Medical assistance in dying was legalized by the Supreme Court of Canada in June 2016 and became a legal, viable end of life care option for Canadians with irremediable illness and suffering. Much attention has been paid to the balance between physicians’ willingness to provide MAiD and patients’ legal right to request medically assisted death in certain circumstances. In contrast, very little attention has been paid to the challenge of making MAiD accessible to vulnerable populations. The purpose of this paper (...) was to examine the extant literature and resources that are available on the provision of MAiD in Canada. We found that the provision of EOLC in Canada offers insufficient access to palliative and EOLC options for Canadians and that vulnerable Canadians experience disproportional barriers to accessing these already limited resources. Consequently, we argue that palliative care, hospice care and MAiD must be considered a spectrum of EOLC that is inclusive and accessible to all Canadians. We conclude by imploring Canadian healthcare professionals, policy makers and legislators to consider MAiD as a viable EOLC option for all Canadians. (shrink)

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) (...) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention. (shrink)

To what degree has biology influenced and shaped the development of moral systems? One way to determine the extent to which human moral systems might be the product of natural selection is to explore behaviour in other species that is analogous and perhaps homologous to our own. Many non-human primates, for example, have similar methods to humans for resolving, managing, and preventing conflicts of interests within their groups. Such methods, which include reciprocity and food sharing, reconciliation, consolation, conflict intervention, and (...) mediation, are the very building blocks of moral systems in that they are based on and facilitate cohesion among individuals and reflect a concerted effort by community members to find shared solutions to social conflict. Furthermore, these methods of resource distribution and conflict resolution often require or make use of capacities for empathy, sympathy, and sometimes even community concern. Non-human primates in societies in which such mechanisms are present may not be exactly moral beings, but they do show signs of a sense of social regularity that -- just like the norms and rules underlying human moral conduct -- promotes a mutually satisfactory modus vivendi. (shrink)

This article focuses on the ways that one individual child, Christina, experienced urban life in and outside of a diversely populated elementary school with a multicultural curriculum. Labeled by the school and her parents as white, Christina identified as Latina, and used specific spaces in the city to support this claim. Drawing on data from a year-long ethnographic study, I show how Christina navigated her life in the city and explore the ways that she consciously represented herself over time, in (...) multiple social spaces, as non-white. Three particular spaces are explored here: the city bus ride to school, Christina's neighborhood, and classroom discussions. Christina used a variety of resources to negotiate each space, in effect drawing a map of her racial identity as she lived in the city. Her case offers ideas about how such a curriculum might influence the senses of self of children in diversely populated classrooms. (shrink)

The Tasmanian salmon industry has become one of the state's most profitable industries to date. Though production conditions notoriously lack transparency, there is a clear dependency on the mass production of complex nonhuman animals who are kept in inappropriate conditions and subject to harmful industry practices. This article explores why the Tasmanian Environmental Protection Agency recently approved the construction of the largest salmon hatchery in Australia, despite serious environmental sustainability and welfare concerns. It considers the likely impact of the new (...) hatchery on the welfare of both the farmed nonhuman animals and the surrounding free-ranging life and advocates for industry improvements that are guided by considerations of nonhuman animal welfare and environmental sustainability. (shrink)

To what degree has biology influenced and shaped the development of moral systems? One way to determine the extent to which human moral systems might be the product of natural selection is to explore behaviour in other species that is analogous and perhaps homologous to our own. Many non-human primates, for example, have similar methods to humans for resolving, managing, and preventing conflicts of interests within their groups. Such methods, which include reciprocity and food sharing, reconciliation, consolation, conflict intervention, and (...) mediation, are the very building blocks of moral systems in that they are based on and facilitate cohesion among individuals and reflect a concerted effort by community members to find shared solutions to social conflict. Furthermore, these methods of resource distribution and conflict resolution often require or make use of capacities for empathy, sympathy, and sometimes even community concern. Non-human primates in societies in which such mechanisms are present may not be exactly moral beings, but they do show signs of a sense of social regularity that—just like the norms and rules underlying human moral conduct—promotes a mutually satisfactory modus vivendi. (shrink)

The publish-or-perish paradigm is a prevailing facet of science. We apply game theory to show that, under rather weak assumptions, this publication scenario takes the form of a prisoner’s dilemma, which constitutes a substantial obstacle to beneficial delayed publication of more complete results. One way of avoiding this obstacle while allowing researchers to establish priority of discoveries would be an updated “pli cacheté”, a sealed envelope concept from the 1700s. We describe institutional rules that could additionally favour high-quality work and (...) publications and provide examples of such policies that are already in place. Our analysis should be extended to other publication scenarios and the role of other stakeholders such as scientific journals or sponsors. (shrink)

Volume 20, Issue 4, May 2020, Page 108-110.

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

Although the overwhelming majority of terminally ill patients in Oregon who seek a physician's aid in dying are enrolled in hospice programs, hospices do not take a major role in this practice. An examination of fifty‐five Oregon hospices reveals that both legal and moral questions prevent hospices from collaborating fully with physician‐assisted death.

Because of the misspecification of models and specificity of operationalizations, many studies produce claims of limited utility. We suggest a path forward that requires taking a few steps back. Researchers can retool large-scale replications to conduct the descriptive research which assesses the generalizability of constructs. Large-scale construct validation is feasible and a necessary next step in addressing the generalizability crisis.

BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, and (...) patient care among ICU nurses.Sample and SettingThe sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period.MethodsAlvita K. Nathaniel’s Theory of Moral Reckoning guided development of the nursing ethics huddle process.1 The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects’ level of MD.2 Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects’ perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions.ResultsOverall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant (p < 0.0001). (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the classic (...) counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

The United States has a population of three hundred million, according to latest Census Bureau estimates. Forty-seven million, including many non-citizens, are uninsured. That is, 16% of the total United States population has no health insurance. Millions more have inadequate coverage and are in danger of losing that. Private, corporatized medical coverage, structured by the insurance industry, is the basis for the current system. This article is an attempt to lay out the principal health care issues, to look at the (...) alternatives and the cost of those alternatives, and to try to determine whether there is a particular regime that, despite its imperfections, is the best available to us now. (shrink)

This paper argues that not only is there a relationship between birth activism and abortion activism, but that if empowering women is the goal, the two cannot be separated. By understanding how women's bodies have been controlled and their reproductive lives appropriated, the current pro-choice and birth activist frameworks that are used to advocate for women can no longer be understood to address women’s needs. It is by working through the framework of full-spectrum reproductive justice that women may become truly (...) empowered to regain control over their reproductive lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Aristotle on the Sources of the Ethical Life by Sylvia BerrymanElizabeth C. Shaw and Staff*BERRYMAN, Sylvia. Aristotle on the Sources of the Ethical Life. Oxford: Oxford University Press, 2019. vii + 220 pp. Cloth, $70.00—Berryman’s goals in Aristotle on the Sources of the Ethical Life are threefold: to establish that Aristotle practiced what contemporary philosophers call metaethics; to refute the idea that Aristotle justified those ethics by (...) recourse to human nature, understood as an “external point” for “establishing substantial ethical truths from a value-neutral perspective”; and to demonstrate that, for Aristotle, the source and justification for ethical demands is human practical reason.Locating the source of normativity in practical reason does not mean that there are no “standards of truth other than human beings as a species.” Positioning Aristotle against both “Archimedean” naturalisms as well as relativisms and subjectivisms, Berryman sees Aristotle’s appeals to nature as delimiting “the kinds of normative positions that could guide practical reason,” and practical reason as responsive to biological constraints. Still, nature is no fulcrum. It does not mandate the contents of the life we should live. All of this together makes Berryman’s Aristotle a “constitutive constructivist,” which is to say, a nonskeptical, cognitivist nonfoundationalist.Chapter 1’s “Introduction” sets the stage for the book’s metaethical project. Chapters 2 and 3 argue against two versions of the claim that “Aristotle was not reflective on the sources and justifications for his ethical views.” Chapter 2 places “Aristotle in the Ethics Wars” of the twentieth and twenty-first centuries, challenging the historicist view that “the kind of metaethical reflection about the sources of normativity” that preoccupies modern philosophy in response to “‘disenchantment’ of the modern world picture” would not have been available to Aristotle. Chapter 3, “Nature and the Sources of Normativity,” positions itself against scholars who maintain that Aristotle was complacent about the values of his own society and/or “too philosophically naïve to even reflect on the sources and justifications of ethical claims.” Inhabiting Aristotle’s social and intellectual milieu, it shows how the epistemological questions, commitments to materialist-scientific worldviews, as well as challenges to divine authority posed by fifth-century sophists, Plato, and fourth-century [End Page 381] hedonists meant that “a philosopher in Aristotle’s position could hardly avoid being reflective on questions of the status of ethics.”After establishing in chapter 3 that Aristotle could have grounded ethical claims in his natural philosophy, chapters 4 through 6 make the case that he did not. Exploring the philosophical work done by Aristotle’s appeals to nature, chapter 4, “Is Aristotle an Archimedean Naturalist?”, focuses on the apparent directionality of human development as well as references to “natural justice” and “natural virtue” in Aristotle’s ethical writings, while chapter 5, “Naturalism in Aristotle’s Politics,” scrutinizes the “naturalness of the polis” and “natural slavery” in Politics 1. Finding “only very minimal appeal to human nature” in the ethical treatises, Berryman sees Aristotle’s recourse to nature in Politics 1 as “the main anomaly” for which her refutation of Archimedean naturalism must account. Based on internal evidence in the Politics and comparison with Aristotle’s biological writings, Berryman concludes that Aristotle wrote the Politics before he “developed his more detailed biological theories.” Rather than evidence of naturalism, Aristotle’s appeals to nature in Politics 1, Berryman argues, are an early reflection of the “nomos-phusis distinction found in sophistic controversies” and a “kind of rhetorical move” based on thorough “prejudice and not reasoned inference.” Concluding “The Case Against a Naturalist Reading,” chapter 6 sets the stage for Berryman’s resourcing of Aristotle’s metaethics away from nature by exploring the inadequacies of the instrumental and theoretical rule-guiding reasoning implicit in naturalist accounts of Aristotelian practical reason.Chapters 7 and 8 offer the book’s positive account. After elaborating Aristotle’s rejection of “metaphysical abstractions” as action-guiding, chapter 7, “Aristotle’s Metaethics,” recovers from the Eudemian Ethics human agency as the source of normativity in Aristotle. Action “carries with it an implicit commitment to the norms of practical reasoning,” and “Aristotle’s insight,” Berryman writes, “is the metaethical recognition that the practical... (shrink)

Evidence that placebo acupuncture is an effective treatment for chronic pain presents a puzzle: how do placebo needles appearing to patients to penetrate the body, but instead sitting on the skin’s surface in the manner of a tactile stimulus, evoke a healing response? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations suggest an embodied healing mechanism. In this qualitative study, we asked a subset of patients in a singleblind randomized trial in irritable bowel syndrome (...) to describe their treatment experiences while undergoing placebo treament. Analysis focused on patients’ unprompted descriptions of any enhanced touch sensations and any significance patients assigned to the sensations. We found in 5/6 cases, patients associated sensations including “warmth” and “tingling” with treatment efficacy. The conclusion offers a “neurophenomenological” account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices, possibly underlying the phenomenology of placebo acupuncture. (shrink)

Body integrity identity disorder is a very rare condition in which people experience long-standing anguish because there is a mismatch between their bodies and their internal image of how their bodies should be. Most typically, these people are deeply distressed by the presence of what they openly acknowledge as a perfectly normal leg. Some with the condition request that their limb be amputated. 1 We and others have argued that such requests should be acceded to in carefully selected patients.1–4 Consistent (...) with this view, a group at the University of Sydney is developing a programme to better understand and treat BIID and to offer amputation if appropriate. In a recent paper, Patrone argues that such amputations should be prohibited.5 He suggests that authors supporting amputation in BIID depend on analogies with more familiar conditions and then claim that the ‘the desires, choices and requests of BIID patients should be held to exactly the same standards and treated with exactly the same respect as the desires, choices and requests of any more conventional patient’.5 He believes that these analogies are invalid and that therefore the arguments for amputation are invalid.Patrone concentrates a great deal upon whether a decision to have a particular medical intervention is to be regarded as ‘rational’. Unfortunately, he makes no attempt to define what he …. (shrink)

Compared to our understanding of positive prediction error signals occurring due to unexpected reward outcomes, less is known about the neural circuitry in humans that drives negative prediction errors during omission of expected rewards. While classical learning theories such as Rescorla–Wagner or temporal difference learning suggest that both types of prediction errors result from a simple subtraction, there has been recent evidence suggesting that different brain regions provide input to dopamine neurons which contributes to specific components of this prediction error (...) computation. Here, we focus on the brain regions responding to negative prediction error signals, which has been well-established in animal studies to involve a distinct pathway through the lateral habenula. We examine the activity of this pathway in humans, using a conditioned inhibition paradigm with high-resolution functional MRI. First, participants learned to associate a sensory stimulus with reward delivery. Then, reward delivery was omitted whenever this stimulus was presented simultaneously with a different sensory stimulus, the conditioned inhibitor. Both reward presentation and the reward-predictive cue activated midbrain dopamine regions, insula and orbitofrontal cortex. While we found significant activity at an uncorrected threshold for the CI in the habenula, consistent with our predictions, it did not survive correction for multiple comparisons and awaits further replication. Additionally, the pallidum and putamen regions of the basal ganglia showed modulations of activity for the inhibitor that did not survive the corrected threshold. (shrink)

Concerted, timely action for mitigating climate change is of uttermost importance to keep global warming as close to 1.5°C as possible. Air traffic already plays a strong role in driving climate change and is projected to grow—with only limited technical potential for decarbonizing this means of transport. Therefore, it is desirable to minimize the expansion of air traffic or even facilitate a reduction in affluent countries. Effective policies and behavioral change, especially among frequent flyers, can help to lower greenhouse gas (...) emissions. For both, a positive evaluation and public support is indispensable. This study contributes to understanding air travel behavior and the perception of regulative policies. We examined the role of attitudes, perceived behavioral control, efficacy, global identity, and justice concerns for intentions to avoid flights and aviation-related environmental policy support. We conducted an online survey study with a quota sample of N = 2,530 participants in Germany. The strongest positive predictors of intentions to refrain from flying and policy support were perceived behavioral control to travel without flying, efficacy beliefs that avoiding air travel contributes to climate change mitigation, and intergenerational justice concerns; pro-travel attitude was a negative predictor. Moreover, we tested whether the provision of additional information on climate impact, global and intranational inequalities as well as subsidies affected the intention to avoid air travel and policy support. We found no effects of the different types of information. Nor did we find an interaction between the type of information provided and global or national identity. Our results highlight the need for a shift within the mobility sector that facilitates attractive and accessible transport alternatives in order to strengthen people’s behavioral control to choose other means than planes and their efficacy perceptions. Moreover, raising awareness of the impacts of climate change on future generations and developing strategies to promote people’s concern for intergenerational justice might motivate people to reduce air travel and thereby contribute to a livable future for new generations. (shrink)

An often-overlooked characteristic of the human mind is its propensity to wander. Despite growing interest in the science of mind-wandering, most studies operationalize mind-wandering by its task-unrelated contents. But these contents may be orthogonal to the processes that determine how thoughts unfold over time, remaining stable or wandering from one topic to another. In this chapter, we emphasize the importance of incorporating such processes into current definitions of mind-wandering, and propose that mind-wandering and other forms of spontaneous thought (such as (...) dreaming and creativity) are mental states that arise and transition relatively freely due to an absence of constraints on cognition. We review existing psychological, philosophical and neuroscientific research on spontaneous thought through the lens of this framework, and call for additional research into the dynamic properties of the mind and brain. (shrink)

Pets often factor in older adults’ health behaviors and decisions. However, the degree to which issues related to pet ownership are encountered or addressed by professionals working with this population remains unknown. The aim of this study was to identify specific issues stemming from pet ownership professionals had encountered in their work with older adults, people living with dementia, and care partners. An interdisciplinary sample completed an online survey addressing pet ownership issues encountered in their work. Descriptive statistics, t-tests, and (...) repeated measures ANOVAs were used to analyze quantitative data. A conventional content analysis was used to analyze open-ended responses to an item asking about “other” issues encountered in their work with these populations. The professionals estimated 46.29% of clients had been pet owners, 41.23% regularly asked about pets, and 79.22% had encountered issues related to pet ownership. Specific issues raised to the professionals varied by type of client. The professionals reported older adults most often raised getting pet items into the home and concerns about their pets’ health. The issues most often raised by people living with dementia to the professionals were planning for the pet due to a housing transition and basic pet care. Care partners focused on basic pet care and planning for the pet due to a housing transition. The professionals themselves most often raised the issues of basic pet care, concerns about falling, and the pets’ behavior. Professionals who entered clients’ homes were more likely to raise issues stemming from pet ownership compared to those who reported they did not enter clients’ homes in their current job, t = 5.59, p < 0.00001. The eleven new issues identified by the content analysis underscored how the health and wellbeing of people and their pets are linked. The results of this study provide strong evidence that professionals do encounter issues related to pet ownership. Including issues stemming from pet ownership into procedures, policies, and programs is likely to have positive impacts on those served by and working in the geriatric workforce. (shrink)

While utopians cannot produce what they can imagine, we can no longer imagine what we produce. It is increasingly the case that undergraduate teacher candidates find themselves enrolled in courses that have been developed “in partnership” with local school districts—districts adjacent to the actual universities where they are enrolled. Recently, one such partnership arrangement had a foundation of education professor and initial certification students oscillating between two school districts located in the same large suburban area. One side of town is (...) inhabited by mostly minority children in underfunded schools—commonly viewed as the “bad” district. The other side of town has the “better” district, as it .. (shrink)

Despite increasing scientific interest in self-generated thought-mental content largely independent of the immediate environment-there has yet to be any comprehensive synthesis of the subjective experience and neural correlates of affect in these forms of thinking. Here, we aim to develop an integrated affective neuroscience encompassing many forms of self-generated thought-normal and pathological, moderate and excessive, in waking and in sleep. In synthesizing existing literature on this topic, we reveal consistent findings pertaining to the prevalence, valence, and variability of emotion in (...) self-generated thought, and highlight how these factors might interact with self-generated thought to influence general well-being. We integrate these psychological findings with recent neuroimaging research, bringing attention to the neural correlates of affect in self-generated thought. We show that affect in self-generated thought is prevalent, positively biased, highly variable (both within and across individuals), and consistently recruits many brain areas implicated in emotional processing, including the orbitofrontal cortex, amygdala, insula, and medial prefrontal cortex. Many factors modulate these typical psychological and neural patterns, however; the emerging affective neuroscience of self-generated thought must endeavor to link brain function and subjective experience in both everyday self-generated thought as well as its dysfunctions in mental illness. (shrink)

The United States has a population of three hundred million, according to latest Census Bureau estimates. Forty-seven million, including many non-citizens, are uninsured. That is, 16% of the total United States population has no health insurance. Millions more have inadequate coverage and are in danger of losing that. Private, corporatized medical coverage, structured by the insurance industry, is the basis for the current system. This article is an attempt to lay out the principal health care issues, to look at the (...) alternatives and the cost of those alternatives, and to try to determine whether there is a particular regime that, despite its imperfections, is the best available to us now. (shrink)