Harcourt argues that in clinical contexts, children and young people with mental health illness can experience epistemic, specifically testimonial, injustice when their perspectives are unjustifiably discounted by health service providers.1 Our goal in this commentary was to illustrate how caregivers, a critical component of CYP treatment triad, can also engage in testimonial injustice towards CYP patients. Testimonial injustice occurs when one suffers a credibility deficit and that credibility deficit is based on prejudice.2 Harcourt expands Fricker’s account of testimonial injustice by (...) arguing that for CYPs, the credibility deficits attributed to them by clinicians, for example, may result from epistemic arrogance in that CYPs are viewed as having unreliable knowledge about their condition. Harcourt writes: ‘Being a CYP is treated as a heuristic for epistemic unreliability across a wide range of domains’, including clinical settings. Harcourt’s expansion of Fricker’s account thus includes epistemic arrogance as an alternative necessary condition, in addition to prejudice, to apply the concept of testimonial injustice. We think Harcourt’s argument can also be extended to caregivers, who are central to the CYP treatment triad. We illustrate how this may be the case by drawing from research we conducted to understand the perspectives of clinicians and prospective families, both caregivers and paediatric patients with obsessive–compulsive disorder about the possibility of …. (shrink)

BackgroundDeep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies hav...

Dystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with (...) refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand. (shrink)

BackgroundPublic health guidelines have recommended that elective medical procedures, including deep brain stimulation surgery for Parkinson’s disease, should not be scheduled during the coronavirus pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded.MethodsWe administered a newly developed phone questionnaire to 20 consecutive patients (...) with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients’ experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care.ResultsMost of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic.ConclusionThe COVID-19 pandemic has considerably impacted medical care and patients’ lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

While the intellectual challenge of digital phenotyping (DP) has evolved from data collection to more complex data analysis (Onnela 2021), core ethical considerations remain centered on patient pri...

Volume 20, Issue 7, July 2020, Page 207-209.

The current study was a cross-sectional research and aimed to investigate the factor structure, internal consistency, and validities of the Persian version of the Teasing Questionnaire-Revised. Forward and backward translations of the TQ-R were performed; face and content validities were determined based on comments by a sample of psychology students and specialists. Using the cluster sampling method, 290 participants were recruited, and 201 valid data were analyzed. The factor structure was assessed by confirmatory and exploratory factor analysis. The result of (...) the confirmatory factor analysis did not confirm the proposed three, four, and five-factor models. EFA revealed four factors with 23 items, explaining 52.03% of the total variance. The internal consistency of the Persian version of Teasing Questionnaire 23 was in the excellent range, and its expected associations with external correlates supported the measure’s convergent validity. The findings indicated that the Persian version of the TQ-R has sound psychometric properties and can be used as a valid and reliable tool in research and clinical outcomes. (shrink)

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

Justice, Sustainability, and Security not only enhances our knowledge of these issues, but it teases out our moral dimensions and offer prescriptions for how governments and global actors might craft their policies to better consider their effects on the global human condition.

Social referencing informs and regulates one’s relation with the environment as a function of the perceived appraisals of social partners. Increased emphasis on relational and social contexts in the study of emotion makes this interpersonal process particularly relevant to the field. However, theoretical conceptualizations and empirical operationalizations of social referencing are disjointed across domains and populations of study. This article seeks to unite and refine the study of this construct by providing a clear and comprehensive definition of social referencing. Our (...) perspective presents social referencing and social appraisal as coterminous processes and emphasizes the importance of a relational and interpersonal approach to the study of emotion. We conclude by outlining possible lines of research on this construct. (shrink)

Climate change and justice are so closely associated that many people take it for granted that a global climate treaty should--indeed, must--directly address both issues together. But, in fact, this would be a serious mistake, one that, by dooming effective international limits on greenhouse gases, would actually make the world's poor and developing nations far worse off. This is the provocative and original argument of Climate Change Justice. Eric Posner and David Weisbach strongly favor both a climate change agreement (...) and efforts to improve economic justice. But they make a powerful case that the best--and possibly only--way to get an effective climate treaty is to exclude measures designed to redistribute wealth or address historical wrongs against underdeveloped countries. In clear language, Climate Change Justice proposes four basic principles for designing the only kind of climate treaty that will work--a forward-looking agreement that requires every country to make greenhouse--gas reductions but still makes every country better off in its own view. This kind of treaty has the best chance of actually controlling climate change and improving the welfare of people around the world. (shrink)

Attempts to explain emotion typically emphasize the interaction of evolutionary and socialization processes. However, in describing this interplay the role of the person is typically underemphasized or unaccounted for. This paper lays out empirical and theoretical rationale for considering the person as a major contributor to emotion generation and development.

The overriding question Stroud confronts in John Dewey and the Artful Life is how to render more of life’s experiences, including the ensuing benefits, as aesthetic or artful as possible. The answer to this question is challenging and complex. The claim most aesthetic theories make is that an object, activity, or experience is artful if and only if it has intrinsic value. Although what constitutes intrinsic value is widely contested, having value in and of itself is a necessary and sufficient (...) condition for an object to be art or an experience aesthetic. This value gives art and aesthetic experience their unique quality and separates them from everyday objects, activities and experiences with only instrumental... (shrink)

With The Perils of Global Legalism, Eric A. Posner explains that such views demonstrate a dangerously naive tendency toward legalism—an idealistic belief that ...

To date, emotion research has primarily focused on the experience and display of the emoter. However, of equal, if not more, importance is how such displays impact and guide the behavior of an observer. We incorporate a functionalist framework of emotion to examine the development of differential responding to discrete emotion, theorize on what may facilitate its development, and hypothesize the functions that may underlie such behavioral responses. Although our review is focused primarily on development, the theoretical and methodological ideas (...) laid out are relevant for researchers of emotion at all ages. (shrink)

Cost-benefit analysis is a widely used governmental evaluation tool, though academics remain skeptical. This volume gathers prominent contributors from law, economics, and philosophy for discussion of cost-benefit analysis, specifically its moral foundations, applications and limitations. This new scholarly debate includes not only economists, but also contributors from philosophy, cognitive psychology, legal studies, and public policy who can further illuminate the justification and moral implications of this method and specify alternative measures. These articles originally appeared in the Journal of Legal Studies. (...) Contributors: - Matthew D. Adler - Gary S. Becker - John Broome - Robert H. Frank - Robert W. Hahn - Lewis A. Kornhauser - Martha C. Nussbaum - Eric A. Posner - Richard A. Posner - Henry S. Richardson - Amartya Sen - Cass R. Sunstein - W. Kip Viscusi. (shrink)

Carroll Izard completed his dissertation in 1952, beginning a career spanning more than six decades that coincided with clinical psychology maturing as a profession, and the birth of clinical science and cognitive neuroscience. Izard’s focus on discrete emotions as evolved systems that organize information, prepare responses, and shape the development of personality and relationships persisted through his career, despite “emotions” often being overshadowed by psychodynamic, behavioral, or cognitive perspectives. His theoretical work anticipated and now integrates contemporary neuroscience and relational perspectives. (...) Exploration of discrete emotions has kept lines of inquiry open that enrich our understanding of psychopathology. Izard also embraced clinical science, combining basic research with effectiveness studies addressing the unmet need for mental health services via emotion-focused interventions. (shrink)

For over 700 years scholastic theologians of varying degrees of allegiance to the text(s) of Thomas Aquinas have discoursed on the mystery of Christ's being (esse): Did Christ have one or two acts of existence? Yet despite this frequent and recurring quaestio, nevertheless only a handful of scholastic commentators pause to note that this is not simply a debate between rival scholastic ‘schools’ in regard to a theological mystery, but that in fact there is an inconsistency within the Angelic doctor's (...) own texts. And while in more recent scholarship this discrepancy has not only been noticed but explicated in various ways, nevertheless it is the contention of this paper that a satisfactory exposition of the meaning of esse secundarium has not yet been achieved. Consequently, I propose in this paper that esse secundarium is the created, substantial, but absolutely supernatural participation of the human nature of Jesus in the uncreated communication of the divine esse of the Word and provide a robust textual defense of this interpretation. (shrink)

Armed reprisals are the limited use of military force in response to unlawful actions perpetrated against states. Historically, reprisals provided a military remedy for states that had been wronged by another state without having to resort to all-out war in order to counter or deter such wrongful actions. While reprisals are broadly believed to have been outlawed by the UN Charter, states continue to routinely undertake such self-help measures. As part of the roundtable, “The Ethics of Limited Strikes,” this essay (...) examines the doctrine of armed reprisals in light of recent instances of states using force “short of war” in this manner. We argue that the ban on reprisals has been largely ignored by states, and that recent attempts to apply the laws of armed conflict to the cyber domain are further weakening this prohibition. We conclude that this is a potentially dangerous development that lowers the bar for resorting to military force, risking escalation and thereby further destabilizing the international system. (shrink)

In 1864 - two years before the publication of The Communist Manifesto and 21 years before the publication of Das Kapital - Karl Marx published an essay titled Peuchet on Suicide. The essay was originally presented as a translation of excerpts from the memoirs of Jacques Peuchet, a leading French police administrator, economist and statistician. Plaut and Anderson reveal that Marx's Peuchet on Suicide is not a straightforward translation, but is an edited version in which Marx adds passages of his (...) own, altering the emphasis of the text from a moral and psychological focus to a profoundly social one. Thus, the essay very strongly reflects Marx's own position on this controversial subject. Sociologist Kevin Anderson provides an extensive introduction situating the essay in the context of Marx's work, especially that on gender; Plaut's essay focuses on the psychological aspects of the work, in particular contrasting Marx's thoughts on suicide with those of Freud and Durkheim. (shrink)

Human rights law does not appear to enjoy as high a level of compliance as the laws of war, yet is institutionalized to a greater degree. This Article argues that the reason for this difference is related to the strategic structure of international law. The laws of war are governed by a regime of reciprocity, which can produce selfenforcing patterns of behavior, whereas the human rights regime attempts to produce public goods and is thus subject to collective action problems. The (...) more elaborate human rights institutions are designed to overcome these problems but fall prey to second-order collective action problems. The simple laws of war institutions have been successful because they can exploit the logic of reciprocity. The Article also suggests that limits on military reprisals are in tension with self-enforcement of the laws of war. The U.S. conflict with Al Qaeda is discussed. (shrink)

This chapter contains section titled: Introduction Welfarism: Law and Economics Nonwelfarist theories Historical Explanations Topics in Contract Theory Conclusion: Whither Contract Theory? References.

What does it mean to say that a particular war is just or unjust, that terrorism is always wrong, or that torture can sometimes be morally justified? What are the moral bases for the possession or use of nuclear weapons, intervening in other nations' civil wars, or being a bystander to genocide? Such questions take us to the heart of what is morally right and wrong behaviour in our world. Global Violence: Ethical and Political Issues provides readers with the analytical (...) tools to better understand the suppositions that underlie the debates about such questions, as well as equipping them to advance their own reasoned and informed moral analyses of these topics. The book engages different normative approaches from the fields of ethics, international relations and political philosophy and uses them to examine a set of case studies on the subjects of inter-state and civil war, nuclear weapons, terrorism, torture and genocide. (shrink)

What does it mean to say that a particular war is just or unjust, that terrorism is always wrong, or that torture can sometimes be morally justified? What are the moral bases for the possession or use of nuclear weapons, intervening in other countries’ civil wars, or being a bystander to genocide? Such questions take us to the heart of what is morally right and wrong behaviour in our world. Global Violence: Ethical and Political Issues provides readers with the analytical (...) tools to better understand the suppositions that underlie the debates about such questions, as well as advances its own reasoned and informed ethical analyses of these topics. The book engages different normative approaches from the fields of ethics, political theory, and international relations and uses them to examine a set of case studies on the subjects of inter-state and civil war, nuclear weapons, terrorism, torture and genocide. (shrink)