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)

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)

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 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)

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)

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)

Ocherk 1. Voprosy ontologii -- Ocherk 2. Voprosy ėtiki i ėstetiki -- Ocherk 3. Voprosy gnoseologii i aksiologii.

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)

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)

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)

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

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)

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...

Prologue, invitation to thinking about God In the Hebrew Bible? -- Part I, questions about God? -- Why does God in the Bible have a body? -- What do God's body parts in the Bible mean? -- Why is God angry in the Bible? -- Does God in the Bible have gender or sexuality? -- Part II, questions about God in the world? -- What can creation tell us about God? -- Who-or what-is the Satan? -- Why do people suffer (...) according to the Hebrew Bible? -- Epilogue, God in the Bible and beyond. (shrink)

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.

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)

Many books explain what is known about the universe. This book investigates what cannot be known. Rather than exploring the amazing facts that science, mathematics, and reason have revealed to us, this work studies what science, mathematics, and reason tell us cannot be revealed. In The Outer Limits of Reason, Noson Yanofsky considers what cannot be predicted, described, or known, and what will never be understood. He discusses the limitations of computers, physics, logic, and our own thought processes. Yanofsky describes (...) simple tasks that would take computers trillions of centuries to complete and other problems that computers can never solve; perfectly formed English sentences that make no sense; different levels of infinity; the bizarre world of the quantum; the relevance of relativity theory; the causes of chaos theory; math problems that cannot be solved by normal means; and statements that are true but cannot be proven. He explains the limitations of our intuitions about the world -- our ideas about space, time, and motion, and the complex relationship between the knower and the known. Moving from the concrete to the abstract, from problems of everyday language to straightforward philosophical questions to the formalities of physics and mathematics, Yanofsky demonstrates a myriad of unsolvable problems and paradoxes. Exploring the various limitations of our knowledge, he shows that many of these limitations have a similar pattern and that by investigating these patterns, we can better understand the structure and limitations of reason itself. Yanofsky even attempts to look beyond the borders of reason to see what, if anything, is out there. (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)

Richard Janko's acclaimed translation of Aristotle's _Poetics_ is accompanied by the most comprehensive commentary available in English that does not presume knowledge of the original Greek. Two other unique features are Janko's translations with notes of both the _Tractatus Coislinianus_, which is argued to be a summary of the lost second book of the Poetics, and fragments of Aristotle’s dialogue On Poets, including recently discovered texts about catharsis, which appear in English for the first time.

This chapter develops a perceptual solution to the epistemological problem of other minds, relying on central ideas from Maurice Merleau-Ponty's phenomenology. The Merleau-Pontian account is contrasted with another attempted perceptual solution to the other minds problem, and it is argued that only the former meets the phenomenologists' desideratum of providing an alternative to inferential solutions. The chapter also provides responses to various objections to the perceptual solution, including a pair of objections recently put forward by Alec Hyslop.

"Williams's masterful translation satisfies (at last!) a long-standing need. There are lots of good translations of Augustine's great work, but until now we have been forced to choose between those that strive to replicate in English something of the majesty and beauty of Augustine's Latin style and those that opt instead to convey the careful precision of his philosophical terminology and argumentation. Finally, Williams has succeeded in capturing both sides of Augustine's mind in a richly evocative, impeccably reliable, elegantly readable (...) presentation of one of the most impressive achievements in Western thought--Augustine's Confessions." --Scott MacDonald, Professor of Philosophy and Norma K. Regan Professor in Christian Studies, Cornell University. (shrink)

Study of Hans-Georg Gadamer's and Julius Stenzel's interpretations of Plato.