Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the number of available organs, including increasing the number of registered donors and procuring organs in uncontrolled environments, are crucial but unlikely to address the shortage in the near future and will not improve donor/recipient compatibility or organ quality. If successful, organ bioengineering can solve the shortage and improve functional outcomes. (...) Studying manufactured organs in animal models has produced valuable data, but is not sufficient to understand viability in humans. Before risking manufactured organ experimentation in living humans, study of bioengineered organs in recently deceased humans would facilitate evaluation of the function of engineered tissues and the complex interactions between the host and the transplanted tissue. Although such studies do not pose risk to human subjects, they pose unique ethical challenges concerning the previous wishes of the deceased, rights of surviving family members, effective operation and fair distribution of medical services, and public transparency. This article investigates the ethical, legal and social considerations in performing engineered organ research on the recently deceased. (shrink)

Mental fictionalism holds that folk psychology should be regarded as a kind of fiction. The present version gives a Lewisian prefix semantics for mentalistic discourse, where roughly, a mentalistic sentence “p” is true iff “p” is deducible from the folk psychological fiction. An eliminativist version of the view can seem self-refuting, but this charge is neutralized. Yet a different kind of “self-effacing” emerges: Mental fictionalism appears to be a mere “parasite” on a future science of cognition, without contributing anything (...) substantial. The paper then rebuts the objection, illustrating that prefix semantics resolves a lingering problem for eliminativism from Boghossian. The problem is that eliminativists seem unable to adopt realism about neuroscience, for such realism implies that neuroscientific statements *represent* reality accurately. However, a deflationary version of prefix semantics allows the eliminativist to draw an ontologically relevant distinction (roughly) between truths that have a story-telling prefix and those that do not. (Deflationism means there is no implication that the unprefixed sentences robustly represent reality.) The overarching lesson is that eliminativists need to approach to ontology carefully so to avoid self-refutation; however, prefix semantical mental fictionalism provides the resources for them to do so. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want-to-be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the (...) class='Hi'>future children's potential to become of a certain type, more specifically: a person that will be the want-to-be parents' child. Want-to-be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want-to-be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence-based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want-to-be parents is morally required and therefore also for want-to-be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk-responsibility analysis. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want‐to‐be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the (...) class='Hi'>future children's potential to become of a certain type, more specifically: a person that will be the want‐to‐be parents' child. Want‐to‐be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want‐to‐be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence‐based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want‐to‐be parents is morally required and therefore also for want‐to‐be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk‐responsibility analysis. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want‐to‐be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the (...) class='Hi'>future children's potential to become of a certain type, more specifically: a person that will be the want‐to‐be parents' child. Want‐to‐be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want‐to‐be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence‐based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want‐to‐be parents is morally required and therefore also for want‐to‐be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk‐responsibility analysis. (shrink)

Prospective parents are sometimes partial towards their future children, engaging in what I call ‘pre-parental partiality’. Common sense morality is as permissive of pre-parental partiality as it is of ordinary parental partiality—partiality towards one’s existing children. But I argue that existing justifications for partiality typically establish weaker reasons in support of pre-parental partiality than in support of parental partiality. Thus, either these existing justifications do not fully account for our reasons of parental partiality, or our reasons to engage (...) in pre-parental partiality are indeed typically weaker than our reasons to engage in parental partiality. (shrink)

ABSTRACT As parents become increasingly able to make genetic trait selections on behalf of their children, they will need ethical guidance in deciding what genetic traits to select. Dena Davis has argued that parents act unethically if they make selections that constrain their child's range of futures. But some selections may expand the child's range of futures. And other selections may shift the child's range of futures, without either constraining or expanding that range. I contend that not only (...) would parents act unethically if they make selections that constrain the range of their child's futures, they would act unethically if they make selections that shift the range of their child's futures, because selections that shift the range of the child's futures would allow parents to over‐determine their child's futures. Thus, I contend that parents would act ethically only if they make selections that expand their child's range of futures. (shrink)

Several philosophers argue that individuals have an interest-protecting right to parent; specifically, the interest is in rearing children whom one can parent adequately. If such a right exists it can provide a solution to scepticism about duties of justice concerning distant future generations and bypass the challenge provided by the non-identity problem. Current children - whose identity is independent from environment-affecting decisions of current adults - will have, in due course, a right to parent. Adequate parenting requires resources. We (...) owe duties of justice to current children, including the satisfaction of their interest-protecting rights; therefore we owe them the conditions for rearing children adequately in the future. But to engage in permissible parenting they, too, will need sufficient resources to ensure their own children's future ability to bring up children under adequate conditions. Because this reasoning goes on ad infinitum it entails that each generation of adults owes its contemporary generation of children at least those resources that are necessary for sustaining human life indefinitely at an adequate level of wellbeing. (shrink)

The debate over the genetic testing of minors has developed into a major bioethical topic. Although several controversial questions remain unanswered, a degree of consensus has been reached regarding the policies on genetic testing of minors. Recently, several commentators have suggested that these policies are overly restrictive, too narrow in focus, and even in conflict with the limited empirical evidence that exists on this issue. We respond to these arguments in this paper, by first offering a clarification of three key (...) concepts—autonomy of the minor, future autonomy, and parental authority—which must be disentangled. We then respond to the arguments by noting the uncertainty of the value of predictive genetic information, and by assessing the psychosocial risks still involved in genetic testing of minors, which are also largely unknown. We conclude that the current consensus position is justified at this stage, in light of the predictions of harm resulting from genetic testing of minors that have not been adequately proved to be unwarranted. (shrink)

Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s thematic synthesis method was used to (...) synthesise data from identified studies. Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices. (shrink)

Guided by the ecosystem theory, this study aimed to explore the association between parental autonomy support and future-oriented coping of high school students, as well as the mediating effects of future time perspective and meaning in life in this relationship. A total of 707 Chinese high school students were involved in a paper questionnaire survey and data analysis. It was found that parental autonomy support was significantly positively related to future-oriented coping. Mediation analyses demonstrated that parental autonomy (...) support directly affects future-oriented coping; parental autonomy support indirectly affects future-oriented coping through separate mediation and serial mediation of future time perspective and meaning in life. These findings have important implications for the improvement of future-oriented coping abilities of high school students. (shrink)

That our ecological future appears grave can no longer come as any surprise. And yet we have so far failed, collectively and individually, to begin the kind of action necessary to shift our path away from catastrophic climate collapse. -/- In this stark and startling little book, Rupert Read helps us to understand the direness of our predicament while showing us a metaphor and a method — a way of thinking — by which we might transform it. From the (...) relatively uncontroversial starting point that we love our own children, we are introduced to a logic of care that iterates far into the future: in caring for our own children, we are committed to caring for the whole of human future; in caring for the whole of human future, we are committed to caring for the future of the natural world. Out of such thinking, hope emerges. -/- As Read demonstrates in this urgent call to action, accepting that we care for our own offspring commits us to a struggle on behalf of us all. (shrink)

Theories of intergenerational obligations usually take the shape of theories of distributive (social) justice. The complexities involved in intergenerational obligations force theorists to simplify. In this article I unpack two popular simplifications: the inevitability of future generations, and the Hardinesque assumption that future individuals are a burden on society but a benefit to parents. The first assumption obscures the fact that future generations consist of individuals whose existence can be a matter of voluntary choice, implying that (...) there are individuals who are responsible and accountable for that choice and for its consequences. The second assumption ignores the fact that the benefits and burdens of future individuals are complex, and different for different “beneficiaries” or “victims.” Introducing individual responsibility for procreation as a (crucially) relevant variable, and allowing a more sophisticated understanding of the impact of new individuals, generates grounds to prioritize the individual’s interest in responsibility for (creating and equipping) future individuals over any collective intergenerational obligation. I illustrate this by introducing a series of moral duties that take precedence over, and perhaps even void, possible collective redistributive duties. (shrink)

Gangestad & Simpson's model of the evolution of within-sex differences in reproductive strategies requires a degree of female choice that probably did not exist because of male coercion. We argue as well that the tradeoff between current and future reproduction accounts for more of the within-sex differences in reproductive strategies than the “good-genes-good parenting” tradeoff they propose.

ObjectiveThe goal of the study was to explore the relationship between parent–children relationships related to using the internet among kids and potentially associated factors.Materials and MethodsA sample of 1.216 Vietnamese students between the ages of 12 and 18 agreed to participate in the cross-sectional online survey. Data collected included socioeconomic characteristics and internet use status of participants, their perceived changes in relationship and communication between parents and children since using the internet, and parental control toward the child’s internet use. (...) An Ordered Logistic Regression was carried out to determine factors associated with parent–children relationship since using the internet.ResultsThe characteristics of the relationship between children and their parents since using the Internet were divided into three levels: deterioration, stability, and improvement. The topics that children most often communicate with their parents include learning, housework, and future directions. Two-way interactive activities, such as supporting parents to use the Internet, have a positive impact on the parent–child relationship. Stubborn parental control, such as establishing rules about contact or allowing Internet access and setting up global positioning system to track negatively affecting parent–child relationships.ConclusionFindings indicated that changes in the quality of the parent–child relationship were self-assessed by participants regard to kids’ internet use, especially in the COVID-19 epidemic context. Educational campaigns and programs to raise awareness of parents as to the dangers and negative influences that their children may encounter online, psychology of children’s behaviors and effects of different responding strategies are recommended. (shrink)

The sources, extent and margins of parental obligations in taking decisions regarding their children’s medical care are subjects of ongoing debates. Balancing children’s immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer (...) treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children—and indeed in some cases taking such actions is problematic. (shrink)

Like any philosophically interesting health care practice, ethical analysis of Pre-implantation Genetic Diagnosis has produced a wide range of moral positions. For example, one might contrast David King's view that warns PGD should be strictly limited and regulated because it will soon result in the expansion of a troubling "laissez-faire eugenics" with Julian Savulescu's argument for the "principle of procreative beneficence" morally requiring parents to use information attained through PGD to select the "best child". That is, these authors represent (...) two poles of a sort of moral spectrum regarding PGD. At one end, we have a deep suspicion of the technology as directly leading to... (shrink)

According to the parent analogy, as a caretaker’s goodness, ability and intelligence increase, the likelihood that the caretaker will make arrangements for the attainment of future goods that are unnoticed or underappreciated by their dependents also increases. Consequently, if this analogy accurately represents our relationship to God, then we should expect to find many instances of inscrutable evil in the world. This argument in support of skeptical theism has recently been criticized by Dougherty. I argue that Dougherty’s argument is (...) incomplete, for there are two plausible ways of construing the parent analogy’s conclusion. I supplement Dougherty’s case by offering a new argument against the parent analogy based on failed expectations concerning the amount of inscrutable evils encountered in the world. Consequently, there remains a significant empirical hurdle for skeptical theism to overcome if it is to maintain its status as a defeater for our reliability when tracking gratuitous evils. (shrink)

This dissertation considers the bases upon which ethical assessments of parental genetic trait selections for their children can be made. It argues that if parents engage in genetic trait selections, they must act to expand their child's range of open futures, not to constrict their child's range of open futures or to differentially shift their child's range of open futures. It contends that other proposed distinctions, including distinctions between normal and diseased states and between treatment selections and enhancement selections, (...) do not provide a sound basis for making ethical assessments of parental genetic trait selections. It contends that children have a right to an open future that parents hold in trust for their children and that parents must respect in making genetic trait selections.It considers examples of possible parental genetic trait selections regarding children's hearing, height and visual acuity. Finally, it addresses a number of concerns about and objections to this proposed basis for ethical assessment and to parental genetic trait selection generally but concludes that none of these concerns or objections are fatal the approach that if parents use parental genetic trait selection, they must do so in ways that expand their child's range of open futures. (shrink)

Imagine a genetic counselor working with a young couple pregnant with their first child. The explosion of genetic knowledge and technology in recent years is complicating this professional relationship as a host of new choices brings a few clients with atypical needs. This couple is deaf. They seek not to avoid a child with their disability but rather to assure that the child too will be deaf—a child to share their culture and perspectives on the world. If prenatal diagnosis indicates (...) that the prospective child would be hearing, they intend to terminate the pregnancy and try again. So, how should the counselor respond to this request for services? Does a traditional deference to parental autonomy in reproductive matters require that we respect such decisions by informed couples? More broadly, what are the concepts by which society will guide policy in this new and sensitive domain? (shrink)

Substantial gender disparities in career advancement are still apparent, for instance in the gender pay gap, the overrepresentation of women in parttime work, and the underrepresentation of women in managerial positions. Regarding the developmental origins of these gender disparities, the current study examined whether children’s views about future career and family involvement were associated with children’s own gender schemas and parents’ career- and family-related gender roles. Participants were 142 Dutch families with a child between the ages of 6 (...) and 12 years old. The families had different compositions. Children completed a computer task assessing gender stereotypes about toys and questionnaires on gender identity and their views about future career and family involvement. Parents reported their occupation, work hours, and task division in the home, which were combined in a composite variable reflecting gender-typicality of career and family involvement. Generalized estimation equations were used to take into account dependency between family members. Results revealed that parents’, and especially mothers’, gender-typical career and family involvement was associated with children’s gender-typical views about future career and family involvement. In addition, children’s felt similarity to the same gender was associated with children’s gender-typical expectations about career and family involvement. These findings suggest that parents’ career, work hours, and task division in the home, together play an important role in how their children envision their future work and family roles. Children themselves also play an active role in developing this vision for the future by their own gender identity, specifically by how similar they feel to individuals of the same gender. To reduce gender disparities in the occupational and domestic domain, programs need to be designed that focus on parental role modeling in the family as well as children’s gender identity development. (shrink)

This paper examines the contribution of parents? education and children?s gender on parental expectations of their children?s future education and the role of parental perceptions of their child?s competencies in the formation of their expectations. A group of university and vocationally educated parents (N = 418) were asked to estimate the probability of their child entering gymnasium (high school) or vocational education and assess the child?s competencies, first in preschool, and then at the end of the third (...) school year. It was found that the education and gender?bound differences in the parental expectations were established before the child entered school, and by the end of the third school year the relationships between expectations and competence assessments strengthened and were more uniform among the parents. The findings suggested that the parental assessments of their child?s abilities can be regarded as a potentially important social?psychological process through which social differences are transformed into the individualized interpretations of the child?s educational prospects. (shrink)

Adolescents who believe that their parents treat them differently from their siblings have poorer psychosocial well-being than otherwise. This phenomenon, which is known as parental differential treatment or PDT occurs in up to 65% of families. Past studies have examined socio-demographic variables (e.g., child gender, age, and birth order) as predictors of PDT, but these immutable characteristics do little to inform interventions and help these adolescents. Hence, this study extends past research by investigating links among parent empathy, parent perception (...) of PDT, child perception of PDT, child perception of fairness and child well-being (self-esteem, depression, anxiety, and trust in the relationship with parents). Furthermore, this study tests whether adolescent personality (openness, conscientiousness, extraversion, agreeableness and neuroticism), child empathy, and child perception of fairness moderate these links. This study will utilize a two-wave longitudinal design with a one-year lapse. Data will be collected from 760 Chinese adolescents studying from Secondary One to Secondary Three in 18 schools in Hong Kong and from their parents. We test our theoretical model via a multilevel structural equation model. This study both addresses (a) theoretical debates about relations among empathy, PDT, fairness, and psychosocial well-being and (b) focuses on modifiable factors and behaviors, to inform future interventions, such as parent education. (shrink)

This book examines the question of what parental obligations procreators incur by bringing children into being. Prusak argues that parents, as procreators, have obligations regarding future children that constrain the liberty of would-be parents to do as they wish. Moreover, these obligations go beyond simply respecting a child’s rights. He addresses in turn the ethics of adoption, child support, gamete donation, surrogacy, prenatal genetic enhancement, and public responsibility for children.

It has been argued that, when there is a probable imminent risk of loss of children’s fertility, their parents should take active steps to preserve their reproductive potential if possible – or even that children have a right to such interventions being undertaken on them on their behalf, as an expression of their right to an open future. In this chapter, I explore these proposals and some of their implications. I place the discussion of fertility preservation for children (...) into the more general context of the choices that parents might have to help keep their children’s future reproductive (and parenting) choices open. I discuss the role of desert and fairness in arguments for fertility preservation and their relevance for framings of infertility in general, as well as the relation between having a (slight) possibility to reproduce and becoming a parent. (shrink)

Analytic philosophers tend to agree that intentional parental genetic shaping and intentional parental environmental shaping for the same feature are, normatively, on a par. I challenge this view by advancing a novel argument, grounded in the value of fair relationships between parents and children: Parental genetic shaping is morally objectionable because it unjustifiably exacerbates the asymmetry between parent and child with respect to the voluntariness of their entrance into the parent–child relationship. Parental genetic shaping is, for this reason, different (...) from and more objectionable than parental environmental shaping. I introduce a distinction between procreative decisions one makes qua mere procreator—that is, without the intention to rear the resulting child—and procreative decisions one makes qua procreator-and-future childrearer. Genetic shaping is objectionable when undertaken in the latter capacity: Both selection and enhancement are objectionable because they introduce an unnecessary and avoidable inequality in the parent–child relationship; in the case of enhancement, this also results in harm to the future child. (shrink)

In recent years, progress in cancer treatment has greatly increased the chances of recovery. Yet, treatment may have irreversible effects on patients’ fertility. In order to protect future fertility, preservation of ovarian tissue may be offered today even to very young girls, involving a surgical procedure that may be performed by minimally invasive laparoscopy, under general anesthesia. However, in the tragic event of a girl’s death, questions may arise regarding the possible use of the preserved ovarian tissue by her (...) parents. Should posthumous reproductive use of ovarian tissue without the girl’s prior consent (due to her young age) be considered a violation of her rights? On the other hand, can it be argued that it is in the interest of a child who died young to leave a genetic trace through posthumous reproduction, because genetic continuity is in the interest of every human being? After presenting the relevant clinical facts, we explore the ethical dimensions of this possible practice through an analysis of the interests of the deceased, her parents, and the child that may be born posthumously. (shrink)

Creating Future People offers readers a fast-paced primer on how advances in genetics will enable parents to influence the traits of their children, including their children's intelligence, moral capacities, physical appearance, and immune system. It explains the science of gene editing and embryo selection, and motivates the moral questions it raises by thinking about the strategic aspects of parental choice. Professor Anomaly takes seriously the diversity of preferences parents have, and the limits policymakers face in regulating what (...) will soon be a global market for reproductive technology. Anomaly argues that once embryo selection for complex traits happens it will change the moral landscape by altering the incentives each person faces. All of us will take an interest in the traits everyone else selects, and this will present coordination problems that previous writers on genetic enhancement have failed to consider. Anomaly ends by considering how genetic engineering will transform humanity. Key Updates to the Second Edition · Significant revisions to the Preface and three separate chapters to include more details about what will be scientifically possible in the coming years and the moral issues these developments will raise · New and substantial coverage of embryo selection (guided by polygenic scores) for minimizing the risk of genetic diseases · Engagement with all important, new publications on the science of genetic enhancement. (shrink)

Creating Future People offers readers a fast-paced primer on how new genetic technologies will enable parents to influence the traits of their children, including their intelligence, moral capacities, physical appearances, and immune systems. It deftly explains the science of gene editing and embryo selection, and raises the central moral questions with colorful language and a brisk style. Jonathan Anomaly takes seriously the diversity of preferences parents have, and the limits policymakers face in regulating what could soon be (...) a global market for reproductive technology. He argues that once embryo selection for complex traits happens it will change the moral landscape by altering the incentives available to parents. All of us will take an interest in the traits everyone else selects, and this will present coordination problems that previous writers on genetic enhancement have failed to consider. Anomaly navigates difficult ethical issues with vivid language and scientifically-informed speculation about how genetic engineering will transform humanity. Key Features: Offers clear explanations of scientific concepts Explores important moral questions without academic jargon Brings discoveries from different fields together to give us a sense of where humanity is headed. (shrink)

Although there is evidence parent–child attachment security is associated with trait-like emotion indices, trait perspectives do not fully capture children's responses to context, an important emotion regulation component. This paper evaluates whether attachment is associated with two dynamic emotion indicators: emotion reactivity and emotion recovery. We review conceptual and empirical connections, describe the dynamic emotion perspective, discuss hypotheses, and review evidence. Our review (15 studies) shows that secure attachment was more consistently related to recovery than reactivity, avoidant attachment was related (...) to low emotion reactivity and recovery, ambivalent attachment was associated with greater emotion reactivity, and disorganized attachment was related to high reactivity and recovery difficulties. We close by comparing trait-like and dynamic emotion conclusions then propose future research directions. (shrink)

Background: Moral distress is an important and well-studied phenomenon among nurses and other healthcare providers, yet the conceptualization of parental moral distress remains unclear. Objective: The objective of this dimensional analysis was to describe the nature of family moral distress in serious pediatric illness. Design and methods: A dimensional analysis of articles retrieved from a librarian-assisted systematic review of Scopus, CINAHL, and PsychInfo was conducted, focusing on how children, parents, other family members, and healthcare providers describe parental moral distress, (...) both explicitly through writings on parental moral experience and implicitly through writings on parental involvement in distressing aspects of the child’s serious illness. Ethical considerations: To promote child and family best interest and minimize harm, a nuanced understanding of the moral, existential, emotional, and spiritual impact of serious pediatric illness is needed. The cases used in this dimensional analysis come from the first author’s IRB approved study at the Children’s Hospital of Philadelphia and subsequent published studies; or have been adapted from the literature and the authors’ clinical experiences. Findings: Three dimensions emerged from the literature surrounding parent moral distress: an intrapersonal dimension, an interpersonal dimension, and a spiritual/existential dimension. The overarching theme is that parents experience relational solace and distress because of the impact of their child’s illness on relationships with themselves, their children, family, healthcare providers, their surrounding communities, and society. Discussion: Elucidating this concept can help nurses and other professionals understand, mitigate, or eliminate antecedents to parental moral distress. We discuss how this model can facilitate future empirical and conceptual bioethics research, as well as inform the manner in which healthcare providers engage, collaborate with, and care for families during serious pediatric illness. Conclusion: Parent moral distress is an important and complex phenomenon that requires further theoretical and empirical investigation. We provide an integrated definition and dimensional schematic model that may serve as a starting point for future research and dialogue. (shrink)

In this paper, I offer a view beyond that which would narrowly reduce the role of parents in medical decision making to acting as custodians of the best interests of children and toward an account of family authority and family autonomy. As a fundamental social unit, the good of the family is usually appreciated, at least in part, in terms of its ability successfully to instantiate its core moral and cultural understandings as well as to pass on such commitments (...) to future generations. The putative rights of children to expression, information, freedom of thought, conscience, religion, and to freedom of association with others are, in this essay, assessed from the perspective of those conditions necessary for the family to function as a moral community. In so doing, I respond to the move to liberate children from parental authority and to effect the transformation of the family as implied by the United Nations’ "Convention on the Rights of the Child" and the pediatric bioethics it supports. (shrink)

This paper provides an answer to the question why birth parents have a moral right to keep and raise their biological babies. I start with a critical discussion of the parent-centred model of justifying parents’ rights, recently proposed by Harry Brighouse and Adam Swift. Their account successfully defends a fundamental moral right to parent in general but, because it does not provide an account of how individuals acquire the right to parent a particular baby, it is insufficient for (...) addressing the question whether and why there is a right to parent one’s biological child. Such a right is important because, in its absence, fairness towards adequate prospective parents who are involuntarily childless would demand a ‘babies redistribution’; moreover, in societies with entrenched histories of injustice there may be reasons of fairness for shuffling babies amongst all recent parents. I supplement the Brighouse-Swift account of fundamental parental rights by an account of how adequate parents acquire the right to parent their biological babies. I advance two arguments to this conclusion: by the time of birth, the birth parents will have already shouldered various burdens in order to bring children into existence, and are likely to have formed an intimate relationship with the future baby. Denying birth parents who would make at least adequate parents the right to keep their baby would be unfair to them and would destroy already formed parent-baby relationships which, I assume, are intrinsically valuable. (shrink)

ABSTRACT We argue that in societies like our own the prevailing view that parents have both special responsibilities for and special rights over their children fails to give a proper understanding of the autonomy both of parents and of children. It is our claim that there is a logical priority of the separable interests of a child over the autonomy of its parents in the fulfilment of their special responsibilities for and the exercise of their special rights (...) over their children. However, we believe that in acknowledging the child as a distinct locus of interests appropriate weight can still be given to parental autonomy. In particular, since raising a child is a long‐term commitment which plays a central role in the life‐plans of many adults it will be a legitimate exercise of an adult's autonomy strongly to influence the future of any children involved in such a plan. Such influence will be quite separate from paternalistic concern for those children. But the logical priority of the child's interests will at the same time show why parents are not entitled to behave proprietorially toward their children, even when paternalistic concern is called for. (shrink)

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by (...) environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. (shrink)

The dominant framework for addressing procreative ethics has revolved around the notion of harm, largely due to Derek Parfit’s famous non-identity problem. Focusing exclusively on the question of harm treats what procreators owe their offspring as akin to what they would owe strangers (if they owe them anything at all). Procreators, however, usually expect (and are expected) to parent the persons they create, so we cannot understand what procreators owe their offspring without also appealing to their role as prospective (...) class='Hi'>parents. I argue that prospective parents can wrong their future children just by failing to act well in their role as parents, whether or not their offspring are ultimately harmed or benefitted by their creation. Their obligations as prospective parents bear on the motivations behind their reproductive choices, including the choice to select for some genetic trait in their offspring. Even when procreators’ motivations aren’t malicious, or purely selfish, they can still fail to recognize and act for the end of the parental role. Procreators can wrong their offspring by selecting for some genetic trait, then, when doing so would violate their obligations as prospective parents, or when their motivation for doing so is antithetical to the end of the parental role. (shrink)

It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear implantation. While I (...) conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam’s concept of the zone of parental discretion. (shrink)

Lower respiratory tract infections are a leading cause of paediatric morbidity and mortality worldwide. Children in low-income countries are disproportionately affected. This is in large part due to limitations in healthcare resources and medical technologies. Mechanical ventilation can be a life-saving therapy for many children with acute respiratory failure. The scarcity of functioning ventilators in low-income countries results in countless preventable deaths. Some hospitals have attempted to adapt to this scarcity by using hand-bag ventilation, as either a bridge to a (...) mechanical ventilator, or until clinical improvement occurs rendering mechanical ventilation no longer necessary. In instances of hand-bag ventilation, an endotracheal tube is first placed. Family members are then asked to play the role of a ventilator, manually compressing a bag repeatedly to inflate the child’s lungs. This approach is fraught with numerous ethical challenges. A careful examination of the data and a nuanced approach to the ethical considerations are imperative. Ethical arguments in support of and in opposition to allowing parental hand-bag ventilation are explored, including the best interests of the child, the child’s right to an open future, beneficence and parental protection, legitimising substandard care, and finally, contextual concerns. An algorithmic, potentially ethically permissible approach to parental participation in manual ventilation is proposed. (shrink)

Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4-15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The (...) audiotaped interviews were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent-child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making. (shrink)

Facing the progress of science and technology, Hans Jonas believes that traditional ethical theories are insufficient to guide the actions of contemporary man. To formulate his own theory, the philosopher takes as its basis the responsibilities of parents towards their children and the one the public man has in relation with his community. Despite their differences, these forms of liability are intertwined and complementary. Then arise in jonas' theory the concepts of wholeness, continuity and future, which will cover (...) following the thinking of the philosopher. (shrink)

The study discusses a new approach to parental agency in pediatric palliative care based on an active form of caregiving. It also explores the possibility of a positive conceptualization of parental agency in its relational context. The paper begins with an illustrative case study based on a clinical situation. This is followed by an analysis of various aspects of parental agency based on empirical studies that disclose the insufficiencies of the traditional approach to parental agency. In the next step, parental (...) agency is analyzed from a reality‐based perspective as an activity focused on relationships and the cognitive capacity of parents vis‐a‐vis their seriously ill children. The paper also considers the importance of the cultural and social contexts in which parental agency and decision‐making take place. This agency is addressed not as individualistic in form, and nor is it exercised in terms of fixed choices. Rather, the focus is on its dynamic and future‐oriented aspects. Consequently, parental agency should be comprehended not only as a form of proxy agency representing the child's best interests but also as a complex decision‐making process in which the parents learn from their child how to become good, compassionate caregivers and at the same time good parents. (shrink)

The current study examined the impact of parental style on early childhood learning, as well as the role of parental self-efficacy as a mediating factor. In the domains of education and psychology, it is increasingly recognized that parents have a considerable impact on their children’s learning and development. Purposive sampling was used and data was gathered over 3 months from school children’s parents. Hypotheses were tested using smart partial least squares-structural equation modeling software. The findings of the present (...) study reveal that an authoritative parenting style is positively associated with learning outcomes among Chinese students. Moreover, the mediating role of parental self-efficacy has been tested and proved to be a potential mediator between parental style and children’s learning outcomes. High PSE is linked to parents’ adoption of a variety of optimum parenting practices throughout childhood, including maternal sensitivity and responsiveness to children’s needs, warm and affectionate parental behavior, and monitoring. Hence, low PSE has been linked to coercive or harsh parenting as well as a proclivity to give up easily when faced with parental difficulties. In China, further study is needed on the relationship between parenting style, parental self-efficacy, and learning outcome. Future parenting programs could also focus on raising parents’ understanding of the need for both parents’ involvement in expressive activities and mentoring. This could help them boost their parenting self-efficacy even more. Lastly, the implications for parents, children, and teachers are discussed. (shrink)

Background: It is not known how neonatologists address the affective and cognitive loads on parents deciding whether to resuscitate infants born extremely preterm. This study explores expert neonatologists' views on these decision-making processes and their own roles in counseling parents. Methods: Semistructured interviews asked internationally recognized experts to share their perspectives on perinatal consultations. Their responses were subjected to thematic analysis. Results: Eighteen of 22 invited experts participated. Approximately equal numbers reported employing a physician-driven approach, a parent-driven approach, (...) and a combined approach during these consultations. Those who followed a physician-driven approach typically focused on conveying standard information about adverse outcomes. Those who followed a parent-driven approach typically focused on addressing parents' information requests, guiding their decision making, and providing affective support. Nearly all experts, in each group, endorsed addressing the child's quality of life, in terms of functionality, when discussing long-term outcomes. Although many believed that families adjusted to life with a disabled child, few discussed the topic during prenatal consultations. Most, in each group, reported trying to alleviate future “decisional regret” for parents whose premature infants subsequently became disabled. None spoke to parents about possible decisional regret after deciding to forgo resuscitation. Conclusions: Expert neonatologists are deeply concerned that parents understand the decision facing them. However, they differ on what information they offer and how they balance parents' need for cognitive and affective support. They expressed more concern about parents' decisional regret should their child survive resuscitation, but have severe disability, than about decisional regret after foregoing resuscitation. (shrink)

Advances in genomic medicine have lead to debate about the potential inclusion of genetic tests for susceptibility to common complex disorders in newborn screening programmes. Empirical evidence concerning psychosocial reactions to genetic testing is a crucial component of both ethical debate and policy development, but while there has been much speculation concerning the possible psychosocial impact of screening newborns for genetic susceptibilities, there remains a paucity of data. The aim of the study reported here is to provide some of this (...) missing empirical evidence, using type 1 diabetes as an example of a common disorder with multiple significant genetic contributors to its aetiology. Semi-structured interviews were conducted with 11 parents of babies who had received increased risk results in a study that involved newborn screening for genetic susceptibility to type 1 diabetes. Interpretative phenomenological analysis was used to evaluate the data. The interview data suggest that the probabilistic nature of results of genetic susceptibility tests impacts upon all aspects of parents' psychosocial reactions, resulting in a complex and dynamic process quite different to that described in relation to current newborn screening programmes. While parents generally reported fairly minor levels of concern in response to news of their child's increased genetic risk, these worries frequently recurred, and perception of risk also varied and fluctuated over time. Both individual and contextual factors appeared to interact with the inherent uncertainty of the test result to contribute to the dynamic nature of parental reactions, and their behavioural responses. The implications of these findings for future research and for the debate concerning potential expansion of newborn screening are discussed. (shrink)