Disturbing international inequalities in health abound. Life expectancy in Swaziland is half that in Japan. A child unfortunate enough to be born in Angola has 73 times as great a chance of dying before age 5 as a child born in Norway. A mother giving birth in southern sub-Saharan Africa has 100 times as great a chance of dying from her labor as one birthing in an industrialized country. For every mile one travels outward toward the Maryland suburbs from downtown (...) Washington, DC on its underground rail system, life expectancy rises by a year – reflecting the race and class inequities in American health. Are the glaring, even larger, international health inequalities also unjust? -/- All of us no doubt think they are grossly unfortunate. Many of us think they are unfair or unjust. Why should some people be at such a health disadvantage through no fault of their own, losers in a natural and social lottery assigning them birth in an unhealthy place? Others of us are troubled by the absence of the kinds of human relationships that ordinarily give rise to the claims of egalitarian justice that we make on each other – for example, being fellow citizens or even interacting in a cooperative scheme. Who has obligations of justice to reduce these international inequalities? And do those obligations hold regardless of how the inequalities came about? What institutions are accountable for addressing them? (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

Previously conducted research has determined that physiological and psychophysiological communications evident during pregnancy are vital to the bond formed prenatally. These innate biological responses are further enhanced through psychophysiological factors, such as maternal prenatal stress, which attest to the essential communication between a mother and child in maternal–fetal attachment. A consideration of these factors is necessary with the increase in assisted reproductive technology, such as in vitro fertilization, surrogacy, and elective cesarean section, as this may affect the development of the (...) maternal–fetal bond. It would be of benefit to the child, the mother, and every society to seek a more complete understanding of the intricate maternal–fetal bond, as the first friendship developed at the beginning of human life. (shrink)

This paper calculates the mean duration of the postpartum amenorrhoea (PPA) and examines its demographic, and socioeconomic correlates in rural north India, using data collected through 'retrospective' (last but one child) as well as 'current status' (last child) reporting of the duration of PPA.

This brief report raises the ethical dilemma encountered by an obstetrician involved in the care of a pregnant woman with life-threatening disease. This is a particularly difficult issue if the maternal well-being is in conflict with the survival of the unborn child.

Extensive research has demonstrated that rs1360780, a common single nucleotide polymorphism within the FKBP5 gene, interacts with early-life stress in predicting psychopathology. Previous results suggest that carriers of the TT genotype of rs1360780 who were exposed to child abuse show differences in structure and functional activation of emotion-processing brain areas belonging to the salience network. Extending these findings on intermediate phenotypes of psychopathology, we examined if the interaction between rs1360780 and child abuse predicts resting-state functional connectivity (rsFC) between the amygdala (...) and other areas of the salience network. We analyzed data of young European adults from the general population (N = 774; mean age = 18.76 years) who took part in the IMAGEN study. In the absence of main effects of genotype and abuse, a significant interaction effect was observed for rsFC between the right centromedial amygdala and right posterior insula (p <.025, FWE-corrected), which was driven by stronger rsFC in TT allele carriers with a history of abuse. Our results suggest that the TT genotype of rs1360780 may render individuals with a history of abuse more vulnerable to functional changes in communication between brain areas processing emotions and bodily sensations, which could underlie or increase the risk for psychopathology. (shrink)

The explicit objective for the 2014 Symposium hosted by the University of North Florida, which serves as the basis for this collection of papers, was to explore the relationship and potential for mutual support between the disciplines of child rights and pediatric bioethics in advancing the health and well-being of children in the United States and around the world. The U.N. Convention on the Rights of the Child served as the locus for this discussion. A significant question emerged in the (...) Symposium about whether the CRC could serve any beneficial purpose in the United States, where it has not yet been ratified. Further, there was.. (shrink)

Purpose. The article aimed at comprehending the phenomenon of education in its anthropological content, by comparing two versions for the analytics of the crisis state in education, given by Hannah Arendt and Evald Ilyenkov. Theoretical basis. For implementing this task, the method of in-depth reflexive reading of texts is used, when traditional academic concepts are considered in a new context determined by the analytics of real social problems. In this case, we are talking about the development of thinking not only (...) as a cognitive ability but as an ethical and ontological feature of a human being. In that event, thinking arises through its invisible belonging of one person to many others that both Arendt and Ilyenkov ascertain. Originality. Originality of the article is to identify the anthropological dimension of education and to establish the negative influence of such ways in organizing the educational process while it is under the dictation of current circumstances. The justification for this thesis is presented by identifying the consonance of the educational concepts from Hannah Arendt and Evald Ilyenkov. Conclusions. The opposition between action and thinking, revealed by Hannah Arendt, cannot be understood as a divorcement of thinking from reality, since another man appears to be the original reality for a person, namely, in thinking a person enters the space of a meeting with another man, put himself into another person’s mind and with this firstly attains his place in the world, becoming himself, acquiring the image of a man. So perceived education does not become manipulative training, but it is a real birth of a subject as creating himself. Undermining of the authority in the modern world is accompanied by the searching new forms in structuring the common space of human endeavor, which is possible when the educational status is determined by its attitude to the world rather than by the social environment. The authority of a teacher is effective when he relies on his responsibility for the world into which he introduces the child and which opens to him. Responsibility for peace and the resulting authority is associated with love for the world. Only with sufficient love for the world, a person is capable of taking responsibility for it. (shrink)

This study examined the quality of children's assent to a clinical trial. In subjects younger than 9 years of age, understanding of most aspects of the study was found to be poor to non-existent. Understanding of procedures was poor in almost all subjects. In addition, voluntariness may have been compromised in many subjects by their belief that failure to complete the study would displease others. If the fact that a child's assent has been obtained is used to justify the exposure (...) of that child to the potential harm of a non-therapeutic blood sample, the assent must be meaningful. In the nutrition study observed here, the quality of the assent of children younger than 9 years of age was very poor. The assent therefore did not provide a valid justification for requesting a blood sample from these children. This study indicates that most children younger than 9 years of age cannot be expected to consent or assent to clinical research in a meaningful way. The current age of 7 years for initiating assent (in addition to parental consent) is possibly not appropriate and should be reconsidered. (shrink)

Western scholarly literature suggests that (1) weaning is initiated by mothers; (2) weaning takes place within a few days once mothers decide to stop nursing; (3) mothers employ specific techniques to terminate nursing; (4) semi-solid foods (gruels and mashed foods) are essential when weaning; (5) weaning is traumatic for children (it leads to temper tantrums, aggression, etc.); (6) developmental stages in relationships with mothers and others can be demarcated by weaning; and (7) weaning is a process that involves mothers and (...) children exclusively, with weaned children moving from close relationships with their mothers to strengthened relationships with other children. In many respects, these presumptions are consistent with contemporary Euroamerican practices: nursing stops early (usually before six months) relative to other cultures and takes place over a few days or weeks with the help of bottles and baby foods. Because bottles are available, weaning seldom appears traumatic, but it is seen as an important step in the establishment of independence between mothers and infants. By contrast, weaning from the bottle is often perceived as traumatic. Despite considerable academic and popular interest, weaning has seldom been studied systematically, especially in small-scale cultures. Qualitative and quantitative data from a study of Bofi foragers in Central Africa are used here to evaluate the cross-cultural applicability of the assumptions summarized above. (shrink)

This chapter aims to show that prospective parents are not bound in their reproductive decision making by a principle of procreative beneficence. That is, they have no obligation (as Julian Savulescu, the principle’s originator, famously thinks they have) to choose the possible child, from a range of possible children they might have, who is likely to lead the best life. I will summarise and clarify the content of previous papers of mine, in which I argue that since the sorts of (...) considerations that underlie the principle of procreative beneficence do not constitute reasons when viewed from a perspective that it is fitting and appropriate for a prospective parent to take up, there can be no requirement for prospective parents to be moved by those considerations. (shrink)

Cooperative child care among humans, where individuals other than the biological mother (allomothers) provide care, may increase a mother’s fertility and the survivorship of her children. Although the potential benefits to the mother are clear, the motivations for allomothers to provide care are less clear. Here, we evaluate the kin selection allomothering hypothesis using observations on Hadza hunter-gatherers collected in ten camps over 17 months. Our results indicate that related allomothers spend the largest percentage of time holding children. The higher (...) the degree of relatedness among kin, the more time they spend holding, supporting the hypothesis of nepotism as the strongest motivation for providing allomaternal care. Unrelated helpers of all ages also provide a substantial amount of investment, which may be motivated by learning to mother, reciprocity, or coercion. (shrink)

Decision-making capacityDecision-making capacity for pediatric patients can be difficult to determine and is influenced by a myriad of developmental considerations. This chapter begins with a discussion concerning the nature of decision-makingDecision-making and what constitutes competency. The “rule of sevensRule of sevens” frameworkFramework is then used to explicate pertinent developmental milestonesMilestones for children, dividing pediatric developmentDevelopment into 0–7, 7–14, and 14+ years of age. In particular, the authors highlight the most important cognitiveCognitive, socialSocial, andSocial emotionalemotionalEmotional considerations in each of these periods (...) and how they pertain to a child’s ability to make important medical decisions. (shrink)

IntroductionThis study reports the findings on how Child life specialists implemented an innovative approach to providing therapeutic support to pediatric patients.MethodsPart of a larger study that uncovered themes about CLSs’ experiences while working with MEDi®, this study reports the reflections that CLSs have about the process of implementation. Seven CLSs participated in semi-structured interviews. Content analysis was conducted on interview data and three themes were generated.ResultsThe first was in regards to the adoption process whereby CLS challenges, successes, and surprises were (...) revealed. Second, CLSs explained how using MEDi® aligned with the roles and responsibilities of their profession. The third area of understanding was in CLS explanation of the friendly emotional impact MEDi® seems to have on the hospital environment.ConclusionChild life specialists are encouraged to use the MEDi® robot to support children at the bedside. (shrink)

Based on the author's ethnographic research in India, the book explores the psychology of Hinduism, and offers an innovative synthesis of psychoanylsis with modern anthropological theories of cultural difference. Stanley N. Kurtz offers a new interpretation of the multiple "mother goddesses" of Hinduism, and explores how this multiplicity is key to understanding early childhood experience in which a child is raised by many "mothers" in the Hindu joint family. Arguing that traditional psychoanalytic approaches to Indian culture have applied Western models (...) without regard to differing cultural circumstances, Kurtz suggests that immersion in a joint family plays a central role in the development of feelings and needs which are carried over into adult life. The book concludes with a briefr comparison of mothering in India and contemporary America. _All the Mothers Are One_ makes a significant contribution to the growing debate concerning the role of psychoanalysis in the interpretation of culture and the study of cross-cultural human development. (shrink)

There are too many people on the planet. This isn’t a popular thing to say, but it’s becoming more and more obvious that it’s true, and that we need to do something to address it. Even in our radically unjust world, where billions of people do not have adequate access to food, water, energy, and other resources, we’re still living unsustainably—overcharging our ecological credit card and torching the climate. But discussing the link between these environmental problems and the population is (...) uncomfortable, because many people believe that procreation is an essentially private act that is morally and politically off-limits. In her new book, One Child, Sarah Conly argues that this belief is false: If... (shrink)

The UK Human Fertilisation and Embryology Authority was right to permit tissue typing preimplantation genetic diagnosisOn July 21 2004, the Human Fertilisation and Embryology Authority , Britain’s regulatory agency for reproductive technologies, revised its policy on preimplantation genetic diagnosis for tissue typing.1,2 The authority of the HFEA to enact such a policy was affirmed by the UK’s highest court, the House of Lords, on April 28 2005.3 Preimplantation genetic diagnosis combines in vitro fertilisation with genetic testing. In PGD, embryos generally (...) undergo biopsy prior to the eight cell stage, followed by genetic testing for a particular trait. Tissue typing PGD is done to identify an embryo that is tissue matched for a child suffering from a severe disease requiring bone marrow or cord blood stem cell transplantation and for whom no living donor exists. This procedure was first performed in 2000.4 Precise matching of tissue types is critical to successful tissue transplant, and the donors of such tissues are often referred to as “saviour siblings”.Where a tissue matched individual already exists, extracting bone marrow from that individual or collecting cord blood already in storage, rather than creating a match, presents the most immediate treatment alternative. Bone marrow donation from adults or other medically competent individuals is not generally ethically contested, and bone marrow donation from medically incompetent individuals is also permissible under certain conditions.5 Where no living tissue donor exists, however, intentionally creating a donor through tissue typing PGD is among a short list of possible treatment options.The July HFEA policy change makes PGD licensable in cases where tissue typing is the only purpose of testing. Previously, PGD was licensable in the UK only for disease testing, and tissue typing PGD was permissible only when …. (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)

Creating a man by means of cloning will certainly raise many legal and halakhic questions. But is this sufficient reason to restrain human creativity? Artificial insemination as well as surrogate motherhood also brought many questions, among them questions concerning who is considered the child's father and who is considered the child's mother. But grave questions such as these arise in every field of human endeavor. The emergence of new questions is however not in itself reason to prohibit the creative endeavors (...) that give rise to them. (shrink)

Paediatric genomic research raises particularly challenging questions on whether and under what circumstances to return research results. In the paediatric context, decision-making is guided by the best interests of the child framework, as enshrined in the 1989 international Convention on the Rights of the Child. According to this Convention, rights and responsibilities are shared between children, parents, researchers, and the state. These "relational" obligations are further complicated in the context of genetic research.

In the article, the phenomenon of dual exceptionality is discussed that takes place in the specific situation when a child simultaneously has the characteristics of giftedness and the diseases impairing the learning process at school. Training the child requires from the teacher, on the one hand, the development of giftedness in a particular area, on the other hand - the correction features complicating the learning process. In this group, there more likely includes the left-handed children, children with attention deficit hyperactivity (...) disorder and those who had the syndrome of autistic specter. The methods of the lateral preferences assessment are described. It was discussed that children with mixed lateral parameters had the most severe problems at school. They have the problems with writing and with reading if they have different predominant parameters, for example right leading hand and left leading ear or left leading eye and right leading ear and so on. In this age corpus callosum works poorly and transmits the information from one hemisphere to another badly. In group with the children having the left lateral preferences, there are a lot of children with the autistic specter disorders and children with hyperactivity and attention deficits. The course of this fact is explained with the knowledge that left lateralization has two mechanisms. The first one is genetic one and the second one is connected with the trauma before the birth and during this process. The set of pedagogical and psychological methods are offered for the teachers for the support of all kinds of students. (shrink)

INTRODUCTION[|]The practice of medicine has evolved from old approach, in which all decisions for the patient are taken by physician, to a new approach, which includes patients to the medical decision-making process and endorses informed consent of the patients. In addition to healthcare professionals and patients, parents or legal representatives are stakeholders in the informed consent process of children. The knowledge and attitudes of physicians and medical school students about the informed consent period in children are important for the effectiveness (...) of the medical intervention and the biopsychosocial development of children. In this study, it was aimed to understand involvement of medical students and physicians in the informed consent process of children and their level of knowledge on children's rights and their attitudes in daily clinical practice.[¤]METHODS[|]The study is a descriptive study and n = 150 participants, who were randomly selected from senior medical school students working in medical school campus or university hospital and physicians serving pediatric patients, were included to this study. Questionnaires were applied for the measurement of participants' socio-demographic characteristics, education on pediatric patient rights, and legal provisions. The data were evaluated using SPSS 20.00 software.[¤]RESULTS[|]Of participants, 62% (n = 93) were phase 6 medical students, while 29.33% (n = 44) were resident physicians and the rest were faculty members (8.67%; n = 13). The proportion of physicians, who didn't received training on child rights, was 80.7% (n = 46) and statistically significantly higher than medical students (49.45%; n = 45) (p <0.001). However, participants who were not educated about the children's rights stated with higher ratio (44.83%; n=65), that informed consent should be obtained before medical intervention from individuals under 18 years of age, when they are compared to the the participants who received education (20.69%; n=30) (p = 0,019). The majority of participants (59.5%; n = 88) find the intervention in individuals under the age of 18 years in emergencies without consent of legal representatives ethically and legally appropriate (p <0.001). The participants believe that it is ethically and legally appropriate to conduct an intervention on an individual under the age of 18 years without the legal representative (36. 7%; n=54) (p <0.001).[¤]DISCUSSION AND CONCLUSION[|]This study compared the levels of knowledge and attitudes of participants, who were previously trained in or didn't received any training about children's rights and informed consent of children. However, the quality of the training of the participants on children's rights, was not questioned. This study showed that education on children's rights does not significantly increase the level of legal knowledge on children's rights. Having well-designed a subject focused on this theme in medical deontology and ethics education can increase the knowledge levels and improve the attitudes of medical students. This study sheds light on the issues that need to be focused in the medical faculties and the trainings of physicians and showed lack of information and need for development of attitudes regarding children's rights and informed consent in children.[¤]. (shrink)

Abstract Since their inception, distributional models of semantics have been criticized as inadequate cognitive theories of human semantic learning and representation. A principal challenge is that the representations derived by distributional models are purely symbolic and are not grounded in perception and action; this challenge has led many to favor feature-based models of semantic representation. We argue that the amount of perceptual and other semantic information that can be learned from purely distributional statistics has been underappreciated. We compare the representations (...) of three feature-based and nine distributional models using a semantic clustering task. Several distributional models demonstrated semantic clustering comparable with clustering-based on feature-based representations. Furthermore, when trained on child-directed speech, the same distributional models perform as well as sensorimotor-based feature representations of children’s lexical semantic knowledge. These results suggest that, to a large extent, information relevant for extracting semantic categories is redundantly coded in perceptual and linguistic experience. Detailed analyses of the semantic clusters of the feature-based and distributional models also reveal that the models make use of complementary cues to semantic organization from the two data streams. Rather than conceptualizing feature-based and distributional models as competing theories, we argue that future focus should be on understanding the cognitive mechanisms humans use to integrate the two sources. (shrink)

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents’ perceptions of their child’s projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of (...) parental refusal based upon an infant’s projected quality of life. (shrink)

We should react to deaf parents who choose to have a deaf child with compassion not condemnationThere has been a great deal of discussion during the past few years of the potential biotechnology offers to us to choose to have only perfect babies, and of the implications that might have, for instance for the disabled. What few people foresaw is that these same technologies could be deliberately used to ensure that children would be born with disabilities. That this is a (...) real possibility, and not merely the thought experiment of a philosopher, is brought home to us by the decision of an American lesbian couple to select a deaf sperm donor in order to maximise the chances that their children, Jehanne and Gauvin, would be deaf like them.1 Their choice has sparked controversy, not only among medical ethicists, but in the opinion pages of newspapers across the world. Ought parents be permitted to make such choices?If the parents of Jehanne and Gauvin have done anything wrong, it must consist in violating their child’s right to an open future—limiting its future potential for choice.2 But what does it mean to respect this right?From the moment a child is born, her parents are making choices for her, which will powerfully shape her future. They will decide what kind of education she will have, what religious experiences, from among what group she can select friends. Thereby, they profoundly mould the person she will be and the life she will have.When this activity is carried out within certain, ill-defined, limits, it is in no way objectionable. It is not merely a …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bringing Cancer Care to Those who Don't Have ItLawrence N. ShulmanI have been treating cancer patients in the Harvard Medical School hospitals since 1977, and in those 35 years we have made tremendous progress. Though work still needs to be done, and far too many patients still die of cancer, many are cured. In particular, children and young adults have a high rate of cure from such diseases as (...) Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, and childhood sarcoma. Patients with breast cancer in the US have a greater than 80% chance for long-term survival. The death rate from cervical cancer in the US is very low. These results have been achieved by making diagnoses earlier, in many cases surgical excision, and often systemic therapies such as chemotherapy, hormonal therapy, radiation therapy, and more recently by using so-called "targeted" therapies—those directed at particular molecular characteristics of the cancer cells.Princess Dina Mired has said that the opportunity to survive cancer should not be an accident of geography. In cases where we already have effective and inexpensive tools to cure cancer, these treatments should be considered a basic human right, a life-saving medical service.I met Patty, a young woman living in the U.S. during November of her senior year in high school, after she discovered a small lump above her left collar bone. Though she felt entirely well, she called her primary care doctor who saw her the next day, felt the enlarged lymph node, and referred her to a surgeon, who did a biopsy later that week. Her primary care doctor also called me, and we scheduled a visit when the pathology results were available. The following week the pathologist notified Patty's pediatrician that the biopsy showed Hodgkin's lymphoma. When I met Patty, she was a bright and focused young woman, waiting to hear about her college applications and enjoying her senior year. Her cancer diagnosis was completely out of context with her life as she planned it, but with the support of her family and boyfriend, she seemed prepared to take things one step at a time. A PET CT scan demonstrated a modest mass in the mediastinum (chest), but no other disease. She was in an early stage of the disease with an excellent prognosis. We recommended and administered six months of chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine—four chemotherapy agents that are off-patent, and relatively inexpensive. She lost her hair, not a trivial issue for her, but otherwise felt reasonably well during the treatment. She was determined to graduate with her classmates, and was able continue to attend school and keep up with her work. In June, seven months into her cancer diagnosis and treatment, she graduated with honors, and was on track to enroll in college in September.Like other 18-year-old women with Hodgkin's lymphoma, Patty had an over 80% chance for cure with the potential for a long and productive life ahead of her because we could perform a biopsy, make a diagnosis, and safely and effectively treat her with four inexpensive, off-patent, chemotherapy drugs. She had nearly the same likelihood of living a long and fruitful life as her classmates, and had the same chances for childbearing. In my line of work, with the knowledge we now possess, to allow someone like Patty to die without a chance of curative care is simply unacceptable. Treatment of curable cancers should be considered on par with the right to clean water, adequate nutrition, treatment for infectious disease, and access to maternal and child healthcare services.But in many places in the world, people with cancers we could easily eradicate in Boston have no access to cancer services, and do die unnecessarily. The local healthcare infrastructure has no [End Page E10] capacity to evaluate a patient, perform or process a biopsy, make a diagnosis, or treat the patient with potentially curative surgery, chemotherapy and radiation. I have rounded on the wards of hospitals in developing countries, stopping to talk with numerous patients like Patty: young women, some of whom might have had Hodgkin's lymphoma, but no... (shrink)

The II. constitutional period is a period of renewal in many areas. Political, social and educational changes also had influences in the field of religious education. One of the examples of these changes is the ʻAmelī I҆lmiḥal textbook written by Halim Sabit (DOD. 1946) in five volumes for both teachers and student. This study particularly aims to assess this textbook in terms of religious education. Accordingly, the following questions are addressed: “What are the topics covered in the ilmihal books written (...) for students and teachers? Is the content of the subjects taught appropriate for the religious education? Which methods, techniques, and essential matters are discussed in the ilmihal books for teachers? As having first grade elementary school textbooks for both teachers and students, the research is made just based on these books. Data were collected through the examination of the document, and the texts in Ottoman Turkish were transcribed into Turkish. Content analysis method was used in the analysis of the data. By examining both books, this study shows that belief, worship, and social issues were taught, and prayers and sūras were addressed as need to be memorized knowledge in the book. The books included inappropriate contents for first grade children regarding the belief issues such as fear of Allah, hell, and the hereafter. Summary: Education I҅lmiḥal, occupies an important place in the history of Islamic religious education. According to the religion of both adults and children to learn the principles of faith and worship, it is aimed to shape the daily life. In this context, for example, during the Ottoman period, In the period of II. Mahmut, boys were required to attend the primary school. Thus, it was ensured that children could learn I҅lmiḥal and Islamic sharia properly. Children are taught alif ba for Qurʾān readings in primary schools, as simple as required by religious duties, writing skills have been acquired and the four processing rules are memorized. The II. constitutional period is a period of renewal in many areas. Extreme innovative thinking is also reflected in education. Especially after the Balkan wars, the idea that the collapsing state would be saved through education was dominant. For the first time, a higher education institution for girls and a kindergarten for young children were opened. By recognizing the importance of pedagogy knowledge in teaching, the students have switched to a system where they can search for observation and experiment. Innovations in educational methods have started to be seen. It was seriously opposed to memorization, and the question and answer was seen as old methods. Instead, it was proposed to use sightseeing observation and discovery. Political, social and educational changes are also reflected in the field of religious education. As a reflection of the newly introduced methods, there have been changes in the ʻAmelī I҆lmiḥal books prepared for children. One of the examples of this is the ʻAmelī ʻIlmiḥal textbook, which was written by Halim Sabit in five volumes. This ʻAmelī I҆lmiḥal was prepared in 5 volumes for teachers and students.The main purpose of this study is to evaluate ʻAmelī I҆lmiḥal textbook in terms of religious education This study particularly aims to assess this textbook in terms of reigious education. Accordingly, the following questions are addressed: “What are the topics covered in the ilmihal books written for students and teachers? Is the content of the subjects taught appropriate for the religious education? Which methods, techniques, and essential matters are discussed in the ilmihal books for teachers? As having first grade elementary school textbooks for both teachers and students, the research is made just based on these books. Data were collected through the examination of the document, and the texts in Ottoman Turkish were transcribed into Turkish. The textbook prepared for the students of the first year consists of 21 boards/sheets. The sentences are quite self and short. The contents of the board/sheet are well suited to be discussed and explained. There are no headlines on the boards/sheets. The language of text is Ottoman. It is possible to express the topics covered in the book under the following themes:Prayer and Sūras: Basmala, Kalima Tawḥīd, Kalima Shahāda, Fātiḥa, Subḥana Rabbiyal Aʿala, Subhana rabbiyal ʿAẓim, As-salāmu ʿalaykum va Raḥmatullah, Taḥiyyat, Salawat Sharif, Iḥlas, Kawthar, Subḥanaka Prayer, Qunut Prayers.Faith Issues: Allāh, the fear of Allāh, thanks to Allāh, the Qurʾān, Prophets, Prophet Muḥammad, The Hereafter, Heaven Hell, Angels.ʿIbādat Issues: Zakāt, Ablution, Prayer, Adhān, worship in General (Salāt, Ṣawm, Zakāt, Ḥajj)Social Issues: Friendship, affection for minors, affection for parents, Muslims are Brother, human love, respect for the elderly, respect for scholars.The textbook prepared for the teachers of the first year; consists of 21 pages, 69 pages and Ottoman. As the students do not include the topics in the textbook, it is appropriate to mention the names of the subjects in the textbook of the teacher:1. Subject: Memorization of the Word of Tawḥīd and word of Shahāda; 2. Topic: Raising ideas about the nation in children; 3. Subject: The adjectives of Allāh Almighty; 4. Subject: Love of Allāh; 5. Subject: Angels; 6. Subject: The Divine Books; 7. Subject: Prophets 8. Subject: The Hereafter; 9. Subject: Thank Allāh; 10. Subject: Repentance; 11. Topic: Protecting the language from bad words and threats; 12. Subject: Zakāt and charity; 13. Subject: Riya҆ and his goodness engrave; 14. Subject: Love to the prophet Muḥammad; 15. Subject: Parental love; 16. Subject: The brotherhood of Islam; Subject: Human love; 18. Subject: Ablution; Subject: Prayer; 20. Subject: Respect for the elderly; 21. Subject: Love to ʿulamāʾ; 22. Subject: Fear of Allāh.Halim Sabit also gave information about the methods and techniques to be used in the course and emphasized that the teacher told his / her not by looking at the book. He thought it would be only influence the student in this way. It is recommended to use the appropriate language for the child, to make an introduction in the subjects that will be learned in the new subjects and to draw attention to the subject and to teach the subject gradually. An important advice is the knowledge that the teacher wants him / her to do in the long-term memory in the present sense. The teacher must repeat a subject several times while teaching a subject, and should not immediately remind a student of forgotten subjects, talk to a student and has finded to him. A subject should not be passed without being thoroughly understood, and the classroom needs to be opened by the teacher in order not to forget the learned subjects. The first fifteen minutes of each course should be reserved for the repetition of previously learned subjects. Content analysis method was used in the analysis of the data. By examining both books, this study shows that belief, worship, and social issues were taught, and prayers and sūras were addressed as need to be memorized knowledge in the book. The books included inappropriate contents for first grade children regarding the belief issues such as fear of Allah, hell, and the hereafter. (shrink)

Research in the organizational sciences has tended to portray prosocial behavior as an unqualified positive outcome that should be encouraged in organizations. However, only recently, have researchers begun to acknowledge prosocial behaviors that help maintain an organization’s positive image in ways that violate ethical norms. Recent scandals, including Volkswagen’s emissions scandal and Penn State’s child sex abuse scandal, point to the need for research on the individual factors and situational conditions that shape the emergence of these unethical pro-organizational behaviors. Drawing (...) on trait activation theory, we argue that the “dark” trait of Machiavellianism should make individuals more willing to engage in UPB. Further, we argue that this willingness will be augmented when Machiavellians hold bottom-line-mentality climate perceptions, or the perception that ethical standards matter less than organizational performance. Using data from 170 U.S. employees, results suggested that Machiavellians are more willing to engage in UPB, but that BLMCPs may not affect their motivation to engage in UPB. We discuss the study’s theoretical and practical implications, as well as avenues for research. (shrink)

There appear to be a number of general things which can be said about forgiveness. If these are left sufficiently vague they seem to be applicable to all the situations in which the term is used.First, there can be no question of forgiveness unless an injury has been inflicted on somebody by a moral agent. There must be something to forgive; and the injury that is to be forgiven must be one for which a moral agent can be held responsible. (...) One cannot forgive a rock for falling on one's foot or a cougar for attacking one's child—even though a child might kick the rock and a father might shoot the cougar. (shrink)

The words in children's language learning environments are strongly predictive of cognitive development and school achievement. But how do we measure language environments and do so at the scale of the many words that children hear day in, day out? The quantity and quality of words in a child's input are typically measured in terms of total amount of talk and the lexical diversity in that talk. There are disagreements in the literature whether amount or diversity is the more critical (...) measure of the input. Here we analyze the properties of a large corpus of speech to children and simulate learning environments that differ in amount of talk per unit time, lexical diversity, and the contexts of talk. The central conclusion is that what researchers need to theoretically understand, measure, and change is not the total amount of words, or the diversity of words, but the function that relates total words to the diversity of words, and how that function changes across different contexts of talk. (shrink)

Background: Pediatric guidelines recommend that children and adolescents participate in a developmentally appropriate way in end-of-life decision making. Shared decision making in pediatrics is unique because of the triadic relationship of patient, parents, and physician. The involvement of the patient may vary on a continuum from no involvement to being the sole decision maker. However, the effects of child participation have not been thoroughly studied. The aims of this literature review are to identify studies on end-of-life decision making in pediatrics, (...) to explore patient participation, and to assess the effects of such participation. Methods: Five databases—PubMed, PsycInfo, Medline, CINAHL, and Sociological Abstract—were searched for empirical studies on end-of-life decision making in pediatrics. Selected articles fulfilling the criteria were assessed for type of decision, participants’ characteristics, reports on participation of the minor patient, and outcome. Results: Fifty-seven articles on end-of-life decision making in pediatrics were identified. The majority of papers (n = 43, 75%) investigated parents’ and clinicians’ perspectives, while only 14 articles (25%) included perspectives of children and adolescents. Twenty-two articles (39%) reported some details on various forms of children's participation (e.g., receive information, plan care details, consulted before or after a decision was made). Positive (e.g., respect for patient's preferences) and negative (e.g., conflict due to diverging opinions) effects of children's participation in end-of-life decision making were reported. Conclusions: This systematic review highlights the need for research to identify factors that contribute to a favorable participation of minors in decision-making processes, as well as strategies to solve possible conflicts. More research should take into account the dynamics in the triadic process of decision making and emphasize children and adolescents’ perspectives. A better understanding of how to meaningfully involve children and adolescents in end-of-life decision making could facilitate the practice of patient participation in pediatrics. (shrink)

Lexical alignment, a communication phenomenon where conversational partners adapt their word choices to become more similar, plays an important role in the development of language and social communication skills. While this has been studied extensively in the conversations of preschool‐aged children and their parents in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) communities, research in other pediatric populations is sparse. This study makes significant expansions on the existing literature by focusing on alignment in naturalistic conversations of school‐aged children from a (...) non‐WEIRD population across multiple conversational tasks and with different types of adult partners. Typically developing children aged 5 to 8 years (n = 45) engaged in four semi‐structured conversations that differed by task (problem‐solving vs. play‐based) and by partner (parent vs. university student), resulting in a corpus of 180 conversations. Lexical alignment scores were calculated and compared to sham conversations, representing alignment occurring at the level of chance. Both children and adults coordinated their conversational utterances by re‐using or aligning each other's word choices. This alignment behavior persisted across conversational tasks and partners, although the degree of alignment was moderated by the conversational context. These findings suggest that lexical alignment is a robust phenomenon in conversations between school‐age children and adults. Furthermore, this study extends lexical alignment findings to a non‐WEIRD culture, suggesting that alignment may be a coordination strategy employed by adults and children across diverse linguistic and cultural backgrounds. (shrink)

Through personal testimony, the author details the experience of fathering a baby with a poor prenatal diagnosis. The author invites the reader to follow his journey, from learning his wife is pregnant, through their experiences as a family with their unborn daughter’s poor prenatal diagnosis, welcoming their baby girl at her birth, and ultimately finding peace in her early passing. Perinatal peer support is discussed and encouraged, drawing attention to the needs and concerns of the babies, women, and families who (...) may not know to seek help in a similar situation. Great honor is given to the beauty and sanctity of life from the perspective of a father with a sick unborn child. National Catholic Bioethics Quarterly 14.1 : 31–37. (shrink)

The opinion of Mr. Justice Francis of the English High Court which denied the parents of Charlie Gard, who had been born with an extremely rare mutation of a genetic disease, the right to take their child to the United States for a proposed experimental treatment occasioned world wide attention including that of the Pope, President Trump, and the US Congress. The case raise anew a debate as old as the foundation of Western medicine on who should decide and on (...) what standard when there is a conflict between a family and the treating physicians over a possible treatment. This paper will explore the different approaches of the British and American courts on the issue and the various proposals from that of John Rawls in his A Theory of Justice to a processed-based approach for resolving such disputes. As carefully crafted as the opinion of Mr Justice Nicholas Francis in the Gard case proved to be, it left commentators unsatisfied. A widespread criticism, captured in an article by Michael Dougherty in The National Review was for the state to ‘get out of the way of the parents trying to act in the best interests of the child’.1 Although he conceded the parents could be adding to the suffering of the child by taking Charlie to America for an experimental therapy and agreed that such a choice ‘may be the wrong decision,’ in Dougherty’s view, it should still be ‘their decision’. Dougherty’s stand was the popular response to the question of ‘Who should decide?’ It fails, however, to propose any rationale for the decision. It provided no norms, no standards and no guidelines for the parents. Their motive could equally well be indifference to the suffering of the child as concern for his well-being. Furthermore, even good, loving parents may make …. (shrink)

To gain insight into the reasons that the public may have for endorsing or eschewing pharmacological moral enhancement for themselves or for others, we used empirical tools to explore public attitudes towards these issues. Participants from the United States were recruited via Amazon’s Mechanical Turk and were randomly assigned to read one of several contrastive vignettes in which a 13-year-old child is described as bullying another student in school and then is offered an empathy-enhancing program. The empathy-enhancing program is described (...) as either involving taking a pill or playing a video game on a daily basis for four weeks. In addition, participants were asked to imagine either their own child bullying another student at school, or their own child being bullied by another student. This resulted in a 2 × 2 between-subjects design. In an escalating series of morally challenging questions, we asked participants to rate their overall support for the program; whether they would support requiring participation; whether they would support requiring participation of children who are at higher risk to become bullies in the future; whether they would support requiring participation of all children or even the entire population; and whether they would be willing to participate in the program themselves. We found that people were significantly more troubled by pharmacological as opposed to non-pharmacological moral enhancement interventions. The results indicate that members of the public for the greater part oppose pharmacological moral bioenhancement, yet are open to non-biomedical means to attain moral enhancement. [248 words]. (shrink)

Over the course of development, children acquire adult-like thinking about social categories such as race, which in turn informs their perceptions, attitudes, and behavior. However, children’s developing perceptions of race have been understudied particularly with respect to their potential influence on cross-race egalitarianism. Specifically, the acquisition of racial constancy, defined as the perception that race is a concrete and stable category, has been associated with increased awareness of racial stereotypes and group status differences. Yet, little work has investigated behavioral outcomes (...) stemming from the acquisition of racial constancy beliefs. Here, we investigate whether the presence or absence of racial constancy beliefs differentially predicts inequality aversion with racial ingroup versus outgroup members for young children. White children ( N = 202; ages 3–8) completed three sticker resource-allocation games with either a White or a Black partner shown in a photograph, after which racial constancy was measured. Results revealed that the acquisition of racial constancy interacted with partner race to predict inequality aversion outcomes in one game; however, age and gender also exerted strong effects. (shrink)

Background This study assesses how pediatric assent is conceptualized and justified within the therapeutic context. Pediatric ethicists generally agree that children should participate in medical care decisions in developmentally appropriate ways. Much attention has been paid to pediatric assent for research participation, but ambiguities persist in how assent is conceptualized and operationalized in the therapeutic context where countervailing considerations such as the child’s best interest and parental permission must also be weighed.Methods Searches were conducted in 11 databases including PubMed, Embase, (...) Cochrane Library, and Web of Science. Articles published between 2010 and 2020 were screened in COVIDENCE for meeting each of four criteria: (1) focusing on pediatric assent, (2) focusing on clinical care, (3) including normative claims, and (4) containing substantive statements about the meaning of pediatric assent. Full texts were abstracted for (1) operational definitions of assent, (2) discussion of the temporal nature of assent, (3) description of the concept of “understanding,” and (4) ethical justifications for soliciting assent. These excerpts were coded and code patterns formed themes presented in the results.Results The final analytic data set contained 29 articles. Analysis yielded three key themes. First, valid assent varies by treatment, population (e.g., younger versus older), and geographic/cultural context. Second, assent represents two distinct longitudinal processes: One involves eliciting preferences over a disease course or care episode; the other focuses on children’s developmental maturation. Third, ethical justifications for assent draw variously on instrumental and intrinsic reasons, but often remain ambiguous.Conclusions There is widespread agreement that assent is morally valuable, but there remain substantial ambiguities or disagreements about its meaning, process, and ethical justification. (shrink)

Although the obesity epidemic appears to have affected all segments of the U.S. population, its impact on children with special health care needs has received little attention. “Children with special health care needs” is a term used in the U.S. to describe children who come to the attention of health care providers and policy makers because they need different services and supports than other children. Government, at both the federal and state levels, has long felt a particular responsibility for safeguarding (...) the health of children with special needs. The definition “children with special health care needs,” in fact, was developed by a work group established by the U.S. Maternal and Child Health Bureau to assist states in their efforts to develop community systems of services for children with complex medical and behavioral conditions. (shrink)

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact upon the (...) inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...) in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

This paper examines the contribution of parents? education and children?s gender on parental expectations of their children?s future education and the role of parental perceptions of their child?s competencies in the formation of their expectations. A group of university and vocationally educated parents (N = 418) were asked to estimate the probability of their child entering gymnasium (high school) or vocational education and assess the child?s competencies, first in preschool, and then at the end of the third school year. It (...) was found that the education and gender?bound differences in the parental expectations were established before the child entered school, and by the end of the third school year the relationships between expectations and competence assessments strengthened and were more uniform among the parents. The findings suggested that the parental assessments of their child?s abilities can be regarded as a potentially important social?psychological process through which social differences are transformed into the individualized interpretations of the child?s educational prospects. (shrink)

The case of Rees v. Darlington Memorial Hospital N.H.S. Trustarises from a lower court backlash against the a prior decision of the British House of Lords in McFarlane v. Tayside Health Board. McFarlane holding that healthy children brought about by negligence in family planning procedures are blessings, and parents should therefore be denied the costs of child maintenance. But, would the House agree with the Court of Appeal in Reesthat the factual variation in that case of a disabled parent with (...) a healthy child should form an exception? In tracing the appeal of Reesto the House of Lords, this note explores their Lordships’ refusal in principle to depart from McFarlane, as well as the invocation of an autonomy-based approach to address the harm of unsolicited parenthood. In reflecting on the extent to which the wrongful conception action can be said to reinforce the value of reproductive autonomy, this note argues, nevertheless, that Reesillustrates in another way a significant departure from McFarlane, but that this is still a turn in the wrong direction. Far from resonating with women’s diverse experiences of reproduction, the law of negligence continues to illustrate little respect for reproductive choice. Therefore, this note calls for a deeper understanding of autonomy, one that recognises and embraces the diversity of individuals’ reproductive lives. (shrink)