BackgroundThe COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.MethodTo inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a (...) literature review to summarize the ethical issues.ResultsThis literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.ConclusionThis literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve. (shrink)

Certification and labeling initiatives that seek to enhance environmental and social sustainability are growing rapidly. This article analyzes the expansion of these private regulatory efforts in the coffee sector. We compare the five major third-party certifications – the Organic, Fair Trade, Rainforest Alliance, Utz Kapeh, and Shade/Bird Friendly initiatives – outlining and contrasting their governance structures, environmental and social standards, and market positions. We argue that certifications that seek to raise ecological and social expectations are likely to be increasingly challenged (...) by those that seek to simply uphold current standards. The vulnerability of these initiatives to market pressures highlights the need for private regulation to work in tandem with public regulation in enhancing social and environmental sustainability. (shrink)

In this paper, T. M. Murray defends a vision of liberal tolerance as grounding the common good. She critiques the discourse that Western liberalism amounts to ‘Islamophobia’ or ‘cultural imperialism’. She argues that liberal academics, in maintaining these narratives, contradict their own vaunted values and tacitly collude with religious hypocrisy and intolerance. She argues for a universal vision of the common good broadly grounded in human flourishing and human nature and linked to the philosophies of Aristotle and J. S. (...) Mill. (shrink)

In a recent case in Great Britain, a couple described as “white” underwent in vitro fertilisation and gave birth to twins described as “black”. In the sense of a fair adjudication of this particular case, serving justice requires a thick description and a sensitive understanding of the relevant facts. We have only a few facts, but they may be sufficient to serve justice in this first sense.We are told that the couple wants to keep the twins. We are told further (...) that British law holds that the woman giving birth is to be regarded as the legal mother . Finally, we are told that DNA testing has established that the gestational mother is also the genetic mother of these infants. Her husband, whose sperm were supposed to be used to fertilise his wife’s eggs, is not the genetic father. A black couple was also undergoing IVF at the same clinic; it may be that this man’s sperm were used by mistake.We know enough to reach a defensible decision in the case. The couple caring for these children has contributed a half share of the children’s genes, and the woman was also the gestational mother, so they have at least an equal argument from biology. Their intention was to have these children and they also wish to raise them; they went through the rigours of IVF, and are willing to take on the responsibility of parenthood. Since the children were born, furthermore, they have shouldered the hard work of parenthood. We don’t know their particular circumstances; perhaps they’ve had help from family or others; but in all likelihood they’ve had an ample share of sleep deprived nights, soiled nappies, and exhausted days. …. (shrink)

Consistent with Ruchkin and colleagues' proceduralist account, recent research on grouping and verbal-spatial binding in immediate memory shows continuity across short- and long-term retention, and activation of classes of information extending beyond those typically allowed in modular models. However, Ruchkin et al.'s account lacks well-specified mechanisms for the retention of serial order, binding, and the control of activation through attention.

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Insulin is a member of a family of hormones, growth factors and neuropeptides which are found in both vertebrates and invertebrates. A common ‘insulin fold’ is probably adopted by all family members. Although the specificities of receptor binding are different, there is possibility of co‐evolution of polypeptides and their receptors.

BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

The dual-deficit model of visual hallucinations (Collerton et al. target article) is compared with the dual-deficit model of auditory hallucinations (Waters et al., in press). Differences in cognitive mechanisms described may be superficial. Similarities between these models may provide the basis for a general model of complex hallucinations extended across disorders and modalities, involving shared (overlapping) cognitive processes.

Fair trade bananas are the latest inan increasing array of commodities that are beingpromoted by various organizations in an effort tocreate alternative production and consumption patternsto the environmentally destructive and sociallyinequitable patterns inherent in traditionalproduction and trade systems. Fair trade is touted asa strategy to achieve more sustainable developmentthrough linking environmentally and socially consciousconsumers in the North with producers pursuingenvironmentally sound and socially just productionpractices in the South. Promotion of fair tradebananas in Europe has achieved impressive initialgains on the consumer (...) end of the commodity chain,capturing 10 percent or more of the banana trade inseveral countries. Yet in spite of these gains, thefair trade banana initiative appears to beencountering serious obstacles to its further success.We argue that the primary challenge in creating atruly alternative trade in bananas stems from thedifficulties of upholding rigorous social andenvironmental standards in the face of increasinginroads into fair trade markets by transnationalcorporations producing under less rigorous conditions.We then develop a series of options for strengtheningfair trade banana initiatives in both Europe and NorthAmerica. We conclude by arguing that the case ofbananas illuminates the general question of how toachieve more progressive and sustainable productionand consumption systems within a global system thatdrives production and consumption toward greaterintegration and homogenization under the control oftransnational corporations. (shrink)

Many people have an aptitude for religious experience and spirituality but don't know how to develop this or take it further. Modern societies offer little assistance, and traditional religions are overly preoccupied with their own organizational survival. Minding the Self: Jungian meditations on contemporary spirituality offers suggestions for individual spiritual development in our modern and post-modern times. Here, Murray Stein argues that C.G. Jung and depth psychology provide guidance and the foundation for a new kind of modern spirituality.Murray (...) Stein explores the problem of spirituality within the cultural context of modernity and offers a way forward without relapsing into traditional or mythological modes of consciousness. Chapters work towards finding the proper vessel for contemporary spirituality and dealing with the ethical issues that crop up along the way. Stein shows how it is an individual path but not an isolationist one, often using many resources borrowed from a variety of religious traditions: it is a way of symbol, dream and experiences of the numinous with hints of transcendence as these come into personal awareness. Minding the Self: Jungian meditations on contemporary spirituality uses research from a wide variety of fields, such as dream-work and the neuroscience of the sleeping brain, clinical experience in Jungian psychoanalysis, anthropology, ethics, Zen Buddhism, Jung's writings and the recently published Red Book. It will be of interest to psychoanalysts, Jungian scholars, undergraduates, graduate and post-graduate students and anyone with an interest in modern spirituality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Liberalism, Art, and FundingDale Francis MurrayLiberalism, Art, and FundingSince Ronald Dworkin published A Matter of Principle, a host of critics have attempted to systematically dismantle his arguments advocating state support for the arts that appear in a chapter entitled, "Can a Liberal State Support Art?"1 The combined critical force of Noël Carroll, Samuel Black, and most recently, Harry Brighouse, has dislodged the main supports of Dworkin's position on this (...) subject.2 However, while I am skeptical that the arguments of liberals who endorse state support for the arts can be fully resurrected, I reckon that a few remarks can be presented to try to deflect at least a fraction of the contentions cast on Dworkin's argument by the critics listed above. In order to refine our understanding of precisely why state support for cultural expression should or should not be permitted, it is imperative that some sort of response to the critics of state support for the arts is offered.In this essay, I focus primarily on Brighouse's objections that Dworkin's arguments supporting arts funding fail primarily because they are not sensitive enough to the ways in which such support violates two demands of justice in a liberal state — state neutrality and publicity. I examine these two objections since they seem to be the most interesting, compelling, and damaging to Dworkin's case if substantiated. If Brighouse is correct, these violations act as heavy bulwarks against state support for arts funding, especially since public distrust of the state's intent (and the state's perceived advocacy of notions of the good with which the public disagrees) is high. I will employ Brighouse's neutrality of intent constraint, because it best represents the alleged specific violations of state neutrality that may undermine Dworkin's case. Additionally, neutrality of intent is the most plausible form of neutrality for advocates of public arts funding to build a case for in the space of a short essay.I also wish to make a distinction, which for the most part, is ignored by Dworkin's critics — that there is a degree to which moral value and aesthetic value are different and that this effects a possible alternative reading of the term "ways of life" as most liberals understand it. As a final note of preface, I will assume that the background conditions of income and wealth are just.3 This proviso will become important when we examine the role of the market in funding arts projects in lieu of the government. Now let us reiterate the two requirements of any just liberal state that are at issue when considering the legitimacy of state support for the arts. [End Page 116]Brighouse sets the pair of constraints on any just liberal state (neutrality and publicity) as the centerpieces of his essay. Neutrality of intent, that he appeals to more specifically, can be understood to mean, as Brighouse himself explains, "[T]hat while it is unobjectionable that state actions will have differential effects on conceptions of the good, the government should not intend to favor some conceptions over others" (NPS, 38, emphasis mine). The publicity constraint can be characterized by saying that in any just, liberal regime, justice must not only be done, but it must also be seen as being done. While this serves as the motto of the publicity constraint, it is significant to acknowledge that it stipulates that the real reasons for governmental action must be comprehensible to, and available for inspection by, reasonable citizens. In addition, it must be readily apparent to citizens that the demands of justice are being met. I will return to this constraint on the state later in this essay.Neutrality is of chief interest, since recent liberal political philosophers have emphasized the primacy of the right over the good (RLD, 245). Presumably, individuals, via their rational autonomy, shall define the good for themselves beyond the dictates of government. Our morality is our own personal affair, just so long as we remain within the confines of the harm principle and do not violate the equal liberty of others.On the surface, it is not apparent that state funding for the... (shrink)

Within philosophy of action, there are three broad views about what, in addition to beliefs, answer the question of “what to do?” and so determine an agent’s motivation: desires, judgments about values/reasons, or states of the will, such as intentions. We argue that recent work in decision theory vindicates the volitionalist. “What to do?” isn’t settled by “what do I value” or “what reasons are there?” Rational motivation further requires determining how to trade off the possibility of a good outcome (...) against the possibility of a bad one—i.e., determining how much of a risk to take. The risk attitudes that embody this tradeoff seem best understood as intentions: as self-governing policies to weight desires or reasons in certain ways. That we need to settle our risk attitudes before making most decisions corroborates Bratman’s claim that self-governing policies are required for resolving impasses of evaluative and normative underdetermination. Moreover, far from being rare or confined to tie-breakings, cases that are underdetermined but for one’s risk attitudes are typical of everyday decision-making. The will is required for most rational action. (shrink)

Following an initial study of the needs of healthcare providers (HCP) regarding the introduction of Medical Assistance in Dying (MAiD), and the subsequent development of an assisted dying program, this study sought to determine the efficacy and impact of MAiD services following the first two years of implementation. The first of three aims of this research was to understand if the needs, concerns and hopes of stakeholders related to patient requests for MAiD were addressed appropriately. Assessing how HCPs and families (...) perceived the quality of MAiD services, and determining if the program successfully accommodated the diverse needs and perspectives of HCPs, rounded out this quality evaluation. This research implemented a mixed-methods design incorporative of an online survey with Likert scale and open-ended questions, as well as focus groups and interviews with staff and physicians, and interviews with MAiD-involved family members. There were 356 online surveys, as well as 39 participants in six focus groups with HCP, as well as fourteen interviews with MAiD-involved family members. Participants indicated that high-quality MAiD care could only be provided with enabling resources such as policies and guidelines to ensure safe, evidence-based, standardized care, as well as a specialized, trained MAiD team. Both focus group and survey data from HCPs suggest the infrastructure developed by the hospital was effective in delivering high-quality MAiD care that supports the diverse needs of various stakeholders. This study may serve as a model for evaluating the impact and quality of services when novel and ethically-contentious clinical practices are introduced to healthcare organizations. (shrink)

This edited volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organised around the main stages of the clinical encounter from the patient's perspective. This introductory chapter opens up crucial issues of methodology and of practical application in this highly innovative approach to the role of ethics in healthcare.

Academic dishonesty, including cheating and plagiarism, is on the rise in colleges, particularly among engineering students. While students decide to engage in these behaviors for many different reasons, academic integrity training can help improve their understanding of ethical decision making. The two studies outlined in this paper assess the effectiveness of an online module in increasing academic integrity among first semester engineering students. Study 1 tested the effectiveness of an academic honesty tutorial by using a between groups design with a (...) Time 1- and Time 2-test. An academic honesty quiz assessed participants’ knowledge at both time points. Study 2, which incorporated an improved version of the module and quiz, utilized a between groups design with three assessment time points. The additional Time 3-test allowed researchers to test for retention of information. Results were analyzed using ANCOVA and t tests. In Study 1, the experimental group exhibited significant improvement on the plagiarism items, but not the total score. However, at Time 2 there was no significant difference between groups after controlling for Time 1 scores. In Study 2, between- and within-group analyses suggest there was a significant improvement in total scores, but not plagiarism scores, after exposure to the tutorial. Overall, the academic integrity module impacted participants as evidenced by changes in total score and on specific plagiarism items. Although future implementation of the tutorial and quiz would benefit from modifications to reduce ceiling effects and improve assessment of knowledge, the results suggest such tutorial may be one valuable element in a systems approach to improving the academic integrity of engineering students. (shrink)