Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

Strategic alliances are increasingly common, as many organizations look towards various partnering arrangements. This second edition of Strategies of Cooperation extends the first edition's clear and comprehensive survey of strategic alliances. Presenting different disciplinary perspectives and numerous examples from the corporate world. The text has been thoroughly revised and updated, taking account of new theoretical models, and its coverage of case studies has been extended. It will be ideal for business students and managers alike wishing to understand the challenges of (...) managing alliances. (shrink)

The beginnings of unity and order in living things, by C. M. Child.--On the structure of the unconscious, by K. Koffka.--The genesis of social reactions in the young child, by J. E. Anderson.--The unconscious of the behaviorist, by J. B. Watson.--The unconscious patterning of behavior in society by E. Sapir.--The configurations of personality, by W. I. Thomas.--The prenatal and early postnatal phenomena of consciousness, by M. E. Kenworthy.--Values in social psychology, by F. L. Wells.--Higher levels of mental integration, by W. (...) A. White. (shrink)

In a series of exquisite examples that could only have been gathered by a professional philosopher with an extraordinary respect for young minds, Gareth...

The welfare of the child is the prevailing principle and concern regarding access to assisted reproduction in Western countries today, and there is a wish to avoid harm to future children. New research fields have developed in order to provide scientific evidence on the welfare of children living with different “types” of parents. Assisted reproductive technologies (ART) seems to be heading in a responsible direction where the care and concern for future children is vital. However, the claim of this article (...) is that the principle of the welfare of the child confuses the ethical framing of ART. Several philosophers in the past have argued that potential people must be regarded as outside the moral domain, and therefore cannot be harmed or benefitted. This message has not reached the policymakers, probably because the welfare of the child principle seems to fit so elegantly with common sense. In this article a different ethical framing of ART is proposed. The author argues that “futile care” and not “the welfare of the child” should be the guiding principle for eventually rejecting access to ART. The desired goal of ART treatment should be understood to be the production of functional families. Assisted reproduction is primarily about us, actual people in an actual society, and how potential children may affect us. (shrink)

The United Nations Convention on the Rights of the Child risks harm to adolescents insofar as it encourages not only poor decision making by adolescents but also parenting styles that will have an adverse impact on the development of mature decision-making capacities in them. The empirical psychological and neurophysiological data weigh against augmenting and expression of the rights of children. Indeed, the data suggest grounds for expanding parental authority, not limiting its scope. At the very least, any adequate appreciation of (...) the moral claims regarding the authority of parents with respect to the decision-making capacity of adolescents needs to be set within an understanding of the psychological and neurophysiological facts regarding the development of adolescent decision-making capacity. (shrink)

The Alligator's Child was full of 'satiable curtiosity. One day while rummaging in a trunk in the lumber room he came across a photograph of his father wearing an aardvark uniform and standing by a large ant hill. All excitement, he rushed to his father and breathlessly said, ‘Father, I didn't know that you had been an aardvark! What is it like to be an aardvark?’.

Despite its prominence in the abortion debate and in public policy, the discourse of 'unborn patient' has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of 'unborn child.' There is a long history of the descriptive use of 'unborn child.' Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of 'unborn child' should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

The Alligator's Child was full of 'satiable curtiosity. One day while rummaging in a trunk in the lumber room he came across a photograph of his father wearing an aardvark uniform and standing by a large ant hill. All excitement, he rushed to his father and breathlessly said, ‘Father, I didn't know that you had been an aardvark! What is it like to be an aardvark?’.

The field of developmental psychology has typically traced its history to Darwin or to changes in views about the nature of childhood. What has been generally neglected is how the core assumptions of contemporary theories were forged in the early history of modern science. In particular, the rise of Newtonian mechanics precipitated similar perspectives in geology and then biology. They all converged on a shared set of assumptions about the nature of change in the physical world. Theology also played a (...) key role in this process, serving not only as a foil, but also as a source of important insights for the emerging scientific, and developmental, world view. The field of developmental psychology is a child of this complex and often stormy relationship between science and theology that has shaped Western thought. (shrink)

Prohibition on sex selection may well be unnecessary and oppressive as well as posing risks to women’s lives The urge to select children’s sex is not new. The Babylonian Talmud, a Jewish text completed towards the end of the fifth century of the Christian era, advises couples on means to favour the birth of either a male or a female child.1 The development of amniocentesis alerted the public in the mid-1970s to the scientific potential for prenatal determination of fetal sex,2 (...) and progressive decriminalisation of abortion afforded choice about continuation of pregnancy. The more recent emergence of preimplantation genetic diagnosis (PGD) obviates resort to abortion, and improved techniques of sperm sorting and diagnosis permit creation of zygotes that will ensure the sex of a future child. Growth of biomedical means to select the sex of future children has been accompanied by fear that such means will be employed to favour births of sons, and so perpetuate devaluation of girl children and women’s inferior family and social status. A reaction to this fear has been the demand for legal and medical professional prohibition of sex selection techniques. For instance, the Council of Europe’s Convention on Human Rights and Biomedicine3 provides in article 14 that: The use of techniques of medically assisted procreation shall not be allowed for the purpose of choosing a future child’s sex, except where serious hereditary sex-related disease is to be avoided. Legislation has been enacted in a number of countries, and proposed in others, to prohibit sex selection on non-medical grounds, such as the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 in India. In Canada, for instance, government draft legislation introduced in May 2002 proposes to make it a crime for any person, for the purpose of creating a human …. (shrink)

The aim of this study was to generate knowledge about how parents who have been part of an ethical decision-making process concerning a son or daughter in a neonatal unit experience life with a severely disabled child. A descriptive study design was chosen using 30 hours of field observations and seven in-depth interviews, carried out over a period of five months with parents who had been faced with ethical decisions concerning their own children in a neonatal unit. Strauss and Glaser’s (...) constant comparative method was used for the analysis. The findings seem to indicate that these parents have an extremely tough life. Their relationships with their children are somewhat ambivalent. The children are very dependent on their parents, who in some ways both love and hate them. Too little rest and sleep and feeding the children are the most serious problems. The parents require respite facilities. The home can seem like a prison, from which it is impossible to escape. It is like having a baby who never grows up. (shrink)

Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers and (...) research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)

Taking children with Cerebral Palsy (CP) as an example, the article seeks an understanding of children with disabilities that connects neuropsychological theories of neural development with the situated cognition perspective and the child as an active participant in its social practices. The early brain lesion of CP is reconceptualised as a neurobiological constraint that exists in the relations between the neural, cognitive and social levels. Through a multi-method study of two children with CP, it is analysed how neurobiological constraints arise, (...) evolve and sometimes are resolved through local matches between the child and its social practices. The result is discussed as support of a developmental science approach that includes processes at the social practice level along with knowledge of biological processes. (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 aim of this paper is to show some of the limitations of the Theory of Mind approach to interaction compared to a conversation analytic alternative. In the former, mental state terms are examined as words that signify internal referents. This study examines children’s uses of ‘I want’ in situ. The data are taken from a corpus of family mealtimes. ‘I want’ constructions are shown to be interactionally occasioned. The analysis suggests that (a) a referential view of language does not (...) adequately account for how mental state terms are used in talk, (b) the dominant methodology for examining children’s understanding of ‘desires’ is based on several problematic assumptions. It is concluded that participation in interaction is a social matter, a consideration that is obscured by Theory of Mind and its favoured methods. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

In this paper, I explore different ways of picturing language learning in philosophy, all of them inspired by Wittgenstein and all of them concerned about scepticism of meaning. I start by outlining the two pictures of children and language learning that emerge from Kripke's famous reading of Wittgenstein. Next, I explore how social-pragmatic readings, represented by Meredith Williams, attempt to answer the sceptical anxieties. Finally, drawing somewhat on Stanley Cavell, I try to resolve these issues by investigating what characteristically happens (...) to our view of language learning when we do philosophy. The focus throughout is on the relation between the individual (the learning child) and the community (usually represented by the parents), and how that relation is deformed when we operate with a certain philosophical notion of ground. (shrink)

This dissertation considers the bases upon which ethical assessments of parental genetic trait selections for their children can be made. It argues that if parents engage in genetic trait selections, they must act to expand their child's range of open futures, not to constrict their child's range of open futures or to differentially shift their child's range of open futures. It contends that other proposed distinctions, including distinctions between normal and diseased states and between treatment selections and enhancement selections, do (...) not provide a sound basis for making ethical assessments of parental genetic trait selections. It contends that children have a right to an open future that parents hold in trust for their children and that parents must respect in making genetic trait selections.It considers examples of possible parental genetic trait selections regarding children's hearing, height and visual acuity. Finally, it addresses a number of concerns about and objections to this proposed basis for ethical assessment and to parental genetic trait selection generally but concludes that none of these concerns or objections are fatal the approach that if parents use parental genetic trait selection, they must do so in ways that expand their child's range of open futures. (shrink)

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss "them": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject (...) of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by Women" (EIRTAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some. (shrink)

Pediatric critical careCritical care refers to the health care of children with life-threatening illness or following major surgery or severe injury. This care is offered in different contexts across the globe. In well-resourced environments, critical careCritical care may be provided in pediatric intensive care units, which provide highly complex medical care with advanced, potentially expensive technological devices aimed primarily at sustaining life; whereas in poorly resourced regions, only primary care may be available for critically ill or injured childrenInjured children. Even (...) where PICU facilities are available, they are a scarce and expensive resource. The knowledge and ability to sustain a critically ill or injured child’sInjured children life, potentially with effects on the child and family’s quality of lifeQuality of life and at the expense of other children’s health care, leads to frequent ethical challenges. Ethical issues related to how best to ensure optimal quality of lifeQuality of life and the fair distribution of scarce resources are common. In-depth knowledge and understanding of the individual patient’s medical, scientific and psychosocial context, through interdisciplinary discussion and collaboration; as well as familiarity with the overriding, relevant ethico-legal policiesPolicy and principles is essential for appropriate decision-makingDecision-making. Truthful communicationCommunication with the family is essential, using a shared decision-makingDecision-making process, and the child’s best interestBest interest must be central to every decision. This chapter presents an overview of the recommended approach to, and important considerations for, ethical decision-makingDecision-making in the PICU, using a hypothetical case example. (shrink)

Child custody evaluators frequently encounter 3 complex problems: assessment of highly contested cases; how to help the court, attorneys, and clients struggle with the ambiguity of the "best interest" standard; and ethical issues in assessing the children's preferences for their primary custodial parent. The purpose of this article is to describe the methodological implications of recent custody evaluation guidelines and recent research. Recommendations include reliance on family-process oriented diagnostic approaches and functional assessment methods, use of evaluation methods in which relevant (...) parties have an opportunity to state their views and rationale concerning the children's best interests, and understanding of the content areas relevant to assessing children's custodial preferences at different developmental levels. (shrink)

This research focuses on how children negotiate gender boundaries in middle childhood play. Over a nine-week period, children were observed creating, defining, and altering gender codes in a summer day camp. When girls and boys disregarded pre-described boundaries, they entered an area we refer to as the gender transgression zone. This area of activity, where boys and girls conduct heterosocial relations in hopes of either maintaining or expanding gender boundaries in child culture, is where gender transgression takes place. The study (...) revealed that high-status boys used hegemonic masculinity to regulate both girls' and boys' boundaries by reserving the authority to sanction all gender transgressions. While race and class were salient for girls' homosocial organization and behavior, within this age group they did not appear to influence the boys' status system. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

A study of 78 parents of Down's syndrome children shows that, while most were in favour of abortion for a handicapped fetus, they were divided equally on whether euthanasia (no distinction made between active and passive euthanasia) was an acceptable practice. Only a third considered an average Down's syndrome child could be a suitable candidate for euthanasia. While parents argued that the degree of handicap of the child was the crucial factor in making this decision, in fact the social class (...) of the parents themselves was the only variable which was statistically significantly related to their opinions. Differences arose from the parents' lack of agreement on what constituted a sufficiently severe handicap. (shrink)

During the past 20 years, states have increasingly expanded the lists of individuals who are obligated to report their suspicions of child abuse and neglect. These legal requirements are juxtaposed with ethical considerations in research and professional practice. The ethical issues include the obligation to maintain both confidentiality of information provided by human participants and the safety and protection of these participants. This article reviews the types of state child abuse reporting statutes and outlines the categories of mandated reporters. I (...) develop a model of how individual researchers should approach deciding whether they are mandated reporters of child abuse and neglect. (shrink)

Statius′ Silvae 5.4 is one of the best-known poems in the collection, although it is also one of the least representative. Its nineteen lines make it the shortest poem in the Silvae, and although there are other brief poems, such as those describing the parrot of Melior and the tame lion , it is quite different from the many longer poems that deal with subjects and persons from contemporary society. Of course insomnia must always be a universal issue, but this (...) is nevertheless a poem that does not draw the reader into the ‘ life and times’ of Statius as do the poems which precede and follow it, the laments for his father and for a child. (shrink)

Statius′ Silvae 5.4 is one of the best-known poems in the collection, although it is also one of the least representative. Its nineteen lines make it the shortest poem in the Silvae, and although there are other brief poems, such as those describing the parrot of Melior and the tame lion, it is quite different from the many longer poems that deal with subjects and persons from contemporary society. Of course insomnia must always be a universal issue, but this is (...) nevertheless a poem that does not draw the reader into the ‘ life and times’ of Statius as do the poems which precede and follow it, the laments for his father and for a child. (shrink)

During the past 20 years, states have increasingly expanded the lists of individuals who are obligated to report their suspicions of child abuse and neglect. These legal requirements are juxtaposed with ethical considerations in research and professional practice. The ethical issues include the obligation to maintain both confidentiality of information provided by human participants and the safety and protection of these participants. This article reviews the types of state child abuse reporting statutes and outlines the categories of mandated reporters. I (...) develop a model of how individual researchers should approach deciding whether they are mandated reporters of child abuse and neglect. (shrink)