As a problem for thought, racial slavery is seated at the intersection of moral philosophy and philosophy of nature where the figure of the slave, a being who is wholly determined by external forces, serves as the negative measure of the capacity to make ethical judgments beyond one’s own private inclinations or exercise self-restraint for the sake of the common good. Recent theoretical interventions into our political-ecological predicament tend to split when it comes to the modern autonomous subject. This essay (...) engages with contemporary theorizing on matters of materialism, freedom, and self-consciousness as they relate to our current predicament and to racial slavery and its system of classification. (shrink)

The birth of a child with hearing impairment imposes more parentaldemands than having a child without a disability. Parents have little concernabout the holistic growth and development of their children with hearingdisability. This study aspires to delineate the parental practice and experience indealing with behavioural problems of their children with hearing-impairmentsin a Special School in Kano State, Nigeria. This study employed a qualitativecase study design in which interviews and observation were used to collectthe data. Purposeful sampling was utilised in selecting (...) three fathers and threemothers of children with hearing impairment. Data was recorded, transcribedand thematically analysed in which categories were identified and generated.The findings accentuated several major themes and categories of parentalpractice and their experiences, which have to do with counselling the childrenwith hearing impairment. Parental experience includes the judgment of othersin the family and based on the findings, the researchers provide discernments toparents, their children with hearing impairment, and the immediate communitywhere such children live. (shrink)

While previous research has established that employees who have a more conscientious leader are more likely to perceive that their leader is ethical, the underlying mechanisms and boundary conditions of this linkage remain unknown. In order to better understand the relationship between leader conscientiousness and ethical leadership, we examine the potential mediating role of leader moral reflectiveness, as well as the potential moderating role of decision-making autonomy. Drawing from social cognitive theory, results from two samples of workgroup leaders and their (...) immediate reports situated in Africa and Asia show that leader conscientiousness is positively related to leader moral reflectiveness, which in turn, is positively associated with employees’ assessment of ethical leadership. Furthermore, and consistent with our hypothesis, results from the two samples show that leader decision-making autonomy moderates the indirect path from leader conscientiousness to ethical leadership through moral reflectiveness, such that only morally reflective leaders who have high decision-making autonomy at work engage in ethical leadership behaviors. In our discussion, we highlight the theoretical and practical implications of our findings and suggest ways in which organizations can better foster ethical leadership. (shrink)

In this article, we investigated a deterministic model of pneumonia-meningitis coinfection. Employing the Atangana–Baleanu fractional derivative operator in the Caputo framework, we analyze a seven-component approach based on ordinary differential equations. Furthermore, the invariant domain, disease-free as well as endemic equilibria, and the validity of the model’s potential results are all investigated. According to controller design evaluation and modelling, the modulation technique devised is effective in diminishing the proportion of incidences in various compartments. A fundamental reproducing value is generated by (...) exploiting the next generation matrix to assess the properties of the equilibrium. The system’s reliability is further evaluated. Sensitivity analysis is used to classify the impact of each component on the spread or prevention of illness. Using simulation studies, the impacts of providing therapy have been determined. Additionally, modelling the appropriate configuration demonstrated that lowering the fractional order from 1 necessitates a rapid initiation of the specified control technique at the largest intensity achievable and retaining it for the bulk of the pandemic’s duration. (shrink)

Although some doctors celebrated when the Court of Appeal overturned Hadiza Bawa-Garba’s erasure from the medical register, it is argued here that in many ways the ruling is by no means good news for the medical profession. Doctors’ interests are served by transparent professional tribunals but the Court of Appeal’s approach to the GMC Sanctions Guidance risks increasing opacity in decision-making. Close attention to systemic factors in the criminal trial protects doctors yet the Court of Appeal states that the (...) structural circumstances surrounding Bawa-Garba’s failings were only of peripheral relevance to her conviction. Public confidence in the profession is undermined when convicted doctors return to work because the public de facto do not understand the nuance of gross negligence manslaughter law. Rather than changing the law to make the regulator more lenient towards doctors, it would be better to ensure that doctors are only convicted of gross negligence manslaughter when their conduct is so serious that they ought to be struck off. (shrink)

In the wake of two recent high-profile, controversial cases involving the prosecution and conviction of Drs Bramhall and Bawa-Garba, this article considers when it is socially desirable to criminalise doctors’ behaviour, exploring how the matters of harm, public wrongs and the public interest can play out to justify—or not, as the case may be—the criminal law’s intervention. Dr Bramhall branded his initials on patients’ livers during transplant surgery, behaviour acknowledged not to have caused his patients any harm by way (...) of injury to their organs. Dr Bawa-Garba misdiagnosed and failed to properly assess a 6-year-old boy with pneumonia and sepsis under her care, who subsequently died. Taking account of contextual and public interest concerns, can and should there be exceptions to imposing criminal liability where a doctor’s behaviour is deemed grossly negligent and a significant contribution to a patient’s death? And is it really appropriate to subject a doctor to penal sanction where he may have committed a private wrong against a patient, but does not set back their interests? (shrink)

Dr Bawa-Garba, a senior paediatric trainee who had been involved in the care of a child who died shortly after admission to hospital, was convicted of gross negligence manslaughter and subsequently erased from the medical register. We argue that criminalisation of doctors in this way is fraught with ethical tensions at levels of individual blameworthiness, systemic failures, professionalism, patient safety and at the interface of the regulator and doctor. The current response to alleged manslaughter during clinical care is not (...) fit for purpose because of its narrow focus on criminalisation and punishment of individual doctors. The justice system fails to take into account systemic issues in a sufficiently proper and informed way particularly in respect of human factors involved in decision-making. It is easier to convict individual doctors for gross negligence manslaughter than it is to effect legal accountability upon organisations. If educational reflections are used to apportion blame, then this could impact detrimentally on honesty and the duty of candour, with negative implications for patient safety. Regulatory processes should not be deployed without consideration of context. There is an urgent need for a fresh and open evaluation of professional and societal expectations from the regulator that should include positive action as well as those that are proportionately punitive. Justice and patient safety would be served better by more sophisticated contextualisation through an approach that balances accountability in healthcare with failures that can occur within complex systems, and by working to a radical shift towards a just culture. (shrink)

There’s no doubt that medical ethics should be ‘grounded’, in the sense that it aims to make a practical, normative contribution to significant ethical issues in medicine. There are a number of ways in which ethics can do that, two of which feature in this issue of the Journal of Medical Ethics. One way is by responding to significant new policy or legal developments that will have an impact on clinical practice. This issue discusses two legal developments that matter to (...) patients and healthcare professionals: the sanctions applied to Dr Bawa-Garba and the Supreme Court’s ruling on the withdrawal of artificial nutrition and hydration. A second way of grounding ethical analysis in the reality and complexity of ethical issues is by using empirical methods. There are two papers in this issue from Canada that illustrate how the subtleties of complex ethical issues can be teased out via qualitative methods. Medical tourism is an important and rapidly developing phenomenon that raises a set of interesting and tricky ethical issues.1 It has been discussed in the Journal of Medical Ethics before and its implications for end of life, dentistry and other health interventions have been explored.2 3 Reproductive tourism occurs in many countries and the complications it can create for issues such as the citizenship of resulting children have been discussed at some length in the JME.4 5 Reproductive tourism is a good example of an area where it is particularly important for ethical analysis to be grounded in the facts and reality of a situation and an empirical approach to ethics is therefore a good option for this topic. In this issue, Couture et …. (shrink)