This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle (...) of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

A uniform theory of conditionals is one which compositionally captures the behavior of both indicative and subjunctive conditionals without positing ambiguities. This paper raises new problems for the closest thing to a uniform analysis in the literature (Stalnaker, Philosophia, 5, 269–286 (1975)) and develops a new theory which solves them. I also show that this new analysis provides an improved treatment of three phenomena (the import-export equivalence, reverse Sobel-sequences and disjunctive antecedents). While these results concern central issues in the study (...) of conditionals, broader themes in the philosophy of language and formal semantics are also engaged here. This new analysis exploits a dynamic conception of meaning where the meaning of a symbol is its potential to change an agent’s mental state (or the state of a conversation) rather than being the symbol’s content (e.g. the proposition it expresses). The analysis of conditionals is also built on the idea that the contrast between subjunctive and indicative conditionals parallels a contrast between revising and consistently extending some body of information. (shrink)

This paper proposes a semantics for free choice permission that explains both the non-classical behavior of modals and disjunction in sentences used to grant permission, and their classical behavior under negation. It also explains why permissions can expire when new information comes in and why free choice arises even when modals scope under disjunction. On the proposed approach, deontic modals update preference orderings, and connectives operate on these updates rather than propositions. The success of this approach stems from its capacity (...) to capture the difference between expressing the preferences that give rise to permissions and conveying propositions about those preferences. (shrink)

No existing conditional semantics captures the dual role of 'if' in embedded interrogatives — 'X wonders if p' — and conditionals. This paper presses the importance and extent of this challenge, linking it to cross-linguistic patterns and other phenomena involving conditionals. Among these other phenomena are conditionals with multiple 'if'-clauses in the antecedent — 'if p and if q, then r' — and relevance conditionals — 'if you are hungry, there is food in the cupboard'. Both phenomena are shown to (...) be problematic for existing analyses. Surprisingly, the decomposition of conditionals needed to capture the link with interrogatives provides a new analysis that captures all three phenomena. The model-theoretic semantics offered here relies on a dynamic conception of meaning and compositionality, a feature discussed throughout. (shrink)

But suppose now that technology were no means, how would it stand with the will to master it? Martin Heidegger.

"Nothing Better Than Death" is a comprehensive analysis of the near-death experiences profiled on my website at www.near-death.com. This book provides complete NDE testimonials, summaries of various NDEs, NDE research conclusions, a question and answer section, an analysis of NDEs and Christian doctrines, famous quotations about life and death, a NDE bibliography, book notes, a list of NDE resources on the Internet, and a list of NDE support groups associated with IANDS.org - the International Association for Near-Death Studies. -/- The (...) unusual title of this book, "Nothing Better Than Death," was inspired by NDE experiencer Dr. Dianne Morrissey who once said, "If I lived a billion years more, in my body or yours, there's not a single experience on Earth that could ever be as good as being dead. Nothing." -/- Having read every NDE book I could get my hands on, I didn't want to create just another NDE book. My motivation was to give readers a large variety of information about NDEs challenging both the seasoned NDE enthusiast as well as the novice. This book gives readers the means to understand the NDE phenomenon from the perspective of a large number of some of the most profound NDEs ever documented. My hope is that you will enjoy this book, my labor of love, and that you will be truly blessed by the heavenly insights within it. (shrink)

After six years (2012-2017) of publishing innovative bioethics scholarship, BioéthiqueOnline becomes the Canadian Journal of Bioethics/Revue canadienne de bioéthique. As executive editors of BioéthiqueOnline, we frequently heard from members of the Canadian bioethics community of the need to develop a platform with the right branding to showcase the value and the richness of our collective reflections, both locally and internationally. Following discussions with colleagues across the country, we came to the conclusion that BioéthiqueOnline had developed a unique expertise publishing bioethics (...) scholarship, but that the original name, created to convey the bilingual and open access mission of the journal, was not enthusiastically received. So the time has come to upgrade and rebrand as the Canadian Journal of Bioethics (CJB). (shrink)

In seeking to clarify the concept of conflict of interest (COI) in debates about physician–industry relationships, Howard Brody (2011) highlights the extent to which the prob- lem turns on a common pejorative understanding of COI. Whether it is the academic or public policy “pharmapologists” or “pharmascolds” talking about COI, there is often a straightforward and overly simplistic correlation made: that is, a conflict of interest—by definition—leads to fraudulent or corrupt behavior. The same type of reasoning is com- monly found in (...) discussions about COI outside the health sciences, most notably in news stories about the awarding of government contracts or the behaviour of corporate executives. The problem is that in focusing on dramatic failures to manage COI (e.g., around Vioxx), there is a tendency to strongly associate COI with extreme forms of financial and even criminal misconduct, leaving the public, policymakers, academics, and professionals with a skewed and limited understanding of the concept. (shrink)

Since the 1970s, there has been rapid and wide ranging development in the field of new reproductive technologies (NRT). With donor insemination (DI) and in vitro fertilization (IVF), previously infertile couples have been given new hope and the chance to have children. A more recent addition to these new methods of reproduction has been the combination of DI and IVF with surrogate mother arrangements.[1] This technique has subtly changed the realm of reproduction, for with the addition of a third party (...) (the surrogate) to the reproductive environment, the nature of motherhood, fatherhood, and the allocation of parental rights and duties has come into question.... In other words, has commercial surrogacy changed the traditional Western understanding of motherhood and does it do an injustice to the surrogate, the contracting mother, and/or women in general? I will argue that the fragmentation of the legal concept of ‘mother’ has created a range of social and ethical problems that need to be addressed; nevertheless, the basic societal definition of ‘motherhood’ remains substantially unchanged. (shrink)

Research on research ethics—regarding both the governance and practice of the ethical review of human subjects research—has a tumultuous history in North America and Europe. Much of the academic literature focuses on issues to do with regulating the conduct and quality of ethics review of research protocols by ethics committees (research ethics boards (REBs) in Canada and institutional review boards (IRBs) in the United States). In addition, some of the literature attends to issues particular to the review of qualitative research, (...) and still other literature addresses the challenges posed by and the need for research on REBs/IRBs. It is this third group of literature within which our article is situated. (shrink)

While there has been significant discussion in the health sciences and ethics literatures about problems associated with publication practices (e.g., ghost- and gift-authorship, conflicts of interest), there has been relatively little practical guidance developed to help researchers determine how they should fairly allocate credit for multi-authored publications. Fair allocation of credit requires that participating authors be acknowledged for their contribution and responsibilities, but it is not obvious what contributions should warrant authorship, nor who should be responsible for the quality and (...) content of the scientific research findings presented in a publication. In this paper, we review arguments presented in the ethics and health science literatures, and the policies or guidelines proposed by learned societies and journals, in order to explore the link between author contribution and responsibility in multi-author multidisciplinary health science publications. We then critically examine the various procedures used in the field to help researchers fairly allocate authorship. (shrink)

Dans notre société de plus en plus digitalisée, avons-nous vraiment le choix d’adopter ou non les technologies? Comment cette digitalisation impacte-t-elle les personnes âgées en particulier et son écosystème? Quels sont les enjeux éthiques soulevés par cette digitalisation? Ce texte vise à amener des éléments de réflexions en lien avec ces enjeux selon le point de vue de divers experts des domaines de la technologie, du vieillissement et de la bioéthique. Ces experts se sont rencontrés lors d’un symposium ayant eu (...) lieu à Angers, France, en octobre 2019. Le texte est un compte-rendu des échanges et points de vue de ces experts, ainsi que des discussions ouvertes qu’ils ont eues avec l’assistance, portant sur les principaux enjeux soulevés par cette digitalisation selon la perspective des personnes âgées, des proches-aidants, des soignants, de la société et de la recherche. (shrink)

L’érosion actuelle de la confiance du public envers les campagnes de vaccination et les décisions de politiques publiques qui y sont associées, aggravée par des scandales comme ceux relatifs à la pandémie H1N1 et l’utilisation du Tamiflu™, risque de diminuer de façon significative l’efficacité de ces interventions importantes pour la santé publique. Un manque de confiance de la population envers les acteurs de santé publique peut conduire à une méfiance accrue face aux interventions, pouvant ainsi compromettre l’atteinte des objectifs recherchés (...) par une intervention spécifique et, conséquemment, avoir un impact important sur les bénéfices attendus pour la population visée par cette intervention. Dans la production des avis d’experts, les membres des comités consultatifs d’experts en immunisation (CCEI) peuvent avoir une influence importante sur la prise de décision publique, notamment, sur la sélection par les décideurs de santé publique de vaccins en particulier et la façon dont les campagnes de vaccination seront déployées. En contrepartie de cette influence sur les décisions publiques, une indépendance et une transparence sont attendues de leur part puisque des mécanismes de divulgation et de gestion de conflits d’intérêts (CI) imparfaits peuvent affecter négativement la confiance du public à l’égard de telles décisions. Il apparaît donc important de s’assurer que des mécanismes de gestion des CI, transparents et robustes, existent pour ces comités. Dans cette étude, les avis ou rapports d’évaluation de la pertinence de la vaccination préparés par un CCEI au Québec ont été examinés pour quatre types de maladies évitables par la vaccination (infections invasives à méningocoques et à pneumocoques, coqueluche et virus du papillome humain). Le but était de : 1) identifier les CI divulgués par les membres du CCEI dans leurs rapports comparativement à ceux déclarés dans leurs publications scientifiques pour ces mêmes infections ; 2) analyser la nature des CI (réel, potentiel, apparent, personnel, financier, institutionnel, etc.) et l’impact potentiel (risque) sur la prise de décision impartiale et sur la confiance du public ; et 3) évaluer les mécanismes de gestion de CI actuellement utilisés par ce CCEI. Les résultats de cette étude montrent que très peu de rapports du CCEI contiennent une section sur les CI par rapport à la pléthore divulguée dans les publications scientifiques publiées par les membres du CCEI. De plus, les CI divulgués dans les rapports fréquemment ne correspondent pas à ceux décrits dans les publications scientifiques. Il serait donc important d’introduire des mesures visant à accroître la transparence des experts en immunisation et d’améliorer les mécanismes de divulgation et de gestion des CI afin de veiller à ce que la confiance du public envers les décideurs en santé publique soit maintenue et améliorée. (shrink)

Antimicrobial resistance is a growing public health concern and is associated with the over- or inappropriate use of antimicrobials in both humans and agriculture. While there has been reco- gnition of this problem on the part of agricultural and public health authorities, there has none- theless been significant difficulty in translating policy recommendations into practical guidelines. In this paper, we examine the process of public health policy development in Quebec agriculture, with a focus on the case of pork production and (...) the role of food animal veterinarians in policy making. We argue that a tendency to employ strictly techno-scientific risk analyses of antimicro- bial use ignores the fundamental social, economic and political realities of key stakeholders and so limits the applicability of policy recommendations developed by government advisory groups. In particular, we suggest that veterinarians’ personal and professional interests, and their ethi- cal norms of practice, are key factors to both the problem of and the solution to the current over-reliance on antimicrobials in food production. (shrink)

Imagine that you are part of the editorial board of a young bioethics journal committed to publishing open access (OA) and to ensuring accessibility to high quality and innovative scholarship. To support junior and interna- tional scholars who might not otherwise find places for their work in the leading Western bioethics journals, you do not charge author fees. Imagine also that you have no financial resources to pay for a professional website, auto- mated submissions manager, or even a part-time coordina- (...) tor: Your government has cut all grants for journals, you cannot go to industry for private funding because of the evident risk of apparent conflicts of interest, and your strapped-for-cash institution cannot afford to offer you any support. If one of the major publishers were to approach you to sign a deal, the temptation would be strong to accept. However, this would likely mean putting aside your ideals: It would be impossible to stay a “Green OA” publication (i.e., free of author publication charges) or supportive of junior and international scholars (because of pressures to “increase credibility” through artificially high rejection rates, for example). (shrink)

Ongoing research in the fields of genetics and biotechnology hold the promise of improved diagnosis and treatment of genetic diseases, and potentially the development of individually tailored pharmaceuticals and gene therapies. Difficulty, however, arises in determining how these services are to be evaluated and integrated equitably into public health care systems such as Canada's. The current context is one of increasing fiscal restraint on the part of governments, limited financial resources being dedicated to health care, and rising costs for new (...) health care services and technologies. This has led to increasing public debate in the last few years about how to reform public health care, and whether we should prohibit, permit or perhaps even encourage private purchase of health care services. ;In Canada, some of these concerns have crystallized around the issue of gene patents and commercial genetic testing, in particular as illustrated by the case of Myriad Genetics' patented BRACAnalysis test for hereditary breast and ovarian cancer. While most Canadians who currently access genetic services do so through the public health care system, for those with the means, private purchase is becoming an option. This situation raises serious concerns---about justice in access to health care; about continued access to safe and reliable genetic testing supported by unbiased patient information; and about the broader effects of commercialization for ongoing research and the Canadian public health care system. Commercial genetic testing presents a challenge to health care professionals, policy analysts, and academics concerned with the social, ethical and policy implications of new genetic technologies. Using the Myriad case as an exemplar, tools from moral philosophy, the social sciences, and health policy and law will be brought to bear on the larger issues of how as a society we should regulate commercial research and product development, and more coherently decide which services to cover under public health insurance and which to leave to private purchase. Generally, the thesis is concerned with the question of "how best to bring capital, morality, and knowledge into a productive and ethical relationship". (shrink)

Van Rensselaer Potter (1911-2001), le biologiste à l’origine du terme « bioéthique » dans les écrits nord-américains, considère que « real bioethics falls in the context of the ideals of […] Aldo Leopold », un forestier, philosophe et poète ayant marqué le XXe siècle. Associer Leopold à Potter a pour effet de placer la bioéthique dans la famille des éthiques de l’environnement, ce qui la différencie du sens conventionnel retenu en médecine et en recherche depuis le Rapport Belmont (1979), une (...) déclaration ayant propulsé l’institutionnalisation de la bioéthique en Amérique du Nord. Cependant, diviser la bioéthique entre le médical et l’environnemental est réducteur. Potter propose au contraire une bioéthique globale s’intéressant aux enjeux situés à leur interface, dont ceux concernant la terre, la vie sauvage, la surpopulation, la consommation, etc. Cet article vise à amorcer un nouveau chantier d’analyse de la pensée de Potter en s’appuyant sur l’héritage de Leopold en biologie. Une synthèse de cette vision potterienne est proposée de manière à considérer son œuvre comme un tout cohérent s’intégrant aux grands débats qui transcendent les XXe et XXIe siècles. Sa vision apparaît comme une sagesse collective et prospective sous la forme d’une science de la survie et d’un code de bioéthique. Dépassant l’éthique de l’environnement, son association avec Leopold offre un modèle de la complexité s’imposant comme cas indissociable du contexte qui l’englobe, en améliorant nos façons d’intervenir en pratique dans un monde en constante transformation, à titre de gouvernance adaptative et de sagesse de la responsabilité. (shrink)

The case study presented by Winch and Sinnott (2011) shows not only how difficult it is for clinicians and researchers to identify conflicts of interest (COI), but also how damaging it can be when there are unin- formed and uncoordinated policy responses by senior administrators.

There is a widely acknowledged shortage of and an increasing demand for transplantable human organs and tissues (e.g., kidney, heart, lung, liver, cornea) in developed and developing countries around the world. In response to this need, Lott and Savulescu (2007) propose the creation of a human embryonic stem (hESC) bank to facilitate the equitable and efficient dissemination of human leukocyte anti- gen (HLA) matched tissues and organs to patients in need of replacement. Although not an unreasonable proposal, the authors go (...) on to make a much stronger claim. They argue that hESCs are such important tools for addressing the massive unmet global need for organs that it is ethically justified to require mandatory banking of spare embryos, and they argue for the use of financial (or other) inducements to procure embryos for the derivation of hESCs. (shrink)

Background There has been debate on whether a global or unified field of bioethics exists. If bioethics is a unified global field, or at the very least a closely shared way of thinking, then we should expect bioethicists to behave the same way in their academic activities anywhere in the world. This paper investigates whether there is a 'global bioethics' in the sense of a unified academic community. Methods To address this question, we study the web-linking patterns of bioethics institutions, (...) the citation patterns of bioethics papers and the buying patterns of bioethics books. Results All three analyses indicate that there are geographical and institutional differences in the academic behavior of bioethicists and bioethics institutions. Conclusion These exploratory studies support the position that there is no unified global field of bioethics. This is a problem if the only reason is parochialism. But these regional differences are probably of less concern if one notices that bioethics comes in many not always mutually understandable dialects. (shrink)

The paper is written in response to those who fail to recognize the relation between a patient's mental competency and her state of pain. Some clinicians claim that a proper diagnosis can only be made in the absent of analgesia. Rather, the patient's state of pain directly affects her mental competency and thus her ability to give valid consent. Clinicians should rethink their approach to diagnosis when the patient is in pain.

For Van Rensselaer Potter (1911–2001), Global Bio-Ethics is about building on the legacy of Aldo Leopold (1887–1948), one of the most notable forest managers of the twentieth century who brought to light the importance of pragmatism in the sciences and showed us a new way to proceed with environmental ethics. Following Richard Huxtable and Jonathan Ives's methodological 'Framework for Empirical Bioethics Research Projects' called 'Mapping, framing, shaping,' published in BMC Medicine Ethics (2019)), we propose operationalizing a framework for Global Bio-Ethics (...) by hybridizing approaches in empirical bioethics and ecosystem management. We explain this framework using the metaphor of forest management. This mixed approach is articulated through three phases: (1) mapping the “landscape” to build a working theory, (2) framing the “scene” to prepare the fieldwork, and (3) shaping bioethics “tools” to stimulate cooperation. Applying this methodology, an adaptive management cycle is outlined to help ensure that political processes are sustainable and socially acceptable, still based on strategic and ethical thinking, but also capable of reshaping failing policies. (shrink)

Surveillance programs supporting the management of One Health issues such as antibiotic resistance are complex systems in themselves. Designing ethical surveillance systems is thus a complex task (retroactive and iterative), yet one that is also complicated to implement and evaluate (e.g., sharing, collaboration, and governance). The governance of health surveillance requires attention to ethical concerns about data and knowledge (e.g., performance, trust, accountability, and transparency) and empowerment ethics, also referred to as a form of responsible self-governance. Ethics in reflexive governance (...) operates as a systematic critical-thinking procedure that aims to define its value: What are the “right” criteria to justify how to govern “good” actions for a “better” future? The objective is to lay the foundations for a methodological framework in empirical bioethics, the rudiments of which have been applied to a case study to building reflexive governance in One Health. This ongoing critical thinking process involves “mapping, framing, and shaping” the dynamics of interests and perspectives that could jeopardize a “better” future. This paper proposes to hybridize methods to combine insights from collective deliberation and expert evaluation through a reflexive governance functioning as a community-based action-ethics methodology. The intention is to empower individuals and associations in a dialogue with society, which operation is carried out using a case study approach on data sharing systems. We based our reasoning on a feasibility study conducted in Québec, Canada (2018–2021), envisioning an antibiotic use surveillance program in animal health for 2023. Using the adaptive cycle and governance techniques and perspectives, we synthesize an alternative governance model rooted in the value of empowerment. The framework, depicted as a new “research and design (R&D)” practice, is linking operation and innovation by bridging the gap between Reflexive, Evaluative, and Deliberative reasonings and by intellectualizing the management of democratizing critical thinking locally (collective ethics) by recognizing its context (social ethics). Drawing on the literature in One Health and sustainable development studies, this article describes how a communitarian and pragmatic approach can broaden the vision of feasibility studies to ease collaboration through public-private-academic partnerships. The result is a process that “reassembles” the One Health paradigm under the perspective of global bioethics to create bridges between the person and the ecosystem through pragmatic ethics. (shrink)

Lee (2017) calls for greater attention to the shared epistemological and normative grounds of both public health ethics and environmental ethics, and to Potter’s original conception of bioethics, which, as she rightly observes, has been largely disregarded in contemporary North American bioethics scholarship and practice. In a previous publication we also argued in favor of reviving the Potterian approach to bioethics; we built a case grounded in “the relatively new field of molecular epigenetics [that] provides novel information that should serve (...) as additional justification for expanding the scope of bioethics to include environmental and public health concerns.”. (shrink)

The label `semiotic grammar' captures a fundamental property of the grammars of human languages: not only is language a semiotic system in the familiar Saussurean sense, but its organizing system, its grammar, is also a semiotic system. This proposition, explicated in detail by William McGregor in this book, constitutes a new theory of grammar. Semiotic Grammar is `functional' rather than `formal' in its intellectual origins, approaches, and methods. It demonstrates, however, that neither a purely functional nor a purely formal (...) account of language is adequate, given the centrality of the sign as the fundamental unit of grammatical analysis. The author distinguishes four types of grammatical signs: experiential, logical, interpersonal, and textural. The signifiers of these signs are syntagmatic relationships of the following types, respectively: constituency, dependency, conjugational and linking. McGregor illustrates and exemplifies the theory with data from a variety of languages including English, Acehnese, Polish, Finnish, Japanese, Chinese, and Mohawk; and from his pioneering research on Gooniyandi and Nyulnyul, two languages of the Kimberleys region of Western Australia. (shrink)

A current advance within the agricultural industry is the use of genetic engineering to produce novel crops for food production. This technology raises questions about how societies should position themselves with respect to genetically modified (GM) crop development and implementation; namely, how should the potentials and risks of this technology be evaluated? We argue that current methods to evaluate the risks and benefits of GM crops are inadequate and not conducive to the strategic development of this technology, where a way (...) to ameliorate technology assessments for GM crops is to include farmers in the research process of evaluating these crops prior to their commercialization. However, particularities concerning the ethical status of such research require special consideration and vigilance. For example, in such technology assessment initiatives, farmers would occupy both the roles of research participant and research investigator. Other particularities surface due to factors related to the nature of GM crops. These particularities are examined with reference to concepts drawn from the field of research ethics, namely informed consent, compensatory decisions, and issues of participant inclusion/exclusion. (shrink)

Promotion of prescription drugs may appear to be severely limited in some jurisdictions due to restrictions on direct-to-consumer advertising. However, in most jurisdictions, strategies exist to raise consumer awareness about prescription drugs, notably through the deployment of direct-to-consumer information campaigns that encourage patients to seek help for particular medical conditions. In Canada, DTCI is presented by industry and regulated by Health Canada as being purely informational activities, but their design and integration in broader promotional campaigns raise very similar ethical concerns (...) as those associated with DTCA. Specifically, DTCI can be an effective means of familiarizing the public with the scope and benefits of a particular prescription drug and so, like DTCA, can promote increased patient-consumer demand and thus a problematic rise in the prescribing and use of medications that may be neither the most appropriate nor the most cost-effective. Yet, with DTCI the industry is playing within the existing rules and regulations set by health regulators. To respond appropriately to this regulatory incoherence, we argue that DTCI should be regulated as a type of direct-to-consumer indirect advertising. Even if the case and specific regulations presented here are Canadian, the implications extend to every country that has a partial or total prohibition on DTCA. (shrink)

Concern about the ethics of clinical drug trials research on patients and healthy volunteers has been the subject of significant ethical analysis and policy development—protocols are reviewed by Research Ethics Committees and subjects are protected by informed consent procedures. More recently attention has begun to be focused on DNA banking for clinical and pharmacogenetics research. It is, however, surprising how little attention has been paid to the commercial nature of such research, or the unique issues that present when subjects are (...) asked to consent to the storage of biological samples. Our contention is that in the context of pharmacogenetic add-on studies to clinical drug trials, the doctrine of informed consent fails to cover the broader range of social and ethical issues. Applying a sociological perspective, we foreground issues of patient/subject participation or ‘work’, the ambiguity of research subject altruism, and the divided loyalties facing many physicians conducting clinical research. By demonstrating the complexity of patient and physician involvement in clinical drug trials, we argue for more comprehensive ethical review and oversight that moves beyond reliance on informed consent to incorporate understandings of the social, political and cultural elements that underpin the diversity of ethical issues arising in the research context. (shrink)

In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced (...) clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians’ duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them. (shrink)

E-money systems have revolutionized global business transactions through digital payment methods. This quantitative correlational study aimed to assess the awareness and acceptance of e-money among individuals in Balayan, Batangas. Employing quota and purposive sampling, 100 participants aged 21 to 70 completed a survey questionnaire. Statistical analysis revealed that consumers were aware of e-money but lacked comprehensive knowledge. They acknowledged the convenience of e-money for online shopping and expense tracking. Age significantly influenced acceptance, while gender did not exhibit a similar effect. (...) Significant differences were observed in awareness and acceptance levels. Recommendations for improving acceptance include administrator-led campaigns, business incentives, consumer education, financial institution partnerships, and integration into student curricula. The study underscores the need for targeted strategies to translate e-money knowledge into practical use. Future research should explore adoption trends over time, barriers, and the impact of regulations on e-money utilization. (shrink)

Nanotechnology research is beginning to see widespread coverage in the media and popular science literatures, but discussions of hopes and fears about nanotechnology have already become polarised into utopian and dystopian visions. More moderate discussions focus on the near-term applications of nanotechnologies, and on potential benefits and harms. However, in exploring the social and ethical implications of nanotechnology, important lessons should be learned from experiences in other fields. In particular, studies of the ethical, legal, and social issues of genetics research (...) have successfully mapped out many of the issues that arise when new technologies are deployed. It is our contention that, for the most part, the ethical and social issues arising in nanomedicine are not altogether new, and thus do not require novel ethical principles or frameworks, nor a massive investment in ‘NELSI’ research. Instead, what is needed is support for the development of a culture of ethics amongst scientists and clinicians, basic scientific and medical knowledge for bioethicists, and a social competency for citizens to participate actively in debates about the implications of new technologies in general. (shrink)

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to what (...) they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based on the (...) variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

Depuis 2020, le monde a connu une situation sanitaire exceptionnelle à la suite de la pandémie de Covid-19, faisant face à une incertitude dans le monde médical clinique, de la recherche et dans l’ensemble des domaines connexes en santé publique. Le caractère imprévisible et l’absence de données fiables en lien avec ce virus ont fait émerger une quantité d’enjeux éthiques concrets, cela a donc révélé un domaine particulier, la bioéthique, et plus particulièrement une profession, les bioéthiciens. Les « bioéthiciens » (...) se sont fait connaître du grand public en se dressant parfois comme des garde-fous contre des dérives sanitaires, à d’autres moments comme des lanceurs d’alertes face à des injustices naissantes, ou comme critiques, polémistes et parfois même militants dans les médias ou en tant qu’acteurs de première ligne dans les systèmes politico-sanitaires. Ces divers rôles et pratiques illustrent bien la diversité et l’hétérogénéité du domaine de la bioéthique. Toutefois, l’absence de professionnalisation traditionnelle et formelle de la bioéthique complexifie la compréhension de ce champ disciplinaire. Même en Amérique du Nord, où la pratique de la bioéthique est professionnalisée, il ne s’agit toujours pas d’une profession officiellement reconnue et le terme « bioéthicien » lui-même peut être controversé. La forte présence de cette profession durant la pandémie de Covid-19 a révélé l’importance de décrire ce qu’est un bioéthicien, les fonctions qu’il occupe et en quoi consistent ses interventions. Nous apportons cette clarification nécessaire en expliquant la nature de la bioéthique contemporaine dans toute sa diversité. Comme nous l’a démontré la pandémie de Covid-19, les bioéthiciens représentant un soutien et un guide indispensable de nos jours menés par leur esprit critique et leur réflexivité permanente. (shrink)

Genetic testing in the workplace is a technology both full of promise and fraught with ethical peril. Though not yet common, it is likely to become increasingly so. We survey the key arguments in favour of such testing, along with the most significant ethical worries. We further propose a set of pragmatic criteria, which, if met, would make it permissible for employers to offer (but not to require) workplace genetic testing.

Genetics research and biotechnology development - while holding the promise of improved pharmaceuticals, medical treatments, and foods - is also raising concerns about the impact of market forces on scientific inquiry, product development, and the provision of health care.

Jusqu’à présent, les discussions au sein de la communauté universitaire et dans la littérature scientifique sur la conduite responsable en recherche (CRR), incluant l’intégrité scientifique et l’éthique de la recherche, ont principalement été menées par les chercheurs en sciences de la santé et en sciences fondamentales. Préoccupés, à juste titre, par des problèmes d’inconduite, leurs effets négatifs sur la rigueur scientifique et la confiance du public dans l’entreprise de la recherche, ces débats ont conduit à l’élaboration et à la mise (...) en œuvre de lignes directrices nationales et de politiques institutionnelles. Ces lignes directrices visent entre autres à promouvoir la CRR, notamment dans le but de prévenir ces inconduites. Cependant, pour garantir la pertinence et une application appropriée de ces normes à tous les domaines universitaires, il est nécessaire que les sciences humaines et sociales (SHS) contribuent plus directement à ces discussions. Un tel engagement devrait permettre d’exprimer les particularités disciplinaires et méthodologiques des SHS, dont certaines peuvent être très différentes des sciences appliquées et fondamentales. Cela permettrait également de s’assurer que la littérature sur la CRR ainsi que les politiques et les directives qui en découlent soient à la fois fondées sur des principes universellement généralisables, mais aussi appliquées avec nuance afin de refléter la diversité des pratiques disciplinaires. Dans ce chapitre, nous explorons trois grands domaines dans lesquels les SHS pourraient contribuer à façonner les discussions dans la littérature sur la CRR, tout en informant les chercheurs en SHS des meilleures pratiques en matière de CRR : l’autorat/paternité, la collaboration et l’autorégulation. (shrink)

BioéthiqueOnline was launched in March 2012 as a non-peer reviewed journal with the aim of providing a platform to facilitate and encourage the development of a bilingual bioethics community in Canada and internationally. In light of discussions amongst the Editorial Committee over the past few months regarding the growth of the journal, we have decided to move to a peer-reviewed process for articles submitted to the journal.

Bioethics experts played a key role in ensuring a coherent ethical response to the COVID-19 pandemic in the fields of healthcare, public health, and scientific research in Canada. In the province of Quebec, a group of academic and practicing bioethicists met periodically in the early months of the pandemic to discuss approaches and solutions to ethical dilemmas encountered during the crisis. These meetings created the opportunity for a national survey of bioethics practitioners from different fields. The survey, in which forty-five (...) Canadian bioethics practitioners (clinical ethicists, ethicist members of REBs and government health policy ethicists, or any bioethicist practicing outside of academia) participated, explored their concerns, challenges and opportunities during the first wave of the pandemic, with the objective of informing bioethics research about the difficulties experienced by bioethicists “in the field”. Participants reported increased stress levels, increased workloads, and a greater proportion of their work being devoted to public health ethics. Most of their concerns focused on groups other than themselves, such as health professionals, patients, research participants, and people in vulnerable socio-economic situations. An optimism about the future of bioethics was noted due to an increased awareness of the importance of bioethics by the public and by health and research institutions. (shrink)

In Québec, the Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information provides an exception to transparency to most public institutions where public health research is conducted by allowing them to not disclose their uses of personal data. This exceptionalism is ethically problematic due to important concerns and we argue that all those who conduct research should be transparent and accountable for the work they do in the public interest.

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

The Repugnant Conclusion served an important purpose in catalyzing and inspiring the pioneering stage of population ethics research. We believe, however, that the Repugnant Conclusion now receives too much focus. Avoiding the Repugnant Conclusion should no longer be the central goal driving population ethics research, despite its importance to the fundamental accomplishments of the existing literature.

Automated reasoning about uncertain knowledge has many applications. One difficulty when developing such systems is the lack of a completely satisfactory integration of logic and probability. We address this problem directly. Expressive languages like higher-order logic are ideally suited for representing and reasoning about structured knowledge. Uncertain knowledge can be modeled by using graded probabilities rather than binary truth-values. The main technical problem studied in this paper is the following: Given a set of sentences, each having some probability of being (...) true, what probability should be ascribed to other (query) sentences? A natural wish-list, among others, is that the probability distribution (i) is consistent with the knowledge base, (ii) allows for a consistent inference procedure and in particular (iii) reduces to deductive logic in the limit of probabilities being 0 and 1, (iv) allows (Bayesian) inductive reasoning and (v) learning in the limit and in particular (vi) allows confirmation of universally quantified hypotheses/sentences. We translate this wish-list into technical requirements for a prior probability and show that probabilities satisfying all our criteria exist. We also give explicit constructions and several general characterizations of probabilities that satisfy some or all of the criteria and various (counter) examples. We also derive necessary and sufficient conditions for extending beliefs about finitely many sentences to suitable probabilities over all sentences, and in particular least dogmatic or least biased ones. We conclude with a brief outlook on how the developed theory might be used and approximated in autonomous reasoning agents. Our theory is a step towards a globally consistent and empirically satisfactory unification of probability and logic. (shrink)

Several recent lines of inquiry have pointed to the amygdala as a potential lesion site in autism. Because one function of the amygdala may be to produce autonomic arousal at the sight of a significant face, we compared the responses of autistic children to their mothers’ face and to a plain paper cup. Unlike normals, the autistic children as a whole did not show a larger response to the person than to the cup. We also monitored sympathetic activity in autistic (...) children as they engaged in a wide range of everyday behaviours. The children tended to use self-stimulation activities in order to calm hyper-responsive activity of the sympathetic (`fight or flight’) branch of the autonomic nervous system. A small percentage of our autistic subjects had hyporesponsive sympathetic activity, with essentially no electrodermal responses except to self-injurious behaviour. We sketch a hypothesis about autism according to which autistic children use overt behaviour in order to control a malfunctioning autonomic nervous system and suggest that they have learned to avoid using certain processing areas in the temporal lobes. (shrink)

Neuroscience hasn’t shown how quite similar sensory circuits encode quite different colors and other qualia, nor how the unified pictorial form of images is encoded, nor how these codes yield conscious images. Neuroscience’s fixation here on cortical codes may be the culprit. Treating conscious images partly as retinal substances may avoid these problems. The evidence for conscious retinal images is that (a) the cortical codes for images are quite problematic, (b) injecting retinas with certain genes turns dichromats into trichromats without (...) cortical help, (c) retinas can discern colors by themselves without cortex, (d) retinal distortions appear in images but cortical distortions don’t, (e) retinal detectors support finely detailed colors, but V4 detectors don’t, due to their big receptive fields, (f) retinal activity has pictorial form, but viable cortical codes for pictorial form don’t exist. So, the colors and unified pictorial form of images arguably arise mainly across arrays of retinal detectors—not from abstract cortical codes. Images may be hidden in retinal activity beyond what EEGs show of it (cf. Strawson’s monism). Also, cortex refines these retinal images but cortical impairment (anesthesia, lesions, etc.) blocks awareness of them, for they’re no longer accessible to the mind’s subject-centered consciousness, resident in cortex. This proposal is largely testable and based in recent evidence. It avoids neuroscience’s elusive, problematic coded images and enigmatic explanations of how they become conscious. (shrink)

A dominant strand of philosophical thought holds that natural kinds are clusters of objects with shared properties. Cluster theories of natural kinds are often taken to be a late twentieth-century development, prompted by dissatisfaction with essentialism in philosophy of biology. I will argue here, however, that a cluster theory of kinds had actually been formulated by William Whewell (1794-1866) more than a century earlier. Cluster theories of kinds can be characterized in terms of three central commitments, all of which (...) are present in Whewell’s work on classification. Like contemporary cluster theorists, Whewell claims that kinds are united by similarity, that many kinds do not have essences, and that there are “gaps” between kinds. Moreover, Whewell advises taxonomists to look for consilience (roughly, convergence) between different classificatory schemes, a recommendation that reinforces the identification of natural classes with property clusters. Thus Whewell was not only an early cluster theorist, but one with important insights into what a cluster theory of kinds means for the practice of classification. (shrink)

Debate between the A- and B-theories has rested on the supposition that there is a clear difference between A- and B-time. I argue that this supposition is mistaken for two reasons. We cannot distinguish the two conceptions of time by means of Bergsonian intuition. Unless we can do so, we cannot distinguish them at all. I defend by imagining various ways to intuit the two kinds of time, and maintaining that none of them works. I defend by showing that the (...) issue is an experiential one, unlike metaphysical issues that are less connected to experience. My conclusion is that no progress will be made in the debate between the two theories until it becomes clear what the difference is between the two kinds of time. (shrink)