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... Nonetheless, many articles in our dataset simply summarized the main positions in Anglo-Saxon language discourse, which suggests that the discussion in the Hispanic academic debate has not yet developed a specific voice reflecting particular cultural values or perspectives. This could just be the reflection of a nascent stage of neuroethics in many of these countries (Salles 2018), as well as a reflection of the fact that academics in related areas are thinly distributed in different institutions, with a lack of financial resources to carry out research in this field, and where organization, structure, collaboration, and development of the field is still under way. ...
... Another possible interpretation for the clear difference between Hispanic and Anglo-Saxon language academic worlds in the volume of articles published on the topic could be, as Salles (2018) argues, that in the Hispanic world, other more practical topics have been prioritized. In fact, Salles points to Argentina as an example of how immediate concerns (e.g., neurodevelopmental effects of poverty, inclusive human rights, access to basic medical care) assume neuroethical relevance, when compared to those which temporal concern is relegated to the distant future, or at least perceived as so. ...
While neuroenhancement has been widely debated in the bioethics and neuroethics literature, the Anglo-American perspective has dominated a majority of these discussions. Thus, little is known about the motives and attitudes towards neuroenhancement in other cultures. Cultural values and linguistic peculiarities likely shape distinct attitudes and perspectives about neuroenhancement. In this paper, we aim to identify universals and points of divergence between the Anglo-American and the Hispanic discussions about neuroenhancement. We carried out a literature review of articles published in the Spanish language discussing perspectives and ethical issues around neuroenhancement. We analyzed the content for (1) the terms used to convey the concept of “neuroenhancement” and (2) the ethical concerns raised. Our results show a wide range of Spanish terms used to refer to neuroenhancement, as well as important differences on the scope and concerns raised. These results invite further research regarding cross-cultural perspectives on neuroenhancement and neuroethical discussion.
... En el caso particular del desarrollo de la neuroética en Argentina, se ha destacado la peculiaridad de que, debido a la influencia de la corriente psicoanalítica en el país, existe un mayor escepticismo acerca de pretensión de la neurociencia de explicar por sí sola el funcionamiento de la mente y de la conducta humanas. Esta pretensión, que parece estar implícita en algunos estudios científicos, suele ser vista como excesivamente simplista y reductiva de la personalidad humana (Salles, 2018). ...
El presente Informe fue preparado por encargo de la UNESCO (Oficina para América Latina y el Caribe). En primer lugar destaca el notable desarrollo neurocientífico que ha tenido lugar en los últimos años en varios países latinoamericanos, tanto en actividades clínicas como de investigación. Al abordar la perspectiva de derechos humanos en relación con las neurotecnologías, el informe identifica cuatro derechos que están llamados a jugar un rol central en la materia: la privacidad mental, la integridad mental, la identidad personal y la libertad cognitiva. El documento presenta a continuación las diversas propuestas de regulación de la materia por parte de distintos organismos internacionales y regionales latinoamericanos, así como a nivel de los órganos legislativos de países de la región, enfatizando el liderazgo de la UNESCO, que puede ser una fuerza motriz en materia de neurotecnología dentro del sistema de las Naciones Unidas, gracias a su mandato único y su experiencia en bioética y ética de la ciencia y la tecnología.
... However, if the science and the research ethics are (ideally) universal, those issues are sometimes profoundly shaped by local social and cultural factors. In Argentina, the traditional weight of psychoanalysis contributes to mold attitudes to neuroscience, and therefore to neuroethics (Salles, 2014(Salles, , 2017; in Japan, understandings of the impact and ethics of neuroscience are likely influenced by distinctive concepts and vocabularies for mind-heart-spirit (Fukushi et al., 2017; on East Asia more generally, see Sakura, 2012). Moreover, how much or little neuroethics institutionalizes is largely dependent on the structure of research funding and academic organizations (see Gaillard, 2018 for the Japanese case). ...
... However, if the science and the research ethics are (ideally) universal, those issues are sometimes profoundly shaped by local social and cultural factors. In Argentina, the traditional weight of psychoanalysis contributes to mold attitudes to neuroscience, and therefore to neuroethics (Salles, 2014(Salles, , 2017; in Japan, understandings of the impact and ethics of neuroscience are likely influenced by distinctive concepts and vocabularies for mind-heart-spirit (Fukushi et al., 2017; on East Asia more generally, see Sakura, 2012). Moreover, how much or little neuroethics institutionalizes is largely dependent on the structure of research funding and academic organizations (see Gaillard, 2018 for the Japanese case). ...
Since its emergence in the early 2000s, neuroethics has become a recognized, institutionalized and professionalized field. A central strategy for its successful development has been the claim that it must be an autonomous discipline, distinct in particular from bioethics. Such claim has been justified by the conviction, sustained since the 1990s by the capabilities attributed to neuroimaging technologies, that somehow ‘the mind is the brain’, that the brain sciences can illuminate the full range of human experience and behavior, and that neuroscientific knowledge will have dramatic implications for views of the human, and challenge supposedly established beliefs and practices in domains ranging from self and personhood to the political organization of society. This article examines how that conviction functions as neuroethics’ ideological condition of possibility.
As early-career neuroethicists, we come to the field of neuroethics at a unique moment: we are well-situated to consider nearly two decades of neuroethics scholarship and identify challenges that have persisted across time. But we are also looking squarely ahead, embarking on the next generation of exciting and productive neuroethics scholarship. In this article, we both reflect backwards and turn our gaze forward. First, we highlight criticisms of neuroethics, both from scholars within the field and outside it, that have focused on speculation and lack of skepticism; the dearth of consideration of broader social issues such as justice and equality, both with regard to who speaks for neuroethics as a field and who benefits from its recommendations and findings; and the insufficient focus on the practical impact of our ethical work. Second, we embrace the concept of “translational neuroethics” to outline a vision for neuroethics that is integrated, inclusive, and impactful. Integration can help us identify more pertinent, real-world issues, and move away from speculation; inclusivity can help ensure that the questions we attend to are not merely relevant to a single subgroup but aim toward just distribution of benefits; and impact can help us think beyond guidelines and recommendations to focus on implementation. Our goal is for this call to action to help shape neuroethics into a discipline that develops rigorous research agendas through relationships with interdisciplinary partners, that is broadly inclusive and attends to issues beyond novel neurotechnologies, and that is devoted to the translation of scholarship into practice.
This article examines in depth whether electroconvulsive therapy (ECT) satisfies bioethics’ four healthcare provision principles: nonmaleficence, beneficence, justice, and autonomy. Treating patients ethically implies protecting them from damages, working to ensure their well-being, and respecting their decisions once they have been correctly informed. Although most of the medical literature states that ECT is an effective and safe technique, there is no conclusive evidence of long-term effectiveness. The frequent and sometimes persistent side effects such as amnesia that imply a profound disturb of lived experience, or the difficulties regarding the informed consent process, allow us to conclude that the bioethical debate about ECT is not currently closed, and the information provided to patients needs to be revised
Electroconvulsive therapy is a treatment that, since its first administration, has been a major topic for debate within the scientific world. In recent years, the debate has become increasingly focused on the short- and/or long-term efficacy of electroconvulsive therapy, its appropriateness in clinical settings, its mechanism of action, the impact evaluation of transient and/or persistent adverse effects, and the drafting of international guidelines, etc .
From the authors’ point of view, these themes are inevitably crossed by three other fundamental issues of significant psychological, relational, ethical, and medico-legal impact. Still, they are less studied than purely biomedical issues in recent times. Therefore, the aim of this article is to focus on the following cross-cutting issues: the therapist-patient relationship, the patient’s perspective, the attitude on electroconvulsive therapy, and informed consent.
This short review refers to the international literature on ECT published since 2000. Analyses of the three previously listed topics are, in part, made within the context of Italian medical settings.
This paper and its first part attempt to comprehend the use of electroshock, a technique whose effectiveness has not been unequivocally demonstrated. The lack of conclusive evidence has generated consensus, but it does not come from a genuine interdisciplinary debate. The concept of therapeutic inhibition is unfounded. Electroshock reduces the sense of personal efficacy and autonomy that characterizes healthy functioning and introduces an implicit stigmatizing message of causality in terms of brain malfunction. There are no specific laws in Spain that regulate this procedure. The quality of the information provided to the patient is poor and could lead to professional liability. Due to its exceptional nature, electroshock should not be considered as just another therapy like any other. Professionals can exercise conscientious objection for ethical and scientific reasons. An interdisciplinary perspective would be to call for potentially less harmful treatment alternatives.
En 1995 la OPS/OMS llevó a cabo una encuesta postal para investigar las características del uso del tratamiento por electrochoques (TEC) en América Latina y en el Caribe de habla inglesa y holandesa. Según los resultados de la encuesta, el uso del TEC difiere en las dos subregiones. La técnica se utiliza ampliamente en América Latina y solo esporádicamente en el Caribe. Asimismo, su uso varía dentro de cada país y ha sufrido cambios a lo largo del tiempo. Solamente la mitad de los países de América Latina tienen normas técnicas para la aplicación del TEC. La administración de anestesia y de relajantes musculares durante el mismo y la obtención de consentimiento informado todavía no son prácticas reglamentarias en las instituciones psiquiátricas de América Latina. La toma de medidas para subsanar estos déficit ayudará a borrar la estereotípica imagen negativa que esta intervención suele evocar.
Mental capacity is central to legal and ethical debates on the use of compulsion in psychiatry.
To describe the clinical epidemiology of mental incapacity in patients with psychiatric disorders, including interrater reliability of assessments, frequency in the psychiatric population and associations of mental incapacity.
Cross-sectional studies of capacity to consent to treatment for psychiatric patients were systematically reviewed from Medline, EMBASE and PsycInfo databases. Information on the reliability of assessments, frequency and associations of mental incapacity was extracted.
Out of 37 papers reviewed, 29 different capacity assessment tools were identified. Studies were highly heterogeneous in their measurement and definitions of capacity. Interrater reliabilities between tools were high. Studies indicate incapacity is common (median 29%) but the majority of psychiatric in-patients are capable of making treatment decisions. Psychosis, severity of symptoms, involuntary admission and treatment refusal were the strongest risk factors for incapacity.
Mental capacity can be reliably assessed. The majority of psychiatric in-patients have capacity, and socio-demographic variables do not have a major impact but clinical ones do.
Cea-Madrid, J., & Parada, T. (2020). Electroshock o Terapia Electroconvulsiva (TEC) en
Terapia electroconvulsiva, la técnica que gatilló la denuncia por tortura del Minsal en contra del Hospital Psiquiátrico de Valparaíso. La Tercera. Retrieved
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Canales, I., & Mayorga, F. (2022, June 16). Terapia electroconvulsiva, la técnica que gatilló
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Tercera. Retrieved June 30, 2023, from: https://www.latercera.com/nacional/noticia/
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Principles and Practice of Electroconvulsive Therapy
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See, for example, Rasmussen K.G. (2019). Principles and Practice of Electroconvulsive
Therapy. American Psychiatric Association Publishing: Washington DC; Mankad, op. cit.
note 8.