In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians (...) about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children’s hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are ethics committee meetings, Nursing Ethics Forum, ethics Brown Bag workshops, PICU ethics rounds, Grand Rounds, NICU Comprehensive Care Rounds, Palliative Care Team case conferences, multidisciplinary consults in Fetal Health Center, and ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of “core competencies” than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple “moral spaces” in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today. (shrink)

In this article, we ask why is it that sociology has been slow to take up the animal challenge, and ask what would happen if it did. We argue that sociology’s fraught relationship with biology, its assumptions about human exceptionalism and its emergence in the context of industrialization and urbanization are key to understanding its lack of attention to animals and contribute to a limited conceptualization of society. This can be remedied by viewing non-human animals as involuntarily embedded in social (...) relationships, a move which involves a redefinition of the social and of what it means to be human; a revision of notions of agency, subjectivity and reflexivity; and a rejection of the speciesism and anthropocentrism on which sociology is based. Finally, the article contends that a full understanding of society is not possible if we continue to direct the sociology gaze only at humans. (shrink)

This book presents a contextual study of the life and work of the Cambridge Platonist Ralph Cudworth (1617-1688). Focusing on the theological basis of Cudworth's ethical philosophy, this book unlocks the hitherto ignored political aspect to Cudworth's ethical philosophy. Through a detailed examination of Cudworth's published works - particularly his voluminous "True intellectual system of the Universe" -, his posthumously published writings, and his 'freewill' manuscripts Benjamin Carter argues that the ethical and political arguments in Cudworth's philosophy develop out of (...) Cudworth's Trinitarian theology. Carter traces the link between Cudworth's trinitarianism and his ethical and political ideas by placing Cudworth's work in the turbulent religious and intellectual context of seventeenth-century England, and the University of Cambridge in particular. (shrink)

In this paper we develop a relational approach to the question of animal agency. We distinguish between agency and action and, using three examples of non-human animal behaviour, explore how human-other animal interactions might be understood in terms of action, agency and resistance. In order to do this we draw on the distinction between primary and corporate agency found in the work of Margaret Archer, arguing that, while non-human animals are able to act and to exercise primary agency, they are (...) unable to exercise corporate agency. Animals are therefore agents; they act and their actions have consequences, they also resist conditions which they do not like and, in some circumstances, are able to change the conditions of their agency. We discuss the place of animals in the social world and the political implications of this way of viewing animal agency. (shrink)

The healthcare ethics consultant holds a widely described role in the modern American hospital. S/he may practice within a clinical discipline and be trained in bioethics, or be a trained phi...

Counseling parents on the cusp of delivering an extremely preterm infant is performed thousands of times every year in North America, Europe, Japan and in centers situated in other countries around...

Given that explicitly realist perspectives are currently quite unfashionable in applied linguistics, we very much welcome your thorough and careful discussion of the various forms they might take. We find the various categories you identify quite persuasive, and we find much to agree with in your characterisation of several of the positions you outline, particularly in the earlier part of the paper. However, we do take issue with aspects of your characterisation of both “social” and “linguistic systems” realism, and with (...) some of the arguments you adduce particularly against the latter and in favour of your seventh way (“linguistic norm circles realism”). Our response, then, concentrates particularly on the challenges arising from these parts of your paper, and addresses: (1) the ways in which we may define language itself, for the purposes of this debate; (2) the distinction between social and linguistic norms; (3) the properties of language; (4) the role of empirical evidence; and (5) the methodological problems we find with the norm circle approach. (shrink)

The English Neoplatonic philosopher Ralph Cudworth introduced the term ‘consciousness’ into the English philosophical lexicon. Cudworth uses the term to define the form and structure of cognitive acts, including acts of freewill. In this article I highlight the important role of theological disputes over the place and extent of human freewill within an overarching system of providence. Cudworth’s intellectual development can be understood in the main as an increasingly detailed and nuanced reaction to the strict voluntarist Calvinism that is typified (...) in the thought of his near contemporary William Perkins. At the heart of Cudworth’s rejection of Calvinism is the dilemma over whether God is understood primarily in terms of will or justice. In this fleshing-out of the power of consciousness Cudworth moves from an instrumental account of the working of the human mind towards an account of human consciousness that is intrinsic to his definition of human agency. (shrink)

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely (...) to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children's rights and alternatives to holding are not always respected or explored. Children's experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children's rights will continue to be compromised. (shrink)

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

BRADLEY SK and CARTER B. Nursing Inquiry 2011; 18: 303–312 Deconstructing child and adolescent mental health: questioning the ‘taken‐for‐granted’…We present a critical deconstructive reading, seeking to problematise ‘taken‐for‐granted’ assumptions in child and adolescent mental health (CAMH). The start point for this critical reading is conventional ‘history‐telling’ within CAMH. The aim is not to take issue with the detail in such histories but to critically examine the texts, so as to highlight constructions that structure the presentation of conventional histories and possible (...) purposes that such constructions may serve. The argument is that such conventional histories leave key questions not just unanswered, but unconsidered – a tendency that can be seen throughout the CAMH literature more generally. Therefore, we then pursue critical discussion of how ‘taken‐for‐granted’ constructions of CAMH enabled psychiatry to successfully expand its power and influence to establish hegemony over ‘problem children’. We do not claim any closure to this critical reading; that is, we do not claim that our critical deconstructive reading is the only reading possible. Similarly, it is not presented in any sense as ‘final word’. Rather our hope for this work is that it might stimulate readers to question the ‘taken‐for‐granteds’ that we present, and indeed others that they might identify themselves. In so doing, it is our hope that creative dialogue might ensue. (shrink)

Fetal medicine is an emerging field that raises unique ethical concerns. Our children’s hospital started a Fetal Health Center 10 years ago. In this specialized setting, a multidisciplinary t...

What might be termed 'the problem of morality' concerns how freedom-restricting principles may be justified, given that we value our freedom. Perhaps an answer can be found in freedom itself. For if the most obvious reason for rejecting moral demands is that they invade one's personal freedom, then the price of freedom from invasive demands that others would otherwise make may well require everyone accepting freedom in general, say, as a value that provides sufficient reason for adhering to principles that (...) serve to maximize, or at least safeguard, freedom in general. But then it is precisely such a value, freedom in general, which can be argued to ground an adequate moral system. Hence whereas the value of freedom appears at first sight to pose problems for moral systems, it can be employed to ground a certain variety of them. (shrink)

The many critical approaches to an ‘ethnicity framework’ have fallen short of a very possible conclusion—that the language of ethnicity provides, for the most part, a poor paradigm with which to work. In the present paper we seek not only to re-state some key weaknesses of this paradigm but also to suggest that these weaknesses are more general in an over-ethnicised sociology. There are numerous critiques of particular models or elements of ethnicity thinking, including critiques of primordialist approaches , of (...) multiculturalism , and of the over-objectification of groups . The major critiques constitute a strong case against ‘thinking with ethnicity’; the broader weaknesses are more general in contemporary ‘identitarian’ sociology. From this position we turn to the question of offering an alternative approach in a sociology which emphasizes agency, and is grounded in an analysis of actors in material situations. This is allied to the concept of ideational resources, social categories and identities upon which actors draw, and a middle-range view of causality and tendency in social change. Ideas of ancestral belonging are among those ideational resources, and these ideas and assumptions are played out in a context of material and political change. The subject of study is not ethnicity, but power, resources, social relations and institutions informed by cultural identities and ideas of ancestry. The strategy of the paper will be first to re-state the deficiencies of ‘ethnicity thinking’ and second to offer an alternative framework for thinking about social action and social structure. (shrink)

The Defective Image develops the argument that Darwinism is predicated on a profound epistemological flaw and proposes to demonstrate that the limitations in Darwinism can be illustrated by its inability to furnish a credible explanation for communication. The author argues that Darwinism is more faith-based ideology than scientific theory and that its character as a faith-based ideology accounts for much of the rancor that characterizes the current debate over evolution.

Pope Francis beautifully describes how the perinatal journey starts in mystery. Doctors may forget this. We focus on the science that may partially explain how conception and implantation occur, how the placenta functions, and the gradual development of embryo and fetus. But science cannot address that meta-physical—or spiritual—reality. The question of “why?” is never too far away from the minds of expectant parents. Why now? Why me? Why did my baby develop these terrible problems? Why is my life being challenged (...) in this way? Maternal-fetal “cross-talk” is a reality that cannot be denied. It occurs both when the fetus is quiet and when the fetus is active. It may be facilitated by fetal imaging—an ultrasound of... (shrink)

ArgumentsPhysicians who counsel expectant parents about the needs for resuscitation and intensive care for an extremely preterm infant must be able to address many clinical facts and be prepared to face several ethical considerations. Such counseling is generally more than an acquisition of informed consent. It must be guided by ethical principles, values held dear by parents, relational priorities and directed toward an informed and shared decision-making process. Parents may come with a need for clinical facts, a desire that they (...) be heard as they express their values, and to help physicians realize that many are determined to follow a certain path well before such counseling occurs. They may well not be moved by counseling of the physician but still desire to be heard, respected, and allowed to contribute to their newborn’s care plans.ConclusionsRealizing this, the physician can be accepting and develop a trusting relationship with the parents that will be of value throughout the hospitalization regardless of outcome. (shrink)

This article brings together research from the fields of chronic pain management and somatic practices to develop a novel framework of principles to support people living with persistent pain. These include movement-based approaches to awareness of the internal body (interoception), the external environment (exteroception) and movement in space (proprioception). These significantly work with the lived subjective experiences of people living with pain, to become aware of body signals and self-management of symptoms, explore fear and pleasure of movement, and understand how (...) social environments impact on pain. This analysis has potential to create new ways of supporting, understanding and articulating pain experiences, as well as shaping the future of somatic practices for chronic pain. (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)

The Spring 1999 issue of CambridgeQuarterly adds to the growing body of academic inquiry into the goals of neonatal intensive care practices. Muraskas and colleagues thoughtfully presented the possibility of nontreatment for neonates born at or under 24 weeks gestation. Jain, Thomasma, and Ragas explained that quality of future life must not be ignored in clinical deliberation. And Hefferman and Heilig described once again the dilemmas nurses face when caring for potentially devastated neonates kept alive by technology. These authors take (...) brave steps by publicly questioning the trend of intensive medical support for most every American-born product of conception. But many questions addressing the goals of neonatal intensive care remain, and few authors have actually tried to distill these goals. (shrink)