Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)

The pragmatic inquiry process used in the Corporantes Pathfinder Notebook (CPN) enables students and others to discern their gifts, find purpose and direction in their lives, and seek a FIT between their values and various corporate cultures before making extensive commitments in their field of studies and their employment. Based on Peirce''s theory of Pragmatism the CPN fosters investigation, interpretation, and action resulting from reflected narratives written in response to a series of questions in the CPN. The CPN was used (...) successfully as a framework in a Business Ethics course for connecting career decisions to their personal lives. Other pedagogic activities were used such as case studies, role playing, service learning, team projects investigating ethical climates of corporations, as well as Socratic questioning and discussions of moral dilemmas to develop ethical sensitivity and understanding of ethical challenges and decisions. The CPN also has been used successfully by senior executives in over fifty applications. (shrink)

In his article, Bester (2018) criticizes the so-called “harm consensus” movement among a growing number of bioethicists and practitioners. He argues that the harm principle is unable to replace the...

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

Does ethical content in organizational mission statements make a difference? Research regarding the effectiveness and results of mission statements is mixed. Krohe (1995, Across the board, 32, 17–21) concluded that much of the good results do not come from the mission statements themselves but from the strategic re-education that happens in producing one. We attempted to discover whether universities that explicitly state their ethical orientation and vision in their mission statements had students with higher perceived character trait importance and activities (...) that reinforce character than universities that did not. While the faculty and administration may receive benefits from mission statement development through strategic re-education as Krohe suggested, do the statements influence the students at the university who may have had no role in its creation? Using a sample of senior business students at 16 universities we found that students at universities with ethical statements in their mission statements had significantly higher perceived character trait importance and character reinforcement than those at universities whose missions lacked ethical statements. This research suggests that schools that explicitly stated ethical content in their␣mission statements do influence student ethical orientation. (shrink)

Key legislations in many countries emphasize the importance of involving children in decisions regarding their own health at a level commensurate with their age and capacities. Research is engaged in developing tools to assess capacity in children in order to facilitate their responsible involvement. These instruments, however, are usually based on the cognitive criteria for capacity assessment as defined by Appelbaum and Grisso and thus ill adapted to address the life-situation of children. The aim of this paper is to revisit (...) and critically reflect upon the current definitions of decision-making capacity. For this purpose, we propose to see capacity through the lens of essential contestability as it warns us against any reification of what it means to have capacity. Currently, capacity is often perceived of as a mental or cognitive ability which somehow resides within the person, obscuring the fact that capacity is not just an objective property which can be assessed, but always operates within a dominant cultural framework that “creates” that same capacity and defines the threshold between capable and incapable in a specific situation. Defining capacity as an essentially contested concept means using it in a questioning mode and giving space to alternative interpretations that might inform and advance the debate surrounding decision-making. (shrink)

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

The involvement of children in non-beneficial clinical research is extremely important for improving pediatric care, but its ethical acceptability is still disputed. Therefore, various pro-research justifications have been proposed throughout the years. The present essay aims at contributing to the on-going discussion surrounding children’s participation in non-beneficial clinical research. Building on Wendler’s ‘contribution to a valuable project’ justification, but going beyond a risk/benefit analysis, it articulates a pro-research argument which appeals to a phenomenological view on the body and vulnerability. It (...) is claimed that children’s bodies are not mere physical objects, but body-subjects due to which children, as persons, can contribute to research that may hold no direct clinical benefit to them even before they can give informed consent. (shrink)

Globalization has increased the need for managers (and future managers) to predict the potential for country corruption. This study examines the relationship between Hofstede''s cultural dimensions and how country corruption is perceived. Power distance, individualism and masculinity were found to explain a significant portion of the variance in perceived corruption. A significant portion of country''s risk, trade flow with U.S.A., foreign investment, and per capita income was explained by perceived corruption.

Viola and Ben, two pediatric oncology patients, need to undergo chemotherapy that might decrease their fertility. Both of them want to participate in the decisions related to their cancer treatment and fertility preservation. Should they be involved, and if so when and how?In many jurisdictions, children are not entitled to provide legally valid consent for medical decisions.1 As a result, others, usually parents, take on the role of surrogate decision-makers who act in their best interest. Still, it is important to (...) keep in mind that the age limit for competence set by legislation does not necessarily coincide with children’s clinical decision-making capacity: some children may be able to make certain health-care... (shrink)

Das 'Sydrac le philosophe' zugeschriebene "Livre de la fontaines de toutes sciences" ist ein enzyklopadisches Werk, das wahrend des 13.-16. Jahrhunderts besonders in Frankreich und durch viele Ubersetzungen auch in anderen volkssprachlichen Literaturen Europas eine beachtliche Wirkung entfaltet hat. Thematisch breit gefachert, vermittelt es - in Form eines losen Dialoges zwischen dem Philosophen und Konig Boctus - religioses, ethisches, medizinisches und naturkundliches Wissen. Auch zu komplexen Problemen - Fragen zum astrologischen Wissen beispielsweise, das hier zum erstenmal in der Volkssprache detailliert (...) zuganglich gemacht wird - versucht der anonyme Verfasser stets, mit moglichst klaren Anworten Orientierung und Lebenshilfe zu geben.Mit dieser Edition wird die letzte terra incognita im Bereich der volkssprachlichen Enzyklopadien Frankreichs fur die Forschung zuganglich gemacht, nachdem die ubrigen Werke - Le Livre du Tresor von Brunetto Latini, L'Image du monde von Gossouin de Metz und der anonyme Dialog Placides et Timeo - inzwischen in modernen Ausgaben vorliegen. (shrink)