From the inception of philosophical counseling an attempt was made to distinguish it from (psychological) therapy by insisting that therapy could not be more misleading. It is true that philosophical counselors should not pretend to be able to heal major mental illness; nevertheless they do contribute to positive health—health understood as something more than the absence of mental disease. This thesis is developed by critiquing Lou Marinoff’s book, Plato not Prozac!, but also by ranging more widely in the (...) literature on philosophical counseling. I also interpret philosophical counseling as a form of philosophical ethics. (shrink)

Much has changed in maternal-fetal medicine since the early 2000s, when the previous ethical frameworks for fetal therapy trials were established. We applaud Hendriks and colleagues for taking on t...

John Dewey and Ludwig Wittgenstein offer devastating critiques of the dominant model of human action that each inherited in their own time. Dewey, very early in his philosophical career, ostensibly put the stimulus–response mechanical understanding of action to rest with his “reflex-arc” concept article. Wittgenstein famously redescribed action as moves within language games that interconnect to constitute an interpretively open-ended form of life. In each case, these fundamental insights serve as heuristics, guiding our intellectual activity with regard to understanding our (...) practices, and as reminders in approaching problems. Several scholars have interpreted Dewey and Wittgenstein as allies in a grand project of... (shrink)

New technologies facilitate the enhancement of a wide range of human dispositions, capacities, or abilities. While it is argued that we need to set limits to human enhancement, it is unclear where we should find resources to set such limits. Traditional routes for setting limits, such as referring to nature, the therapy-enhancement distinction, and the health-disease distinction, turn out to have some shortcomings. However, upon closer scrutiny the concept of enhancement is based on vague conceptions of what is to (...) be enhanced. Explaining why it is better to become older, stronger, and more intelligent presupposes a clear conception of goodness, which is seldom provided. In particular, the qualitative better is frequently confused with the quantitative more. We may therefore not need “external” measures for setting its limits – they are available in the concept of enhancement itself. While there may be shortcomings in traditional sources of limit setting to human enhancement, such as nature, therapy, and disease, such approaches may not be necessary. The specification-of-betterment problem inherent in the conception of human enhancement itself provides means to restrict its unwarranted proliferation. We only need to demand clear, sustainable, obtainable goals for enhancement that are based on evidence, and not on lofty speculations, hypes, analogies, or weak associations. Human enhancements that specify what will become better, and provide adequate evidence, are good and should be pursued. Others should not be accepted. (shrink)

The normative significance of the distinction between therapy and enhancement has come under sustained philosophical attack in recent discussions of the ethics of shaping future persons by means of preimplantation genetic diagnosis and other advanced genetic technologies. In this paper, I argue that giving up the idea that the answer to the question as to whether a condition is “normal” should play a crucial role in assessing the ethics of genetic interventions has unrecognized and strongly counterintuitive implications when it (...) comes to selecting what sort of children should be brought into the world. According to standard philosophical accounts of the factors one should take into account when making such .. (shrink)

Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to (...) consent to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified. (shrink)

Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories has (...) without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions. (shrink)

In this essay I argue that a comprehensive understanding of addiction and its treatment should include an existential perspective. I provide a brief overview of an existential perspective of addiction and recovery, which will contextualize the remainder of the essay. I then present a case study of how the six-step philosophical practice method of Logic-Based Therapy can assist with issues that often arise in addiction treatment framed through an existential perspective.

Behavioural experiments are one of the central and most powerful methods of intervention in cognitive therapy. Yet until now, there has been no volume specifically dedicated to guiding physicians who wish to design and implement behavioural experiments across a wide range of clinical problems.The Oxford Guide to Behavioural Experiments in Cognitive Therapy fills this gap. It is written by clinicians for clinicians. It is a practical, easy to read handbook, which is relevant for practising clinicians at every level, (...) from trainees to cognitive therapy supervisors.Following a foreword by David Clark, the first two chapters provide a theoretical and practical background for the understanding and development of behavioural experiments. Thereafter, the remaining chapters of the book focus on particular problem areas. These include problems which have been the traditional focus of cognitive therapy, as well as those which have only more recently become a subject of study, and some which are still in their relative infancy. The book also includes several chapters on transdiagnostic problems, such as avoidance of affect, low self-esteem, interpersonal issues, and self-injurious behaviour. A final chapter by Christine Padesky provides some signposts for future development.Containing examples of over 200 behavioural experiments, this book will be of enormous practical value for all those involved in cognitive behavioural therapy, as well as stimulating exploration and creativity in both its readers and their patients. (shrink)

The last 20 years have seen the development of a new form of therapy, compassion focused therapy. Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training group, in which (...) usual CFT group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training”. This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists and two artists. There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities. (shrink)

Over 100 million Americans suffer from chronic pain, which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year. Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (...) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions. However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women with chronic musculoskeletal pain. Functional magnetic resonance imaging data were collected pre- and post-ACT, and changes in functional connectivity were measured using Network-Based Statistics. Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire, the Chronic Pain Acceptance Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the NIH Toolbox Neuro-QoLTM scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection, emotion, and cognitive control. These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies. (shrink)

Chris Letheby’s defence of psychedelic therapy hinges on the premise that psychedelic-facilitated insights about the self are in a better epistemic position than those about the external world. In this commentary, I argue that such a claim is not sufficiently defended. More precisely, I argue that one element is underexplored in Letheby’s otherwise compelling picture: namely, that unlike new beliefs about the external world, beliefs about oneself have the capacity to turn into self-fulfilling prophecies. Recognising the psychedelic experience and (...) the subsequent integration process as opportunities not only to apprehend certain facts about the self but also to actively shape and redetermine those facts is key to understanding the epistemic differences between insights patients have about themselves and about the external world. (shrink)

In this essay I explore the notion of philosophy as a way of life as a recovery pathway for individuals in addiction recovery. My hypothesis is that philosophy as a way of life can be a compelling, and legitimate recovery pathway for individuals in addiction recovery, as one of many recovery pathways. I will focus on logic-based therapy applied in the context of addiction recovery. The aim of presenting a case study is to show how a client receiving LBT (...) is provided with techniques and a worldview that can contribute to a philosophically oriented recovery program. In the case study the client was advised to apply the moral philosophy of Friedrich Nietzsche as an uplifting philosophical framework to counteract his unproductive worldview and fallacious thinking. Considering that there is an ostensibly low efficacy rate for the treatment of addiction, articulating the value of philosophy as a way of life as a recovery pathway provides a conceptual and methodological framework for the development of novel philosophically-based addiction treatment and recovery-oriented programs—thus expanding the treatment and recovery options available for those seeking recovery from addiction. (shrink)

The ambiguity regarding whether a given intervention is perceived as enhancement or as therapy might contribute to the angst that the public expresses with respect to endorsement of enhancement. We set out to develop empirical data that explored this. We used Amazon Mechanical Turk to recruit participants from Canada and the United States. Each individual was randomly assigned to read one vignette describing the use of a pill to enhance one of 12 cognitive, affective or social domains. The vignettes (...) described a situation in which an individual was using a pill to enhance the relevant domain under one of two possible enhancement conditions, one perceived as enhancing above the norm, what most people recognize as a clear case of enhancement, whereas the other perceived as enhancing towards the norm, with the individual using the enhancement having a modest, but subclinical deficit. Participants were asked how comfortable they were with the individual using the enhancement and about the impact the enhancement might have had in the individuals’ success in life. We found that irrespective of the domain to be enhanced, participants felt significantly more comfortable with ETN than with EAN, and they regarded the enhancement intervention as contributing to greater success in life with ETN rather than EAN. These data demonstrate that the therapy enhancement distinction is morally salient to the public, and that this distinction contributes to the angst that people feel when considering the propriety of CAS enhancement. (shrink)

Techniques for resolving some types of inherited mitochondrial diseases have recently been the subject of scientific research, ethical scrutiny, media coverage and regulatory initiatives in the UK. Building on research using eggs from a variety of providers, scientists hope to eradicate maternally transmitted mutations in mitochondrial DNA by transferring the nuclear DNA of a fertilised egg, created by an intending mother at risk of transmitting mitochondrial disease, and her male partner, into an enucleated egg provided by another woman. In this (...) article we examine how egg providers for mitochondrial research and therapy have been represented in stakeholder debates. A systematic review of key documents and parliamentary debates shows that the balance of consideration tilts heavily towards therapeutic egg providers; research egg providers have been ignored and rendered invisible. However, mapping the various designations of therapeutic egg providers shows that their role is so heavily camouflaged that they have only an absent presence in discussions. We explore this puzzling ambivalence towards egg providers whose contributions are necessary to the success of current mitochondrial research and proposed therapies. We suggest that labels that diminish the contributions of egg providers serve certain governance objectives in managing possible future claims about, and by, therapeutic egg providers. We demonstrate that the social positioning of research egg providers is entangled within that of therapeutic egg providers which means that the former can also never receive their due recognition. This article contributes to the wider literature on the governance of new technological interventions. (shrink)

Background Stroke is a worldwide problem with a limited number of approved treatments. Obtaining informed consent for acute stroke therapy is complicated by the breadth of information that must be communicated in a short period of time, the hectic nature of the emergency environment, the possible lack of understanding by the patient and/or family, and the critically time-sensitive nature of treatment for stroke. Complicating matters even further, patients are often unable to consent for themselves, placing the burden on surrogates (...) to infer patients’ wishes regarding treatment, and potentially limiting acute treatment by practitioners. Innovation An advance directive for acute stroke therapy was created, entitled COAST (Coordinating Options for Acute Stroke Therapy). This clinical initiative is being piloted at a large comprehensive stroke center, including the development of the advance directive form, integration of the form with electronic medical records, training healthcare providers, and outreach to patients. Conclusions COAST is an advance directive for stroke designed to make stroke care more efficient, optimize patients’ autonomy, improve the quality of healthcare, and streamline the ethical management of complex care decisions in acute stroke. The inherent benefit of COAST is in providing patients and their families with more information regarding stroke and its treatment options, allowing them to take a more active role in their care. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the (...) concept of malady is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive (...) qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

People who suffer from eating disorders often have to be treated against their will, perhaps by being detained, perhaps by being forced to eat. In this paper it is argued that whilst forcing compliance is generally acceptable, there may be circumstances under which a sufferer's refusal of consent to treatment should be respected. This argument will hinge upon whether someone in the grip of an eating disorder can actually make competent decisions about their quality of life. If so, then the (...) decision to refuse therapy may be on a par with other decisions to refuse life‐prolonging therapy made by sufferers of debilitating chronic, or acute onset terminal illness. In such cases, palliation might justifiably replace aggressive therapy. The argument will also draw heavily on the distinction between competent refusal of therapy and passive euthanasia, and the distinction between incompetent and irrational decisions. Both distinctions will then be applied to decisions to refuse food. The extent to which sufferers from anorexia nervosa can be categorised as either incompetent or irrational will be examined. It is against this background that it will be argued that at least some of those who suffer from eating disorders should have their refusals respected, even if they may die as a result. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

Mitochondria, the powerhouses of our cells, are essential to life. Normal mitochondrial function is achieved through the cooperative interaction of the nuclear and mitochondrial genomes. New IVF approaches intended to circumvent devastating mitochondrial disease look set to change the ancient pattern of mtDNA inheritance and interaction with unknown consequences.

This article discusses the potential of using interactive environments in autism therapy. We specifically address issues relevant to the Aurora project, which studies the possible role of autonomous, mobile robots as therapeutic tools for children with autism. Theories of mindreading, social cognition and imitation that informed the Aurora project are discussed and their relevance to the project is outlined. Our approach is put in the broader context of socially intelligent agents and interactive environments. We summarise results from trials with (...) a particular mobile robot. Finally, we draw some comparisons to research on interactive virtual environments in the context of autism therapy and education. We conclude by discussing future directions and open issues. (shrink)

Antimicrobial resistance (AMR) poses an increasing threat to patient care and population health and there is a growing need for novel therapies to tackle AMR. Bacteriophage (phage) therapy is a re-emerging antimicrobial strategy with the potential to transform how bacterial infections are treated in patients and populations. Currently, in the UK, phages can be used as unlicensed medicinal products on a ‘named-patient’ basis. We make an ethical case for why it is crucially important for the UK to invest in (...) Good Manufacturing Practice (GMP) for both ongoing unlicensed and future licensed phage therapy. Access to phages produced to GMP (GMP phages) will ensure effective patient care and better outcomes as well as health systems benefits. The UK also has the potential to become a global leader in the timely and cost-efficient manufacturing and supply of a therapy that meets internationally recognised standards. (shrink)

Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business (...) of enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits.All human agents, whether they have a... (shrink)

Designed to be tough, practical and good value for money, the Rough Guide maps aim to forge a new standard in city maps. Apart from travel information and the city's sites, monuments and attractions, the map shows every shop, restaurant, bar and hotel listed in the Rough Guide travel guide to Morocco, together with their opening times, and, in many cases, phone numbers. The map covers the main areas of Morocco on one side and an enlarged downtown city-centre map on (...) the reverse. The scale of the map makes it large enough for exploring off-the-beaten track as well as route planning. (shrink)

Rereading Renée C. Fox's “A Sociological Perspective on Organ Transplantation and Hemodialysis,” published in 1970, one is likely to be struck more by continuity than by change. The most pressing of the social, policy, and ethical concerns that Fox raised remain problematic fifty years later. We still struggle with scientific and clinical uncertainty, with the boundary between experimentation and therapy, and with the cost of organ replacement therapies and disparities in how they are allocated. We still have an imperfect (...) understanding of transplant immune responses. We still debate when a potential donor “actually” dies, and we still seem to think better empirical criteria could harmonize the diverse religious, cultural, and socioeconomic values of patients, providers, third‐party payers, and policy‐makers. Organ transplantation was for Fox both a particular case unfolding in time and an entryway for discussing the difficult moral questions presented by many new medical technologies in a context of high demand and limited resources. (shrink)

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This (...) study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach, offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that ADIT was acceptable for patients with complex/major depression, that they were likely to refer to ADIT in the future that the use of arts was likely to improve accessibility the use of arts was likely to improve outcomes and that offering ADIT was an effective use of mental health resources.Discussion: Phase I of this intervention development study demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol. (shrink)

Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy. In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature (...) and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient’s inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the ’error’ committed for which the depressed patient blames himself and the social repression of the maniacal patient’s affirmation of his inflated self-esteem. (shrink)

Recently it has been argued that some instances of germ‐line gene therapy will change the identity of the person who receives the benefit of therapy, and that in these instances there is no good moral reason to conduct germ‐line gene therapy. Against this we argue that even if gene therapy should have an effect on the identity of the resulting person, this would not diminish the urgency of the therapy. Not only would impersonal moral reasons (...) speak in favour of such radical gene therapy, there would also be person‐affecting reasons to perform it. (shrink)

With pre-implantation genetic diagnosis (PGD), genetic testing and selective transfer of embryos is possible. In the future, germ-line gene therapy (GLGT) applied to embryos before implantation, in order to introduce missing genes or replace mutant ones, may be possible. The objective of this dissertation is to analyse moral aspects of these technologies, as described by eighteen British, Italian and Swedish gynaecologists and geneticists. The objective is systematised into three parts: research interviews and qualitative analysis, philosophical analysis, and elaboration of (...) a framework that supports the combination of analytic methods. PGD was described as positive since it enabled some couples at risk for a genetic disease to have a child without the disease. PGD was described as in different senses ‘better’ than methods for prenatal diagnosis and selective termination of pregnancy. It was also described as positive since it provided couples at risk with one more option, even if it did not result in the birth of a healthy child. However, interviewees were concerned about the difficulty of defining and evaluating genetic disease. They were also concerned about patients’ choices, and about exaggerated use or misuse. Whereas PGD gave rise to ambivalence in terms of how to understand, describe and evaluate it, GLGT was often described as unrealistic or undesirable. The results of the qualitative analysis are used in a philosophical analysis of the concepts of choice, autonomous choice, ambivalence, trust and ambivalence in trust relations. A set of distinct characteristics of each concept are elaborated. The results of the philosophical analysis are used in the discussion of the results of the qualitative analysis. The study shows that the technologies imply both ‘new’ ways to perform ‘old’ medical practices and ‘new’ practices. Old moral questions are reformulated. New moral questions are added. Against the background of this, the concept of genetic identity is discussed. Key words: empirical ethics, pre-implantation genetic diagnosis, germ-line gene therapy, qualitative research, philosophical analysis, medical progress, genetic disease, choice, autonomous choice, ambivalence, trust, genetic identity. (shrink)

Florence Ashley has responded to our response to ‘Gatekeeping hormone replacement therapy for transgender patients is dehumanising.’ Ashley criticises some of our objections to their view that patients seeking hormone replacement therapy (HRT) for gender dysphoria should not have to undergo a prior psychological assessment. Here we clarify our objections, most importantly that concerning the parity between cosmetic surgery and the sort of intervention Ashley has in mind. Firstly, we show Ashley’s criticism of our comparison is insubstantial. We (...) then examine their comments regarding the analogy between abortion and HRT, and the language of informed consent. We also scrutinize the data upon which Ashley relies to defend the claim that informed consent without assessment always yields positive outcomes, finding this conclusion to be overstated. Finally, even if Ashley’s arguments were vindicated, the claim that the gatekeeping of HRT is motivated by hostility towards transgender people remains unsupported. (shrink)

The text is extensively referenced, but practical in its approach, giving real life examples and cases based on therapeutic practice.

In this paper, I will explore the concept that healing activities shape the objects of therapy and seek to construct those objects through therapeutic activities. Objects of therapy are the persons, patients, human bodies, diseases, physiological processes and personal suffering—that which clinical medicine constructs through its distinctive formative processes, practices and knowledge. The rationale for choice of philosophical sources namely, Cassirer, Foucault, the anthropological perspective of Good and the sociological account of Frank will be discussed. The claim articulated (...) by Good will be examined and its relationship to culture, illness, medical knowledge, practice, truth, and science. I then focus on Frank's concepts of the patient and the body and how medical knowledge and practices affects it. The concept that the medicalization of the illness narrative silences the patient's voice requiring an ethic of listening will be emphasized, described and further supported by Charon's (2006, Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press) and Cassell's (2015, The nature of suffering and the goals of medicine. New York, NY: Oxford University Press) thoughts on narrative of illness in clinical medicine. My position concludes that healing activities construct the objects of therapy: as the medical culture's way of seeking truth; as medicine's way of mediating and organizing forms of reality through culture and symbolic forms; and, as medicine's way of entering the body and constructing the disease. Lastly, I suggest that in spite of the remarkable progress in the control of disease, the failure to address the interpretation of illness meanings is a fundamental flaw in the work of “doctoring.” The experience and meanings of illness are at the centre of clinical practice and is a moral, political, ethical and professional obligation. The person is a cultural construct, a complex and culturally shaped way of experiencing self and other, and cultural “work” is required to constitute the person who is the object of medical attention and it also necessitates the ethic of listening. (shrink)

The case in favor of gene therapy is quite simple. Gene therapy is likely to improve the health and well-being of some people that are among the worst off in society, namely patients with painful and life-threatening diseases. However, two types of objection have been raised.

`Hans Cohn has given us a personal and valuable statement about the theoretical underpinnings of his work as a psychotherapist. These can be little doubt about his contribution to our thinking practice is invaluable. Students will find Cohn's easygoing exposition of complex ideas enormously helpful' - Professor Emmy van Deurzen, Existential Analysis `One of the most important books published this year. This long-awaited book by the foremost expert on the relationship between Heidegger and psychotherapy, manages to encapsulate the essence of (...) Heidegger's thinking and make of understandable and relevant to therapists without losing any of the original meaning' - Counsellingbooks.com Anyone interested in modern philosophy is familiar with the name of Martin Heidegger but there is a serious gap in even the most complete accounts of his life and thought. This is Heidegger's association with, and influence on, psychotherapy. Hans C Cohn explores the role of Heidegger's thought in providing an alternative basis for psychotherapeutic practice to the dominant psychodynamic, humanistic and cognitive approaches, also focusing strongly on the practical therapeutic relevance of Heidegger's ideas. This book will be essential reading for students and teachers of modern philosophy, as well as existential psychotherapists, and all practitioners interested in existential approaches to therapy. (shrink)

This study was concerned with the clarification of the experience of pivotal moments in therapy. By pivotal moment is understood an event within the therapeutic process that leads to enduring change experienced as an important improvement in the life-experience of the client. Retrospective descriptions of a therapeutic process were obtained from three clients in which a distinguishable chain of events could be discerned that the clients identified as a pivotal moment. The descriptive material was analyzed according to the descriptive (...) phenomenological psychological method developed by Amedeo Giorgi on the basis of the philosophical phenomenology of Husserl and Merleau-Ponty. The results show that the pivotal moment is experienced as a figural moment within the therapeutic process where a serious challenge to old assumptions takes place, necessitating a break from old cognitive, affective and behavioral patterns in a context of trust and safety within the therapeutic relationship. (shrink)

Grafts of embryonic neural tissue into the brains of adult patients are currently being used to treat Parkinson's disease and are under serious consideration as therapy for a variety of other degenerative and traumatic disorders. This target article evaluates the use of transplants to promote recovery from brain injury and highlights the kinds of questions and problems that must be addressed before this form of therapy is routinely applied. It has been argued that neural transplantation can promote functional (...) recovery through the replacement of damaged nerve cells, the reestablishment of specific nerve pathways lost as a result of injury, the release of specific neurotransmitters, or the production of factors that promote neuronal growth. The latter two mechanisms, which need not rely on anatomical connections to the host brain, are open to examination for nonsurgical, less intrusive therapeutic use. Certain subjective judgments used to select patients who will receive grafts and in assessment of the outcome of graft therapy make it difficult to evaluate the procedure. In addition, little long-term assessment of transplant efficacy and effect has been done in nonhuman primates. Carefully controlled human studies, with multiple testing paradigms, are also needed to establish the efficacy of transplant therapy. (shrink)

In 1956, I decided to apply my experience in microbial genetics to developing analogous systems for human cell lines, including the selection of mutants with either a loss or gain of a biochemical function. For instance, mutants resistant to azahypoxanthine showed a loss of the HPRT enzyme (hypoxanthine phosphoribosyl transferase), whereas gain of the same enzyme was accomplished by blocking de novo purine biosynthesis with aminopterin, while supplying hypoxanthine and thymine (HAT selection). Using HAT selection, we: (i) genetically transformed HPRT− (...) mutant cells to HPRT+ wild type by using DNA extracted from HPRT+ cells, and (ii) selected HPRT+ hybrid cells by fusing HPRT− D98/AH2 cells with skin cells. These approaches, which we dubbed in 1962 as a [first step toward gene therapy], contributed to the later development of (i) cell fusion techniques, (ii) the development of monoclonal antibodies, (iii) routine transformation of mammalian cells with cloned genes, and (iv) methods for creating transgenic organisms. (shrink)

This article presents research on robot therapy for elderly residents in a care house. Experiments were conducted from June 2005, lasting more than 2 months. Two therapeutic baby seal robots were introduced to the residents, and activated for over 9 hours daily. To investigate the psychological and social effects of the robots, the residents’ activities in public areas were recorded using video cameras, during the daytime for over 2 months. In addition, urinalysis of the residents was performed for 17-ketosteroid (...) sulfate and 17-hydroxycorticosteroid. Results of the video analysis indicated that social interaction increased through interaction with the seal robots. Results of the urine tests showed that the reactions of the subjects’ vital organs to stress improved after the introduction of the robots. (shrink)