In his 1993 novel Headhunter, Canadian author Timothy Findley describes the tendency of some medical practitioners to put scientific interests above the therapeutic needs of the individual. As the book's title and name of the main character Dr. Kurtz attest, Findley reflects the colonialist teleology found in Heart of Darkness as an analogue for the therapeutic zeal shown by many of the physicians in Headhunter. In the novel, such zeal is especially problematic when it is combined (...) with so-called enhancement technologies, since enhancement, like colonialism, can be based in the prejudices of the practitioner and/or the dominant society, rather than in the needs of the patient. To counter therapeutic zeal, Findley, like Conrad, proposes an ethics of restraint in which the practitioner's empathy outweighs his or her desire for scientific discovery. (shrink)

In April 1931, the American Dental Association’s Seal of Acceptance was introduced. The seal is still in use today and has been widely praised in dental literature as a symbol of safety, efficacy and credibility within dental therapeutics and an icon of professionalism for the American Dental Association. The celebratory rhetoric perpetuates a problematic narrative of a unified profession. I argue that it is necessary to go beyond the standard narrative. The complex history of the introduction of the acceptance programme (...) in 1930 and 1931 revolves around personal zeal and struggles for authority between different fractions within the American Dental Association seeking to balance professional ideals with economic necessities. I show how authority and professional identity was claimed, redistributed and communicated within a professional organisation, and demonstrate how the seal was invoked to influence marketing strategies of dental manufacturers, reverse the relationship between manufacturers and the profession of dentistry, to brand dentistry in a wider, public context, and how it became an economic thorn in the side of the Board of Trustees of the American Dental Association. (shrink)

For decades, Anderson has been pressing critical theorists and literary scholars to acknowledge the inescapably normative dimensions of their work. Through careful attention to rhetorical styles, she has persuasively argued that epistemological positions and social theories are tethered to “characterological” judgments—to implicit endorsements of ethos. Meanwhile, critical discourse has warmed to the claims of lived experience (the “turn to ethics,” the interest in “affect”), but the “ethical” has remained a negative movement, either as the critique of social and discursive structures (...) or as clearing space for the “other”—and “affect” has been construed as the pleasure and self-care that enable resistance to the pressure of these structures. The questions that galvanize ethical criticism (What is wrong with the way things are?) and theories of affect (How can I survive?) continue to evade the deeper one that Anderson sees as basic to any theorizing: How should I live?The lesson of Anderson's The Way We Argue Now is that ethics without ethos is shallow. In Psyche and Ethos, the lesson is that psychology without morality is benumbed. Though Anderson is characteristically judicious in her reconstruction of the arguments she opposes, there are several rhetorical targets in these lectures. The first is contemporary cognitive science, which pictures moral thinking as either the “belated” rationalization of decisions really made by “automatic” psychological processes or as a mechanism for eliminating “cognitive dissonance.” Anderson shows how these pictures assume an abstracted, “punctual” model of moral experience; their “deflationary” zeal ironically depends on an untenable ideal of moral voluntarism that is then speciously “debunked.” By contrast, novels are able to explore the temporal dimension of moral consciousness, especially through their representation of what she calls “moral rumination,” a concept further developed in her recent contribution to Character: Three Inquiries in Literary Studies. Anderson shows, moreover, that narrative fictions like The Winter's Tale, Middlemarch, and The Beast in the Jungle understand “belatedness” not as evidence for the superficiality of morality but as a distinct mode of moral recognition that can unfold only across time.Anderson worries that the new “eudaimonic” literary criticism, which explores “enabling moods,” unwittingly perpetuates the moral confusion of empirical psychology and “privileg[es] psychological over moral desiderata,” even as certain “psychological states” are “presented as morally desirable.” This contradiction is another iteration of one she has been confronting throughout her career: the strange incapacity of critical discourse either to recognize or to avow the normative claims—the elaboration of an ethos as good or valuable—with which it is nonetheless saturated. Still, the contradiction has been a defining feature of modern “therapeutic culture” (a formulation she employs): the neutral, functionalist descriptions of empirical psychology ostensibly bracket morality, yet some descriptions are inevitably coded as “better” or “worse,” and they are consistently harnessed to fully moral evaluations. It is rare to hear a literary theorist of Anderson's provenance reanimate, if indirectly, the criticism that Philip Rieff, Christopher Lasch, and Jackson Lears directed toward “therapeutic culture,” which has largely been forgotten or vulgarized by right-wing pundits. In essence, however, her plea is similar to theirs: she wants us to acknowledge that the moral life is integral to the “healthy” life; and she wants critics to stop dismissing it as epiphenomenal to either psychology or politics. She sees the novel, and the humanities more broadly, as the preeminent cultural vehicles for “clarifying” the moral life. (shrink)

The Philadelphia Association is always linked with the name of R. D. Laing, one of its founders, but very little is known about its unorthodox contribution to the development of psychoanalysis. Founded in 1965, it took as its aim the relief of mental illnesss of all desciptions, in particular schizophrenia. At its inception it was a focus for people, with a diversity of backgrounds and interests, concerned with 'mental illness' and how society defines it. Its members - who included psychoanalysis, (...) psychiatrists and artists - developed a philosophical critique of psychoanalysis grounded in phenomenology, and an 'anti-psychiatry' critique of the institutional treatment of the mentally ill. They favoured the setting up of therapeutic community households of which the best known was Kingsley Hall. The PA was then very much part of the counter culture - it staged, for example, the famous Dialectics of Liberation Congress at London's Roundhouse in 1967. The psychotherapists who currently belong to the Philadelphia Association continue to work with community households and to offer a psychotherapy training. Here the authors share their innovative and distinctive approach on a number of interrelated themes: the herapeutic community and differend ways it can be understood; work with deeply regresed patients; the concept of identity in a social context; the debate between Lacan and Derrida on Poe's 'The Purloined Letter'; the phenomenology of knowledge and transference and authority. Together, they offer a cogent critique of many psychiatric and psychonalaytic assumptions. The contributors are Robin Cooper, Joseph friedman, Steven Gans, John Heaton, Chris Oakley, Haya Oakley and Paul Zeal. They are all psychotherapists and members of the Philadelphia Association. (shrink)

What kind of affective phenomenon is religious zeal and how does it relate to other affective phenomena, such as moral anger, hatred, and love? In this paper, I argue that religious zeal can be both, and be presented and interpreted as both, a love-like passion and an anger-like emotion. As a passion, religious zeal consists of the loving devotion to a transcendent religious object or idea such as God. It is a relatively enduring attachment that is constitutive (...) of who the zealot is, and it expresses itself in a distinctive set of mental and behavioral dispositions. Most importantly, it motivates uncompromising actions and involves intense, hot, and deep emotions. As an anger-like emotion, religious zeal is an occurrent affective state of mind that is intentionally directed towards a specific object, characteristically a person or group of persons. It condemns the violation of a religious norm that is taken to be of absolute validity and general applicability. It motivates an action aiming at vengeance and retaliation, and it involves intense and hot feelings of hostility towards its object. I argue that rather than reducing the complex phenomenon of religious zeal to one of these two manifestations, we should reflect upon the question of how the two distinct conceptualizations relate to each other. (shrink)

Today, in a Western secular context, the affective phenomenon of religious zeal is often associated, or even identified, with religious intolerance, violence, and fanaticism. Even if the zealots’ devotion remains restricted to their private lives, “we” as Western secularists still suspect them of a lack of reason, rationality, and autonomy. However, closer consideration reveals that religious zeal is an ethically and politically ambiguous phenomenon. In this article, I explore the question of how this ambiguity can be explained. I (...) do so by drawing on Paul Ricœur’s theory of affective fragility and tracing back the ambiguity of religious zeal to a dialectic inherent to human affectivity and existence itself. According to Ricœur, human affectivity is constituted by the two poles of vital and spiritual desires which are mediated by the thymos. As I show, this theory helps us to understand that religious zeal as a spiritual desire is neither plainly good nor plainly bad, but ambiguous. Moreover, it enables us to acknowledge the entanglement of abstraction and concretion that is inherent to the phenomenon of religious zeal. Finally, this theory helps us to understand why religious zeal, as one possible expression of the human quest for the infinite, is both a promise and a threat. In conclusion, human existence is tragic not in that we necessarily fail, but in that no matter which path we take with regard to our spiritual desires—that of affirmation, rejection, or moderation—we are and remain fallible. (shrink)

Therapeutic touch, a healing technique based upon the laying‐on of hands, has found wide acceptance in the nursing profession despite its lack of scientific plausibility. Its acceptance is indicative of a broad antiscientific trend in nursing. Adherents of this movement use the jargon of postmodern philosophy to justify their enthusiasm for a variety of mystically based techniques, citing such postmodern critics of science as Derrida and Michel Foucault as well as philosophical forerunners Heidegger and Husserl. Between 1997 and 1999, (...) 94 articles in nursing journals referred to postmodernism, according to a database search. This paper criticizes the postmodern movement for abandoning the biological underpinnings of nursing and for misreading philosophy in the service of an antiscientific world‐view. It is also suggested that nursing can retain its tradition of ‘caring’ without abandoning the scientific method. (shrink)

This article utilizes recent Western approaches to the ethical inquiry into human activities of forgetting, especially the approach represented by Ricoeur’s work on memory and forgetting and their ethical functioning. The three areas of Ricoeur’s investigation includes the therapeutic/pathological area; pragmatic area, which deals with the issue of individual and group’s self-identity in relation to time and otherness; and the more explicitly ethical area. These three divisions are useful to start with, but Ricoeur’s work shows some narrowness in neglect (...) of positive, productive and healthy forgetting, which has been deemed significant by the Zhuangzi. This paper is the first of the author’s serial writings to apply Ricoeur’s three areas of forgetting to investigate the forgetfulness of the Zhuangzi, and examines therapeutic forgetting and its ethical dimension only. (shrink)

This paper develops and defends a new account of therapeutic trust, its nature and its constitutive norms. Central to the view advanced is a distinction between two kinds of therapeutic trust – default therapeutic trust and overriding therapeutic trust – each which derives from a distinct kind of trusting competence. The new view is shown to have advantages over extant accounts of therapeutic trust, and its relation to standard (non-therapeutic) trust, as defended by Hieronymi, (...) Frost-Arnold, and Jones. (shrink)

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a (...) conversation with a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in (...) which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

: "Therapeutic misconception" has been misconstrued, and some of the newer, mistaken interpretations are troublesome. They exaggerate the distinction between research and treatment, revealing problems in the foundations of research ethics and possibly weakening informed consent.

Although the therapeutic misconception (TM) has been well described over a period of approximately 20 years, there has been disagreement about its implications for informed consent to research. In this paper we review some of the history and debate over the ethical implications of TM but also bring a new perspective to those debates. Drawing upon our experience of working in the context of translational research for rare childhood diseases such as Duchenne muscular dystrophy, we consider the ethical and (...) legal implications of the TM for parental consent to research. In this situation, it is potentially the parent who is vulnerable to TM. In our analysis we not only consider the context of informed consent for research but also the wider environment in which the value of research is promoted, more broadly through the media but also more specifically through the communication strategies of patient organizations. All dissemination about developments in research for health runs the risk of portraying an overly optimistic view of the promise of biotechnological solutions and has the potential to encourage a ‘collective’ TM. In this paper we consider the challenge that TM presents to parents as well as explore the ethical and legal responsibilities of researchers to ensure an appropriately informed consent: compatible with a hopeful disposition of parents who consent for the their children whilst avoiding a blind and misleading optimism. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining (...) and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

Clinical trials play a crucial role in generating evidence about healthcare interventions and improving outcomes for current and future patients. For individual trial participants, however, there are inevitably trade‐offs involved in clinical trial participation, given that trials have traditionally been designed to benefit future patient populations rather than to offer personalised care. Failure to understand the distinction between research and clinical care and the likelihood of benefit from participation in clinical trials has been termed the ‘therapeutic misconception’. The evolution (...) of the clinical trials landscape, including greater integration of clinical trials into healthcare and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience. Using cancer clinical trials as an exemplar, we describe how methodological changes in early‐ and late‐phase clinical trial designs, as well as changes in the design and delivery of healthcare, impact upon the therapeutic misconception. We suggest that this provides an impetus to re‐examine the ethics of clinical research, particularly in relation to trial access, participant selection, communication and consent, and role delineation. (shrink)

The unexpected roles of the microbiota in cancer challenge explanations of carcinogenesis that focus on tumor-intrinsic properties. Most tumors contain bacteria and viruses, and the host’s proximal and distal microbiota influence both cancer incidence and therapeutic responsiveness. Continuing the history of cancer–microbe research, these findings raise a key question: to what extent is the microbiota relevant for clinical oncology? We approach this by critically evaluating three issues: how the microbiota provides a predictive biomarker of cancer growth and therapeutic (...) responsiveness, the microbiota’s causal role(s) in cancer development, and how therapeutic manipulations of the microbiota improve patient outcomes in cancer. Clarifying the conceptual and empirical aspects of the cancer-associated microbiota can orient future research and guide its implementation in clinical oncology. (shrink)

The doctrines of therapeutic nihilism and administrative nihilism are both based on the belief that the norms of activity are intrinsically linked to the structure of the body. Just as there is a vis medicatrix naturae in the individual organism, which renders any intervention of the therapist vain, there would be a vis medicatrix rei publicae in the social body, which makes the intervention of the legislator in economic life pointless and even dangerous. However, such a symmetry is not (...) quite as clear as it appears at first. It has also been upheld that the real parallel is not between therapeutic and administrative nihilism, but between therapeutic nihilism and statism. In this view, government is less comparable to a therapist than to the nervous system, and just as a well regulated organism is a one with an extensive nervous system, a well regulated society is one with a strong State.We intend to retrace the historical origin of these two schemas of correspondence, which has his roots in the celebrated controversy in the 1870’s between Herbert Spencer and Thomas Henry Huxley. We examine the causes of this apparent paradox, which sometimes views the doctrine of administrative nihilism, and sometimes the opposing doctrine of statism, as being the equivalent in politics of therapeutic nihilism in medicine. In our opinion, an important part of the explanation must be sought in the variations of the field of extension, which is implicitly given to the concept of vis medicatrix, or –as we now usually call this notion– that of Self-regulation. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

This article focuses on two very different thinkers from different periods of time, an early hedonist who belonged to Socrates’ circle and lived until the middle of the fourth century BCE and the late Stoic who ruled the Roman Empire in the second century CE. Despite all substantial divergences – for instance, on the value of pleasure – Aristippus the Elder and Marcus Aurelius shared an interest in presentism, broadly construed as a focus on the present and its primacy, and (...) engaged themselves in exercises regarding the experience of the present. Moreover, in developing their respective positions and the exercises they prescribed, we shall uncover and foreground their essentially therapeutic character. (shrink)

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of (...) class='Hi'>therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and (...) the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process. (shrink)

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of (...) contracts, the development of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)

Objectives: Clinical trials in humans in Germany—as in many other countries—must be approved by local research ethics committees . The current study has been designed to document and evaluate decisions of chairpersons of RECs in the problematic field of non-therapeutic research with minors. The authors’ purpose was to examine whether non-therapeutic research was acceptable for chairpersons at all, and whether there was certainty on how to decide in research trials involving more than minimal risk.Design: In a questionnaire, REC (...) chairpersons had to evaluate five different scenarios with non-therapeutic research. The scenarios described realistic potential research projects with minors, involving increasing levels of risk for the research participants. The chairpersons had to decide whether the respective projects should be approved.Methods: A total of 49 German REC chairpersons were sent questionnaires; 29 questionnaires were returned. The main measurements were approval or rejection of research scenarios.Results: Chairpersons of German RECs generally tend to accept non-therapeutic research with minors if the apparent risk for the participating children is low. If the risk is clearly higher than “minimal”, the chairpersons’ decisions differ widely.Conclusion: The fact that there seem to be different attitudes of chairpersons to non-therapeutic research with minors is problematic from an ethical point of view. It suggests a general uncertainty about the standards of protection for minor research participants in Germany. Therefore, further ethical and legal regulation of non-therapeutic research with minors in Germany seems necessary. (shrink)

Non-therapeutic ventilation of potential organ donors would increase the supply of kidneys for transplantation. There are no major ethical objections to it. The means of permitting it are forbidden by laws with an ethical basis. A law permitting it would need an ethical basis. Introducing a third legal method of diagnosing death would be unethical. Expanding the power of the advance directive to permit procedures involving minimal harm would be ethical but not helpful. Extending the power of proxies to (...) permit specific non-therapeutic procedures which caused or risked minimal harm to incompetent patients is the best way forward. (shrink)

I argue that a variety of physical disabilities, and neurological and psychiatric disorders can be understood in terms of changes to the subject’s affordance space. Understanding disorders in this way also has some implications for therapy. On the basis of a phenomenological- and pragmatist-inspired enactivism I propose an affordance-based approach to therapy with a focus on changing physical, social, and cultural environments, and I consider the role of virtual and mixed realities in this context.

I argue that in recent years, the therapeutic ethos and the ideal of authenticity have become aligned with distinctively neo-liberal notions of personal responsibility and self-reliance. This situation has radically exacerbated the threat to political community that Charles Taylor saw in the ‘ethics of authenticity’. I begin by tracing the history of the therapeutic ethos and its early (Rieff, Lasch, MacIntyre) and late (Furedi) critics. I then discuss Charles Taylor’s argument that the culture of self-fulfillment generated by the (...) therapeutic ethos harbors an important moral ideal, namely, the ethic of authenticity. Pace Taylor, I argue that authenticity has now become thoroughly instrumentalized in the service of the guiding political rationality of neo-liberalism. I make this case through a discussion of its uptake in managerial techniques and practices and also in popular culture. (shrink)

ABSTRACTBased on the case of Rosa, a nine‐year‐old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an (...) ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity. (shrink)

Combined oral contraceptives have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception are (...) approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching. (shrink)

Dissecting Bioethics, edited by Tuija Takala and Matti Hayry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly appreciated. To submit a paper or to discuss (...) a suitable topic, contact Tuija Takala [email protected].:This article examines some of the assumptions and implications associated with the Belmont era context in which the concept of therapeutic misconception was forged. We argue that the justification of therapeutic misconception should be reconsidered based on less paternalistic and more participatory models of research. Finally, we identify conceptual and practical approaches that might better reflect contemporary research practice. (shrink)

ArgumentThis essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, (...) and clinicians. It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called “bacteriological medicine,” tuberculin, in 1890. (shrink)

Since its inception in the 1900s, the concept of countertransference has been mired in controversy. Psychoanalytic literature is divided on its utility, significance and its clinical value in psychotherapy. While some psychotherapists have advocated for the importance of therapists’ expertise in the comprehension and processing of countertransference dynamics in the treatment of sexually abused children, others see no value in competency in countertransference in trauma treatment of sexually abused children. The purpose of this article is to explore whether countertransference is (...) a useful therapeutic tool, or a hindrance in the treatment of sexually abused children. A qualitative paradigm, particularly interpretative phenomenology, was employed in this research to make meaning of the therapists’ experiences. The analysis of the results revealed the following five main themes that were supported by 18 superordinate themes. These themes reveal that therapists treating sexually abused children experience a myriad of feelings, including a) feeling emotionally overwhelmed, b) anger toward perpetrators and the need to protect and rescue their patients, c) the importance of social support and self-healing, d) feelings of empathy and identification with the client, and e) erotic countertransference. These findings reveal two contradictory findings. Firstly, they tell of variable utilisation of countertransference among participants and, secondly, they highlight a lack of application of countertransference in the treatment of sexually abused children. The implications of the current study are that there is a need to both highlight the importance of countertransference as a therapeutic tool and to incorporate it in the treatment of sexually abused children. (shrink)

Cloning Trevor, a story about therapeutic cloning research, appeared in the June issue of The Atlantic Monthly. The story gives a human face to the people whom therapeutic cloning could benefit. It presents an argument for government funding and it puts the usual calls for a moratorium on embryonic stem cell research to allow for more debate, in a less favourable light. The story also highlights some problems with ethical oversight.

The aim of this paper is to discuss monastic paideia in the context of providing shelter for ASD individuals in the High Middle Ages. Firstly, we will canvas the historical and conceptual shift from Ancient Greek paideitic ideas to their Christian counterparts. Then, by drawing on the recent literature in the history of medicine that traces the signs and symptoms of autism spectrum disorder (ASD) in Hildegard of Bingen, a German abbess in the 12th century, we will turn to her (...) invented language Lingua Ignota as a source of both her diagnosis and a manner of dealing with her disability. This, in turn, could be further advanced by identifying monasteries as therapeutic loci for neuroatypical individuals who had trouble finding their place within the arid and somewhat monochromatic medieval society. (shrink)

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of ‘misunderstandings’ that research participants may have. In this paper, we describe a new concept—therapeutic appropriation. Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an (...) opportunity to enhance patients' clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them. (shrink)

The few people familiar with the pseudo-Platonic dialogue Axiochus generally have a low opinion of it. It's easy to see why: the dialogue is a mish-mash of Platonic, Epicurean and Cynic arguments against the fear of death, seemingly tossed together with no regard whatsoever for their consistency. As Furley notes, the Axiochus appears to be horribly confused. Whereas in the Apology Socrates argues that death is either annihilation or a relocation of the soul, and is a blessing either way, "the (...) Socrates of the Axiochus wants to have it both ways": death is both annihilation and a release of the soul from the body into a better realm. This may be used to construct a valid argument for the conclusion that death is not evil, but at the expense of having a contradiction as one of its premises. But D. S. Hutchinson has recently proposed that these inconsistencies shouldn't surprise us if we view the Axiochus as "an unconventional version of a very conventional genre--the consolation letter." In this paper I expand on Hutchinson's brief suggestion and argue that the Axiochus can be rehabilitated by paying attention to its genre. Although the Axiochus does display many similarities to the consolation letter, the shift from letter to dialogue does--pace Hutchinson--significantly affect what's going on. Within the dialogue, Socrates behaves toward Axiochus in a way similar to the way the author of a consolation letter behaves towards the letter's reader: he is willing to use inconsistent arguments, borrowed from any source, in order to soothe the patient. However, in depicting this type of consolatory relationship between Socrates and Axiochus, the dialogue itself is not aiming at consoling its readers. Instead, it should be seen as displaying for the reader's consideration a certain type of consolatory argumentative practice. -/- Socrates notes that Axiochus is "very much in need of consolation" (365a), and he uses any means necessary to accomplish this task. Socrates exhibits many ways in which he is willing to sacrifice argumentative hygiene for the sake of therapeutic effectiveness. These include: -/- * Use of arguments with inconsistent premises, presented in propria persona. * Appeals to emotion * Tailoring arguments to the audience. * Presenting invalid arguments so as to induce unjustified but comforting beliefs. * Evasion. In these respects, I think that Socrates' argumentative practice is best compared to PH III 280-1, where Sextus Empiricus says that the skeptic will deliberately use logically weak arguments as long as they work. Dorothy Tarrant claims that what links the Socrates of the Axiochus to Socrates as he appears elsewhere in the Platonic corpus is his evident care for the welfare of his interlocutor's psyche. But this concern takes a quite different form in the Axiochus than it usually does. As with Sextus, psychic therapy in the Axiochus involves relief from pain. The primary difference between them is that Socrates, unlike Sextus, is not aiming at producing epochê in his patient. (shrink)

The British Parliament legalized therapeutic cloning in December 2000 despite opposition from the European Union. The watershed event in Parliament's move was the active and unprecedented government support for the generation and destruction of human embryonic life merely as a means of medical advancement. This article contends that the utilitarian analysis of this procedure is necessary to identify the real world risks of therapeutic cloning but insufficient to identify the breach of defensible ethical limits that this procedure represents. (...) A value-oriented approach to Kantian ethics demonstrates that the utilitarian endorsement of therapeutic cloning entails a contradiction of the necessity of human vulnerability and a faulty valuation of the human embryo. The concern is that a narrow utilitarian focus ultimately commodifies human embryonic life and preferences outcomes as the sole determinant of moral value. (shrink)

In his article "How Certain Boundaries and Ethics Diminish Therapeutic Effectiveness", Lazarus asserts that many clinicians are adhering to strict therapeutic boundaries and ethics in a fear-driven effort to avoid unwarranted malpractice claims. Although I agree that maintenance of conventional therapeutic boundaries is apt to minimize malpractice claims in most cases, I believe that is because such boundaries are critical to protect patients' welfare and thereby promote effective treatment. My reasoning, discussed next, revolves around the following premises: (...) 1. For many, if not most, types of patient problems and patient populations, boundaries and the personal meaning of the therapeutic boundaries are an arena in which critical emotional issues are manifested and worked through. 2. Clear, consistent boundaries provide a structure and safety for many patients that is a curative factor in itself. 3. Patients' reactions to alterations in usual therapeutic boundaries are often unpredictable ahead of time (even if requested by the patient) and typically complex, ambivalent, and heavily colored by transferential meaning. 4. Because alterations in therapeutic boundaries typically add a new therapist role or activity that involves potential gratification of personal needs of the therapist, objectivity in evaluating such a change may be compromised by the inherent self-interest. 5. Consistent, clear boundaries need have no impact on therapist warmth and empathy. (shrink)

(2002). Therapeutic Beneficence and Patient Recruitment in Randomized Controlled Clinical Trials. The American Journal of Bioethics: Vol. 2, No. 2, pp. 35-36.

Psychotherapy helps one enact ideas about a good life, and therapists practice orientations rooted in their chosen approach. A 'good life' can therefore mean different things depending on the therapy. Building on the philosophy of Charles Taylor, Smith examines the link between therapy, ethics and the root of therapeutic views in comparison to modern, Western ideas about 'living well'. This is one of two complementary volumes. This volume builds on the last to explore what it means to engage the (...) different ethics of different therapies by offering a deeper explication of therapeutic ethics. Utilizing Taylor's work on practical reasoning, Smith explores topics like the nature of the ethical argument, the role of ethical intuitions and the value of framing ethical debate as ongoing dialogue. He applies this to therapeutics ethics to show how vital it is to consider the ethical proposals that are present in current theories and practices in order to understand the psychotherapies. A key text for upper level undergraduate, postgraduate students and professionals in the field of psychotherapy, psychoanalysis, theoretical psychology and philosophy of the mind. (shrink)

In their paper, “Conversational Artificial Intelligence in Psychotherapy: A New Therapeutic Tool or Agent?” Sedlakova and Trachsel (2023) claim that therapeutic insights and therapeutic changes are...

Abortion is forbidden under normal circumstances by nearly all the major world religions. Traditionally, abortion was not deemed permissible by Muslim scholars. Shiite scholars considered it forbidden after implantation of the fertilised ovum. However, Sunni scholars have held various opinions on the matter, but all agreed that after 4 months gestation abortion was not permitted. In addition, classical Islamic scholarship had only considered threats to maternal health as a reason for therapeutic abortion. Recently, scholars have begun to consider the (...) effect of severe fetal deformities on the mother, the families and society. This has led some scholars to reconsider the prohibition on abortion in limited circumstances. This article reviews the Islamic basis for the prohibition of abortion and the reasons for its justification. Contemporary rulings from leading Shiite scholars and from the Sunni school of thought are presented and reviewed. The status of abortion in Muslim countries is reviewed, with special emphasis on the therapeutic abortion law passed by the Iranian Parliament in 2003. This law approved therapeutic abortion before 16 weeks of gestation under limited circumstances, including medical conditions related to fetal and maternal health. Recent measures in Iran provide an opportunity for the Muslim scholars in other countries to review their traditional stance on abortion. (shrink)

Despite the belief that metaphors are thought to be powerful persuasive devices, little empirical evidence exists to support this claim. A first step in examining the persuasive impact of metaphors is to measure recall and production variables concerning the persuasive message. This study examined recollections regarding the Iran-Contra hearings among honors introductory psychology students. Recall of the hearings appeared heavily influenced by externally imposed (i.e., media, politicians) metaphors. Moreover, metaphors used typically expressed an attitude about the Iran-Contra affair, particularly about (...) Lieutenant Colonel Oliver North's involvement. (shrink)

My essay argues that neoliberal forms of government emerged through the shifting political trajectory of the therapeutic ethos in the postwar period in Anglo-American societies. In the postwar era, the therapeutic ethos attracted the attention of conservative cultural critics who described it as a destructive force on communal obligation. Initially, the therapeutic ethos appeared to align naturally with New Left ideas of democratization in the workplace and private sphere. However, I argue that the New Right was subsequently (...) able to sever the therapeutic ethos from its alignment with social democratization by imbuing it with an alternative set of meanings centered on the ideas of market freedom and the entrepreneur. The result was the construction of the new, neoliberal forms of power, which, I argue, take the form of the management of subjectivity. Finally, I outline the two major social pathologies of the neoliberal era, namely, the consequences of its contractualized notion of citizenship and the explosion of social inequality, both of which are traceable to the influence of therapeutic notions of the self. (shrink)