This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal ...

In the first work of investigative journalism in decades to give a comprehensive view into contemporary psychiatric incarceration and forced interventions, Your Consent Is Not Required exposes how rising numbers of people from many walks of life are being subjected against their will to surveillance, indefinite detention, and powerful tranquilizing drugs, restraints, seclusion, and electroshock.

In three parts, this volume in the AP-LS series explores the phenomena of captivity and risk management, guided and informed by the theory, method, and policy of psychological jurisprudence. The authors present a controversial thesis that demonstrates how the forces of captivity and risk management are sustained by several interdependent "conditions of control." These conditions impose barriers to justice and set limits on citizenship for one and all. Situated at the nexus of political/social theory, mental health law and jurisprudential (...) ethics, the book examines and critiques constructs such as offenders and victims; self and society; therapeutic and restorative; health; harm; and community. So, too, are three "total confinement" case law data sets on which this analysis is based. The volume stands alone in its efforts to systematically "diagnose" the moral reasoning lodged within prevailing judicial opinions that sustain captivity and risk management practices impacting: (1) the rights of juveniles found competent to stand criminal trial, the mentally ill placed in long-term disciplinary isolation, and sex offenders subjected to civil detention and community re-entry monitoring; (2) the often unmet needs of victims; and (3) the demands of an ordered society. Carefully balancing sophisticated insights with concrete and cutting-edge applications, the book concludes with a series of provocative, yet practical, recommendations for future research and meaningful reform within institutional practice, programming, and policy. (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric (...) patients who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

Given the dramatic rise in the frequency of nursing research that involves eliciting personal information, one would expect that attempts to maintain the balance between the aspirations of researchers and the needs and rights of patients would lead to extensive discussion of the ethical issues arising. However, they have received little attention in the literature. This paper outlines and discusses some of the issues associated with qualitative research. The discussion converges on the specific case of phenomenological research, which involves (...) the invasion of participants’ personal worlds, and draws attention to some of the ethical issues that arise when the participants are psychiatric patients. (shrink)

This article describes stigmatization and its impact on the mentally ill and on the advancement of psychiatry. The article highlights an ethical review of stigmatization establishing a link between the psychosocial factors, culture and moral development. This paper offers an examination of studies conducted in Turkey and the Western world, and socio-cultural frameworks for dealing with ethical values and psychosocial development. The paper then argues for the need to discuss moral, psychosocial and cultural meanings embedded in (...) various ethical issues in arriving at conclusions and suggestions to prevent stigmatization.The paper concludes by emphasizing the importance of ethical training, cultural diversity and moral development giving reasons and examples why these are important against stigmatization and suggesting ways of handling mentally ill. (shrink)

This book equips readers with a sound understanding of the value-base of mental health care and provides them with the skills and knowledge to demystify complex values in decision-making in order to reach outcomes which are focused on the needs of service users. Engaging case examples and exercises link theory and practice throughout.

Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address (...) intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful. We consider strategies that may be useful in addressing not only the ethical dilemmas or the clinical problems, but also the emotional, social, and moral distress that arise in delivering care in such complex cases, in which standard routine practices of care have been exhausted. In addition, we explore the processes that led to this situation and suggest ways to promote early recognition and intervention for similar cases in the future. (shrink)

Various authors have argued that progress in the neurocognitive and neuropsychiatric sciences might threaten the commonsense understanding of how the mind generates behavior, and, as a consequence, it might also threaten the commonsense ways of attributing moral responsibility, if not the very notion of moral responsibility. In the case of actions that result in undesirable outcomes, the commonsense conception—which is reflected in sophisticated ways in the legal conception—tells us that there are circumstances in which the agent is entirely (...) and fully responsible for the bad outcome and circumstances in which the agent is not at all responsible for the bad outcome. (shrink)

Battle lines have been drawn over involuntary treatment. On one side, there are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others. They also don't allow for the idea that the civil rights of an individual may be at odds with the heartbreak of a caring family. On the other side are groups pushing for increased use of involuntary treatment. These (...) proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights-- Miller and Hanson illuminate the personal consequences of this controversial practice through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions--mental health court, crisis intervention training, and pretrial diversion--that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public. (shrink)

Since the introduction of Prozac (fluoxetine), a number of so‐called selective serotonin reuptake inhibitors (SSRIs) have been developed and introduced. These mood enhancers are being presently prescribed for people whose problems are not recognized mental illnesses. It is probable that in the near future the combination of data from advanced biochips and brain imaging will accelerate the development of neurotechnology. So‐called neuroceuticals, used for therapy and enhancement, and to improve different aspects of mental health, will be efficient (...) neuromodulators. The scientific, ethical, and social issues raised by mood enhancement and alteration of personal resilience require further exploration. The chapter talks about the notion of personal autonomy, cosmetic psychopharmacology, power for autonomous, and moral accountability in this context. It suggests that empirical research should also cover psychological and sociological research into perceptions and experiences of individuals who have used these drugs. (shrink)

WHO suggests mental ill health in terms of depression to be the highest ranking disease problem in the developed world in 2020–2030 and claims a public health approach to be the most appropriate response. But some argue that the alarming reports on mental ill health have their ground in the methods of inquiry themselves and refer to medicalization as an important issue. The aim of this article is to explore and illuminate the issue of what is meant by (...) mental health and mental ill health and what it means that mental ill health is a major public health problem. Basically, two understandings and aspects of public health exist: a ‘reductionist’ and a ‘holistic’ with connections to different theories of health. These diverging understandings may lead to quite different public health responses, and they may have different consequences with regard to medicalization. It is concluded that we need more clearly elaborated ways to think about public health so that the increased attention to mental ill health as a public health problem does not in itself lead to medicalization in terms of just medical treatment. Otherwise, we risk losing the importance of public health as an overarching social and political instrument. (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold (...) kinds of values and value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are (...) obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are (...) obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

In the past 50 years, ethical concerns concerning human experimentation have arisen with the advancement of new medical research and technology. While the benefits of human experimentation are well known in the fields of biology, psychology, sociology, and medicine, the conditions of human subject research have been persistently controversial. This book discusses ethical perspectives, emerging developments and global challenged of patient rights. Topics include effective medical informed consent; rights to health and dental care; the ethics of HIV screening (...) targeted to the seriously mentally ill; and problems in ethics for medical publication. (shrink)

Background:Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field.Objectives:This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis.Research design:We used qualitative content analysis.Ethical considerations:The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required.Findings:The analysis shows that all 12 textbooks describe and (...) present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person.Discussion and conclusion:Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness. (shrink)

In commerce, many moral failures are due to narrow mindsets that preclude taking into account the moral dimensions of a decision or action. In turn, sometimes these mindsets are caused by failing to question managerial decisions from a moral point of view, because of a perceived authority of management. In the 1960s, Stanley Milgram conducted controversial experiments to investigate just how far obedience to an authority figure could subvert his subjects' moral beliefs. In this thought-provoking work, (...) the authors examine the prevalence of narrow mental models and the phenomenon of obedience to an authority to analyse and understand the challenges which business professionals encounter in making ethical decisions. Obstacles to Ethical Decision-Making proposes processes - including collaborative input and critique - by which individuals may reduce or overcome these challenges. It provides decision-makers at all levels in an organisation with the means to place ethical considerations at the heart of managerial decision-making. (shrink)

In this paper I provide an account of the metaphysical foundations of mental illness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mental illness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mental illness as a property that humans may (...) exhibit and to examine the various arguments that realists and anti-realists can use to defend their position on mental illness. I pay particular attention to characterising Szasz's account of mental illness as that of an anti-realist error-theory and present ways in which a realist may counter such a position. Ultimately I argue that in order to hold a realist position on mental illness one would have to adopt some form of realism towards values, such as moral realism. (shrink)

Recent advances in the brain sciences have dramatically improved our understanding of brain function. As we find out more and more about what makes us tick, we must stop and consider the ethical implications of this new found knowledge. This ground-breaking book on the emerging field of neuroethics answers many pertinent questions, such as: What makes monitoring and manipulating the human brain so ethically challenging? Will having a new biology of the brain through imaging make us less responsible for (...) our behavior and lose our free will? Should certain brain scan studies be disallowed on the basis of moral grounds? A distinguished group of contributors from a wide range of fields make this an invaluable introduction to neuroethics. (shrink)

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the (...) difficulty of carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point - even a backbone - for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge. (shrink)

This paper aims to arrive at a coherent concept of one sort of mental disorder and of appropriate methods of treating it. Incoherence arises because of the conflict between modern conceptions both of morality and of health and illness and the necessary use of moral terms in defining what makes some mental disorders. Modern moral philosophy and modern conceptions of health and illness imply that health is a non-moral good, and so that (...) class='Hi'>illness is a “disorder” in a non-moral sense. Ancient ethics, on the other hand, allows states as well as actions to be morally evaluated, and so for the notion of a moral order or disorder which is not consciously chosen. It is argued that some kinds of mental disorder can be modeled on this conception of an unchosen moral disorder, and that the appropriate treatment for them is that species of moral education that we call “psychotherapy.”. (shrink)

Recent advances in the brain sciences have dramatically improved our understanding of brain function. As we find out more and more about what makes us tick, we must stop and consider the ethical implications of this new found knowledge. Will having a new biology of the brain through imaging make us less responsible for our behavior and lose our free will? Should certain brain scan studies be disallowed on the basis of moral grounds? Why is the media so (...) interested in reporting results of brain imaging studies? What ethical lessons from the past can best inform the future of brain imaging? These compelling questions and many more are tackled by a distinguished group of contributors to this volume on neuroethics. The wide range of disciplinary backgrounds that the authors represent, from neuroscience, bioethics and philosophy, to law, social and health care policy, education, religion and film, allow for profoundly insightful and provocative answers to these questions, and open up the door to a host of new ones. The contributions highlight the timeliness of modern neuroethics today, and assure the longevity and importance of neuroethics for generations to come. (shrink)

Those whom the gods wish to destroy, they first make mad, says a Nigerian proverb. These words of wisdom re-echo in traditional approaches to mental health ethics in sub-Saharan Africa. Among many cultures in Nigeria, it is customary to subject persons with mental health illness, especially those who present with violent behavior, to physical restraint and beatings. The belief is that such subjugation could restore mental health in the early stages of madness. Physical restraint and beatings (...) only form a part of the healing process, as it also has communitarian cum spiritual aspects. The healing process is carried out by family members or community, who share in the life of the mentally ill person. Their... (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client? How can clinicians refuse costly gifts from clients without damaging the therapeutic relationship? Should a therapist disclose a client's suicidal intent to the authorities? In Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice, these and other real-life scenarios constitute a comprehensive and definitive ethics casebook for (...) mental health professionals. Inspired by the many difficult situations they themselves have faced, an eminent group of accomplished mental health clinicians provide first-hand accounts of ethical problems that defy boilerplate solutions. Each chapter begins with a compelling and ethically complex case followed by an illustrative yet succinct analysis of the key ethical issues present and a personal reflection on the case itself, along with the process of ethical reasoning used to arrive at a final decision. Every case concludes with key recommendations for promoting ethical practice within an often challenging work setting. Highlighting the human aspect of ethics in mental health practice through the use of mesmerizing narratives while also provoking the reader to reflect upon what is the "right" thing to do, Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice offers trainees and seasoned professionals alike invaluable informative models for dealing with ethical dilemmas, as well as the inspiration to confront seemingly insurmountable clinical problems. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Changing Functions, Moral Responsibility, and Mental IllnessCraig Edwards (bio)Keywordsmental illness, responsibility, character, dysfunction, personhoodI thank both Wakefield and Tomasini for their illuminating comments. Both commentaries are thought provoking and warrant a full response. However, as always, space is limited and I must make the all-too-predictable apology for not addressing both commentaries in full. Wakefield's contribution more directly engages with, and challenges, my claims, and so I (...) focus on addressing his concerns.ClarificationsWakefield correctly notes that I am interested in how mental illness (and illness generally) operates to remove moral responsibility for one's actions. Despite this, it seems at several points that he and I are talking about two different, albeit related, concepts of mental illness. 'Mental illness' is used to both explain and excuse certain behaviors, but these two functions, explanatory and exculpable, do not always operate simultaneously. As we discover biological explanations for apparently immoral behaviors, the question arises as to whether the explanation should remove the immorality and liability for punishment. The 'sick role' can be divided into two aspects. One is the role of deserving and warranting medical treatment. The other is the negation of moral responsibility. Wakefield's own example, pedophilia, involves the first sense of the sick role but not the second. Wakefield's use of this example is unusual, because it deftly highlights the limitation of his HD account. Pedophilia is a mental disorder in the sense of warranting treatment, and is a mental illness under Wakefield's model, but it is not something that negates moral responsibility. There is a sense of the term 'mental illness'—an important and, as I argue, an objective sense—that is relevant to establishing one's moral responsibility for such behaviors.In addressing my account of mental illness as though it contained two distinct answers, 'mental illness as dysfunction of rational agency, or 'mental illness as moral judgment,' it is unclear whether Wakefield takes them to be conjunctive or alternative. Hence it is worth reiterating in point form the structure of my account:1. Illness involves dysfunction;2. The 'proper function' of a bodily or psychological mechanism is determined by the purpose that we impose upon that mechanism (within the constraints of our biological needs);3. Dysfunction of rational agency is necessary, but not sufficient, for 'mental illness' in the normative sense relevant to negating moral responsibility; and [End Page 105]4. The distinction between 'mental illness' (in the above sense) and the many dysfunctions of rational agency for which we are morally responsible, turns upon (objective) normative facts rather than features internal to the dysfunctions themselves.Functions and ValueWakefield misses the point when he criticizes my comment that, although bodily mechanisms are fairly uniformly valued, there is substantial historical and cross-cultural variation in the way people value personhood. He notes—accurately, but irrelevantly—that people almost always place great value on their capacity for rational agency, probably more so than many aspects of their physical health. My comment, taken in context, has nothing to do with how much people value personhood, but has everything to do with what kinds of purposes people want their mental and physical processes to achieve. A heart has the same function for a Londoner today as it did for a Japanese peasant a thousand years ago, and although it is possible for us to want it to achieve other purposes, any culture that seriously imputes a different set of vital functions on the heart is likely to be rather disappointed. By contrast, our species has experienced vast changes in the demands we make of our rational and intellectual capacities—dysfunctions like dyslexia and alcoholism were irrelevant before the availability of written communication and alcohol.Wakefield's HD account is unable to deal with the relevance of such change. The link between evolutionary function and illness is tenuous in any event. Evolutionary explanations of specific mechanisms are often untestable, simply positing some evolutionary purpose that happens to fit our understanding of what the mechanism does. If we were to discover that alcoholism evolved as a means of increasing birthrates, or (perhaps more plausibly) that anxiety disorders occur among those for whom... (shrink)

Empirical studies and ethical-legal analyses have demonstrated that incidental fndings in the brain, most commonly vascular in origin, must be addressed in the current era of imaging research. The challenges, however, are substantial. The discovery and management of incidental fndings vary, at minimum, by institutional setting, professional background of investigators, and the inherent diferences between research and clinical protocols. In the context of human subjects protections, the challenges of disclosure of unexpected and potentially meaningful clinical information concern privacy and (...) confdentiality, communication, and responsibility for follow-up. Risks, including a blurring of boundaries between research and clinical practice, must be weighed against the possible beneft to subjects and a moral duty to inform. Identifcation and examination of these challenges have been met by scientifc interest and a robust, interdisciplinary response resulting in the pragmatic recommendations discussed here. (shrink)

As one of the most compelling technologies for imaging the brain, functional MRI (fMRI) produces measurements and persuasive pictures of research subjects making cognitive judgments and even reasoning through difficult moral decisions. Even after centuries of studying the link between brain and behavior, this capability presents a number of novel significant questions. For example, what are the implications of biologizing human experience? How might neuroimaging disrupt the mysteries of human nature, spirituality, and personal identity? Rather than waiting for an (...) ethical agenda to emerge from some unpredictable combination of the concerns of ethicists and researchers, the attention of journalists, or after controversy is sparked by research that cannot be retracted, we queried key figures in bioethics and the humanities, neuroscience, media, industry, and patient advocacy in focus groups and interviews. We identified specific ethical, legal and social issues (ELSI) that highlight researcher obligations and the nonclinical impact of the technology at this new frontier. (shrink)

This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on whether psychiatric (...) classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation. (shrink)

Coercive medico-legal interventions are often employed to prevent people deemed to be unable to make competent decisions about their health, such as minors, people with mental illness, disability or problematic alcohol or other drug use, from harming themselves or others. These interventions can entail major curtailments of individuals' liberty and bodily integrity, and may cause significant harm and distress. The use of coercive medico-legal interventions can also serve competing social interests that raise profound ethical, legal and clinical (...) questions. Examining the ethical, social and legal issues involved in coerced care, this book brings together the views and insights of leading researchers from a range of disciplines, including criminology, law, ethics, psychology and public health, as well as legal and medical practitioners, social-service 'consumers' and government officials. Topics addressed in this volume include: compulsory treatment and involuntary detention orders in civil mental health and disability law; mandatory alcohol and drug treatment programs and drug courts; community treatment orders; the use of welfare cards with Indigenous populations; mandated treatment of seriously ill minors; as well as adult guardianship and substituted decision-making regimes. These contributions attempt to shed light on why we use coercive interventions, whether we should, whether they are effective in achieving the benefits that are offered to justify their use, and the impact that they have on some of society's most vulnerable citizens in the names of 'justice' and 'treatment'. This book is essential reading for clinicians, researchers and legal practitioners involved in the study and application of coerced care, as well as students and scholars in the fields of law, medicine, ethics and criminology. The collection asks important questions about the increasing use of coercive care that demand to be answered, and offers critical insights, guidance and recommendations for those working in the field. (shrink)

In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is (...) hubris to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness. (shrink)

The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. (...) A constant comparative analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of ‘home’. This reflected the health care workers’ conflict between their professional role and their moral role, which they perceived as unclear. (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client?

The article considers the issues of modern German political philosophy in accordance with its formation, institutionalization and development. Germany’s political philosophy is analyzed in terms of its interaction with social and practical philosophy. The text states that political philoso- phy belongs to both social philosophy and political science. As a political theory, it is a compo- nent of social theories institutionalized in the modern era. As a political philosophy, it appears as a metatheory of political theory. Political philosophy is also (...) part of practical philosophy, exploring the problems of interaction between ethics and politics and the moral reclamation of the political system of modern society. These issues are themed in the context of the institution- alization of this discipline in the early twentieth century, its transformation into a political reli- gion during National Socialism, the revival after World War II, as well as actualization in such areas of socio-humanitarian sciences as discourse philosophy, functional-system theory of so- ciety, etc. according to the political situation of modern Germany. (shrink)

I present a dilemma which depressive behavioral pathology poses for both Humean and non-Humean theories of motivation and value. Although the dilemma shows that neither theory can be considered adequate in its standard form, I argue that if the Humean theory is modified so as to embrace a richer notion of satisfaction than it currently does, it can solve the problem which depression poses for it and, thus, the dilemma can be avoided. Embracing a richer notion of satisfaction not only (...) solves this problem, it also extends the scope of the Humean theory in a potentially dramatic way, by extending the explanatory reach of moral psychology to issues often thought to fall outside its scope, namely, issues in moral psychopathology. (shrink)

This article describes how ethical guidelines have been applied while interviewing psychiatric patients who were recovering from mental illness, especially from psychosis, to allow nurses to understand these patients’ experiences. Because psychiatric patients are vulnerable, their participation in research involves ethical dilemmas, such as voluntary consent, legal capacity to consent, freedom of choice, and sufficient knowledge and comprehension. The first part of this article describes the most important ethical guidelines concerning human research. These have been (...) published by different organizations, departments, committees and commissions for the purpose of protecting human rights and dignity whenever research participants are vulnerable persons or their capacity to consent is limited. At present, however, no special regulations govern research involving adults who have been diagnosed with a condition characterized by mental impairment. Furthermore, a relatively small body of research has documented the effects of various disorders on decision-making capacity per se. One basic moral and policy question is whether these individuals should ever be involved in research. The second part of this article concentrates on how the investigator made sure that participating patients had understood their role in this particular piece of nursing research. During the interviews the investigator noticed that some ethical dilemmas required further study and debate because of the lack of consensus on the proposed regulatory provisions on research involving institutionalized persons and their ability to make an informed and voluntary decision. (shrink)

Psychotherapy is a well-established, efficacious, and fully accepted treatment for mental disorders and psychological problems. Psychotherapy is an interpersonal practice engaging patient values, interests, and personal meanings at every step. Thereby, psychotherapy abounds with moral issues. In psychotherapy ethics, numerous moral issues converge, including self-determination or autonomy, decision-making capacity and freedom of choice, coercion and constraint, medical paternalism, boundaries between health and illness, insight into illness and the need for therapy, dignity, under- and overtreatment, and (...) much more. The Oxford Handbook of Psychotherapy Ethics covers the whole range of ethical issues in the heterogenous field of psychotherapy, closing a commonly perceived gap between ethical sensitivity, technical language, and knowledge among psychotherapists. The primary audience is psychotherapists in clinical practice. Furthermore, the Oxford Handbook of Psychotherapy Ethics addresses the whole range of professionals providing mental health services beyond psychology and medicine including counselors, social workers, nurses, or ministers. The Oxford Handbook of Psychotherapy Ethics is not only intended for a clinical audience but also for a philosophical/ethical audience. The goal of the is to explicitly link the two disciplines by fostering a productive dialogue between them, enriching both the psychotherapeutic encounter and the ethical analysis and sensitivity within and outside the clinic. (shrink)

This article describes how ethical guidelines have been applied while interviewing psychiatric patients who were recovering from mental illness, especially from psychosis, to allow nurses to understand these patients’ experiences. Because psychiatric patients are vulnerable, their participation in research involves ethical dilemmas, such as voluntary consent, legal capacity to consent, freedom of choice, and sufficient knowledge and comprehension. The first part of this article describes the most important ethical guidelines concerning human research. These have been (...) published by different organizations, departments, committees and commissions for the purpose of protecting human rights and dignity whenever research participants are vulnerable persons or their capacity to consent is limited. At present, however, no special regulations govern research involving adults who have been diagnosed with a condition characterized by mental impairment. Furthermore, a relatively small body of research has documented the effects of various disorders (e.g. psychiatric conditions) on decision-making capacity per se. One basic moral and policy question is whether these individuals should ever be involved in research. The second part of this article concentrates on how the investigator made sure that participating patients had understood their role in this particular piece of nursing research. During the interviews the investigator noticed that some ethical dilemmas required further study and debate because of the lack of consensus on the proposed regulatory provisions on research involving institutionalized persons and their ability to make an informed and voluntary decision. (shrink)

Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses’ experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The (...) constant comparative method of grounded theory was used for data collection and analysis. The process of ‘behaving as a nurse or not’ was identified as a core category. Four subcategories were identified: ‘receiving involuntary information’, ‘to take action or not’, ‘behaving as a mediator in the neighbourhood’ and ‘the freedom of choice’. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time. (shrink)

Environmental ethicists and experts in human health have raised concerns about the effects of hydraulic fracking to access natural oil and gas resources found deep in shale rock formations on surrounding ecosystems and communities. In this study, we analyzed the prevalence of discourse on brain and mental health, and ethics, in the peer-reviewed and grey literature in the five-year period between 2016 and 2022. A total of 84 articles met inclusion criteria for analysis. Seventy-six percent (76%) mentioned impacts on (...) brain (e.g., neural tube defects, neurological symptoms), and mental health (e.g., negative psychological effects, stress, depression) briefly; 11 reports dedicated substantive discourse to either or both together. References to safety (77%) dominated the ethics context. Discussion of environmental injustices as fracking sites disproportionately affect vulnerable communities appeared in 38% of the papers. We examine the findings through the lens of environmental neuroethics that brings human-made changes to the environment, brain and mental health, and ethics together into three interwoven lines of inquiry. (shrink)

A brain-computer interface technology that can decode the neural signals associated with attempted but unarticulated speech could offer a future efficient means of communication for people with severe motor impairments. Recent demonstrations have validated this approach. Here we assume that it will be possible in future to decode imagined (i.e., attempted but unarticulated) speech in people with severe motor impairments, and we consider the characteristics that could maximize the social utility of a BCI for communication. As a social interaction, communication (...) involves the needs and goals of both speaker and listener, particularly in contexts that have significant potential consequences. We explore three high-consequence legal situations in which neurally-decoded speech could have implications:Testimony, where decoded speech is used as evidence;Consent and Capacity, where it may be used as a means of agency and participation such as consent to medical treatment; andHarm, where such communications may be networked or may cause harm to others. We then illustrate how design choices might impact the social and legal acceptability of these technologies. (shrink)

Abstract:If climate change is as bad as many now predict, we may be faced with the problem of how to cope with a natural world that is changing more rapidly than our ability to form emotional attachments can keep pace with. How can we love a natural world that seems so strange and unfamiliar to us? For help in answering this question, I turn to structurally similar problems that we face in our emotional attachments to other people. Using the cases (...) of dementia and mental illness, I investigate how people adapt their love in cases where their beloved changes in ways that render her, at least at times, unfamiliar, strange, and unpredictable. I argue that in both human and nonhuman cases, love can be compatible with dramatic and rapid changes in one's beloved, but to achieve this one must remain open-minded about the nature of the beloved and morally attentive to the ongoing question of which states will promote its well-being. (shrink)

In Morality and Ethics of War, which includes a foreword by Major General Susan Coyle, ethicist Deane-Peter Baker goes beyond existing treatments of military ethics to address a fundamental problem: the yawning gap that exists between the diverse moral frameworks defining personal identity in a multicultural society on the one hand, and the professional military ethic on the other. Baker argues that overcoming this chasm is essential to minimising the ethical risks that can lead to operational and strategic (...) failure for military forces engaged in today's complex conflict environment. He contends that spanning the gap is vital in preventing moral injury from befalling the nation's uniformed servants. Drawing on a revised account of what he calls 'the Just War Continuum', Baker develops a bridging framework that combines conceptual clarity and rigour with insights from cutting edge psychological research and creates a practical means for military leaders to negotiate the moral chasm in military affairs. (shrink)

On the powerful qualities view, every fundamental property is both dispositional and qualitative. Identity theory is the standard account of the view, which makes the stronger claim that a property’s dispositionality and qualitativity are identical to each other, and identical to the property itself. Recent defences of the powerful qualities view have involved novel theories of powerful qualities which are not also variants of identity theory. Giannotti (Erkenntnis 86:603–621, 2021a) has suggested a novel theory of his own, the dual aspect (...) account, which makes use of a particular notion of aspects. For Giannotti, dispositionality and qualitativity are each an aspect of a property, and an aspect is a property’s way of being. The importance of aspects is twofold. Firstly, by introducing aspects to identity theory, the theory becomes more precise. Secondly, aspects allow for a novel theory of powerful qualities, the dual aspect account, which maintains that dispositionality and qualitativity are aspects, but rejects the identity claim. Giannotti’s aim is to show that even if identity theory is false, the dual aspect account remains an available theory for advocates of powerful qualities. This paper will be a critical examination of Giannotti’s ideas. Firstly, I will clarify Giannotti’s notion of aspects, explaining how it involves a misunderstanding of supervenience, and why it does not offer the advantages that he claims it does. Secondly, in light of my discussion of aspects, I will argue that the dual aspect account lacks relative advantages over the compound view of powerful qualities. (shrink)