Parental Responsibility and the Duty to Consult - the public's view

This article considers the imposition, by the courts, of a parental duty to consult on matters of importance in a child’s life. The results of a survey of 2,300 respondents, who were asked to respond to a number of scenarios, are analysed and discussed. The survey provides some interesting reflections on the views of the general public as to who should be ‘in control’ over decision making for children.

The Tragedy of Darfur and the Limits of the Responsibility to Protect

The view that states which claim sovereign status must comply with the responsibility to protect their own citizens is gaining ground in international politics. When a state is unable or unwilling to meet this responsibility, the international community is justified in intervening militarily to end widespread human rights violations. This article argues that a diffuse responsibility to protect, as currently conceived, may have important negative consequences. By using the ongoing tragedy of Darfur as an example, the article argues that the responsibility to protect is reactive and focused on the short term, contributes to the outbreak of violence and perversely provides repressed groups with a further incentive to continue their armed struggle after war breaks out. The tragedy of Darfur shows that effective protection requires case-specific policies aimed at prevention, democratization and economic and political development.

The politics of ethical foreign policy::A responsibility to protect whom?

Ethical foreign policy persists as a problem of international relations, especially regarding humanitarian intervention. However, despite apparent international upheavals, the debate about the ethics of humanitarian intervention has remained fundamentally unchanged. To escape the limits of this debate, this article deconstructs British claims to ethical foreign policy since 1997, reading these claims against themselves and against contemporary humanitarian intervention literature. It finds that Britain’s ethical framework, the ‘doctrine of international community’, which justifies interventions in Kosovo, Sierra Leone and Afghanistan, is undone by the anomalous, yet exemplary, invasion of Iraq. This demonstrates the politics of ethical foreign policy: first, that any intervention, no matter how ‘ethical’ or ‘right’, produces suffering and death; and, second, that we cannot know for sure whether we are doing the right thing by intervening. Embracing, rather than effacing, the political nature of ethical foreign policy opens up a more intellectually honest and positive potential future for relating to the foreign in a responsible manner.

A cognitive Approach to Moral Responsibility: the case of a failed attempt to kill

Many theoretical claims about the folk concept of moral responsibility coming from the current literature are indeterminate because researchers do not clearly specify the folk concept of moral responsibility in question. The article pursues a cognitive approach to folk concepts that pays special attention to this indeterminacy problem. After addressing the problem, the article provides evidence on folk attributions of moral responsibility in the case a failed attempt to kill that goes against a specific claim coming from the current literature—that the dimension of causation is part of the structure of the folk concept of moral responsibility.

Decisional responsibility for mechanical ventilation and weaning: an international survey

Introduction: Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.

Methods: A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.

Results: Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0)). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.

Conclusions: Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.