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Enhancing Moral Conformity and Enhancing Moral Worth - Online First - Springer

Enhancing Moral Conformity and Enhancing Moral Worth - Online First - Springer | My favorite as a bioethicist | Scoop.it

It is plausible that we have moral reasons to become better at conforming to our moral reasons. However, it is not always clear what means to greater moral conformity we should adopt. John Harris has recently argued that we have reason to adopt traditional, deliberative means in preference to means that alter our affective or conative states directly—that is, without engaging our deliberative faculties. One of Harris’ concerns about direct means is that they would produce only a superficial kind of moral improvement. Though they might increase our moral conformity, there is some deeper kind of moral improvement that they would fail to produce, or would produce to a lesser degree than more traditional means. I consider whether this concern might be justified by appeal to the concept of moral worth. I assess three attempts to show that, even where they were equally effective at increasing one’s moral conformity, direct interventions would be less conducive to moral worth than typical deliberative alternatives. Each of these attempts is inspired by Kant’s views on moral worth. Each, I argue, fails.


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L'expert prédateur et les finances publiques | The Shunshine act as an inspiring tool

L'expert prédateur et les finances publiques | The Shunshine act as an inspiring tool | My favorite as a bioethicist | Scoop.it
L’avantage d’un vrai débat public avant une opération austérité c’est qu’il permet de dégager des priorités qui donneront sens ensuite à chacune des décisions. Quand, pour gagner du temps, on refuse un tel débat, on accroît le risque d’un sentiment g...
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Jacques Dufresne pose des questions auxquelles nous devons nou attarder:

Et la loi 20: accroître la productivité des médecins est certes politiquement fructueux, mais cette décision pourrait résulter en une augmentation des dépenses plutôt qu'en une diminution, comme cela nous le laisse entendre. La décision, quant à elle, de limiter les dépenses relatives à la procréation assistée, apparaît s'attaquer au problème de fond: «la médicalisation de la population».


Dufresne continu en questionnant le fait que les pratiques «mafieuses» et ses «effets ruineux» sur les finances publiques, dans le contexte actuel, ne sont pas au coeur du débat public.

 

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Jahi McMath family wants brain dead ruling reversed

Jahi McMath family wants brain dead ruling reversed | My favorite as a bioethicist | Scoop.it
An attorney for the family of Jahi McMath says he has new evidence she is alive and will be petitioning to court to have her death declaration reversed. 

Arthur Caplan, director of the division of medical ethics at the New York University School of Medicine, said Jahi's recovery -- if true -- would be "miraculous since she was declared dead three times.

"This would force us to re-exmaine the whole nature of death in America," he said. "But I don't believe it."

And Stanford bioethics professor David McManus called into question the findings, because the examination was not done independently.

"I haven't seen any signs or evidence that they have had such an evaluation," he said. "The rest is smoke and mirrors."

Brain dead "patients don't recover -- it's irreversible," he said. "That would be groundbreaking, and a dramatic finding that would be problematic for the entire neurological community."


Read more: http://www.upi.com/Top_News/US/2014/10/03/Family-of-girl-declared-brain-dead-wants-ruling-reversed/6691412350736/#ixzz3FOnCLZ2Q
Marie-Josée Potvin's insight:

This case notably shows the suffering experience of grieving families facing the "technical Hope" mostly nourished by an advances of modern technological science; while we prolonge life, we also  prolonge hope.

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Caricature du 21 septembre 2014 : Le Dr Barrette et le réseau de la santé | Cari

Caricature du 21 septembre 2014 : Le Dr Barrette et le réseau de la santé | Cari | My favorite as a bioethicist | Scoop.it
Caricature du 21 septembre 2014 : Le Dr Barrette et le réseau de la santé Caricature du 21 septembre 2014
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Ce n'est pas moi qui l'ai dit...

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Remedial action requested of United Nations | #Quebec Euthanasia #Bill52 Violates International Law | Door step to child euthanasia?

Remedial action requested of United Nations | #Quebec Euthanasia #Bill52 Violates International Law | Door step to child euthanasia? | My favorite as a bioethicist | Scoop.it

«Quebec’s proposed law on euthanasia will allow a lethal substance to be injected into an adult person at “the end of life” (which is not defined in the proposed law) who has unsupportable suffering.»

«Quebec’s health care system is managed by the provincial government of Quebec, Canada. This system is plagued by deficiencies including lack of access to family doctors [for 25% of its population], to pediatricians for children and to specialists and specialized tests [resulting in long wait-times].

Moreover, up to 80% of its people lack access to palliative care in some regions.

Thus, many Quebecers will be forced to accept a lethal injection to end their suffering when faced with the possibility of dying painfully without access to adequate health and palliative care.

In the video: “Quebecers call out to the world,” different citizens from a cross section of Quebec society share their personal stories and explain the dangers and abuses that would follow if such a law is enacted.»

French version: http://coalitionmd.org/demande-dintervention-du-secretaire-general-des-nations-unies-loi52-quebec/

Bill 52: http://www.assnat.qc.ca/Media/Process.aspx?MediaId=ANQ.Vigie.Bll.DocumentGenerique_72865en&process=Default&token=ZyMoxNwUn8ikQ+TRKYwPCjWrKwg+vIv9rjij7p3xLGTZDmLVSmJLoqe/vG7/YWzz

Marie-Josée Potvin's insight:

If the Bill proposes a contemporary debate that we can't avoid, the actual socio economical context along with the overall « societal ethical maturity»  in which this Bill is proposed, may well not be the best timing. Are the lack of access to appropriate palliative care, ressources limitations (economical and human), a dominant technological and economical culture within the healthcare system, a generalised inadequate pain management strategy some issues that needs to be seriously addressed before we engage in the arena of life and death in such a direct manner? If, for example, we can't provide adequate support for people to live, in a dignify manner, the time left before their iminent death (e.g., access to palliative care), how are we going to support them for a «human» death experience? The Bill may be a pertinent contemporary debate, but I think that our society overestimates its capapcity (both moral and strustural) to take further the right for «autonomy» .

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«Extension de l'euthanasie aux mineurs en Belgique: fin à une hypocrisie? »

«Extension de l'euthanasie aux mineurs en Belgique: fin à une hypocrisie? » | My favorite as a bioethicist | Scoop.it

«La loi votée ce soir offre une possibilité de soulager une fin de vie douloureuse et pénible. Elle n'est que la continuité de la législation en vigueur pour les adultes et va permettre de mettre fin à une hypocrisie : la pratique de l'euthanasie pour les enfants existait, mais sans cadre légal. La souffrance d'un enfant est la même que celle d'un adulte. C'est terrible d'imaginer que son enfant va mourir, mais la question est de savoir si on laisse la vie suivre son cours ou si on l'aide à partir. Je suis rassuré par le texte, car il pose des balises et notamment que la maladie soit irréversible et que la seule issue soit la mort.»

Marie-Josée Potvin's insight:

Si notre première réaction à l'égard d'une telle initiative peut susciter de vives émotions, il demeure important, à titre de professionnelles de la santé, de considérer la multiplicité des perspectives soulevées par cette délicate question de l'euthanasie chez les enfants. Cet article qui rend compte du point de vue de Daniel Soudant, ancien conseiller au Sénat belge, confronté à la maladie de son enfant et à sa mort précoce, est un excellent témoignage qui peut permettre de mieux comprendre la position de ceux et celles qui valorisent une telle alternative. 

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U de T Student complaints before Human Rights body: too shy to attend women's filled class...

U de T Student complaints before Human Rights body: too shy to attend women's filled class... | My favorite as a bioethicist | Scoop.it

«The Ontario Human Rights Tribunal has dismissed a complaint by University of Toronto student Wongene Daniel Kim, who accused his professor of discriminating against him as a male when she docked him marks for not coming to class because he was too shy to be the only guy.»

«The second-year health science major arrived at the opening of a Women and Gender Studies course for which he had signed up in the fall of 2012 — “It had spaces left and fit into my timetable” — only to discover a room full of women and nary a man in sight.»

«The case comes weeks after York University came under fire for not supporting a professor’s refusal to let a male student be excused from face-to-face group work with female students in an online sociology course because it would violate his religious practice.»

 

Marie-Josée Potvin's insight:

Human rights violation may be the violations of the use (abuse) of this fundamental right itself. Mr Kim is going to be shy for the right reason...hopefully.

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Physician's Social responsibility | Spike In Heroin Use Can Be Traced To Prescription Pads

Physician's Social responsibility | Spike In Heroin Use Can Be Traced To Prescription Pads | My favorite as a bioethicist | Scoop.it

"You didn't usually think of heroin as suburbia, as rural America, and that's what we're seeing," says Joseph Moses, spokesman for the Drug Enforcement Administration.

"The main reason they switched to heroin is because heroin is either easier to access or less expensive than buying painkillers on the black market," he says.

Kolodny says the statistics are stark. Areas with the highest rates of opioid or heroin addiction are often wealthier areas, where people have more access to medical care. With medical care comes access to doctors — doctors who could write prescriptions.

"Often [it was] a doctor who meant well," Kolodny says, "not a doctor who was a drug dealer, but a doctor who may have been under the impression that the compassionate way to treat a complaint of pain was with an aggressive opioid prescription."

Marie-Josée Potvin's insight:

The death of actor Philip Seymour Hoffman has brought our attention to questionned the rise of heroin addiction in more socially and economically privileged population in the US. To prescribe pain killer to treat some medical conditions may certainly be based on an excellent professional judgment. The fact is that statistics shows that the medical  profession should be more proactive in thinking about long term social impacts when prescribing medication such as painkillers.

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Assisted Suicide | New England Journal of Medicine (368; 1450-1452, 2013)

Assisted Suicide | New England Journal of Medicine (368; 1450-1452, 2013) | My favorite as a bioethicist | Scoop.it
“Therapeutic homicide” should not be included among the palliative care options. Euthanasia and healing patients are intrinsically incompatible.

"(...) the role of the physician is not only to preserve life, but to alleviate suffering, which entails, in her opinion, ensuring that dying patients are as comfortable as possible"

Marie-Josée Potvin's insight:

Assisted suicide is a highly complex topic that should be apprehended as such. Being in favor or not should not be independant options from which professionals base their reflexion and action, nor should this be for policy makers. This article may well help better undestand the complexity of the problematic and oblige to make the needed effort to argument and counter argument for one's position in a reflexive manner. Ethics is about the courage to challenge one's perspective in order to access one's inner "spaces" of flourishing unconfort.

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Série Compassion Series

Thalasso Bain Bebe Video - Baby Bath video - Sonia Rochel Video FACEBOOK : SoniaBabyBath (Sonia Rochel) SITE INTERNET (en construction) : www.soniarochel.com...
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Confusion between integrity and intellegence | Johns Hopkins medical unit in a delicate position

Confusion between integrity and intellegence | Johns Hopkins medical unit in a delicate position | My favorite as a bioethicist | Scoop.it

"A surprising force has helped industry defeat black lung benefits claims for ailing miners: Johns Hopkins University."

"When it comes to interpreting the chest films that are vital in most cases, Wheeler is the coal companies’ trump card. He has undergraduate and medical degrees from Harvard University, a long history of leadership at Johns Hopkins and an array of presentations and publications to his credit. In many cases, judges have noted Johns Hopkins’ prestige and described Wheeler’s qualifications as “most impressive,” “outstanding” and “superior.” Time and again, judges have deemed him the “best qualified radiologist,” and they have reached conclusions such as, “I defer to Dr. Wheeler’s interpretation because of his superior credentials.”

 

"For decades, Dr. Paul Wheeler has led a unit of radiologists at Johns Hopkins who often are enlisted by the coal industry to read X-rays in black lung benefits cases. The Center for Public Integrity identified more than 1,500 cases decided since 2000 in which Wheeler was involved, reading a total of more than 3,400 X-rays. In these cases, he never found a case of complicated black lung, and he read an X-ray as positive for the earlier stages of the disease in less than 4 percent of cases. Subtracting from these the cases in which he ultimately concluded another disease was more likely, this number drops to about 2 percent."

 

Marie-Josée Potvin's insight:

Here is an excellent example of how, in our society, there exists a confusion between «intelligence» and integrity. Being ethically mature as a healthcare professionnal certainly necessitates to develop an excellent ethical judgment which requires a certain level of rational intelligence. Nevertheless this is not sufficient; ethical maturity  involves the development of both emotional and rational capacities. Ethical sensitivity, judgment, motivation and character are the four main processes involved in ethical behavior (Rest, 1983).

Because professional ethics teaching focuses mainly on the rational dimension of the moral experience, there is a risk to find such an unethical profil among outstanding leaders in different healthcare professions. Strangely, while these types of individuals are quite easy to detect by some experienced individuals, they still gain good respect from a fair amount of organisations and professionals.

Dr Wheeler (and two of his colleagues) has done great damages to patients, other colleagues and his profession, and yet shows no remorse.

There is a need for «serious» professional ethics teaching among healthcare professionals that involves the courage and expertise (and the necessary supportive infrastructure) to be able to identify these types of individuals - that are poorly suited to enter HCP - from early stages of their professionals education.

 

 

 

 

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COI | Are healthcare professionnals angels? NO

COI | Are healthcare professionnals angels? NO | My favorite as a bioethicist | Scoop.it
The Government Accountability Office found that many doctors who recommended a common prostate cancer therapy had financial relationships with treatment providers.

 

“Some physician groups are steering patients to the most lucrative treatment they offer, depriving patients of the full range of treatment choices, including potentially no treatment at all,” said Dr. Steinberg, who is the chairman of radiation oncology at the U.C.L.A. medical school.»

 

«Representative Sander M. Levin of Michigan, the senior Democrat on the Ways and Means Committee, said that “this analysis confirms that financial incentives, not patients’ needs, are driving some referral patterns.”

 

«Dr. Deepak A. Kapoor, the president of the Large Urology Group Practice Association, which represents 2,200 urologists, said, “The G.A.O. greatly overstated the role of financial motives in treatment decisions and understated the importance of patients’ wanting to have their treatment in the offices of doctors who specialize in prostate cancer.”

Moreover, Dr. Kapoor said, “Prostate cancer treatments are shifting from hospitals to physician offices, where they cost less for patients and for the Medicare program.”

 

«But other doctors applauded the report. Dr. Michael L. Steinberg, the chairman of the American Society for Radiation Oncology, which represents more than 5,000 doctors, said, “We are extremely concerned that many older male patients are receiving possibly unnecessary treatment by urology groups.”

 

Marie-Josée Potvin's insight:

Healthcare professionals (HCP) are not immune against conflict of interest or any other deceptive ethical behaviors. Being a HCP does not mean that you are automatically an ethically reliable person, we all wish that this would be the case...unfortunately, it is not.

This is an excellent example which notably put into light that some HCP have some work to do in terms of moral maturity. My research show that whatever rules you put into place, these, apart from setting more difficult path to deceptive behviors, are unlikely to impact on those individuals who profit from their patient's vulnerability.

After all, it's probably easier, eventually less painfull, to believe, in the first place, that doctors, nurses, psychologist or bioethicists are fundamentally persons of integrity. Well, they may, in many cases, certainly be, but then, we are all human beings.

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Psychology professor had dark secret: He killed his family 46 years ago - Chicago Sun-Times

Psychology professor had dark secret: He killed his family 46 years ago - Chicago Sun-Times | My favorite as a bioethicist | Scoop.it
A psychology professor at Downstate Millikin University killed his parents and sister 46 years ago when he was a teenager, a revelation that has jolted the bucolic liberal arts college that has employed him for nearly three decades and sparked...
Marie-Josée Potvin's insight:

He changed his name for James St-James; James was not so saint as his new name would suggest. I don't want to go into legal aspects of this case even try to «ethically solve» it. Being of legal, ethical and psychological interest, I believe that it should more be taken as an «inspirational» case for reflexive thinking.

As my research aimed (in a very simplified way) at better understanding why people are prompt to act or not ethically (and how they developed and interiorised these  skills), this case is of some interest in many ways. I will briefly focus on one particular perspective that is at the heart of a research article I am currently working on and that will be proposed for publication in the next week or two.

I am always astonished to realised how little attention is given to people's identity when it comes to enter programs such as psychology, bioethics and many other disciplines concerned with human development. The fact is that «who someone is» is the main tool from which we work with vunerable people who seek help from healthcare professionals (HCP). Having killed three people is not a minor event...for a to be psychologist. No one is perfect; we all had a more or less imperfect childhood which impacts on who we are today. This case is extreme, but how many times in my twenty years teaching and professional career  have I encountered people that were not meant to be HCP or not ready to become so. Immaturity do not necessarelly end up in killing people, but it may have negative consequences on patients and communities (e.g., lack of respect, abandon, aggressive behavior). If university does not find ways to better grasp applicant's personality and develop a better understanding on fundational identity caracteristics which play a role in ethical behaviors, we will still encounter these kinds of case in a more or less dramatic manifestations. Being rationally intelligent is not sufficiant, one has to have a certain «inner self terrain» in order to become an ethically mature individual. Any «ethical» behavior (e.g., how to do, how to say) can be superficially learned and replicated to please social expectations. If these superficial ethical manifestations may go unoticed to those who have a limited ethical  sensitivity or ethical maturity, they are unlikely to pass the test of those who have intensively work on themselves and embodied ethical values and standards.

Do not only blame the person who made it to a professor position in psychology after having killed three people... but think about the criterias from which people are recognised as «remarquable» in our societies.

To become a HCP is not an easy job as I am demonstrating in my coming article about professional identity and hopefully, one day, we, as a society, will understand that human standards should not be limited to rational criterias when it comes to engage in a HCP, including bioethics.

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«Against obesity» (Daniel Callahan) and Callahan

Stigmatizing obesity will harm, bioethicists claim
BioEdge
Daniel Callahan has again been chastised for his view that obesity should be stigmatized.

«In his recent article, “Obesity: Chasing an Elusive Epidemic,” Daniel Callahan laments the evidence suggesting that despite intensive devotion of resources, relatively little progress has been made in countering obesity in the United States. He recommends three categories of interventions: “strong and most likely coercive public health measures,” “childhood prevention,” and “social pressure on the overweight.” Our response focuses on the third strategy, which is misguided on several fronts. Not only does weight stigmatization impose psychological and social harm, but it fails as an incentive for improving health behaviors and may instead reinforce obesity. Obese individuals are already highly stigmatized, despite their attempts to lose weight and despite the significant sociocultural and economic conditions that contribute to obesity, which is where our efforts should be focused. Even if obesity stigma were entirely effective, we submit that its use still violates ethical norms of social justice.»

Marie-Josée Potvin's insight:

This is a part of one of six commentaries on “Obesity: Chasing an Elusive Epidemic,” by Daniel Callahan, from the January-February 2013 issue of the Hastings Center Report. Callahan never leaves the room without making some noise. While his positions often bring in the arena of bioethics intense emotional reactions, he certainly does not seems to follow the crowd. You are pro or con? Take a minute, a real one where you will truly reflect upon your own hidden ideas about obesity. Many of you will meet some «dark» sides that, of course, are not what a good bioethicist or professional usually should carry in their vision of the world.

How many of us has thought that obese people have become big because «they chose to eat», «they have no willpower»; it is their entire fault. How many of us have loocked critically at what an obese person was eating at a restaurant?

The problem does not rely on our prejudices, but on the way we mask them to avoid being ourselves stigmatized as having prejudices...something that a well intentioned professional should not have...even more bioethicists.

One day, eating at a restaurant, I met a waitress who said, in a very affirmative way, «I am against obesity». I found this affirmation of a first level. Maybe Callahan has the courage to say out loud what many think silently.

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JUST FOR A CRY | Publisher sets high bar: Only articles "with lowest plagiarism" will be accepted

JUST FOR A CRY | Publisher sets high bar: Only articles "with lowest plagiarism" will be accepted | My favorite as a bioethicist | Scoop.it
Maybe you can be a little bit pregnant after all. At least, that’s what the editors of the Journal of Innovations in Pharmaceutical and Biological Sciences would have submitters believe. In a rathe...
Marie-Josée Potvin's insight:

It's always possible to publish and not perish when one has little concern for integrity in science.

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Panel Urges Overhauling Health Care at End of Life

Panel Urges Overhauling Health Care at End of Life | My favorite as a bioethicist | Scoop.it

«The committee said the health care system was geared toward delivering costly additional care that patients often do not want. 

Many of the report’s recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning. Medicare, which covers 50 million Americans and whose members account for about 80 percent of deaths each year, is considering doing just that, prompted by a recent request from the American Medical Association. Some private insurers are already covering such conversations, and many more would if Medicare did.»

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OIIQ et projet de loi 52 - soins de fin de vie | Mémoire

OIIQ et projet de loi 52 - soins de fin de vie | Mémoire | My favorite as a bioethicist | Scoop.it

 

«Dans ce mémoire, l'Ordre des infirmières et infirmiers du Québec (OIIQ) soutient l'orientation prise par le projet de loi qui reflète une tendance exprimée par la population d'avoir droit à des soins de fin de vie qui permettent aux personnes de vivre, en toute dignité, les derniers moments de leur vie. Il reconnaît l'importance de mettre en place des balises concernant les pratiques de soins de fin de vie, ainsi qu'un encadrement rigoureux de la sédation palliative continue et de l'aide médicale à mourir. Il fait valoir la contribution unique des infirmières tant auprès des patients en fin de vie et de leur famille, dans l'équipe interdisciplinaire, qu'au point de vue organisationnel. Le mémoire aborde six thèmes principaux qui reflètent les préoccupations des infirmières et autour desquels sont énoncées des recommandations.

La terminologie utilisée dans le projet de loi;L'organisation des soins de fin de vie;L'encadrement de la sédation palliative continue et de l'aide médicale à mourir;La représentation des infirmières à la Commission sur les soins de fin de vie;Les infirmières et l'objection de conscience;Les directives médicales anticipées.

L'OIIQ énonce enfin des conditions essentielles à l'implantation de soins de fin de vie de qualité : formation des professionnels, allocation de ressources professionnelles et soutien financier pour accompagner l'offre de services promis dans ce projet de loi.»

Marie-Josée Potvin's insight:

Pas étonnant que ce dossier suscite de vive émotions. Par ailleurs, pour que les infirmières puissent assurer un leadership sur les enjeux liés à ce type de problématique dans nos milieux de pratique, il devient nécessaire, notamment de prendre connaissance du mémoire préparé par l'OIIQ. Ce mémoire aide à mieux saisir les enjeux liés au projet de loi 52 et à développer une vision plus nuancée en regard de questions entourant le mourir. 

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«Pediatric Euthanasia: The End of Life as an End Itself?» | Document to help reflect upon

Marie-Josée Potvin's insight:

Here is an interesting thesis that is worth reading for those who wish to develop a more refined view in regard of pediatric euthanasia. A still «fresh» (2013) paper work for healthcacre professionals or any other people who wish to bring good sound arguments into the actual debate.

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Euthanasia for children in Belgium | VIDEO A plea against the project from Quebec, Canada

Euthanasia for children in Belgium | VIDEO A plea against the project from Quebec, Canada | My favorite as a bioethicist | Scoop.it

Plea from a Child to the King of Belgium . An excellent tool that you could use to bring in the discussion about some ethical and existencial dimensions of care when caring for the children. I am still trying to grasp...not for air but almost, to understand the rational behind such a process. If anyone has other material to share, please do so that we can reflect upon this reality and maybe react to it, if needed.

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Child euthanasia law expected this week in Belgium | Much controversies

Child euthanasia law expected this week in Belgium | Much controversies | My favorite as a bioethicist | Scoop.it

«Belgium’s Parliament is expected to pass a controversial law permitting the voluntary euthanasia of children as early as next Thursday. The bill will allow minors to ask for a lethal injection if they are terminally ill, if they are in great pain and if there is no effective treatment. Their request has to be approved by the medical team and their parents. Supporters claim that there will only be about 10 to 15 cases a year.»

«But the bill has been condemned by members of the Parliamentary Assembly of the Council of Europe.»

Marie-Josée Potvin's insight:

This certainly is not without moving our deepest values related to the question of autonomy. Are we going too far, too fast?

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Research data traceability | Harvard Scientists Say Research Subjects Should See Data

People who give blood or other tissues for research should be able to track their use through the scientific process to see the data their activities or samples generate, Harvard University scientists said.


«23andMe Inc. halted sales of health-related data with its DNA tests after the U.S. Food and Drug Administration said that people who don’t understand the information might react to it inappropriately. For example, people who discover they have mutations in genes related to breast cancer might get unnecessary medical treatment, the FDA said.

Even allowing research subjects to track the use of their data may be risky, Ross said. For example, individuals might make assumptions about their health simply by finding out whether their data were included in a group of subjects with a particular condition or gene mutation, she said.

“Researchers should update individuals about the research their data is being used in,” said Mark Rothstein, a professor of bioethics at the University of Louisville School of Medicine in Kentucky. Even so, “I think tracking your sample like it’s a FedEx delivery is not very valuable.”
«Subjects who were able to monitor their data might help weed out research fraud that has sometimes occurred when scientists have based conclusions on fabricated findings, Lunshof said.

“People should be able to say, ‘That is my data, it’s my sample and it’s right there,’” she said. “And that’s currently totally lacking.”»

Marie-Josée Potvin's insight:

Apart from choosing one way or another, a black and white solution (such as all patients should have access/be informed to every research using their data), this study gives a great opportunity for all of us to questionned the whole scientific enterprise which makes possible, sometimes easy, research related frauds. Patients should not be the ones who takes the pressure to assure research integrity, but probably be better served in terms of their own health interests.

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From inadequate policies to health inequities | An Epidemic of Pain in India

From inadequate policies to health inequities | An Epidemic of Pain in India | My favorite as a bioethicist | Scoop.it

"(...) unlike many developing countries, which must import morphine for pain treatment, according to the International Narcotics Control Broad, India has been “the leading licit producer of opium for several decades, accounting for over 90 per cent of global production.” In 2010, according to the I.N.C.B., ninety-nine per cent of the global production of licit opium—five hundred and eighty tons—occurred in India, which exported the majority of it. Morphine is not expensive: a ten-milligram tablet of costs between one and ten cents. The problem is not supply or cost; rather, it is Indian legal restrictions, which so tightly control opioids that they have strangled access to pain medication for those who need it most. In November, 1985, India enacted the Narcotic Drugs and Psychotropic Substances Act, superseding the previous laws under which the country regulated narcotics and its longstanding opium trade—the Opium Acts of 1857 and 1878 and the Dangerous Drugs Act of 1930. The resulting string of procedures to acquire opioids and narcotics for scientific or medicinal purposes is dizzyingly complex: up to six licenses are required for every consignment of morphine. If a doctor’s possession license expires, an individual could be fined or worse, subject to a non-bailable arrest and a jail term between six months and twenty years long, depending on the amount of the opioid in possession.

 

"The fear of addiction has been cited as one of the leading concerns by the government in its hesitance to drastically increase access to legal morphine. An International Narcotics Control Board report, from 2012, notes that after cannabis, opioids (which include heroin) are the most abused drugs in India. And among those treated for drug-related problems in 2010, sixty-six per cent abused opioids, nineteen per cent of which were prescription medications. M. R. Rajagopal, the director of W.H.O.’s Collaborating Centre for Training and Policy on Access to Pain Relief, says that “the N.D.P.S. Act created by Government of India was concerned only with preventing abuse and diversion; it did not give attention to facilitating medical use.”

 

"If it fails and morphine restrictions continue, it would jeopardize the government’s initiatives to introduce palliative care throughout India. A few medical schools have begun to offer training in pain management for medical students and doctors, with, for instance, workshops on prescribing morphine. But “if the N.D.P.S. bill is not passed, the palliative-care policy will fail,” Dr. Nagesh Simha said. “How can you have a law that forbids use of morphine and then have a policy to educate medical practitioners about using it in pain treatment?”

Marie-Josée Potvin's insight:

People do not always understand the link between policies and ethics. Here is an excellent case which shows that from policy making to policy implementation there is an other step that end up in societal impacts (more or less positive). Policy making is a strong tool to foster health equity, although it may be «a bullet in the foot» for those who develop them without any ethical perspective.

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Becoming ethical is not a comfortable path

Becoming ethical is not a comfortable path | My favorite as a bioethicist | Scoop.it

"In her research, Bella DePaulo, Ph.D. found that people lie in one in five of their daily interactions. Pamela Meyer, author of Liespotting, claims in her TED Talk that we’re lied to from 10-200 times a day. It’s important to consider: how honest is the world we’ve created around ourselves? How often do we ourselves tell lies? And, on the flip side, do we intimidate others in ways that might encourage them to shade the truth?"

"Misleading a person distorts their reality and makes them feel crazy, which is one of the most unethical things you can do to another person. So what can you do to be more honest? You can begin by being honest with yourself."

 

Marie-Josée Potvin's insight:

Lying is fundamentally a protection mecanism. Lying is not just not telling the truth, its also hurting other's integrity. White lies and gossips for example, may be about controlling our own fragility in face of others.  To face the truth is not an easy process because some facets of the truth will always resonate in our own self/reality. Ethics involves the necessity to consider the reality as it is - even if not at our own advantage - and find ways to act upon it in order to foster justice and respect. Becoming ethical (honest with oneself) is often an uncomfortable path.

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Industry Funding and Partiality in Bioethics | Bad bioethicist?

Industry Funding and Partiality in Bioethics | Bad bioethicist? | My favorite as a bioethicist | Scoop.it

Rob MacDougall argues the bioethicist's role is to engage with the whole range of viewpoints and perspectives.

Many bioethicists have misgivings about bioethics scholarship funded by industry. Their misgivings recently came to a head when Glenn McGee, editor of a major bioethics journal, accepted a paid position as president for ethics and strategic initiatives at CellTex Therapies, a Houston-based company selling stem-cell therapies.

These misgivings have led some bioethicists to condemn financial relationships between academic ethicists and industry— arrangements like Glen McGee’s— wholesale. Carl Elliott, for example, lists 6 reasons to avoid pharmaceutical-funded bioethics. He also writes that journals should not accept articles written by bioethicists who receive pharmaceutical funding. Similarly, Dan Callahan has written that bioethicists should avoid consultation with private, for-profit firms.

Marie-Josée Potvin's insight:

MacDougall perspective is interesting, although we may all understand that the limit of a blog is significant when it comes to argue about bioethicist's potential financial conflicts of interest. I will not comment in details on his thought, I invite the reader to dig into his interesting comment that could certainly be a good starter for classroom and research group discussion.

Instead, I wish to share few insights which came to my mind while reading pro and con's from well known researcher's positions notably about the debate around partiality/ impartiality matter.

As a bioethicists working in healthcare and doing research work (notably as a member of the conflict of interest.org research group of the Université de Montréal) in the domain of bioethics, I know that I can't be totally objective by nature. This is a fact, not a fancy stance to affirm my autonomy as a person or as a professional. Nevertheless, my professional ethical standards are very high. These standards which I work on, to somehow embody them in my personality for more than 20 years of professional practice and personal bad and good experience, are the necessary landmarks that guide my practice towards excellence. In doing so, these ideals provide with the sufficiant inner tension to act and offer guidance in a way that I try not to impose my own choices in particular clinical or institutional problematic situations involving a variety of actors (who takes decisions).  I would not impose, but certainly could reflect explicitly upon trajectories that I consider as not taking into perspective as much aspects as possible of this particular situation. This said, how can people be sure that I am being impartial, even if someone is paying me for my services?

I can't answer this question in few words. 

People could rely on my academic or research record, which is without no doubt, a must in such a complex domain. You can not improvise yourself as a bioethicist, but does that mean that you will necessarely have the required maturity to be «impartial» and strive collaboratively for the best interest of the patient/family/community/society? No.

Being a bioethicist is a very delicate responsibility that goes beyong developing knowledge or charisma; its about integrity that proves, notably, with experience. Can you be objective and facilitate a discussion that may trigger intense core conflicts that have been denied for long periods of time by some parties and probably, in the first place, be the one who will be finger pointed? Could you be sufficiently patient and diplomat enough to temporarely accept this tension to eventually, redirect the issue while building trust,  to those who are really concerned? Are you capable to take the sufficiant distance to not work for your boss politcal agenda and ready to leave the boat if this is what it is all about?

«Being partial» is impossible, notably because we are not robots and because it implies complex developemental aspect of the self from the part of the bioethicist. I think, though, that we should strive for this ideal (and others)... conscious that ideals are necessary and inaccessible goals which prevent us (if mature enough), to fall into our lowest imperfect human tendencies.

I agree with MacDougall that «bioehticists should interact with the whole range of viewpoints and perspectives», but this is not enough, he/she also need to interact with one's own self. From that perspective, I guess there are more conflict of interest's sensitive situations in bioethics (such as industry funded position), which requires one to be particularly reflexive...and courageous. These positions then, I argue, does not make these bioethicists bad or corrupted in the first place; they certainly put their integrity to the test.

And in a more down to earth matter, bioethicists can not and should not work for free.

 

 

 

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When No One Is on Call| Nurse staffing issue

When No One Is on Call| Nurse staffing issue | My favorite as a bioethicist | Scoop.it

«Bedside nurses are the hospital’s front line, but we can’t do the first-alert part of our jobs if there aren’t enough of us on the floor. More demands for paperwork, along with increasing complexity of care, means the amount of time any one nurse has for all her patients is diminishing. And as hospitals face increasing financial pressure, nurse staffing often takes a hit, because nurses make up the biggest portion of any hospital’s labor costs.

For patients, though, the moral calculus of the nurses-for-money exchange doesn’t add up. Pioneering work done by Linda H. Aiken at the University of Pennsylvania in 2002 showed that each extra patient a nurse had above an established nurse-patient ratio made it 7 percent more likely that one of the patients would die. She found that 20,000 people died a year because they were in hospitals with overworked nurses.

Research also shows that when floors are adequately staffed with bedside nurses, the number of patients injured by falls declines. Staff increases lead to decreases in hospital-acquired infections, which kill 100,000 patients every year.»

 

«Several months ago I started a new job, and a few weeks in I heard my name being called. A patient getting a drug that can cause dangerous reactions was struggling to breathe. I hurried to her room, only to discover that I wasn’t needed. The other nurses from the floor were already there, stopping the infusion, checking the patient’s oxygen and drawing up the rescue medication.

The patient was rattled, but there were enough nurses to respond, and in the end she was completely fine.

Now picture the same events in a different hospital, one that doesn’t adequately staff, and this time the patient is you. As the drug drips in, you feel a malaise. You breathe deeply but can’t quite get enough air. Your thinking becomes confused, your heart races. Terrified, you press the call light, you yell for help, but the too few nurses on the floor are spread thin and no one comes to help in time. A routine infusion ends with a call to a rapid-response team, a stay in intensive care, intubation, ventilation, death.»

Marie-Josée Potvin's insight:

Well, I think that this situation, which we all are aware of (being nurses or patients) is a very good example of the importance, notably, of nurse's involvement in policy making. Ethics is not only a bedside reality, although it necessarely includes it. As nurses at the bedside, we tend to be less sensitive to the larger perspective of ethics in pratice.

Nurse's ethics leadership is of prime importance to provide with significant health care system transformations. This leadership starts, I believe, with an adequate education which provides tools in multiple aspects involved in the pursuit of excellent and secure care (e.g., policies, professional ethics, professional knowledge).

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Enhancing Moral Conformity and Enhancing Moral Worth - Online First - Springer

Enhancing Moral Conformity and Enhancing Moral Worth - Online First - Springer | My favorite as a bioethicist | Scoop.it

It is plausible that we have moral reasons to become better at conforming to our moral reasons. However, it is not always clear what means to greater moral conformity we should adopt. John Harris has recently argued that we have reason to adopt traditional, deliberative means in preference to means that alter our affective or conative states directly—that is, without engaging our deliberative faculties. One of Harris’ concerns about direct means is that they would produce only a superficial kind of moral improvement. Though they might increase our moral conformity, there is some deeper kind of moral improvement that they would fail to produce, or would produce to a lesser degree than more traditional means. I consider whether this concern might be justified by appeal to the concept of moral worth. I assess three attempts to show that, even where they were equally effective at increasing one’s moral conformity, direct interventions would be less conducive to moral worth than typical deliberative alternatives. Each of these attempts is inspired by Kant’s views on moral worth. Each, I argue, fails.


Via Wildcat2030
Marie-Josée Potvin's insight:

Worth reading

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