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455Bioethics met its COVID‐19 Waterloo: The doctor knows best againBioethics 35 (1): 3-5. 2020.The late Robert Veatch, one of the United States’ founders of bioethics, never tired of reminding us that the paradigm-shifting contribution that bioethics made to patient care was to liberate patients out of the hands of doctors, who were traditionally seen to know best, even when they decidedly did not know best. It seems to us that with the advent of COVID-19, health policy has come full-circle on this. COVID-19 gave rise to a large number of purportedly “ethical” guidance documents aiming to…Read more
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230Principlist Pandemics: On Fraud Ethical Guidelines and the Importance of TransparencyIn Michael Boylan (ed.), Ethical Public Health Policy Within Pandemics: Theory and Practice in Ethical Pandemic Administration, Springer. pp. 131-148. 2022.The COVID-19 pandemic has coincided with the proliferation of ethical guidance documents to assist public health authorities, health care providers, practitioners and staff with responding to ethical challenges posed by the pandemic. Like ethical guidelines relating to infectious disease that have preceded them, what unites many COVID-19 guidance documents is their dependency on an under-developed approach to bioethical principlism, a normative framework that attempts to guide actions based on a…Read more
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162Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or ContraceptionBioethics 30 (9): 162-170. 2017.In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation t…Read more
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94Are Concerns About Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying?Health Care Analysis 26 (4): 326-343. 2018.Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ acce…Read more
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82The distribution of medical resources, withholding medical treatment, drug trials,advance directives, euthanasia and other ethical issues: The Thandi case (II)Developing World Bioethics 1 (2). 2001.In the first part of this article, we considered how Thandi, a 15-year-old girl, was treated when taken by her mother to their GP, Dr Randera. Dr Randera notified them that Thandi was pregnant, HIV positive, and had syphilis and herpes. Dr Randera also informed them that there was a substantial risk that the baby would be born HIV positive. Both Thandi and her mother wanted an abortion. However, Dr Randera, who was morally opposed to abortions, refused to provide the service and did not refer Th…Read more
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76End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-MakingBioethics 25 (s1): 1-73. 2011.ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada…Read more
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75Affordable Access to Essential Medication in Developing Countries: Conflicts Between Ethical and Economic Imperatives1Journal of Medicine and Philosophy 27 (2): 179-195. 2002.Recent economic and political advances in developing countries on the African continent and South East Asia are threatened by the rising death and morbidity rates of HIV/AIDS. In the first part of this paper we explain the reasons for the absence of affordable access to essential AIDS medication. In the second part we take a closer look at some of the pivotal frameworks relevant for this situation and undertake an ethical analysis of these frameworks. In the third part we discuss a few of the pr…Read more
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69Two models in global health ethicsPublic Health Ethics 2 (3): 276-284. 2009.This paper examines two strategies aimed at demonstrating that moral obligations to improve global health exist. The ‘humanitarian model’ stresses that all human beings, regardless of affluence or global location, are fundamentally the same in terms of moral status. This model argues that affluent global citizens’ moral obligations to assist less fortunate ones follow from the desirability of reducing disease and suffering in the world. The ‘political model’ stresses that the lives of the world'…Read more
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66Treatment-resistant major depressive disorder and assisted dyingJournal of Medical Ethics 41 (8): 577-583. 2015.
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65Why medical professionals have no moral claim to conscientious objection accommodation in liberal democraciesJournal of Medical Ethics 43 (4): 234-240. 2017.We describe a number of conscientious objection cases in a liberal Western democracy. These cases strongly suggest that the typical conscientious objector does not object to unreasonable, controversial professional services—involving torture, for instance—but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive. We analyse the conflict between these patients' access rights and the conscientious objection accommodation demanded …Read more
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61Defending the indefensibleJournal of Bioethical Inquiry 7 (1): 83-88. 2010.This response addresses criticisms in this journal of an Editorial written by Willem Landman and Udo Schuklenk. I demonstrate that the UNESCO Declaration on Bioethics and Human Rights is in crucial aspects deficient, despite attempts in this journal to defend the Declaration against its critics. I focus on individual versus societal interests, research ethics, informed consent and the use of “human dignity” to illustrate the weaknesses of the UNESCO Declaration on Bioethics and Human Rights. Thi…Read more
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48What healthcare professionals owe us: why their duty to treat during a pandemic is contingent on personal protective equipment (PPE)Journal of Medical Ethics 46 (7): 432-435. 2020.Healthcare professionals’ capacity to protect themselves, while caring for infected patients during an infectious disease pandemic, depends on their ability to practise universal precautions. In turn, universal precautions rely on the availability of personal protective equipment (PPE). During the SARS-CoV2 outbreak many healthcare workers across the globe have been reluctant to provide patient care because crucial PPE components are in short supply. The lack of such equipment during the pandemi…Read more
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47Public health ethics and obesity prevention: the trouble with data and ethicsMonash Bioethics Review 32 (1-2): 121-140. 2014.In recent years policy makers and public health professionals have described obesity and its associated diseases as a major global public health problem. Bioethicists have tried to address the normative implications of proposed public health interventions by developing guidelines or proposing ethical principles that ethically grounded health policy responses should take into consideration. We are reviewing here relevant literature and conclude that while there are clearly health implications res…Read more
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47Terminal illness and access to phase 1 experimental agents, surgeries and devices: Reviewing the ethical argumentsBritish Medical Bulletin 89 (1): 7-22. 2009.Background: The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended-at the time-on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Sources of data:…Read more
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46Conscientious objection and compromising the patient: Response to HughesBioethics 32 (7): 473-476. 2018.Hughes offers a consequentialist response to our rejection of accommodation of conscientious objection in medicine. We argue here that his compromise proposition has been tried in many jurisdictions and has failed to deliver unimpeded access to care for eligible patients. The compromise position, entailing an accommodation of conscientious objection provided there is unimpeded access, fails to grasp that the objectors are both determined not to provide services they object to as well as to subve…Read more
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46Module one: Introduction to research ethicsDeveloping World Bioethics 5 (1): 1-13. 2005.We will also learn what the issues are that people involved in research on research ethics are concerned with. Ethics without an unde
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45North–south benefit sharing arrangements in bioprospecting and genetic research: a critical ethical and legal analysisDeveloping World Bioethics 6 (3). 2006.ABSTRACT Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that a…Read more
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41Against the accommodation of subjective healthcare provider beliefs in medicine: counteracting supporters of conscientious objector accommodation argumentsJournal of Medical Ethics 43 (4): 253-256. 2017.We respond in this paper to various counter arguments advanced against our stance on conscientious objection accommodation. Contra Maclure and Dumont, we show that it is impossible to develop reliable tests for conscientious objectors' claims with regard to the reasonableness of the ideological basis of their convictions, and, indeed, with regard to whether they actually hold they views they claim to hold. We demonstrate furthermore that, within the Canadian legal context, the refusal to accommo…Read more
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40Module six: Special issuesDeveloping World Bioethics 5 (1). 2005.The objective of this module is to cover ground that was not covered in-depth in any of the other modules, including: scientific misc
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39Physician-assisted death does not violate professional integrityJournal of Medical Ethics 41 (11): 887-888. 2015.
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38For-Profit Clinical Trials in Developing Countries—Those Troublesome Patient BenefitsAmerican Journal of Bioethics 10 (6): 52-54. 2010.(2010). For-Profit Clinical Trials in Developing Countries—Those Troublesome Patient Benefits. The American Journal of Bioethics: Vol. 10, No. 6, pp. 52-54
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38New Frontiers in End‐of‐Life Ethics : Scope, Advance Directives and Conscientious ObjectionBioethics 31 (6): 422-423. 2017.
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38Patient Access to Experimental Drugs and AIDS Clinical Trial Designs: Ethical IssuesCambridge Quarterly of Healthcare Ethics 5 (3): 400. 1996.Today's clinical AIDS research is in trouble. Principal investigators are confronted with young and frequently highly knowledgeable patients. Many of these people with AIDS are often unwilling to adhere to the trial protocols. These PWAs believe they are ethically justified in breaching trial protocols because they do not consider themselves true volunteers in such trials. PWAs argue that they do not really volunteer because existing legislation prevents them from buying and using experimental d…Read more
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38Morality and Justice: Reading Boylan's a Just Society (edited book)Lexington Books. 2009.The essays in this book engage the original and controversial claims from Michael Boylan's A Just Society. Each essay discusses Boylan's claims from a particular chapter and offers a critical analysis of these claims. Boylan responds to the essays in his lengthy and philosophically rich reply.
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36Enforcing Conscientious Objection to Abortion in Medical Emergency Circumstances: Criminal and UnethicalAmerican Journal of Bioethics 18 (7): 60-61. 2018.Lawrence Nelson discusses cases in which abortion is necessary due to a life-threatening medical emergency. He argues that under American law, health care providers who conscientiously refuse to pe...