Contents Preface s3 - - Executive summary s4 - - Introduction s6 - - Background considerations s6 Definitions s6 The extent of withholding and withdrawal of LST in paediatric practice s6 The legal ...framework s7 Statutes s7 The child and young adult s8 Parental Responsibility s8 The role of the courts in end-of-life decision making s9 Best interests s9 Quality of life and legal decisions s9 Withdrawing treatment s9 The ethical framework s10 Fundamental considerations s10 The interests of the child s10 Parental discretion responsibilities, rights, duties and power s10 Parental interests, wishes and professional duties s11 Involving children s11 Children with disabilities s11 Transition to adult services s12 Axioms on which to base best practice s12 - - The process of decision making s13 Practical considerations; substantial issues in decision making s13 To withhold, to withdraw or to limit? s13 Dealing with uncertainty s13 Situations in which it is appropriate to limit treatment s13 Spectrum of decisions and parental discretion s14 - - Practical aspects of end-of-life care: responsibilities, treatments that may be limited, appropriate or permissible actions s15 Clinical responsibilities of the healthcare team s15 The range of treatments that may be withdrawn s15 Cardiopulmonary resuscitation s15 Clinically assisted nutrition and hydration s16 Muscle relaxants and end-of-life care s16 Palliative care s16 Organ donation s17 - - Practical aspects of decision making s17 The basis of decision making by teams s17 Obtaining second opinions s17 Resource considerations s18 Communication as part of decision making s18 Resolution of different opinions s19 Medical input s19 - - Bereavement s20 Families s20 The healthcare team s20 Key goals in the provision of bereavement support s20 - - Future practicalities s21 Training s21 Resources s21 Research/audit s21 Clinical ethics services s21 - - References s21 - - Appendix 1: Suggested bereavement resources s23 Preface The first edition of the Royal College of Paediatrics and Child Health (RCPCH) document 'Withholding or Withdrawing Life Saving Treatment in Children: A Framework for Practice' was published in 1997 and was one of the first documents produced by the newly-formed College.
The 1990s saw a systemic shift from the liberal post–World War II international order of liberal multilateralism (LIO I) to a post–Cold War international order of postnational liberalism (LIO II). ...LIO II has not been only rule-based but has openly pursued a liberal social purpose with a significant amount of authority beyond the nation-state. While postnational liberal institutions helped increase overall well-being globally, they were criticized for using double standards and institutionalizing state inequality. We argue that these institutional features of the postnational LIO II led to legitimation problems, which explain both the current wave of contestations and the strategies chosen by different contestants. We develop our argument first by mapping the growing liberal intrusiveness of international institutions. Second, we demonstrate the increased level and variety of contestations in international security and international refugee law. We show that increased liberal intrusiveness has led to a variety of contestation strategies, the choice of which is affected by the preference of a contestant regarding postnational liberalism and its power within the contested institution.
Estimates of the under-five mortality rate (U5MR) are used to track progress in reducing child mortality and to evaluate countries' performance related to Millennium Development Goal 4. However, for ...the great majority of developing countries without well-functioning vital registration systems, estimating the U5MR is challenging due to limited data availability and data quality issues. We describe a Bayesian penalized B-spline regression model for assessing levels and trends in the U5MR for all countries in the world, whereby biases in data series are estimated through the inclusion of a multilevel model to improve upon the limitations of current methods. B-spline smoothing parameters are also estimated through a multilevel model. Improved spline extrapolations are obtained through logarithmic pooling of the posterior predictive distribution of country-specific changes in spline coefficients with observed changes on the global level. The proposed model is able to flexibly capture changes in U5MR over time, gives point estimates and credible intervals reflecting potential biases in data series and performs reasonably well in out-of-sample validation exercises. It has been accepted by the United Nations Inter-agency Group for Child Mortality Estimation to generate estimates for all member countries.
The Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) has become influential in biodiversity conservation. Its research is published widely and has been adopted ...by the United Nations and the Convention for Biological Diversity. This platform includes discussion about how values relate to biodiversity conservation. The IPBES emphasizes “relational values”, connecting these with living a “good life,” and “nature's contributions to people” (NCP); building upon ecosystem services (ES), which have dominated nature valuation for 15+ years. Although the IPBES acknowledges instrumental and intrinsic natural values, they purport that by adopting relational values, conservation will become more socially- and culturally- inclusive, moving beyond the “unhelpful dichotomy” between instrumental and intrinsic values. We wholeheartedly agree that conservation should become more inclusive – it should, in fact, morally include nonhuman nature. We argue that far from being half of an unhelpful dichotomy, intrinsic natural values are incontrovertible elements of any honest effort to sustain Earth's biodiversity. We find NCP to be mainly anthropocentric, and relational values to be largely instrumental. The “good life” they support is a good life for humans, and not for nonhuman beings or collectives. While passingly acknowledging intrinsic natural values, the current IPBES platform gives little attention to these, and to corresponding ecocentric worldviews. In this paper we demonstrate the important practical implications of operationalizing intrinsic values for conservation, such as ecological justice, i.e., “peoples' obligations to nature”. We urge the IPBES platform, in their future values work, to become much more inclusive of intrinsic values and ecocentrism.
The war in Yemen has remained the world's worst humanitarian crisis since 2015, and yet it is shockingly invisible. The global legal system fails to offer a clear avenue through which the Yemeni ...people can hold the state actors responsible for their harm accountable. This Note analyzes international legal mechanisms for vindicating war crimes and human rights abuses perpetrated in Yemen. Through the lens of Yemen's humanitarian crisis, it highlights gaps in the global legal structure, proposes alternative accountability processes, and uses a variety of sources-including interviews with practitioners and Arabic language legal scholarship - to explicate a victim-centered transitional justice process for the Yemeni people.
Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact ...on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of “medical geology” assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs.
Display omitted
•Medical geology is of increasing significance and a global challenge.•Human impacts of geogenic contaminants (GCs) are underestimated or not recognized.•Not including toxic GCs in standard water analyses exposed millions of people.•Economic and population growth accelerate GCs release and human exposure.•The potential role of GCs in diseases with unknown etiology must be considered.
This second volume from the United Nations Intellectual History Project surveys the history of the UN's regional commissions and the ideas they have developed over the last 40 years. Each essay is ...devoted to one of the five regional commissions -- Europe, Asia and the Far East, Latin America, Africa, and Western Asia -- and how it has approached its mission of assessing the condition of regional economies and making prognoses about future conditions. The essays describe how each commission has added local perspectives to global debates over economic development and brought an authentic regional voice to the UN. Contributors are Adebayo Adedeji, Yves Berthelot, Leelananda de Silva, Blandine Destremau, Paul Rayment, and Gert Rosenthal.
Building, or re-building, states after war or crisis is a contentious process. But why? Sabaratnam argues that to best answer the question, we need to engage with the people who are supposedly ...benefiting from international ‘expertise’.
This book challenges and enhances standard ‘critical’ narratives of statebuilding by exploring the historical experiences and interpretive frameworks of the people targeted by intervention. Drawing on face-to-face interviews, archival research, policy reviews and in-country participant-observations carried out over several years, the author challenges assumptions underpinning external interventions, such as the incapacity of ‘local’ agents to govern and the necessity of ‘liberal’ values in demanding better governance. The analysis focuses on Mozambique, long hailed as one of international donors’ great success stories, but whose peaceful, prosperous, democratic future now hangs in the balance. The conclusions underscore the significance of thinking with rather than for the targets of state-building assistance, and appreciating the historical and material conditions which underpin these reform efforts.
The article is based on investigations by two branches of the United Nations Human Rights Council into the treatment of the whistleblower journalist, Julian Assange – the UN Working Group on ...Arbitrary Detention and The UN Special Rapporteur on Torture. The UN investigations analysed for this ‘Acting Up’ article show that Julian Assange is an inconvenient dissident, who has been subjected to persecution by liberal democracies rather than authoritarian regimes. Previous research into whistleblowing has highlighted the courage and risks taken by individual whistleblowers in speaking truth to power however, this case highlights a different facet of speaking truth to power which shows how lawyers, activists and other professionals often refuse to do this because of the professional costs of speaking up for an apparently toxic individual. This article argues that the UN investigations have built a ‘counter-archive’ of suppressed facts about the case, which challenges the ‘collective amnesia’ of the public discourse. This case demonstrates that speaking truth to power requires not only individual courage but the active support of inconvenient dissidents, who lack other civil society support.
PDF
