In this article, we examine how the U.N. Convention on the Rights of the Child can be useful in pediatric bioethics. Adopted in 1989, the CRC reflects norms that have been deliberated upon for a long period of time and endorsed by most nations. The United States is now the only country that has not ratified the CRC.1 International human rights law shares many key moral concepts with clinical pediatric bioethics, and the CRC provides a considered language common to many (...) jurisdictions that can assist bioethicists in their daily practice and help health-care organizations in their policy development and international interactions. There may, however, be practical challenges with using the CRC in the practice of.. (shrink)

Born at 24 weeks gestation, Baby G now lies in a neonatal intensive care unit two months post-birth. He has pulmonary hypoplasia, congenital scoliosis, and swallowing issues that will require placement of a feeding tube, and bowel dystonia that interferes with his ability to absorb feedings. Shortly after birth, he experienced a cardiopulmonary arrest and now has obvious neurological impairments. As a result of incomplete development of his lungs and severe chronic lung disease, he cannot breathe on his own. Because (...) of his chronic respiratory failure, tracheostomy and long-term assisted ventilation was offered as an option that would allow him to be discharged from the acute care setting. However, his congenital.. (shrink)

Children like Baby G, born with complex chronic medical conditions that compromise function in the long term, are an increasing presence in tertiary-level neonatal intensive care units. The parents and health-care providers of these children are faced with profoundly difficult decisions. Whether severe congenital anomalies with poor prognosis are diagnosed antenatally or are discovered at the time of birth, the issues are vexing, and the impact decisions will have on everyone in the family is profound. What should such decisions be (...) based upon? What values and principles might guide the decision-making process? What moral justifications allow for pursuing.. (shrink)

The explicit objective for the 2014 Symposium hosted by the University of North Florida, which serves as the basis for this collection of papers, was to explore the relationship and potential for mutual support between the disciplines of child rights and pediatric bioethics in advancing the health and well-being of children in the United States and around the world. The U.N. Convention on the Rights of the Child served as the locus for this discussion. A significant question emerged in the (...) Symposium about whether the CRC could serve any beneficial purpose in the United States, where it has not yet been ratified. Further, there was.. (shrink)

The manuscripts in this issue of Perspectives in Biology and Medicine reflect the work of an international group of pediatric bioethicists and child rights advocates who convened in March 2014 to pursue several questions related to the intersection of pediatric bioethics and child rights. The prequel for the Symposium involved several years of dialogue between the editors of this volume—dialogue through which it became clear that there was much to be learned about our respective disciplines and how they might inform (...) our heretofore mutually exclusive work.The principles of pediatric bioethics have been used for decades to analyze and help resolve challenging clinical situations in pediatrics, but there has been.. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by (...) policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in nursing today. Over a (...) series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question. (shrink)

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a (...) positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by (...) policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with a clear justification of why it is important to take best standards, norms, and physician judgment seriously and a clear (...) justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. (shrink)

We study the wisdom of the crowd in three sequential decision‐making tasks: the Balloon Analogue Risk Task (BART), optimal stopping problems, and bandit problems. We consider a behavior‐based approach, using majority decisions to determine crowd behavior and show that this approach performs poorly in the BART and bandit tasks. The key problem is that the crowd becomes progressively more extreme as the decision sequence progresses, because the diversity of opinion that underlies the wisdom of the crowd is lost. We also (...) consider model‐based approaches to each task. This involves inferring cognitive models for each individual based on their observed behavior, and using these models to predict what each individual would do in any possible task situation. We show that this approach performs robustly well for all three tasks and has the additional advantage of being able to generalize to new problems for which there are no behavioral data. We discuss potential applications of the model‐based approach to real‐world sequential decision problems and discuss how our approach contributes to the understanding of collective intelligence. (shrink)

This project examined the ethical issues faced by academics and professionals in the Humanities. We conducted focus groups to gather information about the ethical concerns in these fields and used the qualitative data arising from the discussions to create a taxonomy that represents the structure of ethical issues in the Humanities. A key implication of our findings is that while the focus of ethics research and interventions has been primarily on the sciences and engineering, academics and professionals in other fields (...) also encounter some unique critical ethical dilemmas that require further research and methods of intervention. (shrink)

This study examined the role of key causal analysis strategies in forecasting and ethical decision-making. Undergraduate participants took on the role of the key actor in several ethical problems and were asked to identify and analyze the causes, forecast potential outcomes, and make a decision about each problem. Time pressure and analytic mindset were manipulated while participants worked through these problems. The results indicated that forecast quality was associated with decision ethicality, and the identification of the critical causes of the (...) problem was associated with both higher quality forecasts and higher ethicality of decisions. Neither time pressure nor analytic mindset impacted forecasts or ethicality of decisions. Theoretical and practical implications of these findings are discussed. (shrink)

This study examined the role of reflection on personal cases for making ethical decisions with regard to new ethical problems. Participants assumed the position of a business manager in a hypothetical organization and solved ethical problems that might be encountered. Prior to making a decision for the business problems, participants reflected on a relevant ethical experience. The findings revealed that application of material garnered from reflection on a personal experience was associated with decisions of higher ethicality. However, whether the case (...) was viewed as positive or negative, and whether the outcomes, processes, or outcomes and processes embedded in the experience were examined, influenced the application of case material to the new problem. As expected, examining positive experiences and the processes involved in those positive experiences resulted in greater application of case material to new problems. Future directions and implications for understanding ethical decision making are discussed. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The current study uses a sensemaking model and thinking strategies identified in earlier research to examine ethical decision making. Using a sample of 163 undergraduates, a low-fidelity simulation approach is used to study the effects personal involvement (in causing the problem and personal involvement in experiencing the outcomes of the problem) could have on the use of cognitive reasoning strategies that have been shown to promote ethical decision making. A mediated model is presented which suggests that environmental factors influence reasoning (...) strategies, reasoning strategies influence sensemaking, and sensemaking in turn influences ethical decision making. Findings were mixed but generally supported the hypothesized model. It is interesting to note that framing the outcomes of ethically charged situations in terms of more global organizational outcomes rather than personal outcomes was found to promote the use of pro-ethical cognitive reasoning strategies. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Abstract:AbstractOne of the most recognized playwrights and stage directors on the African continent today, Werewere Liking is the Cameroonian founder of the Village et Fondation Panafricaine Ki-yi Mbock in Abidjan. A 2000 Prince Claus Award laureate for her contributions to culture and development, Liking has also produced impressive works of literature and art. From the beginning of her career in the late 1970s, Liking has always promoted and expanded her project of elite theater for development, with her productions of the (...) last decade bringing to the masses theater and performance as a form of resistance to the surrounding conflict and chaos in the West African nations of Cote-d'Ivoire and, most recently, Mali. The ability of Liking and the Village to carry out their projects to fruition both in times of relative prosperity as well as in periods of conflict is a testament to Liking's successful matriarchal style of African feminist leadership and shared governance made possible by the espousing of traditional African values necessary for tackling problems of a contemporary world. (shrink)

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development (...) of agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient’s decisions in relation to her identity. (shrink)

C.S. Peirce, the founder of pragmatism, argued that truth is what we would agree upon, were inquiry to be pursued as far as it could fruitfully go. In this book, Misak argues for and elucidates the pragmatic account of truth, paying attention both to Peirce's texts and to the requirements of a suitable account of truth. An important argument of the book is that we must be sensitive to the difference between offering a definition of truth and engaging in a (...) distinctively pragmatic project. The pragmatic project spells out the relationship between truth and inquiry; it articulates the consequences of a statement's being true. The existence of a distinct pragmatic enterprise has implications for the status of the pragmatic account of truth and for the way in which philosophy should be conducted. (shrink)

A great deal of scholarly attention has been paid to coercion. Less attention has been paid to what might be a more pervasive form of influence: manipulation. The essays in this volume address this relative imbalance by focusing on manipulation, examining its nature, moral status, and its significance in personal and social life.

Abstract: Some first person statements, such as ‘I am in pain’, are thought to be immune to error through misidentification (IEM): I cannot be wrong that I am in pain because—while I know that someone is in pain—I have mistaken that person for myself. While IEM is typically associated with the self-ascription of psychological properties, some philosophers attempt to draw anti-Cartesian conclusions from the claim that certain physical self-ascriptions are also IEM. In this paper, I will examine whether some physical (...) self-ascriptions are in fact IEM, and—if they are—what role that fact is supposed to play in arguments for the anti-Cartesian claim that self-consciousness is consciousness of oneself as a material object. I will argue that if we accept the assumptions required to show that physical self-ascriptions are IEM, then IEM cannot play the role it needs to play in these anti-Cartesian arguments. (shrink)

Is it allowable for your government, or anyone else, to influence or coerce you 'for your own sake'? This is a question about paternalism, or interference with a person's liberty or autonomy with the intention of promoting their good or averting harm, which has created considerable controversy at least since John Stuart Mill's On Liberty. Mill famously decried paternalism of any kind, whether carried out by private individuals or the state. In this volume of new essays, leading moral, political and (...) legal philosophers address how to define paternalism, its justification, and the implications for public policy, professional ethics and criminal law. So-called 'libertarian' or non-coercive paternalism receives considerable attention. The discussion addresses the nature of freedom and autonomy and the relation of individuals to law, policy and the state. The volume will interest a wide range of readers in political philosophy, public policy and the philosophy of law. (shrink)

Charles Sanders Peirce (1839-1914), the founder of pragmatism, is generally considered the most significant American philosopher. Popularized by William James and John Dewey, pragmatism advocates that our philosophical theories be linked to experience and practice. The essays in this volume reveal how Peirce developed this concept.

Marshall et al. (2024) raise questions regarding patient refusals of care. In this commentary we address refusals of care from the lens of patient autonomy and provide suggestions for patient cente...

Because factory-farmed meat production inflicts gratuitous suffering upon animals and wreaks havoc on the environment, there are morally compelling reasons to become vegetarian. Yet industrial plant agriculture causes the death of many field animals, and this leads some to question whether consumers ought to get some of their protein from certain kinds of non factory-farmed meat. Donald Bruckner, for instance, boldly argues that the harm principle implies an obligation to collect and consume roadkill and that strict vegetarianism is thus immoral. (...) But this argument works only if the following claims are true: all humans have access to roadkill, roadkill would go to waste if those who happen upon it don’t themselves consume it, it’s impossible to harvest vegetables without killing animals, the animals who are killed in plant production are all-things-considered harmed by crop farming, and the best arguments for vegetarianism all endorse the harm principle. As I will argue in this paper, each claim is deeply problematic. Consequently, in most cases, humans ought to strictly eat plants and save the roadkill for cats. (shrink)

The best of Peirce, James, and Dewey has thus resurfaced in deep, interesting, and fruitful ways, explored in this volume by David Bakhurst, Arthur Fine, Ian ...

I first argue that there are many true claims of the form: Φ-ing would be morally required, if anything is. I then explain why the following conditional-type is true: If φ-ing would be morally required, if anything is, then anything is actually morally required. These results allow us to construct valid proofs for the existence of some substantive moral facts—proofs that some particular acts really are morally required. Most importantly, none of my argumentation presupposes any substantive moral claim; I use (...) only plausible claims that most moral skeptics and error theorists can and do accept. The final section diagnoses why my arguments work. Here, I offer an explanation for the supervenience of the moral on the non-moral that may help those worried that the strategy is a sophisticated trick. I conclude by considering two objections. In replying to these objections, I explain why the strategy may allow us to demonstrate more than “obvious” moral truths, and why it may also address a stronger version of error theory, according to which, moral truths are not possible. (shrink)

Traditional approaches to animal ethics commonly emerge from one of two influential ethical theories: Regan’s deontology (The case for animal rights. University of California, Berkeley, 1983) and Singer’s preference utilitarianism (Animal liberation. Avon Books, New York, 1975). I argue that both of the theories are unsuccessful at providing adequate protection for animals because they are unable to satisfy the three conditions of a minimally decent theory of animal protection. While Singer’s theory is overly permissive, Regan’s theory is too restrictive. I (...) argue that a minimally decent animal ethic requires a framework that allows for context-dependent considerations of our complex human–animal relationship in a non-ideal world. A plausible theory which exemplifies this new ethic is virtue ethics. (shrink)

A growing number of animal ethicists defend new omnivorism--the view that it's permissible, if not obligatory, to consume certain kinds of animal flesh and products. This book puts defenders of new omnivorism and advocates of strict veganism into conversation with one another to further debates in food ethics in novel and meaningful ways. The book includes six chapters that defend distinct versions of new omnivorism and six critical responses from scholars who are sympathetic to strict veganism. The contributors debate whether (...) it's ethically permissible to eat the following: "freegan" meat, roadkill, cultured meat, genetically disenhanced animals, possibly insentient animals such as insects, and fish. The volume concludes with two chapters that examine strict vegan and new omnivore policy. Presenting readers with clear defenses and criticisms of the various dietary proposals, this book draws attention to the most important ethical challenges facing traditional animal agriculture and alternative systems of food production. New Omnivorism and Strict Veganism will appeal to scholars and students interested in food ethics, animal ethics, and agricultural ethics. (shrink)