BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Closing the Gaps in Pediatric HIV/AIDS Care, One Step at a TimeLisa V. Adams, Helga Naburi, Goodluck Lyatuu, Paul Palumbo, and C. Fordham von ReynFatuma's* doctors were completely perplexed. It was 2003 and she had returned to the DARDAR clinic in her hometown of Dar es Salaam, Tanzania three times that week with vague complaints of various pains and aches. Her doctors were considering whether these symptoms were (...) due to the initiation of her recent treatment with antiretroviral medications for her HIV infection or related to the last administration of the investigational tuberculosis (TB) vaccine that the DARDAR Health Study was evaluating. Fatuma's doctor, Dr. Lillian Mtei, consulted with Dartmouth's chief of Infectious Disease, Dr. Ford von Reyn, who happened to be in Dar that week on a site visit. Neither physician could determine the basis for her symptoms. Dr. Mtei returned to the exam room once more and this time emerged with the answer: Fatuma had just learned that her three year old daughter was HIV-infected, likely contracted from Fatuma during or shortly after she gave birth to her daughter. Fatuma believed that her HIV diagnosis was a death sentence for her daughter since antiretroviral therapy was not widely available for children.Dr. von Reyn, Dartmouth's lead clinical researcher in Africa and a father, knew too well the harsh reality of inequities in a resource-limited country. He turned to Dr. Mtei and said decidedly, "we need to do something about this."Thus the DARDAR Pediatric Program was born.Pediatric HIV: A Neglected DiseaseThe need for HIV treatment among children in Tanzania, as in most of sub-Saharan Africa, is compelling. At the end of 2009, approximately 160,000 children aged zero to fourteen in Tanzania were living with HIV (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2011). Even with successful roll out of prevention of mother to child transmission programs in Tanzania, there were nearly 29,000 perinatal infections in 2009. As of December 2010, only 18% of these were enrolled in HIV treatment programs (UNAIDS, 2011; World Health Organization [WHO], 2011). Without antiretroviral therapy (ART), one-half of HIV-infected children will die before their second birthday. Since clinical research to determine efficacy and safety of new medical treatments is conducted almost exclusively in adults, provision of new medical treatments to [End Page 75] children always lags behind advances for adults. Furthermore, children are often underrepresented in programs for antiretroviral drugs for the following reasons: 1) they are not prioritized for care; 2) facilities lack infant diagnostic capabilities; 3) there is limited pediatric HIV training and consequently, a shortage of pediatric providers; and 4) pediatric antiretroviral formulations are frequently unavailable. The unacceptable delays in pediatric HIV drug development and treatment access led the international organization Drugs for Neglected Diseases initiative to publish an editorial in which they referred to pediatric HIV as a "neglected disease" (Lallemant, Chang, Cohen, & Pecoul, 2011).The Tip of the Iceberg: More than Just MedicinesWith a grant from the New York-based Foundation for the Treatment of Children with AIDS, the DARDAR Pediatric Program, a joint collaboration between Geisel School of Medicine at Dartmouth and Muhimbili University of Health and Allied Sciences, began seeing patients in May 2006. It was the first dedicated pediatric HIV Care and Treatment Center in Tanzania and operates in accordance with Tanzania's National AIDS Control Programme's guidance. Testing for both children and infants (the latter of which requires a more sophisticated assay) is available.The day the clinic opened we celebrated this collaborative effort that would provide HIV-infected children in Dar es Salaam access to antiretroviral treatment. One of our first patients was a six-year-old boy whose mother, like Fatuma, was a participant in our TB vaccine trial. She had been advised to bring her son to us for HIV screening. Her son looked healthy so she was surprised and understandably distraught when his test results indicated that not only was he HIV-infected, but his CD4 percentage was very low. His mother was reluctant to have him started on antiretrovirals given his general appearance and young age—and that he was... (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help (...) to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process (...) of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n= 13), qualitative data from the application and assessment surveys (n= 35;n= 21), excerpts from the journals of some participants (n= 3), and email correspondence with some participants (n= 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self. (shrink)

Background During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals. Aim The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in (...) the face of moral conflicts. Method The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected. Ethical Considerations Ethical requirements were respected in all study phases. Results The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society. Conclusion The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals. (shrink)

It is argued by Anderson and also in the BrazierReport that Commercial Surrogate Motherhood (C.S.M.)contracts and agencies should be illegal on thegrounds that C.S.M. involves the commodification ofboth mothers and babies. This paper takes issue withthis view and argues that C.S.M. is not inconsistentwith the proper respect for, and treatment of,children and women. A case for the legalisation ofC.S.M. is made.

In this case, an adolescent with a life-threatening immune disease experiences increased social complexity, child welfare involvement, and placement into foster care, which could disrupt a medical...

In this volume, a well-known psychoanalyst, dance therapist, and educational consultant chronicles her clinical work with deeply troubled children who fall between the cracks of our diagnostic and educational systems. These children, who frequently turn out to have been sexually or punitively abused, have no real emotional home despite the fact that they live in materially comfortable circumstances. In spite of their apparent brightness and precocity, they do not thrive in the classroom, where their disruptive behavior, tendency to act out, (...) and fragmented learning bring them to the attention of teachers, counselors, and school psychologists. Standard diagnoses do not explain their plight; such children are neither retarded nor learning disabled nor neurotic. Through poignant case studies, Siegel reviews the developmental circumstances that bring these middle-class waifs to a critical impasse with both their parents and the educational establishment. Time and again she discovers that the children's expectable developmental course has been derailed by their accommodation to parental abuse and deformed parental expectations. Psychodynamic treatment invariably uncovers the maladaptive solutions that fueled the children's behavioral and learning disturbances. This volume speaks to a broad clinical and non-clinical readership: psychoanalytic clinicians; psychologists; counselors; social workers; art, dance, and music therapists; special education teachers; child therapists; and child care workers. They will all join in admiration of Siegel's treatment approach which focuses on what is healthy in deeply traumatized children and, in so doing, helps debunk the myth of the untreatable child. (shrink)

In this volume, a well-known psychoanalyst, dance therapist, and educational consultant chronicles her clinical work with deeply troubled children who fall between the cracks of our diagnostic and educational systems. These children, who frequently turn out to have been sexually or punitively abused, have no real emotional home despite the fact that they live in materially comfortable circumstances. In spite of their apparent brightness and precocity, they do not thrive in the classroom, where their disruptive behavior, tendency to act out, (...) and fragmented learning bring them to the attention of teachers, counselors, and school psychologists. Standard diagnoses do not explain their plight; such children are neither retarded nor learning disabled nor neurotic. Through poignant case studies, Siegel reviews the developmental circumstances that bring these middle-class waifs to a critical impasse with both their parents and the educational establishment. Time and again she discovers that the children's expectable developmental course has been derailed by their accommodation to parental abuse and deformed parental expectations. Psychodynamic treatment invariably uncovers the maladaptive solutions that fueled the children's behavioral and learning disturbances. This volume speaks to a broad clinical and non-clinical readership: psychoanalytic clinicians; psychologists; counselors; social workers; art, dance, and music therapists; special education teachers; child therapists; and child care workers. They will all join in admiration of Siegel's treatment approach which focuses on what is healthy in deeply traumatized children and, in so doing, helps debunk the myth of the untreatable child. (shrink)

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

In a recent article in Health Care Analysis (Vol. 8, No. 1),Campbell misrepresents our specific arguments about commercialsurrogate motherhood (C.S.M.) and our general philosophical andpolitical views by saying or suggesting that we are `Millsian'liberals and consequentialists. He gives too the false impressionthat we do not oppose, in principle, slavery and child purchase.Here our position on C.S.M. is re-expressed and elaborated uponin order to eliminate possible confusion. Our general ethical andphilosophical framework is also outlined and shown to be otherthan (...) Campbell says that it is. In particular, a moral philosophythat it is based on neither consequentialism nor Kantianism ispresented. C.S.M., it is argued, is not child purchase. It is like it insome respects and unlike it in others. It is unlike it in therespects which, relative to the present discussion, matter. (shrink)

We systematically examined the content of the websites of 46 agencies that buy and sell human eggs to understand how they market themselves to both donors and recipients. We found that these websites use marketing techniques that obscure the realities of egg donation, presenting egg donation as a mutually beneficial and fulfilling experience. Sites emphasize egg donors' emotional fulfillment and address recipients' anxieties by stressing the ability to find the perfect “fit” or “match”, suiting recipients’“preferences”/“desires”, and even designing/customizing a (...) class='Hi'>child. Agencies attempt to create a sense of connection between the recipients and donors by reporting donors' personal characteristics — e.g., interests/hobbies, traits, mood/temperament, and self-reported childhood behavior/memories. Sites present donors as caring/generous and smart/successful/beautiful. These data, the first to examine several key aspects of egg donation agency websites, reveal critical aspects of how these companies communicate to prospective donors and recipients, raising several ethical concerns. Websites frame information in ways that may bias consumers, making emotional appeals that may distract from appropriate risk/benefit assessments and obscure the ethical challenges of egg donation. These data highlight needs for improved practices, adherence to guidelines, and consideration of enhanced guidelines or policy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesZohar Lederman, Ola Ziara, Rachel Coghlan, Oksana Sulaieva, Anna Shcherbakova, Oleksandr Dudin, Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun, Lyudmyla Prystupa, Yuliya Nogovitsyna, Ghaiath Hussein, Kathryn Fausch, P. P. Kyaw, Ayesha Ahmad, Richard W Sams II, Handreen Mohammed Saeed, Artem Riga, Ryan C. Maves, Elizabeth Dotsenko, Irina Deyneka, Eva V. Regel, and Vita Voloshchuk• An Unsettling Affair• How We Keep Caring While Walking Through Our Pain• (...) Adjusting Laboratory Practices to the Challenges of Wartime• Why We Stay• A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the War• When Ethics Survives Where People Do Not: A Story From Darfur• Burma’s Healthcare Under Fire: My Experience as an Exiled Medical Professional• When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban Takeover• The Vagaries and Vicissitudes of War• Providing Care to a Potential Aggressor: An Ethical Dilemma• One Surgeon’s Experience During Armed Conflict in Ukraine• The Limits of Our Obligations• A Liberating Breath• Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under Fire• Stories of Families with Chronically Ill Pediatric Patients during the War in UkraineCopyright © 2023 Johns Hopkins University Press... (shrink)

: Originally presented during Ethic Rounds at the Dana-Farber Cancer Institute, this commentary on the case of a patient treated for life-threatening cancer explores the responsibilities of health care providers when addressing the patient's desire to adopt a child.

Through a case study, this paper addresses ethical issues and dilemmas faced by a Family Therapist working in a Child and Adolescent Mental Health Service (CAMHS) in the National Health Service. When there are legal and societal obligations on parents/carers to ensure that the needs of children and young people are met within a family context, working with a young person in a health care setting oriented to the individual raises ethical dilemmas around consent. When the values of (...) young people and their parents conflict, legal, ethical and political issues can be raised. These have implications for the duties of health care professionals and the rights, interests and autonomy of the individual young people and their parents. The importance of justice to CAMHS practitioners' ethical decision-making about when to prioritize the individual over the family, or vice versa, is emphasized. (shrink)

Unlike other states, California retained a large proportion of the child care centers that had been established during World War II. In 1946, the California state government allocated state funds for child care in response to a vigorous child care campaign. The campaign, which was, in large part, a working mothers movement, was a “transformed maternalist” movement. It used maternalist rhetoric to defend state-subsidized child care that was criticized by more traditional (...) maternalists. Using resource mobilization theory, I explain the relatively high degree of political mobilization on the child care issue in California in terms of the greater availability of co-optable social resources, which California's relatively large wartime child care program provided, and the existence of movement entrepreneurs willing to mobilize these latent resources. Child care advocates were successful because they operated within a relatively favorable political opportunity structure since they did not have to contend with a strained state treasury or a mobilized countermovement and were able to garner the support of a wide variety of women's and social organizations and an influential social reformer. (shrink)

Based on four years of participant-observation field research and focused interviews with men and women child care workers, the author analyzes how the marking of men workers and their experiences doing child care work show how deeply feminized the work of child care is. When men choose to do child care work, they become suspect. This suspicion manifests in restriction of men's access to children in child care centers. Restricted (...) access of men workers to children implies men's desire for access to children is pathological. In these and other ways, the organization of child care and the accountability of persons to sex category systematically push men away from nurturing responsibilities and bind these responsibilities to women workers. (shrink)

The claimants brought civil suits against child care institutions and authorities for the sexual abuse to which they were subject whilst under the defendants’ responsibility. These cases were not initiated until the claimants were well into adulthood and began recognising the harms they had suffered, and as a result, their claims were time-barred at first instance. However, after A v Hoare (and Other Appeals), in which the House of Lords significantly altered the laws on limitation, their cases were (...) reheard and allowed to proceed. In this respect, AB and Others v Nugent Care Society; GR v Wirral MBC demonstrates the benefits of the ruling in Hoare; but at the same time, this note argues that the Court of Appeal utilises a problematic conceptualisation of the harm of sexual abuse and the case highlights the potential for inconsistency and uncertainty in such delayed claims following the decision in Hoare—which is not the panacea it initially appears to be. (shrink)

Available from UMI in association with The British Library. Requires signed TDF. ;I deal with two themes: the idea that an account of thought should be given by giving an account of the ascription of thoughts by a radical interpreter--which I call interpretationism; and the idea that psychological concepts like action and perception are essentially causal. It has often been thought that these two themes conflict; or at least, that if they can co-exist, then they must be kept separate, and (...) associated with different perspectives on behaviour. But is that right? I discuss the character of interpretationism and the nature of causal theories, and examine the extent to which the two themes are compatible. ;Chapter I explains and argues for an interpretationist approach, distinguishing between different interpretationist views, and defending interpretationism against various common objections. ;Chapter II examines the links between interpretationism and the anomalousness of the mental. I discuss a number of different arguments and distinguish a range of theses about anomalousness and indeterminacy which they may support. ;Chapter III discusses the motivation for causal theories. I explain why it matters that we should give causal theories within an interpretationist perspective rather than treating the two themes as insights of different perspectives; and I examine the difficulties of doing so. ;Chapter IV considers the causal theory of vision. I argue against the view that the interpretationist's conception of experience undermines the causal theory. ;Chapter V considers the case of action. I develop a substantive causal theory of action which responds to the following argument: that if we accept the interpretationist's claim that the mental is anomalous, then we must concede that mental properties cannot be causally relevant. ;From the particular cases, and on general grounds, I conclude that it is possible to adopt an interpretationist perspective which simultaneously sees the mental in causal terms; and that such a perspective is essential for an adequate understanding of the mind. (shrink)

The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological–hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms (...) of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

Purpose. The purpose of this paper is to investigate the anthropological and socio-philosophical dimensions of human existence of the older age group given the challenges of pandemic threats caused by COVID-19. To this end, it is planned to solve a number of tasks, among which one should distinguish the following: 1) to investigate the manifestations of age discrimination in the context of the social and labor areas of human existence; 2) to focus on the asymmetry of the behavior of society (...) and the state relative to persons of the older age group in the field of healthcare in the context of a pandemic crisis; 3) to represent the anthropological features of changes in the socialization and activity of older people under the current conditions of globalization-pandemic challenges. Theoretical basis. Despite such a broad representation of the age-related issue in public relations, there are still no practical guarantees that would apply to discriminatory aspects of older age groups in various areas of their manifestation. The synergistic evolution of social reality requires substantive analysis of the issue under the current conditions for the transformation of social life, which is affected by globalization crises caused by the pandemic threats of COVID-19. Originality. The stereotypical assumptions underlying legal policy and established social relations are based solely on the application of chronological age. The novelty is in justifying an individual approach to the elderly through the personification of the personal characteristics of a person. The study of anthropological and socio-philosophical dimensions of the existence of a person of the older age group in the face of the challenges of pandemic threats caused by COVID-19 has made it possible to analyze the destructive nature of age discrimination in the context of the social and labor areas of human existence. As well as focus on the asymmetry of the behavior of society and the state in relation to these persons in the field of health care, and emphasize the anthropological features of changes in the socialization and human activity under the current conditions of globalization-pandemic challenges. Conclusions. External threats to human existence call for special attention to the implementation and protection of human rights, freedoms, individual freedoms, and identity. Pandemic threats have transformed all dimensions of human existence, especially for those groups of society that are less socially protected. The pandemic crisis has created additional grounds for discrimination against older people in various areas of human existence. Equalization of persons by age without personifying the personal characteristics of an individual is discrimination on an age basis, which violates the principles of democracy and humanism in the society, leads to stigmatization of the person, is the cause of the anthropological crisis of a person. (shrink)

Illness and hospitalization are sources of vulnerability; they arguably endow nurses and midwives with the moral obligation to develop caring relationships with patients. Fairness and the equal treatment of patients are central to moral practice; current government publications are giving this political emphasis. This article argues that patient partiality is one factor that may result in insidiously unequal caregiving. Data generated during a qualitative study into professional caring suggest that patient partiality is an accepted part of everyday practice. Factors such (...) as the patient’s personality, nurse-patient familiarity and the perceived level of patients’ understanding and interest in their illness emerged as possible sources of partiality and influence on practitioners’ interactions with patients. The article argues that patient partiality can be managed morally if practitioners develop self-awareness and constantly reflect on the moral integrity of everyday practice. Throughout the article, unless it is stated that specific reference is being made to either nurses or midwives, reference to a nurse or practitioner denotes both. It is also emphasized that no implication is intended that any study participants provided unequal care. Rather, data are utilized solely to generate focused discussion around the concept of patient partiality. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

The optimal-pessimal paradox (Bradley, 1975) has been criticized on bizarre grounds by Childs (1980). Assumptions that it never made were attributed to it and attacked. Empirical evidence for its existence (which occupied a large portion of the criticized article) was totally ignored, and it was treated as a mere theoretically based conjecture. Originally proposed solutions to the problems it presents were dismissed and replaced by ineffectual alternatives. In spite of Childs’ claim that “the paradox, although theoretically sound, is grounded upon (...) assumptions that are empirically untenable,” the paradox makes no such assumptions and is an empirical fact. (shrink)

The moral value of law can take many forms. It is instrumentally valuable when it coordinates interaction, provides moral advice and leadership, models the virtues, and motivates us to be moral. It is intrinsically valuable when it constitutes the collective moral conscience of citizens, embodies an ideal form of communal life, and expresses the moral integrity of the community. We analyse all of these potential values of law and assess their moral significance. In doing so, we are careful to distinguish (...) between the general concept of law and the actual law of any particular legal system. We argue that, although in principle law does have the potential to help us to be moral in each of the ways noted, many actual legal systems are conducive to great immorality and injustice. Being moral and living well under such regimes is likely to be much harder than it would be otherwise, even in the absence of any legal system. (shrink)

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle (...) of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

Efforts to address child trafficking require intensive collaboration among professionals of varied disciplines. Healthcare professionals have a major role in this multidisciplinary approach. Training is essential for all professionals, and policies and protocols may assist in fostering an effective, comprehensive response to victimization.

Medicine is a science, and healing, an art. The right mix of a scientist and an artist is essential in a good physician. Clinical detachment is the balance between the scientist and the human. Good physicians are born; however, it is possible to cultivate the qualities. Gaining the patient's confidence is an art; a sense of humor can greatly help. Give a child respect and he becomes your friend. Death is inevitable, but a physician can help make it less (...) agonizing. A good physician is a philosopher, aware of the beauty of life, of his limitations and conscious of the power that controls us. (shrink)

Foundational theories of mental content seek to identify the conditions under which a mental representation expresses, in the mind of a particular thinker, a particular content. Normativists endorse the following general sort of foundational theory of mental content: A mental representation r expresses concept C for agent S just in case S ought to use r in conformity with some particular pattern of use associated with C. In response to Normativist theories of content, Kathrin Glüer-Pagin and Åsa Wikforss propose a (...) dilemma, alleging that Normativism either entails a vicious regress or falls prey to a charge of idleness. In this paper, I respond to this argument. I argue that Normativism can avoid the commitments that generate the regress and does not propose the sort of explanation required to charge that its explanation has been shown to be problematically idle. The regress-generating commitment to be avoided is, roughly, that tokened, contentful mental states are the product of rule-following. The explanatory task Normativists should disavow is that of explaining how it is that beliefs and other contentful mental states are produced. I argue that Normativism, properly understood as a theory of content, does not provide this kind of psychological explanation, and therefore does not entail that such explanations are to be given in terms of rule-following. If this is correct, Normativism is not the proper target of the dilemma offered by Glüer-Pagin and Wikforss. Understanding why one might construe Normativism in the way Glüer-Pagin and Wikforss must, and how, properly understood, it avoids their dilemma, can help us to appreciate the attractiveness of a genuinely normative theory of content and the importance of paying careful attention to the sort of normativity involved in norm-based theories of content. (shrink)

In "Monkeys, Men, and Moral Responsibility: A Neo-Aristotelian Case for a Qualitative Distinction," Paul Carron (2017) uses the tragic case of Travis the chimpanzee to test Frans de Waal's gradualism. If Travis is not to blame for anything simply because he's a chimp, then gradualism cannot be total: There must be a qualitative difference between chimps and humans that makes humans morally responsible and chimps not. As I understand it, Carron's neo-Aristotelian thesis is that chimps cannot emotionally regulate: The emotional (...) states from which primates act are given to them and "lack rational content," whereas the emotional states from which humans act can be self-consciously developed in the cultivation of character. Carron takes this thesis to be a friendly amendment because it arises "from within the sentimentalist tradition itself broadly construed." In this comment I question just how friendly Carron's amendment turns out to be. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and (...) applied a coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and (...) applied a coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

In the paper, a philosophical and methodological analysis of the evolution of cybernetics in the context of the development of scientific rationality is carried out. The evolution of cybernetics is represented as a movement from the methodology of “observable systems” and to the methodology of “observing systems” and to the methodology of self-developing reflexive-active environments. Special attention is paid to the formation of a new promising direction for post-non-classical cybernetics of self-developing poly-subject environments, which, given the correlation with previous stages (...) of cybernetics development, we define as thirdorder cybernetics. The analysis of the basics of the formation of third-order cybernetics was carried out with consideration of interrelated aspects: philosophical, methodological, theoretical, and methodical. We also provide model of self-developing poly-subject environments as well as a system of ontologies, defining the mechanisms of functioning of such self-organizing poly-subject environments and active elements that organize the communication space. The ontology system also makes it possible to integrate cybernetics of the first, second, and third order. Some sociohumanitarian trends in the development of cybernetics are considered: from an external observer to a distributed observer; from monodisciplinary to transdisciplinary approaches; from activity approach to subject-activity one, and further to subject-oriented approach; from information to active knowledge; from ethics of goals to ethics of strategic subjects. Potential opportunities for using third-order cybernetics are described, in order to improve the quality of solving a number of important scientific and practical problems of controlling social systems. Information is provided on the directions of approbation of a third-order cybernetics concept for improving state administration, based on a system of distributed situational centers, and there is its approbation at international scientific conferences. (shrink)