Judith G. Edersheim

What Patients With Behavioral-Variant Frontotemporal Dementia Can Teach Us About Moral Responsibility

Moral and legal responsibility is diminished in neuropsychiatric patients who lack the capacity to use reasoning to determine morally appropriate behavior. Patients with behavioral-variant frontotemporal dementia (bvFTD), however, develop immoral behaviors as a result of their disease despite the ability to explicitly state that their behavior is wrong. In order to determine whether bvFTD patients should be held responsible for their immoral behavior, we begin by discussing the philosophical concepts of free will, determinism, and responsibility. Those who believe in both determinism and free will are called compatibilists. We argue that reason-responsiveness, a specific type of compatibilism, cannot fully determine responsibility in bvFTD patients if reason-responsiveness is considered to be a single, unified concept. Instead, we argue that several different neuropsychological capacities, including many that are impaired in bvFTD patients, contribute to a patients ability to respond to certain reasons in specific situations. Finally, we propose a new framework for understanding reason-responsiveness, using case examples to illustrate how this model can be used to determine responsibility in neuropsychiatric patients.

An approach to selected legal issues: confidentiality, mandatory reporting, abuse and neglect, informed consent, capacity decisions, boundary issues, and malpractice claims.

Medical practice occurs within a legal and regulatory context. This article covers several of the legal issues that frequently arise in the general medical setting. While this article provides an overview of approaches to informed consent, boundary issues, and malpractice claims, it is critical for clinicians to be familiar with the specific requirements and standards in the jurisdictions in which they practice. As a general rule, it is most important that physicians recognize that the best way to avoid legal problems is to be aware of legal requirements in the jurisdictions in which they practice, but to think clinically and not legally in the provision of consistent and sound clinical care to their patients.

An approach to the patient in crisis: assessments of the risk of suicide and violence

Suicide is one of the leading causes of death in the United States and is defined as intentional self-harm with the intent of causing death. Various mental disorders may be a cause for increased violence. This article outlines the elements of the risk assessment (for harm to self and/or others) in patients in crisis and addresses which contributing factors may be modifiable. This article also proposes a practical framework for the management of risk regarding suicide and violence.

The Dialectic Between Empathy and Violence: An Opportunity for Intervention?

The authors provide a comprehensive review of the neurobiology of empathy and compare this with the neurobiology of psychopathic predatory violence-the most extreme deficit of empathy. This suggests that the specific areas of the prefrontal cortex and limbic system, which have been associated with violent behavior, also appear to subserve the capacity for empathy. Damage to these regions may result in the emergence of aggression, but not of empathy, suggesting a structurally inverse relationship between the two. The authors examine the evidence for a dialectic between empathy and predatory violence and explore the implications for early interventions with empathy training in treatment-resistant psychopathy.