This article presents a philosophical framework for physician-family ethical decision-making for the controversial cases of withdrawal, initiation, or continuation of treatment for spina bifida infants. The well-known criteria for selective treatment proposed by Lorber are shown to be ethically sub-optimal on the grounds that they are based on a general conception of the decision framework that is open to serious criticisms and questioning.We propose a model of joint physician-family decision-making that we think represents a more rational method of (...) balancing patient autonomy with the professional expertise and international moral norms of physicians. We raise serious reservations about the wisdom of allowing the state to intervene too strenously in this type of decision, in many cases. (shrink)

Spina bifida is a neurodevelopmental disorder that results in a broad range of disability. Over the last few decades, there have been significant advances in diagnosis and treatment of this condition, which have raised concerns regarding how clinicians prognosticate the extent of disability, determine quality of life, and use that information to make treatment recommendations. From the selective treatment of neonates in the 1970s, to the advent of maternal–fetal surgery today, the issues that have been raised surrounding (...) class='Hi'>spina bifida intervention invoke principles of medical bioethics such as beneficence and nonmaleficence, while also highlighting how quality of life judgments may drive care decisions. Such changes in treatment norms are also illustrative of how disability is viewed both within the medical community and by society at large. An examination of the changes in spina bifida treatment provides a model through which to understand how ethically complex decisions regarding care for children with disabilities has evolved, and the challenges faced when medical information is combined with value-based judgments to guide medical decision making. (shrink)

Defective newborn children are to be considered human persons. Thus, primary duty in proxy consent is to act with the infant's best interest in mind. This duty may at times override the otherwise prima facie right to life, but only under restricted circumstances. Refinements of McCormick's “relational potential” criteria and of ordinary-extraordinary means analysis prove useful in such decisions. Utilitarian considerations of social consequences have impact but can be kept subsidiary. The importance for decision making of available child support services (...) is considered. Spina bifida is used throughout as an example of issues discussed. (shrink)

During the 1970s, prenatal screening technologies were in their infancy, but were being swiftly harnessed to uncover and prevent spina bifida. The historical rise of this screening process and prevention programme is analysed in this paper, and the role of ethical debates in key studies, editorials and letters reported in the Lancet, and other related texts and governmental documents between 1972 and 1983, is considered. The silence that surrounded rigorous ethical debate served to highlight where discussion lay—namely, within (...) the justifications offered for the prevention of spina bifida, and the efficacy and benefits of screening. In other words, the ethical justification for screening and prevention of spina bifida, when the authors are not explicitly interested in ethics, is considered. These justifications held certain notions of disability as costly to society, with an imperative to screen and prevent spina bifida for the good of the society. (shrink)

Since the birth of the first test-tube baby, Louise Brown, in 1977, we have seen truly remarkable advances in biotechnology. We can now screen the fetus for Down Syndrome, Spina Bifida, and a wide range of genetic disorders. We can rearrange genes in DNA chains and redirect the evolution of species. We can record an individual's genetic fingerprint. And we can potentially insert genes into human DNA that will produce physical warning signs of cancer, allowing early detection. In (...) fact, biotechnology has progressed to such a point that virtually any kind of genetic manipulation, if not already possible, is just around the corner. But these breakthroughs also raise serious ethical and moral dilemmas that we are only now beginning to confront. In Wonderwoman and Superman, noted medical ethicist John Harris offers the first thorough analysis of the moral dilemmas created by the revolution in molecular biology. Covering a wide array of recent innovations, Harris discusses, for example, the moral decisions involved and the consequences of creating egg and embryo banks. Who should be allowed to use such resources? Should recipients be screened? Should such banks be open for public or private use? And does it cheapen life to make embryos available for sale? In another chapter, Harris examines the question of conceiving children chiefly for organ donation, focusing on the recent case of a woman who wanted to have a second child to provide a bone marrow donor for her first child sick with leukemia (she intended to abort the fetus if its bone marrow did not genetically match that of her living child). In this case, the medical staff had to decide whether they should perform in-vitro fertilization, knowing that the mother did not satisfy the clinic's criteria (there was no father), and also knowing the potential for abortion. Discussing the ethics of the mother's choice and the clinic's choice, Harris asks whether it is morally correct to create a child as an organ donor, whether the future child would suffer, whether it is worth any suffering to be born, and who has the right to weigh the various factors (both moral and physiological) involved in making these decisions. Delving into a multitude of issues such as when life begins, when suffering is needless, and whether we should play God, Wonderwoman and Superman provides not only a thought-provoking inquiry into the potential and actual ethical dilemmas created by the many advances in biotechnology, but challenges us to learn to choose responsibly and to face the moral implications of the choices that confront us. (shrink)

Suppose a physician advises a woman to delay her planned pregnancy for a few months in order to significantly reduce the likelihood that her baby will suffer with Spina Bifida. If the woman chooses to ignore this advice and conceives soon after, I believe most people would consider it a matter of common sense that the child thus born is a victim of this woman’s negligence, even if it is fortunate enough to not be burdened with Spina (...) Bifida. This common sense judgement appeared to have been done in by the fact that the timing of conception can be identity-influencing, and so the child that is born only exists because of its mother’s decision to ignore her physician’s advice. However, recently, contemporary contractualist theories have been used to make sense of preconception negligence towards persons whose existence is a result of that same negligence. I will briefly discuss this interesting development and then show how this retrieval of the common sense judgement comes at a great cost to prenatal reproductive autonomy. (shrink)

Most of us want to have children. We want them to be healthy and have a good start in life. One way to achieve this goal is to use preimplantation genetic diagnosis . PGD enables people engaged in the process of in vitro fertilisation to acquire information about the genetic constitution of an early embryo. On the basis of this information, a decision can be made to transfer embryos without genetic defects to the uterus and terminate those with genetic defects.1However, (...) is it morally acceptable to use PGD to reduce the probability of children with severe genetic diseases being born? Is the current routine use of PGD in public healthcare services to select against severe genetic diseases like anencephaly, spina bifida, cystic fibrosis and Down’s syndrome morally acceptable?These are complex questions involving a range of difficult ethical issues—for instance, critical discussions about the morality of embryo research and embryo termination.2 They also involve awkward conceptual issues concerning such matters as the meaning of words such as “disability”3 and “severe” in “severe genetic diseases”,4 which will not be discussed here.In this paper I examine an argument which aims to show that efforts to prevent the birth of severely disabled children using PGD are morally unacceptable. Essentially, this argument appeals to our concern for disabled people and the belief that PGD, through a slippery slope process, will have bad consequences for them. I conclude that the argument is problematic for a number of reasons. But before I examine the argument itself, it will be helpful to separate two types of slippery slope argument since these involve different kinds of reasoning.TWO TYPES OF ARGUMENTMany of the arguments against PGD point to the bad consequences it can be expected to have for disabled people. Central to all these …. (shrink)

Open-uterine surgery to repair spina bifida, or ‘fetal surgery of open neural tube defects,’ has generated questions throughout its history—and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University—where the first successful cases of open-uterine repair of spina bifida were carried out—we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering (...) the procedure, with researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design. (shrink)

Some doctors closely involved with children suffering from severe spina bifida believe that the lives of those worst affected are so miserable that it is wrong to resort to surgery to keep them alive. Published descriptions of the lives of these children support the judgment that they will have lives filled with pain and discomfort. When the life of an infant will be so miserable it would not be worth living, and there are no 'extrinsic' reasons - such (...) as the feelings of the parents - for keeping the infant alive, it is better that the child should be helped to die without further suffering. (shrink)

Ethical physicians need to share their biases and prejudices and articulate alternatives and also be tolerant of the decisions of their patients and families.I believe that I am a moral, caring, dedicated doctor working with children and parents who are often faced with ethical problems of large and small dimensions. There is no question that these decisions should be ethical, but, in general, I find ethical theory of little day-to-day use. Indeed, even when an ethicist joins me in a discussion (...) of “What should I do?”, or more appropriately, “What should I advocate be done?”, I usually find their additions to the discussion wanting. Ethical theory gives guidance but does not seem to provide sufficient help in decisions for the individual case: What will be best for the infant with spina bifida while still in utero? Termination of the pregnancy? Birth and long-term care? What is best were that same child already born with a high paraplegia and hydrocephalus? What is best for the infant with a major malformation of the brain and uncontrollable seizures whose only hope for controlling the seizures is removal of half of the brain? What is best for the family in each of these situations and the many others I have encountered? What is best for society?I have been called a Hegelian pragmatist, although my knowledge of Hegel is minimal. I think that the term pragmatist is a badge of honour, because, on the front lines of clinical decision-making, I do not have the philosopher’s luxury of days or weeks for managing words. As a pragmatic doctor, I am forced to be a person of action or inaction. I must make a decision and advocate for the position I take.I am clearly a utilitarian, as I strive to produce the greatest good …. (shrink)

Neural tube defects (NTDs) are very serious malformations for the fetus, causing either low life expectancy or a chance of survival only with costly and difficult surgical interventions. In western countries the average prevalence is 1/1000-2000 and in Turkey it is 4/1000. The aim of the study was to characterize ethical approaches at institutional level to the fetus with an NTD and the mother, and the role of health care professionals in four major centers in Turkey. The authors chose perinatology (...) units of four university hospitals and prepared questionnaires for the responsible professionals concerning their own and their institution’s ethical approaches to the fetus with an NTD and the mother. The investigation revealed that there were no institutional ethical frameworks or ethics committees available to professional teams in the units. The roles of the health care professionals and their individual decisions and approaches based on ethical principles are described. The ethical decision-making process concerning fetuses with NTDs, examples of institutional approaches to the topic and institutional frameworks, and the role of nurses and other health care professionals are all discussed, based on a literature review. The authors suggest that institutional ethical frameworks, ethics committees, professionals’ ethics education and multidisciplinary teamwork should be established for critical situations such as fetuses with an NTD. (shrink)

When surgery is performed on pregnant women forthe sake of the fetus (MFS or maternal fetalsurgery), it is often discussed in terms of thefetus alone. This usage exemplifies whatphilosophers call the fallacy of abstraction: considering a concept as if it were separablefrom another concept whose meaning isessentially related to it. In light of theirpotential separability, research on pregnantwomen raises the possibility of conflictsbetween the interests of the woman and those ofthe fetus. Such research should meet therequirement of equipoise, i.e., a (...) state ofgenuine uncertainty about the risks andbenefits of alternative interventions ornoninterventions. While illustrating thefallacy of abstraction in discussions of MFS,we review the rationale for explicitacknowledgment of the essential tie betweenfetus and pregnant woman. Next we examinewhether it is possible to meet the requirementof equipoise in research on MFS, focusing on afetal condition called myelomeningocele. Weshow how issues related to equipoise innonpregnant populations appear also in debatesregarding MFS. We also examine evidence insupport of claims that the requirement ofequipoise has been satisfied with respect to``the fetal patient'' while considering risks andbenefits to gestating women only marginally ornot at all. After delineating challenges andpossibilities for equipoise in MFS research, weconclude with a suggestion for avoiding thefallacy of abstraction and achieving equipoiseso that research on MFS may be ethicallyconducted. (shrink)

Resumen: Aunque la funcionalidad y versatilidad de la perspectiva comparada es una cuestión prioritaria para una total optimización del análisis de las migraciones internacionales. No toda perspectiva o metodología de investigación comparada puede ser considerada comparación jurídica. Este artículo no pretende ser ni recoger un compendio de virtudes y defectos atribuibles a la investigación jurídica comparada en el ámbito concreto de la inmigración. Más bien, revisando algunas publicaciones, se propone reconsiderar críticamente cual es el rol de la comparación jurídica en (...) el estudio interdisciplinar de la inmigración. A tal efecto, a modo ilustrativo se han valorado los puntos débiles y fuertes de algunos ejemplos de análisis comparados sobre la inmigración y la integración a nivel europeo.Abstract: Currently, despite the functionality and versatility of the comparative approach are priority questions for the full optimization of the international immigration framework’s analysis. All kinds of comparative research method could not be peacefully considered stricto sensu a comparative law. This article does not pretend to be a compendium of attributable virtues and defects to legal comparative research on the specific field of migration. Rather, reviewing some publications, I propose to reconsider critically what is or should be the role of comparative law in the interdisciplinary study of migration. Consequently, the strengths and weaknesses of some comparative analysis regarding immigrant integration at European level have been illustratively valued. (shrink)

Los artículos 21 y 22 del Código Civil sujetan la concesión de la nacionalidad española por residencia a dos tipos de requisitos: en primer lugar, la residencia legal, continuada e inmediatamente anterior a la solicitud durante los plazos de diez, cinco, dos o un año; en segundo lugar, la acreditación positiva de los conceptos jurídicos indeterminados: buena conducta cívica y el suficiente grado de integración en la sociedad española y por último la no concurrencia de motivos de orden público o (...) interés nacional. Sobre esta base, el insuf iciente grado de integración social en casos de poligamia es uno de los más reiterados motivos de denegación de la nacionalidad en la jurisprudencia contenciosa-administrativa del Tribunal Supremo. Sin embargo, la fundamentación jurídica de estas decisiones presenta un acrítico mimetismo respecto al irrefutable nexo poligamia y desintegración social. Este trabajo se centra en el análisis de las inconsistencias y dudas razonables que plantea el argumento “grueso” de la repugnancia moral y el uso abusivo de la integración social como apéndice del orden público. (shrink)

Transcend the limitations of your lower consciousness and discover a perpetual state of peace, flow, and success. RJ Spina, author of the bestselling Supercharged Self-Healing, presents twenty-four meditation-based teachings designed to help tap into your higher self and overcome what's always held you back-your conditioned mind.

Cette étude se propose de vérifier l’efficacité des collocations en tant qu’indice pour distinguer les genres textuels. De plus, elle a le double objectif d’aborder l’exploration de la variabilité de l’italien en utilisant des méthodologies computationnelles, et de vérifier l’efficacité d’une nouvelle mesure d’association dans l’étude des collocations.Quatre typologies de collocations ont été analysées (verbe-nom, nom-adjectif, nom-nom et nom-préposition-nom) dans six genres textuels différents, dont trois sont écrits (textes littéraires, textes académiques et compositions scolaires) et trois sont oraux (conversations, discours (...) et dialogues filmiques).La fréquence des collocations dans les différents genres montre que chaque typologie de texte a des préférences spécifiques pour des typologies de collocations spécifiques; la seule fréquence et la seule distinction entre textes écrits et oraux, toutefois, ne réussit pas à interpréter cette différente distribution selon un modèle cohérent. A cet effet, la mesure statistique de la gravité lexicale semble posséder une efficacité majeure, comme nous essayerons de démontrer. (shrink)

We show that every analytic set in the Baire space which is dominating contains the branches of a uniform tree, i.e. a superperfect tree with the property that for every splitnode all the successor splitnodes have the same length. We call this property of analytic sets u-regularity. However, we show that the concept of uniform tree does not suffice to characterize dominating analytic sets in general. We construct a dominating closed set with the property that for no uniform tree whose (...) branches are contained in the closed set, the set of these branches is dominating. We also show that from a Σ1n+1-rapid filter a non-u-regular Π1n-set can be constructed. Finally, we prove that ∑12-Kσ-regularity implies ∑12-u-regularity. (shrink)

Durante las últimas décadas, el método comparado ha adquirido un protagonismo imprescindible en la investigación jurídica porque este método permite profundizar y comprender de forma crítica la complejidad del fenómeno jurídico. El objetivo de este artículo se centra en analizar cuál es el alcance y cuáles las tensiones entre el binomio necesidad versus finalidad en el desarrollo metodológico de la investigación jurídico-comparada. Al respecto, se recogen las principales aportaciones teóricas y consideraciones sobre la naturaleza del método/disciplina comparados, así como se (...) reflexiona sobre los problemas y los retos de este método, las diferentes fases metodológicas y las estrategias existentes. Y, por último, se incluye una propuesta de mejora basada en un modelo de comparación jurídica “lenta” (slow legal comparative) como una fórmula para equilibrar este binomio en la actividad investigadora iuscomparatista. (shrink)

RESUMEN. La identificación de la categoría "grupo desaventajado" o "grupo especialmente vulnerable" no es un tema resuelto desde el derecho anti-discriminatorio. Sin embargo, los inmigrantes pueden ser considerados fácilmente en situación de vulnerabilidad debido a las importantes restricciones de derechos sociales previstas en el marco normativo de extranjería. En concreto, esta propuesta analiza las formas de categorización de los inmigrantes como potenciales sujetos vulnerables en diferentes contextos sureuropeos de crisis económica. ABSTRACT. The identification of the category "disadvantaged group" or "particularly (...) vulnerable group" is not a closed issue in the anti-discrimination law. However, migrants could be easily considered in a vulnerability situation due to relevant restrictions of social rights fixed by the migration law. Particularly, this proposal analyses the ways of categorizing migrants as potential vulnerable subjects in different Southern European contexts under economic crisis. (shrink)

We investigate uncountable maximal antichains of perfect trees and of splitting trees. We show that in the case of perfect trees they must have size of at least the dominating number, whereas for splitting trees they are of size at least \\), i.e. the covering coefficient of the meager ideal. Finally, we show that uncountable maximal antichains of superperfect trees are at least of size the bounding number; moreover we show that this is best possible.

We continue the investigation of the Laver ideal ℓ 0 and Miller ideal m 0 started in [GJSp] and [GRShSp]; these are the ideals on the Baire space associated with Laver forcing and Miller forcing. We solve several open problems from these papers. The main result is the construction of models for $t , where add denotes the additivity coefficient of an ideal. For this we construct amoeba forcings for these forcings which do not add Cohen reals. We show that (...) c = ω 2 implies $\operatorname{add}(m^0) \leq \mathfrak{h}$ . We show that b = c, d = c implies $\operatorname{cov}(\ell^0) \leq \mathfrak{h}^+, \operatorname{cov}(m^0) \leq \mathfrak{h}^+$ respectively. Here $\operatorname{cov}$ denotes the covering coefficient. We also show that in the Cohen model $\operatorname{cov}(m^0) holds. Finally we prove that Cohen forcing does not add a superperfect tree of Cohen reals. (shrink)

We continue [21] and study partition numbers of partial orderings which are related to /fin. In particular, we investigate Pf, be the suborder of /fin)ω containing only filtered elements, the Mathias partial order M, and , ω the lattice of partitions of ω, respectively. We show that Solomon's inequality holds for M and that it consistently fails for Pf. We show that the partition number of is C. We also show that consistently the distributivity number of ω is smaller than (...) the distributivity number of /fin. We also investigate partitions of a Polish space into closed sets. We show that such a partition either is countable or has size at least D, where D is the dominating number. We also show that the existence of a dominating family of size 1 does not imply that a Polish space can be partitioned into 1 many closed sets. (shrink)

We prove that consistently the Lebesgue null ideal is not Tukey reducible to the Silver null ideal. This contrasts with the situation for the meager ideal which, by a recent result of the author, Spinas [Silver trees and Cohen reals, Israel J. Math. 211 473–480] is Tukey reducible to the Silver ideal.

In this paper we investigate the structure of uncountable maximal antichains of Silver forcing and show that they have to be at least of size d, where d is the dominating number. Part of this work can be used to show that the additivity of the Silver forcing ideal has size at least the unbounding number b. It follows that every reasonable amoeba Silver forcing adds a dominating real.

A family A ⊆ ℘(ω) is called countably splitting if for every countable $F \subseteq [\omega]^{\omega}$ , some element of A splits every member of F. We define a notion of a splitting tree, by means of which we prove that every analytic countably splitting family contains a closed countably splitting family. An application of this notion solves a problem of Blass. On the other hand we show that there exists an $F_{\sigma}$ splitting family that does not contain a closed (...) splitting family. (shrink)

We show that every dominating analytic set in the Baire space has a dominating closed subset. This improves a theorem of Spinas [15] saying that every dominating analytic set contains the branches of a uniform tree, i.e. a superperfect tree with the property that for every splitnode all the successor splitnodes have the same length. In [15], a subset of the Baire space is called u-regular if either it is not dominating or it contains the branches of a uniform tree, (...) and it was proved that Σ21-Kσ-regularity implies Σ21-u-regularity. Here we show that these properties are in fact equivalent. Since the proof of analytic u-regularity uses a game argument it was clear that determinacy implies u-regularity of all sets. Here we show that an inaccessible cardinal is enough to construct a model for projective u-regularity, namely it holds in Solovay's model. Finally we show that forcing with uniform trees is equivalent to Laver forcing. (shrink)

We investigate measure and category in the projective hierarchie in the presence of large cardinals. Assuming a measurable larger than $n$ Woodin cardinals we construct a model where every $\Delta ^1_{n+4}$ -set is measurable, but some $\Delta ^1_{n+4}$ -set does not have Baire property. Moreover, from the same assumption plus a precipitous ideal on $\omega _1$ we show how a model can be forced where every $\Sigma ^1_{n+4}-$ set is measurable and has Baire property.

We investigate several versions of a cardinal characteristic $ \frak f$ defined by Frankiewicz. Vojtáš showed ${\frak b} \leq{\frak f}$ , and Blass showed ${\frak f} \leq \min({\frak d},{\mbox{\rm unif}}({\bf K}))$ . We show that all the versions coincide and that ${\frak f}$ is greater than or equal to the splitting number. We prove the consistency of $\max({\frak b},{\frak s}) <{\frak f}$ and of ${\frak f} < \min({\frak d},{\mbox{\rm unif}}({\bf K}))$.

We describe a list of canonical functions from 2 to ℝ such that every Borel measurable function from 2 to ℝ, on some superperfect rectangle, induces the same equivalence relation as some canonical function.

Let ${{\mathcal J}\,(\mathbb M^2)}$ denote the σ-ideal associated with two-dimensional Miller forcing. We show that it is relatively consistent with ZFC that the additivity of ${{\mathcal J}\,(\mathbb M^2)}$ is bigger than the covering number of the ideal of the meager subsets of ω ω. We also show that Martin’s Axiom implies that the additivity of ${{\mathcal J}\,(\mathbb M^2)}$ is 2 ω .Finally we prove that there are no analytic infinite maximal antichains in any finite product of ${\mathfrak{P}{(\omega)}/{\rm fin}}$.