Showing papers in "Canadian Journal of Bioethics in 2021"
TL;DR: In this article, the authors present an experience pedagogique adossee a des logiques democratiques and epistemiques a ete proposee a des etudiants en sante.
Abstract: Quand des categories d’acteurs sont discredites, les inegalites epistemiques produisent des injustices testimoniales ou hermeneutiques. Ces injustices se manifestent par l’absence de reconnaissance des savoirs d’autrui et par le fait que sa faculte de comprehension soit mise en doute. De plus, bien que subissant des normes exogenes dans lesquelles elles ne se retrouvent pas, les personnes subissant ces injustices eprouvent des difficultes a se faire entendre et a identifier leurs propres normes. Ces deux types d’injustice alterent la qualite des relations de soins, en particulier sur le plan de l’ethique relationnelle en erodant la confiance entre soignes et soignants. Pour les contrer, une experience pedagogique adossee a des logiques democratiques et epistemiques a ete proposee a des etudiants en sante. Cette derniere comporte trois piliers : des enseignements sur le partenariat entre professionnels de sante et patients, des patients comme enseignants ou mentors et des patients comme collegues. Ces trois piliers sont presentes comme inter-relies, l’un n’allant pas sans l’autre. Sur le plan democratique, est vise un reequilibre des rapports de pouvoir. Ainsi, ce sont des patients qui recrutent les patients, selon des criteres qui leur sont propres et ces derniers ont un statut. Sur le plan epistemique, est vise un reequilibre des rapports de savoirs, ce qui conduit a interroger les savoirs et les normes a l’aune de leurs consequences sur les patients, plus exactement sur « l’experience patient ». Deux programmes pedagogiques differents et complementaires mis en oeuvre ont permis de constituer une experience pedagogique au sein d’une faculte de medecine (Universite Sorbonne Paris Nord) situee dans la ville de Bobigny, dite des lors « experience de Bobigny ». Il s’agit, pour l’un, de convoquer la « perspective patient » autour de la resolution de situations cliniques et pour l’autre, de convoquer la medecine narrative, afin de croiser les experiences d’etudiants et de patients autour de sujets precis.
6 citations
TL;DR: In this paper, a qualitative evaluation of the enjeux ethiques of enseignement en ergotherapie and leurs pistes de solutions is presented, and the results show that l’ethique occupe une place limitee dans la preparation and the formation continue des enenseignants en ergotherapy.
Abstract: Cet article consiste en la 2e partie des resultats d’une etude que notre equipe a menee sur les enjeux ethiques de l’enseignement en ergotherapie et leurs pistes de solutions. Tandis que le premier article de 2020 a mis en lumiere ces enjeux, le present article porte sur les moyens de les resoudre. L’ergotherapeute qui enseigne a des etudiants en ergotherapie est tot ou tard confronte a des enjeux ethiques. Or, ces enjeux sont peu documentes dans les ecrits, de meme que les pistes de solutions que les ergotherapeutes qui enseignent utilisent ou envisagent. Cette etude qualitative a permis a onze ergotherapeutes-enseignantes des quatre universites francophones du Quebec qui preparent la releve ergotherapique de partager leurs bons coups. Dix unites de sens relatives a ces pistes de solutions emergent des resultats, lesquelles ont ete regroupees suivant les trois domaines de l’ethique (micro, meso et macro) de Glaser. Les quatre pistes de solutions micro-environnementales sont : a) developper ses competences ethiques; b) se soutenir entre pairs; c) developper ses competences en lien avec sa tâche; et d) prendre soin de soi. Les quatre pistes de solutions meso-environnementales sont : a) creer des espaces de parole; b) offrir de la formation en ethique; c) faire de l’advocacy meso; et d) changer la culture academique. Les deux pistes de solutions macro-environnementales sont : a) faire de l’advocacy macro et b) travailler en partenariat avec les milieux cliniques. Bien que des pistes de solutions documentees dans les ecrits n’aient pas ete discutees par les participantes, celles que ces dernieres discutent rejoignent les pistes de solutions abordees dans les ecrits. Il ressort des resultats que l’ethique occupe une place limitee dans la preparation et la formation continue des enseignants en ergotherapie et que le contexte organisationnel, c’est-a-dire la culture du monde academique en general et de la recherche en particulier, est susceptible d’occasionner des enjeux ethiques preoccupants.
4 citations
TL;DR: In this paper, the authors argue that what matters in dementia and decision-making is an individual's personal identity with their prior self, not their moral personhood, and therefore, in considering when and how we ought to intervene in the decision making of those with dementia, we must look to the philosophy of personal identity rather than personhood.
Abstract: As older people begin to develop dementia, we confront ethical questions about when and how to intervene in their increasingly compromised decision-making. The prevailing approach in bioethics to tackling this challenge has been to develop theories of “decision-making capacity” based on the same characteristics that entitle the decisions of moral persons to respect in general. This article argues that this way of thinking about the problem has missed the point. Because the disposition of property is an identity-dependent right, what matters in dementia and decision-making is an individual’s personal identity with their prior self, not their moral personhood. Therefore, in considering when and how we ought to intervene in the decision-making of those with dementia, we must look to the philosophy of personal identity rather than personhood.
3 citations
TL;DR: The introduction of ImpactPro to identify patients with complex health needs suggests that current bias and impacts of bias in healthcare AIs stem from historically biased practices leading to biased datasets, a lack of oversight, as well as bias in practitioners who are overseeing AIs.
Abstract: The introduction of ImpactPro to identify patients with complex health needs suggests that current bias and impacts of bias in healthcare AIs stem from historically biased practices leading to biased datasets, a lack of oversight, as well as bias in practitioners who are overseeing AIs. In order to improve these outcomes, healthcare practitioners need to engage in current best practices for anti-bias training.
3 citations
TL;DR: In this paper, Sen's Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation.
Abstract: Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic.
2 citations
TL;DR: In this paper, the authors present results of a critical review of the literature discussing the ethical issues arising in humanitarian work, following the method proposed by McCullough, Coverdale and Chervenak.
Abstract: This article presents results of a critical review of the literature discussing the ethical issues arising in humanitarian work, following the method proposed by McCullough, Coverdale and Chervenak. Our aim was primarily to focus on how the ethical issues arising in humanitarian work are conceptualized within the literature we reviewed. We think that properly conceptualizing the ethical issues which humanitarian workers may face can provide avenues to better respond to them. We analysed 61 documents, as part of a literature review, which revealed that there truly is a need, amongst the authors and in humanitarian work, to discuss ethics. Indeed, even if only a small number of authors define explicitly the words they use to discuss ethics, the great quantity that we have uncovered in the documents seem to suggest vast and rich grounds upon which to address ethical issues. We believe it to be important that the ethical issues of humanitarian work are increasingly addressed in the literature and argue that it would be helpful for the vocabulary used by authors to be employed and developed even more rigorously, so that their discussions show more precision, coherence, relevance, exhaustiveness, and sufficiency. The review of the literature, as well as the resulting analysis in this article, is part of a broader project to suggest a way to conceptualize the ethical issues of humanitarian work based on the strengths and innovations of this and other studies.
2 citations
TL;DR: An analysis of the available kinds of AI systems, focusing on macro-level characteristics, argues that “grey box” systems, which include some combination of opacity and transparency, ought to be used in healthcare settings.
Abstract: The prospect of including artificial intelligence (AI) in clinical decision-making is an exciting next step for some areas of healthcare. This article provides an analysis of the available kinds of AI systems, focusing on macro-level characteristics. This includes examining the strengths and weaknesses of opaque systems and fully explainable systems. Ultimately, the article argues that “grey box” systems, which include some combination of opacity and transparency, ought to be used in healthcare settings.
2 citations
TL;DR: This brief commentary is primarily an attempt to draw attention to the normative questions: How much and what kinds of information should be included in clinical ethics documentation?
Abstract: This short perspective piece is about the documentation of clinical ethics consultation in Canada. It is written at a time when the Canadian Association of Practicing Health Care Ethicists (CAPHE) is endeavoring to develop standards of practice for clinical ethics in Canada. This brief commentary is informed by my experience working in clinical ethics in three different provinces, but it is primarily an attempt to draw attention to the normative questions: How much and what kinds of information should be included in clinical ethics documentation? Where should ethics consultation reports be saved, and who should have access to them? These questions are, more fundamentally, about how we should balance concern for privacy, confidentiality, professional integrity, accountability and the promotion of trust. They are also about where clinical ethics fits within the broader Canadian health system.
1 citations
TL;DR: In this paper, a comparative analysis of arguments on both sides of the issue that references such relevant considerations as: claimed moral authority, competing rights-based claims, obligations arising from patient welfare principles, formal justice, dissimilarity in consequences, and two illustrative arguments from analogy is presented.
Abstract: The contentious, topical debate about whether faith-based health care organizations should be granted accommodation on the basis of institutional conscientious objection to medical assistance is dying (MAiD) is addressed through a comparative analysis of arguments on both sides of the issue that references such relevant considerations as: claimed ‘moral-authority’, competing rights-based claims, obligations arising from patient welfare principles, formal justice, dissimilarity in consequences, and two illustrative arguments from analogy. The analysis leads to the conclusion that nonconditional accommodation on the basis of institutional conscientious objection to MAiD is not ethically acceptable in Canada. A compromise mechanism, consisting of a suggested set of pragmatic conditions, is proposed that could effectively balance the competing moral responsibilities that arise from this conclusion and a core assumption of the paper, i.e., that some dominant faith-based health institutions can legitimately request, and expect, that provincial/territorial governments pay them a measure of respect in their operational, health-care-delivery decision making because of these institutions’ long history of providing high quality, health care in Canada. It is further suggested that provincial/territorial governments only allow large, publicly funded, faith-based health care organizations to enact a conditional version of accommodation on the basis of institutional conscientious objection to MAiD in circumstances where the organization has entered into a formal agreement with the relevant health department to meet the proposed, compromise conditions (or a relevantly-similar set of conditions).
1 citations
TL;DR: In this article, the authors explored retired nurses' reflections on their experiences of ethical issues and decision making in various nursing practice settings throughout their careers and to glean recommendations for ethics in contemporary nursing practice.
Abstract: Context: Nurses are often hesitant to talk about ethical issues in their practice for many unique and valid reasons. What if the burden of risk was lifted upon retirement, even if just slightly? The purpose of this study was to explore retired nurses’ reflections on their experiences of ethical issues and decision making in various nursing practice settings throughout their careers and to glean recommendations for ethics in contemporary nursing practice. Methods: Data were collected via in-depth, individual, semi-structured interviews. Guided by an interpretive, descriptive approach, data were managed with NVivo v.11 and analyzed with an inductive, comparative, thematic approach. In northern Ontario, two nurse researchers co-interviewed eight retired nurses with decades of practice experience across diverse Canadian health care settings. Ethics approval was obtained through Lakehead University’s Research Ethics Board. Findings: Three themes emerged to address ethical issues in practice; these are creativity, resourcefulness, and a strong sense of community with other nurses. Further, the retired nurses’ collated reflections on ethics in practice are presented as the FIG model: Fellowship, Ingenuity, and Gumption. Conclusions: This study identifies ethical underpinnings that retired nurses have used to effectively respond to ethical issues in their practice. Those who are currently nursing, and nursing as a profession, may wish to recognize and retain these strategies in order to continue to deliver a high standard of quality, ethical care. Recommendations for practice, research, and education are offered.
1 citations
TL;DR: In this article, the authors argue that the lives of boxers, their relationships, their careers, and their futures, also require its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects.
Abstract: Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings. which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.
TL;DR: In this paper, the authors argue that authentic care relies upon capacities inherently reciprocal and responsive in nature, which ultimately precludes socially assistive robots from being useful caring tools, and they argue that such capacities inherently impair the ability of robots to be useful care tools.
Abstract: To date, ethical critiques of the use of assistive healthcare robotics have not closely examined the purported care relationship between such robots and their users. Drawing upon the work of care ethics scholars, I argue that authentic care relies upon capacities inherently reciprocal and responsive in nature, which ultimately precludes socially assistive robots from being useful caring tools.
TL;DR: In this paper, the authors examine les facteurs potentiels pouvant contribuer a la medicalisation de ces femmes and la maniere dont leur autonomie pourrait etre affectee par le syndrome des ovaires polykystiques (SOPK).
Abstract: Le syndrome des ovaires polykystiques (SOPK) est un trouble endocrinien repandu qui affecte environ 10% des femmes en âge de procreer. Bien qu’il soit principalement connu pour ses effets sur la fertilite, le SOPK est considere comme un facteur de risque pouvant mener au diabete de type 2. Il est egalement associe a des conditions comme les cancers hormono-dependants, les troubles psychiatriques ou encore les maladies cardio-vasculaires. La volonte de prevenir les conditions associees pourrait pousser a une plus grande medicalisation des femmes atteintes par le SOPK, notamment par d’eventuels depistages. Cet article examine les facteurs potentiels pouvant contribuer a la medicalisation de ces femmes et la maniere dont leur autonomie pourrait etre affectee par ce phenomene. Entre autres, l’article met en evidence comment la medicalisation faconne des representations collectives et individuelles par rapport aux notions de sante, de maladie et de traitement. Dans une perspective relationnelle de l’autonomie, il attire l’attention sur l’importance de reconnaitre comment la medicalisation influence ces representations et l’impact potentiel que cela pourrait avoir sur les femmes. Encourager la demedicalisation du SOPK par une approche visant a soutenir la sante pousse a interroger ces representations et fait partie des pistes de solution permettant de favoriser l’autonomie des femmes affectees par le SOPK. Il devient alors possible non seulement de controler la maladie, mais aussi de soutenir la sante, voire de faire les deux selon la situation individuelle.
TL;DR: It is argued that Canada has an ethical responsibility to offer more culturally inclusive long-term care for Indigenous peoples in Ontario.
Abstract: The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive long-term care.
TL;DR: A fictional case study addresses decision-making within the Chinese Immigrant culture and focusses on how this may influence the care team.
Abstract: Having hope that a terminally ill patient may recover is not an unfamiliar sight in intensive care units across the globe. However, cultural heritage may make it even tougher. This fictional case study, which is a collection of years of experience, addresses decision-making within the Chinese Immigrant culture and focusses on how this may influence the care team. A new initiative, the Goals of Care (GOC) team, is also described.
TL;DR: It is suggested that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly the principal activities of moral philosophy.
Abstract: Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it.
TL;DR: In this article, the authors pose the question ethique suivante: sur quels principes ethiques se baser pour effectuer le triage des patients who auront acces aux ressources quand elles sont insuffisantes pour repondre aux besoins de tous?
Abstract: La pandemie de COVID-19 remet a l’honneur la question ethique de l’allocation des ressources limitees, en termes d’acces a des soins intensifs et a des respirateurs. Se pose la question ethique suivante : sur quels principes ethiques se baser pour effectuer le triage des patients qui auront acces aux ressources quand elles sont insuffisantes pour repondre aux besoins de tous? Pour en debattre, deux references historiques de triage sont d’abord presentees ; l’une s’appuie sur un principe egalitaire de reponse aux besoins individuels, l’autre sur un principe d’utilite sociale. Apres avoir defini les conditions d’equite en tant qu’egalite procedurale et reponse adequate aux besoins, deux types de protocoles sont etudies en mettant l’accent sur les criteres d’equite et d’utilite qu’ils preconisent. Les types de protocoles sont ensuite compares en presentant leurs forces et leurs limites dans la reponse qu’ils apportent aux besoins populationnels et individuels. Notre analyse met en evidence la difficile conciliation entre les objectifs populationnels et les objectifs cliniques en situation de pandemie, tout en montrant qu’un protocole qui utilise comme outil le Sequential Organ Failure Assessment (SOFA) facilite cette conciliation.
TL;DR: This review examines Laurent Ravez’s book, Introduction a l’ethique de la sante publique, and highlights the importance of being familiar with public health ethics, both for those working in bioethics andthose working in public health.
Abstract: Ce compte rendu examine le livre de Laurent Ravez, Introduction a l’ethique de la sante publique et souligne l’importance d’etre familier avec l’ethique en sante publique, autant pour les gens oeuvrant en bioethique que celles et ceux qui travaillent en sante publique.
TL;DR: In this paper, an etude de cas fictive sinteresse a la question du droit a la vie privee et a la protection des autres biens de la personnalite, i.e., le nom, la voix et l'image, notamment lorsqu’une personne, soit-elle etudiante, stagiaire ou en recherche d'emploi, desire oeuvrer professionnellement dans l’etablissement ou el
Abstract: Cette etude de cas fictive s’interesse a la question du droit a la vie privee et a la protection des autres biens de la personnalite, qui incluent le nom, la voix et l’image, notamment lorsqu’une personne, soit-elle etudiante, stagiaire ou en recherche d’emploi, desire oeuvrer professionnellement dans l’etablissement ou elle ou ses proches entament une therapie.
TL;DR: Texts published in the “Educating for Professionalism” and “Law, Policy, and Society” sections of this volume serve as theorical starting points to establish a correlation between lack of medical training in sleep disorders and ethical dilemmas encountered by expert witnesses during trials related to problematic automatic behaviours that occurred during REM sleep.
Abstract: En 2008, l’American Medical Association Journal of Ethics a consacre un volume entier aux enjeux ethiques associes a la medecine du sommeil. Des textes publies dans ce volume parus sous les rubriques « Educating for Professionalism » et « Law, Policy, and Society » servent de points de depart tandis qu’une correlation est etablie entre la sous-representation de la medecine du sommeil dans les curriculums des programmes de medecine et les dilemmes ethiques rencontres a l’occasion de temoignages et de production de rapports medico-legaux lors de proces lies a des episodes de comportements automatiques survenus en sommeil paradoxal.
TL;DR: The authors conclude that providing a realistic view of the situation that the team is experiencing in this crisis and highlighting the positive facts and achievements could be a valuable means of help from medical educators behind the scenes.
Abstract: The current COVID-19 pandemic creates a difficult and unprecedented time. With each passing day, the care of the health team itself is essential; and not only physical care, but also for mental health. The authors describe their experience in disseminating recommendations through short videos to help professionals maintain an objective view of the reality they are experiencing. Thus, knowing how to tabulate daily the evolution of the patients that each professional has been entrusted to care for – the hospitalized, the deaths and, very importantly, the discharge of the recovered – provides a sense of reality. Cinema, an educational resource used in medical education, which is also included in these videos, helps to clarify the recommendations made above and to maintain emotional balance. The authors conclude that providing a realistic view of the situation that the team is experiencing in this crisis and highlighting the positive facts and achievements could be a valuable means of help from medical educators behind the scenes.
TL;DR: In this paper, a mise en situation is proposed, which interpelle plusieurs enjeux ethiques entourant la vie privee liee a l’usage de substances.
Abstract: Certains professionnels de la relation d’aide interviennent regulierement en region eloignee et isolee pour offrir differents soins et services. Cette situation est souvent vecue comme une epreuve dans la mesure ou il devient difficile pour eux de satisfaire leurs besoins lies a la vie privee sans compromettre leur professionnalisme. Nous proposons une mise en situation qui interpelle plusieurs enjeux ethiques entourant la vie privee liee a l’usage de substances. Cette mise en situation sera analysee selon differents cadres conceptuels. Si la situation proposee souleve plusieurs enjeux ethiques, nous verrons que les cadres conceptuels utilises pour reflechir et deliberer sur la situation posent eux-memes des enjeux ethiques. Nous terminerons en montrant que si le professionnel vise le bien, le risque de nuire est egalement present. Il en decoule qu’il y a du tragique dans la vie ethique si la reflexion et la deliberation s’appuient sur un seul cadre conceptuel.