We have a philosopher friend who was quite ill and required surgery, but she was not ill enough to be admitted to hospital under the “life, limb, and organ preservation” guidelines that control surgical admissions. Her surgeon told her to go to emergency and gave her a list of symptoms to tell the physicians there. Those, he said, would get her a bed, and he would then come and perform the necessary surgery. And that is how our friend got her (...) surgery. (shrink)

Advance directives enable individuals to project their healthcare preferences into a period of anticipated incapacity. With advance directives, individuals can designate whom they would like to have make healthcare decisions for them, or give their healthcare provider advice on what to do, or both. Canada has an unusually wide variety of legislative approaches to advance directives. In what follows we describe and evaluate these, with the aim of pointing the way toward the ideally best legislation and policies on such directives.

Canada is one of the few countries in the world—China is another—that has decriminalized abortion. In Canada, there are no legislative or judicial restrictions whatsoever on abortion: When, where, and under what circumstances abortions can be performed are all unregulated. In sharp contrast, abortion is generally illegal in South American and predominantly Catholic countries, as well as in African and Muslim countries. And the countries that do allow legal abortions, including most in Europe along with America, Australia, and Russia, typically (...) permit it only up to a certain time or make it subject to circumstances such as risk to the woman. In what follows we will first explain how Canada came to decriminalize abortion and then go on to assess that position from an ethical point of view. (shrink)

ABSTRACT Modern technology has made it uncertain as to when exactly death occurs, and this has put us in a quandary over when we can initiate behaviour traditionally deemed apt if and only if a patient is dead. In the light of this, there is general agreement that death should be redefined, but wide disagreement remains about how. I argue, against this, that it is a mistake to redefine death in any way: (1) redefining death will not help to settle (...) the question of when traditional death‐behaviour becomes appropriate, (2) any attempt to redefine death is attended with significant disutilities and no compensating utilities, and (3) the practical problems generated by the indeterminacy can be better handled in other ways. (shrink)

The recent history of the Canadian healthcare system has been increasingly one of shortages. There are delays for services that impose risk and hardship, disparities between the accessibility of healthcare for rural versus urban populations, and a lack of adequate coverage for or access to prescription drugs, diagnostic services, and homecare. Add to these problems shortages of healthcare providers—in particular, physicians and nurses—and state-of-the-art equipment, and we can understand the universal agreement that the Canadian healthcare system must change. The only (...) question is how. Some argue for modifications within the basic framework of a one-tier single-payer system; others for more radical reform that will allow for infusions of money by expedients such as user fees, extra billing, or a full-blooded second tier where one can buy any healthcare one wants. a. (shrink)

Residents in long-term care facilities and rehab hospitals sometimes ask healthcare professionals to help them do things that HCPs judge to be on balance harmful. A person with respiratory problems may ask for a cigarette, a diabetic for alcohol, a dysphagiac for food or fluids by mouth, a person at risk for falling for her walker, and so on. These requests raise two kinds of problems. The first pits residents against HCPs. Should HCPs ever help residents do what they consider (...) harmful? The second pits HCPs against HCPs. If HCPs disagree among themselves—some thinking that the resident should receive the assistance, others thinking not—what should be done? (shrink)

It is a rare patient who always does everything healthcare providers advise. Sometimes no harm comes from this; sometimes good does. But occasionally, great harm comes from not listening, as when it results in patients returning time and again for costly and invasive treatments of, say, infections, valve replacements, pressure ulcers, and so forth. No class of patients arouses more anger and resentment in healthcare providers, who often put out a call to invoke some version of the three strikes rule (...) and refuse care. And if the patients are also unemployed substance abusers who live in a local park, impolite or dangerous to staff, disruptive to other patients, and have intimidating visitors, the call to say “No” is louder. Can care ever be refused? If so, when? These are the questions we take up in this article. The answers we provide were developed as part of a Paraplegics and Quadriplegics with Pressure Ulcers Project carried out at Vancouver Hospital and Health Sciences Centre. Following an established usage, we refer to patients who exhibit a cluster of the above characteristics, the dominant one of which is a reluctance to heed medical advice, as “noncompliant patients.” This term is offensive to some, but the politically correct lexicon does not provide any alternative which is as short and clear or substantially different. We use the term as a convenient way of referring to a familiar class of patients and without any imputation of blame. (shrink)

Current general restrictions on performance-enhancing drugs pose a collective action problem that cannot be solved and bring a variety of adverse consequences for sport. General prohibitions of PEDs are grounded in claims that they violate the integrity of sport. But there are decisive arguments against integrity of sport-based prohibitions of PEDs for elite sport. We defend a harm prevention approach to PED prohibition as an alternative. This position cannot support a general ban on PEDs, since it provides no basis for (...) prohibiting non-harmful PED use. We argue that a harm prevention approach to restricting PEDs is ethically justified, has better prospects of compliance, is consistent with respecting the integrity of sport, and holds at least a modest prospect of resolving the collective action problem around PED restriction. (shrink)

Elective ventilation (EV) is ventilation applied, not in the interest of patients, but in order to secure transplantable organs. It carries with it a small risk that patients who would otherwise have died will survive in a persistent vegetative state. Is EV ever justifiable? We argue: (1) The only thing which can justify exposing patients to risk not taken for their benefit is their consent, and we cannot rely on implied consent or third party consent in the case of EV. (...) Thus, absent explicit consent of patients, EV is not justifiable. (2) It is not clear that explicit consent should be sought, or where it is offered honoured, given the potential EV has for deterring organ donors and causing stress to staff and families. (shrink)

Mental health acts allow for interference with the liberty of the individual. As such, they serve as test cases for theories of liberty, and thus the question of what Mill would think about them arises. My aim is to answer this question. I argue that Mill would embrace mental health acts to protect mentally disturbed individuals from themselves and others from them, and that they should have broad admission criteria, allow capable patients to refuse treatment, and have treatment decisions made (...) by patients or their families on the basis of substituted judgements rather than representatives of the state acting on best interest judgements. This interpretation will show that many writers who claim Mill's support cannot properly do so. It is also a combination of views that cannot be readily found in mental health acts themselves, but which, as Mill's reasons for it show, is a serious candidate for legislative adoption. (shrink)

The current main source of transplantable organs is from heart-beating donors. These are patients who have suffered a catastrophic brain injury, been ventilated, declared dead by neurological criteria, and had their vital functions maintained mechanically until the point of transplantation. But the demand for organs far outstrips the supply, and these patients are not the only potential donors. The idea behind non-heart-beating transplantation is to expand the donor pool by including in it patients who are in hopeless conditions but who (...) are not dying because of brain injury and hence will not suffer the neurological death necessary to become heart-beating donors. As long as we continue to hold the so-called dead donor rule, according to which dying donors cannot have their organs taken before they are dead, this requires that death be able to be declared by alternative criteria, specifically by cardiopulmonary criteria. The challenge is to find such criteria that will identify a state that the public will readily recognize as death and that will facilitate non-heart-beating transplantation. a. (shrink)

There are 12 different Mental Health Acts in Canada, all of which provide for the involuntary confinement of the mentally disordered to protect both them from themselves and others from them. The Acts differ in many ways, but three issues stand out above all: involuntary admission criteria, the right to refuse treatment, and who has the authority to authorize treatment. I first describe how the MHAs differ on these issues. I then take up the methodological question of how to select (...) or construct a MHA from the many, all of which have something to be said for them. Finally, I apply this test to the three main issues in dispute and identify which solutions would be in an ideal MHA. My aim in this last is not to settle the issues but to engage with them and so deepen our understanding of what is at stake. (shrink)

Baseball rules prohibit pitchers from intentionally throwing at batters. When a pitcher does so, however, it is common practice for a pitcher on the opposing team to retaliate by throwing at the first player of the offending team to bat the next inning, and for umpires to ignore the rule forbidding that. I argue that player retaliation in the form of one for one is a better response to the initial violation than any other that is available, one for one (...) can be justified as payback and for anticipated good consequences, and everyone who becomes a professional baseball player has consented to the practice. From these claims, I conclude that one for one is in the best interest of baseball, it is best if umpires follow common practice and wink at the rule forbidding it, and players cannot complain if they are told to throw at batters in certain circumstances, or are thrown at in just those circumstances. (shrink)

Mr. Paul Mills suffered from cancer of the esophagus. Three major surgeries were unsuccessful in correcting the problem, and other treatment methods likewise failed. His condition deteriorated to the point where there was no longer any hope of recovery. Dr. Morrison, who was Mr. Mills's intensive care physician at the Queen Elizabeth II Health Sciences Centre in Halifax, and Mr. Mills's family agreed that active life support should be discontinued. Dr. Morrison then removed Mr. Mills's ventilator. To everyone's surprise, and (...) dismay, Mr. Mills did not die. He continued to breathe spontaneously and started to show signs of distress. Dr. Morrison increased the dosage of morphine, to no effect. She increased it again to the point where death could reasonably be expected to occur; signs of distress continued. Dr. Morrison at this point administered a dose of potassium chloride and Mr. Mills died. (shrink)

In 2015, the Supreme Court of Canada struck down the criminal law prohibiting physician assisted death in Canada. In 2016, Parliament passed legislation to allow what it called ‘medical assistance in dying.’ The authors first describe the arguments the Court used to strike down the law, and then argue that MAID as legalized in Bill C-14 is based on principles that are incompatible with a free and democratic society, prohibits assistance in dying that should be permitted, and makes access to (...) medically-assisted death unnecessarily difficult. They then propose a version of MAID legislation that gives proponents and opponents of MAID everything they can legitimately want, contend that it is the only way to legalize MAID that is compatible with a free and democratic society, and conclude that it is the way to legalize MAID in Canada and other similarly free and democratic societies. (shrink)

I argue that whether abortions are morally permissible depends on whether the fetus has a right to life, the only point of disagreement between the possible theories on this question--the Extreme Conservative, the Middle, and the Extreme Liberal--concerns the relevant temporal proximity to, or degree of probability of actualizing, some selected potential, there is in principle no non-arbitrary way of resolving this disagreement, and hence the problem of abortion is a pseudo-problem inasmuch as it is not theoretically capable of being (...) solved, and legislators should, in the light of this, act as if the Extreme Liberal Theory were true. (shrink)

I argue that (1) whether abortions are morally permissible depends on whether the fetus has a right to life, (2) the only point of disagreement between the possible theories on this question--the Extreme Conservative, the Middle, and the Extreme Liberal--concerns the relevant temporal proximity to, or degree of probability of actualizing, some selected potential, (3) there is in principle no non-arbitrary way of resolving this disagreement, and hence the problem of abortion is a pseudo-problem inasmuch as it is not theoretically (...) capable of being solved, and (4) legislators should, in the light of this, act as if the Extreme Liberal Theory were true. (shrink)

Two of the most poignant decisions in pediatrics concern disagreements between physicians and families over imperiled newborns. When can the family demand more life-sustaining treatment than physicians want to provide? When can it properly ask for less? The author looks at these questions from the point of view of decision theory, and first argues that insofar as the family acts in the child’s best interest, its choices cannot be constrained, and that the maximax and minimax strategies are equally in the (...) child’s best interest. He then proposes a guideline according to which the family can demand LST if it is physiologically possible to preserve a life the child can be expected to welcome, and refuse such treatment if it causes suffering that is “more than can be borne” even if an uncompromised life is expected to emerge. (shrink)

In any healthcare system in which demand exceeds supply—which means any typical public healthcare system—patients cannot always get the care they want or need when they want or need it. It is also unrealistic to suppose that it will ever be otherwise. There have been such advances in medicine and growth in the population that even if we forgot about all other goods such as education, roads, social services, and so forth and put the entire budget into healthcare, there would (...) still be a gap between supply and demand. Moreover, even if we could by that expedient make them match and had eyes only for health, we still should not. For it is now understood that healthcare is the least important determinant of health, lining up well behind poverty and social status. But if suboptimal care is to be our destiny, we must plan how it is to be delivered. (shrink)

This paper investigates the challenges of implementing antibiotic stewardship – reducing and optimizing the use of antibiotics – in agricultural settings of Low- and Middle-Income Countries (LMICs) as a strategic part of addressing the global problem of antimicrobial resistance (AMR). It does so through analysis of the rapidly transforming yet diverse Kenyan poultry sector, characterized by growing commercial operations alongside traditional smallholder farming. Our research involves interviews with farmers, processors, policymakers, and agro-veterinary stores in these settings. We blend Chandler’s (2019, (...) p. 8) notion of “antibiotics as infrastructure” with value chain frameworks to understand how the structural role of antibiotics in agriculture plays out through contrasting value chains, with different implications for stewardship. Weak regulation and intense market-based pressures are shown to drive widespread antibiotic use in poultry value chains involving small- and medium-sized farms supplying open markets. Antibiotic stewardship through adherence to agricultural and food safety standards is more evident, though unevenly observed, in value chains involving large commercial farms and processors supplying corporate buyers. Our findings reveal the complex structural roles of antibiotics in maintaining producer livelihoods in an intensely competitive and heterogeneous Kenyan poultry sector. This highlights challenges with applying global AMR policy to transforming food systems in LMICs without appropriate translation. We argue that attempts to reduce and optimize the use of antibiotics in agriculture must be informed by nuanced understandings of the roles of antibiotics in food systems in specific places including where very different scales and models of farming and value chain co-exist. (shrink)

Alister McGrath has written to great acclaim on both Richard Dawkins and C. S. Lewis. Here he brings these two intriguing and well-known writers into a conversation. They could hardly have more different perspectives! Engaging with their views is a brilliant way of sharpening up our own thinking on the meaning of life.

Algorithms wield increasing control over our lives—over which jobs we get, whether we're granted loans, what information we're exposed to online, and so on. Algorithms can, and often do, wield their power in a biased way, and much work has been devoted to algorithmic bias. In contrast, algorithmic neutrality has gone largely neglected. I investigate three questions about algorithmic neutrality: What is it? Is it possible? And when we have it in mind, what can we learn about algorithmic bias?

Fallibilists claim that one can know a proposition on the basis of evidence that supports it even if the evidence doesn't guarantee its truth. Jessica Brown offers a compelling defence of this view against infallibilists, who claim that it is contradictory to claim to know and yet to admit the possibility of error.

In this book, the second in the Heart of Christian Faith series, Alister E. McGrath provides an exploration of how we can best understand God using analogies, illustrations, and stories. This short, accessible guide also provides a pastoral and spiritual consideration of the difference that our belief in God makes to the way in which we think about ourselves and our world. With future volumes to examine other core Christian principles, McGrath’s new series will define “mere Chrisitianity” to a (...) new generation for many years to come. (shrink)

According to the Desiderative Lockean Thesis, there are necessary and sufficient conditions, stated in the terms of decision theory, for when one is truly said to want. What one is truly said to want, it turns out, varies remarkably by context—and to an underappreciated degree. To explain this context-sensitivity—and closure properties of wanting—I advance a Desiderative Lockean view that is distinctive in having two context-sensitive parameters.

You want to see the concert, but don’t want to take a long drive (even though the concert is far away). Such *strongly conflicting desire ascriptions* are, I show, wrongly predicted incompatible by standard semantics. I then object to possible solutions, and give my own, based on *some-things-considered desire*. Considering the fun of the concert, but ignoring the drive, you want to see the concert; considering the boredom of the drive, but ignoring the concert, you don’t want to take the (...) drive. (shrink)

This book is a vibrant investigation on a deeply human subconscious desire: the desire for omnipresence, or in a nutshell, the desire to be here, there, and everywhere at the same time. After all, why is it not enough just to be in the offline ordinariness of the here and now? To answer this question, Camila Mozzini-Alister does the crossing of two seemingly distant universes: mediation and meditation. Throughout a vigorous archaeology of the relationship between screen and mind allied (...) with an engaging first-person narrative, the author raises awareness of the risks of becoming addicted to social media and obsessed by meditation. This brings forth a vital question: what are the limits for the desire to be more than a body? (shrink)

During the first few years of the twenty-first century, a number of high-profile populist books offering an aggressively atheist critique of religion appeared. This “clustering” of prominent works of atheist apologetics may be attributed to the fact that developments in biology, especially evolutionary biology, have profound negative implications for belief in God. Richard Dawkins' The God Delusion and Daniel Dennett's Breaking the Spell, both published in 2006, argue that the Darwinian theory of evolution erodes many traditional metaphysical notions—such as belief (...) in God—through its “universal acid.” Several saw Darwinism as a potential challenge to at least some aspects of the traditional Christian view of creation, but most early evolutionists, including Charles Darwin himself, rejected the notion that they were promulgating or promoting atheism. Drawing on the recent works of Dennett and Dawkins, this chapter explores how Darwinism has been transposed in recent atheist apologetics from a provisional scientific theory to an antitheistic ideology. In particular, it considers the ideological use of the biological sciences, especially evolutionary biology, in recent atheist apologetics. (shrink)

"This book presents results from a four-year project addressing the central question: What factors, challenges, and contexts contribute to and constrain literacy achievement among at-risk adolescent learners with culturally diverse ...

Part 1. Introduction -- Introduction: Navigating the Perfect Moral Storm in Light of a Thirty-Five Year Debate -- Thirty-Five Year Climate Change Policy Debate -- Part 2. Priority Ethical Issues -- Ethical Problems with Cost Arguments -- Ethics and Scientific Uncertainty Arguments -- Atmospheric Targets -- Allocating National Emissions Targets -- Climate Change Damages and Adaptation Costs -- Obligations of Sub-national Governments, Organizations, Businesses, and Individuals -- Independent Responsibility to Act -- Part 3. The Crucial Role of Ethics in Climate (...) Change Policy Making -- Why Has Ethics Failed to Achieve Traction? -- Conclusion: Navigating the Perfect Moral Storm. (shrink)

In Born to Wonder, Alister McGrath, a prolific Oxford scholar, scientist, and theologian, explores the deepest mystery at the heart of life itself. Life is a gift. We never asked to be born. Yet here we are, living in this strange world of space and time, trying to work out what it's all about before the darkness closes in and extinguishes us. We are adrift on a misty, grey sea of ignorance, seeking a sun-kissed island of certainty, on which (...) we might hope to find clear answers to our deepest and most poignant questions. What is the point of life? Why are we here? And what is it about us that makes us want to ask these questions? As far as we know, we're the only species on earth that asks these questions, and dares to hope that we might find an answer. It seems that we are born to wonder, not merely to exist. From time to time, all of us find ourselves overwhelmed by a sense of awe or mystery, often when confronted with the beauty of nature, whether it is a mountain stream or the vast expanse of ocean waters. That is when we see a flicker of a grander vision of reality, perhaps lying beyond the horizons of our experience. It is as if, for only a moment, a veil is removed, and we catch a half-glimpsed sight of a promised land, waiting to be mapped and explored. This sense of wonder fuels much of humanity's creativity and its search for understanding. (shrink)

The early Epicurean revival in Florence and Italy -- Medicean Florence : Ficino and Bartolomeo Scala -- Republican Florence : the university lectures of Marcello Adriani -- Niccol Machiavelli and the influence of Lucretius -- Lucretian networks in the late fifteenth and early sixteenth centuries -- Appendix : notes on Machiavelli's transcription of MS Vat. Rossi 884.

In a new interpretation, Garrett Wallace Brown considers Kant's cosmopolitan thought as a form of international constitutional jurisprudence that requires minimal legal demands. He explores and defends topics such as cosmopolitan law, cosmopolitan right, the laws of hospitality, a Kantian federation of states, a cosmopolitan epistemology of culture and a possible normative basis for a Kantian form of global distributive justice.