Inasmuch as unmitigated pain and suffering areoften thought to rob human beings of theirdignity, physicians and other care providersincur a special duty to relieve pain andsuffering when they encounter it. When pain andsuffering cannot be controlled it is sometimesthought that human dignity is compromised.Death, it is sometimes argued, would bepreferred to a life without dignity.Reasoning such as this trades on certainpreconceptions of the nature of pain andsuffering, and of their relationships todignity. The purpose of this paper is to laybare these (...) preconceptions. The duties torelieve pain and suffering are clearly mattersof moral obligation, as is the duty to respondappropriately to the dignity of other persons.However, it is argued that our understanding ofthe phenomena of pain and suffering and theirrelationships to human dignity will be expandedwhen we explore the aesthetic dimensions ofthese various concepts. On the view presentedhere the life worth living is both morally goodand aesthetically beautiful. Appropriate``suffering with'''' another can help to maintainand restore the dignity of the relationshipsinvolved, even as it preserves and enhances thedignity of patient and caregiver alike. (shrink)

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we (...) consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. (shrink)

Canada and California each introduced legislation to permit medical assistance in dying in June, 2016. Each jurisdiction publishes annual reports on the number of deaths that occurred under their respective legislations in the previous years. The numbers are disturbingly different. In 2021, 486 individuals died under California’s End of Life Option. In the same year 10,064 Canadians died under that country’s Medical Assistance in Dying (MAiD) legislation. California has a slightly larger population than Canada, and while medically assisted deaths as (...) a percentage of total deaths remained virtually unchanged in California from 2020-2021, Canada saw a 30% increase from 2020 to 2021. This essay examines some of the factors propelling Canada down the slippery slope of medically assisted suicide, as well as those that may be keeping California and other US jurisdictions from taking the slide. At a time of increasing pressure in many jurisdictions (both nationally and internationally) to liberalize access to medical assistance in dying, some lessons from this comparative analysis are offered. (shrink)

Feticide, the practice of terminating the life of an otherwise viable fetus in utero, has become an increasingly common practice in obstetric centres around the globe, a concomitant of antenatal screening technologies. This paper examines this expanding practice in light of the concept of human dignity. Although it is assumed from the outset that even viable human fetuses are not persons and as such do not enjoy full membership in the moral community, it is argued that the fact that these (...) are nevertheless human fetuses affords them prima facie moral status. Thus even those who accept a liberal position with regard to therapeutic abortion, should be concerned about these more recent developments. Indeed, how we treat viable human fetuses has implications for our prospective treatment of other human non-persons and could undermine the common human dignity we all share. (shrink)

I want to begin this brief response by thanking all of those who took the time to read and reflect upon this piece. There were many thoughtful and thought provoking responses and I have learned fro...

This paper explores the problem of universalism and particularism in contemporary ethics, and its relationship to Christian bioethics in particular. An ethic of human dignity is outlined, which, it is argued, constrains moral discourse in the broad sense – thus meeting the demands of universalism – but which is at the same time amenable to a variety of particularist interpretations – thus acknowledging the current shift toward historicism, traditionalism, and culture. The particularist interpretations that are of central concern here are (...) those provided by historic Christianity. The eventual goal is to indicate how a Christian conception of human dignity can have universal normative relevance both as a standard against which to assess competing particularist conceptions, and as a practical guide for everyday living. A Christian conception of dignity will in turn have significant implications when addressing contemporary issues in bioethics. These are ambitious goals, and a full explication of the ideas presented will not be possible in this context. Nevertheless, there is value in getting a bird's-eye view of the landscape before one goes about scaling the mountains and exploring the valleys. The present essay is intended as a general geography of the moral terrain in which an ethic of dignity in general, and a Christian perspective on dignity in particular, can provide normative guidance. (shrink)

Narrative theory is a dynamic and evolving field of inquiry that has made tremendous inroads in the medical humanities over the past 40 years. Numerous authors have popularized the idea that “thinking narratively” can produce important insights about the illness experience for physician and patient alike. This paper draws on aspects of narrative theory to emphasize the moral responsibilities that arise when we step into another person's life narrative, becoming a character in her or his story. This has especially significant (...) ethical implications for the physician–patient encounter in that each character in this shared story experiences time somewhat differently. This gives rise to the notion of “slow motion ethics” and a somewhat unique perspective on the moral responsibilities clinicians bear toward their patients. (shrink)

Historically the primary role of the Institutional Review Board (IRB) has been "to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in research" (U.S. FDA, 1996). However, there is much to suggest that IRBs have been unable to fulfil this mandate, particularly in regard to the matter of informed consent. Part of the problem in this regard is that the competing interests of other stakeholders (...) often undermine the IRB's capacity to serve the best interests of research subjects. This paper proposes an alternative view of the role of the IRB. It begins by treating the interests of other stakeholders as legitimate matters of concern for IRBs. Hence the process established to review and monitor human research should be treated as an exercise in social justice in which the interests of all legitimate stakeholders must be represented and considered. A variation of Rawls' (1971) heuristic "the veil of ignorance" is employed to explore the dynamic relationship between knowledge and interests that ensues when the role of the IRB is characterized in this manner. Inadequacies in the informed consent process are taken as illustrative of the inability of IRBs as they are presently construed to attend to the interests of research subjects. The major normative implication of the analysis offered here is that the role of the IRB must be expanded to include the granting of a provisional proxy consent on behalf of prospective research subjects. This provision is necessary, it is argued, if the interests of research subjects are to be fairly assessed by IRBs as a matter of social justice. It is necessary as well to ensure that an adequate standard of informed consent is attained. Somewhat paradoxically it is argued competing sets of interests the IRB must serve, rather than as the primary concern of the IRB. (shrink)

The author examines fundamental problems involved in teaching applied ethics in the educational environment of contemporary university culture. American universities are increasingly turning away from liberal arts education and focusing their efforts on constructing more professionalized degrees and programs. As a result, the education process has become increasingly commodified and ethics courses in universities have been further removed from the liberal arts project of moral development in the classroom. The author argues that ethicists should work to reframe the project of (...) moral education if they hope to retain a central role in the process of teaching ethics. The author suggests a growth model to be installed in the undergraduate curriculum that would reacquaint students with the aims and benefits of learning ethical and moral philosophy. (shrink)

BackgroundWhile genomic data sharing can facilitate important health research and discovery benefits, these must be balanced against potential privacy risks and harms to individuals. Understanding public attitudes and perspectives on data sharing is important given these potential risks and to inform genomic research and policy that aligns with public preferences and needs.MethodsA cross sectional online survey measured attitudes towards genomic data sharing among members of the general public in an Eastern Canadian province.ResultsResults showed a moderate comfort level with sharing genomic (...) data, usually into restricted scientific databases with controlled access. Much lower comfort levels were observed for sharing data into open or publicly accessible databases. While respondents largely approved of sharing genomic data for health research permitted by a research ethics board, many general public members were concerned with who would have access to their data, with higher rates of approval for access from clinical or academic actors, but much more limited approval of access from commercial entities or governments. Prior knowledge about sequencing and about research ethics boards were both related to data sharing attitudes.ConclusionsWith evolving regulations and guidelines for genomics research and data sharing, it is important to consider the perspectives of participants most impacted by these changes. Participant information materials and informed consent documents must be explicit about the safeguards in place to protect genomic data and the policies governing the sharing of data. Increased public awareness of the role of research ethics boards and of the need for genomic data sharing more broadly is also needed. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

BackgroundIn 2009, Dr. Paolo Zamboni proposed chronic cerebrospinal venous insufficiency (CCSVI) as a possible cause of multiple sclerosis (MS). Although his theory and the associated treatment (“liberation therapy”) received little more than passing interest in the international scientific and medical communities, his ideas became the source of tremendous public and political tension in Canada. The story moved rapidly from mainstream media to social networking sites. CCSVI and liberation therapy swiftly garnered support among patients and triggered remarkable and relentless advocacy efforts. (...) Policy makers have responded in a variety of ways to the public’s call for action.DiscussionWe present three different perspectives on this evolving story, that of a health journalist who played a key role in the media coverage of this issue, that of a health law and policy scholar who has closely observed the unfolding public policy developments across the country, and that of a medical ethicist who sits on an expert panel convened by the MS Society of Canada and the Canadian Institutes of Health Research to assess the evidence as it emerges.SummaryThis story raises important questions about resource allocation and priority setting in scientific research and science policy. The growing power of social media represents a new level of citizen engagement and advocacy, and emphasizes the importance of open debate about the basis on which such policy choices are made. It also highlights the different ways evidence may be understood, valued and utilized by various stakeholders and further emphasizes calls to improve science communication so as to support balanced and informed decision-making. (shrink)

Daryl Pullman (2023), seeking to slow the slide down what he sees as the slippery slope of MAID, employs an epigraph from H.L. Mencken: “For every human problem there is a solution that is simple,...

This chapter contains sections titled: Introduction Human DNA as Cultural Property The Genetic Appropriation of Culture Community Identity, Cultural Offense and Control of Genetic Information Conclusion References.

By titling his paper “Slowing the Slide Down the Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US,” Daryl Pullman, an esteemed medical ethicist, uses a rhetoric...

The existence of psi—anomalous processes of information transfer such as telepathy or clairvoyance—continues to be controversial. Earlier meta-analyses of studies using the ganzfeld procedure appeared to provide replicable evidence for psi (D. J. Bem & C. Honorton, 1994), but a follow-up meta-analysis of 30 more recent ganzfeld studies did not (J. Milton & R. Wiseman, 1999). When 10 new studies published after the Milton-Wiseman cutoff date are added to their database, the overall ganzfeld effect again becomes significant, but the mean (...) effect size is still smaller than those from the original studies. Ratings of all 40 studies by 3 independent raters reveal that the effect size achieved by a replication is significantly correlated with the degree to which it adhered to the standard ganzfeld protocol. Standard replications yield significant effect sizes comparable with those obtained in the past. (shrink)

Business Ethics, the Environment &Responsibility, Volume 32, Issue S1, Page 1-3, April 2023.

Since St. Thomas Aquinas was one of the first scholastics to analyze the idea of a “just price,” economists, economic historians and philosophers interested in the philosophical underpinnings of the market have focused on Aquinas’s writings. One group insists that Aquinas defined the just price as the payment needed to cover sellers’ labor and material costs. A second camp vehemently counters that Aquinas’s just price is simply the going market price. We argue that neither of these views is correct. The (...) Thomistic just price is the price that would be agreed to by a just person as part of an exchange. This “just person price” takes into account the well-being of the individual transactors and the good of the entire community. Such a price reduces neither to the cost-covering price nor to the market exchange price. A Thomistic concept of the just person price deserves to be reconsidered, especially because a Thomistic approach offers some useful ways to deal with issues quite differently from the popular neoclassical approach directed toward arriving at a socially optimal market price. (shrink)

The global COVID-19 pandemic has created a crisis of suffering. We conceptualize suffering as a deeply existential issue that fundamentally changes people indelible ways and for which there are no easy solutions. To better understand its effects and how people can flourish in the midst of this crisis, we formally introduce and elaborate on an Existential Positive Psychology Model of Suffering (EPPMS) and apply that to the COVID-19 global pandemic. Our model has three core propositions: (a) suffering reveals existential concerns, (...) (b) existential anxiety impairs one's ability to find meaning, and (c) cultivating meaning is the primary way to address suffering and allay existential anxiety, eventually leading to flourishing (and potentially growth). We apply this model to the COVID-19 pandemic, including how to build meaning, and discuss clinical implications. (shrink)

This article explores differences in the ways in which utilitarian, deontological and virtue/aretic ethics treat of act, outcome, and agent. I argue that virtue ethics offers important and distinctive insights into business practice, insights overlooked by utilitarian and deontological ethics.

As each week beings more stories of doctors, lawyers and other professionals abusing their powers, while clients demand extra services as at a time of shrinking resources; it is imperative that all practising professionals have an understanding of professional ethics. In _The Ground of Profesional Ethics_, Daryl Koehn discusses the practical issues in depth, such as the level of service clients can justifiably expect from professionals, when service to a client may be legitimately terminated and circumstances in which client (...) confidences can be broken. She argues that, while clients may legitimately expect professionals to promote their interests, professionals are not morally bound to do whatever a client wants. _The Ground of Professional Ethics_ is important reading for all practising professionals, as well as those who study or have an interest in the subject of professional ethics. (shrink)

. In this post-Enron era, we have heard much talk about the need for integrity. Today’s employees perceive it as being in short supply. A recent survey by the Walker Consulting Firm found that less than half of workers polled thought their senior leaders were people of high integrity. To combat the perceived lack of corporate integrity, companies are stressing their probity. This stress is problematic because executives tend to instrumentalize the value of integrity. This paper argues that integrity needs (...) to be better defined because the current mode of talking about the subject is misleading. The paper considers three traditions’ understanding of the idea of integrity, argues that integrity is intrinsically valuable, and concludes with some reflections on the way in which integrity, properly understood, functions as a business asset. (shrink)

s of selected articles and a list of the online articles can also be accessed from this link.

There is a large gap between attitude and action when it comes to consumer purchases of ethical food. Amongst the various aspects of this gap, this paper focuses on the difficulty in knowing enough about the various dimensions of food production, distribution and consumption to make an ethical food purchasing decision. There is neither one universal definition of ethical food. We suggest that it is possible to support consumers in operationalizing their own ethics of food with the use of appropriate (...) information and communication technology. We consider eggs as an example because locally produced options are available to many people on every continent. We consider the dimensions upon which food ethics may be constructed, then discuss the information required to assess it and the tools that can support it. We then present an overview of opportunities for design of a new software tool. Finally, we offer some points for discussion and future work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Experiences of Tourette SyndromeBeyond the Premonitory UrgeThe authors report no conflicts of interest.There is an evolving recognition in healthcare that the patient's subjective experience needs to be privileged both in understanding clinical phenomena and also ensuring the salience of outcomes used to evaluate the impact of treatment interventions. This is reflected in the expansion of patient-reported outcome measures to capture a person's perception of their own health, and (...) the increasing requirement of involving people with lived experience in the co-design of research studies (National Health and Medical Research Council, 2016) and care improvement initiatives. In mental health it has been long understood that observable behavioral phenomena can only partially inform clinical understanding of the experience of the patient living with the condition. However, capturing the patient's subjective experience faithfully remains a challenge.Tourette syndrome (TS) is a complex condition in which there are clearly observable behavioral phenomena (vocal and motor tics, compulsive and socially inappropriate behaviors), but also a broad and varied range of subjective phenomena reported by different individuals. These may include sensory phenomena such as the premonitory sensory urge preceding a tic, compulsions to touch things a certain number of times or do something repeatedly until it feels "just right," or bothersome intrusive thoughts or images. To further complicate the picture most patients with TS have one or more co-occurring conditions such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, and anxiety, which may actually cause a greater burden of dysfunction and distress than the Tourette symptoms.In their paper, Curtis-Wendlandt et al. (2024) challenge the dependence of current psychiatric diagnostic criteria (e.g., the Diagnostic and Statistical Manual of Mental Disorders, 5th edition) on observable tics, and propose a broader and more dimensional approach to nosology which incorporates sensory, cognitive and affective phenomena. [End Page 47] Data from interviews they conducted identified that premonitory phenomena and urge experiences in tic disorders are more complex and diverse than what is currently reflected in the literature and clinical scales. They also interviewed participants who reported "no urges" or "no premonitory sensations." They commented that the literature generally treats reports of urge absences at face value, and does not address the likelihood that such reports may be ambiguous or problematic. Overall, they concluded that their research suggests that premonitory urges in TS are a complex and diverse phenomenon that requires further study. This reflects with our clinical experience in working with TS patients. Although a large proportion of older patients describe sensory-based premonitory urges, descriptions are not homogenous, with many describing other experiences preceding their tics.When evaluating a patient's response to an intervention (either behavioral or pharmacological) clinicians incorporate a range of information. This includes the severity of their tics (number, type, frequency, intensity, and associated impairment), as well as their mood, participation and performance in study, work, and social activities, and overall quality of life. Standard clinical practice would not typically include assessment of some of the subjective experiences which precede tics. If it was accepted that these subjective phenomena are indeed salient to the patient's well-being, then a challenge would be how to consistently and reliably capture these feelings to operationalize a comprehensive patient-centered assessment.The primary evidence-based treatment for tic disorders, comprehensive behavioral intervention for tics (CBIT), involves training to increase the awareness of premonitory urges (Woods et al., 2008). Furthermore, successful 'blocking' of tics during the course of CBIT requires the patient to be aware of premonitory urges. Clinicians having a better understanding of the complexity and diversity of experiences which precede tics, as well as using open-ended questioning styles, may assist with improving CBIT outcomes. [End Page 48]Related ArticlesFeature Article: Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette SyndromeCommentary: Priming and Narrative Habits in the Phenomenological Interview: Reflections on a Study of Tourette SyndromeCommentary: Subjective Experiences of Tourette Syndrome: Beyond the Premonitory UrgeResponse: Phenomenological Interviews and Tourette’sDaryl EfronThe Royal Children's Hospital MelbourneIvan MathiesonThe Laneway ClinicDaryl Efron Daryl Efron is a Consultant Pediatrician, Royal Children's Hospital Senior Research Fellow, Murdoch... (shrink)

The number of corporate apologies has increased dramatically during the past decade. This article delves into the ethics of apologies offered by chief executive officers (CEOs). It examines ways in which public apologies on the part of a representative (CEO) of a corporate body (the firm) differ from both private, interpersonal apologies, on the one hand, and nation-state/collective apologies, on the other. The article then seeks to ground ethically desirable elements of a corporate apology in the nature or essence of (...) the corporate apology itself. It explores the largely ignored roles played by the speaker’s ethos and audience pathos in genuine or ethical apologies and suggests that attention needs to be paid to the problems posed by “role contamination,” context, and other overlooked factors. The reception by the actual audience of a given apology is a highly contingent matter. Ethicists should concentrate, therefore, on what makes a proffered apology, in principle, trustworthy and not merely efficacious for a given audience. (shrink)

Did Shakespeare read Plato? The evidence suggests that Shakespeare not only read Plato, but also consulted him as though he possessed wisdom of the highest sort. With a focus on comparing the Phaedo and Symposium to Timon of Athens, I show that Shakespeare’s genius is at least in part due to his uncanny ability to transform Platonic wisdom into fully realized dramatic action. Previous attempts at interpreting the play have overlooked the extent to which Timon of Athens mirrors Socratic warnings (...) against flattery, sophistry, and uncivil philosophy. (shrink)

A sizable body of literature calls for a synthesis of Whiteheadian process philosophy and the existential phenomenology of Sartre and Heidegger. However, although the two traditions agree on some points, they are fundamentally incompatible. Those proposing a synthesis see in it the possibility of integrating within a single scheme the viewpoint of natural science and the insights of existential fundamental ontology, but the denial of the possibility of such a smooth integration is at the very heart of the existential phenomenological (...) position. (shrink)

Rudyard Kipling famously penned, “East is East, West is West, and never the twain shall meet.” His poetic line suggests that Eastern and Western cultures are irreconcilably different and that their members engage in fundamentally incommensurable ethical practices. This paper argues that differing cultures do not necessarily operate by incommensurable moral principles. On the contrary, if we adopt a virtue ethics perspective, we discover that East and West are always meeting because their virtues share a natural basis and structure. This (...) article sketches the rudiments of what a universal virtue ethic might look like. Such an ethic is especially relevant and valuable in this era of global business. (shrink)

Rethinking Feminist Ethics bridges the gap between women theorists disenchanted with aspects of traditional theories that insist upon the need for some ethical principles. The book raises the question of whether the female conception of ethics based on care, trust and empathy can provide a realistic alternative to the male ethics based on duty and rule bound conception of ethics developed from Kant, Mill and Rawls. Koehn concludes that it cannot, showing how problems for respect of the individual arise also (...) in female ethics because it privileges the caregiver over the cared for. Drawing on Socrates' Crito , she shows how an ethic of dialogue can instill a critical respect for the view of the other and the ethical principles absent from the female ethic. (shrink)

A developmental theory of erotic/romantic attraction is presented that provides the same basic account for opposite-sex and same-sex desire in both men and women. It proposes that biological variables, such as genes, prenatal hormones, and brain neuroanatomy, do not code for sexual orientation per se but for childhood temperaments that influence a child's preferences for sex-typical or sex-atypical activities and peers. These preferences lead children to feel different from opposite-or same-sex peers — to perceive them as dissimilar, unfamiliar, and exotic. (...) This, in turn, produces heightened nonspecific autonomic arousal that subsequently gets eroticized to that same class of dissimilar peers: Exotic becomes erotic. Specific mechanisms for effecting this transformation are proposed. The theory claims to accommodate both the empirical evidence of the biological essen-. (shrink)

The number of corporate apologies has increased dramatically during the past decade. This article delves into the ethics of apologies offered by chief executive officers (CEOs). It examines ways in which public apologies on the part of a representative (CEO) of a corporate body (the firm) differ from both private, interpersonal apologies, on the one hand, and nation-state/collective apologies, on the other. The article then seeks to ground ethically desirable elements of a corporate apology in the nature or essence of (...) the corporate apology itself. It explores the largely ignored roles played by the speaker’s ethos and audience pathos in genuine or ethical apologies and suggests that attention needs to be paid to the problems posed by “role contamination,” context, and other overlooked factors. The reception by the actual audience of a given apology is a highly contingent matter. Ethicists should concentrate, therefore, on what makes a proffered apology, in principle, trustworthy and not merely efficacious for a given audience. (shrink)