Ethical dilemmas abound in the neonatal intensive care unit as hour-to-hour life and death decisions are made for premature or compromised newborns. This book is a rich tapestry of parental perceptions woven from the many stories parents tell about their experiences with a baby in the unit, as well as major events after discharge related to the ethical decision making.

A project featuring scholars in nursing ethics was planned in 2005. The goal was to document the contributions of some 24 selected American nurse ethicists to bioethics, and to discuss and explore the future trajectory of that work through a two-day working seminar. This article outlines the beginnings of bioethics in the USA and the specific contribution of nurse scholars to the debate, the preparation for the seminar, the results of the project, and the possible application of such a model (...) for teaching and archiving in the future. Documentation of the work carried out at the seminar resulted in the publication of a book. Short biographies of the participants at the seminar are included in Appendix 1. (shrink)

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the (...) reasoning of four women. The implications for ethical decision-making and future research are discussed. (shrink)

Although thousands of articles and books appear annually in the field of nursing ethics, the sheer volume of scholarly publications points to the need to provide assessment and focus, and that is what this book offers. Nursing and Healthcare Ethics documents the work of nurse scholars in ethics, and goes well beyond a mere documentation of what has transpired and a list of what can be done in the future. It creatively looks back to assess previous accomplishments and forward to (...) find new directions and strengthen future scholarly contributions in nursing ethics. Critical thinking activities, organized by the book s themes (such as vulnerability, care and caring, diversity and disparity, and pain and suffering) are examples of applying these scholarly insights into practice. This book is intended not only for undergraduate and graduate students in academic settings, but also for those in professional development programs. (shrink)

This article demonstrates how class and racial dynamics generate different styles of activism among women's movement organizations. Based on a comparative study of two feminist organizations—one composed of lower-class women of color and another of upper-class white women—it charts the formation of divergent types of gender politics. First, it explores how differences in the class and racial backgrounds of the memberships create distinct organizational needs; second, how these divergent political interests motivate contrasting organizational ideologies, activities, and structures; and finally how (...) they motivate different approaches to the wider women's movement. At the conclusion, implications are drawn for cross-class/race alliances among grassroots women's organizations. (shrink)

Heathen Soul Lore Foundations presents a living spiritual landscape, rooted in ancient Germanic languages and understanding, offered for modern Heathens to explore and use in their own spiritual practice. This book also presents an approach for identifying and exploring ancient concepts of 'what a soul is' that may be of interest to followers of other branches of historically based modern Paganism, and to scholars of comparative religion. Linguistic analysis, literature, folklore, comparative religion, anthropology, esoteric and philosophical approaches are used to (...) analyze old Germanic-language words relating to 'the soul'. The following souls, identified through this process, are thoroughly reviewed: Ferah, Ahma, Ghost, Hama, Aldr, Mod, Hugr, Sefa, and Saiwalo. Both scholarly and inspirational perspectives are taken, intended to stimulate both intellectual and imaginative exploration of these soul-concepts and the world-view which opens out from them. This deluxe edition provides full-color illustrations on premium quality paper in a linen-wrap hardcover book. The illustrations are chosen to stimulate engagement of the imagination in comprehending these abstract entities and their metaphysical contexts. // Review by Diana L. Paxson, author of "Essential Asatru: Walking the Path of Norse Paganism": "Since she first sent me the article on "Heathen Full-Souls" for Idunna: A Journal of Northern Tradition in 2006, I have been fascinated by Winifred Hodge Rose's development of the concept of the souls as an interactive system. I am delighted to see the full presentation of so many years of patient research and contemplation becoming available at last. In Winifred's hands, philology becomes a spiritual adventure, as words from the old Germanic languages reveal new insights into who we are and our place in the spiritual universe." // Review by John Michael Greer, author of "A World Full of Gods": "Winifred Rose has done an excellent job of gathering and synthesizing material about Heathen soul lore from a wide range of disparate sources. The resulting book is a scholarly, thorough resource that belongs on the bookshelf of every Heathen, and everyone interested in the subject.". (shrink)

The idea of transgender identity is less perceived as a mental illness but as a sexual health condition in many parts of the Western world, while it is seen as an anomaly in most parts of Africa. Transgender identity is a gender expression that differs from the naturally assigned sex. The widely accepted reason behind transgender is unsatisfactory feelings toward assigned sex by the individual. This work sets out to explore transgender identity and family life in Africa. Several works have (...) explored the concept but with less emphasis on family life as it relates to the African setting. Furthermore, this work sets out to demonstrate some implications of transgender identity in an ideal African family. In this work, we shall argue that once transgender identity is normalized in Africa, it will be a threat to family life. The arguments to be used are historical, analytical, descriptive as well as evaluative. (shrink)

Seamus heaney says that the best lyrics unite “reader and poet and poem in an experience of enlargement, of getting beyond the confines of the first person singular, of widening the lens of receptivity until it reaches and is reached by the world beyond the self.”1 In “Crossing Brooklyn Ferry,”2 the ferry crossing acts as a catalyst for meditations about the self, the interaction between self and other, their common experience of the physical world across time, and how to forge (...) bonds that overcome the intense separateness of each individual. From these meditations arise an apprehension of time that blends past, present, and future; philosophical speculations about individual human identity during corporeal.. (shrink)

This book contends that when late eighteenth- and early nineteenth-century writers sought to explain the origins of emotions, they often discovered that their feelings may not really have been their own. It explores the paradoxes of representing feelings in philosophy, aesthetic theory, gender ideology, literature, and popular sentimentality, and it argues that this period's obsession with sentimental, wayward emotion was inseparable from the dilemmas resulting from attempts to locate the origins of feelings in experience. The book shows how these epistemological (...) dilemmas became gendered by studying a series of extravagantly affective scenes in works by Hume, Wordsworth, Charlotte Smith, and Jane Austen. Making its argument through a provocative conjunction of texts that range across genres and genders and across the divide between the eighteenth century and Romanticism, Strange Fits of Passion rediscovers the relationship of empiricism to the culture of sentimentality, and the significance of emotion to Romanticism. (shrink)

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of (...) ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making.In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

In this brief commentary, I suggest Selinger and Whyte are essentially correct in their criticism of the Nudge approach advocated by Thaler and Sunstein. I use some examples from road behavior and traffic planning to amplify the criticism that the simple behavioral economics approach fails to take account of the embedding of humans and technology in the wider social and cultural context.

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons in order to explore and describe their moral orientation based on the paradigms of justice and care . The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the reasoning of four women. (...) The implications for ethical decision-making and future research are discussed. (shrink)

In my opinion it cannot be denied but that your discourse carries with it much of probability, arguing, as we say, ex suppositione, namely, granting that the Earth moves with the two motions assigned it by Copernicus; but, if one excludes those motions, all that you have said is vain and invalid; and for the exclusion of that hypothesis, it is very manifestly hinted by your discourse itself.

Over against Christianity, John Casey seeks to revive pagan notions and patterns of the cardinal virtues. He highlights the importance of anger in the pagan pattern and connects it to courage, to pride, and ultimately to friendship. I argue that his notion of friendship is overly formal and more modern than ancient pagan. Nonetheless, his treatment of pagan virtue helps clarify why Christians, with Aquinas and contra paganism, assert the primacy of prudence, qualified as infused prudence informed by charity. Only (...) within this context can Christian ideas about anger and pride be set forth. (shrink)

This thoughtful reflection on a valuable questionnaire survey of patients' attitudes regarding being told that their dentist had been infected with hepatitis B is of very direct relevance to HIV, as the authors show.1 The measured tone and analytical approach are a welcome change from the stridency that has characterised some of the debate elsewhere. I am very conscious that more time and effort has gone into drafting and redrafting, amending, revising and refining policy in this area than in any (...) other area of HIV control, with the probable exception of blood transfusion. Yet this is the setting that has the lowest risk among all established routes. Why has it been so hard to establish a satisfactory policy and practice to deal with this situation?Many factors, of course, apply. However, much seems to stem from a prevailing view, fostered by recent political administrations, that health care can be delivered in a risk-free way. This has also been linked with a “blame culture”, where adverse outcomes are seen as someone's fault, and where the professions are regarded with distrust. It has been fuelled by levels of concern about risk for HIV that have stemmed more from media “stories” about risk than careful risk assessment.Hence Blatchford et al comment that public anxiety about HIV relative to hepatitis B was a factor in assessing how the incident was handled, implying that HIV was of greater concern - even though the risk of transmission is some two orders of magnitude less. Interestingly, they also comment that, because the risk of death with HIV is higher than for hepatitis B, this balances the overall risk. I am not sure of the validity of this argument, …. (shrink)

A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and (...) differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues. (shrink)

Dr de Zulueta articulates some important and commonly held concerns about the anonymised screening programme for HIV in pregnant women, which is one of a number of such programmes that are current. However, in my view, many of these concerns reflect a failure to understand two key distinctions.In both these regards, there is a danger of putting up a “straw man” for challenge. In this commentary, I wish to pick up some of these issues to help to resolve the apparent (...) ethical tensions that Dr de Zulueta has set out.Firstly, the unlinked seroprevalence surveillance programmes, including that on pregnant women, comprise research studies that are designed to inform policy and practice, as well as individual decision making. They are not screening for the purpose of clinical care. The anonymisation is a procedural research tool, which enables the studies to be done in a way that does not undermine consent or individual autonomy. The ethical standards and duties expected of professionals are thus, in this specific regard, those that relate to the conduct of clinical research. That research is evidently designed to improve the quality of clinical care as a result of the information and insight gained. The duty of care is to apply the results of properly conducted and valid research in order to improve clinical practice on behalf of the individuals receiving care, in this case the mother and unborn child. The research conducted, in this case by a particular form of screening procedure, is not the same as a screening procedure done for clinical purposes to identify individuals who could benefit from an intervention. The ethical debate must therefore focus on the purpose in applying the procedure, not on the procedure itself, regardless of intent.Secondly, it is vital to distinguish, in debating such …. (shrink)

Guest Editors' introductionFor this special issue of the Journal of Medical Ethics we have assembled articles that reflect some of the newer issues or fresh perspectives. There is a mix of approaches including forward looks, present dilemmas and reflections on the past, now that sufficient time has elapsed to allow a considered view. We are most grateful to our wide range of contributors for their thoughtful analyses of several key areas of contemporary debate. Our own contributions include the following editorials (...) in which each of us has considered, from his own perspective, the impact of AIDS on medical ethics, a case study and a lexicon that allows brief probing of some topics.The impact of aids on medical ethics -1ANTHONY J PINCHINGMedical ethics has been matured through being tested and refined through the multifaceted challenge of AIDS. As with the society and social values from which its moral framework is derived, so medical ethics has been subjected to intense scrutiny by the emergence of this new disease. Few areas of ethical discourse have been untouched. This infection is so intensely private in its transmission, the disease so isolating and so personally devastating in its impact, it readily distinguishes the reality of what people are and do, from the rhetoric of what others may feel they should be and do. AIDS has forced us to recognise that respecting individual rights is a critical safeguard for the health of the community, as well as for the person. These issues are well illustrated by the interweaving issues of patient empowerment, respect for confidentiality, and patient advocacy and activism.EMPOWERMENTPhysicians in this field have been struck by the way in which people affected have wanted to be involved in decision making. While this has often been ascribed to their social groups, it probably was more a reflection of their younger age and a generation change …. (shrink)