http://www.peh-med.com The latest research articles published by Philosophy, Ethics, and Humanities in Medicine 2012-01-17T00:00:00Z Background: Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to various stakeholders involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context.Methods and resultsWe conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups.The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Conclusion: Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders. http://www.peh-med.com/content/7/1/7 Geoffrey Lairumbi Michael Parker Raymond Fitzpatrick Michael English Philosophy, Ethics, and Humanities in Medicine 2012, null:7 2012-01-17T00:00:00Z doi:10.1186/1747-5341-7-7 /content/figures/1747-5341-7-7-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 7 2012-01-17T00:00:00Z XML IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness. Results: First person accounts of psychiatric diagnosis and mental health care (shown here to represent 'counter stories' to the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities. Conclusion: To honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. http://www.peh-med.com/content/7/1/6 Jennifer Radden Philosophy, Ethics, and Humanities in Medicine 2012, null:6 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-6 /content/figures/1747-5341-7-6-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 6 2012-01-13T00:00:00Z PDF The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. http://www.peh-med.com/content/7/1/5 Dan Stein Philosophy, Ethics, and Humanities in Medicine 2012, null:5 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-5 /content/figures/1747-5341-7-5-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 5 2012-01-13T00:00:00Z PDF We compare astronomers' removal of Pluto from the listing of planets and psychiatrists' removal of homosexuality from the listing of mental disorders. Although the political maneuverings that emerged in both controversies are less than scientifically ideal, we argue that competition for "scientific authority" among competing groups is a normal part of scientific progress. In both cases, a complicated relationship between abstract constructs and evidence made the classification problem thorny. http://www.peh-med.com/content/7/1/4 Peter Zachar Kenneth Kendler Philosophy, Ethics, and Humanities in Medicine 2012, null:4 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-4 /content/figures/1747-5341-7-4-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 4 2012-01-13T00:00:00Z XML In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. http://www.peh-med.com/content/7/1/3 James Phillips Allen Frances Michael Cerullo John Chardavoyne Hannah Decker Michael First Nassir Ghaemi Gary Greenberg Andrew Hinderliter Warren Kinghorn Steven LoBello Elliott Martin Aaron Mishara Joel Paris Joseph Pierre Ronald Pies Harold Pincus Douglas Porter Claire Pouncey Michael Schwartz Thomas Szasz Jerome Wakefield G Scott Waterman Owen Whooley Peter Zachar Philosophy, Ethics, and Humanities in Medicine 2012, null:3 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-3 /content/figures/1747-5341-7-3-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 3 2012-01-13T00:00:00Z PDF The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria. http://www.peh-med.com/content/7/1/2 Shadia Kawa James Giordano Philosophy, Ethics, and Humanities in Medicine 2012, null:2 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-2 /content/figures/1747-5341-7-2-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 2 2012-01-13T00:00:00Z XML This Editorial introduces the thematic series on 'Toward a New Psychiatry: Philosophical and Ethical Issues in Classification, Diagnosis and Care' http://www.biomedcentral.com/series/newpsychiatry. http://www.peh-med.com/content/7/1/1 Sabina Alam Jigisha Patel James Giordano Philosophy, Ethics, and Humanities in Medicine 2012, null:1 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-1 Psychiatry moving forward In response to the forthcoming release of the DSM-5, James Giordano and colleagues discuss the movement towards a new psychiatry resulting from influences of economic and socio-cultural forces and advances in diagnostic techniques and neurotechnology. /content/figures/1747-5341-7-1-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 1 2012-01-13T00:00:00Z XML Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD. http://www.peh-med.com/content/6/1/17 Ari Joffe Joe Carcillo Natalie Anton Allan deCaen Yong Han Michael Bell Frank Maffei John Sullivan James Thomas Gonzalo Garcia-Guerra Philosophy, Ethics, and Humanities in Medicine 2011, null:17 2011-12-29T00:00:00Z doi:10.1186/1747-5341-6-17 /content/figures/1747-5341-6-17-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 17 2011-12-29T00:00:00Z PDF Bernard Lonergan's cognitive theory challenges us to raise questions about both the cognitive process through which obesity is perceived as a behavior change issue and the objectivity of such a moral judgment. This theory provides the theoretical tools to affirm that anti-fat discrimination, in the United States of America and in many industrialized countries, is the result of both a group bias that resists insights into the good of other groups and a general bias of anti-intellectualism that tends to set common sense against insights that require any thorough scientific analyses. While general bias diverts the public's attention away from the true aetiology of obesity, group bias sustains an anti-fat culture that subtly legitimates discriminatory practices and policies against obese people. Even though designing anti-discrimination laws seem to be a reasonable way of protecting obese and overweight individuals from discriminatio, obesity bias can be best addressed by reframing the obesity debate from an environmental perspective from which tools and strategies to address both the social and individual determinants of obesity can be developed. Attention should not be concentrated on individuals' behaviour as it is related to lifestyle choices, without giving due consideration to the all-encompassing constraining factors which challenge the social and rational blindness of obesity bias. http://www.peh-med.com/content/6/1/16 Jacquineau Azetsop Tisha Joy Philosophy, Ethics, and Humanities in Medicine 2011, null:16 2011-12-16T00:00:00Z doi:10.1186/1747-5341-6-16 /content/figures/1747-5341-6-16-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 16 2011-12-16T00:00:00Z PDF Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories.These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed.Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment. http://www.peh-med.com/content/6/1/15 Christine Czoli Michael Silva Randi Zlotnik Shaul Lori Agincourt-Canning Christy Simpson Katherine Boydell Natalie Rashkovan Sharon Vanin Philosophy, Ethics, and Humanities in Medicine 2011, null:15 2011-10-05T00:00:00Z doi:10.1186/1747-5341-6-15 /content/figures/1747-5341-6-15-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 15 2011-10-05T00:00:00Z XML