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  1. Passion and Decision-Making Capacity in Anorexia Nervosa.Louis Christian Charland - 2015 - American Journal of Bioethics Neuroscience 6 (4):66-68.
    The question of decision-making capacity for informed consent to experimental brain surgery for severely ill anorectic patients is about as dramatic an ethical issue one can imagine. Sabine Müller and her co-authors (2015) should be commended for this extremely timely and original clinical and ethical discussion of decision-making capacity in relation to the issues raised by informed consent to such therapies. It is not only the therapies themselves that are innovative in this discussion, but also the overall theoretical approach taken (...)
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  • Unlocking the Voices of Patients with Severe Brain Injury.Andrew Peterson, Kevin Mintz & Adrian M. Owen - 2022 - Neuroethics 15 (1):1-15.
    This paper critically examines whether patients with severe brain injury, who can only communicate through assistive neuroimaging technologies, may permissibly participate in medical decisions. We examine this issue in the context of a unique case study from the Brain and Mind Institute at the University of Western Ontario. First, we describe how the standard approach to medical decision making might problematically exclude patients with communication impairments secondary to severe brain injury. Second, we present a modified approach to medical decision making. (...)
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  • A Non-Ideal Authenticity-Based Conceptualization of Personal Autonomy.Jesper Ahlin Marceta - 2019 - Medicine, Health Care and Philosophy 22 (3):387-395.
    Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from Beauchamp and Childress’s theory, (...)
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  • Do We Need a Threshold Conception of Competence?Govert den Hartogh - 2016 - Medicine, Health Care and Philosophy 19 (1):71-83.
    On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her. In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not to respect (...)
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  • Decision Making Capacity Should Not Be Decisive in Emergencies.Dieneke Hubbeling - 2014 - Medicine, Health Care and Philosophy 17 (2):229-238.
    Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients (...)
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  • Authenticity and Psychiatric Disorder: Does Autonomy of Personal Preferences Matter? [REVIEW]Manne Sjöstrand & Niklas Juth - 2014 - Medicine, Health Care and Philosophy 17 (1):115-122.
    In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients’ decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients’ with anorexia nervosa where issues related (...)
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  • Interdisciplinary Workshop on “Mental Disorder and Self Over Time”.Natalie Gold, Jillian Craigie & Tania Gergel - 2017 - Journal of Evaluation in Clinical Practice 23 (5):999-1005.
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  • Decision-Making Capacity.Louis Charland - 2011 - Stanford Encyclopedia of Philosophy.
    In many Western jurisdictions, the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own health care decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This last question has to do with what is commonly called “decisional capacity,” a central concept in health care law (...)
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  • Decision-Making Capacity.Jennifer Hawkins & Louis C. Charland - 2020 - Stanford Encyclopedia of Philosophy.
    Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to do with what (...)
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  • Acceptability of Using a Nasogastric Refeeding Protocol with Adult Patients with Medically Unstable Eating Disorders.Kylie Matthews-Rensch, Adrienne Young, Clare Cutmore, Amanda Davis, Shane Jeffrey & Susan Patterson - forthcoming - Journal of Evaluation in Clinical Practice.
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  • Sense of Agency During and Following Recovery From Anorexia Nervosa.Manja M. Engel, Vivien Ainley, Manos Tsakiris, H. Chris Dijkerman & Anouk Keizer - 2022 - Consciousness and Cognition 103:103369.
  • The Rationality of Eating Disorders.Stephen Gadsby - forthcoming - Mind and Language.
    Sufferers of eating disorders often hold false beliefs about their own body size. Such beliefs appear to violate norms of epistemic rationality, being neither grounded by nor responsive to appropriate forms of evidence. Contrary to appearances, I defend the rationality of these beliefs. I argue that they are in fact grounded in and reinforced by appropriate evidence, emanating from proprioceptive misperception of bodily boundaries. This argument has far-reaching implications for the explanation and treatment of eating disorders, as well as debates (...)
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  • The Need for Authenticity-Based Autonomy in Medical Ethics.Lucie White - 2018 - HEC Forum 30 (3):191-209.
    The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of “authenticity”, the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of medical (...)
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  • Unreasonable Reasons: Normative Judgements in the Assessment of Mental Capacity.Natalie F. Banner - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1038-1044.
  • Risk-Related Standards of Competence Are a Nonsense.Neil John Pickering, Giles Newton-Howes & Simon Walker - forthcoming - Journal of Medical Ethics:medethics-2021-108107.
    If a person is competent to consent to a treatment, is that person necessarily competent to refuse the very same treatment? Risk relativists answer no to this question. If the refusal of a treatment is risky, we may demand a higher level of decision-making capacity to choose this option. The position is known as asymmetry. Risk relativity rests on the possibility of setting variable levels of competence by reference to variable levels of risk. In an excellent 2016 article in Journal (...)
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  • The Values and Rules of Capacity Assessments.Binesh Hass - forthcoming - Journal of Medical Ethics:medethics-2021-107923.
    This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries—the four abilities model—which is often incorrectly advertised as being (...)
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  • Competence in Health Care: An Abilities-Based Versus a Pathology-Based Approach.Gerben Meynen & Guy Widdershoven - 2012 - Clinical Ethics 7 (1):39-44.
    Competence is central to informed consent and, therefore, to medical practice. In this context, competence is regarded as synonymous with decision-making capacity. There is wide consensus that competence should be approached conceptually by identifying the abilities needed for decision-making capacity. Incompetence, then, is understood as a condition in which certain abilities relevant to decision-making capacity are lacking. This approach has been helpful both in theory and practice. There is, however, another approach to incompetence, namely to relate it to mental disorder. (...)
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  • The Ethics of Deep Brain Stimulation for the Treatment of Anorexia Nervosa.Hannah Maslen, Jonathan Pugh & Julian Savulescu - 2015 - Neuroethics 8 (3):215-230.
    There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation could be used to treat some patients with Anorexia Nervosa. Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the neuroscientific (...)
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  • Depression, Possibilities, and Competence: A Phenomenological Perspective. [REVIEW]Gerben Meynen - 2011 - Theoretical Medicine and Bioethics 32 (3):181-193.
    Competent decision-making is required for informed consent. In this paper, I aim, from a phenomenological perspective, to identify the specific facets of competent decision-making that may form a challenge to depressed patients. On a phenomenological account, mood and emotions are crucial to the way in which human beings encounter the world. More precisely, mood is intimately related to the options and future possibilities we perceive in the world around us. I examine how possibilities should be understood in this context, and (...)
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  • Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments.Helena Hermann, Manuel Trachsel, Bernice S. Elger & Nikola Biller-Andorno - 2016 - Frontiers in Psychology 7.
    ver since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, (...)
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  • More Than Just Filler: An Empirically Informed Ethical Analysis of Non-Surgical Cosmetic Procedures in Body Dysmorphic Disorder.Natalie M. Lane - 2021 - Journal of Medical Ethics 47 (12):30-30.
    Objectives To identify and analyse ethical considerations raised when individuals with body dysmorphic disorder consult for non-surgical cosmetic procedures. Methods Ethical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals. Findings Non-surgical cosmetic interventions were viewed not to be in the best interests of individuals with BDD, as they fail to address (...)
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  • Brainjacking in Deep Brain Stimulation and Autonomy.Jonathan Pugh, Laurie Pycroft, Anders Sandberg, Tipu Aziz & Julian Savulescu - 2018 - Ethics and Information Technology 20 (3):219-232.
    'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators that play a central role in Deep Brain Stimulation systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim that the possibility (...)
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  • ‘Encounters with Experience’: Empirical Bioethics and the Future. [REVIEW]Jonathan Ives - 2008 - Health Care Analysis 16 (1):1-6.
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  • Should Neuroscience Inform Judgements of Decision-Making Capacity?Andrew Peterson - 2019 - Neuroethics 12 (2):133-151.
    In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there is strong reason to (...)
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  • What Justifies Judgments of Inauthenticity?Jesper Ahlin - 2018 - HEC Forum 30 (4):361-377.
    The notion of authenticity, i.e., being “genuine,” “real,” or “true to oneself,” is sometimes held as critical to a person’s autonomy, so that inauthenticity prevents the person from making autonomous decisions or leading an autonomous life. It has been pointed out that authenticity is difficult to observe in others. Therefore, judgments of inauthenticity have been found inadequate to underpin paternalistic interventions, among other things. This article delineates what justifies judgments of inauthenticity. It is argued that for persons who wish to (...)
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  • Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry.A. M. Ruissen, T. A. Abma, A. J. L. M. Van Balkom, G. Meynen & G. A. M. Widdershoven - 2016 - Health Care Analysis 24 (1):71-85.
    Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...)
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  • Getting From the Ethical to the Empirical and Back Again: The Danger of Getting It Wrong, and the Possibilities for Getting It Right: 2008 Bioethics Special Edition: Editorial 2. [REVIEW]Anna Smajdor, Jonathan Ives, Emma Baldock & Adele Langlois - 2008 - Health Care Analysis 16 (1):7-16.
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  • Response to Crisp and Sullivan-Bissett.Guy A. M. Widdershoven, Andrea Ruissen, Anton J. L. M. van Balkom & Gerben Meynen - 2017 - Journal of Medical Ethics 43 (6):382-383.
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  • Competence in Chronic Mental Illness: The Relevance of Practical Wisdom.Guy A. M. Widdershoven, Andrea Ruissen, Anton J. L. M. van Balkom & Gerben Meynen - 2017 - Journal of Medical Ethics 43 (6):374-378.
  • Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?Margaret Battin & Brent M. Kious - 2019 - American Journal of Bioethics 19 (10):29-39.
    Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their (...)
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  • Euthanasia and Assisted Suicide for People with an Intellectual Disability and/or Autism Spectrum Disorder: An Examination of Nine Relevant Euthanasia Cases in the Netherlands.Irene Tuffrey-Wijne, Leopold Curfs, Ilora Finlay & Sheila Hollins - 2018 - BMC Medical Ethics 19 (1):17.
    Euthanasia and assisted suicide have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: voluntary and well-considered request; unbearable suffering without prospect of improvement; informing the patient; lack of a reasonable alternative; independent second physician’s opinion. ‘Unbearable suffering’ must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees. The purpose of this (...)
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  • Conceptions of Decision-Making Capacity in Psychiatry: Interviews with Swedish Psychiatrists.Manne Sjöstrand, Petter Karlsson, Lars Sandman, Gert Helgesson, Stefan Eriksson & Niklas Juth - 2015 - BMC Medical Ethics 16 (1):34.
    Decision-making capacity is a key concept in contemporary healthcare ethics. Previous research has mainly focused on philosophical, conceptual issues or on evaluation of different tools for assessing patients’ capacity. The aim of the present study is to investigate how the concept and its normative role are understood in Swedish psychiatric care. Of special interest for present purposes are the relationships between decisional capacity and psychiatric disorders and between health law and practical ethics.
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  • Anorexia Nervosa: The Diagnosis: A Postmodern Ethics Contribution to the Bioethics Debate on Involuntary Treatment for Anorexia Nervosa.Sacha Kendall - 2014 - Journal of Bioethical Inquiry 11 (1):31-40.
    This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter “AN: the diagnosis”) several ethical issues are revealed. Firstly, “AN: the diagnosis” influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, “AN: the diagnosis” impacts on how treatment and treatment efficacy are defined (...)
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  • Assessing Decision-Making Capacity: A Primer for the Development of Hospital Practice Guidelines.Andrew M. Siegel, Anna S. Barnwell & Dominic A. Sisti - 2014 - HEC Forum 26 (2):159-168.
    Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of (...)
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  • Ist die Beihilfe zum Suizid auf der Grundlage des Wunsches, anderen nicht zur Last zu fallen, ethisch gerechtfertigt?Is physician-assisted suicide justifiable when the patient is worried about being a burden to others?Julian Bleek - 2012 - Ethik in der Medizin 24 (3):193-205.
    ZusammenfassungEin Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...)
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  • Einwilligungsfähigkeit: inhärente Fähigkeit oder ethisches Urteil?Decision-making capacity: inherent ability or ethical judgment?Helena Hermann, Manuel Trachsel & Nikola Biller-Andorno - 2016 - Ethik in der Medizin 28 (2):107-120.
    ZusammenfassungDie Bestimmung der Einwilligungsfähigkeit von Patienten beinhaltet weitreichende ethische und rechtliche Implikationen. Ausreichende Klärung des Begriffs ist daher unerlässlich. Solche Bemühungen gelten vorwiegend der Definition von Kriterien hinsichtlich relevanter mentaler Fähigkeiten. Grundlegendere Aspekte werden kaum explizit besprochen, so die Frage, ob Einwilligungsfähigkeit eher eine inhärente Fähigkeit oder ein ethisches Urteil bezeichnet. Zentral bei dieser Unterscheidung ist der Stellenwert ethischer Überlegungen die Zulässigkeit fürsorglicher Bevormundung betreffend. Geht man von einer inhärenten Fähigkeit aus, schließen solche Überlegungen an die Beurteilung von Einwilligungsfähigkeit an. (...)
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  • Deep Brain Stimulation, Authenticity and Value.Sven Nyholm & Elizabeth O’Neill - 2017 - Cambridge Quarterly of Healthcare Ethics 26 (4):658-670.
    In this paper, we engage in dialogue with Jonathan Pugh, Hannah Maslen, and Julian Savulescu about how to best interpret the potential impacts of deep brain stimulation on the self. We consider whether ordinary people’s convictions about the true self should be interpreted in essentialist or existentialist ways. Like Pugh et al., we argue that it is useful to understand the notion of the true self as having both essentialist and existentialist components. We also consider two ideas from existentialist philosophy (...)
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  • Manipulating Body Representations with Virtual Reality: Clinical Implications for Anorexia Nervosa.Stephen Gadsby - 2019 - Philosophical Psychology 32 (6):898-922.
    ABSTRACTAnorexia nervosa patients exhibit distorted body-representations. Specifically, they represent their bodies as larger than reality. Given that this distortion likely exacerbates the conditi...
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  • Teens and Research.Carolyn Plunkett Neuhaus - 2016 - Cambridge Quarterly of Healthcare Ethics 25 (4):659-673.
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  • Social Work and the Ethics of Involuntary Treatment for Anorexia Nervosa: A Postmodern Approach.Sacha Kendall & Richard Hugman - 2013 - Ethics and Social Welfare 7 (4):1-16.
  • An Ethical Evaluation of Stereotactic Neurosurgery for Anorexia Nervosa.Sabine Müller, Rita Riedmüller, Henrik Walter & Markus Christen - 2015 - American Journal of Bioethics Neuroscience 6 (4):50-65.
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  • An Ethical Reevaluation: Where Are the Voices of Those With Anorexia Nervosa and Their Families?Anthony Barnett, Wayne Hall & Adrian Carter - 2015 - American Journal of Bioethics Neuroscience 6 (4):73-74.
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  • Including Emotionality in Tests of Competence: How Does Neurodiversity Affect Measures of Free Will and Agency in Medical Decision Making?Robin Mackenzie & John Watts - 2011 - American Journal of Bioethics Neuroscience 2 (3):27-36.
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