The management of child protection concerns arouses strong emotions and controversies and creates ethical tensions for all concerned. This paper provides a rational analysis of some of the issues involved and suggests responses to them. The ethical and legal duties of health-care professionals are to act in the best interests of the child by safeguarding children and reporting concerns. But this may involve conflicts with parents and produce reluctance of professionals to become involved, especially in controversial types of abuse. Mandatory (...) reporting of concerns might overcome such reluctance, but may be ineffective in the face of diagnostic uncertainties. Assembly of a stronger diagnostic evidence base would seem ethically justified, but organization of the necessary case controlled studies might be problematic. Even with a comprehensive evidence base, individual diagnoses of abuse will always involve value judgements that should be underpinned by effective training and assessment of core competencies of professionals. These manoeuvres are unlikely to prevent both justified and vexatious complaints, often in relation to breaches in professional duties or concerning professional misconduct. The tendency to blame experts may have contributed to a reluctance of other professionals to become involved, despite proposals for reforms in the expert witness and court systems. Current approaches to child protection may neither promote greater understanding nor be in the best interests of children. A revised social contract for the effective protection of children could include: a duty of care that adequately addresses the primacy of the child's welfare; the acquisition of a sound evidence base; professional transparency and accountability (but with protection from malicious and vexatious complaints); and a shift emphasis towards a more inquisitorial system that embraced the principles of truth and reconciliation. (shrink)

A balance needs to be struck between facilitating compassionate access to innovative treatments for those in desperate need, and the duty to protect such vulnerable individuals from the harms of untested/unlicensed treatments. We introduced a principle-based framework to evaluate such requests and describe its application in the context of recently evolved UK, US and European regulatory processes. 24 referrals were received by our quaternary children's hospital Clinical Ethics Committee over the 5-year period. The CEC-rapid response group evaluated individual cases within (...) 48-hours; the main referrers being haematology/oncology, immunology or transplant services. Most requests were for drug/vaccine/pre-trial access or biological/cellular therapies. The majority of individual requests were approved ; neutral or negative opinions were given in 5, including 3 group requests. Recently evolved regulatory processes share common criteria and conditions to our framework including: demonstration of clinical need; sound scientific basis with lack of viable alternative; risks-benefit/best interests evaluation; arrangements for fully informed consent; no compromise of arrangements to test treatment for licensing purposes; consideration of resource implications. There are differences between individual processes and with our framework, with respect to procedures, scope, application format, costs and obligation to make available all outcome data. Our experience has emphasized the need for an independent, principled, consistent, fair and transparent response to the increasing demand for innovative treatment on a compassionate basis. We believe that there is a need for harmonization of the recent proliferation of regulation and legislation in this area. (shrink)

We outline a process, undertaken at a large tertiary children's hospital, intended to provide practical guidance and support for those involved in the management of children with life-limiting conditions. Initial discussions with representatives of clinical and support services identified communication problems and ethical dilemmas as key issues. These were further explored in multidisciplinary hospital meetings, culminating in a conference (Living Well, Dying Well) where individual perspectives - clinical, multi-faith, parental and legal - and cases were presented. Communication problems were found (...) to involve unrealistic expectations, failures of anticipation and difficulties in discussing sensitive issues, while ethical dilemmas arose from balancing burdens and benefits, clinical uncertainty, respecting autonomy and achieving equity and justice in delivery of care. An integrated service has been developed that is intended to provide clinical and spiritual care, psychosocial and ethical support, advice and mediation for children, families and staff, and to address the latter's educational and training needs. (shrink)

In the UK an increasing number of Clinical Ethics Committees (CECs) have been developed mainly in response to local need and interest. Their functions include education of health professionals, of policy and guideline development, and case review (both retrospective analysis of topics and advice on acute cases). The UK Clinical Ethics Network, a charitable foundation provides CEC s with help, support and advice and enables them to share their experience The legal status of UK CECs is unclear but some legal (...) commentators have suggested that CECs lack competencies and procedural rules necessary for acute case review. The UKCEN has proposed core competencies for CECs that lists the ethical, operational and procedural skills, knowledge and personal attributes required and how they may be acquired, assessed and maintained. Their implementation might lead to the development of ethical and legal governance which should benefit to future patient care. (shrink)

We present the case of a six-year-old child with a fatal brainstem tumour, who was left in a ‘locked-in state’ post-decompressive biopsy. A discussion of the ethical dilemma this situation presents, together with the deliberations of the ethics service when consulted about the optimal course of action, follow. The issues raised highlight an important conflict between the parental view of what is in the child's best interests and what may appear, prima facie, to clinical staff, to be in that child's (...) best interests. We discuss how creative ethical thinking may facilitate resolution of seemingly insoluble situations. (shrink)

Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, (...) and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity. (shrink)

The paper questions the effectiveness of the United Kingdom Central Council's (UKCC's) Code of Professional Conduct upon the moral climate of nursing. It challenges the claim that the empowerment of nurses is significantly enhanced by the Code or that it necessarily makes them more accountable for their practice. The position is taken that the Code, in the absence of an effective support network for whistle-blowers, places an unreasonable burden upon nurses in its exhortations to report unprofessional conduct. The paper acknowledges (...) the need to retain the Code, but with more modest claims being made concerning its empowering qualities. It is argued that unless more attention is focused on ways to support potential whistle-blowers, the Code will come to be seen as an irrelevance. Cet article met en question l'effet du Code du UKCC sur le climat moral des soins infirmiers. Il conteste l'affirmation que les infirmiers/ères sont considérablement plus fort à cause du Code ou qu'il les rend plus responsables dans leur pratique. La position est prise que le Code, en l'absence d'un réseau efficace de soutien pour les 'Whistleblowers' (personnes qui dévoilent un système), met un fardeau excessif sur les infirmiers/ères dans ses exhortations de signaler une conduite contraire au Code professionnel. Cet article reconnâit la nécessité de retenir le Code, mais avec des demandes plus modestes concernant ses pouvoirs de rendre fort. Il est soutenu que si non plus d'attention est concentré sur les moyens de soutenir les 'Whistlebowers', le Code va devenir hors de propos. Dieser Artikel bezweifelt die Wirksamkeit des Kodex des UKCC über das moralische Klima der Krankenpflege. Er stellt die Behauptung in Frage, dass der Kodex das Pflegepersonal bedeutend ermächtigt, oder dass er es mehr verantwortlich macht für seine Praxis. Die Position ist hier, dass der Kodex, in der Abwesenheit von effektiver Unterstützung für 'Whistleblowers' (d.h. Leute, die ein System verpfeifen), zu viel vom Pflegepersonal verlangt, in seiner Ermahnung, berufswidrige Praxis zu melden. Dieser Artikel anerkennt die Notwendigkeit, den Kodex zu behalten, aber mit kleineren Ansprüchen für seine ermächtigenden Qualitäten. Wenn nicht mehr Aufmerksamkeit gelegt wird, auf welche Weise die 'Whistleblowers' unterstützt werden können, dann wird der Kodex als eine Nebensächlichkeit verurteilt. (shrink)

A majority of Americans say they are Christians. In fact, when you ask what they really believe about God you find that almost half are really deists. Let’s look at the data. A 2006 Pew survey reports that about 50 percent of Americans are Protestants and another 25 percent Catholics, which would indicate a strong Christian majority of 75 percent. Like most such surveys, however, Pew simply asked people to state their religious affiliations. A 2005 survey by Baylor University tried (...) something different and questioned people about what they actually believe. The results were surprising and have great significance in properly comprehending religious belief in the U.S. For some reason, they have received little attention. (shrink)

Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about charting a path to recovery, albeit to a ‘new normal’ that mitigates them. Children have not suffered as much from the direct effects of COVID-19 infection as older adults. Still, there is mounting evidence that their health and welfare are being adversely affected. Closure (...) of schools has been a critical component of social isolation but has a far broader impact than the diminution of educational opportunities, as important as these are. Reopening of schools is therefore essential to recovery, with some countries already tentatively implementing it. Children’s interests are vital considerations in any recovery plan, but the question remains as to how to address them within the context of how society views children; should they be regarded as pawns, pathfinders or partners in this enterprise? (shrink)

OBJECTIVES: To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics. DESIGN: Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals. SETTING: Two major London children's hospitals. RESULTS: Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and treatment; (...) lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting. CONCLUSION: Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees. (shrink)

The Judeo-Christian tradition testifies to a God that cries out, demanding that justice "roll down like waters, righteousness like an ever-flowing stream" (Amos 5:24). Christians agree that being advocates for justice is critical to the Christian witness. And yet one need not look widely to see that Christians disagree about what social justice entails. What does justice have to do with healthcare reform, illegal immigration, and same-sex marriage? Should Christians support tax policies that effectively require wealthy individuals to fund programs (...) that benefit the poor? Does justice require that we acknowledge and address the inequalities borne out of histories of gender and ethnic exclusivity? Is the Christian vision distinct from non-Christian visions of social justice? Christians disagree over the proper answer to these questions. In short, Christians agree that justice is important but disagree about what a commitment to justice means. Christian Faith and Social Justice makes sense of the disagreements among Christians over the meaning of justice by bringing together five highly regarded Christian philosophers to introduce and defend rival perspectives on social justice in the Christian tradition. While it aspires to offer a lucid introduction to these theories, the purpose of this book is more than informative. It is purposefully dialogical and is structured so that contributors are able to model for the reader reasoned exchange among philosophers who disagree about the meaning of social justice. The hope is that the reader is left with a better understanding of range of perspectives in the Christian tradition about social justice. (shrink)

This essay considers more closely Nigel Biggar’s account of the role love plays in orienting and qualifying the moral experience of just warriors. The evidence that Biggar employs is highly selective and belies a more complex picture of the motivations of soldiers, the experience of killing, and the moral ends of training for modern warfare. This essay argues that a more ambivalent account of love can be reconciled more easily with recent research on the experience of moral injury among combat (...) veterans and is a more useful starting point for grounding the Christian community’s service to combat veterans. (shrink)

WHAT DOES RESPECT REQUIRE OF RELIGIOUSLY MOTIVATED CITIZENS AS they support coercive public policies? In his recent work, Christopher Eberle argues against the doctrine of restraint, a norm that requires citizens to refrain from supporting laws for which public reasons are unavailable. Against Eberle, I defend the doctrine of restraint as a necessary corollary to liberal democratic respect. For this defense, I draw from one imaginary case, Robert Audi's example of "sacred dandelions" and laws banning lawn maintenance, and one real-world (...) dispute, current debates about same-sex marriage policies. I argue that the doctrine of restraint when coupled with an inclusive definition of public reason better accords with our intuitive sense of what respect requires in both cases. (shrink)

To discover a unifying theory of biology, it is necessary first to believe in its existence and second to seek its elements. Such a theory would explain the regulation of the cell cycle, differentiation and the origin of life. Some elements of the theory may be obtained by considering both eukaryotic and prokaryotic cell cycles. These elements include cytoskeletal proteins, calcium, cyclins, protein kinase C, phosphorylation, transcriptional sensing, autocatalytic gene expression and the physical properties of lipids. Other more exotic candidate (...) elements include the dynamic enzoskeleton, ATP generation, mechanotransduction, the piezoelectric effect and resonance. Bringing these disparate elements together — and discovering others — will require extensive collaborations between specialists from different sciences. This can only be achieved within the context of an integrated approach to biology. (shrink)

What is biological complexity? How many sorts exist? Are there levels of complexity? How are they related to one another? How is complexity related to the emergence of new phenotypes? To try to get to grips with these questions, we consider the archetype of a complex biological system, Escherichia coli. We take the position that E. coli has been selected to survive adverse conditions and to grow in favourable ones and that many other complex systems undergo similar selection. We invoke (...) the concept of hyperstructures which constitute a level of organisation intermediate between macromolecules and cells. We also invoke a new concept, competitive coherence, to describe how phenotypes are created by a competition between maintaining a consistent story over time and creating a response that is coherent with respect to both internal and external conditions. We suggest how these concepts lead to parameters suitable for describing the rich form of complexity termed hypercomplexity and we propose a relationship between competitive coherence and emergence. (shrink)

Caplan has argued that the philosophy of medicine does not exist. Although I will not deny the points he makes, I will argue that the philosophy of medicine has characteristics of a developing field with the potential to meet all of Caplan's criteria. The argument is based on Dewey's established views on logical development for a field of inquiry, as well as pointing out how other criteria Caplan imposes can be fulfilled.

[fr] Dans les Ḫaṣā’iṣ, Ibn Ǧinnī (m. 392/1002) fait état, incidemment, d’une différenciation entre parlers arabes nomades et sédentaires, ces derniers étant caractérisés par une perte partielle de la flexion désinentielle (’i‘rāb). Dans la mesure où Ibn Ǧinnī se réfère sur ce point à une source antérieure de près de deux siècles d’une part, indique qu’il n’y a presque plus, à son époque, de bédouin au parler « châtié » (faṣīḥ, c’est-à-dire fléchi mu‘rab) d’autre part, on peut voir dans ses (...) remarques une reconnaissance implicite d’une situation de diglossie, les parlers nomades étant à l’origine de la variété haute (al-luġa al-‘arabiyya al-faṣīḥa). Cette situation est d’ailleurs révélée par une anecdote, où l’on voit un même usager, d’origine bédouine, alterner ce qu’Ibn Ǧinnī appelle « les deux manières de parler » (ǧihatā al-kalām), avec et sans flexion désinentielle. Malgré les apparences, il ne s’agit pas de sociolinguistique et d’histoire de la langue. Il s’agit de théorie du langage, avec l’hypothèse d’un phénomène d’entropie, liée à l’utilisation de la langue, l’utilisateur se passant, par d’autres moyens, de la flexion désinentielle, source de difficulté et d’erreurs. Il s’agit aussi et surtout d’un discours épilinguistique, conforme à l’idéologie linguistique (thèse de la faṣāḥa bédouine) et à la théologie (thèse de la « langue du Ḥiǧāz » comme al-luġa alfuṣḥā), deux thèses difficilement conciliables. (shrink)

Childbearing trans and nonbinary people are confronted with the heteronormative and cisgender frameworks that underpin “maternity” services. We explored the educational needs of 108 perinatal staff in the United Kingdom as related to the needs of trans and nonbinary service users. Participants were most confident in formulating care plans and least confident about the provision of colleagues’ perinatal care in this context. While the majority of participants were positive toward the trans and nonbinary communities, they considered that those communities remain (...) marginalized in perinatal services. Transphobic, anti-trans, and nonbinary attitudes were highlighted by our respondents. Our findings suggest that caregivers witnessed transphobia among colleagues and were apprehensive themselves about providing care to childbearing trans and nonbinary people. They reported a cisheteronormative model of care that lacked awareness of trans and nonbinary issues. The educational needs identified included information about the practicalities of childbearing as a trans or nonbinary person, how to use inclusive language effectively, and creating policies and processes for supporting childbearing trans and nonbinary people. These caregivers’ preferences included hearing from trans and nonbinary people and sharing best practices among themselves, with open discussions about how to be inclusive. (shrink)

As do all forms of science, medical theories have a factual as well as a logical basis. New information is presented in medical research articles. These papers have three separate arguments: the argument of the hypothesis, the argument of the experimental protocol, and the argument of the hypothesis's judgment. These arguments may be examples of the hypothetico-deductive or confirmational model of scientific inference. The logical form of these arguments are informal and inductive rather than formal and deductive. Understanding the nature (...) of the logic of the medical research article may help avoid erroneous conclusions. (shrink)

The paucity of research data to guide current paediatric practice has led to children being termed therapeutic orphans. This difficulty is especially pertinent to research in emergency situations, such as acute resuscitation or critical care, where accepted ethical standards for overall research, have historically created practical difficulties for researchers. The welcome establishment of organisations to support UK paediatric research is helping to ensure safer and more effective medications for children, however as the balance between protection and access at the heart (...) of the paediatric research ethical debate shifts to ever increasing access for researchers to children, it remains crucial to ensure the protection for these vulnerable participants. The fundamental protection for research subjects, namely their full informed consent before any recruitment, is not tenable in true emergency situations and so other approaches are warranted if standards are to be improved by human subjects research in such areas. Proxy, deferred and retrospective consent have all been advocated as solutions to this difficulty and this paper explores the ethical justification for these approaches and their utility in safeguarding children and families in emergency situations when traditional informed consent, as currently defined, cannot be obtained in the necessary time frame to enable research. (shrink)

À la posture de l’écrivain engagé dont la littérature viserait l’éveil national de son peuple, l’écrivain martiniquais Patrick Chamoiseau préfère l’art de mettre les histoires au service d’une mutation des imaginaires,..

L’esclavage colonial occupe une place récente dans les médias français. Soumis aux récupérations et manipulations médiatiques des uns ou des autres, souvent non spécialistes, il fait généralement l’objet sur les plateaux de télévision, dans la presse, de simplifications maladroites, d’amalgames fâcheux, traduisant finalement l’ampleur de l’ignorance et de l’indifférence incrustées au fil des années dans la société civile sur une période de l’histoire de la France de plus de trois siècles, et pourtant fondatrice de l’Empire colonial français.

SILYANE LARCHER. — La question coloniale ne se pose pas aux Antilles comme ailleurs, puisque la période coloniale ne s’est pas suivie de l’indépendance, mais de l’assimilation juridico-politique faisant de la Martinique et de la Guadeloupe des départements français d’outre-mer, au même titre que n’importe quel département en France. Comment définiriez-vous..

Avec la Révolution, le système de représentation politique est proportionnel au territoire et non plus à la population. Cet ordre territorial fait d’encastrements d’échelles et d’imbrications entre territoires politiques et administratifs (dont les matrices sont le département et la commune) a été approprié par les habitants et a légitimé des milliers de notables, ce qui explique sa résistance à l’heure de l’explosion des frontières, de la métropolisation, de la géographie aléatoire des mobilités. Pour répondre à ces mutations, plus qu’une guerre (...) de gabarits substituant au couple commune-département le couple intercommunalités-régions (ou grande région), des innovations institutionnelles sont à inventer, telles la différenciation territoriale et la coopération interterritoriale. (shrink)

Research involving human participants has been conducted in the Philippines since the beginning of the Spanish colonial period. Such studies are expected to adhere to internationally accepted ethical guidelines. This paper discusses trends in clinical research ethics in the Philippines during the American colonial period (1898‐1946). Specifically, studies were assessed on: 1) their observance of ethical protocols, including review; 2) identification of inclusion and exclusion criteria in the selection of participants; 3) use of vulnerable subjects; and 4) practice of the (...) informed consent process. Only the informed consent process had a significant logistic correlation with progression of years. Recruitment of vulnerable groups was common during this period; children and prisoners were the most common participants. Trends in medical ethics in the Philippines reflected those in the United States prior to the publication of the Nuremberg Code, which served as a milestone in the protection of human welfare in clinical research. (shrink)

The paper suggests that some of the preconditions for peace may have a better chance of being fulfilled in the 1990's than they had previously during this century of wars and other bloody upheavals. Most importantly, it highlights the fact (through giving examples) that business can use the sophisticated technology developed for arms manufacture for the production of consumer goods; so that the argument that industries will fail and employees lose their jobs if there is global arms reduction no longer (...) holds. Ways of dampening demand for arms are also discussed. (shrink)

Many abiotic and other signals are transduced in eukaryotic cells by changes in the level of free calcium via pumps, channels and stores. We suggest here that ion condensation should also be taken into account. Calcium, like other counterions, is condensed onto linear polymers at a critical value of the charge density. Such condensation resembles a phase transition and has a topological basis in that it is promoted by linear as opposed to spherical assemblies of charges. Condensed counterions are delocalised (...) and can diffuse in the so‐called near region along the polymers. It is generally admitted that cytoskeletal filaments, proteins colocalised with these filaments, protein filaments distinct from cytoskeletal filaments, and filamentous assemblies of other macromolecules, constitute an intracellular macromolecular network. Here we draw attention to the fact that this network has physicochemical characteristics that enable counterion condensation. We then propose a model in which the feedback relationships between the condensation/decondensation of calcium and the activation of calcium‐dependent kinases and phosphatases control the charge density of the filaments of the intracellular macromolecular network. We show how condensation might help mediate free levels of calcium both locally and globally. In this model, calcium condensation/decondensation on the macromolecular network creates coherent patterns of protein phosphorylation that integrate signals. This leads us to hypothesize that the process of ion condensation operates in signal transduction, that it can have an integrative role and that the macromolecular network serves as an integrative receptor. BioEssays 26:549–557, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

For each topic the obiectives, instruments and performance of the policy concerned are expounded. In the field of fiscal policy special attention is drawn to the rather large deficit of the budget, its consequences and possible remedies. The section on monetary policy deals in particular with the discussion around the maintaining of the Belgian franc within the European small snake and with the argumentation of the Belgian central bank against the monetarist's contention in favour of the monetary rule.

On august 9th 1980 the Belgian government took a number of important decisions with relation to the ports of Zeebrugge and Antwerp. The author takes this occasion to analyse and to evaluate the existing seaport policy in Belgium. The first section tries to give an answer to the question : why do public authorities intervene in port activities? Subsequently the article deals with the fundamental data for a port policy until 2000 and with the institutional organisation of this policy. The (...) two last sections present an analysis of the general orientation as far as investment, competition, employment, environment and international relations are concerned. The author arrives at the conclusion that seaport policy in Belgium has to be prepared in a more systematic way and coordinated with other branches of transport, energy and economic policy. (shrink)

A drastic change in economie and monetary policy, which started in 1982, has up to now resulted in a normalisation of the rate of inflation and the balance of payments. However, the growth rate of GNP is still low and unemployment high. Budget deficits, public debt and related interest payments are in proportion to GNP between the highest in the industrialised world. Economic events and political constraints hampered the efforts of the government to restore the situation. In 1986 a new (...) plan was introduced and approved by Parliament, confirming an important cut in public expenditures. The existing burden of taxation already leads to a series of negative effects and a small open economycannot stay indifferent against the international movements towards lower taxes. So a tax reform in Belgium can only mean a restructering, leading to a decrease in personal income tax, largely compensated by an increase in indirect taxes. Further cuts in primary public expenditures will be unavoidable, but have to take into account, more than in the past, the repercussions on economie evolution in the long run. (shrink)