scholarly journals Decision-Making in Neonatology: An Ethical Analysis from the Catholic Perspective

Author(s):  
Peter A.
2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Bayefsky ◽  
V Dorice ◽  
A Caplan ◽  
G Quinn

Abstract Study question Periodically, parents and children disagree about whether to pursue fertility preservation (FP). How should medical teams navigate these ethically complex situations? Summary answer Several considerations must be weighed, including the minor’s age, the burden of the proposed procedure, and whether the minor or parent seeks to decline FP. What is known already As reproductive technology advances, FP prior to gonadotoxic therapy has become the standard of care. Periodically, parents and children disagree about whether to pursue FP. To date, there is no clear guidance on how to navigate these difficult situations. Prior studies have demonstrated that adolescents undergoing gonadotoxic therapy want their views regarding FP to be taken into account, and also that most children and adolescents are comfortable with parental involvement in decision-making. However, transgender adolescents pursue FP at lower rates than adolescents with cancer, and more research is required to elucidate the unique needs and barriers of transgender youth. Study design, size, duration This study involves a scoping review and ethical analysis about parent-child disagreement regarding FP in minors. The review analyzes papers that either demonstrate that parent-child disagreement occurs, describe the preferences of parents or children regarding decision-making around FP, or provide recommendations that can be used to resolve parent-child conflicts. The ethical analysis weighs relevant rights and interests, including the child’s best interest, the right to an open future, the child’s autonomy, and parental autonomy. Participants/materials, setting, methods A search string was developed to identify all relevant published manuscripts on the topic of FP in minors, including studies on decision-making, family relations and ethical challenges. The search was run through several databases, abstracts were screened using Covidence, and data were extracted from full texts. Data abstracted from the review and existing literature on general medical decision-making for minors were used to construct an ethical framework for parent-child disagreements regarding FP in minors. Main results and the role of chance Published work directly on the topic of parent-child disputes regarding FP is limited, however a number of studies tangentially discuss parent-child disagreements and provide insight into the desires of parents and children regarding decision-making around FP. Studies suggest that adolescents desire to have their views taken into account, and a minority of adolescents believe their wishes alone should be followed. The age of the minor is a crucial factor, and some propose that as adolescents approach adulthood, their autonomy should increase. At the same time, in practice, legal and financial constraints often render parents the ultimate decision-makers. Our ethical analysis weighs competing considerations, including the child’s best interest, the right to an open future, the child’s autonomy, and parental autonomy. It concludes that who prevails should depend on contextual factors, including the minor’s age, the burden of the proposed procedure, and whether the minor or parent seeks to decline FP. There may also be special considerations for transgender adolescents, some of whom might have deeply personal reasons for pursuing or forgoing FP that are not well-understood by cisgender parents. Limitations, reasons for caution The scoping review captured a variety of results, including survey and interview studies, society guidelines, and ethical analyses. As such, we were unable to define a uniform quality metric. However, we aimed to be more rather than less inclusive because of the limited results directly pertaining to parent-child disagreements. Wider implications of the findings: This study provides a robust review of decision-making for FP in minors and offers an ethical framework for weighing countervailing considerations when parents and children disagree about whether to pursue FP. The conclusions can be used to inform guidance for clinicians presented with this challenging ethical dilemma. Trial registration number N/A


Author(s):  
Carolyn Roper ◽  
Cynthia Roberts

The need for ethical leadership continues to become increasingly important as the environment grows more interconnected and complex. Educators are being called upon to assist in the development of ethical leaders; however, ethical decision-making, because of its complex nature, is not something that can be taught in a simple, straight forward fashion. This chapter provides an overview of a variety of strategies regarding when, what, and how to teach ethics and presents an instructional module in ethical decision-making, grounded in scholarly literature. The module can be used to provide depth and richness for undergraduate and graduate university students by creating an opportunity for them to ponder ethical situations, mull over and debate alternatives based on philosophical lenses, and arrive at decisions, which are probably not identical, but personally defensible. The educational unit focuses on developing awareness of one’s own ethical stance as well as teaching the utility of a system for ethical analysis which allows for contextual difference, nuance and complexity rather than imposing one set of moral standards. In addition, several keys to effective ethics instruction are suggested.


2021 ◽  
Vol 9 ◽  
Author(s):  
Pierfrancesco Biasetti ◽  
Barbara de Mori

Decision making-process in conservation can be very complex, having to deal with various value dimensions and potential conflicts. In fact, conflicts and competing interests between stakeholders are among the most quoted reasons for failure of projects. Ethical analysis can be helpful in this regard. In this paper we present a revision of the Ethical Matrix specifically tailored to decision-making processes in conservation. The Ethical Matrix is a conceptual tool devised to help decision-makers by supplying them with a framework of the ethically relevant aspects involved in decision-making process. It was originally developed for the ethical assessment of agri-food biotechnologies and later has been applied to other fields. The revised version we propose here has been designed for the ethical analysis of conservation priority-setting and impact. As conservation can raise many ethical relevant controversies, conceptual tools like the one presented here can be of help for conservationists, providing a map of the value demands involved. This map can be used to question the reasonableness of the value judgments, estimate the impact of different courses of actions, anticipate conflicts, and rank their severeness.


2011 ◽  
Vol 38 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Nitzan Rimon-Zarfaty ◽  
Alan Jotkowitz

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