This paper examines an under-explored issue in organ donation: whose decision making authority should be privileged posthumously in the context of known, explicit consent for donation? Current practices in Canada support the family as the ultimate decision maker, despite the existence of legislative support in many Canadian provinces for the potential donor as legitimate decision maker. Arguments for and against privileging the family and the potential donor are identified. Informing the question of “who should decide” are considerations of individual and (...) relational autonomy, distributive and social justice, personhood, and arguments “from distress”. Tensions and competing obligations emerge from an exploration of these considerations that call for further, inclusive dialogue and deliberation on this important organ donation issue. (shrink)

This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings , is exploitative of surrogate women. Arising out of consideration of (...) the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...) an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold. (shrink)

Bianchi, Stanley, and Sutander argue in an insightful, cogent manner for the consideration of harm reduction as an ethically-defensible, non-paternal management approach for capable persons...

The contentious, topical debate about whether faith-based health care organizations should be granted accommodation on the basis of institutional conscientious objection to medical assistance is dying (MAiD) is addressed through a comparative analysis of arguments on both sides of the issue that references such relevant considerations as: claimed ‘moral-authority’, competing rights-based claims, obligations arising from patient welfare principles, formal justice, dissimilarity in consequences, and two illustrative arguments from analogy. The analysis leads to the conclusion that nonconditional accommodation on the basis (...) of institutional conscientious objection to MAiD is not ethically acceptable in Canada. A compromise mechanism, consisting of a suggested set of pragmatic conditions, is proposed that could effectively balance the competing moral responsibilities that arise from this conclusion and a core assumption of the paper, i.e., that some dominant faith-based health institutions can legitimately request, and expect, that provincial/territorial governments pay them a measure of respect in their operational, health-care-delivery decision making because of these institutions’ long history of providing high quality, health care in Canada. It is further suggested that provincial/territorial governments only allow large, publicly funded, faith-based health care organizations to enact a conditional version of accommodation on the basis of institutional conscientious objection to MAiD in circumstances where the organization has entered into a formal agreement with the relevant health department to meet the proposed, compromise conditions (or a relevantly-similar set of conditions). (shrink)

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, (...) there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). (shrink)

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...) an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold. (shrink)

Historically, the triage of temporarily scarce health resources has served narrow utilitarian ends. The recent H1N1 pandemic experience provided an opportunity for expanding the theoretical foundations/understandings of critical care triage in the context of declared infectious pandemics. This paper briefly explores the ethics-related challenges associated with the development of modern critical care triage protocols and provides descriptions of some ‘enhanced fairness’ features which were developed through the use of an inclusive deliberative engagement process by a Canadian provincial Department of Health.

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed choice/consent, relevant (...) critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that : 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. (shrink)

The modern practice of organ donation after cardiocirculatory death (DCD) emerged in the 1990s as a response to the alarmingly wide gap between the number of transplantable organs available through organ donation after neurological death and the urgent organ transplantation needs of persons in end-organ failure. Various important ethical dimensions of DCD have been considered and debated by prominent organ donation/transplantation theorists and clinicians.In this article, consideration of some of these ethical elements provides a foundation for a proposed set of (...) ethically informed, pragmatic conditions that could assist in the development of health policies to guide the practice of organ donation after cardiocirculatory death. (shrink)

In this critical commentary, a set of ethical considerations of relevance to the (currently contested) interpretation of irremediability for medical assistance in dying (MAiD) in circumstances where the sole-underlying medical condition is a mental health disorder is explored and analyzed. Based on the application of an ethics lens, a practical description of irremediability is proposed for intended use as guidance by Canadian mental health care clinicians, MAiD assessors and providers, and provincial/territorial professional regulatory authorities.

Overby and colleagues (2015) draw our critical attention to a variety of ethical challenges associated with the practice of controlled donation after circulatory determination of death (cDCDD). Alt...

There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three (...) practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances. The analytical outcomes suggest that a bright moral line cannot be demonstrated between any two of the practices in paradigm circumstances, and that there are significant, morally-relevant distinctions between their use in paradigm and non-paradigm circumstances. A thought experiment is employed to illustrate how these outcomes could possibly inform the decisions of hypothetical deliberators who are engaged in the collaborative development of assisted dying regulatory frameworks. (shrink)

MacKay and Robinson (2016) provide a critical analysis of four organ donation registration options using an expanded conception of manipulation introduced by Jennifer Blumenthal-Barby (Blumenthal-B...

The complex health and social circumstances of living-at-risk, frequent users of emergency departments (aREDFUs) in the health jurisdictions of high-income countries, and the related, significant challenges posed for emergency departments and the health care providers working within them, are identified and explored in the paper. Ethical analyses of a set of relevant domains are performed, i.e., individual and relational autonomy considerations, relevant social construction and personal responsibility conceptions, patient welfare principles (beneficence, nonmaleficence, continuity of care), harm reduction methodologies and their (...) applications, health equity, and justice considerations of the distributive, formal and social types. The outcomes of these analyses demonstrate that there are ethically compelling reasons for emergency departments to adopt an ethics-informed, policy-based approach to the longitudinal care and management of living-at-risk, frequent users of emergency departments. From a formal justice perspective, the development and uses of such an approach are justified by a demonstrable relevant difference between living-at-risk, frequent users of emergency departments and other persons and groups of patients who visit emergency departments. We propose an example of such a policy-based approach. Examples of possible, pragmatic applications of this approach, which help ensure that aREDFUs who present to the ED are managed in a fair and optimally consistent manner, are provided for the consideration of an urban emergency department’s policymaking working group. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 57-59, June 2011.

This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings, is exploitative of surrogate women. Arising out of consideration of the (...) heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

Despite successful transplantation outcomes in Europe, uncontrolled organ donation after circulatory determination of death has essentially been a non-starter in North America. In this paper, I identify and explore a set of interesting, ethics-related considerations that are of relevance to this organ donation-transplantation practice. The analysis provides a theoretical platform for my development of a proposal for the creation of a particular ethical practice and policy space for kidney uDCDD in the U.S. and Canada that recognizes and aims to effectively (...) address the various, identified challenges and constraints. (shrink)

A provocative question has emerged since the Supreme Court of Canada’s decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cDCD that are of relevance to this research question are explored, and morally-relevant (...) distinctions between cDAD and cDCD are identified. In addition, a set of morally-relevant advantages of one practice over the other is uncovered, and a few potential, theoretical issues specifically related to cDAD practice are articulated. Despite these concerns, the analysis suggests a counterintuitive conclusion: cDAD is, overall, less ethically-problematic than cDCDD. The former practice better respects the autonomy interests of the potential donor, and a claim regarding irreversibility of cessation of the donor’s circulatory function in the cDAD context can be supported. Further, with cDAD, there is no possibility that the donor will have negative sensory experiences during organ procurement surgery. Although the development of appropriate policy-decision and regulatory approaches in this domain will be complex and challenging, the comparative ethical analysis of these two organ donation practices has the potential to constructively inform the deliberations of relevant stakeholders, resource persons and decision makers. (shrink)

Early on in the development of Practicing Healthcare Ethicists Exploring Professionalization (PHEEP), the founding members recognized the need to address and meet two important goals: (1) the creation of a dynamic, rigorous process to support the exploratory work, and (2) the establishment of the means—deliberative engagement—to generate and justify the substantive content of professionalization-related products, such as practice standards and position statements. Drawing from social justice and deliberative democracy conceptions and insights (among others), the authors identify and describe the core (...) elements of the “process scaffolding” and “deliberative means” that inform PHEEP’s deliberative engagement methodology. The paper demonstrates how these process and substantive features have been meaningfully instantiated in the decision making framework established by PHEEP for its use in the development of professionalization-related products by Canadian practicing healthcare ethicists. (shrink)

This paper explores how using a domains of ethics analysis approach might constructively contribute to an enhanced understanding (among those without specialized ethics training) of ethically-complex health care practices through the consideration of one such sample practice, i.e., deep and continuous palliative sedation (DCPS). For this purpose, I select four sample ethics domains (from a variety of possible relevant domains) for use in the consideration of this practice, i.e., autonomous choice, motives, actions and consequences. These particular domains were choosen because (...) of their relevance to the analysis of DCPS and their relative ease of access to those without ethics training. The analysis demonstrates that such an approach could facilitate the emergence of accessible arguments and discussion points that could enhance the understanding and appreciation of this and other health care practices with strong ethics dimensions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminism and Classics:Framing the Research AgendaBarbara K. GoldA landmark conference on "Feminism and Classics: Framing the Research Agenda" was held at Princeton University on November 7-10, 1996; the coorganizers were Janet M. Martin (Princeton University) and Judith P. Hallett (University of Maryland). This conference is the second in a series of more-or-less triennial meetings devoted to feminist research in various areas of classical studies. The first of these conferences (...) ("Feminism and Classics I") was held at the University of Cincinnati in 1992 and was codirected by Kathryn J. Gutzwiller and Ann N. Michelini (both of the University of Cincinnati; for a review of this conference see Clara Hardy and Kirk Ormand, BMCR 4.2 [1993] 135-41).The goals of the Princeton conference were several:mdash To address the evidential deficiencies of the traditional classical literary canon-by examining new kinds of sources and evidence, particularly nonliterary texts and material culture; and by giving increased attention to the ancient Near East and Africa (especially Egypt) as well as to post-classical Greek and Latin texts;mdash To address the methodological inadequacies of traditional historical and philological approaches-by applying the new literary and textual criticism and theory to the traditional classical literary canon as well as to nonliterary and postclassical texts; by adopting comparative approaches to the study of ancient sexuality and gender; and by considering women (in addition to men) as agents in the transmission of the classical tradition;mdash To clarify, illuminate, and evaluate the relations between classical scholarship and the politics of social change-by defining the actual and potential relations among feminist studies, gender studies, and women's studies, and the relation of classical studies to each; by examining the variety of relations that feminist and other scholarship can have to the politics of social change; and by addressing the role of theory in feminist scholarship in classics.The conference was divided into four plenary sessions, each one devoted to a core area of feminist scholarly research in classics: The Historical Recovery of Ancient Women (Speakers: Shelby Brown, UCLA [End Page 328] and Alan Shapiro, University of Canterbury, New Zealand; Discussants: Barry S. Strauss, Cornell University and Sandra R. Joshel, New England Conservatory of Music); Women and the Classical Tradition (Speakers: Joan M. Ferrante, Columbia University and Shelley P. Haley, Hamilton College; Discussants: Diana Robin, University of New Mexico and Judith P. Hallett, University of Maryland); Feminist Literary Studies and the Construction of Sexuality and Gender in the Ancient World (Speakers: David Konstan, Brown University and Barbara K. Gold, Hamilton College; Discussants: Ellen Oliensis, Yale University and Ruth Webb, Princeton University); Feminism and Classics in the Next Century: Feminist Studies, Gender Studies, Women's Studies (Speakers: Peter W. Rose, Miami University of Ohio and Nancy F. Partner, McGill University; Discussants: Sarah B. Pomeroy, Hunter College and CUNY and Amy Richlin, University of Southern California).In addition to the four plenary sessions, there was a rich variety of discussion and presentation in other formats: opening and closing roundtables (including, in addition to some of the speakers and organizers, Nancy Sorkin Rabinowitz, Hamilton College, Barbara M. McManus, College of New Rochelle, Bella Zweig, University of Arizona, Kathryn J. Gutzwiller, and Ann N. Michelini, both of the University of Cincinnati); the keynote address by Ernestine Friedl, Duke University; and sixteen interactive workshops, which followed up on the topics of the plenary sessions. These covered topics as broad as "Reading Gender in Epigraphical Text and Context" (Susan Guettel Cole), "The Classical World in Twentieth-Century Historical Fiction by Women" (Sheila Murnaghan and Deborah H. Roberts), "Feminist Theory/Queer Theory" (Kirk Ormand and Rabinowitz), "Politics, Pedagogy, and the Future of Gender Studies" (Mary Whitlock Blundell, Jeffrey S. Carnes, and John T. Kirby), and "Feminist Anthropology and Feminist Work in Classics" (Deborah Lyons).The conference was one of several events celebrating the 250th anniversary of Princeton University. In certain respects it carried on the work of the 1917 Princeton conference organized by Dean Andrew Fleming West. Entitled "Value of the Classics," the 1917 conference was also in its own way interdisciplinary, documenting the impact of classics on such fields as medicine, law, economics, sociology, and public... (shrink)

This essay assesses Robert Merrihew Adams' contribution to the religion-morality debate in light of questions in philosophical semantics and metaphilosophy, questions Adams raises without addressing directly. It sketches a holistic theory of the use of language in thought in the hope of providing a context for determining the value and philosophical relevance of Adams' semantic claims. It concludes by suggesting that descriptive metaethics should give way to explicitly historical studies, and by maintaining that historians of ethics need not postulate "meanings" (...) in order to make sense of what they do. (shrink)

Quantifiers are a test case for an interface between psychological questions, which attempt to specify the numerical content that supports the semantics of quantifiers, and linguistic questions, which uncover the range of possible quantifier meanings allowable within the constraints of the syntax. Here we explore the development of comprehension of most in English, of particular interest as it calls on precise numerical content that, in adults, requires an understanding of large exact numerosities (e.g., 23 blue dots and 17 yellow is (...) an instance of “most of the dots are blue”). In a sample of 100 children 2 to 5 years of age we find that (a) successful most comprehension in cases with two salient subsets is achieved at 3 years, 7 months of age, and (b) most comprehension is independent of knowledge of large exact number words; that is, knowledge of large exact number words is neither necessary, as evidenced by children who understand “most” but not “four,” nor sufficient, as evidenced by children who understand “nine” but not “most.”. (shrink)

Various hypotheses about the importance of psycho-neural concomitants are reviewed and their implications discussed for the 'easy' and 'hard' problems of consciousness -- especially, as viewed by cognitive and ecological psychology. In Ecological Psychology, where the subjective-objective dichotomy is repudiated, these concepts are without foundation, and are replaced by informed awareness, which is argued to play an important, perhaps, indispensable role in goal- directed actions and thus to have survival value. The significance of informed awareness is illustrated in several real- (...) world goal-directed tasks. (shrink)

Consider a group of people whose preferences satisfy the axioms of one of the current versions of utility theory, such as von Neumann-Morgenstern (1944), Savage (1954), or Bolker-Jeffrey (1965). There are political and economic contexts in which it is of interest to find ways of aggregating these individual preferences into a group preference ranking. The question then arises of whether methods of aggregation exist in which the group’s preferences also satisfy the axioms of the chosen utility theory, and in (...) which at the same time the aggregation process satisfies certain plausible conditions (e.g., the Pareto conditions below). (shrink)

Th is article examines the extent to which spaces are structuring influences on, or targets of, action. Two factors and their interactions are presented: the extent to which a space is 1) maintained and 2) used. As these factors increase in strength, the structural influences of a space increase while agential opportunities are diminished. Conversely, as spaces become dilapidated and abandoned, structural forces are weakened and the potential for creative action heightens. These spaces can be conceptualized as elements of the (...) ‘residual landscape’: spaces left behind by socio-historical processes and practices. Special cases are considered where the factors are inversely related and issues of structure and agency are complicated. A brief case study serves to illustrate each type of spaceand the factors which operate therein. (shrink)

A well-trod debate at the nexus of cognitive science and linguistics, the so-called past tense debate, has examined how rules and exceptions are individually acquired. However, this debate focuses primarily on individual mechanisms in learning, saying little about how rules and exceptions function from a sociolinguistic perspective. To remedy this, we use agent-based models to examine how rules and exceptions function across populations. We expand on earlier work by considering how repeated interaction and cultural transmission across speakers affects the dynamics (...) of rules and exceptions in language, measuring linguistic outcomes within a social system rather than focusing individual learning outcomes. We consider how population turnover and growth effect linguistic rule dynamics in large and small populations, showing that this method has considerable potential particularly in probing the mechanisms underlying the linguistic niche hypothesis. (shrink)

The definitive biography of Alain Locke, the first African American Rhodes Scholar and Harvard PhD in philosophy, Howard University philosophy scholar, and architect of the Harlem Renaissance, who mentored a generation of artists including Langston Hughes and Zora Neale Nurston and promoted the work of African Americans as the quintessential creators of American modernism. This biography explores his professional and private life, including his relationships with white patrons and his lifelong search for love as a gay man.