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Childhood Ethics: An ontological advancement for childhood studies
Children & Society
Abstract
We describe an ontological approach to childhood studies that we refer to as Childhood Ethics. This involves an interdisciplinary hermeneutic orientation towards examining the morally meaningful dimensions of matters that affect young people. We draw on our empirical research with young people from 3‐ to 17‐years old, examining their experiences in a diversity of contexts and geographical settings. Our investigations challenge dominant binary conceptions of young people along lines of decisional in/capacity and im/maturity. We argue for a view of children as active agents with meaningful relational engagements and participation interests and capacities and outline corresponding implications for research and practice.
... The status quo across research, policy, and practice realms is a systemic exclusion of young people 1 in domains that directly and indirectly impact their lives. This exclusion is rooted in a dominant conception of young people as incapable and immature (Carnevale et al., 2021). This conception has been sharply contested by several decades of research in childhood studies which has advanced the recognition of young people as active moral agents with meaningful interests, aspirations, and concerns about matters that affect them and others. ...
... As such, it means also risking producing research, policy, and practice that is misaligned with their needs, realities, and priorities. Minimally, resultant outputs and outcomes will be ineffective; maximally, they will be harmful (Carnevale et al., 2021;Montreuil et al., 2020). ...
... Le statu quo dans le monde de la recherche, des politiques et de la pratique est l'exclusion systématique des jeunes des domaines qui touchent directement et indirectement leurs vies. Cette exclusion est ancrée dans la conception dominante selon laquelle les jeunes sont incapables et immatures (Carnevale et al., 2021). Cette conception est vivement contestée par la recherche en études de l'enfance, qui contribue depuis plusieurs dizaines d'années à faire reconnaître que les jeunes sont dotés d'autonomie morale et qu'ils ont des intérêts, des aspirations et des motifs de préoccupation sérieux à l'égard des questions qui les touchent ou qui en touchent d'autres. ...
... Childhood ethics calls for shifts that build on advances in the field of childhood studies [17,18]. Specifically, these shifts include changing the ways we understand: childhood, social/human sciences research, ethics research and practice, and interdisciplinary collaboration [17,19]. Young people are viewed as agents with rights, capabilities, meaningful aspirations, moral concerns and voices to contribute to discussions and decisions that affect them [17], contesting dominant "developmental" conceptions of children as "immature" or "incapable". ...
... There is much debate around what a young person's best interests are or how best interests ought to be defined. In this analysis, 'best interests' is imagined in terms of: a non-universal definition of best interests for young people, attuned to the particular social contexts young persons are situated within, and a recognition of young people's voices and agency as crucial sources for informing the discernment of their best interests [19]. ...
... As we re-envision the duty to provide care ethical value with a young person-lens, it is vital to specify what "good care" is within a pandemic when related to young people, where the concepts of best interests, agency, and capacity-as advanced within childhood ethics [19] and childhood studies [44]-are central. The value of young people as full human beings is paramount, along with the inherent relationality associated with childhood that requires public health agencies and policymakers to attend to the interests of parents/caregivers too, even when the focus is on the young person. ...
Background
Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics—one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people’s perspectives, informed by advances in childhood ethics and children’s rights.
Main body
In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted—aligned with the approach used by Thompson and colleagues—to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.
Conclusion
Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts.
... The ability of children to be involved in shared decision making through being listened to, included, protected, and treated as a competent active social agent differs across clinical settings (Carnevale et al., 2021;Foster et al., 2018). Listening to children's voices is vital to install trust, foster respect, autonomy, self-determination, and regard as well as honour social justice and equity (Green et al., 2018;Stålberg et al., 2016;United Nations General Assembly, 1989). ...
... The UNCRC declaration is enacted in clinical practice through models of care including Family Centred Care (FCC), Child Centred Care (CCC) or Child and Family Centred Care (CFCC). The models can facilitate the promotion of children's best interests and participation as active agents (Carnevale et al., 2021;Foster et al., 2013;Foster et al., 2016). The FCC approach views the family as the focus of care where collaboration, negotiation, partnership, and shared decision-making with healthcare professionals is undertaken through the family where the child assumes a passive role (Coyne et al., 2016;Coyne et al., 2018). ...
... Within a CCC or CFCC approach, the child is viewed as an active competent agent within their own right and care is planned around the child's self-reported perspective and preferences with the guidance of adults based on the child's competence and capacity within the context of family and community (Coyne et al., 2016;Foster & Shields, 2019). A child's ability, choice, and opportunity to participate in shared decision-making should be viewed as a constant evolving iterative process and be situated for that child's best interest as reported by that child (Carnevale et al., 2021;Coyne et al., 2016;Ford et al., 2018). The literature refers to child friendly hospitals and child healthcare professionals codesigning healthcare initiatives, interventions and research projects with children inclusive of using child self-report tools as a measure of CCC but there is only one published psychometrically validated child self-report tool available with most of the literature on children's self-reported healthcare experiences being qualitative designs or reported by adults as proxies (Dijkstra et al., 2006). ...
Purpose
To explore school-aged children's experiences about their best interests and participation in care during a hospital admission.
Design and methods
A descriptive qualitative design involving in-depth, iterative inductive review of child responses to generate key words that led to identification of categories and themes. The study was guided by the United Nations Convention on the Rights of the Child's definition of the best interests of the child, Bronfenbrenner's bioecological model and a child centred care approach.
Results
Nine school-aged children (5–15 years old) from one children's ward in Australia participated. Analysis yielded thirteen categories, six sub-themes, and three themes: 1) Relationships with parents were positive when they met their children's physical and emotional needs and advocated for them; 2) Relationships with staff were positive when staff created opportunities for children to have a say in their healthcare, and checked in on the children and 3) Seeking familiarity away from home was facilitated when the environment children found themselves in provided them their own space and various forms of entertainment.
Conclusion
School-aged children were able to verbalize what their best interests were and how participation in care could be facilitated in the hospital setting. The inter-relationships of the children with their parents, healthcare professionals, and the immediate environment reflected interactions both within, and between systems.
Research and practice implications
Children in hospital need to be provided with age-appropriate opportunities to participate in shared decision making to support their best interests. Studies that model and evaluate such opportunities are needed.
... To address these gaps, our interdisciplinary team developed an open-access online training module called Ethical Considerations for Children Undergoing Surgery (ChildSxEthics; Figure 1). The module contents were derived from the team's collective expertise in childhood ethics and healthcare (VOICE: Views on Interdisciplinary Childhood Ethics) and guided by the Childhood Ethics Framework, which recognizes children as active moral agents with interests and capacities for participating in decisions about their health (Carnevale, 2020;Carnevale et al., 2021). Montreuil and Carnevale (2016) define children's moral agency as "children's capacity to act deliberately, speak for oneself, and actively reflect on their social worlds, shaping their lives and the lives of others" (p. ...
... 510). The framework proposed by Carnevale et al. (2021) emphasizes that enabling children to exercise their agency and express their voices both verbally and non-verbally is crucial for supporting children's best interests. The training module aims to teach clinicians to authentically elicit, listen to, and interpret children's voice to help inform their understanding of a child's best interests. ...
Background: To challenge dominant conceptions of children and innovate nursing education, our team created an open-access training module (https://childsxethics.net/) addressing ethical considerations for children undergoing surgery. Objective: To evaluate the level of Bloom’s Taxonomy cognitive, affective, and psychomotor learning reached by graduate nursing students after completing the training module. Methods: A qualitative descriptive study was conducted using Bloom’s Taxonomy. Data sources comprised of participants’ course assignments. Results: Participants (n=19) wrote 19 online reflections, 43 peer responses and completed two group assignments. The module and associated class assignments promoted high levels of cognitive and affective learning. The type of assignment influenced participants’ levels of learning. Cognitive and affective learning processes were enhanced when integrating reflections and fostering interactions among learners. Implications: Study findings will inform future iterations of the training module. Our innovative educational resource will facilitate the recognition of children as active moral agents and improve their surgical experiences.
... Childhood ethics is an emerging field of inquiry that is striving to advance (a) empirical research on ethical concerns that affect young people, as well as (b) normative research aiming to develop ethical standards for clinical practice that can attend to these concerns [1]. VOICE (Views On Interdisciplinary Childhood Ethics) is an internationallyrecognised research programme in childhood ethics affiliated with the team that conducted the inquiry reported in this article [1][2]. ...
... Childhood ethics is an emerging field of inquiry that is striving to advance (a) empirical research on ethical concerns that affect young people, as well as (b) normative research aiming to develop ethical standards for clinical practice that can attend to these concerns [1]. VOICE (Views On Interdisciplinary Childhood Ethics) is an internationallyrecognised research programme in childhood ethics affiliated with the team that conducted the inquiry reported in this article [1][2]. ...
Background: Childhood cancer has been ranked the most common cause of death due to non-communicable disease among 5- to 14-year-old children in India. Ethical concerns have been identified in the care of children with cancer in India, yet there is a paucity of ethical standards for clinical practice to help address these concerns. For example, emerging research has demonstrated that many children are distressed when they are impeded from participating in discussions and decisions regarding their cancer care. Therefore, we sought to create an ethical framework to guide practice with this population. Methods: We developed this ethical framework by conducting (a) a normative analysis of relevant documents that articulate norms for healthcare providers working with children in India and (b) stakeholder consultations with childhood cancer survivors, parents, and clinicians. Results: The ethical framework is structured according to twelve key ethical principles and corresponding challenges or implications for clinical practice. We discuss how this ethical framework can help address three leading ethical concerns that we have identified within the care of children with cancer in India: (a) communication problems; (b) inadequate care of symptoms or promotion of comfort; and (c) injustices or inequities related to limited financial means or poverty. Conclusion: Ethical concerns that have been related to the care of children with cancer in India can be prevented or at least mitigated through the integration of this ethical framework in everyday clinical practice.
... Sur la base de nos travaux précédents qui démontraient (a) les trois volets de l'agentivité des jeunes (les aspirations moralement significatives, les préoccupations et les capacités) (Siedlikowski et al., 2022) et (b) comment leur agentivité est socialement imbriquée (c' est-à-dire comment le contexte social renforce ou entrave l' expression de l'agentivité) (Carnevale, 2020;Carnevale et al., 2021;Esser et al., 2016;Hausfather et al., 2023;Siedlikowski et al., 2022), cette étude démontre les façons précises, élaborées dans la section qui suit, dont les programmes de cirque social peuvent être bénéfiques au développement de la connaissance de soi des jeunes en tant qu'agents moraux. ...
... Ce sont des êtres sensibles dont l' expression et les expériences prennent racine dans le mouvement et les sensations corporelles. La dimension incarnée de l'agentivité humaine est couramment méconnue ou ignorée, ce qui est conséquent avec la dissociation cartésienne de l' esprit et du corps qui domine la pensée occidentale (Carnevale, 2020;Carnevale, 2021;Carnevale et al., 2021;Esser et al., 2016;Taylor, 1985). La perspective désincarnée valorise les échanges sociaux verbaux et « rationalistes » où les acteur·rices sociaux·les qui communiquent différemment ou qui sont plus confortables avec les modes de communication non verbaux -et qui peuvent être attiré·es par des façons plus « incarnées » d' entrer en relation avec leur monde (les jeunes par exemple) -sont systématiquement désavantagé·es et socialement exclu·es. ...
Le cirque social réfère aux programmes qui utilisent le cirque dans un contexte d’intervention sociale. Bien qu’ils leur soient destinés, peu de données existent sur l’impact qu’ils ont sur les jeunes. Nous nous penchons sur un événement de cirque social de quatre jours. Quatre thématiques caractérisent l’expérience des participant·es : (a) la création d’un espace social sécuritaire; (b) l’enrichissement de la compréhension de soi; (c) le renforcement des capacités expressives; et (d) l’expérimentation du monde qui nous entoure. Cette recherche démontre comment le cirque social peut créer des milieux sociaux sécuritaires et enrichissants, adaptés aux expériences des jeunes.
... Building on our previous work that demonstrated (a) the three-fold structure of young people's agency (i.e., morally meaningful aspirations, concerns, and capacities; Siedlikowski et al., 2022) and (b) how their agency is socially embedded (i.e., social contexts can bolster or impede agential expression; Carnevale, 2020;Carnevale et al., 2021;Esser et al., 2016;Hausfather et al., 2023;Siedlikowski et al., 2022), this study has demonstrated specific ways that social circus programs can be beneficial in supporting young peoples' development of their self-understanding as moral agents. We discussed these results in further detail in the sections that follow. ...
... They are sentient beings whose experiences and expressions are rooted in corporal sensations and movement. The embodied dimensions of human agency are commonly underrecognized or suppressed, which has been related to the dominant Cartesian dissociation of mind and body within Western outlooks (Carnevale, 2020;Carnevale, 2021;Carnevale et al., 2021;Esser et al., 2016;Taylor, 1985). Dominant disembodied outlooks value verbal and "rationalistic" social exchanges, where social actors who communicate differently or who are more comfortable with nonverbal communication modes-and who may be drawn to more "bodily" modes of engaging with their world (e.g., young people)-are systemically disadvantaged and socially excluded. ...
Social circus refers to programs that use circus arts to facilitate social intervention with people experiencing marginalization. Although some programs focus specifically on youth, little is known about how they are impacted by their participation. We examined the experiences of youth participating in a four-day social circus event. Four themes were identified that characterized participants’ experiences: (a) creating a safe social space; (b) enriching your self-understanding; (c) bolstering your expressive capacities; and (d) experiencing the world around you. This research highlights how social circus activities can create safe and enriching social spaces that are adapted to the experiences of youth.
... This presumption is valid for an adult-centred conception of moral agency. However, I argue for a recognition of children's moral agency, regardless of their level of cognitive development, especially in light of the ways in which child development models are sometimes used to discount the moral significance of children's voices (Carnevale, 2021;Carnevale et al., 2021;Greene and Hogan, 2005). ...
... This essentially refers to acts committed out of necessity or duress, wherein many would agree that the individual could not really have done otherwise under those particular circumstances.17 This is further related to professional practice with children in Carnevale(2020)andCarnevale et al. (2021).18 Assent should be distinguished from consent. ...
... 26 Given that the goal of protecting children's best interests is to achieve the best possible outcomes for them, 16,33,34 understanding the moral experiences of children with OI using art-making as a vehicle for communication may provide nurses, doctors, and other HCPs with much-needed insight regarding their lived experiences and the factors that challenge or support their moral agency, participation, and best interests. 35 Moral experience encompasses a person's "sense that values that [they] deem important are being realised or thwarted in everyday life", and includes their interpretations of lived encounters that "fall on spectrums of right-wrong, good-bad or just-unjust." 36 ...
... Although stage-based models are prevalent in most professions dealing with children, they have also been criticized for (a) being based on observations of white, middle-class males or boys, leading to inadequacies when they are generalized to other genders and/or backgrounds; (b) minimizing children's capacities by framing their differences from adults as signs of immaturity; and (c) perpetuating singular notions of what capacity, agency, and "normal" development looks like. 35,[56][57][58] Since OI is a chronic condition for which children are seen since birth, parents are typically considered the "most" responsible or capable in managing their child's health; in turn, parents may be viewed as the most relevant individuals to target in relation to OI knowledge. Yet, the creation of accessible education resources for children with information on treatment, coping strategies, communication, and shared decision-making with clinicians can enhance chronically-ill children's health knowledge, literacy, self-advocacy, and decision-making capacity, which are necessary skills to prepare them for inclusion in care and transition into adult care. ...
Background
Serious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.
Research aims
To explore children’s actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.
Research design
A focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured interviews, and practice-based research (art-making) with 10 children with OI; and local documents.
Participants and research context
The study was conducted at a pediatric, orthopedic hospital.
Ethical considerations
This study was approved by McGill University Institutional Review Board.
Findings/results
Children expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children’s voice and participation in health-related discussions.
Conclusions
Healthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children’s actual and desired participation in care and promote positive moral experiences.
... The following ethical analysis is intended to recognize the particular impacts of the COVID-19 pandemic on Indigenous children and youth within Canada. Based on our understandings of childhood ethics (Carnevale et al., 2020) and Indigenous worldviews, we have chosen to position Indigenous young peoples' experiences as integral to our articulation of a working framework for Indigenous childhood ethics. This working framework consists of three guiding Indigenous values and is intended as an initial step towards advancing our understanding of the ethical dimensions of the experiences of Indigenous young people. ...
... One Indigenous youth leader sees the new normal post-COVID as a time for connection to self, identity and revitalized priorities attuned to Indigenous youth outlooks. From a childhood ethics perspective, Indigenous children and youth should be actively consulted on matters affecting them, including pandemic response measures (Carnevale et al., 2020). Furthermore, the ongoing exclusion of young Indigenous peoples from pandemic-related discussions is ethically problematic as it directly infringes upon their right to have their views respected and their right to participate in all aspects of their lives (CRC Article 12-15) (National Collaborating Centre for Aboriginal Health, 2013). ...
In response to new and exacerbated challenges imposed by the COVID-19 pandemic, Indigenous children and youth in Canada have developed innovative and holistic solutions to amplify their voices, continue cultural engagement and combat social isolation for themselves and their communities as a whole. In this analysis, we have selected three Indigenous philosophical tenets as an ethical orientation for discussion of how the COVID-19 pandemic is impacting the well-being of Indigenous young people. The guiding values of interconnected relationships, holism and Indigenous-informed restorative justice help us interpret existing pandemic-specific literature and identify, define and prioritize considerations of child and youth well-being from an Indigenous-centred worldview. This analysis can (a) help inform future pandemic measures affecting Indigenous young people and (b) foster similar considerations for Indigenous communities in other regions of the world.
... It is unclear how much of this Western-dominated evidence is transferable to an Indian context, given how little is known about the latter. The term "capability" refers to children's abilities to: (a) understand information regarding their health care and how various treatment options would affect them, and (b) form preferences for treatment options that best align with their interests (Carnevale et al., 2020). ...
... In keeping with the foundational tenets of childhood ethics that oriented this research (Carnevale et al., 2020), and the paucity of data on children's own experiences in India and internationally, our research focus was centered on the moral experiences of children. Nonetheless, other important research concerns that warrant their own investigation include: understanding parents' moral experiences; the moral dimensions involved in parental striving to be a "good parent"; and the influences of dharma, karma, non-maleficence, and beneficence in parents' decisions regarding their child's care. ...
There is a paucity of research examining children’s experiences with cancer in India. Childhood ethics is an emerging field, focusing on the moral dimension of children’s experiences, to promote children’s participation in their health care. A focused ethnography, using a moral experience framework, was conducted to better understand children’s participation in decisions, discussions, and actions in three oncology settings in New Delhi, India. We interviewed key informants, retrieved key documents, and conducted semi-structured interviews and participant observations with children. All 22 children demonstrated interest in varying aspects of their cancer care. Certain factors facilitated or impeded their participation. Some children became distressed when they lacked information about their treatment or were not given opportunities to enhance their understanding. The results advance our understanding of the moral experiences of children with cancer in India for healthcare professionals, policy makers, families, and interested others.
... Whereas stage-based theories characterise children as immature and incapable, and development as 'normative' and universal, transactional models recognise development as a dynamic bidirectional interplay in which children, and their social contexts, mutually influence each other over time (Sameroff, 2009). By conceptualising children as active agents, and development as socially contextual and rooted in relationships, transactional models invite a more holistic examination of how bidirectional interactions contribute to similarities and variations in developmental trajectories (Carnevale et al., 2021). ...
Bereavement during childhood impacts children’s wellbeing and biopsychosocial development. Research examining impacts and outcomes of childhood bereavement and supportive interventions has highlighted a myriad of factors that influence children’s unique, complex experiences of grief, necessitating a personalized, child-centred approach. Children’s grief support is underpinned by well-established grief theories studied primarily in adult populations, and stage-based developmental theories that characterise child development as “normative” and universal. We propose a rethinking that recognises: development in childhood as transactional, dynamic, and bidirectional; children as active agents; and social contexts influencing grief and development. This conceptualisation invites expanded understandings of: children’s grief in response to death and non-death losses; contextual, relational influences on children’s experiences of grief; ways that grieving children’s rights and agency are supported and thwarted in their daily lives; and opportunities for professionals, family and community members to support grieving children with compassionate curiosity and cultural humility to nurture grief-literate communities.
... Institutional policies, designed to protect health, came at a cost to mental health according to clinicians and patients [59], and paternalism was privileged over ethical principles of reciprocity, self-determination and autonomy, as has been found in other studies prior to the pandemic [60]. Child psychiatry, has a responsibility and need to create spaces of reflection that can help clinicians, teams and institutions grapple with ethical tensions, especially considering children who are often viewed as deficient adults lacking capacity, and are thus apt to have their autonomy undervalued [61]. Concretely, while pediatric teams often consult biomedical ethicists [62], child psychiatry wards have less experience with developing interdisciplinary spaces to negotiate individual and institutional care practices. ...
Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-024-11899-9.
... In this way, children's interactions within the clinical setting are always negotiated in a triangulated relationship between themselves, their parent or guardian, and the presiding healthcare professional. By design, this triangulation systematically lessens children's power by positioning the parent or guardian as the default 'knowledge holder', those believed to interpret and communicate their child's experiences and perceptions with an implied accuracy on their behalf (Carnevale et al., 2021;Joslin et al., 2023). ...
In the field of childhood pain, the knowledge and expertise of children has long been overlooked. Instead, adult knowledge has been privileged over child knowledge, despite contemporary understandings that the experience of pain is subjective in nature and can only be fully appreciated by the person experiencing it – regardless of age, stage, or status. In this paper, we report on a pilot study that combined virtual semi-structured interviewing methods with arts-based research methods (drawing or painting, produced offline in the time between virtual interviews) to explore children’s experiences of chronic pain from their own perspectives. We use this study as a backdrop to make visible the ‘behind the scenes’ methodological work of arts-based research with children, paying particular attention to the ways in which our methodological approach created time and space for reflection, supported the co-production of knowledge, provided a means through which to visualize the effect of broader social influences on knowledge production, and provoked novel lines of analysis and inquiry. All these affordances call for deeply reflexive research practices. We suggest the methodological approach described in this paper can help amplify and add value to research with young children. The richness of the children’s accounts concerning chronic pain add to the body of evidence demonstrating that ‘even’ young children have knowledge, expertise, and insights that should be elicited to expand understandings of children’s pain and other similarly abstract topics, phenomenon, and lines of inquiry in health.
... In our workshop we classified children under the definition used by the United Nations Convention on the Rights of the Child in reference to persons under the age of 18 (1). However, the perspectives presented in our workshop also incorporated a more expansive conception of a 'child' that includes social and relational aspects of participation in their environments as central to their identity as 'children' (2). Children are often assumed to lack the capacity to make medical decisions, but this assertion is inconsistent with the majority of provincial statutes in Canada, which do not define an age with regard to the capacity to make medical decisions (3). ...
This summary reports on the design and proceedings of a collaborative case-based workshop and panel on how we ‘ought’ to consider the best interests of children in medical decision-making, presented virtually at the Canadian Bioethics Society - Société Canadienne de Bioéthique Workshop and Community Forum in May of 2023.
... From an ethical perspective, it is important to consider the relational nature of autonomy and decision making. At times, individuals may make choices beyond individual interests, and their values are influenced by their relationships and environment (see e.g [22]). Supporting clinicians to navigate ethical considerations in the unique context of pediatric care, where relational autonomy is distinctly explicit can alleviate the moral distress that arises with these complex clinical presentations. ...
Objective
Models of treatment for adults with severe and enduring eating disorders focus on harm reduction and improving quality of life. However, there is a notable gap in the pediatric literature in this area. The current study set out to assess the perspectives of health professionals regarding clinical care for young people (e.g., ages 10–25 years) with severe and enduring eating disorders, and to explore perceptions about appropriate treatment options for these presentations.
Methods
Health professionals were invited to complete a two-stage online survey about their experiences with clinical care for pediatric eating disorders through Canadian and Australian professional eating disorder networks. Survey 1 included questions about their experiences in supporting individuals with severe and enduring presentations. Participants who completed Survey 2 reviewed clinical vignettes and shared their perspectives about treatment recommendations and models of care, including for a severe and enduring presentation.
Results
A total of 85 clinicians responded to questions on Survey 1 about severe and enduring eating disorder presentations. A portion of these respondents (n = 25) also participated in Survey 2. The majority of respondents to Survey 1 reported providing clinical care for pediatric severe and enduring eating disorder presentations. Amongst respondents to Survey 2, there was low consensus amongst respondents for the clinical care that would be most appropriate for young people with a severe and enduring eating disorder presentation. Numerous challenges in models of care for severe and enduring presentations in pediatric settings were raised in responses on Survey 2, with clinicians sharing their awareness of models focusing on quality of life, while also raising concerns about the appropriateness of these models for young people.
Conclusions
The preliminary results of this study demonstrate that the majority of clinicians report that they have provided care to young people with severe and enduring presentations. There is a clear need for establishing guidance for clinicians working in pediatric eating disorder settings around models of care focused on quality of life. Engagement with interested parties, including those with lived experience, can clarify the development of terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders.
... Additionally, because ethics concerns everyone, practical interventions that make ethics more accessible and understandable (e.g., knowledge transfer, public education, awareness-raising) resonate with a living ethics stance. Likewise, awareness-raising educational interventions and methods that follow horizontal teaching methods are ideal ways to prepare children and youth for the active participation in their health and healthcare (Carnevale, Collin-Vézina et al. 2020), and in a democratic citizenship with respect to health and health issues. ...
Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process.
... To promote the manifold dimensions of students' learning and development, an integrated institutional planning process is needed that considers all the experiences that students have on campus, within the same framework, as well as their experiences over time. Assessments of the efficacy of these frameworks and experiences in advancing students' multifaceted learning and development (e.g., persistence, engagement, motivation, belonging, communication skills, capacity to lead/work well with others, problemsolving, academic growth, management of cognitive and non-cognitive complexity, etc.) should then be used to determine how student-centered curricular and co-curricular experiences can be modified to best meet their needs longitudinally -as part of a continuous feedback loop (Carnevale et al., 2020). These competencies should be assessed, as should post-secondary outcomes --such as job placement, income, graduate/professional study, educational attainment/post-baccalaureate completion rates, military service, and volunteer service --as all are fundamental for success in emerging adulthood (Klor de Alva & Christensen, 2020). ...
Higher education is at a crossroads. Institutions need to be increasingly adaptable to unexpected stressors while building more robust systems for assessing their students’ longitudinal, multifaceted development within the context of mission-driven operations. Integrated planning is a collaborative process that meets these goals through the intentional coordination, within and among units, to engage in long-term planning while nimbly responding to changes that warrant procedural alterations so that institutions can meet their strategic goals. In this paper, we demonstrate how the architecture of institutional effectiveness (IE) is inextricably linked to the quality of its integrated planning (IP), with student learning and developmental outcomes at its nexus.
... The associated emphasis on illuminating the child's specific perspective on their living environment sees children not as sources of data to be mined, but as actors in their own developmental journey and experts on their own lifeworlds (Eßer, 2016). The critical sociology of childhood has pointed out that children's agency is not a phenomenon we can naturalistically assume is present a priori, but rather is itself a construct linked to the assumption of specific positions within a lifeworld (Carnevale et al., 2020;Eßer, 2016). The roles and requirements that emerge during the design of a research process depend on how researchers themselves theorise or establish the difference between children and adults. ...
The paper reflects on researchers’ adultness in the context of two central motifs that accompany interview research with children, “ascertaining children’s perspectives” and “meeting research objectives (the researcher’s objectives)”. Sequential re-analysis of conflictual interview sequences reveals “ad hoc practices” in which researchers (re)produce adultness and generational orders. Reflection on such practices in connection with ‘turning points’ in adult actions may assist in fine-tuning the appositeness in the approach to interviews with children and helping researchers advance their individual research skills.
... ward examining the morally meaningful dimensions of young people's lives, 7 this Viewpoint aims to question the value of compliance-oriented programs' principles as they apply to traumatized children and youth. ...
This Viewpoint aims to question the value of compliance-oriented programs’ principles as they apply to traumatized children and youth.
... 37 If the right to participation is understood as a primary step for preserving children's rights, the best interest principle has the consequence of excluding them from determinations that affect their lives, and this view can represent a threat to the child's fundamental rights. 39 Decisions made in the context of child exclusion are based on the paternalistic paradigm, meaning a specific group -mostly adults -has structural and legislative privileges in decision-making, while the opinion of the children involved with the outcomes of the action taken is disregarded. 40,41 The International Convention on the Rights of the Child recognizes the right of children to participate in decision-making processes. ...
The COVID-19 pandemic has impacted the lives of children and adolescents around the world. Hence, this study aimed to examine how the pandemic has impacted children and adolescents in Brazil through an ethical analysis. An interpretive analysis of Brazilian research on child and adolescent health during the pandemic was conducted. Recognizing this ethical dimension is pivotal to shedding more light on how responses to crisis situations, such as the current situation of the COVID-19 pandemic, can be shaped and where the priorities for action are according to all interested parties, situating the child between these parts of interest. Our analysis highlighted both direct and indirect effects surrounding the decision-making processes for children in the COVID-19 pandemic reality. These decisional processes must sustain the child’s right to participation to ascertain that the action taken is in the child’s best interests. Nevertheless, the Brazilian reality has shown a structural exclusion of children’s voices in decisions affecting them, particularly concerning the effects of the pandemic on their lives. Further studies must be conducted to deepen the knowledge about children’s best interests and their participation in the actions planned during the pandemic.
Keywords:
Child Care; Child Health; COVID-19 Pandemic, Ethical Analysis
... 37 Entendendo-se o direito à participação como passo primordial para a preservação dos direitos das crianças, o princípio do melhor interesse tem como consequência a exclusão delas das determinações que afetam as suas vidas, e essa visão pode representar uma ameaça aos direitos fundamentais da criança. 39 As decisões tomadas em um contexto de exclusão da criança baseiam-se no paradigma paternalista. Ou seja, um grupo específico -na sua maioria adultos -possui privilégios estruturais e legislativos na tomada de decisão, sendo desconsiderada, em contrapartida, a opinião das crianças que estão envolvidas com os resultados da ação tomada. ...
The COVID-19 pandemic has impacted the lives of children and adolescents around the world. Hence, this study aimed to examine how the pandemic has impacted children and adolescents in Brazil through an ethical analysis. An interpretive analysis of Brazilian research on child and adolescent health during the pandemic was conducted. Recognizing this ethical dimension is pivotal to shedding more light on how responses to crisis situations, such as the current situation of the COVID-19 pandemic, can be shaped and where the priorities for action are according to all interested parties, situating the child between these parts of interest. Our analysis highlighted both direct and indirect effects surrounding the decision-making processes for children in the COVID-19 pandemic reality. These decisional processes must sustain the child’s right to participation to ascertain that the action taken is in the child’s best interests. Nevertheless, the Brazilian reality has shown a structural exclusion of children’s voices in decisions affecting them, particularly concerning the effects of the pandemic on their lives. Further studies must be conducted to deepen the knowledge about children’s best interests and their participation in the actions planned during the pandemic.
Keywords:
Child Care; Child Health; COVID-19 Pandemic, Ethical Analysis
... For example, children can be vulnerable by dint of their age and position in society and thus in need of protection, while at the same time demonstrating moral agency that deserves authentic recognition. 36 Similarly, Indigenous peoples can be vulnerable and in need of affirmative action to counter ongoing colonial policies that produce health disparities while also empowered, agential, and working towards decolonized systems and policies. 24,37 Our conventional concepts do not often capture this complexity; and worse, sometimes our approaches actually produce the siloes that simplify rather than complexify. ...
This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to ‘othering’ thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the ‘how,’ ‘why,’ and ‘therefore’ that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them ‘at risk,’ and to what are they ‘at risk’? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co‐engagement and co‐production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.
... Dans la discussion autour de la mise en pratique du principe d'autonomie en pédopsychiatrie, est remise en cause la compréhension binaire de la capacité à s'autodéterminer, qui envisage l'enfant soit comme autonome, soit comme non-autonome [7,8]. Pour les enfants atteints d'une pathologie psychiatrique, cette compréhension binaire entraîne souvent une prise de pouvoir décisionnelle de la part des professionnels au détriment de la prise en compte du point de vue de l'enfant [7]. ...
Résumé
Introduction
Cette étude porte sur le respect de l’autonomie des enfants et adolescents hospitalisés en psychiatrie vu sous l’angle de la participation. L’objectif est de mieux comprendre le potentiel des approches participatives dans ce contexte particulier. La conflictualité du principe d’autonomie et l’absence d’une revue de la littérature sur ce sujet motivent cette recherche.
Méthode
Une revue de la littérature concernant la participation des enfants et adolescents hospitalisés en pédopsychiatrie est employée. Neuf cent soixante dix huit textes ont été passés au crible et 27 sont inclus dans la revue. La revue de la littérature est évaluée au regard des modèles de participation et du principe d’autonomie.
Résultats
La littérature étudiée se focalise sur les freins et leviers à la participation et à sa mise en pratique en pédopsychiatrie. La plupart des arguments sont conséquentialistes et rapportent des avantages pour les patients, les professionnels et l’hôpital. Face aux arguments en faveur de la participation, de nombreux freins sont décrits. Trois catégories de méthodes concrètes de mise en pratique du modèle de la participation sont distinguées : les structures de participation, les personnes clés, les outils de participation. Le niveau conceptuel de la participation est souvent peu élaboré. Au regard des modèles théoriques, comme le shared decison-making, des faiblesses conceptuelles sont démontrées dans ce contexte particulier. En tenant compte du discours autour de l’autonomie du patient, les notions d’estime de soi et de confiance envers les professionnels se révèlent également pertinentes pour les approches participatives.
Conclusion
La littérature sur la participation donne des arguments forts et présente des méthodes expérimentées en pédopsychiatrie. Une approche contextuelle de la participation est proposée : le shared care planning. Ce concept permet de renforcer l’estime de soi du patient en prenant en compte la dimension relationnelle des soins et de l’accompagnement en pédopsychiatrie.
Within this commentary, I contest dominant views and practices regarding im/maturity within Children’s Nursing that are rooted in refuted age-based conceptions of child development. I highlight how these operate as forms of epistemological oppression that perpetuate the exclusion of young people’s voices and experiences in research, policymaking and practice development that affects them. These dominant approaches breach their participation rights and can generate significant distress and trauma. To counter these oppressive views and practices, I discuss an inclusive participatory framework that is centered on the recognition of young people as human agents, acknowledging their voices as forms of agential expression and action. I argue that all research, policymaking and practice development that affects young people should be informed by their aspirations and concerns expressed through respectful – not tokenistic - youth engagement initiatives. I argue for an urgently-needed restructuring of Children’s Nursing theory and practice.
Introduction While cancer treatments clearly improve cancer outcomes, they inadvertently damage healthy tissues and organs, including causing oral and dental complications. Oral health complications can lead to cognitive, psychological, and social impairments which can have a profound impact on children’s well-being. Current knowledge of these consequences comes from clinical studies focusing on caregivers' viewpoints. Though it is important to directly involve children in research to gain a firsthand understanding of their experiences. Objectives The aim of this study is to better understand how oral health effects of cancer and its treatment impact the well-being of children with, or who have survived, cancer from their own perspective. Methodology Participants will be recruited from a tertiary care pediatric hospital. We will use a participatory hermeneutic ethnographic methodology and a Childhood Ethics theoretical framework to center children’s perspectives. Data will be generated through document analysis, participant observation and semi-structured interviews. We will observe discussions among children, families, and healthcare professionals, and conduct interviews with stakeholders: children (n=10-15) who are undergoing or completed treatments; parents/caregivers (n=10-15); and healthcare professionals (n=8-10). Interviews will be audio-recorded and transcribed. Analysis will use SAMSSA methods to identify key aspects of children’s experiences related to their oral health and the impact it has on their well-being, as well as health and social factors that affect this experience. Significance: Through this study, we will gain insight into how cancer and treatment-induced oral health complications impact children’s well-being, results from which will be translated into clinical and policy recommendations
The concept of childhood has evolved over the years, inspired by the United Nations Convention on the Rights of the Child in 1989, shifting from developmental models to a conception of childhood that recognizes children as moral agents. This evolution highlights the importance of respecting children's agency and their right to be heard in matters that are related to them. In conventional health research, however, children's voices are often inadequately accessed. In this commentary, we discuss the imperative to recognize children's agency in dental research and a shift from research on children to research with and by children. Moreover, we underscore the importance of actively seeking and listening to children's voices and recognizing their agency in shaping research and healthcare practices in the field of dentistry. Further, we explore the application of participatory research approaches in dental research and provide examples of studies that have involved children in various capacities. We conclude this commentary by emphasizing the potential benefits of participatory research in both qualitative and quantitative dental studies to promote deeper understanding, clearer communication, and stronger advocacy regarding children's interests. Primarily, we call for greater recognition of children's agency in dental research and advocate for more inclusive and child‐centred research methodologies.
The article begins with a discussion of the contribution of childhood studies to our understanding of children's ethics, taking into account feminist inputs to the debate over the ethics of care and the ethics of justice. Then, based on two qualitative studies carried out in Chile with children between 10 and 13 years of age, the article shows the emphasis the children place on reciprocal care between parents and children. This concern for reciprocity is accompanied by notions of justice and rights in how they evaluate the parent–child relationship. The data reveal the complex ways in which the ethics of care and of justice interlock in the children's discourses. The article concludes by tracing the links between these results and the conditions of productive and reproductive work in contemporary Chile as reflected in the children's discourses, and it shows how children have begun to internalise a focus on children's rights in reflecting on their daily lives.
Participation has been discussed as a multi-layered concept with varied outlooks on children’s lived experiences. Children’s participation occupies a complicated terrain in that whose participation counts and how it manifests itself within complex adult–child relations are enduring questions in the early childhood field. This qualitative study explored early years practitioners’ perspectives about children’s participation through their Froebelian lenses in the Scottish context. Semi-structured in-depth interviews (n = 14) were conducted online (May 2020–September 2020). As a result of the thematic analysis, three interrelated themes unfold practitioners’ conceptualisations of children’s participation: (i) listening to children’s perspectives, (ii) acting upon children’s perspectives and (iii) active learning and development. The study shows that Froebelian approaches open diverse intellectual spaces for practitioners to consider children’s participation, agency and competency alongside everyday pedagogical encounters. Children’s participation, which was not a common concept in Froebel’s time, is reconceptualised by the practitioners in this research and identified as a substantial but fluid concept in children’s multiple experiences, which is also acknowledged as children’s rights.
Research increasingly suggests that positive youth development programmes play an important part in preventing youth violence and promoting positive developmental trajectories. We conducted a focussed ethnography of LOVE, a social development programme aimed at supporting youth who have been exposed to violence. Building on a previous study's exploration of this programme's afterschool setting, we examined the programme's social functioning in school settings. Findings underline the role of playfulness—alongside an egalitarian/friendly approach, gentle authority/structure, strengths‐based support and a safe space to express vulnerability—to foster in youth the ability to feel free, confident/empowered, connected/empathic and positive feelings about school and life.
Millions of children are hospitalized each year for an array of illnesses, injuries, procedures, and medical or social needs; for many, these encounters will challenge their developmental progress and psychosocial wellbeing for weeks to months to come. In these cure-oriented healthcare environments, play is often viewed as a privilege or an indicator of the child’s improving physical state, rather than being recognized for its centrality to the child’s agency, coping, development, and resilience. However, it is especially in this unfamiliar, adult-centered, and highly controlled healthcare environment that play is exactly what children need and desire—and a fundamental human right to which they are entitled. Therefore, the purpose of this chapter is to explore children’s experience of and access to play in pediatric healthcare settings, as well as the limitations for play that these spaces and circumstances engender. Using Fraser’s framework of social justice as parity of participation and invoking the child life specialist profession as a lens, it is possible (and necessary) to enhance awareness, shift attitudes, and cultivate advocacy for children’s right to play in times of both sickness and health.
Objective:
To examine the quality of life of children who depend on health technologies as expressed in their own words.
Methods:
A parallel and convergent mixed methods design was employed with 30 aged five to 12 year old children who depend on health technologies. Data collection was done through a characterization form, Pediatric Quality of Life Inventory 4.0 questionnaire with the total sample in quantitative phase; semi-structured interviews with a subset of nine participants in qualitative phase. Quantitative and qualitative data were analyzed using descriptive statistics and deductive thematic content analyses, respectively.
Results:
Findings from PedsQL 4.0 showed that quality of life for children who depend on health technologies is average. However, data integration through mixed methods showed that this average goes beyond quantitative data through hearing the children's own voices. The results from data integration pointed out that children recognize their limitations and adapt to them; what most affects their quality of life is the emotional domain; children reported suffering prejudice due to their physical limitations; and that the school positively impacts their quality of life.
Conclusions:
Data integration highlighted that children acknowledge their limitations and pain generated by these devices. Concerns about the future and the ability to do things that other children the same age can do was the most impactful aspect on their quality of life.
Implications for practice:
Nursing care plans should consider that what affects most children who depend on health technologies' quality of life is anxiety for the future of being incapacitated or dependent.
Assisted dying legislation is available to support adult deaths in multiple international jurisdictions. In Canada, a parliamentary committee has recommended extending Medical Assistance in Dying (MAID) legislation to include ‘competent mature minors’. Even though such a policy change would affect young people, to date formal discussions about MAID for minors have excluded them. No empirical studies have elicited youth perspectives on including them in future legislation. This qualitative descriptive study uses focus groups to explore young people's perspectives on MAID and its potential extension to include minors using methodological and theoretical commitments to participatory research and children's agency. Our participants explored philosophical and medical dimensions of MAID, including pain and suffering, the choice to die, and how MAID enables a peaceful, controlled death. They unpacked the concept of maturity vis‐à‐vis age and a child/adult binary, using these reflections to posit safeguards for ensuring minors' MAID requests would be fairly evaluated. Finally, they explored relational dimensions of dying, paying particular attention to the impact of MAID on grievers. Our results illustrate that young people are capable and keen to contribute toward discussions and decisions about MAID. Our study supports the participation of young people in any extension of MAID, as well as in other high‐stakes matters that may affect them, challenging dominant assumptions that underestimate their capacities to do so.
Qualitative health research is ever growing in sophistication and complexity. While much has been written about many components (e.g. sampling and methods) of qualitative design, qualitative analysis remains an area still needing advanced reflection. Qualitative analysis often is the most daunting and intimidating component of the qualitative research endeavor for both teachers and learners alike. Working collaboratively with research trainees, our team has developed SAMMSA (Summary & Analysis coding, Micro themes, Meso themes, Syntheses, and Analysis), a 5-step analytic process committed to both clarity of process and rich ‘quality’ qualitative analysis. With roots in hermeneutics and ethnography, SAMMSA is attentive to data holism and guards against the data fragmentation common in some versions of thematic analysis. This article walks the reader through SAMMSA’s 5 steps using research data from a variety of studies to demonstrate our process. We have used SAMMSA with multiple qualitative methodologies. We invite readers to tailor SAMMSA to their own work and let us know about their processes and results.
I artikeln kommer ett enskilt, överraskande trassligt, fokusgruppssamtal med fyra elever att omtolkas med utgångspunkt i Charles Sanders Peirce’s begrepp abduktion. Materialet är hämtat ur ett treårigt forskningsprojekt kring elevers erfarenheter av konstnärlig undervisning som bedrevs av professionella konstnärer. Istället för att, vilket jag inledningsvis gjorde, konstatera att samtalet med några av skolans allra yngsta elever inte gav värdefull kunskap om barnens erfarenheter ifrån skolprojektet omprövas tolkningen. Då framträder inte barnen längre som busfrön. Med en abduktiv ansats synliggörs istället ett kreativt barnsamspel som utmanar och skapar förskjutningar i både relationen mellan den vuxna och barnen och av skolans normer, och därigenom även barns konventionella in- och underordning. Barns aktörskap kan ha olika uttryckssätt och för att erkänna dessa varianter krävs en öppenhet, och ett analytiskt arbete kring det oväntade. Via en abduktiv strategi (Paavola, 2014) används i analysen nya begrepp för tolkning, här estetisk negation (aesthetic sublation, Ylönen, 2021) genom vilket materialet rekontextualiseras. Detta synliggör i sin tur dimensioner av barns agens och deras omskapande motstånd till den vuxnas intention. I en avslutande diskussion relateras pragmatism till vad abduktion och sådan rekontextualisering kan bibringa, i termer av nya möjliga tolkningar av meningsskapandets praktiska konsekvenser.
In Canada, Medical Assistance in Dying (MAiD) is legal for many Canadians based on several criteria, though minors who are deemed sufficiently capable to make medical decisions (ie, mature minors) remain ineligible. In this article, we provide insight into recent philosophical and legal evidence related to MAiD for mature minors. We begin by providing an overview of literature pertaining to MAiD for mature minors in particular (including evidence from Belgium and the Netherlands), followed by a discussion on the lessons that can be learnt from Canada’s MAiD implementation process (in general) and other forms of paediatric end-of-life care. As a whole, we aim to highlight some key takeaway messages for health leaders to consider as deliberations on MAiD for mature minors continue.
Children with medical complexity have been defined within the literature as chronically ill and medically fragile children with complex care needs. Care for these children raises significant ethical and moral considerations. Therefore, this participatory ethnographic study conducted with eight children and their families aimed to better understand the moral experiences of children with medical complexity, based on views of children as moral agents and capable of understanding and expressing interpretations about their lived experiences. Through our participatory hermeneutical ethnographic research, we were able to shed light on how children with medical complexity express their moral experiences within a complex sociopolitical context, perpetuating dominant outlooks on what is considered a "normal" child. Children with medical complexity described their resistance to these dominant views as they strive to be included in discussions about matters that affect them, reacting to painful medical procedures and treatments, and expressing their concerns about their future aspirations. The knowledge advanced by this study about moral experiences of children with medical complexity can inform understandings of children's interests based on their own interpretations within complex sociopolitical contexts that value their lives differently.
Bu araştırmanın amacı, Web of Science (WoS) veri tabanında erken çocukluk döneminde etnografik yöntemle ilişkili dokümanların tanımlayıcı ve değerlendirici bulgularını incelemektir. Araştırmada bibliyometrik analiz yöntemi kullanılmıştır. Sistematik literatür taramasına uygun yapılan araştırmada, WoS veritabanında yıl, doküman tipi ve dil sınırlaması olmaksızın yayımlanan 221 doküman incelenmiştir. Analiz sonuçlarını görselleştirmek için VOSviewer yazılımı kullanılmıştır. Tanımlayıcı sonuçlar, yıllara göre en fazla dokümanın 2017 yılında yayımlandığını; H. Ferguson’ın en üretken yazar ve Nottıngham Üniversitesi’nin en üretken kurum; Ethnography and Education’ın en verimli dergi; en fazla yayının İngilizce dilinde ve en üretken ülkenin Amerika Birleşik Devletleri olduğunu göstermiştir. Değerlendirme sonuçları, A. Chambon, P. Mckeever, P. Elizabeth, K. Spalding ve H. Zitzelsberger yazarların en yüksek ortak yazarlık ağına ve İngiltere’nin en yüksek ortak yazarlık ağına sahip ülke olduğunu göstermiştir. Diğer yandan ortak atıf alan yazarlar arasında toplam bağlantı gücü en yüksek olan yazar A. James olmuştur. Son olarak, anahtar kelime oluşum ağlarında toplam bağlantı gücü en yüksek olan anahtar kelime “ethnography” olmuştur. Bu sonuçlara dayanarak, erken çocukluk döneminde etnografik yöntemle ilişkili dokümanların farklı veri tabanları üzerinden sistematik literatür taraması yapılabilir.
Nursing scholars have called for nursing approaches with children that ensure the promotion of their childhood, contesting dominant adult‐based approaches that are adapted for practice with children. Although the nursing literature includes many important advances in the promotion of child‐centered approaches, there are still significant gaps in fully recognizing the complexities of childhood within nursing. Within this paper, I (a) outline some key advances in nursing approaches with children, sometimes referred to as “Children's Nursing” (shifting away from “Pediatric Nursing” conceptions that may be focused more on diseases than childhood); (b) highlight key gaps in current conceptions of Children's Nursing, namely the inadequate integration of work from the interdisciplinary field of Childhood Studies which challenges dominant age‐based developmental models which discount children's voices and experiences as “immature”; and (c) propose a Childhood Ethics‐based framework that bridges advances in Children's Nursing with those within Childhood Studies, which I refer to as the VOICE Children's Nursing Framework. The latter is rooted in the recognition of (a) children as active agents with capacities and interests in participating in discussions and decisions that affect them, and (b) best interests as the foundational basis for determining the nursing care required by a child which should be defined in an individualized manner, informed by a child's expressed aspirations and concerns. This Framework integrates biological, relational, and ethical dimensions of children's wellbeing and draws on hermeneutic approaches for eliciting and interpreting children's agential expressions, which involves continuous part/whole shifting to meticulously discern what is meaningful within a situation. The Framework is operationalized for clinical practice through the use of orienting questions, which is demonstrated through discussion of a clinical exemplar. The paper closes with proposed future directions for Children's Nursing development in practice, education, and research.
Drawing on a hermeneutic ethnographic methodology, we studied the everyday moral experiences of young people aged 11 to 16 and how these related to expressions of agency. Our results revealed that young people's agency was manifested through three interrelated dimensions: their aspirations, concerns, and capacities. Agential expression was context dependent, either bolstered or thwarted by certain people or social institutions. Our study empirically supports our ontological advancement of Childhood Ethics as a sub-specialization of Childhood Studies, offering novel evidence on children's agency. This work further promotes the importance of meaningfully including young people in discussions, decisions, and actions that affect them.
Within his earliest contributions to the human sciences, Charles Taylor challenged dominant behavioral views by advancing a hermeneutical conception of human agency. For Taylor, persons continually navigate their meaningful worlds and make sense of things and act in light of background horizons of significance and social imaginaries. Yet, conceptions of children have lagged as dominant outlooks construe young people as immature and incapable – perpetuating behavioral approaches to controlling their actions rather than hermeneutic ones that recognize them as agents. Working with Taylor’s ideas, I discuss a Childhood Ethics ontological approach to understanding children and childhood. Specifically, I: (a) draw on Taylor’s critique of naturalistic approaches to the human sciences to highlight problems that underlie universalist claims about all childhoods; (b) relate Taylor’s articulation of human agency, centered on strong evaluation and human linguistic capacity, to the Philosophy of Childhood and Childhood Studies to address current questions regarding our understanding of agency within childhood; and (c) describe a hermeneutic ontology that can inform the development of empirical research, policy-making and practices that relate to children. I close with an outline of priority questions that can orient future investigations within this area of inquiry.
The last chapter of the book indicates how the author has extended his integration and unification bent into the area of ethics. It summarizes recent publications on an integrated health work ethics code, in particular, based on a five-principle model that incorporates the work of Maslow and Erikson, and which is consistent with the five-stage Neo-Piagetian model of the present work. The chapter continues with a manifesto on children and youth protection and rights based on the five-principle ethics integration proposed by the author. It includes a description of what children and youth should be told of their rights according to the proposed five ethical principles.
Adultcentrism is an inherent feature of the social fabrics comprising most resource-rich countries in the twenty-first century that undermines the capacities, value, and voices of young people in various ways. In the context of COVID-19, we are confronted with the question of whose voice matters and must ask: is adultcentrism ethically permissible during a pandemic? This Critical Controversy examines this question in relation to evolving concepts of childhood, children’s rights, and the capacities of young people, to highlight areas of tension, future research, and potential for critical dialogue.
Au sein des unités d’hospitalisation de pédopsychiatrie, des équipes de soins travaillent auprès de patients ayant une déficience intellectuelle (DI) et/ou un trouble du spectre autistique (TSA), qui présentent des troubles graves du comportement (TGC) : automutilation, hétéro-agressivité, agitation psychomotrice incoercible, pica, stéréotypies envahissantes, destruction d’objets. Les blessures associées à l’intensité des crises sont problématiques pour les patients, les familles et les soignants : leurs complications sont nombreuses et le recours à des mesures de contention est fréquent alors qu’il faudrait pouvoir les limiter. Cette recherche porte sur les pratiques de sécurisation alternative à la contention dans la prise en charge des TGC des personnes avec DI/TSA. L'objectif est de recenser chacune de ces pratiques en s’intéressant à l’usage des outils de sécurisation (ex. casque, gants, manchettes, veste, combinaison, attelles, bouclier rembourré, tapis, papoose board) et à l’expérience morale des soignants directement exposés à la violence de ces situations extrêmes. Une étude ethnographique a été conduite en France, au Canada, aux États-Unis entre 2017 et 2019, au sein de trois unités d’hospitalisation spécialisées dans l’évaluation et la prise en charge des TGC des personnes avec DI/TSA. La collecte des données a reposé sur une observation participante en immersion, 37 entretiens individuels menés auprès de professionnels et l’analyse des procédures propre à ces trois unités. La dimension internationale de l'étude nous a permis de questionner les normes locales à travers des cultures de service et des politiques de santé différentes dont les valeurs du soin sont à approfondir et à distinguer. Dans un premier temps, nos résultats portent sur le recensement exhaustif des équipements de protection individuelle (EPI) et la découverte d’autres outils de sécurisation novateurs. Les EPI modulent le degré de restriction et permettent une marge de mouvement qui favorise un cadre de soins plus ouvert et respectueux de la liberté d’aller et venir au sein de ces unités fermées. Leur recours rassure les soignants et contribue à la restauration d’un raisonnement clinique permettant d’identifier les étiologies des TGC et d’individualiser les prises en charge psychoéducative et médicale. Sur le plan éthique, ces résultats ethnographiques ont ouvert une discussion sur le concept de « vulnérabilité partagée ». Dans un second temps, nous avons développé la dimension participative de notre étude à partir d’un cadre interprétatif reposant sur l’herméneutique de Charles Taylor. Ce cadre méthodologique nous a permis d’approfondir l’expérience morale des soignants confrontés aux situations complexes en DI/TSA. Nos résultats mettent en lumière une dimension négligée de la relation de soin : la vulnérabilité du soignant. Cette vulnérabilité se caractérise par l'impact global des TGC et une détresse morale associée à la contention et à l’exclusion des personnes avec DI/TSA. La forte ambiguïté entre « soin » et « contention » et le manque d’approche inclusive ont été identifiés comme les principaux freins aux alternatives à la contention. À l’inverse, les leviers favorables aux alternatives à la contention, sont définis à travers d’une part, une intégrité professionnelle qui envisage simultanément la protection des patients et des soignants, et d’autre part, une implication relationnelle permettant aux soignants de s’ajuster aux besoins spécifiques des personnes avec DI/TSA. Ces résultats ouvrent une discussion sur la reconnaissance de la vulnérabilité des soignants alors considérée comme une vertu relationnelle pour penser la violence et créer des approches plus équilibrées, entre l’excès et le défaut de protection. Cette thèse défend une posture soignante fondée sur la prudence. À la recherche du refus de l'abandon et de la domination, elle ouvre une réflexion sur le souci de soi envisagé comme un respect mutuel.
The COVID-19 pandemic has had a far-ranging impact. As societies struggled to minimize infection, questions arose regarding the consequences for children. Initial research reported the urgent need for child protective services worldwide to adapt existing policies and practices to protect children from maltreatment during this time, which is the rationale for the current systematic literature review. This review examined studies published in peer-reviewed journals from March 2020 to October 2020 on child maltreatment (CM) in the context of COVID-19. Twenty-five manuscripts met the inclusion criteria and were predominantly from the United States, with three international studies. The majority of the studies included CM reports during COVID-19 based on official data. The results clearly demonstrated an increased risk for children alongside a worrisome international decrease in CM reports. Only two studies addressed interventions during the pandemic. The current review highlights that, along with the obligation of scholars to advance the protection of children during COVID-19, there is much that is unknown. Future studies should examine the impact of the pandemic on children and their surrounding systems as well as child protective services’ responses, which face enormous challenges during a pandemic. An additional conclusion is that, since children were not identified as a health risk group during the pandemic, their protection rights may have been jeopardized. Furthermore, the variance identified in the policies of different countries pinpoints the urgent need to establish an international protocol for protecting children from maltreatment during COVID-19, a protocol that will hopefully be a basis for policymakers worldwide.
During the COVID-19 pandemic, the lives of children and adolescents in resource-limited countries have been significantly impacted in complex ways, while largely having their interests overlooked. The purpose of this colloquium is to examine these impacts across seven resource-limited nations and apply an ethical lens to examine the ways in which children and adolescents have been treated impermissibly. We finish with recommendations and calls to action for key stakeholders to consider.
“Listening to children’s voices” can help foster respectful regard for their experiences and concerns and promote the recognition of children as active agents; that is, persons who have interests and capacities to participate in discussions and decisions that affect them and other people. However, “listening to children’s voices” can have many different forms, and the ways that these voices should be linked to children’s agency can be unclear. I outline several common misconceptions that can impede “listening to children’s voices” as forms of epistemological oppression. I argue for a thick conception of children’s voices, recognizing that children’s expressions are relationally embedded expressions of their agency. Understanding children’s voices and experiences requires hermeneutical approaches that can help discern what is meaningful for a child in a particular situation. I discuss ontological, epistemological, and methodological shifts that are required for hermeneutical inquiry with children and outline specific methods that can be used, oriented by guiding questions. This hermeneutical methodology can help advance our understanding of children’s experiences as well as their aspirations and concerns in research and in professional practice.
Restraints and seclusion are routinely used in child mental health settings for conflict and crisis management, but raise significant ethical concerns. Using a participatory hermeneutic ethnographic framework, we studied conflict and crisis management in a child mental health setting offering care to children aged 6–12 years old in Quebec, Canada. The use of this framework allowed for an in-depth examination of the local imaginaries, of what is morally meaningful to the people in the setting, in addition to institutional norms, structures and practices. Data collection involved participant observation, interviews, and documentation review, with an interpretive framework for data analysis. We argue that the prevalent view of children shared by staff members as “incomplete human becomings” led to the adoption and legitimization of authoritative norms, structures and practices guided largely by a behavioral approach, which sometimes led to an increased use of control measures for reasons other than imminent harm. Children experienced these controlling practices as abusive and hindering the development of trusting relationships, which impeded the implementation of more collaborative approaches staff members sought to put in place to prevent the use of control measures. Study results are discussed in light of conceptions of children as moral agents.
Inconsistencies have been noted in how moral agency is conceived in childhood, leading to variations in children’s levels of inclusion/exclusion from discussions and decisions affecting them in children’s services and research. Through a scoping review of 261 articles, we examined the different ways in which children’s moral agency is imagined in the literature across different disciplines: education, health, law, psychology, and social services. A developmental psychology perspective dominated the results, while other viewpoints were less prevalent (e.g., children as active moral agents). We discuss how the different perspectives could be bridged to advance more integrated perspectives on interdisciplinary knowledge and practices related to childhood ethics.
When conducting ethics research with children in health care settings, studying children’s experiences is essential, but so is the context in which these experiences happen and their meaning. Using Charles Taylor’s hermeneutic philosophy, we developed a methodological framework for health ethics research with children that bridges key aspects of ethnography, participatory research, and hermeneutics. This qualitative framework has the potential to offer rich data and discussions related to children as well as family members and health care workers’ moral experiences in specific health care settings, while examining the institutional norms, structures, and practices and how they interrelate with experiences. Through a participatory hermeneutic ethnographic study, important ethical issues can be highlighted and examined in light of social/local imaginaries and horizons of significance, to address some of the ethical concerns that can be present in a specific health care setting.
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A focused ethnography was conducted in an after-school academic support program serving vulnerable populations in Montreal, Quebec, Canada. The aim of this study was to explore the moral experiences of children living in poverty to inform on their daily experiences and moral lives. Our results highlighted that these children, who were experiencing economic hardship and/or social isolation, faced various social barriers, such as stigmatization, family isolation, and linguistic challenges for new immigrant children. As active agents, they navigated the challenges they encountered with help from the program.
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Background
A growing number of frameworks for the practice of clinical ethics are described in the literature. Among these, hermeneutical frameworks have helped highlight the interpretive and contextual nature of clinical ethics practice.
Objectives
The aim of this article is to further advance this body of work by drawing on the ideas of Charles Taylor, a leading hermeneutical philosopher.
Design/Findings
A Hermeneutical Rapprochement Framework is presented for clinical ethics practice, based on Taylor’s hermeneutical “retrieval” and “rapprochement.” This builds on existing hermeneutical approaches for the practice of clinical ethics by articulating a framework with interpretive and reconciliatory scope that extends beyond the presenting “local” context. A Hermeneutical Rapprochement Framework considers broader socio-historical horizons and imaginaries grounded on Taylor’s expansive work in epistemological, ontological, political, and moral philosophy.
Discussion
The framework is discussed in terms of how it can be operationalized for clinical practice as well as normative development. Implications for the educational preparation of clinical ethicists are also discussed. Although this work is directly relevant for clinical ethicists, it can also help inform the ethical practice of all clinicians.
In this chapter, it is argued that, as part of the modern Enlightenment project, the dominant discourse on 'child development' reflects and reproduces racism and imperialism. In the first section, it is asserted that racism, as defined by Foucault (1975-76/2003), is found within the child development discourse, both in the regulation of children's bodies and the bodies and spaces with which children interact. Racism also serves to divide, classify, and 'normalize' notions of childhood. Through the above, the discourse aims to produce useful and docile children who will become useful and docile adults. In the second section, it is argued that the child development discourse privileges and produces characteristics associated with the modern Western imperial subject. This includes imagined notions of progress towards civility, and a fantasy of the White Subject who is scientist, conqueror and explorer, citizen of democracy, and a contributor and consumer in a capitalist market economy. Moreover, the discourse emphasizes a Western imperial sense of 'Self' versus 'Other', both in the goals of child development, and in the discipline's representation of itself. These arguments are demonstrated empirically through a textual analysis of the official position statement of the U.S.A. National Association for the Education of Young Children (NAEYC, 1997), found in the guidebook entitled: Developmentally Appropriate Practice in Early Childhood Programs (Bredekamp & Copple, 1997, p. 3-30). This text is an example of the dominant child development discourse, and is highly influential in the design, development, and evaluation of programs, curricula, and pedagogical practices with young children, both in North America and around the world.
Taking a legally pluralist stance which reflects global socio-legal reality, this article first identifies signficant mental blockages for legal scholars in theorising legal pluralism. It then argues that a socially responsible approach to law teaching, not only in India, cannot ignore society, culture and competing value systems. If law is everywhere dynamic and internally plural, even if not immediately visible, acknowledging pluralisms becomes necessarily a highly dynamic activity, comparable to the challenges of kiteflying. One wrong move, and the subtle structure crashes. Unless law teaching takes pluralism seriously, legal education will empower only a few privileged actors, capable to manipulate law and its multiple power-related uses. Socially conscious approaches to law teaching must problematise that while we need law to avoid chaos, everywhere it risks constant exploitation and misappropriation. Improved teaching about legalpluralism and choice making in Indian law schools offers hope, but many challenges remain.
Sexual health is a signficant dimension of health among children and youth in Tanzania. Local discourses highlight concerns regarding HIV/AIDS and sexual violence. The aim of this study was to examine the experiences and participation of children and youth in sexual health-related discussions, decisions, and actions in Njombe; a Tanzanian rural community. A focused ethnography, with a participatory approach, was conducted over a 3.5 month period, using participant observation, group interviews, and analysis of key texts, as well as key informant advisors. Twenty-eight participants, 8–16 years of age, were recruited from a community Youth Peer Health Educator program and an HIV youth group. Four principal themes were identified: (a) knowledge and understanding of sexual health, (b) children/youth value sexual health education and discussion, (c) supports and barriers for participation in sexual health education, and (d) children/youth value participation in their own care and promotion of their health. Results demonstrated that these children/youth have the capacities, interests, and values to actively participate in matters affecting their health and sexual health. Specific barriers and supports to sexual health education were identified. The study demonstrated how young people’s agency is socially mediated and can persist even when confronting significant barriers.
There is developing evidence that more effective means for preventing violence should involve social development programs for youths. A focused ethnographic study was conducted over 8 months in a social development program situated in Montreal (Quebec, Canada), aimed at providing support to youths who have been exposed to violence as actors, recipients, or witnesses. The study included participant observation, interviews with youths and staff members, and a review of documents, to examine how the program operates socially and how these social processes affect youths favorably and unfavourably. Youths’ experiences with the program were meaningful by permitting them to examine and reflect on who they are, what they have experienced and how to “connect” with others. The safe social space that was created by the youths and coordinators allowed for this meaningful engagement with the program, which led to outcomes that could go beyond the program itself and affected youths’ relationships with others, their self-perception, as well as their mental wellbeing. The program contributed to help manage some of the difficulties youths were facing.
There is a paucity of published research and normative standards to guide health care providers in managing issues related to children’s confidentiality. In this article, we examine challenges regarding the respect for confidentiality with children and youth in health care and offer guiding principles for clinical practice. We present an ethical framework and practice recommendations for: (a) respecting confidentiality for children who have decision-making capacity (as legally defined in different jurisdictions) and (b) recognizing some degree of respect for confidentiality among children who do not have decision-making capacity. This article will help incite additional analyses and research that can further refine the normative and practice standards proposed here.
Medical decision-making in the paediatric population is complicated by the wide variation in physical and psychological development that occurs as children progress from infancy to adolescence. Parents and legal guardians are the de facto decision-makers in early infancy, but thereafter, the roles of parents/legal guardians and paediatric patients become ever more complex. Health care providers (HCPs), while not decision-makers per se, have a significant role in medical decision-making throughout childhood. This statement outlines the ethical principles of medical decision-making for HCPs involved in caring for paediatric patients. This revision focuses on individual decision-making in the context of the patient–provider relationship and provides increased guidance for dealing with disagreements.
Children with complex health care needs are an emerging population that commonly requires long-term supportive services. A growing body of evidence has highlighted that these children and their families experience significant challenges. Many of these challenges involve ethical concerns that have been under-recognized. In this article, we (a) outline ethical concerns that arise in clinical practice with children with complex health care needs and their families (e.g.: exclusion of children’s voices in discussions and decisions that affect them; difficulties in defining their best interests; clashes across the array of social roles that parents manage; limited recognition of the ethical significance of parents’ and other family members’ interests) and (b) propose a relational ethics framework for addressing these concerns. Our framework draws on hermeneutical interpretation and moral experience as foundational orientations, recognizing children with complex health care needs as relationally embedded agents, who while dependent and entitled to protection, are simultaneously agential. Children’s and parents’ interests are relationally intertwined and interdependent. Families are recognized as significant social microcosms for the cultivation and transmission of intergenerational cultural heritage, narratives, and outlooks. We describe strategies for (a) conducting a relational ethics inquiry and (b) reconciliation of identified ethical concerns through a process of rapprochement. A relational ethics framework can promote clinical practices that are ethically attuned to the complexity of this population’s needs.
In this completely revised and updated edition, Deconstructing Developmental Psychology interrogates the assumptions and practices surrounding the psychology of child development, providing a critical evaluation of the role and contribution of developmental psychology within social practice. Since the second edition was published, there have been many major changes. This book addresses how shifts in advanced capitalism have produced new understandings of children, and a new (and more punitive) range of institutional responses to children. It engages with the paradoxes of childhood in an era when young adults are increasingly economically dependent on their families, and in a political context of heightened insecurity. The new edition includes an updated review of developments in psychological theory (in attachment, evolutionary psychology, theory of mind, cultural-historical approaches), as well as updating and reflecting upon the changed focus on fathers and fathering. It offers new perspectives on the connections between Piaget and Vygotsky and now connects much more closely with discussions from the sociology of childhood and critical educational research. Coverage has been expanded to include more material on child rights debates, and a new chapter addresses practice dilemmas around child protection, which engages even more with the “raced” and gendered effects of current policies involving children. This engaging and accessible text provides key resources to inform better professional practice in social work, education and health contexts. It offers critical insights into the politics and procedures that have shaped developmental psychological knowledge. It will be essential reading for anyone working with children, or concerned with policies around children and families. It was also be of interest to students at undergraduate and postgraduate levels across a range of professional and practitioner groups, as well as parents and policy makers.
Bringing together two topics of wide and growing sociological interest, The Body, Childhood and Society examines how children’s bodies are constructed in schools, families, courts, hospitals and in film. Recognising that children’s bodies are a target for adult practices of social regulation, the contributors show that children are also active in their construction, employ them in resistance and social action, and generate their own meanings about them. The editor, a leading sociologist of childhood, draws out the theoretical implications of this work, indicates the limits of social constructionism, and suggests new ways of thinking about the hybrid of material, discursive and collective processes involved. It will be a valuable text for social scientists interested in the body, childhood, schooling, the law, medicine and health.
The role of children's agency in the socio-cultural reproduction of educational inequality is mostly overlooked by quantitative research in education. This is problematic because a potentially important source of variance in children's educational success is not included in the analyses. Childhood Studies offers different ways to conceptualise children's agency. To address the role of children's agency in educational inequality, the authors outline a conceptual framework that merges socio-cultural reproduction theory following Bourdieu with the idea of children's agency. Using quantitative data on elementary school children and their parents, the authors ask how children contribute to the reproduction of educational inequality. They explore the links between children's dispositions towards school, their out-of-school practices and social class, and they discuss the implications of their findings for investigating children's agency in both Childhood Studies and educational research. © 2016 Florian Esser, Meike S. Baader, Tanja Betz and Beatrice Hungerland. All rights reserved.
This volume offers a theoretical and practical overview of the ethics of pediatric medicine. It serves as a fundamental handbook and resource for pediatricians, nurses, residents in training, graduate students, and practitioners of ethics and healthcare policy. Written by a team of leading experts, Pediatric Bioethics addresses those difficult ethical questions concerning the clinical and academic practice of pediatrics, including an approach to recognizing boundaries when confronted with issues such as end of life care, life-sustaining treatment, extreme prematurity, pharmacotherapy, and research. Thorny topics such as what constitutes best interests, personhood, or distributive justice and public health concerns such as immunization and newborn genetic screening are also addressed.
Childhood faces humanity with its own deepest and most perplexing questions. An ethics that truly includes the world's childhoods would transcend pre-modern traditional communities and modern rational autonomy with a postmodern aim of growing responsibility. It would understand human relations in a poetic rather than universalistic sense as openly and interdependently creative. As a consequence, it would produce new understandings of moral being, time, and otherness, as well as of religion, rights, narrative, families, obligation, and power. Ethics in Light of Childhood fundamentally reimagines ethical thought and practice in light of the experiences of the third of humanity who are children. Much like humanism, feminism, womanism, and environmentalism, Wall argues, a new childism is required that transforms moral thinking, relations, and societies in fundamental ways. Wall explores childhood's varied impacts on ethical thinking throughout history, advances the emerging interdisciplinary field of childhood studies, and reexamines basic assumptions in contemporary moral theory and practice. In the process, he does not just apply ethics to childhood but applies childhood to ethics - in order to imagine a more expansive humanity. © 2010 by the Georgetown University Press. All rights reserved.
The idea of children's agency is central to the growing field of childhood studies. in this book David Oswell argues for new understandings of children's agency. He traces the transformation of children and childhood across the nineteenth, twentieth and early twenty-first centuries and explores the dramatic changes in recent years to children's everyday lives as a consequence of new networked, mobile technologies and new forms of globalisation. The author reviews existing theories of children's agency as well as providing the theoretical tools for thinking of children's agency as spatially, temporally and materially complex. With this in mind, he surveys the main issues in childhood studies, with chapters covering family, schooling, crime, health, consumer culture, work and human rights. This is a comprehensive text intended for students and academic researchers across the humanities and social sciences interested in the study of children and childhood.
The capacity of children to act as agents is being increasingly recognized and has important implications for health research and practice. However, there are various discrepancies in how children's agency is defined in the literature. The aim of this analysis was to examine the concept of children's agency within the health-related literature, using Rodgers evolutionary method. The following questions were addressed: How did the concept of agency become associated with children in the health-related literature? What are the sociocultural and legal contexts that surround the concept of children's agency? What is the meaning of children's agency? Forty-five articles were included in the analysis. An inductive approach was used to identify the attributes of children's agency as well as the temporal, disciplinary, and paradigmatic trends in its conceptualization. The concept of children's agency first appeared in the health literature in the 1980s and was defined as an ability children could gradually develop. Later on, children's agency was used to refer to the capacity of all children to influence their own and others' health-care needs and is now increasingly used to refer to children as active agents who reflect on and construct their social worlds.
Is there a sense in which interpretation is essential to explanation in the sciences of man? The view that it is, that there is an unavoidably “hermeneutical” component in the sciences of man, goes back to Dilthey. But recently the question has come again to the fore, for instance, in the work of Gadamer,1 in Ricoeur’s interpretation of Freud,2 and in the writings of Habermas.3
Résumé
L'auteur s'interroge sur l'importance des normes non formalisées dans les systèmes normatifs institutionnalisés. Il conteste l'approche réductrice du positivisme institutionnel, qui distingue le droit du non juridique par le critère de la source et qui privilégie en fait un modèle particulier de norme: la proposition formalisée émanant d'un organe législatif. L'auteur propose plutôt une typologie combinant le mode d'élaboration des normes et la manière dont on en extrait la signification. Dans cette optique plus sociologique, la question de la source du droit devient un problème d'argument et la fonction d'une norme n'apparaît plus fondamentalement affectée par sa formulation explicite dans une loi. S'il est vrai que la naissance d'institutions spécifiquement chargées d'appliquer la loi oriente la recherche normative vers les normes explicites formulées par ces institutions, il reste que, d'un point de vue dynamique, seules les nonnes implicites et "inférentielles" sont réellement normatives.
This paper considers the agency of children moving to the streets of Accra, Ghana's capital city. A much used but largely unexamined concept, agency is nevertheless commonly deployed in childhood studies as a means to stress the capacity of children to choose to do things. In the literature on street and working children, and a cognate area of study concerned with children's independent migration, this has involved accounts of children's agency made meaningful by reference to theories of rational choice or to the normative force of childhood. It is our argument that both approaches leave unanswered important questions and to counter these omissions we draw upon the arguments of social realists and, in particular, the stress they place on vulnerability as the basis for human agency. We develop this argument further by reference to our research with street children. By drawing upon the children's accounts of leaving their households and heading for Accra's streets, it is our contention that these children do frame their departures as matters of individual choice and self-determination, and that in doing so they speak of a considerable capacity for action. Nevertheless, a deeper reading of their testimonies also points to the children's understandings of their own vulnerability. By examining what we see as their inability to be dependent upon family and kin, we stress the importance of the children's perceptions of their vulnerability, frailty and need as the basis for a fuller understanding of their agency in leaving their households.
Agency is a conceptual problem for youth studies. While the term is used in many analyses of young people's lives, this paper argues that the nature and conceptual meaning of agency remain ambiguous: agency is a ‘black box’ which while fundamental to youth sociology remains unpacked. Ontological and epistemological confusion about the concept means that appeals to agency in contemporary youth sociology beg the very questions they claim to answer. Nevertheless, the concept has become central to the conceptual and political basis of youth research, coming to stand for practices that are ‘bounded’ by structures and resist existing states of affairs. This limits the explanatory power of theoretical frameworks in youth studies, and does not serve the ethical commitments of a politically engaged discipline. Identifying conceptual and normative problems raised by the way agency is deployed, this paper argues that a conceptually powerful and politically engaged youth sociology must move beyond the problem of agency as it stands, and incorporates theoretical perspectives on youth subjectivities and social action that indicate possibilities for how this might take place.
Child-headed households (CHHs), in which adults or guardians are either absent or not fully functioning in terms of providing for the material and emotional needs of children, have been largely explored through a coping strategies approach. These studies emphasise the ability of children and young people to exert agency in the face of adversity, typically casting them as extraordinary survivors. This perspective continues to drive social interventions with CHHs, which take less account of how children and young people themselves make sense of their daily lives. Drawing on ethnographic research with 11 CHHs in Zambia (2004–2008), this article theoretically extends notions of agency by moving beyond an approach which considers the agency of children and young people in CHHs as inherently connected with coping, resilience and competency. It introduces the concept of ‘everyday agency’, not to offer a new view of agency, but to convey a picture of daily life in CHHs from the vantage points of children and young people living in them, and considers the implications of this standpoint for social interventions.
Providing empirical evidence of young people's experiences of survival and coping in eastern Democratic Republic of Congo (DRC), this article draws on elements of resilience theory and presents narratives offered by young people on how they survive and cope with violence and adversity. Exploring individual accounts of coping and survival, this article reveals how far removed international rights-based child protection approaches are from the actual lived realities of young people in eastern DRC. The aim of this article is to challenge child protection actors to deepen their understandings of the socio-economic adversity and structural violence in which young people live towards the development of more relevant interventions which might more effectively contribute to improved outcomes for young people living in contexts of protracted violence.
The principal aim of this investigation was to help develop ‘Interdisciplinary Studies of Childhood Ethics’ as a new field of inquiry. We identified: (i) current intra-disciplinary and interdisciplinary knowledge gaps in childhood ethics; and (ii) priorities for future research and development. A prominent problem, highlighted within and across disciplines, relates to how the best interests standard should be reconciled with the recognition of children as agents. This project makes an innovative contribution by promoting the development of interdisciplinary childhood ethics knowledge and standards, informing future improvements in childhood research and services.
Children are increasingly described as agents and agency is important to arguments for children’s rights and participation. Yet agency is rarely defined or theorised in childhood studies. This article reviews common uses and meanings of agency and argues that critical, social conceptualisations have yet to be extensively taken up in childhood studies but offer much to the field. Based on the work of Giddens, his critics and feminist theory, I propose a model of agency that is more ambivalent than that usually presented in childhood studies. Given the conventional emphasis of agency on articulation, rationality and strategy, a failure to incorporate a critical, embodied, engendered, material account of agency into childhood studies risks reinscribing a model in which privileged children will be accorded more agency than those who do not display rationality and choice in conventional ways.
Emerging evidence indicates that critically ill children are particularly at risk for incurring significant psychological harm. Little is known about these children's actual experiences.
The aim of the study was to examine children's experience of critical illness. The research question was: What are a critically ill child's sources of discomfort and comfort?
Interpretive phenomenology was selected as the study's method. Children's accounts were examined to identify what they considered meaningful, in terms of their experienced discomfort and comfort. Data sources included formal and informal interviews with child-participants, drawings provided by some participants, and field-notes documenting observed non-verbal data.
Twelve children were enrolled in the study, ranging from 3 to 17years of age; including four girls and eight boys.
Although all participants were able to discuss the discomfort and comfort they experienced, they reported difficulties in remembering part or most of their experience. Some participants characterized their Pediatric Intensive Care Unit stay quite favourably or as "not that bad", while some described their experience unfavourably. Diverse types of discomforts were reported, including fears and worries, hurt and pain, invasive interventions, missing significant people, noise, food or eating problems, boredom, physical symptoms, as well as four additional discomforts reported by individual participants. Several sources of comfort were described, including parents, visitors and friends, hospital staff (principally nurses), stuffed animal/favourite blanket, entertainment and play, food, selected medical interventions, thinking of going home, being able to walk or run, sleep, waking up, gifts, along with two other comforts reported by individual participants. Embodiment and a tension between aloneness and being with were identified as the principal phenomena underlying these children's experiences.
The findings complement existing knowledge regarding the psychological impact of critical illness by highlighting how children regard specific phenomena as discomforting or comforting. This sheds light on future directions for practice and research development in pediatric critical care.
Hermeneutics, also referred to as interpretive phenomenology, has led to important contributions to nursing research. The philosophy of Charles Taylor has been a major source in the development of contemporary hermeneutics, through his ontological and epistemological articulations of the human sciences. The aim of this paper is to demonstrate that Taylor's ideas can further enrich hermeneutic inquiry in nursing research, particularly for investigations of ethical concerns. The paper begins with an outline of Taylor's hermeneutical framework, followed by a review of his key ideas relevant for ethics research. The paper ends with a discussion of my empirical research with critically ill children in Canada and France in relation to Taylor's ideas, chiefly Social Imaginaries. I argue that Taylor's hermeneutics provides a substantive moral framework as well as a methodology for examining ethical concerns.
We consider the problem of reconciling the two commitments to hear a child and to promote a child's best interests by identifying the principal issues at stake and illustrating them by reference to legal decision-making in the domains of health in the United Kingdom and custody and child protection in Norway. We agree that a child's views are not authoritative but dispute Harry Brighouse's claim that they are only of consultative value, affirming the fundamental right of a child capable of expressing a view of doing so and of thereby participating in the procedures where decisions affecting his or her interests are made. In conclusion we offer a checklist of questions that need to be asked about the way in which jurisdictions combine their explicit commitments to the two principles of best interests and hearing the child's views.
Originally proposed in 1975, the transactional model has become central to understanding the interplay of nature and nurture in explaining the development of positive and negative outcomes for children. Although scientists have long acknowledged that nature and nurture work together in producing positive or negative developmental outcomes, such cooperation has been difficult to demonstrate because of inadequate conceptual models, experimental designs, or statistical methodologies. This book documents the state-of-the-art research in developmental psychology for overcoming these inadequacies and presents new ideas for future work. The book is divided into five parts. Part I introduces the transactional model and designs for transactional research. Parts II and III focus on the predictive power of the transactional model and the many social settings that contribute to child progress. Part II specifically examines the relations between infants and children and their parents, focusing on the relationship between child characteristics and behaviors and parents' child-rearing beliefs and behaviors. Part III broadens the perspective on child development to include the effects of the interplay among children and parents, neighborhood, school, ethnic, and socioeconomic environments. Parts IV and V discuss new directions in transactional psychology and examine the idea of the transaction itself. The overall result is a comprehensive examination of the transactional model with a focus on practical implications for how children grow and develop. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Anthropological attention to children and childhoods has had an uneven but lengthy history, both within the discipline and in interdisciplinary endeavors. Recently, there has been a resurgence of interest in the study of children, with work often carried out under the rubrics of “Childhood Studies” or the “Anthropology of Childhoods.” In these frameworks, children are at once developing beings, in possession of agency, and to varying degrees vulnerable. It has been a hallmark of anthropological work to recognize that these attributes manifest themselves in different times and places, and under particular social, political, economic, and moral circumstances and conditions. The five articles in this “In Focus” put forward some key challenges and opportunities for the anthropological study of children and childhoods.
This paper integrates the worlds of Harry Potter and civil liability, in the context of exploring the ways in which the integrity of young people - their sense of self - deserves both respect and protection. By intertwining the two realms, each structured by its particular norms and narratives, the exploration emphasises the intricate connections among personal vulnerability, dignity and autonomy. Notions central to an understanding of the individual in the private law of civil liability, these aspects of the individual are just as firmly situated in Harry Potter. Thus, as the books illustrate how people, institutions and experiences shape the period that leads from childhood to adulthood, they reveal a complex yet necessary coexistence of dependence and self-reliance. So too, when the law deals with decision-making by young people, the difficulties with assuming or requiring autonomy against a backdrop of adolescence are stark. Often hidden from view in legal, as opposed to literary, narrative, the necessary tension between individual vulnerability and independence - given contour by the relationships in which the young person participates - is brought to light by bringing together the stories of Harry Potter with those of adolescent decision-making in law.
The need for a holistic general model for the design, implementation, and interpretation of studies on specific psychological issues is motivated by the circumstances that an individual functions as an indivisible, integrated organism and develops in a dynamic, complex process of change from birth to death in continuous interaction with the environment. The holistic approach has the following consequences: Strict consideration to the basic principles of developmental change–transformation with novelty and emergence, functional interaction, organization, and integration. The maintenance of a close link between the characteristic features of the target phenomena and the research strategy and methodological tools being applied in each specific case– the application of the appropriate measurement model.
Keywords:
basic principles;
individual development;
interactionistic holism;
measurement models;
research strategies