Discussions of both personal responsibility and the importance of trust in health-care settings are increasingly prominent in the bioethics literature. In this paper I link the two discussions and argue that health policies that include personal responsibility ought to address climates of social trust. Trust is a social good that is not always fairly distributed. Disadvantaged social groups often face default distrust. I suggest that agent-centered models in which responsibilities are negotiated do a better job of repairing social distrust than (...) authoritative models in which responsibilities are assigned . Attending to climates of trust, distrust, or antitrust is essential for addressing health inequalities. (shrink)

This article explores the accounts of Canadian-trained health professionals working in humanitarian and development organizations who considered not treating a patient or group of patients because of resource limitations. In the narratives, not treating the patient(s) was sometimes understood as the right thing to do, and sometimes as wrong. In analyzing participants’ narratives we draw attention to how medications and equipment are represented. In one type of narrative, medications and equipment are represented primarily as scarce resources; in another, they are (...) represented as patient care. In the contexts respondents were working, medications and equipment were often both patient care interventions and scarce resources. The analytic point is that health professionals tend to emphasize one conceptualization over the other in coming to assert that not treating is right, or wrong. Rendering tacit ethical frameworks more explicit makes them available for reflection and debate. (shrink)

ABSTRACT The emergence of the coronavirus disease 2019 pandemic has wide-ranging implications for the field of professional psychology. As clinical practice has rapidly adapted to ensure continuity of care, doctoral students have encountered unique opportunities for ethics-related competency development across practicum training settings. This article discusses the relevant American Psychological Association Ethics Code standards and additional ethical considerations facing trainees as they navigate their foundational clinical experiences and develop as professional psychologists in light of a pandemic.

Non-Invasive Prenatal Testing is a technology which provides information about fetal genetic characteristics very early in pregnancy by examining fetal DNA obtained from a sample of maternal blood. NIPT is a morally complex technology that has advanced quickly to market with a strong push from industry developers, leaving many areas of uncertainty still to be resolved, and creating a strong need for health policy that reflects women’s social and ethical values. We approach the need for ethical policy-making by studying the (...) use of NIPT and emerging policy in the province of Ontario, Canada. Using an adapted version of constructivist grounded theory, we conducted interviews with 38 women who have had personal experiences with NIPT. We used an iterative process of data collection and analysis and a staged coding strategy to conduct a descriptive analysis of ethics issues identified implicitly and explicitly by women who have been affected by this technology. The findings of this paper focus on current ethical issues for women seeking NIPT, including place in the prenatal pathway, health care provider counselling about the test, industry influence on the diffusion of NIPT, consequences of availability of test results. Other issues gain relevance in the context of future policy decisions regarding NIPT, including funding of NIPT and principles that may govern the expansion of the scope of NIPT. These findings are not an exhaustive list of all the potential ethical issues related to NIPT, but rather a representation of the issues which concern women who have personal experience with this test. Women who have had personal experience with NIPT have concerns and priorities which sometimes contrast dramatically with the theoretical ethics literature. These findings suggest the importance of engaging patients in ethical deliberation about morally complex technologies, and point to the need for more deliberative patient engagement work in this area. (shrink)

_A portion of the revenue from this book’s sales will be donated to Doctors Without Borders to assist in the fight against COVID-19._ The rapid spread of COVID-19 has had an unprecedented impact on modern health-care systems and has given rise to a number of complex ethical issues. This collection of readings and case studies offers an overview of some of the most pressing of these issues, such as the allocation of ventilators and other scarce resources, the curtailing of standard (...) privacy measures for the sake of public health, and the potential obligations of health-care professionals to continue operating in dangerous work environments. (shrink)

Discussions of both personal responsibility and the importance of trust in health-care settings are increasingly prominent in the bioethics literature. In this paper I link the two discussions and argue that health policies that include personal responsibility ought to address climates of social trust. Trust is a social good that is not always fairly distributed. Disadvantaged social groups often face default distrust. I suggest that agent-centered models in which responsibilities are negotiated do a better job of repairing social distrust than (...) authoritative models in which responsibilities are assigned. Attending to climates of trust, distrust, or antitrust is essential for addressing health inequalities. (shrink)

Mucopolysaccharidosis type I (MPS I) is a rare lysosomal storage disorder treated with bone marrow transplantation or enzyme replacement therapy with laronidase, a high-cost orphan drug. Laronidase was approved by the US Food and Drug Administration and the European Medicines Agency in 2003 and by the Brazilian National Health Surveillance Agency in 2005. Many Brazilian MPS I patients have been receiving laronidase despite the absence of a governmental policy regulating access to the drug. Epidemiological and treatment data concerning MPS I (...) are scarce. This study aims to present a demographic profile of Brazilian patients with MPS I, describe the routes of access to laronidase in Brazil, and discuss associated ethical issues relating to public funding of orphan drugs. (shrink)

This collection of essays is a sequel to the editors' 1976 volume Studies in Nietzsche and the Classical Tradition. Philosophers, theologians, and literary historians discuss important aspects of Nietzsche's attack on Judaism and Christianity. The book contains studies of his view of biblical figures, Luther and Pascal as well as comparisons of his thought with that of Spinoza, Lessing, Heine, and Kierkegaard. Nietzsche's critique of the Old Testament, the Jewish religion of the diaspora, and historical Christianity are also investigated. Of (...) the eighteen articles included here, thirteen were prepared expressly for this volume--five were translated from German, one from French, and one from Hebrew. Contributors to this volume are: Eugen Biser, Harry Neumann, Israel Eldad, Charles Lewis, Jorg Salaquarda, Joan Stambaugh, Max L. Baeumer, Brendan Donellan, Diana Behler, Sander L. Gilman, Gerd-Gunther Grau, Josef Simon, James C. O'Flaherty, Bernd Magnus, Georges Goedert, Hans Lung, and Karl Barth. (shrink)

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Introduction: Variation across research ethics boards in conditions placed on access to medical records for research purposes raises concerns around negative impacts on research quality and on human subject protection, including privacy.Aim: To study variation in REB consent requirements for retrospective chart review and who may have access to the medical record for data abstraction.Methods: Thirty 90-min face-to-face interviews were conducted with REB chairs and administrators affiliated with faculties of medicine in Canadian universities, using structured questions around a case study (...) with open-ended responses. Interviews were recorded, transcribed and coded manually.Results: Fourteen sites required individual patient consent for the study to proceed as proposed. Three indicated that their response would depend on how potentially identifying variables would be managed. Eleven sites did not require consent. Two suggested a notification and opt-out process. Most stated that consent would be required if identifiable information was being abstracted from the record. Among those not requiring consent, there was substantial variation in recognising that the abstracted information could potentially indirectly re-identify individuals. Concern over access to medical records by an outside individual was also associated with requirement for consent. Eighteen sites required full committee review. Sixteen allowed an external research assistant to abstract information from the health record.Conclusions: Large variation was found across sites in the requirement for consent for research involving access to medical records. REBs need training in best practices for protecting privacy and confidentiality in health research. A forum for REB chairs to confidentially share concerns and decisions about specific studies could also reduce variation in decisions. (shrink)

College students from small, medium, and large institutions with either a modified or no honor code were presented with cheating scenarios and asked to rate how dishonest they perceived the behavior to be and the likelihood that they would report it. No main effects were found for institution size or type of honor code. Student–faculty ratio was not correlated with responses to the cheating scenarios. Students from modified honor code schools perceived more severe punishments for cheating and understood the reporting (...) process better than students from non–honor code schools. Implications for modified honor code systems are discussed. (shrink)

To address growing concerns about academic integrity, college students (n?=?758) at honor system and non-honor system institutions were presented with eight scenarios to determine the influence of an honor system on their perceptions of and responses to academic dishonesty. Main effects for honor code status emerged. Students from traditional honor system schools considered the behaviors to be more dishonest, and were more likely to respond that they would report the incident when compared to students attending modified and non-honor system institutions. (...) Findings suggest traditional honor systems, with specific rules and regulations in place, are more effective at cultivating academic integrity among students; modified honor systems may not be as effective as previous research suggests. (shrink)

These fifteen essays on Nietzsche's indebtedness to the Classical Tradition were composed by scholars in the fields of philosophy, theology, German and Classics. The essays roughly cover the following epochs: the age of the Fathers of the Western Church, medieval scholasticism, the Renaissance, the Enlightenment, Weimar Classicism, Romanticism and the several other intellectual trends and movements in the nineteenth century. Collection includes three essays comparing Nietzsche's perceptions of Plato, Aristotle, and Socrates with those (respectively) of Augustine, Aquinas, and Hamann. Three (...) essays treat Nietzsche's relationship to Goethe, Schiller, and Heine. Three deal with Nietzsche and French literature or thought, one explores possible parallels between Nietzsche and Dante, another the extent of his debt to Byron. Four contributions center on Nietzsche's view of tragedy, and an older study has been expanded to show the underlying harmony of Nietzsche's conception with that of the French classical tragedians. This book affirms and fulfills the need for serious scholarship by the student of Nietzsche unable to work in German, while presenting a readable cross-section of the work being done relating Nietzsche to the intellectual tradition from which he sprang. (shrink)