Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...) in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

Engaging Polanyi’s embeddedness–disembeddedness framework, this study explored the work experiences of Bhil children employed in Indian Bt cottonseed GPNs. The innovative visual technique of drawings followed by interviews was used. Migrant children, working under debt bondage, underwent greater exploitation and perennial and severe depersonalized bullying, indicative of commodification of labour and disembeddedness. In contrast, children working in their home villages were not under debt bondage and underwent less exploitation and occasional and mild depersonalized bullying, indicative of how civil society organizations, (...) along with the state, attempt to re-embed economic activities in the social context. Polanyi’s double movement was evident. ‘Place’ emerged as the pivotal factor determining children’s experiences. A ‘protective alliance’ of community controls and social power, associated with in-group affiliations and cohesive ties, stemming from a common village and tribal identity, aided children working at home for Bhil farmers. ‘Asymmetric intergroup inequality’ due to pronounced social identity and class differences, coupled with locational constraints and developmental disadvantage, made migrant children vulnerable targets. Social embeddedness influences how child workers are treated because it forces employers to be ethical and not engage in bullying. However, by shifting production to children’s home villages, there is an attempt to obscure the difference between child labour and child work. Thus, the seeds of disembeddedness are sown through the very act of re-embeddeding, potentially hampering future interventions. (shrink)

This book begins with an overview of the current legal status of children under U.S. federal and state law, It includes an analysis of relevant Supreme Court decisions and an extended critique of the philosophical arguments for treating children differently from adults under the law. Sections in the book include discussions of the need for a theory of juvenile rights, the moral arguments that prop up such theories, Professor Houlgate's proposal for a theory, and a final discussion of the applications (...) of his theory to the debates about status offenses, child neglect, and rehabilitation of juvenile offenders. (shrink)

This book provides an in-depth discussion of the aspects of a whole-child learner paradigm including how educator and school-based influences interrelate with personal and interpersonal demonstrations of learning to create a holistic learning system.

This case conference concerns a child who has been in care following a diagnosis of emotional abuse and a serious incident of physical abuse. She wants to return home again, and her parents, who had previously scapegoated her, now blame the family's previous ills on her sister instead. The Children Act 1989 gives considerable weight to the child's wishes, but what if the child returns home and is re-abused? In this case conference a child psychiatrist, a (...) philosopher and a lawyer discuss the issues of clinicians' responsibilities, moral luck, and child care law. (shrink)

The use of covert video surveillance in the investigation of suspected life-threatening child abuse and Munchausen syndrome by proxy raises important ethical questions. That the recently reported provision of this facility in North Staffordshire was not presented to a Local Research Ethics Committee (LREC) for approval as a research exercise raises important questions about the ethical review of research and practice. The case made for avoiding such review is first set out and then examined. The three main premisses which (...) form the basis of the view that LREC approval is not required are identified and tested in turn. The conclusion is that there is an undeniable element of research involved in the procedure and that the welfare of all those subjected to the surveillance would be best protected by the submission of the protocol to an independent committee for ethical assessment. (shrink)

Much effort and many resources have been expended in enacting smoking bans for private businesses catering to adult-only clientele. Although the arguments in favor of bans leave much to be desired, many people believe that banning smoking in the hospitality industry is justified.What is puzzling is the lack of attention on banning smoking around children in cars, houses, and other private property. After all, if such prohibitions are justified for autonomous adults, then they must be for non-autonomous minors as well. (...) A good case can be made out for banning smoking around children in the best interests of their health. (shrink)

In Epistemic Injustice Miranda Fricker argues that there is a distinctively epistemic type of injustice in which someone is wronged specifically in his or her capacity as a knower. Fricker's examples of identity-prejudicial credibility deficit primarily involve gender, race, and class, in which individuals are given less credibility due to prejudicial stereotypes. We argue that children, as a class, are also subject to testimonial injustice and receive less epistemic credibility than they deserve. To illustrate the prevalence of testimonial injustice against (...) children we document examples of negative prejudicial treatment in forensic contexts where children frequently act as testifiers. These examples, along with research on the child's competence and reliability as a testifier, reveal widespread epistemic prejudice against children. Given that subjection to prejudice can have a detrimental impact on children we discuss ways to ameliorate this form of testimonial injustice. We argue that, both in formal and natural contexts, the child's testimony should be evaluated alongside the relationships that support her development as a testifier. The adult can play a central role in creating successful testimonial interactions with children by acting as a. (shrink)

Raising a child with an autism spectrum disorder (ASD) is a stressful experience and has been associated with poor maternal mental health and increased maternal emotional distress. However, the experiences of fathers of children with ASD are largely unexplored and the coping strategies these men employ to cope with the challenges they face have received little research attention. This research aimed to explore the phenomenological experiences of fathers of preschool children with ASD by gaining a better understanding of the (...) manner in which these individuals attempted to cope with their situation. A multiple, single-case study design was employed and five participants were recruited via two local paediatric practices. Semi-structured interviews were conducted with the participants and data were analysed making use of Interpretative Phenomenological Analysis (IPA). This analysis yielded three superordinate themes, which were labelled as follows: (a) the experience of fathering a child with ASD, (b) challenges of fathering a child with ASD, and (c) coping with fathering a child with ASD. The results suggest that the fathers of children with ASD experience their parental role as stressful. The participants in the current study related the stress they experienced to a number of challenges associated directly with their children’s behaviour, as well as to the effects that parenting a child with ASD had on their own wellbeing and functioning. The participants reported making use of a number of coping strategies in order to deal with the challenges they faced. The participants used both problem-focussed and avoidant coping strategies. The results are discussed and recommendations made with regard to future research. (shrink)

This article discusses whether a child can and should be engaged as a co-researcher on moral and epistemological grounds. Selected research literature has been used to illustrate various approaches to the issue of children's participating as co-researchers in social research. By exploring the predicament of childhood and the meaning of the concept ‘research’, we attempt to clarify the necessary conditions for a person to qualify as a researcher and for an activity to qualify as research. We then look at (...) the extent to which the concept of ‘child’ fits within these frames. (shrink)

The onset of the Covid-19 pandemic has disrupted the lives of families in the United States and across the world, impacting parent mental health and stress, and in turn, the parent-child relationship. Music is a common parent-child activity and has been found to positively impact relationships, but little is known about music’s role in parent-child interactions during a pandemic. The current study utilized an online questionnaire to assess the use of music in the home of young children (...) and their parents in the United States and Canada during Covid-19 and its relationship with parents’ affective attachment with their child. Musical activity was high for both parents and children. Parents reported using music for both emotion regulation and to socially connect with their children. Parent-child musical engagement was associated with parent-child attachment, controlling for relevant parent variables including parent distress, efficacy, education, and parent-child engagement in non-musical activities. These results indicate that music may be an effective tool for building and maintaining parent-child relationships during a period of uncertainty and change. (shrink)

Multiple groups, including the National Bioethics Advisory Commission, the American Society of Clinical Oncology, the National Coalition of Comprehensive Cancer Centers, Workgroup 6 of the Summit Series on Cancer, PRIM&R, the Bell Report, and prominent ethicists have called for replacing the current system of local institutional review with central review for multisite national trials. We argue that this need is particularly acute in pediatric oncology, as shown by the experience of the Children's Oncology Group.

This paper examines the issue of global child labor. The treatment is grounded in the classical economics of Adam smith and the more recent writings of human capital theorists. Using this framework, the universal problem of child labor in newly industrializing countries is investigated. Child labor is placed in its historical context with a brief review of practices in the United States and Great Britain at the time those countries were industrializing. Then, child labor is examined (...) in its contemporary global context. We argue that, as countries industrialize, they tend to follow predictable patterns of development – including use of and eventual abandonment of child labor. We argue that this convergence under the logic of industrial capitalism supports a universalist approach to human rights (that would condemn child labor) over a more tolerant cultural relativist approach. (shrink)

The final report of the Australian Royal Commission into institutional responses to child sexual abuse comprises 17 volumes, one of which addresses its findings in relation to schools. In this arti...

Trisomy 13 and 18 are rare chromosomal abnormalities associated with high morbidity and mortality. Improved survival rates and increased prevalence of aggressive medical intervention have resulted in families and physicians holding different perspectives regarding the appropriate management of children with T 13/18. Families were invited for open-ended interviews regarding their experiences with the medical care of a child with T 13/18 over the past 5 years. Seven of 33 invited families were surveyed; those who had spent more than 40 (...) days in the hospital were most likely to accept the invitation. Grounded theory technique was used to analyze the interviews. This method elicited four key themes regarding family perspectives on children with T 13/18: they are unique and significant, they transform the lives of others, their families can feel overwhelmed and powerless in the medical setting, their families are motivated to “carry the torch” and tell their story. Families also emphasized ways in which Internet support groups can provide both positive and negative perspectives. The ensuing discussion explores the difficulties of parents and physicians in forecasting the impact that T 13/18 will have on families and emphasizes a narrative approach to elicit a map of the things that matter to them. The paper concludes that while over-reliance on dire prognostic data can alienate families, examining the voice, character and plot of patient stories can be a powerful way for physicians to foster shared decision-making with families. (shrink)

Approximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child’s medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child’s biological parents should play in making serious medical decisions. Here we highlight (...) some of the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician. (shrink)

The aim of this book is to provide a better foundation for the legal rights of children than what now exists. The first part of the book describes the current legal status of children and critically discusses the traditional arguments for denying certain legal rights to children while granting them others. The second part describes and defends a general theory of children's rights, based on the principles of utility and egalitarian justice. The third part shows how the theory justifies significant (...) change in the current legal system. (shrink)

I argue that an ambiguity exists between Philip Pettit's largely normative and Quentin Skinner's largely historical accounts of republican liberty. Historical republican liberty, as seen in Livy's narrative of the period following the expulsion of the Roman kings to the passage of the Licinian-Sextian laws, was largely defensive, in the form of the tribunate. Though republican liberty protected the plebeians from wanton patrician abuse, removing them from a formal dependence analogous to that of slave or child in Roman law, (...) it left them under the tutelage and guidance of a paternalistic order. Thus, while historical republican liberty was anti-patriarchal, it was normatively compatible with paternalism. Yet paternalism is probably undesirable for both normatively- and historically-minded advocates of republicanism. (shrink)

This article first summarizes research regarding the relationship between sports that intentionally structure multiple types of brain trauma into their practice, such as rugby and boxing, and the range of negative health outcomes that flow from participation in such sports. The resultant brain injuries are described as ‘now’ and ‘later’ diseases, being those that affect the child immediately and then across their lifetime. After highlighting how these sports can permanently injure children, it examines this harm in relation to existing (...) British laws and policies concerning child abuse. The conclusion drawn is that neither children nor adults on their behalf are legally able to give informed consent for participation, and that impact sport organisations effectively groom children into sustaining and accepting brain trauma. Adults providing brain-traumatizing versions of these sports are thus described as being complicit in a form of child abuse that we term brain abuse. The contradictions in existing sports policy are highlighted, where policy describes that children are to be protected from harm, and yet the very practice of such sports creates harm by design. Implications of the argument are that children should be prohibited from partaking in impact sports. (shrink)

Background: This study developed a photo and video database of 4-to-6-year-olds expressing the seven induced and posed universal emotions and a neutral expression. Children participated in photo and video sessions designed to elicit the emotions, and the resulting images were further assessed by independent judges in two rounds. Methods: In the first round, two independent judges, experts in the Facial Action Coding System, firstly analysed 3,668 emotions facial expressions stimuli from 132 children. Both judges reached 100% agreement regarding 1,985 stimuli, (...) which were then selected for a second round of analysis between judges 3 and 4. Results: The result was 1,985 stimuli were produced from 124 participants. A Kappa index of 0.70 and an accuracy of 73% between experts were observed. Lower accuracy was found for emotional expression by 4-year-olds than 6-year-olds. Happiness, disgust and contempt had the highest agreement. After a sub-analysis evaluation of all four judges, 100% agreement was reached for 1,381 stimuli which compound the ChildEFES database with 124 participants and 51% induced photographs. The number of stimuli of each emotion were: 87 for neutrality, 363 for happiness, 170 for disgust, 104 for surprise, 152 for fear, 144 for sadness, 157 for anger 157, and 183 for contempt. Conclusions: The findings show that this photo and video database can facilitate research on the mechanisms involved in early childhood recognition of facial emotions in children, contributing to the understanding of facial emotion recognition deficits which characterise several neurodevelopmental and psychiatric disorders. (shrink)

Ender’s Game, Orson Scott Card’s award-winning 1985 novel, has been discovered and rediscovered by generations of science fiction fans, even being adopted as reading by the U.S. Marine Corps. Ender's Game and its sequels explore rich themes — the violence and cruelty of children, the role of empathy in war, and the balance of individual dignity and the social good — with compelling elements of a coming-of-age story. Ender’s Game and Philosophy brings together over 30 philosophers to engage in wide-ranging (...) discussion on issues such as: the justifiability of pre-emptive strikes; how Ender’s disconnected and dispassionate violence is mirrored in today’s drone warfare; whether the end of saving the species can justify the most brutal means; the justifiability of lies and deception in wartime, and how military schools produce training in virtue. The authors of Ender’s Game and Philosophy challenge readers to confront the challenges that Ender’s Game presents, bringing new insights to the idea of a just war, the virtues of the soldier, the nature of childhood, and the serious work of playing games. (shrink)

This paper argues that Husserl’s account of adult recognition of another allows for immediate, noninferential, analogical access to the other, though onedoes not experience the other’s experience as s/he does. The passive-associative processes at work in adult recognition of another make possible infant syncretic sociability and play a role in constituting the infant’s self prior to reflection. The reflective perspective of the psychologist and philosopher discovers that such infant experiences, though at first seeming indistinguishable from their parents’ experience, belong to (...) their own stream of consciousness and constitute a non-eliminable Cartesian residue and an inescapable solitude of identity. Finally new research in joint attention reveals that the infant self is constituted not only by passive experience but also by active movements evident in the infant’s attempt to shape the direction of adults in joint attention, however this may fall short of high-level reflection. (shrink)

One of the most contentious ethical issues in the neonatal intensive care unit is the withdrawal of life-sustaining treatment from infants who may otherwise survive. In practice, one of the most important factors influencing this decision is the prediction that the infant will be severely intellectually disabled. Most professional guidelines suggest that decisions should be made on the basis of the best interests of the infant. It is, however, not clear how intellectual disability affects those interests. Why should intellectual disability (...) be more important than physical disability to the future interests of an infant? Is it discriminatory to base decisions on this? This paper will try to unravel the above questions. It seems that if intellectual disability does affect the best interests of the child it must do so in one of three ways. These possibilities will be discussed as well as the major challenges to the notion that intellectual disability should have a role in such decisions. The best interests of the child can be affected by severe or profound intellectual disability. It is, though, not as clear-cut as some might expect. (shrink)

The dissemination of information about patients through computers and multidisciplinary teams involves departures from traditional tenets of confidentiality. This raises ethical problems, exemplified by current practices in child health. In multidisciplinary teams, problems may arise because different professions utilise different types of data. Some team members may not appreciate the extent to which data may be unscientific and judgmental. Children and thier families may be labelled, without justification, preventing objective reappraisal. The ethical and legal implications are considered. Practice may (...) not conform to principles of natural justice, for example when care orders are sought. Obligations to the State may also imperil the confidentiality of the doctor-patient relationship, and of medical records, the legal status of which is confused and requires clarification. Allowing patients access to their records could be a useful safeguard, and the medical profession should devise alternatives should it not be accepted. (shrink)

Children's consent to treatment remains a contentious topic, with confusing legal precepts and advice. This paper proposes that informed consent in children should be regarded as shared between children and their families, the balance being determined by implicit, developmentally based negotiations between child and parent--a "family rule" for consent. Consistent, operationalized procedures for ethically obtaining consent can be derived from its application to both routine and contentious situations. Therefore, use of the "family Rule" concept can consistently define negligent procedure (...) in obtaining consent from children, and could be used as a unifying framework in the development of new professional guidelines. A "guideline"-based approach to children's consent to treatment may offer greater individuality than a "rights"-based approach, though careful training and oversight will be needed for it to be effective. (shrink)