347 research outputs found

    Where Do I Go to Wait? Ethical Considerations During the 90 Day Reflection Period for MAiD

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    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?La lĂ©gislation canadienne sur l’aide mĂ©dicale Ă  mourir (AMM) a changĂ© en 2021 ; les personnes n’ayant pas de mort naturelle raisonnablement prĂ©visible (MNPR) peuvent dĂ©sormais ĂŞtre Ă©ligibles Ă  l’AMM et doivent attendre au moins 90 jours avant leur intervention. Ce changement lĂ©gislatif a soulevĂ© une nouvelle question Ă©thiquement complexe, que nous explorons dans ce commentaire, Ă  savoir : OĂą les personnes qui ne sont pas en Ă©tat de MNPR doivent-elles attendre (pendant 90 jours) dans un système de santĂ© financĂ© par l’État

    Online Portals for Sharing Health Research: Comparative Guidance amid Regulatory Uncertainty

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    Online resources offer a uniquely efficient way of sharing health research with scientists and the public. Using web portals to make results and study information available to diverse audiences could work to accelerate research translation and empower patients to play a more active role in their care. But using online tools to broadly share health information raises several challenging ethical and regulatory questions. Issues such as equity, privacy, and patient empowerment may create challenges for regulators, portal developers, as well as researchers. It is additionally unclear whether web portals designed to facilitate access to research results and general health information will be regulated as medical devices under emerging regimes that control software with medical purposes. This paper aims to comparatively address whether online therapeutic portals for sharing health research are likely to be regulated in Canada, the United States, the United Kingdom, and France. We find that though these jurisdictions have each taken recent steps to regulate software as medical devices, the applicable regimes will generally not capture online portals for sharing health research. Though online portals for sharing health research are probably unregulated in many (if not most) jurisdictions, agencies have nevertheless signalled their concerns regarding several important ethical considerations (such as equity, transparency, and safety), to which portal developers and researchers should be attentive and respond. We describe here one set of issues highlighted by regulators – that is, efficiency, equity, transparency, confidentiality, communication, empowerment, training, and safety & efficacy – and consider how to best guide the design of online portals in a context of regulatory uncertainty

    For Women Only? Reconsidering Gender Requirements for Uterine Transplantation Recipients

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    Uterine transplantation is an experimental procedure currently available only to cisgender women recipients suffering from absolute uterine factor infertility. Clinicians, researchers, and advocates have advanced the possibility of providing these quality-of-life transplantations to transgender women. This article examines the ethical and practical implications of removing sex- and gender-based requirements entirely for uterine transplantation recipients. Given the significant costs and risks, and the modest quality-of-life benefits, ethical arguments against offering uterine transplantations to people who do not identify as women but are otherwise suitable recipients are dubious and prejudicial. Successful uterine transplantations with non-women recipients could potentially diminish the socio-cultural connection between uterine functionality and womanhood, which is a key motivation for women now seeking this high-risk procedure

    Frameworks and Practices in Bioethics

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    I begin this essay with an autobiographical introduction to explain why I studied philosophy and how I came to work in bioethics. I then consider three ethical frameworks and practices that I adopted in my work in bioethics. I begin with the framework that John Rawls makes explicit, where the purpose of ethical theory is to set out aims and objectives to guide our responses to the world. Since this approach did not provide the guidance that I was looking for, I took up writing haiku as an ethical practice. I present here many examples of haiku that I wrote to pay attention to situations in life and bioethics. The hope was that paying attention would lead me to respond in better ways. Since this practice helped me more with attending than responding, I turned to a third framework. Here I explore John Dewey’s ethical framework. After characterizing this framework, I consider features that an associated practice needs to have. In a brief conclusion, I note some affinities between the second and third ethical approaches, and note that the last ethical framework adopted may just be the latest stage in trying out frameworks and practices.Je commence cet essai par une introduction autobiographique pour expliquer pourquoi j’ai étudié la philosophie et comment j’en suis venue à travailler en bioéthique. Je considère ensuite trois cadres et pratiques éthiques que j’ai adoptés dans mon travail en bioéthique. Je commence par le cadre explicité par John Rawls, où le but de la théorie éthique est de définir des buts et des objectifs pour guider nos réponses au monde. Comme cette approche ne fournissait pas l’orientation que je recherchais, j’ai adopté l’écriture de haïkus comme pratique éthique. Je présente ici de nombreux exemples de haïkus que j’ai écrits pour prêter attention à des situations de la vie et de la bioéthique. L’espoir était que le fait de prêter attention m’amènerait à réagir de meilleures façons. Comme cette pratique m’a davantage aidée à faire attention qu’à répondre, je me suis tournée vers un troisième cadre. Ici, j’explore le cadre éthique de John Dewey. Après avoir caractérisé ce cadre, je considère les caractéristiques qu’une pratique associée doit avoir. Dans une brève conclusion, je relève certaines affinités entre la deuxième et la troisième approche éthique, et je note que le dernier cadre éthique adopté n'est peut-être que la dernière étape de l'essai de cadres et de pratiques

    Allen Buchanan, Our Moral Fate (2020)

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    In debates surrounding the biomedical enhancement of human morality, it is widely believed that morality was evolutionarily shaped to be rigidly tribal. Allen Buchanan challenges this assumption by making the case that a plastic morality that responds to our environment would be evolutionarily favored, and thus the best way to shape human morality going forward would not be through biomedical interventions, but by designing better institutions.Dans les débats entourant l’augmentation biomédicale de la moralité humaine, il est largement affirmé que la moralité a été façonnée au cours de l’évolution pour être rigidement tribale. Allen Buchanan remet en question cette hypothèse en faisant valoir qu’une moralité plastique qui répond à l’environnement serait évolutionnellement privilégiée, et donc que la meilleure façon de modifier la moralité humaine à l’avenir ne serait pas par des interventions biomédicales, mais par la conception de meilleures institutions

    A Scoping Review of Ethical and Legal Issues in Behavioural Variant Frontotemporal Dementia

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    Behavioural variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia characterized by changes in personality, social behaviour, and cognition. Although neural abnormalities cause bvFTD patients to struggle with inhibiting problematic behaviour, they are generally considered fully autonomous individuals. Subsequently, bvFTD patients demonstrate understanding of right and wrong but are unable to act in accordance with moral norms. To investigate the ethical, legal, and social issues associated with bvFTD, we conducted a scoping review of academic literature with inclusion & exclusion criteria and codes derived from our prior work. Among our final sample of fifty-six articles, four mentioned bvFTD patient-offenders as unfit to stand trial by insanity, and sixteen mentioned the use of dementia evidence in a court of law to better understand the autonomy of bvFTD patients. Additional emergent issues that were discovered include: training police officers to handle situations involving bvFTD patients and educating healthcare providers on how to help caregivers navigate bvFTD. The current literature highlights the inadequacy of traditional applications of medico-legal categories such as autonomy, capacity and competence, in informing cognitive capacity assessments in clinical and legal settings and deserves consideration by neuroethicists

    Chronique du cinéma 2 : De son vivant – apprivoiser le mourir

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    Apprivoiser et penser le mourir par le biais du cinéma, c’est peut-être une des possibilités offertes par ce long métrage d’Emmanuelle Bercot mettant en vedette Benoît Magimel et Catherine Deneuve. Le film De son vivant aborde de manière frontale la question de la fatalité, au travers du récit de vie, et de mort, d’un jeune quadragénaire atteint d’une maladie dont le sombre pronostic ne fait aucun doute. Nous y suivons Benjamin, dans la dernière année de sa vie, alors que ce dernier affronte, l’inéluctable de sa finitude annoncée dans ce délai posé clairement : de six mois à un an. Se faisant, il se trouve plongé, ainsi que ses proches, de manière radicale, au cœur de ses questions existentielles, placé devant une série de choix qui se posent à lui, malgré – ou grâce à – la réalité de sa mort. Les nombreux enjeux éthiques rencontrés tout au long de son parcours sont exposés pour toutes les personnes impliquées : soignants, patient et proches

    Les restes humains : législation, intérêt scientifique et enjeu éthique des ensembles anthropobiologiques, de Yann Ardagna et Anne Chaillou

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    Compte rendu du livre de 2022 par Yann Ardagna et Anne Chaillou, Les restes humains : législation, intérêt scientifique et enjeu éthique des ensembles anthropobiologiques.Review of the 2022 book by Yann Ardagna and Anne Chaillou, Les restes humains : législation, intérêt scientifique et enjeu éthique des ensembles anthropobiologiques

    The “Third” Eye: Ethics of Video Recording in the Context of Psychedelic-Assisted Therapy

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    Après des cas très médiatisés d’agressions sexuelles et d’autres comportements contraires à l’éthique de la part de thérapeutes, la recherche clinique récente sur les drogues psychédéliques a généralement rendu obligatoire l’enregistrement vidéo de toutes les séances de thérapie. Dans cet article, j’examine les questions éthiques liées à l’enregistrement vidéo dans le contexte unique des séances de thérapie psychédélique. Je commence par résumer les avantages et les risques importants liés à l’enregistrement vidéo, puis ensuite les préoccupations éthiques concernant l’enregistrement obligatoire des séances de thérapie psychédélique du point de vue du patient, et je soutiens que ces préoccupations doivent être prises au sérieux par les cliniciens et chercheurs. J’examine également le point de vue selon lequel l’enregistrement vidéo est essentiel pour la sécurité des cliniciens. Acceptant la légitimité des préoccupations des deux points de vue, j’expose quelques considérations de base sur le consentement éclairé qui pourraient générer un dialogue autour des préoccupations potentielles des patients. Je défends l’option de refuser, tant pour les patients que pour les cliniciens. En conclusion, je souligne l’importance de poursuivre l’enquête bioéthique critique et la recherche qualitative concernant les pratiques d’enregistrement vidéo dans le contexte des thérapies assistées par les psychédéliques.In light of high-profile cases of sexual assault and other unethical conduct by therapists, recent clinical research involving psychedelic drugs has generally mandated the video recording of therapy sessions. In this paper, I address a gap in the literature by investigating ethical issues related to video recording in the unique context of psychedelic therapy sessions. I begin by summarizing the important benefits and risks related to video recording. I then examine ethical concerns about mandatory recording of psychedelic therapy sessions from a patient perspective and argue that these concerns must be taken seriously by clinicians and researchers. I also examine the view that video recording is essential for clinician safety. Given the legitimacy of concerns from both perspectives, I outline some basic informed consent considerations that could generate dialogue around potential patient concerns and defend the option to opt-out for both patients and clinicians. In conclusion, I underscore the importance of further critical bioethical inquiry and qualitative research regarding video recording practices in the context of psychedelic-assisted therapies

    Causes for Conscientious Objection in Medical Aid in Dying: A Scoping Review

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    In the light of current legislation on Medical Aid in Dying ─euthanasia and assisted suicide─ in different countries worldwide, there have been some arguments devoted to the right to conscientious objection for healthcare professionals in these specific practices. The goals of this scoping review are to provide an overview of the motivations and causes that lie behind conscientious objection identified by previous literature according to professionals’ experience and to verify if these motives match with theoretical debates on conscientious objection. As the results show, there seems to be a dissonance between the motivations included in the traditional and mainstream definition of conscientious objection that is used in the theoretical and speculative framework and the actual factors that empirical studies note as reported motivations to object to Medical Aid in Dying. Hence, either we consider new factors to include as causes of “conscience”, or we accept that there are motivations that are not actually applicable to conscientious objection and should be addressed by other means. As conscientious objection in Medical Aid in Dying is multifaceted, we claim from the results that there can be different kinds of motivations acting at the same time. In any case, it is helpful to rebalance theoretical and empirical considerations to fully understand the complexity of the phenomenon and give some insights on how to deal with it.&nbsp
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