Sequenom Inc., a developer of medical diagnostic products, recently made their noninvasive test for Down syndrome available for clinical practice.1 The DNA-based test—given the name “MaterniT21”—requires only a simple maternal blood sample as early as 10 weeks of gestation. In recent clinical trials involving thousands of pregnant women, the MaterniT21 test identified 99.1% of cases of Down syndrome, and gave the correct result in 99.9% of cases when the fetus did not have Down syndrome. Sequenom’s test is thought to be (...) an improvement on previous prenatal testing techniques because of its. (shrink)

This book provides an introduction to postphenomenology, an emerging school of thought in the philosophy of technology and science and technology studies, which addresses the relationships users develop with the devices they use.

Over the past few years, a number of authors in the new field of neuroethics have claimed that there is an ethical challenge presented by the likelihood that the findings of neuroscience will undermine many common assumptions about human agency and selfhood. These authors claim that neuroscience shows that human agents have no free will, and that our sense of being a “self” is an illusory construction of our brains. Furthermore, some commentators predict that our ethical practices of assigning moral (...) blame, or of recognizing others as persons rather than as objects, will change as a result of neuroscientific discoveries that debunk free will and the concept of the self. I contest suggestions that neuroscience’s conclusions about the illusory nature of free will and the self will cause significant change in our practices. I argue that we have self-interested reasons to resist allowing neuroscience to determine core beliefs about ourselves. (shrink)

This article defends the public funding of abortion in the Canadian health care system in light of objections by opponents of abortion that the procedure should be denied public funding. Abortion opponents point out that women terminate their pregnancies most often for social reasons, that the Canadian health care system only requires funding for medically necessary procedures, and that abortion for social reasons is not medically necessary care. I offer two lines of response. First, I briefly present an argument that (...) characterizes abortion sought for social reasons as medically necessary care, directly contesting the anti-abortion position. Second, and more substantially, I present a justice argument that shows that even if abortion is not regarded as medically necessary care, the reasons that typically motivate women to seek abortion are sufficiently weighty from the moral perspective that it would be unjust to deny them public funding. I finish by drawing the more general conclusion that health care funding decisions should be guided by a broader concept of necessary care, rather than by a narrow concept of specifically medical necessity. A broad concept of necessary care has been debated in health care policy in the Netherlands, and I suggest that such a concept would be a more just and defensible guide for funding decisions than the concept of medical necessity. (shrink)

This article describes a qualitative study of models of ethics consultation used by ethics consultants in Canada. We found four different models used by Canadian ethics consultants whom we interviewed, and one sub-variant. We describe the lone ethics consultant model, the hub-and-spokes sub-variant of this model; the ethics committee model; the capacity-building model; and the facilitated model. Previous empirical studies of ethics consultation describe only two or three of these models.

This paper examines eight publicly available critical care triage protocols intended for use during an influenza pandemic. These protocols place an emphasis on objective measures of survivability as the primary criterion for assigning priority for lifesaving critical care during a pandemic. Triage would then be undertaken without consideration of the relational or social characteristics of patients who need critical care. We argue that enacting these protocols could result in the denial of lifesaving care to oppressed and disadvantaged groups. The lens (...) of relational theory reveals this ethical flaw in the triage protocols we examine, and suggests ways of improving these protocols. (shrink)

Philosophical debate about the ethics of abortion has reached stalemate on two key issues. First, the claim that foetuses have moral standing that entitles them to protections for their lives has been neither convincingly established nor refuted. Second, the question of a pregnant woman's obligation to allow the gestating foetus the use of her body has not been resolved. Both issues are deadlocked because philosophers addressing them invariably rely on intuitions and analogies, and such arguments have weaknesses that make them (...) unfit for resolving the abortion issue. Analogical arguments work by building a kind of consensus, and such a consensus is virtually unimaginable because (1) intuitions are revisable, and in the abortion debate there is great motive to revise them, (2) one's position on abortion influences judgments about other issues, making it difficult to leverage intuitions about other ethical questions into changing peoples' minds about abortion, and (3) the extent of shared values in the abortion debate is overstated. Arguments by analogy rely on an assumption of the commensurability of moral worldviews. But the abortion debate is currently unfolding in a context of genuinely incommensurable moral worldviews. The article ends by arguing that the default position must be to permit abortion as a consequence of the freedom of conscience protected in liberal societies. (shrink)

In this study, Canadian healthcare ethics consultants describe their use of ethics decision-making frameworks. Our research finds that ethics consultants in Canada use multi-purpose ethics decision-making frameworks, as well as targeted frameworks that focus on reaching an ethical resolution to a particular healthcare issue, such as adverse event reporting, or difficult triage scenarios. Several interviewees mention the influence that the accreditation process in Canadian healthcare organizations has on the adoption and use of such frameworks. Some of the ethics consultants we (...) interviewed also report on their reluctance to use these tools. Limited empirical work has been done previously on the use of ethics decision-making frameworks. This study begins to fill this gap in our understanding of the work of healthcare ethics consultants. (shrink)

This article describes the shortage of generic injectable medications in Canada that affected hospitals in 2012. It traces the events leading up to the drug shortage, the causes of the shortage, and the responses by health administrators, pharmacists, and ethicists. The article argues that generic drug shortages are an ethical problem because health care organizations and governments have an obligation to avoid exposing patients to resource scarcity. The article also discusses some options governments could pursue in order to secure the (...) drug supply and thereby fulfill their ethical obligations. (shrink)

People with cognitive disabilities and their advocates often express uneasiness about prenatal testing and the selective termination of pregnancies because the fetus has a cognitively disabling condition. There are high rates of abortion in such circumstances, and new forms of noninvasive prenatal testing (NIPT) have been introduced to improve the detection of genetic conditions. This chapter argues that the feeling of disquiet about prenatal testing and selective termination is justified. Philosophers working in the field of bioethics often offer reassurance that (...) such feelings are unjustified. This chapter shows that such reassurances fail and presents an argument that bias against people with cognitive disability plays a role in prenatal decision-making. Feelings of disquiet are justified because it is justified to object to bias that is otherwise directed at oneself. (shrink)

The institutional review board at the University of Nebraska Medical Center has a policy on contraceptive use in research that aims to balance the protection of potential fetuses from potential harm resulting from drug exposure in research against respect for the autonomy of women research participants. The policy draws on the U.S. Food and Drug Administration’s Use-in-Pregnancy categories in an innovative way. These categories are meant to help prevent the exposure of fetuses to harmful drugs when used for therapy by (...) pregnant women. The UNMC IRB policy applies the FDA categories as a guideline for mandating contraceptive use among research participants. Clinical trials of drugs in the different FDA categories require different levels of contraceptive protection under the UNMC IRB policy. Though we agree with the insight that contraceptive requirements in research could helpfully be guided by the current and future FDA Use-in-Pregnancy guidelines, we argue that in several places, the UNMC IRB policy unjustifiably prioritizes the protection of potential fetuses from potential harm at the expense of respecting the autonomy and well-being of women research participants. In response to the deficiencies we identify in the UNMC IRB policy, we formulate an alternative, ideal policy on contraceptive use in research. (shrink)

This paper tells the story of a recent laboratory medicine controversy in the Canadian province of Newfoundland and Labrador. During the controversy, a DAKOAutostainer machine was blamed for inaccurate breast cancer test results that led to the suboptimal treatment of many patients. In truth, the machine was not at fault. Using concepts developed by Bruno Latour and Pierre Bourdieu, we document the changing nature of the DAKO machine’s agency before, during, and after the controversy, and we make the ethical argument (...) that treating the machine as a scapegoat was harmful to patients. The mistreatment of patients was directly tied to a misrepresentation of the DAKO machine. The way to avoid both forms of mistreatment would have been to include all humans and nonhumans affected by the controversy in the network of decision-making. (shrink)

Though abortion is legal in Canada, policies currently in place at various levels of the health care system, and the individual actions of medical professionals, can inhibit access to abortion. This paper examines the various extra-legal barriers to abortion access that exist in Canada, and argues that these barriers are unjust because there are no good reasons for the restrictions on autonomy that they present. The paper then outlines the various policy measures that could be taken to improve access.

A letter to the editor from Françoise Baylis and Chris Kaposy concerning the recent commentary by Toby Schonfeld and colleagues , which was written in response to Baylis and Kaposy’s article.

This paper seeks to apply some of the tools of analytic philosophy to a text written by a 'continental' philosopher, in order to evaluate the quality of its arguments. In 'On Forgiveness', Jacques Derrida seems to be making two different claims about forgiveness. First, he claims that an act of forgiveness is only truly meaningful as forgiveness when one is forgiving the unforgivable. Second, he is also recommending that we change our understanding of the concept of forgiveness for ethical reasons. (...) I examine three lines of argument used in the essay to support the first claim. I find each of these lines of argument problematic. Since these arguments are unconvincing, I argue that this leaves only the second claim for Derrida to defend. (shrink)

The philosophers Peter Singer and Jeff McMahan hold variations of the view that infant interests in continued life are suspect because infants lack the cognitive complexity to anticipate the future. Since infants cannot see themselves as having a future, Singer argues that the future cannot have value for them, and McMahan argues that the future can only have minimal value for an infant. This paper critically analyzes these arguments and defends the view that infants can have interests in continuing to (...) live. Even though infants themselves lack a strong psychological connection to the future, others who are involved in an infant’s life can anticipate, on an infant’s behalf, the kind of future that awaits the infant, and on the basis of this insight judge that continuing to live would be in the infant’s interests. After defending this position, I argue that this position on the interests of infants in continued life does not commit one to opposing abortion, and it does not commit one to the view that our ethical obligations to protect the lives of sentient animals are the same as our ethical obligations to protect infant lives. (shrink)

In "Relational Autonomy as Theoretical Lens for Qualitative Bioethics Research" Jennifer A. H. Bell shows the importance of attending to the relational factors that affect the autonomy of research participants. Drawing on the example of her own research into cancer clinical trial participation, Bell illustrates how relational autonomy theory enhances the various stages of qualitative research. Relational theory can contribute insight into the development of a research question. It can help determine research methodology, and it can provide direction on the (...) data sources needed for the study. As recommended by relational theory, the informed consent process should take oppression and power imbalances into... (shrink)

This is a study involving three HIV clinics in the Canadian provinces of Newfoundland and Labrador, and Manitoba. We sought to identify ethical issues involving health care providers and clinic clients in these settings, and to gain an understanding of how different ethical issues are managed by these groups. We used an institutional ethnographic method to investigate ethical issues in HIV clinics. Our researcher conducted in-depth semi-structured interviews, compiled participant observation notes, and studied health records in order to document ethical (...) issues in the clinics, and to understand how health care providers and clinic clients manage and resolve these issues. We found that health care providers and clinic clients have developed work processes for managing ethical issues of various types: conflicts between client-autonomy and public health priorities, difficulties associated with the criminalization of nondisclosure of HIV positive status, challenges with non-adherence to HIV treatment, the protection of confidentiality, barriers to treatment access, and negative social determinants of health and well-being. Some ethical issues resulted from structural disadvantages experienced by clinic clients. The most striking findings in our study were the negative social determinants of health and well-being experienced by some clinic clients – such as experiences of violence and trauma, poverty, racism, colonization, homelessness, and other factors affecting well-being such as problematic substance use. These negative determinants were at the root of other ethical issues, and are themselves of ethical concern. (shrink)

This paper tells the story of a recent laboratory medicine controversy in the Canadian province of Newfoundland and Labrador. During the controversy, a DAKOAutostainer machine was blamed for inaccurate breast cancer test results that led to the suboptimal treatment of many patients. In truth, the machine was not at fault. Using concepts developed by Bruno Latour and Pierre Bourdieu, we document the changing nature of the DAKO machine’s agency before, during, and after the controversy, and we make the ethical argument (...) that treating the machine as a scapegoat was harmful to patients. The mistreatment of patients was directly tied to a misrepresentation of the DAKO machine. The way to avoid both forms of mistreatment would have been to include all humans and nonhumans affected by the controversy in the network of decision-making. (shrink)

Prenatal genomics appears to be on an expansive trajectory toward universally-available, routine, whole-genome prenatal sequencing. But for people living with disabilities, this expansion of prenatal genomics may not be a welcome development. This chapter explores some of the objections arising from the community of people with disabilities, and articulates a defense of one particular form of objection: the claim that the expansion of prenatal genomics expresses negative messages about people with disabilities.

Down syndrome (Trisomy 21) is a mild to moderate intellectual disability. Historically, this condition has been a primary target for prenatal testing. However, Down syndrome has not been targeted for prenatal testing because it is an especially severe illness. The condition was just one that could be easily identified prenatally using the techniques first available decades ago. We are moving into an era in which we can prenatally test for a vast range of human traits. I argue that when we (...) can test for anything, there is no longer any reason to continue targeting Down syndrome. I present an argument based on the value of nondiscrimination. It is justified to set limits on access to prenatal information if the information is going to be used for discriminatory purposes. I use the examples of (1) prenatal testing for misogynistic fetal sex selection, and (2) homophobia-motivated prenatal testing for potential homosexuality, as compelling analogies. (shrink)