Mandating Vaccination

A short piece exploring some arguments for mandating vaccination for Covid-19

What is Criminal Rehabilitation?

It is often said that the institutions of criminal justice ought or—perhaps more often—ought not to rehabilitate criminal offenders. But the term ‘criminal rehabilitation’ is often used without being explicitly defined, and in ways that are consistent with widely divergent conceptions. In this paper, we present a taxonomy that distinguishes, and explains the relationships between, different conceptions of criminal rehabilitation. Our taxonomy distinguishes conceptions of criminal rehabilitation on the basis of (i) the aims or ends of the putatively rehabilitative measure, and (ii) the means that may be used to achieve the intended end. We also explore some of the implications of each conception, some of the payoffs of a taxonomy of the kind we offer, and some areas for future work

Chapter 8 Three Rationales for a Legal Right to Mental Integrity

Many states recognize a legal right to bodily integrity, understood as a right against significant, nonconsensual interference with one’s body. Recently, some have called for the recognition of an analogous legal right to mental integrity: a right against significant, nonconsensual interference with one’s mind. In this chapter, we describe and distinguish three different rationales for recognizing such a right. The first appeals to case-based intuitions to establish a distinctive duty not to interfere with others’ minds; the second holds that, if we accept a legal right to bodily integrity, then we must, on pain of philosophical inconsistency, accept a case for an analogous right over the mind; and the third holds that recent technological developments create a need for a legal right to mental integrity

Achievement and Enhancement

We engage with the nature and the value of achievement through a critical examination of an argument according to which biomedical “enhancement” of our capacities is impermissible because enhancing ourselves in this way would threaten our achievements. We call this the argument against enhancement from achievement. We assess three versions of it, each admitting to a strong or a weak reading. We argue that strong readings fail, and that weak readings, while in some cases successful in showing that enhancement interferes with the nature or value of achievement, fail to establish that enhancement poses an unusual threat to achievement

Fetal exposure to neurotropic drugs : neonatal effects and long-term outcome

Chronic illness in pregnant women is common. In epilepsy, bipolar disorder (BD) or major depressive disorder (MDD), pharmacotherapy is often necessary. Some neurotropic drugs may have negative effects on children exposed in utero. The aim of this thesis was to describe how neurotropic drugs and/or maternal chronic illness during pregnancy may influence the health of the child, both in the neonatal period and long-term outcome, with emphasis on neurodevelopment. In study I, we investigated school results at age 16 in children born to women with epilepsy (WWE), with or without antiepileptic drugs (AED) during pregnancy. Study II and study III aimed at describing neonatal morbidity in infants prenatally exposed to antidepressant drugs. In study IV we studied neonatal and long-term outcome of children born to mothers with severe mood disorders, mostly BD. Methods: In study I, national health care and education registers as well as maternal care records were used to compare final grades of children of WWE with the rest of the population. Study II was a retrospective, hospital-based study of patient records of women treated with antidepressants in late pregnancy and their children. Information on neonatal diagnoses, maternal use of antidepressant drugs and scoring according to Neonatal Abstinence Score (NAS) was used. In study III, we used the Medical Birth Register, the Prescribed Drug Register and two neonatal quality registers to obtain data on maternal use of antidepressants, maternal health and infant morbidity (diagnoses, admission to neonatal care unit (NCU) and interventions). In study IV, information on maternal health during and after pregnancy was obtained from patient records and at a structured interview. At age 4 to 5 years, the children were assessed by a psychologist with a cognitive test (WPPSI-III). Results: In study I, we observed an increased risk of not receiving a final grade from compulsory school for children exposed to ≥ 2 AED during pregnancy, adjusted odds ratio (OR) 2.99 (95 % confidence interval [CI] 2.14–4.17), but no increased risk for children born to mothers with untreated epilepsy or exposed to AED in monotherapy. In study II, 22 % of 205 infants assessed with NAS had signs of mild neonatal abstinence and 3 % of severe abstinence. Among a total of 741 040 infants included in study III, 22 507 (3 %) were exposed to antidepressants during pregnancy. Thirteen percent of exposed infants were admitted to NCU compared to 8 % in the population, adjusted OR 1.5 (95 % CI 1.4-1.6). Respiratory disorders, persistent pulmonary hypertension and hypoglycemia were more common after maternal use of selective serotonin reuptake inhibitors. In study IV, there were no statistically significant differences in IQ between children born to women with mood disorders with lithium use during pregnancy (n=20), children born to mothers with mood disorders but no lithium use during pregnancy (n=8) and children born to mothers with no mood disorders (n=11). Conclusions: Neurotropic drugs during pregnancy can be associated to adverse outcomes in exposed children. Infants exposed to antidepressants have a moderately increased risk of being admitted to NCU. AED polytherapy during pregnancy may be associated to a worsened neurodevelopmental outcome but a causal connection is not established. Lithium exposure during pregnancy was not associated to adverse cognitive outcome at preschool age in our cohort

Motivational Interviewing in an ordinary clinical setting: A controlled clinical trial at the Swedish National Tobacco Quitline

AbstractIntroductionThe present study aimed to assess the effect of adding Motivational Interviewing (MI) to the first session of an effective smoking cessation treatment protocol in an ordinary clinical setting: the Swedish National Tobacco Quitline (SNTQ).MethodThe study was designed as a controlled clinical trial. Between September 2005 and October 2006, 772 clients accepted the invitation to participate in the study and were semi-randomised to either standard treatment (ST) or MI. The primary outcome measures were self-reported 7-day point prevalence abstinence and 6-month continuous abstinence.ResultsAt 12-month follow-up, the 772 clients were included in an intention to treat analysis. Of the clients allocated to MI, 57/296 (19%) reported 6-month continuous abstinence compared to 66/476 (14%) of the clients allocated to ST (OR 1.48, 95% CI 1.00–2.19; P=.047).ConclusionsIntegrating MI into a cognitive behavioural therapy-based smoking cessation counselling in an ordinary clinical setting at a tobacco quitline increased client 6-month continuous abstinence rates by 5%

Ethical Challenges in the Applications of Motivational Interviewing in HIV Care

This chapter engages with ethical challenges of using motivational interviewing (MI) and MI-based interventions in HIV care. We first outline two general ethical worries in respect of MI use. We argue that the relational and technical components of MI provide insufficient ethical action guidance and ethical safeguards respectively. It is necessary to consider factors external to the method of MI in order to establish the ethical permissibility of its applications. We subsequently consider the ethics of MI in the context of HIV care, specifically in relation to pre-exposure prophylaxis, medication adherence, and disclosure of HIV/AIDS diagnosis/prognosis. Our framework for discussion of these specific issues may be relevant to other applications of MI in HIV care

Should we delay covid-19 vaccination in children?

The net benefit of vaccinating children is unclear, and vulnerable people worldwide should be prioritised instead, say Dominic Wilkinson, Ilora Finlay, and Andrew J Pollard. But Lisa Forsberg and Anthony Skelton argue that covid-19 vaccines have been approved for some children and that children should not be disadvantaged because of policy choices that impede global vaccinatio

Would it be ethical to use motivational interviewing to increase family consent to deceased solid organ donation?

We explore the ethics of using motivational interviewing (MI), an evidence-based, client-centred and directional counselling method, in conversations with next of kin about deceased solid organ donation. After briefly introducing MI and providing some context around organ transplantation and next of kin consent, we describe how MI might be implemented in this setting,with the hypothesis that MI has the potential to bring about a modest yet significant increase in next of kin consent rates. We subsequently consider the objection that using MI in this context would be manipulative.Although we cannot guarantee that MI would never be used in a problematically manipulative fashion, we conclude that its use would, nevertheless, be permissible as a potential means to increase next of kin consent to deceased solid organ donation. We propose that MI be trialled in consent situations with next of kin in nations where there is widespread public support for organ donation