It seems to be commonly understood that sometimes a family lawyer’s advocacy can go too far; however, absent disciplinary proceedings or a claim in negligence, it is not always easy to identify exactly what line a lawyer has crossed. A lawyer’s role, properly understood, is to pursue their client’s interests within the bounds of legality. In this paper, I examine the positivist conception of the bounds of legality in the context of family law. My examination includes consideration of (...) adversarial and non-adversarial advocacy, how much resolve a lawyer can properly use as an advocate, and the means of a lawyer’s craft – both substantive and procedural tactics. In doing so, I provide a theoretical mapping of the bounds of legality, demonstrating that they are insufficient in family law. My aim is to provide the theoretical tools to help inform change to family law, and the law and professional rules governing lawyers. (shrink)

It seems to be commonly understood that sometimes a family lawyer’s advocacy can go too far; however, absent disciplinary proceedings or a claim in negligence, it is not always easy to identify exactly what line a lawyer has crossed. A lawyer’s role, properly understood, is to pursue their client’s interests within the bounds of legality. In this paper, I examine the positivist conception of the bounds of legality in the context of family law. My examination includes consideration of (...) adversarial and non-adversarial advocacy, how much resolve a lawyer can properly use as an advocate, and the means of a lawyer’s craft – both substantive and procedural tactics. In doing so, I provide a theoretical mapping of the bounds of legality, demonstrating that they are insufficient in family law. My aim is to provide the theoretical tools to help inform change to family law, and the law and professional rules governing lawyers. (shrink)

The aim of the article is to present the application of the lean management method as appropriate for the management of the organizational system of psychiatric care in the Zealand region of Denmark. The organizational solutions of the Danish psychiatric care system presented in this paper are individualized and adapted to the regional needs of the residents. In Denmark, there are five administrative regions, in which each independently organizes its own system of medical (psychiatric) care. This means that the (...) regions have considerable independence in choosing the acceptable and necessary methods of management, including – as is clear from the conducted research – the use of methods put-upon other areas of economy. Although the national laws in Denmark define certain conditions and guidelines for the functioning of psychiatric care (e.g. regarding the use of direct coercion/restrains for patients treated in the centres), there is a distinct separation of structures and methods of functioning throughout the whole country, which constitutes unique observation material – from the cognitive point of view. The authors of this paper conduct extensive research and analyse the systems of psychiatric care organizations in various countries (including Spain, Italy and Japan) and, as a result, the obtained results may lead to the selection of the best models from other systems (good organizational practices and management, the management methods in use), which can be applied in the currently reorganised system of the Polish psychiatric care. The choice of Denmark for the observational study is not accidental and is related not only to the fact that there is a large degree of systemic identity within the country and between the regions, but also because the country applies solutions addressed to patients with very different cultural conditions and needs, resulting from their descent, religion, and (world)-views. Denmark is one of those European countries that express a significant acceptance of diversity and tolerance, which is why communities with very different imponderables, denominations, and worldviews co-exist. In the area related to the organization of the psychiatric system, these conditions are of key importance. In the period from January 2015 to December 2017 the authors participated in study visits in Denmark, conducting research aimed at identifying the key success factors of the psychiatric care organization system in the country. The conducted analysis is also based on the analysis of literature and own and participant observations. The conclusions concerning this subject are also the result of interviews conducted with employees of the visited hospitals and system users, both professionals and patients. As the search for an optimal organizational model of psychiatric care is currently an ongoing concern in Poland, it seems justified to review the existing solutions in Europe and perform their critical analysis. A comparison of the adopted solutions was performed, in the context of, above all, the improvement of the quality of these services, their availability, and the satisfaction of patients and their families from the proposed organizational changes. The economic benefits of these solutions are also significant. (shrink)

This Article calls for a departure from the ‘positivist–professional’ definition of Elder Law. It offers a new definition that demands answers regarding the justifications for this legal area and the normative base that should guide its content. The paper draws on findings from a qualitative study with grown children who have an elderly parent in need. These findings point toward a) a preliminary theoretical framework that justifies a special area of Elder Law, embracing and transcending that of anti-ageist law, and (...) b) the relevance of Family Law jurisprudence as a normative inspiration for this legal area. (shrink)

Current literature suggests that the adversarial legal system may undergo some changes or may even be transformed by a recent influx of women lawyers into the profession. Such research indicates that women may approach ethical problems differently than men. This paper examines the responses of family law lawyers in Vancouver, British Columbia and the surrounding Lower Mainland to a hypothetical case which requires an assessment of professional responsibilities in light of potential conflicts in personal moral values.

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and (...) thematic narrative analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians. (shrink)

Immigration law is exceptional enough to deserve an administrative law focus of its own. The Administrative Procedure Act (APA) does not demand uniformity in adjudication. Therefore, it may be counterintuitive to argue that any one area of administrative adjudication is exceptional. Removal adjudication is indeed exceptional because it is an extremely dysfunctional system, it operates in a double void of fewer constitutional protections and without the protections of the APA, it relies on a vast network of civil detention, and it (...) is of a different genre than the type of regulation that drove the development of the APA. The exceptionality of removal adjudication demands a review of administrative law doctrine with this exceptionality in mind. (shrink)

Following surveys identifying the need for ongoing learning in relation to law and ethics amongst health professionals, the Law and Ethics Education and Development initiative was launched. This was a programme of education designed for, and delivered to, health professionals working within the National Health Service , UK, with the added value of multiprofessional learning amongst colleagues from a single institution. The initiative was funded by the NHS Executive and provided for two lecturers to work for three years (...) within the northwest region. The lecturers, an academic lawyer based at the University of Liverpool, and an ethicist based at the University of Manchester worked in collaboration through the auspices of the Institute of Medicine Law and Bioethics. A central …. (shrink)

The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other. To describe and synthesize Australian laws and guidelines on the disclosure of identifying information. Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. (...) Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson’s (1994) policy analysis framework. Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients. Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws. (shrink)

Law's article begins by restating the classical ANT position that objects do not exist `in themselves' but are the effect of a performative stabilization of relational networks. In addition, these material enactments inevitably have a spatial dimension; they simultaneously establish spatial conditions for objectual identity, continuity, and difference. Space must not be reified as a natural, pre-existing container of the social and the material, but is itself a performance. Moreover, there are multiple forms of spatiality beyond the Euclidean space of (...) regions, and objects may exist and achieve homeomorphism within several different spatial systems. Technologies such as the Zimbabwe Bush Pump present a fluid object which is able to exist and cohere without the presence of fixed boundaries or the permanence of a particular functional definition. The network logic, however, which gravitates towards stability and functionality, tends to exclude and silence this spatial Other. An alternative political ontology is needed which goes beyond the reification of network space in order to give voice to the fluid objects which escape its unidimensional functionality. (shrink)

Human rights discourse has been likened to a global lingua franca, and in more ways than one, the analogy seems apt. Human rights discourse is a language that is used by all yet belongs uniquely to no particular place. It crosses not only the borders between nation-states, but also the divide between national law and international law: it appears in national constitutions and international treaties alike. But is it possible to conceive of human rights as a global language or lingua (...) franca not just in a figurative or metaphorical sense, but in a literal or linguistic sense as a legal dialect defined by distinctive patterns of word choice and usage? Does there exist a global language of human rights that transcends not only national borders, but also the divide between domestic and international law? Empirical analysis suggests that the answer is yes, but this global language comes in at least two variants or dialects. New techniques for performing automated content analysis enable us to analyze the bulk of all national constitutions over the last two centuries, together with the world’s leading regional and international human rights instruments, for patterns of linguistic similarity and to evaluate how much language, if any, they share in common. Specifically, we employ a technique known as topic modeling that disassembles texts into recurring verbal patterns. The results highlight the existence of two species or dialects of rights talk—the universalist dialect and the positive-rights dialect—both of which are global in reach and rising in popularity. The universalist dialect is generic in content and draws heavily on the type of language found in international and regional human rights instruments. It appears in particularly large doses in the constitutions of transitional states, developing states, and states that have been heavily exposed to the influence of the international community. The positive-rights dialect, by contrast, is characterized by its substantive emphasis on positive rights of a social or economic variety, and by its prevalence in lengthier constitutions and constitutions from outside the common law world, especially those of the Spanish-speaking world. Both dialects of rights talk are truly transnational, in the sense that they appear simultaneously in national, regional, and international legal instruments and transcend the distinction between domestic and international law. Their existence attests to the blurring of the boundary between constitutional law and international law. (shrink)

This paper investigates force shift, a phenomenon in which the canonical discourse conventions, or force, associated with a clause type can be overridden to yield polar questions with the help of additional force-indicating devices. Previous studies attribute force shift to the presence of a complex question force component operating on semantic content. Based on utterance particles and particle clusters in Cantonese, we analyze force shift as resulting from compositional operations on force-bearing expressions. We propose that a simplex force, such as (...) assertion or question, denotes unanchored sentence acts, while a force-shifting particle like Cantonese _ho2_ is an anchoring function anchoring a sentence act to the speaker while querying whether or not the addressee can perform the sentence act. The proposed semantics makes predictions about _ho2_’s interactions with addressee-changing operations and imperatives, as well as about a larger family of force shift phenomena. (shrink)

In a secular society, does Christmas mean anything anymore? As we stuff ourselves with plumped-up turkeys, unwrap the latest useless gadget, and gather round the family tree, what real relevance does the festive season have and why do we perpetuate it? The Philosophy of Christmas is designed to be a fun book but one underpinned by an exploration of serious philosophical issues. The way we celebrate Christmas says a lot about the way we relate to each other, our society (...) and values. For instance, did you know that Santa's outfit is only red and white because those are the colours of the Coca Cola company? Already a bestselling author, Stephen Law takes a look at such things as the virgin birth (David Hume's theories on miracles), Bertrand Russell's turkey, the existential angst of Santa, and peace on earth to produce a humourous, varied and thought-provoking collection. (shrink)

In the theater the fictional Dr. Kelekian’s relief that he does not have to talk to family members about his patient’s cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as “trouble”? And why do families so often see medical professionals as uncaring and uncommunicative? (...) Presumably everyone wants the same goal—recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of “dysfunctional families” or “callous doctors,” although there are undoubtedly many of each. (shrink)

In the theater the fictional Dr. Kelekian’s relief that he does not have to talk to family members about his patient’s cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as “trouble”? And why do families so often see medical professionals as uncaring and uncommunicative? (...) Presumably everyone wants the same goal—recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of “dysfunctional families” or “callous doctors,” although there are undoubtedly many of each. (shrink)

Background: When a genetic mutation is identified in a family member, internationally, it is usually the proband’s or another responsible family member’s role to disclose the information to at-risk relatives. However, both active and passive non-disclosure in families occurs: choosing not to communicate the information or failing to communicate the information despite intention to do so, respectively. The ethical obligations to prevent harm to at-risk relatives and promote the duty of care by genetic health professionals is in (...) conflict with Privacy laws and professional regulations that prohibits disclosure of information to a third party without the consent of the proband. In New South Wales, Australia, amendments to Privacy legislation permits such disclosure to living genetic relatives with the process defined under guidelines although there is no legal duty to warn. This study assessed NSW GHP’s awareness and experience of the legislation and guidelines. Methods: An online survey collected demographics; theoretical knowledge; clinical scenarios to assess application knowledge; attitudes; confidence; experience with active non-disclosure. A link to correct answers was provided after completion. Knowledge scores above the median for non-parametric data or above the mean for parametric data were classified as ‘good’ or ‘poor’. Chi square tests assessed associations between confidence and knowledge scores. Results: While many of the 37 participants reported reading the guidelines, there was limited awareness of their scope and clinical application; that there is no legal duty to warn; and that the threat does not need to be imminent to warrant disclosure. No association between confidence and ‘good’ theoretical or applied clinical knowledge was identified. Uncertainty of their professional responsibility was identified and in the several case examples of active non-disclosure that were reported this uncertainty reflected the need for further understanding of the guidelines in regard to the processes required before disclosure was initiated. Conclusions: There is a need for further education and training about the guidelines associated with the legislation that would be relevant to support disclosure. The findings may inform future strategies to support introduction of policy changes in other jurisdictions where similar regulatory regimes are introduced. (shrink)

Medvedev's intermediate logic (MV) can be defined by means of Kripke semantics as the family of Kripke frames given by finite Boolean algebras without units as partially ordered sets. The aim of this paper is to present a proof of the theorem: For every set of connectives such that the-fragment ofMV equals the fragment of intuitionistic logic. The final part of the paper brings the negative solution to the problem set forth by T. Hosoi and H. Ono, namely: is (...) an intermediate logic based on the axiom (abc) (ab)(a c) separable? (shrink)

Sexual and reproductive health is a challenge worldwide, and much progress is needed to reach the relevant UN Sustainable Development Goals. This paper presents cross-sectional data collected in Sierra Leone on sexual and gender-based violence, family planning, child, early and forced marriage, and female genital mutilation using an innovative method of measurement: situational judgment tests, as a subset of questions within a larger survey tool. For the SJTs, respondents saw hypothetical scenarios on these themes and had to indicate how (...) they would react. The objective is to give an impression of beliefs and norms on specific behaviors, which provide insights for social and behavior change interventions. Data was collected by enumerators traveling to villages randomly selected in six districts of the country. The sample is composed of 566 respondents. Results show that FGM in particular seem to be a priority topic, in comparison to the other topics for which the norms seem to be stronger against those practices. Age differences emerged and suggest priority groups to be targeted. In terms of validity of the measurement methods, situational judgment test answers correlated positively with other items in the survey, but the magnitude of the association is often small, and sometimes not significant. Thus, more studies are needed to further explore the validity of this measure by comparing against a reference value. Using SJTs could complement other data collection tools to perform community assessment, and orient the direction of the program in its planning phase. (shrink)

Informal science learning sites create opportunities for children to learn about science outside of the classroom. This study analyzed children’s learning behaviors in ISLS using video recordings of family visits to a zoo, children’s museum, or aquarium. Furthermore, parent behaviors, features of the exhibits and the presence of an educator were also examined in relation to children’s behaviors. Participants included 63 children and 44 parents in 31 family groups. Results showed that parents’ science questions and explanations were positively (...) related to children observing the exhibit. Parents’ science explanations were also negatively related to children’s science explanations. Furthermore, children were more likely to provide science explanations when the exhibit was not interactive. Lastly there were no differences in children’s behaviors based on whether an educator was present at the exhibit. This study provides further evidence that children’s interactions with others and their environment are important for children’s learning behaviors. (shrink)

Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the (...) interaction between ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient. (shrink)

This paper is an analysis of the limits of family authority to refuse life saving treatment for a family member (in the Chinese medical context). Family consent has long been praised and practiced in many non‐Western cultural settings such as China and Japan. In contrast, the controversy of family refusal remains less examined despite its prevalence in low‐income and middle‐income countries. In this paper, we investigate family refusal in medical emergencies through a combination of legal, (...) empirical and ethical approaches, which is highly relevant to the ongoing discussion about the place of informed consent in non‐Western cultures. We first provide an overview of the Chinese legislation concerning informed consent to show the significance of family values in the context of medical decision‐making and demonstrate the lack of legal support to override family refusal. Next, we present the findings of a vignette question that investigated how 11,771 medical professionals and 2,944 patients in China responded to the family refusal of emergency treatment for an unconscious patient. In our analysis of these results, we employ ethical reasoning to question the legitimacy of family refusal of life‐sustaining emergency treatment for temporarily incompetent patients. Last, we examine some practical obstacles encountered by medical professionals wishing to override family refusal to give context to the discussion. (shrink)

Most academic papers on ethics in pandemics concentrate on the duties of healthcare professionals. This paper will consider non-professional healthcare workers: do they have a moral obligation to work during an influenza pandemic? If so, is this an obligation that outweighs others they might have, e.g., as parents, and should such an obligation be backed up by the coercive power of law? This paper considers whether non-professional healthcare workers—porters, domestic service workers, catering staff, clerks, IT support workers, etc.—have an (...) obligation to work during an influenza pandemic. It uses data collected as part of a study looking at the attitudes of healthcare workers to working during a pandemic to suggest the philosophical arguments explored. These include: being in a position to do good, the ethics of work, competing obligations to family members and in particular to children and the obligations of citizens in a state of national emergency. We also look at whether compulsory measures are justified to support a national health service during a health emergency. We conclude that even if they are, compulsion should not be restricted to non-professionals who happen to be working in the health service at the time. Rather, compulsion involving a larger pool of people with the relevant skills and abilities is more equitable. (shrink)

In recent years, the research participant’s family’s need, if not right, to know their disease risk has comprised a great deal of the genetic testing discourse. This most often arises in the context of clinical genetic tests for hereditary cancers, especially colorectal and breast cancer, and other genetic disorders where the presence of a genetic mutation greatly increases the likelihood of the disease’s manifestation. However, this discussion has not led to comprehensive or cohesive guidance for health care professionals (...) or patients. Indeed, various governmental and professional bodies run the gamut of possibilities, from no disclosure to family without the consent of the patient, to recognition that genetic risk information is important enough to the family to allow exception to traditional notions of confidentiality. (shrink)

This study examines the socioeconomic and familial background of Irish Catholic priests born between 1867 and 1911. Previous research has hypothesized that lack of marriage opportunities may influence adoption of celibacy as part of a religious institution. The present study traced data from Irish seminary registries for 46 Catholic priests born in County Limerick, Ireland, using 1901 Irish Census returns and Land Valuation records. Priests were more likely to originate from landholding backgrounds, and with landholdings greater in size and wealth (...) than the local average. Priests were found to originate from families with more sons than the national average, but with similar numbers of daughters. These findings are discussed in relation to competition for resources and lineage survival strategies. (shrink)

An Asian Indian Hindu family chose no intervention and hospice care for their newborn with hypoplastic right heart syndrome as an ethical option, and the newborn expired after five days. Professional nursing integrates values-based practice and evidence-based care with cultural humility when providing culturally responsive family-centered culture care. Each person’s worldview is unique as influenced by culture, language, and religion, among other factors. The Nursing Team sought to understand this family’s collective Indian Hindu worldview and end-of-life beliefs, (...) values, and practices, in view of the unique aspects of the situation while the team integrated evidence-based strategies to provide family-centered culture care. Parental care choices conflicted with those of the Nursing Team, and some nurses experienced moral distress and cultural dissonance when negotiating their deeply held cultural and religious views to advocate for the family. The inability to reconcile and integrate a stressful or traumatic experience impacts nurses’ well-being and contributes to compassion fatigue. Nurses need to be intentional in accessing interventions that promote coping and healing and moral resilience. Reflection and cultural humility, assessment, and knowledge in context, increase evidence-based culture care and positive outcomes. U.S. society’s views on ethical behavior continue to evolve, and some may argue that the law should place more limits on parents’ right to choose or to refuse treatment for their infants and children. Moral distress can lead to moral resilience and satisfaction of compassion when nurses provide family-centered culture care with cultural responsiveness and integrate values-based practice with evidence-based care, and aim to first do no harm. (shrink)

The “family rule” paper by Dr Foreman proposes a way of resolving the present uncertainty about medical law on children's consent and refusal. This commentary reviews how doctors' decisions are already well protected by English law and respected by the courts. The “family rule” appears to be likely only to complicate the already diffuse law on parental consent, and to weaken further the competent minor's position in cases of uncertainty and disagreement. It leaves the difficult questions about defining (...) and assessing children's competence unanswered. This commentary suggests that these questions would be better resolved through professionally determined standards of good practice that respect children and parents, rather than through rules or laws. (shrink)

The purpose of the study is to determine the compliance of the legislative interpretation of the concept of "traditional family values" with the cultural codes of legal consciousness that have developed to the current moment. In connection with this goal, the article examines the types of modern Russian family, taking into account the peculiarities of the mentality, cultural and religious traditions of the peoples of our country, analyzes the content of the norms of the Basic Law, as well (...) as other legislative acts of the Russian Federation. The scientific novelty lies in the application of the methodological tools of legal hermeneutics to determine the content of the concept of "traditional family values" and substantiate the conclusion that the transfer of this concept from broad social contacts to the field of professional legal thinking occurs in accordance with the formed cultural code. As a result of the analysis, the duality of the corresponding cultural code of legal consciousness is revealed. (shrink)

Most contemporary bioethicists believe that Western bioethical principles, such as the principle of autonomy, are universally binding wherever bioethics is found. According to these bioethicists, these principles may be subject to culturally‐conditioned further interpretations for their application in different nations or regions, but an ‘abstract content’ of each principle remains unchanged, which provides ‘an objective basis for moral judgment and international law’. This essay intends to demonstrate that this is not the case. Taking the principle of autonomy as an example, (...) this essay argues that there is no such shared ‘abstract content’ between the Western bioethical principle of autonomy and the East Asian bioethical principle of autonomy. Other things being equal, the Western principle of autonomy demands self‐determination, assumes a subjective conception of the good and promotes the value of individual independence, whilst the East Asian principle of autonomy requires family‐determination, presupposes an objective conception of the good and upholds the value of harmonious dependence. They differ from each other in the most general sense and basic moral requirement. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of (...) health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of (...) health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This study aimed to advance our understanding of 5-year-olds’ behavioral difficulties by modeling and testing both mediational protective and risk pathways simultaneously. Drawing on two national samples from different Western European countries—the United Kingdom and Germany, the proposed model considered observed sensitive parental interactive behaviors and tested child vocabulary as protective pathways connecting parental education with children’s behavioral outcomes; the risk pathways focused on negative parental disciplinary practices linking parental education, parental distress, and children’s difficult temperament to children’s behavioral difficulties. (...) Further, the tested model controlled for families’ income as well as children’s sex and formal child care attendance. Children with comparatively higher educated parents experienced more sensitive interactive behavior, had more advanced vocabulary, and exhibited fewer behavioral difficulties. Children with a comparatively higher level of difficult temperament or with parents who suffered from distress tended to experience more negative disciplinary behavior and exhibited more behavioral difficulties. Additionally, children’s vocabulary skills served as a mechanism mediating the association between parental education and children’s behavioral difficulties. Overall, we found similar patterns of results across the United Kingdom and Germany with both protective and risk pathways contributing simultaneously to children’s behavioral development. The findings suggest that promoting parents’ sensitive interactive behaviors, favorable disciplinary practices, and child’s vocabulary skills have potential for preventing early behavioral difficulties. (shrink)

Legislation for dementia care needs to be continually rethought, if the rights of older persons and other persons with dementia are to be addressed properly. We propose a theoretical framework for understanding vulnerability and dependency, which enables us to problematize the currently prevailing legal conception of adults as always able — irrespective of health or age — to act autonomously in their everyday lives. Such an approach gives rise to difficult dilemmas when persons with dementia are forced to make decisions (...) on their own about basic living conditions, such as housing and care, without decision-making support. In Sweden, for example, such matters are frequently left to the person him- or herself to decide, often without any assistance from social workers, and with family members serving as caregivers of last resort.Using vulnerability theory as the framework for our discussion, we argue that policymakers should not apply a group-oriented approach (based on factors like age, legal status, or mental capacity) to persons suffering from dementia. The needs of such individuals are as complex and varied as they themselves are. We discuss our findings from an interdisciplinary (law/social work) research project in which we examine the dilemma that social workers face when they are required, under the terms of the Swedish Social Services Act, to determine whether persons with dementia are to be granted support.We argue further that a cross-disciplinary approach — in which vulnerability theory furnishes the framework — opens up for new ways of understanding and developing social welfare law and practice. This, we believe, can help us better address the rights, interests, and needs of people with dementia, of their families, and of professionals in the social welfare system. Finally, many of the problems faced by ageing societies in general can be understood on the basis of such an approach. (shrink)

Genocide as a part of nation or ethnic group extermination process is not a well-defined concept. Its meaning is understood intuitively. When law intervenes, the issue of defining the term comes back. Nevertheless, the Polish nation has been recognized as subjected to genocide activities during the Second World War by the Nazi Germany and Soviet Union. The paper focuses on the genocide against mainly one group of Poles that is to say foresters. The martyrologic evidence proves that foresters were an (...) occupation group which for a variety of reasons suffered most. The research carried out in this respect by the National Forests in Poland has revealed that over 20% of pre-war staff of the institution actually lost their lives. They were killed by the German and Soviet occupiers, as well as the Ukrainian Insurgent Army. In the eastern parts of Poland foresters and their families were deported and sent to various labour and extermination camps e.g. in Siberia. The aim of the paper is to present the scale of genocide with the main emphasis on genocide against foresters. The definition of genocide provided by Lemkin, who coined the term, is a starting point for the analysis. The main research methods included the analysis of pertinent literature and source materials as well as the semiotic analysis of genocide circumstances. The thesis put forward by the authors is that foresters due to their education, practical skills, professional experience and insight knowledge turned out to be the group especially vulnerable and subjected to extermination on purpose. (shrink)

Social welfare workers in the protective services field—among them social workers, psychologists, and psychiatrists—are expected to follow the laws of the state in which they practice, but are also bound by their professional code of ethics. Often this does not present a problem, but at times ethical and legal expectations differ. This is particularly problematic where the professionals may be seen as agents of control, reporting possible child abuse, conducting child abuse investigations, inspecting homes, monitoring families, removing children from (...) their homes and the like, often working with or reporting to law enforcement agents where expectations are different and codes of ethics absent. This paper explores the relationship between law and professional ethics, and, in particular, situations in which actions and decisions can be legal yet unethical or ethical but yet illegal. It then analyzes some critical child protective service activities where Child Protective Services (CPS) workers exert significant control over parents and children, and where the legal and ethical requirements may differ. Finally, the paper discusses the problems that CPS professionals face when law and ethics collide, and suggests various steps to resolve some of these conflicts. (shrink)

Thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children each year, and some choose not to vaccinate their children at all. While most physicians continue to provide care to these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians are choosing to dismiss these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along (...) with the reasons given by those who advocate such an approach. I will argue that the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for doing so fail to stand up to close scrutiny. Such a strategy does not benefit the child or the health of the community, and may have a negative impact on both. Furthermore, some of the arguments in support of dismissal policies ignore the importance of professional obligation and appear to favor self-interest over the interest of the patient. (shrink)

Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain (...) the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent. (shrink)

Several studies have explored differences between North American and European doctor patient relationships. They have focused primarily on differences in philosophical traditions and historic and socioeconomic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultural studies have been carried out to identify in practice these cultural differences. This lack of standard comparative empirical studies led us to compare differences between France and the (...) USA regarding end-of-life decision-making. We tested certain assertions put forward by bioethicists concerning the impact of culture on the acceptance of advance directives in such decisions. In particular, we compared North American and French intensive care professional's attitudes toward: advance directives, and the role of the family in decisions to withhold or withdraw life-support. (shrink)

Several studies have explored differences between North American and European doctor patient relationships. They have focused primarily on differences in philosophical traditions and historic and socioeconomic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultural studies have been carried out to identify in practice these cultural differences. This lack of standard comparative empirical studies led us to compare differences between France and the (...) USA regarding end-of-life decision-making. We tested certain assertions put forward by bioethicists concerning the impact of culture on the acceptance of advance directives in such decisions. In particular, we compared North American and French intensive care professional's attitudes toward: (1) advance directives, and (2) the role of the family in decisions to withhold or withdraw life-support. (shrink)

This article examines two cases that present ethical challenges encountered by social workers in making decisions either to maintain professional boundaries or fulfil moral obligations while working with service users in vulnerable situations. In the first case, a Lebanese social worker narrates how she was motivated to step out of her official responsibilities to assist a refugee mother of three who showed suicidal ideation. In the second case, a Ugandan social worker recounts her experience while working with a family (...) whose 12-year-old daughter was raped and became pregnant, but whose parents refused to accept abortion when medical diagnosis showed that the girl’s life was in danger. A commentary from the authors is provided after each case. Both social workers were arguably motivated to act based on their concern to care for people, protect human rights, and save lives in the two case scenarios. This underscores the relevance of the ethics of care and virtue ethics in describing the associated ethical challenges in both cases. Furthermore, the dynamic nature of the ethical challenges encountered by the social workers demands open minds and flexibility in decision-making. (shrink)

BackgroundThe increasing emphasis on research, development and innovation for health in providing solutions to the high burden of diseases in the African Region has warranted a proliferation of studies including clinical trials. This changing public health landscape requires that countries develop adequate ethics review capacities to protect and minimize risks to study participants. Therefore, this study assessed the readiness of national ethics committees to respond to challenges posed by a globalized biomedical research system which is constantly challenged by new (...) public health threats, rapid scientific and technological advancements affecting biomedical research and development, delivery and manufacture of vaccines and therapies, and health technology transfer.MethodsThis is a descriptive study, which used a questionnaire structured to elicit information on the existence of relevant national legal frameworks, mechanisms for ethical review; as well as capacity requirements for national ethics committees. The questionnaire was available in English and French and was sent to 41 of the then 46 Member States of the WHO African Region, excluding the five Lusophone Member States. Information was gathered from senior officials in ministries of health, who by virtue of their offices were considered to have expert knowledge of research ethics review systems in their respective countries.ResultsThirty three of the 41 countries responded. Thirty of respondent countries had a national ethics review committee ; 79 % of which were established by law. Twenty-five NECs had secretarial and administrative support. Over 50 % of countries with NECs indicated a need for capacity strengthening through periodic training on international guidelines for health research ethics; and allocation of funds for administrative and secretariat support.ConclusionsDespite the existing training initiatives, the Region still experiences a shortage of professionals trained in health research ethics/ethicists. Committees continue to face various capacity needs especially for evaluating clinical trials, for monitoring ongoing research, database management and for accrediting institutional ethics committees. Given the growing number of clinical trials involving human participants in the African Region, there is urgent need for supporting countries without NECs to establish them; capacity strengthening where they exist; and creation of a regional network and joint ethical review mechanisms, whose membership would be open to all NECs of the Region. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis (...) on the family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe (...) abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

Vague expressions are omnipresent in natural language. Their use in legal texts is inevitable. A law phrased in vague terms will often leave it indeterminate whether it applies to a particular case. This places the law at odds with legal values. One of the fundamental pillars of the rule of law is legal certainty. The determinacy of the law enables people to use it as a guide and allows judges make impartial decisions. Vagueness poses a threat to these ideals. In (...) borderline cases, the law seems to be indeterminate and thus incapable of serving its core rule of law value. -/- In the philosophy of language, vagueness has become one of the hottest topics of the past two decades. Linguists and philosophers have investigated what distinguishes ‘soritical’ vagueness from other kinds of linguistic indeterminacy, such as ambiguity, generality, open texture, and family resemblance concepts. There is a vast literature that discusses the logical, semantic, pragmatic, and epistemic aspects of these phenomena. Legal theory has hitherto paid little attention to the differences between the various kinds of linguistic indeterminacy that are grouped under the heading of ‘vagueness’, let alone to the various theories that try to account for these phenomena. -/- Bringing together leading scholars working on the topic of vagueness in philosophy and in law, this book fosters a dialogue between philosophers and legal scholars by examining how philosophers conceive legal ambiguity from their theoretical perspective and how legal theorists make use of philosophical theories of vagueness. -/- The chapters of the book are organized into three parts. The first part addresses the import of different theories of vagueness for the law, referring to a wide range of theories from supervaluationist to contextualist and semantic realist accounts in order to address the question of whether the law can learn from engaging with philosophical discussions of vagueness. The second part of the book examines different vagueness phenomena. The contributions suggest that paying greater attention to these phenomena can make lawyers aware of specific issues and solutions as yet overlooked. The third part deals with the pragmatic aspects of vagueness in law and with the professional, political, and moral issues to which such vagueness gives rise. (shrink)

The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism: While the law has been justified by an appeal to professional values such as avoiding harm to patients, avoiding (...) the provision of unseemly care, and good stewardship of medical resources, it is applied incompletely. It allows physicians and institutional committees to refuse “futile” treatments desired by patients and families while at the same time providing no way of regulating physicians who recommend or even push “futile” treatments in similar cases. In this sense, the TADA is incomplete on its own terms. (shrink)

Background:Organ donation and transplantation have made it possible to both save life and to improve the quality of life for a large number of patients. In the last years there has been an increasing gap between the number of patients who need organs and organs available for transplantation, and the focus worldwide has been on how to meet the organ shortage. This also rises some ethical challenges.Objective:The objective of this study was to explore healthcare professionals' experience of ethics related (...) to care and interaction with critically ill patients with severe brain injuries and their families.Research design:A hermeneutic phenomenological approach was used to explore the participants' experiences. Methods for collecting data were a combination of participant observations and in-depth interviews.Participants and research context:Two ICUs in a Norwegian university hospital were recruited for data collection. A total of 12 cases were observed, and 32 of the healthcare professionals involved were interviewed.Ethical considerations:The study was approved by the Regional Committee for Research Ethics. Permission to the study in the ICUs was obtained from the Chief Physician in the two ICUs respectively. The right of the participants was ensured by written, voluntary, and informed consent.Findings:From the thematic analysis, a structure of the participants' experiences emerged as a process. While the patients' condition was clarified through phases of prognostic ambiguity, gradual clarification and prognostic certainty, interaction with the families was characterized by ambiguity that involved withholding. The prognostic process had a great impact on how the healthcare professionals interacted with the family. The interaction challenged the participants' caring values in various ways and captured an important structure in their experiences of the ethical interaction with the patients' families. These challenges distinguish caring for families in donation situations from caring for relatives of critically ill patients in general.Discussion:In the discussion we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act.Conclusion:Ethical questions should be discussed more both in educations of healthcare professionals and in clinical practice. (shrink)

In 2005, Ethiopia changed its abortion law to curb its high maternal mortality. This has led to a considerable reduction in deaths from unsafe abortions. Abortion is now legal if the woman’s pregnancy is a result of rape or incest, if her health is endangered, if the fetus has a serious deformity, if she suffers from a physical or mental deficiency, or if she is under 18 years of age. The word of the woman, if in compliance with the law, (...) is sufficient to qualify for an abortion. In this context, where the law makes the door slightly open, health workers become important in deciding who gets access to safe services and who doesn’t, thus creating considerable ethical dilemmas. The objective of this study was to explore abortion service providers’ personal experiences and reflections, perceptions of the abortion law, and ethical and dilemmas that arise. Data collection took place from March to May 2016 in Addis Ababa, at different health clinics providing abortion services. Thirty in-depth interviews and three focus group discussions were conducted with 41 abortion service providers at governmental and non-governmental clinics. Content analysis was drawn upon in the interpretation of the findings. When working in a context where the law has slightly opened the door for abortion seeking women, the health workers describe conflicting concerns, burdensome responsibilities, and ambiguity concerning how to interpret and implement the law. They describe efforts to balance their religious faith and values against their professional obligations and concern for women’s health and well-being. This negotiation is particularly evident in the care of women who fall outside the law’s indications. They usually handle ethical dilemmas and decision-making alone without guidance. Moreover, many health workers face a stigma from fellow colleagues not performing abortions and therefore keep their job a secret from family and friends. Health workers in Ethiopia experience ethical dilemmas trying to maneuver between the abortion law, their personal values, and their genuine concern for the health of women. More research is needed to further explore this. (shrink)