The aim of this article is to review the recent popularity of casuistry as a model of moral inquiry. I argue that proponents of casuistry do not endorse the particularist epistemology that seems to be implied by their position, and that this is why casuistry does not seem to present something really new in comparison to 'top-down' generalist approaches. I contend that casuistry should develop itself as a (moderately) particularist position and that the challenge for the defender of casuistry is (...) to come up with ideas that strengthen the ('intuitionist') model of rationality that underlies most forms of particularism. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

Two key themes structure the work of French philosopher of science Gilbert Simondon: the processes of individuation and the nature of technical objects. Moreover, these two themes are also at the heart of contemporary debates within Ethics and Bioethics. Indeed, the question of the individual is a key concern in both Virtue Ethics and Feminist Ethics of Care, while the hyper-technical reality of the present stage of medical technology is a key reason for both the urgency for and the success (...) of the field of Bioethics. And yet, despite its potential for thinking about these issues, Simondon’s philosophy remains largely unknown. Rather than exploring Simondon’s complex ontology for itself, the aim of this paper is to establish what contribution his work can make in Ethics and Bioethics on two essential questions: the relational structure of the self and the nature of the human-technology relation. I argue that Simondon’s re-conceptualization of the individual harmonizes with perspectives in Feminist Bioethics and points toward what I call an “open” Virtue Ethics that takes relations to be essential. In order to establish this connection, I explore at length the relational approach to Feminist Bioethics offered by Susan Sherwin’s work. I argue that a Simondonian account of technology and of the individual furthers the relational understanding of the self, offers a characterization of Virtue Ethics that is in harmony with the Ethics of Care, and clarifies a notion of responsibility that is implicated in the complex reality of the modern technological milieu. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks. The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: rehabilitation and services for people with disabilities; chronic illness and cancer care; senior's health; community support services; children's health; health promotion; and mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

Liberal societies are characterized by respect for a fundamental value pluralism; i.e., respect for individuals’ rights to live by their own conception of the good. Still, the state must make decisions that privilege some values at the cost of others. When public ethics committees give substantial ethical advice on policy related issues, it is therefore important that this advice is well justified. The use of explicit tools for ethical assessment can contribute to justifying advice. In this article, I will discuss (...) one approach to ethical assessment, the ethical matrix method. This method is a variant of intuitionist balancing. Intuitionism is characterized by stressing the existence of several (at least two) fundamental prima facie moral principles, between which there is no given rank order. For some intuitionist approaches, coherentism has been proposed as a model of justification. This article will discuss justification of ethical advice and evaluate the appropriateness of coherentism as a justificatory approach to intuitionist tools. (shrink)

This essay describes an interdisciplinary educational experiment in health law. The experiment was funded by the National Science Foundation, received Institutional Review Board approvals, incorporated inter-disciplinary faculty and graduate students from several universities in Atlanta, and employed problem-based learning. After discussing my motivation to undertake this experimental approach to teaching health law, I explain how the course was developed and structured and how we are assessing its results. I also offer some reflections on why other health law teachers might be (...) motivated to incorporate some features of our experimental approach into their own classes, and some thoughts on how they might do so based on lessons learned.I undertook this experiment to test in an educational setting an approach to problem solving that I have developed for addressing certain kinds of seemingly intractable policy problems. I call this a “navigational approach” to “fractious problems.”. (shrink)