OBJECTIVES: To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics. DESIGN: Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals. SETTING: Two major London children's hospitals. RESULTS: Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and treatment; (...) lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting. CONCLUSION: Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees. (shrink)

The paucity of research data to guide current paediatric practice has led to children being termed therapeutic orphans. This difficulty is especially pertinent to research in emergency situations, such as acute resuscitation or critical care, where accepted ethical standards for overall research, have historically created practical difficulties for researchers. The welcome establishment of organisations to support UK paediatric research is helping to ensure safer and more effective medications for children, however as the balance between protection and access at the heart (...) of the paediatric research ethical debate shifts to ever increasing access for researchers to children, it remains crucial to ensure the protection for these vulnerable participants. The fundamental protection for research subjects, namely their full informed consent before any recruitment, is not tenable in true emergency situations and so other approaches are warranted if standards are to be improved by human subjects research in such areas. Proxy, deferred and retrospective consent have all been advocated as solutions to this difficulty and this paper explores the ethical justification for these approaches and their utility in safeguarding children and families in emergency situations when traditional informed consent, as currently defined, cannot be obtained in the necessary time frame to enable research. (shrink)

The management of child protection concerns arouses strong emotions and controversies and creates ethical tensions for all concerned. This paper provides a rational analysis of some of the issues involved and suggests responses to them. The ethical and legal duties of health-care professionals are to act in the best interests of the child by safeguarding children and reporting concerns. But this may involve conflicts with parents and produce reluctance of professionals to become involved, especially in controversial types of abuse. Mandatory (...) reporting of concerns might overcome such reluctance, but may be ineffective in the face of diagnostic uncertainties. Assembly of a stronger diagnostic evidence base would seem ethically justified, but organization of the necessary case controlled studies might be problematic. Even with a comprehensive evidence base, individual diagnoses of abuse will always involve value judgements that should be underpinned by effective training and assessment of core competencies of professionals. These manoeuvres are unlikely to prevent both justified and vexatious complaints, often in relation to breaches in professional duties or concerning professional misconduct. The tendency to blame experts may have contributed to a reluctance of other professionals to become involved, despite proposals for reforms in the expert witness and court systems. Current approaches to child protection may neither promote greater understanding nor be in the best interests of children. A revised social contract for the effective protection of children could include: a duty of care that adequately addresses the primacy of the child's welfare; the acquisition of a sound evidence base; professional transparency and accountability (but with protection from malicious and vexatious complaints); and a shift emphasis towards a more inquisitorial system that embraced the principles of truth and reconciliation. (shrink)

We outline a process, undertaken at a large tertiary children's hospital, intended to provide practical guidance and support for those involved in the management of children with life-limiting conditions. Initial discussions with representatives of clinical and support services identified communication problems and ethical dilemmas as key issues. These were further explored in multidisciplinary hospital meetings, culminating in a conference (Living Well, Dying Well) where individual perspectives - clinical, multi-faith, parental and legal - and cases were presented. Communication problems were found (...) to involve unrealistic expectations, failures of anticipation and difficulties in discussing sensitive issues, while ethical dilemmas arose from balancing burdens and benefits, clinical uncertainty, respecting autonomy and achieving equity and justice in delivery of care. An integrated service has been developed that is intended to provide clinical and spiritual care, psychosocial and ethical support, advice and mediation for children, families and staff, and to address the latter's educational and training needs. (shrink)

Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about charting a path to recovery, albeit to a ‘new normal’ that mitigates them. Children have not suffered as much from the direct effects of COVID-19 infection as older adults. Still, there is mounting evidence that their health and welfare are being adversely affected. Closure (...) of schools has been a critical component of social isolation but has a far broader impact than the diminution of educational opportunities, as important as these are. Reopening of schools is therefore essential to recovery, with some countries already tentatively implementing it. Children’s interests are vital considerations in any recovery plan, but the question remains as to how to address them within the context of how society views children; should they be regarded as pawns, pathfinders or partners in this enterprise? (shrink)

SILYANE LARCHER. — La question coloniale ne se pose pas aux Antilles comme ailleurs, puisque la période coloniale ne s’est pas suivie de l’indépendance, mais de l’assimilation juridico-politique faisant de la Martinique et de la Guadeloupe des départements français d’outre-mer, au même titre que n’importe quel département en France. Comment définiriez-vous..

[fr] Dans les Ḫaṣā’iṣ, Ibn Ǧinnī (m. 392/1002) fait état, incidemment, d’une différenciation entre parlers arabes nomades et sédentaires, ces derniers étant caractérisés par une perte partielle de la flexion désinentielle (’i‘rāb). Dans la mesure où Ibn Ǧinnī se réfère sur ce point à une source antérieure de près de deux siècles d’une part, indique qu’il n’y a presque plus, à son époque, de bédouin au parler « châtié » (faṣīḥ, c’est-à-dire fléchi mu‘rab) d’autre part, on peut voir dans ses (...) remarques une reconnaissance implicite d’une situation de diglossie, les parlers nomades étant à l’origine de la variété haute (al-luġa al-‘arabiyya al-faṣīḥa). Cette situation est d’ailleurs révélée par une anecdote, où l’on voit un même usager, d’origine bédouine, alterner ce qu’Ibn Ǧinnī appelle « les deux manières de parler » (ǧihatā al-kalām), avec et sans flexion désinentielle. Malgré les apparences, il ne s’agit pas de sociolinguistique et d’histoire de la langue. Il s’agit de théorie du langage, avec l’hypothèse d’un phénomène d’entropie, liée à l’utilisation de la langue, l’utilisateur se passant, par d’autres moyens, de la flexion désinentielle, source de difficulté et d’erreurs. Il s’agit aussi et surtout d’un discours épilinguistique, conforme à l’idéologie linguistique (thèse de la faṣāḥa bédouine) et à la théologie (thèse de la « langue du Ḥiǧāz » comme al-luġa alfuṣḥā), deux thèses difficilement conciliables. (shrink)

A balance needs to be struck between facilitating compassionate access to innovative treatments for those in desperate need, and the duty to protect such vulnerable individuals from the harms of untested/unlicensed treatments. We introduced a principle-based framework to evaluate such requests and describe its application in the context of recently evolved UK, US and European regulatory processes. 24 referrals were received by our quaternary children's hospital Clinical Ethics Committee over the 5-year period. The CEC-rapid response group evaluated individual cases within (...) 48-hours; the main referrers being haematology/oncology, immunology or transplant services. Most requests were for drug/vaccine/pre-trial access or biological/cellular therapies. The majority of individual requests were approved ; neutral or negative opinions were given in 5, including 3 group requests. Recently evolved regulatory processes share common criteria and conditions to our framework including: demonstration of clinical need; sound scientific basis with lack of viable alternative; risks-benefit/best interests evaluation; arrangements for fully informed consent; no compromise of arrangements to test treatment for licensing purposes; consideration of resource implications. There are differences between individual processes and with our framework, with respect to procedures, scope, application format, costs and obligation to make available all outcome data. Our experience has emphasized the need for an independent, principled, consistent, fair and transparent response to the increasing demand for innovative treatment on a compassionate basis. We believe that there is a need for harmonization of the recent proliferation of regulation and legislation in this area. (shrink)

À la posture de l’écrivain engagé dont la littérature viserait l’éveil national de son peuple, l’écrivain martiniquais Patrick Chamoiseau préfère l’art de mettre les histoires au service d’une mutation des imaginaires,..

L’esclavage colonial occupe une place récente dans les médias français. Soumis aux récupérations et manipulations médiatiques des uns ou des autres, souvent non spécialistes, il fait généralement l’objet sur les plateaux de télévision, dans la presse, de simplifications maladroites, d’amalgames fâcheux, traduisant finalement l’ampleur de l’ignorance et de l’indifférence incrustées au fil des années dans la société civile sur une période de l’histoire de la France de plus de trois siècles, et pourtant fondatrice de l’Empire colonial français.

In the UK an increasing number of Clinical Ethics Committees (CECs) have been developed mainly in response to local need and interest. Their functions include education of health professionals, of policy and guideline development, and case review (both retrospective analysis of topics and advice on acute cases). The UK Clinical Ethics Network, a charitable foundation provides CEC s with help, support and advice and enables them to share their experience The legal status of UK CECs is unclear but some legal (...) commentators have suggested that CECs lack competencies and procedural rules necessary for acute case review. The UKCEN has proposed core competencies for CECs that lists the ethical, operational and procedural skills, knowledge and personal attributes required and how they may be acquired, assessed and maintained. Their implementation might lead to the development of ethical and legal governance which should benefit to future patient care. (shrink)

We present the case of a six-year-old child with a fatal brainstem tumour, who was left in a ‘locked-in state’ post-decompressive biopsy. A discussion of the ethical dilemma this situation presents, together with the deliberations of the ethics service when consulted about the optimal course of action, follow. The issues raised highlight an important conflict between the parental view of what is in the child's best interests and what may appear, prima facie, to clinical staff, to be in that child's (...) best interests. We discuss how creative ethical thinking may facilitate resolution of seemingly insoluble situations. (shrink)

Ocherk 1. Voprosy ontologii -- Ocherk 2. Voprosy ėtiki i ėstetiki -- Ocherk 3. Voprosy gnoseologii i aksiologii.

Research on brain or cognitive/affective processes, culture, social interaction, and structural analysis are overlapping but often independent ways humans have attempted to understand the origins of their evolution, historical, and contemporary development. Each level seeks to employ its own theoretical concepts and methods for depicting human nature and categorizing objects and events in the world, and often relies on different sources of evidence to support theoretical claims. Each level makes reference to different temporal bandwidths (milliseconds, seconds, minutes, hours, days, months, (...) years, decades, and centuries) and focuses on different spatio-temporal activities and controlled and non-controlled stimulus conditions. Biological mechanisms and environmental pressures for survival simultaneously created a gradual intersection and enhancement of cognitive/affective skills, cultural practices, and changes in collaborative social interaction and communicative skills. The evolution of a given level of analysis is assumed to have been incremental and overlapping. These innovative and independent ways humans have learned to characterize their brain or cognitive/affective and social/economic/political life often depend on unexamined, representational re-descriptions or cognitive/affective and socio-cultural devices and forms of communication that facilitate the depiction of practices and beliefs we attribute to respondents or subjects and research colleagues. (shrink)

The article is devoted to the memory of Vyacheslav Semenovich Stepin and Nikita Nikolaevich Moiseev, whose multifaceted work was integrally focused on philosophical, interdisciplinary and transdisciplinary research of the key ideas and principles of universal human-dimensional evolutionism. Other remarkable Russian scientists V.I. Vernadsky, S.P. Kurdyumov, S.P. Kapitsa, D.S. Chernavsky worked in the same tradition of universal evolutionism. While V.I. Vernadsky and N.N. Moiseev had been the originators of that scientific approach, V.S. Stepin provided philosophical foundations for the ideas of those (...) remarkable scientists and thinkers. The scientific legacy of V.S. Stepin and N.N. Moiseev maintained the formation of a new quality of research into the philosophy of science and technology as well as into the philosophy of culture. This new quality is multidimensional and it is difficult to define unambiguously, but we presume the formation of those areas of philosophical knowledge as constructively oriented languages of interdisciplinary and transdisciplinary co-participation of philosophy in the convergent-evolutionary development of scientific knowledge in general. In this regard, attention is paid to V.S. Stepin’s affirmations about non-classical nature of modern social and humanitarian knowledge. Quantum mechanics teaches us that the reality revealed through it is a hybrid construct, or symbiosis, of both mean and object of cognition. Therefore, the very act of cognitive observation constructs quantum reality. Thus, it is very close to the process of cognition in modern sociology and psychology. V.S. Stepin insisted that these principles are applicable to all complex selfdeveloping systems, and such are all “human-dimensional” objects of modern humanities. In all the phases of homeostasis changes, or crises, there is necessarily a share of chaos, instability, uncertainty in the selection process of future development scenarios, which is ineliminably affected by our observation. Therefore, a cognitive observer in the humanities should be considered as a concept of post-non-classical rationality, that is as an observer of complexity. (shrink)

Formulation of a general model of evolution is presented which is based upon the recognition of the ?biosocial? entity, that is the biosphere and human society, as a component?system. It can be demonstrated that the interactions of the components (moleculas, cells, organisms, ecosystems in the biological realms and people, artifacts and ideas in the societies) have replicative organization. We suggest an explanation for the spontaneous emergence of replicative function and organization, a process called autogenesis. During autogenesis, hierarchical levels of replicative (...) organization emerge and compartmentalization and convergence of replicative information occurs. Questions of the origin and evolution of life are discussed. The replicative paradigm can also be applied to the processes of cultural evolution, in which complex replicative networks of people, ideas, and man?made artifacts show all stages and phenomena of autogenesis. Finally, the present state of evolution of the whole global biosocial system is discussed. (shrink)

V. C. Chappell; IV*—Stuff and Things, Proceedings of the Aristotelian Society, Volume 71, Issue 1, 1 June 1971, Pages 61–76, https://doi.org/10.1093/aristotelia.

Despite the so-called ‘paradigm wars’ in many social sciences disciplines in recent decades, debate as to the appropriate philosophical basis for research in business ethics has been comparatively non-existent. Any consideration of paradigm issues in the theoretical business ethics literature is rare and only very occasional references to relevant issues have been made in the empirical journal literature. This is very much the case in the growing fields of cross-cultural business ethics and undergraduate student attitudes, and examples from these fields (...) are used in this article. No typology of the major paradigms available for, or relied upon in, business ethics has been undertaken in the wider journal literature, and this article addresses that gap. It contributes a synthesis of three models of paradigms and a tabulated comparison of ontological, epistemological and methodological assumptions in the context of empirical business ethics research. The author also suggests the likely (and usually unidentified) positivist paradigm assumptions underlying the vast majority of empirical business ethics research published in academic journals and also argues for an increased reliance on less positivist assumptions moving forward. (shrink)

One of the main problems in effective model theory is to find an appropriate information complexity measure of the algebraic structures in the sense of computability. Unlike the commonly used degrees of structures, the structure degree measure is total. We introduce and study the jump operation for structure degrees. We prove that it has all natural jump properties (including jump inversion theorem, theorem of Ash), which show that our definition is relevant. We study the relation between the structure degree jump (...) (in the sense of Soskov) and the jump degrees of a structure (in the sense of Jockusch) and give necessary and sufficient conditions for their existence in the terms of structure degrees. We show some properties, distinguishing the structure degrees from the enumeration degrees. (shrink)

In this article, cognitivism is understood as the view that the engine of human (individual and collective) action is the intentional, dispositional, or other mental capacities of the brain or the mind. Cognitivism has been criticized for considering the essence of human action to reside in its alleged source in mental processes at the expense of the social surroundings of the action, criticism that has often been inspired by Ludwig Wittgenstein's later philosophy. This article explores the logical extent of the (...) critique of cognitivism, arguing that by positing collectively shared knowledge of criteria as the engine of human action many such critiques themselves display latent cognitivism. (shrink)