We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons (...) behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (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 presents a pedagogical framework for teaching cross-cultural clinical ethics. The approach, offered at the intersection of anthropology and bioethics, is innovative in that it takes on the “social sciences versus bioethics” debate that has been ongoing in North America for three decades. The argument is made that this debate is flawed on both sides and, moreover, that the application of cross-cultural thinking to clinical ethics requires using the tools of the social sciences within a principles-based framework for clinical (...) ethics. This paper introduces the curriculum and provides guidelines for how to teach cross-cultural clinical ethics. The learning points that are introduced emphasize culture in its relation to power and underscore the importance of viewing both biomedicine and bioethics as culturally constructed. (shrink)

In this commentary we describe the interplay between 1) contemporary popular and professional understandings of “risk” and “normality” in health and healthcare, and 2) the promotion by state and market forces of individual self-regulation of health. We draw upon the work of critical theorists who have described the relationship between risk, fear, and the notion of “normal” in health discourse to argue that these factors act, primarily via the popular media, to shape the discourse on, and overuse of, diagnostic tests (...) in Canada. (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 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)

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)

In this commentary we describe the interplay between 1) contemporary popular and professional understandings of “risk” and “normality” in health and healthcare, and 2) the promotion by state and market forces of individual self-regulation of health. We draw upon the work of critical theorists who have described the relationship between risk, fear, and the notion of “normal” in health discourse to argue that these factors act, primarily via the popular media, to shape the discourse on, and overuse of, diagnostic tests (...) in Canada. (shrink)