Families and clinicians approaching a child’s death in the paediatric intensive care unit (PICU) frequently encounter questions surrounding medical decision-making at the end of life (EOL), including defining what is in the child’s best interest, finding an optimal balance of benefit over harm, and sometimes addressing potential futility and moral distress. The best interest standard (BIS) is often marshalled by clinicians to help navigate these dilemmas and focuses on a clinician’s primary ethical duty to the paediatric patient. This approach does (...) not consider a clinician’s potential duty to the patient’s family. This paper argues that when a child is dying in the PICU, the physician has a duty to serve both the patient and the family, and that in some circumstances, the duty to serve the family becomes as important as that owed to the child. We detail the limitations of the BIS in paediatric EOL care and propose the relational potential standard as an additional ethical framework to guide our decisions. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

In spring 2012, after losing the main source of funding for its Enviropig project, the University of Guelph killed its last remaining Enviropigs. Or, as a university spokesperson put it, the pigs were "humanely euthanized." Through an engagement with this particular case, I examine the ethical implications of using the term euthanasia to describe the killing of perfectly healthy animals who were bred for research but are no longer needed for this purpose. Given the ethical shortcut that terms like euthanasia (...) provide, I call on research institutions, and the institutions that regulate them, to attempt to justify the killing of these animals without recourse to such terms. (shrink)

This article takes as its starting point the recent work of Frank Ankersmit on subjective historical experience. Such an experience, which Ankersmit describes as a ‘sudden obliteration of the rift between present and past’ is connected strongly with the Deweyan theory of art as experiential, which contains an account of aesthetic experience as affording a similar breakdown in the polarization of the subject and object of experience. The article shows how other ideas deriving from the phenomenological tradition and the philosophy (...) of perception can fruitfully be applied to the same terrain, and an account of aesthetic experience is built up that stresses embodied, differential and virtual aspects in the perception of aesthetic objects. The disruption and/or enhancement of these aisthetic aspects of perception, coupled with the self-conscious reflection thereby occasioned, is put forward as an account of aesthetic experience that links Ankersmit’s ideas with those of others, and a critical reading is made of a section of Ankersmit’s Sublime Historical Experience that centers on his experience of a painting by Francesco Guardi. The fijinal section aims at strengthening aspects of Ankersmit’s ideas and renews his critique of the radical constructivism of Oakeshott. (shrink)

Programmes serving international patients are increasingly common throughout the USA. These programmes aim to expand access to resources and clinical expertise not readily available in the requesting patients’ home country. However, they exist within the US healthcare system where domestic healthcare needs are unmet for many children. Focusing our analysis on US children’s hospitals that have a societal mandate to provide medical care to a defined geographic population while simultaneously offering highly specialised healthcare services for the general population, we assume (...) that, given their mandate, priority will be given to patients within their catchment area over other patients. We argue that beyond prioritising patients within their region and addressing inequities within US healthcare, US institutions should also provide care to children from countries where access to vital medical services is unavailable or deficient. In the paper, we raise and attempt to answer the following: (1) Do paediatric healthcare institutions have a duty to care for all children in need irrespective of their place of residence, including international patients? (2) If there is such a duty, how should this general duty be balanced against the special duty to serve children within a defined geographical area to which an institution is committed, when resources are strained? (3) Finally, how are institutional obligations manifest in paradigm cases involving international patients? We start with cases, evaluating clinical and contextual features as they inform the strength of ethical claim and priority for access. We then proceed to develop a general prioritisation framework based on them. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 26-27, November 2011.

This article concerns the notion of aesthetic negativity, and related ideas regarding the autonomy of art. After giving some initial definitions and a brief historical sketch of these concepts, we will examine the definition proposed by arguably the greatest thinker of aesthetic negativity, Theodor Adorno, and its recent semiotic reconstruction in the work of Christoph Menke. This reconstruction configures aesthetic negativity and autonomy jointly as the capacity of artworks, and the experiences that they occasion; to processurally negate ‘‘automatic’’ modes of (...) understanding. This account is then critiqued, and contrasted with views on aesthetic experience that stress its nonconceptual and asemiotic aspects, and the close affinity of this modality of experience with perceptual presence and affective intensity, with a clear reference to the phenomenological tradition. Some recent ideas about how semiotic and phenomenological theories regarding art can interact are then cited, and an undertheorized aspect of their connection introduced, which is the main original import of the article. This connection, which is furnished by the concept of aisthetic trait, is derived from psychoanalytic metapsychology, and is an example of how the meaning and presence effects of art can act not just in a competing synchronic fashion, but can morph into each other over time. A trait is a signifier-like perceptual remnant of a prior subjective experience of high intensity that provides a kind of ratification of the experience that endures within the life history of an individual. This is then shown to have relevance to the previous topics of aesthetic negativity and autonomy in terms of the way that the trait mechanism may bring to light important diachronic aspects of aesthetic experience that are currently absent in other accounts in the literature. (shrink)