BACKGROUND: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice.
OBJECTIVE: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare.
METHODS: Conceptual and ethical analyses.
RESULTS: After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed.
CONCLUSIONS: Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants.
UNASSIGNED: HINTERGRUND: Im Rahmen klinischer Ethikberatung unterstützen Ethikberater*innen im Gesundheitswesen Professionelle in der Psychiatrie dabei, moralische Probleme zu identifizieren und zu analysieren.
UNASSIGNED: Darstellung von zentralen ethischen Grundbegriffen und Begründungsansätzen, die für die klinische Ethikberatung in der Psychiatrie von Relevanz sind.
METHODS: Konzeptionelle und ethische Analyse.
UNASSIGNED: Nach einer Unterscheidung von Moral, Ethik und Recht werden moralische von anderen Problemen abgegrenzt. Im Anschluss werden ethische Grundbegriffe geklärt und das Konzept des moralischen Stresses vorgestellt. Im Hinblick auf ethische Begründungsansätze werden philosophische ethische Theorien von medizinethischen Theorien, wie der Prinzipienethik und der Care-Ethik, abgegrenzt. Abschließend werden Rechtfertigungstests auf Grundlage des Schadensprinzips und des schwachen Paternalismus zur ethischen Entscheidungsfindung in Situationen von Eigen- oder Fremdgefährdung erläutert.
CONCLUSIONS: Die Kenntnis ethischer Grundbegriffe und Begründungsansätze ist wichtig für die Identifikation und Analyse moralischer Probleme in der Psychiatrie und sollte in der Ausbildung von Ethikberater*innen im Gesundheitswesen stärker vermittelt werden.

We address the unconsciously biased perception of psychiatric disorders, highlighting a hierarchical perspective that favours certain diagnoses over others. We aim to uncover reasons for these inequities, emphasising the need for a shift toward pathophysiology-based nomenclature that can promote equal support for each disorder, enhance treatment adherence and encourage open discussions.

Some bioethicists argue that a doctor may frame treatment options in terms of effects on survival rather than on mortality in order to influence patients to choose the better option. The debate over such framing typically assumes that the survival and mortality frames convey the same numerical information. However, certain empirical findings contest this numerical equivalence assumption, demonstrating that framing effects may in fact be due to the two frames implying different information about the numerical bounds of survival and mortality rates. In this paper, I use these findings to argue that framing is presumptively wrong because it violates the duty of proper disclosure. Along the way, I highlight morally relevant features affecting the permissibility of framing, tackle three objections and draw some general lessons for the ethics of nudging.

The recent explosion of Large Language Models (LLMs) has provoked lively debate about \"emergent\" properties of the models, including intelligence, insight, creativity, and meaning. These debates are rocky for two main reasons: The emergent properties sought are not well-defined; and the grounds for their dismissal often rest on a fallacious appeal to extraneous factors, like the LLM training regime, or fallacious assumptions about processes within the model. The latter issue is a particular roadblock for LLMs because their internal processes are largely unknown - they are colossal black boxes. In this paper, I try to cut through these problems by, first, identifying one salient feature shared by systems we regard as intelligent/conscious/sentient/etc., namely, their responsiveness to environmental conditions that may not be near in space and time. They engage with subjective worlds (\"s-worlds\") which may or may not conform to the actual environment. Observers can infer s-worlds from behavior alone, enabling hypotheses about perception and cognition that do not require evidence from the internal operations of the systems in question. The reconstruction of s-worlds offers a framework for comparing cognition across species, affording new leverage on the possible sentience of LLMs. Here, we examine one prominent LLM, OpenAI\'s GPT-4. Inquiry into the emergence of a complex subjective world is facilitated with philosophical phenomenology and cognitive ethology, examining the pattern of errors made by GPT-4 and proposing their origin in the absence of an analogue of the human subjective awareness of time. This deficit suggests that GPT-4 ultimately lacks a capacity to construct a stable perceptual world; the temporal vacuum undermines any capacity for GPT-4 to construct a consistent, continuously updated, model of its environment. Accordingly, none of GPT-4\'s statements are epistemically secure. Because the anthropomorphic illusion is so strong, I conclude by suggesting that GPT-4 works with its users to construct improvised works of fiction.

The discussion paper synthesises the insights shared during a keynote panel at the 26th International Philosophy of Nursing Conference, themed \"Reimagining a nursing ecosystem in an uncertain world.\" It delves into the substantial impact uncertainty has on nursing, offering innovative strategies for reconceptualization. Through a critical examination of evidence-based practice, the tendency to homogenise nursing is discussed, prompting advocacy for a Nietzschean political framework as a form of resistance and emancipation. Drawing inspiration from Donna Haraway, a transition from individualistic to relational approaches is needed, especially amidst social and economic instability. Furthermore, the integration of caritas and Indigenous epistemologies underscore the significance of cultural sensitivity in nursing. Meanwhile, Ubuntu philosophy champions empathy and collective values, while a convergence of Eastern and Western philosophical traditions promises to enrich nursing practice. Ultimately, the panellists advocate for overcoming rigid ideologies in favour of a pluralistic approaches, ontologies, epistemologies and ethics to address contemporary challenges, and signal for a philosophical reorientation to engage uncertainty and reshape nursing roles in an ever-evolving and world.

Ethical questions about confidentiality arise when patients refuse to inform relatives who are at risk of a genetic condition. Specifically, healthcare providers may struggle with the permissibility of breaching confidentiality to warn patients\' at-risk relatives. In exploring this issue, several authors have converged around the idea that genetic cases differ from non-genetic cases (e.g., involving a threat of violence or the spread of an infectious disease) along two related dimensions: (1) In genetic cases, the risk of harm is already present in an at-risk third party, whereas in non-genetic cases, it is not; and (2) In genetic cases, the patient does not create a risk of harm to a third party, whereas in non-genetic cases, the patient does. I argue that these distinctions do not exclusively differentiate genetic from non-genetic cases and should not bear on the permissibility of breaching confidentiality. Instead, such determinations should be based on other considerations.

The history of amyotrophic lateral sclerosis (ALS)-also known as Charcot\'s disease, Lou Gehrig\'s disease, and motor neuron disease (MND)-freezes the texts of the scientist and physician Jean-Martin Charcot in a hagiographic narrative describing a brilliant discovery, based on the anatomo-clinical method. This narrative is often used by biologists and physicians as a reference point. This article shows that the use of the hagiographic register faces limitations. In particular, it obscures points of interest from Charcot\'s texts on ALS, such as the epistemological and ontological implications of scientific plurality in medicine. Although Charcot recognized the importance of scientific plurality in medicine, he prioritized the approaches and conferred the most important epistemic authority on clinical and pathological observations. In his view, animal modeling remains secondary to the understanding of disease. The concept of ALS and its diagnostic operability are the result of symptoms and lesions. By studying the past, we can highlight the specific features of the present. Today, although the ALS concept retains its diagnostic and clinical relevance, it is increasingly called into question in etiological and mechanistic research. Despite these differences, Charcot\'s reflections are a reminder of the importance of theoretical thinking on scientific plurality, all the more so today in the context of ALS research, in which combining different approaches is increasingly valued to understand the phenotypic and genetic heterogeneity of ALS.

Many technology ethicists hold that the time has come to articulate neurorights: our normative claims vis-à-vis our brains and minds. One such claim is the right to mental integrity (\'MI\'). I begin by considering some paradigmatic threats to MI (§1) and how the dominant autonomy-based conception (\'ABC\') of MI attempts to make sense of them (§2). I next consider the objection that the ABC is overbroad in its understanding of what threatens MI and suggest a friendly revision to the ABC that addresses the objection (§3). I then consider a second objection: that the ABC cannot make sense of the MI of the non-autonomous This objection appears fatal even to the revised ABC (§4). On that basis, I develop an alternative conception on which MI is grounded in a plurality of simpler capacities, namely, those for affect, cognition, and volition Each of these more basic capacities grounds a set of fundamental interests, and they are for that reason worthy of protection even when they do not rise to the level of complexity necessary for autonomy (§5). This yields a fully general theory of MI that accounts for its manifestations in both the autonomous and the non-autonomous.

Occupational Health Nursing (OHN) has followed a complex path to build and strengthen its theoretical basis. Starting with Public Health core principles, theories were shaped by the dualism of person worker and working environment, where sometimes the centre of the thought was given to the latter and other times to the former. The problem was not much on such conflict but on the definition of the correct OHN focus and whether genuine nursing knowledge was being applied. We are worried that other disciplines radically influenced the theoretical path taken by OHN theorists. To approach this problem, a unitary-transformative perspective can help us describe and analyse this phenomenon and engage scholars to reflect upon the accurate epistemological focus of OHN. We aimed to deepen this reflection and uncover a new OHN theoretical focus.

This essay analyzes from a personalistic bioethics the model of technological progress supported by an autonomy without controls and an imperative that is governed by the maxim: if it can be done, let\'s do it!, as a necessary and sufficient condition of progress. This puts us on the slippery slope between the technically feasible and the morally lawful. The pioneering work of the philosopher, José Sanmartin Esplugues 2 , urges reflection in the face of a technological profusion that sees the human being as a useful embodied object and offers powers of intervention on human life that were previously unimaginable. The reduction of the person to mere biological-material data opens the door to increasing deshumanization by subordination to the calculations of an instrumental rationalism. Underlying the desire to see ourselves at the top of the world and genetic techniques are the ultimate expression of a longing for human emancipation that aspires to take the reins of evolution through an abstract postbiological imaginary. Sanmartin proposes a model of ethical evaluation and social insertion of technoscientific activity that goes beyond the conventional categories of impact, use and effectiveness to distinguish social, cultural, economic, political and values correlates, in order to embroider a pattern that decides on the means and ends of human life through technologies that are neither innocuous nor neutral. A society without antidotes to manipulation that also teaches us to cultivate utopian dreams about human nature is easily malleable by elites who promise happy worlds and redeem us from our vulnerability.