Suppose “chicken” eggs could be produced by quasi‐chickens—genetically engineered humps of living chicken‐flesh that do nothing but lay eggs. Would there be anything amiss with that? Animal ethicists invoke the notion of animal integrity in order to give intellectual content to the intuition that there would be. On inspection, ‘integrity’ isn't everything its proponents want it to be. Yet there's enough in it to make reasoned argument possible.

As the world population is growing and government directives tell us to consume more fatty acids, the demand for fish is increasing. Due to declines in wild fish populations, we have come to rely more and more on aquaculture. Despite rapid expansion of aquaculture, this sector is still in a relatively early developmental stage. This means that this sector can still be steered in a favorable direction, which requires discussion about sustainability. If we want to avoid similar problems to the (...) ones we have experienced with livestock farming, we need to generate knowledge of the biology, profitability, environmental aspects, consumer awareness, and product appreciation of particular fish species. However, the discussion about a sustainable aquaculture also raises the question how we should treat fish. This moral question is regularly addressed as a problem of applied ethics with a focus on tailoring ethical principles to practical questions. In this article we do not deny the importance of the practical accounts, but we start from the fundamental question whether and why fish matter in our moral deliberations, i.e., from the discussion on moral status. We elaborate the distinction between moral considerability and moral significance in order to show both the importance and the limitations of the discussion about moral status for practical problems in aquaculture. We illustrate these points with a case-study about the farming of a specific fish species, the African catfish. (shrink)

In this special issue we will investigate, from the perspective of agricultural ethics the potential to develop a Responsible Research and Innovation approach to agriculture, and the limitations to such an enterprise. RRI is an emerging field in the European research and innovation policy context that aims to balance economic, socio-cultural and environmental aspects in innovation processes. Because technological innovations can contribute significantly to the solution of societal challenges like climate change or food security, but can also have negative societal (...) consequences, it is assumed that social and ethical aspects should be considered during the R&I process. For this reason, the emerging concept of RRI calls for ethical reflection on the nature, scope and applicability of responsibility and innovation in innovation practices in general, and the way social–ethical issues can be applied and addressed in agriculture. (shrink)

Emerging infectious diseases such as Ebola, Hendra, SARS, West Nile, Hepatitis E and avian influenza have led to a renewed recognition of how diseases in human beings, wildlife and livestock are interlinked. The changing prevalence and spread of such infections are largely determined by human activities and changes in environment and climate—where the latter are often also caused by human activities. Since the beginning of the 21st century, these insights have been brought together under the heading of OneHealth—a concept that (...) calls for interdisciplinary collaboration between various sciences as well as professional practices to promote and protect the health of human and non-human animals and the natural environment. Just as insights from public health have led to a broadened focus for health policy and medical care, from treating individual patients to protecting and promoting population health, OneHealth calls for an even broader perspective, including a concern for the environment and animals, and for social-cultural factors that affect human, animal and environmental health. OneHealth not only covers collaborative work to understand and control zoonotic diseases, but also other ways in which interactions between animals, plants and humans may positively or negatively impact on each other’s health. Thus, studies in veterinary medicine and environmental sciences may lead to new insights in human medicine, and vice versa. Acknowledgment of the links between environmental, animal and social health is of course not a novel insight. Hippocrates already pointed to the importance of a clean environment as a requirement for good health; the early public health movements emphasized hygienic living conditions including good-quality housing, sewage systems and clean air and water; and the founders of modern medicine such as William Osler and Rudolf Virchow promoted …. (shrink)

Climate change could be described as an unstructured policy problem, in which we encounter disagreement on facts and values, problem definition, policy aims, procedures and instruments. For the solution of this type of problem public deliberation is often proposed. According to theories of deliberative democracy all those potentially affected by a decision should have the opportunity to participate in the drafting of that decision. However, in the context of climate change many of the potentially affected cannot speak for themselves, because (...) they do not yet exist. Could future generations nevertheless be represented in public deliberations? And if so, who could legitimately represent them? Moreover, how could such representation get shape institutionally within a deliberative democracy? I will examine some obstacles––in particular the non-identity and the pluralism problems––that have to be overcome before future generations can be represented and question how deliberative democracy could deal with these.. (shrink)

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at (...) least one respect and resembles the others in several respects. Moreover, our classification shows that “health” always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as “thick concepts.” It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices. (shrink)

In this article, two ways of thinking about the potential disruptiveness of de-extinction and gene drives for conservation are presented. The first way of thinking zooms in on particular technologies and assesses the disruptiveness of their potential implications. This approach is exemplified by a framework proposed by Hopster (2021) that is used to conduct our assessment. The second way of thinking turns the logic of the first around. Here, the question is how gene drives and de-extinction fit into a wider (...) and partly pre-existing context of disruption of human-nature relations. By only zooming in on a particular technology and its potential implications, the context out of which the technology is born is unavoidably disregarded. Gene drives and de-extinction are catalysts of a wider disruption already underway. And it is precisely because this disruption is already underway that the terrain is opened for the development and application of these technologies. In other words, the disruptiveness of these technologies strengthens the disruptiveness that was already underway and vice versa. It is argued that the two ways of thinking about emerging technologies in conservation need to go together, meaning in technology assessment both perspectives need to be included. (shrink)

Gene drives are potentially ontologically and morally disruptive technologies. The potential to shape evolutionary processes and to eradicate (e.g. malaria-transmitting or invasive) populations raises ontological questions about evolution, nature, and wilderness. The transformative promises and perils of gene drives also raise pressing ethical and political concerns. The aim of this article is to arrive at a better understanding of the gene drive debate by analysing how ontological and moral assumptions are coproduced in this debate. Combining philosophical analysis with a critical (...) reading of the gene drive literature and an ethnographic study of two leading research groups, the article explores the hypothesis that the development of and debate about gene drives are characterized by a particular intervention-oriented mode of coproduction. Based on the results of this exploration, we highlight the need for a broadening of the perspective on gene drives in which empirical, moral, and ontological concerns are addressed explicitly in their interplay rather than in (disciplinary) isolation from each other. (shrink)

The leading question of this article is whether it is acceptable, from a moral point of view, to take wild animals that are ill out of their natural habitat and temporarily bring them under human control with the purpose of curing them. To this end the so-called 'seal debate' was examined. In the Netherlands, seals that are lost or ill are rescued and taken into shelters, where they are cured and afterwards reintroduced into their natural environment. Recently, this practice has (...) been criticised because it is thought to interfere with the wildness of the animals and population. In this research, the moral assumptions behind the arguments of both the proponents and opponents of sheltering have been analysed within a morally pluralistic framework. It is concluded that sheltering on too large a scale would be contrary to the efforts of the last few decades to maintain an independent or wild seal population, which means that a certain amount of caution is called for. However, in the current situation there is no decisive reason to completely prohibit shelters either. Good arguments can even be given in favour of sheltering. It also becomes clear that the acceptability of sheltering wild animals depends on the specific circumstances in which an animal is encountered. (shrink)

Pedigree dog breeding has been the subject of public debate due to health problems caused by breeding for extreme looks and the narrow genepool of many breeds. Our research aims to provide insights in order to further the animal-ethical, political and society-wide discussion regarding the future of pedigree dog breeding in the Netherlands. Guided by the question ‘How far are we allowed to interfere in the genetic make-up of dogs, through breeding and genetic modification?’, we carried out a multi-method case-driven (...) research, reviewing literature as well as identifying the perceptions of pedigree dog breeding of a variety of parties in the Netherlands. We examined what moral arguments and concepts different stakeholders, including breeders, veterinarians and animal protection societies, put forward when considering this question. While welfare arguments were often used as a final justification, we also frequently encountered arguments beyond welfare in practice, in particular the arguments that certain adaptations were unnatural, that they instrumentalised animals, or that they amounted to playing God. We argue that the way these arguments are employed points to a virtue ethical approach, foregrounding the virtue of temperance, as a balance between extreme positions was sought by our respondents in a variety of ways. Moreover, we argue against a rejection of unnaturalness arguments based on the naturalistic fallacy, as philosophers tend to do. We point out that unnaturalness arguments are related to people’s worldviews, including views on the proper human–animal relationship. We argue that such arguments, which we label ‘life-ethical’, should be the subject of more public discussion and should not be relegated to the private sphere. (shrink)

This book provides reflection on the increasingly blurry boundaries that characterize the human-animal relationship. In the Anthropocene humans and animals have come closer together and this asks for rethinking old divisions. Firstly, new scientific insights and technological advances lead to a blurring of the boundaries between animals and humans. Secondly, our increasing influence on nature leads to a rethinking of the old distinction between individual animal ethics and collectivist environmental ethics. Thirdly, ongoing urbanization and destruction of animal habitats leads to (...) a blurring between the categories of wild and domesticated animals. Finally, globalization and global climate change have led to the fragmentation of natural habitats, blurring the old distinction between in situ and ex situ conservation. In this book, researchers at the cutting edge of their fields systematically examine the broad field of human-animal relations, dealing with wild, liminal, and domestic animals, with conservation, and zoos, and with technologies such as biomimicry. This book is timely in that it explores the new directions in which our thinking about the human-animal relationship are developing. While the target audience primarily consists of animal studies scholars, coming from a wide range of disciplines including philosophy, sociology, psychology, ethology, literature, and film studies, many of the topics that are discussed have relevance beyond a purely theoretical one; as such the book also aims to inspire for example biologists, conservationists, and zoo keepers to reflect on their relationship with animals. (shrink)

Due to its emphasis on experiential interests, animal ethics tends to focus on individuals as the sole unit of moral concern. Many issues in animal ethics can be fruitfully analysed in terms of obligations towards individual animals, but some problems require reflection about collective dimensions of animal life in ways that individualist approaches can’t offer. Criticism of the individualist focus in animal ethics is not new; it has been put forward in particular by environmental ethics approaches. However, the latter tend (...) to be so far removed from the concerns of animal ethicists that both groups talk at cross purposes. We think the gap between environmental and animal ethics could be bridged by on the one hand focusing more on the collective dimensions of our concerns with animals - after all, individuals are constituted by the collective of which they are a part - and on the other hand, by showing that moral status can also be attributed to groups in an indirect way, related to the moral status of their individual members. In our paper we explore various ways of conceptualising the moral relevance of collectiveness in animal life. We draw on insights from public health ethics, as this field of inquiry has also developed - at least partly—in response to individualist approaches in human bioethics, creating more room for recognizing the value of population health, interpersonal relations, solidarity, and ways in which a collective is constituted. (shrink)

Aquaculture is the fastest growing animal-production sector in the world. This leads to the question how we should guarantee fish welfare. Implementing welfare standards presupposes that we know how to weigh, define, and measure welfare. While at first glance these seem empirical questions, they cannot be answered without ethical reflection. Normative assumptions are made when weighing, defining, and measuring welfare. Moreover, the focus on welfare presupposes that welfare is a morally important concept. This in turn presupposes that we can define (...) the capacities of fish, which is an empirical undertaking that informs and is informed by ethical theories about the moral status of animals. In this article we want to illustrate the need for a constant interaction between empirical scientific research and ethics, in which both fields of research make their own contribution. This is not a novel claim. However, the case of fish sheds new light on this claim, because regarding fish there is still much empirical uncertainty and there is a plurality of moral views on all levels. Therefore, we do not only want to show the necessity of this interaction, but also the added value of a cooperation between ethicists and empirical scientists, such as biologists, physiologists, and ethologists. We demonstrate this by considering the different steps in the process of reflection about and implementation of fish welfare. (shrink)

Aquaculture is the fastest growing animal-production sector in the world. This leads to the question how we should guarantee fish welfare. Implementing welfare standards presupposes that we know how to weigh, define, and measure welfare. While at first glance these seem empirical questions, they cannot be answered without ethical reflection. Normative assumptions are made when weighing, defining, and measuring welfare. Moreover, the focus on welfare presupposes that welfare is a morally important concept. This in turn presupposes that we can define (...) the capacities of fish, which is an empirical undertaking that informs and is informed by ethical theories about the moral status of animals. In this article we want to illustrate the need for a constant interaction between empirical scientific research and ethics, in which both fields of research make their own contribution. This is not a novel claim. However, the case of fish sheds new light on this claim, because regarding fish there is still much empirical uncertainty and there is a plurality of moral views on all levels. Therefore, we do not only want to show the necessity of this interaction, but also the added value of a cooperation between ethicists and empirical scientists, such as biologists, physiologists, and ethologists. We demonstrate this by considering the different steps in the process of reflection about and implementation of fish welfare. (shrink)

Precision livestock farming is the management of livestock using the principles and technology of process engineering. Key to PLF is the dense monitoring of variegated parameters, including animal growth, output of produce, diseases, animal behaviour, and the physical environment. While its proponents consider PLF a win-win strategy that combines production efficiency with sustainability goals and animal welfare, critics emphasise, inter alia, the potential interruption of human-animal relationships. This paper discusses the notion that the objectification of animals by PLF influences the (...) developmental pathways of conventional industrial farming. We conduct a conceptual analysis of objectification by comparing discussions in feminist ethics and animal ethics. We find that in animal ethics, objectification includes deontological arguments regarding instrumentalisation, de-animalisation, alienation, commodification and quantification of animals. The focus on socio-political context and relationality connects these debates to central ideas in care ethics. We adopt a care ethics perspective to assess the implications of the objectification of animals in livestock farming. The basic claim is that sensory knowledge symbolised by the farmers’ unity of hand, head and heart would make it harder to objectify animals than abstract and instrumental reasoning where the pursuit of knowledge is intertwined with the pursuit of control, as in mainstream PLF. Despite of what can be considered as a good caring relationship between farmers and animals that is mediated by PLF, people involved in conventional industrial farming still seem to become further detached from farmers and animals, because the PLF system itself is objectifying. PLF redefines the notion of care, in terms of data transparency, standardisation of methods for analysis, real-time collection and processing of data, remote control, and the use of digital platforms. This creates new expectations and requires a redistribution of responsibilities within a wider scope of relations in the value chain. (shrink)

Precision livestock farming (PLF) is the management of livestock using the principles and technology of process engineering. Key to PLF is the dense monitoring of variegated parameters, including animal growth, output of produce (e.g. milk, eggs), diseases, animal behaviour, and the physical environment (e.g. thermal micro-environment, ammonia emissions). While its proponents consider PLF a win-win strategy that combines production efficiency with sustainability goals and animal welfare, critics emphasise, inter alia, the potential interruption of human-animal relationships. This paper discusses the notion (...) that the objectification of animals by PLF influences the developmental pathways of conventional industrial farming. We conduct a conceptual analysis of objectification by comparing discussions in feminist ethics and animal ethics. We find that in animal ethics, objectification includes deontological arguments regarding instrumentalisation, de-animalisation, alienation, commodification and quantification of animals. The focus on socio-political context and relationality connects these debates to central ideas in care ethics. We adopt a care ethics perspective to assess the implications of the objectification of animals in livestock farming. The basic claim is that sensory knowledge symbolised by the farmers’ unity of hand, head and heart would make it harder to objectify animals than abstract and instrumental reasoning where the pursuit of knowledge is intertwined with the pursuit of control, as in mainstream PLF. Despite of what can be considered as a good caring relationship between farmers and animals that is mediated by PLF, people involved in conventional industrial farming still seem to become further detached from farmers and animals, because the PLF system itself is objectifying. PLF redefines the notion of care, in terms of data transparency, standardisation of methods for analysis, real-time collection and processing of data, remote control, and the use of digital platforms. This creates new expectations and requires a redistribution of responsibilities within a wider scope of relations in the value chain. (shrink)

To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are not well equipped to handle moral (...) dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

Governments have used several mechanisms to deal with intractable policy conflicts about issues in bioethics. One mechanism is the installment of an ethics committee and another one is the organization of public debates. Often, ethics committees have an implicit or explicit role in the stimulation of such public debate. However, this role is not self-evident and we therefore analyse the relation between committees and public debate. What should the function of biotechnology ethics committees be, how does this relate to their (...) composition, and to what extent are these functions met in practice? To this end, we have examined the three national committees of the Netherlands, Switzerland, and Australia in the field of animal and plant biotechnology. We argue that there is often a mismatchbetween the goals one wants to reach by stimulating public debate and the way this has been given shape, partly through ethics committees. In fact, installing (biotechnology) ethics committees is to a certain extent a premature move that contains rather than stimulates public debate. (shrink)

With In Focus Sacred Geometry, learn the fascinating history behind this ancient tradition as well as how to decipher the geometrical symbols, formulas, and patterns based on mathematical patterns. People have searched for the meaning behind mathematical patterns for thousands of years. At its core, sacred geometry seeks to find the universal patterns that are found and applied to the objects surrounding us, such as the designs found in temples, churches, mosques, monuments, art, architecture, and nature. Learn the fundamental principles (...) behind: Interpreting the sacred symbolism and principles behind shapes Calculating numbers used in sacred geometry Applying the golden ratio and Fibonacci’s Sequence to objects Translating symbolic and geometrical letters and alphabets This accessible and beautifully designed guide to sacred geometry includes a frameable poster of the main sacred geometrical shapes and their unique, innate arrangements. The In Focus series applies a modern approach to teaching the classic body, mind, and spirit subjects. Authored by experts in their respective fields, these beginner's guides feature smartly designed visual material that clearly illustrates key topics within each subject. As a bonus, each book includes reference cards or a poster, held in an envelope inside the back cover, that give you a quick, go-to guide containing the most important information on the subject. (shrink)

Das Buch enthält aktuelle Fallbesprechungen: Zukonkreten Fällen aus dem Feld der Bio- und Medizinethik wird eine kurze Analyse ethischer Aspekte dargestellt, an die sich juristische Kommentare anschließen. Diskutiert werden nicht-klinische Fälle aus Forschungsethik und Ethik in den Lebenswissenschaften sowie Fälle aus der klinischen Praxis in den Bereichen Chirurgie, Intensiv- und Notfallmedizin, genetisches Screening, Allgemeinmedizin, Neurologie, Psychiatrie und innere Medizin.

This article explores trends in the presence and centrality of males and females in American children's picture books in the twentieth century. Using the Children's Catalog as a population base and a time series analysis, we found that the imbalance in depicting males and females varies through the century in a curvilinear fashion. The earlier and later periods of the century show more egalitarian representations of females in titles and central roles. However, when stories involving only adults or animal characters (...) are considered, males become more prominent over time. Changes in literary themes and the position of women during this time span may be useful in developing a theory to account for these trends. (shrink)

In spite of their performance of highly valuable roles in the civil rights movement, southern Black women remain a category of invisible, unsung heroes and leaders. Utilizing archival data and a subsample of personal interviews conducted with civil rights leaders, this article explores the specific leadership roles of Black women activists; describes the experiences of selected Black women activists from their own “standpoint”; and offers explanations for the lack of recognition and non-inclusion of Black women in the recognized leadership cadre (...) of the civil rights movement. The modern southern-based struggle is most illustrative of how the interlocking systems of gender, race, and class structure Black women's movement leadership and participation. (shrink)

A celebration of a distinctly American form of commercial architecture The only comprehensive history of America's 5-&-10-cent stores It was where you went to browse the latest issues of Life and Photoplay, where the folks bought reading glasses, and where your mom took you for a hot dog and a malted. It was the local 5-&-10-cent store, and it was an integral part of everyday life. In this lavishly illustrated homage to the 5-&-10-cent store, architectural historian Bernice Thomas looks (...) at the architectural achievements of the Kress Company. Devoted to bringing outstanding design to Main Street America, Kress supported an architectural division of more than 100 architects and draftsmen. The over 200 stores these people designed and built between 1900 and 1950 set a new standard in commercial architecture. Thomas takes us on an illustrated tour of sites across the United States —from New Orleans to Honolulu, Albuquerque to New York. She introduces us to the architects and how they deftly balanced sound merchandising principles with aesthetics. (shrink)

With more than 700 specific strategies and solutions to use in the classroom, school, and community, this book covers just about everything that educators need, providing a comprehensive and detailed blueprint for an overall plan and policy to prevent and deal with peer harassment.

This introduction provides an overview of the life, career, and social thought of Gerhard Lenski. Following a preliminary description of Lenski's contributions, this essay is divided into two sections. The first section examines the origins, education, and biographical influences on Lenski as a major social theorist as well as the intellectual foundation of his sociological theories. The second section presents Lenski's work, impact, and legacy and sets the stage for the original essays that are grouped around four of six key (...) areas of Lenski's work, which has had enormous impact on both American and international sociology: (1) teaching sociology; (2) "status crystallization" and "status inconsistency"; (3) sociology of religion and "the religious factor"; (4) social stratification, "power and privilege"; (5) gender stratification in comparative-historical perspective; and (6) ecological-evolutionary theory. While these six areas do not correspond neatly to the progressive phases of Lenski's theory development and sociological career, they are interconnected and reflect Lenski's central concerns in asking the big questions about human societies and in providing explanations for understanding the processes of social change, differentiation, and inequality among and within human societies, across time and space, from hunting and gathering to postindus trial societies. (shrink)

Developments in the last several years have sparked renewed interest in the ethics of research involving humans. Issues relating to the global extent of research and its guiding principles are of particular importance to researchers, health officials, and individual ethics committees who want a deeper and more encompassing inquiry regarding the foundation and evolution of human research. This department of CQ launches a long overdue effort to explore these wider issues. Readers are invited to submit papers to Charles MacKay, 5011 (...) Worthington Drive, Bethesda, MD, 20816, USA. E-mail: [email protected]. a. (shrink)

Interpreting a scene of lactation failure allows us to represent breast-feeding as a contested social practice. This essay reads a novelistic scene of lactation failure in the context of the decline of breast-feeding in the twentieth century. The protagonist's ignorance of the female experiences of pregnancy, childbirth, and lactation is an effect of her objectification within the opposition between science and nature. Unnatural as a woman because she is a natural individual, the pastor's wife exemplifies the dilemmas of breast-feeding as (...) a biosocial practice of maternity in a technological society which features the breakdown of traditional female networks in which knowledge about maternity and breast-feeding are circulated. (shrink)

ABSTRACT The Institute of Medicine (IOM) Committee on Ethical Considerations for Revisions to DHHS Regulations for Protection of Prisoners Involved in Research published its report in 2006. It was charged with developing an ethical framework for the conduct of research with prisoners and identifying the safeguards and conditions necessary to ensure that research with prisoners is conducted ethically. The recommendations contained in the IOM report differ from current European regulations in several ways, some being more restrictive and some less so. (...) For example, the IOM report suggests limiting the percentage of prisoners that should be involved in a biomedical study to 50%, a limit that does not exist in Europe. However, the report does not specifically advise against research without a direct benefit to an individual prisoner: the European regulations are more restrictive than the IOM committee recommendations in this respect. The definition of minimal risk varies, as well as the proposed role of the minimal risk requirement and of the principle of subsidiarity (research that can only be done effectively in prisons). The IOM report proposes a number of thoughtful suggestions, which it would be beneficial to implement everywhere, such as registers of research on prisoners. The European regulations offer pragmatic solutions to several thorny issues. In summary, the IOM committee report represents an admirable effort to tackle the present inconsistencies and deficiencies of federal regulations in the US on research on prisoners (45 CFR 46 Subpart C). Nonetheless, before acting on the recommendations, US regulators might consider revisiting international guidelines such as those published by the Council for International Organizations of Medical Science (CIOMS) and the Declaration of Helsinki. (shrink)

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)