Whither Authenticity?

The discipline of Bioethics, being the amalgam that it is, features myriad concepts, theories, and approaches. Singh adds another dimension to the field, with her sensitive and penetrating investigation into parents' perceptions of Ritalin use. One concept Singh uses in her analysis is that of authenticity. She applies Abbey's earlier conception of an ethics of authenticity to describe it as the “self's sense of its own uniqueness and individuality, and the desire to be true to this self” (Singh 2005). Those who lack the capacity to “lead a life of one's own” (Taylor 1991, 17) are unable to find and create their own authentic selves. Over time, this could lead to feelings of disorientation and disturbance, displacement and alienation (Vadas 1989). Applications of authenticity have become increasingly prevalent in bioethics and are utilised by both deontologists and utilitarians. The concept has been utilized in, for example, discussions of the doctor–patient relationship (Arnason 1994), treatment of persons with dementia (Holm 2001), advance directives (Vollman 2001), and enhancement technologies (Newson, forthcoming). Some of the allure of this kind of concept in bioethics is that it provides academics with a tool for a more nuanced assessment of the issue at hand, albeit with the caveat that it does tend to fall in and out of favour (Welie 1994). More specifically, employing an analysis of authenticity allows one to step back from more traditional, individualistic approaches of liberal bioethics to find new questions that require answering and which can influence debates on what we should do (Welie 1994). Singh, however, has shown that authenticity is a flexible and “inherently relational” concept, inconsistently applied by parents whose definition of authenticity shifts with what is valued in a particular context

Clinical Ethics Support in Contemporary Health Care

This chapter concerns current initiatives to create and maintain specialized services to help respond to ethical issues that arise in the practice of health care. These initiatives, the obstacles they face, and the controversies they engender should be of considerable interest to those concerned with the management of health care organizations. This is because ethics is and should be intrinsic to routine health care practice. Also, no less, it is because ethical disputes and controversies, even if they seldom occur, can severely disrupt the complex organizations that deliver health care in modern societies. Clinical ethics support services (CES services) are comprised of an individual or group, usually in an organization, who can provide a suite of services to support all stakeholders in identifying and managing the ethical issues that inevitably arise in the design and delivery of health care. While there is a degree of consensus about the potential value of such services, they are also the focus of ongoing theoretical, methodological and political debates. This chapter does not aim to resolve these debates. Rather, our aim is to provide health care managers with an account of how and why CES services are becoming a part of the contemporary organizational landscape of health care, and describe the concerns that bioethicists and observers and critics of bioethics have raised regarding their role, function, and dissemination. We first describe the origins of CES services, to provide a context for the following discussion about the goals, functions and models of support that exist across this discipline—drawing on some relevant examples. We then describe how CES services can be evaluated. Third, we discuss initiatives that aim to optimise quality of CES services and some of the criticisms and suspicions that these initiatives have engendered. Finally, we offer some reflections on the direction that CES services may take in the future

Enrolling Children in Clinical Trials for Genetic Neurodevelopmental Conditions: Ethics, Parental Decisions, and Children's Identities.

Knowledge of genetic mechanisms contributing to neurodevelopmental conditions is advancing. This is informing development of new drugs to treat or ameliorate these conditions, through targeting underlying genetic pathways. Drugs are tested in clinical trials, necessitating parents to engage with decisions about whether to enroll their child. In this article, we consider important ethical issues to anticipate as clinical research opportunities in genetic neurodevelopmental conditions arise. For example, genetic pathways targeted by the drugs may interact with valued character and personality traits. It is essential that recruitment and consent processes are optimized for families who will grapple with whether these novel drug treatments interact with their child's personality and authentic identity. We call for focused social science research and further normative analysis so that parents are better supported to make informed choices. Additionally, clinical research regulators should have a sound understanding of the contextual experiences regarding how this population of parents engages with decisions

Exploring gender differences within forest schools as a physical activity intervention

This study investigated whether children engaged in more physical activity (PA) on school days that included Forest School (FS) sessions than a regular school day or a school day with a Physical Education (PE) lesson. How FS sessions influenced children’s general levels of PA and wellbeing was also explored across gender. A mixed-methods study followed a sample of 59 child participants aged 7 to 9 years old, from four primary schools, whilst taking part in twelve weekly FS sessions. Measures included the PA Questionnaire for Older Children and accelerometry data together with an individual Write and Draw task to inform focus groups. Children had significantly greater levels of light PA on a FS day and a PE school day compared to a regular school day and children reported feeling both happier and relaxed as a consequence of the intervention. From the qualitative data, boys and girls reported different likes of the FS interventions, whereas their dislikes of FS were comparable. Findings from this research provide evidence for such outdoor, nature-based learning within the school curriculum contributing to daily PA in children

Licensed control does not reduce local Cormorant Phalacrocorax carbo population size in winter

Cormorants Phalacrocorax carbo have increased on European freshwaters, creating conflicts with fishing interests. As a result, control measures have been implemented in several countries, although their effect on the English population has yet to be determined. Wetland Bird Survey data was used to derive population growth rates (PGR) of non-coastal Cormorant populations in England. PGR was analysed in relation to control intensity at different scales (5- to 30-km radius) from 2001 to 2009 in order to determine (1) the extent to which control intensity (proportion of the local population shot per winter) was associated with site-level population change, and (2) whether potential effects of control intensity were evident on Special Protection Areas (SPAs). There were no clear differences in PGR when comparing sites which had experienced control versus sites where control had never been carried out. The few significant relationships between control intensity and Cormorant PGR detected were mostly positive, i.e. population growth was associated with higher control intensity. Control intensity was not related to Cormorant numbers in SPAs. Positive associations with control may arise because control is reactive, or because non-lethal effects cause greater dispersal of Cormorants. These results provide no evidence that Cormorant removal at local scales is having an effect on longer term (i.e. year-to-year) population size at a site level. They also suggest that control measures have not affected national population trends, although a better understanding of site use and movements of individual Cormorants needs to be developed at smaller scales (including those due to disturbance caused by control measures) to more fully understand processes at larger scales. Further research is also needed into the extent to which lethal and non-lethal effects of control on Cormorants are having the desired impact on predation rates of fish, and so help resolve the conflict between Cormorants and fisheries.</p

Roads as a contributor to landscape-scale variation in bird communities.

Roads and their traffic can affect wildlife over large areas and, in regions with dense road networks, may influence a high proportion of the ecological landscape. We assess the abundance of 75 bird species in relation to roads across Great Britain. Of these, 77% vary significantly in abundance with increasing road exposure, just over half negatively so. The effect distances of these negative associations average 700 m from a road, covering over 70% of Great Britain and over 40% of the total area of terrestrial protected sites. Species with smaller national populations generally have lower relative abundance with increasing road exposure, whereas the opposite is true for more common species. Smaller-bodied and migratory species are also more negatively associated with road exposure. By creating environmental conditions that benefit generally common species at the expense of others, road networks may echo other anthropogenic disturbances in bringing about large-scale simplification of avian communities

Clinical ethics consultation in Europe: A comparative and ethical review of the role of patients

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014