This chapter highlighted some salient trends in pediatric ethicsEthics, pediatric from different parts of the globe. It is interesting to note that although diverse, there are many similarities between ethical challenges in pediatrics in different parts of the world.

There is an inconsistency in the ways that doctors make clinical decisions regarding the treatment of babies born extremely prematurely. Many experts now recommend that clinical decisions about the treatment of such babies be individualized and consider many different factors. Nevertheless, many policies and practices throughout Europe and North America still appear to base decisions on gestational age alone or on gestational age as the primary factor that determines whether doctors recommend or even offer life-sustaining neonatal intensive care treatment. These (...) policies are well intentioned. They aim to guide doctors and parents to make decisions that are best for the baby. That is an ethically appropriate goal. But in relying so heavily on gestational age, such policies may actually do the babies a disservice by denying some babies treatment that might be beneficial and lead to intact survival. In this paper, we argue that such policies are unjust to premature babies and ought to be abolished. In their place, we propose individualized treatment decisions for premature babies. This would treat premature babies as we treat all other patients, with clinical decisions based on an individualized estimation of likelihood that treatment would be beneficial. (shrink)

A recent American Academy of Pediatrics (AAP) clinical report states that it is an acceptable option for pediatric care clinicians to dismiss families who refuse vaccines. This is a clear shift in guidance from the AAP, which previously advised clinicians to “endeavor not to discharge” patients solely because of parental vaccine refusal. While this new policy might be interpreted as encouraging or recommending dismissal of vaccine-refusing families, it instead expresses tolerance for diverse professional approaches. This is unlike the earlier guidance, (...) which promoted a unified response to vaccine refusal. In fact, the resolution (which was presented at the AAP’s Annual Leadership Forum) that led to this clinical report also calls on the AAP “to continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.” However, the shift toward embracing dismissal as an acceptable response to vaccine refusal may erode professional solidarity. Pediatricians are clearly divided on this question; most do not dismiss vaccine-refusing families. By declaring that dismissal is an acceptable option, the AAP has sanctioned a practice that may be unfair to the many clinicians who do not dismiss these families. Clinicians who adopt a policy of dismissal toward families who refuse vaccines might impose burdens on colleagues who remain willing to offer care to those families, and their actions might show insufficient commitment to the efforts of their profession to promote health for all children. (shrink)

Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate because they were threatened with dismissal. Other (...) heavy-handed interventions have failed to move most such parents. When Washington state made nonmedical exemptions more difficult to obtain, nearly two-thirds of vaccine refusers were unmoved and their children remained unvaccinated. Even if dismissal threats led some parents to accept vaccines, this alone would not justify a dismissal policy. The benefits would still have to be weighed against the risks of dismissing those families who do not change their minds. (shrink)

Parents respond to the death of a child in very different ways. Some parents may be violent or angry, some sad and tearful, some quiet and withdrawn, and some frankly delusional. We present a case in which a father’s reaction to his daughter’s death is a desire to protect his wife from the stressful information. The wife is in the second trimester of a high-risk pregnancy and so is particularly fragile. We asked pediatricians and bioethicists to discuss the ways in (...) which they might respond to the father’s understandable but troubling request. -/- The death of a young child is one of the most stressful events that can happen to parents. The stress of such a loss is compounded if the parents are in a foreign country, far from home, and without a network of family and friends to provide social support. The stress may be more difficult to deal with if the parents have acute health problems of their own. In this month’s “Ethics Rounds,” we present a case in which a father whose daughter died requested that the doctors delay telling his wife. His reason: She is pregnant, in the second trimester, and on bed rest because of preterm labor. He does not want to add to her stress. We asked both pediatricians and bioethicists to respond to this request. (shrink)

In this article, we first review the development of clinical ethics in pediatrics in the United States. We report that, over the last 40 years, most children’s hospitals have ethics committees but that those committees are rarely consulted. We speculate that the reasons for the paucity of ethics consults might be because ethical dilemmas are aired in other venues. The role of the ethics consultant, then, might be to shape the institutional climate and create safe spaces for the discussion of (...) difficult and sometimes contentious issues. Finally, we report how pediatric clinical ethics has evolved differently in a number of other countries around the world. (shrink)

A commentary on “Were There ‘Additional Foreseeable Risks’ in the SUPPORT Study?,” by Henry J. Silverman and Didier Dreyfuss; “SUPPORT: Risks, Harms, and Equipoise,” by Robert M. Nelson; “The Controversy over SUPPORT Continues and the Hyperbole Increases,” by Alan R. Fleischman; and “SUPPORT and Comparative Effectiveness Trials: What's at Stake?,” by Lois Shepherd, all in the January‐February 2015 issue.

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

Scientists and laypeople alike use the sense of understanding that an explanation conveys as a cue to good or correct explanation. Although the occurrence of this sense or feeling of understanding is neither necessary nor sufficient for good explanation, it does drive judgments of the plausibility and, ultimately, the acceptability, of an explanation. This paper presents evidence that the sense of understanding is in part the routine consequence of two well-documented biases in cognitive psychology: overconfidence and hindsight. In light of (...) the prevalence of counterfeit understanding in the history of science, I argue that many forms of cognitive achievement do not involve a sense of understanding, and that only the truth or accuracy of an explanation make the sense of understanding a valid cue to genuine understanding. (shrink)

There is a standard story told about the rise and fall of ordinary language philosophy: it was a widespread, if not dominant, approach to philosophy in Great Britain in the aftermath of World War II up until the early 1960s, but with the development of systematic approaches to the study of language—formal semantic theories on one hand and Gricean pragmatics on the other—ordinary language philosophy more or less disappeared. In this paper we present quantitative evidence to evaluate the standard story (...) of the rise and fall of ordinary language philosophy, building on the topic model of over 30,000 philosophy articles in Weatherson (2022). Using a combination of qualitative judgment and a topic-model-based measurement of similarity between individual articles, we find evidence that supports the first part of the standard story, according to which ordinary language philosophy arises in the 1940s, peaks between the early 1950s and the late 1960s, and then rapidly declines. But we argue that there is also evidence of a "new wave" of ordinary language philosophy in the early 21st century that defies the second part of the standard story. (shrink)

This paper examines narrativism’s claim that the historical past cannot be known once and for all because it must be continuously re-described from the standpoint of the present. We argue that this claim is based on a non sequitur. We take narrativism’s claim that the past must be re-described continuously from the perspective of the present to be the result of the following train of thought: 1) “all knowledge is conceptually mediated”; 2) “the conceptual framework through which knowledge of reality (...) is mediated changes with every new generation of historians”; therefore (narrativism’s claim) “the historical past changes with every new generation of historians”. The idea of an unchanging past, for the narrativist, requires denying premise 1 (all knowledge is conceptually mediated”) and therefore rests on a problematic commitment to the chimerical notion of the past as it is in-itself, wie es eigentlich gewesen. We argue that the narrativist’s conclusion does not follow unless one adds a further premise, namely 3) “it is not possible to view reality through the categorial framework of historical agents”. If one asserts the possibility of grasping reality through the categorial framework of others, be they contemporary or past agents (as much philosophy of history written in an idealist key does), then one no longer has to accept the narrativist’s inference that since the past cannot be known in-itself or independently of conceptual mediation, then it cannot be known as it always was for the historical agents. Narrativism’s inference that the past cannot be known as it always was does not follow from premises 1 and 2 unless one smuggles in another problematic premise, premise 3. In this paper we defend the claim that the past can be known as it always was (not as it is in-itself) by invoking a different conception of the role of conceptual mediation in historical knowledge, one which assumes the possibility of viewing reality through the categorial framework of others. This notion of the role of conceptual mediation in historical knowledge is prevalent in the idealist tradition but, in the interest of brevity, we will defend this notion of mediacy by specific reference to the idealist philosophy of R.G. Collingwood. (shrink)

The Church of England By Law Established, in incidental payment for secular privilege, has submitted to the bonds of established clichá, in particular to the reproach that its rulers seem more concerned with the external or practical working of Anglican faith and ritual than with their intellectual definition and justification. This intellectual looseness remained unimportant in practice as long as a forceful anti–Roman spirit blew all waves of opinion in one practical direction. In time, however, that wind gradually lost force (...) and positive cross–currents of Anglican belief came to the public surface. The legislators of the sixteenth century had formulated the positive rules of the Thirty–Nine Articles and the Prayer Book in tolerantly broad language. They left no decisive teaching authority to explain their texts and to meet the challenge of shifting ritual and speculative doubt. Time has subjected both instruments to an everwidening range of individual interpretation especially since the early nineteenth century, when the Anglican monopoly of political, social and educational institutions was disputed by fresh tides of Protestant dissenters, renascent Catholics and nascent agnostics. To–day, as Mr. Cockshut wryly comments: “to throw doubt on the Anglican formularies is itself part of the Anglican tradition”. (shrink)

The meticulous printing at a moderate price of this remarkable work is a credit to the publisher. During the past thirty years M. Gilson has been the greatest single influence upon lay readers in reviving serious interest in the clerical speculation, which for twelve hundred years conscientiously spanned the gap between the collapse of Greek science and Roman law and the late sweep of modern sciences and their secular philosophies. Preoccupation with short-term apologetics after the Reformation increased clerical aloofness from (...) professional science and philosophy and probably increased the non-scholastic’s assumption that the Christian Era was merely a dark or middle age between ancient and modern intellectual life. In fact, early and medieval thinkers gradually confronted their Christian faith and pagan science and against the basso ostinato of secular warfare developed the varied themes of scientific theology and human philosophy, which crystallized into the mature Scholasticism of the thirteenth century. Hence the seventeenth century founders of modern philosophy, as M. Gilson first found à propos of Descartes, started to philosophize from a metaphysical inheritance much richer than the original Greek patrimony, especially in the light it cast upon the reality of God, the origin of the universe in which man lives, the nature and destiny of man himself. To overlook this linking inheritance, is to make modern philosophy less intelligible; while to personally judge its value, we must return to its historical sources. This is the task to which M. Gilson has devoted his pioneering judgment; this work is probably the final synthesis of his scholarship. (shrink)