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)

BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

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)

According to Xenophon, the hetaira "gratified" her patron as a philos, participating in an aristocratic network of gift exchange , while the pornê, as her name signified, trafficked in sex as a commodity. Recent writers on Greek prostitution have acknowledged that hetaira vs. pornê may be as much a discursive opposition as a real difference in status, but still, very little attention has been paid to the period of the "invention" of this binary. Hetaira meaning "courtesan" first occurs in Herodotus (...) and does not exist in Homer: hence, the conceptual category of the hetaira is an invention of the archaic period. What needs generated the constitution of this category? And what conceptual "work" was the opposition hetaira-pornê doing in Greek culture in the period of its inception? This paper addresses these questions through a reading of fragments of archaic lyric-predominantly those of Anakreon-as well as consideration of Attic vase painting. I suggest that the hetaira-pornê opposition participates in the overarching tension between the aristocratic symposium and the public sphere in archaic Greece. Oswyn Murray has suggested that the symposium constitutes itself as a kind of anti-city with its own rules and conventions. Part of the discursive exclusion of the public sphere is the complete suppression of the city's monetarized economy from the domain of the aristocratic symposium, and it is this impulse to mystify economic relations for sex that generates the category of the hetaira within a framework of gift exchange. But if the motives for this discursive invention are economic, they are also political: the hetaira affirms and embodies the circulation of charis within a privileged elite, while the pornê figures the debased and promiscuous exchanges of the agora. (shrink)

In our article, “The Faces of Reason and Its Critics”, Dialogue 25/1, 105–118, Elizabeth Trott and I said that, in his presidential address to the Canadian Philosophical Association, Francis Sparshott “mysteriously seemed to have confused … John Clark Murray … with John Macmurray”. In footnote 6, we reported Martyn Estall's theory that there might, indeed, have been no confusion because Sparshott probably did mean Macmurray who was being “promoted” at Queen's at the time. Professor Sparshott reports that Professor Estall's (...) surmise is the correct solution to the “mystery”. He also reminds us that, when he came to Canada in 1950 he was at University College, Toronto. Later, from 1955 onwards, he was John Irving's colleague at Victoria College. (shrink)

Answering important public health questions often requires collection of sensitive information about individuals. For example, our understanding of how HIV is transmitted and how to prevent it only came about with people's willingness to share information about their sexual and drug-using behaviors. Given the scientific need for sensitive, personal information, researchers have a corresponding ethical and legal obligation to maintain the confidentiality of data they collect and typically promise in consent forms to restrict access to it and not to publish (...) identifying data.The interests of others, however, can threaten researchers' promises of confidentiality when legal demands are made to access research data. In some cases, the subject of the litigation is tightly connected to the research questions, and litigants' interest in the data is not surprising. Researchers conducting studies on tobacco or occupational or other chemical exposures, for example, are relatively frequent targets of subpoenas. (shrink)

This book marks a total departure from previous studies of the Boxer War. It evaluates the way the war was perceived and portrayed at the time by the mass media. As such the book offers insights to a wider audience than that of sinologists or Chinese historians. The important distinction made by the author is between image makers and eyewitnesses. Whole categories of powerful image makers, both Chinese and foreign, never saw anything of the Boxer War but were responsible for (...) disseminating images of that war to millions of people in China and throughout the world. (shrink)

Many defenders of libertarianism have, in recent years, come to endorse the idea that free agents are rarely able to choose otherwise than they do.1 These libertarians argue that it is often true that the beliefs and desires, or the character of a free agent are sufficient to render numerous possible choice-alternatives ineligible for the agent having them. In fact, they claim, it is frequently the case that beliefs, desires, character, etc. are sufficient to narrow the eligible alternatives to a (...) single one (I will henceforth refer to such choices as “single-option choices”). In these cases, such agents, even though they are unable to choose otherwise, are still morally responsible as long as certain conditions are met. In particular, it must be the case that the factors that narrow the available alternatives result from prior free choices of the agent (I will henceforth refer to such factors as “limiting factors”). In other words, limiting factors must be traceable to prior free choices. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy (...) and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

Researchers now commonly collect biospecimens for genomic analysis together with information from mobile devices and electronic health records. This rich combination of data creates new opportunities for understanding and addressing important health issues, but also intensifies challenges to privacy and confidentiality. Here, we elucidate the “web” of legal protections for precision medicine research by integrating findings from qualitative interviews with structured legal research and applying them to realistic research scenarios involving various privacy threats.

Preston's (2011) challenge to the moral presumption against geoengineering is applied to carbon dioxide capture and storage (CCS) in Scotland, United Kingdom. Qualitative data is analysed to assess if and how Preston's arguments play out in practice. We argue that the concepts of ‘lesser evil’ and prioritising human well-being over non-interference in natural processes do bring different value positions together in support of CCS, but that not all people see short-term carbon abatement as the ‘least worst’ option or a suitable (...) way to prioritise human well-being. (shrink)

People with cognitive impairments often have difficulties formulating, understanding, or articulating decisions that others judge reasonable. The frequent response shifts decision-making authority to substitutes through advance directives of the person or guardianship orders from a court. The Convention on the Rights of People with Disabilities defends supported decision-making as an alternative to such forms of supplanted decision-making. But supported decision-making raises both metaphysical questions—what is required for a decision to be the person’s own?—and epistemological questions: how do we know what (...) persons judge to be their good, when they have difficulty conceptualizing and articulating? It raises practical questions, too, such as protection against risks of exploitation. This article uses a non-discrimination account of legal personhood drawn from the CRPD to explore how common features of decisions employed by people without cognitive disabilities are important in supported decision-making too. These features include prostheses, guardrails, relationships, and social contexts. (shrink)

Virtue ethics prescribes cultivating global and behaviorally efficacious character traits, but John Doris and others argue that situationist social psychology shows this to be infeasible. Here, I show how certain versions of virtue ethics that ‘go mental’ can withstand this challenge as well as Doris’ further objections. The defense turns on an account of which psychological materials constitute character traits and which the situationist research shows to be problematically variable. Many situationist results may be driven by impulsive akrasia produced by (...) low-level , emotionally induced ignorance about one’s situation, and some may be driven by a further subtype: modal akrasia. Many subjects in the infamous Milgram experiments, e.g., seem to have recognized what the virtuous thing to do was and that they should do it, and only failed to do it because their emotions prevented them from seeing that they could. If the primary constituents of character traits are higher-level mental dispositions involved in deliberation, though, then the results don’t show that these psychological materials are problematically variable. (shrink)

Intimate and medicalized, natural and technological, reproduction poses some of the most challenging ethical dilemmas of our time. This volume brings together scholars from multiple perspectives to address both traditional and novel questions about the rights and responsibilities of human reproducers, their caregivers, and the societies in which they live.

This book argues that Nietzsche bases his affirmative morality on the model of individual responsiveness to otherness which he takes from the mythology of Dionysus. The subject is not free to choose to avoid such responding to the demands of the other. Nietzsche finds that the basic mode of responding is pleasure. This feeling, as a basis for morality, underlies the morality which is true to the earth and the major concepts of "will to power", "eternal return", and "amor fati". (...) The priority of otherness makes all thought ethical and not only aesthetic. The basis of all meanings combines the fundamental impulse of responding outwards with an immediate complement in the individual interpretation-world. This is specifically ethical because the recognition of our own historical specificity arises as a result of the refusal of others to become mere differences within our notion of the Same, and through their demand that we "become who we are" in the recognition of their separate existence. (shrink)

This paper presents a computer model of cortical broadcast and competition based on spiking neurons and inspired by the hypothesis of a global neuronal workspace underlying conscious information processing in the human brain. In the model, the hypothesised workspace is realised by a collection of recurrently inter-connected regions capable of sustaining and disseminating a reverberating spatial pattern of activation. At the same time, the workspace remains susceptible to new patterns arriving from outlying cortical populations. Competition among these cortical populations for (...) influence on the workspace is effected by a combination of mutual inhibition and top-down amplification. (shrink)

In “Medical Ethics: Common or Uncommon Morality,”1 Rosamond Rhodes defends a specialist view of medical ethics, specifically the ethics of physicians. Rhodes’s account is specifically about the ethics of medical professionals, rooted in what these professionals do. It would seem to follow that other healthcare professions might be subject to ethical standards that differ from those applicable to physicians, rooted in what these other professions do, but I leave this point aside for purposes of this commentary. Rhodes’s view includes both (...) a negative and a positive thesis. The negative thesis is that precepts in medical ethics—understood as the ethics of physicians—cannot be derived from principles of common morality. The positive thesis is two-fold: that precepts in medical ethics must be derived from an account of the special nature of what physicians do, and that this account is to be understood through an overlapping consensus of rational and reasonable medical professionals. While I agree emphatically with, and have learned a great deal from, Rhodes’s defense of the negative thesis, I disagree with both claims in Rhodes’s positive thesis, for reasons I will now explain after a brief observation about the negative thesis. (shrink)

One of the key intentions of fresh expressions of church is to reach the kind of people inherited church find it hard to reach. Psychological type profiling of church congregations has demonstrated that Anglican churches have particular difficulty in reaching those whose Jungian judging preference is for thinking rather than for feeling. Studies that have explored the psychological type profile of participants within fresh expressions suggest that they do not significantly differ from inherited congregations in terms of reaching thinking types. (...) Two previous studies, however, have reported higher proportions of thinking types attending cathedral carol services. The present study among 441 individuals attending the Holly Bough service in Liverpool Cathedral also found a higher proportion of thinking types among the participants. These findings suggest that cathedral carol services may be functioning as fresh expressions of church in a significant way.Contribution: Situated within the science of cathedral studies, rooted in psychological type theory, and drawing on data from 441 attendees at the Holly Bough service, this study demonstrates that cathedral services at Christmas are more successful than either inherited church or fresh expressions of church in reaching thinking types. (shrink)

Sexual Violation in Islamic Law: Substance, Evidence, and Procedure By AzamHina, xi + 270 pp. Price HB £60.00. EAN 978–1107094246.

Despite extinction-based processes demonstrating efficacy in the animal extinction and human anxiety literatures, extinction for substance use disorders has shown poor efficacy. Reasons for this lack of success include common threats to extinction, such as renewal and reinstatement. In recent decades, research on mindfulness for SUD has flourished, and a key aspect of these mindfulness-based interventions includes teaching individuals to stay present with whatever experience they have, even if unpleasant, without trying to change/escape/avoid it. Similarly, CET teaches individuals to not (...) escape/avoid conditioned responses by engaging in drug use behavior. This paper discusses how mindfulness-based research and practices could positively influence CET through future research, with the long-term goal of improving SUD treatment. (shrink)

ABSTRACTMost scholars agree that meaning and intelligibility are central to Heidegger’s account of Dasein and Being-in-the-world, but there is some confusion about the nature of this intelligibility. In his debate with McDowell, Dreyfus draws on phenomenologists like Heidegger to argue that there are two kinds of intelligibility: a basic, nonconceptual, practical intelligibility found in practical comportment and a conceptual, discursive intelligibility. I explore two possible ways that Dreyfus might ground this twofold account of intelligibility in Heidegger: first in the distinction (...) between the hermeneutic and apophantic “as”, and second in the presence and absence of the as-structure. I argue that neither approach succeeds because practical intelligibility is always already discursive and discursive articulation is a condition of practical comportment. (shrink)

Pro-Ana's are young women who proclaim themselves to be proudly anorexic, and they have created a vibrant community online. This article will examine the nature of the Pro-Ana sites, analyzing their discursive community, and discuss the ethical issues surrounding the sites, wherein many have been censured or shut down by commercial website hosting sites, which has raised issues of censorship versus freedom of speech.

A recent book of mine defends three distinct varieties of immortality. One of them is an infinitely lengthy afterlife; however, any hopes of it might seem destroyed by something like Brandon Carter's 'doomsday argument' against viewing ourselves as extremely early humans. The apparent difficulty might be overcome in two ways. First, if the world is non-deterministic then anything on the lines of the doomsday argument may prove unable to deliver a strongly pessimistic conclusion. Secondly, anything on those lines may break (...) down when an infinite sequence of experiences is in question. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:688 JOURNAL OF THE HISTORY OF PHILOSOPHY 33:4 OCTOBER 1995 ters by Robert Payne and Gilbert Sheldon. (To my knowledge the only library in the United States that has The Theologian and Ecclesia.,tic is The Newbury Library in Chicago.) There are also letters in A Collection of Letters Illustrative of the Progress of Science, ed. J. Halliwell (London, 1840. Scholars in recent years have complained, usually justifiably, about the (...) cost of the books they need for their research. While $78.00 per volume is a lot of money, it would be well spent by anyone with a serious interest in the person or the philosophy of Thomas Hobbes. These volumes, judiciously building upon the great labors of previous scholars, are the single most important contribution to Hobbes scholarship in the twentieth century. A. P. MARTINICH University of Texas at Austin Jeff Jordan, editor. Gambling on God: Essays on Pascars Wager. Lanham, MD: Rowman and Littlefield, 1994. Pp. viii + 164. Cloth, $49.oo. Paper, $19.95. Jeff Jordan has put together nine essays which give those who want to gamble on God something to think about. Though only three of them are really about Pascalk wager, all of them are worth reading. The most entertaining paper is Roy A. Sorensen's "Infinite Decision Theory." Sorensen confronts the St. Petersburg Paradox, which stems from the fact that there are available wagers with a potentially infinite payoff on which no one would bet $ao. Suppose you are offered $2n for each throw of a standard balanced coin until a head turns up. N = the number of tosses. It could be a long time--forever--before heads turns up. By the time n = loo you would have a bag of gold bigger than the sun. But Sorensen says the right bet is at least $23,but not much more. It is also true that since we don't know which actions God will reward, any human action has a possible infinite payoff and since all such actions have the same potential payoff none is better than the others. (Some god was moved to save Coleridge's Ancient Mariner, who had kindly thoughts about water-snakes.) Sorensen also notes that it is often said (Pascal would have agreed) that persons can be of infinite worth. If so, is rescuing one drowning person as good as rescuing five? The total worth seems to be the same. (Luckily, if Cantor is to be believed, there are larger and smaller infinities.) Sorensen ends inconclusively, but he is right that decision theory needs to address the infinite. Pascal would have had something to say. He thought that his bet was morally good. To bet on God is to act as if God exists. One who treats everyone as saved behaves as if God exists. (You don't know who is saved, but if you treat the saved as damned God will be annoyed whereas if you treat the damned as saved you won't detract from their ultimate penalty.) You don't have to bet $3, you only have to do what you ought to do anyway. The incremental cost of the bet appears to be zero. Anyhow, Pascal thought that it was not the infinite payoff (in the sense of a life of bliss) which provided the main motive for the bet but the fact that the required action was one's moral duty. Moreover, nook REVIEWS 689 if everyone behaves as if everyone is saved the result is a world in which God could appear and not be crucified. To be sure, there is a chance of an infinite life. Pascal believed human beings are potentially infinite--as is shown by our capacity for extending our knowledge to the infinite--but we are also potentially nothing, as is shown by the fact that the person never really appears in our scientific accounts. It is through God that our infinity is to be achieved, and so betting on God is also betting on ourselves in a perfectly intelligible way. This involw~s a notion of infinity not explored in any of these essays, which makes it possible to share with God without changing the divine nature... (shrink)