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)

Parsa-Parsi et al systematically discuss and elucidate contentious and non-controversial ethical issues that emerged during the ICoME (International Code of Medical Ethics) revision process and the consensus they achieved. The ethical issues discussed include the physician’s duty to act in the best interests of patients and to ensure they are protected from the unjustifiable risk of harm, respect for patient autonomy and the duties of physicians during emergencies, among others. This paper examines paragraph 26, which requires doctors to provide only (...) medically justified remote treatment, ensure patients offer informed consent and adequately protect their confidentiality.1 At the peak of the COVID-19 pandemic, many countries in Europe and America implemented remote-by-default healthcare policies. At that time, the policy aimed to ensure that patients enjoyed continued access to care while protecting healthcare professionals’ health and well-being. After the COVID-19 pandemic, this policy remained in place. Regardless of the nature of their ailment, patients have consistently preferred in-person care out of concern that their health issues might not be accurately diagnosed and that they may not receive quality care …. (shrink)

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)

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)

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)

[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)

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)

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.

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)

The book outlines the contribution of passivity to the constitution of phenomena as diverse as temporal syntheses, perceptual associations, memory fulfillment and cross-cultural communication.

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..

This book examines leadership strategies that allow administrators to be proactive, visionary, and flexible while increasing collaboration, open communication, and closely integrating theory and practice to ensure successful administration in higher education settings.

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)

Western scholarship on religion and gender has devoted considerable attention to women’s entry into leadership roles across various religious traditions and denominations. However, very little is known about the dynamics of women’s religious authority and leadership in developing settings, especially in sub-Saharan Africa, a region of powerful and diverse religious expressions. This study employs a combination of uniquely rich and diverse data to examine women’s formal religious authority in a predominantly Christian setting in Mozambique. I first use survey data to (...) test hypotheses regarding the prevalence and patterns of women’s formal leadership across different denominational groups. I then support and extend the quantitative results with insights on pathways and consequences of women’s ascent to formal congregation authority drawn from qualitative data. The analysis illustrates how women’s religious authority both defies and reasserts the gendered constraints of the religious marketplace and the broader gender ideology in this developing context. (shrink)

Excerpt from Les Sceptiques Grecs Enfin le doute lui-meme n'est pas le scepticisme. C'est du doute seulement qu'on pourrait dire qu'il est a peu pres contem porain de la pensee humaine; car, pour un esprit qui reflechit, la decouverte de la premiere erreur suffit a inspirer une certaine defiance de soi; et combien de temps a-t-il fallu a des esprits un peu attentifs pour s'apercevoir qu'ils s'etaient plus d'une fois trompee? About the Publisher Forgotten Books publishes hundreds of thousands of (...) rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

Célestin Freinet était un innovateur, et ses racines pédagogiques et intellectuelles expliquent les origines de ses idées, celles du Mouvement Freinet.

The place of men in reproductive and contraceptive changes and the role of informal social interaction in these processes have become central themes in recent research on fertility change in sub-Saharan Africa and other developing regions. These two themes, however, have been treated separately in the literature, and this study bridges them by examining men's informal communication on family planning matters through a gender lens. This analysis, based on qualitative data collected in Greater Maputo, Mozambique, indicates that although men's communication (...) on these matters is limited in comparison to women's communication, it nonetheless plays an important role in the formation of men's reproductive and contraceptive attitudes and preferences. Gender ideology emerges as a powerful delimiter of men's communication circles and of the information transmitted in those circles. The author argues that gender barriers in peer communication affect individuals' perceptions of reproductive and contraceptive matters and their corresponding preferences and decisions. (shrink)

In this article I argue that there are two different types of understanding: the understanding we get from explanations, and the understanding we get from unification. This claim is defended by first showing that explanation and unification are not as closely related as has sometimes been thought. A critical appraisal of recent proposals for understanding without explanation leads us to discuss the example of a purely classificatory biology: it turns out that such a science can give us understanding of the (...) world through unification of the phenomena, even though it does not give us any explanations. The two types of understanding identified in this paper, while strictly separate, do have in common that both consist in seeing how the individual phenomena of the universe hang together. Explanations give us connections between the phenomena through the asymmetric, ‘vertical’ relation of determination; unifications give us connections through the symmetric, ‘horizontal’ relation of kinship. We then arrive at a general definition of understanding as knowledge of connections between the phenomena, and indicate that there might be more than two types of understanding. (shrink)

This article explores the possibility of a notion of left-wing populism that is conceptually opposed to the identitarian logic of embodiment that characterises right-populist interpellations of ‘th...

J. L. Mackie famously argued that a commitment to non-existent objective values permeates ordinary moral thought and discourse. According to a standard interpretation, Mackie construed this commitment as a universal and indeed essential feature of moral judgments. In this paper I argue that we should rather ascribe to Mackie a form of semantic pluralism, according to which not all moral judgments involve the commitment to objective values. This interpretation not only makes better sense of what Mackie actually says, but also (...) renders his error theory immune to a powerful objection. (shrink)

In this article I give a unified account of three phenomena: bullshit, pseudoscience and pseudophilosophy. My aims are partly conceptual, partly evaluative. Drawing on Harry Frankfurt's seminal analysis of bullshit, I give an account of the three phenomena and of how they are related, and I use this account to explain what is bad about all three. More specifically, I argue that what is defective about pseudoscience and pseudophilosophy is precisely that they are special cases of bullshit. Apart from raising (...) interesting philosophical issues, gaining a clearer understanding of these phenomena is also of practical importance, in that it bears on how best to tackle the threat that they pose. (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)

Central to Watts and Newson’s argument in their seminal paper ‘ Is there a duty to routinely reinterpret genomic variant classifications? ’ is that diagnostic laboratories are not morally obligated to actively reinterpret variants of uncertain significance (VUS) due to the superior outcomes offered by next-generation sequencing (NGS) compared with traditional methods.1 NGS technologies can identify, analyse and interpret millions of genetic variations at once. For example, ‘the use of conventional molecular assays in clinical contexts could require doing a lot (...) of assays for various mutations. Using these different assays, more tissue may be required. These targets can accurately be questioned using NGS technology in a single test.’2 If NGS-based genomic sequencing is reliable and its output outweighs the potential harm of uncertainties, then, it is plausible to say that those test providers cannot incur a moral duty to actively reinterpret VUS because there won’t be any need to do so.1 Despite its seeming reliability, diagnostic laboratories face enormous challenges in implementing NGS-based …. (shrink)

A core tenet of metanormative non-naturalism is that genuine or robust normativity—i.e., the kind of normativity that is characteristic of moral requirements, and perhaps also of prudential, epistemic and even aesthetic requirements—is metaphysically special in a way that rules out naturalist analyses or reductions; on the non-naturalist view, the normative is sui generis and metaphysically discontinuous with the natural. Non-naturalists agree, however, that the normative is modally as well as explanatorily dependent on the natural. These two commitments—discontinuity and dependence—at least (...) initially pull in opposite directions, and one of the central challenges to non-naturalism is how to reconcile them. In this paper I spell out the most pressing version of this discontinuity problem, as I propose to call it, and I go on to offer a novel solution. Drawing on the ideology of reasons-firstism, I formulate an account of normative explanation which reconciles the two commitments, and I argue that competing accounts either do not solve the problem or are implausible on independent grounds. (shrink)

Non-naturalists about normativity hold that there are instantiable normative properties which are metaphysically discontinuous with natural properties. One of the central challenges to non-naturalism is how to reconcile this discontinuity with the supervenience of the normative on the natural. Drawing on J. L. Mackie’s seminal but highly compressed discussion in Ethics: Inventing Right and Wrong, this paper argues that the supervenience challenge as usually conceived is merely a symptom of a more fundamental challenge in the vicinity.

Cet ouvrage de Victor Goldschmidt, pour la premiere fois en edition de poche, est le seul consacre a une notion centrale de la philosophie platonicienne, le paradigme, a la fois exemple, comparaison et modele.En prenant comme fil conducteur la definition donnee dans le Politique, l'auteur commence par etudier le role joue par ce procede privilegie dans la methode dialectique des derniers Dialogues. S'exercer sur une realite banale permet de decouvrir la structure d'un grand sujet, plus difficile a definir, comme (...) le sophiste ou l'art politique. Cependant la reussite d'une demarche en saurait en fonder la legitimite. En s'interrogeant sur son fondement, Victor Goldschmidt montre que l'usage d'un paradigme obeit a un mouvement profond de la pensee platonicienne, il nous mene du visible a l'invisible. (shrink)