The manuscripts in this issue of Perspectives in Biology and Medicine reflect the work of an international group of pediatric bioethicists and child rights advocates who convened in March 2014 to pursue several questions related to the intersection of pediatric bioethics and child rights. The prequel for the Symposium involved several years of dialogue between the editors of this volume—dialogue through which it became clear that there was much to be learned about our respective disciplines and how they might inform (...) our heretofore mutually exclusive work.The principles of pediatric bioethics have been used for decades to analyze and help resolve challenging clinical situations in pediatrics, but there has been.. (shrink)

In the fast-paced world of clinical medicine, recognizing and acknowledging differences in worldviews is often overlooked. When dealing with the delicate issues broached in advance care planning, such oversights can lead to deep rifts within the health care provider-patient relationship. By providing guidance to those engaged in such endeavors and setting advance care planning in a global context, health care practitioners will be better able to care for their patients and achieve the noble goal of advance care planning_giving volume to (...) the voice of the patient in the last chapter of her life. (shrink)

Born at 24 weeks gestation, Baby G now lies in a neonatal intensive care unit two months post-birth. He has pulmonary hypoplasia, congenital scoliosis, and swallowing issues that will require placement of a feeding tube, and bowel dystonia that interferes with his ability to absorb feedings. Shortly after birth, he experienced a cardiopulmonary arrest and now has obvious neurological impairments. As a result of incomplete development of his lungs and severe chronic lung disease, he cannot breathe on his own. Because (...) of his chronic respiratory failure, tracheostomy and long-term assisted ventilation was offered as an option that would allow him to be discharged from the acute care setting. However, his congenital.. (shrink)

The "best interest of the child" standard is central to both pediatric bioethics and the child rights community. In pediatric bioethics in the United States, the best interest of the child standard is cited as the guidance principle for parental decision-making.1 Likewise, in the child rights community, the best interest of the child standard is "of paramount consideration" ). Both approaches also recognize parental rights and responsibilities and support a role for the maturing child in the decision-making process. Why, then, (...) do members of the pediatric bioethics community and the child rights communities not speak the same language?This article was developed out of... (shrink)

This CQ department is dedicated to bringing noted bioethicsts together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St. #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

Children like Baby G, born with complex chronic medical conditions that compromise function in the long term, are an increasing presence in tertiary-level neonatal intensive care units. The parents and health-care providers of these children are faced with profoundly difficult decisions. Whether severe congenital anomalies with poor prognosis are diagnosed antenatally or are discovered at the time of birth, the issues are vexing, and the impact decisions will have on everyone in the family is profound. What should such decisions be (...) based upon? What values and principles might guide the decision-making process? What moral justifications allow for pursuing.. (shrink)

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees , almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

The elimination of child marriage is a goal that ranks high on the agendas of civil society organizations, national governments, and multilateral institutions. To date, however, there has been very little scholarship on the historical debates over the definition of child marriage. This article examines the history of age-restricted marriage as it was debated during the development of human rights instruments in the post-World War II era. Using archives of the United Nations and affiliated organizations, we detail how and why (...) efforts to establish a universal minimum age for marriage were repeatedly unsuccessful. We illustrate how the current, commonly used definition of child marriage—as marriage before the age of 18—has never been agreed upon in a legally binding international convention but was seemingly established through a discursive innovation that borrowed principles from the 1989 Convention on the Rights of the Child. (shrink)

In contested areas of environmental research and policy, all stakeholders are likely to claim that their position is scientifically grounded but disagree about the relevant scientific conclusions or the weight of the evidence. In this article, I draw on a year of participant observation and over 110 in-depth interviews, with the case study of controversial chemicals used as flame retardants in consumer products. I develop the concept of strategic science translation, the process of interpreting and communicating scientific evidence to an (...) intended audience in order to advance certain goals and interests. Engaging in selective, interpretive, or inaccurate SST allows competing stakeholders to bolster their arguments, strengthen their authority, and inspire change regarding a policy-relevant issue. Because stakeholders deploy imbalanced resources when they participate in contested environmental fields, their actions in those fields and the resulting policy outcomes often reduce not to the settling of scientific truths but to power differentials. (shrink)

Name der Zeitschrift: Studies in Logic, Grammar and Rhetoric Jahrgang: 45 Heft: 1 Seiten: 69-86.

This book offers a significant reinterpretation of the history of republican political thought and of Niccolo Machiavelli's place within it. It locates Machiavelli's political thought within enduring debates about the proper size of republics. From the sixteenth century onward, as states grew larger, it was believed only monarchies could govern large territories effectively. Republicanism was a form of government relegated to urban city-states, anachronisms in the new age of the territorial state. For centuries, history and theory were in agreement: constructing (...) an extended republic was as futile as trying to square the circle; but then James Madison devised a compound representative republic that enabled popular government to take on renewed life in the modern era. This work argues that Machiavelli had his own Madisonian impulse and deserves to be recognized as the first modern political theorist to envision the possibility of a republic with a large population extending over a broad territory. (shrink)

ABSTRACTThomas Hobbes transforms fear and curiosity from primarily theological to anthropological concerns. Fear and curiosity go from being, most centrally, part of religiousness, or part of worsh...

_ Source: _Volume 30, Issue 2, pp 156 - 177 Using the example of ghosts and religion, this paper argues for the importance of social context and background operative in Hobbes’s account of social life and, in particular, the role of environment, education, and language in explaining much of what we think we know, and much of what we believe. The paper looks to aspects of Hobbes’s epistemology and his account of belief, to make the case that he recognizes how (...) a kind of social conditioning is required to sustain certain beliefs. The paper briefly concludes with a focus on the commonwealth itself and how the example of religion and religious belief extends to the commonwealth and the kinds of beliefs required for the commonwealth to sustain itself. (shrink)

Mindfulness-based training programs are highly established in competitive and recreational sports. One of the best-known approaches is the Mindfulness-Acceptance-Commitment Approach by Gardner and Moore), which integrates mindfulness aspects of awareness, non-judgmental attitude, and focus. Based on these aspects, Thienot and colleagues developed and validated an English language sport-specific questionnaire, the so-called Mindfulness Inventory for Sport, for the assessment of mindfulness skills in athletes. The aim of this study is to psychometrically test a German language version of the MIS. To assess (...) the psychometric properties, the MIS-D was examined in an online survey with an integrated test–retest design for reliability, validity, and measurement invariance. The present results support the psychometric quality of the German language version of the MIS. Necessary replications should among others focus on checking the measurement invariance for further relevant subgroups. (shrink)

Under the sign of Libitina, the Roman goddess of burials and funerals invoked in Horace's Ode 3.30, this essay provides a celebratory introduction to the work of the Polish Jewish poet Zuzanna Ginczanka, situating her within the cultural history of commemoration and consecration of the dead in Poland and the painful confrontation with the unburied dead of the Holocaust, of whom Ginczanka is one. Her best-known poem, a bitter parody of Juliusz Słowacki's “My Testament,” turns the Horatian notion of poetry (...) as the most precious and enduring legacy on its head by construing the author's meager household possessions, looted after her denunciation to the Nazis in wartime, as the only offering her fellow citizens will cherish, while the text itself was actually brought as evidence in a postwar trial of the Polish woman she accuses in the poem and contributed to a conviction for collaboration. Using historian Thomas Laqueur's terms necro-sociability and necronominalism as competing impulses in a seemingly intractable struggle, this essay argues that it is possible to find in Ginczanka's joyful defiance of traditional accounts of body and spirit the point of departure for a poetics that claims a new freedom of imagination in the attempt to transcend the most stubborn of memory wars. (shrink)

Brain-computer interfaces are communication bridges between a human brain and external world, enabling humans to interact with their environment without muscle intervention. Their functionality, therefore, depends on both the BCI system and the cognitive capacities of the user. Motor-imagery BCIs rely on the users’ mental imagination of body movements. However, not all users have the ability to sufficiently modulate their brain activity for control of a MI-BCI; a problem known as BCI illiteracy or inefficiency. The underlying mechanism of this phenomenon (...) and the cause of such difference among users is yet not fully understood. In this study, we investigated the impact of several cognitive and psychological measures on MI-BCI performance. Fifty-five novice BCI-users participated in a left- versus right-hand motor imagery task. In addition to their BCI classification error rate and demographics, psychological measures including personality factors, affinity for technology, and motivation during the experiment, as well as cognitive measures including visuospatial memory and spatial ability and Vividness of Visual Imagery were collected. Factors that were found to have a significant impact on MI-BCI performance were Vividness of Visual Imagery, and the personality factors of orderliness and autonomy. These findings shed light on individual traits that lead to difficulty in BCI operation and hence can help with early prediction of inefficiency among users to optimize training for them. (shrink)

The act of drawing a line or uttering a word is often seen as integral to the process of making art. This is especially obvious in music and the visual arts, but applies to literature, performance, and other arts as well. These collected essays, written by scholars from diverse fields, take a historical view of the richness of creation out of nothing (creatio ex nihilo) in order to draw out debates, sometimes implicit and sometimes formally stated, about the production and (...) reproduction of cultural meaning in a period of great change and novelty, between the beginnings of the medieval intellectual tradition and the imprint of the Enlightenment. The authors pose the following questions: Do tradition and creativity conflict with one another, or are they complementary? What are the tensions between composition and live performance? What is the role of the audience in perceiving the object of art? Are such objects fixed or flexible? What about the status of the event? Is the event part of creation, in the sense that it disturbs the still waters of historical continuity? These and other questions build on the foundation of Roland Barthes' concept of Degree Zero, offering new insights into what it means to create"--Back cover. (shrink)

The main objective of this 2-week RCT study was to test the efficacy of the previously developed Noticing Nature Intervention to boost wellbeing during winter months. The NNI consists of noticing the everyday nature encountered in one’s daily routine and making note of what emotions are evoked. Community adults were randomly assigned to engage in the NNI or were assigned to one of two control conditions. Paired t-tests revealed significant increases pre- to post-intervention in the NNI group for positive affect, (...) elevation, nature connectedness, and hope agency, and a marginally significant increase in transcendent connectedness. No significant pre-post difference emerged for any aspect of wellbeing in the control conditions. Analysis of qualitative findings revealed that negative emotion themes were 2.13 times more likely to be associated with built photos than with nature photos. Feelings of peace, awe, happiness, humbleness, and hope were more likely to be associated with nature photos, while feelings of annoyance, loneliness, curiosity, uncertainty, anger, yearning, and comfortableness were more likely to be associated with built photos. Overall, results indicated that engaging in the NNI can provide a wellbeing boost, even in the cold of winter. This study is the first to test any nature-based wellbeing intervention during colder, winter months, and to directly assess the impact of a nature-based wellbeing intervention on levels of hope. (shrink)

Caretaking stability in the early life environment supports neurobehavioral development, while instability and neglect constitute adverse environments that can alter maturational processes. Research in humans suggests that different types of early life adversity can have differential effects on caretaker relationships and later cognitive and social development; however, identifying mechanistic underpinnings will require animal models with translational validity. Two common rodent models, maternal separation and limited bedding, influence the mother-infant relationship during a critical window of development. We hypothesized that these paradigms (...) may affect the development of communication strategies on the part of the pup. Ultrasonic vocalizations are a care-eliciting mechanism and ethologically relevant response to stressors in the rat pup. USV emission rates and acoustic parameters change throughout early development, presenting the opportunity to define developmental milestones in USVs that would reflect neurobehavioral aberrations if disrupted. This study investigated the effects of MS or LB on the dam-pup relationship by quantifying pup USVs, maternal behavior, and the relationship between the two. First, we used a generalized additive model approach to establish typical developmental trajectories of USV acoustic properties and determine windows of change in MS or LB rearing. Additionally, we quantified maternal behaviors and the predictability of maternal care sequences using an entropy rate calculation. MS and LB each shifted the developmental trajectories of USV acoustic parameters and call types in a sex-specific manner. MS more often impacted male USVs, while LB impacted female USVs. MS dams spent more time passive nursing, and LB dams spent more time on the nest. The predictability of maternal care was associated with the rate of USV emissions exclusively in females. Taken together, findings demonstrate sex- and model-specific effects of rearing environments on a novel developmental trajectory involving the mother-infant relationship, facilitating the translation of animal ELA paradigms to assess later-life consequences. (shrink)

Background: Newer “closed-loop” neurostimulation devices in development could, in theory, induce changes to patients’ personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment. Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program (...) and collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception. Results: Participants generally did not attribute changes in patients’ personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients’ experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians .Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients’ illness experiences and social circumstances. (shrink)

Background: Recently, a singular survey titled “Measure of Moral Distress—Healthcare Professionals,” which addresses shortcomings of previous instruments, has been validated. Aim: To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. Participant and research context: We distributed a self-administered, validated survey titled “Measure of Moral Distress—Healthcare Professionals” to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. Findings: A total of 101 (...) surveys were included in the study. The mean Measure of Moral Distress—Healthcare Professionals score for all respondents was 143.0. The mean Measure of Moral Distress—Healthcare Professionals score was 1.75 greater for nurses than for physicians, and nurses were 2.52 times more likely to consider leaving their position due to moral distress. The mean Measure of Moral Distress—Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward and highest in the telemetry ward. The intensive care unit ward had a mean Measure of Moral Distress—Healthcare Professionals score mildly greater than the emergency room. Ethical considerations: No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center’s Institutional Review Board. Discussion: This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. Conclusion: In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress—Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians. (shrink)