Medical tourism (MT) can be conceptualized as the intentional pursuit of non-emergency surgical interventions by patients outside their nation of residence. Despite increasing popular interest in MT, the ethical issues associated with the practice have thus far been under-examined. MT has been associated with a range of both positive and negative effects for medical tourists' home and host countries, and for the medical tourists themselves. Absent from previous explorations of MT is a clear argument of how responsibility for the harms (...) of this practice should be assigned. This paper addresses this gap by describing both backward looking liability and forward looking political responsibility for stakeholders in MT. We use a political responsibility model to develop a decision-making process for individual medical tourists and conclude that more information on the effects of MT must be developed to help patients engage in ethical MT. (shrink)

Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health‐care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi‐structured interviews with Canadian family caregivers, care recipients and nurses, the intersection (...) of language, place and health‐care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as ‘guests’; home environments facilitate the development of nurse–client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health‐care. We conclude by discussing the importance of considering the language–place–healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice. (shrink)

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...) former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

BackgroundMedical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.MethodsThe methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.ResultsThe final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: Inbound medical tourism to Canada’s public hospitals; Inbound medical tourism to a First Nations reserve; Canadian patients opting to go abroad for medical (...) tourism; and Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system. (shrink)

The international migration of health workers, including long-term care workers for aging populations, contributes to a shortage of these workers in many parts of the world. In the Anglophone Caribbean, LCW shortages and the migration of nurses to take on LCW positions abroad threaten the health of local populations and widen global inequities in health. Many responses have been proposed to address the international migration of health workers generally, including making it more difficult for these workers to emigrate and increasing (...) and improving local employment opportunities. In this article, we suggest an additional means of ethically reducing health worker migration, targeting the Anglophone Caribbean specifically. Countries in this region can take advantage of their warmer climate and well-trained work force to encourage aging populations in the global north to emigrate temporarily or permanently through international retirement migration. As a result, countries in the Anglophone Caribbean can not only decrease the international migration of trained health workers through the provision of well-paying, local jobs, but potentially reverse this flow by drawing on the international diaspora of their workers. International retirement migration, if carefully managed, can reduce global inequities in health while treating both retirees and LCWs ethically. (shrink)

International travel for medical care, or medical tourism, creates ethical and safety concerns for patients. Guidelines could be developed and distributed to help address these concerns, but they may at the same time appear to endorse this practice.

When people use online platforms to solicit funds from others for health-related needs, they are engaging in medical crowdfunding. This form of crowdfunding is growing in popularity, and its visibility is increasing as campaigns are commonly shared via social networking. A number of ethical issues have been raised about medical crowdfunding, one of which is that it introduces a number of privacy concerns. While campaigners are encouraged to share very personal details to encourage donations, the sharing of such details may (...) result in privacy losses for the beneficiary. Here, we explore the ways in which privacy can be threatened through the practice of medical crowdfunding by exploring campaigns for children with defined health needs scraped from the GoFundMe platform. We found specific privacy concerns related to the disclosure of private details about the beneficiary, the inclusion of images and the nature of the relationship between campaigner, funding recipient and beneficiary. For example, it was found that identifying personal and medical details about the beneficiary, including symptoms and treatment history, were often mentioned by campaigners. While the privacy concerns identified are problematic, they are also difficult to remedy given the strong financial incentive to crowdfund. However, crowdfunding platforms can enhance privacy protections by, for example, requiring those campaigning on behalf of child beneficiaries to ensure consent has been obtained from their guardians and providing additional guidelines for the inclusion of personal information in campaigns made on behalf of those not able to give their consent to the campaign. (shrink)

Background: Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing (...) surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. Methods: An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Results: Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally, brokers' roles in follow up care, their prices, and the speed of surgery were the most commonly included business dimensions on the reviewed websites. Conclusion: Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implications for the informed consent and consequent safety of Canadian medical tourists. (shrink)

Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism.

The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care. This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and/or avoiding wait times for care in the patient’s home country. This practice raises numerous ethical concerns, including potentially exacerbating health inequities in destination and source countries and disrupting (...) continuity of care for patients. In this report, we synthesize conference presentations and present three lessons from the conference: 1) Medical tourism research has the potential for cross- or inter-disciplinarity but must bridge the gap between researchers trained in ethical theory and scholars unfamiliar with normative frameworks; 2) Medical tourism research must engage with empirical research from a variety of disciplines; and 3) Ethical analyses of medical tourism must incorporate both individual and population-level perspectives. While these lessons are presented in the context of research on medical tourism, we argue that they are applicable in other areas of research where global practices, such as human subject research and health worker migration, are occurring in the face of limited regulatory oversight. (shrink)

First words on silence -- The secret of literary silence -- Law, "life/living," language -- Between Derrida and Agamben -- The wild child : politics and ethics of the name -- The wild child and scientific names -- HumAnimal acts : potentiality or movement as rest.

Discours recents sur les recherches psychiques / William Crookes; traduits par M. SageDate de l'edition originale: 1903Ce livre est la reproduction fidele d'une oeuvre publiee avant 1920 et fait partie d'une collection de livres reimprimes a la demande editee par Hachette Livre, dans le cadre d'un partenariat avec la Bibliotheque nationale de France, offrant l'opportunite d'acceder a des ouvrages anciens et souvent rares issus des fonds patrimoniaux de la BnF.Les oeuvres faisant partie de cette collection ont ete numerisees par la (...) BnF et sont presentes sur Gallica, sa bibliotheque numerique.En entreprenant de redonner vie a ces ouvrages au travers d'une collection de livres reimprimes a la demande, nous leur donnons la possibilite de rencontrer un public elargi et participons a la transmission de connaissances et de savoirs parfois difficilement accessibles.Nous avons cherche a concilier la reproduction fidele d'un livre ancien a partir de sa version numerisee avec le souci d'un confort de lecture optimal. Nous esperons que les ouvrages de cette nouvelle collection vous apporteront entiere satisfaction.Pour plus d'informations, rendez-vous sur www.hachettebnf.frhttp: //gallica.bnf.fr/ark: /12148/bpt6k5679595c. (shrink)

Desiring Whiteness provides a compelling new interpretation of how we understand race. Race is often seen to be a social construction. Nevertheless, we continue to deploy race thinking in our everyday life as a way of telling people apart visually. How do subjects become raced? Is it common sense to read bodies as racially marked? Employing Lacan's theories of the subject and sexual difference, Seshadri-Crooks explores how the discourse of race parallels that of sexual difference in making racial identity (...) a fundamental component of our thinking. Through close readings of literary and film texts, Seshardi-Crooks also investigates whether race is a system of difference equally determined by Whiteness. She argues that it is in relation to Whiteness that systems of racial classification are organized, endowing it with a power to shape human difference. (shrink)

Since its initial release in 2004, Ethics for the Practice of Psychology in Canada has filled a vital need for a single source on professional ethics and law relevant to Canadian psychologists. This important new edition reflects the fourth edition of the Canadian Code of Ethics for Psychologists and highlights discussions in the areas of diversity and social justice. An essential resource, it focusses on the most pertinent ethical and legal issues for Canadian psychologists, including decision making, consent, confidentiality, helping (...) without harming, professional boundaries, diversity, social responsibility, and conducting research. An appendix includes discussion questions and reflective journal exercises to facilitate awareness of personal motives and biases relevant to making ethical choices. (shrink)

Atypical sensorimotor developmental trajectories greatly contribute to the profound heterogeneity that characterizes Autism Spectrum Disorders. Individuals with ASD manifest deviations in sensorimotor processing with early markers in the use of sensory information coming from both the external world and the body, as well as motor difficulties. The cascading effect of these impairments on the later development of higher-order abilities underlines the need for interventions that focus on the remediation of sensorimotor integration skills. One of the promising technologies for such stimulation (...) is Immersive Virtual Reality. In particular, head-mounted displays have unique features that fully immerse the user in virtual realities which disintegrate and otherwise manipulate multimodal information. The contribution of each individual sensory input and of multisensory integration to perception and motion can be evaluated and addressed according to a user’s clinical needs. HMDs can therefore be used to create virtual environments aimed at improving people’s sensorimotor functioning, with strong potential for individualization for users. Here we provide a narrative review of the sensorimotor atypicalities evidenced by children and adults with ASD, alongside some specific relevant features of IVR technology. We discuss how individuals with ASD may interact differently with IVR versus real environments on the basis of their specific atypical sensorimotor profiles and describe the unique potential of HMD-delivered immersive virtual environments to this end. (shrink)

A number of popular theories about trauma have suggested rhythm has potential as a mechanism for regulating arousal levels. However, there is very little literature examining this proposal from the perspective of the young people who might benefit. This action research project addresses this gap by collaborating with four groups of children in the out-of-home-care system to discover what they wanted from music therapists who brought a strong focus on rhythm-based activities. The four music therapy groups took place over a (...) 12 month period and each cycle of action and reflection led to adjustments in what activities were offered, as well as exploring different levels of structure and ways of building relationships in the groups. The initial group incorporated a strong emphasis on highly structured rhythm-based activities, but young people found the format difficult to engage with. The second cycle included more opportunities for creativity and self-direction within semi-structured activities which children reported enjoying, but too much freedom also became overwhelming at times. The two groups in the third cycle seemed to balance structure and responsiveness successfully but were also influenced by the introduction of individual sessions prior to group commencement, which was designed to contribute to safety and trust building. Final reflections on the role of rhythm in supporting young people who have had adverse experiences were centred around the ideas of co-regulation. This was qualitatively different to our expectations that practicing rhythm-based activities would lead to an expanded window of tolerance that resulted in less time being spent in either hypo-arousal or hyper-arousal. Instead of entraining to an external rhythm, young people felt safe when their rhythms were matched, even if they were irregular, out of time and unpredictable. The small moments of co-regulation resulted in pleasure, comfort, satisfaction and peace and these moments were highly valued by the young people, who described just wanting to be relaxed and happy. Although not as rhythm-specific as the literature might suggest, music making with trusted adults helped the young people in this study feel more content. (shrink)

Medical tourism is a practice, whereby individuals travel across national borders with the intention of receiving medical care. Medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatments not available at home, and wait times for care at home. In this article, we share the findings of interviews conducted with 32 Canadian medical tourists with the aim of developing a better understanding of medical tourism, the ethical issues it raises (...) for public health within Canada and other source countries for medical tourists, and to identify research gaps and policy responses to this practice. While patient and academic perspectives overlap in several regards, we suggest areas in which academic consideration of the ethical issues raised by medical tourism can be informed by patient perspectives. (shrink)

Materialist metaphysicians want to side with physics, but not to take sides within physics.If we took literally the claim of a materialist that his position is simply belief in the claim that all is matter, as currently conceived, we would be faced with an insoluble mystery. For how would such a materialist know how to retrench when his favorite scientific hypotheses fail? How did the 18th century materialist know that gravity, or forces in general, were material? How did they know (...) in the 19th century that the electromagnetic field was material, and persisted in this conviction after the aether had been sent packing?The doctrine of physicalism casts a long shadow in contemporary philosophy, configuring all kinds of philosophical issues and projects. Unsurprisingly, its proponents argue that physicalism has all the obvious features necessary for a scientific hypothesis to be in what we will call ‘good standing,’ i.e. being worthy of serious scientific investigation. In fact, many claim much more, arguing that physicalism is a well-confirmed hypothesis and possibly amongst the best of our theories. But, as our second opening passage makes clear, a persistent worry has been that physicalism, or ‘materialism’ as van Fraassen terms it, is an edifice built on sand. For many philosophers question whether the ‘physical’ can be specified at all, or at least in a manner that will produce a physicalism that would be in good standing. (shrink)

Background: Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood. -/- (...) Methods: 12 facilitators were interviewed from 10 Canadian medical tourism companies. -/- Results: Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. -/- Conclusion: Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (shrink)

This exploratory study engages with eight case studies of music performances broadcast online to investigate the role of music in facilitating social cohesion, intercultural understanding and community resilience during a time of social distancing and concomitant heightened racial tensions. Using an online ethnographic approach and thematic analysis of video comments, the nature of audience engagement with music performances broadcast via YouTube during COVID-19 lockdown of 2020 is explored through the lens of ritual engagement with media events and models of social (...) capital. The eight case studies featured virtual choirs, orchestras and music collaborations of various genres, including classical, pop and fusion styles drawing from European, Asia Minor, South African, West African, North African, Arabic, South Asian, and East Asian cultural origins. Five overarching themes resulted from thematic analysis of video comments, including Interaction, Unity, Resilience, Identity, and Emotion. The paper contributes important theorisation that ritual engagement and social learning fosters intercultural understanding through engaging with music both cognitively and emotionally, which can in turn shape both individual and collective identity. Online platforms provide scope for both bonding and bridging opportunities. Community resilience is supported through the sharing of knowledge, sustaining music practice during social distancing, as well as emotional support shared among audience participants, with potential wellbeing outcomes. (shrink)

Materialist metaphysicians want to side with physics, but not to take sides within physics.If we took literally the claim of a materialist that his position is simply belief in the claim that all is matter, as currently conceived, we would be faced with an insoluble mystery. For how would such a materialist know how to retrench when his favorite scientific hypotheses fail? How did the 18th century materialist know that gravity, or forces in general, were material? How did they know (...) in the 19th century that the electromagnetic field was material, and persisted in this conviction after the aether had been sent packing?The doctrine of physicalism casts a long shadow in contemporary philosophy, configuring all kinds of philosophical issues and projects. Unsurprisingly, its proponents argue that physicalism has all the obvious features necessary for a scientific hypothesis to be in what we will call ‘good standing,’ i.e. being worthy of serious scientific investigation. In fact, many claim much more, arguing that physicalism is a well-confirmed hypothesis and possibly amongst the best of our theories. But, as our second opening passage makes clear, a persistent worry has been that physicalism, or ‘materialism’ as van Fraassen terms it, is an edifice built on sand. For many philosophers question whether the ‘physical’ can be specified at all, or at least in a manner that will produce a physicalism that would be in good standing. (shrink)

This paper describes how to ethically conduct research with Black populations at the intersection of COVID-19 and the Black Lives Matter movement. We highlight the issues of historical mistrust in the USA and how this may impact Black populations’ participation in COVID-19 vaccination trials. We provide recommendations for researchers to ethically engage Black populations in research considering the current context. Our recommendations include understanding the impact of ongoing trauma, acknowledging historical context, ensuring diverse research teams and engaging in open and (...) honest conversations with Black populations to better address their needs. The core of our recommendation is recognising the impact of trauma in our research and health care practices. (shrink)