Albany Medical College, Alden March Bioethics Institute, Albany, New York, United States.
Molloy College, Philosophy Department, Rockville Centre, New York, United States.
Bioethics. 2021 May;35(4):337-347. doi: 10.1111/bioe.12849. Epub 2021 Feb 20.
Individuals diagnosed with conduct disorder (CD) in childhood and adolescence are at risk for increasingly maladaptive and dangerous behaviors, which unchecked, can lead to antisocial personality disorder (ASPD) in adulthood. Children with CD, especially those with the callous unemotional subgroup qualifier ("limited prosocial emotions"/DSM-5), present with a more severe pattern of delinquency, aggression, and antisocial behavior, all markings of prodrome ASPD. Given this recognized diagnostic trajectory, with a pathological course playing out tragically at the individual, familial, and societal level, and lack of effective remediation via current standards of care, we posit an alternate treatment approach; case-specific compulsory moral habilitation aimed at rectifying the undeveloped affective domain of adolescents and young adults suffering from these disorders. We begin with a brief historical overview of response to mental illness, review CD and ASPD diagnostic criteria and treatment limitations, and posit a unique neurohabilitative approach that focuses on the absent affective moral development of these populations. Next, we invoke a public health safety argument to justify case-specific compulsory moral habilitation, discuss neurotechnologies to be considered in treatment, and conclude with ethical considerations and suggestions for further research.
个体在儿童和青少年时期被诊断患有品行障碍(CD),则其有较高风险表现出日益适应不良和危险的行为,如果不加控制,可能会导致成年后患反社会人格障碍(ASPD)。患有 CD 的儿童,特别是那些具有无情无情感亚组特征的儿童(“有限的亲社会情感”/DSM-5),表现出更严重的犯罪、攻击和反社会行为模式,这些都是前驱 ASPD 的标志。鉴于这种公认的诊断轨迹,以及在个体、家庭和社会层面上表现出的病态病程,以及当前护理标准缺乏有效的矫正措施,我们提出了一种替代治疗方法;针对患有这些障碍的青少年和年轻人,进行特定病例的强制性道德矫正,旨在纠正其未发育完全的情感领域。我们首先简要回顾一下对精神疾病的反应,回顾 CD 和 ASPD 的诊断标准和治疗限制,并提出一种独特的神经康复方法,该方法侧重于这些人群中缺失的情感道德发展。接下来,我们援引公共卫生安全论点来证明特定病例的强制性道德矫正的合理性,讨论治疗中需要考虑的神经技术,并以伦理考虑和进一步研究的建议结束。