In ‘Patients, doctors and risk attitudes,’ Makins argues for ‘straightforwardly’ (Makins1 p1) extending antipaternalistic views about medical decision-making to include deferential considerations of risk attitudes that a patient might endorse. Reflecting on Makins’ important contribution to higher order attitudes in decision theory, we seek to clarify the practical applicability of his argument to specific clinical settings, namely in mental health. We argue that considering low and higher order risk preferences are not only practically difficult, but also potentially ethically fraught and (...) especially so in the provision of mental healthcare. Deferring to risk attitudes potentially mutes a more robust curiosity of patients’ preferences and desires that can promote both autonomy and beneficence but are explicitly relationally grounded. We argue that a relational understanding of autonomy is a much more robust way of thinking about the value of risk attitudes among other patient preferences, attitudes and goals. Makins rightly expounds on the challenges faced by healthcare professionals who are often required to make determinative recommendations for their patients. Providers must explain uncertain benefits in relation to uncertain risks, therefore, exploring the risk attitudes of patients, appears, prima facie, a rational, patient-centred and autonomy-promoting choice. It invariably invites discussion of Perske’s 1972 dignity of …. (shrink)

This poem was written during the first COVID-19 lockdown in 2020 when many were feeling the painful impact of sudden isolation. During this time, mental health crises were increasingly attended to by local emergency services who may or may not have had relevant training to respond appropriately to vulnerable persons. The outcomes of these 911 calls concerned me, loaded as they can be with bias and...

In “Acquiescence Is Not Agreement: The Problem of Marginalization in Pediatric Decision Making,” Caruso Brown argues that clinicians and ethicists should attend to voices marginalized by hie...

The desperate straits to which commentators are driven in attempting to explain inter impotentis et ualidos falso quiescas: ubi manu agitur, modestia ac probitas nomina superioris sunt are illustrated by a recent contributor to this journal . In the decent obscurity of a review of Büchner's fourth volume of Studien zur römischen Literatur I hazarded a suggestion that has escaped notice. The crux may be removed by reading non superioris and supposing a confusion between N ═ non and Ñ ═ (...) nomine . In war legality is dumb, and amid the squabbles of competing tribes restraint and honesty are not the marks of the winner. The Chatti were proved wiser than the children of light, for they had fought and flourished: Chattis uictoribus fortuna in sapientiam cessit. (shrink)

The present paper proposes to discuss three passages in Tacitus, Histories 3 where current interpretations have led to difficulties which can be shown to be baseless so soon as it is realized that Tacitus is willing on occasion to sacrifice truth and clarity to stylistic effect. In each of these passages the same literary device lies at the root of the matter, a device which may be labelled ‘die grouping of participles’: the juxtaposition of participles in a sentence to die (...) detriment of strict chronological order. (shrink)

The goal of this paper is to examine the impact of leadership and promotion regulatory focus on employees’ willingness to engage in unethical pro-organizational behavior . Building from a person–situation interactionist perspective, we investigate the interaction of leadership style and how leaders frame messages, as well as test a three-way interaction with promotion focus. Using an experimental design, we found that inspirational and charismatic transformational leaders elicited higher levels of UPB than transactional leaders when the leaders used loss framing, but (...) not gain framing. Furthermore, followers’ promotion regulatory focus moderated this relationship such that the effect held for followers with low promotion focus, but not for individuals with high promotion focus. Our findings extend the understanding of UPB, offer theoretical mechanisms to explain when this behavior occurs, and contribute to leadership theory and research on ethical decision making. (shrink)

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches (...) to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees. (shrink)

Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain (...) the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent. (shrink)

This book has been written in the hopes of equipping teachers-in-training—that is, teacher candidates—with the skills needed for action research: a process that leads to focused, effective, and responsive strategies that help students succeed.

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two (...) London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

Using 452 letters sent in 1990 to Wellesley College over a student petition objecting to the choice of Barbara Bush as the graduation speaker, this article explores how an attempt to expand the boundaries of elite women's political behavior created a cultural and symbolic battle that centered upon the content of education, women's “manners” and civility, and their implications for elite women's participation in the broader Hobbesian social contract for citizenship. The article demonstrates that social class in its gendered (...) form is essential to understanding the construction of citizenship. (shrink)