Neuroimaging has provided insight into numerous neurological disorders in children, such as epilepsy and cerebral palsy. Many clinicians and investigators believe that neuroimaging holds great promise, especially in the areas of behavioral and cognitive disorders. However, concerns about the risks of various neuroimaging modalities and the potential for misinterpretation of imaging results are mounting. Imaging evaluations also raise questions about stigmatization, allocation of resources, and confidentiality. Children are particularly vulnerable in this milieu and require special attention with regards to safety (...) guidelines and modality adaptations. This article examines pediatric neuroimaging practice through an ethics lens. Most authors in the field of neuroethics focus on the future concerns of neuroimaging. In contrast, our paper examines ethical matters surrounding current clinical applications in the pediatric population. We first provide a brief overview of the neuroimaging technologies most commonly used in a pediatric clinical context and then discuss a variety of ethical issues arising from the use of these technologies. (shrink)

The question of whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying has recently come to the fore in debates about the legalisation of assisted dying. For example, it was central to critiques of the 2021 amendments made to Canada’s assisted dying law. The question of whether changes to a country’s assisted dying legislation lead to descents down slippery slopes has also come to the fore—as it does any time a jurisdiction (...) changes its laws. We explore these two questions through the lens of Canada’s experience both to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law. Canada’s Medical Assistance in Dying law has evolved through a journey from the courts to Parliament, back to the courts, and then back to Parliament. Along this journey the eligibility criteria, the procedural safeguards, and the monitoring regime have changed. In this article, we focus on the eligibility criteria. First, we explain the evolution of the law and what the eligibility criteria were at the various stops along the way. We then explore the ethical justifications for Canada’s new criteria by looking at two elements of the often-corrosive debate. First, we ask whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying of decisionally capable people with mental illnesses and people with disabilities as their sole underlying medical conditions. Second, we ask whether Canada’s journey supports slippery slope arguments against permitting assisted dying. All data relevant to the study are included in the article. (shrink)

In this paper, I offer a personal and professional narrative of how Canada went from prohibition to permission for medical assistance in dying. I describe the legal developments to date and flag what might be coming in the near future. I also offer some personal observations and reflections on the role and impact of bioethics and bioethicists, on what it was like to be a participant in Canada's law reform process, and on lessons that readers in other jurisdictions might take (...) from Canada's experience. (shrink)

Medical assistance in dying has received considerable attention from many in the field of bioethics. Philosophers, theologians, lawyers, and clinicians of all sorts have engaged with many challenging aspects of this issue. Public debate, public policy, and the law have been enhanced by the varied disciplinary analyses. With the legalization of MAiD in Canada, some attention is now being turned to issues that have historically been overshadowed by the debate about whether to permit MAiD. One such issue is voluntary stopping (...) eating and drinking as an alternative to MAiD. In this paper, I will apply a legal lens to the issue. An understanding of whether VSED is legal provides a foundation for ethical reflection on whether it ought to be permitted. Is it permitted for those who prefer VSED to MAiD? Is it permitted for those who do not qualify for MAiD under our current legislation – for those who do not have a grievous and irremediable medical condition, for mature minors, for individuals whose sole underlying medical condition is a mental disorder and who do not otherwise meet the eligibility criteria, and for individuals who have lost capacity but had completed an advance directive? (shrink)

L’assistance médicale à mourir (AMM) a reçu beaucoup d’attention de la part de nombreux acteurs dans le domaine de la bioéthique. Des philosophes, des théologiens, des avocats et des cliniciens de toutes sortes ont abordé de nombreux aspects difficiles de cette question. Le débat public, la politique publique et la loi ont été renforcés par des analyses disciplinaires variées. Avec la légalisation du AMM au Canada, on s’intéresse maintenant à des questions qui ont toujours été éclipsées par le débat sur (...) l’autorisation de l’AMM. Un de ces problèmes est l’arrêt volontaire de manger et boire (AVMB) comme une alternative à l’AMM. Dans cet article, je vais appliquer une perspective légale à la question. Une compréhension des aspects légaux de l’AVMB permet d'établir les fondements d'une réflexion éthique au sujet de son autorisation. Est-il permis pour ceux qui préfèrent l’AVMB à l’AMM? Est-il permis pour ceux qui ne sont pas admissibles à l’AMM en vertu de notre législation actuelle – pour ceux qui n’ont pas de maladie grave et irrémédiable, pour les mineurs matures, pour les personnes dont la seule condition médicale sous-jacente est un trouble mental et qui ne rencontrent pas les critères d’admissibilité, et pour les personnes ayant perdu leur capacité, mais ayant rempli une directive préalable? (shrink)

In “Slowing the slide down the slippery slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US,” Daryl Pullman (2023) gets a variety of empirical, logical and legal things wro...

Although the term mental illness is problematic, it is unavoidable for those most deeply harmed by it. In contrast to some current theological responses to mental illness, fully intersectional responses recognize not only gender, race, and class but also religion as a factor in some mental illness experience. A panentheistic theological response begins with a relational ontology, understands bodily diversities as part of finitude, and affirms the already-beloved identity of persons living with mental illness. This starting point of original blessing (...) rather than original sin dismantles stigma rather than obscuring it through associating mental illness with the Fall. A theology of Spirit as that which opens to and empowers possibilities within repeated losses and turmoil responds to mental illness without minimizing suffering. (shrink)

In the not-too-distant past, medical assistance in dying was illegal in Canada. Assisted suicide and voluntary euthanasia were prohibited by the Criminal Code. Many attempts were made to change the law. The most famous of these was the case of Sue Rodriguez, who took a Charter challenge of the prohibition to the Supreme Court of Canada. A number of bills were also introduced in the Federal Parliament. All were doomed to failure. But then … change came.First, the province of Quebec (...) passed An Act Respecting End-of-Life Care in 2015 establishing a legal right to MAiD "at the end of life." Then, the Carter case... (shrink)

Une personne compétente peut-elle refuser des soins afin de rendre son décès naturel raisonnablement prévisible pour être admissible à l’aide médicale à mourir (AMM)? Prenons l’exemple d’un patient compétent atteint d’une paralysie du côté gauche à la suite d’un accident vasculaire cérébral droit qui ne devrait pas mourir avant de nombreuses années ; normalement, la cause de son décès ne serait pas prévisible. Cependant, il refuse de se retourner régulièrement, de sorte que son médecin peut prédire que des plaies de (...) pression se développeront, entraînant une infection pour laquelle il refusera le traitement et mourra par conséquent. Est-il maintenant admissible à l’AMM? Prenons l’exemple d’un patient compétent atteint d’une sténose spinale (affection non mortelle) qui refuse de manger (mais pas de boire pour ne pas perdre sa capacité à cause de la déshydratation). Par conséquent, son médecin peut prédire la mort par famine. Est-elle maintenant admissible à l’AMM? Pour répondre à ces questions, nous devons répondre à trois sous-questions : 1) les patients compétents ont-ils le droit de refuser des soins ; 2) les prestataires de soins de santé ont-ils l’obligation de respecter ces refus ; et 3) les décès résultant de refus de soins sont-ils naturels aux fins de déterminer si un patient est admissible à l’AMM? Si un patient compétent a le droit de refuser certains soins particuliers et que les prestataires de soins de santé ont l’obligation de respecter ce refus, et si le décès qui résulterait du refus de ces soins est naturel, alors ce refus de soins est une voie légale vers le AMM. Toutefois, si le patient compétent n’a pas le droit de refuser certains soins particuliers, ou si les prestataires de soins de santé n’ont pas l’obligation de respecter ce refus, ou si le décès qui résulterait du refus de ces soins n’est pas naturel, alors ce refus de soins ne constitue pas une voie légale vers le AMM. Dans cet article, nous explorons ce terrain juridique complexe avec les implications éthiques les plus profondes : l’accès à l’AMM. (shrink)

In this book Bernard Williams delivers a sustained indictment of moral theory from Kant onward. His goal is nothing less than to reorient ethics toward the individual. He deals with the most thorny questions in contemporary philosophy and offers new ideas about issues such as relativism, objectivity, and the possibility of ethical knowledge.

Feminists have critiqued assumptions and structures of inter-religious dialogue even as they have acknowledged the need for more feminist presence in this area. Because ecofeminist values span religious differences, exploring a spirituality evident across Christian ecofeminist authors makes a contribution to inter-religious feminist work. A spirituality of openness manifests in four prominent themes which recur across diverse Christian ecofeminist thinkers. Each of these themes arises from a foundational orientation to openness. Relational theories of self are grounded in the openness of (...) fluid identity construction; a stress on personal narrative as a relational way of knowing depends upon the openness of experiencing subjects to each other; an ethic of risk and discernment emphasizes openness in the courage and responsibility required to act within ambiguity; and the openness of receptivity is a prerequisite for engaging the potentially transformative power of beauty. (shrink)

R. S. Downie; IX—Can there be a Private Morality?, Proceedings of the Aristotelian Society, Volume 68, Issue 1, 1 June 1968, Pages 167–186, https://doi.org/10.1.

In his paper ‘Collective Responsibility’ Mr. D. E. Cooper argues for the thesis that collectives can be held responsible in a sense not reducible to the individual responsibility of the members of the collective. And he uses this conclusion to support views of individual responsibility and of blame and punishment which he wishes to assert independently. Is hall argue that although there is a sense in which the actions and responsibility of a collective cannot be analysed in terms of the (...) actions and responsibilities of the individual persons who compose the collective, it is not moral responsibility which is involved. I shall then maintain that Cooper's account of collective responsibility does not support his account of individual responsibility; and that his account of individual responsibility is in any case false, if he means moral responsiblity. (shrink)

Supererogation can be distinguished from altruism, in that the former is located in the category of duty but exceeds the strict requirements of duty, whereas altruism belongs to a different moral category from duty. It follows that doctors do not act altruistically in their professional roles. Individual doctors may sometimes show supererogation, but supererogation is not a necessary feature of the medical profession. The aim of medicine is to act in the best interests of patients. This aim involves neither supererogation (...) nor even the moral quality of beneficence. It is simply a job description. Morality enters medicine through the quality of the individual doctor's work, not by the definition of that work. (shrink)

The concept of moral responsibility has many applications. We speak, for example, of a person's responsibilities, and mean his professional or domestic commitments. In this sense a person can be said to have too many responsibilities, or none at all, and he can be said to be responsible to or for another person. Again, we can speak of the person himself as being responsible or irresponsible, and mean that he is conscientious and trustworthy in the performance of his duties or (...) that he has a sense of responsibility. Finally, we can speak of a person as accepting responsibility for an action or another person. A thorough analysis of these complexities of usage would require the investigation of a number of background concepts, but in this paper I have the more limited object of classifying some of the usages. I propose to do this by constructing three analytical models based on the concept of a social role. (shrink)

The introduction to a special issue of the journal Bioethics that we edited.

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)

It is often said that human beings have the ability to plan and choose what to do, can think for themselves and have the freedom and the right to form their own opinions on moral questions. Such claims are sometimes expressed by saying that the human agent is autonomous. In this paper we shall try to disentangle various theses about the autonomy of the agent which the common claims do not always distinguish.

We are accustomed to the claim that appropriate backing must be available if criticism is to be justifiable. For example, if someone criticises a film he must be prepared to cite the criteria he is using and to show how they are or are not satisfied by the film. Such processes of evaluation have frequently been investigated: what has been less thoroughly sexplored is the right to criticise itself. Certainly, questions of the appropriate backing for critical utterances have bearing on (...) the right to criticise , for one way of denying that a person has that right is to deny that he can provide the appropriate backing for his criticism. But the question of his right is a wider one, since the attempt to criticise may be blocked before the question of backing can arise at all. It is therefore worthwhile to explore the right to criticise with a view to discovering in what circum-stances it is defeasible. I shall be concerned mainly with the moral right to criticise as investigation of the legal right would raise issues for specialists in the laws of libel and slander. (shrink)

R S Downie; Personal and Impersonal Relationships, Journal of Philosophy of Education, Volume 5, Issue 2, 30 May 2006, Pages 125–138, https://doi.org/10.1111/j.

R S Downie; Professions and Professionalism, Journal of Philosophy of Education, Volume 24, Issue 2, 30 May 2006, Pages 147–159, https://doi.org/10.1111/j.1467-.