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Human gene therapy: scientific and ethical considerations.

The term 'gene therapy' encompasses at least four types of application of genetic engineering for the insertion of genes into humans. The scientific requirements and the ethical issues associated with each type are discussed. Somatic cell gene therapy is technically the simplest and ethically the least controversial. The first clinical trials will probably be undertaken within the next year. Germ line gene therapy will require major advances in our present knowledge and it raises ethical issues that are now being debated. In order to provide guidelines for determining when germ line gene thera

What Is Precision Psychotherapy?

Precision medicine impacts virtually all medical specializations, including psychiatry. Although precision psychiatry, in general, is a flourishing area of research and debate, psychotherapy as one pillar of psychiatry receives little attention. Theoretical discussions about precision psychotherapy are rare; research on precision in psychotherapy is just evolving. In this paper, we provide a conceptualization of precision psychotherapy providing a common idea of what should be understood as precision in the context of psychotherapy and what kind of psychotherapy research is considered to contr

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… Philosophy, Ethics, and Humanities in Medicine 15 ( 1 ): 11 . 10.1186/s13010-020-00095-2 PMC7672902 33203434 Adam G. , Rampášek L. , Safikhani Z. , Smirnov P. , Haibe-Kains B. , Goldenberg A. 2020 . Machine learning approaches to drug response prediction: Challenges and recent progress . … Philosophy and the Mind Sciences 4 ( 6 ): 1 – 38 . Kind A. 2025 . How Does the Psychiatrist Know? On the Epistemology of Psychiatric Diagnostic Reasoning . Bielefeld, Germany : Elanders Waiblingen . Köhne A. , Van Os J. 2021 . …

Clinical Ethics in Name Only? The Case for Moral Realism at the Bedside.

As Clinical Ethics Consultation (CEC) becomes more institutionalized, concerns about its legitimacy and efficacy have grown. We defend a realist orientation, according to which CEC has normative force only if its recommendations answer to stance-independent reasons, not to individual preferences and institutional policies. Public justification can and should proceed through familiar means (e.g., shared mid-level norms and transparent procedures) so that stakeholders can scrutinize the reasoning. We show how neutrality, admirable as a procedural virtue, hollows CEC when treated as a master idea

Conscience, Conflict, and Health Care: A Critical Examination of the Conflict-of-Interest Argument against Conscientious Objection.

I critically examine a conflict-of-interest argument against conscientious objection in health care. This argument claims that conscientious objection is analogous to conflict of interest in which objecting professionals place their personal interest above patients' health, which violates the healthcare professional's primary ethical obligation. The argument concludes that conscientious objection in health care is impermissible. I argue that this argument proceeds from false or dubious premises. First, it categorizes conscientious objection with conflict of interest. I argue that conscientious

Understanding in conditions of neutrality: a closer look at its objects.

Studies in vitro have shown that phosphorylated translation initiation factor 2 alpha (TIF 2 alpha) may have several functions, including regulation of protein synthesis, control of cell death and procurement of resistance to oxidative stress in nerve cells. These properties may have implications in certain human neurodegenerative diseases, such as Alzheimer's disease (AD) and Creutzfeldt-Jakob's disease (CJD), in which oxidative stress appears to be involved in the process of neurodegeneration and neurone death. Single and double-labelling immunohistochemistry to phosphorylated TIF 2 alpha, p

Phenomenological Interview and Gender Dysphoria: A Third Pathway for Diagnosis and Treatment.

Gender dysphoria (GD) is marked by an incongruence between a person's biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called "wait-and-see" approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a "third pathway" for the diagnosis and treatment of GD in youths. T

Inconsistency between the Circulatory and the Brain Criteria of Death in the Uniform Determination of Death Act.

The Uniform Determination of Death Act (UDDA) provides that "an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead." We show that the UDDA contains two conflicting interpretations of the phrase "cessation of functions." By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the other, what matters is the cessation of both sponta

The Balanced View of the Value of Conscience.

On the mainstream view, consciences are valuable because they promote moral unity. However, conscience, so defined, will systematically prevent moral growth that threatens unity, even when unity has formed around oppressive moral values. This motivates Carolyn McLeod's alternative 'Dynamic View' whereby consciences are valuable to the extent that they are dynamic. Consciences are dynamic when they interact with our best moral judgements to shape or 'retool' the moral values underpinning conscience, sometimes at an initial cost to unity. We modify and extend McLeod's account in two ways: (1) We

Embryo Loss and Moral Status.

There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos have the same moral status as infants, children, and adults. However, critics claim that the frequency of pregnancy loss/miscarriage/spontaneous abortion shows a moral inconsistency in this view. One line of criticism is that those who know the facts about pregnancy loss and nevertheless attempt to conceive children are willing to sacrifice embryos lost for the healthy children they ultimately have. I respond to this criticism

Miscarriage, Abortion, and Disease.

The frequency of death from miscarriage is very high, greater than the number of deaths from induced abortion or major diseases. Berg (2017 , Philosophical Studies 174:1217-26) argues that, given this, those who contend that personhood begins at conception (PAC) are obliged to reorient their resources accordingly-towards stopping miscarriage, in preference to stopping abortion or diseases. This argument depends on there being a basic moral similarity between these deaths. I argue that, for those that hold to PAC, there are good reasons to think that there is no such similarity. There is a mora

Moral Injury, Moral Identity, and "Dirty Hands" in War Fighting and Police Work.

In this article, I undertake three main tasks. First, I argue that, contrary to the standard view, moral injury is not a species of PTSD (post-traumatic stress disorder) but rather, on the most coherent conception of moral injury, PTSD is (in effect) a species of moral injury. In doing so, I make use of the notion of caring deeply about something or someone worthy of being cared deeply about. Second, I consider so-called "dirty hands" actions in police work and in war, and distinguish these from the morally legitimate, but harmful, actions of police officers and of war fighters, such as the mo

Disability and the Complexity of Choice in the Ethics of Abortion and Voluntary Euthanasia.

In the polarized debates about abortion and voluntary euthanasia, disability advocates, who normally align with left-wing social forces, have tended to side with conservative and religious voices in expressing concerns about the impact of technological and sociopolitical developments on disabled futures. This paper draws on the social model of disability and the virtue ethics tradition to explain the alignment between the religious and disability perspectives, and the theory of transformative choice to highlight the limits and biases of the pro-choice logic. Yet, it also recognizes the inheren

Family-Based Consent for Organ Donation: Benevolence and Reconstructionist Confucianism.

This paper explores organ donation through the perspective of Reconstructionist Confucianism. I argue that for organ donation in China to be morally permissible, public policy must conform to the norms of Confucian benevolence. Reconstructionist Confucianism appreciates benevolence as an objectively important feature of morality deeply connected to moral rules governing propriety, integrity, righteousness, and human freedom. Here, benevolence involves sincere affection for another as an intrinsic good, rather than as a means to achieve other purposes. It requires developing self-restraint and

Criminalizing Health-Related Behaviors Dangerous to Others? Disease Transmission, Transmission-Facilitation, and the Importance of Trust.

BACKGROUND: The DYX5 locus for developmental dyslexia was mapped to chromosome 3 by linkage study of a large Finnish family, and later, roundabout guidance receptor 1 (ROBO1) was implicated as a candidate gene at DYX5 with suppressed expression from the segregating rare haplotype. A functional magnetoencephalographic study of several family members revealed abnormal auditory processing of interaural interaction, supporting a defect in midline crossing of auditory pathways. In the current study, we have characterized genetic variation in the broad ROBO1 gene region in the DYX5-linked family, ai

Transplanting hearts after death measured by cardiac criteria: the challenge to the dead donor rule.

The current definition of death used for donation after cardiac death relies on a determination of the irreversible cessation of the cardiac function. Although this criterion can be compatible with transplantation of most organs, it is not compatible with heart transplantation since heart transplants by definition involve the resuscitation of the supposedly "irreversibly" stopped heart. Subsequently, the definition of "irreversible" has been altered so as to permit heart transplantation in some circumstances, but this is unsatisfactory. There are three available strategies for solving this "ir

The ethics of creating and responding to doubts about death criteria.

Expressing doubts about death criteria can serve healthy purposes, but can also cause a number of harms, including decreased organ donation rates and distress for donor families and health care staff. This paper explores the various causes of doubts about death criteria-including religious beliefs, misinformation, mistrust, and intellectual questions-and recommends responses to each of these. Some recommended responses are relatively simple and noncontroversial, such as providing accurate information. However, other responses would require significant changes to the way we currently do busines

Constructing the death elephant: a synthetic paradigm shift for the definition, criteria, and tests for death.

In debates about criteria for human death, several camps have emerged, the main two focusing on either loss of the "organism as a whole" (the mainstream view) or loss of consciousness or "personhood." Controversies also rage over the proper definition of "irreversible" in criteria for death. The situation is reminiscent of the proverbial blind men palpating an elephant; each describes the creature according to the part he can touch. Similarly, each camp grasps some aspect of the complex reality of death. The personhood camp, in contrast to the mainstream "organism" camp, recognizes that a huma

A matter of respect: a defense of the dead donor rule and of a "whole-brain" criterion for determination of death.

Many accounts of the historical development of neurological criteria for determination of death insufficiently distinguish between two strands of interpretation advanced by advocates of a "whole-brain" criterion. One strand focuses on the brain as the organ of integration. Another provides a far more complex and nuanced account, both of death and of a policy on the determination of death. Current criticisms of the whole-brain criterion are effective in refuting the first interpretation, but not the second, which is advanced in the 2008 President's Council report on the determination of death.

Using the Best Interests Standard to decide whether to test children for untreatable, late-onset genetic diseases.

A new analysis of the Best Interests Standard is given and applied to the controversy about testing children for untreatable, severe late-onset genetic diseases, such as Huntington's disease or Alzheimer's disease. A professional consensus recommends against such predictive testing, because it is not in children's best interest. Critics disagree. The Best Interests Standard can be a powerful way to resolve such disputes. This paper begins by analyzing its meaning into three necessary and jointly sufficient conditions showing it: 1. is an "umbrella" standard, used differently in different conte