This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

Conflicts over the proper role of religion in schools-and particularly in public schools supported by tax monies-are frequently featured in news reports. For example, in the United States there currently are conflicts over the teaching of evolution, inserting the word God in the pledge of allegiance, conducting school holiday celebrations, posting the biblical Ten Commandments in schools, and praying at school functions. People who are interested in such controversies often-or, perhaps, usually-fail to understand the historical backgrounds to the conflicts and (...) therefore do not recognize the very complex factors that affect why the controversies become so heated. To help readers gain a better understanding of such matters, this book focuses on the seven major types of conflicts that have become particularly confrontational during the first decade of the twenty-first century. The cases on which the chapters focus concern issues that currently are being hotly debated in America. Controversies are described in relation to their historical origins and the author shows how the history affects current understanding of the issues. Thomas does not take sides in the arguments; rather, he lays out the arguments, their historical and cultural contexts, and the groups that debate them and their goals. Anyone wishing to gain a better understanding of the controversies surrounding religion in American schools will be happy to find here not just a review of the issues, but a deeper consideration of the causes, consequences, and future of the debates and the role of religion in our public schools. (shrink)

An organization's management control system can play an important role in influencing ethical behavior among employees. In this paper a theoretical framework of control is developed by linking various ethics related control mechanisms reported in the literature to the primary components of a management control system. In addition, the findings of a survey of the Financial Post's Top 1 000 Canadian industrial and service companies are reported. The survey investigated organizations' use of ethical codes of conduct, whistleblowing systems, ethics committees, (...) judiciary boards, employee training in ethics, and ethics focused corporate governance and reward systems. The findings indicate that ethics related control mechanisms, particularly codes of conduct, are being used by a good number of organizations. However, closer analysis of the data suggests that many companies may only be paying lip service to the importance of promoting ethical behavior. (shrink)

Schafer contends that we suffer from an overabundance of acoustic information, and explores ways to restore our ability to hear the nuances of sounds around us.

This monograph analyzes the moral reasoning behind people's proposed consequences for wrongdoers and compares group modes of moral decision making.

The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, explicit, (...) and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety‐net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community‐based care, and fully staff hospitals and clinics on nights and weekends. (shrink)

Veterinary medicine has undergone dramatic, rapid feminization while in many ways remaining gendered masculine. With women constituting approximately half of its practitioners and nearly 80 percent of students, veterinary medicine is the most feminized of the comparable health professions. Nevertheless, the culture of veterinary medicine glorifies stereotypically masculine actions and attitudes. This article examines how women veterinarians understand the gender dynamics within the profession. Our analysis reveals that the discursive strategies available to women sustain and justify the status quo, and (...) thus preserve hegemonic masculinity. Women use strategies previously used toward female tokens in nontraditional jobs, such as role encapsulation, and strategies previously used by male tokens in traditionally female jobs, such as distancing from the feminine. Through this discursive “gender work,” women help to maintain the institutionalized inequality and the masculine ethic of the profession. Veterinary medicine illustrates the importance of considering organizational context in studies of feminization. (shrink)

Volume 20, Issue 7, July 2020, Page 109-111.

When the Covid‐19 pandemic reached the United States in spring 2020, many states and hospitals announced crisis standards of care plans that used age as a categorical exclusion criterion. Such age choosing was quickly flagged as discriminatory, and so some states and hospitals shifted to embedding age as a tiebreaker deeper in their plans. Different rationales were given for using age as a tiebreaker: that younger patients were more likely to survive than older patients, that saving younger patients would save (...) more life years, and that younger patients deserved a chance to live through life's stages. We provide a critical analysis of these three rationales, noting the differences between them, and then questioning the ethical and legal justifications for such age choosing. (shrink)

Volume 20, Issue 7, July 2020, Page 92-94.

Following an initial study of the needs of healthcare providers (HCP) regarding the introduction of Medical Assistance in Dying (MAiD), and the subsequent development of an assisted dying program, this study sought to determine the efficacy and impact of MAiD services following the first two years of implementation. The first of three aims of this research was to understand if the needs, concerns and hopes of stakeholders related to patient requests for MAiD were addressed appropriately. Assessing how HCPs and families (...) perceived the quality of MAiD services, and determining if the program successfully accommodated the diverse needs and perspectives of HCPs, rounded out this quality evaluation. This research implemented a mixed-methods design incorporative of an online survey with Likert scale and open-ended questions, as well as focus groups and interviews with staff and physicians, and interviews with MAiD-involved family members. There were 356 online surveys, as well as 39 participants in six focus groups with HCP, as well as fourteen interviews with MAiD-involved family members. Participants indicated that high-quality MAiD care could only be provided with enabling resources such as policies and guidelines to ensure safe, evidence-based, standardized care, as well as a specialized, trained MAiD team. Both focus group and survey data from HCPs suggest the infrastructure developed by the hospital was effective in delivering high-quality MAiD care that supports the diverse needs of various stakeholders. This study may serve as a model for evaluating the impact and quality of services when novel and ethically-contentious clinical practices are introduced to healthcare organizations. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

Tim Wardle’s 2018 documentary film Three Identical Strangers is an exploration of identity, family, and loss. It’s also about nature versus nurture and the boundaries of ethically permissible research, particularly research involving children. The film tells the story of identical triplets who were separated soon after birth in 1961. A different family adopted each boy, without being told that their son had two identical brothers. The adoption agency responsible for finding the families was collaborating with a group of researchers working (...) on a study about … something. Three Identical Strangers details the boys’ fight to obtain information about the study and for closure. But while the film may have received rave reviews, it left us feeling uneasy. We came away with two sets of questions, one having to do with the story that the film documents and the second with the ethics of filmmaking itself. (shrink)

Number concepts must support arithmetic inference. Using this principle, it can be argued that the integer concept of exactly ONE is a necessary part of the psychological foundations of number, as is the notion of the exact equality - that is, perfect substitutability. The inability to support reasoning involving exact equality is a shortcoming in current theories about the development of numerical reasoning. A simple innate basis for the natural number concepts can be proposed that embodies the arithmetic principle, supports (...) exact equality and also enables computational compatibility with real- or rational-valued mental magnitudes. (shrink)

The acid rain issue came into prominence because scientists kept telling the world of acid rain's potential devastating effects. Yet, the acid rain debate was marked by mistrust between American and Canadian scientists. The signing of the Air Quality Accord in 1991 appears to have quelled this divisiveness and promises to bring about a new era of scientific cooperation. Using surveys of acid rain scientists in the United States and Canada across three time periods, this study finds both similarities and (...) differences between how Canadian and American scientists view many of the issues surrounding the acid rain debate. (shrink)

The emergence and development of the field of clinical ethics coincided with the revitalization of moral philosophy following the publication of John Rawls’ ma...

The case and commentaries below were developed as part of a project, Graduate Research Ethics Education, undertaken by the Association for Practical and Professional Ethics with funding from the National Science Foundation (NSF Grant No. SBR 9421897 and NSF Grant No. 9817880). The project aims at training graduate students in research ethics and building a community of scientists and engineers who are interested in and capable of teaching research ethics. As part of the project, each graduate student participant develops a (...) case for use in teaching and writes a commentary to go with the case, and then a staff member is asked to write additional commentary on the case. The case below was written in the second year of the project and was published in Research Ethics: Cases and Commentaries edited by B. Schrag, Association for Practical and Professional Ethics, Bloomington, Indiana, Vol. II (1998). Publication of these cases and commentaries will be a recurring feature of Science and Engineering Ethics. (shrink)

This paper explores the concept of “livity,” the ground of Rastafari subjectivity. In its multifaceted nuances, “livity” represents the Rastafari invention of a religious tradition and discourse, whose ethos was fundamentally sacred, signified the immanence of the Absolute in dialectic with the Rastafari worldview and life world. Innovatively, the Rastafari coined the term “livity” to a discourse to combat despair, damnation, social death, and the existential chaos-monde they referred to as Babylon. In the process, the Rastafari reclaimed their power to (...) name their world. The Rastafari neologism “livity” articulated a mysticism, alternative spatial visions, and a positive technology of the self that revalorized blackness, explored, and interrogated profound dimensions of the human condition, from within the Jamaican context, that inevitably brought them into conflict with the local colonial authorities and implicitly shifted the model of social relations between the master and slave. (shrink)