The Medicalization of Love

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. Although such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to the ‘medicalization’ of human love and heartache—for some, a source of a serious concern. In this essay, we argue that the medicalization of love need not necessarily be problematic, on balance, but could plausibly be expected to have either good or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help to direct the course of love’s medicalization—should it happen to occur—more toward the ‘good’ side than the ‘bad.’

• Worry 1: The Pathologization of Everything. Medicalization can transform ‘ordinary’ human differences and experiences into ‘pathologies,’ redefining what is “normal, expected, and acceptable in life” through the ever-expanding application of disease categories and labels.⁵¹
• Worry 2: The Expansion of Medical Social Control. Medicalization can expand the scope of medical surveillance and thus medical social control over so-called deviance.⁵² It can also create openings for pharmaceutical companies and other ‘medical entrepreneurs’ to sell us drugs we don’t need for diseases we don’t have (or that have been simply invented out of whole cloth), thereby expanding the power of Big Pharma to meddle in our lives.⁵³
• Worry 3: The Narrow Focus on Individuals Rather Than the Social Context. Medicalization can lead to the “individualization of social problems,” taking resources and attention away from the wider social and contextual factors that may be creating the need for ‘treatment’ in the first place.⁵⁴ This concern has been summarized by Barbara Wootton: “Always it is easier to put up a clinic than to pull down a slum.”⁵⁵

Full article at:   http://goo.gl/EloFEH

By:  Brian D. Earp,* Anders Sandberg,* And Julian Savulescu*

Thanks are due to Marion Godman, Andrew Buskell, Alessa Colaianni, Tomi Kushner, and members of the HPS Philosophy Workshop at the University of Cambridge for helpful feedback on earlier drafts of this manuscript. Please note that this work was supported in part by a Wellcome Trust grant, #086041/Z/08/Z.

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“Decision-Making Capacity for Research Participation among Addicted People

Background

Informed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research.

Methods

53 subjects with DSM-5 diagnoses of a Substance Use Disorder (SUD) and 50 non psychiatric comparison subjects (NPCs) participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out at a community-based Outpatient Treatment Center and at an urban-located Health Centre in Spain. A binary judgment of capacity/incapacity was made guided by the MacArthur Competence Assessment Tool for Clinical Research (MacCAT–CR) and a clinical interview. Demographics and clinical characteristics were assessed by cases notes and the Mini-Mental State Examination, the Global Assessment Functional Scale and the Clinical Global Impression Scale.

Results

NPCs performed the best on the MacCAT–CR, and patients with SUD had the worst performance, particularly on the Understanding and Appreciation subscales. 32.7 % SUD people lacked research-related decisional capacity. There were no statistically significant differences between the groups in terms of capacity to consent to research.

Conclusions

The findings of our study provide evidence that a large proportion of individuals with SUD had decisional capacity for consent to research. It is therefore inappropriate to draw conclusions about capacity to make research decisions on the basis of a SUD diagnosis. In the absence of advanced cognitive impairment, acute withdrawal or intoxication, we should assume that addicted persons possess decision-making capacity. Thus, the view that people with SUD would ipso facto lose decision-making power for research consent is flawed and stigmatizing.

Below:  MacCAT-CR scales scores in SUD. Abbreviations: MacCAT-CR, MacArthur Competence Assessment Tool for Clinical Research; SUD, Substance Use Disorders; NS, Non significant

Full article at:   http://goo.gl/i6RhhQ

By:  Inés Morán-Sánchez, Aurelio Luna, Maria Sánchez-Muñoz, Beatriz Aguilera-Alcaraz, and Maria D. Pérez-Cárceles

Mental Health Centre (Health Service of Murcia), Real St 8, E-30201, Cartagena (Murcia), Spain

Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, (Murcia), Spain

Isaac Peral Health Centre (Health Service of Murcia), Ulloa St 6. E 30300, Cartagena (Murcia), Spain

Inés Morán-Sánchez, Email: se.mrac@narom.seni.

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Preventing HIV By Understanding Patterns of Transmission with Susan Little, MD -- Exploring Ethics

Via: http://goo.gl/ZrlNsO  By: https://twitter.com/uctelevision

Sexuality Research in Iran: A Focus on Methodological and Ethical Considerations

BACKGROUND:

Research on sensitive topics, such as sexuality, could raise technical, methodological, ethical, political, and legal challenges. The aim of this paper was to draw the methodological challenges which the authors confronted during sexuality research with young population in the Iranian culture.

METHODS:

This study was an exploratory mixed method one conducted in 2013-14. We interviewed 63 young women aged 18-34 yr in qualitative phase and 265 young women in quantitative phase in (university and non-university) dormitories and in an Adolescent Friendly Center. Data were collected using focus group discussions and individual interviews in the qualitative phase. We employed conventional content analysis to analyze the data. To enhance the rigor of the data, multiple data collection methods, maximum variation sampling, and peer checks were applied.

RESULTS:

Five main themes emerged from the data: interaction with opposite sex, sexual risk, sexual protective, sex education, and sexual vulnerability. Challenges while conducting sex research have been discussed. These challenges included assumption of promiscuity, language of silence and privacy concerns, and sex segregation policy.

CONCLUSION:

We described the strategies applied in our study and the rationales for each strategy. Strategies applied in the present study can be employed in contexts with the similar methodological and moral concerns.

Table 1:

The process of extracting risky sexual behaviors theme

Theme	Sub-themes	Cods	Units of meanings
Risky sexual behaviors	Multi-partner-ship	Engaging in sexual behaviors with more than one person in order to: - Select the best one - Keep one of them for the future	“Sometimes, I had more than one boyfriend; I experienced sexual behaviors with both of them. My goal was to select and keep one of them in my life.”
	Casual relation-ship	- Unplanned sexual relationships - Inability to reject sexual behaviors	“In some of my relationships, I engaged in unplanned sexual relationships; for example, last year, I participated in a party and met a cool guy. Sexual relationships happened in the first meeting and I could not resist it.”
	Lack of contraception use	Lack of perceived risk of pregnancy because of: - Low frequency of sexual intercourse - Vaginal douche after each intercourse	“I did not use contraception because I thought I would not become pregnant because we had intercourse not frequently and I washed my vagina after each intercourse.”
	Lack of condom use	Lack of condom use because of fear of Lose of confidence	“I could not tell my boyfriend to use condom because I think he will miss his confidence to me or he think I have a sexual disease.”

Table 2:

Themes and sub-themes of premarital sexual behaviors

Themes	Sub-themes
Interaction with opposite sex
	Social friendship
	Intimate relationship
Sexual risk
	Risky sexual behaviors
	Risky sexual factors
Sexual protective
	Protective sexual behaviors
	Protective sexual factors
Sex education
	Sex education effects
	Sex education barriers
	Sex education principles
	Sex education content
	Organizations for sex education
Sexual vulnerability
	Reasons for sexual vulnerability
	Strategies for preventing sexual vulnerability

Full article at:  http://goo.gl/MZZgUg

By:  Rahmani A1, Merghati-Khoei E2, Moghaddam-Banaem L1, Zarei F3, Montazeri A4, Hajizadeh E5.

• 1Dept. of Midwifery & Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
• 2Iranian National Center of Addiction Studies (INCAS); the Risk Behavior Institution. Tehran University of Medical Sciences, Tehran, Iran.
• 3Dept. of Health Education, Tehran University of Medical Sciences, Tehran, Iran.
• 4Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
• 5Dept. of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. 

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The Return of Lombroso? Ethical Aspects of (Visions of) Preventive Forensic Screening

The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.

Introduction

Nineteenth-century Italian anthropologist and criminology and forensic psychiatry pioneer Cesare Lombroso is notorious for his idea (first published in Italian in 1876, see Parmelee, 1911) that crime originates from specific individual anomalies, and that a scientific mapping of these should be used for preventive criminal policy purposes. Ideally, ‘criminal science’ should facilitate early identification of ‘moral insanity’ to foresee which individuals risk developing criminal behaviour and to instigate suitable therapeutic, preventive or mitigating action (Lombroso, 1911; Parmelee, 1911). Lombroso’s own specific ideas, as those of his US parallel Isaac Ray (1861), regarding the purely biological nature of the causes of crime were criticized early on for paying too little attention to psychological and social factors (Ellwood, 1912), and the very idea of a biological explanation of crime was criticized for undermining the institution of criminal justice (Gray, 1858).¹ A student of Lombroso, Enrico Ferri (1895), who shared Lombroso’s basic assumption that criminal behaviour results from factors behind the individual’s control, included social factors as possible causes for criminality, as may indeed have been Lombroso’s own intention (Gibson, 2002). This view was also endorsed by the Swedish psychiatrist Olof Kinberg (1935), who argued that crime could and should be prevented by detaining the very sick criminals, try to treat those who can be treated, but also to reform society to eradicate poverty and ignorance...

Below:  Map of generic new Lombrosian strategies

Full article at:  http://goo.gl/bia3eZ

By: Christian Munthe^, Department of Philosophy, Linguistics and Theory of Science & Centre for Ethics, Law and Mental Health, University of Gothenburg

Susanna Radovic, Department of Philosophy, Linguistics and Theory of Science & Centre for Ethics, Law and Mental Health, University of Gothenburg

  

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Singling Out the Double Effect - Sexual Health Advice & Contraception Are Ethically Distinct

This article is a response to an article previously published in LJPC, which employed the doctrine of double effect to explain the Gillick judgement and exculpate health care workers who provide contraceptives and sexual health advice to under-16s. In this analysis, the two acts: provision of contraceptives and provision of sexual health advice are examined separately against the four criteria of the doctrine of double effect. In conclusion, whilst sexual health advice provision fits into the doctrine reasonably well, in the case of contraceptive provision, the validity of the doctrine of double effect is more doubtful...

• Whilst sexual health advice provision fits into the doctrine of double effect reasonably well, in the case of contraceptive provision, the validity of the doctrine of double effect is more doubtful.
• Some health care workers will not agree that the provision of contraception is a morally neutral act.
• The benefits of sexually transmitted disease and pregnancy prevention cannot be realised unless underage sex actually occurs.
• Prevention of pregnancy is implicitly counted as a benefit. However, in and of itself, pregnancy is not a harm...

Full article at:  http://goo.gl/amsS2L

By:  Steven Bow a , *

^aPublic Health Department, London Borough of Richmond upon Thames, Twickenham, UK

Email: ku.vog.dnomhcir@wob.nevets

 

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Translating PrEP Effectiveness into Public Health Impact: Key Considerations for Decision-Makers on Cost-Effectiveness, Price, Regulatory Issues, Distributive Justice and Advocacy for Access

Read at: http://ht.ly/Q6ptI HT @UvA_Amsterdam 

Discussion

In considering the role that PrEP can play in combination prevention programmes, decision-makers must determine who can benefit most from PrEP, how PrEP can be provided safely and efficiently, and what kind of health system support will ensure successful implementation. To do this, they need contextualized information on disease burden by population, analyses of how PrEP services might best be delivered, and projections of the human resource and infrastructure requirements for each potential delivery model. There are cost considerations, varying cost-effectiveness results and regulatory challenges. The principles of ethics can inform thorny discussions about who should be prioritized for oral PrEP and how best to introduce it fairly. We describe the cost-effectiveness of PrEP in different populations at higher risk of HIV exposure, its price in low- and middle-income countries, and the current regulatory situation. We explore the principles of ethics that can inform resource allocation decision-making about PrEP anchored in distributive justice, at a time when universal access to antiretroviral treatment remains to be assured. We then highlight the role of advocacy in moving the PrEP agenda forward.

Conclusions

The time is ripe now for decisions about whether, how and for whom PrEP should be introduced into a country's HIV response. It has the potential to contribute significantly to high impact HIV prevention if it is tailored to those who can most benefit from it and if current regulatory and pricing barriers can be overcome. Advocacy at all levels can help inform decision-making and push the access agenda to avert HIV infections among those at highest risk of HIV exposure. The benefits will accrue beyond the individual level to slow HIV transmission at the population level.

Below: Regulatory approval in trial host countries for daily TFD/FTC