Les espaces de rencontre enfants-parents sont des dispositifs qui ont émergé il y a plusieurs décennies en Europe occidentale avec des modalités de fonctionnement en partie convergentes. Cet article s’intéresse aux analogies de fonctionnement entre les différents dispositifs européens à partir des discours professionnels ou institutionnels. Les auteurs font l’hypothèse que ces derniers sont soutenus, en partie, par des métacadres culturels communs. Afin de traiter de cette problématique, l’article s’inscrit, sur le plan méthodologique, dans une double perspective : (...) synchronique (les témoignages des professionnels et des représentants institutionnels des différents pays concernés) et diachronique (les écrits des psychothérapeutes fondateurs des espaces de rencontre en France). Les métacadres culturels repérés sont observés selon trois axes : celui du maintien du lien parents-enfants, celui des rapports entre générations en termes de droit et d’autorité, enfin celui des rapports de genre dans le couple parental. (shrink)

Le présent article est le fruit d’une recherche qualitative auprès de l’ensemble des acteurs concernés par le dispositif « Espace de rencontre » ( er ) en France. Ce dispositif tant judiciaire que répondant aux nouvelles aspirations sociales autour de la famille vient soutenir le lien parent-enfant dans le cadre de séparations conflictuelles ou en cas d’incapacité de l’un des parents d’accueillir son ou ses enfants. Cette recherche, conduite entre 2017 et 2020 au sein de douze structures, visait (...) à mieux appréhender les pratiques en er, à identifier tant l’intérêt que les limites du dispositif et à faire émerger de nouveaux questionnements sur le maintien des liens filiaux dans des situations complexes. Le vécu des parents, enfants et professionnels concernés y a été recueilli par des chercheurs issus des sciences humaines et sociales. Si cette mesure socio-judiciaire est bien admise par une majorité des usagers, la manière dont les enfants, eux, vivent les rencontres reste questionnante. (shrink)

Cet entretien croisé propose un échange avec Pierre Lalart, président de la Fédération française de espaces de rencontre, et Phil Coleman, chargé de communication pour les centres de contact au Royaume-Uni. Il repose sur un rapport établi par les deux pays concernant les points de divergence et de convergence entre eux. L’interview comprend trois domaines d’investigation : le premier porte sur l’histoire et le fonctionnement de chaque structure, le deuxième précise l’évolution des pratiques cliniques et sociales en leur (...) sein, le troisième apporte un éclairage sur les enseignements tirés de ce regard croisé. (shrink)

Les espaces de rencontre existent depuis plus de trente ans en France. Le dispositif est une ressource en cas de séparation conjugale conflictuelle. Il offre un lieu, dit « neutre », pour l’exercice du droit de visite et permet de maintenir ou parfois de créer le lien parent-enfant dans des contextes difficiles. L’auteure s’appuie sur une vignette clinique extraite d’une étude française sur le vécu des enfants passés en espace de rencontre qui, devenus adultes, témoignent de leur expérience. Elle (...) souligne, d’un point de vue psychodynamique, la complexité des enjeux mobilisés, le rôle d’enveloppe transitoire de l’espace de rencontre et signale aussi les limites du dispositif. (shrink)

In July 1993, the Scottish Highlands Centre for Human Caring sponsored a conference with the title Exploring the Spirituality in Caring. The papers given at the conference and included in this volume are offered as a contribution to the debate that must take place in nursing and in the wider context of health care provision. Ann Bradshaw's paper puts the debate in context arguing that nursing is fundamentally a loving response to the human being created in the image of (...) God. (shrink)

This article aims at achieving a detailed qualitative vision of the chronic disease in the adolescent population and its specific issues. To that end, a first-person experiential research based on significant events regarding healthcare pathways was developed. Six interviews were conducted with three practitioners. The results of this researchallow us to identify spaces of configuration in terms of parenthood, of therapeutic alliances and of negotiating care strategies between teenagers, parents and professionals.Which co-construction spaces should be built with the teenagers (...) in conflict or in rupture or with the suffering parents? Which positions should be adopted by practitioners to avoid or postpone chronicity? (shrink)

Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with Botulinum Neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with cerebral palsy. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic cerebral palsy were included in the study, (...) eight girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around six weeks after at the peak effect of BoNT-A, and at six months after treatment, with measurement of muscle strength, gait analysis and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions. (shrink)

Les situations de séparation conflictuelle entre parents peuvent provoquer une rupture du lien entre l’enfant et un de ses parents. L’espace de rencontre ( er ), en mettant en place des droits de visite encadrés, est alors le dernier recours de ces parents pour retisser un lien. Dans l’ er dont il est question dans cet article, les visites concernent principalement le père, la mère étant alors le parent gardien. Dans ce cadre ont été rencontrés des (...) enfants qui affichaient une volonté de rompre tout lien avec leur père, ce refus massif s’apparentant à un clivage de loyauté. Pour comprendre cette attitude, l’article interroge, à travers le cas de Marie, la dimension psychosociale de la fonction paternelle, la dimension intrapsychique et la dynamique relationnelle dans cette triade père-mère-enfant afin d’envisager le dispositif à mettre en place dans les situations de conflit de loyauté. (shrink)

In this paper we re-examine Hugh LaFollette's proposal that the state carefully determine the eligibility and suitability of prospective parents before granting them a ?license to parent?. Assuming a prima facie case for licensing parents grounded in our duty to promote the welfare of the child, we offer several considerations that complicate LaFollette's radical proposal. We suggest that LaFollette can only escape these problems by revising his proposal in a way that renders the license effectively obsolete, a route (...) he implicitly adopts in his recent revisiting of the licensing proposal. We conclude that there is little merit in the idea of licensing ?natural? parents as a practical policy proposal, and raise some questions about its continued use in relation to adoptive and foster parents. (shrink)

Malm and colleagues (2008) consider (and reject) five arguments putatively justifying the idea that healthcare workers (HCWs) have a duty to treat (DTT) during a pandemic. We do not have sufficient...

Bioethics has dedicated itself to exploring and defending both reasons for and against certain aspects of clinical care, biomedical research and health policy, including what decisions must be made, who should make them, and how they should be made. In pediatrics, it’s widely acknowledged that parents’ reasons may matter pragmatically; attending to parents’ reasons is important if we want to work with families. Yet the conventional view in pediatric ethics is that parents’ reasons are irrelevant to whether (...) a decision is permissible or impermissible according to accepted ethical standards. In this paper, we explore whether parents’ reasons matter ethically and, if so, in what way and for whom. First, we clarify what we mean by ‘reasons.’ Second, we provide an overview of how reasons are typically treated in medical decision-making and pediatric ethics. Third, we analyze a hypothetical pediatric case to illustrate how changing reasons can transform ethical analyses, including by contributing to where and how clinicians and ethicists draw the boundaries intrinsic to common pediatric ethical frameworks. We push back against the conventional view and argue that parents’ reasons matter ethically in several ways. We call for further research on the role of parents’ reasons in clinical ethics deliberation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodAnonymous One, Anonymous Two, Lorri Centineo, Anonymous Three, Virginia Clapp, Catherine Cornell, Nancy Coughlin, David McDonald, Mark Osteen, Laura Shumaker, Julie Van der Poel, Anonymous FourMy Son's Life with Autistic Spectrum DisorderAnonymous OneThis is the story of how my son, David, has tried to become independent. David is now 25–years–old. His immediate family is his dad, a brother (age (...) 22) and myself (his mother). He was diagnosed with an autism spectrum disorder (ASD) when he was 13. We looked up all the information and decided not to make a big deal of it. Looking back, he displayed all the classic signs of a high functioning autistic disorder. Would he have been diagnosed with the new DSM 5 guidelines? He probably would have. His life would be much, much different if he had been diagnosed at an early age.I'll start with David at age 13 when he was able to harness his big interest in computer science into a career for himself. He was expelled from middle school for threatening some kid that had been picking on him all year. He had a meltdown and wasn't able to communicate his side of the story and that was it.During the summer of that year he took classes in computer engineering (Microsoft) and became an engineer when he was 13. At that time it was quite an accomplishment because he was the youngest person in the United States to do so at such a young age. (By the way, the administration of the school that expelled him sent him a congratulatory card when he was written up in the paper).His father and uncle are in business running a computer company so David had a ready–made job waiting for him when he graduated from high school and was able to keep it during difficult times. David finished high school (mainstreamed special education as emotionally disturbed) and he also received another engineering certification (Cisco).I have to mention here that I truly did not understand what it was like for my son until one day when he was in high school, as I was lecturing him again for some stupid reason, he said, "You don't know how hard it is for me to not sit in a corner and rock every day." Think about that. ASD individuals get up and keep going every day when they know they are going to be misunderstood and picked on. They all deserve a medal for bravery.David became really upset that he had never had a date and that girls were not even interested in talking to him. He started cutting himself and shaving his head. That got him some attention from the stoner group. He had someone to sit with at lunch anyhow. Parents, I think it's better to have no friends than the wrong friends. They introduced him to drugs.We did not mention any trouble David was having to any relatives. We had lived 800 miles from our families in a very unspoiled part of northern America. In hindsight this was not good either. [End Page 151]Another thing, and I think every parent will agree with this—teachers, school staff, health care industry staff, doctors and every one that comes into contact with an ASD individual—take the time to get to know them. It may be difficult and some may appear non–caring and rude. You must overlook this and look to the person underneath. They are great people. They have been through stuff and it means so much to them. Like I said—parents, you know this. Please remember it when times get tough.During David's senior year he started work release so he could start earning money to buy a car and move out as soon as he turned 18. Things were made easy for David since the company was owned by his father and his uncle and I worked there also. David enjoyed the work but had the occasional meltdown and had difficulties fitting in with other employees. He wasn't able to communicate... (shrink)

What do we mean when we say we want to put children at the centre of policy? What are the moral justifications for this approach? Has it become harder for us to understand this concept, when in practice paid work has been at the centre? In part confusion arises because the unpaid work of caring for children is invisible until it is marketized. In turn, the underlying problem is that we have forgotten our traditions of egalitarianism and adopted a powerful (...) mindset that is proving to be paralyzing. Exploring New Zealand family policies such as paid parental leave, early childhood education, child tax credits suggests that there is much room for improvement if the needs of children are to come first. But first and foremost we must have a very different, child-centric, colour-blind, non-judgmental change of heart. (shrink)

What is family-centred care of a hospitalized child? A critical understanding of the concept of family-centred care is necessary if this widely preferred model is to be differentiated from other health care ideals and properly evaluated as appropriate to the care of hospitalized children. The article identifies distinguishable interpretations of family-centred care that can pull health professionals in different, sometimes conflicting directions. Some of these interpretations are not qualitatively different from robust interpretations of the ideals of parental participation, care-by-parent and (...) partnership in care that are said to be the precursors of family-centred care. A prominent interpretation that regards the child and his or her family collectively as the ‘unit of care’ arguably arises from ambiguity and is significantly problematic as a model for the care of hospitalized children. Clinical practice driven by this interpretation can include courses of action that do not aim to do what will best promote a hospitalized child’s welfare, and such cases will not be unusual. More broadly, this interpretation raises challenging questions about the responsibilities and authority of health professionals in relation to the interests of hospitalized children and their families. (shrink)

We report on the mechanisation of (preference-based) conditional normative reasoning. Our focus is on Åqvist's system E for conditional obligation, and its extensions. Our mechanisation is achieved via a shallow semantical embedding in Isabelle/HOL. We consider two possible uses of the framework. The first one is as a tool for meta-reasoning about the considered logic. We employ it for the automated verification of deontic correspondences (broadly conceived) and related matters, analogous to what has been previously achieved for the modal (...) logic cube. The equivalence is automatically verified in one direction, leading from the property to the axiom. The second use is as a tool for assessing ethical arguments. We provide a computer encoding of a well-known paradox (or impossibility theorem) in population ethics, Parfit's repugnant conclusion. While some have proposed overcoming the impossibility theorem by abandoning the presupposed transitivity of ‘better than’, our formalisation unveils a less extreme approach, suggesting among other things the option of weakening transitivity suitably rather than discarding it entirely. Whether the presented encoding increases or decreases the attractiveness and persuasiveness of the repugnant conclusion is a question we would like to pass on to philosophy and ethics. (shrink)

Children's consent to treatment remains a contentious topic, with confusing legal precepts and advice. This paper proposes that informed consent in children should be regarded as shared between children and their families, the balance being determined by implicit, developmentally based negotiations between child and parent--a "family rule" for consent. Consistent, operationalized procedures for ethically obtaining consent can be derived from its application to both routine and contentious situations. Therefore, use of the "family Rule" concept can consistently define negligent procedure in (...) obtaining consent from children, and could be used as a unifying framework in the development of new professional guidelines. A "guideline"-based approach to children's consent to treatment may offer greater individuality than a "rights"-based approach, though careful training and oversight will be needed for it to be effective. (shrink)

In this paper, I explain the demands of filial obligations from act and rule consequentialism. More specifically, I defend a rule-consequentialist explanation of filial obligations, and identify a few factors in relation to the determination of filial demands; they include the costs of internalization of filial obligations, and the proportions of the young and the old generations in a population pyramid. I believe that in a society with an aging population, we may accept a strong view of filial obligation. Towards (...) the end of the paper, I explain that rule-consequentialism is compatible with certain special views of filial obligations, such as the gratitude theory and the special goods theory; these theories represent ways in which adult children and their parents may obtain special goods from engaging in the relationship. (shrink)

Les espaces de rencontre, ou d’accueil enfants-parents lors de séparation ou divorce conflictuel, sont intrinsèquement très sensibles à la parentalité et à son évolution. Cet article tente ainsi de repérer le travail de « scénarisation » des professionnels face aux liens emmêlés entre parents et enfants. L’auteur montre d’abord comment la pression s’accentue sur l’enfant, plus que jamais « coupable d’être » et responsable des « chagrins d’amour » de ses parents, comme l’illustrent plusieurs exemples littéraires. Il (...) analyse ensuite des situations cliniques avec recompositions familiales et homoparentalité. La diversité de la parentalité ne met pas à l’abri l’enfant, « acteur faible » des déchirements des adultes en couple. On doit sans cesse lui offrir un espace de subjectivation non inféodé à la souffrance de l’un ou l’autre des parents, d’autant plus qu’il tend à être l’objet de « leur projet ». (shrink)

The definition of ‘patient’ is commonly taken for granted and considered as obvious, but the term is rather underconceptualised in the literature. In this paper, it will be argued that the criterion of suffering can be considered a sufficient criterion for a parent to be considered a secondary patient when their seriously ill child is receiving medical care (i.e. not necessarily the parents themselves) – these parents are sufferers in virtue of the suffering of others. The nature of (...) parental and child health and well-being is clearly relational and bidirectional, thus also a bidirectional and relational integration of parental and paediatric patient care is necessary. A genuine expansion of the concept ‘patient’ to parents, both practically and theoretically, can help to bring awareness to the closely intertwining, interacting and interdependent vulnerabilities of both parties, the potential conflicts of interests involved, and also to demand support and reduce hurdles, for example, in reimbursement by health insurers. Treating parents as patients will (1) help the affected child (the primary patient), as unhealthy and/or mentally unstable parents are likely to negatively influence a child's treatment and (2) prevent the parents (the secondary patients) from becoming primary patients themselves due to their suffering because of their child's illness. (shrink)

The definition of ‘patient’ is commonly taken for granted and considered as obvious, but the term is rather underconceptualised in the literature. In this paper, it will be argued that the criterion of suffering can be considered a sufficient criterion for a parent to be considered a secondary patient when their seriously ill child is receiving medical care (i.e. not necessarily the parents themselves) – these parents are sufferers in virtue of the suffering of others. The nature of (...) parental and child health and well-being is clearly relational and bidirectional, thus also a bidirectional and relational integration of parental and paediatric patient care is necessary. A genuine expansion of the concept ‘patient’ to parents, both practically and theoretically, can help to bring awareness to the closely intertwining, interacting and interdependent vulnerabilities of both parties, the potential conflicts of interests involved, and also to demand support and reduce hurdles, for example, in reimbursement by health insurers. Treating parents as patients will (1) help the affected child (the primary patient), as unhealthy and/or mentally unstable parents are likely to negatively influence a child's treatment and (2) prevent the parents (the secondary patients) from becoming primary patients themselves due to their suffering because of their child's illness. (shrink)

Objectives During the COVID-19 pandemic, healthcare resources including staff were diverted from paediatric services to support COVID-positive adult patients. Hospital visiting restrictions and reductions in face-to-face paediatric care were also enforced. We investigated the impact of service changes during the first wave of the pandemic on children and young people (CYP), to inform recommendations for maintaining their care during future pandemics. Design A multi-centre service evaluation was performed through a survey of consultant paediatricians working within the North Thames Paediatric Network, (...) a group of paediatric services in London. We investigated six areas: redeployment, visiting restrictions, patient safety, vulnerable children, virtual care and ethical issues. Results Survey responses were received from 47 paediatricians across six National Health Service Trusts. Children's right to health was largely believed to be compromised by the prioritisation of adults during the pandemic (81%; n = 33). Sub-optimal paediatric care due to redeployment (61%; n = 28) and the impact of visiting restrictions on CYP's mental health (79%; n = 37) were reported. Decreased hospital attendances of CYP were associated with parental fear of COVID-19 infection-risks (96%; n = 45) and government ‘stay at home’ advice (89%; n = 42). Reductions in face-to-face care were noted to have disadvantaged those with complex needs, disabilities and safeguarding concerns. Conclusion Consultant paediatricians perceived that paediatric care was compromised during the first wave of the pandemic, resulting in harm to children. This harm must be minimised in subsequent pandemics. Recommendations for future practice which were developed from our findings are provided, including maintaining face-to-face care for vulnerable children. (shrink)

Le Relais de Sceaux (clinique Dupré, Fondation santé des étudiants de France), qui reçoit des adolescents et jeunes adultes et leurs familles, est une porte d’entrée aux soins médico-psychologiques. À partir de 2013, l’ouverture de l’accueil aux 11-15 ans a bouleversé le fonctionnement de départ du Relais. À côté du dispositif d’accueil sans rendez-vous des 16-25 ans, un protocole spécifique adapté aux collégiens a été mis en place. Il s’appuie sur un contact téléphonique avec les parents préparant la (...) première rencontre. Via une situation clinique, les auteurs, psychologues et psychiatres exerçant au Relais de Sceaux, exposent les spécificités cliniques de collégiens pour lesquels la rencontre familiale est un préalable indispensable à l’instauration d’un soin psychique individualisé. (shrink)

This collection of essays emphasizes society s increasingly responsible engagement with ethical challenges in emerging medical technology. Expansion of technological capacity and attention to patient safety have long been integral to improving healthcare delivery but only relatively recently have concepts like respect, distributive justice, privacy, and autonomy gained some power to shape the development, use, and refinement of medical tools and techniques. Medical ethics goes beyond making better medicine to thinking about how to make the field of medicine better. These (...) essays showcase several ways in which modern ethical thinking is improving safety, efficacy and efficiency of medical technology, increasing access to medical care, and empowering patients to choose care that comports with their desires and beliefs. Included are complimentary ethical approaches as well as compelling counter-arguments. Together, the articles demonstrate how improving the quality of medical technology relies on every stakeholder -- not just medical researchers and scientists -- to assess each given technology s strengths and pitfalls. This collection also portends one of the next major issues in the ethics of medical technology: developing the requisite moral framework to accompany shifts toward patient-centred personalized healthcare.". (shrink)

Although previous work has linked parent autonomy support to the development of children’s executive function skills, the role of specific autonomy-supportive behaviors has not been thoroughly investigated. We compiled data from four preschool-age samples in the Midwestern United States to examine three relevant autonomy-supportive behaviors and their associations with child EF. We coded parent autonomy-supportive behaviors from a 10-min interaction between parent and child dyads working on challenging jigsaw puzzles together. Children completed a battery of EF. Overall, child EF was (...) most consistently correlated with the offering choice subscale. Additionally, only the offering choice subscale predicted child EF while controlling for the other autonomy support subscales and child age. These results suggest that parent provision of choice is an especially relevant aspect of autonomy-supportive parenting and may be important to the development of EF in early childhood. Future research should directly measure children’s experience with choice and how it relates to emerging EF. (shrink)

Pratiques des rencontres et réflexion théologique s’interrogent et se fécondent mutuellement. Ainsi existe-t-il deux dialogues : le dialogue entre croyants de différentes religions, d’une part, où il peut y avoir interférence du théologique, mais pas toujours, le vivre ensemble étant souvent à l’origine ; et, d’autre part, le dialogue théologique au sein des communautés chrétiennes, dialogue suscité par l’existence du pluralisme religieux et donc la question de son interprétation. Sans ignorer la complexité des réalités, G. Comeau, s’appuyant sur son expérience (...) et sa compétence, précise dans quel cadre conceptuel elle fait intervenir les rencontres et ce qu’on peut en attendre pour la réflexion théologique.Encounters and theological reflection question each other and are mutually enriching. Thus there are two dialogues: the dialogue between believers of different religions, on the one hand, where there may sometimes but not always be theological overlap, due to living together; and, on the other hand, theological dialogue within Christian communities, a dialogue brought about by the existence of religious pluralism and hence the issue of its interpretation. Without ignoring the complexity of some realities, G. Comeau, relying on her experience and competence, shows precisely in what conceptual framework it involves encounters and what one can expect from them for theological reflection. (shrink)

Many people move house at some point during their childhood and not rarely more than once. While relocations are not always harmful for under-aged children, they can, and frequently do, cause great disruption to their lives by severing their social ties as well as any attachments that they might have to their neighbourhood, town, or wider geographical region, with long-lasting psychological effects in some cases. Since it is increasingly recognised within normative philosophy as well as within Western societies that older (...) minors should have the final say over certain issues that significantly affect their lives (think, for instance, of custody disputes, decisions about whether to get specific vaccinations or use contraceptives), this raises the question: Can it be morally incumbent upon parents to give their minor children a veto over family relocation? This article argues that the answer is affirmative. Specifically, it suggests that such duties exist if and only if (i) parents are not morally required to either relocate their families or stay put, (ii) the stakes of the decision about a family relocation are fairly low, and (iii) the children have the competence to make these decisions, as many older minors do. (shrink)

Nursing work increasingly demands forms of expertise that complement specialist knowledge. In child and family nursing, this need arises when nurses work in partnership with parents of young children at risk. Partnership means working with parents in respectful, negotiated and empowering ways. Existing partnership literature emphasises communicative and relational skills, but this paper focuses on nurses’ capacities to facilitate parents’ learning. Referring to data from home visiting, day‐stay and specialist toddler clinic services in Sydney, a pedagogical framework (...) is presented. Analysis shows how nurses notice aspects of children, parents and parent–child interactions as a catalyst for building on parents’ strengths, enhancing guided chance or challenging unhelpful constructs. Prior research shows the latter can be a sticking point in partnership, but this paper reveals diverse ways in which challenges are folded into learning process that position parents as agents of positive change. Noticing is dependent on embodied and communicative expertise, conceptualised in terms of sensory and reported channels. The framework offers a new view of partnership as mind‐expanding for the parent and specifies the nurse's role in facilitating this process. (shrink)

This second of a two-part series of articles on applied semiotics and intercultural training provides a qualitative evaluation of the research initiative Tools for Cultural Development. The discussion will firstly centre on several theoretical and methodological challenges inherent to the qualitative research paradigm and then relate these shifting concerns to convergent findings in poststructuralist semiotics, especially with respect to phenomenology and pragmatics. Analysis of four focus group interviews in France and Australia will examine and evaluate the 2007 training experience in (...) light of the culture-specific contexts and stakeholder groups involved. Of particular concern will be the capacity of qualitative evaluative processes to account for the "local meanings" and "voices" within the trainee narratives so as to highlight their perceptions as to the use of semiotics for designing culturally significant practices in education and praxis. (shrink)

This paper provides an answer to the question why birth parents have a moral right to keep and raise their biological babies. I start with a critical discussion of the parent-centred model of justifying parents’ rights, recently proposed by Harry Brighouse and Adam Swift. Their account successfully defends a fundamental moral right to parent in general but, because it does not provide an account of how individuals acquire the right to parent a particular baby, it is insufficient for (...) addressing the question whether and why there is a right to parent one’s biological child. Such a right is important because, in its absence, fairness towards adequate prospective parents who are involuntarily childless would demand a ‘babies redistribution’; moreover, in societies with entrenched histories of injustice there may be reasons of fairness for shuffling babies amongst all recent parents. I supplement the Brighouse-Swift account of fundamental parental rights by an account of how adequate parents acquire the right to parent their biological babies. I advance two arguments to this conclusion: by the time of birth, the birth parents will have already shouldered various burdens in order to bring children into existence, and are likely to have formed an intimate relationship with the future baby. Denying birth parents who would make at least adequate parents the right to keep their baby would be unfair to them and would destroy already formed parent-baby relationships which, I assume, are intrinsically valuable. (shrink)

Perhaps the greatest determinant of individual and societal welfare is who raises children and with what degree of discretion. Philosophers have endeavored in myriad ways to provide normative justification for ascribing a right to be a legal parent and to possess particular legal powers as a parent. This Article shows why they fail and offers an alternative theoretical framework for delimiting parental rights. The prevailing tendency in philosophical writing on the topic is to begin with observations and intuitions specific to (...) parent-child relationships. Against that tendency, this Article demonstrates the need to begin with principles at a high level of generality, covering a broad range of human relationships. This yields a much more limited moral right in connection with parenthood than do accounts that fail to generalize. (shrink)

In recent years, reports on youth sports excesses and abuses of minors underscore the need for a safer sport environment. However, the way in which parents guide their children in dealing with winning and losing in sports is less understood. A care ethical inquiry into sport parenting might contribute to a better understanding of the role parents play in creating a safe sport environment for their children. This study applies theoretical perspectives from care ethics into practical context focusing (...) on the relationship between parents and their sporting children through the lens of relational identity. An interpretative phenomenological study was conducted into the meaning of competitiveness amongst Dutch parents of children aged eleven and twelve, who play hockey and are in the midst of transitioning from sport as a game to competitive sport. This article concludes that the meaning of competitiveness for these parents is twofold. On the one hand there is a desire to be proud of your child’s success, fuelled by meritocratic ideals. On the other hand, parents desire their child’s ongoing commitment to sport, which they consider a return investment for the sacrifices they make to support their child’s sport participation. From a care ethical stance of relational responsibility, parents should not solely view sport as a quid pro quo concept in which desires are fulfilled or battles settled, but rather as a game that is enjoyed by both parents and children. Mature sport parenting can only emerge once the tensions resulting from parental sacrifices on the one hand and the child’s loyalty to meet parental expectations on the other are overcome through dialogue and reflection, aimed at elucidating responsibilities within the relationship. More research is needed to gain insight into the significance of this relational connection for the youth sports climate. (shrink)

Ethical approval must be obtained before medical research can start. We describe the differences in EA for an pseudonymous, non-interventional, observational European study. Sixteen European national coordinators of the international study on very old intensive care patients answered an online questionnaire concerning their experience getting EA. N = 8/16 of the NCs could apply at one single national ethical committee, while the others had to apply to various regional ECs and/or individual hospital institutional research boards. The time between applying for (...) EA and the first decision varied between 7 days and 300 days. In 9/16 informed consent from the patient was not deemed necessary; in 7/16 informed consent was required from the patient or relatives. The upload of coded data to a central database required additional information in 14/16. In 4/16 the NCs had to ask separate approval to keep a subject identification code list to de-pseudonymize the patients if questions would occur. Only 2/16 of the NCs agreed that informed consent was necessary for this observational study. Overall, 6/16 of the NCs were satisfied with the entire process and 8/16 were unsatisfied. 11/16 would welcome a European central EC that would judge observational studies for all European countries. Variations in the process and prolonged time needed to get EA for observational studies hampers inclusion of patients in some European countries. This might have a negative influence on the external validity. Further harmonization of ethical approval process across Europe is welcomed for low-risk observational studies. Getting ethical approval for low-risk, non-interventional, observational studies varies enormously across European countries. (shrink)

Efforts to bring science into early 19th century breeding practices in Central Europe, organised from Brno, the Hapsburg city in which Mendel would later turn breeding experiments into a body of timeless theory, are here considered as a significant prelude to the great discovery. During those years prior to Mendel's arrival in Brno, enlightened breeders were seeking ways to regulate the process of heredity, which they viewed as a force to be controlled. Many were specialising in sheep breeding for (...) the benefit of the local wool industry while others were showing an interest in commercial plants, especially fruit trees and vines, and later cereals. Breeders explained their problems in regulating heredity in terms of climatic influences disruption due to crossing sports or saltations. Practical experience led them to the concepts of 'inheritance capacity' and the 'mutual elective affinity' of parents. The former was seen to differ among individuals and also among traits; the latter was proposed as a means of adding strength to heredity. The breeders came to recognise that traits might be hidden and yet transmitted as a 'potential' to future generations. They also grew to understand that heredity would be strengthened when a quality was 'fixed' within a lineage by 'pure blood relations.' Continued selection of the desired quality might then lead to 'a higher perfection.' But the ultimate 'physiological' question about breeding, 'what is inherited and how?,' found no answer. Major figures in this development included Abbot Napp, the one who asked this question and who was due to receive Mendel into the monastery in 1843, and Professor Diebl whose lectures on agriculture and natural science at the Brno Philosophical Institute Mendel would attend in 1846. Here we analyse their progress in theorizing about breeding up until about 1840. In discussing this development, we refer to certain international contacts, especially with respect to information transfer and scientific education, within the wider context of the late Enlightenment. (shrink)

Objective: To examine i) how ethical frameworks can be used in concrete cases of parent–doctors’ disagreements for extremely preterm infants born in the grey zone to guide such difficult decision-making; and ii) what challenges stakeholders may encounter in using these frameworks. Design: We did a case analysis of a concrete case of parent–doctor disagreement in the grey zone using two ethical frameworks: the best interest standard and the zone of parental discretion. Results: Both ethical frameworks entailed similar advantages and challenges. (...) They have the potential 1) to facilitate decision-making because they follow a structured method; 2) to clarify the situation because all relevant ethical issues are explored; and 3) to facilitate reaching an agreement because all parties can explain their views. We identified three main challenges. First, how to objectively evaluate the risk of severe disability. Second, parents’ interests should be considered but it is not clear to what extent. Third, this is a value-laden situation and different people have different values, meaning that the frameworks are at least partially subjective. Conclusions: These challenges do not mean that the ethical frameworks are faulty; rather, they reflect the complexity and the sensitivity of cases in the grey zone. (shrink)

This article is concerned with choices that parents or guardians make about the food they give to their children. Those with primary responsibility for the care of young children determine the set of foods that their children eat and have a significant impact on children’s subsequent dietary choices, both in later childhood and in adulthood. I argue that parents have a morally significant reason not to feed meat to their children, which stems from their fiduciary responsibility for the (...) child’s moral development. This should, at a minimum, be factored into parental decisions about their children’s diet. In the absence of compelling countervailing reasons, it will mean that parents should not, in an all-things-considered sense, feed meat to their children. This claim does not rely upon the obviously contentious claim that it is morally wrong to eat meat. Instead, the fact that children, when adults, may reasonably themselves come to believe that consuming meat is wrong gives parents morally compelling reasons to avoid acting in ways which may have the predictable consequence of corrupting the moral character of those for whom they are responsible. (shrink)

Introduction: Medical ethics raises the question of the meaning of medical practices in light of the humanities. In France, the spaces for ethical discussion (SED) are multiple and heterogeneous. The objective of this study was to investigate the typology and functioning of SEDs in the health field. Methods: Twenty-one semi-structured interviews were conducted with members of eleven different SEDs in France. The data were analyzed according to the basic steps of qualitative research: coding, categorization, linking and presentation of results. Results: (...) The five categories of SEDs (National Consultative Ethics Committee, Regional Ethical Reflection Spaces, Ethics Commissions of Medical Learned Societies, Research Institute Ethics Committees, Hospital Ethics Committees) all differ in their links with institutions, their composition, their choice of themes discussed and the presentation of their work. However, they all agree on the following points: the importance of multi-disciplinarity, the frequency of working meetings, the sense of ethical commitment, the absence of professional recognition, the difficulty of valorizing work and the lack of recognition by peers. The respondents regret that there is insufficient coordination between the different SEDs, although their work may be complementary. Conclusion: Opening up the SEDs and encouraging their articulation, without distancing them from the practice of care, could promote the visibility of their ethical approach in the daily lives of caregivers. Finally, if ethical reflection is encouraged by the scientific community as a whole, greater recognition is desired by professionals who participate in applied ethics research. (shrink)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being unjust to those (...) on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

Technology is not just a tool but an amalgam of conceptual, institutional, and interactional issues that occupy the space of technical reason. In this space, parents' identity is becoming narrowed according to a limited conception in which the place of caring is in danger of being lost. Parents are increasingly required to adopt knowledge on parent ing instead of adapting it to their child's needs. By use of the Heideggerian idea of Enframing, I argue that educational experts and (...) practitioners need to undo parent ing from this technological straitjacket. It needs to be recognised that being a parent is about ac knowledging that caring for your children is about questioning the borders of Enframing rather than accepting its boundaries uncritically. I argue that experts, in order to provoke parents to care, ought to create space for ethical questions on how the Information and Communication Technology we once managed has come to manage us. (shrink)

One might think that parental obligation to children ends with the end of childhood. I argue that if we consider why parents are obligated to their children, we will see that this view is false. Creating children exposes them to life’s risks. When we expose others to risks, we are often obligated to minimize damages and compensate for harms. Life’s risks last a lifetime, therefore parental obligation to one’s children does too. Grown children’s autonomy, and grown children’s independent responsibility (...) for some of their own problems, can sometimes limit what parental responsibility demands of parents but it doesn’t do away with the responsibility. I argue that my conclusions are not as counterintuitive as they might initially seem. I also consider the implications that parental obligation to grown children might have on the oft assumed obligation that grown children have to care for their parents. (shrink)

This paper discusses the use of deep brain stimulation for the treatment of neurological and psychiatric disorders in children. At present, deep brain stimulation is used to treat movement disorders in children and a few cases of deep brain stimulation for psychiatric disorders in adolescents have been reported. Ethical guidelines on the use of deep brain stimulation in children are therefore urgently needed. This paper focuses on the decision-making process, and provides an ethical framework for (future) treatment decisions in pediatric (...) deep brain stimulation. I defend a shared decision-making model in case of deep brain stimulation for neurological and psychiatric disorders in children. To protect the vulnerable child patient, a dual consent process is needed where parents or parental guardians give their consent, and the child gives his/her assent. (shrink)

The article presents a theory of the basis and nature of parents’ rights that appeals to the goods distinctively produced by intimate-but-authoritative relationships between adults and the children they parent. It explores the implications of that theory for questions about parents’ rights to raise their children as members of a religion, with particular attention to the issue of religious schooling. Even if not obstructing the development of their children’s capacity for autonomy, parents exceed the bounds of their (...) legitimate authority in so far as they aim deliberately to influence their children’s religious views. Healthy familial relationships involve some identification of child with parent and require a sphere of spontaneous interaction between parent and child that are in any case likely to influence those views and constitute a standing threat to autonomy. Correcting over-deferential understandings of parents’ rights enables schools better to promote not only children’s autonomy but also other legitimate civic goals. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

That our ecological future appears grave can no longer come as any surprise. And yet we have so far failed, collectively and individually, to begin the kind of action necessary to shift our path away from catastrophic climate collapse. -/- In this stark and startling little book, Rupert Read helps us to understand the direness of our predicament while showing us a metaphor and a method — a way of thinking — by which we might transform it. From the relatively (...) uncontroversial starting point that we love our own children, we are introduced to a logic of care that iterates far into the future: in caring for our own children, we are committed to caring for the whole of human future; in caring for the whole of human future, we are committed to caring for the future of the natural world. Out of such thinking, hope emerges. -/- As Read demonstrates in this urgent call to action, accepting that we care for our own offspring commits us to a struggle on behalf of us all. (shrink)

Philosophers and psychologists generally hold that, in light of the empirical data, a subject lacks infallible access to her own mental states. However, while subjects certainly are fallible in some ways, I show that the data fails to discredit that a subject has infallible access to her own occurrent thoughts and judgments. This is argued, first, by revisiting the empirical studies, and carefully scrutinizing what is shown exactly. Second, I argue that if the data were interpreted to rule out all (...) such infallibility, the relevant psychological studies would be self-effacing. For they adopt a methodology where a subject is simply presumed to know her own second-order thoughts and judgments--as if she were infallible about them. After all, what she expresses as her second-order judgment is trusted as accurate without independent evidence — even though such judgments often misrepresent the subject’s first-order states. The upshot is that such studies do not discredit all infallibility hypotheses regarding self-attributions of occurrent states. (shrink)

People are using innovative internet of things technologies to gain individualised management of their type 1 diabetes. The #WeAreNotWaiting movement supports them to build their own hybrid closed loop systems and access their real time blood sugar data via any web connected device. A small number of parents in Australia use such DIY looping systems to manage their child’s type 1 diabetes, but these systems have not been approved by the Therapeutic Goods Administration in Australia, creating ethical dilemmas for (...) clinicians about how to respond to the use of medical devices that are not registered on the Australian Register of Therapeutic Goods. This article considers whether the use of DIY looping is in the best interests of the child and, if not, whether intervention in parental decision making is justified to prevent harm to the child. It addresses the ongoing duty of healthcare professionals to provide care to children who are ‘looping.’ Reference is made to findings from a study, Personalised Closed Loop Systems for Childhood Diabetes, to illustrate stakeholders’ perceptions of benefits and harms of DIY looping systems. I conclude that the decision of parents to use DIY looping technology could be considered to be in a child’s best interests, broadly defined, and falls within the Zone of Parental Discretion, however healthcare practitioners who support parents may have professional concerns in doing so. (shrink)

Palliative care is provided at a certain timepoint, both in a person's life and in a societal context. What is considered to be a good death can therefore vary over time depending on prevailing social values and norms, and the person's own view and interpretation of life. This means that there are many interpretations of what a good death can actually mean for an individual. On a more general level, research in palliative care shows that individuals have basic common needs, (...) for example physical, mental, social and spiritual well‐being. Therefore, in today's pluralistic Western society, it becomes important that palliative care is person centred to enable individuals to receive, as far as can be achieved, care that promotes as good a life as possible based on the person's own needs and preferences, and in accordance with evidence and current laws. For many years a research group, consisting nurse researchers together with nurses working in palliative care, has developed a model for person‐centred palliative care, the 6S‐model. The model's central concept is Self‐image, where the starting point is the patient as a person and their own experience of the situation. The other concepts: Self‐determination, Symptom relief, Social relationships, Synthesis and Strategies are all related to the patient's self‐image, and often to each other. The model's development, value base and starting assumptions are reported here, as are examples of how the model is applied in palliative care in Sweden. The model has been, and still is, constantly evolving in a collaboration between researchers and clinically active nurses, and in recent years also with patients and close relatives. (shrink)

Children’s early science interest begins well before middle school, and parents can be important in generating and sustaining such interest. This qualitative study addresses how parental occupations shape physical scientists’ early science interest. Our framework uses Social Cognitive Career Theory, and our research question is, “How do parental occupations create learning opportunities for children and motivate them to pursue physical science?” We examine interviews from 17 physical scientists in Project Crossover, a sequential mixed-methods study that broadly examines factors influencing (...) entry into physics and chemistry doctoral programs. Parental occupations can create learning opportunities through role modeling, encouragement, exposure, familiarity, and bonding. Thus, parents can be valuable in creating learning opportunities for children outside classrooms. Study limitations include a small sample and lack of information about familial structure. Our research contributes to the emergent understanding of the role of parental occupations in science interest, which further influences individual career trajectories. (shrink)

Based on extensive questionnaire data, this paper focuses on parents’ views about children’s right to decide about participation in research. The data originates from 4000 families participating in a longitudinal prospective screening as 1997. Although current regulations and recommendations underline that children should have influence over their participation, many parents in this study disagree. Most (66%) were positive providing information to the child about relevant aspects of the study. However, responding parents were split about whether or not (...) children should at some point be allowed decisional authority when participating in research: 41.6% of the parents reported being against or unsure. Those who responded positively believed that children should be allowed to decide about blood-sampling procedures (70%), but to a less extent about participation (48.5%), analyses of samples (19.7%) and biological bank storage (15.4%). That as many as possible should remain in the study, and that children do not have the competence to understand the consequences for research was strongly stressed by respondents who do not think children should have a right to decide. When asked what interests they consider most important in paediatric research, child autonomy and decision-making was ranked lowest. We discuss the implications of these findings. (shrink)

Lower respiratory tract infections are a leading cause of paediatric morbidity and mortality worldwide. Children in low-income countries are disproportionately affected. This is in large part due to limitations in healthcare resources and medical technologies. Mechanical ventilation can be a life-saving therapy for many children with acute respiratory failure. The scarcity of functioning ventilators in low-income countries results in countless preventable deaths. Some hospitals have attempted to adapt to this scarcity by using hand-bag ventilation, as either a bridge to a (...) mechanical ventilator, or until clinical improvement occurs rendering mechanical ventilation no longer necessary. In instances of hand-bag ventilation, an endotracheal tube is first placed. Family members are then asked to play the role of a ventilator, manually compressing a bag repeatedly to inflate the child’s lungs. This approach is fraught with numerous ethical challenges. A careful examination of the data and a nuanced approach to the ethical considerations are imperative. Ethical arguments in support of and in opposition to allowing parental hand-bag ventilation are explored, including the best interests of the child, the child’s right to an open future, beneficence and parental protection, legitimising substandard care, and finally, contextual concerns. An algorithmic, potentially ethically permissible approach to parental participation in manual ventilation is proposed. (shrink)

This paper aims to critically evaluate some impacts of the so-called “posthumanist turn” for philosophy of technology, with special reference to the problem of ontological status of artifacts. In the first place, we reconstruct the meaning and scope of posthumanist turn in social and human sciences, while we indicate in what sense this turn questions a group of traditional operative concepts for philosophy. Second, we propose to admit a “weak” version of posthumanism for philosophy of technology. In this sense, two (...) lines of research compatible to this “weak” approach are pointed out. The first one consists in the exploration of immanent aspects of technical objects. The second one commits us to introduce the category of “hybridization” in order to account for the complex and multidimensional relationships between humans and environments. (shrink)