Obstetricians face difficult decisions when the interests of fetus and mother conflict. An example is the problem of choosing the delivery method when labour begins prematurely and the fetus is breech. Vaginal delivery involves risks for the breech fetus of brain damage or death caused by umbilical cord compression and head entrapment. Caesarean section might avoid these dangers but involves risks for the mother, including infection, haemorrhage and even death in a small percentage of cases. If a caesarean section is (...) performed the infant might die anyway, due to complications of prematurity. Thus, decisions about delivery method involve balancing the risks to mother and fetus. Uncertainty about the frequency of fetal injuries in vaginal breech deliveries adds to the difficulty of these decisions. (shrink)

"In preparing this remarkable book, Ernest Hook persuaded an eminent group of scientists, historians, sociologists and philosophers to focus on the problem: why are some discoveries rejected at a particular time but later seen to be valid? The interaction of these experts did not produce agreement on 'prematurity' in science but something more valuable: a collection of fascinating papers, many of them based on new research and analysis, which sometimes forced the author to revise a previously-held opinion. The book (...) should be enthusiastically welcomed by all readers who are interested in how science works."—Stephen G. Brush, co-author of Physics, The Human Adventure: From copernicus to Einstein and Beyond "Prematurity and Scientific Discovery contains interesting and insightful papers by numerous well-known scientists and scholars. It will be of wide interest, not only to science studies scholars but also to working scientists and to science-literate general readers."—Thomas Nickles, editor of Scientific Discovery, Logic, and Rationality. (shrink)

The Child Abuse Amendments of 1984 established the norms for treating disabled newborns, but they did not address the treatment of premature babies. Parents and physicians need a framework for decisionmaking. A decision handed down recently by the Texas Supreme Court is a step forward.

The Child Abuse Amendments of 1984 established the norms for treating disabled newborns, but they did not address the treatment of premature babies. Parents and physicians need a framework for decisionmaking. A decision handed down recently by the Texas Supreme Court is a step forward.

The practical goal of preventing premature death seems uncontroversial. But the term ‘premature death’ is vague with several, sometimes conflicting definitions. This ambiguity results in several conceptions with which not all will agree. Moreover, the normative rationale behind the goal of preventing premature deaths is masked by the operational definition of existing measures. In this article, we argue that ‘premature death’ should be recognized as a normative concept. We propose that normative theories should be used to justify measures of premature (...) death to provide them with normative validity and public legitimacy. (shrink)

The paper makes use of two frameworks to develop a discussion on the merits of delaying agreement in partnership contexts. The first framework — the Arenas of Power — is helpful in understanding the different contexts in which negotiation and discussion take place. Four Arenas are identified, depending on the potential for agreement between parties who may hold very different worldview perspectives, and the power distribution between the various parties involved. Each leads to different ways of working, and to different (...) goals in terms of what can constructively be agreed and what could prove false or artificial. The second framework develops the idea of alethic pluralism through the use of Wilber’s four quadrants. The two frameworks are then related to four processes taken by ‘alternative’ systems of knowledge which illustrate examples of how things play out in and between the Arenas: annihilation, systematic exclusion/segregation, assimilation, and integration/accommodation. Several approaches are then outlined which can be used in these Arenas. They include Drama Theory (a development of Games Theory which has proved particularly useful in settings where there are dilemmas facing the parties which cannot be resolved through rational analysis), Principled Negotiation and Whole Systems Interventions. A number of practical examples are given which develop and enrich the argument, including cases where delaying agreement has proved beneficial, and cases where premature agreement has proved problematic. (shrink)

This paper addresses the problem of ‘premature consent’. The term ‘premature consent’ denotes patient decisions that are: formulated prior to discussion with the appropriate healthcare professional ; based on information from unreliable sources ; and resolutely maintained despite the HCP having provided alternative reliable information. HCPs are not obliged to respect premature consent patients’ demands for unindicated treatments. But why? What is it that premature consent patients do or get wrong? Davis has argued that premature consent patients are incompetent and (...) misinformed. We argue that this view is not sustainable. A more plausible position asserts that premature consent threatens the integrity of the medical profession. We argue that this gives rise to a negative patient duty which premature consent patients fail to honour. We argue for a further positive duty of good faith engagement in shared decision-making. This implies willingness to potentially revise or justify one’s evaluative bases. Fundamentally, the problem with premature consent patients is that certain of their evaluative bases are not open to revision. They therefore fail in their duty to participate faithfully in the shared decision-making process. (shrink)

Moral values in healthcare range widely between interest groups and are principally subjective. Disagreements diminish dialogue and marginalize alternative viewpoints. Extremely premature births exemplify how discord becomes unproductive when conflicts of interest, cultural misunderstanding, constrained evidence review, and peculiar hierarchy compete without the balance of objective standards of reason. Accepting uncertainty, distributing risk fairly, and humbly acknowledging therapeutic limits are honorable traits, not relativism, and especially crucial in our world of constrained resources. We think dialogics engender a mutual understanding that: (...) i) transitions beliefs beyond bias, ii) moves conflict toward pragmatism (i.e., the truth of any position is verified by subsequent experience), and iii) recognizes value pluralism (i.e., human values are irreducibly diverse, conflicting, and ultimately incommensurable). This article provides a clear and useful Point-Counterpoint of extreme prematurity controversies, an objective neurodevelopmental outcomes table, and a dialogics exemplar to cultivate shared empathetic comprehension, not to create sides from which to choose. It is our goal to bridge the understanding gap within and between physicians and bioethicists. Dialogics accept competing relational interests as human nature, recognizing that ultimate solutions satisfactory to all are illusory, because every choice has downside. Nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end. (shrink)

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. (...) But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies. (shrink)

The one who dies is deprived of goods that this person would have enjoyed if he or she had continued living, according to the popular “deprivation account of harm.” The person who dies “prematurely” is generally thought to suffer the most harm from death. However, the concept of a premature death is unclear, as will be shown. I will evaluate various definitions of a premature death and will argue that the existing definitions are too ambiguous and unreliable to serve as (...) the basis for estimating the degree of harm from death. (shrink)

In an incisive critique of Professor Hick's Evil and the God of Love , Professor Puccetti claims to ‘carry the campaign as well as the battle’—i.e. to show that, with respect to evil, theists ‘are either “explaining it away” or saying it cannot be explained at all. And in both cases they are in effect admitting they have no rational defence to offer. Which means that despite appearances they really are abandoning the battlefield.’.

This article examines the ethical validity of using viability as the cutoff point for abortion in the Netherlands, in view of potential changes to the Dutch perinatal care guideline. According to the Dutch Penal Code, abortion is permitted until viability: the point at which a fetus can survive outside the womb with technological assistance. Since the law was enacted in 1984, viability has been set at 24 weeks gestational age. Currently, in the Netherlands, the treatment limit for extreme prematurity (...) is also set at 24 weeks. The potential revision of the guideline could lower this threshold. Such a change could have implications for abortion in the Netherlands. We critically evaluate the use of viability within the Dutch context and offer recommendations for modifying the legal framework concerning abortion. We conclude that relying on any interpretation of viability is morally problematic for abortion regulation, as it is too indeterminate a concept to establish a threshold in a morally relevant way. (shrink)

Schoene-Seifert's and Stier's thought-provoking target article (2013) addresses so many complex issues that it seems impossible to provide a comprehensive commentary in this space. Therefore, we co...

Clinical trials give rise to ethical dilemmas, especially in the acutely ill, but we take issue with two points raised in a recent comment on a specific acute myocardial infarction (AMI) trial. The commentators judged that the trial most likely could, and therefore should, have been terminated much earlier. By analysing the problem statistically we arrive at results that go against their intuitive judgment—they also see it as mandatory to update the patient Information sheet as trial results accrue and trends (...) begin to emerge. In our view, interpreting subtle trends and borderline p-values must rest with data monitoring boards, not patients. Moreover, patients with AMI or in other medical emergencies need very simple instructions. Empirical studies of the consent process confirm that the idea of a genuinely informed consent is problematic in such cases. (shrink)

A growing number of patients make up their minds about some medical issue before they see their provider, either by googling their symptoms or asking a friend. They’ve made up their minds before coming in, and they resist their provider’s recommendations even after receiving information and advice from their provider. This is a new kind of medical autonomy problem; it differs from cases of standard consent, futility, or conscientious refusal. Providers sometimes call this problem “Dr. Google.” I call it premature (...) consent. Providers may wonder whether these patient decisions command the same deference and respect as other patient decisions. The answer is “no,” for these patients are neither fully competent nor properly informed. They typically appear to be competent, but competence includes the ability to deliberate, and they are not deliberating well when they make up their minds before consulting a qualified provider. They seem informed, especially after talking to their provider, but they are misinformed about what sources of medical advice to trust. Moreover, being informed requires believing the information one has received, and these patients sometimes don’t believe the information their provider gives them. (shrink)

Peterson et al. (2023) identify two potential uses of psychedelic drugs in Alzheimer’s disease and related disorders (AD/ADRD). The first is to treat depression and anxiety that commonly occur afte...

In lieu of an abstract, here is a brief excerpt of the content:September 27, 2008 (1:09 pm) G:\WPData\TYPE2801\russell 28,1 048RED.wpd Reviews 81 CAUSATION: A PREMATURELY DEPOSED MONARCH? Chad Trainer 1006 Davids Run Phoenixville, pa 19460, usa stratof{[email protected] Huw Price and Richard Corry, eds. Causation, Physics, and the Constitution of Reality: Russell’s Republic Revisited. Oxford: Clarendon P.; New York: Oxford U. P., 2007. Pp. x, 403. isbn: 978-0-19-927819-0. £58 (hb); £19.99 (pb.). us$35 (pb). In 1911 the Aristotelian Society elected Bertrand Russell (...) its president, and in November of 1912 Russell’s presidential address to the Society was “On the Notion of Cause”, which, in addition to being published in the Society’s Proceedings, was later included in Russell’s book Mysticism and Logic. Russell’s address to the Aristotelian Society occurred during an interesting, brief era in the history of physics. This was a stage after the science of gravitational astronomy had beneWted from the use of diTerential equations but before the British physics community was aware of the German physicists’ advances. Less than three years after Russell delivered “On the Notion of Cause”, Einstein revolutionized the Weld of gravitational astronomy; and the quantum physicists were to eventually unearth phenomena that proved to be especially recalcitrant to comprehensive mathematical analysis. At the time of “On the Notion of Cause”, though, physics was understood as providing a thorough account of all the phenomena within its domain. In this address, Russell speaks of how Certain diTerential equations can be found, which hold at every instant for every particle of the system, and which, given the conWguration and velocities at one instant, or the conWgurations at two instants, render the conWguration at any other earlier or later instant theoretically calculable. … This statement holds throughout physics, and not only in the special case of gravitation. But there is nothing that could be properly called “cause” and nothing that could be properly called “eVect” in such a system.… [T]here is merely a formula. (ML, p. 194, Papers 6: 202; my emphasis) Russell further remarked: All philosophers, of every school, imagine that causation is one of the fundamental axioms or postulates of science, yet, oddly enough, in advanced sciences such as gravitational astronomy, the word ‘cause’ never occurs…. To me it seems that … the reason September 27, 2008 (1:09 pm) G:\WPData\TYPE2801\russell 28,1 048RED.wpd 82 Reviews why physics has ceased to look for causes is that, in fact, there are no such things. The law of causality, … like much that passes muster among philosophers, is a relic of a bygone age, surviving, like the monarchy, only because it is erroneously supposed to do no harm. (ML, p. 180; Papers 6: 193). What Russell has in mind here when saying “in advanced sciences such as gravitational astronomy, the word ‘cause’ never occurs” is that it is rash to infer from the observation of particular uniformities that there necessarily is a legitimate apriori category of causality (ML, p. 205; Papers 6: 209). Rather, “the law of causality, as usually stated by philosophers, is false, and is not employed in science” (ML, p. 207; Papersz 6: 210). Huw Price and Richard Corry’s Causation, Physics, and the Constitution of Reality: Russell’s Republic Revisitedz features thirteen chapters from diTerent contributors (except for Huw Price who authors one and co-authors another) who address diTerent aspects of this matter. Price and Corry explain: One key theme of the volume turns on the possibility that in presenting philosophy with a stark choice between Wnding causation in physics and rejecting it altogether, Russell missed an important range of intermediate views. In particular, he missed what, by a natural extension of his own constitutional analogy, we may call the republican option. In the political case, rejecting the view that political authority is vested in our rulers by God leaves us with two choices: we may reject the notion of political authority altogether ; or we may regard it, with republicans, as invested in our rulers by us. Arguably, the republican option exists in metaphysics, too. Causal republicanism is thus the view that although the notion of causation is useful, perhaps indispensable, in our dealings with... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Declining Circumcision for My Premature NewbornDionne DeschenneIn 1993, I was pregnant with my first of three sons and was busy preparing for his arrival. Unlike most parents, who focus much of their time on decorating the nursery and buying supplies, I was researching the medical decisions that I would need to make in the moments and weeks following his birth. Having worked in a hospital while a pre-medicine student, (...) I had heard the cries of babies undergoing tests and procedures shortly after birth and knew I needed to be clear on the necessity of those tests and procedures if I was going to consent to them for my baby.My husband was in the Navy and out to sea for six months, so I took a few college courses to pass the time. One was a philosophy course on ethics, and I chose the bioethics of infant male circumcision as the focal point of my coursework that quarter. This allowed me to work through my findings in a racially, religiously, and age-diverse classroom under the guidance of a skilled professor. I was shocked to learn that even the American Academy of Pediatrics (AAP) at that time acknowledged that there were no known medical benefits that resulted from circumcision. How, I wondered, could parents allow their newborns to undergo such a harrowing experience for no reason?As the months passed and the birth of our first son grew nearer, I had everything ready—all of the decisions made, the doctors prepared, and the hospital selected. All of that preparation went out the proverbial window when I contracted pneumonia at 30 weeks. I was admitted to the Naval Hospital and treated for a week before being airlifted to a nearby Army Hospital when my condition worsened. After a few days there, the doctor came in very early one morning to wake me. Our son's heart rate was slowing, and we were at risk of losing him. They needed to immediately perform an emergency Cesarean section to preserve his life. I was terrified, knowing the potential myriad adverse effects his pre-term birth could cause.We were rushed into the OR and within seconds I had an epidural in my back. Moments later, my perfect, tiny but silent baby was whisked from the room to be attended to by a highly skilled and immensely respected NICU team. My husband followed to keep a watchful eye on our son while I was taken to Recovery. A few hours later, I was allowed to join my husband and son in the NICU.Our baby was beautiful, but so tiny that my husband could hold him in one hand. He weighed four pounds and had an enormous needle in the top of his head. The nurse explained to me that the IV needle was in the best location for administering the IV fluids and medications that our baby needed. His pre-term birth had introduced the need for several tests and treatments I had not anticipated. This was immensely distressing for me as someone who wanted to research and understand so that I could make well-informed and ethical decisions. Keep in mind that this was in the days before smartphones. In fact, we didn't even have cell phones at that time! In order to do research, I needed to find a medical text within the hospital that I could read, or get to a library. I had an abdomen full of staples, couldn't drive, and refused to be away from my baby, so going to the library was not an option.Under the conditions, I relied on the hospital staff to help me understand the risks, benefits, and necessities of each procedure or test that they recommended. We formed a relationship of mutual respect. I think this was due to the in-depth [End Page 89] conversations we had during that time. That mutual respect we developed likely led to a remarkable conversation toward the end of our son's first week in the NICU. Our doctor was making his rounds when a nurse asked if we wanted to have our son circumcised that day since the doctor... (shrink)

Much public policy analysis requires us to place a monetary value on the bad- ness of a premature human death. Currently dominant approaches to determining this ‘value of a life’ focus exclusively on the ‘self-regarding’ value of life — that is, the value of a person’s life to the person whose death is in question — and altogether ignore effects on other people. This procedure would be justified if, as seems intuitively plausible, other-regarding effects were negligible in comparison with self-regarding (...) ones. I argue that in the light of the issue of overpopulation, that intuitively plausible condition is at best highly questionable. Unless the world is in fact underpopulated, the social disvalue of a premature death is likely to be significantly lower than the current estimates. (shrink)

The current paper aims at merely charting a brief outline of Jewish philosophical attitudes toward idolatry. In its first part, I discuss some chief trends in Rabbinic approach toward idolatry. In the second part, I examine the role of idolatry in the philosophy of religion of Moses Maimonides and Benedict de Spinoza, two towering figures of medieval and early modern Jewish philosophy. In the third and last part, I address the relevance of the notion of idolatry to contemporary Jewish life, (...) and argue that the early rabbinic announcement on the perishing of the inclination toward idolatry might have been premature. (shrink)

Reproductive senescence in human females takes place long before other body functions senesce. This fact presents an evolutionary dilemma since continued reproduction should generally be favored by natural selection. Two commonly proposed hypotheses to account for human menopause are (a) a recent increase in the human lifespan and (b) a switch to investment in close kin rather than direct reproduction. No support is found for the proposition that human lifespans have only recently increased. Data from Ache hunter-gatherers are used to (...) test the kin selection hypothesis. Ache data do not support the proposition that females can gain greater fitness benefits in old age by helping kin rather than continuing to reproduce. Nevertheless, one crucial parameter in the model, when adjusted to the highest value within the measured 95% confidence interval, would lead to the evolution of reproductive senescence at about 53 years of age. Further investigation is necessary to determine whether the kin selection hypothesis of menopause can account for its current maintenance in most populations. (shrink)

The aim of this article is to generate knowledge about parents’ participation in life-and-death decisions concerning their very premature and/or critically ill infants in hospital neonatal units. The question is: what are parents’ attitudes towards their involvement in such decision making? A descriptive study design using in-depth interviews was chosen. During the period 1997-2000, 20 qualitative interviews with 35 parents of 26 children were carried out. Ten of the infants died; 16 were alive at the time of the interview. The (...) comparative method (grounded theory) was used to analyse the data. The analysis was carried out continuously and in parallel with data collection. Six categories were revealed by the analysis: indecision and uncertainty (ambivalence); information and communication; participate, but do not decide; seeming to be included; the parents’ child; and individual consideration. The findings appear to indicate that parents agree that they should not have the final word in decisions concerning their infants’ future life or death. Such a responsibility would put too heavy a burden on parents who lack the medical knowledge and the professional experience needed to make such a decision, and would be likely to lead to them experiencing strong feelings of guilt. The findings show that parents should be well informed and listened to during the whole decision-making process. Their primary concern was how nurses and physicians communicate with parents who are experiencing a crisis, and how this serious information is presented. (shrink)

Abortion is permitted in many jurisdictions after the age at which an infant is viable on the basis of intensive neonatal care techniques. Does this cause special concerns for those involved in perinatal care and termination of pregnancy services or is the overlap mainly an abstract issue fretted over by ethicists and academics? In order to explore this question, a group of clinicians involved in this area of care were interviewed and their interviews analysed using qualitative measures. The clinicians concerned (...) were exercised by the ethical issues and had various ways of resolving them which tended to reflect a gradualist, multifaceted and, to some extent, particularist approach to ethical decision-making in relation to the edges of human life. The ways in which those strands of ethical thought are instanced in the interview material are reported and discussed. (shrink)

Drawing on the relevant alternatives framework and Mary Kate McGowan’s work on conversational scorekeeping, I argue that usage of the term ‘conspiracy theory’ in ordinary language and public discourse typically entails the performance of what I call a dismissive conversational exercitive, a kind of speech act that functions to exclude certain propositions from (or prevent their inclusion in) the set of alternatives considered relevant in a given conversational context. While it can be legitimate to perform dismissive conversational exercitives, excluding alternatives (...) that deserve to be taken seriously can be highly problematic for a variety of reasons. For one, it can give rise to what I call the problem of premature conclusions when subjects illegitimately dismiss certain propositions as irrelevant and, as a result, prematurely take certain conclusions or claims to be warranted. Depending on the kind of conclusion or claim, the problem can come in different variants, three of which I shall examine in more detail: the problem of premature knowledge claims, the problem of premature causal claims, and the problem of premature generic generalizations. (shrink)

Lifelong premature ejaculation (LPE) is a common male sexual dysfunction. Lack of active control for rapid ejaculation brought great distress to sexual harmony, and even fertility. Previous neurophysiology studies revealed an ejaculation-related control mechanism in the brain. However, it remains unclear whether this inhibitory network is altered in LPE patients. The present study investigated the central inhibitory network function of LPE patients by using stop signal task-related functional magnetic resonance imaging and resting-state functional connectivity analysis. The results showed no difference (...) in task-related behavioral performance or neural activation during response inhibition between LPE patients and controls. However, LPE patients showed a significantly different correlation pattern between the stop signal reaction time (SSRT) and left inferior frontal gyrus activation during successful inhibition, in which a typical negative correlation between SSRT and the activation was completely disappeared in patients. In addition, using the left inferior frontal gyrus as a seed, patients showed weaker functional connectivity between the seed and two areas (left dental nucleus and right frontal pole) compared with controls. These data suggest that LPE patients have an abnormal brain control network, which may contribute to the reduced central control of rapid ejaculation. This study provides new insights into the neural mechanism of LPE involving the central inhibitory network, which may offer an underlying intervention target for future treatment. (shrink)