Policies and position statements regarding decision-making for extremely premature babies exist in many countries and are often directive, focusing on parental choice and expected outcomes. These recommendations often state survival and handicap as reasons for optional intervention. The fact that such outcome statistics would not justify such approaches in other populations suggests that some other powerful factors are at work. The value of neonatal intensive care has been scrutinized far more than intensive care for older patients and suggests that neonatal (...) care is held to a higher standard of justification. The relative value placed on the life of newborns, in particular the preterm, is less than expected by any objective medical data or any prevailing moral frameworks about the value of individual lives. Why do we feel less obligated to treat the premature baby? Do we put newborns in a special and lesser moral category? We explore this question from a legal and ethical perspective and offer several hypotheses pertaining to personhood, reproductive choices, “precious children,” and probable evolutionary and anthropological factors. (shrink)

For a minority of children managed in the NICU, there is a need for more complex technologic assistance in order to sustain life, mitigate a more chronic debilitation from a pervasive life-limiting condition, or provide a bridge from life-sustaining therapy to a more semi-permanent treatment such as organ transplantation. This chapter will address two major types of technology assistance for infants and children—tracheostomy and assisted home ventilation, and dialysis—and the myriad complications and considerations that they raise. Some attention to why (...) clinicians may be so inclined to impose technology as a solution to life-limiting conditions will be noted, as well as why some parents may seem to insist on pursuing technology. (shrink)

Background: It is not known how neonatologists address the affective and cognitive loads on parents deciding whether to resuscitate infants born extremely preterm. This study explores expert neonatologists' views on these decision-making processes and their own roles in counseling parents. Methods: Semistructured interviews asked internationally recognized experts to share their perspectives on perinatal consultations. Their responses were subjected to thematic analysis. Results: Eighteen of 22 invited experts participated. Approximately equal numbers reported employing a physician-driven approach, a parent-driven approach, and (...) a combined approach during these consultations. Those who followed a physician-driven approach typically focused on conveying standard information about adverse outcomes. Those who followed a parent-driven approach typically focused on addressing parents' information requests, guiding their decision making, and providing affective support. Nearly all experts, in each group, endorsed addressing the child's quality of life, in terms of functionality, when discussing long-term outcomes. Although many believed that families adjusted to life with a disabled child, few discussed the topic during prenatal consultations. Most, in each group, reported trying to alleviate future “decisional regret” for parents whose premature infants subsequently became disabled. None spoke to parents about possible decisional regret after deciding to forgo resuscitation. Conclusions: Expert neonatologists are deeply concerned that parents understand the decision facing them. However, they differ on what information they offer and how they balance parents' need for cognitive and affective support. They expressed more concern about parents' decisional regret should their child survive resuscitation, but have severe disability, than about decisional regret after foregoing resuscitation. (shrink)

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. (...) While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad. (shrink)

Les auteurs ont étudié les médiations réalisées dans le cadre d’une association, durant une année, en dirigeant leur recherche sur les attentes des parents séparés, et les motifs et conditions de mise en place de la médiation. La moitié de ces médiations sont imposées par le juge aux Affaires familiales, mais cependant ce n’est pas le fait qu’elle soit ordonnée ou le choix volontaire d’une médiation qui permettent la réussite de ce processus, mais bien l’adhésion des personnes qui viennent. Une (...) partie de ces médiations ont été consacrées à la question de la résidence alternée. L’enjeu central du partage de la vie de l’enfant justifie souvent – pour les juges comme pour les parties – l’utilisation de ce processus dont le résultat ne se compte pas en nombre d’accords conclus mais en possibilité de débloquer les situations. La médiation permet d’ajuster les attentes, et non des motifs « judiciarisés », et de les travailler – de faire en quelque sorte des compromis « sur mesure ». (shrink)

Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are (...) more secure with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the SIDP-IV and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire. Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have. (shrink)

This case analysis examines the pediatric clinical ethics issues of adolescent autonomy and parental authority in medical decision–making. The case involves a dying adolescent whose parents request that the medical team withhold diagnosis and prognosis information from the patient. The analysis engages two related ethical questions: Should Annie be given information about her medical condition? And, who is the proper decision–maker in Annie’s case? Ultimately, four practical recommendations are offered.

Among philosophers, there are at least two prevalent views about the core concept of intentional action. View I (Adams 1986, 1997; McCann 1986) holds that an agent S intentionally does an action A only if S intends to do A. View II (Bratman 1987; Harman 1976; and Mele 1992) holds that there are cases where S intentionally does A without intending to do A, as long as doing A is foreseen and S is willing to accept A as a consequence (...) of S’s action. Joshua Knobe (2003a) presents intriguing data that may be taken to support the second view.1 Knobe’s data show an asymmetry in folk judgements. People are more inclined to judge that S did A intentionally, even when not intended, if A was perceived as causing a harm (e.g. harming the environment). There is an asymmetry because people are not inclined to see S’s action as intentional, when not intended, if A is perceived as causing a benefit (e.g. helping the environment). In this paper we will discuss Knobe’s results in detail. We will raise the question of whether his ordinary language surveys of folk judgments have accessed core concepts of intentional action. We suspect that instead Knobe’s surveys are tapping into pragmatic aspects of intentional language and its role in moral praise and blame. We will suggest alternative surveys that we plan to conduct to get at this difference, and we will attempt to explain the pragmatic usage of intentional language. (shrink)

In a recent paper, Al Mele (2003) suggests that the Simple View of intentional action is “fiction” because it is “wholly unconstrained” by a widely shared (folk) concept of intentional action. The Simple View (Adams, 1986, McCann, 1986) states that an action is intentional only if intended. As evidence that the Simple View is not in accord with the folk notion of intentional action, Mele appeals to recent surveys of folk judgments by Joshua Knobe (2003, 2004a, 2004b). Knobe’s surveys appear (...) to show that the folk judge unintended but known side effects of actions to be performed intentionally. In this paper we will reject Mele’s suggestion that the Simple View is “fiction.” We will also discuss the relationship between surveys and philosophical theories, and the abilities of surveys to access folk core concepts. We will argue that considerations of both fail to support Mele’s suggestion. (shrink)

This essay is composed of five stories written by practicing physicians about their patients. Each clinical story describes a challenging ethical condition–potential abuse of medical power, gravely ill and probably over-treated newborns, iatrogenic narcotic addiction, deceived dying people. Rather than singling out one ethical conflict to resolve or adjudicate, the authors attempt, through literary methods, to grasp the singular experiences of their patients and to act according to the deep structures of their patients' lives. Examining these five stories with simple (...) literary tools–attention to narrative frames, time, plot, and desire–reveals the mechanisms through which acts of writing and reading contribute to clinical clarity and ethical actions. (shrink)

Twenty-first-century biology rejects genetic determinism, yet an exaggerated view of the power of genes in the making of bodies and minds remains a problem. What accounts for such tenacity? This article reports an exploratory study suggesting that the common reliance on Mendelian examples and concepts at the start of teaching in basic genetics is an eliminable source of support for determinism. Undergraduate students who attended a standard ‘Mendelian approach’ university course in introductory genetics on average showed no change in their (...) determinist views about genes. By contrast, students who attended an alternative course which, inspired by the work of a critic of early Mendelism, W. F. R. Weldon, replaced an emphasis on Mendel’s peas with an emphasis on developmental contexts and their role in bringing about phenotypic variability, were less determinist about genes by the end of teaching. Improvements in both the new Weldonian curriculum and the study design are in view for the future. (shrink)

En choisissant de consacrer un ouvrage à Antiphon « l’Athé­nien », M. Gagarin opte, dans le cadre du débat sur l’identité d’Anti­phon, pour la thèse unitariste. Une des principales vocations de cet ouvrage est en effet de soutenir qu’Antiphon le sophiste, auteur du De la vérité et du De la concorde, Antiphon l’orateur et Antiphon l’auteur des Tétralogies, sont une seule et même personne. Les arguments clas­siques en faveur de la thèse unitariste sont présentés au chapitre 2, mais cet ouvrage,...

David Annis is professor of philosophy at Ball State University. In this essay, Annis offers an alternative to the foundationalist-coherent controversy: "contextualism." This theory rejects both the idea of intrinsically basic beliefs in the foundational sense and the thesis that coherence is sufficient for justification. he argues that justification is relative to the varying norms of social practices.

The doctor patient relationship starts with a story. Doctors' notes, a patient's chart, the recommendations of ethics committees and insurance justifications all hinge on written and verbal narrative interaction. The "practice" of narrative profoundly affects decision making, patient health and treatment and the everyday practice of medicine. In this edited collection, the contributors provide conceptual foundations, practical guidelines and theoretical considerations central to the practice of narrative ethics.

The Mental Health Literacy Scale is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin’s translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health (...) Professionals, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-2 were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named “knowledge of mental disorder,” “ability to seek information and help,” “recognition of mental disorder,” and “acceptance of patients with mental illness,” with factor 1-3 were summarized into MHLS-Core and factor 4 as MHLS-SA. The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 and highly positively correlated with JSE-HP. The Cronbach’s α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50th percentile for the MHLS-C was 99, with 50th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended. (shrink)

In this article we examine the specific contributions Native American thought can make to the ongoing search for a Western ecological consciousness. We begin with a review of the influence of Native American beliefs on the different branches of the modem environmental movement and some initial comparisons of Western and Native American ways of seeing. We then review Native American thought on the natural world, highlighting beliefs in the need for reciprocity and balance, the world as a living being, and (...) relationships with animals. We conclude that Native American ideas are important, can prove inspirational in the search for a modem environmental consciousness, and affirm the arguments of both deep ecologists and ecofeminists. (shrink)

This paper presents an overview of the process of entanglement at the 25th International Philosophy of Nursing Conference (IPNC) at University of California at Irvine held on August 18, 2022. Representing collective work from the US, Canada, UK and Germany, our panel entitled ‘What can critical posthuman philosophies do for nursing?’ examined critical posthumanism and its operations and potential in nursing. Critical posthumanism offers an antifascist, feminist, material, affective, and ecologically entangled approach to nursing and healthcare. Rather than focusing on (...) the arguments of each of the three distinct but interrelated panel presentation pieces, this paper instead focuses on process and performance (per/formance) and performativity as relational, connected and situated, with connections to nursing philosophy. Building upon critical feminist and new materialist philosophies, we describe intra‐activity and performativity as ways to dehierarchise knowledge making practices within traditional academic conference spaces. Creating critical cartographies of thinking and being are actions of possibility for building more just and equitable futures for nursing, nurses, and those they accompany—including all humans, nonhumans, and more than human matter. (shrink)

In this study, we examined the perception of actual and ideal ethical climate type among 95 nurses working in the internal medicine wards of one central hospital in the state of Israel. We also examined whether nurses’ demographic characteristics influence that perception and if a relationship between perceptions of an actual and an ideal ethical climate type influences nurses’ job satisfaction. A questionnaire composed of three subquestionnaires was administered and the responses analyzed using multiple linear regressions, analysis of variance and (...) Pearson’s correlation coefficient. The results demonstrated that demographic characteristics (such as: gender, job tenure and level of education) partially influence the perception of an ideal ethical climate. Incongruence in perceptions of ‘caring’ and ‘independence’ climate types indicated a decline in nurses’ job satisfaction, while perception of actual ‘caring’ and ‘service’ climates positively influenced all aspects of job satisfaction. We recommend constructing training programs emphasizing the ethics of nursing practice and also to help lead nurses to clarify an ethical framework and guide nursing staff in dealing with ethical dilemmas. (shrink)

This paper argues that the augmented reality gaming application for smart devices, _Pokémon GO_ shows the fate of the legal subject as a neoliberal monster subjugated to the limitations imposed by hypercapitalism. The game, derived from Nintendo’s iconic Pokémon franchise, reveals the legal subject as a frenzied, diminished and impulsive being, allowed to see, move, catch and accumulate but unable to participate in more meaningful self-narration. It is not that the game is lawless, notwithstanding, anxieties in the semiosphere about users (...) trespassing or engaging in criminal behaviour. Rather the game is over structured and highly limited, both within its game-play which is repetitive and impulsive, and in its absence of narrative. Unlike the classic Nintendo Pokémon games which are within the role-playing game genre, _Pokémon GO_ abstracts the seeing, moving, catching and accumulating features of the classic games without the overarching narrative, questing and competition. In this _Pokémon GO_ manifests the transformation of the liberal legal subject of capitalism to the neoliberal subject of a digital orientated hypercapitalism where seeing, moving, catching and accumulating is immediate and impulsive, obliterating the ‘prudent’ subject participating in their own self-narration. (shrink)

The extremely preterm infant, born before 28 weeks of gestational age, has been the focus of much ethical discussion. These infants have a significant risk of mortality and morbidity, and it is not...

Background: There are numerous benefits to ethics consultation services, but little is known about the reasons different professionals may or may not request an ethics consultation. Inter-professional differences in the perceived utility of ethics consultation have not previously been studied.Methods: To understand profession-specific perceived benefits of ethics consultation, we surveyed all employees at an urban tertiary children’s hospital about their use of ethics committee services (n = 842).Results: Our findings suggest that nurses and physicians find ethics consultations useful for different (...) reasons; physicians were more likely to report normative benefits, while nurses were more likely to report communicative and relational benefits.Conclusions: These findings support an open model of ethics consultation and may also help ethics committees to better understand consultation requests and remain attuned to the needs of various professional groups. (shrink)

Friendship was an important topic for classical philosophers; the analysis, Value, And duties of friendship all received considerable attention. But friendship has been a relatively dormant topic among more recent philosophers. This paper (a) presents an analysis of friendship and explains its core elements, (b) discusses several different models for explaining the value of friendship, And (c) argues that there are special duties of friendship and that these aren't based solely on utilitarian considerations.

Children acquiring languages with noun classes have ample statistical information available that characterizes the distribution of nouns into these classes, but their use of this information to classify novel nouns differs from the predictions made by an optimal Bayesian classifier. We use rational analysis to investigate the hypothesis that children are classifying nouns optimally with respect to a distribution that does not match the surface distribution of statistical features in their input. We propose three ways in which children's apparent statistical (...) insensitivity might arise, and find that all three provide ways to account for the difference between children's behavior and the optimal classifier. A fourth model combines two of these proposals and finds that children's insensitivity is best modeled as a bias to ignore certain features during classification, rather than an inability to encode those features during learning. These results provide insight into children's developing knowledge of noun classes and highlight the complex ways in which statistical information from the input interacts with children's learning processes. (shrink)

W.E.B. Du Bois’s elegy for his infant son, “Of the Passing of the First-Born,” in The Souls of Black Folk, has received relatively scant attention from political theorists. Yet it illuminates crucial developments in Du Bois’s political thought. It memorializes a tragedy central to his turn from scientific facts to rhetorical appeals to emotion. Its rhetoric also exemplifies a broader tension in his writings, between masculinist and elitist commitments and more insurrectionary impulses. In its normalizing rhetorical mode, which dominates, the (...) elegy depicts an idealized patriarchal bourgeois household—potentially eliciting white readers’ sympathetic identification, but failing to displace the gendered and classed logic of racial exclusion. Its moments of transgressive rhetoric complicate or refuse such identification, celebrating Burghardt’s racial impurity and invoking a lineage of black maternal ambivalence. Though each is vexed and ephemeral, these moments of transgressive rhetoric reveal countervailing impulses that Du Bois would articulate in later writings. (shrink)

In an age of professionalization and specialization, the practice of clinical ethics is facing an identity crisis. Are clinical ethicists moral experts, ethics experts, or merely quasi-lawyers giving legal advice? Are they extensions of the hospital, always working to advance the hospital’s interests? Or is there another option? Since 1998, when the American Society for Bioethics and Humanities first issued its Core Competencies for Healthcare Ethics Consultation, there has been debate about the role of standardization and proceduralism in clinical ethics (...) consultation. Now, as ASBH continues to move forward with its credentialing program, proceduralism in clinical ethics must be critically examined. In this paper, I argue that the proceduralist approach to clinical ethics consultation, as espoused by the ASBH’s call for credentialing, creates a demeaning experience for all parties involved and precludes goods internal to the practice of clinical ethics consultation from being actualized. As a practice embedded in medicine and in institutions such as the hospital, clinical ethics consultation must define and examine its own goods in order to bring about more than a sterile, law-like solution to difficult moral quandaries, as these sterile solutions leave patients, families, and providers unsatisfied, abandoned, and disappointed. Thus, in an effort to push back against this proceduralism in clinical ethics consultation, I will offer a preliminary exploration of what these goods might be. (shrink)

I have become curious about reciprocity within clinical practice. A vast topic that mobilizes considerations of money, knowledge, kinship, power, culture, and uses of the body, reciprocity is a strong means by which to achieve the egality required of just health care. Within health care, reciprocity might enable not only so‐called shared decision‐making and patient autonomy. It might open the door to mutual acknowledgement of the value of each participant's beliefs and habits. It might appear as a humble realization that (...) no one understands what health is and a concurrent welcoming curiosity about one another's conception of how the body and speech and mind work. From the intimate to the international levels of care, such forms of reciprocity may culminate in the radical and powerful state of reciprocal recognition.In this short essay, I will focus on one aspect of reciprocity in health care: the narrative and potentially reciprocal nature of attention in health care. A critical element in the development of therapeutic alliance, clinical accuracy, and effective practice, attention requires a donation of the self as a vessel into which can enter that which is perceived or, from the other side, a penetrating of that which is perceived so that one sees it from within its own vessel. (shrink)

Kant’s treatment of laughter in section 54 of the Critique of Judgment is intriguing: he places laughter among the arts, but does not deem it serious enough to be a fine art. According to Kant, laughter is an agreeable art, and ministers only to the senses. But when he describes to us what laughter actually does, it turns out that this bodily phenomenon is actually a moral phenomenon akin to the sublime in that it elevates and humbles us at the (...) same time. This paper revisits Kant’s aesthetic themes, shows the distinctive role of laughter in the third Critique, and explores the possibilities of a true reunification of law and freedom through laughter. (shrink)