Given the rapid growth of music technology, this study reports Chinese pre-service music teachers’ perceptions of musical instrument learning assisted by augmented reality. In this study, we conducted a small-scale case study with six pre-service teachers enrolled in a music teacher training programme at a comprehensive university in China. Participants engaged in semi-structured, face-to-face interviews after hands-on experiences with an AR-based piano learning app. Thematic analysis revealed that the participants were generally aware of the potential of this instructional (...) approach but doubted its efficacy and exhibited weak intention to adopt it in their future classrooms. Implications of the findings for music teacher training are discussed. (shrink)

This paper outlines the potential and necessity of the development of assistive technologies for people with intellectual disabilities. We analyse a policy recommendation designed to determine the contents of a basic health package supplied by the state, known as the Dunning Funnel. We contend that the Dunning Funnel is a useful methodology, but is weakened by a potentially relativistic understanding of “necessity” in relation to the requirements of people with IDs. We remedy this defect by using the capabilities approach as (...) outlined by Martha Nussbaum. We argue that this approach provides a strong normative case for ensuring that communities provide help to people with IDs, if those communities are to achieve a minimal standard of justice. However, the capabilities approach does not offer much specific guidance on how AT ought to be distributed, nor does it offer guidance on risks, like the bottomless pit problem. We propose that the Dunning Funnel used in combination with the capabilities approach will provide a suitable heuristic for determining the distribution of AT in a basic health package. (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)

Computer-Assisted Argument Mapping (CAAM) is a new way of understanding arguments. While still embryonic in its development and application, CAAM is being used increasingly as a training and development tool in the professions and government. Inroads are also being made in its application within education. CAAM claims to be helpful in an educational context, as a tool for students in responding to assessment tasks. However, to date there is little evidence from students that this is the case. This paper outlines (...) the use of CAAM as an educational tool within an Economics and Commerce Faculty in a major Australian research university. Evaluation results are provided from students from a CAAM pilot within an upper-level Economics subject. Results indicate promising support for the use of CAAM and its potential for transferability within the disciplines. If shown to be valuable with further studies, CAAM could be included in capstone subjects, allowing computer technology to be utilised in the service of generic skill development. (shrink)

RESUMEN Introducción: El mundo enfrenta un acelerado envejecimiento poblacional y tasas de fecundidad por debajo de los niveles de reemplazo, situación a la que no son ajenos la población y el servicio de Salud cubanos. Objetivo: Valorar las implicaciones sociales de los resultados del Servicio Provincial de Reproducción Asistida de Baja Complejidad de Camagüey, durante el bienio 2016-2017, dados en el incremento del número de embarazos logrados por Estimulación Ovárica Controlada e Inseminación Intrauterina. Métodos: En la contribución se emplearon los (...) métodos investigativos pertinentes, así como procedimientos diagnósticos y terapéuticos. Resultados: En el período estudiado, se logró un número significativo de embarazos por técnicas de baja complejidad, así como un número superior de embarazo en mujeres mayores de 36 años con respecto a años anteriores. Discusión: El Estado cubano ha trazado estrategias de trabajo para brindar atención diferenciada a las parejas que presenten alteraciones de la reproducción, en favor de solucionar la problemática mediante alternativas cuyos resultados se correlacionan con los obtenidos a nivel mundial. ABSTRACT Introduction: The world faces an intensive population aging and valuations of fecundity below the levels of substitution, situation which is not foreign to the Cuban population and health service. Objective: To value the social implications of the results of the Provincial Service of Assisted Reproduction of Low Complexity of Camagüey, during the two-year period 2016-2017, given for the increase of the number of pregnancies achieved by Controlled Ovarian Stimulation and Intrauterine Insemination. Methods: In the contribution thepertinent,investigative methods were used as well as diagnostic and therapeutic procedures. Results: In the studied period, a significant number of pregnancies was achieved by skills of low complexity, as well as a top number of pregnancy in women older than 36 years old with regard to previous years. Discussion: The Cuban State has planned work strategies to offer attention differentiated to the couples that present alterations of the reproduction, in favor of solving the problems by means of alternatives which results are correlated by the obtained ones on a global scale. (shrink)

This short paper is based on a presentation delivered by four young people from Sunderland Children Services—Amy, Claire, Jordan and Glen (supported by Grace Roddam, Young People's Training and Development Mentor, and Dave Laverick, Workforce Development Consultant)—at the ‘Learning Professional Wisdom: Courage and Compassion’ Ethics and Social Welfare conference, which took place on 15 May 2009 at St Mary's College, Durham University, UK. The conference was organized by the newly formed Ethics and Social Welfare network, with support from the Social (...) Work and Policy Subject Centre (SWAP), Durham University and Ethics & Social Welfare journal. The conference focused on the contested nature of ‘moral character’ in professional education, whether this can be learnt and developed and how it links with judgements about ‘suitability for practice’. The four young people, drawing on their specific experiences of the looked after system, provided a valuable contribution which will assist understanding of what is meant by the term ‘ethical practitioner’ and the values and attributes they believe practitioners should have in order to fulfil their ethical obligations. (shrink)

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element (...) of assistance cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die. (shrink)

This chapter contains sections titled: General Assessments of Assisted Reproduction Pre‐birth Testing Conclusion References Further reading.

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)

Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that this (...) approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assisted suicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assisted suicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime. (shrink)

Increasingly, commissioners and providers of services for people with intellectual disabilities are turning to assistive technology and telecare as a potential solution to the problem of the increased demand for services, brought about by an expanding population of people with intellectual disabilities in the context of relatively static or diminishing resources. While there are numerous potential benefits of assistive technology and telecare, both for service providers and service users, there are also a number of ethical issues. The aim (...) of this paper is to raise these issues and to set them within the ethical framework proposed by Beauchamp and Childress. There is a need for a wider debate as a first step in the development of strategies to address the issues raised in the paper. (shrink)

Understand the challenges faced by university based EAPs and the strategies to effectively meet needs&#;and discover what works and what does not Academia is a diverse workplace unlike any other, and subsequently, employee assistance program issues are unique. Employee Assistance Programs in Higher Education focuses on the unique challenges of employee assistance service delivery in a university setting. This handy resource discusses the evolution, development, and strategies in managing an EAP in academia while comparing the substantial differences in program (...) application between academic settings and corporate settings. Discussions include outsourcing, support groups, implementation of services, and effective model frameworks. Employee Assistance Programs in Higher Education explores in depth how the difference of being an academic institution influences the administration of an EAP. Reducing costs, assessing the value of an EAP, faculty resistance to accessing EAPs, organizational and interpersonal problems, manager support groups to reduce stress, developing ’soft skills’, and addressing the deaths of faculty, staff, and students are examined in detail. This unique resource is extensively referenced and includes tables to clearly present data. Topics in Employee Assistance Programs in Higher Education include: the evolution of the IAEAPE university EAP response to traumas on campus enhancing faculty access university EAPs and outsourcing creating a specialized EAP program comparison between academic and corporate cultures case study of the University of Saskatchewan EAP _and more! _ Employee Assistance Programs in Higher Education is a comprehensive resource for academic administrators; benefit plan managers; university based EAP managers and directors; EAP, work/life, and wellness professionals; members of International Association of Employee Assistance Professionals in Education; Employee Assistance Professionals Association; Employee Assistance Society of North America; Association of Work Life Professionals; Society for Human Resource Management Schools of Social Work; educators in schools of social work, psychology, counseling education, and business. (shrink)

In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies . These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility , or on social concerns: that it “goes against nature”; (...) particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just “gatekeeping” practices associated with these sensitive medical services are examined. (shrink)

This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction technologies (ART), particularly the surrogacy. For that purpose, we interviewed: 1) a lesbian woman who had her daughter through her partner's pregnancy, using ART with anonymous donor semen; 2) a gay man who, together with his partner, used a surrogacy service under contract via a specialised offshore agency; 3) a woman who was a surrogate, in Brazil, for her sister-in-law (...) and brother who lived abroad and, from abroad, sent an embryo fertilised for surrogacy; 4) a woman who resorted to her sister-in-law in order to be a mother by surrogacy, with ovules from the woman herself fertilised with semen from her husband; and 5) the sister-in-law mentioned in 4), who acted as surrogate for her brother and his wife. These interviews made it possible to think about the discursive construction of the legitimacy of such parenthoods, as it is produced by access to, and manipulation and circulation of, reproductive technologies and persons. This biomedical management of bodies sets up a material and discursive circuit that, in turn, produces a complex web of personal, normative, legal, professional and market relationships, particularly with a view to construction of a parenthood anchored in a notion of biologically-constituted origin. In this respect, biological, affective and social bonds merge to produce a precise placement of who is the father and/or who is the mother, as well as who are the important others and how they are linked to the child in a broader web of parenthood. (shrink)

Some jurisdictions that allow assisted dying require participating patients to have a terminal illness. This includes all Australian and US states where assisted dying is allowed. 1 Philip Reed 2 argues that this requirement constitutes discrimination against the dying. As Reed 2 argues: ‘assisted death laws that limit their services to the dying discriminate against them because death is offered to them to solve their problems’. This discrimination could take two forms: (1) via harm to dying patients as a group (...) as a result of the existence of assisted dying programmes; (2) via a negative message that such programmes communicate about whether the lives of dying patients are worth living. Assisted dying programmes are not unjustly discriminatory in either sense so long as we assume that unjust discrimination requires harm to the group in question. If assisted dying singles out the terminally ill for a programme... (shrink)

Infertility is an unpredictable but widespread condition. While high‐income countries grapple with when, or how to cover the costs of assisted reproductive technology (ART), such as in‐vitro fertilisation (IVF), these services are generally only available to wealthy persons at private facilities in low‐ and middle‐income countries (LMICs). Although the principle of non‐interference with normal individual reproductive rights is robust, whether it is also the responsibility of collective society to provide the means (when ART applies) to achieve pregnancy, is controversial. Recently, (...) a low‐cost model was developed at a South African public institution. The target population for this model was “helpless and marginalised, childless couples”, but a new threat has arisen, namely, infertile couples who could conceivably afford private care. In the allocation of this scarce resource, we argue for a prioritarian response that first addresses the worst‐off, in order to even out unequal access imposed by sharp differences in income. (shrink)

Recently, several authors have argued that assisted dying may be ethically appropriate when requested by a person who suffers from serious depression unresponsive to treatment. We here present four arguments to the contrary. First, the arguments made by proponents of assisted dying rely on notions of “treatment-resistant depression” that are problematic. Second, an individual patient suffering from depression may not be justified in believing that chances of recovery are minimal. Third, the therapeutic significance of hope must be acknowledged; when mental (...) healthcare opens up the door to admitting hopelessness, there is a danger of a self-fulfilling prophecy. Finally, proponents of assisted dying in mental healthcare overlook the dangers posed to mental-health services by the institutionalization of assisted dying. (shrink)

Physician-Assisted Death is the eleventh volume of Biomedical Ethics Reviews. We, the editors, are pleased with the response to the series over the years and, as a result, are happy to continue into a second decade with the same general purpose and zeal. As in the past, contributors to projected volumes have been asked to summarize the nature of the literature, the prevailing attitudes and arguments, and then to advance the discussion in some way by staking out and arguing forcefully (...) for some basic position on the topic targeted for discussion. For the present volume on Physician-Assisted Death, we felt it wise to enlist the services of a guest editor, Dr. Gregg A. Kasting, a practicing physician with extensive clinical knowledge of the various problems and issues encountered in discussing physician assisted death. Dr. Kasting is also our student and just completing a graduate degree in philosophy with a specialty in biomedical ethics here at Georgia State University. Apart from a keen interest in the topic, Dr. Kasting has published good work in the area and has, in our opinion, done an excellent job in taking on the lion's share of editing this well-balanced and probing set of essays. We hope you will agree that this volume significantly advances the level of discussion on physician-assisted euthanasia. Incidentally, we wish to note that the essays in this volume were all finished and committed to press by January 1993. (shrink)

Ever since medical assistance in dying (MAID) became legal in Canada in 2016, controversy has enveloped the refusal by many faith‐based institutions to allow this service on their premises. In a recent article in this journal, Philip and Joshua Shadd have proposed ‘changing the conversation’ on this issue, reframing it as an exercise not of conscience but of an institutional right of self‐governance. This reframing, they claim, will serve to show how health‐care institutions may be justified in refusing to (...) provide MAID on moral or religious grounds. I argue that it will not make it easier to justify institutional refusal, and is likely to make it harder. (shrink)

Dysfunctional customer behavior is common in service settings. For frontline employees, negative encounters can cause short-term despondency or have profound, long-term psychological effects that often result in both direct and indirect costs to service firms. Existing research has explored the influence of dysfunctional customer behavior on employee emotions, but it has not fully investigated the psychological mechanism through which customer misbehavior transforms into employee responses. To maintain service quality and employee well-being, it is important to understand the (...) impact of customer misconduct on employee emotions and its effect on subsequent service behavior. To assess the process through which dysfunctional customer behavior manifests as negative emotions in frontline service employees, and the influence of negative employee emotions on their prosocial service behavior, we surveyed 185 frontline banking service employees. We sought information on service employee experiences, attitudes, and feelings regarding dysfunctional customer behaviors, the perceived level of supervisor support, and employee prosocial service behavior intentions. Structural equation modeling and hierarchical linear modeling were used for statistical analysis and hypothesis verification. Results indicate that dysfunctional customer behavior has a positive relationship with bank service employee negative emotions and a negative influence on employee prosocial service behavior. The study found that negative emotions fully mediated the relationship between dysfunctional customer behavior and prosocial service behavior. The moderating role that perceived supervisor support plays on the relationships between dysfunctional customer behavior and negative emotion was also investigated. The results show that perceived supervisor support moderates the relationship between dysfunctional customer behavior and negative employee emotions. Finally, the study provides bank managers with effective strategies to assist frontline employees to manage and deter dysfunctional customer behavior, and presents employees with internal recovery strategies when encountering dysfunctional customer behavior. (shrink)

The idea of commercial‐assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial‐assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service‐provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician‐assisted suicide (PAS), I defend the idea that adopting it as (...) policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will. (shrink)

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical (...) impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff. (shrink)

The acknowledgement of basic human vulnerability in relationships between mental health service users and professionals working in community-based mental health services (in Norway) was a starting point. The purpose was to explore how users of these services describe and make sense of their meetings with other people. The research is collaborative, with researcher and person with experienced-based knowledge cooperating through the research process. Data is derived from 19 interviews with 11 people who depend on mental health services for assistance (...) at least three times a week. Data is analysed according to the Interpretative Phenomenological Analysis (IPA). Results confirm that reciprocity is fundamental for relationships, and that recognizing the individual entails personal involvement. The participants describe a struggle, and recognizing this struggle may help the professional to achieve a deeper understanding of the individual. (shrink)

There is controversy in the Catholic medical ethics community surrounding assisted nutrition and hydration (ANH). Recently, the Ethical and Religious Directives for Catholic Health Care Services were amended to make ANH “obligatory.” The persistent vegetative state is cited specifically in the document, and the sentence following its mention states that ANH is “optional” when it cannot be expected to “prolong life” or when it would be “excessively burdensome.” For patients suffering from other medical conditions, such as dementia and frailty, ANH (...) may be excessively burdensome and may not prolong life. For these patients, ANH may be of no real benefit and may even have significant morbidity and mortality. Competent individuals with these conditions can ethically elect to forgo ANH. National Catholic Bioethics Quarterly 10.3 (Autumn 2010): 481–488. (shrink)

Controversies arise over abortion, assisted dying and conscientious objection in healthcare. The purpose of the study was to examine the relationship between attitudes towards these bioethical dilemmas, and secularity and religiosity. Data were drawn from a 2017 web-based survey of a representative sample of 1615 Norwegian adults. Latent moderated structural equations modelling was used to develop a model of the relationship between attitudes. The resulting model indicates that support for abortion rights is associated with pro-secular attitudes and is a main (...) “driver” for support for assisted dying and opposition to conscientious objection. This finding should be regarded as a hypothesis which ought to be tested in other populations. If the relationship is robust and reproduced elsewhere, there are important consequences for CO advocates who would then have an interest in disentangling the debate about CO from abortion; and for health systems who ought to consider carefully how a sound policy on CO can safeguard both patient trust in the services and the moral integrity of professionals. It is suggested that if religiosity wanes and pro-secular and pro-abortion attitudes become more widespread, support for CO might decline, putting into question whether present policies of toleration of conscientious refusals will remain acceptable to the majority. (shrink)

Abstract It is common practice to regard participants in assisted and collaborative reproduction (gamete donors, embryologists, fertility doctors, etc.) as simply providing a desired biological product or medical service. These agents are not procreators in the ordinary sense, nor do they stand in any kind of meaningful parental relation to the resulting offspring. This paper challenges the common view by defending a principle of procreative responsibility and then demonstrating that this standard applies as much to those who provide reproductive (...) assistance in the form of medical services or gametes, as it does to coital reproducers or intending parents. Drawing on vocabulary from the common law tradition, I suggest that it may be helpful to refer to the various participants in assisted and collaborative reproduction (ACR) as accessories to procreation. Referring to the participants in ACR as accessories to procreation highlights the fact that these agents are not just providing medical services or products. They are participating in a supply chain designed to bring about new persons. I conclude by arguing that regulative standards in the fertility industry should be structured such that they permit, facilitate, and encourage agents to satisfy the requirements of procreative responsibility. Content Type Journal Article Pages 1-16 DOI 10.1007/s10677-011-9330-7 Authors Melissa Seymour Fahmy, Department of Philosophy, University of Georgia, 107 Peabody Hall, Athens, GA 30602, USA Journal Ethical Theory and Moral Practice Online ISSN 1572-8447 Print ISSN 1386-2820. (shrink)

Medical assistance in dying (MAiD) was legalized in Canada in 2016. Canadians’ opinions on the service are nuanced, particularly as the legislation changes over time. In this paper, we outline findings from our review of representations of MAiD in Canadian news media texts since its legalization. These stories reflect the concerns, priorities, and experiences of key stakeholders and function pedagogically, shaping public opinion about MAiD. We discuss this review of Canadian news media on MAiD, provide examples of four key (...) themes we identified (vulnerability, autonomy, dignity, and human rights), and discuss their implications for health policy and equity. Though key stakeholders share the values of autonomy, dignity, and human rights, they appeal to them in diverse ways, sometimes with conflicting policy demands. These representations offer a useful gauge of how views about MAiD continue to shift alongside changes in federal legislation. These stories can influence related policies, respond to the powerful voices that shape MAiD legislation, and have the potential to change national conversations. Our analysis adds to the existing body of scholarship on MAiD by examining post-Bill C-7 news media, identifying related health equity issues and tensions, and discussing potential impacts of MAiD’s representations in news media. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Technology is “unruly” because it operates in a social context where it is shaped by institutions, organisations and individuals in ways not envisaged when it was first developed. In the UK assisted reproductive technology has developed from strictly circumscribed beginnings as a treatment for infertility within the NHS, to a service which is more often offered by commercial clinics and purchased by clients who are not necessarily infertile. The article considers the process by which assisted reproductive technology has been (...) created and developed, a process which is ideological rather than technical, and the social implications of its ever expanding use. In a society where the discourse around reproduction and family life is one of choice and acceptance of diversity of life styles, the conditions are set for further “unruliness” supported by clinicians and commercial interests. The HFEA, public consultations and media coverage tend to subscribe to the way ethical issues are framed by those interested parties, an approach that favours increased liberalisation. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

Exercer le métier d’assistant(e) maternel(le) dans le cadre spécifique d’une crèche familiale préventive à gestion associative requiert, outre des compétences « techniques » avérées, une disponibilité et un « savoir-être » bien particuliers, sur lesquels repose une large part de la qualité du service personnalisé rendu aux familles qui s’y adressent. L’ensemble de ces aptitudes se manifeste aux niveaux certes de l’accueil des enfants, mais aussi des relations intenses et complexes établies avec les parents et de l’organisation, nécessairement (...) très minutieuse, du travail en équipe. Il importe aujourd’hui de consolider et de diffuser les expériences acquises dans ce contexte par les assistant(e)s maternel(le)s de façon à en enrichir les pratiques déployées dans le champ de l’action socio-éducative et des politiques familiales. (shrink)

Assisted conception can be distinguished from assisted gestation.1 These processes have tended to be grouped together under the generic term assisted reproductive technology in the bioethical literature. According to Chloe Romanis, however, it is worth distinguishing interventions such as surrogacy, uterus transplantation, and potentially artificial placenta technology, as falling under the genus assisted gestative technologies. This is because gestation carries unique ethico-legal implications as compared with conception. The proposed genus of assisted gestative technologies is a helpful first step in the (...) endeavour to distinguish between the different ethico-legal landscapes across various ‘assisted reproductive technologies.’ I am generally in favour of adopting AGT as a term which separates various forms of gestational services from other kinds of reproductive technologies. Yet, if assisted gestative technologies can be considered a genus of assisted reproductive technologies, we might consider surrogacy, UTx, and artificial placenta technology their individual species. Between these various species of AGTs, I would argue, there remains enough ethico-legal diversity to warrant independent discussion about the descriptive and normative functions of each AGT and the relationship between gestation, genetic relatedness and legal/moral parenthood. Chloe Romanis claims that legal and social issues about attribution of parenthood and the importance that might be placed on information about gestational origins affect all forms of AGTs.1 I take it ethical ambiguities arise because the relationship between who gestates, genetic relatedness to the prospective child, and claims to legal/moral parental responsibility can be disrupted or made ambivalent with the involvement of third-party support. For many of those who do not require reproductive assistance, the gestational labour, genetic relatedness and parental responsibility would traditionally …. (shrink)

In service marketing, AI assistants and self-service technology have become popular. As a result, it is critical to enrich the understanding of whether consumers react differently in the artificial intelligence service context in comparison with the human service context. This study examines the effect of assistant type on consumers’ decision-making. Through three experiments, this research finds that variety seeking will be higher when consumers are making decision in AI service environment. Furthermore, we tested uncertainty (...) as the underlying mechanism. Moreover, we demonstrated that this pattern is moderated by situational involvement. Specifically, in consumption contexts of high involvement, the consumers are less likely to seek variety, and in consumption contexts of low involvement, they prefer more variety. This research offers service providers new insights by revealing how, why, and when the interaction of AI technology influences consumers’ decision-making in service marketing. (shrink)

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal (...) code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator. (shrink)

In contemporary global knowledge based society there are scorching needs for new knowledge and unprecedented vision of future development. Author is focuses attention to new possibilities of fostering creative abilities and gaining new socio-economic knowledge by the assistance of ICT, Internet and mainly by using products and services of computational intelligence. His method used is prevailingly new knowledge creation by experimentation in virtual laboratories. In using conventional methods, he combines inductive and deductive methods as set up for developing mental models (...) from up to down and bottom to up. Because in socio-economic branches it is very difficult and even almost wholly impossible to do experiments in objective reality the experimentation by the assistance of computational intelligence is promising advance in gaining new socioeconomic knowledge in contemporary complex world. Using such new approaches, methods and tools is the main scientific aim of the author. He uses convictive demonstration of successful using these unprecedented possibilities in gaining deeper knowledge about complex evolutionary phenomena. The distinction of such knowledge is against conventional one is consisting in very deep understanding of complex socio-economic dynamics. Using meant knowledge acquisition approaches is promising in quality and in abiding knowledge and skill of single individuals but the extraordinary progress of creative knowledge based society fostered by using them in advanced webs is useful for whole society. (shrink)

This qualitative study investigated the personal and professional stances of 40 health and social care professionals confronted with assisted suicide of older persons living in nursing homes or supported by social welfare or home care and support services in French-speaking Switzerland. Requests of assisted suicide triggered questions with regard to the professional mission, the quality of accompaniment, values, and ethical principles. Four types of stances emerged from the analysis performed according to the principles of the grounded theory: favorable in principle, (...) professional compromise, personal compromise, and opposed in principle. Each stance results from the combination of several dimensions: personal or professional concordance or compatibility with assisted suicide; implication in, and impact of, the process; appreciation of the process; and satisfaction with the resources at disposal. The differentiated stances adopted by professionals depend largely on their way of interpreting their mission, deontology, and the relationship to the older person. (shrink)

In Nigeria, reproduction is highly valued, with many people desiring to produce a child ‘in their own image and likeness’. Previously, aspiring parents often resorted to adoption. Today, the availability of assisted reproductive technologies (ARTs) has provided options other than adoption for those desiring to procreate. Through ARTs, aspirations for a family may be attained through an exchange of reproductive goods and services, and not necessarily through traditional heterosexual relationships. ARTs have altered the perception of parenthood as it exists in (...) Nigeria, and courts face a difficult task in defining parenthood within Nigerian jurisprudence, as they can only adjudicate based on extant law. Although ARTs provide greater individual choices for fulfilling the desire to procreate, they raise a number of ethical and legal issues that evolving legal systems, such as that in Nigeria, are ill‐equipped to manage. This paper describes the traditional assignment of parenthood under indigenous laws and other sources of law within the Nigerian jurisprudence. We carried out an in‐depth study of the Nigerian legislative framework and found that there are no laws directly regulating parenthood, procreation and ARTs in Nigeria. We also found that the extant laws are only tangentially related and do not answer the relevant questions sufficiently well, especially concerning succession, nationality and assignment of responsibility in collaborative reproduction. We conclude by highlighting the need for and recommending a regulatory framework on ARTs with a particular focus on providing a definition for parenthood achieved through ARTs in Nigeria. (shrink)

One area of ethical concern in higher education is writing services for graduate students, which can range from simple proofreading to rewriting content for flow, coherence, and structure to extensive content creation akin to ghostwriting. There are various ways to look at the use of writing services: 1) as a clear violations of ethics, presenting the student as a more capable writer than he or she is; 2) as a “necessary evil” resulting from greater numbers of individuals with inadequate writing (...) preparation entering university graduate programs; and 3) as a routine part of professional practice utilized by published writers who uniformly benefit from editing and proofreading. Professors, research advisors, and writing center tutors must face a range of ethical questions regarding writing assistance, particularly given that many graduate students, particularly those at the doctoral level, will soon be established professionals expected to guide others in the production of scholarly work. What are the ethical differences between types of writing assistance? What is the appropriate level of writing help for those in graduate programs? How does a strict stance on the editing of student papers reflect on the common practice of professional editing for publication—which can make published writers appear perhaps more capable than they really are? This article examines the complex issues those working with graduate students can face in trying to improve the writing they produce while also maintaining strong ethical standards regarding authorship and encouraging the learning process. It provides an overview of the ethical issues involved in writing services and extensive outside writing help provided to graduate students, and offers suggestions for creating a balance between compassion, professionalism, and honesty in graduate writing. It also proposes general ideas for offering appropriate assistance based on the type of writing in question—assistance that honors the learning process, demonstrates respect for the concept of authorship, and adheres to the concepts of Respect for Persons, Beneficence, and Justice outlined in the Belmont Report. (shrink)

Assisted dying is a divisive and controversial topic and it is therefore desirable that a broad range of interests inform any proposed policy changes. The purpose of this study is to collect and synthesize the views of an important stakeholder group—namely people with disabilities —as expressed by disability rights organisations in Great Britain. Parliamentary consultations were reviewed, together with an examination of the contemporary positions of a wide range of DROs. Our analysis revealed that the vast majority do not have (...) a clear public stance; those that do exhibit a significant diversity of opinion. DROs opposing legislation on assisted dying have argued that it would be premature, misguided, inequitable and culturally undesirable. Some specify conditions that would have to be satisfied before they could support legalisation, such as radical improvements in health and social care services and the elimination of discrimination against PwD. DROs supporting assisted dying maintain that a change in the law would promote autonomy, end intense suffering, can be delivered safely and is supported by the DRO’s membership. The discussion considers the reasons why several DROs adopt a neutral stance and the argument is made that, whatever their overarching stance on the issue, DROs need to be involved in the policy debate so that the crucial perspectives of PwD are heard and addressed. This is an important message for countries around the world that permit, or are considering legalising, assisted dying. (shrink)

Assistive technology has great potential to contribute to health, functioning, and quality of life. To date, as exemplified in the Canadian context, variations and inequities in access to assistive technology are evident; the development of legislation, policies, and programs has not kept up with the increasing use of assistive technology. In this article, we apply ;Daniels’s (2008) theory of just health to argue that equitable access to assistive technology funding and services is necessary for justice. In doing so, we offer (...) theoretical guidance for the development of legislation, policies, and programs to guide such access in health and social services. (shrink)

Our social relations are changing, we are now not just talking to each other, but we are now also talking to artificial intelligence (AI) assistants. We claim AI assistants present a new form of digital connectivity risk and a key aspect of this risk phenomenon is related to user risk awareness (or lack of) regarding AI assistant functionality. AI assistants present a significant societal risk phenomenon amplified by the global scale of the products and the increasing use in healthcare, (...) education, business, and service industry. However, there appears to be little research concerning the need to not only understand the changing risks of AI assistant technologies but also how to frame and communicate the risks to users. How can users assess the risks without fully understanding the complexity of the technology? This is a challenging and unwelcome scenario. AI assistant technologies consist of a complex ecosystem and demand explicit and precise communication in terms of communicating and contextualising the new digital risk phenomenon. The paper then argues for the need to examine how to best to explain and support both domestic and commercial user risk awareness regarding AI assistants. To this end, we propose the method of creating a risk narrative which is focused on temporal points of changing societal connectivity and contextualised in terms of risk. We claim the connectivity risk narrative provides an effective medium in capturing, communicating, and contextualising the risks of AI assistants in a medium that can support explainability as a risk mitigation mechanism. (shrink)

The objective of this paper is to describe the organization and modality of provision of clinical psychology services for those patients who had to be hospitalized due to COVID-19 during the pandemic in Northern Italy. The IRCCS Policlinico San Donato hospital in Milan was converted into a COVID-19 center in March 2020, and all the staff, including the Clinical Psychology Service Team, were diverted to assist these patients. A description is given of how the service was organized and (...) the modalities which were utilized to assist the patients. Following the pertinent ministerial decrees, guidelines, and relevant literature, the patients were followed up through telehealth. A COVID-19 rehabilitation unit was later opened in April 2020, where all patients were seen and followed up by the Clinical Psychology team, the last patient being discharged at the end of June. Details are given about the type of services provided during the hospitalization at the different points in time. At admittance and subsequent isolation, patients indicated by the medical and nursing staff, and those who specifically requested it, were given psychological support. Patients transferred to the COVID-19 rehabilitation unit were all evaluated for anxiety, depression, posttraumatic stress disorder, and sleep disorders both on admission and at discharge when possible. (shrink)

This paper interprets the British legislative process that initiated the first comprehensive national regulation of embryo research and fertility services and examines subsequent efforts to restrain the assisted reproduction industry. After describing and evaluating British regulatory measures, I consider successive failures to control the assisted reproduction industry in the US. I discuss disparities between UK and US regulatory initiatives and their bearing on regulation in other countries. Then I turn to the political and social structures in which the assisted reproduction (...) industry is embedded. I argue that regulatory bodies are seldom neutral arbiters. They tend to respond most readily to special interests and neglect strategies that could more effectively meet the health needs of the people they represent. Neither national nor international bodies have aggressively pursued policies to harness the industry, reduce infertility rates, or meet the needs of people whose fertility is threatened by substandard healthcare and environmental neglect. In conclusion, I consider recent initiatives by activist groups to mount an alternative response to the industry's current practices and build a transnational reproductive justice movement. (shrink)

Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among researchers seeking to investigate psychedelic therapies in active-duty service (...) members of the US military, particularly those with treatment refractory mental health conditions. At the same time, psychedelics remain in early stages of clinical investigation, have not yet achieved regulatory approval for general clinical use and may confer unique psychological and neurobiological effects that could raise novel ethical considerations when treating active-duty service members. Should psychedelics achieve regulatory approval, military relevant considerations may include issues of access to these treatments, appropriate procedures for informed consent, confidentiality standards, and possible unanticipated mental health risks and other psychological sequelae. A service member’s deployability, as well as their ability to return to full military duty following PAT, may also be of unique concern. The authors argue that MDMA-assisted therapy currently represents a promising treatment that should be more rapidly investigated as a clinical therapy for service members while still taking a measured approach that accounts for the many military-specific uncertainties that remain. (shrink)

The development of ethical and practice guidelines related to mental health service on the Internet has lagged behind the movement of practitioners into this area. Even for clinicians who are not offering services on the Web, the Internet has led to confusion and concern about proper roles and responsibilities. This article discusses an actual experience we had with a self-described rationally suicidal man with multiple sclerosis. After presenting some background on MS, we report initial interactions with the man verbatim (...) and summarize subsequent correspondence in an analysis of the man's claim that his decision to die was well reasoned and that he should be allowed a physician's assistance. (shrink)

This book paints a comprehensive portrait of Mexico’s system of assisted reproduction first from a historical perspective, then from a more contemporary viewpoint. Based on a detailed analysis of books and articles published between the 1950s and 1980s, the first section tells the story of how the epistemic, normative, and material infrastructure of the assisted reproduction system was built. It traces the professionalization process of assisted reproduction as a medical field and the establishment of its professional association. Drawing on ethnographic (...) material, the second part looks at how this system developed and flourished from the 1980s up to 2010, its commercialization process, how the expansion of reproductive services took place, and the messages regarding reproductive technologies that circulated within a wide discursive landscape. Given its scope and methods, this book will appeal to scholars interested in science and technology studies, reproduction studies, history of medicine, medical anthropology, and sociology. (shrink)