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Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness.

Loss and damage is the “third pillar” of international climate governance alongside mitigation and adaptation. When mitigation and adaptation fail, losses and damages occur. Scholars have been reacting to international political discourse centred around governing actual or potential severe losses and damages from climate change. Large gaps exist in relation to understanding the underlying power dimensions, rationalities, knowledges, and technologies of loss and damage governance and science. We draw from a Foucauldian-inspired governmentality framework to argue there is an emerging governmentality of loss and damage. We find, among other things, that root causes of loss and damage are being obscured, Western knowledge and technocratic interventions are centred, and there are colonial presupposed subjectivities of Global South victims of climate change, which are being contested by people bearing the brunt of the climate crisis. We propose future directions for critical research on climate change loss and damage.

Since entry into force of the UN Framework Convention on Climate Change (UNFCCC) in 1994, negotiations on controlling future greenhouse gas emissions have turned into one of the largest development issues of our time. In February 2005, the Kyoto Protocol entered into force and 9 months later a historical first meeting of the Kyoto Protocol (COP/MOP 1) was held in Montreal side-by-side with the 11th Conference of the Parties to the UNFCCC (COP 11). After several years of stalemate, the Montreal meeting has resulted somewhat unexpectedly in a constructive outcome that has opened the door for new momentum in climate talks. Along with several key technical decisions, an agreement was reached to hold separate talks to discuss the futures of the UNFCCC and the Kyoto Protocol. This paper discusses the main outcomes of the conference and explores possible ways forward. It concludes that success in the UNFCCC process is imperative to address climate change in both developing and developed countries, even if the most effective actions are taken outside the immediate context of the legal process.