Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
Med Health Care Philos. 2020 Jun;23(2):269-279. doi: 10.1007/s11019-019-09932-4.
The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I argue that we should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we (i) integrate insights from several areas of ethics, (ii) translate bioethical principles into the mental health context, and (iii) proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna's notion of 'layers of vulnerability' to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis.
精神疾病的神经科学和基因组学研究日益交织在一起。这主要是由于医学技术向精神病学的转化以及技术融合。本文聚焦于精神病学。我认为，在精神病学背景下，神经科学和基因组学的融合在道德上存在问题，伦理学术研究不应仅仅局限于确定一些伦理、法律和社会问题。我的论点由两个部分组成。首先，我认为我们应该通过开发一种以个体脆弱性评估为重点的综合、以患者为中心的方法来应对技术融合。应对技术融合需要我们（i）整合来自多个伦理领域的见解，（ii）将生物伦理原则转化为心理健康背景，以及（iii）积极尝试预测未来的伦理问题。其次，我认为对脆弱性概念的细致理解可能有助于我们完成这项任务。我借鉴了弗洛伦西亚·卢娜（Florencia Luna）的“脆弱性的层次”概念，以表明如何将潜在的对经历精神病的个体的伤害或错误概念化为源于脆弱性的不同来源或层次。我认为，脆弱性的层次概念可以作为一个共同基础，实现确保生物医学创新真正造福而不是伤害患有精神病的个体所需的伦理整合。
