RNA can catalyse chemical reactions through its ability to fold into complex three‐dimensional structures and to specifically bind small molecules and divalent metal ions. The 2′‐hydroxyl groups of the ribose moieties contribute to this exceptional reactivity of RNA, compared to DNA. RNA is not only able to catalyse phosphate ester transfer reactions in ribonucleic acids, but can also show aminoacyl esterase activity, and is probably able to promote peptide bond formation. Bearing its potential for functioning both as a genome and (...) as a gene product, RNA is suitable for in vitro evolution experiments enabling the selection of molecules with new properties. The growing repertoire of RNA catalysed reactions will establish RNA as a primordial molecule in the evolution of life. (shrink)

Wittgenstein's treatment of private language is the dissolution of some of the major problems in traditional philosophy. Philosophical problems, for Wittgenstein, are the conceptual confusion arising due to the abuse of language. They can be fully dispensed with by commanding a clear view of language. Language, for Wittgenstein, is on the one hand, the source of philosophical problems while, on the other hand, it is a means to dispense with them. Private language is one such issue which is ultimately rooted (...) I a mistaken conception of language and is the sources of various philosophical problems/ puzzles. (shrink)

Genetics: Medical, Theological and Ethical Aspects Tibbi, Dini ve Etik Boyutlariyla Genetik -/- Genetik bilimi biyolojinin botanik ve zooloji alanındaki uygulamalarını aşarak, sınırlarını önce antropolojiye sonra tıbba doğru hızla genişletmiştir. Öyle ki artık biyokimyadan onkolojiye kadar neredeyse tüm biyomedikal disiplinler, genetiğin kavramları, ilkeleri ve metodolojisi ile aşılanmıştır. Modern tıbbın uygulama alanında geniş bir yer tutan genetik bilimi, bir hastalığa dair risk analizi, teşhis ve tedavi seçeneklerinin belirlenmesi, prognozun değerlendirilmesi gibi klinik uygulamanın farklı evrelerinde söz sahibi olmaktadır. İçinde bulunduğumuz 21. yüzyılda (...) ise bu etkileşim eskisinden daha da güçlü hale gelerek devam etmektedir. Genetik biliminin klinikteki etkilerinin kapsamlı bir şekilde değerlendirildiği bu kitap, tüm dünyada tıbbın seyrini değiştirecek gelişmelere zemin teşkil eden genetik disiplininin olumlu ve olumsuz etkileri hakkında okuyucuya yetkili ağızlardan bilgiler taşımayı ve daha net bir fikir oluşturmayı hedeflemektedir. Kitapta dört ana bölüm bulunmaktadır. İlk bölümde doğum öncesi genetik uygulamalara, ikinci bölümde doğum sonrası (çocuk ve erişkinde) genetik testlere, üçüncü bölümde tıbbi genetiğin sıcak tartışma konusu olan Spinal Müsküler Atrofi’ye (SMA) ve dördüncü bölümde ise genetik bilgiyi felsefi bakışla ele alan makalelere yer verilmiştir. Genetiğin tıp pratiğini değiştirici ve dönüştürücü etkisine multidisipliner bir yaklaşımla ışık tutmayı amaçlayan bu eserin genetik hakkındaki Türkçe literatüre katkıda bulunmasını ümit ediyoruz. (shrink)

Papers presented by three scholars from Asia, Africa and Europe, at a seminar held at the Hague Academy of International Law, Netherlands.

The study is based on validating and exploring the effects of a mega project plan on infrastructure development and Sustainable Project Management. The CPEC has great importance to infrastructure development and economy-boosting. The current study's primary aim is to deal with environmental protection, economic boost up, international relations influencing to the Project's success. The paper also addressed project management as a moderator between environmental protection, economic boost up, international relations, and the CPEC project's success. The primary data has been gathered (...) by using questionnaires, and PLS-SEM has been employed for the analysis. The results revealed that environmental protection, economy boost up, and international relations have a positive association with the success of CPEC. The outcomes also exposed that project management moderating among the nexus of economy boosts up the international relations and success of CPEC. The present study results guided how Pakistan and China make the CPEC project stronger with the efficient implementation of practices required for protecting the environment, with the economic growth and boost up, and good strong relations with foreign countries. This study was an attempt to validate the different factors to check their association with each other in a new environment, resulting in a leading edge for the success of mega projects that influence project management. (shrink)

No one in twentieth-century analytic philosophy was more preoccupied with the issues of ethics and religion than Ludwig Wittgenstein. In an age when religion has remained a prominent force, contrary to what some would have thought a hundred years ago, it is not surprising to see a book on Wittgenstein's concern with ethics and religion by a group of Indian philosophers. Ludwig Wittgenstein: Ethics and Religion, edited by Kali Charan Pandey—a collection of fifteen essays, some of which were presented at (...) a conference—is divided into three sections; the first provides a broad outline while the other two deal with the issues of ethics and religion, respectively. The editor has written a detailed introduction to the .. (shrink)

Türkiye hosts approximately 3.6 million Syrian refugees, which accounts for roughly 4.5% of Türkiye's population. This places undeniable pressure on public institutions, particularly on healthcare services. The objective of this study is to document the healthcare structure for Syrian refugees and various challenges faced by Syrians when seeking healthcare and to highlight the ethical concerns emerging from those challenges. To achieve this, we conducted a comprehensive review of several qualitative studies and reports conducted by various organizations and institutions, specifically focusing (...) on health or including a dedicated chapter on health issues, published between 2011 and 2023. Following an extensive analysis of the secondary literature, we classified the challenges into three categories: procedural, cultural, and psychosocial. We argue that each of these challenges is linked to overarching medical ethics concerns. Finally, we propose three possible means to mitigate the challenges Syrians experience in accessing and uptake of healthcare services in Türkiye. (shrink)

This paper depicts a case study of an organizational strategy for the promotion of ethical practice when introducing a new, high-risk, ethically-charged medical practice like Medical Assistance in Dying (MAiD). We describe the development of an interprofessional program that enables the delivery of high-quality, whole-person MAiD care that is values-based and sustainable. A “care ecology” strategy recognizes the interconnected web of relationships and structures necessary to support a quality experience of MAiD for patients, families, and clinicians. This program exemplifies a (...) care ecology approach that addresses common barriers to entry to MAiD practice, and also meets the needs of a variety of stakeholders through the creation of patient and family resources, team supports, standards of practice, professional development opportunities, organizational infrastructure, and community partnerships. We also describe how a thriving care ecology evolves to remain resilient, and to enable integration as the needs of the organization, team and program change over time. The design and development of this program may be adapted to other jurisdictions and organizations where MAiD is introduced, or where new patient populations become eligible for MAiD. This care ecology model may also be applicable to the creation of sustainable programs that provide other morally controversial or novel clinical services. (shrink)

Bioethical concerns about the potential for abuse in medical aid in dying (MAID) have focused primarily on the risk of coercion (Battin et al. 2007; Foley and Hendin 2002). Accordingly, the require...

This article examines the complexity of feminized domestic labor in the context of global migration. I view unpaid household labor and paid domestic work not as dichotomous categories but as structural continuities across the public and private spheres. Based on a qualitative study of Filipina migrant domestic workers in Taiwan, I demonstrate how women travel through the maid/madam boundary—housewives in home countries become breadwinners by doing domestic work overseas, and foreign maids turn into foreign brides. While migrant women sell their (...) domestic labor in the market, they remain burdened with gendered responsibilities in their own families. Their simultaneous occupancy of paid and unpaid domestic labor is segmented into distinct spatial settings. I underscore women’s agency by presenting how they articulate their paid and unpaid domestic labor and bargain with the monetary and emotional value of their labor. (shrink)

Pullman (2023) compares medically-assisted dying (MAiD) laws and rates of medically-assisted deaths in Canada and California, noting some differences in the legal regime and a higher rate of MAiD i...

Canadian ethicists Jocelyn Downie and Udo Schuklenk seek to assess the effect of Canada’s decriminalisation of ‘medical assistance in dying’ ‘to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law.’1 Their assessment focuses on two arguments earlier levied against expansion of these procedures. The first is that of a ‘slippery slope’ and the second is what they disingenuously call, ‘social determinants of health’. They conclude that, in both cases, (...) the effect of legislation permitting first limited and then expanded options for medical termination has been benign. The argument in this brief commentary is that the ‘slippery slope’ is clearly evident and support for those with chronic, progressive diagnoses a clear contributor to the ever increasing number of persons seeking MAID. Downie and Schuklenk first review the legal and legislative history of MAID. In Carter v Canada, the courts found …. (shrink)

This paper engages with debates about the increasing use of paid domestic labour in Europe and the USA, contributing with a reflection about the case of Brazil. Relations of gender, class and race are considered in the deployment of maids for housework, the patterns of consumption of household technologies and the moral reasoning of daily living with hierarchical divisions within the home. The paper considers some parallels between the Brazilian context and that of more developed countries and also the specificity (...) of Brazil. Based on participant observation, secondary data and an ethnographic study, rich empirical data is weaved through to discuss material and moral dimensions of domestic labour and care. How does the availability of cheap domestic labour configure relations of inequality? How are social differences in the home lived with and justified? The exploration of the Brazilian case illuminates some of the problems, contradictions and possible consequences of wealthier households benefitting from the displacement of poor women that is currently happening through international migration. The paper argues that in Brazil the deflecting of tensions in gender divisions of labour in households onto a subordinate person has affected relations of equality between women and men and also the patterns of technological innovation to facilitate housework. These are outcomes to be guarded against in Europe and the United States in face of the current trends in ‘global woman’ relations. (shrink)

In the past, a vast majority of medical assistance in dying patients were elderly patients with cancer who are not suitable for organ donation, making organ donation from such patients a rare event. However, more expansive criteria for MAiD combined with an increased participation of MAiD patients in organ donation is likely to drastically increase the pool of MAiD patients who can serve as organ donors. Previous discussions of ethical issues arising from these trends have not fully addressed difficulties involved (...) in separating decision to end one’s life from the one to donate one’s organs. However, realities of organ donation logistics and human decision making suggest that this separation can be extraordinary difficult. The need to maximise quality of donated organs complicates dying experience of the donor and is likely in tension with the dying experience the patient envisioned when first considering MAiD. Furthermore, the idea that patients will think about MAiD first, and only when firmly decided to end their life, consider organ donation, runs contrary to organ donation policies in some countries as well as end of life and everyday decision making. This opens the door for organ donation to serve as an incentive in MAiD decisions. Dispensing with the simplistic assumption that organ donation can never be a factor in MAiD decisions is, therefore, essential first step to properly addressing ethical issues at hand. (shrink)

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the need (...) for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

This book, written both for a Canadian and an international readership, provides a multidisciplinary review of the framework and performance of the Canadian Medical Assistance in Dying (MAID) program. In the first five years (2015-2021) of operation, this program delivered voluntary euthanasia and assistance in suicide to over 30,000 Canadian residents, presently representing a 30% annual growth. Looking back on these first five years, the 30 Canadian scholars and clinicians contributing to this volume raise important issues and attempt to answer (...) key questions that have arisen in regards to its operation and its stated objectives. This volume strikes the most appropriate balance between the autonomy of persons who seek medical assistance, versus the interests and protection of vulnerable persons. Finally, the book makes suggestions on how the program can presently be improved. It identifies gaps in knowledge about MAID’s operational program and its impact on individuals, families and society in order to stimulate the necessary research that is essential to the evolution of a healthy and well-balanced program. As a first, comprehensive examination of medically assisted deaths in Canada, this publication will be of great value to lay, professional, academic, political audiences both domestically and internationally, especially in jurisdictions that are examining their options of permitting assisted deaths. (shrink)

Monitoring of MAIDMonitoring of MAID was recognised as an essential component of the MAID program. However, monitoring started late in the rollout of the program, and even at present is missing some essential elements that would be important for effective oversight and public accountability. Health CanadaCanada is using some of the data obtained from practitioners and pharmacists to produce Annual Reports on MAID, but these reports aim at providing only a “societal perspective,” rather than an in-depth assessment of the program’s (...) performance. A major deficit is lack of monitoring and reporting on the compliance with eligibility criteria and procedural safeguards that should be coming from territorial and provincial governments, and that would provide assurance that MAID delivery complies with the Criminal CodeCriminal Code of Canada. Monitoring is based entirely on self reporting and therefore it is recommended that Health Canada obtain supportive data by initiation of on-site retrospective reviews of randomly selected MAID deliveries across the country. In addition, it would be useful to enhance the quantity and quality of data collected from MAID assessors and providers. Organizations involved in MAID provisions (hospitals, regional health authorities and so on) should also report annually on MAID activities to their respective communities. Improvement of monitoring and reporting would address serious concerns among professionals, people with disabilities and advocates for vulnerable populations while providing for a higher level of transparency and accountability. (shrink)

This letter was submitted to the Senate Standing Committee on Legal and Constitutional Affairs, Government of Canada, on 29th January, 2021, as final debate over Bill C-7 was being undertaken in the Senate regarding MAiD and the strong opposition to the legislation expressed across the Canadian disability community. It draws on our individual and joint work on eugenics, well-being, and disability.

Annual Reports on Medical Assistance in Dying (MAID) issued by Health CanadaCanada on behalf of the Government of Canada strive to make essential information public, on this large national program that over five years has provided death to over 30,000 Canadians. The source of the information is self-reporting by physicians and nurse practitioners who offer to act as MAID assessors and providers, as well as self-reporting by cooperating pharmacists. Focus of this discussion is the latest available document in this series, (...) the Third Annual Report on MAID published in July 2022 and providing data on 10,064 deaths by MAID in 2021. In addition to reviewing essential information about MAID recipients and MAID providers, the discussion is centered on the method of data collection, the rapid and unexpected annual increase of cases, the underlying medical conditions, the nature of suffering reported by MAID applicants, the use of palliative care, the decision-making about one’s eligibility, the role of the reflection period, necessary requirement to obtain informed consent and the denial of assisted dying. In each case, the attention is drawn to missing or indeterminate elements, and essential but unavailable analysis of data, in order to identify further information that ought to be collected and used to generate future annual reports and to refine the delivery of MAID program and its oversight. (shrink)

The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at (...) the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions. (shrink)

In this critical commentary, a set of ethical considerations of relevance to the (currently contested) interpretation of irremediability for medical assistance in dying (MAiD) in circumstances where the sole-underlying medical condition is a mental health disorder is explored and analyzed. Based on the application of an ethics lens, a practical description of irremediability is proposed for intended use as guidance by Canadian mental health care clinicians, MAiD assessors and providers, and provincial/territorial professional regulatory authorities.

Argues that Hannah Arendt's two major philosophical works, The Human Condition and The Life of the Mind, reveal not a dependency upon Heidegger, but rather a constant and increasing ironic debate with him.

BackgroundFollowing several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).AimThis review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework.MethodsWe review the proposed (...) Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.FindingsIn this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD. (shrink)

Canada’s Medical Assistance in Dying (MAID) legislation changed in 2021; persons without a reasonably foreseeable natural death (RFND) could now be eligible for MAID and would have to wait at least 90 days before their intervention. This legislative change caused a new ethically complex question to arise, which we explore in this commentary, namely: Where should individuals without a RFND wait (for 90 days) in a publicly funded health system?

BackgroundWith the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision. This study explored healthcare providers’ perspectives on honouring eligible patients’ request for MAiD in the absence of a contemporaneous consent following their loss of decision-making capacity. (...) MethodA critical qualitative methodology, using a feminist ethics theoretical lens with its focus on power and relationality, was used to examine how socio-political and environmental contexts influenced healthcare providers' moral agency and perspectives. Semi-structured interviews were conducted with 30 healthcare providers (13 physicians, six nurse practitioners, nine nurses and two social workers) from across Canada who provide MAiD-related care.ResultsThemes identified include; (1) balancing personal values and professional responsibilities, (2) anticipating strengths and limitations of the proposed waiver of final consent amendment, (3) experiencing ethical influences on decisions to enter into written agreements with eligible patients, (4) recognizing barriers to the enactment of MAiD in the absence of a contemporaneous consent and (5) navigating the potential for increased risks and burden.DiscussionTo our knowledge, this is the first study in Canada to explore healthcare providers’ perspectives on waiving the final consent for MAiD using a written agreement. Most participants supported expanding eligible people’s access to MAiD following loss of capacity, as they believed it would improve the patients’ comfort and minimize suffering. However, the lack of patients’ input at the time of provision and related ethical and legal challenges may impact healthcare providers’ moral agency and reduce some patients’ access to MAiD. Providers indicated they would enter into written agreements to waive final consent for MAiD on a case-by-case basis. This study highlights the importance of organizational, legal and professional support, adequate resources, clear policies and guidelines for the safety and wellbeing of healthcare providers and to ensure equitable access to MAiD. (shrink)

Feminist investigations into caring technologies emphasise the tension between their reproduction of care’s assumed femininity and their ability to destabilise gendered markers and systems. However, the existing literature ignores the historical racialisation of care and its perpetuation in the form of the posthuman caring object. This article examines how racialised relations of power shape the posthumanisation of care in three science-fiction works, Channel 4’s television show Humans (2015), Alex Riviera’s film Sleep Dealer (2008) and Spike Jonze’s film Her (2013). While (...) Her’s disembodied operating systems are premised upon an implicit whiteness, posthuman caring objects in Humans and Sleep Dealer take a racialised, embodied form. Drawing upon the work of Saidiya Hartman and Fred Moten, this article examines how the racialised objects in Humans and Sleep Dealer are constituted as both labourers and commodities, purchased for the purpose of facilitating white reproductivity. Nonetheless, this article also documents how these caring technologies complicate key binaries such as subject/object, human/machine and productive/reproductive labour. In doing so, they disrupt the whiteness of the social reproduction paradigm. The article concludes by calling for greater feminist engagement with the racialisation of care labour in human and posthuman forms, in order to challenge white, heterosexual models of reproductivity based upon the exploitation of racialised labour. (shrink)