Parents and guardians in child protection systems are in unequal power relationships with child protection practitioners. This relationship is experienced as exclusionary or even oppressive by many parents and guardians. For families and communities in the child protection system who experience intersectional discrimination and disadvantage, such as people with intellectual disabilities and First Nations people, this unequal relationship and subsequent potential exclusion and oppression can be even more profound. A growing body of literature indicates that advocacy can assist in addressing (...) unequal relationships in other contexts, such as involuntary mental health. This paper explores the role of representational advocacy in supporting parents in child protection settings through a case study of an advocacy service in Victoria, Australia. Using a human rights framework to guide the analysis, the paper highlights how advocacy can help support rights, but that broader structural change will be required to consistently uphold the rights of parents. (shrink)

This paper attempts to give an insight into emerging ethical issues due to the increased usage of the Internet in our lives. We discuss three main theoretical approaches relating to the ethics involved in the information technology era: first, the use of IT as a tool; second, the use of social constructivist methods; and third, the approach of phenomenologists. Certain aspects of ethics and IT have been discussed based on a phenomenological approach and moral development. Further, ethical issues related to (...) social networking sites are discussed. A plausible way to make the virtual world ethically responsive is collective responsibility which proposes that society has the power to influence but not control behavior in the virtual world. (shrink)

Extant literature romanticizes frugality as a lifestyle trait that helps in the spiritual evolution of consumers, which in turn enables them in overcoming the negative consequences of materialism and over-consumption. Extant studies have not paid attention to cultural contexts, such as caste and gender, which could outline the non-volitional enactment of frugality in societies such as India. We draw from the work of the political philosopher Alain Badiou to argue that frugality embodies non-volitional subjectivities and is linked to processes of (...) responsibilization and de-politicization. We engage with layered narratives from three story-sites and conceptualize frugality as a socio-political subjectivity that disenfranchises consumers and normalizes inequality. Our study provides evidence of how consumers are made to adopt frugality to conform to political conservatism and unequal orders of caste and gender. (shrink)

Extant literature romanticizes frugality as a lifestyle trait that helps in the spiritual evolution of consumers, which in turn enables them in overcoming the negative consequences of materialism and over-consumption. Extant studies have not paid attention to cultural contexts, such as caste and gender, which could outline the non-volitional enactment of frugality in societies such as India. We draw from the work of the political philosopher Alain Badiou to argue that frugality embodies non-volitional subjectivities and is linked to processes of (...) responsibilization and de-politicization. We engage with layered narratives from three story-sites and conceptualize frugality as a socio-political subjectivity that disenfranchises consumers and normalizes inequality. Our study provides evidence of how consumers are made to adopt frugality to conform to political conservatism and unequal orders of caste and gender. (shrink)

On philosophy of history from Hindu perspectives in Indonesia.

Decentralization is predicted to increase popular participation in all processes, and especially decision-making at the local level. Through the analysis of interview data and secondary information, this claim was tested in five districts in Ghana. The evidence showed that contrary to theory, formal and informal procedures for participation are inadequate and irregular. Although the spaces for participation have been established and expanded, these are dominated by males with educated and professional backgrounds as well as the rich and influential with access (...) to power at the center. Women, the poor and disabled as well as people from rural peripheries are excluded from the process. Their exclusion is attributable to gender-insensitive decentralization policy, lack of socio-economic resources, low educational attainment, cultural practices, and patronage politics. The paper concludes that decentralization cannot compel the predicted level of participation unless these structural conditions inhibiting engagement and empowerment of especially marginalized groups are addressed. (shrink)

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

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

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

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