The Well- and Unwell-Being of a Child

The concept of the ‘well-being of the child’ (like the ‘child’s welfare’ and ‘best interests of the child’) has remained underdetermined in legal and ethical texts on the needs and rights of children. As a hypothetical construct that draws attention to the child’s long-term welfare, the well-being of the child is a broader concept than autonomy and happiness. This paper clarifies some conceptual issues of the well-being of the child from a philosophical point of view. The main question is how well-being could in practice acquire a concrete meaning and content for a particular issue or situation. A phenomenological-hermeneutic research perspective will be outlined that allows the child’s well-being to be elucidated and specified as an anthropological and ethical idea. It is based on a contextual understanding of generative relationships, a combination of the theory and practice of making sense, here described as ‘generative insight’, which could provide ethical guidance for decision making in families, legal practice, medicine or biomedical research.     

Masked ball: Ethics,laws and financial contradictions in hungarian health care

Corruption is a major problem in the societies of the post-communist Central European countries. Corruption in health care has some unique characteristics undermining the efficacy of and respect for Hungarian health care. One of the forms of corruption is tipping. This highly contested phenomenon is present in most of the patient/health professional’s interactions in a sophisticated manner, raising serious ethical and legal dilemmas. The present paper analyzes tipping and other corruption-related factors, such as financial conflict of interest between industry and health care and argues that since ethical and legal considerations are often ignored in the country, patient care and clinical research are affected by these controversial issues to a great extent.     

医疗市场化失败后的法律和伦理思考

法律上对于医疗机构的民事主体定位,虽然暂时满足了医疗市场化的需要,但却淡化了医疗机构所应承担的公共伦理职责.私权与公共伦理之间的剧烈冲突,最终使得医疗市场化走向终结.     

Mobile-Centric Ambient Intelligence in Health- and Homecare—Anticipating Ethical and Legal Challenges

Ambient Intelligence provides the potential for vast and varied applications, bringing with it both promise and peril. The development of Ambient Intelligence applications poses a number of ethical and legal concerns. Mobile devices are increasingly evolving into tools to orientate in and interact with the environment, thus introducing a user-centric approach to Ambient Intelligence. The MINAmI (Micro-Nano integrated platform for transverse Ambient Intelligence applications) FP6 research project aims at creating core technologies for mobile device based Ambient Intelligence services. In this paper we assess five scenarios that demonstrate forthcoming MINAmI-based applications focusing on healthcare, assistive technology, homecare, and everyday life in general. A legal and ethical analysis of the scenarios is conducted, which reveals various conflicting interests. The paper concludes with some thoughts on drafting ethical guidelines for Ambient Intelligence applications.     

Some Legal Issues Patients May Face While in Therapy

This article on forensic family therapy touches upon a few of the major germane ethical and legal dicta which regulate and circumscribe psychotherapy practice. Differences between ethical and legal rulings are delineated. Some of the problems which may confront and even engulf individuals, couples, and families during their life cycle and which bring them into the orbit of the legal and/or judicial systems before, during, or after the period of assessment and treatment are explored. Some issues that have received the least coverage in the family forensic literature are highlighted; and some of the areas that have been accorded a great deal of attention elsewhere are mentioned only briefly. A short commentary on the forensic family professionals’ potential role in each arena of practice is provided.     

Ethical Concepts and Future Challenges of Neuroimaging: An Islamic Perspective

Neuroscience is advancing at a rapid pace, with new technologies and approaches that are creating ethical challenges not easily addressed by current ethical frameworks and guidelines. One fascinating technology is neuroimaging, especially functional Magnetic Resonance Imaging (fMRI). Although still in its infancy, fMRI is breaking new ground in neuroscience, potentially offering increased understanding of brain function. Different populations and faith traditions will likely have different reactions to these new technologies and the ethical challenges they bring with them. Muslims are approximately one-fifth of world population and they have a specific and highly regulated ethical and moral code, which helps them deal with scientific advances and decision making processes in an Islamically ethical manner. From this ethical perspective, in light of the relevant tenets of Islam, neuroimaging poses various challenges. The privacy of spirituality and the thought process, the requirement to put community interest before individual interest, and emphasis on conscious confession in legal situations are Islamic concepts that can pose a challenge for the use of something intrusive such as an fMRI. Muslim moral concepts such as There shall be no harm inflicted or reciprocated in Islam and Necessities overrule prohibitions are some of the criteria that might appropriately be used to guide advancing neuroscience. Neuroscientists should be particularly prudent and well prepared in implementing neuroscience advances that are breaking new scientific and ethical ground. Neuroscientists should also be prepared to assist in setting the ethical frameworks in place in advance of what might be perceived as runaway applications of technology.     

La souplesse relative des règles relatives à la fin de vie,corollaire d’un objet insaisissable

The Claeys-Léonetti law of 2 February 2016 provides a framework for the practice of deep and continuous sedation causing an alteration of consciousness maintained until death (SPCMD). In order to apply this measure, the doctor must implement a collegial procedure and respect certain conditions set out in the legislative provisions, but which are not defined and are therefore subject to interpretation. Moreover, the criteria for inclusion in the so-called “end-of-life” phase are not specified. This flexibility, deliberately chosen by the legislator, seems adapted to the complexity and variety of clinical situations and mobilizes the ethical deliberation of practitioners who must dialogue with the patient to implement an ad hoc medicine. However, this terminological vagueness may result in legal uncertainty and be a source of inequalities in the use of SPCMD. In any case, in order to promote the interests of patients and equal opportunities, it is urgent to reduce territorial inequalities in the provision of palliative care and to provide solid training on the law in force.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.     

Personal Identity, Autonomy and Advance Statements

abstract    Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a sound basis for extending the moral autonomy of an individual — and hence their autonomous wishes expressed through an advance statement — past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient's best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interests judgements concerning an individual's care or treatment.     

Preconception Gender Selection

Safe and effective methtods of preconception gender selection through flow cytometric separation of X- and Y-bearing sperm could greatly increase the use of gender selection by couples contemplating reproduction. Such a development raises ethical, legal, and social issues about the impact of such practices on offspring, on sex ratio imbalances, and on sexism and the status of women. This paper analyzes the competing interests in preconception gender selection, and concludes that its use to increase gender variety in a family, and possibly for selecting the gender of firstborn, might in many instances be ethically acceptable.     

Thinking theologically about reproductive and genetic enhancements: the challenge.

Current philosophical and legal bioethical reflections on reprogenetics provides little more than a rationalization of the interests of science. There are two reasons for this. First, bioethicists attempt to address ethical issues in a "language of precision" that characterizes science, and this works against analogical and narratological modes of discourse that have traditionally provided guidance for understanding human nature and purpose. Second, the current ethical and legal debate is framed by a public/private distinction that banishes robust norms to the private realm, and leaves a minimalist public discourse of harm avoidance that is insuffucient for regulating the science. In this essay, I argue that Mark Hanson's account of anxiety provides a valuable starting point for addressing deficiencies in the current philosophical and legal debate, and it highlights the need for a theological discourse on genetic enhancements. Through an assessment of Joel Shuman's criticism of the public/private distinction, I show how the needed theological discourse should be situated in the context of robust communities, and how such a communitarian inter-ethic is compatible with a variant of liberalism. Finally, I critically assess James Keenan's account of virtue and perfection, in order to outline what a sufficient discourse on reproductive and genetic enhancements requires.     

Die Behandlung paraphiler Störungen mit GnRH-Agonisten unter besonderer Berücksichtigung ethischer und rechtlicher Aspekte

Current guidelines recommend the use of antiandrogenic medication in addition to psychotherapeutic procedures in the treatment of patients and sexual offenders with severe paraphilic disorders and a high to very high risk of committing severe sexual offences. This article provides an overview about the current state of research concerning the effectiveness and possible side effects of antiandrogens and discusses the legal and ethical basis of using antiandrogens in the therapy of paraphilic disorders with a focus on gonadotropin-releasing hormone (GnRH) agonists. Meanwhile, a great deal of empirical evidence exists with respect to the effectiveness of GnRH agonists for lowering paraphilic sexual fantasies and behaviors; however, GnRH agonist treatment also still has a risk of mild to severe undesired side effects, e.?g. hypertension, hyperlipidemia, liver damage, bone demineralization and depression. Nevertheless, in German forensic psychiatric institutions a not insignificant proportion of patients are treated with antiandrogens and furthermore, in the last few years treatment with GnRH agonists has become more important. In Germany, GnRH agonists can only be used on a voluntary basis; however, in some European countries and North American states legal statutes for compulsory treatment also exist. This is clearly contrary to the recommendations of current international guidelines. In light of the fact that GnRH agonist treatment could violate basic human rights, the need for an ethically sound approach is even more important in the decision for therapy with GnRH agonists. This article provides some proposals for a treatment approach that is in line with current ethical and legal requirements.     

Legal and Ethical Considerations for Requiring Consent for Apnea Testing in Brain Death Determination

Abstract

The past decade has witnessed escalating legal and ethical challenges to the diagnosis of death by neurologic criteria (DNC). The legal tactic of demanding consent for the apnea test, if successful, can halt the DNC. However, US law is currently unsettled and inconsistent in this matter. Consent has been required in several trial cases in Montana and Kansas but not in Virginia and Nevada. In this paper, we analyze and evaluate the legal and ethical bases for requiring consent before apnea testing and defend such a requirement by appealing to ethical and legal principles of informed consent and battery and the right to refuse medical treatment. We conclude by considering and rebutting two major objections to a consent requirement for apnea testing: (1) a justice-based objection to allocate scarce resources fairly and (2) a social utility objection that halting the diagnosis of brain death will reduce the number of organ donors.     

The Notion of Ubuntu and Communalism in African Educational Discourse

The notion of ubuntu and communalism is of great importance in anAfrican educational discourse, as well as inAfrican Philosophy of Education and in Africanphilosophical discourse. Ubuntu is aphilosophy that promotes the common good ofsociety and includes humanness as an essentialelement of human growth. In African culture the community always comesfirst. The individual is born out of and intothe community, therefore will always be part ofthe community. Interdependence, communalism, sensitivity towards others and caring for others are all aspects of ubuntu as a philosophy of life (Le Roux, 2000, p. 43). The community and belonging to acommunity is part of the essence of traditionalAfrican life. Philosophy of life and Philosophyof Education, thus, go together, because aphilosophy of life helps to identify the goalsand purposes that a particular society holdsdear. Humanness is very important in Africanphilosophy in the sense of seeing human needs,interests and dignity as fundamental to humanexistence and therefore it will also beimportant in African Philosophy of Education(Letseka, 2000, p. 182). According to Letseka(2000, p. 186) nobody is born with botho orubuntu– these are communally acceptedand desirable ethical standards that a personacquires throughout his/her life and thereforeeducation also plays a very important role intransferring the African philosophy of life.     

Mandatory neurotechnological treatment: ethical issues

What if neurofeedback or other types of neurotechnological treatment, by itself or in combination with behavioral treatment, could achieve a successful “rewiring” of the psychopath’s brain? Imagine that such treatments exist and that they provide a better long-term risk-minimizing strategy compared to imprisonment. Would it be ethical to offer such treatments as a condition of probation, parole, or (early) prison release? In this paper, I argue that it can be ethical to offer effective, non-invasive neurotechnological treatments to offenders as a condition of probation, parole, or (early) prison release provided that: (1) the status quo is in no way cruel, inhuman, degrading, or in some other way wrong, (2) the treatment option is in no way cruel, inhuman, degrading, or in some other way wrong, (3) the treatment is in the best interests of the offender, and (4) the offender gives his/her informed consent.     

School Counselors’ General Self-Efficacy,Ethical and Legal Self-Efficacy,and Ethical and Legal Knowledge

School counselors encounter ethical and legal situations that necessitate the knowledge and confidence to apply decision-making skills. We report the findings from a correlational investigation that examines practicing school counselors’ (N = 287) ethical and legal self-efficacy, ethical and legal knowledge, and general self-efficacy. Higher ethical and legal self-efficacy was associated with higher general self-efficacy and ethical and legal knowledge. The implications of these findings are discussed.     

The hazards of writing or disclosing information in psychiatry

The health care professional must be aware of the potential hazards in writing or disclosing information about a patient or a non-patient. Two important interests are pitted against each other: dissemination of scientific information versus confidentiality. Presented is a discussion of the legal and ethical issues involved in (1) writing an article or book about a patient, (2) writing about a research subject, (3) writing about a subject of a forensic examination on behalf of the court or attorney, and (4) writing in a medical record.     

Philosophy of Science and Ethics

The issue whether science can be correctly submitted to ethical judgment has been widely debated especially in the 1960s. Those who denied the legitimacy of such a judgment stressed that this would entail an undue limitation of the freedom of science; those who defended such a limitation laid stress on the great dangers that an uncontrolled growth of scientific knowledge has already produced and would continue to produce against humankind. This sterile debate can be settled by recognizing that scientific knowledge can and must be evaluated, as far as its validity is concerned, exclusively through the methodological criteria admitted by the professionals of the single scientific disciplines concerned, and no ethical judgment is pertinent from this point of view. Nevertheless, if we consider science as a particular system of social activities, entailing concrete procedures, conditions and applications, the ethical evaluation of these actions is pertinent and correct. A second question is whether or not the inclusion of these ethical investigations in the specific domain of philosophy of science is correct. If one conceives philosophy of science simply as an epistemology of science consisting in a logical-methodological investigation about the language of scientific theories, this broadening would appear spurious. This view, however, is too narrow and dated: a fully fledged philosophical investigation on the complex phenomenon of science cannot prevent important outlooks and instruments of the philosophical inqujiry (in particular ethics) from legitimately pertaining to the philosophy of science.     

Incongruences of Ethical and Legal Norms in Academia: the Case on Revocation of Doctoral Degrees

In the academic setting as in any organization legal norms prevail and are assumed to be congruent with ethical norms. Nevertheless, there are cases when the ratio of ethical and legal norms is inadequate and disproportional, especially those dealing with socially responsible decisions in academia. For this reason, the aim here is to analyse incongruences of ethical and legal norms related to the revocation of doctoral degrees in Lithuania, illustrated with examples of deviant behaviour by academic degree holders in terms of decisions of the courts and the ombudsman for academic ethics. Lithuania, being a Member State of the European Union, is currently facing the challenge of implementing newly-adopted laws related to the revocation of doctoral degrees. Accordingly, data were collected from available online official sources to gain more comprehensive evidence, and then analysed using the inductive approach of qualitative content analysis. Research findings show that there is still a thin line between ethical and legal norms, and this line fluctuates depending on nuanced considerations. This is to say that it is still problematical to dress ethical principles in legal clothing.     

Attitude change in marital cotherapy

Abstract

Ethical and legal issues concerning the application of informed consent in psychotherapy are reviewed in relation to: 1) controversies in defining an informed consent; 2) ethical and legal responsibilities of a psychotherapist in obtaining an informed consent; 3) potential ethical and legal liabilities for not implementing the informed consent doctrine; and 4) principles of confidentiality and privileged communication as they apply to this doctrine. Suggestions are made on how to implement an informed consent legally and ethically in psychotherapy.