This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of health (...) care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of health (...) care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

The legal risks associated with health research involving human subjects have been highlighted recently by a number of lawsuits launched against those involved in conducting and evaluating the research. Some of these cases have been fully addressed by the legal system, resulting in judgments that provide some guidance. The vast majority of cases have either settled before going to trial, or have not yet been addressed by the courts, leaving us to wonder what might have been and what guidance future (...) cases may bring. What is striking about the lawsuits that have been commenced is the broad range of individuals/institutions that are named as defendants and the broad range of allegations that are made. The research community should take this early experience as a warning and should reflect carefully on practices where research involving human subjects is concerned. (shrink)

This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different (...) understandings. Finally, we consider the ethical challenges of building policy on what is still an extremely controversial social practice. While MAID is currently available to capable patients in Canada who are 18 years or older—a small but important subsection of the population our hospital serves—we write our policy with an eye to the near future when capable young people may gain access to MAID. We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves. Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID. We offer a view of the roads taken and considered along the way, and our justifications for travelling the paths we chose. By providing a record of our in-progress thinking, we hope to stimulate wider discussion about the issues and questions encountered in this work. (shrink)

Potential conflicts between the roles of physicians and researchers have been described at the theoretical level in the bioethics literature (Czoli, et al., 2011). Physicians and researchers are generally in mutually distinct roles, responsible for patients and participants respectively. With increasing emphasis on integration of research into clinical settings, however, the role divide is sometimes unclear. Consequently, physician–researchers must consider and negotiate salient ethical differences between clinical– and research–based obligations (Miller et al, 1998). This paper explores the subjective experiences and (...) perspectives of 30 physician–researchers working in three Canadian paediatric settings. Drawing on qualitative interviews, it identifies ethical challenges and strategies used by physician–researchers in managing dual roles. It considers whether competing obligations could have both positive and adverse consequences for both physician–researchers and patients. Finally, we discuss how empirical work, which explores the perspectives of those engaged in research and clinical practice, can lead the way to understanding and promoting best practice. (shrink)

In their summary and critique, Gamble, Gamble, and Pruski mischaracterise both the central arguments and the primary objectives of our original paper. Our paper does not provide an ethical justification for paediatric Medical Assistance in Dying by comparing it with other end of life care options. In fact, it does not offer arguments about the permissibility of MAID for capable young people at all. Instead, our paper focuses on the ethical questions that emerged as we worked to develop a policy (...) for responding to MAID requests at our tertiary paediatric institution. Following the Supreme Court of Canada’s recent decriminalisation of MAID, our hospital needed to answer immediate on-the-ground questions such as: ‘What are we going to do if an 18-year-old patient in our care requested MAID today, as is now their legal right? How should we protect their privacy? What is the best way to ensure patients are informed when making these decisions?’ On these important questions, Gamble, Gamble, and Pruskiare silent. (shrink)

The application of artificial intelligence and machine learning technologies in healthcare have immense potential to improve the care of patients. While there are some emerging practices surro...

This paper provides a description of the role of the clinical ethicist as it is generally experienced in Canada. It examines the activities of Canadian ethicists working in healthcare institutions and the way in which their work incorporates more than ethics case consultation. The Canadian Bioethics Society established a Taskforce on Working Conditions for Bioethics (hereafter referred to as the Taskforce), to make recommendations on a number of issues affecting ethicists and to develop a model role description. This essay carefully (...) assesses this model role description. (shrink)

IntroductionThe value of a short life characterized by disability has been hotly debated in the literature on fetal and neonatal outcomes.MethodsWe conducted a scoping review to summarize the available empirical literature on the experiences of families in the context of trisomy 13 and 18 (T13/18) with subsequent thematic analysis of the 17 included articles.FindingsThemes constructed include (1) Pride as Resistance, (2) Negotiating Normalcy and (3) The Significance of Time.InterpretationOur thematic analysis was guided by the moral experience framework conceived by Hunt (...) and Carnevale (2011) in association with the VOICE (Views On Interdisciplinary Childhood Ethics) collaborative research group.RelevanceThis article will be of interest and value to healthcare professionals and bioethicists who support families navigating the medically and ethically complex landscape of T13/18. (shrink)

This paper provides a description of the role of the clinical ethicist as it is generally experienced in Canada. It examines the activities of Canadian ethicists working in healthcare institutions and the way in which their work incorporates more than ethics case consultation. The Canadian Bioethics Society established a “Taskforce on Working Conditions for Bioethics” (hereafter referred to as the Taskforce), to make recommendations on a number of issues affecting ethicists and to develop a model role description. This essay carefully (...) assesses this model role description. (shrink)

In this article, we examine how the U.N. Convention on the Rights of the Child can be useful in pediatric bioethics. Adopted in 1989, the CRC reflects norms that have been deliberated upon for a long period of time and endorsed by most nations. The United States is now the only country that has not ratified the CRC.1 International human rights law shares many key moral concepts with clinical pediatric bioethics, and the CRC provides a considered language common to many (...) jurisdictions that can assist bioethicists in their daily practice and help health-care organizations in their policy development and international interactions. There may, however, be practical challenges with using the CRC in the practice of.. (shrink)

Clinicians such as Sir William Osler reinvented Hippocrates and built the image of a noble, lone, professional man replete with black bag, minister...

Gifts have served as a fundamental aspect of the human experience across time, even as their precise roles and functions have shifted. In the past, bioethicists and others have drawn upon anthropol...

Char and colleagues provide a useful conceptual framework for the proactive identification of ethical issues arising throughout the lifecycle of machine learning applications in healthcare. Th...

Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth.

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many (...) were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of (...) bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist. (shrink)

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Following the lead of Duncan Pritchard’s “Wittgensteinian Pyrrhonism,” this paper takes a further, comparative and contrastive look at the problem of justification in Sextus Empiricus and in Wittgenstein’sOn Certainty. I argue both that Pritchard’s stimulating account is problematic in certain important respects and that his insights contain much interpretive potential still to be pursued. Diverging from Pritchard, I argue that it is a significant and self-conscious aspect of Sextus’ sceptical strategies to call into question large segments of our belief systemen (...) masseby exposing as apparently unjustifiable fundamental propositions which are closely related in their linchpin role to Wittgenstein’s hinge propositions. In the first instance, the result is a more complex account of both a deeper affinity between Wittgenstein’s approach to hinge propositions and Sextus’ approach to what I termarchaipropositions and a divergence between the two. In the second instance, I suggest how the comparison withOn Certaintycan be illuminating for the interpreter of Sextus. In particular, it can help us to see how the Pyrrhonist’s everyday conduct—common assumptions to the contrary notwithstanding—involves rational procedures of justification, in line with a naturalism reminiscent of Wittgenstein. Furthermore, it can help us to reflect on the Pyrrhonist’s attitude to what Wittgenstein would have called her ‘worldview’. Throughout, I suggest that the comparison with Wittgenstein is interesting, although it must be cashed out differently, not only on the interpretation—or, perhaps, strand—of ancient Pyrrhonism which has the sceptic exempt ordinary beliefs from her suspension of judgement, but also on the interpretation (or strand) which has her disavow all beliefs categorically. (shrink)

Recent developments in science and technology point to the need to unify, and extend, the definition of memory. On the one hand, molecular neurobiology has shown that memory is largely a chemical process, which includes conditioning and any form of stored experience. On the other hand, information technology has led many to claim that cognition is also extended, that is, memory may be stored outside of the brain. In this paper, we review these advances and describe the increasingly accepted extended (...) definition of memory. This definition is largely accepted in neuroscience but not explicitly stated. In the extended definition, memory is the capacity to store and/or retrieve information. Does this new definition of memory mean that everything is now a form of memory? We stress that memory still requires incorporation, that is, a corpore. It is a relationship -- where one biological or chemical process is incorporated into another, and changes both in a permanent way. Looking at natural and biological processes of incorporation can help us think of how incorporation of internal and external memory occurs in cognition. We further argue that, if we accept that there is such a thing as the storage of information outside the brain -- and that this organic, dynamic process can also be called “memory” -- then we open the door to a very different world. The mind is not static. The brain, and the memory it uses, is a work in progress; we are not now who we were then. (shrink)

This study examines the influence of ethical fit on employee attitudes and intentions to turnover. The results of this investigation provides support for the conjecture that ethical work climate is an important variable in the study of person-organization fit. Ethical fit was found to be significantly related to turnover intentions, continuance commitment, and affective commitment, but not to job satisfaction. Results are discussed in regard to some of the affective and cognitive distinctions among satisfaction, commitment, and behavioral intentions.

The purpose of this study was to determine if there is a relationship between the ethical climate of the organization and the development of person-organization fit. The relationship between an individual's stage of moral development and his/her perceived ethical work environment was examined using a sample of 86 working students. Results indicate that a match between individual preferences and present position proved most satisfying. Subjects expressing a match between their preferences for an ethical work climate and their present ethical work (...) climate indicated that they were less likely to leave their positions. (shrink)

Research on the nature of science and science education enjoys a longhistory, with its origins in Ernst Mach's work in the late nineteenthcentury and John Dewey's at the beginning of the twentieth century.As early as 1909 the Central Association for Science and MathematicsTeachers published an article – ‘A Consideration of the Principles thatShould Determine the Courses in Biology in Secondary Schools’ – inSchool Science and Mathematics that reflected foundational concernsabout science and how school curricula should be informed by them. Sincethen (...) a large body of literature has developed related to the teaching andlearning about nature of science – see, for example, the Lederman and Meichtry reviews cited below. As well there has been intensephilosophical, historical and philosophical debate about the nature of scienceitself, culminating in the much-publicised ‘Science Wars’ of recent time. Thereferences listed here primarily focus on the empirical research related to thenature of science as an educational goal; along with a few influential philosophicalworks by such authors as Kuhn, Popper, Laudan, Lakatos, and others. Whilenot exhaustive, the list should prove useful to educators, and scholars in otherfields, interested in the nature of science and how its understanding can berealised as a goal of science instruction. The authors welcome correspondenceregarding omissions from the list, and on-going additions that can be made to it. (shrink)

Developers are often the engine behind the creation and implementation of new technologies, including in the artificial intelligence surge that is currently underway. In many cases these new technologies introduce significant risk to affected stakeholders; risks that can be reduced and mitigated by such a dominant party. This is fully recognized by texts that analyze risks in the current AI transformation, which suggest voluntary adoption of ethical standards and imposing ethical standards via regulation and oversight as tools to compel developers (...) to reduce such risks. However, what these texts usually sidestep is the question of how aware developers are to the risks they are creating with these new AI technologies, and what their attitudes are towards such risks. This paper asks to rectify this gap in research, by analyzing an ongoing case study. Focusing on six Israeli AI startups in the field of radiology, I carry out a content analysis of their online material in order to examine these companies’ stances towards the potential threat their automated tools pose to patient safety and to the work-standing of healthcare professionals. Results show that these developers are aware of the risks their AI products pose, but tend to deny their own role in the technological transformation and dismiss or downplay the risks to stakeholders. I conclude by tying these findings back to current risk-reduction recommendations with regards to advanced AI technologies, and suggest which of them hold more promise in light of developers’ attitudes. (shrink)

This book demonstrates that we need not choose between seeing so-called Presocratic thinkers as rational philosophers or as religious sages. In particular, it rethinks fundamentally the emergence of systematic epistemology and reflection on speculative inquiry in Hesiod, Xenophanes and Parmenides. Shaul Tor argues that different forms of reasoning, and different models of divine disclosure, play equally integral, harmonious and mutually illuminating roles in early Greek epistemology. Throughout, the book relates these thinkers to their religious, literary and historical surroundings. It (...) is thus also, and inseparably, a study of poetic inspiration, divination, mystery initiation, metempsychosis and other early Greek attitudes to the relations and interactions between mortal and divine. The engagements of early philosophers with such religious attitudes present us with complex combinations of criticisms and creative appropriations. Indeed, the early milestones of philosophical epistemology studied here themselves reflect an essentially theological enterprise and, as such, one aspect of Greek religion. (shrink)

This narrative case study, created from several qualitative sources, portrays a young woman’s life experiences and an eight yearlong therapy process with Norwegian Psychomotor Physiotherapy. It is analyzed retrospectively from an analytical angle, where NPMP theory is expanded with Løgstrup’s phenomenology of sensation and Ricoeur’s narrative philosophy. Understanding Rita’s narrative through this window displayed some foundational phenomena in a singular way, illuminating embodied experiences in inter-subjective relationships in movement, sensation and time entwined. It illustrates how traumatic life experiences may cause (...) pain, suffering and ruptured narratives with fragmented physical and sensuous reactions, chaos and loss of temporal coherence with consequences for a person’s sense of identity. Rita’s narrative also illuminates how intersubjective interaction has healing potentials when there is time and space for trust to emerge and to support new bodily-based experiences. Embodied sensuous experiences in present time may help clarify past and present and support chronology in narration and the sense of identity. With this exemplary case study, we argue that Løgstrup’s and Ricoeur’s thinking may add valuable perspectives to understanding suffering and healing processes in the field of embodied therapies like NPMP. (shrink)

The man behind the New York Times Magazine ’s immensely popular column “The Ethicist”–syndicated in newspapers across the United States and Canada as “Everyday Ethics”–casts an eye on today’s manners and mores with a provocative, thematic collection of advice on how to be good in the real world. Every week in his column on ethics, Randy Cohen takes on conundrums presented in letters from perplexed people who want to do the right thing (or hope to get away with doing the (...) wrong thing), and responds with a skillful blend of moral authority and humor. Cohen’s wisdom and witticisms have now been collected in The Good, the Bad & the Difference , a collection of his columns as wise and funny as a combination of “Dear Abby,” Plato, and Mel Brooks. The columns are supplemented with second thoughts on (and sometimes complete reversals of) his original replies, follow-up notes on how his advice affected the actions of various letter writers, reactions from readers both pro and con, and observations from such “guest ethicists” as David Eggers and the author’s mom. Each chapter also features an “Ethics Pop Quiz,” and readers will be invited to post their answers on the book’s Web site. The best of them will appear in a future paperback edition of the book. The Good, the Bad & the Difference is divided into seven sections: •Civic Life (what we do in public) •Family Life (what we do at home) •Social Life (what we do in other people’s homes) •Commercial Life (what we do in situations where money is a factor) •Medical Life (the rights and obligations of patients and caregivers) •Work Life (ethics for the professional sphere) •School Life (moral questions from and about kids) Each section provides a window into how we live today, shedding light on the ways in which a more ethical approach to the decisions we make, and to our daily behavior, can make a big difference in how we feel about ourselves tomorrow. (shrink)

This study considers the ethical decision making of individual employees and the influence their perception of organizational expectations has on employee feelings about the decision making process. A self-administered questionnaire design was used for gathering data in this study, with a sample size of 245 full-time employees. The match between the ethical alternative chosen by the respondent and that alternative perceived to be encouraged by his/her organization was found to be significantly related to both feelings of discomfort and feelings of (...) intrapersonal role conflict. Implications for these findings are discussed. (shrink)

This article argues that Empedocles’ trust in Strife (DK31 B115.14 = LM22 D10.14) is not, as the prevailing interpretation has it, only a past misjudgement and failure. Rather, trust in Strife still, and to his own lament, infects Empedocles’ mind and informs his life. This detail then offers a fresh perspective on Empedocles’ self-conception and on how, through the daimōn’s cosmic peregrinations, Empedocles raises and pursues questions of agency and responsibility. Furthermore, it sheds light on Empedocles’ understanding of his own (...) ethical standing: common assumptions to the contrary notwithstanding, he does not see himself as an unqualifiedly successful embodiment of his own ideals. (shrink)

A caged animal in the heart of the city, thousands of miles from its natural habitat, neurotically pacing in its confinement . . . Zoos offer a convenient way to indulge a cultural appetite for novelty and diversion, and to teach us, albeit superficially, about animals. Yet what, conversely, do they tell us about the people who create, maintain, and patronize them, and about animal captivity in general? Rather than foster an appreciation for the lives and attributes of animals, zoos, (...) in Randy Malamud's view, reinforce the idea that we are, by nature, an imperial species: that our power and ingenuity entitles us to violate the natural order by tearing animals from the fabric of their ecosystems and displaying them in an "order" of our own making. In so doing, he argues, zoos not only contribute to the rapid disintegration of our ecosystems, but also deaden our very sensibilities to constraint, spatial disruption, and physical pain. Invoking an array of literary depictions of animals, from Albee's Zoo Story and Virginia Woolf's diaries to the films of Harold Pinter and the poetry of Marianne Moore, Reading Zoos links culture, literature, and nature in an engaging and accessible introduction to environmental ethics, animal rights, cultural critique, and literary representation. (shrink)

Introduction -- Closed mindedness in movies -- Failed alternatives to optional thinking -- Optional thinking in movies -- Conclusion.

Introduction -- What is initiative, grit & perseverance? -- Goal setting -- Controlling projects -- Self-starting & self-control -- Research & ideas -- Time management -- Starting & finishing successfully.

This article argues that we live in a highly technical world in which people are disappearing. Religion does not have the tools to help us resist this extinction since it has itself diminished humanity by positing a perfect Other Being, which controls our lives. The author argues that we need to reclaim a sense of ourselves as essentialising animals. We need to have a more body-based sense of humanity, which will lead to a fuller awareness and acceptance of difference and (...) combat hierarchical and alienating thinking. (shrink)

How has the storage of information shaped human cognition? We bring together current advances in cognitive science, the neurobiology of memory, and archaeology to explore how storage of information affects consciousness. These fields strongly suggest that the increase in storage of information in the environment – which we call exosomatic storage of information – may have led to changes in human consciousness and human neurophysiology over time. To bring these findings together conceptually, we develop what we call a dialectical model (...) of the relationship between storage of information and the development of human consciousness. Using the system of dialectic philosophy, we put forward that (a) environmental changes, consciousness, and neurophysiology develop together, (b) these changes were irreversible, (c) quantitative increases in exosomatic storage of information may have led to qualitative changes in human consciousness and neurophysiology, (d) these changes in turn affected how we see ourselves. Indeed, our capacity to store information exosomatically distinguishes us from other animals, and may be a key attribute of our self-awareness and therefore self-consciousness. Because metaphors are central to human thought and can help structure scientific inquiry, we illustrate our model using a metaphor of drops of silver on the back of a glass, eventually making a mirror—where successive quantitative change leads to an irreversible qualitative development in human consciousness. The dialectic model can offer new insights into the co-evolution of material culture and human beings through its broader philosophical foundations and explanatory power. (shrink)