Andrea Palk

The question of 'what is a mental disorder?' is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars - real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non‐acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision‐making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna’s account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent‐related vulnerabilities, we suggest that a particular kind of exploitation‐related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low‐ and middle‐income countries. At the same time, the automatic exclusion of inpatients from research elicits justice‐related vulnerabilities.

In recent decades, recourse to notions of human dignity has increased extensively within the field of bioethics. In particular, the notion has been utilised in arguments that seek to constrain a variety of biotechnological endeavours, examples of which include human cloning and transhumanism. In this regard, transhumanism is frequently described as an affront to human dignity in a manner that appears to be aimed at halting the possibility of further debate. The efficacy of the concept of human dignity has itself, however, been questioned. Criticisms include its ambiguous nature and thus the lack of adequate definition by those who utilise it, its supposedly religious undertones as well as the fact that it may be used to argue for diametrically opposing positions within the same argument, due to the existence of distinct and conflicting interpretations. In this paper, I briefly discuss the aims of the transhumanist movement and explicate the concept of human dignity in order to assess one of the most renowned dignity arguments that has been lodged against transhumanism, namely, the argument of the bioconservative thinker Leon Kass. In addition, I discuss the counter-argument of the transhumanist Nick Bostrom. These findings have implications for the concept’s efficacy to adjudicate the complex ethical conundrums posed, not only by transhumanism, but in the bioethics arena in general