While the best interest standard (BIS) enjoys wide endorsement as the ethical and decision-making standard in pediatrics, it has been criticized as vague and indeterminate. Alternate decision-making standards have been proposed to replace or augment the BIS, notably the harm principle (HP) and constrained parental autonomy (CPA) model. In this edition of The Journal of Clinical Ethics, Lainie Friedman Ross argues that CPA is a better standard than the BIS or the HP as both guide and limiter in pediatrics. In (...) response, I review the important work done by the BIS in pediatrics, and argue that neither the HP nor the CPA can take over these functions or replace the BIS. Among other things I argue: (1) The BIS provides more robust protections for the moral claims of children. (2) The CPA model and the HP do not resolve the indeterminacy and vagueness present in complex medical situations, and the BIS is better suited to deal with this vagueness and indeterminacy. (3) The BIS is a general principle of medical ethics with special application in pediatrics; it fits seamlessly into the system of medical ethics and fulfills many functions within pediatrics. The HP and the CPA model do not fit so readily within medical ethics, and are not equipped to take over the functions of the BIS. (shrink)

This article presents arguments that reframe the discussion on vaccination ethics. The correct starting point for discussions on vaccination ethics is not what society owes parents, but rather what society owes children. Drawing on the justice theory of Powers and Faden, two conclusions are defended by presenting and defending a set of arguments. First, a just society is obligated to protect its children against serious vaccine‐preventable diseases such as measles through adequate levels of vaccination. Second, this obligation of the just (...) society rests on identifiable individuals and institutions: parents, healthcare professionals, government, and vaccine producers have important obligations in this regard. This removes vaccination out of the realm of individual or parental discretion, and situates it in the realm of societal obligation. Children are owed vaccination, society is obligated to provide it. If parents cannot or will not provide it, society ought to respond. (shrink)

This article presents an argument related to justice obligations during a pandemic and explores implications of the argument. A just society responds to a serious threat to the well-being of its people such as a viral pandemic to mitigate the impact of the pandemic on the well-being of its members. This creates identifiable societal obligations which are discharged by the institutions and individuals within society that are situated to do so. There are therefore identifiable obligations resting on various societal institutions, (...) such as government, churches, schools, and corporate institutions, as well as obligations resting on individuals. Should an institution or individual fail to act in ways consistent with these social obligations, they perpetrate an injustice on society and its members. (shrink)

Malm and Navin (2020) argue that it is wrong to withhold varicella vaccine from children to let wild virus circulate purely to prevent zoster in older adults. They demonstrate how this practice acc...

This book offers a novel theory of childhood well-being as a social good. It re-examines our fundamental assumptions about parenting, parental authority, and a liberal society's role in the raising of children. The author defends the idea that the good of a child is inexorably linked to the good of society. He identifies and critiques the problematic assumption that parenting is an extension of individual liberty and shows how we run into problems in medical decision-making for children because of this (...) assumption. He develops an objective conception of what is good for a child in liberal society, drawing on the assumptions of liberty, and from here constructs a set of things that society and its members owe children. There are ways in which society should support and intervene in parental decisions to guarantee a child's well-being. Ultimately, raising children is a social activity that requires input from society. The author then applies this theory of childhood well-being to develop a framework for medical decision-making for children. He also uses practical examples, such as vaccinations, parental leave, and healthcare access, to demonstrate the implications of his theory for public policy. The Limits of Parental Authority: Childhood Wellbeing as a Social Good will be of interest to research and advanced students working in bioethics, political philosophy, and public health policy. (shrink)

This book assists health care providers to understand the specific interplay of the roles and relationships currently forming the debates in pediatric clinical ethics. It builds on the fact that, unlike adult medical ethics, pediatric ethics begins within an acutely and powerfully experienced dynamic of patient-family-state-physician relationship. The book provides a unique perspective as it interacts with established approaches as well as recent developments in pediatric ethics theory, and then explores these developments further through cases. The book first focuses on (...) setting the stage by introducing a theoretical framework and elaborating how pediatric ethics differ from non-pediatric ethics. It approaches different theoretical frameworks in a critical manner drawing on their strengths and weaknesses. It helps the reader in developing an ability to engage in ethical reasoning and moral deliberation in order to focus on the wellbeing of the child as the main participant in the ethical deliberation, as well as to be able to identify the child’s moral claims. The second section of the book focuses on the practical application of these theoretical frameworks and discusses specific areas pertaining to decision-making. These are: the critically ill child, new and enduring ethical controversies, and social justice at large, the latter of which includes looking at the child’s place in society, access to healthcare, social determinants of health, and vaccinations. With the dynamic changes and challenges pediatric care faces across the globe, as well as the changing face of new technologies, no professional working in the field of pediatrics can afford not to take due note of this resource. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Abraham J. Malherbe was one of the most influential New Testament scholars of the past half century. He is especially known for his use of Hellenistic moral philosophy in the interpretation of New Testament texts, especially Pauline literature. Whilst the comparative study of New Testament and Greco-Roman material remains a contentious approach in scholarship, Malherbe’s work provides important pointers in how to make such comparisons in a meaningful and reasoned manner, by paying due respect to the integrity of the texts (...) being compared and to the function textual elements have within their own contexts. I discussed the salient features of Malherbe’s approach, focusing in particular on his study of topoi. One of the most significant findings was Malherbe’s emphasis on the dialectical combination of common and individual elements in such topoi, which enabled ancient authors to embed their own texts within the cultural discourse of their time. His approach opens the way to further research of the New Testament within its philosophical context without requiring proof of a genealogical relationship between the texts or authors concerned. (shrink)

The target article's evolutionary approach provides an excellent framework for understanding when and why people retaliate or forgive. We argue that recent findings on the basic processes in forgiveness can further refine the authors' proposed model. Specifically, the lack of executive control may restrict the explanatory power of relationship value and exploitation risk.

Previous research has demonstrated that trait self-control is related to a range of positive romantic relationship processes, suggesting that trait self-control should be positively and robustly linked to relationship satisfaction in both partners in a romantic relationship. However, the existing empirical evidence is limited and mixed, especially regarding partner effects. With three datasets of heterosexual couples, the present pre-registered studies examined: the dyadic associations between trait self-control and relationship satisfaction both cross-sectionally and longitudinally, and whether these effects hold when controlling (...) for both partners’ relationship commitment. The results indicated a cross-sectional positive actor effect, some support for a positive cross-sectional partner effect, and only little support for a longitudinal actor effect. After controlling for relationship commitment, all effects of trait self-control on satisfaction diminished except for a longitudinal actor effect among women in Study 2. Potential explanations for the current results, and implications for theory and practice, are discussed. (shrink)

The study focused on the adventure-based experiential learning component of the North-West University peer helper training program. The aim of this study was to explore and describe a group of peer helpers’ subjective experiences of their participation in an ABEL program, with a focus on how these experiences related to the concept of grit. A total of 26 students at the North-West University, both male and female, participated in the study. A qualitative research approach with a case study research design (...) was used. The participants completed daily reflective diaries for the duration of the three-day ABEL program. After 3 months of performing their duties as peer helpers, the same individuals participated in focus group interviews. Themes were identified through inductive analysis and discussed regarding their relevance to the concept of grit. The main themes that emerged from both phases of data collection included intra-, inter-, and transpersonal/transcendent aspects, within which participants regularly referred to elements of grit. It was concluded that ABEL, due to its unique nature and demands, provides an ideal mechanism for the facilitation of personal growth on various levels. More specifically, through its clear association with the improvement and/or development of participants’ grit, it could equip these students to be more effective in their role as peer helpers. (shrink)

One of the leading causes for failing at expatriate assignments is the accompanying expatriate partners’ unhappiness with life abroad or inability to adjust to the challenges of the host country. Strength-based therapeutic interventions have the potential to increase individuals’ mental health and well-being. The current study formed part of a multimethod study consisting of three related but independent sub-studies. The first sub-study identified the strengths of Gratitude, Curiosity and Hope to be positively associated with AEPs’ resilience and well-being. These results (...) were used to construct a quantitative model that illustrates the interplay between these constructs. In the second sub-study, the proposed model was qualitatively reviewed by a smaller group of AEPs to inform and enrich our understanding of AEPs’ personal experiences of these constructs. In the current study, a panel of practicing psychologists who provide counselling services for South African expatriates and AEPs were asked to qualitatively review a proposed quantitative model. A cross-sectional, interpretive descriptive research design, applying purposive sampling was used to identify and recruit participants. The objective for the current study was firstly to ascertain why participants thought strengths of Gratitude, Curiosity and Hope featured so prominently in the model. Secondly, the study aimed to determine how these participants would, from their experience in working with AEPs, enhance these strengths and AEPs’ resilience in therapy, and ultimately facilitate greater well-being and successful adjustment abroad. Participants completed an online questionnaire consisting of two semi-structured, open-ended questions. The data were analyzed using primary and secondary cycle coding to ultimately develop themes. Results indicated that strengths of Curiosity, Gratitude and Hope featured prominently because these strengths include elements that form part of the process of expatriation. Participants were able to suggest practical strength-based therapeutic techniques which would assist in enhancement of strengths, resilience and ultimately well-being. It is proposed that the therapeutic techniques and approaches suggested in this study could contribute to the success rate of expatriate assignments. (shrink)

Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient’s wellbeing, to promote the patient’s interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient’s goals and wishes, or is it a (...) matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: (1) objective functioning/health and (2) the patient’s view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. (shrink)

For many years the prevailing paradigm for medical decision making for children has been the best interest standard. Recently, some authors have proposed that Mill’s “harm principle” should be used to mediate or to replace the best interest standard. This article critically examines the harm principle movement and identifies serious defects within the project of using Mill’s harm principle for medical decision making for children. While the harm principle proponents successfully highlight some difficulties in present-day use of the best interest (...) standard, the use of the harm principle suffers substantial normative and conceptual problems. A medical decision-making framework for children is suggested, grounded in the four principles. It draws on the best interest standard, incorporates concepts of harm, and provides two questions that can act as guide and limit in medical decision making for children. (shrink)

This work clarifies the role of the best interest standard (BIS) as ethical principle in the medical care of children. It relates the BIS to the ethical framework of medical practice. The BIS is shown to be a general principle in medical ethics, providing grounding to prima facie obligations. The foundational BIS of Kopelman and Buchanan and Brock are reviewed and shown to be in agreement with the BIS here defended. Critics describe the BIS as being too demanding, narrow, opaque, (...) not taking the family into account and not suitable as limiting principle. This work responds to these criticisms, showing that they do not stand up to scrutiny. They either do not apply to the BIS, only apply to misuses of the BIS or criticise a BIS that is not seriously defended in the literature. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when (...) addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is (...) inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state. (shrink)

Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of (...) defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is (...) inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state. (shrink)

This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are: (1) The obligation to protect patients against COVID-19 spread; (2) The obligation to maintain professional competence and remain available for patients; (3) Clinicians’ role and place in society in relation to COVID-19; (4) The obligation to encourage societal vaccination uptake. These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a (...) duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional’s ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians. (shrink)

The interests of a patient are not only related to objective ideas about health, but are also determined by the patient’s own view of the good. To act in the best interests of a patient requires co...

Carson and Flood (2017) present an interesting argument regarding a duty to vaccinate as a social obligation. Their argument is based on Catholic social teaching, and particularly on the moral prec...

Questions related to end-of-life decision making are common in clinical ethics and may be exceedingly difficult. Chief among these are the provision of cardiopulmonary resuscitation (CPR) and do-not-resuscitate orders (DNRs). To better address such questions, clarity is needed on the values of medical ethics that underlie CPR and the relevant moral framework for making treatment decisions. An informed consent model is insufficient to provide justification for CPR. Instead, ethical justification for CPR rests on the rule of rescue and on substituted (...) interest judgments. Patients’ known wishes and values are relevant, particularly in protecting them from unwanted CPR. Clinicians should rescue patients with the means at their disposal, as a prima facie moral imperative, unless there are compelling reasons to refrain. We present a moral framework for making decisions regarding CPR and DNR. (shrink)

Several congregations in the workspace of the Netherdutch Reformed Church of Africa are losing viability and sustainability. This can be attributed to various factors, the most prominent being isolation. Isolation is defined here as the inability of some congregations to move away from maintenance and an inward focus towards making necessary adjustments on the way to a dimension of missional focus. While commitment and enthusiasm are present in the work of all congregations, some find it difficult to adapt their established (...) ideas and in some cases obsolete customs and traditions. Other congregations have made the necessary adjustments by defining themselves as missional. In congregations where constructive change occurs, the focus moves to undertake congregational ministries. The congregation not only gains insight into their own situation but also becomes aware of God’s calling for that specific congregation within a specific context. The focus shifts from their own situation and needs to the needs and challenges of the context surrounding the specific congregation. A consequence of this change in focus is that the whole ministry of the congregation adjusts accordingly. These congregations discover their own unique spirituality and begin to ask: For whom do we exist? The article is based on a PhD thesis, where Osmer’s four questions of practical theology were brought into the conversation with the modelling process of neuro-linguistic programming, in an attempt to sojourn with congregations towards a contextual missional focus. This research was undertaken to expand Osmer’s four questions of practical theology by using the modelling process of neuro-linguistic programming so that congregations may succeed in making the necessary adjustments. (shrink)

Pickering, Newton-Howes, and Young argue that a person should be considered incapable of making a specific decision if that decision is judged by onlookers to be seriously harmful to the dec...

Children do not belong to their parents. They are not property, although throughout much of history they were considered chattel. In the 21st century, it is generally agreed that children are indiv...

This article is an attempt to provide a systematic and integrative picture of the main contributions presented at the colloquium which addressed the current state of theological education, proposals for the basic values to be laid as foundation for a new theological curriculum and concrete attempts to build such a curriculum in South Africa, the African continent and especially at the University of Pretoria with a particular stress on decolonisation as contextualisation. In dealing with these aspects, the article focuses on (...) whether or not theology as an academic field has a future in university and society by implementing a concrete programme of decolonisation which is adapted – by means of education – to the specifics of various local contexts including those in Africa. If the answer to this question is positive – and the colloquium contributors, as well as the authors, of this article do believe to be so – then one must find out how theology should be done in the university, how theology should work in society and what theology should be taught in the university so that its impact in society is continuously transformative and permanently relevant to human life and human existence in Africa and throughout the world. (shrink)

This article’s premise is that science holds the promise of deepening religious perspectives on creation. The natural sciences have convincingly proved that nature is not static, or a ready-made creation dropped from heaven. Theologians need to read nature as scientists see it and engage with that understanding theologically.The concept of resonance is applied to denote this tangential relationship as an eco-social constructivist understanding of reality. Two proponents, one scientist and one theologian, have been chosen who share this view of a (...) holistic reality, and the objective is to determine the degree of resonance viable of these magisteria. A method of polycentric hermeneutics is thus pursued.Although we referred to the concept of consilience regarding von Humboldt’s enterprise, it is not in the authors’ scope to achieve this with science and theology as disciplines sui generis. However, if resonance becomes vital in understanding reality, faith is inevitable. If a creation theology seeks a degree of plausibility, it requires the feedback-loop methodology of science. We all share one earth: the closer we all come to a shared end, the closer we also come together and relativise differences. The naturalist Edward O. Wilson suggested that science and religion should set aside their differences to save the planet. Resonance has the potential to let new horizons emerge in our mutual endeavour to come to grips with reality and to map out certain tangentially overlapping magisteria.Contribution: Through resonance, the thought constructs of a scientist and a theologian are juxtaposed. An iterative hermeneutics’ importance is emphasised in the theology and science discourse, if faith seeks understanding and leads to awe. And the conclusion is that the ‘spiritual dimension’ and the ‘natural dimension’ do not only overlap but are tangential, as they engage with the same reality. (shrink)

The basic challenge that readers of the New Testament face is not only about what Jesus Christ teaches but who he is. Functional Christology has developed at the expense of ontological Christology. This challenge centres on Jesus Christ’s relevance, in terms of his identity, not only for Christians in particular but also for creation as a whole. The question ‘who is Jesus Christ in relation to creation?’ is thus of special interest to this study. Various authors such as Gunton, Gregersen, (...) Peacocke and others have approached this question from different perspectives. The PhD study by Rabie-Boshoff was completed to shed light into the context of dialogue between Christian theology and the science of linguistics in an effort to understand the Genesis 1 creation story. This article refers to part of the study in an effort to make sense of who Jesus Christ is in relation to creation. This provides consolation in a time of worldwide lockdown because of the Coronavirus Disease 2019 virus. The human struggle of making sense of the world is brought into sharp focus in times like these, more so in terms of making sense of their creatureliness and mortality. Although science as a valid knowledge base may provide some answers to this human dilemma, Christians in particular appeal to the Bible and their belief in Jesus Christ. This turn to Jesus, and who he is, provides human beings with enduring and satisfying answers to their suffering and pain.Contribution: This article is an attempt to contribute to the ongoing discussion on creation in terms of how human beings make sense of creation, considering who Jesus Christ is in relation to creation. Human beings have always been engaged in a process of making sense of the world they live in. Ancient cultures provide such a window, allowing a glimpse into how those cultures perceived their world. (shrink)

On 29 July 2017, an international colloquium entitled ‘Re-Imagining Curricula for a Just University in a Vibrant Democracy – Carrying the Conversation Forward’ was held at the Faculty of Theology, University of Pretoria, Pretoria, South Africa. A wide range of scholars from African and non-African countries provided variegated perspectives on how tertiary theological and religious education could contribute positively to the development of contemporary societies – African and non-African. This article focuses on the colloquium’s African contributors by means of the (...) concept of ecodomy, envisaged as a constructive process. Whilst the attending academics came from Europe, the USA, South Africa and Ghana, this article takes into consideration only the contributions provided by African scholars. The purpose of this selection is to identify ecodomic or constructive ways to argue in favour of university education in the fields of theology and religion which share the potential to be applied across the whole African continent. Bearing in mind that Africa has been dealing with decolonisation awhile, these African contributions investigate issues such as contextualisation, science, practice, illumination and holism from the governing principle of decolonisation, which is also the overarching societal umbrella for academic development in Africa. This study concludes with an assessment and a proposal written from an exclusively South African vantage point which demonstrates the viability of tertiary theological and religious education for the ongoing ecodomic development of African societies. (shrink)

This article is about the imago Dei, proceeding from an ecotheological perspective. Both the ‘image of God’ and the ‘likeness of God’ are examined based on the understanding that God is a relational God. It approaches the question of the imago Dei in terms of God’s incorporeal nature, and what it is that human beings have in common with God apart from the human being’s capacity for personal and interpersonal relationships. It addresses the question of the imago Dei in terms (...) of God’s spiritual nature and the human being’s ‘earthly’ nature by utilising the metaphor of ‘shadow’. This metaphor was investigated in terms of its meaning in Hebrew (tselem), and Genesis 2:7–8 where the creation of the human being is described in terms of God breathing the breath of life into the human being. A distinction has been drawn between the ‘image of God’ and the ‘likeness of God’, with the ‘likeness of God’ (demuth) that was investigated in the context of Exodus 31:1–5, and the various spiritual gifts conferred to Bezalel by the Spirit of God. Based on this investigation the article posits that the imago Dei as the Shadow of God (life) has been bestowed on all living creatures and not only human beings.Contribution: The suggestion that the imago Dei as the Shadow of God is present in all of the creation urges us to seek further and look deeper into the issue of imago Dei in the sense that such an understanding pointedly has far-reaching implications for the current understanding of the place of human beings in creation. In consideration of this, it bears on our understanding of the meaning of life within the bigger picture of creation and how we respond to the living environment with which we share life. (shrink)