Compensatory comorbidity is a special case of compensatory phenomena in relation to disrupted health.

Practical and evidence-based, this unique book is the first comprehensive text focused on person-centered approaches to people with serious mental illness such as schizophrenia and bipolar disorder. It reflects a range of views and findings regarding assessment, treatment, rehabilitation, self-help, policy-making, education and research. It is highly recommended for all healthcare professionals, students, researchers and educators involved in general practice, psychiatry, nursing, social work, clinical psychology and therapy. Healthcare service providers, and policy makers and shapers, will find the book's wide-ranging, (...) multi-professional approach enlightening. 'Serious Mental Illness reflects a continued distancing from the outmoded and unsubstantiated belief that people with severe mental illnesses could not recover, and that they would respond positively only to goals and treatment plans chosen, designed and implemented by providers in order to prevent their further deterioration. Anyone with an interest in the concept of person-centered approaches will discover new ideas in this book. Indeed, anyone with an interest in person-centered approaches has to read this book. Not only is it the first such book on person-centered approaches, but it will serve as the gold standard in this topic area for years to come.' William A Anthony, in the Foreword. (shrink)

Philosophical discussion of the general methodology of qualitative research, such as that used in some health research, has been inductivist or relativist to date, ignoring critical rationalism as a philosophical approach with which to discuss the general methodology of qualitative research. This paper presents a discussion of the general methodology of qualitative research from a critical rationalist perspective (inspired by Popper), using as an example mental health research. The widespread endorsement of induction in qualitative research is positivist and is suspect, (...) if not false, particularly in relation to the context of justification (or rather theory testing) as compared to the context of discovery (or rather theory generation). Relativism is riddled with philosophical weaknesses and hence it is suspect if not false too. Theory testing is compatible with qualitative research, contrary to much writing about and in qualitative research, as theory testing involves learning from trial and error, which is part of qualitative research, and which may be the form of learning most conducive to generalization. Generalization involves comparison, which is a fundamental methodological requirement of any type of research (qualitative or other); hence the traditional grounding of quantitative and experimental research in generalization. Comparison—rather than generalization—is necessary for, and hence compatible with, qualitative research; hence, the common opposition to generalization in qualitative research is misdirected, disregarding whether this opposition’s claims are true or false. In conclusion, qualitative research, similar to quantitative and experimental research, assumes comparison as a general methodological requirement, which is necessary for health research. (shrink)

The essays by Scott DeVito and Abraham Rudnick are on largely the same topics - the meanings of health(y), normal, disease, pathological, diagnosis , etc., and they contain compatible conclusions - that medical precepts are value-laden and less objective than some na?ve model of scientific objectivity would suggest. This commentary opens with a brief critique of each and ends with a more in-depth account, one complaint being how lacking in weight the analyses are. In the middle portion of (...) this commentary, I consider the sorts of values that are present in some case studies - values that give the project much more weight . These include the values, scientific and self-serving, that professionalism provides. I show how medicine and its disease-related concepts can be thought to evolve in many ways. (shrink)

An innovative literary analysis of Freud's "Wolf Man.".

It is questionable whether counterfeiting in many areas of life contributes to unethical behavior to a wider extent. If the notion is supported by data, then the moral damage in a society could be prevented by reducing the counterfeit self and behavior to a bare minimum. This study aimed at empirically testing the measurement model of counterfeit self of Wood et al. (2008) among Indonesians as well as theoretically reviewing counterfeit self roles in unethical behavior. The participants of this study (...) were 1,655 high school students (764 males, 891 females; Mage = 15.76 years old; SDage = 1.08 years) recruited through a purposive sampling technique in North Sumatera and West Kalimantan, Indonesia. The data analysis technique used was Confirmatory Factor Analysis. The results showed that the counterfeit self model--comprised of counterfeit self dimensions, namely Self-alienation (ALIEN), Inauthentic Living (LIVE), and Accepting External Influence (EXT)--was supported by the empirical data. However, the dimension of EXT could not be represented by its indicators. The study contributed to the psychological body of knowledge that the EXT dimension might need to be excluded from the measurement of counterfeit self on teenagers, especially in Indonesia and other Eastern countries. (shrink)

Marriage is one of the most important topics in the education field since life in this world is structured by interaction among families and between families and other social institutions. Dissatisfaction and unsustainability of marriage have led the urgency of premarital education in various countries. The problem is that the spread of virtual reality has made marriage itself to become more complex and experience reinterpretation and reconfiguration, moreover with the emergence of new kind of marriage in the digital era, i.e. (...) virtual marriage. Everybody who has observed, known, or even tried, certainly asks the question, “Could (or: should) I accept virtual marriage?” . This study was aimed to investigate the role of tolerance of ambiguity and illusion of intimacy in online dating in predicting the acceptance of virtual marriage. There were 420 adolescents and young adults (212 males, 208 females; Mage=21.10 years old, SDage=1.459 years; 338 students, 82 employees or entrepreneurs) in the Greater Jakarta, Indonesia, participated in this study. It was found that the acceptance was not predicted by the ambiguity tolerance, but by the illusion of intimacy in online dating. The psychometric issues, substantive discussion, and recommendation are presented at the end of this article. The trend of virtual marriage should not be allowed to roll away, by autopilot, without loaded by strategies in designing an online game as one of the pivotal educational technologies that needs to shape appropriate character and attitude for it. (shrink)

This book examines reason and unreason in the legal and political responses to terrorism. Terrorism is often perceived as sheer madness, unreasonable use of extreme violence and senseless, futile political action. These assertions are challenged by this book. Combining ‘traditional’ thought on reason and unreason in terrorism with empirical explorations of post-modern terrorism and its use of communication platforms the work uses interdisciplinary and cross disciplinary dimensions to provide a multidimensional picture of critical issues in current politics and a deeper (...) examination of their implications than previously available. The book looks at various aspects of modern politics, from terrorism to protest, from decision-making to political discourse, applying the perspective of philosophical thought. To do so, political issues and actions are examined by using concepts such as reason, emotions, madness, magic, morality, absolutism, extremism, psychopathology, rationality and others. The analysis is rooted in theories and concepts derived from history, philosophy, religion, art, sociology, psychology, and political science. This book, which was mostly written by the late Abraham Kaplan, an American philosopher, and edited and updated by Gabriel Weimann, will be of much interest to students of political violence/terrorism, philosophy, war and conflict studies and political science in general. (shrink)

In the early twentieth century Walter Benjamin introduced the idea of epochal and ongoing progression in interaction between mind and the built environment. Since early antiquity, the present study suggests, Benjamin’s notion has been manifest in metaphors of gender in city-form, whereby edifices and urban voids have represented masculinity and femininity, respectively. At the onset of interaction between mind and the built environment are prehistoric myths related to the human body and to the sky. During antiquity gender projection can be (...) detected in western perceptions linking natural and built environments, commencing with Plato’s Atlantis and his Myth of Er, and later as a likely import of the Chinese yin-yang mythology. Culminating with the Age of Discovery, alongside advances in experiential awareness of the Earth’s sphericity, respective feminine and masculine earmarks can be detected in early modern perspicacity of the Earth’s southern and northern hemispheres. Our conceptions of natural and built environments inherently continue to contain gender traits. Yet urban voids, as the feminine face of city-form, have been severely understated in the built environment. Through design and configuration of urban voids, allegories of femininity in city-form ought to be celebrated, not discarded. (shrink)

This present study aims at exploring the meaning of the building of Santa Maria de Fatima Catholic Church (abbreviated as: SMFCC) or Toasebio Parish located in District Glodok, Jakarta, Indonesia. The author exposes in advance the meaning of the physical elements of the building SMFCC as understood by history writers and building experts. These meanings are not inseparable from the elements of human activities in the building. Through qualitative methods and literature review, the author describes in the Results section, how (...) those meanings can be further interpreted through the existing studies and expressions of the SMFCC Parish Head. It is found that these meanings are contested − from the direction of religious faith and of culture − but complete our understandings of the church which is well-known as an Indonesian cultural heritage and dominated by Chinese and pastors from Europe. (shrink)

Anton Wilhelm Rudolph Amo (1703–c. 1759 ce), philosopher and physician, was born at Axim, Ghana, and died at Fort Chama, Ghana. When he was four years old, the Dutch West Indies Company's preacher in Ghana sent him to Holland to be baptized and educated in the Bible for future service in Ghana. However, the Company headquarters, undesirous of any interference with its lucrative trade in slaves, turned little Amo over to the German Duke Anton Ulric‐Wolfenbuttel.