Chest pain is the pain felt in the chest by infants, children and adolescents. In most cases the pain is not associated with the heart. It is mainly recognized by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or care givers. Chest pain is not unusual in children. Lots of children are seen in ambulatory clinics, emergency rooms and hospitals and cardiology clinics. Usually there (...) is a benign cause for the pain for utmost children. Certain patients have conditions that are serious and perhaps life-threatening. Chest pain in pediatric patients needs careful physical examination and a detailed history that would point to the possibility of a serious cause. Researches of pediatric chest pain are scarce. It has been difficult to create evidence-based guidelines for evaluation. In this paper we propose an expert system to help doctors and parents, and care giver in diagnosing chest pain in infants and children. This expert System is design and implemented in SL5 Object language. (shrink)

I argue that newborn infants are conscious. I propose a methodology for investigating infant consciousness, and I present two approaches for determining whether newborns are conscious. First, I consider behavioral and neurobiological markers of consciousness. Second, I investigate the major theories of consciousness, including both philosophical and scientific theories, and I discuss what they predict about infant consciousness.

Our focus has been on the role of early cry as a commanding source of information about infant pain and distress that requires interpretation by an adult caregiver. Its inherent ambiguity may offer an adaptive advantage, as resolution requires adult presence and scrutiny of other behavioral, physical, and contextual factors.

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally (...) in other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pains And Gains Of Rural Health Practice:Lessons Books Never TaughtSridevi Seetharam, Bindu Balasubramaniam, G. S. Kumar, and M. R. SeetharamHow The Journey BeganIn the early 1980s, as fresh graduates from Mysore Medical College in southern India, we were brimming with a zeal to "cure the sick" and "change the world." We had an ideal of evidence-based, rational, ethical and equitable health care and set out to serve rural and (...) under-served communities which included displaced forest-based tribes. In the initial years, with the naivety of the inexperienced, we believed that by correcting the dehydration of the doe-eyed six-year-old Mare and giving her a free course of antibiotics, we had made health care accessible to her. Much to our dismay, within a month, Mare was back in the outpatient clinic, with diarrhea all over again and looking thinner than ever. We realized that it was a losing battle to keep her healthy as long as she continued to drink water from the same contaminated stream, live in unhygienic surroundings, and eat only the paltry meals that her family could barely afford. We gradually began to connect these living examples to what our preventive medicine text books had stressed all along—there are many social determinants of health which, if left unaddressed, do not permit realization of the vision of health for all.Such instances continually pulled us out of the hospital building and into the villages and tribal hamlets. We discovered that our textbook of Preventive and Social Medicine (Park, 1986) (P&SM as we used to call it), was our most valuable possession. [End Page 106] We devoured the descriptions of national health programs, sanitation procedures, water treatment protocols, and maintenance of cold chain for vaccines with a completely new perspective. We discovered the Manual of Basic Techniques for a Health Laboratory, (World Health Organization, 1980) detailing how to set up a laboratory with low cost, reliable and simple methods. We learned to drive a jeep to haul supplies and patients. To step up the level of clinical care, some of us pursued post-graduate programs and equipped ourselves to provide more specialized care too. It has been over two decades since we embarked on this journey. We have encountered a variety of perplexing dilemmas with no clear solutions. We have sometimes been compelled to adopt health practices that were not really evidence-based, seemingly irrational, inequitable and even downright unethical. This narration describes only a few of our thousands of cases, and hopefully conveys our periods of self-doubt, despair and hope, as well as, the challenges we face to reconcile with the difficult choices we are forced to make every day.Unforeseen Challenges in Saving Mothers and ChildrenHigh maternal and child mortality rates have been one of the most disturbing aspects of the health care scenario in rural India. To ensure immunization of all children, health workers with vaccine carriers go from village to village and hamlet to hamlet to reach those infants that would have missed visits to the immunization clinics. Our grass-root workers facilitate these visits by identifying households with such children. Occasionally, they encounter families who spirit away the infant into the adjoining woods as soon as the health worker is seen approaching, and blandly proclaim that the child is not at home. Despite reassurance and counseling about the safety and necessity of the vaccine, their apprehensions and misconceptions are insurmountable. What is the extent of the responsibility of the health worker? Is it ethical to hunt down the child and force the administration of the vaccine in view of the public health gains, besides the child's welfare?A few months ago, a pre-term neonate was admitted to our hospital, but worsened and needed referral to a higher centre in the city. The family refused to go despite repeated persuasion and detailed explanation about the technical limitations of care at our centre. From the family's perspective, the variety of social, cultural, and monetary challenges they would face in the city were themselves limitations for care. We were compelled to retain the baby and continue giving the best care we could.Two... (shrink)

Two questions about infant consciousness are especially central. First: are infants conscious? Second: what is infants’ conscious experience like? In previous work, I have addressed the first, arguing that newborn babies are conscious at birth and that it is possible to know something about what infants’ experiences are like. In this talk, I address the second, investigating the phenomenal structure of infant consciousness. I discuss whether infants have a rich or a minimal phenomenology. The current consensus is that (...) infants have perceptual experiences and experiences of pain and pleasure. But, do they have other types of phenomenology? Using Kriegel’s framework from The Varieties of Consciousness (2015), I explore whether infants have sensory phenomenology, cognitive phenomenology, imaginative phenomenology, emotional phenomenology, and agentive phenomenology. I also address the question of what is the phenomenal background of infants’ first-person experiences, and whether or not they have a minimal pre-reflexive structure of consciousness. (shrink)

This article examines the foundations of social experience from a psychoanalytic perspective. In current developmental psychology, social cognition debate, and phenomenology of empathy, it is widely assumed that the self and the other are differentiated from the outset, and the basic challenge is accordingly taken to consist in explaining how the gap between the self and the other can be bridged. By contrast, in the psychoanalytic tradition, the central task is considered to lie in explaining how such a gap is (...) established in the first place. My article develops this latter idea. I focus on the infant’s early experience of care, show how the presence of the caregiver can be interpreted in terms of an interoceptive experience, illustrate the gradual self/other differentiation from this perspective, and thus argue that the other is granted ‘otherness’ gradually. By emphasising this graduality, I challenge the assumption that self/other differentiation dominates the infant’s life from the outset. In this manner, I show how the psychoanalytic theory may be used in contesting one of the cornerstones of the current research paradigm. (shrink)

The problem of infant suffering and death has remained one of the most intractable problems for theists. Andrew Chignell has attempted to develop a theodicy for this problem that is based on Marilyn Adam’s paradigm for theodicy. However, his discussion repeatedly avoids the argument that, traditionally, most have thought to be the basis of this problem of evil. Thus, his theodicy provides the traditional theist with no adequate response to the problem. I argue that since infant suffering is (...) a serious (and inadequately addressed) problem for any theodicy, animal torture and death is a serious problem as well. I note that few theodicies have addressed animal suffering in a manner that takes their pain seriously. (shrink)

In this article, epoch-based dynamic features such as sequence of epoch interval values and epoch strength values are explored to classify infant cries. Epoch is the instant of significant excitation of the vocal tract system during the production of speech. For voiced speech, the most significant excitation takes place around the instant of glottal closure. The different types of infant cries considered in this work are hunger, pain, and wet diaper. In this work, epoch strength and epoch (...) interval features are used to represent infant cry-specific information from the acoustic signal. In this study, the proposed features such as epoch interval and epoch strength values are determined using zero-frequency filter-based method. Gaussian mixture models are used to classify the above-mentioned cries from the features proposed in this work. GMMs are developed separately for each of the cries using the proposed features. The infant cry database collected under a telemedicine project at the Indian Institute of Technology Kharagpur has been used for this study. In the first step, infant cry recognition accuracy is investigated separately using epoch interval and epoch strength features. To enhance recognition performance, GMMs developed using various features are combined through score level fusion techniques. The recognition performance using a combination of evidence is found to be superior over individual systems. (shrink)

Biologically, pain is neither intrinsically good nor bad, but is a communication mechanism designed to serve organismal ends. Pain for any given person at any given time should be evaluated on the basis of “success” (or not) in serving those purposes. Yet, the physiological, psychological, and cultural complexity of the experience makes moral consideration of pain complicated. This is especially the case with infants in pain. The competence of the infant as a “decision maker” cannot, (...) of course, be assumed. Even if the child “thinks” about pain, an epistemological barrier exists in that the child cannot clearly communicate about the pain experience. Furthermore, any expressions of pain from the child may be necessary for diagnosis. Just coercion criteria provide a means of evaluating when and to what extent pain in infants should be controlled under the authority of surrogate decision makers. (shrink)

In this article I evaluate recent attempts to illuminate the human infant cry from an evolutionary perspective. Infants are born into an uncertain parenting environment, which can range from indulgent care of offspring to infanticide. Infant cries are in large part adaptations that maintain proximity to and elicit care from caregivers. Although there is not strong evidence for acoustically distinct cry types, infant cries may function as a graded signal. During pain-induced autonomic nervous system arousal, for (...) example, neural input to the vocal cords increases cry pitch. Caregivers may use this acoustic information, together with other cues, to guide caregiving behavior. Serious pathology, on the other hand, results in chronically and severely abnormal cry acoustics. Such abnormal crying may be a proximate cause of adaptive infant maltreatment, in circumstances in which parents cut their losses and reduce or withdraw investment from infants with low survival chances. An increase in the amount of crying during the first few months of life is a human universal, and excessive crying, or colic, represents the upper end of this normal increase. Potential signal functions of excessive crying include manipulation of parents to acquire additional resources, honest signaling of need, and honest signaling of vigor. Current evidence does not strongly support any one of these hypotheses, but the evidence is most consistent with the hypothesis that excessive early infant crying is a signal of vigor that evolved to reduce the risk of a reduction or withdrawal of parental care. Key Words: colic; crying; early infant crying; honest signaling; infanticide; parental care; parent-offspring conflict; separation call; vocalization. (shrink)

In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child’s future life? Third, if the life of (...) a child with life-limiting illness is prolonged, how much suffering will she experience and can any of it be alleviated? Is there a risk that negative experiences for such a child will remain despite the provision of palliative care? We argue that both the subjective and objective components of well-being for children could be greatly reduced if they are anticipated to have a short life that is affected by profound cognitive impairment. This does not mean that their overall well-being will be negative, but rather that there may be a higher risk of negative overall well-being if they are expected to experience pain, discomfort, or distress. Furthermore, we point to some of the practical limitations of therapies aimed at relieving suffering, such that there is a risk that suffering will go partially or completely unrelieved. Taken together, these considerations imply that some life-prolonging treatments are not in the best interests of infants with severe life-limiting illness. (shrink)

The overwhelming majority of commentary on fetal pain has looked at the maturation of cortical pathways to decide a lower age limit for fetal pain. This approach assumes pain can be felt directly from neural activation and ignores psychological development. Here we propose that neural activation is a necessary but not a sufficient condition for phenomenological experience, including pain. Isolated neural activation is just one physical fact amongst an infinity of physical facts that requires order or (...) structure to be isolated and experienced. A new theoretical approach is necessary to understand essential phenomenological experience. We conjecture that infant caregiver interaction provides the necessary order or structure so that the infant can isolate fundamental sense experiences delivered by neural activity. Cortical structures provide the necessary neural basis for qualia but qualia are revealed as phenomenological only as the infant becomes a subjective self. (shrink)

A literature review of 98 articles concerning clinical pain research in newborn infants was conducted to evaluate how researchers report the ethical issues related to their studies and how journals guide this reporting. The articles were published in 49 different scientific journals. The ethical issues most often mentioned were parental informed consent (94%) and ethical review approval (87%). In 75% of the studies the infants suffered pain during the research when placebo, no treatment or otherwise inadequate pain (...) management was applied. Discussion about benefits versus harm to research participants was lacking. A quarter of the journals did not have any ethical guidelines for submitted manuscripts. We conclude that ethical considerations did not play a significant role in the articles studied. Missing and superficial guidelines enable authors to offer studies with fragile research ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How We Keep Caring While Walking Through Our PainOla Ziara and Rachel CoghlanAuthor Dedication. To my dear brother Omar Ziara, a bright doctor, entrepreneur, and community advocate who was killed in an Israeli bombing in November 2023.May your soul rest in peace and may your memory remain alive in our hearts. May your unborn child grow up to become the wonderful man that you were. Forever loved by all.Palestinian-American (...) poet, Suheir Hammad, writes:Occupation means that every day you die, and the world watches in silence. As if your death was nothing, as if you were a stone falling in the earth, water falling over water.And if you face all of this death and indifference and keep your humanity, and your love and your dignity and you refuse to surrender to their terror, then you know something of the courage that is Palestine.I am a doctor from the Gaza Strip in Palestine. I live through acute war and protracted occupation. I work under missiles and through scant resources. I experience risks and dangers and face abominable choices made from nightmares. I know heartbreaking death.As doctors here, we fear, suffer, cry, and grieve alongside our patients and their families. This is my story of how we continue to care.Summer 2014 A Fifty-Two-Day War: How To Stay And How To Keep Them SafeThe huge bombardment strikes close to the hospital, scattering glass and rubble. It brings an abrupt end to my rare, quiet pause for coffee. Are the babies hit? We sprint to the Neonatal Intensive Care Unit, our full attention only on those infants, hastily checking every crib. My thoughts are frenzied. What if the next missile strikes us? Will I be able to rescue them? Will I have time to carry their tiny bodies outside through wreckage and fire? How will I choose who to save, and who to leave behind? Could I choose? Will I even be able to think lucidly, act logically for those babies if the fire consumes us? We stay.Somewhere, a house razed to the ground, a mother and her children dead. This time, our babies are safe.Summer 2014 A Fifty-Two-Day War: How To Cast Off Danger And How To Find ConsolationA missile shatters our neighbour’s roof. I am about to leave home for my evening shift. I check on my shaking mum; she is okay, not hurt at least. I ring the senior doctor. I am sorry. I am coming. I will be a little late. Two further missiles hit, wiping out the next-door building completely. No, do not send an ambulance for me. It is too dangerous. I will come [End Page 153] alone. Trembling through the dust and darkness, I leave on foot to reach those babies. I must compose myself. We are needed there to bring calm, to keep caring.And we gamble our lives to seek distraction and comfort for ourselves. We find solace through unbearable pain in our caring.Winter, Spring, Autumn, Summer, Any Day: How To Question Purpose And How To Feel HelplessIt is an ordinary night shift in ‘quiet’ times. Tonight, all the beds are occupied. All the ventilators are taken, forcing life into small, sick faces. At dawn, the phone call comes. A new baby struggling to breathe is on his way. I call around. No more beds to take him here or anywhere. No more ventilators—here or anywhere. Bring him here. We will care for him.He is in a very bad way. He needs immediate life-saving care. We take turns manually ventilating him, working to the hissing rhythm of the Ambu Bag1—inflating, deflating, inflating. Our arms ache. We keep pumping the bag. Do not stop. The moment when the morning shift arrives is our moment of salvage. We can go home. We have made it through the night without medicines, machines, disposables, or enough manpower, our arms throbbing. We have kept him alive.But he is so fragile, the system is fragile, we are fragile. Dare I even ask—is it worth it? Is it worth a baby surviving the... (shrink)

Parents may experience profound stress when their infant is extremely premature or has exceptionally low birth weight. This article presents several approaches that clinicians and ethics consultants can use to reduce this stress when a parent is single and alone, as well as when both parents are present. Offering parents additional options, taking preventative measures, and using approaches based on recent innovations in psychotherapies are emphasized. Since the clinicians who care for these neonates may find it exceptionally stressful and (...) may experience “burn out,” especially over time, this article also addresses what may work best for them. Finally it will discuss clinicians, who, despite their best efforts, find that caring for these infants is simply too painful to bear. (shrink)

I agree with Williams that evolutionary theory provides the best account of the pain expression. We may disagree as to whether pain has an emotional dimension or includes discrete basic emotions as integral components. I interpret basic emotion expressions that occur contemporaneously with pain expression as representing separate but highly interactive systems, each with distinct adaptive functions.

The recent MB case involved a dispute between an infant’s parents and his medical team about the appropriateness of continued life support. The dispute reflected uncertainty about two key factors that inform medical decision making for seriously ill infants: both the amount of pain MB experiences and the extent of his cognitive capacities are uncertain. Uncertainty of this order makes decision making in accordance with the best-interests principle very problematic. This article addresses two of the problems that cases (...) such as that of MB pose for those charged with making medical decisions for infants. First, the question of the moral significance of the interest in avoiding pain is considered. It is claimed that this interest can be outweighed by higher-order interests such as those related to autonomy but that where such higher-order interests do not exist, the interest in avoiding pain should be prioritised. Second, the question of how to proceed in cases in which the level of pain or the extent of an infant’s higher-order interests cannot be decisively established is considered. It is suggested that when genuine uncertainty over the interests of an infant exists, parental views about treatment should prevail.The English family courts recently adjudicated on another case involving conflict between parents and a medical team over the provision of life-prolonging medical treatment for an infant. At the time of the ruling, MB was an 18-month-old boy with type I spinal muscular atrophy. His life expectancy was very short , he was almost completely paralysed and he required constant ventilation. MB’s parents wanted a tracheotomy to be performed to facilitate long-term ventilation and allow for some independence from the hospital ward, but the …. (shrink)

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a (...) do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

The ArgumentPain has important biomedical socioanthropological, semiotic, and other facets. In this contribution pain and the experssion of pain are looked at from the perspective of evolutionary biology, utilizing, among others, cross-cultural data from field work in Melanesia.No other being cares for sick and suffering conspecifics in the way humans do. Notwithstanding aggression and neglect, common in all cultures, human societies can be characterized as empathic, comforting, and promoting the health and well-being of their members. One important stimulus (...) triggering this caring response in others is the expression of pain. The nonverbal channel of communication, particularly certain universal — i.e., culture-independent facial expressions, gestures, and body postures, convey much of the message from the painstricken person to the group.These behaviors signal the person's physical and psychical pain, sadness, grief, and despair in ways very similar to the signs given by infants and small children: the body loses tonus and sinks or drops to the ground, the gestures are those of helplessness. Pain and grief may be so strong that control is lost not only over the body's posture but also over the mind's awareness. In such cases the afflicted person may carry out actions endangering himself or others. In general, these behavior patterns resemble those of infants in situations of distress and danger, and it is not surprising that the response of the members of the group is basically parental: taking care, assisting and consoling.Perceptive and behavioral patterns which developed in the course of avian and mammalian phylogeny to serve the well-being of the young have proven, as was shown by Eibl-Eibesfeldt, to be powerful building blocks for actions in other spheres of human interaction. Love is one such field, the reactions to a conspecific suffering pain is another. (shrink)

In this paper, I argue for the modest claim that people's apparent indifference to animal pain may not be predicated upon speciesism. I defend that claim by developing an analogy between current attitudes toward at least some non‐human animal pain — that which pigs endure while having their tails ‘docked’— and our culture's indifference to the pain that male human infants experience while being circumcised. And I conclude that to convince more of their philosophical and social critics, (...) ‘animal liberationists’ need to spend more time analyzing the pain that non‐human animals experience and defending its moral significance, rather than assuming that such pain is significant and then simply arguing that unnecessary forms of it exist. (shrink)

Objective: To develop an approach for seeking informed consent to examine tissues retained from a previous study of sudden infant death syndrome as part of a study on asthma, and to document responses and participation rate.Design: Pilot open-ended approach to 10 volunteer SIDS parents, followed by staged approach to seek consent from the target SIDS families for the asthma study.Participants: Parents of SIDS infants known to SIDS and Kids Victoria and parents of SIDS infants from the 1991–2 SIDS in (...) Victoria case–control study.Main outcomes: Qualitative responses of the piloted parents and study parents, and participation rates.Results: The pilot group responses were used to refine the written material to be provided. Of the 72 families for which contact details were available, 45 gave verbal consent for contact by the Victorian Institute of Forensic Medicine regarding the asthma study, three refused and 24 did not respond to two letters. Thirty-three completed consent forms, all positive for participation in the asthma study, giving a positive response rate of 73% .Conclusions: The use of postmortem tissue for research is acceptable to the next of kin when an approach is sensitive to their concerns and needs and is made by experienced counsellors from a familiar organisation. Despite the painful memories evoked by the approach of the research group, the acceptance rate among those who could be contacted was high. (shrink)

Maternal opioid use during pregnancy is a growing national problem and can lead to newborns developing neonatal opioid withdrawal syndrome soon after birth. Recent data demonstrates that nearly every 15 min a baby is born in the United States suffering from NOWS. The primary treatment for NOWS is opioid replacement therapy, commonly oral morphine, which has neurotoxic effects on the developing brain. There is an urgent need for non-opioid treatments for NOWS. Transcutaneous auricular neurostimulation, a novel and non-invasive form of (...) electrostimulation, may serve as a promising alternative to morphine. tAN is delivered via a multichannel earpiece electrode worn on and around the left ear, targeting two cranial nerves—the vagus and trigeminal nerves. Prior research suggests that auricular neurostimulation exerts an anxiolytic effect on the body by releasing endogenous opioids and reduces withdrawal symptoms in adults actively withdrawing from opioids. In this first-in-human prospective, open-label trial, we investigated tAN as an adjuvant to morphine therapy in eight infants >33 weeks gestational age suffering from NOWS and receiving oral morphine treatment. Infants received tAN for 30 min 1 h before receiving a morphine dose. tAN was delivered at 0.1 mA below perception intensity at two different nerve targets on the ear: Region 1, the auricular branch of the vagus nerve; and Region 2, the auriculotemporal nerve. tAN was delivered up to four times daily for a maximum of 12 days. The primary outcome measures were safety [heart rate monitoring, Neonatal Infant Pain Scale, and skin irritation] and morphine length of treatment. tAN was well-tolerated and resulted in no unanticipated adverse events. Comparing to the national average of 23 days, the average oral morphine LOT was 13.3 days and the average LOT after tAN initiation was 7 days. These preliminary data suggest that tAN is safe and may serve as a promising alternative adjuvant for treating NOWS and reducing the amount of time an infant receives oral morphine. (shrink)

Infants, children and adolescents with life-limiting and life-threatening disease need long-term care that may change according to disease’s natural history. With the primary goal of quality of life, the psychologist of pediatric palliative care network deals with a large variety of issues. Little consideration has been given to the variety of intervention areas of psychology in PPC that concern the whole life span of the patient and family. The PPC network is composed by a multidisciplinary team of palliative care specialists (...) that intervenes at home, in the hospital and in every place where the patient is living. The network coordinates different public health services to respond to clinical, psychosocial and spiritual needs. In these scenarios, the psychological need is not a single event but a moment inserted in the complexity of the child’s needs. This retrospective monocentric project consists of an analysis of characteristics of psychological interventions in our PPC service. The time frame taken into consideration is 2019–2020, analyzing the clinical records of 186 patients of Pediatric Palliative Care and Pain Service of Veneto Region. The areas that emerged in the analysis show how the intervention of the psychologist in PPC does not concern only end-of-life, but a series of topics that are significant for the family to guarantee psycho-social wellbeing oriented toward the best quality of life. In conclusion, these different topics highlight the complexity of the child and family experience. This variety must be taken into consideration, the psychologist must increase holistic support with a dedicated skills curriculum. (shrink)

Consideration of the evolutionary and cross-cultural history of childbirth reveals many differences between the ways in which most human females have experienced childbirth and the ways in which most women in contemporary industrialized obstetric settings experience the event. In this paper I review two of these differences: the pain and anxiety of labor and delivery and the discontinuity of care provided for the mother and infant. I argue that much of the dissatisfaction with birth practices in the United (...) States results from the failure of modern obstetric practice to meet the evolved needs of mothers and infants. (shrink)

In search of good -- A Socratic question -- Flourishing and well-being -- Mind and value -- Utilitarianism -- Rawls and the priority of the right -- Right, wrong, should -- The elimination of moral rightness -- Rules and good -- Categorical imperatives -- Conflicting interests -- Whose good? The egoist's answer -- Whose good? The utilitarian's answer - Self-denial, self-love, universal concern -- Pain, self-love, and altruism -- Agent-neutrality and agent-relativity -- Good, conation, and pleasure -- "Good" and (...) "good for" -- "Good for" and advantage -- "Good that" and "Bad that" -- Pleasure and advantage -- Good for S that P -- The "for" of "good for" -- Plants, animals, humans -- Ross on human nature -- The perspectival reading of "good for" -- The conative approach to well-being -- Abstracting from the content of desires and plans -- The faulty mechanisms of desire formation -- Infants and adults -- The conation of an ideal self -- The appeal of the conative theory -- Conation hybridized -- Strict hedonism -- Hedonism diluted -- Prolegomenon to flourishing -- Development and flourishing: the general theory -- Development and flourishing: the human case -- More examples of what is good -- Appealing to nature -- Sensory un-flourishing -- Affective flourishing and un-flourishing -- Hobbes on tranquility and restlessness -- Flourishing and un-flourishing as a social being -- Cognitive flourishing and un-flourishing -- Sexual flourishing and un-flourishing -- Too much and too little -- Comparing lives and stages of life -- Adding goods: Rawls's principle of inclusiveness -- Art, science, and culture -- Self-sacrifice -- The vanity of fame -- The vanity of wealth -- Making others worse-off -- Virtues and flourishing -- The good of autonomy -- What is good and why -- The sovereignty of good -- The importance of what is good for us -- Good's insufficiency -- Promises -- Retribution -- Cosmic justice -- Social justice -- Pure antipaternalism -- Moral space and giving aid -- Slavery -- Torture -- Moral rightness revisited -- Lying -- Honoring the dead -- Meaningless goals and symbolic value -- Good-independent realms of value -- Good thieves and good human beings -- Final thoughts. (shrink)

Huang and colleagues provide some intriguing insights into the attitudes about end of life care of practising Taiwanese neonatal doctors and nurses.1 There are some similarities with surveys from other parts of the world. Most Taiwanese neonatologists and nurses agreed that it was potentially appropriate to withhold or limit treatment for infants who were dying. A very high proportion was opposed to active euthanasia of such infants. But there were also some striking differences. Only 21% of Taiwanese doctors ‘agreed’ with (...) withdrawal of mechanical ventilation for dying newborn infants. This proportion is lower than reported in any European country.2 More than 90% of neonatologists surveyed in the UK, the USA, The Netherlands and Sweden found withdrawal of mechanical ventilation acceptable.2 ,3 Taiwanese doctors also seemed reluctant to give analgesia or sedatives to such infants, with almost 60% disagreeing with their use in dying infants where there was a risk of hastening death.1 In contrast, two-thirds or more of European neonatologists thought this was acceptable .2The results of the survey of Huang et al highlight three beliefs about end-of-life care that are widespread, but all of which are seriously mistaken1. None are new, but …. (shrink)

The management of an infant after a decision to withdraw active treatment creates dilemmas. Both lingering death and active killing are undesirable, but palliative interventions can hasten death. We investigated what staff on our neonatal unit thought were the limits of acceptable practice and why. We administered a structured interview to elucidate their views, and asked them to justify their answers. The interviews were analysed quantitatively and qualitatively. A total of 25 participants (15 nurses and 10 doctors) were recruited. (...) 80% emphasized the importance of pain relief following withdrawal, 60% mentioned meeting parental needs at that time. 76% agreed that death can be a desired consequence of withdrawal, yet 52% felt that death should never be hastened. 96% felt that morphine is acceptable after withdrawal, and 72% would give a higher than normal dose if necessary. 56% would stop paralysis at extubation but not reverse it, while 24% would continue paralysis. 16% would consider a drug that ended life instantly in some cases. A wide variety of views emerged, but there were two main positions, a cautious majority, and a more proactive minority. Apparent contradictions within the majority position could be explained using the doctrine of double effect and the acts and omissions distinction. (shrink)

In this paper I aim to show why pediatric suffering must be understood as a judgment or evaluation, rather than a mental state. To accomplish this task, first I analyze the various ways that the label of suffering is used in pediatric practice. Out of this analysis emerge what I call the twin poles of pediatric suffering. At one pole sits the belief that infants and children with severe cognitive impairment cannot suffer because they are nonverbal or lack subjective life (...) experience. At the other pole exists the idea that once child suffering reaches some threshold it is ethical to eliminate the sufferer. Concerningly, at both poles, any particular child vanishes from view. Second, in an attempt to identify a theory of suffering inclusive of children, I examine two prominent so-called experiential accounts of suffering. I find them both wanting on account of their absurd entailments and their flawed assumptions regarding the subjective experiences of people who cannot communicate expressively. Finally, I extend arguments found in Alastair MacIntyre’s Dependent Rational Animals to argue that child suffering can be understood only as a set of absences—absences of conditions such as love, warmth, and freedom from pain. An evaluation of these absences reveals the exquisite dependency of children. It also discloses why pediatric suffering is necessarily a social and political event. Unlike adults, children will never be either the authors or the mitigators of their own suffering. Rather, children must rely wholly on others in order to resist suffering, grow, and flourish. (shrink)

1000 time-travelers travel back in time, each with the intention of killing their own infant-self. If there is no branching time, then on pain of bringing about a logical contradiction, all must fail. But this seems inexplicable: what is to ensure that the time-travelers are stopped? For a time, this inexplicability objection was thought to provide evidence that there is something incoherent about the possibility of backwards time travel in a universe without branching time. There is now near-consensus, (...) however, that the objection has no bite: there is nothing inexplicable about the mass failure. Lewis, Sider and Ismael independently argue that since it is built into the description of the class of cases considered that the time-travelers must fail – and so we consider only unsuccessful attempts – there is no mystery. Smith argues that the absence of possible worlds at which auto-infanticide is committed suffices as a complete explanation for the failures. And Baron and Colyvan maintain that available causal and logical explanations jointly account for everything that needs accounting for. I argue that these are wrong. There is remaining, problematic inexplicability. For backwards time travel not to lead to logical contradiction, something would need to do logic’s bidding, after all. (shrink)

As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey (...) aimed at assessing public views on when a life is not worth living, in an effort to inform ongoing legal and clinical debates about withdrawal of life-sustaining treatment for children. These findings raise important questions about how we define and measure outcomes that matter to parents as they make these tragic decisions. It is challenging to interpret these findings in the absence of context of how decision-making for infants occurs in real-time. The nature of this study and its objective required that cases be substantially simplified. As the authors acknowledge, the prognoses and function of the children involved in these cases were often deeply contested. Prognostic uncertainty is common for children with significant …. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

Many people hold that there is an important moral distinction between passive euthanasia and active euthanasia. Thus, while the AMA maintains that people have a right quote to die with dignity, quote so that it is morally permissible for a doctor to allow someone to die if that person wants to and is suffering from an incurable illness causing pain that cannot be sufficiently alleviated, the MA is unwilling to countenance active euthanasia for a person who is in similar (...) straits, but who has the misfortune not to be suffering from an illness that will result in a speedy death. -/- A similar distinction with respect to infanticide has become a commonplace of medical thinking and practice. If an infant is a mongoloid or a microcephalic, and happens also to have some other defect requiring corrective surgery if the infant is to live, many doctors and hospitals believe that the parents have the right to decide whether the surgery will be performed, and thus whether the infant will survive. But if the child does not have any other defect, it is believed that the parents do not have the right to terminate its life. -/- The rationale underlying these distinctions between active and passive euthanasia, and between active and passive infanticide, is the same: the idea that there is a crucial moral difference between intentionally killing and intentionally letting die. This idea is admittedly very common. But I believe that it can be shown to reflect either confused thinking or a moral point of view unrelated to the interests of individuals. (shrink)

An incisive examination of bioethics and American healthcare, and their profound affects on American culture over the last sixty years, from two eminent scholars. An eye-opening look at the inevitable moral choices that come along with tremendous medical progress, Everybody Wants to Go to Heaven but Nobody Wants to Die is a primer for all Americans to talk more honestly about health care. Beginning in the 1950s when doctors still paid house calls but regularly withheld the truth from their patients, (...) Amy Gutmann and Jonathan D. Moreno explore an unprecedented revolution in health care and explain the problem with America’s wanting everything that medical science has to offer without debating its merits and its limits. The result: Americans today pay far more for health care while having among the lowest life expectancies and highest infant mortality of any affluent nation. Gutmann and Moreno—“incisive, influential, and pragmatic thinkers” (Arthur Caplan)—demonstrate that the stakes have never been higher for prolonging and improving life. From health care reform and death-with-dignity to child vaccinations and gene editing, they explain how bioethics came to dominate the national spotlight, leading and responding to a revolution in doctor-patient relations, a burgeoning world of organ transplants, and new reproductive technologies that benefit millions but create a host of legal and ethical challenges. With striking examples, the authors show how breakthroughs in cancer research, infectious disease, and drug development provide Americans with exciting new alternatives, yet often painful choices. They address head-on the most fundamental challenges in American health care: Why do we pay so much for health care while still lacking universal coverage? How can medical studies adequately protect individuals who volunteer for them? What’s fair when it comes to allocating organs for transplants in truly life-and-death situations? A lucid and provocative blend of history and public policy, this urgent work exposes the American paradox of wanting to have it all without paying the price. (shrink)

Appeals to nature are ubiquitous in Epicurean ethics and politics. The foundation of Epicurean ethics is its claim that pleasure is the sole intrinsic good and pain the sole intrinsic evil, and this is supposedly shown by the behavior of infants who have not yet been corrupted, "when nature's judgement is pure and whole." Central to their recommendations about how to attain pleasure is their division between types of desires: the natural and necessary ones, the natural but non-necessary ones, (...) and the vain and empty ones. Elsewhere, the Epicureans talk about the "natural goods" of political power and fame, and they contrast "natural wealth" with wealth as "defined by empty opinion." Finally, in their politics, Epicurus claims that the "the justice of nature is a pledge of reciprocal usefulness, [i.e.,] neither to harm one another nor to be harmed." This paper explores two questions regarding these various appeals to nature. The first is: what is it for these things to be natural, i.e., what notion of "natural" or "nature" is at play here? (Furthermore, is there a single notion being used across these appeals, and if not, how are they related?) The second is: what normative work does a thing's being natural do? That is, what reason, if any, does a desire's being natural give me for pursuing the object of that desire and trying to fulfill that desire, as opposed to not doing so and trying to eliminate it, and similarly for the other appeals to nature? (shrink)

This essay maintains that the question in its title is really three sets of questions: a conceptual inquiry, a moral/political inquiry, and an empirical inquiry. After devoting some attention to the relevant conceptual issues, the essay ponders in detail the moral/political issues. It suggests some answers to the germane moral/political questions, and it takes pains to distinguish those questions from other lines of inquiry with which they might be confused. Although only animals and dead people are mentioned in the title, (...) the essay also considers whether infants, comatose people, lunatics, future generations, groups, trees, and natural phenomena such as rivers should be classified as potential holders of legal rights. (shrink)

I offer a principled objection to arguments in favour of legalizing non-voluntary euthanasia on the basis of the principle of beneficence. The objection is that the status of death as a benefit to people who cannot formulate a desire to die is more problematic than pain management care. I ground this objection on epistemic and political arguments. Namely, I argue that death is relatively more unknowable, and the benefits it confers more subjectively debatable, than pain management. I am (...) not primarily referring to the claim that it is difficult to make comparisons between live and post-mortem states, but rather to the fact that it is epistemically and metaphysically problematic to impute a “life-worse-than-death” or a state of “suffering-calling-for-death” to people who cannot subjectively wish to die, as though this kind of suffering were a medically observable fact rather than a belief- and value-laden notion. On the contrary, people enduring similar causes of pain may have different experiences of suffering and views on how it affects the worthwhileness of their existence or the desirability of death or of continuing their lives. The projection of a “suffering-calling-for-death” onto infants or people with severe intellectual disabilities may not be indefensible, but it is more controversial than judging that pain management will improve their well-being from the perspective of beneficence. My argument also relies on our society’s liberal endeavour to avoid endorsing unverifiable beliefs about life and death or controversial conceptions of the good life. My goal is not to suggest we should not attend the suffering of cognitively disabled people. On the contrary, I only cast doubt on too quick an assumption that ending their lives is the best way of caring for them, when robust palliative treatments are available. Moreover, I express the concern that a lack of attention to distinctions between “pain-calling-for-relief” and “suffering-calling-for-death” may be based on ableist projections and assumptions. I conclude that it is imperative to continue research into the nature of pain and suffering experienced by individuals with mental or cognitive impairments preventing them from expressing autonomous wishes about the kind of treatment that would most benefit them. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Changed Life: Becoming True to Who I amJay Kyle PetersenI was born intersex in 1952 in the county hospital of a very small, ultraconservative town in rural Southwestern Minnesota. My biological parents and paternal grandparents raised me on a small family farm nearby. I knew by age four I was a boy. No one told me. There was nothing to decide. I have always known I am male. (...) My parents never discussed my unusual condition with me and died having never accepted me. They denied my true identity and instead chose to give me a girl’s name and raise me as a girl.My paternal grandmother knew I was different. She lived on the farm with us and, as she explained to me later on in life, changed my diapers and helped take care of me as an infant and toddler. She also was a Certified Nurse’s Aide in the pediatric ward of the county hospital where I was born and could see that anatomically I was different from other infants. She remained my lifelong ally and friend until her death in 1993. She and Grandpa provided an oasis in their farmhouse where I felt accepted. I felt relaxed and comfortable in their company, and could just be myself. Grandpa took me fishing. Grandma drove me to 4–H State Fair demonstrations and supported me in the audience for which she had helped prepare me. My grandmother taught me good humor, excellence and how it was okay to make mistakes. Much later, in 1977, she drove four hours alone to Minneapolis in blizzard conditions to be my “concerned family person” during chemical dependency treatment, when my mother and dad refused and she also celebrated with me after my successful completion of the program. I loved her and she loved me and she showed it. With her I found refuge away from the pressure and abuse in our farmhouse.But my grandparents and parents did not show me affection physically. The only touch I felt from my family, except my paternal grandparents, was abusive including certain religious figures outside our family. Farm animals and pets provided warmth, love, acceptance, and companionship. I loved riding around the farm on the back of my pet pig, Lucy. Nature, especially trees, wild weather, and local lakes provided rest for my stretched, weary nerves and stimulation for my imagination. There was something about the vivid and contrasting colors, even the sounds and livingness about it all—rich deep moist greens, clean pure vast open blues, dark warm earth which I laid upon and felt in my hands. These and the soothing sounds of the wind gently moving through tree leaves and corn leaves and the lake water lapping calmly upon sandy shores, as Grandpa cast out his line: all this I found both relaxing and energizing and allowed for me the safety and environment to rest, let go and expand so my natural inclinations to express myself creatively could open up. Otherwise, I had a very lonely, frustrated, painful, humiliating childhood and adolescence filled with mounting anger and a sense of futility because I could not be or express my real male self—including my attraction to girls.The cultural and religious pressure I felt, the increased abuse and social lies I was forced to live with—including being forced to wear girls’ clothing against my will—became unbearable. I sought [End Page 106] refuge in addiction early on—food for comfort, nicotine for mood alteration, alcohol given to me by my dad, and more. I became suicidal, and remained for a long time terribly depressed.The geneticist I have consulted for the last four years says that physicians who examined me prior to my genital surgeries described my genitals as “male structures formed without enough testosterone,” rather than female structures formed in the presence of excess androgen. She told me that the features recorded in my medical records, and that she had observed, indicate androgen exposure in utero along with an inherited genetic condition such that she says my condition began at conception. I was born with XX karyotype and testing for usual causes for androgen excess with someone... (shrink)

Human ethical practices and attitudes with respect to the other animals exhibit a curious instability. On the one hand, most people believe that it is wrong to inflict torment or death on a non-human animal for a trivial reason. Skinning a cat or setting it on fire by way of a juvenile prank is one of the standard examples of obvious wrongdoing in the philosophical literature. Like torturing infants, it is the kind of example that philosophers use when we are (...) looking for something ethically uncontroversial, so that disputes about the example won’t get in the way of the point we are trying to make.2 On the other hand, human beings have traditionally counted nearly any reason we might have for hurting or killing animals, short of malicious enjoyment, as non-trivial and sufficient. We kill non-human animals, and sometimes inflict pain on them, because we want to eat them, because we can make useful products out of them, because we can learn from experimenting on them, and.. (shrink)

The rapidly increasing number of cases of Zika virus and limited understanding of its congenital sequelae (e.g., microcephaly) led to stories of fear and uncertainty across social media and other mass communication networks. In this study, we used techniques generic to netnography, a form of ethnography, using Internet‐based computer‐mediated communications as a source of data to understand the experience and perceptions of families with infants diagnosed with Zika‐related microcephaly. We screened 27 YouTube™ videos published online between October 2015 and July (...) 2016, during which the Zika epidemic started, peaked, and declined. We identified three themes: (a) experiencing the news of a diagnosis of Zika‐associated microcephaly; (b) experiencing feelings and expectations of the ‘imperfect’ child; and (c) seeking to understand microcephaly to care for the child. We found that families experienced distressing feelings of shock, sadness, hopelessness, and pain, while dealing with emerging and sometimes conflicting information being transmitted by news outlets, uncertainty about the child's health, and healthcare providers’ lack of clarity to guide the family members. The ‘unknown’ factor of ZIKA was an additional stressful factor in the experience of the families. (shrink)

Many people hold that there is an important moral distinction between passive euthanasia and active euthanasia. Thus, while the AMA maintains that people have a right quote to die with dignity, quote so that it is morally permissible for a doctor to allow someone to die if that person wants to and is suffering from an incurable illness causing pain that cannot be sufficiently alleviated, the MA is unwilling to countenance active euthanasia for a person who is in similar (...) straits, but who has the misfortune not to be suffering from an illness that will result in a speedy death. -/- A similar distinction with respect to infanticide has become a commonplace of medical thinking and practice. If an infant is a mongoloid or a microcephalic, and happens also to have some other defect requiring corrective surgery if the infant is to live, many doctors and hospitals believe that the parents have the right to decide whether the surgery will be performed, and thus whether the infant will survive. But if the child does not have any other defect, it is believed that the parents do not have the right to terminate its life. -/- The rationale underlying these distinctions between active and passive euthanasia, and between active and passive infanticide, is the same: the idea that there is a crucial moral difference between intentionally killing and intentionally letting die. This idea is admittedly very common. But I believe that it can be shown to reflect either confused thinking or a moral point of view unrelated to the interests of individuals. (shrink)

Background: Previous systematic review indicated the prevalence of prenatal anxiety as 14–54%. Pregnant women are a high-risk population for COVID-19. However, the prevalence of anxiety symptoms and related factors is unknown in Chinese pregnant women during COVID-19 outbreak.Objective: To investigate the prevalence of anxiety symptoms and the related factors in Chinese pregnant women who were attending crisis intervention during the COVID-19 pandemic.Methods: The data of this cross-sectional study were collected in about 2 months. Data analysis was performed from April to (...) May 2020. Participants completed a set of questionnaires via the Wechat Mini-program before starting the online self-help crisis intervention for COVID-19 epidemic. A total of 2,120 Chinese pregnant women who were attending a self-help crisis intervention participated in this study. A survey was developed to address possible stress-related factors in pregnant women during the COVID-19 outbreak, including demographic, socioeconomic, and pregnancy-related factors, as well as COVID-19 related factors. Generalized Anxiety Disorder-7 scale and the 10-item perceived stress scale were, respectively, employed to measure anxiety and stress-related factors.Results: A total of 21.7% of pregnant women reported at least mild anxiety, and only 82 women reported moderate to severe anxiety. Factors associated with at least mild anxiety included living in Hubei province, nobody providing everyday life support, pelvic pain or vaginal bleeding, and higher perceived stress. Having relatives or neighbors with a diagnosis of COVID-19 was not associated with anxiety.Conclusions and Relevance: Our findings indicate that evaluation and intervention for maternal and infant health are necessary in pregnant women with anxiety during COVID-19 epidemic, especially those with higher perceived stress, less everyday life support, or vaginal bleeding. Interactions among these related medical, social and psychological factors need to be investigated in future studies. (shrink)

The liberty of the woman is at stake in a sense unique to the human condition and so unique to the law. The mother who carries a child to full term is subject to anxieties, to physical constraints, to pain that only she must bear. That these sacrifices have from the beginning of the human race been endured by woman with a pride that ennobles her in the eyes of others and gives to the infant a bond of (...) love cannot alone be grounds for the State to insist that she make the sacrifice. Her suffering is too intimate and personal for the State to insist, without more, upon its own vision of the woman's role ….For years, Jehovah's Witnesses have posed a challenge to the medical profession. Bound by religious belief to refuse blood and blood products, they can frustrate physicians who, since World War II, have utilized transfusions when indicated in the course of treatment. (shrink)

The liberty of the woman is at stake in a sense unique to the human condition and so unique to the law. The mother who carries a child to full term is subject to anxieties, to physical constraints, to pain that only she must bear. That these sacrifices have from the beginning of the human race been endured by woman with a pride that ennobles her in the eyes of others and gives to the infant a bond of (...) love cannot alone be grounds for the State to insist that she make the sacrifice. Her suffering is too intimate and personal for the State to insist, without more, upon its own vision of the woman's role ….For years, Jehovah's Witnesses have posed a challenge to the medical profession. Bound by religious belief to refuse blood and blood products, they can frustrate physicians who, since World War II, have utilized transfusions when indicated in the course of treatment. (shrink)