Heroin prescription involves the medical provision of heroin in the treatment of heroin addiction. Rudimentary clinical trials on that treatment modality have been carried out and others are currently underway or in development. However, it is questionable whether subjects considered for such trials are mentally competent to consent to them. The problem has not been sufficiently appreciated in ethical and clinical discussions of the topic. The challenges involved throw new light on the role of value and accountability in contemporary discussions (...) of mental competence. (shrink)

When emotions are mentioned in the literature on mental competence, it is generally because they are thought to influence competence negatively; that is, they are thought to impede or compromise the cognitive capacities that are taken to underlie competence. The purpose of the present discussion is to explore the possibility that emotions might play a more positive role in the determination of competence. Using the MacArthur Treatment Competence Study as an example, it is argued that appreciation, a central theoretical concept (...) in many contemporary approaches to competence, has important emotive components that are seldom sufficiently recognized or acknowledged. If true, this means that some leading contemporary accounts of competence need to be revised in order to make more adequate provision for the positive contribution of emotion. (shrink)

It has been argued recently that some basic emotions should be considered natural kinds. This is different from the question whether as a class emotions form a natural kind; that is, whether emotion is a natural kind. The consensus on that issue appears to be negative. I argue that this pessimism is unwarranted and that there are in fact good reasons for entertaining the hypothesis that emotion is a natural kind. I interpret this to mean that there exists a distinct (...) natural class of organisms whose behavior and development are governed by emotion. These are emoters. Two arguments for the natural kind status of emotion are considered. Both converge on the existence of emotion as a distinct natural domain governed by its own laws and regularities. There are then some reasons for being optimistic about the prospects for consilience in emotion theory. 1 The mantra 2 Griffiths on emotions as natural kinds 3 Panksepp on emotions as natural kinds 4 Emotion as a neurobiological kind 5 Emotion as a psychological kind 6 Response to the mantra 7 Unification or fragmentation? 8 Concluding remarks. (shrink)

In many Western jurisdictions, the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own health care decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This last question has to do with what is commonly called “decisional capacity,” a central concept in health care law (...) and ethics, and increasingly an independent topic of philosophical inquiry. (shrink)

The distinction between cognitive and perceptual theories of emotion is entrenched in the literature on emotion and is openly used by individual emotion theorists when classifying their own theories and those of others. In this paper, I argue that the distinction between cognitive and perceptual theories of emotion is more pernicious than it is helpful, while at the same time insisting that there are nonetheless important perceptual and cognitive factors in emotion that need to be distinguished. A general representational metatheoretical (...) framework for reconciling cognitive and perceptual theories is proposed. This is the Representational Theory of Emotion (RTE). A detailed case study of Antonio Damasio's important new contribution to emotion theory is presented in defense of the RTE. The paper is intended for readers interested in the foundations of emotion theory and cognitive science. (shrink)

In this paper I review some leading developments in the empirical theory of affect. I argue that (1) affect is a distinct perceptual representation governed system, and (2) that there are significant modular factors in affect. The paper concludes with the observation thatfeeler (affective perceptual system) may be a natural kind within cognitive science. The main purpose of the paper is to explore some hitherto unappreciated connections between the theory of affect and the computational theory of mind.

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia (...) nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals. (shrink)

In this paper I link two hitherto disconnected sets of results in the philosophy of emotions and explore their implications for the computational theory of mind. The argument of the paper is that, for just the same reasons that some computationalists have thought that cognition may be a natural kind, so the same can plausibly be argued of emotion. The core of the argument is that emotions are a representation-governed phenomenon and that the explanation of how they figure in behaviour (...) must as such be undertaken in those terms. I conclude with some interdisciplinary reflections in defence of the hypothesis that emotions might be more fundamental in the organization of behaviour than cognition; that, in effect, we may be emoters before we are cognizers . The aim of the paper is: (1) to introduce a number of promising results in philosophical and empirical emotion theory to a wider audience; and (2) to begin the task of organizing those results into a computational theoretical framework. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anorexia and the MacCAT-T Test for Mental Competence:Validity, Value, and EmotionLouis C. Charland (bio)Keywordsmental competence, decisional capacity, anorexia, value, emotionValidity of the MacCAT-THow does one scientifically verify a psychometric instrument designed to assess the mental competence of medical patients who are asked to consent to medical treatment? Aside from satisfying technical requirements like statistical reliability, results yielded by such a test must conform to at least some accepted pretheoretical (...) desiderata; for example, determinations of competence, as measured by the test, must capture a minimal core of accepted basic intuitions about what competence means and what a theory of competence is supposed to do. The concepts of "face validity" and "content validity" are both important here. Face validity "indicates that an instrument appears to test what it is supposed to and that it is a plausible method for doing so" (Portney and Watkins 2000, 82). Content validity "means that the test contains all the elements that reflect the variable being studied" (Portney and Watkins 2000, 83). An adequate instrument for measuring mental competence must at minimum satisfy both of these requirements.What Tan and her colleagues (2006) have shown is that the MacArthur Competence Assessment Tool—Treatment (MacCAT-T) test for mental competence may not be an empirically valid measure of mental competence for some cases of anorexia. The data they report show that "competence," as measured by the MacCAT-T, does not conform sufficiently well with what is wanted of a clinical medical theory of competence. More specifically, the MacCAT-T is deficient in both face and content validity. This result is extremely significant; previous challenges to the validity of the MacCAT-T have often been largely theoretical in nature. My own objection that the MacCAT is inadequate because it omits the influence of emotion is based on a combination of empirical theory (Charland 1998a) and philosophical argument (Charland 1998b). However, it is entirely theoretical in nature. So is my argument that in ignoring emotion the MacCAT misses a crucial contributing ingredient in competence, namely, value (Charland 2001, see especially 136 note 2). Tan's study provides valuable empirical evidence for the second of these challenges, which deals more specifically with value. On the one hand, the study clearly demonstrates that patients sometimes do [End Page 283] base their treatment decisions on reasons derived from values. And on the other hand, it also nicely illustrates the centrality of values—"utilities" or "preferences"—in the decision-making process generally; a basic assumption of standard decision theory for which, paradoxically, there appears to be no satisfactory counterpart in the MacCAT-T model of reasoning and decision making.Thus, values figure among the reasons that patients actually use in reasoning when they weigh the risks and benefits of proposed treatment options. The MacCAT-T must be amended to incorporate this fact if it is to be a satisfactory clinical medical tool. Without such a correction, the concept of mental competence it measures is empirically invalid. At the root of the problem is a clash of intuitions. Tan's data provide convincing evidence that some of the patients who are deemed to be mentally competent by MacCAT-T standards should not in fact be considered competent. Note that the language in which this clash is expressed—"should not in fact"—involves a combination of descriptive and prescriptive elements, reminding us that the concept of competence is dual in nature: it is both prescriptive and descriptive (Freedman 1981). These problems underscore the need for greater clarity about what pretheoretically we want a clinical theory and test of competence to capture. It is of course reasonable to say that such a test must be consistent with major tenets of the relevant case law (Appelbaum 1998). But a legally valid concept of competence of this sort is too thin and arbitrary a foundation on which to build a clinical medical theory of competence. An empirically valid theory and test of the latter sort must incorporate the role of values if it is be truly helpful in medical practice.Value and the MacCAT-TI agree with Tan and her colleagues that some notion of "pathological value" needs to be... (shrink)

The target of Hanna Pickard's very erudite and thought-provoking article is compulsion. She argues that “addiction is not a form of compulsion” and that “addictive desires are not irresistible” (Pickard 2012, 40). However, I fear that compulsion as she presents it is ultimately a metaphysical straw figure, trapped in a false metaphysical dichotomy. What is lacking is a proper attention to specific individual clinical cases, examined over time. At the same time, Pickard's discussion is extremely important because of the manner (...) in which it highlights both the merits and the perils of philosophical inquiry into the nature of addiction... (shrink)

Mental competence, or decision‐making capacity, is an important concept in law, psychiatry, and bioethics. A major problem faced in the development and implementation of standards for assessing mental competence is the issue of objectivity. The problem is that objective standards are hard to formulate and apply. The aim here is to review the limited philosophical literature on the place of value in competence in an attempt to introduce the issues to a wider audience. The thesis that the assessment of competence (...) must incorporate elements of value and rationality is defended, and some tentative suggestions offered about how this might be achieved in a clinical setting. (shrink)

As the research integrity officer at my university for two years, I handled eight allegations of plagiarism. These eight cases show that initial appearances can be mistaken, that policies for handling allegations of research misconduct cannot cover every contingency, and that many cases can be resolved collegially without resort to formal procedures.

Following a Canadian Supreme Court ruling invalidating an absolute prohibition on physician assisted dying, two reports and several commentators have recommended that the Canadian criminal law allow medical assistance in dying (MAID) for persons with a diagnosis of mental disorder. A key element in this process is that the person requesting MAID be deemed to have the ‘mental capacity’ or ‘mental competence’ to consent to that option. In this context, mental capacity and mental competence refer to ‘decision-making capacity’, which is (...) a distinct area of clinical study and research in the theory of informed consent. The purpose of this discussion is to bring several controversial but insufficiently acknowledged problems associated with decision-making capacity to the forefront of the proposed extension of MAID to persons diagnosed with mental disorders. Open-ended access to MAID by persons who suffer from mental health conditions already exists in Belgium and the Netherlands, where the issues raised here are equally relevant. In this paper, we highlight the serious limitations of relying on capacity assessments to allow access to MAID/Euthanasia. (shrink)

Purpose of review This review considers the literature on ethical and conceptual issues in eating disorders from the last 18 months. Some reference to earlier work is necessary in order to provide context for the recent findings from research that is ongoing. -/- Recent findings Empirical ethics research on anorexia nervosa includes novel ethical and conceptual findings on the role of authenticity and personal identity in individuals’ reports of their experience, as well as new evidence on the role of affective (...) states and values in decision making at later stages of the illness. Evidence points to the hypothesis that anorexia nervosa may be a distinct affective syndrome that organizes feelings and emotions in accordance with a fixed idea. -/- Summary There has been impressive progress in empirical ethics research on anorexia nervosa, with important implications for ethical and conceptual issues that surround decision-making capacity and our understanding of the illness. (shrink)

Addiction of the variety discussed in this chapter, is a condition that by its very nature compromises decision-making capacity across the decisional spectrum. The impairment is present not only at moments of withdrawal and intoxication, but at all stages of the active addictive cycle, as long as the pathological dispositions to overvalue addictive drugs remain entrenched and operative. In light of this entrenched and pervasive reorientation in pathological values, it seems reasonable to question the unilateral presumption of capacity for cases (...) of this sort. The reason is that there is an important, but restricted, sense in which the addicted individuals in question are not ‘responsible’ for their decisions regarding drug use. The high likelihood of relapse means that, as a clinical matter of fact, they are usually not accountable. At the same time, clinical experience also suggests that we should treat addicted individuals as if they are responsible because that empowerment is crucial to their recovery. In the end, there is probably only one safe course of action to take when faced with such a difficult situation. This is to suspend the unilateral global presumption of capacity and instead assess decision-making capacity on a case-by-case basis, with careful monitoring and encouragement. (shrink)

How does one scientifically verify a psychometric instrument designed to assess the mental competence of medical patients who are asked to consent to medical treatment? Aside from satisfying technical requirements like statistical reliability, results yielded by such a test must conform to at least some accepted pretheoretical desiderata; for example, determinations of competence, as measured by the test, must capture a minimal core of accepted basic intuitions about what competence means and what a theory of competence is supposed to do. (...) The concepts of “face validity” and “content validity” are both important here. Face validity “indicates that an instrument appears to test what it is supposed to and that it is a plausible method for doing so” (Portney and Watkins 2000, 82). Content validity “means that the test contains all the elements that reflect the variable being studied” (Portney and.. (shrink)

Most contemporary models and tests for mental competence do not make adequate provision for the positive influence of emotion in the determination of competence. This most likely is due to a reliance on an outdated view of emotion according to which these models are essentially noncognitive. Leading developments in modern emotion theory indicate that this noncognitive theory of emotion is no longer tenable. Emotions, in fact, are essentially representational in a manner that makes them “cognitive” in an important sense. This (...) requires a reassessment of the place of emotion in the theory of mental competence. Building on Benjamin Freedman’s “recognizable reasons” account of competence, it will be argued that (1) emotions form a class of recognizable reasons of their own, and (2) that competence to consent is a matter of practical, rather than theoretical, reasoning. Emotions, then, are an essential ingredient in mental competence, and the cognitive bias that permeates the theory of mental competence today must be rejected. (shrink)

The passions have vanished. After centuries of dominance in the ethical and scientific discourse of the West, they have been eclipsed by the emotions. To speak of the passions now is to refer to a relic of the past, the crumbling foundation of a once mighty conceptual empire that permeated all aspects of Western cultural life. Philosophical and scientific wars continue to be fought in these ruins; new encampments are built, rebels plot in the catacombs, and bold victors plant their (...) flags on the highest peaks. But it is hard to escape the conclusion that now it is the emotions which reign supreme in affective science. It is in their terms that conflicts are fought and settled. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry and its supporters. It (...) is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

To support the teaching of ethics in science and engineering, educational technologies offer a variety of functions: communication between students and instructors, production of documents, distribution of documents, archiving of class sessions, and access to remote resources. Instructors may choose to use these functions of the technologies at different levels of intensity, to support a variety of pedagogies, consistent with accepted good practices. Good pedagogical practices are illustrated in this paper with four examples of uses of educational technologies in the (...) teaching of ethics in science and engineering. Educational technologies impose costs for the purchase of hardware, licensing of software, hiring of support personnel, and training of instructors. Whether the benefits justify these costs is an unsettled question. While many researchers are studying the possible benefits of educational technologies, all instructors should assess the effectiveness of their practices. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along the way. The discussion closes (...) with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

The history and philosophy of affective terms and concepts contains important challenges for contemporary scientific accounts of emotion regulation. First, there is the problem of moral undertow. This arises because stipulating the ends of emotion regulation requires normative assumptions that ultimately derive from values and morals. Some historical precedents are considered to help explain and address this problem. Second, there is the problem of organization. This arises because multiple emotions are often organized and oriented in very particular ways over the (...) life of the individual in a manner that cannot be adequately explained using the concept of “emotion.” A modern variant of the traditional concept of passion is invoked to help address this problem. (shrink)

Building on what he believed was a new ‘medico-philosophical’ method, Philippe Pinel made a bold theoretical attempt to find a place for the passions and other affective posits in psychopathology. However, his courageous attempt to steer affectivity onto the high seas of medical science ran aground on two great reefs that still threaten the scientific status of affectivity today. Epistemologically, there is the elusive nature of the signs and symptoms of affectivity. Ethically, there is the stubborn manner in which fact (...) and value are intermingled in affectivity. Both obstacles posed insuperable difficulties for Pinel, who never really managed to extricate his affective psychopathology from the confines of the Lockean intellectual paradigm. -/- . (shrink)

The author comments on the article “The neurobiology of addiction: Implications for voluntary control of behavior,‘ by S. E. Hyman. Hyman suggests that addicted individuals have substantial impairments in cognitive control of behavior. The author states that brain and neurochemical systems are involved in addiction. He also suggests that neuroscience can link the diseased brain processes in addiction to the moral struggles of the addicts.

Many college and university courses are complemented by collaborative or cooperative activities such as role playing, team projects, or problem solving in small groups. This paper summarizes the importance of multidisciplinary collaboration in professional ethics, describes two courses (Engineering Ethics and Professional Ethics) that involved a fieldwork component where students were required to interview a group of professional who deal with an ethical problem, and articulates the pedagogical value of complementing a course using a fieldwork assignment. By integrating a fieldwork (...) assignment into philosophy courses, students are not only better able to connect classroom learning to concrete ethical problems associated with a given profession but also, since fieldwork is conducted in groups, acquire a deeper understanding of collective moral responsibility. (shrink)

Psychiatric labeling has been the subject of considerable ethical debate. Much of it has centered on issues associated with the application of psychiatric labels. In comparison, far less attention has been paid to issues associated with the removal of psychiatric labels. Ethical problems of this last sort tend to revolve around identity. Many sufferers are reticent to relinquish their iatrogenic identity in the face of official label change; some actively resist it. New forms of this resistance are taking place in (...) the private chat rooms and virtual communities of the Internet, a domain where consumer autonomy reigns supreme. Medical sociology, psychiatry, and bioethics have paid little attention to these developments. Yet these new consumer-driven initiatives actually pose considerable risks to consumers. They also present complex ethical challenges for researchers. Clinically, there is even sufficient evidence to wonder whether the Internet may be the nesting ground for a new kind of identity disturbance. The purpose of the present discussion is to survey these developments and identify potential issues and problems for future research. Taken as a whole, the entire episode suggests that we may have reached a turning point in the history of psychiatry where consumer autonomy and the Internet are now powerful new forces in the manufacture of madness. (shrink)

The question of decision-making capacity for informed consent to experimental brain surgery for severely ill anorectic patients is about as dramatic an ethical issue one can imagine. Sabine Muller and her co-authors (2015) should be commended for this extremely timely and original clinical and ethical discussion of decision-making capacity in relation to the issues raised by informed consent to such therapies. In this commentary, I elaborate on the new account of the nature of anorexia nervosa that the authors allude to (...) in order to frame their discussion. This is the hypothesis that anorexia nervosa is a passion: a view with important implications for how we think about decision-making capacity in anorexia nervosa and elsewhere. (shrink)

I am delighted that Zachar and Potter have chosen to refer to my work on the DSM-IV cluster B personality disorders in their very interesting and ambitious target article. Their suggestion that we turn to virtue ethics rather than traditional moral theory to understand the relation between moral and nonmoral factors in personality disorders is certainly original and worth pursuing. Yet, in the final instance, I am not entirely sure about the exact scope of their proposed analysis. I also worry (...) whether they may have inadvertently presented a slightly inaccurate account of my views on the cluster B personality disorders, as they seek to formulate and defend their own views, which seem to be far wider in scope. I .. (shrink)

Locke is famous for defining madness as an intellectual disorder in the realm of ideas. Numerous commentators take this to be his main and only contribution to the history of psychiatry. However, a detailed exegetical review of all the relevant textual evidence suggests that this intellectualist interpretation of Locke’s account of madness is both misleading and incomplete. Affective states of various sorts play an important role in that account and are in fact primordial in the determination of human conduct generally. (...) Locke’s legacy in this domain must therefore be revised and the intellectualist bias that dominates discussions of his views must be redressed. (shrink)

In a small course on technology and society, students participated in an extended role-play simulation for two weeks. Each student played a different adult character in a fictional community, which faces technological decisions in three scenarios set in the near future. The three scenarios involved stem cell research, nanotechnology, and privacy. Each student had an active role in two scenarios and served as an observer for the third. At the beginning, students were apprehensive, excited, and uncertain. During the first and (...) second sessions, they experienced some frustration, but by the end, they were generally satisfied with the outcomes. Over the two weeks, students changed their definitions of success: Initially they tried to convince others to agree with their positions; at the end, they felt that a consensus represented success. In their final reflective essays, students reported that the role-play experience helped them learn to understand the perspectives of others. (shrink)

Alexander Crichton (1763—1856) made significant contributions to the medical theory of the passions, yet there exists no systematic exegesis of this particular aspect of his work. The present article explores four themes in Crichton's work on the passions: (1) the role of irritability in the physiology of the passions; (2) the manner in which irritability and sensibility contribute to the valence, or polarity, of the passions; (3) the elaboration of a psychopathology of the passions that emphasizes their physiological form rather (...) than meaningful content or connections; and (4) the insistence that medical science ought to ignore ethical and other `moral' psychological and social aspects of the passions. (shrink)