Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not (...) survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

(No abstract is available for this citation).

A review of Charles Blattberg's From Pluralist to Patriotic Politics (Oxford: Oxford University Press, 2000).

2000 Years and Beyond brings together some of the most eminent thinkers of our time - specialists in philosophy, theology, anthropology and cultural theory. In a horizon-scanning work, they look backwards and forwards to explore what links us to the matrix of the Judaeo-Christian tradition from which Western cultural identity has evolved. Their plural reflections raise searching questions about how we move from past to future - and about who 'we' are. What do the catastrophes of the twentieth century signify (...) for hopes of progress? Can post - Enlightment humanism and its notion of human nature survive without faith? If the 'numinous magic global capitalism' is our own giant shadow cast abroad, does that shadow offer hope enough of a communal future? Has the modern, secularized West now outgrown its originating faith matrix? Often controversial and sometimes visionary, these seven new essays ask: how do we tell - and rewrite - the story of the Common Era? Introduced by Paul Gifford, and discussed in a lively dialogic conclusion, they add their distinctive voices to a debate of profound and urgent topicality. (shrink)

I criticise the ‘liberal’view of the proper relationship between the family and State, namely that, although the interests of the child should be paramount, parents are entitled to rights of both privacy and autonomy which should be abrogated only when the child suffers a specifiable harm. I argue that the right to bear children is not absolute, and that it only grounds a right to rear upon an objectionable proprietarian picture of the child as owned by its producer. If natural (...) parents have any rights to rear they derive from duties to bring their children into rational maturity where they can exercise rights for themselves. The presumption that natural parents are best suited to rear their own children should be discounted, as should the assumption that alternatives to natural parenting are unacceptably bad. I reject the suggestion that parents should be ‘licensed’but argue for a much closer monitoring of the family. Familial privacy, which such monitoring breaches, is shown to have a culturally specific and, given the facts of abuse, dubious value. In conclusion, I briefly specify the forms of monitoring I approve. (shrink)

This article examines a particular debate between Eamonn Callan and William Galston concerning the need for a civic education which counters the divisive pull of pluralism by uniting the citizenry in patriotic allegiance to a single national identity. The article offers a preliminary understanding of nationalism and patriotism before setting out the terms of the debate. It then critically evaluates the central idea of Callan that one might be under an obligation morally to improve one''s own patriotic inheritance, pointing to (...) the ineliminable tension between the valuation of one''s own patria by its own terms and a detached critical reason. It concludes by suggesting that we are, in advance of our education, members of a particular patria and that any education must be particularistic. Finally, the danger is noted of presuming that, in each case, there is a single, determinate national tradition. (shrink)

Background Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder. Objectives To validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and investigate characteristics for adherence to medication measured via smartphones. Methods Patients with BD evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional (...) Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials. Findings During the study 90.50% of the days were evaluated as ‘medication taken’, 6.91% as ‘medication taken with changes’ and 2.59% as ‘medication not taken’. Adherence to medication measured via smartphones was valid compared with the MARS. Younger age and longer illness duration were significant predictors for non-adherence to medication. Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence. Conclusions Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence. Clinical implications Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings. Trial registration number NCT01446406 and NCT02221336. (shrink)

John O'Neill argues in a recent article, ‘Should Communitarians be Nationalists?’, that communitarians are wrong to be committed to the defence of ties of nationhood, both because the nation‐state's rise is associated with the disappearance of the ties of community and because the nation is an illusory community. I argue that the evidence that communitarianism is committed as charged to the defence of nationality is unconvincing. Further, the familiar accusation that the nation is a false or unreal community is neither (...) perspicuous nor obviously true. It is important to evaluate the significance and worth of the nation as a community independently of the nationalist prescription that the nation and the state should coincide. The important question is not whether the political community should be a nation, but what sort of community the nation should be. (shrink)

The pace of change and, indeed, the sheer number of clinical ethics committees has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street Hospital for Children (...) NHS Foundation Trust v MX, FX and X, [21]–[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK. (shrink)

Mary Midgley asserts that my argument concerning the problem of child-abuse was inappropriately framed in the language of rights, and neglected certain pertinent natural facts. I defend the view that the use of rights-talk was both apposite and did not misrepresent the moral problem in question. I assess the status and character of the natural facts Midgley adduces in criticism of my case, concluding that they do not obviously establish the conclusions she believes they do. Finally I briefly respond to (...) the charge that my suggestions were illiberal. (shrink)

Children: Rights and Childhood is widely regarded as the first book to offer a detailed philosophical examination of children’s rights. David Archard provides a clear and accessible introduction to a topic that has assumed increasing relevance since the book’s first publication. -/- The third edition has been fully revised and updated throughout with a new chapter providing an in-depth analysis of the United Nations Convention on the Rights of the Child (UNCRC) and Part 2 has been restructured to move (...) the reader from general theoretical considerations of children’s rights through to practical issues. This volume is ideal reading for advanced studies across Philosophy, Social Work, Law, Childhood Studies, Politics, and Social Policy. (shrink)

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

Worldwide populations are aging with economic development as a result of public health initiatives and advances in therapeutic discoveries. Since 1850, life expectancy has advanced by 1 year for every four. Accompanying this change is the rapid development of anti‐aging science. There are three schools of thought in the field of aging science. One perspective is the life course approach, which considers that aging is a good and natural process to be embraced as a necessary and positive aspect of life, (...) where the aim is to improve the quality of existing lifespan and “compress” morbidity. Another view is that aging is undesirable, and that rejuvenation and indeed immortality are possible since the biological basis of aging is understood, and therefore, strategies are possible for engineering negligible senescence. Finally, a hybrid approach is that life span can be extended by anti‐aging medicines but with uncertain effects on health. While these advances offer much promise, the ethical perspectives are seldom discussed in cross‐disciplinary settings. This article discusses some of the key ethical issues arising from recent advances in biogerontology. (shrink)

Whether children have rights is a debate that in recent years has spilled over into all areas of public life. It has never been more topical than now as the assumed rights of parents over their children is challenged on an almost daily basis. David Archard offers the first serious and sustained philosophical examination of children and their rights. Archard reviews arguments for and against according children rights. He concludes that every child has at least the right to (...) the best possible upbringing. Denying that parents have any significant rights over their children, he is able to challenge current thinking about the proper roles of state and family in rearing children. Crucially, he considers the problem of how to define and understand `child abuse'. (shrink)

This book develops some of the most important themes of Sen's works over the last decade. He argues in a rich and subtle approach that we should be concerned with people's capabilities rather than their resources or welfare.