Nicholas Abernethy

En 2021, en réponse à la décision de la Cour supérieure du Québec dans l’affaire Truchon c. Canada, le Parlement canadien a modifié le Code criminel afin d’autoriser l’aide médicale à mourir (AMM) pour certaines personnes qui n’ont pas de « mort naturelle raisonnablement prévisible ». Cette modification fait l’objet d’un vif débat. Certains universitaires et militants soutiennent notamment qu’elle devrait être abrogée car elle est discriminatoire à l’égard des personnes handicapées. En 2024, ces arguments ont été présentés dans le cadre d’une procédure judiciaire canadienne ; deux personnes handicapées et quatre organisations de défense des droits des personnes handicapées ont intenté une action en justice devant la Cour supérieure de justice de l’Ontario, contestant la modification. Dans cet article, j’analyse de manière critique les arguments centrés sur le préjudice présentés dans l’avis de demande des requérants (qui cristallise l’opposition plus large à la modification). Pour ce faire, je m’appuie sur l’analyse des deux côtés du débat éthique sur la modification. En fin de compte, je conclus que les arguments des requérants — et ceux des autres opposants à la modification — ne sont pas recevables. Certaines de mes objections récurrentes sont que les effets néfastes allégués de la modification sont soit 1) néfastes uniquement si les hypothèses éthiques douteuses des requérants sont vraies, 2) non attribuables à la modification, soit 3) inexistants, négligeables ou improbables. Pour défendre la modification, j’explique en quoi elle respecte l’autonomie des personnes et évite l’instrumentalisation.

Shared Decision-Making (SDM) is a process wherein patients and clinicians make healthcare decisions collaboratively. There are two main versions of SDM. The first is narrow SDM, wherein the clinician’s role is limited to things like providing information and eliciting (without challenging) the patient’s preferences. The second is broad SDM, wherein the clinician participates in the decision-making in various additional ways (e.g., by providing recommendations). In this paper, I argue that there are cases where a patient would not be wronged by a clinician letting them choose from a range of versions of SDM – including narrow SDM and types of broad SDM – for an end-of-life treatment decision. This paper’s structure is as follows. First, I explain my proposal. Second, I provide a brief rationale for it. Third, I thoroughly defend it from the likeliest objection, which holds that clinicians in the relevant cases should offer only narrow SDM because broad SDM would unduly influence patients. This paper’s originality comes from (i) presenting a new and uniquely detailed proposal for when and how to offer versions of SDM and (ii) exploring the ethical implications of a patient’s choice of a version, understood as an act of consent. The main purpose of my proposal’s many details is to maximize how much the SDM would advance patient autonomy (and, secondarily, patient wellbeing).

In late 2022, the large language model (LLM) known as ChatGPT was released for public use, and a few researchers began crediting it as a coauthor of publications. The academic reaction was overwhelmingly negative; experts condemned LLM coauthorship, and major journals banned LLM coauthorship. In this paper, I challenge this reaction. Specifically, my main thesis is that journals should allow LLMs to coauthor articles. My two sub-theses are that journals should allow “heavy LLM usage” and that journals should allow LLMs to be credited as coauthors when they are heavily used. However, I argue that journals should do this only in conjunction with adopting policies like the ones I propose. Unlike the existing publications that share my conclusion, this paper is extensive, covering the enormous number of prima facie plausible reasons for banning LLM coauthorship. As I show, the alleged downsides of LLM coauthorship are either exaggerated, similarly applicable to human coauthorship, heavily mitigated by existing journal policies and/or my proposed journal policies, or outweighed by the upsides of LLM coauthorship.

Debate rages over whether Canadian provincial and territorial governments should allow healthcare institutions to conscientiously object to providing medical assistance in dying (MAiD). This issue is likely to end up in court soon through challenges from patients, clinicians, or advocacy groups such as Dying With Dignity Canada. When it does, one key question for the courts will be whether allowing institutional conscientious objection (ICO) to MAiD respects (i.e., shows due regard for) the consciences of the objecting healthcare institutions, understood as unitary entities. This question has been thoroughly explored elsewhere in the academic literature. However, another key question has been underexplored. Specifically, precedent set by the Supreme Court of Canada’s decision in Loyola High School v. Quebec (Attorney General) suggests that the courts will consider whether allowing ICO to MAiD respects the consciences of the personnel within objecting healthcare institutions. My answer to this question is no, by which I mean that allowing ICO to MAiD shows undue disregard for some consciences and undue regard for others. To justify this answer, I analyze the arguments that hold that allowing ICO in healthcare respects the consciences of the personnel within objecting healthcare institutions. My conclusion is that none of these personnel-based arguments succeed in the case of ICO to MAiD. Some fail because they are wrong about the nature of conscience and complicity. Others fail because they contradict the arguments’ proponents’ positions on conscientious objection by individual healthcare providers. Still others fail because they are internally inconsistent.