This chapter highlighted some salient trends in pediatric ethicsEthics, pediatric from different parts of the globe. It is interesting to note that although diverse, there are many similarities between ethical challenges in pediatrics in different parts of the world.

There is an inconsistency in the ways that doctors make clinical decisions regarding the treatment of babies born extremely prematurely. Many experts now recommend that clinical decisions about the treatment of such babies be individualized and consider many different factors. Nevertheless, many policies and practices throughout Europe and North America still appear to base decisions on gestational age alone or on gestational age as the primary factor that determines whether doctors recommend or even offer life-sustaining neonatal intensive care treatment. These (...) policies are well intentioned. They aim to guide doctors and parents to make decisions that are best for the baby. That is an ethically appropriate goal. But in relying so heavily on gestational age, such policies may actually do the babies a disservice by denying some babies treatment that might be beneficial and lead to intact survival. In this paper, we argue that such policies are unjust to premature babies and ought to be abolished. In their place, we propose individualized treatment decisions for premature babies. This would treat premature babies as we treat all other patients, with clinical decisions based on an individualized estimation of likelihood that treatment would be beneficial. (shrink)

A recent American Academy of Pediatrics (AAP) clinical report states that it is an acceptable option for pediatric care clinicians to dismiss families who refuse vaccines. This is a clear shift in guidance from the AAP, which previously advised clinicians to “endeavor not to discharge” patients solely because of parental vaccine refusal. While this new policy might be interpreted as encouraging or recommending dismissal of vaccine-refusing families, it instead expresses tolerance for diverse professional approaches. This is unlike the earlier guidance, (...) which promoted a unified response to vaccine refusal. In fact, the resolution (which was presented at the AAP’s Annual Leadership Forum) that led to this clinical report also calls on the AAP “to continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.” However, the shift toward embracing dismissal as an acceptable response to vaccine refusal may erode professional solidarity. Pediatricians are clearly divided on this question; most do not dismiss vaccine-refusing families. By declaring that dismissal is an acceptable option, the AAP has sanctioned a practice that may be unfair to the many clinicians who do not dismiss these families. Clinicians who adopt a policy of dismissal toward families who refuse vaccines might impose burdens on colleagues who remain willing to offer care to those families, and their actions might show insufficient commitment to the efforts of their profession to promote health for all children. (shrink)

Parents respond to the death of a child in very different ways. Some parents may be violent or angry, some sad and tearful, some quiet and withdrawn, and some frankly delusional. We present a case in which a father’s reaction to his daughter’s death is a desire to protect his wife from the stressful information. The wife is in the second trimester of a high-risk pregnancy and so is particularly fragile. We asked pediatricians and bioethicists to discuss the ways in (...) which they might respond to the father’s understandable but troubling request. -/- The death of a young child is one of the most stressful events that can happen to parents. The stress of such a loss is compounded if the parents are in a foreign country, far from home, and without a network of family and friends to provide social support. The stress may be more difficult to deal with if the parents have acute health problems of their own. In this month’s “Ethics Rounds,” we present a case in which a father whose daughter died requested that the doctors delay telling his wife. His reason: She is pregnant, in the second trimester, and on bed rest because of preterm labor. He does not want to add to her stress. We asked both pediatricians and bioethicists to respond to this request. (shrink)

Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate because they were threatened with dismissal. Other (...) heavy-handed interventions have failed to move most such parents. When Washington state made nonmedical exemptions more difficult to obtain, nearly two-thirds of vaccine refusers were unmoved and their children remained unvaccinated. Even if dismissal threats led some parents to accept vaccines, this alone would not justify a dismissal policy. The benefits would still have to be weighed against the risks of dismissing those families who do not change their minds. (shrink)

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

A commentary on “Were There ‘Additional Foreseeable Risks’ in the SUPPORT Study?,” by Henry J. Silverman and Didier Dreyfuss; “SUPPORT: Risks, Harms, and Equipoise,” by Robert M. Nelson; “The Controversy over SUPPORT Continues and the Hyperbole Increases,” by Alan R. Fleischman; and “SUPPORT and Comparative Effectiveness Trials: What's at Stake?,” by Lois Shepherd, all in the January‐February 2015 issue.

In this article, we first review the development of clinical ethics in pediatrics in the United States. We report that, over the last 40 years, most children’s hospitals have ethics committees but that those committees are rarely consulted. We speculate that the reasons for the paucity of ethics consults might be because ethical dilemmas are aired in other venues. The role of the ethics consultant, then, might be to shape the institutional climate and create safe spaces for the discussion of (...) difficult and sometimes contentious issues. Finally, we report how pediatric clinical ethics has evolved differently in a number of other countries around the world. (shrink)

A fresh, daring, and genuine alternative to the traditional story of scientific progress Explaining the world around us, and the life within it, is one of the most uniquely human drives, and the most celebrated activity of science. Good explanations are what provide accurate causal accounts of the things we wonder at, but explanation's earthly origins haven't grounded it: we have used it to account for the grandest and most wondrous mysteries in the natural world. Explanations give us a sense (...) of understanding, but an explanation that feels right doesn't mean it is true. For every true explanation, there is a false one that feels just as good. A good theory's explanations, though, have a much easier path to truth. This push for good explanations elevated science from medieval alchemy to electro-chemistry, or a pre-inertial physics to the forces underlying nanoparticles. And though the attempt to explain has existed as long as we have been able to wonder, a science timeline from pre-history to the present will reveal a steep curve of theoretical discovery that explodes around 1600, primarily in the West. Ranging over neuroscience, psychology, history, and policy, Wondrous Truths answers two fundamental questions-Why did science progress in the West? And why so quickly? J.D. Trout's answers are surprising. His central idea is that Western science rose above all others because it hit upon successive theories that were approximately true through an awkward assortment of accident and luck, geography and personal idiosyncrasy. Of course, intellectual ingenuity partially accounts for this persistent drive forward. But so too does the persistence of the objects of wonder. Wondrous Truths recovers the majesty of science, and provides a startling new look at the grand sweep of its biggest ideas. (shrink)

This paper examines narrativism’s claim that the historical past cannot be known once and for all because it must be continuously re-described from the standpoint of the present. We argue that this claim is based on a non sequitur. We take narrativism’s claim that the past must be re-described continuously from the perspective of the present to be the result of the following train of thought: 1) “all knowledge is conceptually mediated”; 2) “the conceptual framework through which knowledge of reality (...) is mediated changes with every new generation of historians”; therefore (narrativism’s claim) “the historical past changes with every new generation of historians”. The idea of an unchanging past, for the narrativist, requires denying premise 1 (all knowledge is conceptually mediated”) and therefore rests on a problematic commitment to the chimerical notion of the past as it is in-itself, wie es eigentlich gewesen. We argue that the narrativist’s conclusion does not follow unless one adds a further premise, namely 3) “it is not possible to view reality through the categorial framework of historical agents”. If one asserts the possibility of grasping reality through the categorial framework of others, be they contemporary or past agents (as much philosophy of history written in an idealist key does), then one no longer has to accept the narrativist’s inference that since the past cannot be known in-itself or independently of conceptual mediation, then it cannot be known as it always was for the historical agents. Narrativism’s inference that the past cannot be known as it always was does not follow from premises 1 and 2 unless one smuggles in another problematic premise, premise 3. In this paper we defend the claim that the past can be known as it always was (not as it is in-itself) by invoking a different conception of the role of conceptual mediation in historical knowledge, one which assumes the possibility of viewing reality through the categorial framework of others. This notion of the role of conceptual mediation in historical knowledge is prevalent in the idealist tradition but, in the interest of brevity, we will defend this notion of mediacy by specific reference to the idealist philosophy of R.G. Collingwood. (shrink)

There is now a considerable literature on Michel Foucault but this is the first monograph which explicitly addresses his influence and impact upon education. Personal autonomy has been seen as a major aim, if not the aim of liberal education. But if Foucault is correct that personal autonomy and the notion of the autonomous person are myths, then the pursuit of such an aim by educationalists is misguided. The author develops this critique of personal autonomy and liberal education from the (...) writings of Foucault, and also considers Foucault's own educational practices. The author, James Marshall, who lives in New Zealand, has already written several articles for academic journals on Foucault. (shrink)

Philosophers agree that scientific explanations aim to produce understanding, and that good ones succeed in this aim. But few seriously consider what understanding is, or what the cues are when we have it. If it is a psychological state or process, describing its specific nature is the job of psychological theorizing. This article examines the role of understanding in scientific explanation. It warns that the seductive, phenomenological sense of understanding is often, but mistakenly, viewed as a cue of genuine understanding. (...) The article closes with a discussion of several new paths of research that tie the psychology of scientific explanation to cognate notions of learning, testimony, and understanding. (shrink)

Scientists and laypeople alike use the sense of understanding that an explanation conveys as a cue to good or correct explanation. Although the occurrence of this sense or feeling of understanding is neither necessary nor sufficient for good explanation, it does drive judgments of the plausibility and, ultimately, the acceptability, of an explanation. This paper presents evidence that the sense of understanding is in part the routine consequence of two well-documented biases in cognitive psychology: overconfidence and hindsight. In light of (...) the prevalence of counterfeit understanding in the history of science, I argue that many forms of cognitive achievement do not involve a sense of understanding, and that only the truth or accuracy of an explanation make the sense of understanding a valid cue to genuine understanding. (shrink)

The cumbersome title of this argumentative and often tedious book is illustrative of its intention, which is to offer a Marxist interpretation of Socrates, Plato, and Aristotle. By presenting history as the progressive unfolding of the course of dialectical materialism, the authors are enabled to argue that political philosophy is best understood in the context of the ever evolving class struggle that constitutes that unfolding. The ancient world is conceived of as being divided into two hostile camps: reactionary, authoritarian aristocrats (...) on the one hand, and progressive, or liberating democrats on the other. As Athens became more of a polis, that is, as political life within it became more public or democratic, class lines between the "producers and appropriators" hardened. Socrates, Plato, and Aristotle, political partisans of the first order, were the articulate, although morally obtuse apologists for "the increasing class consciousness of the aristocracy." More often than not, the projection of this recent concept upon the distant past has the effect of reducing the thought of the past to simple ideological cant. (shrink)

At some distance from a high-rate source in an elastic half-space, the dominant wave motion at the free surface is a Rayleigh surface wave. The calculation of surface waves generated by a concentrated force in a half-space is a basic problem in elastodynamics. By straightforward manipulations, the result can be used to obtain surface waves for other kinds of wave-generating body-force arrangements. For example, appropriate combinations of double-forces (or dipoles) can be used to represent the surface loading due to laser (...) irradiation, or due to acoustic emission from the opening of a sub-surface crack or from sliding over a fault surface. The surface wave motion is usually obtained by the application of integral transform techniques and the subsequent extraction of the surface waves as the contributions from poles in the integral for the inverse transform. In this paper, we use a much simpler approach based on the elastodynamic reciprocity theorem. We consider a transversely isotropic solid whose axis of symmetry is normal to the surface of the half-space. Surface wave pulses generated by a single force, by irradiation from a laser source, and by opening of a crack, have been determined. (shrink)

Scientific realism has been advanced as an interpretation of the natural sciences but never the behavioral sciences. This book introduces a novel version of scientific realism, Measured Realism, that characterizes the kind of theoretical progress in the social and psychological sciences that is uneven but indisputable. It proposes a theory of measurement, Population-Guided Estimation, that connects natural, psychological, and social scientific inquiry. Presenting quantitative methods in the behavioral sciences as at once successful and regulated by the world, the book will (...) engage philosophers of science, historians of science, sociologists of science, and scientists interested in the foundations of their own disciplines. Part I introduces measured realism beginning with a novel realist theory of measurement (Population-Guided Estimation, or PGE). It examines two other versions of scientific realism — minimal (Hacking) and robust (Boyd, Putnam, and Newton-Smith) — and advances measured realism as best supported by the evidence in the behavioral sciences. It also critically evaluates the anti-realist arguments of van Fraassen, Laudan, and Fine. Part II formulates and develops a version of epistemological naturalism most appropriate to measured realism. Drawing upon the realist theory of measurement developed earlier, it favorably appraises a variety of statistical methods in the behavioral sciences against selected criticisms. It concludes that traditional, narrative methods in the behavioral and social sciences are unreliable by the measures of epistemological naturalism. (shrink)

Bayesian probabilistic explication of inductive inference conflates neutrality of supporting evidence for some hypothesis H ("not supporting H") with disfavoring evidence ("supporting not-H"). This expressive inadequacy leads to spurious results that are artifacts of a poor choice of inductive logic. I illustrate how such artifacts have arisen in simple inductive inferences in cosmology. In the inductive disjunctive fallacy, neutral support for many possibilities is spuriously converted into strong support for their disjunction. The Bayesian "doomsday argument" is shown to rely entirely (...) on a similar artifact. Copyright 2010 by the Philosophy of Science Association. All rights reserved. (shrink)