Pediatric critical careCritical care refers to the health care of children with life-threatening illness or following major surgery or severe injury. This care is offered in different contexts across the globe. In well-resourced environments, critical careCritical care may be provided in pediatric intensive care units, which provide highly complex medical care with advanced, potentially expensive technological devices aimed primarily at sustaining life; whereas in poorly resourced regions, only primary care may be available for critically ill or injured childrenInjured children. Even (...) where PICU facilities are available, they are a scarce and expensive resource. The knowledge and ability to sustain a critically ill or injured child’sInjured children life, potentially with effects on the child and family’s quality of lifeQuality of life and at the expense of other children’s health care, leads to frequent ethical challenges. Ethical issues related to how best to ensure optimal quality of lifeQuality of life and the fair distribution of scarce resources are common. In-depth knowledge and understanding of the individual patient’s medical, scientific and psychosocial context, through interdisciplinary discussion and collaboration; as well as familiarity with the overriding, relevant ethico-legal policiesPolicy and principles is essential for appropriate decision-makingDecision-making. Truthful communicationCommunication with the family is essential, using a shared decision-makingDecision-making process, and the child’s best interestBest interest must be central to every decision. This chapter presents an overview of the recommended approach to, and important considerations for, ethical decision-makingDecision-making in the PICU, using a hypothetical case example. (shrink)

v. 1. Philosophie. Rechtsphilosophie -- v. 2-4. Volkenrecht -- v. 5-6. Rechtsgeschiedenis. Burgerlijk recht. Procesrecht. Octrooirecht. Studie.

Unrecognized presuppositions about patient appearance have become increasingly important in medicine, medical ethics and medical law. Symptoms of these historically conditioned assumptions include common ageism, aesthetic surgery, and litigation about ‘wrongful life’. These phenomena suggest a societal intolerance for what is considered an ‘abnormal’ appearance. Among others, eighteenth-century artists and anatomists helped to set these twentieth-century precedents, actually measuring deviations of external traits to analogous deformations of the soul, and drawing moral conclusions from physiognomic measurements. Other eighteenth-century artists countered with (...) pathognomy, recognizing that uneven physical features may indicate humanity, instead of character flaws. We suggest that there is an important and as yet unrecognized role played by visual and perceptual preferences in our judgments concerning normalcy and anomaly. We further suggest a shift away from our current fashion-magazine, youth-oriented aesthetic, and towards an aesthetic of imperfection. Physicians and medical students can be made aware of their historically conditioned reactions to ‘abnormal’ appearing patients by studying the understandings and methods with which artists have portrayed those who are considered deformed in appearance. (shrink)

Prohibition on sex selection may well be unnecessary and oppressive as well as posing risks to women’s lives The urge to select children’s sex is not new. The Babylonian Talmud, a Jewish text completed towards the end of the fifth century of the Christian era, advises couples on means to favour the birth of either a male or a female child.1 The development of amniocentesis alerted the public in the mid-1970s to the scientific potential for prenatal determination of fetal sex,2 (...) and progressive decriminalisation of abortion afforded choice about continuation of pregnancy. The more recent emergence of preimplantation genetic diagnosis (PGD) obviates resort to abortion, and improved techniques of sperm sorting and diagnosis permit creation of zygotes that will ensure the sex of a future child. Growth of biomedical means to select the sex of future children has been accompanied by fear that such means will be employed to favour births of sons, and so perpetuate devaluation of girl children and women’s inferior family and social status. A reaction to this fear has been the demand for legal and medical professional prohibition of sex selection techniques. For instance, the Council of Europe’s Convention on Human Rights and Biomedicine3 provides in article 14 that: The use of techniques of medically assisted procreation shall not be allowed for the purpose of choosing a future child’s sex, except where serious hereditary sex-related disease is to be avoided. Legislation has been enacted in a number of countries, and proposed in others, to prohibit sex selection on non-medical grounds, such as the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 in India. In Canada, for instance, government draft legislation introduced in May 2002 proposes to make it a crime for any person, for the purpose of creating a human …. (shrink)

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.

I defend the following version of the ought-implies-can principle: (OIC) by virtue of conceptual necessity, an agent at a given time has an (objective, pro tanto) obligation to do only what the agent at that time has the ability and opportunity to do. In short, obligations correspond to ability plus opportunity. My argument has three premises: (1) obligations correspond to reasons for action; (2) reasons for action correspond to potential actions; (3) potential actions correspond to ability plus opportunity. In the (...) bulk of the paper I address six objections to OIC: three objections based on putative counterexamples, and three objections based on arguments to the effect that OIC conflicts with the is/ought thesis, the possibility of hard determinism, and the denial of the Principle of Alternate Possibilities. (shrink)

How can naïve realism defend itself in face of the illusion of the penny which looks elliptical when it is seen obliquely? Of late many philosophers have tried to deny that a penny looks elliptical when viewed obliquely: they have claimed that it still looks round. It may be true to say this of a small object like a penny, but it cannot be denied that the surfaces of objects in general do look different in shape when viewed from different (...) angles: a large circular object, like a round table, does not look round but elliptical when viewed obliquely. Nevertheless, for convenience, I shall use the example of the penny. The reader may suppose, if he wishes, that the penny is viewed from a considerable distance, say ten feet. (shrink)

The Acarnanian chrēsmologos Amphilytos spoke the verses to Peisistratos just before the battle of Pallene in 546 b.c. They contain a prediction of imminent victory for Peisistratos and total defeat for the Athenians. The Athenians will be routed and deprived of political self-determination, while the victory will restore to Peisistratos the tyranny from which he was twice forced, ‘rooting’ it once for all. Of course, all of this appears quite evident from the narrative. But as the verses form part of (...) Herodotos' account of Peisistratos' ascent to power they amount to much more, for they constitute penultimate proof of Peisistratos' irresistibility , a recurrent theme in Herodotos' logos, but one which was undoubtedly encouraged by his Athenian sources as a means of explaining how the Athenians were forced to yield the tyranny. Indeed, the theme of irresistibility helps to excuse the Athenians for being overcome; as much of the logos, which is historically quite vague, it is a reaction to fact, not factual itself. (shrink)

Relatives of persons with severe mental illness face a straining life situation and need support. Exclusion of relatives in mental health care has long been reported. The aim of this study was to describe conceptions of nurses in mental health care about supporting relatives of persons with severe mental illness. Focus group interviews with nurses from all levels of mental health care in Norway were performed. A phenomenographic approach was used. The nurses found that their responsibility first and foremost was (...) the patient, especially to develop an alliance with him or her. Additional premises for supporting relatives were the context framing the nursing care, aspects of the actors, and relational concerns between them. Competing or contradictory demands were found within these premises. Two paths were identified concerning the nurses’ support of relatives: seeing the relative in the shadow of the patient or as an individual person. (shrink)

The Genetic Information Nondiscrimination Act of 2008 prohibits most forms of discrimination on the basis of genetic information in health insurance and employment. The findings cited as justification for the act, the almost universal political support for it, and much of the scholarly literature about genetic discrimination, all betray a confusion about what is really at issue. They imply that genetic discrimination is wrong mainly because of genetic exceptionalism: because some special feature of genetic information makes discrimination on the basis (...) thereof wrong. I suggest, to the contrary, that the best arguments against genetic discrimination assume that health care is an entitlement . I do this by examining two different exceptionalist arguments for genetic nondiscrimination, showing that they do not furnish good reasons for prohibiting genetic discrimination unless one supposes that health care is an entitlement. (shrink)

Usage of psychotropics during pregnancy and lactation has always been a topic of debate and controversy. The debate stems from the potential adverse effects on the growing fetus or infants due to the transfer of psychotropic drugs through placenta or breast milk of mothers receiving them; and the problem of discontinuing psychotropics in lactating mother considering chances of relapse. However, most of the psychotropics are found to be relatively safe when used cautiously during the lactation phase. This article describes available (...) data on the use of psychotropics in lactating mothers, in particular, in relation to the safety profile of infants. (shrink)

You may not know me well enough to evaluate me in terms of my moral character, but I take it you believe I can be evaluated: it sounds strange to say that I am indeterminate, neither good nor bad nor intermediate. Yet I argue that the claim that most people are indeterminate is the conclusion of a sound argument—the indeterminacy paradox—with two premises: (1) most people are fragmented (they would behave deplorably in many and admirably in many other situations); (2) (...) fragmentation entails indeterminacy. I support (1) by examining psychological experiments in which most participants behave deplorably (e.g., by maltreating “prisoners” in a simulated prison) or admirably (e.g., by intervening in a simulated theft). I support (2) by arguing that, according to certain plausible conceptions, character evaluations presuppose behavioral consistency (lack of fragmentation). Possible reactions to the paradox include: (a) denying that the experiments are relevant to character; (b) upholding conceptions according to which character evaluations do not presuppose consistency; (c) granting that most people are indeterminate and explaining why it appears otherwise. I defend (c) against (a) and (b). (shrink)

Imperatives cannot be true or false, so they are shunned by logicians. And yet imperatives can be combined by logical connectives: "kiss me and hug me" is the conjunction of "kiss me" with "hug me". This example may suggest that declarative and imperative logic are isomorphic: just as the conjunction of two declaratives is true exactly if both conjuncts are true, the conjunction of two imperatives is satisfied exactly if both conjuncts are satisfied—what more is there to say? Much more, (...) I argue. "If you love me, kiss me", a conditional imperative, mixes a declarative antecedent ("you love me") with an imperative consequent ("kiss me"); it is satisfied if you love and kiss me, violated if you love but don't kiss me, and avoided if you don't love me. So we need a logic of three -valued imperatives which mixes declaratives with imperatives. I develop such a logic. (shrink)

We analyse the effect of the regulatory T cells (Tregs) in the local control of the immune responses by T cells. We obtain an explicit formula for the level of antigenic stimulation of T cells as a function of the concentration of T cells and the parameters of the model. The relation between the concentration of the T cells and the antigenic stimulation of T cells is an hysteresis, that is unfold for some parameter values. We study the appearance of (...) autoimmunity from cross-reactivity between a pathogen and a self antigen or from bystander proliferation. We also study an asymmetry in the death rates. With this asymmetry we show that the antigenic stimulation of the Tregs is able to control locally the population size of Tregs. Other effects of this asymmetry are a faster immune response and an improvement in the simulations of the bystander proliferation. The rate of variation of the levels of antigenic stimulation determines if the outcome is an immune response or if Tregs are able to maintain control due to the presence of a transcritical bifurcation for some tuning between the antigenic stimuli of T cells and Tregs. This behavior is explained by the presence of a transcritical bifurcation. (shrink)

THE question which I am to raise for discussion is one which has long been debated by philosophers, and consequently I consider it doubtful whether anything very new can be said on the matter. But it may be profitable to review once more the present position of the controversy and to have in mind the reasons which at present make the question of interest and of importance.

The title of this article might quite well be given the more hackneyed form, Has Kant answered Hume? Much of the discussion pertains to this latter question, but as the aim is also to emphasize some points concerned with Kant himself a deviation in title may be permissible.

The subject of the present paper is the central conception of a philosophy that has been particularly dominant and influential, and the following remarks are prompted because of difficulties experienced in the attempt to understand that philosophy. The aim of the paper is to point out what seems to be a serious defect in that type of philosophy; but it is even more its aim to emphasize the danger into which philosophy in all its forms may easily fall, and against (...) which it must exercise precautions. (shrink)

It is well known to readers of the Republic that, according to Plato's representation, a casual meeting of several friends develops into a sederunt for the express purpose of finding a solution to the question, what is justice? The question has its origin in the remark of the aged Cephalus, quoting Pindar, that whoever lives a life of justice and holiness, Sweet hope, the nourisher of age, his heart Delighting, with him lives; which most of all Governs the many veering (...) thoughts of man. (shrink)

Alarm over the prospect that prenatal diagnostic techniques, which permit identification of fetal sex and facilitate abortion of healthy but unwanted female fetuses has led some to urge their outright prohibition. This article argues against that response. Prenatal diagnosis permits timely action to preserve and enhance the life and health of fetuses otherwise endangered, and, by offering assurance of fetal normality, may often encourage continuation of pregnancies otherwise vulnerable to termination. Further, conditions in some societies may sometimes render excusable the (...) inclination to abort certain healthy female fetuses. In places where abortion for fetal sex alone is recognised as unethical, however, medical licensing authorities already possess the power to discipline, for professional misconduct, physicians who prescribe or perform prenatal diagnosis purely to identify fetal sex, or those who disclose fetal sex when that is unrelated to the fetus's medical condition. (shrink)

Professor Kemp Smith in providing a new edition of Hume’s Dialogues Concerning Natural Religion , embodying all the author’s additions and corrections, has given expression to the perennial interest and fascination which this work has possessed for many minds during the odd one hundred and fifty years since it was first published by Hume’s nephew. The editor himself has performed a great service by contributing an Introduction and a clear and concise summary of the Dialogues , in both of which (...) he expounds his own view as to how Hume’s discussion is to be interpreted. Hume employs three characters—Demea, Philo, and Cleanthes; and. (shrink)