The History and Ethics of the Therapeutic Relationship

Author(s):  
Ulrich Koch ◽  
Kelso Cratsley

This chapter reviews past and present debates about the therapeutic relationship in order to draw out the ethical implications of relational practices in psychotherapy. The therapeutic relationship has been understood differently across psychotherapeutic approaches, with each tradition responding to the attendant ethical challenges in distinctive ways. Aside from practitioners’ theoretical and practical commitments, the therapeutic relationship has also been, and continues to be, shaped by broader societal influences. The chapter discusses the shifting ethical implications of relational practices, then, as situated in their theoretical and historical contexts. The historical variability of concerns raised by the therapeutic relationship requires continued ethical analysis in order to confront the diversity and complexity of contemporary clinical practice.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 67-67
Author(s):  
Alexandra Urman ◽  
Ching-Kun Wang ◽  
Irene Dankwa-Mullan ◽  
Ethan Scheinberg ◽  
Michael J. Young

67 Background: Recent advances in artificial intelligence (AI) carry underexplored practical and ethical implications for the practice of clinical oncology. As oncologic applications of AI proliferate, a framework for guiding their ethical implementations and equitable distribution will be crucial. Methods: We reviewed the current landscape of AI applications in oncology research and clinical practice by reviewing the current body of evidence in PubMed and Medline. Key ethical challenges and opportunities to address health equity are critically evaluated and highlighted. Ethical implications for patients, clinicians and society at large are delineated, with particular focus on the impact and ramifications of AI with respect to healthcare disparities and equity of oncology care delivery. Results: Growing concerns that AI may widen disparities in oncologic care by virtue of lack of affordability, inconsistent accessibility and biased machine-learning models are addressed. Although there is potential for AI to widen disparities in oncology care, using foresight in application, AI has the potential to (1) democratize access to specialized clinical knowledge, (2) improve the accuracy of predicting cancer susceptibility, recurrence and mortality, (3) prevent diagnostic errors in under-resourced settings, (4) minimize unintended bias and (5) enable access to tailored therapeutic options including clinical trials if appropriately deployed. Separately, AI can be harnessed to identify areas of underserved needs and optimize systems of health-information sharing and reimbursements as blockchain technology converges with AI. As AI advances it will have a larger presence in oncology research and clinical practice. Conclusions: A strategic framework integrating ethical standards and emphasizing equitable implementation can help ensure that the potential of AI to address disparities in oncology are maximally captured and its perils averted. Further work is being done on exploring these challenges and will be submitted as a manuscript.


2020 ◽  
pp. medethics-2020-106163
Author(s):  
Anna-Karin Margareta Andersson

This article is the first indepth ethical analysis of empirical studies that support the claim that children born without major parts of their cerebral cortex are capable of conscious experiences and have a rudimentary capacity for agency. Congenitally decorticate children have commonly been classified as persistently vegetative, with serious consequences for their well-being and opportunities to flourish. The paper begins with an explication of the rights-based normative framework of the argument, including conceptual analysis of the terms ‘agency’, ‘potentiality for agency’ and ‘gradual approach of agency’. It critically examines Alan Gewirth’s account of the criteria for being a rights bearer and principles for settling rights conflicts between agents and potential agents. It then applies the rights-based normative framework to the ethical challenges associated with care for congenitally decorticate children. It argues that recent empirical studies support the claim that the concepts ‘potential for agency’ and ‘capacity for rudimentary agency’ apply to children who are born without major parts of their cerebral cortex. The article finally discusses important medical ethical implications of these results. It specifically focuses on congenitally decorticate children’s preparatory rights to a stimulating intellectual and social environment.


Author(s):  
Katja Voit ◽  
Cristian Timmermann ◽  
Florian Steger

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.


Author(s):  
Adrienne de Ruiter

AbstractDeepfake technology presents significant ethical challenges. The ability to produce realistic looking and sounding video or audio files of people doing or saying things they did not do or say brings with it unprecedented opportunities for deception. The literature that addresses the ethical implications of deepfakes raises concerns about their potential use for blackmail, intimidation, and sabotage, ideological influencing, and incitement to violence as well as broader implications for trust and accountability. While this literature importantly identifies and signals the potentially far-reaching consequences, less attention is paid to the moral dimensions of deepfake technology and deepfakes themselves. This article will help fill this gap by analysing whether deepfake technology and deepfakes are intrinsically morally wrong, and if so, why. The main argument is that deepfake technology and deepfakes are morally suspect, but not inherently morally wrong. Three factors are central to determining whether a deepfake is morally problematic: (i) whether the deepfaked person(s) would object to the way in which they are represented; (ii) whether the deepfake deceives viewers; and (iii) the intent with which the deepfake was created. The most distinctive aspect that renders deepfakes morally wrong is when they use digital data representing the image and/or voice of persons to portray them in ways in which they would be unwilling to be portrayed. Since our image and voice are closely linked to our identity, protection against the manipulation of hyper-realistic digital representations of our image and voice should be considered a fundamental moral right in the age of deepfakes.


Author(s):  
David A. Craig

Social media have amplified and accelerated the ethical challenges that communicators, professional and otherwise, face worldwide. The work of ethical journalism, with a priority of truthful communication, offers a paradigm case for examining the broader challenges in the global social media network. The evolution of digital technologies and the attendant expansion of the communication network pose ethical difficulties for journalists connected with increased speed and volume of information, a diminished place in the network, and the cross-border nature of information flow. These challenges are exacerbated by intentional manipulation of social media, human-run or automated, in many countries including internal suppression by authoritarian regimes and foreign influence operations to spread misinformation. In addition, structural characteristics of social media platforms’ filtering and recommending algorithms pose ethical challenges for journalism and its role in fostering public discourse on social and political issues, although a number of studies have called aspects of the “filter bubble” hypothesis into question. Research in multiple countries, mostly in North America and Europe, has examined social media practices in journalism, including two issues central to social media ethics—verification and transparency—but ethical implications have seldom been discussed explicitly in the context of ethical theory. Since the 1980s and 1990s, scholarship focused on normative theorizing in relation to journalism has matured and become more multicultural and global. Scholars have articulated a number of ethical frameworks that could deepen analysis of the challenges of social media in the practice of journalism. However, the explicit implications of these frameworks for social media have largely gone unaddressed. A large topic of discussion in media ethics theory has been the possibility of universal or common principles globally, including a broadening of discussion of moral universals or common ground in media ethics beyond Western perspectives that have historically dominated the scholarship. In order to advance media ethics scholarship in the 21st-century environment of globally networked communication, in which journalists work among a host of other actors (well-intentioned, ill-intentioned, and automated), it is important for researchers to apply existing media ethics frameworks to social media practices. This application needs to address the challenges that social media create when crossing cultures, the common difficulties they pose worldwide for journalistic verification practices, and the responsibility of journalists for countering misinformation from malicious actors. It is also important to the further development of media ethics scholarship that future normative theorizing in the field—whether developing new frameworks or redeveloping current ones—consider journalistic responsibilities in relation to social media in the context of both the human and nonhuman actors in the communication network. The developing scholarly literature on the ethics of algorithms bears further attention from media ethics scholars for the ways it may provide perspectives that are complementary to existing media ethics frameworks that have focused on human actors and organizations.


2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 133-133
Author(s):  
Regina Mueller ◽  
◽  
Sebastian Laacke ◽  
Georg Schomerus ◽  
Sabine Salloch ◽  
...  

"Artificial Intelligence (AI) systems are increasingly being developed and various applications are already used in medical practice. This development promises improvements in prediction, diagnostics and treatment decisions. As one example, in the field of psychiatry, AI systems can already successfully detect markers of mental disorders such as depression. By using data from social media (e.g. Instagram or Twitter), users who are at risk of mental disorders can be identified. This potential of AI-based depression detectors (AIDD) opens chances, such as quick and inexpensive diagnoses, but also leads to ethical challenges especially regarding users’ autonomy. The focus of the presentation is on autonomy-related ethical implications of AI systems using social media data to identify users with a high risk of suffering from depression. First, technical examples and potential usage scenarios of AIDD are introduced. Second, it is demonstrated that the traditional concept of patient autonomy according to Beauchamp and Childress does not fully account for the ethical implications associated with AIDD. Third, an extended concept of “Health-Related Digital Autonomy” (HRDA) is presented. Conceptual aspects and normative criteria of HRDA are discussed. As a result, HRDA covers the elusive area between social media users and patients. "


Author(s):  
Anna Magdalena Elsner

Ethical issues arising in the practice of psychotherapy, such as confidentiality, boundaries in the therapeutic relationship, and informed consent, figure prominently in a range of twentieth-century literary texts that portray psychotherapy. This chapter analyzes the portrayal of these conflicts, but also stresses that they are often marginal to the overall plot structures of these narratives and that literary depictions of psychotherapy are often vague or even inaccurate concerning key characteristics of psychotherapeutic practice. Focusing on examples that either illustrate professionalism and the absence of ethical challenges in psychotherapy, or take up the ethical reservations that fueled anti-Freudianism or the anti-psychiatry movement, the chapter proposes that selected literary depictions of psychotherapy can play a key role in sensitizing therapists to the complex make-up of ethical dilemmas as well as illustrating the cultural and historical contexts of these dilemmas.


2021 ◽  
Vol 11 (3-4) ◽  
pp. 181-195
Author(s):  
Anetta Jedličková

Abstract The current coronavirus disease 2019 (COVID-19) pandemic has led to essential adjustments in clinical research involving human subjects. The pandemic is substantially affecting most procedures of ongoing, as well as new clinical trials related to diseases other than COVID-19. Procedural changes and study protocol modifications may significantly impact ethically salient fundamentals, such as the risk-benefit profile and safety of clinical trial participants, which raise key ethical challenges the subject-matter experts must face. This article aims to acquaint a wide audience of clinical research professionals, ethicists, as well as the general public interested in this topic with the legal, ethical and practical considerations in the field of clinical trials during the COVID-19 pandemic and to support the clinical researchers and study sponsors to fulfil their responsibilities in conducting clinical trials in a professional way that does not conflict with any legal or ethical obligations.


2021 ◽  
Vol 35 (1) ◽  
pp. 25-27
Author(s):  
Constance L. Milton

The advancement of a healthcare discipline is reliant on the disciplines’ ability to produce rigorous scholarship activities and products. The healthcare disciplines, especially nursing, are facing ever-changing priorities as shortages loom and exhaustion permeates the climate. Empirical public health priorities during the pandemic have dominated professional healthcare literature and global health communications. This article shall offer ethical implications for the discipline of nursing as it seeks the advancement of scholarship. Topics include straight-thinking issues surrounding nursing and medicine national policy statements, the big data movement, and evolutionary return of competency-based nurse education.


Author(s):  
Rachel Baarda ◽  
Rocci Luppicini

Ethical challenges that technology poses to the different spheres of society are a core focus within the field of technoethics. Over the last few years, scholars have begun to explore the ethical implications of new digital technologies and social media, particularly in the realms of society and politics. A qualitative case study was conducted on Barack Obama's campaign social networking site, my.barackobama.com, in order to investigate the ways in which the website uses or misuses digital technology to create a healthy participatory democracy. For an analysis of ethical and non-ethical ways to promote participatory democracy online, the study included theoretical perspectives such as the role of the public sphere in a participatory democracy and the effects of political marketing on the public sphere. The case study included a content analysis of the website and interviews with members of groups on the site. The study's results are explored in this chapter.


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