Jennifer Rowland

One barrier to optimal pain management in the neonatal intensive care unit is how the healthcare community perceives, and therefore manages, neonatal pain. In this paper, we emphasise that healthcare professionals not only have a professional obligation to care for neonates in the NICU, but that these patients are intrinsically worthy of care. We discuss the conditions that make neonates worthy recipients of pain management by highlighting how neonates are vulnerable to pain and harm, and completely dependent on others for pain management. We argue for a relational account of ethical decision-making in the NICU by demonstrating how an increase in vulnerability and dependence may be experienced by the healthcare community and the neonate’s family. Finally, an ethical framework for decisions around neonatal pain management is proposed, focussing on surrogate decision-making and the importance of compassionate action through both a reflective and an affective empathy. As empathy can be highly motivating against pain, we propose that, in addition to educational programs that raise awareness and knowledge of neonatal pain and pain management, healthcare professionals must cultivate empathy in a collective manner, where all members of the NICU team, including parents, are compassionate decision-makers.

Aldo Leopold was a pragmatist in the vernacular sense of the word. Bryan G. Norton claims that Leopold was also heavily influenced by American Pragmatism, a formal school of philosophy. As evidence, Norton offers Leopold's misquotation of a definition of right (as truth) by political economist, A.T. Hadley, who was an admirer of the philosophy of William James. A search of Leopold's digitised literary remains reveals no other evidence that Leopold was directly influenced by any actual American Pragmatist or by Pragmatism (although he may have been indirectly influenced by Pragmatism early in his career). A 1923 reference, by Leopold, to Hadley and Hadley's putative definition of truth, cited by Norton, is dripping with irony. Leopold, as he matured philosophically, regarded a profound cultural shift from anthropocentric dominionism and consumerism to an evolutionary-ecological worldview and an associated non-anthropocentric 'land ethic' to be necessary for successful and sustainable conservation. Hadley espoused a brutal form of Social Darwinism and his philosophy, as expressed in the book of Hadley's that Norton cites, is politically reactionary, militaristic and unconcerned with conservation. Leopold's mature philosophy and Hadley's – far from consonant, as Norton claims – are diametrically opposed