Thomas Schramme

Skeptical psychiatry puts doubt on common and deeply engrained psychiatric beliefs. These critical voices have usually been combined, often disapprovingly, under the label antipsychiatry. This chapter introduces the arguments of skeptical psychiatry along six lines of thought: First, the idea of the social construction of mental illness will be explored. It will be shown that constructionist arguments do not undermine the validity of psychiatric classifications. Second, the skeptical opposition to the medical model of mental pathology will be explained. Third, a common argument of skeptics is to contrast mental illness and somatic disease to undermine the cogency of the concept of mental pathology. This argument will be explained in the context of the philosophical mind-body problem, and it will be shown why it fails. Fourth, some skeptics retell the history of psychiatry. The purpose is to open alternative viewpoints on an alleged story of success and to make explicit concealed developments. Fifth, skeptical psychiatry has identified social control and exclusion as functions of psychiatry and thereby challenged the almost exclusive focus on therapeutic and humanistic functions. Sixth, many authors, as well as interest groups, have made strides to reassess madness. The purpose is to attack the common negative evaluation of mental affliction as something necessarily bad. Altogether, although some arguments of skeptical psychiatry are not convincing, the overarching effect of providing unorthodox viewpoints is to make valuable contributions to the theoretical and practical advancement of psychiatry.

The chapter aims to provide a classification of different philosophical theories of well-being. This is important because patient’s well-being is often referred to in medical practice. However, the notion itself is unclear and contested. A common issue of contestation is whether well-being is subjective or objective. It will be argued that ontological and evaluative perspectives in this regard need to be disentangled. The ontological perspective is concerned with the problem whether well-being is a mode of consciousness or of existence. The evaluative perspective focuses on the criteria of well-being. There are then altogether four different accounts: (i) experience theories (ontological subjectivism), (ii) state-of-being theories (ontological objectivism), (iii) desire-fulfillment theories (evaluative subjectivism), and (iv) essence theories (evaluative objectivism). This classification is applied to a particular philosophical and social dispute, namely, whether and, if so, in what way disability undermines the quality of life of persons with disability.

Public health is a scientific and practical endeavor. It aims at preventing disease and promoting health in a population. Public health has a specific way to use the concept of health. It is positive in the sense that it facilitates the measurement of the health status of a population over and above the absence of disease. Health in public health is a gradual, not an absolute, notion. Public health also targets health risks or health dispositions, which should not be confused with intrinsic health statuses. This chapter also discusses the aspect of referring to health within a population, which poses some issues of measurement. Finally, it is discussed what normative issues are due to the specific understanding of health in public health.

The chapter discusses ways to understand the notion of philosophy of medicine, with a special focus on the relation between philosophy of medicine and bioethics. Philosophy of medicine has been distinguished from other associations between philosophy and medicine. These conceptual distinctions lead to an account that delineates bioethics from the realm of philosophy of medicine. It has often been argued that medicine itself is a normative practice in that it aims at the good of patients. This undermines a simple account of medicine as a purely empirical, natural science. Yet such a normative account of medicine does not show that philosophy of medicine needs to aim at normative guidance like bioethics.

This chapter discusses different philosophical theories regarding the goals of medicine and places this debate within the context of the moral limits of the proper use of medical means. Two approaches are distinguished: first, a teleological approach, which sees medicine as a practice with an inherent telos; second, a consensual approach, which aims at assembling a list of goals of medicine that are identified in a deliberative process. This chapter also discusses the concept of medicine and scrutinizes whether it has any bearing on the debate regarding the goals of medicine. It is argued that the goals of medicine are still contested and will probably remain so. They cannot be used in a direct way to solve normative questions regarding the proper use of medicine.

“Genetic information” may refer to information about a person’s family history, raw DNA sequence data, or an interpretation derived from the raw data. This chapter addresses what counts as genetic information, especially about humans, and the limitations on what can be known.Family history provides information relating to risk of disease without genetic testing. Genetic linkage studies provide information about the co-localization of a disease-related gene and a nearby marker on a chromosome. Tracking the marker can indicate whether someone has inherited the corresponding disorder. In contrast, association studies are performed on large populations and identify many dispersed genetic factors that influence the chance of developing complex diseases. Confidence in the accuracy of individual predictions based on linkage studies is often very high, while genetic association studies provide information that applies robustly to a population but not so readily to individuals. Further, predictions based on linkage analyses are open to improvement through the identification of errors, while such feedback is not feasible with polygenic scores applied to individuals from association studies.The distinction between “raw data” and “information” is fuzzy: when does data become information? The high-throughput methods now in use require an interpretive step based upon sequence information and an accumulated body of knowledge from other individuals of known phenotype in order to draw any useful conclusions from a person’s genetic constitution. Some variants will be assessed as of Uncertain Significance (VUSs). This raises the question of future reanalyses and reinterpretations of such VUSs or genome sequence data in general. In addition, unsought information may be found concerning risks of other diseases or of misattributed relationships within a family.Developments in DNA sequencing have led to an explosion in genome sequence data. Ownership of individuals’ DNA sequence is probably an unhelpful concept, but access to such information and control of how it is applied is important and may be subject to legislation.

Conceptions of childhood have undergone continuous and historical evolution; children can no longer be regarded as small adults. Most contemporary views on the nature of childhood are derived from Aristotelian concepts; they stress its developmental nature and the role of adults in guiding and facilitating children’s development. Transformation to adulthood occurs by a process of biological, cognitive, and moral development in which distinct stages can be identified. Children’s portrayal in art, literature, and the media has largely mirrored evolving concepts of childhood and increasingly takes account of children’s voices.Biologically, children’s anatomy, physiology, and pathology go through significant changes. Infants and very young children show an increased vulnerability to environmental and other harms, because of their size, immature anatomy and physiology, and differing pharmacodynamics. Organ development determines the patterns of disease that occur in childhood and affects drug treatments and responses to them.Cognitive development (the child’s evolving ability to think and understand) is classically understood as following a series of stages in which genetically determined characteristics interact with events and experiences to influence patterns of cognition. A similar staged pattern is seen in moral development in which the child’s capacity to make decisions about what is right or wrong gradually evolves. Contemporary neuroimaging techniques have provided structural and functional evidence to underpin this process. A child’s stage of cognitive and moral development is used to determine what legal status they may have and what weight should be placed on their desire to determine their own best interests.Concepts of children as rights holders allow them to have moral agency, irrespective of their cognitive ability or capacity to exercise choices. A staged acquisition of liberty rights (i.e., right to self-determination) seems plausible, as does the universal possession of welfare and protection rights.The interests of children who lack the capacity to exercise liberty rights can be protected by the application of the best interests or welfare principle. Determination of best interests includes consideration of the harms and benefits involved; the likely outcome of various options; the wishes, preferences, beliefs, and values of the child insofar as she/he is able to express them; the wishes, beliefs, and values of the family and other relevant individuals; and which option is least restrictive of future choices for the child.Children are not small adults who can be treated as though they were, and neither are they uniformly vulnerable beings who need protection; rather they are individuals in transition whose growth into adulthood should be supported, encouraged, and facilitated.

Often, in our popular discourse around science skepticism, we are quick to dismiss those who are suspicious of science or science-based policies as being obviously irrational, confused, or dangerous. This ignores the wide variety of ways that one might be worried about science and its associated incursions into our lives.This chapter aims to give the reader a sense of the diverse ways that one might be suspicious of science. It tracks some of the trouble we have describing members of skeptical groups, particularly in the cases of those who are skeptical about the causal connection between HIV and AIDS, and those who are worried about vaccine safety. It then looks at groups whose skepticism takes the form of wanting more science to be done, rather than skepticism about science as a good route to knowledge about health and disease. This can take the form of either calling for more research to be done on specific diseases or on particular types of bodies. Finally, the chapter looks at skepticism that has nothing to do with the science itself, but is rather directed at science-based policy or clinic-level implementation of policy.

Health promotion is the “science and art of preventing disease, prolonging life and promoting health through the organised efforts of society.” The philosophical questions concerning Health Promotion fall into three categories.A) Philosophy of ScienceIdentifying causation in public health is difficult. Standard empiricist approaches prioritizing prioritize randomized trials may not work. Scientific inquiry using a realist approach and modeling may be better.B) EthicsHidden harms: There are concerns about the quality of evidence behind Health Promotion and that potential harmful effects are ignored in its evaluation.Treating populations: Ethical concerns arise when treatment is based more on the health of the population than of an individual person, such as in vaccination and mass medication.C) Political PhilosophyPersonal autonomy. Libertarians object to State attempts to alter the behavior of the population; they often invoke Mill’s liberty principle, that the State should only protect individuals from harming others, not themselves. By contrast, communitarians believe community efforts that limit autonomy to improve community health can be justified.Inequality. Health promotion can be at odds with another political goal, health equality; measures that improve average population health might also and unacceptably increase health inequality.Precautionary principle. This states roughly that the possibility of severe public health harm permits major State intervention. It was used to justify highly restrictive measures during the Covid pandemic. Its formulation and scope are controversial, however.

TugendethikenTugend, Tugendethik sind normative Theorien des richtigen und guten Handelns, die den zentralen Gesichtspunkt der ethischen Bewertung in der handelnden Person, genauer in ihrer charakterlichen und motivationalen Verfassung sehen. Eine Tugend ist eine charakterlich gefestigte Haltung von Menschen, die sie das Richtige und Gute aus eigener Überzeugung erkennen und erstreben lässt. Als Tugenden gelten dabei nicht nur die im engen Sinne moralischen Tugenden wie Gerechtigkeit oder Aufrichtigkeit,WahrhaftigkeitAufrichtigkeitAufrichtigkeit, sondern sie umfassen beispielsweise auch selbstbezogene und intellektuelle Vortrefflichkeiten wie Besonnenheit oder WeisheitWeisheit, die beide lange Zeit zu den Kardinaltugenden gehörten.

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of assistance cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die.

Philosophy of medicine is thought of today as a distinct discipline with its own set of concerns. This title focuses on all major aspects of the philosophy of medicine and the attempts of philosophers, bioethicists, and physicians to address its unique set of problems and questions. It deals with the various metaphysical, ethical and practical problems and questions facing modern medicine such as human nature and mind; reductionism and holism; causation and etiology; notions of disease, health, illness and disability; ageing, death and suicide; medical theory and models; social determinants of health and the role of factors such as technology and evidence-based medicine in providing valid diagnostic and therapeutic knowledge.

This paper outlines a novel framing of the normative significance of health by considering the idea of ‘health capital’. Health capital is a set of health-related assets of individuals that enable them to pursue their interests and to collaborate with others. The specific contribution of this paper is to establish the notion of health capital beyond a metaphorical idea and to initially explore the repercussions of it for theories of health justice. We propose a sufficientarian approach to health capital justice. Our theory claims that social justice requires enabling people to achieve enough health capital to meet threats to health. This is a dynamic ideal, establishing claims of justice over time. The overarching goal is to avoid disadvantageous tipping points of health depletion.

“Classic,” serotonergic psychedelic drugs such as LSD and psilocybin are the objects of renewed attention in science and psychiatry. A recent spate of research has produced evidence that psychedelics might be safe and effective adjuncts to the treatment of mood and addictive disorders, agents of positive psychological change in healthy subjects, and valuable tools for studying the neural mechanisms of perception and cognition. This chapter surveys three philosophical debates that have arisen in response to this “renaissance” of psychedelic research. The first concerns the mechanisms of psychedelic-assisted psychotherapy (“psychedelic therapy”): How, exactly, does psychedelic administration in controlled conditions cause lasting psychological benefits? The second concerns the implications of psychedelic research for the philosophy of mind: Does psychedelic evidence show that there can be conscious mental states lacking all forms of self-consciousness? The third concerns the epistemic status of the psychedelic state: Is it possible that certain kinds of knowledge, or other epistemic benefits, could be gained by undergoing a psychedelic experience?

Misunderstanding other people can be interpreted as the result of an insufficient performance of people’s skills to understand other persons and their experiences. But what does understand mean in these contexts? And what are the relevant skills that need to be engaged to successfully understand other people? I argue that understanding other people is a form of recognition of the epistemic validity of another person’s perspective. I claim that minimal understanding does not require an endorsement of another person’s perspective. This makes the avoidance of lack of understanding a feasible achievement in almost all cases, though it often requires effort in the interactive process of understanding. I specifically analyse the epistemic and normative roles of empathy in this process. In pursuing this aim, I also defend empathy against recent philosophical arguments that point at moral dangers of empathic processes.

Individualität stellt für Mill eine Quelle und gleichzeitig ein Ziel individuellen und gesellschaftlichen Fortschritts dar. Individualität ist ein Element des Wohlergehens, wie die Überschrift des dritten Kapitels seiner Freiheitsschrift festhält. Individualität ist somit ein vorrangiges Ziel der Erziehung, Bildung und guten Regierung. Zudem kann Individualität, ausgedrückt in verschiedensten Lebensexperimenten, die Entwicklung einer Gesellschaft voranbringen. Es sollte insofern nicht überraschen, dass Individualität ein zentrales Konzept des Mill’schen. Denkens darstellt. Schließlich war sein Denken insgesamt auf die Verbesserung der Menschheit und der Lebensverhältnisse gerichtet.