The third edition of Health Care Ethics in Canada builds on the commitment to Canadian content established in earlier editions without sacrificing breadth or rigor.

Health Care Ethics is another addition to the growing number of texts that attempt to provide a much-needed Canadian perspective on many of the issues that arise in the delivery of health care. The readings are divided into three parts: “The Nature and Context of Health Care Ethics”; “Decision-Making in Health Care”; and “Decisions Near the Beginning and End of Life.” Collectively, they cover a variety of different issues—pluralism and multiculturalism, resource allocation and rationing, consent, research involving human subjects, genetics, (...) abortion, assisted reproductive technologies, euthanasia, and assisted suicide. The editorial introductions to these issues, while well written, readable, and clear, are general and deliberately non-committal in assessing the different and competing approaches and arguments reflected in the selected articles in which these issues are discussed. (shrink)

In Canada there is a growing demand for human eggs for reproductive purposes and currently demand exceeds supply. This is not surprising, as egg production and retrieval is onerous. It requires considerable time, effort, and energy and carries with it significant physical and psychological risks. In very general terms, one cycle of egg production and retrieval involves an estimated total of 56 hours for interviews, counseling, and medical procedures. The screening carries risks of unanticipated findings with severe consequences for insurability. (...) The daily hormone injections can be painful and uncomfortable, causing cramping, abdominal pain, nausea, vomiting, bloating, mood changes, and irritability. (shrink)

In this paper, we provide as accurate a picture as possible of transnational trade in human eggs involving Canadians. We explain the legal status in Canada, and call for reform in the regulation, of such trade.

In Canada, the use of reproductive technologies is largely governed by the Assisted Human Reproduction Act . One of the founding principles of the AHR Act is that “trade in the reproductive capabilities of women and men, and the exploitation of children, women and men for commercial ends raise health and ethical concerns that justify their prohibition” ). This principle is instantiated in several sections of the AHR Act, including s. 7, which prohibits the purchase of gametes. It follows that, (...) in Canada, the legal supply of human eggs is limited to eggs from donors.1Donors, by definition, are women who do not receive payment for their eggs. Typically, known .. (shrink)

To avoid the commercialization of reproduction, the Canadian Assisted Human Reproduction Act prohibits the purchase of human eggs. We endorse this legal prohibition and moreover believe that this facet of the law should not be allowed to have as an unintended consequence an increase in transnational trade in human eggs. In an effort to avoid this consequence, and to be consistent with the AHR Act, we advocate the pursuit of national altruistic self-sufficiency. This article briefly outlines a number of strategies (...) to increase the domestic altruistic supply of third-party eggs and decrease the domestic demand for them. (shrink)

Transnational reproductive travel is a largely unfettered multibillion-dollar global industry that flourishes, in part, by capitalizing on differences in legal regimes, wages and standards of living, and cultural and ethical norms. Indeed, as Scott Carney explains with respect to the commercialization of human eggs for third-party reproduction, “internationalization has made oversight laughable. … [R]egulators are dogs with no teeth” . While professional organizations can introduce guidelines and nation-states can introduce laws, the fact is that patients can travel to places where (...) there are no restrictions on .. (shrink)

oise Baylis, 1234 Le Marchant Street, Halifax, Nova Scotia, Canada B3H 3P7. Tel.: (902)-494–2873; Fax: (902)-494-2924; Email: francoise.baylis{at}dal.ca ' + u + '@' + d + ' '//--> . Abstract Recently, there has been a growing interest in public health and public health ethics. Much of this interest has been tied to efforts to draw up national and international plans to deal with a global pandemic. It is common for these plans to state the importance of drawing upon (...) a well-developed ethics framework and we argue that this framework should reflect the values and insights of feminist relational theory. More specifically, we argue that pandemic planning must be squarely situated in the larger realm of public health and that an ethics framework for public health will be one that recognizes the need to pay particular attention to the vulnerability of subpopulations lacking in social and economic power. We propose an ethics framework for public health that builds on the notions of relational personhood (including relational autonomy and social justice) and relational solidarity. In this way, we aim for a public health ethics that, as appropriate, promotes the public interest and the common good. CiteULike Connotea Del.icio.us What's this? (shrink)

There is the world of ideas and the world of practice; the French are often for sup pressing the one and the English the other; but neither is to be suppressed. -Matthew Arnold The Function of Criticism at the Present Time From its inception, bioethics has confronted the need to reconcile theory and practice. At first the confrontation was purely intellectual, as writers on ethical theory (within phi losophy, theology, or other humanistic disciplines) turned their attention to topics from the (...) world of medical practice. Recently the confrontation has grown more intense. The ap pointment of clinical ethicists in hospitals and other health care settings is an accelerating trend in North America. Concomitantly, those institutions involved in training peo ple in clinical ethics have added organized exposure to the world of practice, in the form of placement requirements, to the normal academic course load. In common with other dis ciplines, bioethics has begun to see clinical training as a con dition of didactic theory and apprenticeship. (shrink)

I have known Susan Sherwin all of my academic life—as a newbie graduate student in philosophy following on from an undergraduate degree in political science; as a newly minted PhD trying to figure out what I wanted to do with my degree; and later as a faculty member at Dalhousie University trying to craft a career in a medical school. Over the years, Sue has been an important mentor, colleague and friend.In thinking about what I want to say (...) about Sue's legacy, a well-known adage, often attributed to the renowned poet Maya Angelou,1 came to mind: "People will forget what you said, people will forget what you did, but people will never forget how you made them feel." I doubt that I will ever forget what Sue said, or... (shrink)

Throughout his remarkable and too‐brief career, Benjamin Freedman was concerned with the ethical standards of ethicists themselves. He worried that ethicists had been bought out, as he knew of none whose opposition to an employer had ever led to being fired. If we look today for what he sought—a bioethical hero—Benjy is himself still the preeminent example.

Throughout his remarkable and too‐brief career, Benjamin Freedman was concerned with the ethical standards of ethicists themselves. He worried that ethicists had been bought out, as he knew of none whose opposition to an employer had ever led to being fired. If we look today for what he sought—a bioethical hero—Benjy is himself still the preeminent example.

This academic text features articles regarding paranormal, extraordinary, or fringe-science claims. It logically examines the claims of astrology; psychic ability; alternative medicine and health claims; after-death communication; cryptozoology; and faith healing, all from a skeptical perspective. Paranormal Claims is a compilation of some of the most eye-opening articles about pseudoscience and extraordinary claims that often reveal logical, scientific explanations, or an outright scam. These articles, steeped in skepticism, teach critical thinking when approaching courses in psychology, sociology, philosophy, education, or science.

The case of Dr. Nancy Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc. vividly illustrates many of the issues central to contemporary health research and the safety of research participants. First, it exemplifies the financial and health stakes in such research. Second, it shows deficits in the ways in which research is governed. Finally, it was and remains relevant not only in Toronto but in communities across Canada and well beyond its borders because, absent appropriate (...) policies, what happened in Toronto could have happened (and could well still happen) elsewhere. In Part One of this paper, we review the facts of the Olivieri case relevant to the issues we wish to highlight: first, the right of participants in a clinical trial to be informed of a risk that an investigator had identified during the course of the trial and the obligation of the investigator to inform participants (both her own and those of other investigators); and second, the obligation of institutions to protect and promote the well-being of research participants as well as academic freedom and research integrity, the obligations of research sponsors to inform participants, research regulators, and others about unforeseen risks, and the obligations of research regulators to ensure that participants are informed of unforeseen risks and to otherwise protect and promote research integrity. In Part Two, we relate these facts and issues to New Zealand and Australia. We also make detailed recommendations for changes to the various instruments used for the governance of research involving humans in Australasia. (shrink)

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

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

This work was supported, in part, by a Stem Cell Network grant to Françoise Baylis and Jason Scott Robert and a CIHR grant to Françoise Baylis. We sincerely thank Alan Fine, Rich Campbell, Cynthia Cohen, and Tim Krahn for helpful comments on an earlier draft of this paper. Thanks are also owed to Tim Krahn for his research assistance. An earlier version of this paper was presented to the Department of Bioethics and the Novel Tech Ethics (...) research team. We thank the participants at each of these meetings for their helpful comments. (shrink)

The primary objective of The Health Care Ethics Con sultant is to focus attention on an immediate practical problem: the role and responsibilities, the education and training, and the certification and accreditation of health care ethics consultants. The principal questions addressed in this book include: Who should be considered health care ethics consultants? Whom should they advise? What should be their responsi bilities and what kind of training should they have? Should there be some kind of accreditation or certification program (...) to ensure that those who call themselves ethics consultants are in fact qualified to advise, consult, research, and write in health care ethics? The distinguished authors ofthese articles are persons with diverse backgrounds, interests, presumptions, and val ues. Not surprisingly, therefore, diverse responses have emerged to the questions posed. Though the book's chapters are individually authored, they are informed by the group discussions that went on during active workshop sessions, and by knowledge of the contributions of others. All of the chapters meaningfully represent their consensus. This is not to say that there were no disagreements regarding specific details, but rather that there were no fundamental objections on the book's basic content among a panel of authors who share basic premises regarding the role, responsibilities, education, and certifica tion of health care ethics consultants. (shrink)

Some stem cell researchers believe that it is easier to derive human embryonic stem cells from fresh rather than frozen embryos and they have had in vitro fertilization (IVF) clinicians invite their infertility patients to donate their fresh embryos for research use. These embryos include those that are deemed 'suitable for transfer' (i.e. to the woman's uterus) and those deemed unsuitable in this regard. This paper focuses on fresh embryos deemed suitable for transfer - hereafter 'fresh embryos'- which IVF patients (...) have good reason not to donate. We explain why donating them to research is not in the self-interests specifically of female IVF patients. Next, we consider the other-regarding interests of these patients and conclude that while fresh embryo donation may serve those interests, it does so at unnecessary cost to patients' self-interests. Lastly, we review some of the potential barriers to the autonomous donation of fresh embryos to research and highlight the risk that female IVF patients invited to donate these embryos will misunderstand key aspects of the donation decision, be coerced to donate, or be exploited in the consent process. On the basis of our analysis, we conclude that patients should not be asked to donate their fresh embryos to stem cell research. (shrink)

This paper critically examines the biology of species identity and the morality of crossing species boundaries in the context of emerging research that involves combining human and nonhuman animals at the genetic or cellular level. We begin with the notion of species identity, particularly focusing on the ostensible fixity of species boundaries, and we explore the general biological and philosophical problem of defining species. Against this backdrop, we survey and criticize earlier attempts to forbid crossing species boundaries in the creation (...) of novel beings. We do not attempt to establish the immorality of crossing species boundaries, but we conclude with some thoughts about such crossings, alluding to the notion of moral confusion regarding social and ethical obligations to novel interspecies beings. (shrink)

This book concerns the ethics of having children through adoption or technologically-assisted reproduction. Some people who choose between these methods struggle between them. Others do not agonize in this way, perhaps because they have a profound desire for a genetic link to the child(ren) they will parent and so prefer assisted reproduction, they view adoption as the only morally decent choice in an overcrowded world, or for some other reason. This book critically examines moral choices that involve each of these (...) ways of making or expanding families with children. The contributors discuss how adoption and assisted reproduction are morally distinct from one another, but also emphasize how they are morally similar, given that both are forms of family‐making. (shrink)

The feminist literature against the commodification of embryos in human embryo research includes an argument to the effect that embryos are “intimately connected” to persons, or morally inalienable from them. We explore why embryos might be inalienable to persons and why feminists might find this view appealing. But, ultimately, as feminists, we reject this view because it is inconsistent with full respect for women's reproductive autonomy and with a feminist conception of persons as relational, embodied beings. Overall, feminists should avoid (...) claims about embryos’ being inalienable to persons in arguments for or against the commodification of human embryos. (shrink)

Geron recently announced that it had begun enrolling patients in the world's first-in-human clinical trial involving cells derived from human embryonic stem cells (hESCs). This trial raises important questions regarding the future of hESC-based therapies, especially in spinal cord injury (SCI) patients. We address some safety and efficacy concerns with this research, as well as the ethics of fair subject selection. We consider other populations that might be better for this research: chronic complete SCI patients for a safety trial, subacute (...) incomplete SCI patients for an efficacy trial, and perhaps primary progressive multiple sclerosis (MS) patients for a combined safety and efficacy trial. (shrink)

Genetic relatedness poses significant challenges to traditional practices of medical ethics as concerns the biobanking of human biological samples. In this paper, we first outline the ethical challenges to informed consent and confidentiality as these apply to human biobanks, irrespective of the type of tissue being stored. We argue that the shared nature of genetic information has clear implications for informed consent, and the identifying nature of biological samples and information has clear implications for promises of confidentiality. Next, with regard (...) to the special case of biobanking human embryos and eggs, we consider issues arising from: first, the type of tissues being stored; second, the use to which these tissues are put; and third, how this plays out given the shared and identifying nature of these tissues. Specifically, we examine the differences between human bodily tissues and human reproductive tissues focusing on the assumed potential of the reproductive tissues and on the possible greater emotional attachment to these tissues because of their real and imagined kinship. For some donors there may be a sense of family connection with embryos and eggs they once thought of as ‘children-in-waiting’. Finally, we conclude by considering the implications for ethical practice. (shrink)

In this article, we critically examine some of the ethical challenges and interpretive difficulties with possible future non-clinical applications of pediatric fMRI with a particular focus on applications in the classroom and the courtroom - two domains in which children come directly in contact with the state. We begin with a general overview of anticipated clinical and non-clinical applications of pediatric fMRI. This is followed by a detailed analysis of a range of ethical challenges and interpretive difficulties that trouble the (...) use of fMRI and are likely to be especially acute with non-clinical uses of the technology. We conclude that knowledge of these challenges and difficulties should influence policy decisions regarding the non-clinical uses of fMRI. Our aim is to encourage the development of future policies prescribing the responsible use of this neuroimaging technology as it develops both within and outside the clinical setting. (shrink)

Now that stem cell scientists are clamouring for human eggs for cloning-based stem cell research, there is vigorous debate about the ethics of paying women for their eggs. Generally speaking, some claim that women should be paid a fair wage for their reproductive labour or tissues, while others argue against the further commodification of reproductive labour or tissues and worry about voluntariness among potential egg providers. Siding mainly with those who believe that women should be financially compensated for providing eggs (...) for research, the new stem cell guidelines of the International Society for Stem Cell Research (ISSCR) legitimise both reimbursement of direct expenses and financial compensation for many women who supply eggs for research. In this paper, the authors do not attempt to resolve the thorny issue of whether payment for eggs used in human embryonic stem cell research is ethically legitimate. Rather, they want to show specifically that the ISSCR recommended payment practices are deeply flawed and, more generally, that all payment schemes that aim to avoid undue inducement of women risk the global exploitation of economically disadvantaged women. (shrink)

In this article, I argue that there is no compelling therapeutic ‘need’ for human nuclear genome transfer to prevent mitochondrial diseases caused by mtDNA mutations. At most there is a strong interest in this technology on the part of some women and couples at risk of having children with mitochondrial disease, and perhaps also a ‘want’ on the part of some researchers who see the technology as a useful precedent – one that provides them with ‘a quiet way station’ in (...) which to refine the micromanipulations techniques essential for other human germline interventions and human cloning. In advance of this argument, I review basic information about mitochondrial disease and novel genetic strategies to prevent the transmission of mutated mitochondria. Next, I address common features of contemporary debates and discussions about so-called mitochondrial replacement. First, I contest the cliché that science-and-technology is fast outpacing ethics. Second, I dispute the accuracy of the term ‘mitochondrial replacement’. Third, I provide a sustained critique of the purported ‘need’ for genetically-related children. In closing, I call into question the mainly liberal defense of human nuclear genome transfer. I suggest an alternative frame of reference that pays particular attention to issues of social justice. I conclude that our limited resources should be carefully expended in pursuit of the common good, which does not include pandering to acquired desires. (shrink)

Public attention on embryo research has never been greater. Modern reproductive medicine technology and the use of embryos to generate stem cells ensure that this will continue to be a topic of debate and research across many disciplines. This multidisciplinary book explores the concept of a 'healthy' embryo, its implications on the health of children and adults, and how perceptions of what constitutes child and adult health influence the concept of embryo 'health'. The concept of human embryo health is considered (...) from preconception to pre-implantation genetic diagnosis to recent foetal surgical approaches. Burgeoning capacities in both genetic and reproductive science and their clinical implications have catalysed the necessity to explore the concept of a 'healthy' embryo. The authors are from five countries and 13 disciplines in the social sciences, humanities, biological sciences and medicine, ensuring that the book has a broad coverage and approach. (shrink)

With the cure rate for many pediatric malignancies now between 70% and 90%, infertility becomes an increasingly important issue. Strategies for preserving fertility in girls and adolescent women occur in two distinct phases. The first phase includes oophorectomy and cryopreservation of ovarian cortex slices or individual oocytes; ultrasound-guided needle aspiration of oocytes, with or without in vitro maturation, followed by cryopreservation; and ovarian autografting to a distant site. The second phase occurs if the woman chooses to pursue pregnancy, and includes (...) IVM of the oocytes, followed by in vitro fertilization and transfer of any created embryos to the woman's uterus. For ovarian autografting, the woman would undergo menotropin ovarian stimulation and retrieval of matured oocytes. The ethical challenges with each of these phases are many of fertility preservation and include issues of informed choice. The lack of proven benefit with these strategies and the associated potential physical and psychological harms require careful attention to the key elements of informed choice, which include decisional capacity, disclosure, understanding and voluntariness, and to the benefits of in-depth counseling to promote free and informed choice at a time that is emotionally difficult for the decision makers. (shrink)

Beverly Beckham writes in the Boston Globe in praise of Lisa Genova’s Still Alice: “You have to get this book. … I couldn’t put it down. …” After I read Still Alice, a book of fiction about an accomplished Harvard professor with early-onset Alzheimer’s disease, I too wanted to tell everyone to get this book, but not because “I couldn’t put it down.” The first time I read it, I put it down several times to cry. It was too painful (...) to read in one stretch. Years back, my mother, Gloria Baylis,1 had been diagnosed with vascular dementia, and recently there had been findings suggestive of an atypical presentation of Alzheimer’s disease. The story of Alice Howland, the Alice of Still Alice, was both too... (shrink)

We outline a number of ethical objections to genetic technologies aimed at enhancing human capacities and traits. We then argue that, despite the persuasiveness of some of these objections, they are insufficient to stop the development and use of genetic enhancement technologies. We contend that the inevitability of the technologies results from a particular guiding worldview of humans as masters of the human evolutionary future, and conclude that recognising this worldview points to new directions for ethical thinking about genetic enhancement (...) technologies. (shrink)

In April 2007, as part of its public consultation initiative, the Human Fertilisation and Embryology Authority in the United Kingdom published Hybrids and chimeras: A consultation on the ethical and social implications of creating human/animal embryos in research. This HFEA document identifies a number of possible arguments against the creation of human/animal embryos. One of these arguments concerns the worry that human/animal embryos “might be transferred to a woman to create babies with some animal DNA in them.” Although the HFEA (...) dismisses this slippery slope argument, I argue that this possible future is not as farfetched as one might think. For example, human admixed embryos might be transferred to women in an effort to prevent the transmission of mitochondrial diseases. The ethical acceptability of this possible future practice is examined from different feminist perspectives with a focus on issues of reproductive freedom and social justice. (shrink)