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"Mackenzie, Catriona"
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The Systemic Inflammatory Response Syndrome and Predictors of Infection and Mortality in 1068 Critically Ill Newborn Foals
Abstract
Background
Sepsis has been defined in humans as the concurrent proven or suspected presence of microbial infection and the systemic inflammatory response syndrome (SIRS). Sepsis is the leading cause of morbidity and mortality in neonatal foals. The clinical utility of using SIRS or its individual components to predict infection and mortality in critically ill foals is currently unknown.
Objectives
Assess the ability of history and signalment, clinical findings, laboratory results, and SIRS-related indices to predict infection and mortality in critically ill foals.
Animals
Retrospective, multi-center, cross-sectional study using a convenience sample of 1068 critically ill foals < 3 days of age admitted to 16 veterinary referral hospitals in 4 countries.
Methods
Data were retrieved from medical records. Infection was defined as the presence of bacteremia (positive blood culture) or clinical identification of an infected focus on admission. Univariate non-parametric and categorical methods, multivariate logistic regression, and classification tree methods were used for statistical analysis.
Results
Foal age at admission and presence of toxic neutrophils were independent predictors of infection, whereas SIRS-related indices were not predictive of infection. In-hospital mortality was 24%. Independent predictors for mortality were hypokinetic pulses, cold extremities, presence of seizures, blood L-lactate concentration > 6.0 mmol/L, and increased serum potassium and total bilirubin concentrations.
Conclusions and Clinical Importance
The presence of infection in critically ill newborn foals was not predicted by SIRS indices. Cardiovascular dysfunction was strongly associated with mortality, suggesting that maintaining adequate perfusion and pulse pressure should be important treatment goals.
Journal Article
Autonomy, vulnerability and capacity: a philosophical appraisal of the Mental Capacity Act
The UK Mental Capacity Act provides an important legislative framework for protecting persons who are vulnerable, by virtue of partial or total lack of capacity, from abuse, coercion, exploitation, disrespect or unwarranted intrusions on their privacy and liberty. In this article we argue, however, that in order to effectively implement the Act's governing principles and promote the autonomy of persons whose capacities are impaired, health and social welfare professionals must go beyond a primarily cognitive approach to capacity assessment and refer to a range of more demanding autonomy conditions relating to authenticity, diachronic coherence and consistency, accountability to others, and affective attitudes towards oneself. We suggest that these conditions are in fact implicit in the guidelines, scenarios and practical advice contained in the Act's accompanying Code of Practice. To ground our analysis, we discuss two cases of end-of-life decision-making, and consider how these cases might have been assessed had the Mental Capacity Act been applied. We also address the question of whether the conditions for autonomy we identify raise the bar too high to be met by persons who are vulnerable because their capacity is partially compromised.
Journal Article
The Empathy Dilemma: Democratic Deliberation, Epistemic Injustice and the Problem of Empathetic Imagination
One of the challenges facing complex democratic societies marked by deep normative disagreements and differences along lines of race, gender, sexuality, culture and religion is how the perspectives of diverse individuals and social groups can be made effectively present in the deliberative process. In response to this challenge, a number of political theorists have argued that empathetic perspective-taking is critical for just democratic deliberation, and that a well-functioning democracy requires the cultivation in citizens of empathetic skills and virtues. In this paper, we begin by distinguishing several kinds of imaginative projection and corresponding kinds of empathy. On the basis of this analysis, we suggest that genuine empathetic perspective-taking, especially across gendered, racial and embodied differences, is more challenging than is often assumed in the literature. This poses a dilemma for theorists who place great store on the role of empathetic imagination to overcome the challenges of democratic deliberation. On the one hand, placing responsibilities for empathetic perspective-taking primarily on the socially privileged raises risks of inaccurate and inappropriate projection. On the other hand, mitigating the risks of projection by calling on the socially marginalised to articulate their experiences and feelings in a way that can engage the imagination of the socially privileged, risks perpetuating epistemic injustice. We suggest that while this dilemma may be difficult to overcome, its effects can nevertheless be mitigated through both the cultivation of individual deliberative virtues and pragmatic institutional responses.
Journal Article
Why bioethics needs a concept of vulnerability
Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis.
Journal Article
Emotions, Imagination, and Moral Reasoning
This volume brings together philosophical perspectives on emotions, imagination and moral reasoning with contributions from neuroscience, cognitive science, social psychology, personality theory, developmental psychology, and abnormal psychology.
The book explores what we can learn about the role of emotions and imagination in moral reasoning from psychopathic adults in the general community, from young children, and adolescents with callous unemotional traits, and from normal child development. It discusses the implications for philosophical moral psychology of recent experimental work on moral reasoning in the cognitive sciences and neurosciences. Conversely, it shows what cognitive scientists and neuroscientists have still to learn from philosophical perspectives on moral reasoning, moral reflection, and moral responsibility. Finally, it looks at whether experimental methods used for researching moral reasoning are consistent with the work in social psychology and with philosophical thought on adult moral reasoning in everyday life.
The volume's wide-ranging perspectives reflect the varied audiences for the volume, from students of philosophy to psychologists working in cognition, social and personality psychology, developmental psychology, abnormal psychology, and cognitive neuroscience.
eBook
Neurotechnologies, Relational Autonomy, and Authenticity
The ethical debate about neurotechnologies has been largely framed around their effects on authenticity. In this paper, we investigate the concept of authenticity and associated conceptions of the self. We develop a conception of authenticity that eschews problematic essentialist or existentialist views of the self and the assumption that the authentic self transcends socialization. In our view, authenticity is a condition for self-governance and can involve either endorsement or acknowledgment. Revisiting the debate about neurotechnologies, we show why framing the ethical debate in terms of authenticity is unhelpful and argue that these ethical concerns are better understood as concerns about autonomy.
Journal Article
Nussbaum, Kant, and the Capabilities Approach to Dignity
The concept of dignity plays a foundational role in the more recent versions of Martha Nussbaum's capabilities theory. However, despite its centrality to her theory, Nussbaum's conception of dignity remains under-theorised. In this paper we critically examine the role that dignity plays in Nussbaum's theory by, first, developing an account of the concept of dignity and introducing a distinction between two types of dignity, status dignity and achievement dignity. Next, drawing on this account, we analyse Nussbaum's conception of dignity and contrast it with Kant's conception of dignity. On the basis of this comparison between Nussbaum and Kant, we highlight tensions between Nussbaum's Aristotelianism, which is central to her conception of dignity, and her commitment to political liberalism. This leads us to conclude that Nussbaum's claim that her conception of dignity is only a partial political conception is implausible and that her conception of dignity seems to commit her to a satisficing form of perfectionist liberalism.
Journal Article
Narrative Integration, Fragmented Selves, and Autonomy
In this paper we defend the notion of narrative identity against Galen Strawson's recent critique. With reference to Elyn Saks's memoir of her schizophrenia, we question the coherence ofStrawsons conception of the Episodic self and show why the capacity for narrative integration is important for a flourishing life. We aho argue that Scú< s's case and reflections on the therapeutic role of u illness nanatives }> put pressure on narrative theories that specify unduly restncúve constraints on self-constituting narratives, and chrify the need to distinguish identity from autonomy.
Journal Article