In the western healthcare, shared decision making has become the orthodox approach to making healthcare choices as a way of promoting patient autonomy. Despite the fact that the autonomy paradigm is poorly suited to paediatric decision making, such an approach is enshrined in English common law. When reaching moral decisions, for instance when it is unclear whether treatment or non-treatment will serve a child’s best interests, shared decision making is particularly questionable because agreement does not ensure moral validity. With reference (...) to current common law and focusing on intensive care practice, this paper investigates what claims shared decision making may have to legitimacy in a paediatric intensive care setting. Drawing on key texts, I suggest these identify advantages to parents and clinicians but not to the child who is the subject of the decision. Without evidence that shared decision making increases the quality of the decision that is being made, it appears that a focus on the shared nature of a decision does not cohere with the principle that the best interests of the child should remain paramount. In the face of significant pressures toward the displacement of the child’s interests in a shared decision, advantages of a shared decision to decisional quality require elucidation. Although a number of arguments of this nature may have potential, should no such advantages be demonstrable we have cause to revise our commitment to either shared decision making or the paramountcy of the child in these circumstances. (shrink)

The Anthropocene confronts environmental philosophy with one of the most urgent questions of the 21st century: How to maintain the earth’s condition in a way that allows current and future human generations to thrive? By asking such a question, ethical thought ceases to be solely a matter of individuality or morality. Instead, it raises a political issue: How can or should environmental philosophy relate to society in the Anthropocene? This article argues for a critical perspective that draws on contemporary historic (...) materialist scholars and politicises societal power relations. It exemplifies this approach by discussing key-terms of the Anthropocene discourse, like planetary boundaries, tipping points, and space-ship earth. The article concludes that the idea that “we have to act fast now” would be dangerously too easy because it ignores the ambivalent character of human-nature relations. (shrink)