BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the (...) range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence. (shrink)

Over the course of human history, the sciences, and biology in particular, have often been manipulated to cause immense human suffering. For example, biology has been used to justify eugenic programs, forced sterilization, human experimentation, and death camps—all in an attempt to support notions of racial superiority. By investigating the past, the contributors to _Biology and Ideology from Descartes to Dawkins_ hope to better prepare us to discern ideological abuse of science when it occurs in the future. Denis R. Alexander (...) and Ronald L. Numbers bring together fourteen experts to examine the varied ways science has been used and abused for nonscientific purposes from the fifteenth century to the present day. Featuring an essay on eugenics from Edward J. Larson and an examination of the progress of evolution by Michael J. Ruse, _Biology and Ideology_ examines uses both benign and sinister, ultimately reminding us that ideological extrapolation continues today. An accessible survey, this collection will enlighten historians of science, their students, practicing scientists, and anyone interested in the relationship between science and culture. (shrink)

It is commonly thought that evolution is a chance process, an idea found in popular writings on evolution, but also in academic writing in a broad range of scientific disciplines: scientific, philosophical and theological. One problem is that words such as ‘chance’ and ‘random’ are used with a range of different meanings according to context, and in evolutionary biology the word ‘chance’ is sometimes used in a way that is different from its use in mathematics and philosophy. The present article (...) aims to clarify the range of meanings and to argue the case that the evolutionary process is far from being a ‘theory of chance’ from biological, mathematical, or indeed philosophical and theological perspectives. (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were members (...) of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

This article represents comments arising from The Compatibility of Evolution and Design by Rope Kojonen (Palgrave Macmillan, 2021) concerning the role of chance and randomness in evolution (citations from this book are shown as page numbers in brackets). The various meanings of chance and randomness as used in descriptions of biological evolution are discussed and contrasted with their meanings in mathematics and metaphysics. The discussion relates to the role of contingency in evolution and to ideological and rhetorical extrapolations from biology (...) into philosophical world views. Overall it is concluded that evolution is not a chance process, except in the epistemic sense of “chance.” Theologically, this has implications for the idea that God creates through “a free evolutionary process” and may also influence our perspectives on divine action and intentionality in evolutionary history. (shrink)

There is a common misconception that our genomes - all unique, except for those in identical twins - have the upper hand in controlling our destiny. The latest genetic discoveries, however, do not support that view. Although genetic variation does influence differences in various human behaviours to a greater or lesser degree, most of the time this does not undermine our genuine free will. Genetic determinism comes into play only in various medical conditions, notably some psychiatric syndromes. Denis Alexander here (...) demonstrates that we are not slaves to our genes. He shows how a predisposition to behave in certain ways is influenced at a molecular level by particular genes. Yet a far greater influence on our behaviours is our world-views that lie beyond science - and that have an impact on how we think the latest genetic discoveries should, or should not, be applied. Written in an engaging style, Alexander's book offers tools for understanding and assessing the latest genetic discoveries critically. (shrink)

Over the past centuries the pendulum has constantly swung between an emphasis on the role of either nature or nurture in shaping human destiny, a pendulum often energised by ideological considerations. In recent decades the flourishing of developmental biology, genomics, epigenetics and our increased understanding of neuronal plasticity have all helped to subvert such dichotomous notions. Nevertheless, the media still report the discovery of a gene 'for' this or that behaviour, and the field of behavioural genetics continues to extend its (...) reach into the social sciences, reporting the heritability of such human traits as religiosity and political affiliation. There are many continuing challenges to notions of human freedom and moral responsibility, with consequent implications for social flourishing, the legal system and religious beliefs. In this book, Denis Alexander critically examines these challenges, concluding that genuine free will, often influenced by genetic variation, emerges from an integrated view of human personhood derived from contemporary biology. (shrink)

Phosphotyrosine phosphatases (PTPases) are the enzymes which remove phosphate groups from protein tyrosine residues. An enormous number of phosphatases have been cloned and sequenced during the past decade, many of which are expressed in haematopoietic cells. This review focuses on the biochemistry and cell biology of three phosphatases, the transmembrane CD45 and the cytosolic SH2‐domain‐containing PTPases SHP‐1 and SHP‐2, to illustrate the diverse ways in which PTPases regulate receptor signal transduction. The involvement of these and other PTPases has been demonstrated (...) in haematopoietic cell development, apoptosis, activation and non‐responsiveness. A common theme in the actions of many haematopoietic cell PTPases is the way in which they modulate the thresholds for receptor signalling, thereby regulating critical events in the positive and negative selection of lymphocytes. There is growing interest in haematopoietic PTPases and their associated regulatory proteins as targets for pharmaceutical intervention and in the involvement of these enzymes in human disease. (shrink)