This article considers the nature of Mr Burke's concerns in bringing his action and the practical implications of similar situations. When artificial nutrition and hydration is provided, practical issues arise regarding future, potentially long-term care. This in turn raises concerns about place of care, provision of carers and funding, which may not easily be resolved. The GMC guidance exists to provide direction and help for practitioners when difficult decisions have to be made about future treatment with the intention that the (...) patients' wishes and benefit of any potential treatment will be central to the discussions. Nevertheless, the reality of having these conversations, raising emotive issues with the patient and/or carers, and the implications of the final decision, may be very different in practice. (shrink)

Autism spectrum disorder affects an estimated 1 in 54 children aged 8 years in the United States. For many of these children, there are concomitant eating and/or behavioral challenges that can make managing their nutritional health challenging. This commentary responds to a particularly challenging case in which a pediatric patient with ASD presented to the local hospital’s emergency department with severe weight loss and malnutrition.

Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional (...) diet was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts. (shrink)

This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role of the family in management is discussed. This issue requires wide debate by the public and the profession.

The preparation of food and nutrition is a pervasive techne in the classical Greek world. Indeed, food technology may be a defining characteristic of humanity. We begin with a glimpse of a tension in the use of the word techne in relation to the preparation of food in Plato’s Gorgias 462d-e. Turning to the Presocratics, we discern three distinct perspectives on food, those of Empedocles, Anaxagoras, and the treatise Regimen. In Regimen, we find an anticipation of the distinctions made by (...) Plato in the Gorgias passage, and trace some of the implications in what we may call the “food technology” of this treatise that manages to be both philosophical and technically informative. (shrink)

Personalised nutrition (PN) has emerged over the past twenty years as a promising area of research in the postgenomic era and has been popularized as the new big thing out of molecular biology. Advocates of PN claim that previous approaches to nutrition sought general and universal guidance that applied to all people. In contrast, they contend that PN operates with the principle that “one size does not fit all” when it comes to dietary guidance. While the molecular mechanisms studied within (...) PN are new, the notion of a personal dietary regime guided by medical advice has a much longer history that can be traced back to Galen’s “On Food and Diet” or Ibn Sina’s (westernized as Avicenna) “Canon of Medicine”. Yet this history is either wholly ignored or misleadingly appropriated by PN proponents. This (mis)use of history, we argue helps to sustain the hype of the novelty of the proposed field and potential commodification of molecular advice that undermines longer histories of food management in premodern and non-Western cultures. Moreover, it elides how the longer history of nutritional advice always happened in a heavily moralized, gendered, and racialized context deeply entwined with collective technologies of power, not just individual advice. This article aims at offering a wider appreciation of this longer history to nuance the hype and exceptionalism surrounding contemporary claims. (shrink)

BackgroundThere have been notable investments in large multi-partner research programmes across the agriculture-nutrition-health (ANH) nexus. These studies often involve human participants and commonly require research ethics review. These ANH studies are complex and can raise ethical issues that need pre-field work, ethical oversight and also need an embedded process that can identify, characterise and manage ethical issues as the research work develops, as such more embedded and dynamic ethics processes are needed. This work builds on notions of ‘ethics in practice’ (...) by developing an approach to facilitate ethical reflection within large research programmes. This study explores the application of a novel ‘real-time research ethics approach’ (RTREA) and how this can support ethical mindfulness. This involves embedding ethical analysis and decision-making within research implementation, with a continuous dialogue between participants and researchers. The aim is to improve ethical responsiveness and participant experience, which in turn may ethically support adherence and retention. In this case study, a bioethics team (BT) was embedded in a community-based randomised, controlled trial conducted in rural Malawi, titled the ‘Addressing Hidden Hunger with Agronomy’. To identify ethical issues, the researchers conducted ten focus group discussions, fourteen in-depth interviews with key informants, two workshops, observed two sensitisation and three activity meetings conducted by the trial team, and analysed fifteen reports from pre-trial to trial implementation.ResultsThe RTREA facilitated the identification of social and ethical concerns and made researchers aware of participants’ ‘lived research experience’. To address concerns and experiences, the BT worked with researchers to facilitate conversation spaces where social and ethical issues were discussed. Conversation spaces were designed to create partnerships and promote participatory methods to capture trial participants’ (TPs) perspectives and experiences.ConclusionsThe use of RTREA showed the value of real-time and continuous engagement between TPs and researchers. These real-time processes could be embedded to complement traditional ethical guidance and expert opinions. A deeper engagement appeared to support greater operationalising of principles of inclusion, empowerment, and participant autonomy and supported researchers ‘ethical mindfulness’ which in turn may support instrumental outcomes of high recruitment, retention, and adherence levels. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managing the Transition from Patient-Centered Care to ProtocolDavid SlakterI learned that I would need a kidney transplant in the summer of 2015. This was not a complete surprise to me, as I had been subjected to a number of tests and invasive procedures to investigate nephritis since I was a child. I had heard similar stories of clinicians performing repeated tests on my father for similar reasons without any (...) conclusions. Following my recommendation for transplant and consultation with genomics specialists, the cause of my kidney failure was determined to be Alport syndrome. What made Alport syndrome so difficult to diagnose in my case was that the associated mutation is a rare, autosomal-dominant one that has only recently been associated with the condition.After reviewing the data on survival rates for transitioning to dialysis versus a transplant, my family and I then considered the success rates for living versus cadaver donors, and the success rates at various transplant centers. The current data favor the long-term outcomes of transplant over dialysis and living over cadaver donors. Since we had decided to focus on searching for a live donor, my nephrologist recommended contacting Renewal, an organization that specializes in connecting those in need of a kidney transplant with live donors and providing support for donors to make the donation process less burdensome.On Renewal’s recommendation, my family and friends reached out across their social networks to search for potential donors. Many of those tested for compatibility were eliminated on basic matching criteria, others due to previously undiagnosed medical problems. Finally, the wife of a childhood friend came forward as an eligible donor and was also an incredibly close match on the antigens tested for kidney transplants.Having a living donor who was also a friend made the transplant experience somewhat less intimidating than it might have been. It meant the transformation of an existing relationship with someone already close to me, with fewer open questions about what may have motivated them to be so generous than if the donor had been someone I did not know. It also meant our families could be together in the waiting room, and that we shared in each other’s recoveries.Life post-transplant has been a significant improvement from what it was like immediately beforehand. Before my transplant, I regularly weighed food and consulted nutrition charts to gauge how much potassium I was consuming. To prevent too much potassium from building up in my bloodstream, I had to take sodium polystyrene [End Page 111] regularly. As one might guess from the name, it tastes much like burnt Styrofoam, and I could only ingest it with copious amounts of fruit-flavored syrup (strawberry covered up the awful flavor the best). There are other potassium binders on the market now, so fewer people with kidney failure will likely need to engage in such gustatory experimentation.I was also able to engage in more activities than what was possible even years before my transplant. I had long experienced difficulty with aerobic exercises, but assumed the reason was merely being out of shape. Though I have always walked regularly, even the one-mile walk from my office to my apartment had become a chore by the end. Within a few months after my transplant, I was riding a bicycle all over NYC, from Harlem to Brooklyn and back regularly, and hiking trails in nearby state parks. I began sessions with a personal trainer and attained a level of fitness I had not reached since I played soccer as a child.The transition from personalized care to one more driven by protocol has been a surprising and challenging aspect of the transplant process. While my previous experience with medical treatment has been individual meetings with physicians, my post-transplant care is managed by a team of nephrologists and other specialists in transplant care. My initial transplant nephrologist was automatically assigned to me. Because the standard of care for transplant patients is often driven by protocol, my assigned nephrologist recommended a biopsy on my transplanted kidney due to results in my recent lab tests. When pressed on the necessity of a biopsy in my case versus... (shrink)

IntroductionResponsible investment, in which environmental, social and governance considerations are incorporated into investment decision making, is a potentially powerful tool for increasing corporate accountability and improving corporate practices to address broad societal challenges. Whilst the RI sector is growing, there is limited understanding of the extent to which pressing social issues, such as obesity and unhealthy population diets, are incorporated within RI decision making. This study aimed to investigate the extent to which obesity prevention and population nutrition are considered by (...) Australian institutional investors engaged in responsible investment.MethodsA desk-based review was conducted of investment approaches of prominent Australian asset managers and superannuation funds identified as engaged in responsible investment. Relevant information on the incorporation of ESG issues related to obesity and population nutrition was extracted for each investor, drawing on websites, published policy documents and annual reports. Strategies were categorized as: negative/exclusionary screening; positive/best-in-class screening; norms-based screening; ESG integration; sustainability-themed investing; impact/community investing; and corporate engagement and shareholder action. These strategies were compared across investors and by themes related to obesity and population nutrition.ResultsEighteen of the 35 investors indicated that they applied investment strategies that considered issues related to obesity and population nutrition. The most commonly identified strategy was ESG integration, followed by sustainability-themed investing, and positive screening. The ways in which obesity and population nutrition were considered as part of these approaches included relatively high-level general health considerations, considerations around the healthiness of food company product portfolios, and consideration of specific company nutrition policies and practices. The specificity and depth to which RI strategies were disclosed varied.ConclusionThere is significant potential for investment decisions to contribute to efforts to address key social issues, such as obesity and unhealthy diets. Some institutional investors in Australia have recognized the potential importance of incorporating obesity- and population nutrition-related issues into decision-making processes. However, the extent to which these considerations translate into investment decisions and their impact on companies in the food sector warrant further exploration. (shrink)

This article deals with scientific advice to the public where the relevant science is subject to public attention and uncertainty of knowledge. It focuses on a tension in the management and presentation of scientific uncertainty between the uncertain nature of science and the expectation that scientific advisers will provide clear public guidance. In the first part of the paper the tension is illustrated by the presentation of results from a recent interview study with nutrition scientists in Denmark. According to (...) the study, nutrition scientists feel their roles as ‘‘public advisers’’ and ‘‘scientists’’ differ in that the former involves an expectation that they will provide unambiguous advice of the kind that might relegate scientific uncertainty to the background. In the second, more general, part of the paper we provide a normative analysis of different strategies of dealing with the tension. The analysis is structured around the extremes of either total concealment or full openness regarding scientific uncertainty. The result of analysis is that scientific advisers should not simply ‘‘feed’’ scientific conclusions to the public. They should rather attempt to promote the ability and willingness of the public to assess and scrutinize scientific knowledge by displaying uncertainties in the scientific basis of advice. On the other hand, scientific advisers must accommodate the public’s need for guidance. Such guidance should be restricted by careful consideration of what it is relevant for the public to know in order to evaluate scientific advice in practical terms. (shrink)

Ideally, guidelines reflect an accepted position with respect to matters of concern, ranging from clinical practices to researcher behaviour. Upon close reading, authorship guidelines reserve authorship attribution to individuals fully or almost fully embedded in particular studies, including design or execution as well as significant involvement in the writing process. These requirements prescribe an organisation of scientific work in which this embedding is specifically enabled. Drawing from interviews with nutrition scientists at universities and in the food industry, we demonstrate that (...) the organisation of research labour can deviate significantly from such prescriptions. The organisation of labour, regardless of its content, then, has consequences for who qualifies as an author. The fact that fewer food industry employees qualify is actively used by the food industry to manage the credibility and ownership of their knowledge claims as allonymous science: the attribution of science assisted by authorship guidelines blind to all but one organisational frame. (shrink)

Due to the pandemic and the suspension of in-person school classes, there was an interruption in the meals served to approximately 40 million students who benefited from the Brazilian National School Feeding Program (PNAE). This article describes two case studies, comparing the strategies adopted by two municipalities for maintaining school feeding during the Covid-19 pandemic in the northern region of the state of Rio de Janeiro, Brazil, and discuss possible impacts of these strategies on food and nutrition security. These municipalities (...) together cover about 81% of the population in the region. In July 2020, we conducted interviews with PNAE municipal managers, following a qualitative approach. We discuss the results in relation to existing Brazilian guidance on food and nutrition security. The municipalities have developed distinct strategies to overcome operational obstacles and maintain PNAE goals, such as distributing food kits and making cash transfers to students’ families. The main determinants of these strategies are financial availability, the relationship between municipal teams and school communities, and the pre-pandemic PNAE logistics and management. Depending on the strategy and duration of the pandemic, the impacts on food and nutrition security can be wide-ranging, affecting food quality and local farmers who sell products to PNAE. It is necessary to acknowledge that this is not a short-term pandemic and find ways to perform school feeding in accordance with PNAE criteria. (shrink)

Infant A was born at term with an antenatal diagnosis of gastroschisis. His parents were well informed about the condition and understood that he would require surgery. However, at delivery, his bowel was found to be severely compromised. Infant A returned from theatre with only four centimeters of small bowel. This is physiologically devastating and easily qualifies as ultrashort bowel syndrome. Whilst the prognosis from ultrashort bowel syndrome is greatly improving, the condition continues to carry a significant risk of mortality (...) and morbidity, in part attributable to treatment itself. The cornerstone of management of USBS is provision of intravenous parenteral nutrition. This is not a physiologically normal route of nutrition; it is a medical treatment. Infant A’s parents questioned whether continuation of active treatment was appropriate. If a treatment is not in the patient’s best interests, then it can be argued it is not justified to administer it. Decisions about quality of life are intensely personal. Where there is a significant burden of treatment, even when there is a potential for increased survival, whether the course of treatment is in the child’s best interests must be taken with huge emphasis on the parental perspective and their family values. For well-informed, realistic parents who are welcoming of the full picture of information and implications of their decision, I argue that parents are best placed to make the decision for their child. Long-term PN for USBS may well be a medically encouraged treatment. However, it should not be medically mandated. (shrink)

In postmodern society, many of the perceptions that people had about them, their lives, the values ​​that define them and the strategies that they can use to achieve their ideals have changed. Specifically, today we can talk about new paradigms, such as health, lifestyle focused on personal well-being, obtained through fitness and wellness, respectively wellbeing that adds the spiritual component, in an holistic interdependence. An important role in the changes we are talking about has been played by the media, which (...) promote living standards built on hedonistic principles, specific to the consumer society. The consequence is that more and more teenagers and young people want to look good and feel good, but only a small part of them reach the specialists, who are best able to provide individualized guidance, support, and programs to prevent any negative consequences of uninspired choices or poorly dosed enthusiasm The stakes of choice are high, because a healthy lifestyle, which should not be limited to body aesthetics, but also aims to develop the spiritual side, can support a more effective adaptation to the dynamics of changes in society. The last year, marked by a new challenge, the pandemic, has fully demonstrated the need to assume on a personal level a balanced and responsible lifestyle, which offers new values ​​of quality of life, as well as complementing proactive management with that managed by specialists. (shrink)

Farm to School programs aim to connect school children with local foods, to promote a synergistic relationship between local farmers, child nutrition and education goals, and community development. Drawing from 18 months of ethnographic research with a regional FTS project and interviews with child nutrition program operators implementing FTS across Georgia, we identify perceptions of food safety as an emerging barrier in efforts to bring local foods into schools. Conducting a thematic analysis of data related to food safety, we find (...) that FTS participation may be hindered by discourses and perceptions of safety risks attributed to local foods—and to local produce in particular. We argue that this results, paradoxically, from a core tenant of FTS and other local food movements: forging personal relationships with farmers, through which POs confront the transparency of local food production, in contrast to the opacity of food procured through standard supply chains. Faced with unfamiliar production practices, and responsibilized to protect students as “at risk” subjects, POs may decide that buying local food is “not worth the risk.”. (shrink)

Farm to School programs aim to connect school children with local foods, to promote a synergistic relationship between local farmers, child nutrition and education goals, and community development. Drawing from 18 months of ethnographic research with a regional FTS project and interviews with child nutrition program operators implementing FTS across Georgia, we identify perceptions of food safety as an emerging barrier in efforts to bring local foods into schools. Conducting a thematic analysis of data related to food safety, we find (...) that FTS participation may be hindered by discourses and perceptions of safety risks attributed to local foods—and to local produce in particular. We argue that this results, paradoxically, from a core tenant of FTS and other local food movements: forging personal relationships with farmers, through which POs confront the transparency of local food production, in contrast to the opacity of food procured through standard supply chains. Faced with unfamiliar production practices, and responsibilized to protect students as “at risk” subjects, POs may decide that buying local food is “not worth the risk.”. (shrink)

Assess to quality diets is a basic human right. Geographical challenges and cultural traditions have contributed to the widespread malnutrition present among ethnic minorities of mountainous areas in Northwest Vietnam. Home gardens can play a role in increased diet diversity and micronutrient intakes. However, low production yields and plant diversity in ethnic home gardens have limited their contributions to household food security and nutrition. The pilot study tested a home garden intervention in weekly vegetable harvests and increasing household production and (...) consumption of diverse vegetables year-round. Food ethics issues encountered included limited access to quality food by resource-poor groups, conflicts arising from low preference and value given to some nutritious foods, limited access to information and technology for food production and consumption, each of which were addressed in the study design. The intervention includes: (1) nutrition-focused home garden training and (2) locally-adapted home garden packages consisting of garden planning, technical assistance, and high-yielding seed varieties. Twenty households from two ethnic villages in Son La province participated in the study and were randomly assigned into two groups (intervention and non-intervention). The total vegetable supply from weekly harvests of home garden produce was significantly higher in the intervention households (226 kg) compared to the non-intervention households (39 kg). The intervention group yielded 5.8 and 1.7 times more vegetables by weight and weight per area than those without the intervention. The vegetables were mainly consumed at home for both groups, but the intervention households gave more vegetables as gifts to neighbors. The intervention group cultivated a higher diversity of vegetables with a total of 42 different vegetables compared to 24 in the non-intervention group, which is reflected in an overall higher nutritional yield of vitamin A, iron, other micronutrients and phytochemicals. The home garden training significantly improved the amount, diversity and continuity of household food and nutrient supply. The home garden model is effective and could be scaled up to improve household vegetable supply and consumption, particularly in Northwest Vietnam. (shrink)

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefitDespite advances in nutritional management, aggressive antibiotic usage, and physiotherapy, cystic fibrosis remains a life limiting illness with high morbidity that imposes considerable burdens on children and families.1 Although survival to 40 years is predicted for children born in 1990s, the median age of death in 2003 was 24.2 years .The pathophysiological features of CF are produced by a (...) defective gene on chromosome 7, resulting in the defective production of a protein that regulates cellular ion transport. Defective ion transport is thought to lead to increased mucus viscosity , with poor airway clearance, recurrent bacterial infection, lung damage, and death.Gene therapy , the insertion of a normally functioning gene into deficient host cells using a suitable vector, is a potential treatment or cure for diseases produced by single gene defects—for example, CF. Gene therapy does, however, have potential or actual risks, leading many to suggest that evidence of efficacy in adults should be demonstrated before trials are conducted in children. Many serious diseases in adults such as CF have their onset in childhood. If early treatment provides greater hopes of benefit, children may be more appropriate targets for GT in CF than adults. It may be unethical to deny them access to properly constructed, ethically approved clinical trials from which they might benefit.Since research in children should be scientifically valid, in the child’s best interests, and the subject of valid consent, this article will consider these parameters in relation to trials of GT in children with CF. Because of the importance of consumer participation in the design of research we present the results of a questionnaire about GT trials delivered …. (shrink)

Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

This chapter focuses on the use of gestation stalls in sow confinement facilities. Gestation stalls are metal cages used to confine sows during nearly the entire duration of their four-month pregnancy. The dimensions of gestation stalls are such that the sows confined in them can only take one step forward and one step back. The American Veterinary Medical Association’s policy statement on pregnant sow housing cites advantages of gestation stalls: Gestation stall systems may minimize aggression and injury, reduce competition, and (...) allow individual feeding and nutritional management, assisting in control of body condition. These advantages largely mirror those identified in the National Pork Board’s position statement on gestation stalls. A survey of the considerations the industry offers in favor of gestation stalls in sow production, though, helps to show that what it means for a producer to take an interest in animal welfare is quite different from what we might expect. (shrink)

Alzheimer's disease remains the most common form of dementia. Dementia symptoms vary depending on individual personality, life experience, and social and cultural influences. As dementia progresses, involvement of multi-disciplinary health care professionals is needed to manage the disease. Alzheimer research is progressing rapidly. While 5% of all Alzheimer's disease may be genetically determined, the majority is not. Susceptibility genes can reveal the risk of contracting Alzheimer's disease. Early life risk factors such as education, nutrition, and vascular disease may increase the (...) likelihood of dementia in later life. In the United States, two acetylcholinesterase inhibitors have been approved as cognitive enhancers. Possible prevention and symptomatic treatment interventions have focused on estrogen replacement therapy, antioxidants, and anti-inflammatory medications. Research advances have improved the clinical management of dementia. Ethical implications to the patient, family, and society are multiple and remain challenging. (shrink)

I argue that hunting is not a sport, but a neo-traditional cultural trophic practice consistent with ecological ethics, including a meliorist concern for animal rights or welfare. Death by hunter is on average less painful than death in wild nature. Hunting achieves goods, including trophic responsibility, ecological expertise and a unique experience of animal inter-dependence. Hunting must then be not only permissible but morally good wherever: a) preservation of ecosystems or species requires hunting as a wildlife management tool; and/or (...) b) its animal deaths per unit of nutrition is lower than that caused by farming practices. Both conditions obtain at least some of the time. (shrink)

Professional management in health care is very much dependent on the model of health that is assumed by healthcare providers. The current model derives from a chemical/mechanical view of the patient body. Simply put: we are healthy if all of our mechanical parts are working properly and if all of the chemicals in our body are in the right proportions and have the appropriate reactions. This view is based on philosophical accounts of the body that go back to Paracelsus, (...) Bacon, Descartes and others. It became the central basis of medical practice only in the late 19th Century after several hundred years of research and professional politics. The success of the chemical/mechanical model has been so great that the social and relational aspects of health have been largely ignored. Yet we know that people require the resources not only of (mechanical) exercise and proper nutrition (chemical) in order to develop into healthy adults; they also need loving relationships, good friends and a viable social context. A growing movement has emerged that includes philosophers who recognize the Cartesian error, physicians and nurses who are searching for a more humane healthcare management, and patients and families who feel the need for a better understanding of the social and relational aspects of their health. The Chemical/Mechanical Patient traces the intellectual development of the chemical/mechanical model of the patient and its implementation and the provides a sound and readily understandable philosophical and historical basis for this new and growing movement towards a social/relational model of health. This book names the problem and prepares us to respond to the exaggerated place of the chemical mechanical model in our society. It provides a historical and conceptual background and explains how the chemical/mechanical model of health gained such a strong hold over our thinking and took the place of the earlier Galenic humoral model. It sketches a promising outline of a more humanized model for understanding health and calls for help to fully articulate it. In that way, it joins a growing movement to go beyond our current chemical/mechanical orientation. (shrink)

The management of obesity in childhood may be more difficult than in adulthood, since the child is subject to the influence of the lifestyle of his relatives. Those with incorrect eating habits tend to become obese in adolescence and adulthood. Therefore, the prevention of obesity and other health problems should occur from the fetal period and soon after birth, continuing for the rest of life. Therefore, it is important that adequate pedagogical proposals become effective in schools to minimize the (...) barrier between theory and practice, as well as to develop teaching-learning activites about healthy eating. Teaching children the importance of healthy nutrition and giving them subsidies for them to practice is the best way to train adults with good eating habits. Thus, the objective of this study was to analyze the contributions of feeding and nutritional education activities in the prevention and fight against obesity in schoolchildren, by means of an integrative review of the literature. (shrink)

The management of patients suffering from chronic disorders of consciousness inevitably raises important ethical questions about the end of life decisions. Some ethical positions claim respect of human life sacredness and the use of good medical practices require allowing DOC patients to live as long as possible, since no one can arbitrarily end either his/her or others’ life. On the other hand, some currents of thought claim respect of human life dignity, patients’ wishes, and the right of free choice (...) entail allowing the withdrawal of life sustaining therapy. This could happen when patients believe their own life to be not worth living, or if therapy is not very beneficial, excessively burdensome, or even futile. Indeed, the decision to withdraw therapies in a DOC patient should be guided by reliable information about DOC diagnosis and prognosis and on how the patient would wish to be treated in such a condition. Taking into account such issues, it would be possible to make the decision that more adequately fits a DOC patient’s best interest. This review aims to overview the range of ethical issues referring to end-of-life decisions in DOC patients, with regard to the thorny debate on the sacredness and dignity of human life. (shrink)

Throughout the 19th century and early decades of the 20th century, milk was a dangerous food that required state intervention to make it safe. Throughout this period, the germ theory of contagious disease came to prominence, but could not explicitly determine the causal relationships linking germs, milk, and human illness. Using the notion of an ideational regime, I examine how (1) knowledge claims move from uncertainty to certainty and become privileged claims within ideational regimes that (2) result in an unintended, (...) but necessary deployment of a biopolitical strategy for governance. The argument here is that theoretical uncertainty meant managing populations as a uniform undifferentiated reality using pasteurization technologies. I use two historical moments as evidence of these processes. The first is the 1901 British Congress on Tuberculosis when I argue germ theory came to a theoretical standstill and the second is Ontario’s 1938 amendment to the province’s Public Health Act that permanently institutionalised province-wide compulsory pasteurisation laws organised around the notion of nutritional equivalency. This genealogical exploration should provide some insight into how bacteria became the singular cause of illness and into the conditions that led to targeting milk as the main site of intervention instead of treating individual bodies. (shrink)

Neoliberal cultural frames of individual choice inform mothers’ accounts of why they refuse state-mandated vaccines for their children. Using interviews with 25 mothers who reject recommended vaccines, this article examines the gendered discourse of vaccine refusal. First, I show how mothers, seeing themselves as experts on their children, weigh perceived risks of infection against those of vaccines and dismiss claims that vaccines are necessary. Second, I explicate how mothers see their own intensive mothering practices—particularly around feeding, nutrition, and natural living—as (...) an alternate and superior means of supporting their children’s immunity. Third, I show how they attempt to control risk through management of social exposure, as they envision disease risk to lie in “foreign” bodies outside their networks, and, therefore, individually manageable. Finally, I examine how these mothers focus solely on their own children by evaluating—and often rejecting—assertions that their choices undermine community health, while ignoring how their children benefit from the immunity of others. By analyzing the gendered discourse of vaccines, this article identifies how women’s insistence on individual maternal choice as evidence of commitment to their children draws on and replicates structural inequality in ways that remain invisible, but affect others. (shrink)

Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt to develop (...) a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship. (shrink)

Theological basis -- Religion and health care -- The dignity of human life -- The integrity of the human person -- Implications for health care -- Theological principles in health care ethics -- Method -- The levels and questions of ethics -- Freedom and the moral agent -- Right and wrong -- Metaethics -- Method in Catholic bioethics -- Catholic method and birth control -- The principle of double effect -- Application -- Forgoing treatment, pillar one: ordinary and extraordinary means (...) -- Forgoing treatment, pillar two: killing and allowing to die -- Forgoing treatment, pillar three: decisions by competent patients -- Forgoing treatment, pillar three: decisions for incompetent patients -- Forgoing treatment, pillar three: advance directives -- Hydration and nutrition -- Physician-assisted suicide and euthanasia -- Medical futility -- Pain and pain management -- Ethics committees -- Embryonic stem cells and the beginning of human personhood -- Genetic engineering -- Allocating health care resources -- The use and misuse of the allocation argument. (shrink)

Modern strains of broiler chicken are capable of achieving a 2.4 kg liveweight at 42d of age. This extremely fast growth is accomplished in part by balanced diets containing pharmaceutical growth promoting compounds. Over the last few years, a number of ethical questions have arisen regarding the use of such compounds. Such fast growth rate is accompanied by reduced bird welfare related to morbidity and mortality of a proportion of the birds. In two trials we have shown that acceptable growth (...) rate can be achieved in diets without these compounds, and that economics of production are not adversely affected. It is concluded that future management programs for broiler chickens should consider a tempering of growth rate and that this could lead to improved bird well-being. (shrink)

The origins of agriculture lie in the distant past, approximately 12 000 years ago, when hunter-gatherers of the Palaeolithic embraced sedentism at the dawn of the Neolithic. The variety of life history transitions emanating from this unique phenomenon have had an enormous impact on the biodiversity of the planet, while subjecting humanity to a variety of life-changing physical and social challenges right up to the present. The ever-present consequences of the Agricultural Revolution continue to demand our attention, yet frustrate our (...) efforts, on a seemingly perpetual basis, to effectively manage the outcomes. Here we review the origins and lasting after-effects of the Agricultural Revolution and its impact on the human condition, with reference to sedentism, nutrition, health issues, disease, gender discrimination as well as mythmaking and religion. Contribution: Our aim is to engage a wider audience with respect to the causes and consequences of the Agricultural Revolution. We discuss a broad spectrum of relevant phenomena implicated in this epochal event and consequently underline that the Agricultural Revolution precipitated not only major changes to the ecology of the planet, but also and most importantly to the social and cultural well-being of humanity. (shrink)

The Fourth Edition of this bestselling, highly regarded book has been fully revised to incorporate changes in law and clinical guidance making a vital impact on patient management, encompassing: The Equalities Act 2010 which provides a right of older people to treatment without discrimination ; Case law on withdrawing nutrition and hydration ; Updated guidance on resuscitation from the Resuscitation Council, the British Medical Association and the Royal College of Nursing ; The redefining of good medical practice by the (...) General Medical Council ; The abolition of the Liverpool Care Pathway with an updated guidance on end of life care and advance care planning. Expanded throughout, this new edition also integrates two entirely new chapters covering testamentary capacity and role of the physician, and religious beliefs and end of life issues. Its practical, reflective and informative approach continue to make it essential reading for all health professionals, particularly trainees, involved in making difficult decisions in the care of older persons. It is also highly recommended for undergraduate medical students. (shrink)

The intensification of farm animal welfare debate has led to an increasing number of certification schemes covering this issue; however, there are concerns about the contribution of these schemes in improving welfare. The aims of this study were to identify certification schemes for broiler chicken welfare at farm level in Brazil, to investigate the extent of nutritional, environmental, health and behavioral indicators within the schemes and to analyze the content of scheme and the capacity to promote continuous improvement on (...) certified farms. GLOBALG.A.P.® and Certified Humane® were the only schemes observed, corresponding to 2.1 % of broiler chicken farms in Brazil. Environmental and health indicators were in greater number, and the requirements classified as behavioral indicator were commonly related to the resolution of low levels of animal welfare. Both schemes were in accordance with the European Food Safety Authority recommendations for farmer training, birds and buildings inspection, temperature control, air and litter quality, stocking density and lighting. The selection of breeds and the use of animal-based indicators needs to be improved, as well the inclusion animal welfare objectives and management review as part of continuous improvement. Welfare certification is a potential market to be developed in Brazil. Overall, assessed schemes may potentially enhance animal welfare at farm level by including new concepts and practices. It is desirable to increase the number of certified farms in Brazil and that certification schemes be critically analyzed on a regular basis regarding their content to meet new demands and to include updates from scientific research. (shrink)

A great deal of research has examined computer-mediated communication discussions in educational environments for evidence of learning. These studies have often been disappointing, with analysts not finding the kinds of ‘quality’ talk that they had hoped for. In this study we draw upon elements of discursive psychology as we oriented to what was happening in the talk from the participants’ perspective in addition to what should be happening from the researcher/instructor perspective. We examine the talk of undergraduate nutrition science students (...) within web logs, exploring ways in which the students, when asked to make blog posts on their beliefs about and experiences with dietary supplements, display knowing in dynamic and fluid ways. We analyzed 152 blog posts students were asked to make prior to attending the lecture on the topic. Our findings point to how students negotiate and at times resist doing being a knowledgeable student, using disclaimers such as ‘I don’t know’ and script formulations to minimize accountability for their posts. Our findings highlight how students oriented to the blogs as a venue for institutional talk, responding to the required academic task while simultaneously managing their identities as students. (shrink)

This paper aims to fill the gap in literature concerning community gardens in post-communist countries by focusing on the situation in Prague, Czechia. It introduces Prague′s newly emerged community gardens and presents the results of a first representative survey of these gardens. Information was gathered about eleven of the sixteen larger community gardens and the data were collected by semi-structured interviews with the managers of the particular gardens. The paper compares the Czech community gardens as representatives of civic agriculture forms (...) in post-communist countries with their counterparts and stresses their similarities and differences. The results show that the new community gardens reflect much of what can be seen elsewhere in terms of spatial and organizational design, as well as reasons for starting them, motivations for participation and some of the challenges experienced. However, in contrast to many community gardens in the USA, Canada and UK that focus on food and nutrition provision, in Prague the community is more of a priority than food and the other mentioned benefits. The paper shows that different activities, events and functions make gardens important hubs of their communities and potential tools of further community involvement and social change. (shrink)

The peculiarities of the philosophy and practices of realization of the principles of a healthy way of life by the Seventh-day Adventist Church in Ukraine are considered. It has been established that the social and cultural changes caused by Ukraine’s independence have contributed to the opening of sanatoriums, boarding houses, and health centers by Adventist believers. It has been stated that since 1991, Adventists have generally conducted short-term health programs and exhibitions, but over time have shifted to the Western system (...) of providing services based on permanent health facilities. The philosophy and practices of the Church's implementation of a healthy lifestyle are outlined Seventh-day Adventists in Ukraine in the context of the work of medical, sanatorium and health facilities that belong directly to this religious organization. The practical novelty of the study is based on interviews with health care managers who were directly involved in the establishment of health facilities and the implementation of various Adventist health programs. It was found that representatives of other Protestant and Orthodox denominations who visited the recreation centers changed their minds about Adventism and Adventists, which, in turn, contributed to the creation of an atmosphere of religious tolerance and tolerance for each other. The activities of the inspected health centers, sanatoriums and boarding houses mainly carry out the mission of the Seventh-day Adventist Church, and the performers (staff) see their contribution to the service of God in the prevention of diseases and rehabilitation of patients. In addition, in the institutions we have studied, special attention is paid to teaching about the principles of a healthy lifestyle, proper nutrition, hydrotherapy and more. It is determined that the process of implementing health programs is based on the principles of Christian ethics, which managers and staff try to follow, seeing it as fulfilling Christ’s mission on earth, especially in the field of restoring and preventing the health of sanatorium visitors. (shrink)

Whether as New Year's resolutions, birthday wishes, or daily promises, most everyone vows at some point to make a major life change. But change is easier said than done, especially when it comes to better managing our wellness amidst the chaos of everyday living. Fortunately, wellness coach and award-winning writer Brett Blumenthal has devised a way to inspire and motivate her readers to live healthier and make positive changes in their lives. Although Blumenthal's method is not a quick fix, it (...) is a surprisingly simple one: make one small change per week, for fifty-two weeks, and at the end of a year, you'll be happier and healthier. After all, it is the small changes that are the most realistic, instead of trying to overhaul your lifestyle all at once. 52 Small Changes addresses all areas of wellbeing, including nutrition, exercise, stress management, mental wellness, and even the health of one's home environment. By guiding readers through these changes at an easy, manageable pace, Blumenthal provides an engaging roadmap to lasting results and "happier, healthier you."'. (shrink)

Background Intestinal transplant in infants with severe short bowel syndrome (SBS) is an emerging therapy, yet without sufficient long-term data or established guidelines, resulting in possible variation in practice. Objectives To assess current attitudes and counselling practices among physicians regarding intestinal transplant in infants with SBS, and to determine whether counselling and management vary between subspecialists or centres. Methods A national sample of practicing paediatric surgeons and neonatologists was surveyed via the American Academy of Paediatrics listserves. Results were analysed (...) by physician subspecialty and again by presence or absence of intestinal transplant at respondent's centre. Results The survey was completed by 433 respondents, consisting of 363 neonatologists and 70 paediatric surgeons. Fifty-seven respondents (13.2%) practiced at a centre that performed intestinal transplants in children. The vast majority of respondents (91% for preterm, 95% for term neonates) felt that maintaining a neonate with SBS on total parenteral nutrition for intestinal transplant was ethically optional (neither impermissible nor obligatory), and that parents should be given an informed choice whether to pursue that option. However, only 33% indicated they often/always offer intestinal transplant as a treatment option to families in this situation. Conclusions There is a marked disparity between individual physicians’ beliefs regarding the acceptability of intestinal transplant for severe SBS and their reported practice. Wide variability exists among physicians with respect to their knowledge, beliefs and practice regarding severe SBS, raising concerns about transparency and justice. Survival data prior to transplant, currently unavailable, are essential to rational decision making and informed parental permission. (shrink)