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)

What do we mean when we call something or someone evil? The word "evil" tends to conjure up images of demons, devils, and horrifying crimes, things that you and I couldn't possibly get involved with! But is that true? Is evil really something that only wicked people who are "quite unlike ourselves" get up to? Could it be that you and I are not only capable of doing evil things, but are already involved with such things? This book explores the (...) hidden nature of evil and draws out the ways in which all of us, knowingly or otherwise, are caught up in webs of evil that bring about disastrous consequences, often to the weakest and most vulnerable amongst us. We need to find ways of learning to see evil and resisting it by all means possible. If we can't see evil, we can't resist it. If we can't resist it, we get sucked into it. (shrink)

This investigation develops in three steps. First, we seek to complexify the opioid crisis in a way that helps us to see how the issues of misguided desire and misplaced attachments are fundamentally important for a theological account of opioid addiction.1 Second, acknowledging the connections between pain and opioid addiction, we explore some of the ways in which our understanding of pain can influence our understanding of and responses to opioid use. Finally, we offer some tentative reflections on the theological (...) and ecclesial dimensions of the opioid crisis which hold the potential to influence the nature of a Christian response to the issues. Having laid out these steps, we argue for the church’s calling, where she complexifies the narratives about the opioid crisis and provides individuals suffering from opioid use “homeful” encounters with God and the community. (shrink)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of (...) the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

This paper explores and develops a theological perspective on taking and receiving medication. It argues that the task of prescribing and administering psychopharmaceutical drugs is a thoroughly theological enterprise and should be looked at and practiced accordingly. The paper presents a theological anthropology that opens up space for rethinking the role of medication not only in relation to therapeutic intervention, but in relation to the chief end of human beings: to glorify God and live with God forever. Drawing on theology (...) and the narratives of people living with mental health challenges, the paper seeks to facilitate a movement from neurons to souls: a movement that realigns the goals of prescribing and opens up space to rethink the nature of “symptoms” and the ultimate intentions of the psychopharmacological enterprise. (shrink)

I am grateful to Anastasia Scrutton for opening up a very important area for thought, reflection, and practice. Her paper presents a fascinating argument for an understanding of depression that is framed as a potentially spiritually transformative experience with positive therapeutic implications. In doing so, she offers a way for theologians, philosophers, and practitioners to effectively perceive, understand, and engage with the spiritual dimensions of the experience of depression. As such, she has made an important contribution to the ongoing and (...) often fraught conversations around the role of spirituality in understanding mental health issues. The models she outlines neatly encapsulates a broad range of... (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe conducted seven (...) day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (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)

In his Philosophical Inquiry concerning Human Liberty (1717), the English deist Anthony Collins proposed a complete determinist account of the human mind and action, partly inspired by his mentor Locke, but also by elements from Bayle, Leibniz and other Continental sources. It is a determinism which does not neglect the question of the specific status of the mind but rather seeks to provide a causal account of mental activity and volition in particular; it is a ‘volitional determinism’. Some decades later, (...) Diderot articulates a very similar determinism, which seeks to recognize the existence of “causes proper to man” (as he says in the Réfutation d’Helvétius). The difference with Collins is that now biological factors are being taken into account. Obviously both the ‘volitional’ and the ‘biological’ forms of determinism are noteworthy inasmuch as they change our picture of the nature of determinism itself, but my interest here is to compare these two determinist arguments, both of which are broadly Spinozist in nature – and as such belong to what Jonathan Israel called in his recent book “the radical Enlightenment,” i.e. a kind of underground Enlightenment constituted by Spinozism – and to see how Collins’ specifically psychological vision and Diderot’s specifically biological vision correspond to their two separate national contexts: determinism in France in the mid-1750s was a much more medico-biological affair than English determinism, which appears to be on a ‘path’ leading to Mill and associationist psychology. (shrink)

J. Willard Gibbs derived the following equation to quantify the maximum work possible for a chemical reaction$${\text{Maximum work }} = \, - \Delta {\text{G}}_{{{\text{rxn}}}} = \, - \left( {\Delta {\text{H}}_{{{\text{rxn}}}} {-}{\text{ T}}\Delta {\text{S}}_{{{\text{rxn}}}} } \right) {\text{ constant T}},{\text{P}}$$ Maximum work = - Δ G rxn = - Δ H rxn - T Δ S rxn constant T, P ∆Hrxn is the enthalpy change of reaction as measured in a reaction calorimeter and ∆Grxn the change in Gibbs energy as measured, if (...) feasible, in an electrochemical cell by the voltage across the two half-cells. To Gibbs, reaction spontaneity corresponds to negative values of ∆Grxn. But what is T∆Srxn, absolute temperature times the change in entropy? Gibbs stated that this term quantifies the heating/cooling required to maintain constant temperature in an electrochemical cell. Seeking a deeper explanation than this, one involving the behaviors of atoms and molecules that cause these thermodynamic phenomena, I employed an “atoms first” approach to decipher the physical underpinning of T∆Srxn and, in so doing, developed the hypothesis that this term quantifies the change in “structural energy” of the system during a chemical reaction. This hypothesis now challenges me to similarly explain the physical underpinning of the Gibbs–Helmholtz equation$${\text{d}}\left( {\Delta {\text{G}}_{{{\text{rxn}}}} } \right)/{\text{dT}} = - \Delta {\text{S}}_{{{\text{rxn}}}} \left( {\text{constant P}} \right)$$ d Δ G rxn / dT = - Δ S rxn constant P While this equation illustrates a relationship between ∆Grxn and ∆Srxn, I don’t understand how this is so, especially since orbital electron energies that I hypothesize are responsible for ∆Grxn are not directly involved in the entropy determination of atoms and molecules that are responsible for ∆Srxn. I write this paper to both share my progress and also to seek help from any who can clarify this for me. (shrink)

The most pressing issues of the twenty-first century—climate change and persistent hunger in a world of food surpluses, to name only two—are not problems that can be solved from within individual disciplines, nation-states, or cultural perspectives. They are predicaments that can only be resolved by generating sustained and globally robust coordination across value systems. The scale of the problems and necessity for coordinated global solutions signal a world historical transit as momentous as the Industrial Revolution: a transition from the predominance (...) of technical knowledge to that of ethical deliberation. This volume brings together leading thinkers from around the world to deliberate on how best to correlate worth (value) with what is worthwhile (values), pairing human prosperity with personal, environmental, and spiritual flourishing in a world of differing visions of what constitutes a moral life. Especially in the aftermath of what is now being called the Great Recession, awareness has mounted of the imperative to question the modern divorce of economics from ethics. While the domains of economics and ethics were from antiquity through at least the eighteenth century understood in many cultures to be coterminous and mutually entailing, the modern assumption has been that the goal of maximizing human prosperity and the aim of justly enhancing our lives as persons and as communities were functionally and practically distinct. Working from a wide array of perspectives, the contributors to this volume offer a set of challenges to the assumed independence of the quantitative and qualitative dimensions of human and planetary well-being. Reflecting on the complex interrelationship among economics, justice, and equity, the book resists "one size fits all" approaches and struggles to revitalize the marriage of economics and ethics by activating cultural differences as the basis of mutual contribution to shared human flourishing. The publication of this important collection will stimulate or extend critical debates among scholars and students working in a number of disciplines in the social sciences and humanities, including philosophy, history, environmental studies, economics, and law. Contributors: Roger T. Ames, James Behuniak Jr., Steve Bein, Nalini Bhushan, Purushottama Bilimoria, Steven Burik, Amita Chatterjee, Baoyan Cheng, Gordon Davis, Jay L. Garfield, Steven F. Geisz, Peter D. Hershock, Larry A. Hickman, Kathleen M. Higgins, Heidi M. Hurd, Thomas P. Kasulis, Workineh Kelbessa, Lori Keleher, Oliver Leaman, James McRae, Jin Y. Park, James Peterman, Naoko Saito, May Sim, Robert Smid, Paul Standish, Kenneth W. Stikkers, Karsten J. Struhl, Meera Sushila Viswanathan, Wu Shiu- Ching, Xu Di, T. Yamauchi, Yang Liuxin. (shrink)

Experimental Phenomena of Consciousness is the definitive collection of consciousness phenomena in which awareness emerges as an experimental variable. With its comprehensive yet succinct entries, arranged alphabetically, this dictionary will be a valuable reference tool for libraries and researchers at all levels in psychology, neuroscience, and philosophy, who are investigating consciousness, cognition, perception, and attention. It will also be an important addition to the reading lists of courses on consciousness and cognition. Most entries include illustrations and a list of references (...) where a more thorough treatment of the topic can be found. The text is supported by a web page that provides dynamic illustrations and other supplemental material. As the first reference book on the topic, Experimental Phenomena of Consciousness will be a valuable tool for undergraduates, graduate students, professional researchers, and anyone who has an interest in the subject of consciousness. (shrink)

How do we judge whether an action is morally right or wrong? If an action is wrong, what reason does that give us not to do it? Why should we give such reasons priority over our other concerns and values? In this book, T. M. Scanlon offers new answers to these questions, as they apply to the central part of morality that concerns what we owe to each other. According to his contractualist view, thinking about right and wrong is thinking (...) about what we do in terms that could be justified to others and that they could not reasonably reject. He shows how the special authority of conclusions about right and wrong arises from the value of being related to others in this way, and he shows how familiar moral ideas such as fairness and responsibility can be understood through their role in this process of mutual justification and criticism. Scanlon bases his contractualism on a broader account of reasons, value, and individual well-being that challenges standard views about these crucial notions. He argues that desires do not provide us with reasons, that states of affairs are not the primary bearers of value, and that well-being is not as important for rational decision-making as it is commonly held to be. Scanlon is a pluralist about both moral and non-moral values. He argues that, taking this plurality of values into account, contractualism allows for most of the variability in moral requirements that relativists have claimed, while still accounting for the full force of our judgments of right and wrong. (shrink)

At the very beginning of L’Homme-Machine, La Mettrie claims that Leibnizians with their monads have “rather spiritualized matter than materialized the soul”; a few years later Pierre-Louis Moreau de Maupertuis, President of the Berlin Academy of Sciences and natural philosopher with a strong interest in the modes of transmission of ‘genetic’ information, conceived of living minima which he termed molecules, “endowed with desire, memory and intelligence,” in his Système de la nature ou Essai sur les corps organisés. This text first (...) appeared in Latin in 1751 under the title Dissertatio inauguralis metaphysica de universali naturae systemate, with the pseudonym Dr Baumann; it was translated by Maupertuis in 1754 as Essai sur la formation des corps organisés and was later included in his 1756 Œuvres under the title Système de la nature. Now, it is clear that Maupertuis was a kind of Leibnizian; and that his molecule possessed higher-level, ‘mental’ properties. In that sense he falls under the first category described by La Mettrie. But he was also involved in a debate on this issue with Diderot, who put forth a sustained critique of Maupertuis’ theory of the molecule in the additions to his 1753 Pensées sur l’interprétation de la nature. Where Maupertuis attributes higher-level properties to his living minima, Diderot argues that these properties are ‘organizational’, i.e., they can only be properties of the whole. At issue here is the degree of commitment to a form of materialism. (shrink)