Treatment and Understanding in Psychiatry

Understanding is a fundamental concept in medical ethics. I want to discuss two contrasting senses in which medical treatments require understanding on behalf of the patient. The first of these is very familiar, and much discussed. The second is less so. Continue reading

Guest Post: Should the army abandon their zero-tolerance policy on substance use?

Written by Anke Snoek

Macquarie University

In the UK around 500 soldiers each year get fired because they fail drug-testing. The substances they use are mainly recreational drugs like cannabis, XTC, and cocaine. Some call this a waste of resources, since new soldiers have to be recruited and trained, and call for a revision of the zero tolerance policy on substance use in the army.

This policy stems from the Vietnam war. During the First and Second World War, it was almost considered cruel to deny soldiers alcohol. The use of alcohol was seen as a necessary coping mechanism for soldiers facing the horrors of the battlefield. The public opinion on substance use by soldiers changed radically during the Vietnam War. Influenced by the anti-war movement, the newspapers then were dominated by stories of how stoned soldiers fired at their own people, and how the Vietnamese sold opioids to the soldiers to make them less capable of doing their jobs. Although Robins (1974) provided evidence that the soldiers used the opioids in a relatively safe way, and that they were enhancing rather than impairing the soldiers’ capacities, the public opinion on unregulated drug use in the army was irrevocably changed. Continue reading

Mandatory submission of patient information about FGM: a pointless, damaging, discriminatory mess

Brenda Kelly and Charles Foster

Female Genital Mutilation (‘FGM’) is a term covering various procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, 2012). It can be associated with immediate and long-term physical and psychological health problems. FGM is prevalent in Africa, Middle East and South East Asia as well as within diaspora communities from these countries

The Government, keenly aware of the political capital in FGM, has come down hard. The Serious Crime Act 2015 makes it mandatory to report to the police cases of FGM in girls under the age of 18. While we have some issues with that requirement, it is at least concordant with the general law of child protection.

What is of more concern is the requirement, introduced by the cowardly device of a Ministerial Direction and after the most cursory consultation (in which the GMC and the RCOG hardly covered themselves in glory), by which healthcare professionals, from October 2015, are legally obliged to submit patient-identifiable information to the Department of Health (‘DOH’) on every female patient with FGM who presents for whatever reason, through the Enhanced Dataset Collection (EDC). The majority of these women will have undergone FGM in their country of origin prior to coming to the UK. Continue reading

Guest Post: The food environment, obesity, and primary targets of intervention

Written By Johanna Ahola-Launonen

University of Helsinki

Chronic diseases, their origins, and issues of responsibility are a prevalent topic in current health care ethics and public discussion; and obesity is among one of the most discussed themes. Usually the public discussion has a tendency to assume that when information about health lifestyle choices exist, the individual should be able to make those choices. However, studies increasingly pay attention to the concept of food environment[1] and its huge influence. If obesity really is that serious an issue to public health, health care costs, and economy as many suggest, focus should be directed to the alteration of food environment instead of having the individual as the primary target of intervention.   Continue reading

Guest Post: Bullying in Medicine

Written by Christopher Chew

Monash University

Today, the Royal Australasian College of Surgeons (RACS), the peak representative organization for the surgical profession in Australia, released the results of the Expert Advisory Group convened to investigate allegations of bullying, harassment, and sexual assault earlier this year.

Shockingly, of nearly half its members  who responded to a survey, including trainees and full members (fellows), a full 49 percent reported that they had been subjected to bullying, discrimination, or sexual harassment. The burden fell disproportionately on junior, female, and minority surgeons, with senior surgeons and consultants being reported as the main source of these issues. Continue reading

Guest Post: Pervitin instead of coffee? Change in attitudes to cognitive enhancement in the 50’s and 60’s in Brazil  


Written by Marcelo de Araujo

State University of Rio de Janeiro

CNPq – The Brazilian National Council for Scientific and Technological Development

How does our attitude to drugs in general shape our reaction to “smart drugs” in particular? Ruairidh Battleday and Anna-Katharine Brem have recently published a systematic review of 24 studies on the effect of modafinil on healthy individuals. They concluded that “modafinil may well deserve the title of the first well-validated pharmaceutical ‘nootropic’ agent.”[1] This publication has rekindled the debate on the ethics of “smart drugs”. Of course further studies are necessary for a better assessment of the safety and efficacy of modafinil. But if modafinil, or some other drug, proves safe and effective in the future, are there reasons to oppose its widespread use in society?

Continue reading

Is this really me? Parasites and other humans’ cells in our brains change our psychology

Many people are suspicious about being manipulated in their emotions, thoughts or behaviour by external influences, may those be drugs or advertising. However, it seems that – unbeknown to most of us – within our own bodies exist a considerable number of foreign entities. These entities can change our psychology to a surprisingly large degree. And they pursue their own interests – which do not necessarily coincide with ours.

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Is the NHS surcharge just?

Not long ago the UK implemented an NHS surcharge – an extra fee that non-EEA nationals (Australia and New Zealand are also exempt) applying for leave to remain in the UK must pay. It costs £200 per year, and must be paid up front. So, for example, if you are applying for a work visa for 3 years, and you have a family of three, you must pay £1800 to cover the surcharge for you and your family (on top of other visa costs).

It is difficult to find much public discussion in the UK regarding this surcharge, outside of a few articles that recently noted that the surcharge is unlikely to do what we were told it would do – namely, benefit the NHS. (See here)

Is the surcharge a just policy? Continue reading



Written by Darlei Dall’Agnol[1]

Universidade Federal de Santa Catarina

As we humans find ways of enhancing our physical, intellectual, emotional and other capabilities and, as a result, our lifespan expands, caring for the elderly becomes more challenging and complex too. We may postpone aging, but perhaps not forever and serious care will be needed at some point. Now, recent figures show that the number of carers aged 85 and over has risen in England by 128% in the last decade and is around 87.000.[2] Half of these carers work for 50 hours or more each week. Most are compromising their own well-being showing that we must deal with the problem in a different way to avoid aggravating it. These individuals should be cared for and not be the ones caring. An aging population brings greater burdens for the health care system raising many issues about fairness and justice in distributing resources. In countries like Japan, with 25% of the population over 65,[3] caring is even becoming a social problem and some companies are turning to robots.

Pepper “a robot with a heart” will be sold to care for the elderly and children. Other examples include: Wakamaru a “companion robot” designed to co-inhabit with humans (see figure below); Paro a fur-covered robotic seal developed by AIST that responds to petting; Sony’s AIBO robotic dog and NeCORO robotic cat covered in synthetic fur used for therapeutic purposes; Secom My Spoon an automatic feeding robot; Sanyo robot for monitoring, delivering messages, and reminding about medicine and other devices to help on the problem of caring for the elderly. In continental Europe, there are a few robots in experimental tests as caregivers too. But are robots the best solution for caring for the elderly? Continue reading

Anorexia Nervosa and Deep Brain Stimulation: Philosophical Analysis of Potential Mechanisms

By Hannah Maslen, Jonathan Pugh and Julian Savulescu


According to the NHS, the number of hospital admissions across the UK for teenagers with eating disorders has nearly doubled in the last three years. In a previous post, we discussed some ethical issues relating to the use of deep brain stimulation (DBS) to treat anorexia nervosa (AN). Although the trials of this potential treatment are still in very early, investigational stages (and may not necessarily become an approved treatment), the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this post, we show how different possible mechanisms of intervention raise different questions for philosophers to address. The prospect of intervening directly in the brain prompts exploration of the relationships between a patient’s various mental phenomena, autonomy and identity. Continue reading