This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of (...) children. Such models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of (...) children. Such models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

With places at nursery school promised for every child above the age of four, this book raises the stakes by looking at the quality of what is provided, and how that compares to what should be provided. Beyond Quality In Early Childhood Education and Care challenges received wisdom and the tendency to reduce philosophical issues of value to purely technical issues of measurement and management. In its place, it offers alternative ways of understanding early childhood, early childhood institutions (...) and pedagogical work. The book places issues of early childhood into a global context and relates them to writers from many fields. Drawing on work with aboriginal peoples in Canada, on the experience of Reggio-Emilia in Italy and on a project in Stockholm inspired by Reggio, the book considers the implications of these alternative ways of understanding, for practice and a reconceptualization of early childhood education and care. (shrink)

This article regards a particular way through which adults take children into consideration and listen their voices. Reflections have sprung from a research context, focused on existential questions that children pose during their preschool years in early education settings. The research explored the meanings of these questions for children and adults involved in their education. The questions of meaning emerged by children’s discourses are considered through the representations of childhood that subtend parents and teachers’ educational practices. The article discusses one (...) of these representations, that of philosopher child, with regard on his various internal perspectives. Lipman, Kyle, Martens and Matthews are some of the authors taken into consideration in order to examine briefly some traditional approaches of doing philosophy with children and to understand the practices that teachers operate everyday in early childhood education and care services. (shrink)

What this book is about -- Theoretical perspectives : modernity and postmodernity, power and ethics -- Constructing early childhood institution : what do we think it is? -- Constructing the early childhood institution : what do we think they are for? -- Beyond the discourse of quality to the discourse of meaning making -- The stockholm project : constructing a pedagogy that speaks in the voice of the child, the pedagogue and the parent -- Pedagogical documentation : a practice (...) for reflection and democracy -- Minority directions in the majority world : threats and possibilities. (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care (...) units. Clinicians who were members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

This book explores two public sector scandals in the UK, drawing on Max Weber's thought on 'the iron cage' to understand how these cases of patient-neglect in NHS hospitals and failures by police and social workers to address the organised sexual exploitation of young girls occurred. Through examination of the management failures and institutional vulnerabilities, and with attention to the trends of bureaucratisation and rationalisation that characterised both scandals, it reveals the explanatory power of Weber's thought, developing a theoretical model (...) that updates and extends Weber's work in light of the cases discussed. Showing that ordinary people as well as ordinary people, including professionals, are still trapped in the 'iron cage', it will appeal to scholars of sociology and social theory, as well as those providing training and working within the caring and service professions of policing, social work and nursing. (shrink)

Home-based service jobs have developed considerably across Western societies. In fact, chances are high that a working-class woman in France today will, at some point in her life, be a house cleaner, home-based child care provider, or home aide for the elderly. Going against political, scholarly, and everyday discourses that, saturated with the double prejudices of gender and class, treat all these home service occupations, which require little prior training, the same, this article illuminates the variability of the (...) forms of subordination experienced by women practicing these occupations in France. Comparing these jobs with the ensemble of low-skill jobs and with each other exposes what is specific to the particular form of subordination each job type entails, in terms of the extent of job supervision and the nature of the home where it is practiced, the presence or absence of relations with coworkers and/or a “public,” and the nature of this “public.” It mobilizes nationwide statistical data in a new way to shift attention to these numerous ordinary work situations, which are much less studied than those of the domestic workers of the wealthiest cities of the Western world. (shrink)

For many rare diseases, the availability of effective interventions is limited or non-existent. In this context, clinical research evaluating emerging interventions may be the only potentially “the...

This study uses data from the Ghana Demographic and Health Survey of 1993 to examine factors determining the use of maternal–child health services in rural Ghana. The MCH services under study are: use of a doctor for prenatal care; soliciting four or more antenatal check-ups; place of delivery; participation in family planning. Bivariate and multivariate techniques are employed in the analyses. The analyses reveal that the use of MCH services tends to be shaped mostly by (...) level of education, religious background and region of residence, and partially by ethnicity and occupation. The implications of these results are discussed. (shrink)

In recent decades, many studies have examined gender-related differences in paid employment and the reconciliation of family and employment. Considering perceptions of time conflicts with regards to work at home and leisure activities, this article contributes to a more encompassing understanding of attitudes toward reconciliation problems. Special attention is given to the role of external child care services. The use of an original data set from 60 Swiss municipalities and hierarchical multiresponse regression models enable an analysis of (...) the various aspects of time conflicts simultaneously, and a consideration of how different policy contexts shape these attitudes. This study provides evidence that the communal provision of external child care is related to gender-specific perceptions of time conflicts. Most interestingly, men seem to be affected most strongly by communal policy conditions, whereby the provision of external child care is related to systematically higher levels of time conflicts. (shrink)

“Only about 25 percent of the employees in child-care operations around the country have had professional training in dealing with children.”—_Newsweek_ This book is a proven, practical approach to providing that training at a minimum of expense and disruption of services. Written for trainers, it may profitably be used by any individual who wants to know more about positive methods for working with children. The information provided here has been used extensively to train child-care providers (...) throughout Illinois. Covered in detail are discipline, professionalism, child and adult communication, child development, observation, assessment, play, nutrition, health and safety, parent involvement and education, child abuse, developmental care, and organization of the environment. Illinois Governor James Thompson, former DCFS Director Gregory Coler, and DCFS Director Gordon Johnson have all endorsed these materials by continuing to recommend them for day-care training in Illinois. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, (...) ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

Children’s and young persons’ rights have received increasing been focus in recent decades, due in a significant degree to the UN Convention on the Rights of the Child. In Sweden, compulsory care in the social-services system is disputed, not least for the forceful measures that facility personnel have at their disposal to control children in certain conflict situations. The general aim of this article is to examine how the increased emphasis in Sweden on children’s rights is promoting (...) resilience for children and youth in youth compulsory secure-care settings. A more general question is whether the child-rights discourse leads in practice to increased resilience for children and youth in this setting, or even in general. The empirical material shows that children and young people’s perceptions of care and treatment are strongly linked to their interactions with staff and how the staff use restrictive measures. Applying Martha Fineman’s vulnerability theory in this context means that achieving resilience demands an analysis of the institutional settings in which children and young persons live their day-to-day lives, including their relationships in this setting. Comparing the legal possibilities of physical constraint with interviews of children and personnel reveals that relevant legislative frameworks and children’s-rights discourse should serve as a protection mechanism for children and youths, but in real life, these seem to have limited effect. (shrink)

This article is guided by principles and practices of bioethics and public health ethics focused on health care reform within the context of promoting Optimal Health. The Tuskegee University National Center for Bioethics in Research and Health Care is moving beyond the traditions of bioethics to incorporate public health ethics and Optimal Health. It is imperative to remember the legacy of the ill-fated research entitled Tuskegee Study of Untreated Syphilis in the Negro Male. Human participant research and health (...) care must be connected to principles of bioethics and public health ethics if the Affordable Care Act is expected to positively impact on the health of people living in the United States. Optimal Health describes a strategy to achieve individual and population health. Health care reform offers an opportunity to shift from the traditional pathology focus of managing diseases to target disease prevention and health promotion with a new set of tools. Transformational change is possible if the lessons learned from the U.S. Public Health Service Syphilis Study at Tuskegee are considered and strategies in bioethics and public heath ethics are employed. (shrink)

Zen is not just about what we do in the meditation hall, but what we do in the home, the workplace, and the community. That's the premise of this book: how to cook what Zen Buddhists call "the supreme meal"—life. It has to be nourishing, and it has to be shared. And we can use only the ingredients at hand. Inspired by the thirteenth-century manual of the same name by Dogen, the founder of the Japanese Soto Zen tradition, this book (...) teaches us how we can "enlarge the family we're feeding" if we just use some imagination. Bernie Glassman founded Greyston Bakery in Yonkers, New York, in 1982 to employ those whom other companies deem unemployable—the homeless, ex-cons, recovering addicts, low-skill individuals—with the belief that investing in people, and not just products, does pay. He was right. Greyston has evolved into an $8 million-a-year business with clients all over New York City. It is the sole supplier of brownies to Ben & Jerry's Ice Cream, and has even sold cakes to the White House. But financial profit is only one of two bottom lines that Greyston is committed to. The other one is social impact, and this goal is certainly being met. The bakery enterprise has led to the creation of the Greyston Foundation, an integrated network of organizations that provide affordable housing, child care, counseling services, and health care to families in the community. Using entrepreneurship to solve the problems of the inner city, Greyston has become a national model for comprehensive community development. Its giving back is more than just sloughing off a percentage of its profits and donating it to charity; it's about working with the community's needs right from the beginning—bringing them from the margins to the core. As its company motto goes, "We don't hire people to bake brownies. We bake brownies to hire people." This book is as much a self-manual as a business manual, addressing such concepts as • Beginner's mind • The Middle Way of Sustainability • The "hungry ghosts" of Buddhism as a picture of all humanity • Working with our faults • Indra's Net and the interconnectedness of life • Leaving no trace. (shrink)

The relatively recent shift of family caregiving to the public market of service work raises questions about how to theorize paid caregiving. This article examines how to conceptualize child rearing when it is transferred to a paid worker. The gendered character of commodified caregiving is complicated by structural locations of race and class that define the employer-employee relationship. Previous discussions of paid child care work as emotionally meaningful work have been criticized as idealizations that mask the exploitative (...) nature of the work. Yet, emotional meaning is not simply a cover-up or an idealization of the labor; rather, it is an integral component of the work of caregiving, the practice of which is distorted by societal assumptions about gender and race. To better understand paid child care work, the significance of emotional meaning, as well as gender, race, and ethnic dimensions of paid child care work need to be explored. (shrink)

The philosophy of family‐centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision‐making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require (...) frequent hospitalizations during which parents must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. (shrink)

Geographical variations are documented for a wide range of health care services. As many such variations cannot be explained by demographical or epidemiological differences, they are problematic with respect to distributive justice, quality of care, and health policy. Despite much attention, geographical variations prevail. One reason for this can be that the ethical issues of geographical variations are rarely addressed explicitly. Accordingly, the objective of this article is to analyse the ethical aspects of geographical variations in the (...) provision of health services. Applying a principlist approach the article identifies and addresses four specific ethical issues: injustice, harm, lack of beneficence, and paternalism. Then it investigates the normative leap from the description of geographical variations to the prescription of right care. Lastly, the article argues that professional approaches such as developing guidelines, checklists, appropriateness criteria, and standards of care are important measures when addressing geographical variations, but that such efforts should be accompanied and supported by ethical analysis. Hence, geographical variations are not only a healthcare provision, management, or a policy making problem, but an ethical one. Addressing the ethical issues with geographical variations is key for handling this crucial problem in the provision of health services. (shrink)

El presente texto se inscribe dentro de la temática dirigida a la investigación sobre la violencia intrafamiliar. Tiene como objetivo sistematizar aspectos históricos y teóricos inherentes al estudio del maltrato infantil y sus consecuencias en el ámbito social y familiar para su detección y tratamiento en el nivel de atención primaria de los servicios de salud en Cuba. Mediante una revisión bibliográfica se logró concretar un análisis documental de materiales y textos en soporte digital e impreso que condujo a los (...) acercamientos teórico e histórico del fenómeno en el ámbito internacional y nacional, para su conceptualización, la determinación de su tipología y el establecimiento de sus consecuencias; elementos imprescindibles del saber profesional del futuro egresado de las ciencias médicas, en función de su desempeño en los diferentes niveles de atención de salud, en especial, la atención primaria. The text falls within the research on intrafamiliar violence subject matter. Its objective is to systematize historical and theoretical aspects inherent to the study of child abuse and its consequences within the social and domestic scopes for its detection and treatment in the Cuban primary health care services. By means of a bibliographic review, a documentary analysis of electronic and printed form materials and texts was summarized. It led to theoretical and historical approaches to the phenomenon within the national and international scopes for its conceptualization, the establishment of its typology and consequences. They are essential elements of the professional knowledge of future medical sciences graduates towards their performance in different health care levels, especially in primary health care. (shrink)

Two answers to the question ‘how can we allocate health care resources fairly?’ are introduced and discussed. Both utilitarian and egalitarian approaches are found relevant, but both exhibit considerable theoretical and practical difficulties. Neither seems capable of solving the problem on its own. It is suggested that, for practical purposes, a version of Rawls' famous thought experiment might provide at least some enlightenment about which theoretical approach should be used to address the question.

Our current culture is dominated by the ideology of creativity. One is supposed to create the new and not to care about the things as they are. This ideology legitimises the domination of the "creative class" over the rest of the population that is predominantly occupied by forms of care - medical care, child care, agriculture, industrial maintenance and so on. We have a responsibility to care for our own bodies, but here again our (...) culture tends to thematize the bodies of desire and to ignore the bodies of care - ill bodies in need of self-care and social care. But the discussion of care has a long philosophical tradition. The book retraces some episodes of this tradition - beginning with Plato and ending with Alexander Bogdanov through Hegel, Heidegger, Bataille and many others. The central question discussed is: who should be the subject of care? Should I care for myself or trust the others, the system, the institutions? Here, the concept of the self-care becomes a revolutionary principle that confronts the individual with the dominating mechanisms of control. (shrink)

This study explores the pivotal role of the body for political recognition and rights claims in child welfare “moral” interventions. I examine how the bodily figures in child welfare assessments, linking these manifestations to the concept of the moral economy of care. A sample of assessment reports from a Swedish municipality, all addressing violations of children’s bodies or integrity, are used as empirical material. I show how the psychosomatically suffering child is being best “heard” as vulnerable. (...) I also argue that such a moral economy of care silences children’s accounts of gendered and racial injustices. Furthermore, racialized moral divides are indicated when assessments of different child bodies are considered. A concluding remark points to a need for a child welfare moral economy of social justice that responds to structural intersecting injustices in childhoods, including to those of a racialized child welfare and its individualized and symptom-oriented services. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective (...) of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing criteria (...) NHS managers and clinicians used at local level in the Child B case; and the organisational structures which confronted them with such decisions. Primary Care Groups are likely to confront similar rationing decisions in respect of 'gate-kept' NHS services. However, such rationing processes are not so easily transposed to open-access services such as general practice. NHS rationing decisions, especially in PCGs, will require a much more specific ethical code than hitherto used. (shrink)

Erik Wielenberg recently invoked the parent-child analogy in an argument against Christian theism. The argument relies on the claim that a loving parent would never allow her child to feel abandoned in the midst of what feels like gratuitous suffering. In this paper, I offer three clear counterexamples to Wielenberg’s central premise. At the same time, a successful counterexample does not a robust theology of suffering make. To that end, and with a careful eye towards anti-theodical concerns, I (...) defend the need for a more proactive Christian philosophical examination of the role of suffering in a meaningful life. (shrink)

Background: Hospitalized children have the right to “partake in practices related to their treatment and care.” Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children. Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes. Methods: This descriptive cross-sectional study included (...) 122 midwives and nurses in total. The data were collected through a questionnaire. Ethical considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted. Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child’s consent about the treatment by looking at the child’s facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child’s consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher. Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children’s rights make a difference in terms of children’s rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs. (shrink)

This article conceptualises theories of ethics relevant to the recognised problem of decision variability in child protection. Within this field, social workers are faced with multiple ethical imperatives when making decisions about children’s care. They must respond to justice principles concerned with duties and consequences, as well as ethical obligations created by the relational and contextual elements of each case. Recent scholarship on decision variability highlights the justice issues that arise when decisions in response to apparently similar cases (...) differ. An ethical imperative is that similar cases should be treated ‘like for like’ so that children’s and family’s rights are upheld consistently. This article contends that ethical concepts relating to both universalist duties such as respect for persons, extended by the concept of interactive universalism, and contextual responses based on an ethic of care, help theorise the complexities of ethical decisions in child protection. These concepts develop a nuanced understanding of the ways social workers resist risk discourses, may make decisions reflecting the participation of service users, and contextual evaluations of risk based on understanding service user’s life histories. Understanding this combination helps explain the reasons behind variability, and evaluate the moral acceptability or otherwise of apparently variable decisions. (shrink)

First published in 1980, Caring and Curing is for all those involved in the 'caring professions' - medicine, social work, and the other health and welfare occupations. It is both an introduction to philosophy for the caring professions and a philosophy of those professions. The authors believe that the best way to introduce philosophy is to engage in it, to philosophize, and that the most exciting way to philosophize is to offer a reasoned but controversial point of (...) view on matters to which people are professionally committed. They argue, first, that there is an essential unity of the caring professions in that the concepts of health and welfare are different aspects of a single value judgement as to what sort of life a person should be enabled to live in his society. Secondly, they show the limits of scientific expertise in relation to human behaviour and argue that the education of medical and social workers should include broader humane disciplines to assist them in coping with the problems of ethics and values of all kinds in present-day society. Thus, the discussion introduces the main branches of philosophy and deals with many of the current moral dilemmas in medicine and social work. (shrink)

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should (...) act when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders, we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just. (shrink)

This study examined the patterns and characteristics of non-parental child care arrangements for Chinese very young children before they enter preschool and the extent to which families’ utilization of non-parental child care influenced parenting stress. A total of 3,842 Chinese parents of infants and toddlers were selected from 10 provinces to participate in this study. The results indicated that Chinese families relied heavily on grandparents to care for their children; a set of family demographics predicted (...) the utilization of non-parental child care arrangements, including parents’ educational level, household income, labor force participation, and maternal age; there existed a clear parental preference for publicly funded, affordable, and high-quality child care services; and families’ use of non-parental child care was generally not linked to parenting stress. These findings shed light on the development of the infant-toddler non-parental child care system in the Chinese sociocultural context. (shrink)

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health (...) outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. (shrink)

This paper depicts a case study of an organizational strategy for the promotion of ethical practice when introducing a new, high-risk, ethically-charged medical practice like Medical Assistance in Dying (MAiD). We describe the development of an interprofessional program that enables the delivery of high-quality, whole-person MAiD care that is values-based and sustainable. A “care ecology” strategy recognizes the interconnected web of relationships and structures necessary to support a quality experience of MAiD for patients, families, and clinicians. This program (...) exemplifies a care ecology approach that addresses common barriers to entry to MAiD practice, and also meets the needs of a variety of stakeholders through the creation of patient and family resources, team supports, standards of practice, professional development opportunities, organizational infrastructure, and community partnerships. We also describe how a thriving care ecology evolves to remain resilient, and to enable integration as the needs of the organization, team and program change over time. The design and development of this program may be adapted to other jurisdictions and organizations where MAiD is introduced, or where new patient populations become eligible for MAiD. This care ecology model may also be applicable to the creation of sustainable programs that provide other morally controversial or novel clinical services. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of (...) health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

ABSTRACT This article seeks to “contaminate” an ethics of care with three different but interrelated theoretical interventions: the expansion of the care ethic beyond interpersonal relations, ecofeminism, and feminist political theory. This makes care theoretically resilient: durable enough to have grounded meaning but flexible enough for situational application. This also makes care a primary concept capable of subsuming some aspects of the traditional ethical theories of deontology, consequentialism, and virtue ethics. This holds vast implications for journalists (...) as they seek new ways to delineate and articulate their service to democracy in an ever-changing mediascape. Furthermore, this ethic of care engenders media literacy and enables an active public to critically question media content and influence. This theoretical explication is thus not an abstract exercise but intentionally focused to aid the difficult work of worldmaking. (shrink)

This paper evaluates the ethical consequences of the use of marketing techniques in the child adoption process within England and Wales. Since 1995 the political climate in the UK has seen a reassessment of the manner in which the state organises care for children who are within its legal guardianship. Successive UK governments have acknowledged the under‐utilisation of child adoption as a moral and efficient means of child‐care. However, the presentation of child adoption in (...) a more active fashion involves concerns about the manner in which child adoption has been organised. Increasingly child adoption organisations and social work professionals are being made accountable through the language of customer service and performance measurements. The use of commercial techniques such as marketing is justified on utilitarian grounds. However, any utilisation of marketing within the child adoption process is forced to ensure that the child is not de‐centred. Legislation requires that the needs and welfare of the child are the first consideration for the adoption agency. Here we begin to see tensions between the humanitarian project that is child adoption, and the unease produced by viewing the child as human ‘product’. This invites analysis via critical theory. The use of marketing in child adoption raises issues related to the objectification and commodification of the child and prospective adopters. Within child adoption it is assumed that we must engage with the child as ‘face’ (Bauman, 1995). But will these assumptions stand the encroachment of marketing techniques into this very sensitive area? (shrink)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

Any attempt to describe a "best health service' must make political assumptions. For example, should it help everyone? Do different people have different entitlements to its support? Should its help be offered according to need, value for money or ability to benefit? These assumptions are not always clear to health service decision-makers immersed in clinical and economic technicalities, so HCA invited two philosophers --John Shand and David Seedhouse -- to engage in conversation about the political philosophy of health (...) class='Hi'>care. (shrink)

This paper aims to consider the implications of Noddings’ ethics of care theory for child-friendly projects and their underlying philosophical assumptions. It is explained that this theory with its emphasis on the children’s needs and rights and, more importantly, the emphasis on the care relation and care encounter indicates how Noddings’ main concepts and ideas could be taken into consideration in exploring the challenges of implementing child-friendly projects. Therefore, the main concepts of ethics of (...) class='Hi'>care theory including need and right, empathy and sympathy, receptive and projective, care about and cared-for, expressed and inferred needs were investigated by considering their adaptation with the origin and the destination of child-friendly projects. Accordingly, a series of questions was set out to illustrate the theoretical challenges that may have been reflected in implementing the child-friendly project. These questions were also categorized in light of three core characteristics of Noddings’ theory of caring: 1) relational ontology; which refers to the relational nature of children life, 2) attention with concern; which refers to the moral sentiment/non-rational life of children and 3) particularism; which refers to the particularity of children’s lives. As individuals/researchers and as members of the child-friendly community we can focus on these questions to understand the challenges of the project and provide a potential for its qualitative evaluation. (shrink)

Certain health care services and goods, although legal and often generally accepted in a society, are by some considered morally problematic. Debates on conscientious objection in health care try to resolve whether and when physicians, nurses and pharmacists should be allowed to refuse to provide medical services and goods because of their ethical or religious beliefs. These debates have most often focused on issues such as how to balance the interests of patients and health care (...) professionals, and the compatibility of conscientious objection with professional obligations, but it is also possible to think about conscientious objection in terms of how to respond to moral disagreement and the requirements of liberal neutrality. (shrink)

Child welfare clinics established in a rural Jamaican community for research purposes are described. These special clinics were able to devote more resources to the care of their children than is usual, yet the growth and health of these children were very similar to those in another group to whom this service was not available and who attended routine government welfare clinics only infrequently.

Background Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, (...) some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested. Methods This paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources. Results Surrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society. Conclusion Policies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child. (shrink)

James Warren, Facing Death, Epicurus and his Critics. Oxford: Clarendon Press, 2004. Pp. viii, 240. ISBN 0-19-925289-0. $45.00. Reviewed by Thornton Lockwood, Sacred Heart University Word count: 2152 words ------------------------------- To modern ears, the word Epicurean indicates an interest in fine dining. But at least throughout the early modern period up until the 19th century, Epicureanism was known less for its relation to food preparation and more so, if not scandalously so, for its doctrine about the annihilation of the human (...) soul at death, its denial of human immortality, and its attempt to justify the claim that death should not be feared since "Death is nothing to us". Epicureans -- like many ancient schools of thought -- sought to establish an objective "morality of happiness" or rational teaching about right conduct which allowed its practitioners to arrive at a kind of well-being. Epicureans identified such well-being or happiness with "freedom from disturbance" taraci/a ), and insofar as the fear of death undermined such contentedness in life, they presented arguments against the claim that death was a bad thing. Put more concisely, Epicureans believe that, "if we think about death correctly, we think about living a good life correctly, and vice versa". But whereas other ancient thinkers -- most famously Socrates and his students -- had sought to cure the fear of death by positing an immortal soul which philosophy was to prepare for life after the death of one's body, Epicureans took the opposite route and argued that in part it was the longing for an impossible immortality that contributed to the fearfulness of death. JW has done both classicists and philosophers the service of presenting a detailed analysis of the philosophical arguments which Epicureanism -- as found principally in the sayings and correspondence of Epicurus, Lucretius' De Rerum Natura, and Philodemus' De Morte -- presented about facing death. As the book's title accurately reflects, the presentation of the arguments is organized in large part as a response to the criticisms which both ancient and modern thinkers such as Cicero, Thomas Nagel and Bernard Williams have made against the Epicurean belief about death. JW is principally concerned with the accurate presentation and fair evaluation of philosophical arguments. Much of his analysis will appeal to philosophers interested in the problem of death or the cogency of ancient ethical thought, but, as he also notes, questions about death and how to live a good life are hardly the problem only of philosophical specialists. "If any questions are worth pursuing, these are". Insofar as JW's task requires careful scrutiny of ancient texts, he also sheds light on the proper understanding of difficult Epicurean texts, especially in those cases where different passages from different Epicurean authors appear to be in tension.[[1]] For the aid of philosophers coming to Epicurus without the skills of classicists, JW translates all Greek and Latin texts into English; at the same time, all translations are accompanied by the passage in its original language. The citations and corresponding bibliography are extensive, covering not only the relevant works of contemporary philosophers such as Nagel, Williams, Feldman, and Parfit, but also the philological works of classicists writing on Epicureanism in English, French, Italian, and German. The volume concludes with a helpful index locorum. The Epicurean belief that "death is nothing to us" is meant to correct the mistaken beliefs which people have that generate a fear of death. But as JW acutely notes, precisely what is fearful about death is ambiguous. On his analysis, it could include at least four analytically distinct fears: 1) the fear of being dead ; 2) the fear that one will die ; 3) the fear of premature death ; and 4) the fear of the process of dying. JW claims that "there is no single Epicurean 'argument against death'. Rather, they had an armoury of arguments which could be deployed against the various different kinds of fear of death". Thus, JW organizes his book into chapters which consider the "armoury"of arguments made against each of these four fears. After an initial introductory chapter which analytically distinguishes the different fears of death, JW next devotes chapters to: the argument that, since humans are without perception of death and the process of death, neither should be feared ; the "symmetry argument" which seeks to prove that apprehension about the coming end of life is as irrational as apprehension that one's life did not begin earlier ; and the Epicurean analysis of what constitutes "completeness" in life. In these first four chapters, JW lays out all the arguments which the Epicurean makes against each of the four fears, considers counterarguments which have been made by ancient and modern authors, and then evaluates the overall strengths and weaknesses of each argument. A fifth chapter considers a slightly different argument, namely one which alleges that either the historical fact that Epicurus wrote a will or the Epicurean attitude towards suicide generate inconsistencies between Epicurean theories and actual Epicurean practice. Finally, a sixth chapter summarizes and evaluates as a whole the Epicurean project to rid humans of their fear of death. Although all of JW's analyses are thorough and detailed, let me focus upon his evaluation of some of the more central -- and more difficult to justify -- claims which Epicureans make to give a sense of JW's argumentation. With respect to the fear of being dead or not existing, Epicureans claim that since the atoms which make up a person dissipate upon death, then there is no person who could perceive any postmortem harm, and thus there is nothing to fear about death itself. Philosophers like Thomas Nagel have raised against this argument examples which appear to justify the belief that postmortem non-perceived harms are something in fact that should be feared.[[2]] For instance, there seems to be something fearful about the death of an individual who does not get the chance to see his or her children grow up, but such a scenario seems to be an example of something which "harms" that individual even though the individual is dead and incapable of feeling or perceiving anything. The case is related to the problem of dying before one's life is "complete," but a merit of JW's analyses of the different fears of death is that it shows that the Epicurean has two distinct arguments against the claim that such a scenario is fearful, one of which concerns the question of fearing something which happens after one's death, the other which concerns the question of fearing that one's life ends before it is complete. With respect to the first question, JW suggests that the source behind our intuition that premature death could be an unperceived harm is a "comparative" evaluation with a non-tragic death. For instance, it is not implausible to say that a child raised in a less developed country has been "harmed" in comparison to a child growing up in a country with adequate access to schooling and health care.[[3]] Even if the child raised in the less developed country never perceives the harm, in comparison to the life she or he might have lived elsewhere such lowered access to resources seems to be a "harm". But, although the case of children being raised with different levels of access to resources may have a place within the question of global justice, the case of such "unperceived" comparative posthumous harms fails as a counter argument to the Epicurean position. In the original example, it was thought that dying before seeing one's children grow up is an unperceived harm because we know of other individuals who have had that opportunity, and comparatively the former individual seems to be "harmed." One of the main problems with such a counter argument, according to JW, is that it ends up proving too much. Since one could imagine for almost every death a comparative case which was better, the counter argument makes almost every conceivable death a "harm" to the individual who died. In JW's words, "given the thought that death may rob us of goods we would have experience were we to die later, it is difficult to resist the thought that any death will fit this description". But the force of the counter argument is supposed to seize upon the case of a "tragic death" where someone is prematurely struck down before life is complete. If all deaths are tragic, none is. If the claim that death is to be feared because of unperceived harms in the case of comparative loss is unpersuasive, what about the claim that death is to be feared instead because it sometimes strikes before one has arrived at completeness or fullness in life? Solon famously claimed that we must "look to the end" and call no man happy until his life is complete; Aristotle picks up on Solon's remarks in part because eudaemonists have traditionally placed special emphasis on "completeness" as a criterion of a life well-lived. Should not all fear death because death can strike prematurely, before one has reached the various goals and stages of a life well-lived? JW persuasively argues that Epicureans were concerned with addressing the fear of premature death but that they countered such a fear on the basis of their understanding of completeness and pleasure. A complete life is a good life, but for the Epicureans, the good is pleasure and the highest pl. (shrink)