Medicine › Pediatrics, Perinatology and Child Health

Ethical Considerations in Pediatric Medical Decision-Making

Works Count: 59422

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This cluster of papers focuses on the ethical considerations and complexities involved in pediatric medical decision-making, particularly when there are disagreements between parents and medical professionals. It explores topics such as parental discretion, best interest standards, state intervention in treatment refusals, shared decision-making, conflict management, adolescent autonomy, and end-of-life decisions in pediatric care.

Keywords

Pediatric; Medical Ethics; Parental Discretion; Best Interest Standard; State Intervention; Treatment Refusals; Shared Decision-Making; Conflict Management; Adolescent Autonomy; End-of-Life Decisions

A guide to genetic counseling

1998-01-01

Wendy R. Uhlmann , Jane L. Schuette , Beverly M. Yashar

Foreword. Preface. Contributors. 1. The Practice of Genetic Counseling ( Ann P. Walker ). 2. The Ultimate Genetic Tool: The Family History ( Jane L. Schuette and Robin L. Bennett … Foreword. Preface. Contributors. 1. The Practice of Genetic Counseling ( Ann P. Walker ). 2. The Ultimate Genetic Tool: The Family History ( Jane L. Schuette and Robin L. Bennett ). 3. Interviewing: Beginning to See Each Other ( Kathryn Spitzer Kim ). 4. Thinking It All Through: Case Preparation and Management ( Wendy R. Uhlmann ). 5. Psychosocial Counseling ( Luba Djurdjinovic ). 6. Patient Education ( Ann C. M. Smith and Toni I. Pollin ). 7. Risk Communication and Decision-Making ( Bonnie Jeanne Baty ). 8. The Medical Genetics Evaluation ( Elizabeth M. Petty ) 9. Understanding Genetic Testing ( W. Andrew Faucett and Patricia A. Ward ). 10. Medical Documentation ( Debra Lochner Doyle ). 11. Multicultural Counseling ( Gottfried Oosterwal ). 12. Ethical and Legal Issues ( Susan Schmerler ). 13. Student Supervision: Strategies for Providing Direction, Guidance, and Support ( Patricia McCarthy Veach and Bonnie S. LeRoy ). 14. Genetic Counseling Research: Understanding the Basics ( Beverly M. Yashar ). 15. Professional Identity and Development ( Elizabeth A. Gettig and Karen Greendale ). 16. Genetic Counselors as Educators ( Debra L. Collins and Joseph D. McInerney ). 17. Evolving Roles, Expanding Opportunities ( Elizabeth A. Balkite and Maureen E. Smith ). 18. Putting it All Together: Three Case Examples ( Jane L. Schuette, Donna F. Blumenthal, Monica L. Marvin, and Cheryl Shuman ). Index.

Promoting Children's Participation in Democratic Decision-Making

2001-01-01

Gerison Lansdown

In this Innocenti Insight, Gerison Lansdown examines the meaning of Article 12 of the Convention on the Rights of the Child, which says that children are entitled to participate in … In this Innocenti Insight, Gerison Lansdown examines the meaning of Article 12 of the Convention on the Rights of the Child, which says that children are entitled to participate in the decisions that affect them. Lansdown takes a close look at the full meaning of this Article as a tool that can help children themselves to challenge abuses of their rights and take action to defend those rights. She also stresses what the Article does not do. It does not, for example, give children the right to ride roughshod over the rights of others, particularly parents. The Insight makes a strong case for listening to children, outlining the implications of failing to do so and challenging many of the arguments that have been levelled against child participation. It is, above all, a practical guide to this issue, with clear checklists for child participation in conferences and many concrete examples of recent initiatives.

REACTIONS TO THE THREATENED LOSS OF A CHILD: A VULNERABLE CHILD SYNDROME. PEDIATRIC MANAGEMENT OF THE DYING CHILD, PART III.

1964-07-01

Morris Green , Albert J. Solnit

1. A group of clinical features constituting a vulnerable child syndrome is reported and described in 25 children with a history of an illness or accident from which they recovered … 1. A group of clinical features constituting a vulnerable child syndrome is reported and described in 25 children with a history of an illness or accident from which they recovered although the parents were expecting a fatal outcome. 2. This paper describes a study of this group based on the hypothesis that children who are expected by their parents to die prematurely often react with a disturbance in psychosocial development and in the parent-child relationship. 3. Outstanding clinical features include difficulty with separation, infantile behavior, bodily overconcerns, and school underachievement. 4. Predisposing factors and determinants of the symptomatology are discussed along with suggestions for management and prevention.

Textbook of Pediatric Rheumatology

2016-01-01

James T. Cassidy , R.E. Petty

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The intrauterine bougie and voorhees bag today

1958-09-01

Clifford R. Taylor

Children, Families, and Health Care Decision Making

1998-12-17

Lainie Friedman Ross

Abstract Issues In Biomedical Ethics General Editors: John Harris, University of Manchester; S(ren Holm, University of Copenhagen. Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London. North American Consulting … Abstract Issues In Biomedical Ethics General Editors: John Harris, University of Manchester; S(ren Holm, University of Copenhagen. Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London. North American Consulting Editor: Bonnie Steinbock, Professor of Philosophy, SUNY, Albany. The late twentieth century has witnessed dramatic technological developments in biomedical science and the delivery of health care, and these developments have brought with them important social changes. All too often ethical analysis has lagged behind these changes. The purpose of this series is to provide lively, up-to-date, and authoritative studies for the increasingly large and diverse readership concerned with issues in biomedical ethics--not just health care trainees and professionals, but also social scientists, philosophers, lawyers, social workers, and legislators. The series will feature both single-author and multi-author books, short and accessible enough to be widely read, each of them focused on an issue of outstanding current importance and interest. Philosophers, doctors, and lawyers from several countries already feature among the contributors to the series. It promises to become the leading channel for the best original work in this burgeoning field. this book: Lainie Friedman Ross presents an original and controversial examination of the moral principles that guide parents in making health care decisions for their children, and the role of children in the decision-making process. She opposes the current movement to increase child autonomy, in favour of respect for family autonomy. She argues that children should be included in the decision-making process but that parents should be responsible for their children's health care even after the children have achieved some threshold level of competency. The first half of the book presents and defends a model of decision-making for children's health care; the second half shows how it works in various practical contexts, considering children as research subjects and as patients, organ donorship, and issues relating to adolescent sexuality. Implementation of Ross's model would result in significant changes in what informed consent allows and requires for paediatric health care decisions. This is the first systematic medical ethics book that focuses specifically on children's health care. It has important things to say to health care providers who work with children, as well as to ethicists and public policy analysts.

The evolving capacities of the child

2005-01-01

Gerison Lansdown

The Convention on the Rights of the Child introduces for the first time in an international human rights treaty, the concept of the ‘evolving capacities’ of the child. This principle … The Convention on the Rights of the Child introduces for the first time in an international human rights treaty, the concept of the ‘evolving capacities’ of the child. This principle has been described as a new principle of interpretation in international law, recognising that, as children acquire enhanced competencies, there is a diminishing need for protection and a greater capacity to take responsibility for decisions affecting their lives. The Convention allows for the recognition that children in different environments and cultures, and faced with diverse life experiences, will acquire competencies at different ages. Action is needed in law, policy and practice so that the contributions children make and the capacities they hold are acknowledged. The purpose of the study is to open the discussion and promote debate to achieve a better understanding of how children can be protected, in accordance with their evolving capacities, and also provided with opportunities to participate in the fulfillment of their rights.

Children, Rights and Childhood

2006-05-26

Michael Freeman

Children, Rights and Childhood by David Archard London : Routledge , 2004 ISBN 0415305845 , 246 pp , £16.99 (pb) Eleven years separate this book from an earlier version of … Children, Rights and Childhood by David Archard London : Routledge , 2004 ISBN 0415305845 , 246 pp , £16.99 (pb) Eleven years separate this book from an earlier version of it. It is now much more substantial and there is greater emphasis on children's rights, with much more attention given to the UN Convention of 1989. It is a book by a philosopher and it has the characteristic of that discipline: the argument is clear, it is well reasoned and balanced. Philosophers can often offer insights even when they traverse relatively unexplored philosophical terrain: Archard's chapter on child abuse is a case in point. He is particularly good at teasing out arguments and at assessing implications. Look, for example, at his discussion on whether children should have the vote – on this he sits on the fence – or at his analysis of why corporal punishment is not a form of child abuse. I think both of these conclusions are wrong, but I would certainly recommend those who wish to debate either of these issues to read his incisively-argued text. The book begins slowly and rather unpromisingly with a discussion of Locke. There is then an excellent appraisal of the Ariès thesis on childhood. This employs the Rawlsian distinction between ‘concept’ and ‘conception’ (Rawls, 1971). Archard explains that ‘to have a concept of ‘‘childhood’’ is to recognize that children differ interestingly from adults; to have a conception of childhood is to have a view of what those interesting differences are’. (p. 27) There are many philosophical insights like this throughout the book. The following chapter on the modern conception of childhood traces the origins of this and discusses standard luminaries, notably Freud and Piaget. It also contains an interesting passage (pp. 48–49) on J.M. Barrie's Peter Pan. Is this a magical tale of childhood innocence preserved or, as Archard argues, a social satire that most emphatically does not celebrate the possibility of eternal youth? This leaves me wishing to explore other (children's) novels of that era. Let us not forget that two of the early advocates of children's rights, Kate Douglas Wiggin and Janusz Korzcak were writing stories for children at more or less the same time. [For those unfamiliar with Korzcak – sadly most of us for I had to recently recommend him to a professor of childhood history! – Betty Jean Lifton's (1988) biography is a great read.] The central part of Archard's book is on children's rights and by itself would make a highly recommendable undergraduate text. There is a simple explanation of the difference between moral and legal rights, a brief tour of the Convention which rightly emphasises both Article 3 (the best interests provision) and Article 12 (which stresses that the child is a subject and not merely the object of intervention): a rational appraisal of the child liberation movement of the 1970s, with a particularly good critique of Howard Cohen's proposal for children to ‘borrow’ capacities by having representatives [oddly, Richard Farson (1974), whose Birthrights is the seminal text of this movement, sometimes features as Daniel Farson!]. There is a separate chapter on two of the rights of self-determination identified by Farson and the other leading proponent of liberation, John Holt, viz. voting and sexual freedom, which is particularly good on citizenship rights. Sexual choice and sexual abuse are both discussed by Archard, but the bulk of the discussion of the latter is placed 100 pages after that on sexual rights, which is, I think, a pity. In a pedagogical context there is a need to juxtapose them. The chapter on wrongdoing by children is all too brief. The impression is conveyed that the doli incapax doctrine survives, whereas in fact it was a victim to the hysteria of the Bulger case. The merits of the Scottish Children's Hearings are alluded to (pp. 130–132), but those unfamiliar with it will be left with questions unanswered. There follows a section on ‘Children, Parents, Family and State’. There is a good discussion of the right to reproduce (the ‘right to bear’, he calls it), though this pays insufficient attention to the infertile (should they be vetted when the fertile are not? Should there be a right to fertility treatment on the NHS?), and to the asymmetry between men and women (men have no say once a pregnancy has commenced). There is discussion also of the rights of parents, to rear, to autonomy and to privacy. Archard is strong on trying to tease out the justifications for parental rights. He does not discuss Hill's (1991) oft-quoted view that emphasises intention – this works particularly well where there is assisted conception – or, obviously as it came too late, the dilemma of a case like that of Evans (2005), where on a break-up of a relationship the would-be-father (that is genetic father) withdrew his consent thus frustrating his former partner's only chance of motherhood. He could devote more attention to explaining what a parent is; the significance of emphasising the ‘social’ as opposed to the ‘genetic’ for example. The licensing of parents is also usefully debated. La Follette's proposal is discussed, but Eisenberg's (1994) more thought-through prospectus is not. As already noted, this section of the book contains a good chapter on child abuse. His reasons for thinking corporal punishment is not child abuse repay study. I think he ignores too much evidence which points the other way. It is a pity there is no reference to the experience of countries which have made hitting children unlawful. He recognises the social engineering potential of such legislation, but maintains ‘it may be acceptable to do to a child what one may not do to an adult precisely because it is a child one is doing it to’ (p. 197). But this is an argument for a range of anti-child practices including child abuse. A society which does not use physical violence as a means of correction is far less likely to abuse its children physically (and, I would add, sexually). Archard's ‘Conclusion’ is packed with ideas. He puts forward, what he calls, ‘a modest collectivist proposal’. He starts from the principle that ‘the valuation and understanding of childhood and adulthood are mutually interdependent’. (p. 208) He notes ‘the character of adult society will derive from the ways in which its children are brought up’. (p. 209) Does this mean that a society which tolerates the hitting of children will become/remain one which uses violence to resolve conflict? Archard does not say. Archard goes on to spell out the values of adult society which should determine our thinking about childhood: they are equality, democracy and collectivism. And it is collectivism which is, he argues, the most crucial. His is a defence of ‘modest collectivism’. And it is an odd assortment: a universal provision of pre-school facilities, diffusion of parenting, a collective valuation of children and a significant extension of children's rights. He favours the incorporation of the UN Convention into UK law. Some countries, for example Brazil, have already done this. And we will, as we did with the European Convention on Human Rights, but it will take time – and sustained pressure. He favours a Children's Commissioner. I suspect he would not be satisfied by what England has now got. Earlier in his book, he is ambivalent about giving children the vote, but by his ‘conclusion’ he advocates lowering the age of voting, though he does not say to what. But should there any more be a minimum age than there is a maximum one? My 2-year-old granddaughter is as capable of exercising a voting choice as my 89-year-old mother, and the impact of the result will be felt more by the toddler than the old lady. This is a thought-provoking text and as such a highly recommendable read. Its audience could range from policy-makers to sixth-formers for it offers insights into one of the issues of our time – how to understand childhood. And one that requires ongoing debate.

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Informed Consent, Parental Permission, and Assent in Pediatric Practice

1995-11-01

William G. Bartholome

As the author of the first draft of the recently published Academy statement, Informed Consent, Parental Permission, and Assent in Pediatric Practice,1 I would like to comment on several of … As the author of the first draft of the recently published Academy statement, Informed Consent, Parental Permission, and Assent in Pediatric Practice,1 I would like to comment on several of the "qualifying" or "clarifying" additions that have been made in this statement during its decade long struggle to gain Academy approval. I am particularly concerned about the possible misinterpretation of three of these additions. The first addition is the statement, "Parents and physicians should not exclude children and adolescents from decision-making without persuasive reasons"

The optimistic child

1996-03-01

Martin E. P. Seligman , Karen Reivich , Lisa Jaycox +1 more

Principles of health care ethics

1995-02-01

R Gillon , Ann Lloyd

Partial table of contents: APPROACHES TO APPLIED HEALTH CARE ETHICS. The 'Four Principles' Approach (T. Beauchamp). Medical Ethics, Kant and Mortality (S. Furness). RELATIONSHIPS AND HEALTH CARE ETHICS. The Doctor-Patient … Partial table of contents: APPROACHES TO APPLIED HEALTH CARE ETHICS. The 'Four Principles' Approach (T. Beauchamp). Medical Ethics, Kant and Mortality (S. Furness). RELATIONSHIPS AND HEALTH CARE ETHICS. The Doctor-Patient Relationship (R. Downie). Absolute Confidentiality? (D. Black). MORAL PROBLEMS IN PARTICULAR HEALTH CARE CONTEXTS. Ethical Problems in Infertility Treatment (R. Snowden & E. Snowden). Children: Problems in Pediatrics (P. Graham). HEALTH CARE ETHICS AND SOCIETY. Medical Research, Society and Health Care Ethics (T. Ackerman). AIDS: Health Care Ethics and Society (A. Pinching). ETHICAL PROBLEMS OF SCIENTIFIC ADVANCE. Genetic Counseling (M. Seller). Against Brainstem Death (M. Evans). Index.

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Empathy and Moral Development: Implications for Caring and Justice

2001-09-01

Zora Raboteg-Šarić , Martin L. Hoffman

1. Introduction and overview 2. Empathy, its arousal and prosocial functioning 3. Development of empathic distress 4. Empathic anger, sympathy, guilt, feeling of injustice 5. Guilt and moral internalization 6. … 1. Introduction and overview 2. Empathy, its arousal and prosocial functioning 3. Development of empathic distress 4. Empathic anger, sympathy, guilt, feeling of injustice 5. Guilt and moral internalization 6. From discipline to internalization 7. Relationship and other virtual guilts 8. Empathy's limitations: is empathy enough? 9. Empathy and moral principles 10. Development of empathy-based justice principles 11. Multiple- claimant and caring-versus-justice dilemmas 12. The universality and culture issue 13. Implications for intervention.

Sex, gender, and health: the need for a new approach

2001-11-03

Lesley Doyal

With advances in medical technology more can be offered with respect to treatment, for example, in neonates born prematurely. This raises the public’s expectations of what medical professionals can offer … With advances in medical technology more can be offered with respect to treatment, for example, in neonates born prematurely. This raises the public’s expectations of what medical professionals can offer and puts healthcare professionals under pressure to continue treatment, which may ultimately be futile. The courts may be asked to intervene in those cases where there is disagreement between parents and healthcare professionals. This may occur where doctors refuse to instigate or continue futile treatments or where treatment is not felt to be in the best interests of the patient. Cases may also be referred to the courts where doctors feel treatment options do exist but those with parental responsibility refuse to consent. Disagreement may also occur between parents. The best interests of the child are paramount and their welfare should always be the primary consideration. However, the court’s opinion will be increasingly sought as parents’ expectations increase and doctors fear litigation if they act against the parents’ wishes. This paper reviews the role of the courts, using a number of high profile cases as examples. While the courts generally support the views of the healthcare professional, this cannot be guaranteed.

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Patient preferences and randomised clinical trials.

1989-07-29

Chris R. Brewin , Clare Bradley

The child should be examined but not without the knowledge and agreement of a parent (or the order of a court). Mothers of pr?adolescent children should always be invited to … The child should be examined but not without the knowledge and agreement of a parent (or the order of a court). Mothers of pr?adolescent children should always be invited to be present, except in the most exceptional circumstances. Adolescent patients should be asked whether they wish a parent to be present. It is usually counterproductive to examine a resistant child, and if his or her cooperation cannot be obtained the examination should be deferred unless there are urgent medical reasons to proceed. The child should be examined as soon as optimal arrangements can be made. Few children require urgent examination. Repetitive examination is usually abusive and should be avoided. The examination should be conducted in absolute privacy and in an environment where the child can be comfortable?not behind screens in open wards or in police stations. There should be adequate equipment for any necessary diagnostic tests. Recording and photographic facilities are an advantage but their value is outweighed if they cause distress to the child or mean that another examination has to be conducted. Who should examine?

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Dignity is a useless concept

2003-12-18

Ruth Macklin

It means no more than respect for persons or their autonomy Appeals to human dignity populate the landscape of medical ethics. Claims that some feature of medical research or practice … It means no more than respect for persons or their autonomy Appeals to human dignity populate the landscape of medical ethics. Claims that some feature of medical research or practice violates or threatens human dignity abound, often in connection with developments in genetics or reproductive technology. But are such charges coherent? Is dignity a useful concept for an ethical analysis of medical activities? A close inspection of leading examples shows that appeals to dignity are either vague restatements of other, more precise, notions or mere slogans that add nothing to an understanding of the topic. Possibly the most prominent references to dignity appear in the many international human rights instruments, such as the United Nations' universal declaration of human rights.1 With few exceptions, these conventions do not address medical treatment or research. A leading exception is the Council of Europe's convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine.2 In this and other documents “dignity” seems to have no meaning beyond what is implied by the principle of medical ethics, respect for persons: the need to obtain voluntary, informed consent; the requirement to protect confidentiality; …

Competing Institutions: Law, Medicine, and Family in Neonatal Intensive Care

1999-01-01

Carol A. Heimer

To understand the varying impact of law, we must compare the effects of legal institutions with the effects of rival institutions and the impact one law with the impact of … To understand the varying impact of law, we must compare the effects of legal institutions with the effects of rival institutions and the impact one law with the impact of another. We must also ask how the setting in which institutions compete and laws are implemented—very often an organization—shapes outcomes. Using the competition between legal, medical, and familial institutions in infant intensive care units as an example, this article elaborates a theory of institutional competition and therefore of the influence of law in organizations. I show that institutions, including legal institutions, gain influence by working through internal organizational processes. Thus, the impact of law on medical decisionmaking varies with whether legal actors have learned how to be present when decisions are to be made, make legal issues into organizational problems, introduce choice points that require action, and alter the possibility space of eligible solutions. Using variations among the major categories of laws that govern the practice of infant intensive care, the article also shows how organizational and institutional theories help explain why some laws have more impact than others.

PARENTAL AGE AND MUTATION

1955-08-01

L. S. PENROSE

Prenatal Testing and Disability Rights

2001-01-01

Laura Purdy

Pediatric and Adolescent Gynecology,

1991-02-01

S. Jean Emans , Marc R. Laufer , Donald P. Goldstein

Office Evaluation of the Child and Adolescent S. Jean Emans Sexual Differentation and Ambiguous Genitalia in the Newborn Ingrid Holm Vulvovaginal Problems in the Prepubertal Child S. Jean Emans Physiology … Office Evaluation of the Child and Adolescent S. Jean Emans Sexual Differentation and Ambiguous Genitalia in the Newborn Ingrid Holm Vulvovaginal Problems in the Prepubertal Child S. Jean Emans Physiology of Puberty and The Menstrual Cycle Catherine Gordon and Marc Laufer Precocious Puberty Joan Mansfield Delayed Puberty S. Jean Emans Amenorrhea in the Adolescent S. Jean Emans Dysfunctional Uterine Bleeding S. Jean Emans Androgen Abnormalities in the Adolescent S. Jean Emans Structural Abnormalities of the Female Reproductive Tract Marc Laufer, Don Goldstein, and Hardy Hendren Dysmenorrhea, Pelvic Pain, and PMS Marc Laufer and Don Goldstein Education of the Child and Adolescent: In the Office and Perioperatively Phaedra Thomas, Ann Jenks Micheli and Vicki Burke Urologic Problems in the child and adolescent Craig Peters Vulvovaginal Complaints in the Adolescent Elizabeth Woods and S. Jean Emans STD's: Gonorrhea, Chlamydia, PID, Syphilis Lydia Shrier HIV in Young Women Cathryn Samples HPV in children and adolescents, and Pap Smear Evaluation in Adolescents Jessica Kahn, Lauren Brown, and Merrill Weitzel Benign and Malignant Ovarian Masses Don Goldstein and Marc Laufer Breast Don Goldstein and Marc Laufer Contraception S. Jean Emans Teen Pregnancy Angela Nicoletti, S. Jean Emans, and Marc Laufer Sexuality Amy Middleman and Moe Melchiono Gynecologic Issues in Young Women with Chronic Diseases Marc Laufer and S. Jean Emans Sexual Abuse in the Child and Adolescent Ranee Leder and S. Jean Emans Complimentary and Alternative Medicine for Gyn patients Wendy Wornham Legal Issues in Pediatric and Adolescent Gynecology Richard Bourne and The Honorable Susan Ricci Appendix 1. Gyn Health Education Resources for Parents, Children, and Adolescent, Include websites Appendix 2: Instructions for taking OCs Appendix 3: WHO guidelines Appendix 4: State of California Sexual Abuse Protocol Appendix 5: Body Fat Appendix 6: Bone Age Predictions for Final Height Appendix 7: Topical Steroids

Technical report: ethical and policy issues in genetic testing and screening of children

2013-02-21

L. F. Ross , Howard M. Saal , Karen L. David +1 more

Empathy and Moral Development: Implications for Caring and Justice

2001-05-01

B Stilwell

Death and Dignity

1991-03-07

Timothy E. Quill

Diane was feeling tired and had a rash. A common scenario, though there was something subliminally worrisome that prompted me to check her blood count. Her hematocrit was 22, and … Diane was feeling tired and had a rash. A common scenario, though there was something subliminally worrisome that prompted me to check her blood count. Her hematocrit was 22, and the white-cell count was 4.3 with some metamyelocytes and unusual white cells. I wanted it to be viral, trying to deny what was staring me in the face. Perhaps in a repeated count it would disappear. I called Diane and told her it might be more serious than I had initially thought — that the test needed to be repeated and that if she felt worse, we might have to . . .

The Groningen Protocol — Euthanasia in Severely Ill Newborns

2005-03-09

Eduard Verhagen , Pieter J. J. Sauer

Drs. Eduard Verhagen and Pieter Sauer state that of the 200,000 children born in the Netherlands every year, about 1000 die during the first year of life. For 600 of … Drs. Eduard Verhagen and Pieter Sauer state that of the 200,000 children born in the Netherlands every year, about 1000 die during the first year of life. For 600 of these infants, death is preceded by a medical decision regarding the end of life. The question now is whether deliberate life-ending procedures are acceptable for newborns and infants, despite the fact that these patients cannot express their own will.

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End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries

2000-06-01

Marina Cuttini , Michela Nadai , Monique Kaminski +7 more

Daily Living With Distress and Enrichment: The Moral Experience of Families With Ventilator-Assisted Children at Home

2006-01-01

Franco A. Carnevale , Eren Alexander , Michael W. Davis +2 more

OBJECTIVE. The growing shift toward home care services assumes that “being home is good” and that this is the most desirable option. Although ethical issues in medical decision-making have been … OBJECTIVE. The growing shift toward home care services assumes that “being home is good” and that this is the most desirable option. Although ethical issues in medical decision-making have been examined in numerous contexts, home care decisions for technology-dependent children and the moral dilemmas that this population confronts remain virtually unknown. This study explored the moral dimension of family experience through detailed accounts of life with a child who requires assisted ventilation at home. This study involved an examination of moral phenomena inherent in (1) the individual experiences of the ventilator-assisted child, siblings, and parents and (2) everyday family life as a whole. METHODS. A qualitative method based on Richard Zaner's interpretive framework was selected for this study. The population of interest for this study was the families of children who are supported by a ventilator or a positive-pressure device at home. Twelve families (38 family members) were recruited through the Quebec Program for Home Ventilatory Assistance. Children in the study population fell into 4 diagnostic groups: (1) abnormal ventilatory control (eg, central hypoventilation syndrome), (2) neuromuscular disorders, (3) spina bifida, and (4) craniofacial or airway abnormalities resulting in upper airway obstruction. All 4 of these diagnostic groups were included in this study. Among the 12 children recruited, 4 received ventilation via tracheostomies, and 8 received ventilation with face masks. All of the latter received ventilation only at night, except for 1 child, who received ventilation 24 hours a day. Family moral experiences were investigated using semistructured interviews and fieldwork observations conducted in the families' homes. RESULTS. Data analysis identified 6 principal themes. The themes raised by families whose children received ventilation invasively via a tracheostomy were not systematically different or more distressed than were families of children with face masks. The principal themes were (1) confronting parental responsibility: parental responsibility was described as stressful and sometimes overwhelming. Parents needed to devote extraordinary care and attention to their children's needs. They struggled with the significant emotional strain, physical and psychological dependence of the child, impact on family relationships, living with the daily threat of death, and feeling that there was “no free choice” in the matter: they could not have chosen to let their child die. (2) Seeking normality: all of the families devoted significant efforts toward normalizing their experiences. They created common routines so that their lives could resemble those of “normal” families. These efforts seemed motivated by a fundamental striving for a stable family and home life. This “striving for stability” was sometimes undermined by limitations in family finances, family cohesion, and unpredictability of the child's condition. (3) Conflicting social values: families were offended by the reactions that they faced in their everyday community. They believe that the child's life is devalued, frequently referred to as a life not worth maintaining. They felt like strangers in their own communities, sometimes needing to seclude themselves within their homes. (4) Living in isolation: families reported a deep sense of isolation. In light of the complex medical needs of these children, neither the extended families nor the medical system could support the families' respite needs. (5) What about the voice of the child? The children in this study (patients and siblings) were generally silent when asked to talk about their experience. Some children described their ventilators as good things. They helped them breathe and feel better. Some siblings expressed resentment toward the increased attention that their ventilated sibling was receiving. (6) Questioning the moral order: most families questioned the “moral order” of their lives. They contemplated how “good things” and “bad things” are determined in their world. Parents described their life as a very unfair situation, yet there was nothing that they could do about it. Finally, an overarching phenomenon that best characterizes these families' experiences was identified: daily living with distress and enrichment. Virtually every aspect of the lives of these families was highly complicated and frequently overwhelming. An immediate interpretation of these findings is that families should be fully informed of the demands and hardships that would await them, encouraging parents perhaps to decide otherwise. This would be but a partial reading of the findings, because despite the enormous difficulties described by these families, they also reported deep enrichments and rewarding experiences that they could not imagine living without. Life with a child who requires assisted ventilation at home involves living every day with a complex tension between the distresses and enrichments that arise out of this experience. The conundrum inherent in this situation is that there are no simple means for reconciling this tension. This irreconcilability is particularly stressful for these families. Having their child permanently institutionalized or “disconnected” from ventilation (and life) would eliminate both the distresses and the enrichments. These options are outside the realm of what these families could live with, aside from the 1 family whose child is now permanently hospitalized, at a tremendous cost of guilt to the family. CONCLUSIONS. These findings make important contributions by (1) advancing our understanding of the moral experiences of this group of families; (2) speaking to the larger context of other technology-dependent children who require home care; (3) relating home care experiences to neonatal, critical care, and other hospital services, suggesting that these settings examine their approaches to this population that may impose preventable burdens on the lives of these children and their families; and (4) examining a moral problem with an empirical method. Such problems are typically investigated through conceptual analyses, without directly examining lived experience. These findings advance our thinking about how we ought to care for these children, through a better understanding of what it is like to care for them and the corresponding major distresses and rewarding enrichments. These findings call for an increased sensitization to the needs of this population among staff in critical care, acute, and community settings. Integrated community support services are required to help counter the significant distress endured by these families. Additional research is required to examine the experience of other families who have decided either not to bring home their child who requires ventilation or withdraw ventilation and let the child die.

Moral and Ethical Dilemmas in the Special-Care Nursery

1973-10-25

Raymond S. Duff , A. G. M. Campbell

Abstract Of 299 consecutive deaths occurring in a special-care nursery, 43 (14 per cent) were related to withholding treatment. In this group were 15 with multiple anomalies, eight with trisomy, … Abstract Of 299 consecutive deaths occurring in a special-care nursery, 43 (14 per cent) were related to withholding treatment. In this group were 15 with multiple anomalies, eight with trisomy, eight with cardiopulmonary disease, seven with meningomyelocele, three with other Central-nervous-system disorders, and two with short-bowel syndrome. After careful consideration of each of these 43 infants, parents and physicians in a group decision concluded that prognosis for meaningful life was extremely poor or hopeless, and therefore rejected further treatment. The awesome finality of these decisions, combined with a potential for error in prognosis, made the choice agonizing for families and health professionals. Nevertheless, the issue has to be faced, for not to decide is an arbitrary and potentially devastating decision of default. (N Engl J Med 289:890–894, 1973)

Synthesis of -fetoprotein by liver, yolk sac, and gastrointestinal tract of the human conceptus.

1972-05-01

David Gitlin , Anita Perricelli , Geraldine M. Gitlin

Synthesis of serum alpha fetoprotein (AFP) was studied in 16 human embryos and fetuses from 4.2-18 weeks of gestation by incubation of selected tissues in radiolabeled amino acids followed by … Synthesis of serum alpha fetoprotein (AFP) was studied in 16 human embryos and fetuses from 4.2-18 weeks of gestation by incubation of selected tissues in radiolabeled amino acids followed by immunoelectrophoresis of the culture fluids and radioautography. Relatively large amounts of radioactive AFP, judged by relative intensity of AFP precipitation line on radioautography, were found in each of the liver cultures of the developing yolk sac. AFP was observed in smaller amounts in almost all gastrointestinal tract cultures studied. Labeled AFP formed in kidney cultures from 1 of 9 conceptuses and in only 1 of 14 placentas cultured. None of the cultures containing lung, thymus, pancreas, skeletal muscle, amnion, chorion, or blood produced detectable amounts of AFP.

Parental refusals of medical treatment: the harm principle as threshold for state intervention

2004-01-01

Douglas S. Diekema

Ethical and Policy Issues in Genetic Testing and Screening of Children

2013-02-21

Mary E. Fallat , Aviva L. Katz , Mark R. Mercurio +7 more

The genetic testing and genetic screening of children are commonplace. Decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. The … The genetic testing and genetic screening of children are commonplace. Decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. The growing literature on the psychosocial and clinical effects of such testing and screening can help inform best practices. This policy statement represents recommendations developed collaboratively by the American Academy of Pediatrics and the American College of Medical Genetics and Genomics with respect to many of the scenarios in which genetic testing and screening can occur.

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Deciding for others: the ethics of surrogate decision making

1990-10-01

Preface Introduction Part I. Theory: 1. Competence and incompetence 2. The primary ethical framework: patient-centered principles 3. Advance directives, personhood, and personal identity 4. Distributive justice and the incompetent Part … Preface Introduction Part I. Theory: 1. Competence and incompetence 2. The primary ethical framework: patient-centered principles 3. Advance directives, personhood, and personal identity 4. Distributive justice and the incompetent Part II. Application: 5. Minors 6. The elderly 7. The mentally ill Looking forward Appendix 1: living trust and nomination of conservatorship Appendix 2: durable power of attorney for health care Notes Index.

Medicine and the Law

1987-07-01

Diana Brahams

At the British Medical Association's 1987 conference, members approved a statement, contrary to the Association's official policy, that testing for human immunodeficiency virus (HIV) infection "should be at the discretion … At the British Medical Association's 1987 conference, members approved a statement, contrary to the Association's official policy, that testing for human immunodeficiency virus (HIV) infection "should be at the discretion of the patient's doctor and should not necessarily require the consent of the patient." Brahams considers whether the practice is unlawful. General consent for treatment that requires blood tests could include HIV tests if not expressly excluded, but might be invalid if deception was involved. The mentally incompetent may be tested as good medical practice demands. Brahams also discusses the legal aspects of confidentiality and disclosure of HIV status to various third parties, and the legal liability and legal claims of HIV infected persons. She concludes that the law could be used to control the spread of AIDS by regulating behavior.

Medicine and the Law

1983-07-01

Diana Brahams

According to the British Medical Association's Handbook of Medical Ethics and the General Medical Council's latest guidelines, the parents of a minor requesting contraceptive advice from a physician should not … According to the British Medical Association's Handbook of Medical Ethics and the General Medical Council's latest guidelines, the parents of a minor requesting contraceptive advice from a physician should not be informed without the minor's consent. Both publications fail to note that British criminal law regards intercourse with girls under the age of 13 as a serious offense. Brahams argues that a physician's responsibility to these young patients is greater than that to older girls and that the final decision on whether or not to notify parents should rest with the doctor rather than the patient.

Informed Consent in Decision-Making in Pediatric Practice

2016-07-25

Aviva L. Katz , Sally A. Webb , Robert Macauley +5 more

This Technical Report was reaffirmed January 2023. Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that … This Technical Report was reaffirmed January 2023. Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in their health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child’s and adolescent’s opinion in medical decision-making in clinical practice and research. This technical report, which accompanies the policy statement “Informed Consent in Decision-Making in Pediatric Practice” was written to provide a broader background on the nature of informed consent, surrogate decision-making in pediatric practice, information on child and adolescent decision-making, and special issues in adolescent informed consent, assent, and refusal. It is anticipated that this information will help provide support for the recommendations included in the policy statement.

Informed Consent, Parental Permission, and Assent in Pediatric Practice

1995-02-01

A re-analysis of informed consent leads to the identification of important limitations and problems in its application to pediatric practice. Two additional concepts are needed: parental permission and patient assent. … A re-analysis of informed consent leads to the identification of important limitations and problems in its application to pediatric practice. Two additional concepts are needed: parental permission and patient assent. The American Academy of Pediatrics believes that in most cases, physicians have an ethical (and legal) obligation to obtain parental permission to undertaken recommended medical interventions. In many circumstances, physicians should also solicit a patient assent when developmentally appropriate. In cases involving emancipated or mature minors with adequate decision-making capacity, or when otherwise permitted by law, physicians should seek informed consent directly from patients.

Willful Subjects

2014-01-01

Sara Ahmed

Th ere is a story called "Th e Willful Child."O nce upon a time there was a child who was willful, and would not do as her mother wished.For this … Th ere is a story called "Th e Willful Child."O nce upon a time there was a child who was willful, and would not do as her mother wished.For this reason God had no pleasure in her, and let her become ill, and no doctor could do her any good, and in a short time she lay on her death-bed.When she had been lowered into her grave, and the earth was spread over her, all at once her arm came out again, and stretched upwards, and when they had put it in and spread fresh earth over it, it was all to no purpose, for the arm always came out again.Th en the mother herself was obliged to go to the grave, and strike the arm with a rod, and when she had done that, it was drawn in, and then at last the child had rest beneath the ground.(Grimm and Grimm 1884, 125) 1 What a story.Th e willful child: she has a story to tell.In this Grimm story, which is certainly a grim story, the willful child is the one who is disobedient, who will not do as her mother wishes.If authority assumes the right to turn a wish into a command, then willfulness is a diagnosis of the failure to comply with those whose authority is given.Th e costs of such a diagnosis are high: through a chain of command (the mother, God, the doctors) the child's fate is sealed.It is ill will that responds to willfulness; the child is allowed to become ill in such a way that no one can "do her any good."Willfulness is thus compromising; it compromises the capacity of a subject to survive, let alone fl ourish.Th e punishment for willfulness is a passive willing of death, an allowing of death.Note that willfulness is also that which persists even after death: displaced onto an arm, from a body onto a body part.Th e arm inherits the willfulness of the child insofar as it will not be kept down, insofar as it keeps coming up,

The Ethics of Killing

2002-02-28

Jeff McMahan

Abstract A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose … Abstract A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism.

The Ethics of Social Research with Children: An Overview

1996-06-01

Virginia Morrow , Martin Richards

Moral Distress, Moral Residue, and the Crescendo Effect

2009-12-01

Elizabeth G. Epstein , Ann B. Hamric

The restatement of children and the law: A roadmap for ongoing law reform

2025-06-25

Marsha Levick | Family Court Review

Abstract This article discusses some key provisions of the new ALI Restatement of Children and the Law with a specific focus on how the Restatement reflects doctrinal developments in children's … Abstract This article discusses some key provisions of the new ALI Restatement of Children and the Law with a specific focus on how the Restatement reflects doctrinal developments in children's law over the last two decades as well as significant research that has informed those doctrinal developments, and points out how advocates can use the Restatement to further advance children's rights and interests in the justice system.

The right to invite and the right to decline: Parental rights in public schools

2025-06-25

Kathleen Knight Abowitz , Dustin Hornbeck | Theory and Research in Education

Parental rights are the subject of heated deliberation and policy-making in local, state, and national governing bodies. These debates are characterized by powerful disagreements regarding the role of parents, schools, … Parental rights are the subject of heated deliberation and policy-making in local, state, and national governing bodies. These debates are characterized by powerful disagreements regarding the role of parents, schools, and the interests of children and adolescents. Parents’ rights conflicts, contributing to the polarization and mistrust of public schools more broadly, demand a more nuanced and complex rendering of parenting, particularly as it functions as an ethical domain. In this article, we seek to complicate understandings of parental rights by defining parenting as a practice – a socially recognized activity with normative standards and often associated with moral traditions. We describe parenting as a practice using the example of the education of LGBTQ+ students to explore justifications for, and limitations to parental rights claims. The practice of parenting establishes, and helps safeguard, the parental right to invite their children into their own cultural and religious ways of life. We argue that, while public schools in a liberal democracy should be largely neutral in regards to the varied parenting practices seen in US society, and honor the parental right to invite, these schools must simultaneously be preparing students with an education that enables them to exercise their rights to accept or decline their parents’ cultural norms and roles. Public schools thus should prepare students with an education that enables them, if needed, to exercise a corresponding right to decline the ways of life on offer by parents. While parents are key partners in the process, student’s educational interests are the ultimate focus of a public educational institution.

“Everything is Tuberculosis” – Except the Law?

2025-06-24

James G. Hodge | The Journal of Law Medicine & Ethics

Abstract In “Everything is Tuberculosis,” author John Green assesses the intricacies of the communicable condition, TB, as a source of significant morbidity and mortality globally over centuries. Despite available vaccines, … Abstract In “Everything is Tuberculosis,” author John Green assesses the intricacies of the communicable condition, TB, as a source of significant morbidity and mortality globally over centuries. Despite available vaccines, treatments, and protocols, tens of millions are infected and over a million persons will die from TB in 2025 alone. In searching for answers to mitigate this global scourge, however, Green looks past a key factor — specifically the role of law — as a primary tool for prevention and control.

An Adolescent with Unusual Behavior

2025-06-23

| American Academy of Pediatrics eBooks

Biopolitics and Education

2025-06-23

Kenneth J. Saltman | Routledge eBooks

Parents’ capacity to make decisions for their children

2025-06-20

Robert Wheeler | Archives of Disease in Childhood

The Impact of State Legislation on the Incidence of Births With Congenital Anomalies in Texas

2025-06-20

Neha Malik , Connor Fritz , Clark R. Andersen +6 more | Annals of Surgery

Objective: To investigate changes in the incidence of births with congenital anomalies after the passage of abortion restrictions in Texas. Background Summary: In-utero diagnosis of congenital abnormalities allows families to … Objective: To investigate changes in the incidence of births with congenital anomalies after the passage of abortion restrictions in Texas. Background Summary: In-utero diagnosis of congenital abnormalities allows families to discuss predicted quality of life and costs and potentially decide to terminate a pregnancy. However, in September 2021, Texas Senate Bill 8 (SB8) banned abortion after 6 weeks’ gestation with no exceptions for fatal fetal anomalies. Methods: We retrospectively reviewed all “Newborn” admissions in the Texas Inpatient Public Use Discharge Data File from Q1 of 2019 to Q3 of 2023. Congenital anomalies were identified based on relevant International Classification of Diseases–10 codes. Logistic regression and interrupted time series analysis was performed to assess the incidence of congenital anomalies in relation to SB8. Slopes for each time interval were compared to determine if the odds of congenital anomalies changed significantly per quarter. Results: We identified 1,686,198 newborn patients. Of these, 277,826 patients (16.5%) had congenital anomalies. The incidence of congenital anomalies increased significantly beginning in Q3 of 2022 through Q3 of 2023 (odds ratio [OR]: 1.05; P =0.002). The per-year odds of congenital anomalies increased from 1.063 before SB8 to 1.147 after SB8 ( P <0.0001). The number of lethal congenital anomalies or mortality did not change significantly after Q2 of 2022. Results were unchanged when controlling for race and ethnicity. Conclusions: With the passage of SB8, the incidence of births with congenital anomalies increased substantially in Texas. Further research is warranted on the long-term implications of this increase.

Consensus Statements on End‐Of‐Life Care in <scp>ICU</scp>

2025-06-19

Jon Henrik Laake , Tayyba Naz Aslam | Acta Anaesthesiologica Scandinavica

When parents disagree

2025-06-18

Cayetano García-Castrillón Armengou | Routledge eBooks

Legal Liability in Neurology: Navigating Malpractice and Regulatory Compliance

2025-06-18

Joseph S. Kass | Seminars in Neurology

Abstract This article provides a comprehensive examination of legal liability in neurology, encompassing both malpractice litigation and compliance with federal regulations. The article highlights how legal accountability hinges on adherence … Abstract This article provides a comprehensive examination of legal liability in neurology, encompassing both malpractice litigation and compliance with federal regulations. The article highlights how legal accountability hinges on adherence to the standard of care, the adequacy of informed consent, and accurate documentation of decision-making capacity. Special attention is given to legal and ethical challenges in treating vulnerable populations, including children, pregnant women, and cognitively impaired individuals, for whom neurologists must navigate consent, reporting mandates, and surrogate decision-making. The article also explores driving restrictions for individuals with epilepsy or dementia, where state-specific laws and evolving tort doctrines influence physician liability. The assessment of decision-making capacity and testamentary competency is addressed, emphasizing the role of the neurologist in legal proceedings and estate planning. Brain death determination is discussed as a particularly contentious area with significant implications for organ donation and family disputes. On the regulatory side, the article reviews key statutes such as HIPAA, the 21st Century Cures Act, the False Claims Act, and the Stark Law, identifying the implications for privacy, billing practices, and physician referral behavior. Risk management strategies are offered to help neurologists navigate legal uncertainty, strengthen patient relationships, and comply with federal mandates. This article aims to serve as both a practical guide and a legal primer for neurologists practicing in an increasingly litigious and regulated environment.

Pediatrik Palyatif Bakımda Sosyal Hizmet Uygulamaları

2025-06-17

Cihangir Karakaya | Tıbbi Sosyal Hizmet Dergisi

Yaşamı tehdit eden ya da sınırlayan hastalıklara sahip çocukların ve ailelerinin fiziksel, psikososyal ve ruhsal ihtiyaçlarını karşılamayı ve yaşam kalitelerini yükseltmeyi amaçlayan bir bakım felsefesi olan pediatrik palyatif bakım Türkiye’de … Yaşamı tehdit eden ya da sınırlayan hastalıklara sahip çocukların ve ailelerinin fiziksel, psikososyal ve ruhsal ihtiyaçlarını karşılamayı ve yaşam kalitelerini yükseltmeyi amaçlayan bir bakım felsefesi olan pediatrik palyatif bakım Türkiye’de son yıllarda hızlı bir gelişme göstermektedir. Pediatrik palyatif bakım, çocukların güçlenmesini ve yaşam kalitelerinin artırılmasını hedefleyen, toplum temelli bir yaklaşımı esas alan sosyal hizmet mesleği için oldukça önemli bir çalışma alanıdır. Pediatrik palyatif bakımda sosyal hizmet uzmanları, çocukların ve ailelerinin duygusal, sosyal ve ekonomik ihtiyaçlarını karşılamak, yaşam kalitelerini artırmak ve tedavi sürecindeki zorluklarla başa çıkmalarına yardımcı olmak için bütüncül bir psikososyal bakım sunarlar. Multidisipliner ekipte eşsiz bir konuma sahip olmalarına rağmen sosyal hizmet uzmanlarının pediatrik palyatif bakımdaki rolleri ulusal literatürde yeterince tanımlanmamıştır. Bu kapsamda çalışmada sosyal hizmet mesleğinin pediatrik palyatif bakımdaki yeri ve geleceği ele alınmıştır. Çalışma, hem sosyal hizmet uzmanlarının hem de diğer sağlık profesyonellerinin sosyal hizmet mesleğinin pediatrik palyatif bakımdaki kritik rolünü anlamalarına ve benimsemelerine yardımcı olarak multidisipliner uygulamanın gelişmesine katkı sağlayabilir.

Virtue Ethics: Some Reflections From The Philosophy Of Aristotle, Hume And Nietzsche

2025-06-17

Satap Halder | International Journal For Multidisciplinary Research

This article explores the distinct yet interconnected approaches to virtue ethics presented by Aristotle, David Hume, and Friedrich Nietzsche. Virtue ethics, broadly defined, is a moral theory emphasizing character and … This article explores the distinct yet interconnected approaches to virtue ethics presented by Aristotle, David Hume, and Friedrich Nietzsche. Virtue ethics, broadly defined, is a moral theory emphasizing character and moral virtues over rules or consequences. While Aristotle grounds virtue in reason and defines the good life (eudaimonia) as living in accordance with rational activity and social excellence, Hume reinterprets virtue through the lens of emotion, arguing that moral judgment stems from feelings like sympathy and benevolence rather than rational deliberation. Nietzsche, diverging further, criticizes traditional moral frameworks altogether, presenting virtue as a dynamic and personal expression of strength and individuality, independent of universal reason or emotion. By employing these three perspectives, the study categorizes Aristotle’s model as eudaimonian virtue ethics, Hume’s as sentimentalist virtue ethics, and Nietzsche’s as a virtue ethics of becoming. These distinctions illuminate the evolving role of reason in moral philosophy and highlight contrasting views of human flourishing, moral development, and the nature of virtue itself.

School-Related Public Inquiries Received by the Centers for Disease Control and Prevention During the COVID-19 Pandemic, United States, 2020-2022

2025-06-16

Danielle L. Kleven , Lisa C. Barrios , Lillian Fineman +2 more | medRxiv (Cold Spring Harbor Laboratory)

Objectives: After supporting the COVID-19 emergency response and responding to public inquiries, we sought to identify common themes to prepare for and improve future emergency response efforts. We examined how … Objectives: After supporting the COVID-19 emergency response and responding to public inquiries, we sought to identify common themes to prepare for and improve future emergency response efforts. We examined how often various themes (topics) were asked of the Centers for Disease Control and Prevention (CDC) through CDC-INFO (agents who respond to public requests) about the COVID-19 pandemic and kindergarten through grade 12 (K-12) schools, whether inquiries included questions or complaints, how theme frequency changed, and how the source of CDC-INFO agent responses varied by theme. Methods: We analyzed inquiries (questions or complaints) received by CDC-INFO from January 17, 2020, to November 8, 2022. We pilot-tested our protocol by coding 300 inquiries to create a code book with 11 themes (eg, quarantine and isolation, general guidance) and then tested them for interrater reliability before coding 4000 additional randomly selected inquiries (of 24 502 inquiries received). We then compiled descriptive statistics and used Chi-square goodness-of-fit tests to compare differences between frequencies of categorical variables. Results: We found 2180 inquiries related to K-12 schools and COVID-19 and assigned 1 or more themes for analysis (resulting in 2439 themes). The most common theme was quarantine and isolation (39%). Across all themes, except for closures, the frequency of questions was greater than the frequency of complaints. For 5 of 11 themes (closure, general guidance, face masks, quarantine and isolation, travel), we found significant differences in inquiry frequency over time. For all themes, except for travel, we found significant differences in which sources CDC-INFO agents used to respond to inquiries. Conclusions: Public health officials should be prepared to respond to school-based questions about quarantine and isolation and to address various topics as the emergency changes over time.

Judge rules against medical school

2025-06-16

| Campus Legal Advisor

Case name: Yoder v. Ohio State University, et al. , No. 2:23‐cv‐3967 (S.D. Ohio 03/10/25). Case name: Yoder v. Ohio State University, et al. , No. 2:23‐cv‐3967 (S.D. Ohio 03/10/25).

Understanding Garbha Vriddhi Kram (Foetal Development) in Sushruta Samhita: A Textual Review and Interpretation with Modern Embryology

2025-06-15

Sangeeta Dev | International Journal For Multidisciplinary Research

This review explores the Ayurvedic concept of Garbha Vriddhi Kram (fetal development) as presented in the Sushruta Samhita and examines its comparative alignment with modern embryology. Rooted in holistic philosophy, … This review explores the Ayurvedic concept of Garbha Vriddhi Kram (fetal development) as presented in the Sushruta Samhita and examines its comparative alignment with modern embryology. Rooted in holistic philosophy, Ayurvedic embryology integrates physical, metaphysical, and elemental principles, notably the union of Shukra (sperm), Artava (ovum), and Atma (consciousness), and the influence of Panchamahabhutas (five elements) in embryogenesis. The review aims to (a) analyze the month-wise fetal development process (Masanumasik Vikas) described in Sharira Sthana, (b) interpret metaphoric stages such as Kalala and Mamsavat in the light of modern biological milestones, and (c) assess clinical and philosophical implications of these descriptions in prenatal care. A systematic literature review was conducted using PRISMA methodology across databases like PubMed, Google Scholar, AYUSH Portal, and ResearchGate, focusing on sources from 2000 to 2025. From an initial pool of 243 articles, 36 high-relevance papers were selected and critically evaluated using a modified CASP checklist. These included classical commentaries, clinical trials, philosophical essays, and comparative anatomy studies. The findings reveal a deep parallelism between Ayurvedic embryological metaphors and contemporary stages such as zygote formation, organogenesis, and fetal neurological development. Additionally, Ayurvedic constructs like Garbhini Paricharya (prenatal care regimen), Chetana (consciousness), and maternal influences closely align with emerging understandings in epigenetics and perinatal science. The study also identifies research gaps, including metaphorical ambiguities and limited empirical validation, and calls for interdisciplinary collaborations in integrative embryology. This review offers a novel synthesis bridging ancient and modern perspectives, underscoring the continued relevance of Ayurvedic wisdom in contemporary prenatal care and biomedical education.

How paediatric nurses frame the ethics of non-disclosure directives

2025-06-14

Mandy El Ali , Jenny O’Neill , Lynn Gillam | Nursing Ethics

Background Nurses caring for hospitalised children can be told not to disclose information to the patient. Such non-disclosure directives in adult care pose recognised ethical problems, as they impinge on … Background Nurses caring for hospitalised children can be told not to disclose information to the patient. Such non-disclosure directives in adult care pose recognised ethical problems, as they impinge on a patient’s autonomy and right to their own information, and have been discussed widely in the literature, from a physician’s perspective. Despite the ethical implications, there is less discussion of the ethics of withholding information from children. Nurses are well positioned to advocate for the rights of a child while considering their best interests; hence, nurses’ thinking about the ethics of non-disclosure directives is valuable. Aim The aim of this study was to explore the experiences and attitudes of nurses with truth-telling to seriously ill children, specifically how nurses frame and think about the ethical challenges when given a directive not to tell the truth to a child. Design An interpretive phenomenological approach was employed for this research, with data collected by semi-structured interviews. Participant Population Twenty-six nurses in Australia who had cared for children hospitalised with a serious illness in the previous 5 years. Ethical Considerations Ethics approval was granted by the University of Melbourne’s Human Research Ethics Committee (37283A). Informed consent was acquired from all participants. Findings Four themes encompass the views nurse-participants expressed about the ethics of a non-disclosure directive: (i) Lying is wrong, (ii) Children should know, (iii) It’s hard for us when the child doesn’t know, but (iv) It’s not our place to tell. Nurse-participants described how a non-disclosure directive affected how they cared for their patients. Conclusions Nurse-participants believed they should be honest and articulated ethical reasons why children should be told the truth about their medical condition, but did not feel they were able to initiate this. It is recommended that nurses are supported in these ethically challenging situations and included in decision-making about how to respond when parents direct that information be withheld from their child.

INTERNATIONAL STANDARDS OF THE INSTITUTION OF CHILD ADOPTION

2025-06-13

Viktoriia Kuzyk , Vasyl Kasiyanchuk , Oleg Ukrainian | Scientific and informational bulletin of Ivano-Frankivsk University of Law named after King Danylo Halytskyi

Purpose. The purpose of the article is to study the foreign experience of legal regulation of adoption of children by foreigners, primarily under the laws of the European Union and … Purpose. The purpose of the article is to study the foreign experience of legal regulation of adoption of children by foreigners, primarily under the laws of the European Union and the countries bordering Ukraine. Methodology. In order to achieve this goal, the author conducted a comprehensive analysis of the available information on the issue under consideration and formed conclusions and proposals based on the same. The following methods of scientific cognition were used in the course of the study: dialectical, system-structural, terminological, system-functional, historical, normative-dogmatic, and generalization methods. Results. As a result of the research, it was found that in the practice of the states neighboring Ukraine and the European Union member states, there are three approaches to determining the procedure for the adoption of children by foreign citizens: by determining the national regime for foreigners, similar to that which exists for citizens of the respective state (Latvia); by determining the conflict of laws applicable to adoption relations, as defined in civil codes (Germany, France, Czech Republic or separate laws on private international law (Spain, Switzerland); through the establishment of a separate adoption procedure (Bulgaria, Belarus, Moldova, Ireland) or the exceptional case of adoption by foreigners using the same adoption procedure as in domestic adoption (Poland, Hungary). Originality. For the first time, the author systematizes and summarizes the material on the peculiarities of legal regulation of adoption of children by foreigners under the family law of foreign countries and identifies international standards for the functioning of this institution. Practical significance. The results of the research can be used in the law-making and human rights activities of officials, human rights activists and scholars regarding the legal regulation of adoption of children by foreigners under the family law of Ukraine based on the international standards that have been formed on the European continent.

Disciplining the child

2025-06-13

Veena Nandagiri | Routledge eBooks

Cracking down on fake nurses to protect professional identity

2025-06-12

Stephanie Heughan | Learning Disability Practice

Bridging the Gap: Genetic Counseling, Islamic Bioethics, Challenges, and Recommendations

2025-06-11

Iqra Javaid , Abdul Mannan , Mariam Khan +2 more | Indus journal of bioscience research.

This paper examines the intersection between genetic counseling, testing, and Islamic bioethics, with a particular emphasis on the challenges faced by Muslim communities and the often neglected experiences of migrants … This paper examines the intersection between genetic counseling, testing, and Islamic bioethics, with a particular emphasis on the challenges faced by Muslim communities and the often neglected experiences of migrants and refugees. In predominantly Muslim nations, the high prevalence of consanguineous marriages significantly contributes to the burden of genetic disorders such as sickle cell anaemia and β-thalassemia. While advancements in genetic testing and prenatal diagnostics have improved early detection, there remain significant gaps in ethical guidance, accessibility, and training. Muslim communities face additional challenges, including language barriers, cultural displacement, and inconsistent healthcare. This study investigates these gaps, explores emerging ethical issues associated with technologies such as CRISPR, and proposes frameworks for culturally sensitive genetic counseling.

Euthanasia, Anti‐Egalitarian Bias, and Breach of the Duty of Medical Care: A Reply to Rivera López

2025-06-11

Federico Germán Abal | Bioethics

ABSTRACT Rivera López offers a coherent defense of three norms: the right to active euthanasia, the right to refuse or withdraw medical treatments, and the prohibition of consensual homicide. These … ABSTRACT Rivera López offers a coherent defense of three norms: the right to active euthanasia, the right to refuse or withdraw medical treatments, and the prohibition of consensual homicide. These norms appear to come to tension if an autonomy‐based justification for euthanasia is adopted. To resolve this tension, Rivera López appeals to a paternalistic argument and to the distinction between the right to autonomy and the right to bodily integrity. In this paper, I argue that the paternalistic argument implies an anti‐egalitarian bias about the value of certain lives and that the distinction between the right to autonomy and the right to bodily integrity leads to consequences that are incompatible with the special duty of medical care.

Dishonesty and Young People's Liability

2025-06-10

Mark Telford , Rose Tempowski | Routledge eBooks

My Future parental Responsibility, My Choice

2025-06-10

Alex Naileg | Elpis Filozófiatudományi Folyóirat

I show that equality of rights and responsibilities, abortion rights, and genuine parental responsibility cannot coexist. Abortion rights entail that persons capable of becoming pregnant have the right to relinquish … I show that equality of rights and responsibilities, abortion rights, and genuine parental responsibility cannot coexist. Abortion rights entail that persons capable of becoming pregnant have the right to relinquish future parental responsibility; however, biological fathers of their born children do not have such a right, thereby violating equality of rights. I carefully analyze the available options to resolve the logical contradiction. One consequence of the contradiction is that those justification attempts of abortion rights which implicitly assume equality of rights and responsibilities and genuine parental responsibility (such as an argument of Réz in Elpis) are either logically invalid or based on contradictory premises. Instead of abandoning abortion rights or equality, I note that ultimate parental responsibility may rest not with natural persons, but with the state. Either way, mandatory child support laws should be reexamined.

Every child has the right to be counted

2025-06-09

| United Nations eBooks

Correcting Your Child's Conduct

2025-06-06

David Adams | Routledge eBooks

Supplemental Material for Turkish Mothers’ Judgments Around Personal Choice and Autonomy

2025-06-05

Children and law

2025-06-05

Advocating for child health through storytelling

2025-06-05

Dawn Gano | Pediatric Research

Ethical dimensions of electronic fetal monitoring: challenges and practices

2025-06-04

Ayşe Kurtoğlu , Berna Arba | Medicine and law

- Electronic fetal monitoring (EFM) plays a central role in modern obstetric care but faces ethical, legal and practical challenges. - It was initially developed to reduce neonatal complications and … - Electronic fetal monitoring (EFM) plays a central role in modern obstetric care but faces ethical, legal and practical challenges. - It was initially developed to reduce neonatal complications and improve maternal outcomes, and introduced into practice without a single clinical trial. - It is now ubiquitous and accepted globally as the standard of care, raising concerns about over-medicalisation, high false-positive rates and the risk of unnecessary interventions. - Informed consent plays an important role in ensuring that patients understand EFM’s benefits, potential risks and limitations. - This review considers the historical development, ethical implications and current issues related to EFM, focusing on informed consent and malpractice risks. - By promoting evidence-based practice, improving clinician education and advancing patient-centred care, the health professions can address these challenges and ensure that EFM is not used in support of a woman’s care, unless the physician can articulate a benefit and obtain informed consent. - EFM must be guided by autonomy, beneficence and justice principles to optimise maternal and fetal outcomes.

Five decades of fetal monitoring and cerebral palsy litigation: A Sage of denialism, double speaking, and insanity

2025-06-04

Thomas P. Sartwelle , James C. Johnston | Medicine and law

- Electronic Fetal Monitoring (EFM) became a worldwide obstetrical standard of care even though there were no clinical trials, and its scientific foundations were weak to nonexistent. - Trial lawyers … - Electronic Fetal Monitoring (EFM) became a worldwide obstetrical standard of care even though there were no clinical trials, and its scientific foundations were weak to nonexistent. - Trial lawyers in the industrialized world and their EFM “courtroom experts” turned EFM into a courtroom truncheon assaulting their colleagues for causing cerebral palsy which the EFM inventors said EFM would predict and just-in-time cesarean sections (C-sections) would prevent. - These courtroom assaults continue today even though EFM-CP research proves this courtroom theory is nothing more than junk science. - A few EFM-CP researchers and a few thought leaders warned that EFM was causing more harm than good but mainstream obstetrics attacked or ignored these naysayers accelerating EFM use and C-section rates to ever increasing numbers. - Obstetrics has begun to acknowledge EFM’s faults but adopting the best version of 1984 doublespeak