ABSTRACT
There are reasons to believe that decision-making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women's decisional capacity. Decision-making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to 'understanding' alone. A systematic literature search identified a total of 20 empirical studies focused on women's decision-making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women's autonomy. To fill in the significant gap in clinical knowledge about laboring women's decision-making capacity, well-designed prospective and retrospective studies may be required.
Subject(s)
Analgesia, Epidural/ethics , Decision Making/ethics , Informed Consent/ethics , Labor Pain/drug therapy , Labor, Obstetric , Mental Competency , Personal Autonomy , Analgesia, Epidural/psychology , Analgesics/administration & dosage , Analgesics/therapeutic use , Analgesics, Opioid/administration & dosage , Anxiety/etiology , Cognition , Comprehension , Delivery, Obstetric/ethics , Emotions , Female , Humans , Informed Consent/psychology , Labor Pain/psychology , Labor, Obstetric/psychology , Pain Management/ethics , Pain Management/methods , Pregnancy , Pregnant Women/psychology , Stress, Psychological/etiologyABSTRACT
The distinction between 'passion' and 'emotion' has been largely overlooked in the history of psychiatry and the psychopathology of affectivity. A version of the distinction that has gone completely unnoticed is the one proposed by Florentine physician Vincenzo Chiarugi (1759-1820). The purpose of the present discussion is to introduce this Italian version of the distinction and to inquire into its origins.
Subject(s)
Emotions , History, 18th Century , History, 19th Century , Humans , Italy , Psychiatry/historyABSTRACT
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.
ABSTRACT
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.
Subject(s)
Decision Making/ethics , Feeding and Eating Disorders/therapy , Bioethical Issues , Empirical Research , Ethics, Medical , Ethics, Research , HumansABSTRACT
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.
Subject(s)
Emotions , Mood Disorders/history , Morals , Philosophy, Medical/history , Psychopathology/history , Science/history , France , History, 18th Century , History, 19th Century , HumansABSTRACT
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.
Subject(s)
Emotions , Irritable Mood , Psychiatry/history , Psychopathology/history , Psychophysiology/history , History, 18th Century , History, 19th Century , Humans , ScotlandABSTRACT
The York Retreat is famous in the history of nineteenth-century psychiatry because of its association with moral treatment. Although there exists a substantial historical literature on the evolution of moral treatment at the Retreat, several interpretive problems continue to obscure its unique therapeutic legacy. The nature of moral treatment as practised at the Retreat will be clarified and discussed in a historical perspective. It will be argued that moral treatment at the Retreat was primarily a matter of affective conditioning guided by 'benevolent theory'.
Subject(s)
Conditioning, Psychological , Hospitals, Psychiatric/history , Mental Disorders/history , Morals , Psychiatry/history , Emotions , England , History, 19th Century , Humans , Mental Disorders/therapy , Psychiatry/methodsSubject(s)
Affect , Behavior, Addictive/psychology , Brain Diseases/psychology , Choice Behavior , Emotions , Decision Making , Humans , Moral Obligations , Neurosciences , Social ValuesABSTRACT
Moral considerations do not appear to play a large role in discussions of the DSM-IV personality disorders and debates about their empirical validity. Yet philosophical analysis reveals that the Cluster B personality disorders, in particular, may in fact be moral rather than clinical conditions. This finding has serious consequences for how they should be treated and by whom.
Subject(s)
Complicity , Morals , Personality Disorders/diagnosis , Personality Disorders/therapy , Bipolar Disorder/diagnosis , Bipolar Disorder/therapy , Diagnostic and Statistical Manual of Mental Disorders , Humans , Observer Variation , Psychometrics , Reproducibility of Results , Suicide/psychology , Terminology as TopicSubject(s)
Chimera , Genetic Engineering/ethics , Morals , Animals , Bioethics , Biological Evolution , Consensus , Humans , Interdisciplinary Communication , Social Sciences , Species SpecificityABSTRACT
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.
Subject(s)
Clinical Trials as Topic/ethics , Informed Consent , Mental Competency/psychology , Depressive Disorder , Drug Prescriptions , Ethical Analysis , Ethics, Research , Humans , Internationality , Models, Psychological , Third-Party Consent , Vulnerable PopulationsABSTRACT
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.