Fiester and Yuan discuss important ethical concerns regarding the use of behavior contracts in addressing conflict with patients and families labeled as “difficult” (Fiester and Yuan 2023). We agre...

In this paper, I outline various pedagogical practices that I believe are important for diversifying the field of philosophy. I outline these practices through a discussion of knowledge and its production, the production of relations through collective acts, the creation of space in and beyond the institution, and finally moving beyond inclusion narratives. The various pedagogical practices that I outline have been developed in, and drawn from, a workshop titled the Feminist Decolonial Politics Workshop. Ultimately, in this paper I utilize (...) what I call a “tenderness approach to philosophy”—tenderness as devotion of time and concentration, as directional, relational, and embodied—in order to demonstrate how tenderness can be applied to a pedagogical context. (shrink)

Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians’ skills in conflict management. Familiarizing careproviders with basic mediation techniques is an important step towards (...) preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required. (shrink)

The ethics of long-term Extracorporeal Membrane Oxygenation (ECMO) use, especially when organ recovery appears highly unlikely and the patient does not qualify for organ transplantation, are compli...

A couple and their five‐year‐old daughter are in a car accident. The parents are not expected to survive. The child is transported to a children's hospital, and urgent treatment decisions must be made. Whom should the attending physician approach to make decisions for the child? When such cases arise in, for example, the hospitals where we work, the social worker or chaplain is instructed to use the Illinois Health Care Surrogacy Act as a guidepost to identify a decision‐maker. But in (...) our state and the country overall, the limitations of such statutes leave hospital workers to make a judgment call among friends, family, and clergy who may come forward. While surrogate decision‐making statutes comprehensively address surrogate decision‐makers for adults, a patchwork of laws—permanency statutes, kinship provider statutes, standby guardianship statutes, and, in some cases, surrogate decision‐making statutes—provide variable decision‐making pathways for children. (shrink)

En contexte de protection de la jeunesse, dans plusieurs situations, il arrive que le développement d’un lien d’attachement ne puisse s’établir suite à du rejet, de l’abandon ou par l’incapacité des parents à reconnaître ou répondre aux besoins de l’enfant. Dans de telles situations, au Québec, on envisage de plus en plus une approche « projet de vie » pour l’enfant avec l’objectif de mettre fin à l’ambivalence et au vide affectif, ceci dans des délais qui ne compromettent pas sa (...) capacité de se développer harmonieusement. Dans cette perspective, nous présentons ici les résultats d’une étude exploratoire qui a pour objectif de dresser un premier portrait des jeunes pour qui un « projet de vie » fut élaboré dans sept centres jeunesse du Québec. (shrink)

Throughout Mary Shelley’s early life, she was exposed to numerous well-known and influential people regarding cultural, political, and socio-economic matters. As she began writing, these influences undoubtedly played a role in her narrative. Her novel, _Frankenstein_, written during the time of the first Industrial Revolution in Britain, was one such novel that exhibited her political and economic influences through science fiction. This article addresses many of those influences, including the introduction of the machine into manufacturing. It further addresses how Frankenstein’s (...) Monster may have been one of the first created forms of artificial intelligence (AI). We further expound upon many economic concepts that have persisted through time and are relevant today given the faciliatory aspects, as well as the uncertainty, of AI. We relate these through the literary piece _Frankenstein_ to explore how a two-century-year-old tale provides a blueprint for understanding the conflict among humans and machines and provides a roadmap for harmonization in the past, present, and future. (shrink)

This is a welcome reprint of a book that continues to grow in importance.

Decision making for children who suffer abusive head trauma invokes multiple ethical considerations. The degree to which parents are permitted to participate in decision making after the injury has occurred is controversial. In particular, in this issue of The Journal of Clinical Ethics, Grigorian and colleagues raise concerns about the potential for conflict of interest in end-of-life decision making if the parents are facing criminal charges that could be escalated if the child dies. There are additional concerns about the parents’ (...) capacity to make decisions that are best for the child, given that the injury occurred. We argue that there are important reasons not to exclude parents from the decision-making process and that, with appropriate safeguards in place, parents are integral to determining what is best for the child. (shrink)

Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors and negative body image among a community sample of women during the COVID-19 pandemic. Furthermore, we explored the possible relation between body (...) image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs. (shrink)

The present study fills a void in research on passion by examining for the first time the role of passion in physiological responses. The aim of the study was to investigate the role of passion, and the mediating role of cognitive appraisals, in the psychological and physiological responses to a stressful situation related to one’s passion. Students, who were passionate for their studies, completed the Passion Scale for their studies and the Cognitive Appraisal Scale. Then, they engaged in an education (...) task under stressful conditions, and a subsequent unrelated leisure task under no-stress. Physiological reactivity was measured throughout the entire session and their perceptions of situational vitality and positive and negative emotions were assessed directly after the education task. Results showed that harmonious passion positively predicted challenge appraisals that, in turn, were positively related to positive emotions, vitality, and positive cardiovascular adaptation while engaging in the stressful education task, but less so with the leisure task. On the other hand, obsessive passion positively predicted threat appraisals. In turn, threat appraisals were positively related to negative emotions, negatively associated with vitality, and not related to cardiovascular reactivity. The present findings suggest that HP creates the onset of an adaptive psychological and physiological response whereas the response is less adaptive with OP. (shrink)

Volume 20, Issue 6, June 2020, Page 17-19.

Clinical ethicists move in different environments and interface with a variety of stakeholders, and are therefore uniquely positioned to answer the call for equity and anti-racism. We describe why a clinical ethicist should contribute to anti-racism efforts and describe general approaches for addressing racism across institutional contexts, including: (1) addressing racism as a bedside clinical ethics consultant, (2) addressing a wider lens of anti-racism work across multiple ethics consults over time, and (3) addressing racism at the organizational level.

The author presents and defends three theses: (1) "the first is that it is not profitable for us at present to do moral philosophy; that should be laid aside at any rate until we have an adequate philosophy of psychology." (2) "the second is that the concepts of obligation, And duty... And of what is morally right and wrong, And of the moral sense of 'ought', Ought to be jettisoned if this is psychologically possible...." (3) "the third thesis is that (...) the differences between the well-Known english writers on moral philosophy from sidgwick to the present day are of little importance." (staff). (shrink)

Controversies surrounding the determination of death by neurologic criteria (DNC), also known as brain death, have become increasingly common over the last decade, occasionally leading to parental refusal of all or part of an evaluation or declaration of DNC. We performed a prospective, crosssectional study of pediatric neurologists and intensivists who participate in professional listservs to ascertain perspectives and practices concerning the evaluation of DNC, specifically on obtaining permission for evaluations and managing refusals. Of the 334 respondents who had performed (...) an evaluation for DNC, 35 percent reported they had experienced at least one parental refusal, and 64.4 percent reported that they did not seek permission to perform an evaluation. Pediatric neurologists, careproviders who had less experience doing evaluations, and careproviders who had experienced parental refusal of an evaluation were more likely to obtain permission from parents. Most (80.8 percent) of respondents reported that their institution had a DNC policy. We found variability in many aspects of DNC evaluations and declarations, as well as the handling of refusals. Lack of consistency may make it more difficult for careproviders and families. Greater understanding of parental refusal of DNC evaluation is essential to inform efforts to increase consistency. (shrink)

The aim of this article is to interrogate the concept of cultural genocide. The primary context examined is the Government of Canada's recent attempt at reconciliation through the Truth and Reconciliation Commission. Drawing on the work of Audra Simpson, Glen Sean Coulthard, Kyle Powys Whyte, Stephanie Lumsden, and Luana Ross, I argue that cultural genocide, like cultural rights, is depoliticized, thus limiting the political impact these concepts can invoke. Following Sylvia Wynter, I also argue that the aims of “truth and (...) reconciliation” can sometimes serve to resituate the power of a liberal multicultural settler state, rather than seek systemic changes that would properly address the present-day implications of the residential school system. Finally, I argue that genocide and culture need to be repoliticized in order to support Indigenous futurity and sovereignty. (shrink)

A core tenet of research ethics is that risks assumed by research participants are reasonable, balanced, and minimized in relation to benefit to the individual and to society. It is also generally accepted that people who cannot give their own informed consent ought only to be exposed to low risks in research, unless there is a compensating potential for direct benefit.However, there is no consensus on whether individuals should be able to voluntarily consent to high net risk in research—or, in (...) other words, to research that is not justified by direct benefits to the individual and must be justified by benefits to others in society. The Belmont Report—perhaps the most canonical document in research ethics—does not... (shrink)

SummaryThis essay is an introduction to a special issue on ‘Liberalism in the Early Nineteenth-century Iberian World’. The essay reviews why Iberian intellectual history, particularly liberal political thought, has been neglected in English-language scholarship. It offers suggestions for the incorporation of Portuguese and Spanish language texts into the broader canon. The essay then outlines persistent debates common to the study of liberalism in both Iberian and other national contexts, in an effort to instigate a dialogue between intellectual historians of Spain (...) and Portugal and their counterparts elsewhere. It concludes with a consideration of the geopolitical forces, cultural trends, and social conditions that encouraged the forging of transnational liberalism in the early nineteenth century. (shrink)

In “An Overview of Ethical Challenges Raised by Medicolegal Challenges to Death by Neurologic Criteria in the United Kingdom and a Comparison to Management of these Challenges in the USA,” Ariane L...

The relations between reason, motivation and value present problems which, though ancient, remain intractable. If values are objective and rational how can they move us and if they are dependent on our contingent desires how can they be rational? E. J. Bond makes a bold attack on this dilemma. The widespread view among philosophers today is that judgements contain an irreducible element of personal commitment. To this Professor Bond proposes an account of values as objective and value judgements as true (...) or false, employing a distinction between grounding and motivating reasons to establish their connection with action. He defines and tests his position against a number of recent theories, providing in the process forceful criticism of Williams, Wiggins, Foot, Narveson and Nagel, among others. A distinctive contribution to the subject, it will stimulate interest and worthwhile debate among philosophers, while also serving as an introduction to this vital topic. (shrink)

In “The Harm Principle Cannot Replace the Best Interest Standard: Problems With Using the Harm Principle for Medical Decision Making for Children,” Bester argues that conceptual and normative diffi...

Decisions regarding life-sustaining medical treatments for young children with profound disabilities can be extremely challenging for families and clinicians. In this study, Brick and colleagues1 surveyed adult residents of the UK about their attitudes regarding withdrawal of treatment using a series of vignettes of infants with varying levels of intellectual and physical disability, based on real and hypothetical cases.1 This is an interesting study on an important topic. We first highlight the limitations of using these survey data to inform public (...) policy and then offer a different interpretation from the authors’ regarding their findings about the value the public appears to place on relational capacity. The authors asked members of the lay public to interpret a disabled child’s best interest in a series of vignettes. The respondents were 92% white; 59% were atheist or reported no religious affiliation. Though the authors note this lack of diversity as a limitation, we would add that this limitation is particularly problematic in this context. Minority views on this issue may differ significantly from the majority perspective. When the stakes are high, use of public opinion data to directly inform policy requires, at a minimum, a representative sample reflecting both the true diversity of views within the public and a method to justly account for the alternate views of the minority. Even if the sampled population were more …. (shrink)

Derek Parfit’s view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. However, rather than accepting that an unknown metaphysical ‘further fact’ underpins agential unity, one can accept Parfit’s view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring (...) advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death. (shrink)

The focus of this essay is Sylvia Wynter’s conception of ceremony. I argue that ceremonies provide the conditions for a new conception of what it means to be human, that is no longer hierarchical. As such, both ceremonies and this new human are necessary for processes of liberation. In order to be liberatory, however, ceremonies must be place-based and yet fluid and mobile, are steeped in history and are thrust into the future, depend upon community, and impact daily experiences. I (...) argue that employing the best aspects of ceremony can provide the tools for developing coalitional movements, which are often already employed by Black and Indigenous communities. I call this process ceremonies of liberation. (shrink)

In Autopoiesis and Cognition, Humberto R. Maturana and Franscico J. Varela state that “the way an autopoietic system maintains its identity depends on its particular way of being autopoietic, that is, on its particular structure, different classes of autopoietic systems have different classes of ontogenies”. With this in mind, in this article I develop how this conception of autopoietic systems is both present in, and operates through, Wynter’s employment of space and place, poetry, and wonder.

Children’s age and developmental capacity leave them incapable of making medical decisions for themselves. Decisions for children are traditionally made under the best interest standard. Ross calls into question whether the best interest standard can function as both a guidance and intervention principle, able to be applied across the spectrum of pediatric decision making. Ross describes constrained parental autonomy as an alternative model, arguing that it affords parents the ability to make decisions within the context of their family while upholding (...) a child’s current and future interests. Although the model provides a robust framework for intrafamilial decision making, I question whether it can be broadly applied to children living in non-intimate families. (shrink)