This article explores the current parenting culture, particularly the promotion of competitive and excessive parenting, as an important background issue against which the debates around pre-natal testing take place. It offers an alternative vision of parenting, relying on care ethics, which sees parenting as a relationship, rather than a job. A relationship that should change a parent’s understanding of what is valuable in life. Parenting should not be about moulding the ‘perfect child’ but being open to being profoundly (...) changed. The parent–child with a disability relationship offers particular opportunities to find new meanings and values in life. This analysis is offered as another dimension to the debates over pre-natal testing. It is not intended as an argument against such testing, but rather raises concerns about some of the broader attitudes around it. (shrink)

This article explores the current parenting culture, particularly the promotion of competitive and excessive parenting, as an important background issue against which the debates around pre-natal testing take place. It offers an alternative vision of parenting, relying on care ethics, which sees parenting as a relationship, rather than a job. A relationship that should change a parent’s understanding of what is valuable in life. Parenting should not be about moulding the ‘perfect child’ but being open to being profoundly (...) changed. The parent–child with a disability relationship offers particular opportunities to find new meanings and values in life. This analysis is offered as another dimension to the debates over pre-natal testing. It is not intended as an argument against such testing, but rather raises concerns about some of the broader attitudes around it. (shrink)

Where one stands to engage with the world is not as some New Age Psychologists continue to argue, completely free and self-determined. Rather, it is formed largely beyond one’s control and is fraught with both dangers and opportunities. This pre-determined point of view is referred to as the Assumptive World (Parkes, 1975). This is defined as a “strongly held set of assumptions about the world and the self that is confidently maintained and used as a means of recognizing, planning and (...) acting…Assumptions such as these are learned and confirmed by the experience of many years” (Parkes, 1975, p. 132). There are, further, levels and intensities of assumptions, as refined by Janoff-Bulman, R. (1992). These assumptions form the centre point of our world and our consciousness. They are so much a part of us that we tend not to challenge them. Though unchallenged, these assumptions nevertheless drive our behaviors, set our expectations, and operationalize our moral views. (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the (...) practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

During the perinatal period, the establishment of the attachment relationship with the fetus and subsequently with the real child is crucial for the parents' and the child's well-being. Coherently with the assumption that the attachment relationship starts to develop during pregnancy, this systematic review aims to analyze and systematize studies focused on the association between pre-natal attachment and parent-to-infant attachment, in order to clarify the emerging results and provide useful information for clinical purposes. Nineteen studies were included. Sixteen researches (...) identified a positive relationship between pre-natal attachment and parent-to-infant attachment, and three articles highlighted a negative association between antenatal attachment and post-partum bonding disorders. These results were found both in women and men, in normative and at-risk pregnancies, adopting different assessment approaches. However, only small or moderate associations were found. Future studies are needed to further confirm these findings across different populations and with different methodological approaches. Moreover, studies would be needed in order to clarify mechanisms through which pre-natal attachment influences parent-to-infant attachment, as well as protective and risk factors which intervene between these two variables. (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is often (...) assumed. In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is often (...) assumed. In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)

In 2006, the Centers for Disease Control and Prevention launched an initiative to address the health of women of childbearing age in the United States—a preconception care campaign to improve fetal and maternal health in the country by targeting interventions on parents, and largely women, before conception occurs. In The Zero Trimester: Pre-Pregnancy Care and the Politics of Reproductive Risk, sociologist Miranda Waggoner uses this campaign as an entry point to address the emergence and widespread acceptance of preconception (...) care and its political consequences in the United States. Throughout the book, Waggoner interrogates how preconception care extends assumptions that the onus for children’s health falls... (shrink)

In 2006, the Centers for Disease Control and Prevention launched an initiative to address the health of women of childbearing age in the United States—a preconception care campaign to improve fetal and maternal health in the country by targeting interventions on parents, and largely women, before conception occurs. In The Zero Trimester: Pre-Pregnancy Care and the Politics of Reproductive Risk, sociologist Miranda Waggoner uses this campaign as an entry point to address the emergence and widespread acceptance of preconception (...) care and its political consequences in the United States. Throughout the book, Waggoner interrogates how preconception care extends assumptions that the onus for children’s health falls... (shrink)

In this paper, a rights-based argument for the impermissibility of abortion, infanticide and neglect of some pre-natal organisms and infants/children is advanced. I argue, in opposition to most rights-ethicists, that the potentiality for autonomous agency gives individuals negative rights. I also examine the conjecture that potential autonomous agents have positive rights in virtue of their vulnerability. According to this suggestion, once an individual obtains actual autonomous agency, he or she has merely negative rights. Possible solutions to conflicts of rights (...) between parents and their offspring are investigated. Finally, I discuss a lexical order between positive and negative rights, which may solve conflicts between the rights of potential autonomous agents and actual autonomous agents. (shrink)

In this paper, a rights-based argument for the impermissibility of abortion, infanticide and neglect of some pre-natal organisms and infants/children is advanced. I argue, in opposition to most rights-ethicists, that the potentiality for autonomous agency gives individuals negative rights. I also examine the conjecture that potential autonomous agents have positive rights in virtue of their vulnerability. According to this suggestion, once an individual obtains actual autonomous agency, he or she has merely negative rights. Possible solutions to conflicts of rights (...) between parents and their offspring are investigated. Finally, I discuss a lexical order between positive and negative rights, which may solve conflicts between the rights of potential autonomous agents and actual autonomous agents. (shrink)

Background:Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision.Objectives:The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel.Methods:In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were collected by deep and semi-structured (...) interviews. Finally, the data are analyzed using the content analysis approach.Ethical considerations:Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality.Findings:The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes.Conclusion:Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients’ moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them. (shrink)

Feminist scholarship has demonstrated the importance of sustained critical engagement with ultrasound visualizations of pregnant women’s bodies. In response to portrayals of these images as “objective” forms of knowledge about the fetus, it has drawn attention to the social practices through which the meanings of ultrasound are produced. This article makes a novel contribution to this project by addressing an empirical context that has been neglected in the existing feminist literature concerning ultrasound, namely, its use during pregnancies that women decide (...) to terminate. Drawing on semi-structured interviews with women concerning their experiences of abortion in England, I explore how the meanings of having an ultrasound prior to terminating a pregnancy are discursively constructed. I argue that women’s accounts complicate dominant representations of ultrasound and that in so doing, they multiply the subject positions available to pregnant women. (shrink)

Thomas Paine's words were like no others in history: they leaped off the page, inspiring readers to change their lives, their governments, their kings, and even their gods. In an age when spoken and written words were the only forms of communication, Paine's aroused men to action like no one else. The most widely read political writer of his generation, he proved to be more than a century ahead of his time, conceiving and demanding unheard-of social reforms that are now (...) integral elements of modern republican societies. Among them were government subsidies for the poor, universal housing and education, pre- and post-natal care for women, and universal social security. An Englishman who emigrated to the American colonies, he formed close friendships with Benjamin Franklin, Thomas Jefferson, and James Madison, and his ideas helped shape the Declaration of Independence and the Bill of Rights. (shrink)

John Martin Fischer and Anthony L. Brueckner have argued that a person’s death is, in many cases, bad for him, whereas a person’s prenatal non-existence is not bad for him. Their suggestion relies on the idea that death deprives the person of pleasant experiences that it is rational for him to care about, whereas prenatal non-existence only deprives him of pleasant experiences that it is not rational for him to care about. Jens Johansson has objected to this justification (...) of ‘The Asymmetry’ between the badness of death and pre-natal non-existence on the grounds that what it is actually rational for us to care about is irrelevant to the question of whether the event is bad for us. Taylor Cyr has recently argued that Jens Johansson’s objection to Fischer’s and Brueckner’s position relies on an incoherent example, and is thus unsuccessful. I argue that Cyr’s attempt to defend Fischer and Brueckner in fact illustrates that their position is incoherent, and that Johansson’s objection therefore succeeds. (shrink)

Pope Francis beautifully describes how the perinatal journey starts in mystery. Doctors may forget this. We focus on the science that may partially explain how conception and implantation occur, how the placenta functions, and the gradual development of embryo and fetus. But science cannot address that meta-physical—or spiritual—reality. The question of “why?” is never too far away from the minds of expectant parents. Why now? Why me? Why did my baby develop these terrible problems? Why is my life being challenged (...) in this way? Maternal-fetal “cross-talk” is a reality that cannot be denied. It occurs both when the fetus is quiet and when the fetus is active. It may be facilitated by fetal imaging—an ultrasound of... (shrink)

Background: To place a dependent with severe dementia in a nursing home is a painful and difficult decision to make. In collectivistic oriented societies or families, children tend to be socialised to care for ageing parents and to experience guilt and shame if they violate this principle. Leaving the care to professional caregivers does not conform with the cultural expectations of many ethnic groups and becomes a sign of the family’s moral failure. Research design: Qualitative design with individual (...) in-depth interviews with nurses, family members and dementia care coordinators in Norway, Montenegro, Serbia and South Africa. Braun and Clarke’s six analytic phases were used. Ethical considerations: The project was approved by the Regional Committee for Research, South-Eastern Norway; the Norwegian Centre for Research Data; the Ethics Committee; University of Limpopo, MEDUNSA Campus, South Africa; and by the local heads of the respective nursing homes or home care services. Interviewees were informed orally and in writing and signed an informed consent form. Findings: Healthcare professionals tend to be contacted only when the situation becomes unmanageable. Interviewees talked about feelings of obligation, shame and stigma in their societies regarding dementia, particularly in connection with institutionalisation of family members. Many lacked support during the decision-making process and were in a squeeze between their own needs and the patients’ need of professional care, and the feeling of duty and worry about being stigmatised by their surroundings. This conflict may be a source of pre-decision regret. Conclusion: Family caregivers need help to understand the behaviours of persons with dementia and how to access the formal and informal services available. Thus, they may provide effective support to patients and family carers alike. Supportive interventions for caregivers need to be tailored to meet the individual needs of both the caregiver and the persons with dementia. (shrink)

Digital parenting tools, such as child-tracking technologies, play an ever-increasing role in contemporary child rearing. To explore opinions and experiences related to the use of such tracking devices, we conducted Q methodology and a semi-structured individual interview-study with Estonian parents and their 8- to 13-year-old pre-teens. Our aim was to study how such caring dataveillance was rationalized within the families, and to explore the dominant parenting values associated with the practice. Relying upon communication privacy management theory, the issues of privacy (...) related to such intimate surveillance were also studied. Three factors relating to the use of tracking technologies were extracted from both parents and pre-teens. Tracking technologies were viewed as parental aids that made it possible to ease anxieties and provide assurance to parents and children alike. Although children did not associate the use of tracking technologies with intrusion on privacy, they expected to have a chance to coordinate their privacy boundaries. (shrink)

Jurgen Habermas has argued that carrying out pre-natal germline enhancements would be inimical to the future child's autonomy. In this article, I suggest that many of the objections that have been made against Habermas' arguments by liberals in the enhancement debate misconstrue his claims. To explain why, I begin by explaining how Habermas' view of personal autonomy confers particular importance to the agent's embodiment and social environment. In view of this, I explain that it is possible to draw two (...) arguments against germline enhancements from Habermas' thought. I call these arguments ‘the argument from negative freedom’ and ‘the argument from natality’. Although I argue that many of the common liberal objections to Habermas are not applicable when his arguments are properly understood, I go on to suggest ways in which supporters of enhancement might appropriately respond to Habermas' arguments. (shrink)

The last few years have seen dramatic progress in the development of HIV pre-exposure prophylaxis (PrEP). These developments have been met by ethical concerns. HIV interventions are often thought to be ethically difficult. In a context which includes disagreements over human rights, controversies over testing policies, and questions about sexual morality and individual responsibility, PrEP has been seen as an ethically complex intervention. We argue that this is mistaken, and that in fact, PrEP does not raise new ethical concerns. Some (...) of the questions posed by PrEP are not specific to HIV prophylaxis, but simply standard public health considerations about resource allocation and striking a balance between individual benefit and public good. We consider sexual disinhibition in the context of private prescriptions, and conclude that only unjustified AIDS-exceptionalism or inappropriate moralism about sex supports thinking that PrEP raises new ethical problems. This negative conclusion is significant in a context where supposed ethical concerns about PrEP have been raised, and in the context of HIV exceptionalism. (shrink)

This essay offers a critical analysis of Hannah Arendt's notion of natality through the lens of Adriana Cavarero's feminist philosophy of birth. First, I argue that the strength of Arendtian natality is its rootedness in an ontology of uniqueness, and a commitment to human plurality and relationality. Next, I trace with Cavarero three critical concerns regarding Arendtian natality, namely that it is curiously abstract; problematically disembodied and sexually neutral; and dependent on a model of vulnerability that assumes equality rather than (...) asymmetry. This last issue is further developed in the final section of the essay, where I examine the idea that birth, for Cavarero, becomes the very concept by which we can distinguish and normatively differentiate acts of care and love from acts of wounding and violence. Upholding the normative distinction here depends on a conceptual distinction between vulnerability and helplessness. To maintain the ethical potential of the scene of birth, I argue that we have to insist on the very characteristics Cavarero attributes to it—ones, as this essay aims to show, that are ultimately missing in the Arendtian account thereof. (shrink)

In the first part of the paper, I discuss Benatar’s asymmetry argument for the claim that it would have been better for each of us to have never lived at all. In contrast to other commentators, I will argue that there is a way of interpreting the premises of his argument which makes all of them come out true. (This will require one departure from Benatar’s own presentation.) Once we see why the premises are true, we will, however, also realise (...) that the argument trades on an ambiguity that renders it invalid. In the second part of the paper, I consider whether discussions of how best to implement the anti-natalist conclusion crosses a moral barrier. I ask whether we can, independently of any philosophical argument, raise a legitimate moral objection to discussions of how best to end all life on earth. I discuss three views concerning the role of our pre-philosophical views and attitudes in philosophical debates: the external view according to which these attitudes set moral barriers to the content of philosophical debate whilst themselves standing outside this debate; the internal view according to which our intuitions are part of the material for philosophical reflection and play no further role; and the intermediate view according to which our pre-reflective views and attitudes, without themselves requiring philosophical validation, can play an important role when it comes to issues regarding the implementation of philosophical claims. (shrink)

Healthcare professionals working in intensive care units are often involved in end-of-life decision-making. No research has been done so far about these processes taking place in Croatian ICUs. The aim of this study was to investigate the perceptions, experiences, and challenges healthcare professionals face when dealing with end-of-life decisions in ICUs in Croatia. A qualitative study was performed using professionally homogenous focus groups of ICU nurses and physicians of diverse professional and clinical backgrounds at three research sites. In total, (...) six institutions at the tertiary level of healthcare were included. The constant comparative analysis method was used in the analysis of the data. Differences were found between the perceptions and experiences of nurses and physicians in relation to end-of-life decisions. Nurses’ perceptions were more focused on the context and features of immediate care, while physicians’ perceptions also included the wider sociocultural context. However, the critical issues these specific professional groups face when dealing with end-of-life decisions seem to overlap. A high variability of practices, both between individual practitioners and between different organizational units, was omnipresent. The lack of adequate legal, professional, and clinical guidelines was commonly expressed as one of the most critical source of difficulties. (shrink)

Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients’ intention and perceived ability to act in future situations where they risk experiencing abuse.

Controlling Natality - the ratio of births to the general population - is one of the best means a state has to control its demographic composition. However, the fact that the state has certain interests with regard to the size and composition of its population does not necessarily give it the right to set and pursue natality policies, because such policies can potentially infringe on various human rights such as the rights of women and the rights of minorities. Using a (...) feminist perspective I first argue that even if it is illegitimate for states to try to influence people's choice as to the number of their children in order to achieve demographic change, the state may, and should, enact natality policies aimed at promoting women's right to equality, regardless of whether their end result is to achieve a demographic change. Next I examine whether states are allowed to pursue natality policies that are aimed at decreasing natality rates in specific cultural groups, whose cultural precepts are oppressive to women and dictate very high natality rates. Using the ultra orthodox Jewish community in Israel as a test case, I present and reject three objections to the state's right to pursue such natality policies: the objection from free choice, the objection from free association, and the objection from culture. Rejecting these objections I conclude that not only is the state allowed, but it is indeed obligated, to pursue natality policies that aim to alleviate the oppression of women by decreasing inordinately high birth rates in illiberal communities. However, when choosing the measures for the implementation of such policies the state must take care to choose only measures that respect human rights. (shrink)

Vrinda Dalmiya's Caring to Know is an exciting, impressive, and above all important work on caring in ethics and epistemology. Its central focus is to articulate what Dalmiya calls "care-knowing"—which proposes care as a basic intellectual virtue. In developing its dual aspects—caring as a process and caring as a disposition—Dalmiya offers a systematic argument that defends the viability and efficacy of care-knowing. The early chapters set the stage by offering a "thumbnail" account of the main moves in (...) the literature on care ethics and virtue epistemology. All the building blocks are then assembled to develop the central concept of the book, namely the virtue of "relational humility," a... (shrink)

Every day we make choices, but our degree of investment in them differs, both in terms of pre-verbal experience and verbal justification. In an earlier experimental study, participants were asked to pick the more attractive one among two human faces, and among two abstract figures, and later to provide verbal motivations for these choices. They did not know that in some of the cases their choices were manipulated. Against claims about our unreliability as conscious agents, the study found that in (...) about half the cases the manipulations were detected. In the present study, we investigated whether varying degrees of choice investment could be an explanatory factor for such findings. We analysed the verbal justifications of the participants along a set of semantic categories, based on theoretical ideas from phenomenology and cognitive linguistics, and formulated a matrix of eleven markers of choice investment. We predicted a greater degree of investment when motivating choices of faces than figures, manipulated than actual choices, and detected than non-detected manipulations. These predictions were confirmed, but with various strength. This allows us to argue for both consilience and differences between pre-verbal choice investment and the corresponding verbal motivations of the choices made, and thus for conscious awareness of choice making. (shrink)

Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to deal (...) with every day, ethical decision-making has become an inevitable challenge. The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. The process of data analysis resulted in the emergence of 3 main categories “respecting client’s values”, “performing tasks within the professional manner”, “personal characteristic”, and the emergence of eight sub-categories signifying participants’ experiences with regard to EDM. According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client’s values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties. (shrink)

Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While (...) ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a ‘see-saw’ model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes. (shrink)

Subjective probabilities play a significant role in the assessment of evidence: in other words, our background knowledge, or pre-trial beliefs, cannot be set aside when new evidence is being evaluated. Focusing on homeopathy, this paper investigates the nature of pre-trial beliefs in clinical trials. It asks whether pre-trial beliefs of the sort normally held only by those who are sympathetic to homeopathy can legitimately be disregarded in those trials. The paper addresses several surprisingly unsuccessful attempts to provide a satisfactory justification (...) for ignoring the pre-trial beliefs of the homeopathic community. The ensuing diagnosis of the difficulties here emphasizes that the reason the arguments for choosing the pre-trial beliefs of the conventional community seem insufficient is not the arguments per se. It is rather that there is no cogent argument for choosing the conventional stance which would at the same time rationally persuade a member of the homeopathic community. The paper concludes that, once we understand that this is the predicament, there is no genuine reason to doubt the reasoning that leads us to reject the pre-trial beliefs of the homeopathic community. (shrink)

Pre-natal exposure to acute maternal trauma or chronic maternal distress can confer increased risk for psychiatric disorders in later life. Acute maternal trauma is the result of unforeseen environmental or personal catastrophes, while chronic maternal distress is associated with anxiety or depression. Animal studies investigating the effects of pre-natal stress have largely used brief stress exposures during pregnancy to identify critical periods of fetal vulnerability, a paradigm which holds face validity to acute maternal trauma in humans. While understanding (...) these effects is undoubtably important, the literature suggests maternal stress in humans is typically chronic and persistent from pre-conception through gestation. In this review, we provide evidence to this effect and suggest a realignment of current animal models to recapitulate this chronicity. We also consider candidate mediators, moderators and mechanisms of maternal distress, and suggest a wider breadth of research is needed, along with the incorporation of advanced -omics technologies, in order to understand the neurodevelopmental etiology of psychiatric risk. (shrink)

This chapter applies the modified philosophy of Alasdair MacIntyre to mental health law, and in particular to the mental health tribunal. The natural law approach of Thomas Aquinas is used to assist in this. It is argued that, for law to be just in pre-modern terms, it requires that it be assessed as rational together with the care it supports as a single entity. As such, according to a modified version of the Thomistic Aristotelian ethics of MacIntyre, justice would (...) require reconciliation of both doctor and patient narratives regarding care, possibly at the tribunal. It is suggested that psychiatric intensive care, in particular, could benefit from this approach. The approach might be seen as an additional protection to human rights-based considerations. It is also argued that the tribunal can be seen differently, according to the tradition of enquiry. (shrink)

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36·6 to 16·9 deaths per 1000 over 15 years. The decrease in (...) IMR was larger in the 25000·63); it increased to 0·57 (95% CI 0·350·97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth. (shrink)

This paper presents ethical dilemmas concerning the termination of pregnancy, the management of childbirth, and the withdrawal of life-support from infants in special care, for a small sample of British Pakistani Muslim parents of babies diagnosed with fatal abnormalities. Case studies illustrating these dilemmas are taken from a qualitative study of 66 families of Pakistani origin referred to a genetics clinic in Southern England. The paper shows how parents negotiated between the authoritative knowledge of their doctors, religious experts, and (...) senior family members in response to the ethical dilemmas they faced. There was little knowledge or open discussion of the view that Islam permits the termination of pregnancy for serious or fatal abnormality within 120 days and there was considerable disquiet over the idea of ending a pregnancy. For some parents, whether their newborn baby would draw breath was a main worry, with implications for the baby's Muslim identity and for the recognition of loss the parents would receive from family and community. This concern sometimes conflicted with doctors' concerns to minimize risk to future pregnancies by not performing a Caesarean delivery if a baby is sure to die. The paper also identifies parents' concerns and feelings of wrong-doing regarding the withdrawal of artificial life-support from infants with multiple abnormalities. The conclusion considers some of the implications of these observations for the counselling and support of Muslim parents following the pre- or neo-natal diagnosis of fatal abnormalities in their children. (shrink)

This paper is written in response to the planetary times in which we live, marked as they are by the interwoven realities of political polarisation and environmental degradation. Looking to Hannah Arendt’s political writings for a response to this reality, in this paper I challenge the predominance of natality as a revolutionary concept and turn instead to Arendt’s discussion of love. After an initial rereading of the temporality of love at work in her concept of amor mundi, the paper develops (...) the idea of “amor terra,” or love for the pre-political and planetary constitution of politics. Taking seriously Arendt’s claim that what is required in times of crisis is a renewed conception of human dignity, I offer amor terra in precisely these terms. Developed in dialogue with Arendt’s writings on the earthly condition of responsibility, politics, and care, I ultimately argue that what amor terra offers is a renewed setting from which the integrity of the political can be reimagined. (shrink)

BackgroundCarrier screening is generally performed with the aim of identifying healthy couples at risk of having a child affected with a monogenic disorder to provide them with reproductive options. Expanded carrier screening, which provides the opportunity for multiple conditions to be screened in one test, offers a more cost-effective and comprehensive option than screening for single disorders. However, implementation of ECS at a population level would have implications for genetic counseling practice.MethodsWe conducted semi-structured interviews with sixteen European clinical and molecular (...) geneticists with expertise in carrier screening to explore their views on the implementation of ECS in the clinical setting.ResultsUsing inductive content analysis, we identified content categories relevant to the pre- and post-test settings. Participants believed ECS would ideally be targeted at couples before pregnancy. There was some disagreement regarding the acceptability of performing ECS in individuals, with several participants actively opposing individual-based screening. In addition, participants discussed the importance of ensuring informed and voluntary participation in ECS, recommending measures to minimize external pressure on prospective parents to undergo testing. A need for adequate counseling to foster informed, autonomous reproductive decision-making and provide support for couples found to be at risk was emphasized.ConclusionsPractical challenges in optimizing pre-test education and post-test counseling should not be underestimated and they should be carefully addressed before implementing ECS in the clinical setting. (shrink)

Recently, teacher emotions have become the focus of research in teacher education. Teacher emotions not only affect teachers themselves but also have an impact on their students. However, pre-service teachers’ emotions have been neglected. This study is based on a qualitative analysis of online emotional diaries related to emotional experience expression by 120 Chinese pre-service teachers before, during, and after teaching practice. The results in this study show three characteristics of pre-service teachers’ emotional experiences: the overall positive emotions are higher (...) than negative emotions; “caring” and “nervous” are the most typical emotions and variability in emotional experience across gender and internship schools. Then, it is surprising that pre-service teachers’ emotional trajectories are complex and dynamic, positive emotions are decreasing, and negative emotions increase as time goes by. Finally, from the perspective of emotional experience sources, organizational factors affect the emotional experience, personal factors, and background factors. (shrink)

Many studies have shown that women are more likely than men to be living kidney donors, and the discrepancy is particularly marked in heterosexual couples: wives are more likely than husbands to donate a kidney to their spouse. This ‘ Gender Kidney Donation Gap’ can be understood in terms of Carol Gilligan’s claims about gender differences in ethical decision-making style, making it appropriate to analyse responses to this imbalance using an ethic of care. This article centres the vast majority (...) of living donors, those who donate in the context of a significant pre-existing relationship. A cost-neutral approach is unfair on donors who make society richer and healthier by helping a loved one. However, models of kidney sale fail to offer an acceptable alternative, either (a) compelling donors to sell into a pool where they do not know the recipient or (b) allowing affluent individuals unfair access to kidneys. Drawing on surrogacy law in England and Wales, a model of compensation is proposed that includes a range of non-financial benefits. This option celebrates donation and expresses gratitude to all donors while avoiding the pitfalls of the marketplace, with an emphasis on fair treatment of donors. Nevertheless, if more generous treatment led to a 10% increase in directed donation, then it would be equivalent to doubling ‘altruistic’ stranger donations. As long as the Gender Kidney Donation Gap persists, the best response is to minimise the discomfort and disruption caused to donors by their profound act of kindness. (shrink)

Combine the following: medicine, ethics, jurisprudence, behavioral genetics, and antisocial behavior. Given our level of scientific knowledge today, this combination is more akin to a cerebral smorgasbord than to a dinner where starter, entree, wine, and dessert are carefully chosen to complement one another. Hence, any survey of menus must be highly selective. We accept as a given that there is a noteworthy genetic influence on ASB no matter how it is defined. In terms of behavioral research, the magnitude of (...) that genetic influence is substantial, but so is the impact from the environment, broadly defined to include pre-and post-natal, physical as well as psychosocial elements.We will discuss some of the major issues raised by this fact of genetic influence that have most applicability to topics usually raised by observers outside of behavioral genetics. (shrink)

The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in “voluntourism,” health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short term medical volunteer work (...) in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data. (shrink)