Medical legal partnerships address individual legal needs that can create impediments to health. Little is known about outcomes from medical legal partnerships and their relationship to access to justice. This paper reports outcomes from one medical legal partnership from the perspective of the client, with specific emphasis on impact on health and concepts related to access to justice. We suggest a conceptual model for incorporating medical legal partnerships into a broader framework about access to justice.

In this paper, I outline various pedagogical practices that I believe are important for diversifying the field of philosophy. I outline these practices through a discussion of knowledge and its production, the production of relations through collective acts, the creation of space in and beyond the institution, and finally moving beyond inclusion narratives. The various pedagogical practices that I outline have been developed in, and drawn from, a workshop titled the Feminist Decolonial Politics Workshop. Ultimately, in this paper I utilize (...) what I call a “tenderness approach to philosophy”—tenderness as devotion of time and concentration, as directional, relational, and embodied—in order to demonstrate how tenderness can be applied to a pedagogical context. (shrink)

This article looks at the controversy surrounding Heidegger's National Socialism and asks the following question: was Heidegger a Nazi and if so, why did he not disavow it more vigorously after the war? This leads to an argument that Heidegger's pride led him to amend his work to dilute the consistencies of his work with National Socialism after the fact, in addition to allowing his work to remain obscure in meaning. He did the same with the rejection of transcendence, and (...) for the same reasons: to do so would be to point out that his work, however radical, achieved less that he claimed for it. Heidegger’s story remains a cautionary tale for any intellectual who comes after him. (shrink)

The aim of this article is to interrogate the concept of cultural genocide. The primary context examined is the Government of Canada's recent attempt at reconciliation through the Truth and Reconciliation Commission. Drawing on the work of Audra Simpson, Glen Sean Coulthard, Kyle Powys Whyte, Stephanie Lumsden, and Luana Ross, I argue that cultural genocide, like cultural rights, is depoliticized, thus limiting the political impact these concepts can invoke. Following Sylvia Wynter, I also argue that the aims of “truth and (...) reconciliation” can sometimes serve to resituate the power of a liberal multicultural settler state, rather than seek systemic changes that would properly address the present-day implications of the residential school system. Finally, I argue that genocide and culture need to be repoliticized in order to support Indigenous futurity and sovereignty. (shrink)

Alongside Colin Wright, I contend that it is important to consider the implications of Alain Badiou’s political project in various distinct geopolitical locations. To this end, in this paper I bring Badiou’s work into conversation with the decolonial feminist project of Sylvia Wynter. Both Badiou and Wynter provide an account of political emancipation that operates by disrupting already existing oppressive structures. However, I argue that the manner in which they hope to achieve this emancipation, or the manner in which it (...) is possible, is inherently distinct. Badiou proposes a kind of universality that subtracts from differences and identity in order to achieve justice and equality. However, Wynter underlines the importance of the liminal or marginal position that exists as identity or difference for the purpose of disrupting problematic hierarchical structures in order to attain a kind of universal emancipation. (shrink)

The ethics of long-term Extracorporeal Membrane Oxygenation (ECMO) use, especially when organ recovery appears highly unlikely and the patient does not qualify for organ transplantation, are compli...

Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians’ skills in conflict management. Familiarizing careproviders with basic mediation techniques is an important step towards (...) preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required. (shrink)

SummaryThis essay is an introduction to a special issue on ‘Liberalism in the Early Nineteenth-century Iberian World’. The essay reviews why Iberian intellectual history, particularly liberal political thought, has been neglected in English-language scholarship. It offers suggestions for the incorporation of Portuguese and Spanish language texts into the broader canon. The essay then outlines persistent debates common to the study of liberalism in both Iberian and other national contexts, in an effort to instigate a dialogue between intellectual historians of Spain (...) and Portugal and their counterparts elsewhere. It concludes with a consideration of the geopolitical forces, cultural trends, and social conditions that encouraged the forging of transnational liberalism in the early nineteenth century. (shrink)

A couple and their five‐year‐old daughter are in a car accident. The parents are not expected to survive. The child is transported to a children's hospital, and urgent treatment decisions must be made. Whom should the attending physician approach to make decisions for the child? When such cases arise in, for example, the hospitals where we work, the social worker or chaplain is instructed to use the Illinois Health Care Surrogacy Act as a guidepost to identify a decision‐maker. But in (...) our state and the country overall, the limitations of such statutes leave hospital workers to make a judgment call among friends, family, and clergy who may come forward. While surrogate decision‐making statutes comprehensively address surrogate decision‐makers for adults, a patchwork of laws—permanency statutes, kinship provider statutes, standby guardianship statutes, and, in some cases, surrogate decision‐making statutes—provide variable decision‐making pathways for children. (shrink)

Volume 20, Issue 6, June 2020, Page 17-19.

A vital and timely contribution to the growing scholarship on the political thought of Alain Badiou.

Fiester and Yuan discuss important ethical concerns regarding the use of behavior contracts in addressing conflict with patients and families labeled as “difficult” (Fiester and Yuan 2023). We agre...

Background: Understanding is an important goal of the informed consent process in research. We sought to assess the interrater reliability (IRR) and concurrent validity of two measures of understanding in child and young adult subjects and their parents. Methods: We conducted a cross-sectional survey and interview-based study of children and young adults participating in a clinical trial for cancer, along with one parent per child or young adult subject. We estimated the IRR of the Semi-Structured Comprehension Interview (SSCI) and the (...) MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). We also estimated concordance between the SSCI, the MacCAT-CR, and the Quality of Informed Consent (QuIC). Results: For our sample of 32 subjects (16 parent–child pairs), IRR estimates were high for total score on the SSCI (intraclass correlation coefficient [ICC] = 0.88, 95% confidence interval [CI] = 0.76–0.94), as well as on the understanding (ICC = 0.93, 95% CI = 0.86–0.97) and reasoning (ICC = 0.97, 95% CI = 0.94–0.98) subscales of the MacCAT-CR. IRR was lower for the appreciation subscale of the MacCAT-CR (ICC = 0.70, 95% CI = 0.47–0.84). Scores on the SSCI were strongly correlated with scores on the understanding subscale of the MacCAT-CR (Spearman's rho = 0.72, 95% CI = 0.48–0.85) and the QuIC (Spearman's rho = 0.66, 95% CI = 0.24–0.87). Mean administration time for the SSCI was 3.1 minutes (95% CI = 2.7–3.5 minutes). Conclusions: The SSCI is a valid and reliable measure of understanding for use with both pediatric and adult research participants. It is easy to administer and score consistently, even by nonprofessional raters. The SSCI is a promising tool for use by clinician-investigators to study, detect, and correct deficiencies in understanding among children, adolescents, and adults making decisions about research participation. (shrink)

Clinical ethicists move in different environments and interface with a variety of stakeholders, and are therefore uniquely positioned to answer the call for equity and anti-racism. We describe why a clinical ethicist should contribute to anti-racism efforts and describe general approaches for addressing racism across institutional contexts, including: (1) addressing racism as a bedside clinical ethics consultant, (2) addressing a wider lens of anti-racism work across multiple ethics consults over time, and (3) addressing racism at the organizational level.

Throughout Mary Shelley’s early life, she was exposed to numerous well-known and influential people regarding cultural, political, and socio-economic matters. As she began writing, these influences undoubtedly played a role in her narrative. Her novel, _Frankenstein_, written during the time of the first Industrial Revolution in Britain, was one such novel that exhibited her political and economic influences through science fiction. This article addresses many of those influences, including the introduction of the machine into manufacturing. It further addresses how Frankenstein’s (...) Monster may have been one of the first created forms of artificial intelligence (AI). We further expound upon many economic concepts that have persisted through time and are relevant today given the faciliatory aspects, as well as the uncertainty, of AI. We relate these through the literary piece _Frankenstein_ to explore how a two-century-year-old tale provides a blueprint for understanding the conflict among humans and machines and provides a roadmap for harmonization in the past, present, and future. (shrink)

Controversies surrounding the determination of death by neurologic criteria (DNC), also known as brain death, have become increasingly common over the last decade, occasionally leading to parental refusal of all or part of an evaluation or declaration of DNC. We performed a prospective, crosssectional study of pediatric neurologists and intensivists who participate in professional listservs to ascertain perspectives and practices concerning the evaluation of DNC, specifically on obtaining permission for evaluations and managing refusals. Of the 334 respondents who had performed (...) an evaluation for DNC, 35 percent reported they had experienced at least one parental refusal, and 64.4 percent reported that they did not seek permission to perform an evaluation. Pediatric neurologists, careproviders who had less experience doing evaluations, and careproviders who had experienced parental refusal of an evaluation were more likely to obtain permission from parents. Most (80.8 percent) of respondents reported that their institution had a DNC policy. We found variability in many aspects of DNC evaluations and declarations, as well as the handling of refusals. Lack of consistency may make it more difficult for careproviders and families. Greater understanding of parental refusal of DNC evaluation is essential to inform efforts to increase consistency. (shrink)

Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors and negative body image among a community sample of women during the COVID-19 pandemic. Furthermore, we explored the possible relation between body (...) image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs. (shrink)

En contexte de protection de la jeunesse, dans plusieurs situations, il arrive que le développement d’un lien d’attachement ne puisse s’établir suite à du rejet, de l’abandon ou par l’incapacité des parents à reconnaître ou répondre aux besoins de l’enfant. Dans de telles situations, au Québec, on envisage de plus en plus une approche « projet de vie » pour l’enfant avec l’objectif de mettre fin à l’ambivalence et au vide affectif, ceci dans des délais qui ne compromettent pas sa (...) capacité de se développer harmonieusement. Dans cette perspective, nous présentons ici les résultats d’une étude exploratoire qui a pour objectif de dresser un premier portrait des jeunes pour qui un « projet de vie » fut élaboré dans sept centres jeunesse du Québec. (shrink)

The present study fills a void in research on passion by examining for the first time the role of passion in physiological responses. The aim of the study was to investigate the role of passion, and the mediating role of cognitive appraisals, in the psychological and physiological responses to a stressful situation related to one’s passion. Students, who were passionate for their studies, completed the Passion Scale for their studies and the Cognitive Appraisal Scale. Then, they engaged in an education (...) task under stressful conditions, and a subsequent unrelated leisure task under no-stress. Physiological reactivity was measured throughout the entire session and their perceptions of situational vitality and positive and negative emotions were assessed directly after the education task. Results showed that harmonious passion positively predicted challenge appraisals that, in turn, were positively related to positive emotions, vitality, and positive cardiovascular adaptation while engaging in the stressful education task, but less so with the leisure task. On the other hand, obsessive passion positively predicted threat appraisals. In turn, threat appraisals were positively related to negative emotions, negatively associated with vitality, and not related to cardiovascular reactivity. The present findings suggest that HP creates the onset of an adaptive psychological and physiological response whereas the response is less adaptive with OP. (shrink)

A core tenet of research ethics is that risks assumed by research participants are reasonable, balanced, and minimized in relation to benefit to the individual and to society. It is also generally accepted that people who cannot give their own informed consent ought only to be exposed to low risks in research, unless there is a compensating potential for direct benefit.However, there is no consensus on whether individuals should be able to voluntarily consent to high net risk in research—or, in (...) other words, to research that is not justified by direct benefits to the individual and must be justified by benefits to others in society. The Belmont Report—perhaps the most canonical document in research ethics—does not... (shrink)

In “The Harm Principle Cannot Replace the Best Interest Standard: Problems With Using the Harm Principle for Medical Decision Making for Children,” Bester argues that conceptual and normative diffi...

In “An Overview of Ethical Challenges Raised by Medicolegal Challenges to Death by Neurologic Criteria in the United Kingdom and a Comparison to Management of these Challenges in the USA,” Ariane L...

In summer 2022, six points of consensus emerged from a symposium addressing the question, “In the context of U.S. pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?” (Salter et al. 2023). The authors of this statement wrote, however, that the points of consensus may require modification or may not apply in their entirety to children in state custody. This article addresses the consensus recommendations in the context of the thousands of children (...) removed annually from the custody of their parents. While the consensus statements developed at the symposium provide a good starting point for decision-making in the context of these children, some alterations and nuance must be applied to attend to the specific needs of this population. The article works through what special considerations and changes ought to be made to expand the reach of the original points of consensus without neglecting the particular conditions of children in state custody, as well as their parents and caregivers. (shrink)

Decision making for children who suffer abusive head trauma invokes multiple ethical considerations. The degree to which parents are permitted to participate in decision making after the injury has occurred is controversial. In particular, in this issue of The Journal of Clinical Ethics, Grigorian and colleagues raise concerns about the potential for conflict of interest in end-of-life decision making if the parents are facing criminal charges that could be escalated if the child dies. There are additional concerns about the parents’ (...) capacity to make decisions that are best for the child, given that the injury occurred. We argue that there are important reasons not to exclude parents from the decision-making process and that, with appropriate safeguards in place, parents are integral to determining what is best for the child. (shrink)

The focus of this essay is Sylvia Wynter’s conception of ceremony. I argue that ceremonies provide the conditions for a new conception of what it means to be human, that is no longer hierarchical. As such, both ceremonies and this new human are necessary for processes of liberation. In order to be liberatory, however, ceremonies must be place-based and yet fluid and mobile, are steeped in history and are thrust into the future, depend upon community, and impact daily experiences. I (...) argue that employing the best aspects of ceremony can provide the tools for developing coalitional movements, which are often already employed by Black and Indigenous communities. I call this process ceremonies of liberation. (shrink)