The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at (...) the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions. (shrink)

Fashion design is a feminized occupation, but there is a widespread perception that gay male designers are advantaged in receiving awards, publicity, and praise. This article develops the notion of a “glass runway” to explain this inequality. First, using design canons and lists of award recipients, I show that men, especially gay men, receive more consecration than women. Second, I show how men and women are consecrated differently by analyzing the content of 157 entries in Voguepedia’s design canon and 96 (...) fashion media articles. Attributions of value and legitimacy construct a gendered image of the ideal fashion designer through discourses of art and culture that reinforce essentialist ideas about gender difference. Because cultural value is ambiguous, processes of valorization are shaped by gender essentialism, pushing male cultural producers down the glass runway and into the spotlight of fame, consecration, and legitimation. Finally, the case of fashion design offers insights into how intersecting inequalities can shape the glass runway. Gay designers experience both valorization and discrimination from intersections of gender and sexuality. (shrink)

Denunciations of child sexual abuse in the sport context have been increasing in the last decades. Studies estimate that between 14 and 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process (...) of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: pathway to understanding, pathway to disclosure, and pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process. (shrink)

In debates about the proper analysis of demonstrative expressions, ostensive gestures and speaker intentions are often seen as competing for primary importance in securing reference. Underlying some of these debates is the mistaken assumption that ostensive gestures always make the demonstrated object maximally salient to interlocutors. When we abandon this assumption and focus on an object’s mutually-recognized salience itself, rather than on how the object came to be salient, we can work towards a more promising analysis with a uniform treatment (...) of demonstrative reference whether or not there is an ostensive gesture, and whether reference is ordinary or deferred. (shrink)

Within the class of indexicals, a distinction is often made between “pure” or “automatic” indexicals on one hand, and demonstratives or “discretionary” indexicals on the other. The idea is supposed to be that certain indexicals refer automatically and invariably to a particular feature of the utterance context: ‘I’ refers to the speaker, ‘now’ to the time of utterance, ‘here’ to the place of utterance, etc. Against this view, I present cases where reference shifts from the speaker, time, or place of (...) utterance to some other object, time, or place. I consider and reject the claim that these counterexamples to the automatic indexical theory all involve non-literal uses of indexicals and argue that they cannot be explained away on the grounds that they involve conversational implicature or pretense. (shrink)

There is an expectation that all researchers will act ethically and responsibly in the conduct of research involving humans and animals. While research ethics is mentioned in quality indicators and codes of responsible researcher conduct, it appears to have little profile in doctoral assessment. There seems to be an implicit assumption that ethical competence has been achieved by the end of doctoral candidacy and that there is no need for candidates to report on the ethical dimensions of their study nor (...) for examiners to assess this integral aspect of researcher development. In the context of ensuring that institutions are fulfilling their responsibility of producing ethically sensitive and competent researchers, it is salient to investigate whether doctoral thesis examiners make comment about ethical issues in their reports. This study analysed an archive of examiner reports to identify the frequency, magnitude and nature of examiner comment about ethics. Although comment was rare examiners provided: prescriptive instruction on ethical review processes; formative instruction on the design, conduct, and reporting of research projects; and positive or negative judgments about a candidate's ethical competence, the latter often aligned with meeting, or not meeting, 'doctoral standards'. The scarcity of ethics in examination criteria and examiner reports implies a silence that needs to be addressed to ensure graduating candidates are prepared to conduct ethical and responsible research. (shrink)

Core indexicals like ‘I’, ‘here’, and ‘now’ sometimes appear to refer to an object, place, or time other than the speaker, location, or time of utterance. This presents well-known problems for Kaplan's view, which treats reference shifting as a violation of the character rules that give the meaning of indexicals. I propose a view according to which indexical reference is essentially a matter of the mutually-accepted perspective of interlocutors. It follows that contexts need not be ‘proper’ in Kaplan's sense, and (...) a successful convergence of perspectives is needed for indexical reference to succeed. I provide reasons for embracing these conclusions. (shrink)

The COVID-19 pandemic introduced significant disruptions and challenges to the learning environment for many post-secondary students with many shifting entirely to remote online learning. Barriers to academic success already experienced in traditional face-to-face classes may be compounded in the online environment and exacerbated by stressors related to the pandemic. In 2020–2021, post-secondary institutions were faced with the reality of rolling out fully online instruction with limited access to resources for assisting students in this transition. Instructional interventions that target students’ ability (...) to self-regulate their learning have been shown to improve academic performance and self-regulated learning competencies have also been found to mediate the effect of SRL interventions on higher education. However, few studies have examined the efficacy of fully online SRL intervention on mitigating the impact of psychological distress and academic challenges on academic success. This study examined the moderating roles of self-regulatory practices and SRL intervention in buffering the influence of COVID-related psychological distress and academic challenges on academic outcomes and academic challenges) in a Canadian sample of undergraduate students. We found levels of metacognitive and motivational challenges fully mediated the impact of COVID distress on GPA, SRL adapting practices moderated the impact of metacognitive challenges on GPA, and semester-long SRL intervention buffered the impact of COVID distress on academic challenges and resulted in lower levels of social-emotional, cognitive, and metacognitive challenges for first year undergraduate students. (shrink)

Empathy is widely touted as a springboard for social change. Within the academy, ‘identification’ is often used to promote the social value of literary and cultural studies. But to what degree have scholars, in seeking to defend the value of literary and cultural studies, conceived the act of reading in problematic ways? ‘An Ethics of Reading’ argues that adopting a Lacanian paradigm of self (reader) and text (other) to discuss the act of textual interpretation reduces a complex event involving multiple (...) actors to a simple dualism, while ineluctably consigning any act of interpretation to simple projection. Turning instead to psychoanalyst Jean Laplanche’s concept of the enigmatic signifier, this article rethinks the relation between reader and cultural text – reconceiving the act of interpretation by situating it within a dynamic of transference, as opposed to projection. When conceived via this Laplanchian framework, reading becomes not only an effective path to cognition and knowledge, but a radical means of subjective transformation. (shrink)

In the clinical setting, not enough attention is paid to the role that emotion plays. It is at worst ignored or avoided, isolating those who are suffering, at best treated as something to help another to endure. This is the result, in part, of an impoverished idea that views emotion as mere feelings. However, emotions are not just feelings, they are cognitive. If we look beneath the surface, emotions can provide information about values and beliefs, some of which may be (...) false or unreasonable. When they are motivating decisions that seriously affect the lives of others, there is a moral obligation to ferret them out and correct or deal with them. Attention needs to be paid to the emotions of healthcare providers as well as to the emotions of patients and their loved ones, and more done to train healthcare providers to deal effectively and productively with emotion – their own and others’. A son tearfully requests everything be done for his dying father. He fears limiting treatment means his father will be ignored. A physician orders another course of chemotherapy because she cannot bear for this patient to die. The patient, fearing he will painfully suffocate to death, agrees. Paying attention to emotions and bringing to light the beliefs and values behind them can only enhance the care and consideration of all involved. (shrink)

A definitive theory for ethical decision making in nursing is still only conjecture. The literature confirms that there have been numerous examinations of ethical decision making in nursing, with most proposing either the justice or the care orientation, or a combination of both. In the absence of a definitive theory, this exploratory work sets out, via grounded theory, to shed some light on the methods used every day by nurses to make ethical decisions in the clinical area. The data show (...) that some factors, such as doctors, colleagues and the organization, profoundly influence ethical decision making. The informants used both care and justice to formulate decisions, which is known as the combined approach. As a result of these findings, this article concludes with tentative suggestions and recommendations for practice. (shrink)

The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent—or informed refusal—is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee to (...) serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. (shrink)

This article offers the critical concept misfit in an effort to further think through the lived identity and experience of disability as it is situated in place and time. The idea of a misfit and the situation of misfitting that I offer here elaborate a materialist feminist understanding of disability by extending a consideration of how the particularities of embodiment interact with the environment in its broadest sense, to include both its spatial and temporal aspects. The interrelated dynamics of fitting (...) and misfitting constitute a particular aspect of world-making involved in material-discursive becoming. The essay makes three arguments: the concept of misfit emphasizes the particularity of varying lived embodiments and avoids a theoretical generic disabled body; the concept of misfit clarifies the current feminist critical conversation about universal vulnerability and dependence; the concept of misfitting as a shifting spatial and perpetually temporal relationship confers agency and value on disabled subjects. (shrink)

It is commonly believed that disability disqualifies people from full participation in or recognition by society. This view is rooted in eugenic logic, which tells us that our world would be a better place if disability could be eliminated. In opposition to this position, I argue that that disability is inherent in the human condition and consider the bioethical question of why we might want to conserve rather than eliminate disability from our shared world. To do so, I draw together (...) an eclectic, rather than systematic, configuration of counter-eugenic arguments for conserving disability. The idea of preserving intact, keeping alive, and even encouraging to flourish denoted by conserve suggests that disabilities would be better understood as benefits rather than deficits. I present, then, a reading of disability as a potentially generative resource rather than unequivocally restrictive liability. In other words, what I consider here is the cultural and material contributions disability offers to the world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethical, Legal, and Social Implications Research Program at the National Human Genome Research InstituteEric M. Meslin (bio), Elizabeth J. Thomson (bio), and Joy T. Boyer (bio)Organizers of the Human Genome Project (HGP) understood from the beginning that the scientific activities of mapping and sequencing the human genome would raise ethical, legal, and social issues that would require careful attention by scientists, health care professionals, government officials, and (...) the public. The establishment of the ELSI (ethical, legal, and social implications) programs at the National Human Genome Research Institute (NHGRI) and the Department of Energy (DOE) was thought to be vital to the success of the HGP in the United States. It also provided a novel approach to the simultaneous study of ethical, legal, and social issues and basic scientific issues. Eric Juengst, the first director of the ELSI program, described its origins in a previous issue of the Kennedy Institute of Ethics Journal (Juengst 1991). Now in its seventh year, the ELSI program has accomplished much. This article summarizes the evolution and goals of the ELSI program at NHGRI, outlines the program’s current research priorities with examples of activities within each priority area, and provides a look to the future, including the initiation of a strategic planning process.Evolution and Goals of the ELSI Research ProgramThe HGP’s “genomic” goals are unique: to map and sequence the entire human genome—some 3 billion base pairs that make up approximately 80–100,000 genes—and the genomes of related model organisms by the year 2005. This goal was particularly ambitious since, when it was proposed, the technologies for mapping and sequencing had yet to be developed. When the HGP was first established, its organizers also elaborated a set of ELSI goals, which they saw as vital to the success of the genome project. The original ELSI goals were: (1) to anticipate and address the implications of the HGP for individuals and society and (2) to examine the ELSI consequences of mapping and sequencing the human genome in order to stimulate public discussion. To meet these goals, the NHGRI created its ELSI research program in 1990. Along with mapping, sequencing, [End Page 291] and mammalian genetics, ELSI was one of four original branches in the NHGRI Division of Extramural Research that funded research in those areas. Although the individual “branches” no longer exist, the mechanisms for funding research remain much the same. While the overall goals of the program have not changed, the specific ways of achieving the goals have continued to evolve. The importance of the ELSI program lies not in the collection of a full set of data that will be valuable in and of itself, but in the value of using and interpreting this new set of information.Early on, the NHGRI described a set of somewhat more specific goals: (1) to develop a program to help understand the ethical, legal, and social implications of the human genome project and (2) to identify and define the major issues of concern and develop policy options to address them. These more specific goals have been largely met. As the most recent biennial NHGRI Progress Report notes, “a robust ELSI research and education program has been established, many of the most urgent ELSI issues have been identified, and many policy options to address these issues have been proposed” (NCHGR 1995, p. 21). Between 1990 and 1996, ELSI provided more than $32.5 million in funding through 128 research and education grants in more than 30 states and in Canada (Table 1). The ELSI research budget is unique in that when originally created, it was specifically tied to the amount of money provided for the overall NHGRI budget. The NHGRI originally devoted 3 percent of its extramural budget to fund ELSI projects, but in FY 1991, it increased the ELSI budget to 5 percent, a figure that remains today. Table 2 lists the expenditures for each fiscal year since 1990 and the cumulative expenditures to date. The ELSI research budget at NHGRI this year will be about $7 million. When other sources of funding—e.g., co-funding arrangements with other institutes and agencies and the funding of ELSI... (shrink)

This essay examines the symbolic significance of blood in the twentieth century and its role in determining the composition of a national community along racial lines. By drawing parallels between Nazi notions of blood and racial purity and historically contemporaneous U.S. policies regarding blood and blood products, Polsky reveals a disturbing proximity in discourse and policy. While the Nazis attempted to locate Jewish racial essence and inferiority in blood and instituted eugenic measures and laws forbidding racial admixture, similar policies existed (...) in the U.S. based on the so-called one drop rule that systematically discriminated against African Americans. (shrink)

In the first book of its kind, Garland-Thomson defines staring, explores the factors that motivate it, and considers the targets and the effects of the stare.

What has come to be called critical disability studies is an emergent field of academic research, teaching, theory building, public scholarship, and something I'll call "educational advocacy." The critical part of critical disability studies suggests its alignment with areas of intellectual inquiry, sometimes awkwardly called identity studies, rooted in the political and social transformations of the mid-20th century brought forward by the broad civil and human rights movement. These movements pressed both the law and the social order toward an expansion (...) of rights for people previously marginalized or excluded from full participation in exercising the obligations and benefits of equal citizenship. The ideas of... (shrink)

This paper examines the French erudite scholar Théodore Godefroy's (1580-1649) service to Cardinal Richelieu as a commercial expert. Using manuscripts that reveal his reading, connections and intellectual methods, it shows how Godefroy used his connections in the Parisian lettered circles and a politicized group within the Republic of Letters to gather commercial information, and used the techniques of juridical scholarship to organize his collection. His papers suggest that historians must look beyond a narrow canon of "mercantilist" works to understand seventeenth (...) century debates about the governance of commerce, to a broader context of debates about law, history, and sovereignty. (shrink)

we always get to this difficult conversation one way or another when I'm talking to friends who have kids with disabilities. It goes like this: "If there had been a test for autism when my wife was pregnant with our son," my close friend tells me, "she would definitely have had an abortion." He tells me this with candor because he knows I know that this does not mean that he regrets having the son, grown up now, that they do (...) have. Parents with disabled children are usually rightfully wary about engaging in such conversations, but perhaps because I have a significant congenital genetic disability myself, we talk together about this with intimacy and mutual understanding. With his reflection about what we now... (shrink)

Why should we seek and tell the truth? Does anyone know what truth is? Many are skeptical about the relevance of truth. Truth Matters endeavours to show why truth is important in a world where the very idea of truth is contested. Putting philosophers in conversation with educators, literary scholars, physicists, political theorists, and theologians, Truth Matters ranges across both analytic and continental philosophy and draws on the ideas of thinkers such as Aquinas, Balthasar, Brandom, Davidson, Dooyeweerd, Gadamer, Habermas, Kierkegaard, (...) Plantinga, Ricoeur, and Wolterstorff. Some essays attempt to provide a systematic account of truth, while others wrestle with the question of how truth is told and what it means to live truthfully. Contributors address debates between realists and anti-realists, explore issues surrounding relativism and constructivism in education and the social sciences, examine the politics of truth telling and the ethics of authenticity, and consider various religious perspectives on truth. Most scholars agree that truth is propositional, being expressed in statements that are subject to proof or disproof. This book goes a step farther: yes, propositional truth is important, but truth is more than propositional. To recognize how it is more than propositional is crucial for understanding why truth truly matters. Contributors include Doug Blomberg (ICS), Allyson Carr (ICS), Jeffrey Dudiak (King’s University College), Olaf Ellefson (York University), Gerrit Glas (VU University Amsterdam), Gill K. Goulding (Regis College), Jay Gupta (Mills College), Clarence Joldersma (Calvin College), Matthew J. Klaassen (ICS), John Jung Park (Duke University), Pamela J. Reeve (St. Augustine’s Seminary), Amy Richards (World Affairs Council of Western Michigan), Calvin Seerveld (ICS), Ronnie Shuker (ICS), Adam Smith (Brandeis University), John Van Rys (Redeemer University College), Darren Walhof (Grand Valley State University), Matthew Walhout (Calvin College), and Lambert Zuidervaart (ICS). (shrink)

I begin by distinguishing two notions of model, the notion of a truth-making structure and the notion of a mathematical model (in one specific sense). I then argue that although the models of the semantic view have often been taken to be both truth-making structures and mathematical models, this is in part due to a failure to distinguish between two ways of truth-making; in fact, the talk of truth-making is best excised from the view altogether. The result is a version (...) of the semantic view which is better supported by the direct evidence offered for it, better equipped to achieve its avowed aims, and, I think, closer to the intentions of the original proponents of the view in many ways, despite some of their own declarations to the contrary. (shrink)

Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grass-roots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely know. Unfortunately, (...) some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians’ rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve? (shrink)

Berger and Miller assert that race and ethnicity based cultural competence is a failure because medicine grounds its conceptualization of cultural competence on a “flawed” understanding of r...