In this paper, we present a comprehensive case study analysis of a specific legal order issued by the Court of First Instance Number 6 of Santiago de Compostela on March 21, 2023. The focal point of the case study is the utilization of Electroconvulsive Therapy (ECT), a specific neurotechnology, in an emergency clinical situation. The objective of this article is to examine the legal and bioethical dimensions surrounding the use of ECT, shedding light on the ethical implications and decision‐making processes (...) involved in such cases. The analysis delves into the legal aspects of the case, considering relevant laws and regulations governing the use of ECT. The examination includes an exploration of the court's interpretation of the legal framework within the context of emergency situations, highlighting the specific legal arguments presented in the court judgment. Additionally, the article provides an in‐depth bioethical analysis, exploring the ethical principles that come into play when making decisions about ECT in emergency clinical scenarios. The examination considers the delicate balance between respecting patient autonomy and promoting beneficence, while also addressing potential harms and adverse effects associated with ECT. We also consider the moral issues created by the court judgment, specifically those involving patient autonomy and the invasive nature of the process, particularly in cases of mental illness. (shrink)

This paper emphasizes that, contrary to the claims of ECT experts and the ECT industry, a majority, not "a small minority," of ECT recipients sustain permanent memory dysfunction each year as a result of ECT. The paper exposes the convulsion hypothesis, upon which ECT is allegedly based, as mythological. Finally, through hidden and comparative electrical parameters, it exposes the extreme destructive power of today's "new and improved" ECT devices.

The debate about ECT in Ireland in recent times has been vibrant and often polarised. The uniqueness of the Irish situation is that the psychiatric profession is protected by legislation whereby ECT treatment can be authorized by two consultant psychiatrists without the consent of the patient. This paper will consider if ECT is ever ethically justified, and if so, under what circumstances. The proposal is to investigate ECT from an ethical perspective with reference to the UNESCO Universal Declaration on Bioethics (...) and Human Rights. The enquiry will begin with an historical context to the origin and development of ECT as a treatment for severe mental illness. The application of various ethical principles will be considered in conjunction with the relevant literature before arriving at a conclusion. (shrink)

Aspect-seeing, I claim, involves reflection on concepts. It involves letting oneself feel how it would be like to conceptualize something with a certain concept, without committing oneself to this conceptualization. I distinguish between two kinds of aspect-perception: 1. Preparatory: allows us to develop, criticize, and shape concepts. It involves bringing a concept to an object for the purpose of examining what would be the best way to conceptualize it. 2. Non-Preparatory: allows us to express the ingraspability of certain experiences. It (...) involves bringing a concept to an object for the purpose of showing—per impossible—what it would take to properly capture one’s experience. I demonstrate the usefulness of the two kinds of aspect perception in making conceptual judgments, and in making moral and aesthetic judgments. (shrink)

This is a response to Dr Charlotte Rosalind Blease's paper ‘Electroconvulsive Therapy (ECT), the Placebo Effect and Informed Consent’, written by Julie K. Hersh who has had ECT. Hersh argues that placebo effect is impossible to prove without endangering the lives of participants in the study. In addition, informing potential ECT patients of unproven placebo effect could discourage patients from using a procedure that from experience has proven highly effective.

Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. In many circumstances, drugs constitute the best allies of psychotherapeutic interventions. A robust scientific literature is oriented on finding the best strategies to improve therapeutic efficacy through different modes and timing of combined interventions. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches of (...) medicine. An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. In this paper I corroborate the idea that therapists should provide drug-resistant patients with every effective and available treatment, even if some of such interventions could be invasive, like Electroconvulsive Therapy (ECT). ECT carries upon its shoulders a long and dramatic history that should be better investigated to provide new insights. In fact, ECT has attracted renewed interest in recent years. This is due to the fact that antidepressant drugs in younger patients show often scarce effectiveness and unpleasant side-effects. Moreover, I show that, thanks to modern advances, ECT may work as a successful form of treatment for specific and rare cases, such as severe depression (with suicide attempts) and catatonia. (shrink)

Obtaining informed consent before providing treatment is a routine part of modern clinical practice. For some treatments, however, there may be disagreement over the requirements for ‘informed’ consent. Electroconvulsive therapy (ECT) is one such example. Blease argues that patients ‘should surely be privy to the matters of fact that: (1) there is continued controversy over the effectiveness of ECT; (2) there is orthodox scientific consensus that there is currently _no_ acknowledged explanation for ECT and (3) there is a serious (mainstream) (...) debate over whether the response to ECT may be a placebo response.’ Before embracing these suggestions, two key questions must be asked. Are these claims a reasonable representation of current ECT research? And if so, will this information be of benefit to patients? The evidence-based support for ECT from both National Institute for Health and Care Excellence and the Royal College of Psychiatrists appears to undermine the validity of claims (1) and (3), and therefore the rationale for providing this information. Concerning assertion (2), it is true that the mechanism by which ECT has its therapeutic effect is not yet established, although the importance of conveying this fact to the patient is questionable. Of greater certainty is that the same irresolution surrounds the mechanism of action of pharmaceutical antidepressants, and so a double standard in patient care should be mindfully avoided if provision of this information is deemed a prerequisite for proper ‘informed’ consent. (shrink)

Should the `irrational' refusal to consent to ECT of a depressed patient who knows he is thought to be ill, knows that his doctor believes ECT will help him and knows that he is being asked to decide, be respected or overridden? The author of the first paper, an American bioethicist argues that the refusal should be overridden in the interests of fostering the autonomy of the patient by overcoming the impediment to that autonomy which major depression represents. A philosopher (...) and a psychiatrist respond and an editorial discusses the issues. (shrink)

Dr Taylor, an English psychiatrist, considers the issue of the symposium in the context of the Mental Health (Amendment) Act 1982. This, she says, gives little guidance on how judgment of a patient's competency or capability to consent to treatment should be made, although it specifies that unless compulsorily detained patients competently consent to ECT a special second medical opinion is required. Although some guidelines from the Department of Health may be offered before implementation of the Act in September 1983 (...) all those working with psychiatric patients will have to consider the issues. After discussing her criteria for informed consent, some practical approaches for obtaining it and problems arising from these, and problems of surrogate consent, Dr Taylor concludes that there is no single or simple solution to the dilemma. She ends by asking: `Can refusal of ECT for severe depression ever be a competent decision?'. (shrink)

Despite extensive evidence for its effectiveness, ECT remains the subject of fierce opposition from those contesting its benefits and claiming extreme harms. Alongside some reflections on my experiences of this treatment, I examine the case against ECT, and find that it appears to rest primarily on unsubstantiated claims about major ethical violations, rather than clinical factors such as effectiveness and risk.

By way of comment, I suggest: 1) That the definitions of 'competence' and 'rationality' require some modification. 2) That Professor Sherlock is right to argue that a competent but irrational decision to refuse beneficial treatment ought to be overruled; but in practice it is extremely difficult to be sufficiently sure that the decision is really irrational and the treatment really will be beneficial, except when the patient's life is in danger or he is refusing basic necessities. 3) That in practice (...) the issue is further complicated by such questions as whether there are alternative treatments, whether persuasion is possible, what the doctor's or institution's legal obligations are, and what resources are available. 4) That the presumption should be against coercion, and the patient--however irritating this may be to some doctors--should be considered 'rational until proved irrational'. (shrink)

In this note two propositions about the epistemic formalization of Church's Thesis are proved. First it is shown that all arithmetical sentences deducible in Shapiro's system EA of Epistemic Arithmetic from ECT are derivable from Peano Arithmetic PA + uniform reflection for PA. Second it is shown that the system EA + ECT has the epistemic disjunction property and the epistemic numerical existence property for arithmetical formulas.

UCLA Cognitive Systems Laboratory, Technical Report (R-321), June 2005. In Proceedings of International Joint Conference on Artificial Intelligen ce, Edinburgh, Scotland, August 2005.

Zuk et al. (2023) explore personality, mood, and behavioral (PMB) changes in DBS and aDBS, though have not invoked what is known about the similarities and differences for other available brain sti...

This paper is part of a longer project on the semantics of depiction verbs and their associated relational nouns. Depiction verbs include verbs for physical acts, such as ‘draw’ (with relational noun ‘drawing’), ‘sketch’, ‘caricature’, ‘sculpt’, ‘write (about)’, and verbs for mental ones, such as ‘visualize’, ‘imagine’, and ‘fantasize’.

We present a maximum-entropy based system for identifying Named Entities (NEs) in biomedical abstracts and present its performance in the only two biomedical Named Entity Recognition (NER) comparative evaluations that have been held to date, namely BioCreative and Coling BioNLP. Our system obtained an exact match f-score of 83.2% in the BioCreative evaluation and 70.1% in the BioNLP evaluation. We discuss our system in detail including its rich use of local features, attention to correct boundary identification, innovative use of external (...) knowledge resources including parsing and web searches, and rapid adaptation to new NE sets. We also discuss in depth problems with data annotation in the evaluations which caused the final performance to be lower than the optimal. (shrink)

Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of possible, (...) probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available. (shrink)

Since its introduction, electroconvulsive therapy (ECT) has been controversial. Recently, a report by the World Health Organization called for an ECT ban for children and adolescents. This has added a new layer to consider in the debate about the ethical use of ECT. To better understand ethical concerns and attitudes toward the use of ECT in this population, and to assess whether a ban might be justified, we conducted a comprehensive literature review. Close to 75% of our analyzed papers reported (...) agreement about ECT’s effectiveness for treating a wide range of adolescent mental disorders. Almost half of the papers reported memory side effects as an ethical concern. In addition, the lack of rigorous side-effect reporting was found to be a key barrier to the ethical use of ECT in this population. We hope this review will advance our understanding of ongoing ethical concerns and barriers regarding use of ECT in adolescents. (shrink)

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA+ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, (...) respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA+ECT groups had markedly greater clinical response rate than controls on SAPS [72.7% and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3% and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% versus 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. (shrink)

We study the effect of transaction costs (e.g., a trading fee or a transaction tax, like the Tobin tax) on the aggregation of private information in financial markets. We analyze a financial market à la Glosten and Milgrom, in which informed and uninformed traders trade in sequence with a market maker. Traders have to pay a cost in order to trade. We show that, eventually, all informed traders decide not to trade, independently of their private information, i.e., an informational cascade (...) occurs. We replicated our financial market in the laboratory. We found that, in the experiment, informational cascades occur when the theory suggests they should. Nevertheless, the ability of the price to aggregate private information is not significantly affected. (JEL C92, D8, G14). (shrink)

Luck permeates our lives, and this raises a number of pressing questions: What is luck? When we attribute luck to people, circumstances, or events, what are we attributing? Do we have any obligations to mitigate the harms done to people who are less fortunate? And to what extent is deserving praise or blame a ected by good or bad luck? Although acquiring a true belief by an uneducated guess involves a kind of luck that precludes knowledge, does all luck undermine (...) knowledge? And how accurate are our luck attributions anyway? The academic literature has seen growing, interdisciplinary interest in luck, and this volume brings together and explains the most important areas of this research. It consists of 39 newly commissioned chapters, written by an internationally acclaimed team of philosophers and psychologists, for a readership of students and researchers. Its coverage is divided into six sections: (i) The History of Luck, (ii) The Nature of Luck, (iii) Moral Luck, (iv) Epistemic Luck, (v) The Psychology of Luck, and (vi) Future Research. The chapters in these sections cover a wide range of topics, from the problem of moral luck, to anti-luck epistemology, to the relationship between luck attributions and cognitive biases, to meta-questions regarding the nature of luck itself, to a range of other theoretical and empirical questions currently being investigated by ethicists, epistemologists, and psychologists. By bringing this research together, the Handbook serves as both a touchstone for understanding the relevant issues and a first port of call for future philosophical and psychological research on luck. (shrink)

Motivated by the seeming structure of the sciences, metaphysical emergence combines broadly synchronic dependence coupled with some degree of ontological and causal autonomy. Reflecting the diverse, frequently incompatible interpretations of the notions of dependence and autonomy, however, accounts of emergence diverge into a bewildering variety. Here I argue that much of this apparent diversity is superficial. I first argue, by attention to the problem of higher-level causation, that two and only two strategies for addressing this problem accommodate the genuine emergence (...) of special science entities. These strategies in turn suggest two distinct schema for metaphysical emergence---'Weak' and 'Strong' emergence, respectively. Each schema imposes a condition on the powers of entities taken to be emergent: Strong emergence requires that higher-level features have more token powers than their dependence base features, whereas Weak emergence requires that higher-level features have a proper subset of the token powers of their dependence base features. Importantly, the notion of “power” at issue here is metaphysically neutral, primarily reflecting commitment just to the plausible thesis that what causes an entity may bring about are associated with how the entity is---that is, with its features. (shrink)

Over the past fifteen years there has been a considerable amount of debate concerning what theoretical population dynamic models tell us about the nature of natural selection and drift. On the causal interpretation, these models describe the causes of population change. On the statistical interpretation, the models of population dynamics models specify statistical parameters that explain, predict, and quantify changes in population structure, without identifying the causes of those changes. Selection and drift are part of a statistical description of population (...) change; they are not discrete, apportionable causes. Our objective here is to provide a definitive statement of the statistical position, so as to allay some confusions in the current literature. We outline four commitments that are central to statisticalism. They are: 1. Natural Selection is a higher order effect; 2. Trait fitness is primitive; 3. Modern Synthesis (MS)-models are substrate neutral; 4. MS-selection and drift are model-relative. (shrink)

Using traditional meta-analytic techniques, we compile relevant research to enhance conceptual appreciation of ethical climate theory (ECT) as it has been studied in the descriptive and applied ethics literature. We explore the various treatments of ethical climate to understand how the theoretical framework has developed. Furthermore, we provide a comprehensive picture of how the theory has been extended by describing the individual-level work climate outcomes commonly studied in this theoretical context. Meta-analysis allows us to resolve inconsistencies in previous findings as (...) well as confirm the central tenets of the overall ethical climate framework. In addition, we consider the ethical climate relationships in the larger context of the␣theoretical framework, using path analysis to test the structural relationships. Overall, our results provide evidence of the relationships between ethical climate perceptions and individual-level work outcomes. Based on our analyses, we offer future research directions important for further development of ECT. (shrink)