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INTRODUCTION: We are reporting the case of a 64-year-old patient with chronic cough who has been diagnosed with an intercostal hernia with pleural and hepatic content associated with a diaphragmatic hernia of non-traumatic origin. CASE REPORT: The patient was treated for an acutely febrile cough with signs of respiratory distress. Thoracic scan showed an intercostal hernia containing an encysted hematoma and a right anterior diaphragmatic hernia with epiploic content. The COVID PCR was negative. This is one of the rare reported cases of intercostal hernia associated with a homolateral diaphragmatic rupture. Visceral and thoracic surgery enabled treatment of the two hernial orifices by raphy as well as omentectomy of the necrotic omentum ascending to the right pulmonary hilum. CONCLUSION: These two parietal complications of chronic cough should be considered in case of intercostal flap or acute respiratory distress. Surgery must then be carried out as a matter of urgency to reduce the content of the hernias and treat the musculoaponeurotic dehiscent orifices.

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Multiple gestations, or multifetal pregnancies, raise a number of significant policy questions concerning the well being of women and the well being of the children fetuses might become. Important questions for feminists pertain not only to multifetal pregnancy itself, but also to the medical interventions associated with these pregnancies. In this paper, we address the questions of how many embryos should be transferred in assisted reproduction, how many fetuses should remain in a multiple gestation, who should make these decisions, and the need to protect women from overexposure to exogenous hormones. Although we focus on assisted reproduction in the United States, we believe that our suggestions are applicable to other countries where the technology is comparable.

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PIP: This article responds to two papers: one describing and defending the intracardiac injection of potassium chloride (KCl) to achieve immediate cardiac arrest in fetuses destined for second-trimester abortion because of abnormalities and a second, accompanying, paper that replies to objections to KCl injection and presents positive arguments for the use of KCl. This response concurs with the moral acceptability of the use of KCl and goes further to argue for its use in late elective abortions of nonanomalous fetuses. The response, however, while agreeing with the conclusions of the arguments presented in the second paper, finds the reasoning set forth in the arguments to be faulty. The objections to the procedure addressed in the second paper are that all abortions are unjust, that newborns and second-trimester fetuses with identical defects should be managed in like manner, and that a woman is not entitled to the death of her fetus. The arguments presented in the second paper to defend KCl use are that the abortion decision is protected by the right to noninterference, that potential harm is avoided by the procedure, and that the potential for coercion is eliminated. Abortion is defended on the grounds that a majority supports a woman's right to choose abortion. The author of this response asserts that abortion can be defended because human fetuses are not persons and because religious commitments cannot be enforced in a pluralistic society. Furthermore, even infants who have severe anomalies need not be treated as potential persons. While a woman has no moral right to the death of her fetus, she does have the right to the safest surgical procedure and to a consideration of the short-term welfare of the fetus or the long-term welfare of children who may result from rescued fetuses. In each case, the denial of life may be the only way to minimize suffering. Even healthy fetuses can be aborted using this procedure on these grounds. Every child should be a wanted child, and until our society learns to care about the reality of a child instead of merely the idea, we have a duty to ensure a stillborn in any late abortion. While basing moral arguments on society's moral failures places ethicists in an uncomfortable position, it is harder to ignore the realities of life that suggest that children should be born only to those prepared to accommodate them.^ieng

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KIE: Callahan's paper on paternalism and involuntary psychiatric commitment of adults, with comments by Rebecca Dresser, appeared in the August 1984 issue of the Journal of Medicine and Philosophy (Vol. 9, No. 3). In this brief essay, Callahan responds to Dresser's criticisms, in particular to those directed at Callahan's proposed standards for commitment and at her discussion of the incompetence criterion.^ieng

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My purpose in this paper is to show that current legal criteria for paternalistic involuntary psychiatric confinement of the mentally ill are both too narrow and too broad. I do this by first developing a principle of justified paternalistic interference with adults, which I take to be acceptably protective of individual liberty, but which does not require unnecessary sacrifices of individual welfare. After offering an analysis of current legal criteria for involuntary confinement, I argue that an acceptable theory of paternalistic interference reveals that those criteria (1) exclude some cases where confinement would be morally permissible, and (2) allow paternalistic confinement of many whose detention is not morally justifiable.

KIE: Callahan develops a principle of justified paternalism for involuntary commitment of the mentally ill which supports a narrower definition of dangerousness, and permits a wider range of self harms to meet the standard of incompetence, than do current legal criteria. She argues that the current criteria exclude some cases where confinement would be morally permissible, while allowing paternalistic confinement of many whose detention is not justifiable.

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