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8Ethically Informed Pragmatic Conditions for Organ Donation after Cardiocirculatory Death: Could They Assist in Policy Development?Journal of Clinical Ethics 24 (4): 373-380. 2013.The modern practice of organ donation after cardiocirculatory death (DCD) emerged in the 1990s as a response to the alarmingly wide gap between the number of transplantable organs available through organ donation after neurological death and the urgent organ transplantation needs of persons in end-organ failure. Various important ethical dimensions of DCD have been considered and debated by prominent organ donation/transplantation theorists and clinicians.In this article, consideration of some o…Read more
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15Shifting the Emphasis to Meaningful Ethics Engagement in the Development of Health PoliciesAmerican Journal of Bioethics 12 (11): 18-20. 2012.No abstract
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29Responding to cDCDD Ethical Challenges: Translating Analysis Into Policy ActionAmerican Journal of Bioethics 15 (8): 27-29. 2015.Overby and colleagues (2015) draw our critical attention to a variety of ethical challenges associated with the practice of controlled donation after circulatory determination of death (cDCDD). Alt...
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26Reconceptualizing ‘Psychiatric Futility’: Could Harm Reduction, Palliative Psychiatry and Assisted Dying Constitute a Three-Component Spectrum of Appropriate Practices?American Journal of Bioethics 21 (7): 65-67. 2021.Bianchi, Stanley, and Sutander argue in an insightful, cogent manner for the consideration of harm reduction as an ethically-defensible, non-paternal management approach for capable persons...
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15Is There a Particular Ethical Practice and Policy Space in North America for Uncontrolled Kidney Donation after Circulatory Death?Journal of Law, Medicine and Ethics 45 (1): 142-148. 2017.Despite successful transplantation outcomes in Europe, uncontrolled organ donation after circulatory determination of death has essentially been a non-starter in North America. In this paper, I identify and explore a set of interesting, ethics-related considerations that are of relevance to this organ donation-transplantation practice. The analysis provides a theoretical platform for my development of a proposal for the creation of a particular ethical practice and policy space for kidney uDCDD …Read more
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12Interpreting Irremediability When a Mental Health Disorder is the Sole-qualifying Medical Condition for MAiDCanadian Journal of Bioethics / Revue canadienne de bioéthique 5 (4): 83-88. 2022.In this critical commentary, a set of ethical considerations of relevance to the (currently contested) interpretation of irremediability for medical assistance in dying (MAiD) in circumstances where the sole-underlying medical condition is a mental health disorder is explored and analyzed. Based on the application of an ethics lens, a practical description of irremediability is proposed for intended use as guidance by Canadian mental health care clinicians, MAiD assessors and providers, and prov…Read more
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18Beyond Influence and Autonomy: Expanding the Scope of Ethical Considerations in Organ Donation RegistrationAmerican Journal of Bioethics 16 (11): 31-33. 2016.MacKay and Robinson (2016) provide a critical analysis of four organ donation registration options using an expanded conception of manipulation introduced by Jennifer Blumenthal-Barby (Blumenthal-B...
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34Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy DevelopmentAmerican Journal of Bioethics 16 (1): 38-47. 2016.Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-…Read more
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41Accessing the Ethics of Complex Health Care Practices: Would a “Domains of Ethics Analysis” Approach Help? (review)HEC Forum 22 (2): 133-143. 2010.This paper explores how using a domains of ethics analysis approach might constructively contribute to an enhanced understanding (among those without specialized ethics training) of ethically-complex health care practices through the consideration of one such sample practice, i.e., deep and continuous palliative sedation (DCPS). For this purpose, I select four sample ethics domains (from a variety of possible relevant domains) for use in the consideration of this practice, i.e., autonomous choic…Read more
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8An Ethics-informed, Policy-based Approach to the Management of Challenges Posed by Living-at-Risk, Frequent Users of Emergency DepartmentsCanadian Journal of Bioethics / Revue canadienne de bioéthique 6 (1): 44-55. 2023.The complex health and social circumstances of living-at-risk, frequent users of emergency departments (aREDFUs) in the health jurisdictions of high-income countries, and the related, significant challenges posed for emergency departments and the health care providers working within them, are identified and explored in the paper. Ethical analyses of a set of relevant domains are performed, i.e., individual and relational autonomy considerations, relevant social construction and personal responsi…Read more
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42Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-…Read more
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127Transnational Gestational Surrogacy: Does It Have to Be Exploitative?American Journal of Bioethics 14 (5): 24-32. 2014.This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently pra…Read more
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118Organ donation: Who should decide?—A canadian perspective (review)Journal of Bioethical Inquiry 6 (1): 123-128. 2009.This paper examines an under-explored issue in organ donation: whose decision making authority should be privileged posthumously in the context of known, explicit consent for donation? Current practices in Canada support the family as the ultimate decision maker, despite the existence of legislative support in many Canadian provinces for the potential donor as legitimate decision maker. Arguments for and against privileging the family and the potential donor are identified. Informing the questio…Read more
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34Organ donation after assisted death: Is it more or less ethically-problematic than donation after circulatory death?Medicine, Health Care and Philosophy 19 (4): 629-635. 2016.A provocative question has emerged since the Supreme Court of Canada’s decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cD…Read more
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38Morally-Relevant Similarities and Differences Between Assisted Dying Practices in Paradigm and Non-Paradigm Circumstances: Could They Inform Regulatory Decisions?Journal of Bioethical Inquiry 14 (4): 475-483. 2017.There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper…Read more
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46Engaging With a Peer-Proposed, Additional Exploitation Condition: Response to Open Peer Commentaries on “Transnational Gestational Surrogacy: Does It Have to Be Exploitative?”American Journal of Bioethics 14 (5). 2014.This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently pra…Read more
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27Ethically Preferable Alternative Practice: “No”; A Preferable, Head-to-Head Analytical Approach: “Maybe”American Journal of Bioethics 11 (6). 2011.The American Journal of Bioethics, Volume 11, Issue 6, Page 57-59, June 2011
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28Deliberative Engagement: An Inclusive Methodology for Exploring Professionalization (review)HEC Forum 24 (3): 187-201. 2012.Early on in the development of Practicing Healthcare Ethicists Exploring Professionalization (PHEEP), the founding members recognized the need to address and meet two important goals: (1) the creation of a dynamic, rigorous process to support the exploratory work, and (2) the establishment of the means—deliberative engagement—to generate and justify the substantive content of professionalization-related products, such as practice standards and position statements. Drawing from social justice and…Read more
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23Balancing competing interests and obligations in mental health‐care practice and policyBioethics 33 (6): 699-707. 2019.It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, …Read more
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19An Ethics-Informed, Comparative Analysis of Uterus Transplantation and Gestational Surrogacy for Uterine Factor Infertility in High-Income CountriesJournal of Bioethical Inquiry 18 (3): 417-427. 2021.Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six et…Read more
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121A new group-selection model for the evolution of homosexualityBiology and Philosophy 18 (5): 683-694. 2003.Abstract. Scientists have long puzzled over how homosexual orientation has evolved, given the assumed low relative fitness of homosexual individuals compared to heterosexual individuals. A number of theoretical models for the evolution of homosexuality have been postulated including balance polymorphism, "Fertile females", hypervariability of DNA sequences, kin selection, and "parental manipulation". In this paper, I propose a new group-selection model for the evolution of homosexuality which of…Read more
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41An innovative, inclusive process for meso-level health policy developmentHEC Forum 19 (2): 161-176. 2007.