The relationships between socioeconomic and biogenetic reproduction are always socially constructed but not always acknowledged. These relationships are examined as they apply to an instance of infertility and assisted reproduction presented in a seventeenth-century English play, Thomas Middleton’s 1613 comedy, A Chaste Maid in Cheapside. Middleton’s satirization of the effects of secrecy on the category of reproductive disability is analyzed and its applicability to our own time considered. The discussion is in four parts, focusing on: the attribution (...) of disabled status to one member of the couple, the wife; the use of this attribution to protect the husband’s reputation for sexual and reproductive health; the concealment of the nature of assisted reproduction; and the interests of the child conceived with such assistance. (shrink)

Genetics: Medical, Theological and Ethical Aspects Tibbi, Dini ve Etik Boyutlariyla Genetik -/- Genetik bilimi biyolojinin botanik ve zooloji alanındaki uygulamalarını aşarak, sınırlarını önce antropolojiye sonra tıbba doğru hızla genişletmiştir. Öyle ki artık biyokimyadan onkolojiye kadar neredeyse tüm biyomedikal disiplinler, genetiğin kavramları, ilkeleri ve metodolojisi ile aşılanmıştır. Modern tıbbın uygulama alanında geniş bir yer tutan genetik bilimi, bir hastalığa dair risk analizi, teşhis ve tedavi seçeneklerinin belirlenmesi, prognozun değerlendirilmesi gibi klinik uygulamanın farklı evrelerinde söz sahibi olmaktadır. İçinde bulunduğumuz 21. yüzyılda (...) ise bu etkileşim eskisinden daha da güçlü hale gelerek devam etmektedir. Genetik biliminin klinikteki etkilerinin kapsamlı bir şekilde değerlendirildiği bu kitap, tüm dünyada tıbbın seyrini değiştirecek gelişmelere zemin teşkil eden genetik disiplininin olumlu ve olumsuz etkileri hakkında okuyucuya yetkili ağızlardan bilgiler taşımayı ve daha net bir fikir oluşturmayı hedeflemektedir. Kitapta dört ana bölüm bulunmaktadır. İlk bölümde doğum öncesi genetik uygulamalara, ikinci bölümde doğum sonrası (çocuk ve erişkinde) genetik testlere, üçüncü bölümde tıbbi genetiğin sıcak tartışma konusu olan Spinal Müsküler Atrofi’ye (SMA) ve dördüncü bölümde ise genetik bilgiyi felsefi bakışla ele alan makalelere yer verilmiştir. Genetiğin tıp pratiğini değiştirici ve dönüştürücü etkisine multidisipliner bir yaklaşımla ışık tutmayı amaçlayan bu eserin genetik hakkındaki Türkçe literatüre katkıda bulunmasını ümit ediyoruz. (shrink)

Türkiye hosts approximately 3.6 million Syrian refugees, which accounts for roughly 4.5% of Türkiye's population. This places undeniable pressure on public institutions, particularly on healthcare services. The objective of this study is to document the healthcare structure for Syrian refugees and various challenges faced by Syrians when seeking healthcare and to highlight the ethical concerns emerging from those challenges. To achieve this, we conducted a comprehensive review of several qualitative studies and reports conducted by various organizations and institutions, specifically focusing (...) on health or including a dedicated chapter on health issues, published between 2011 and 2023. Following an extensive analysis of the secondary literature, we classified the challenges into three categories: procedural, cultural, and psychosocial. We argue that each of these challenges is linked to overarching medical ethics concerns. Finally, we propose three possible means to mitigate the challenges Syrians experience in accessing and uptake of healthcare services in Türkiye. (shrink)

This letter was submitted to the Senate Standing Committee on Legal and Constitutional Affairs, Government of Canada, on 29th January, 2021, as final debate over Bill C-7 was being undertaken in the Senate regarding MAiD and the strong opposition to the legislation expressed across the Canadian disability community. It draws on our individual and joint work on eugenics, well-being, and disability.

This chapter contains sections titled: Notes.

This paper attempts a critical examination of the thesis that an apprenticeship to a Lancaster druggist was, for Edward Frankland, a wholly inappropriate preparation for a career in chemistry. This view, which stems directly from Frankland himself, is defective in several ways. It fails to take into account certain benefits which he accepted as valuable; it implies an exceptional degree of ‘negligence’ which was in fact quite typical; it ignores certain positive indicators of the value of such experience; and it (...) involves questionable value-judgments on the behaviour of one individual, the druggist Stephen Ross. Although Frankland's perspective may be no longer acceptable, the reasons for its inadequacy are perhaps the most important aspect of the whole affair. Their identification raises questions of historiography of wider significance, while the whole episode underlines certain issues in scientific training that were to become crucial in the growth of Victorian chemistry in Britain. (shrink)

The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This (...) study occurred at the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions. (shrink)

This essay addresses feminist approaches to medical aid in dying (MAID), considering whether it is a practice that should be supported for women and other marginalized groups. Some feminists have raised rights and justice-based arguments in support of MAID; others have taken a care-based approach to suggest that the practice violates relationships of care and only worsens distrust between marginalized groups and the medical establishment. I argue that we need to adopt both justice and care approaches to develop (...) a robust feminist account of MAID. I defend a woman’s right to choose death in cases of terminal illness or suffering but argue that relational concerns of care, trust, and trustworthiness must be addressed at the same time to ensure that MAID is justly practiced and accessible to all those who want it. (shrink)

Canada is six years into a new era of legalized medical assistance in dying (MAiD). The law continues to evolve, following a pattern in which Canadian courts rule that legal restrictions on eligibility for MAiD are unconstitutional and Parliament responds by gradually expanding eligibility for MAiD. The central tension underlying this dialogue between courts and government has focused on two conceptions of how to best promote and protect the interests of people who are vulnerable by virtue of (...) intolerable and irremediable suffering due to an illness, disease, or disability. Do we, as a society, have a duty to protect vulnerable people from seeking certain medical procedures that are contrary to their interests, as those are perceived by others? Or do we have a duty to uphold their rights to autonomy, including the right to make choices within a range that may be constrained by many factors, some of which may be socially unjust? This is a recurrent problem in bioethics and medical law, which we explore through the lens of how Canadian courts and Parliament have grappled with defining eligibility for MAiD. (shrink)

In their forthcoming article, Shavelson and colleagues (2023) identify a key ethical concern associated with medical aid-in-dying (MAiD) laws in the eleven US jurisdictions where the practice is le...

“Hooking up,” a popular type of sexual behavior among college students, has become a pathway to dating relationships. Based on open-ended narratives written by 273 undergraduates, we analyze how students interpreted a vignette describing a heterosexual hookup followed by a sexless first date. In contrast to the sexual script which holds that women want relationships more than sex and men care about sex more than relationships, students generally accorded women sexual agency and desire in the hookup and validated men’s post-hookup (...) relationship interest. However, in explaining the sexless date, students typically reasoned the woman was being chaste and withholding sex to redeem her reputation whereas they often characterized the man’s abstinence in terms of a pity date. The findings underscore the tenacity of gendered sexual scripts around heterosexual dates and hookups but also reveal fissures and contradictions that suggest some changes to the sexual double standard. (shrink)

Medical assistance in dying legislation in Canada followed much deliberation after the Supreme Court of Canada’s ruling in Carter v. Canada. Included in this deliberation was the Special Joint Committee on Physician Assisted Dying’s recommendation to extend MAID legislation beyond the inclusion of adults to mature minors. Children's agency is a construct advanced within childhood studies literature which entails eliciting children’s voices in order to recognise children as active participants in constructing their own childhoods. Using this framework, we consider (...) the possible extension of MAID legislation to most minors. We highlight important questions regarding how insights from children’s voices could be mobilised in the life or death context of MAID. We conclude that children’s voices have the potential to help determine their eligibility for MAID; however, incorporating children's voices in the context of MAID requires careful consideration due to the complexity of voice. (shrink)

This book, written both for a Canadian and an international readership, provides a multidisciplinary review of the framework and performance of the Canadian Medical Assistance in Dying (MAID) program. In the first five years (2015-2021) of operation, this program delivered voluntary euthanasia and assistance in suicide to over 30,000 Canadian residents, presently representing a 30% annual growth. Looking back on these first five years, the 30 Canadian scholars and clinicians contributing to this volume raise important issues and attempt to (...) answer key questions that have arisen in regards to its operation and its stated objectives. This volume strikes the most appropriate balance between the autonomy of persons who seek medical assistance, versus the interests and protection of vulnerable persons. Finally, the book makes suggestions on how the program can presently be improved. It identifies gaps in knowledge about MAID’s operational program and its impact on individuals, families and society in order to stimulate the necessary research that is essential to the evolution of a healthy and well-balanced program. As a first, comprehensive examination of medically assisted deaths in Canada, this publication will be of great value to lay, professional, academic, political audiences both domestically and internationally, especially in jurisdictions that are examining their options of permitting assisted deaths. (shrink)

The biological species (biospecies) concept applies only to sexually reproducing species, which means that until sexual reproduction evolved, there were no biospecies. On the universal tree of life, biospecies concepts therefore apply only to a relatively small number of clades, notably plants andanimals. I argue that it is useful to treat the various ways of being a species (species modes) as traits of clades. By extension from biospecies to the other concepts intended to capture the natural realities of what keeps (...) taxa distinct, we can treat other modes as traits also, and so come to understand that theplurality of species concepts reflects the biological realities of monophyletic groups.We should expect that specialists in different organisms will tend to favour those concepts that best represent the intrinsic mechanisms that keep taxa distinct in their clades. I will address the question whether modes ofreproduction such as asexual and sexual reproduction are natural classes, given that they are paraphyletic in most clades. (shrink)

Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...) a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged. (shrink)

Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...) a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged. (shrink)

Het Leids-Haags Allegorieënlexicon toont nieuwe perspectieven op de maatschappelijke werkelijkheid met een actuele duiding van vijftig kernthema’s uit de wetenschap. De auteurs zijn de duale promovendi en hun promotores van Leiden University Dual PhD Centre The Hague. Ze worden daarbij geïnspireerd door de metafoor van de grot van Plato: Waar ben ik? Waar sta ik? Welk beeld zie ik? Hoe kan ik dat begrijpen? Er ontstaan beeldende voorstellingen van begrippen waarin op zoek wordt gegaan naar de centrale gedachten die ten (...) grondslag liggen aan die begrippen. Zo wordt de veranderende wereld waargenomen met het besef dat we nooit kunnen weten of we de gehele werkelijkheid kunnen zien of begrijpen. De waarneming is afhankelijk van de zichtpositie die de waarnemer inneemt. Zo ontstaan verbeeldingen van waarnemingen van ons menselijk bestaan. Zoals: assimilatie, creativiteit, gender, kunstenaarschap, magistraat, participatie, regels, tragedie en verzorgingsstaat. Eerst wordt actuele literatuur besproken. Daarna volgt discussie. Tenslotte neemt de auteur positie in. Met bijdragen van promotores Wilfried Admiraal, Ingrid van Biezen, Hans Borgman, Paul Cliteur, Jaap van den Herik, Rikki Holtmaat, Willem Otterspeer, Jos Raadschelders, Robert Tijssen, Wim Willems en promovendi. (shrink)

These range from merely good reads to really outstanding books. A raw ranking of them would be of little use to others, unless I explained why I gave them the ranks I did, and anyway I'd probably give different rankings by the time your read this. (When I know of an on-line review about a book which I agree with --- e.g., because I wrote it --- I've included a link; also some exceedingly short remarks about interesting cases.).

This paper depicts a case study of an organizational strategy for the promotion of ethical practice when introducing a new, high-risk, ethically-charged medical practice like Medical Assistance in Dying (MAiD). We describe the development of an interprofessional program that enables the delivery of high-quality, whole-person MAiD care that is values-based and sustainable. A “care ecology” strategy recognizes the interconnected web of relationships and structures necessary to support a quality experience of MAiD for patients, families, and clinicians. This (...) program exemplifies a care ecology approach that addresses common barriers to entry to MAiD practice, and also meets the needs of a variety of stakeholders through the creation of patient and family resources, team supports, standards of practice, professional development opportunities, organizational infrastructure, and community partnerships. We also describe how a thriving care ecology evolves to remain resilient, and to enable integration as the needs of the organization, team and program change over time. The design and development of this program may be adapted to other jurisdictions and organizations where MAiD is introduced, or where new patient populations become eligible for MAiD. This care ecology model may also be applicable to the creation of sustainable programs that provide other morally controversial or novel clinical services. (shrink)

BackgroundFollowing several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).AimThis review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative (...) framework.MethodsWe review the proposed Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.FindingsIn this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mimetic Desire and the Nigerian Novel:The Case of Chike Momah's Titi: Biafran Maid in GenevaTerri Ochiagha (bio)René Girard's mimetic theory was first informed by Western canonical novels. Girard's paradigm, with its psychological, anthropological, and historical backing, provides explanations for universal phenomena like rivalry, violence, scapegoat mechanisms, and the religious processes of sin and redemption. While it is not reflected in his choice of literary subjects, Girard has endeavored (...) to assert the universality of mimetic desire and its implications in "Other," non-Western cultures. However, little or no attention has been paid to novels that do not circulate primarily within Western canonical circles. To start redressing this gap in the literature, I use Girard's mimetic theory to study a Nigerian novel, Chike Momah's Titi: Biafran Maid in Geneva and show how the paradigm is suited to a novel so distant in space, time, and culture from the famous works that first inspired it. Apart from identifying the nature and phases of mimetic desire that appear in the novel, I propose other possible triangulations of desire, separating out the mimetic from the nonmimetic, and address the possible implications of the homosexual nature of the novel's interracial triangular desire. [End Page 205]A First Encounter with the NovelSince I assume that neither the author nor the novel under discussion are well known to the readers of this article, I will briefly discuss the author and trace the outline of the plot, in order to allow for an uninterrupted flow in my explication of the dialectics of mimetic desire.The situation of Chike Momah in Nigerian letters is singular. He belongs to the Ibadan golden generation of authors, heralded by Chinua Achebe's first novel, Things Fall Apart (1958), and his contemporaries at University College, Ibadan, including the Nobel laureate Wole Soyinka, plus Chukwuemeka Ike, Elechi Amadi, Christopher Okigbo, Flora Nwapa, and J. P. Clark, among others. Despite his talent, Momah did not join the literary movement that his fellow alumni inaugurated. Almost 40 years later and two years prior to his retirement from his United Nations position in 1990, he began his literary career, which has yielded five novels and several essays. Being a firsthand witness to the birth of Nigerian written literature, he was sought after by biographers and conference organizers. However, his oeuvre has not garnered sufficient attention. This could be the result of a number of factors: first, the distribution of most of his novels has been limited; second, his writings began to emerge at a time when the literary reputations of his contemporaries had long since arrived at their zenith; and third, novels that primarily seek to entertain, as most of his do, are often disregarded in the realm of postcolonial criticism.Titi: Biafran Maid in Geneva (1999) is Momah's second novel. It is the sole Nigerian Civil War novel to portray the horrors of the conflict from the viewpoint of a Biafran family living in Geneva, the Okekes. Its excellent exploration of war trauma frames an entertaining story line. This involves Titi, the Okekes' maid, and her multiple love affairs. Mimetic desire sets in during the course of her relationship with Eddy Mafa and the love triangle that ensnares them with Suzanne, Eddy's European lover. This tangled web provides the perfect substrate on which to test Girard's theory of mimetic desire.Suzanne, Titi, and Eddy: The Genesis of Mimetic DesireAccording to Girard, mimetic desire occurs when we crave for an object, place, status, or person simply because someone else desires it. The resulting rivalry can bring us into conflict with the models we imitate. According to this theory, [End Page 206] the romantic concept of spontaneous desire is illusory since it is learned from the Other. One therefore learns the value of desired objects from desiring subjects. Mimetic desire is schematized by a triangle. However, as we will see, not all love triangles are triangulations of mimetic desire.In Titi: Biafran Maid in Geneva, the eponymous protagonist meets Eddy at the Okekes' house. They begin a relationship, which does not show many signs of prospering beyond its physicality. Apart from the fact that both... (shrink)

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators (...) across Canada has highlighted the need for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

Many disabled individuals adamantly oppose medical assistance in dying, quite rightly referencing pervasive ableism and, euthanasia’s dark history in the Aktion T4 program of Nazi Germany in which...

Canadian ethicists Jocelyn Downie and Udo Schuklenk seek to assess the effect of Canada’s decriminalisation of ‘medical assistance in dying’ ‘to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law.’1 Their assessment focuses on two arguments earlier levied against expansion of these procedures. The first is that of a ‘slippery slope’ and the second is what they disingenuously call, ‘social determinants of health’. They conclude that, in both cases, (...) the effect of legislation permitting first limited and then expanded options for medical termination has been benign. The argument in this brief commentary is that the ‘slippery slope’ is clearly evident and support for those with chronic, progressive diagnoses a clear contributor to the ever increasing number of persons seeking MAID. Downie and Schuklenk first review the legal and legislative history of MAID. In Carter v Canada, the courts found …. (shrink)

The locus classicus for Plutarch's own views on his methods is in the Alexander He has begun by asking for the indulgence of his readers if they do not find all the exploits of Alexander and Caesar recounted by the biographer or if they discover him not reporting some famous incident in detail (); and he goes on to compare his own search for evidence which will indicate the kind of soul, with the activity of the painter, who, in order (...) to create a likeness, concentrates on the eyes and pays little attention to the other parts. Commentators and critics have been right to take this as a key text for the purpose of understanding Plutarch's attitude towards his biographical work; nevertheless there are other passages in the Lives where we can at least glimpse his attitude to his subject, and we can only see the Alexander-remarks in correct perspective if we take these other passages into account. I propose therefore, starting with the Alexander, to see how far these critical remarks apply to Plutarch's theory and practice elsewhere in the Lives. (shrink)

Purpose. To examine the existential anthropology of G. Marcel and E. Minkowski, in order to demonstrate the necessity of distinguishing the universal-spiritual, as human in human being, apart from the individual-existential in him, and to reveal the hierarchical correlation of biosocial, existential and spiritual spheres in personality. Theoretical basis. Within existential philosophy the author differentiates two separate traditions and proceeds from the insufficiency of the distinction of existential sphere, proposed by phenomenological tradition, showing the necessity of its correlation with the (...) spiritual sphere as a sphere of humanity, proposed by non-phenomenological tradition of G. Marcel and E. Minkowski. Originality. The author presents the anthropological conception of G. Marcel and E. Minkowski, in which human personality is understood as unity of individual-existential and universal-spiritual, which requires a special trans-empirical field of culture, which contains senses, images and symbols of humanity. Also, the author presents the recent developments of existential thinkers in distinguishing existential and spiritual dimensions, both not reducible to the physical and social dimensions. Conclusions. In both existential traditions, the specifically human was founded as a trans-biological and trans-social phenomenon, which appears as indefinable and non-predetermined. But in first tradition, humanity is understood as an existence, as a unique individuality, "project", variant of humanity, equivalent to other variants, and universal is understood as a community of human condition in the world. While in the second tradition, the universal is understood as spiritual. Thus, horizontal level of our private existence, as the process of movement from birth to death, is supplemented by vertical of human, universal ideals and images. Humanity appears as a task, on the way to which human being transcends beyond the limits of his individual "self" to the "super-individual", through inclusion into spiritual community, into universal culture. (shrink)