End-of-life disputes in Ontario are currently overwhelmingly assessed through the singular lens of patient autonomy. The current dispute resolution mechanism does not adequately consider evidence-based medical guidelines, standards of care, the patient’s best interests, expert opinion, or distributive justice. We discuss two cases adjudicated by the Consent and Capacity board of Ontario that demonstrate the over emphasis on patient autonomy. Current health care policy and the Health Care Consent Act also place emphasis on patient autonomy without considering other ethically defensible (...) factors. We argue that current policy and legislation require amendment, and unless there are measures undertaken to modify them, both the quality of care provided and the long-term capabilities of the health care system to remain publicly-funded, comprehensive and equitable, are at stake. (shrink)

Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers, though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings. Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context (...) of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs, typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed, using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases, focusing on patients’ “well-being” and “best interests.” Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable. (shrink)

This paper reports on collaborative research undertaken with the African Australian Christian Impact Centre (CIC) in Perth, Western Australia. It is part of a larger university philosophy outreach program in which the researchers seek to create opportunities for those on the educational and social margins, and young people, to engage in ‘doing philosophy’, and to learn from them about their experiences. We were interested to evaluate whether the collaborative philosophical inquiry methods we use in our university teaching could be beneficial (...) outside of a formal educational setting, for members of the culturally diverse, faith-based community of CIC. In this multi-method evaluative study, we examined the extent to which participation in a series of Community of Inquiry (CoI) sessions improved or did not improve participants’ self-assessment of: (1) their competence and confidence in communicating with others in different contexts; (2) their competence and confidence as a ‘thinker’; and (3) their social competence and confidence. Our findings on ‘communication’ are discussed in this paper. The facilitated philosophical discussions led to insights about ‘speaking out’ and ‘listening’, particularly with respect to participants’ experiences of cultural and generational differences. We suggest that participation in CoI in a faith-based community setting has the potential to significantly increase confidence in communication skills, and lead to greater intergenerational, intercultural, and intercommunity sensitivity. (shrink)

The individual informed consent model remains critical to the ethical conduct and regulation of research involving human beings. Parental informed consent process in a rural setting of northern Ghana was studied to describe comprehension and retention among parents as part of the evaluation of the existing informed consent process.

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was (...) carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students’ perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era. (shrink)

The purpose of this study is to assess the intention of typically developing peers towards learning in the classroom with students with Autism Spectrum Disorder. In developing countries, such as Ghana, the body of literature on the relationship between students with disabilities and typically developing peers has been sparsely studied. Using Ajzen's theory of planned behaviour as a theoretical framework for this study, 516 typically developing students completed four scales representing belief constructs, attitudes, subjective norms, and perceived behavioural controls, hypothesised (...) to predict behavioural intention. The data were subjected to a t-test, analysis of variance, and structural equation modelling. The modelling confirmed the combining ability of attitude, subjective norms, and perceived behavioural controls to predict intention. We conclude by revealing the need for policymakers to consider designing programmes aimed towards promoting social relationships between students with ASD and typically developing peers. (shrink)

Background: Seeking consent for genetic and genomic research can be challenging, particularly in populations with low literacy levels, and in emergency situations. All of these factors were relevant to the MalariaGEN study of genetic factors influencing immune responses to malaria in northern rural Ghana. This study sought to identify issues arising in practice during the enrolment of paediatric cases with severe malaria and matched healthy controls into the MalariaGEN study. Methods: The study used a rapid assessment incorporating multiple qualitative methods (...) including in depth interviews, focus group discussions and observations of consent processes. Differences between verbal information provided during community engagement processes, and consent processes during the enrolment of cases and controls were identified, as well as the factors influencing the tailoring of such information. Results: MalariaGEN participants and field staff seeking consent were generally satisfied with their understanding of the project and were familiar with aspects of the study relating to malaria. Some genetic aspects of the study were also well understood. Participants and staff seeking consent were less aware of the methodologies employed during genomic research and their implications, such as the breadth of data generated and the potential for future secondary research.Moreover, trust in and previous experience with the Navrongo Health Research Centre which was conducting the research influenced beliefs about the benefits of participating in the MalariaGEN study and subsequent decision-making about research participation. Conclusions: It is important to recognise that some aspects of complex genomic research may be of less interest to and less well understood by research participants and that such gaps in understanding may not be entirely addressed by best practice in the design and conduct of consent processes. In such circumstances consideration needs to be given to additional protections for participants that may need to be implemented in such research, and how best to provide such protections.Capacity building for research ethics committees with limited familiarity with genetic and genomic research, and appropriate engagement with communities to elicit opinions of the ethical issues arising and acceptability of downstream uses of genome wide association data are likely to be important. (shrink)

Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony’s Hospital, Dzodze, in the Volta Region of Ghana. A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered (...) at St Anthony’s Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. The findings revealed that partographs were used by midwives at St Anthony’s Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR 4.29 ], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR 5.31 ]. Midwives used partographs during labour at St Anthony’s Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases. (shrink)