Rethinking Mental Health Reform: A case for reviving community-based care

by Zain Khalid

October 10th marked the first anniversary of California’s Senate Bill 43 (SB 43), a major revision of the landmark Lanterman-Petris-Short Act of 1967, a de-institutionalization era law designed to “end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders.” The law loosened eligibility standards for civil commitment by expanding the existing “grave disability” criterion, making it easier to detain and hospitalize persons with mental illness against their will.

New York City’s mayor, Eric Adams, enacted a similar initiative in November 2022, the same year 40-year-old Michelle Alyssa Go, was tragically killed after being shoved onto the subway by an unhoused man with a long history of mental illness and patchy treatment. New York’s plan authorized emergency medical workers and police officers to involuntarily remove people with severe mental illness from the streets to be evaluated for hospitalization. Mayor Adams framed his plan in terms of the city’s “moral obligation” to help mentally ill citizens and California Governor Gavin Newsom spoke of a “life-and-death urgency” in advocating for SB 43.

These controversial initiatives are among the highest profile of a growing national trend toward expanding civil commitment laws: Ohio, DC, Tennessee, Alabama and Florida have introduced similar legislation in just the past year. Across the U.S., this turn toward civil commitment is driven by a triple whammy of unmitigated housing crises, an increasingly visible unhoused mentally ill population, and rising violent crime. But is civil commitment a defensible strategy in tackling this Gordian knot of intersecting social crises? Or does it merely serve to keep unseemly realities away from the public eye? To understand the role of civil commitment in addressing these challenges, we must begin by looking at how we got here. Read More

Love and Liberalism in Surrogate Decision-Making

by James Toomey

If you are supposed to make a legally binding decision on behalf of someone incapacitated by dementia, chances are the law will tell you to apply the “substituted judgment” standard—you will be asked to make the decision the person for whom you are deciding would have made, if they had capacity. But why? You might think that the decision they would have made is a very bad one. And it’s not as though someone in the late stages of dementia is coming back to appreciate what you’ve done for them. Indeed, according to many philosophers (and ordinary people), someone in the late stages of dementia might not even be the same person they had been previously — why decide based on what some now-gone person would have wanted?

In Love, Liberalism, Substituted Judgment, recently published in the Indiana Law Journal, I offer a novel account of why the law might be justified in endorsing the substituted judgment standard in dementia cases, notwithstanding these sorts of difficulties. The argument proceeds in three steps. First, I suggest that dementia cases might not be the right place to start. In cases of temporary incapacity, such as that caused by a transient psychotic episode, questions about whether decisions made in the interim are really for the person don’t arise — that person will come back, and their life will be affected one way or another by what happened in the interim. The substituted judgment standard applies in these cases too, and, indeed, that is where it historically arose. Read More

Capacity and Medical Decision-Making in First- and Third-Person Perspectives

by James Toomey

Imagine that you were to develop dementia and someone else had to make medical decisions on your behalf. How would you want them to decide? Then suppose that you had to make medical decisions on behalf of another person with dementia. Would you think about decision-making in the same way? A new study in AJOB Empirical Bioethics by myself, Jonathan Lewis, Ivar Hannikainen, and Brian Earp suggests that people may favor different decisions when deciding for others versus when deciding what they would want for themselves.

In the study, we presented a cohort of nearly 1,500 U.S. participants with a vignette based on one of the most persistent and difficult questions in bioethics. The vignette describes someone with ordinary, lifelong cognitive functioning considering the possibility that in the future they might develop dementia and need to make a significant medical decision. But many years later, after they have undergone cognitive decline sufficient to lose legal capacity, the very circumstances they had contemplated occur and they make the opposite decision.

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Q&A: Alex Zhavoronkov on Cognitive Enhancement, Anti-Aging, and AI Drug Development

Interviewed by William Leonard Pickard

Alex Zhavoronkov, PhD, is Founder and CEO of Insilico Medicine, a leading clinical stage biotechnology company developing next-generation artificial intelligence and robotics platforms for drug discovery, with headquarters in Cambridge, MA and facilities around the world. He has invented critical technologies for the creation of novel molecular structures, and pioneered the prediction of human biological aging.

Q: Tell us about Insilico’s work

AZ: Insilico has two main focus areas: developing software and discovering and developing novel drugs for aging-related diseases (thus enhancement in neurodegenerative states and in healthy adults). When it comes to software, most of our platforms are commercially available for startups and academics with free trial access, and for some specific projects we can provide software for free in the form of a collaboration. When it comes to drug discovery, academics and startups can contact us to test our drugs in a variety of experimental models.

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Q&A: George Church on Genomics of Cognitive Enhancement

Interviewed by William Leonard Pickard

George Church, PhD, is the Robert Winthrop Professor of Genetics at Harvard Medical School, Professor of Health Sciences and Technology at Harvard University and the Massachusetts Institute of Technology. He is a founding member of the Wyss Institute for Biologically Inspired Engineering at Harvard.

His research efforts include the first direct genome sequencing method, collaborating in initiating the Human Genome Project, and creating the Personal Genome Project. He co-founded over 50 biotechnology companies as spin-offs from the Church Lab, including Veritas Genetics, Rejuvenate Bio, and Nebula Genomics. Church began Colossal Biosciences to de-extinct the woolly mammoth.

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New Portable MRI Revolutionizing Brain Research Demands Ethical and Legal Innovation

by Francis X. Shen, Susan M. Wolf, and Frances Lawrenz

The advent of highly portable MRI will transform brain research, but urgently requires ethical and legal guidance.

Rather than participants traveling to the MRI scanner, now the scanner can travel to them. This advance could enable research with remote and marginalized communities that have not previously been able to participate, and in doing so address the lack of representativeness and diversity in human neuroscience research.

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figurine with a void shape of a child and family of parents with a child. Surrogacy concept.

Regulating International Commercial Surrogacy

By Hannah Rahim

In January 2024, Pope Francis called for a universal ban on surrogacy as a threat to global peace and human dignity, claiming that the practice is a “grave violation” of the mother and child’s dignity and based on the “exploitation of situations of the mother’s material needs.” Surrogacy raises complex ethical and legal issues, particularly in cases of international surrogacy, where people seek surrogacy services from another country. There is currently no regulation of international surrogacy. Creating such regulation is important to allow appropriate access to surrogacy services while mitigating its harmful consequences.

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rendering of luminous DNA with gene being removed with forceps.

Designer Babies? The Ethical and Regulatory Implications of Polygenic Embryo Screening

By Hannah Rahim

New technologies are increasing the accessibility of polygenic embryo screening, which can assess the likelihood of an embryo developing polygenic diseases (e.g., diabetes, schizophrenia) or provide insight into certain polygenic traits (e.g., height, intelligence). This procedure has many complex clinical, social, and ethical implications, but is currently unregulated in the U.S.

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Doctor working with modern computer interface.

Thank Ketamine for the Telehealth Extension

By Vincent Joralemon

In my last post, I discussed the rise of psychedelic lobbying — how companies with vested economic interests in psychedelics have applied pressure to shape regulations that favor their business models.

One such initiative — the ketamine therapy industry’s push to extend the COVID-era telemedicine flexibilities for prescriptions of controlled substances — highlights how sophisticated these campaigns can be, and how their impact stretches beyond the psychedelic industry.

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