{"title":"Can We Justify Military Enhancements? Some Yes, Most No.","authors":"Blake Hereth, Nicholas Evans","doi":"10.1017/S0963180122000421","DOIUrl":"https://doi.org/10.1017/S0963180122000421","url":null,"abstract":"<p><p>The United States Department of Defense has, for at least 20 years, held the stated intention to enhance active military personnel (\"warfighters\"). This intention has become more acute in the face of dropping recruitment, an aging fighting force, and emerging strategic challenges. However, developing and testing enhancements is clouded by the ethically contested status of enhancements, the long history of abuse by military medical researchers, and new legislation in the guise of \"health security\" that has enabled the Department of Defense to apply medical interventions without appropriate oversight. This paper aims to reconcile existing legal and regulatory frameworks on military biomedical research with ethical concerns about military enhancements. In what follows, we first outline one justification for military enhancements. The authors then briefly address existing definitional issues over what constitutes enhancement before addressing existing research ethics regulations governing military biomedical research. Next, they argue that two common justifications for rapid military innovation in science and technology, including enhancement, fail. These justifications are (a) to satisfy a compelling military need and (b) strategic dominance. The authors then turn to an objection that turns on the idea that we need not have these justifications if warfighters are willing to adopt enhancement, and argue that laissez-faire approaches to enhancement fail in the context of the military due to pressing and historically significant concerns about coercion and exploitation. The paper concludes with what is referred to as the \"least-worst\" justification: Given the rise of untested enhancements in civilian and military life, we have good reason to validate potential enhancements even if they do not satisfy reasons (a) or (b) above.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"557-569"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda Kim, Michael Hsu, Amanda Koire, Matthew L Baum
{"title":"Incidental Findings from Deep Phenotyping Research in Psychiatry: Legal and Ethical Considerations.","authors":"Amanda Kim, Michael Hsu, Amanda Koire, Matthew L Baum","doi":"10.1017/S0963180122000135","DOIUrl":"https://doi.org/10.1017/S0963180122000135","url":null,"abstract":"<p><p>Substantial advancement in the diagnosis and treatment of psychiatric disorders may come from assembling diverse data streams from clinical notes, neuroimaging, genetics, and real-time digital footprints from smartphones and wearable devices. This is called \"deep phenotyping\" and often involves machine learning. We argue that incidental findings arising in deep phenotyping research have certain special, morally and legally salient features: They are specific, actionable, numerous, and probabilistic. We consider ethical and legal implications of these features and propose a practical ethics strategy for managing them.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"482-486"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40484344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Evidence for the Pharmaceutical Strengthening of Attachment: What, <i>Precisely</i>, Would Love Drugs Enhance?","authors":"Peter N Herissone-Kelly","doi":"10.1017/S0963180122000196","DOIUrl":"https://doi.org/10.1017/S0963180122000196","url":null,"abstract":"<p><p>In recent decades, scientists have begun to identify the brain processes and neurochemicals associated with the different stages of love, including the all-important stage of attachment. Experimental findings-readily seized upon by those bioethicists who want to urge that we sometimes have good reason pharmaceutically to enhance flagging relationships-are presented as demonstrating that attachment is regulated and strengthened by the neuropeptides oxytocin and vasopressin. I shall argue, however, that often what the experimental data in fact show is only that exogenous administration of such chemicals can control and intensify the trappings of attachment, not attachment itself. That this is sometimes overlooked by both scientists and ethicists, is due to attachment being miscategorised as a set of feelings or a drive, rather than as a disposition to think about, feel toward, and behave toward its object in certain distinctive ways.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"536-544"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40484347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychedelics as Standard of Care? Many Questions Remain.","authors":"Kurt Rasmussen, David E Olson","doi":"10.1017/S096318012200010X","DOIUrl":"https://doi.org/10.1017/S096318012200010X","url":null,"abstract":"the of of a","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"477-481"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40484345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mackenzie Graham, Francesca Farina, Craig W Ritchie, Brian Lawlor, Lorina Naci
{"title":"Fear of Dementia and the Obligation to Provide Aggregate Research Results to Study Participants.","authors":"Mackenzie Graham, Francesca Farina, Craig W Ritchie, Brian Lawlor, Lorina Naci","doi":"10.1017/S0963180122000408","DOIUrl":"https://doi.org/10.1017/S0963180122000408","url":null,"abstract":"<p><p>A general obligation to make aggregate research results available to participants has been widely supported in the bioethics literature. However, dementia research presents several challenges to this perspective, particularly because of the fear associated with developing dementia. The authors argue that considerations of respect for persons, beneficence, and justice fail to justify an obligation to make aggregate research results available to participants in dementia research. Nevertheless, there are positive reasons in favor of making aggregate research results available; when the decision is made to do so, it is critical that a clear strategy for communicating results is developed, including what support will be provided to participants receiving aggregate research results.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"498-505"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40484341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurolaw-A Call to Action.","authors":"David R Lawrence","doi":"10.1017/S0963180122000123","DOIUrl":"https://doi.org/10.1017/S0963180122000123","url":null,"abstract":"relevant to sentencing; predicting recidivism; distinguishing pain from malingering; verifying intent; and manipulating memories.","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"415-417"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen Rainey, Karmele Olaciregui Dague, Roger Crisp
{"title":"Brain-State Transitions, Responsibility, and Personal Identity.","authors":"Stephen Rainey, Karmele Olaciregui Dague, Roger Crisp","doi":"10.1017/S096318012100092X","DOIUrl":"https://doi.org/10.1017/S096318012100092X","url":null,"abstract":"<p><p>This article examines the emerging possibility of \"brain-state transitioning,\" in which one brain state is prompted through manipulating the dynamics of the active brain. The technique, still in its infancy, is intended to provide the basis for novel treatments for brain-based disorders. Although a detailed literature exists covering topics around brain-machine interfaces, where targets of brain-based activity include artificial limbs, hardware, and software, there is less concentration on the brain itself as a target for instrumental intervention. This article examines some of the science behind brain-state transitioning, before extending beyond current possibilities in order to explore philosophical and ethical questions about how transitions could be seen to impact on assessment of responsibility and personal identity. It concludes with some thoughts on how best to pursue this nascent approach while accounting for the philosophical and ethical issues.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"453-463"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"One Health Requires a Theory of Agency.","authors":"Benjamin Capps","doi":"10.1017/S0963180122000044","DOIUrl":"https://doi.org/10.1017/S0963180122000044","url":null,"abstract":"<p><p>One health suggests that human and animal health are comparable, but in practice, the concept aligns with the principles of public health ethics. One health ethics, as such, appears to eschew connotations of equality for the natural world. A theory of agency revises that anthropocentric assumption. This article begins with a critique of environmental dualism: the idea that human culture and nature are separate social realms, thus justifying public health as a (unifying) purpose. In response, this article argues that, first, a neuroethics of one health might equally regard humans and (some) animals, which have comparable mental states, as rational agents. Second, rational agency should ground our moral connections to nature in terms of the egalitarian interests we have (as coinhabitants) in the health of the planet. While this article makes a moderate case for interspecific rights (as the first argument asserts), neuroscience is unlikely for now to change how most public institutions regard nonhuman animals in practice. However, the second argument asserts that rational agency is also grounds for philosophical environmentalism. One health ethics, therefore, is a theory of equality and connects culture to nature, and, as such, is a separate, but coextensive approach to that of public health.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"518-529"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40484349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethical Issues Regarding Nonsubjective Psychedelics as Standard of Care.","authors":"David B Yaden, Brian D Earp, Roland R Griffiths","doi":"10.1017/S096318012200007X","DOIUrl":"https://doi.org/10.1017/S096318012200007X","url":null,"abstract":"<p><p>Evidence suggests that psychedelics bring about their therapeutic outcomes in part through the subjective or qualitative effects they engender and how the individual interprets the resulting experiences. However, psychedelics are contraindicated for individuals who have been diagnosed with certain mental illnesses, on the grounds that these subjective effects may be disturbing or otherwise counter-therapeutic. Substantial resources are therefore currently being devoted to creating psychedelic substances that produce many of the same biological changes as psychedelics, but without their characteristic subjective effects. In this article, we consider ethical issues arising from the prospect of such potential \"nonsubjective\" psychedelics. We are broadly supportive of efforts to produce such substances for both scientific and clinical reasons. However, we argue that such nonsubjective psychedelics should be reserved for those special cases in which the subjective effects of psychedelics are specifically contraindicated, whereas classic psychedelics that affect subjective experience should be considered the default and standard of care. After reviewing evidence regarding the subjective effects of psychedelics, we raise a number of ethical concerns around the prospect of withholding such typically positive, meaningful, and therapeutic experiences from most patients.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"464-471"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40473105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Animal Models in Neuropsychiatry: Do the Benefits Outweigh the Moral Costs?","authors":"Carrie Figdor","doi":"10.1017/S0963180122000147","DOIUrl":"https://doi.org/10.1017/S0963180122000147","url":null,"abstract":"<p><p>Animal models have long been used to investigate human mental disorders, including depression, anxiety, and schizophrenia. This practice is usually justified in terms of the benefits (to humans) outweighing the costs (to the animals). The author argues on utility maximization grounds that we should phase out animal models in neuropsychiatric research. The leading theories of how human minds and behavior evolved invoke sociocultural factors whose relation to nonhuman minds, societies, and behavior has not been homologized. Thus, it is not at all clear that we are gaining the epistemic or clinical benefits we want from this animal-based research.</p>","PeriodicalId":520577,"journal":{"name":"Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees","volume":" ","pages":"530-535"},"PeriodicalIF":1.8,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40484343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}