The 'Rule of Rescue' in Medical Priority Setting: Ethical Plausibilities and Implausibilities

Not infrequently, the so-called Rule of Rescue gets invoked as an allegedly self-evident constraint to the CBE-goal of maximizing health benefit with a given health budget. In this paper this constraint is critically analyzed. It will be argued that some of its implications are worth considering - but not the inherently vague Rule as such.health care, health ethics, prioritization

The philosophy of psychiatry and biologism

In the philosophy of psychiatry, there has been an ongoing dispute about the capabilities and limits of the bio-natural sciences as a source of methods and knowledge for quite some time now. Still, many problems remain unsolved. This is at least in part due to the regrettable fact that the opposing parties are far too rarely prepared to swap ideas and to try to increase their mutual understanding. On the one hand there are those—psychiatrists as well as philosophers—who maintain a more mentalistic and/or phenomenalistic view of the psyche and its disturbances. On the other hand there are researchers who follow biologically inspired strategies: Since the human mind is something through and through biological, mental diseases, too, can and should be explained and treated biologically. Even though there are examples of fruitful collaboration, in general the split prevails. One often gets the impression that both sides remain in their “trenches”, busy with confirming each other's opinions and developing their positions in isolation. Even though there are also examples of fruitful collaboration, the split leads to several shortcomings:(1) Good arguments and insights from both sides of the debate get less attention than they deserve.(2) The further improvement of each position becomes harder without criticism, genuinely motivated by the opposing standpoint.(3) The debate is not going to stop, at least not in the way it would finish after a suggested solution finds broad support.(4) Related to this, insisting on the ultimate aptness of one side is just plainly wrong in almost every case, since undeniably, most philosophical positions usually have a grain of truth hidden in them.In sum, many controversies persist with regard to the appropriate methodological, epistemological, and even ontological level for psychiatric explanation and therapies. In a conference which took place in December 2011 in Muenster, Germany, we tried to contribute to a better understanding about what really is at issue in the philosophy of psychiatry. We asked for a possible common basis for several positions, for points of divergence, and for the practical impact of different solutions on everyday work in psychiatry.The present Frontiers research topic is a fruit of that conference. Since psychiatry is a subject too wide to be covered in toto, this research topic collects six target articles, each focusing a particular aspect. They are accompanied by a number of commentaries providing both critical and supportive arguments

The Philosophy of Psychiatry and Biologism

There has been an ongoing debate about the capabilities and limits of the bio-natural sciences as sources and the methodological measure in the philosophy of psychiatry for quite some time now. Still, many problems remain unsolved, at least partly for the following reasons: The opposing parties do not tend to speak with each other, exchange their arguments and try to increase mutual understanding. Rather, one gets the impression that they often remain in their “trenches”, busy with confirming each others' opinions and developing their positions in isolation. This leads to several shortcomings: (1) Good arguments and insights from both sides of the debate get less attention they deserve. (2) The further improvement of each position becomes harder without criticism, genuinely motivated by the opposing standpoint. (3) The debate is not going to stop, at least not in the way it would finish after a suggested solution finds broad support; (4) Related to this, insisting on the ultimate aptnessof one side is just plainly wrong in almost every case. Since undeniably, most philosophical positions usually have a grain of truth hidden in them. In sum, many controversies persist with regard to the appropriate methodological, epistemological, and even ontological level for psychiatric explanation and therapies. In a conference which took place in December last year, we tried to contribute to a better understanding about what really is at issue in the philosophy of psychiatry. We asked for a common basis for several sides, for points of divergence and for the practical impact of different solutions on everyday work in psychiatry. Since psychiatry as a whole is a subject that is to wide to be covered in a single meeting, we focused on the following four core topics: 1. Competing accounts of psychiatric biologism, reductionism, and physicalism. 2. Mental disease and brain disease in the light of current neuroscientific and epigenetic findings. 3. Normative suppositions for different accounts of mental disease. 4. Normative implications of different accounts of mental disease. These topics, which have been vigorously as well as fruitfully discussed at our conference, will (ideally) be, too, in the center of our contribution to Frontiers. More precisely, we think of arranging a “research topic” which assembles the issues of the conference. At this point, it seems promising to us to group three or four Target Articles (TA) and let them get criticized by a couple of commentaries from different angles to give the issue a much broader and detailed perspective