Canada and California each introduced legislation to permit medical assistance in dying in June, 2016. Each jurisdiction publishes annual reports on the number of deaths that occurred under their respective legislations in the previous years. The numbers are disturbingly different. In 2021, 486 individuals died under California’s End of Life Option. In the same year 10,064 Canadians died under that country’s Medical Assistance in Dying (MAiD) legislation. California has a slightly larger population than Canada, and while medically assisted deaths as (...) a percentage of total deaths remained virtually unchanged in California from 2020-2021, Canada saw a 30% increase from 2020 to 2021. This essay examines some of the factors propelling Canada down the slippery slope of medically assisted suicide, as well as those that may be keeping California and other US jurisdictions from taking the slide. At a time of increasing pressure in many jurisdictions (both nationally and internationally) to liberalize access to medical assistance in dying, some lessons from this comparative analysis are offered. (shrink)

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we (...) consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. (shrink)

Inasmuch as unmitigated pain and suffering areoften thought to rob human beings of theirdignity, physicians and other care providersincur a special duty to relieve pain andsuffering when they encounter it. When pain andsuffering cannot be controlled it is sometimesthought that human dignity is compromised.Death, it is sometimes argued, would bepreferred to a life without dignity.Reasoning such as this trades on certainpreconceptions of the nature of pain andsuffering, and of their relationships todignity. The purpose of this paper is to laybare these (...) preconceptions. The duties torelieve pain and suffering are clearly mattersof moral obligation, as is the duty to respondappropriately to the dignity of other persons.However, it is argued that our understanding ofthe phenomena of pain and suffering and theirrelationships to human dignity will be expandedwhen we explore the aesthetic dimensions ofthese various concepts. On the view presentedhere the life worth living is both morally goodand aesthetically beautiful. Appropriate``suffering with'''' another can help to maintainand restore the dignity of the relationshipsinvolved, even as it preserves and enhances thedignity of patient and caregiver alike. (shrink)

This paper explores the problem of universalism and particularism in contemporary ethics, and its relationship to Christian bioethics in particular. An ethic of human dignity is outlined, which, it is argued, constrains moral discourse in the broad sense – thus meeting the demands of universalism – but which is at the same time amenable to a variety of particularist interpretations – thus acknowledging the current shift toward historicism, traditionalism, and culture. The particularist interpretations that are of central concern here are (...) those provided by historic Christianity. The eventual goal is to indicate how a Christian conception of human dignity can have universal normative relevance both as a standard against which to assess competing particularist conceptions, and as a practical guide for everyday living. A Christian conception of dignity will in turn have significant implications when addressing contemporary issues in bioethics. These are ambitious goals, and a full explication of the ideas presented will not be possible in this context. Nevertheless, there is value in getting a bird's-eye view of the landscape before one goes about scaling the mountains and exploring the valleys. The present essay is intended as a general geography of the moral terrain in which an ethic of dignity in general, and a Christian perspective on dignity in particular, can provide normative guidance. (shrink)

I want to begin this brief response by thanking all of those who took the time to read and reflect upon this piece. There were many thoughtful and thought provoking responses and I have learned fro...

BackgroundWhile genomic data sharing can facilitate important health research and discovery benefits, these must be balanced against potential privacy risks and harms to individuals. Understanding public attitudes and perspectives on data sharing is important given these potential risks and to inform genomic research and policy that aligns with public preferences and needs.MethodsA cross sectional online survey measured attitudes towards genomic data sharing among members of the general public in an Eastern Canadian province.ResultsResults showed a moderate comfort level with sharing genomic (...) data, usually into restricted scientific databases with controlled access. Much lower comfort levels were observed for sharing data into open or publicly accessible databases. While respondents largely approved of sharing genomic data for health research permitted by a research ethics board, many general public members were concerned with who would have access to their data, with higher rates of approval for access from clinical or academic actors, but much more limited approval of access from commercial entities or governments. Prior knowledge about sequencing and about research ethics boards were both related to data sharing attitudes.ConclusionsWith evolving regulations and guidelines for genomics research and data sharing, it is important to consider the perspectives of participants most impacted by these changes. Participant information materials and informed consent documents must be explicit about the safeguards in place to protect genomic data and the policies governing the sharing of data. Increased public awareness of the role of research ethics boards and of the need for genomic data sharing more broadly is also needed. (shrink)

Historically the primary role of the Institutional Review Board (IRB) has been "to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in research" (U.S. FDA, 1996). However, there is much to suggest that IRBs have been unable to fulfil this mandate, particularly in regard to the matter of informed consent. Part of the problem in this regard is that the competing interests of other stakeholders (...) often undermine the IRB's capacity to serve the best interests of research subjects. This paper proposes an alternative view of the role of the IRB. It begins by treating the interests of other stakeholders as legitimate matters of concern for IRBs. Hence the process established to review and monitor human research should be treated as an exercise in social justice in which the interests of all legitimate stakeholders must be represented and considered. A variation of Rawls' (1971) heuristic "the veil of ignorance" is employed to explore the dynamic relationship between knowledge and interests that ensues when the role of the IRB is characterized in this manner. Inadequacies in the informed consent process are taken as illustrative of the inability of IRBs as they are presently construed to attend to the interests of research subjects. The major normative implication of the analysis offered here is that the role of the IRB must be expanded to include the granting of a provisional proxy consent on behalf of prospective research subjects. This provision is necessary, it is argued, if the interests of research subjects are to be fairly assessed by IRBs as a matter of social justice. It is necessary as well to ensure that an adequate standard of informed consent is attained. Somewhat paradoxically it is argued competing sets of interests the IRB must serve, rather than as the primary concern of the IRB. (shrink)

The author examines fundamental problems involved in teaching applied ethics in the educational environment of contemporary university culture. American universities are increasingly turning away from liberal arts education and focusing their efforts on constructing more professionalized degrees and programs. As a result, the education process has become increasingly commodified and ethics courses in universities have been further removed from the liberal arts project of moral development in the classroom. The author argues that ethicists should work to reframe the project of (...) moral education if they hope to retain a central role in the process of teaching ethics. The author suggests a growth model to be installed in the undergraduate curriculum that would reacquaint students with the aims and benefits of learning ethical and moral philosophy. (shrink)

This chapter contains sections titled: Introduction Human DNA as Cultural Property The Genetic Appropriation of Culture Community Identity, Cultural Offense and Control of Genetic Information Conclusion References.

Feticide, the practice of terminating the life of an otherwise viable fetus in utero, has become an increasingly common practice in obstetric centres around the globe, a concomitant of antenatal screening technologies. This paper examines this expanding practice in light of the concept of human dignity. Although it is assumed from the outset that even viable human fetuses are not persons and as such do not enjoy full membership in the moral community, it is argued that the fact that these (...) are nevertheless human fetuses affords them prima facie moral status. Thus even those who accept a liberal position with regard to therapeutic abortion, should be concerned about these more recent developments. Indeed, how we treat viable human fetuses has implications for our prospective treatment of other human non-persons and could undermine the common human dignity we all share. (shrink)

Narrative theory is a dynamic and evolving field of inquiry that has made tremendous inroads in the medical humanities over the past 40 years. Numerous authors have popularized the idea that “thinking narratively” can produce important insights about the illness experience for physician and patient alike. This paper draws on aspects of narrative theory to emphasize the moral responsibilities that arise when we step into another person's life narrative, becoming a character in her or his story. This has especially significant (...) ethical implications for the physician–patient encounter in that each character in this shared story experiences time somewhat differently. This gives rise to the notion of “slow motion ethics” and a somewhat unique perspective on the moral responsibilities clinicians bear toward their patients. (shrink)

BackgroundIn 2009, Dr. Paolo Zamboni proposed chronic cerebrospinal venous insufficiency (CCSVI) as a possible cause of multiple sclerosis (MS). Although his theory and the associated treatment (“liberation therapy”) received little more than passing interest in the international scientific and medical communities, his ideas became the source of tremendous public and political tension in Canada. The story moved rapidly from mainstream media to social networking sites. CCSVI and liberation therapy swiftly garnered support among patients and triggered remarkable and relentless advocacy efforts. (...) Policy makers have responded in a variety of ways to the public’s call for action.DiscussionWe present three different perspectives on this evolving story, that of a health journalist who played a key role in the media coverage of this issue, that of a health law and policy scholar who has closely observed the unfolding public policy developments across the country, and that of a medical ethicist who sits on an expert panel convened by the MS Society of Canada and the Canadian Institutes of Health Research to assess the evidence as it emerges.SummaryThis story raises important questions about resource allocation and priority setting in scientific research and science policy. The growing power of social media represents a new level of citizen engagement and advocacy, and emphasizes the importance of open debate about the basis on which such policy choices are made. It also highlights the different ways evidence may be understood, valued and utilized by various stakeholders and further emphasizes calls to improve science communication so as to support balanced and informed decision-making. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

Daryl Pullman (2023), seeking to slow the slide down what he sees as the slippery slope of MAID, employs an epigraph from H.L. Mencken: “For every human problem there is a solution that is simple,...

In lieu of an abstract, here is a brief excerpt of the content:Subjective Experiences of Tourette SyndromeBeyond the Premonitory UrgeThe authors report no conflicts of interest.There is an evolving recognition in healthcare that the patient's subjective experience needs to be privileged both in understanding clinical phenomena and also ensuring the salience of outcomes used to evaluate the impact of treatment interventions. This is reflected in the expansion of patient-reported outcome measures to capture a person's perception of their own health, and (...) the increasing requirement of involving people with lived experience in the co-design of research studies (National Health and Medical Research Council, 2016) and care improvement initiatives. In mental health it has been long understood that observable behavioral phenomena can only partially inform clinical understanding of the experience of the patient living with the condition. However, capturing the patient's subjective experience faithfully remains a challenge.Tourette syndrome (TS) is a complex condition in which there are clearly observable behavioral phenomena (vocal and motor tics, compulsive and socially inappropriate behaviors), but also a broad and varied range of subjective phenomena reported by different individuals. These may include sensory phenomena such as the premonitory sensory urge preceding a tic, compulsions to touch things a certain number of times or do something repeatedly until it feels "just right," or bothersome intrusive thoughts or images. To further complicate the picture most patients with TS have one or more co-occurring conditions such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, and anxiety, which may actually cause a greater burden of dysfunction and distress than the Tourette symptoms.In their paper, Curtis-Wendlandt et al. (2024) challenge the dependence of current psychiatric diagnostic criteria (e.g., the Diagnostic and Statistical Manual of Mental Disorders, 5th edition) on observable tics, and propose a broader and more dimensional approach to nosology which incorporates sensory, cognitive and affective phenomena. [End Page 47] Data from interviews they conducted identified that premonitory phenomena and urge experiences in tic disorders are more complex and diverse than what is currently reflected in the literature and clinical scales. They also interviewed participants who reported "no urges" or "no premonitory sensations." They commented that the literature generally treats reports of urge absences at face value, and does not address the likelihood that such reports may be ambiguous or problematic. Overall, they concluded that their research suggests that premonitory urges in TS are a complex and diverse phenomenon that requires further study. This reflects with our clinical experience in working with TS patients. Although a large proportion of older patients describe sensory-based premonitory urges, descriptions are not homogenous, with many describing other experiences preceding their tics.When evaluating a patient's response to an intervention (either behavioral or pharmacological) clinicians incorporate a range of information. This includes the severity of their tics (number, type, frequency, intensity, and associated impairment), as well as their mood, participation and performance in study, work, and social activities, and overall quality of life. Standard clinical practice would not typically include assessment of some of the subjective experiences which precede tics. If it was accepted that these subjective phenomena are indeed salient to the patient's well-being, then a challenge would be how to consistently and reliably capture these feelings to operationalize a comprehensive patient-centered assessment.The primary evidence-based treatment for tic disorders, comprehensive behavioral intervention for tics (CBIT), involves training to increase the awareness of premonitory urges (Woods et al., 2008). Furthermore, successful 'blocking' of tics during the course of CBIT requires the patient to be aware of premonitory urges. Clinicians having a better understanding of the complexity and diversity of experiences which precede tics, as well as using open-ended questioning styles, may assist with improving CBIT outcomes. [End Page 48]Related ArticlesFeature Article: Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette SyndromeCommentary: Priming and Narrative Habits in the Phenomenological Interview: Reflections on a Study of Tourette SyndromeCommentary: Subjective Experiences of Tourette Syndrome: Beyond the Premonitory UrgeResponse: Phenomenological Interviews and Tourette’sDaryl EfronThe Royal Children's Hospital MelbourneIvan MathiesonThe Laneway ClinicDaryl Efron Daryl Efron is a Consultant Pediatrician, Royal Children's Hospital Senior Research Fellow, Murdoch... (shrink)

In this paper, I provide an account of subjective epistemic obligations. In instances of peer disagreement, one possesses at least two types of obligations: objective epistemic obligations and subjective epistemic obligations. While objective epistemic obligations, such as conciliationism and remaining steadfast, have been much discussed in the literature, subjective epistemic obligations have received little attention. I develop an account of subjective epistemic obligations in the context of worldview disagreements. In recent literature, the notion of worldview disagreement has been receiving increasing (...) attention, and I discuss how understanding worldview disagreements through different classes of beliefs might clarify our understanding of subjective epistemic obligations. I first distinguish between three classes of beliefs, by virtue of their justificatory functions within worldviews: fundamental, crucial and incidental. I then discuss four kinds of worldview disagreements based on this account. Finally, I argue that each disagreement results in different subjective epistemic obligations for each disputant. I conclude by discussing some implications this analysis has for issues such as defeat, peerhood, and epistemic injustice. (shrink)

This paper offers a neo-Aristotelian approach to PCSR aimed at enabling us to more systematically ascertain which sorts of corporate political activities, if any, might be politically acceptable. Part 1 sketches Aristotle’s account of the “political.” Aristotelian politics have at least four key dimensions. When we speak of PCSR, we should, from this Aristotelian perspective, evaluate how specific behaviors accord with or undermine these four aspects of political life. Part 2 of the paper explores which forms of activity by corporations (...) qualify as genuinely (and thus acceptably) political within a neo-Aristotelian framework. Part 3 highlights strengths and limitations of this approach to PCSR. (shrink)

There is a large gap between attitude and action when it comes to consumer purchases of ethical food. Amongst the various aspects of this gap, this paper focuses on the difficulty in knowing enough about the various dimensions of food production, distribution and consumption to make an ethical food purchasing decision. There is neither one universal definition of ethical food. We suggest that it is possible to support consumers in operationalizing their own ethics of food with the use of appropriate (...) information and communication technology. We consider eggs as an example because locally produced options are available to many people on every continent. We consider the dimensions upon which food ethics may be constructed, then discuss the information required to assess it and the tools that can support it. We then present an overview of opportunities for design of a new software tool. Finally, we offer some points for discussion and future work. (shrink)

In the Fragment on Evil, Hume announces that he “shall not employ any rhetoric in a philosophical argument, where reason alone ought to be hearkened to.” To employ the rhetorical strategy, in the context of the Fragment, just is to “enumerate all the evils, incident to human life, and display them, with eloquence, in their proper colours.” However, in Part 11 of the Dialogues Concerning Natural Religion, Hume employs precisely this rhetorical strategy. I discuss three interpretations that might account for (...) Hume’s decision to employ the strategy in the Dialogues but not the Fragment. The heart of this discussion concerns the relationship between reason and rhetoric. The Dialogues can be understood as part of the education of Pamphilus. Consequently, the three interpretations align with three ways of understanding the roles that reason and rhetoric play in Hume’s views on pedagogy and education (or more specifically, Philo’s attitude towards the education of Pamphilus). (shrink)

Unsatisfied with an intellectual history that divides the philosophy of technology into classical and empirical approaches, the following paper suggests a renewed attention to dialectical philosophies of technology. Drawing on the work of Andrew Feenberg, I argue that dialectical philosophies of technology are not essentialist holdovers from the past, but are empirically grounded approaches that direct researchers to ask why we have the technologies we do. From this, dialectical philosophies of technology open up ways to think about technology that prioritize (...) the tension between the sociotechnical world as it is and concrete potentials of what it could be. Contrasting this against postphenomenology, I argue that avoiding these moments of potential can lead to a conservative and paternalistic philosophy of technology that fixes sociotechnical agency to a professional class of designers, engineers, and policy makers. I conclude by suggesting that Feenberg's dialectical philosophy of technology presents a modest alternative to the design imperatives that now guide the trajectory of postphenomenology. (shrink)

This paper explores possible connections between gender and the willingness to tolerate unethical academic behavior. Data from a sample of 285 accounting majors at four public institutions reveal that females are less tolerant than males when questioned about academic misconduct. Statistically significant differences were found for 17 of 23 questionable activities. Furthermore, females were found to be less cynical and less often involved in academic dishonesty. Overall, the results support the finding of Betz et al. (1989) that the gender socialization (...) approach dominates the structural approach. (shrink)

Wennemann argues that the traditional concept of personhood may be fruitfully applied to the ethical challenge we face in a posthuman age. The book posits that biologically non-human persons like robots, computers, or aliens are a theoretical possibility but that we do not know if they are a real possibility.

It is widely accepted among Mencius scholars that for Mencius, the junzi 君子 is the kind of person who accepts Heaven’s will and never resents Heaven. There are, however, several passages where resentment seems to be presented as a quality that the junzi possesses. In particular, Mencius 2B13 has been the subject of much contention. In Section 1, I will discuss various interpretations of 2B13, building on and updating Philip Ivanhoe’s helpful 1988 survey. In Section 2, I will present an (...) argument for resentment against Heaven in the Mencius. I argue from passages in the Mencius and its relationship with the Shijing 詩經 that we have good reason to think that, under certain circumstances, the junzi ought to resent Heaven. In Section 3, I will develop a theory of resentment from the Mencius and demonstrate how 2B13 can be understood in the larger context of this theory. (shrink)

Did Shakespeare read Plato? The evidence suggests that Shakespeare not only read Plato, but also consulted him as though he possessed wisdom of the highest sort. With a focus on comparing the Phaedo and Symposium to Timon of Athens, I show that Shakespeare’s genius is at least in part due to his uncanny ability to transform Platonic wisdom into fully realized dramatic action. Previous attempts at interpreting the play have overlooked the extent to which Timon of Athens mirrors Socratic warnings (...) against flattery, sophistry, and uncivil philosophy. (shrink)

In the Fragment on Evil, Hume announces that he “shall not employ any rhetoric in a philosophical argument, where reason alone ought to be hearkened to.” To employ the rhetorical strategy, in the context of the Fragment, just is to “enumerate all the evils, incident to human life, and display them, with eloquence, in their proper colours.” However, in Part 11 of the Dialogues Concerning Natural Religion, Hume employs precisely this rhetorical strategy. I discuss three interpretations that might account for (...) Hume’s decision to employ the strategy in the Dialogues but not the Fragment. The heart of this discussion concerns the relationship between reason and rhetoric. The Dialogues can be understood as part of the education of Pamphilus. Consequently, the three interpretations align with three ways of understanding the roles that reason and rhetoric play in Hume’s views on pedagogy and education (or more specifically, Philo’s attitude towards the education of Pamphilus). (shrink)

Dormandy argues that stubborn counterevidence provides a reason for Evidentialists to form negative beliefs about God. Focusing on ‘horrendous evils’ as a kind of stubborn counterevidence, I discuss two possible interpretations of Dormandy’s account (a stronger and a weaker view). Against the stronger view, I consider the case of a Committed Theistic Evidentialist, that is, an evidentialist who possesses a defeater belief against horrendous evils. I argue that it would be improbable that she would form negative beliefs about God on (...) the basis of horrendous evils alone. I consider the response of a Committed Theistic Evidentialist towards horrendous evils, arguing that for her, ‘honesty’, which results in a psychological struggle, is an excellent-making property of her faith. (shrink)

Every year thousands of computers deemed obsolete by companies upgrading to newer models are kept out of landfills by organizations like World Computer Exchange 1 which recycle them to schools in developing countries. It is possible to set up at a very low cost, clusters of recycled PCs, using Linux software to substantially reduce the cost of establishing school‐based community Internet centers. In the case of such an implementation in Goa, India by a WCE partner‐NGO the key to its success (...) has been collaboration between the NGO and the private sector to encourage the growth of local Linux support skills and with the government sector ‐ the Goa State Education Department ‐ to ensure the acceptance of Linux in the curriculum, and the provision of teacher training. The Goa Schools Computers project 2 project provides an example of how low initial costs of infrastructure and linkages between different stakeholders can result in cost savings of up to 60% over a conventional community Internet center thereby increasing their chances for financial viability. (shrink)