Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to (...) measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC. (shrink)

The historical continuity of spinal catastrophism, traced across multiform encounters between philosophy, psychology, biology, and geology. Drawing on cryptic intimations in the work of J. G. Ballard, Georges Bataille, William Burroughs, Andre Leroi-Gourhan, Elaine Morgan, and Friedrich Nietzsche, in the late twentieth century Daniel Barker formulated the axioms of spinal catastrophism: If human morphology, upright posture, and the possibility of language are the ramified accidents of natural history, then psychic ailments are ultimately afflictions of the spine, which itself is a (...) scale model of biogenetic trauma, a portable map of the catastrophic events that shaped that atrocity exhibition of evolutionary traumata, the sick orthograde talking mammal. Tracing its provenance through the biological notions of phylogeny and "organic memory" that fueled early psychoanalysis, back into idealism, nature philosophy, and romanticism, and across multiform encounters between philosophy, psychology, biology, and geology, Thomas Moynihan reveals the historical continuity of spinal catastrophism. From psychoanalysis and myth to geology and neuroanatomy, from bioanalysis to chronopathy, from spinal colonies of proto-minds to the retroparasitism of the CNS, from "railway spine" to Elizabeth Taylor's lost gill-slits, this extravagantly comprehensive philosophical adventure uses the spinal cord as a guiding thread to rediscover forgotten pathways in modern thought. Moynihan demonstrates that, far from being an fanciful notion rendered obsolete by advances in biology, spinal catastrophism dramatizes fundamental philosophical problematics of time, identity, continuity, and the transcendental that remain central to any attempt to reconcile human experience with natural history. (shrink)

Pharmaceutical industry funding has transformed much grassroots community activism on health into corporate-sponsored advocacy. This critical commentary outlines recent evidence about industry funding of patient advocacy groups, offers a commentary on the history of grassroots activism appearing in this issue of the journal, and calls for greater scrutiny of the impacts and ethics of such sponsorship.

This book closely examines our commonly held beliefs about human suffering, and offers unique insights into God's role in why we suffer. Dr. Perri critically examines what it means to be human from a Judeo-Christian perspective, and extrapolates from the work of Carl Gustav Jung showing a deeply complex development of human transcendence in human suffering. On an interpersonal level, Dr. Perri elaborates on the work of Martin Buber and Emanuel Levinas and shows how our suffering can be shared and (...) lessened by our unconditionality and presence for the other. Scriptural passages are quoted from both the Hebrew and New Testament texts, and are used to depict the suffering of humankind as seen in the face of Job. It was this face, according to Perri, that Jesus saw in the faces of those He came to redeem, and that ultimately brought Him to the crucifix of redemption. Dr. Perri challenges Sartre's position that our existence precedes our essence, and draws on the work of Abraham Joshua Heschel and Christian theology in this regard. He further elaborates a neurodevelopmental paradigm that creates essence as the basis of our freedom to choose. This book can be read and studied by both professionals in the helping and healing professions, and lay persons seeking to better understand our suffering, and how to better help those who suffer. Dr. Perri offers specific ways in how to be present for those who suffer, how to read and receive the hidden language of human suffering, and how to use silence as a communication skill. (shrink)

Measuring outcomes using quantitative analytic methods is the hallmark of scientific research in healthcare. For clinical ethics support services (CESS), tangible outcome metrics are lacking and literature examining CESS quality is limited to evaluation of single cases or the influence on individual healthcare professional’s perceptions or behaviour. This represents an enormous barrier to implementing and evaluating ethics initiatives to improve quality. In this context, Kok _et al_ propose a theoretical framework for how moral case deliberation (MCD) can drive quality at (...) an organisational-level, termed _morisprudence_ 1. By offering mechanistic insights into how MCD can lead to organisational learning and quality improvement (QI), they provide a roadmap for actionable items to measure quality. As conceptualised, _morisprudence_ follows accumulation of organisational practical wisdom from a repertoire of ‘paradigmatic’ MCDs, aiding identification of patterns of morally important features. Here, there are parallels between healthcare professionals’ clinical judgement, where past experience... (shrink)

The draft Code of Conduct for Research is an important initiative towards assisting the scientific community in complying with the provisions of the Protection of Personal Information Act 4 of 2013 (POPIA). However, its approach towards cross-border data sharing should be reconsidered to clarify the ambiguities inherent in the legal requirements for the cross-border sharing of health data in the POPIA. These ambiguities include the concept of ‘transfer of information’, the application of adequacy as a legal mechanism for transfer, the (...) nature of consent for cross-border sharing and the scope of the recipient third party. We suggest that the draft Code of Conduct for Research can be improved by: Explaining or defining the concept of ‘transfer of information’ and when it applies to cross-border sharing in research Clarifying the application of adequacy as a legal mechanism for transfer vis-à-vis the other alternatives Expanding on the interpretation and application of consent as a legal mechanism for cross-border transfers Expanding the category of persons who may be recipients of personal information in a third country. (shrink)

"The demonization of the radical right ill serves us when now, more than ever before, it is vitally important to know all we can about this esoteric milieu's nature and potentialities…by…demonizing the many, we cloak the few, and, however unwittingly, facilitate the existence of evil in the world." —From the Introduction by Jeffrey Kaplan White power groups are universally vilified and feared. But to better understand the threat they pose, scholars and activists must try to better understand their disturbing ideas (...) and practices. In this controversial volume, Jeffrey Kaplan brings to light the workings of white supremacy movements in the United States and Europe in the years since World War II. The first half of the Encyclopedia is made up of over 100 entries—many of them essay-length—describing the people, groups and themes that make up the radical racist right. Some of the entries are written by movement activists themselves, providing useful insider accounts. The second half contains original resources circulated within the movement, each prefaced and placed in scholarly context by the editor. These documents, although offending, are invaluable to researchers and often available nowhere else. Cross-references and an index make the information easily accessible. For scholars of race, religion, politics or social movements, the Encyclopedia of White Power is an essential resource. (shrink)

Life-saving healthcare technology evolves over time, raising new ethical questions. What was once experimental becomes standard care, and what was once unthinkable becomes the next frontier. Ethici...

Language, like other human traits, could only have evolved during one or more stages of development. We enlist the theoretical framework of human life history to account for certain aspects of linguistic evolution, with special reference to initial phases in the process. It is hypothesized that selection operated at several developmental stages, the earlier ones producing new behaviors that were reinforced by additional, and possibly more powerful, forms of selection during later stages, especially adolescence and early adulthood. Peer commentaries have (...) provided opportunities to explain human life history more comprehensively, and to add details to our account of spoken language. We made no attempt to explain syntax in the target article, but we propose here that selection for “vocal plumage” may have increased our species’ capacity for utterance complexity, a development that would have benefited all levels of language. (shrink)

In this timely book L.W. Sumner addresses these issues within the wider context of palliative care for patients in the dying process.

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child’s right to an open future. Individual consent to transplant is (...) in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs. (shrink)

Rationality requires us to respond to apparent normative reasons. Given the independence of appearance and reality, why think that apparent normative reasons necessarily provide real normative reasons? And if they do not, why think that mistakes of rationality are necessarily real mistakes? This paper gives a novel answer to these questions. I argue first that in the moral domain, there are objective duties of respect that we violate whenever we do what appears to violate our first-order duties. The existence of (...) these duties of respect, I argue, ensures that apparent moral reasons are exceptions to the independence of appearance and reality. I then extend these arguments to the domain of overall reason. Just as there are objective duties of respect for moral reasons that explain moral blameworthiness, so there are objective duties of respect for reasons that explain blameworthiness in the court of overall reason. The existence of these duties ensures that apparent reasons are exceptions to the independence of appearance and reality. (shrink)