Robyn Bluhm

This paper looks at the implications of contemporary work in philosophy of science for nursing science. Early work on the nature of theories in nursing was strongly influenced by logical empiricism, and this influence remains even long after nurse scholars have come to reject logical empiricism as an adequate philosophy of science. Combined with the need to establish nursing as an autonomous profession, nursing theory's use of logical empiricism has led to serious conceptual problems. Philosophers of science have also rejected many of the central tenets of logical empiricism, including its focus on the logical justification of theories and the idea that science is, or should be, unified. Instead, there has been an increasing focus on the practice of science, which in turn has led to a pluralist understanding of science that emphasizes the construction of scientific models that are appropriate for certain purposes or in certain contexts. I suggest that this approach to philosophy of science may provide better resources for nursing science.

Deep brain stimulation (DBS) uses electrodes implanted in the brain to modulate dysregulated brain activity related to a variety of neurological and psychiatric conditions. A number of people who use DBS have reported changes that affect their sense of self. In the neuroethics literature, there has been significant debate over the exact nature of these changes. More recently, there have been suggestions that this debate is overblown and detracts from clinically-relevant ways of understanding these effects of DBS. In this paper, we offer an alternative approach to understanding the effects of DBS on the self, drawing on John Sadler’s work on self-illness ambiguity. We argue that self-illness ambiguity is a complex concept, with at least three different aspects, and that each of the three aspects we identify also characterizes one kind of DBS-related change. Our analysis also suggests ways of helping patients to adjust to life as a DBS user.

Medical interventions are usually categorized as “invasive” when they involve piercing the skin or inserting an object into the body. Beyond this standard definition, however, there is little discussion of the concept of invasiveness in the medical literature, despite evidence that the term is used in ways that do not reflect the standard definition of medical invasiveness. We interviewed psychiatrists, patients with depression, and members of the public without depression to better understand their views on the invasiveness of several psychiatric electroceutical interventions (treatments that involve electrical or magnetic stimulation of the brain) for the treatment of depression. Our study shows that people recognize several kinds of invasiveness: physical, emotional, and lifestyle. In addition, several characteristics of therapies influence how invasive they are perceived to be; these include the perceived capacity of an intervention to result in harm; how localized the effects of the intervention are; the amount of control retained by the person receiving the intervention; how permanent its effects are perceived as being; and how familiar it seemed to participants. Our findings contribute to a small literature on the concept of invasiveness, which emphasizes that categorizing an intervention as invasive, or as noninvasive, evokes a variety of other normative considerations, including the potential harm it poses and how it compares to other potential therapies. It may also draw attention away from other salient features of the intervention.

Deep brain stimulation (DBS) uses electrodes implanted in the brain to modulate dysregulated brain activity related to a variety of neurological and psychiatric conditions. A number of people who use DBS have reported changes that affect their sense of self. In the neuroethics literature, there has been significant debate over the exact nature of these changes. More recently, there have been suggestions that this debate is overblown and detracts from clinically-relevant ways of understanding these effects of DBS. In this paper, we offer an alternative approach to understanding the effects of DBS on the self, drawing on John Sadler’s work on self-illness ambiguity. We argue that self-illness ambiguity is a complex concept, with at least three different aspects, and that each of the three aspects we identify also characterizes one kind of DBS-related change. Our analysis also suggests ways of helping patients to adjust to life as a DBS user.

Timothy Brown invites us to think about the ways in which people who are being treated with deep brain stimulation might come to interact with their devices. He suggests that a framework of relational agency can help us to understand both the benefits and the challenges of DBS because DBS systems are, while not full fellow agents, more than mere props; users must sometimes "negotiate and collaborate with their stimulators". We agree that it is important to develop conceptual frameworks that both do justice to the ways that individuals respond to using DBS and give them new ways to think about the device, their relationship to it, and its role in their lives. In this commentary, we consider three...

Background Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders’ perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI).Methods We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs.Results Participants’ ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies.Conclusions To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs.

With this issue of IJFAB, we mark the end of one phase of the journal’s life and take our first steps into the next. It was eleven years ago, in 2007, that the first issue of IJFAB, then based at Stony Brook University and published by Indiana University Press, appeared with Mary Rawlinson as editor. That first issue was made possible by long months of work on the part of Mary and a group of others who were convinced that for feminist bioethics to develop as a field, it needed its own journal with dedicated space to publish the best of contemporary feminist perspectives in bioethics. The first issue included a foundational paper by Sue Sherwin on how feminism could revitalize mainstream bioethics; one by Margrit...

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine.

This section of the journal consists of reflections on the COVID-19 pandemic by feminist bioethicists. We wanted to have a record in IJFAB of the ways in which feminist bioethicists/feminist bioethics were and are affected by the pandemic and also record how our community sees feminist approaches to bioethics as providing resources for understanding and addressing ethical themes raised by the pandemic. The contributions we received cover a wide range of personal, professional, and theoretical issues and approach them in different ways. We are deeply grateful to the authors for sharing their experiences, and hope that our readers find their contributions engaging and...

COVID-19 has meant that the past year has been difficult for everybody and terrifying and heartbreaking for many. We here at IJFAB found ourselves, for the first time, separated by physical distances and pandemic-era planning that precluded those necessary in-person meetings and less formal interactions during conferences and other social occasions that connect so much of the feminist bioethics community. The editorial team has been variously in lockdown, shielding because of health vulnerabilities, or ill, in our different cities and continents. Alongside so many of our readers, contributors, and reviewers, Zoom became the space where we tried to continue to bring you what we consider...