According to typical ought-implies-can principles, if you have an obligation to vaccinate me tomorrow, then you can vaccinate me tomorrow. Such principles are uninformative about conditional obligations: what if you only have an obligation to vaccinate me tomorrow if you synthesize a vaccine today? Then maybe you cannot vaccinate me tomorrow ; what you can do instead, I propose, is make it the case that the conditional obligation is not violated. More generally, I propose the ought-implies-can-obey principle: an agent has (...) an obligation only at times at which the agent can obey the obligation. I also propose another principle, which captures the idea that ‘ought’ implies ‘can avoid’. I defend both principles mainly by arguing that they help explain why agents lose obligations, including conditional ones. (shrink)

Causes for celibacy, divorces and successful marriage are discussed in the article. Absence of true love and inability to build and keep it are the main reasons for family disruption. Amorousness, immature love and various forms of false or flawed love substitute the true feeling. It is caused by increased women’s independence, loss of mutual understanding and trust (due to infidelity or jealousy), incompatibility of characters or values. Celibacy is often conditioned by physical disability, revaluation of freedom and independence, huge (...) requirements to partners, consumer attitude to life, infertility, alcohol and drug abuse, abnormalities in personality and sexuality. (shrink)

Pediatric critical careCritical care refers to the health care of children with life-threatening illness or following major surgery or severe injury. This care is offered in different contexts across the globe. In well-resourced environments, critical careCritical care may be provided in pediatric intensive care units, which provide highly complex medical care with advanced, potentially expensive technological devices aimed primarily at sustaining life; whereas in poorly resourced regions, only primary care may be available for critically ill or injured childrenInjured children. Even (...) where PICU facilities are available, they are a scarce and expensive resource. The knowledge and ability to sustain a critically ill or injured child’sInjured children life, potentially with effects on the child and family’s quality of lifeQuality of life and at the expense of other children’s health care, leads to frequent ethical challenges. Ethical issues related to how best to ensure optimal quality of lifeQuality of life and the fair distribution of scarce resources are common. In-depth knowledge and understanding of the individual patient’s medical, scientific and psychosocial context, through interdisciplinary discussion and collaboration; as well as familiarity with the overriding, relevant ethico-legal policiesPolicy and principles is essential for appropriate decision-makingDecision-making. Truthful communicationCommunication with the family is essential, using a shared decision-makingDecision-making process, and the child’s best interestBest interest must be central to every decision. This chapter presents an overview of the recommended approach to, and important considerations for, ethical decision-makingDecision-making in the PICU, using a hypothetical case example. (shrink)