Jennifer Flynn

Drug shortages are not new; they have been managed through conservation, procurement of alternatives, and redistribution of stock. The Sandoz shortage in 2012 has caused a radical reduction of generic injectables. In Newfoundland and Labrador, our response has led to the development of the framework, structure, and process outlined in this paper. The efforts have eased the concerns of clinicians and leaders, as they are aware of the decision-making resource for situations of drug and technology shortage.

Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement.

Vascularized Composite Allotransplantation (VCA) enables improved function and quality of life for those who have lost anatomical parts such as a limb and the relief of profound suffering for those with severe facial disfiguration. VCA differs from vital organ transplantation in two important ways: (1) these transplants are not necessary for recipient survival, impacting risk-benefit ratios; and (2) face and limb transplants are visible and touchable, leading to issues of identity changes, social interaction and psychological adjustments. This chapter will consider the ethical implications of VCA in pediatrics. This chapter will be divided into the following six sections: (1) introduction; (2) the state of the science and experience with VCA; (3) risk-benefit assessment; (4) informed consent (i) donors and donor surrogate decision makers (ii) recipients and recipient surrogate decision makers; (5) establishing a pediatric program (i) recipient selection (ii) allocation; (iii) accountability for surgical innovation and (6) conclusion.

What kind of criticism does the term ‘moralism’ make? In this paper, I examine whether clinical ethics consultation is even moralistic, and the relevance to this question of the moral expertise of the clinical ethicist. More specifically, I pose two questions: why might clinical ethics consultation sometimes be perceived as moralistic, and does clinical ethics consultation ever require a certain kind of moralism? I begin by looking at the term moralism, providing an exposition of some relevant philosophical work. Moving to clinical ethics, I examine two concerns about clinical ethics, concerns at least partly underwritten by worries about moralism. I then address the issue of the perception of moralism in clinical ethics consultation, and suggest that the clinical ethics consultant’s moral expertise can (and ought to) reduce that perception. Finally, I examine the requirement of clinical ethics consultation of a certain kind of moralism, this in fact as a result of the clinical ethics consultant’s moral expertise.