Canada and California each introduced legislation to permit medical assistance in dying in June, 2016. Each jurisdiction publishes annual reports on the number of deaths that occurred under their respective legislations in the previous years. The numbers are disturbingly different. In 2021, 486 individuals died under California’s End of Life Option. In the same year 10,064 Canadians died under that country’s Medical Assistance in Dying (MAiD) legislation. California has a slightly larger population than Canada, and while medically assisted deaths as (...) a percentage of total deaths remained virtually unchanged in California from 2020-2021, Canada saw a 30% increase from 2020 to 2021. This essay examines some of the factors propelling Canada down the slippery slope of medically assisted suicide, as well as those that may be keeping California and other US jurisdictions from taking the slide. At a time of increasing pressure in many jurisdictions (both nationally and internationally) to liberalize access to medical assistance in dying, some lessons from this comparative analysis are offered. (shrink)

Inasmuch as unmitigated pain and suffering areoften thought to rob human beings of theirdignity, physicians and other care providersincur a special duty to relieve pain andsuffering when they encounter it. When pain andsuffering cannot be controlled it is sometimesthought that human dignity is compromised.Death, it is sometimes argued, would bepreferred to a life without dignity.Reasoning such as this trades on certainpreconceptions of the nature of pain andsuffering, and of their relationships todignity. The purpose of this paper is to laybare these (...) preconceptions. The duties torelieve pain and suffering are clearly mattersof moral obligation, as is the duty to respondappropriately to the dignity of other persons.However, it is argued that our understanding ofthe phenomena of pain and suffering and theirrelationships to human dignity will be expandedwhen we explore the aesthetic dimensions ofthese various concepts. On the view presentedhere the life worth living is both morally goodand aesthetically beautiful. Appropriate``suffering with'''' another can help to maintainand restore the dignity of the relationshipsinvolved, even as it preserves and enhances thedignity of patient and caregiver alike. (shrink)

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we (...) consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. (shrink)

Historically the primary role of the Institutional Review Board (IRB) has been "to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in research" (U.S. FDA, 1996). However, there is much to suggest that IRBs have been unable to fulfil this mandate, particularly in regard to the matter of informed consent. Part of the problem in this regard is that the competing interests of other stakeholders (...) often undermine the IRB's capacity to serve the best interests of research subjects. This paper proposes an alternative view of the role of the IRB. It begins by treating the interests of other stakeholders as legitimate matters of concern for IRBs. Hence the process established to review and monitor human research should be treated as an exercise in social justice in which the interests of all legitimate stakeholders must be represented and considered. A variation of Rawls' (1971) heuristic "the veil of ignorance" is employed to explore the dynamic relationship between knowledge and interests that ensues when the role of the IRB is characterized in this manner. Inadequacies in the informed consent process are taken as illustrative of the inability of IRBs as they are presently construed to attend to the interests of research subjects. The major normative implication of the analysis offered here is that the role of the IRB must be expanded to include the granting of a provisional proxy consent on behalf of prospective research subjects. This provision is necessary, it is argued, if the interests of research subjects are to be fairly assessed by IRBs as a matter of social justice. It is necessary as well to ensure that an adequate standard of informed consent is attained. Somewhat paradoxically it is argued competing sets of interests the IRB must serve, rather than as the primary concern of the IRB. (shrink)

I want to begin this brief response by thanking all of those who took the time to read and reflect upon this piece. There were many thoughtful and thought provoking responses and I have learned fro...

Feticide, the practice of terminating the life of an otherwise viable fetus in utero, has become an increasingly common practice in obstetric centres around the globe, a concomitant of antenatal screening technologies. This paper examines this expanding practice in light of the concept of human dignity. Although it is assumed from the outset that even viable human fetuses are not persons and as such do not enjoy full membership in the moral community, it is argued that the fact that these (...) are nevertheless human fetuses affords them prima facie moral status. Thus even those who accept a liberal position with regard to therapeutic abortion, should be concerned about these more recent developments. Indeed, how we treat viable human fetuses has implications for our prospective treatment of other human non-persons and could undermine the common human dignity we all share. (shrink)

This paper explores the problem of universalism and particularism in contemporary ethics, and its relationship to Christian bioethics in particular. An ethic of human dignity is outlined, which, it is argued, constrains moral discourse in the broad sense – thus meeting the demands of universalism – but which is at the same time amenable to a variety of particularist interpretations – thus acknowledging the current shift toward historicism, traditionalism, and culture. The particularist interpretations that are of central concern here are (...) those provided by historic Christianity. The eventual goal is to indicate how a Christian conception of human dignity can have universal normative relevance both as a standard against which to assess competing particularist conceptions, and as a practical guide for everyday living. A Christian conception of dignity will in turn have significant implications when addressing contemporary issues in bioethics. These are ambitious goals, and a full explication of the ideas presented will not be possible in this context. Nevertheless, there is value in getting a bird's-eye view of the landscape before one goes about scaling the mountains and exploring the valleys. The present essay is intended as a general geography of the moral terrain in which an ethic of dignity in general, and a Christian perspective on dignity in particular, can provide normative guidance. (shrink)

Narrative theory is a dynamic and evolving field of inquiry that has made tremendous inroads in the medical humanities over the past 40 years. Numerous authors have popularized the idea that “thinking narratively” can produce important insights about the illness experience for physician and patient alike. This paper draws on aspects of narrative theory to emphasize the moral responsibilities that arise when we step into another person's life narrative, becoming a character in her or his story. This has especially significant (...) ethical implications for the physician–patient encounter in that each character in this shared story experiences time somewhat differently. This gives rise to the notion of “slow motion ethics” and a somewhat unique perspective on the moral responsibilities clinicians bear toward their patients. (shrink)

The author examines fundamental problems involved in teaching applied ethics in the educational environment of contemporary university culture. American universities are increasingly turning away from liberal arts education and focusing their efforts on constructing more professionalized degrees and programs. As a result, the education process has become increasingly commodified and ethics courses in universities have been further removed from the liberal arts project of moral development in the classroom. The author argues that ethicists should work to reframe the project of (...) moral education if they hope to retain a central role in the process of teaching ethics. The author suggests a growth model to be installed in the undergraduate curriculum that would reacquaint students with the aims and benefits of learning ethical and moral philosophy. (shrink)

BackgroundIn 2009, Dr. Paolo Zamboni proposed chronic cerebrospinal venous insufficiency (CCSVI) as a possible cause of multiple sclerosis (MS). Although his theory and the associated treatment (“liberation therapy”) received little more than passing interest in the international scientific and medical communities, his ideas became the source of tremendous public and political tension in Canada. The story moved rapidly from mainstream media to social networking sites. CCSVI and liberation therapy swiftly garnered support among patients and triggered remarkable and relentless advocacy efforts. (...) Policy makers have responded in a variety of ways to the public’s call for action.DiscussionWe present three different perspectives on this evolving story, that of a health journalist who played a key role in the media coverage of this issue, that of a health law and policy scholar who has closely observed the unfolding public policy developments across the country, and that of a medical ethicist who sits on an expert panel convened by the MS Society of Canada and the Canadian Institutes of Health Research to assess the evidence as it emerges.SummaryThis story raises important questions about resource allocation and priority setting in scientific research and science policy. The growing power of social media represents a new level of citizen engagement and advocacy, and emphasizes the importance of open debate about the basis on which such policy choices are made. It also highlights the different ways evidence may be understood, valued and utilized by various stakeholders and further emphasizes calls to improve science communication so as to support balanced and informed decision-making. (shrink)

BackgroundWhile genomic data sharing can facilitate important health research and discovery benefits, these must be balanced against potential privacy risks and harms to individuals. Understanding public attitudes and perspectives on data sharing is important given these potential risks and to inform genomic research and policy that aligns with public preferences and needs.MethodsA cross sectional online survey measured attitudes towards genomic data sharing among members of the general public in an Eastern Canadian province.ResultsResults showed a moderate comfort level with sharing genomic (...) data, usually into restricted scientific databases with controlled access. Much lower comfort levels were observed for sharing data into open or publicly accessible databases. While respondents largely approved of sharing genomic data for health research permitted by a research ethics board, many general public members were concerned with who would have access to their data, with higher rates of approval for access from clinical or academic actors, but much more limited approval of access from commercial entities or governments. Prior knowledge about sequencing and about research ethics boards were both related to data sharing attitudes.ConclusionsWith evolving regulations and guidelines for genomics research and data sharing, it is important to consider the perspectives of participants most impacted by these changes. Participant information materials and informed consent documents must be explicit about the safeguards in place to protect genomic data and the policies governing the sharing of data. Increased public awareness of the role of research ethics boards and of the need for genomic data sharing more broadly is also needed. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

Daryl Pullman (2023), seeking to slow the slide down what he sees as the slippery slope of MAID, employs an epigraph from H.L. Mencken: “For every human problem there is a solution that is simple,...

This chapter contains sections titled: Introduction Human DNA as Cultural Property The Genetic Appropriation of Culture Community Identity, Cultural Offense and Control of Genetic Information Conclusion References.

The existence of psi—anomalous processes of information transfer such as telepathy or clairvoyance—continues to be controversial. Earlier meta-analyses of studies using the ganzfeld procedure appeared to provide replicable evidence for psi (D. J. Bem & C. Honorton, 1994), but a follow-up meta-analysis of 30 more recent ganzfeld studies did not (J. Milton & R. Wiseman, 1999). When 10 new studies published after the Milton-Wiseman cutoff date are added to their database, the overall ganzfeld effect again becomes significant, but the mean (...) effect size is still smaller than those from the original studies. Ratings of all 40 studies by 3 independent raters reveal that the effect size achieved by a replication is significantly correlated with the degree to which it adhered to the standard ganzfeld protocol. Standard replications yield significant effect sizes comparable with those obtained in the past. (shrink)

Since St. Thomas Aquinas was one of the first scholastics to analyze the idea of a “just price,” economists, economic historians and philosophers interested in the philosophical underpinnings of the market have focused on Aquinas’s writings. One group insists that Aquinas defined the just price as the payment needed to cover sellers’ labor and material costs. A second camp vehemently counters that Aquinas’s just price is simply the going market price. We argue that neither of these views is correct. The (...) Thomistic just price is the price that would be agreed to by a just person as part of an exchange. This “just person price” takes into account the well-being of the individual transactors and the good of the entire community. Such a price reduces neither to the cost-covering price nor to the market exchange price. A Thomistic concept of the just person price deserves to be reconsidered, especially because a Thomistic approach offers some useful ways to deal with issues quite differently from the popular neoclassical approach directed toward arriving at a socially optimal market price. (shrink)

The global COVID-19 pandemic has created a crisis of suffering. We conceptualize suffering as a deeply existential issue that fundamentally changes people indelible ways and for which there are no easy solutions. To better understand its effects and how people can flourish in the midst of this crisis, we formally introduce and elaborate on an Existential Positive Psychology Model of Suffering (EPPMS) and apply that to the COVID-19 global pandemic. Our model has three core propositions: (a) suffering reveals existential concerns, (...) (b) existential anxiety impairs one's ability to find meaning, and (c) cultivating meaning is the primary way to address suffering and allay existential anxiety, eventually leading to flourishing (and potentially growth). We apply this model to the COVID-19 pandemic, including how to build meaning, and discuss clinical implications. (shrink)

Race and sex/gender are commonly argued to deserve equal priority with class oppression in egalitarian politics. However, placing race and sex in the same list as what is here termed “standard-of-living class” constitutes a category error. Standard of living, alongside power and status, belongs to a distinctive list of “metrics of hierarchy” that should be accorded priority in an important respect: in the specification of the hierarchies that egalitarians seek ultimately to eliminate or reduce. Race and sex, along with other (...) “differentiators,” matter primarily for the way they are “used” by social arrangements to assign persons to places in hierarchies of living standard, power, and status. Examining policies to promote black capitalism in post-apartheid South Africa, the author shows how the conflation of differentiators and distribution strata is complicit in justifying multiracialized inequality. (shrink)

Rethinking Feminist Ethics bridges the gap between women theorists disenchanted with aspects of traditional theories that insist upon the need for some ethical principles. The book raises the question of whether the female conception of ethics based on care, trust and empathy can provide a realistic alternative to the male ethics based on duty and rule bound conception of ethics developed from Kant, Mill and Rawls. Koehn concludes that it cannot, showing how problems for respect of the individual arise also (...) in female ethics because it privileges the caregiver over the cared for. Drawing on Socrates' Crito , she shows how an ethic of dialogue can instill a critical respect for the view of the other and the ethical principles absent from the female ethic. (shrink)

A sizable body of literature calls for a synthesis of Whiteheadian process philosophy and the existential phenomenology of Sartre and Heidegger. However, although the two traditions agree on some points, they are fundamentally incompatible. Those proposing a synthesis see in it the possibility of integrating within a single scheme the viewpoint of natural science and the insights of existential fundamental ontology, but the denial of the possibility of such a smooth integration is at the very heart of the existential phenomenological (...) position. (shrink)

After one has read for a while in the history of Western thought, one becomes cognizant of how many great intellects, believers and non-believers alike, have presented compelling examinations of Christian theism. And until recently, religious skeptics, following in the wake of David Hume, assumed that the ship of Christian philosophy of religion was too damaged to sail again. However, something unexpectedly emerged recently from the weathered ship, even after many pilots advised cautious hugging the shores, especially in light of (...) the ‘death of God’ storms of the 1960’s. Many abandoned the ancient mother ship, some escaping on rafts, lifeboats, or flotsam, transferring to modern vessels, such as SS Darwin, Freud, Marx, or Nietzsche. Still, a number of sailors stayed on board the ancient craft, and responded to the latter secularist fleet, honing their skills as navigators, first mates, and lookouts, so as to safeguard the ancient ship from secularist vessel forays.The anthology under re .. (shrink)

s of selected articles and a list of the online articles can also be accessed from this link.

For decades, student ratings of university faculty have been used by administrators in high stakes faculty employment decisions such as tenure, promotion, contract renewal and reappointment, and merit pay. However, virtually no attention has been paid to the ethical questions of using ratings in employment decisions. Instead, the ratings literature is generally limited to psychometric issues such as whether a given student ratings instrument exhibits the statistical properties of reliability and validity. There is no consensus understanding of teaching effectiveness, the (...) very attribute that students are alleged to “evaluate.” What students are actually doing when they complete a ratings form—whether measuring, evaluating, reporting, judging, opining, etc.—remains unsettled in the ratings literature. If ratings are surveys of student satisfaction, they have no logical or ethical connection with teaching expertise. I argue that the administrative use of student ratings in faculty employment decisions violates basic moral principles including nonmaleficence, beneficence, professional autonomy and clinical independence, and multiple aspects of justice including due care, truthfulness, and equitable treatment. These ethical violations rule against any administrative use of student ratings in faculty employment decisions, including the “use with caution in conjunction with other evaluative methods” deployment of student ratings. My conclusion is that such use should be immediately and universally terminated. Formative use of student questionnaires as part of ordinary instructional communication and feedback between instructor and students is a separate issue and outside of the scope of this paper. (shrink)

This article explores differences in the ways in which utilitarian, deontological and virtue/aretic ethics treat of act, outcome, and agent. I argue that virtue ethics offers important and distinctive insights into business practice, insights overlooked by utilitarian and deontological ethics.

Did Shakespeare read Plato? The evidence suggests that Shakespeare not only read Plato, but also consulted him as though he possessed wisdom of the highest sort. With a focus on comparing the Phaedo and Symposium to Timon of Athens, I show that Shakespeare’s genius is at least in part due to his uncanny ability to transform Platonic wisdom into fully realized dramatic action. Previous attempts at interpreting the play have overlooked the extent to which Timon of Athens mirrors Socratic warnings (...) against flattery, sophistry, and uncivil philosophy. (shrink)

By titling his paper “Slowing the Slide Down the Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US,” Daryl Pullman, an esteemed medical ethicist, uses a rhetoric...

It is widely accepted among Mencius scholars that for Mencius, the junzi 君子 is the kind of person who accepts Heaven’s will and never resents Heaven. There are, however, several passages where resentment seems to be presented as a quality that the junzi possesses. In particular, Mencius 2B13 has been the subject of much contention. In Section 1, I will discuss various interpretations of 2B13, building on and updating Philip Ivanhoe’s helpful 1988 survey. In Section 2, I will present an (...) argument for resentment against Heaven in the Mencius. I argue from passages in the Mencius and its relationship with the Shijing 詩經 that we have good reason to think that, under certain circumstances, the junzi ought to resent Heaven. In Section 3, I will develop a theory of resentment from the Mencius and demonstrate how 2B13 can be understood in the larger context of this theory. (shrink)

Abstract:Much of the current discussion of evil within business and professions locates evil within the individual employee. Dennis Moberg (1997) has argued for conceiving of employee viciousness as a lack of self-control. This paper argues, that while some evil behaviors may be well-modelled as instances of low self-control, this model does not fit much of what might qualify as evil (e.g., child-caregivers falsely accusing their fellow employees of ritual child abuse). The paper examines three alternative models of evil, two drawn (...) from literature, one from theology, and shows why these alternative models are just as relevant for thinking about the nature and cause of evil as the low self-control model drawn from the criminology literature.How intoxicating to feel like God the Father and to hand out definitive testimonials of bad character and habits—Albert Camus. (shrink)