Following an initial study of the needs of healthcare providers (HCP) regarding the introduction of Medical Assistance in Dying (MAiD), and the subsequent development of an assisted dying program, this study sought to determine the efficacy and impact of MAiD services following the first two years of implementation. The first of three aims of this research was to understand if the needs, concerns and hopes of stakeholders related to patient requests for MAiD were addressed appropriately. Assessing how HCPs and families (...) perceived the quality of MAiD services, and determining if the program successfully accommodated the diverse needs and perspectives of HCPs, rounded out this quality evaluation. This research implemented a mixed-methods design incorporative of an online survey with Likert scale and open-ended questions, as well as focus groups and interviews with staff and physicians, and interviews with MAiD-involved family members. There were 356 online surveys, as well as 39 participants in six focus groups with HCP, as well as fourteen interviews with MAiD-involved family members. Participants indicated that high-quality MAiD care could only be provided with enabling resources such as policies and guidelines to ensure safe, evidence-based, standardized care, as well as a specialized, trained MAiD team. Both focus group and survey data from HCPs suggest the infrastructure developed by the hospital was effective in delivering high-quality MAiD care that supports the diverse needs of various stakeholders. This study may serve as a model for evaluating the impact and quality of services when novel and ethically-contentious clinical practices are introduced to healthcare organizations. (shrink)

What do we mean when we call something or someone evil? The word "evil" tends to conjure up images of demons, devils, and horrifying crimes, things that you and I couldn't possibly get involved with! But is that true? Is evil really something that only wicked people who are "quite unlike ourselves" get up to? Could it be that you and I are not only capable of doing evil things, but are already involved with such things? This book explores the (...) hidden nature of evil and draws out the ways in which all of us, knowingly or otherwise, are caught up in webs of evil that bring about disastrous consequences, often to the weakest and most vulnerable amongst us. We need to find ways of learning to see evil and resisting it by all means possible. If we can't see evil, we can't resist it. If we can't resist it, we get sucked into it. (shrink)

This investigation develops in three steps. First, we seek to complexify the opioid crisis in a way that helps us to see how the issues of misguided desire and misplaced attachments are fundamentally important for a theological account of opioid addiction.1 Second, acknowledging the connections between pain and opioid addiction, we explore some of the ways in which our understanding of pain can influence our understanding of and responses to opioid use. Finally, we offer some tentative reflections on the theological (...) and ecclesial dimensions of the opioid crisis which hold the potential to influence the nature of a Christian response to the issues. Having laid out these steps, we argue for the church’s calling, where she complexifies the narratives about the opioid crisis and provides individuals suffering from opioid use “homeful” encounters with God and the community. (shrink)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of (...) the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

In this book, T. L. Short places the notorious difficulties of Peirce's important writings in a more productive light, arguing that he wrote philosophy as a scientist, by framing conjectures intended to be refined or superseded in the inquiries they initiate. He argues also that Peirce held that the methods and metaphysics of modern science are amended as inquiry progresses, making metaphysics a branch of empirical knowledge. Additionally, Short shows that Peirce's scientific work expanded empiricism on empirical grounds, grounding his (...) phenomenology and subverting the fact/value dichotomy, and that he understood statistical explanations in nineteenth-century science as reintroducing the idea of final causation, now made empirical. Those innovations underlie Peirce's late ideas of a normative science and of philosophy as a branch of science. Short's rich and original study shows us how to read Peirce's writings and why they are worth reading. (shrink)

This paper explores and develops a theological perspective on taking and receiving medication. It argues that the task of prescribing and administering psychopharmaceutical drugs is a thoroughly theological enterprise and should be looked at and practiced accordingly. The paper presents a theological anthropology that opens up space for rethinking the role of medication not only in relation to therapeutic intervention, but in relation to the chief end of human beings: to glorify God and live with God forever. Drawing on theology (...) and the narratives of people living with mental health challenges, the paper seeks to facilitate a movement from neurons to souls: a movement that realigns the goals of prescribing and opens up space to rethink the nature of “symptoms” and the ultimate intentions of the psychopharmacological enterprise. (shrink)

I am grateful to Anastasia Scrutton for opening up a very important area for thought, reflection, and practice. Her paper presents a fascinating argument for an understanding of depression that is framed as a potentially spiritually transformative experience with positive therapeutic implications. In doing so, she offers a way for theologians, philosophers, and practitioners to effectively perceive, understand, and engage with the spiritual dimensions of the experience of depression. As such, she has made an important contribution to the ongoing and (...) often fraught conversations around the role of spirituality in understanding mental health issues. The models she outlines neatly encapsulates a broad range of... (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe conducted seven (...) day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

Can God create an unliftable stone? Beall & Cotnoir propose that ‘God can create an unliftable stone’ is a truth-value gap (neither true nor false). However, this yields a revenge paradox on whether God can eschew gaps. Can God avoid gappy ascriptions of power? Either way, God’s power seems to have limits. In response, it may be said that ascribing God the power to avoid gaps is itself gappy—it concerns a power that God neither has nor lacks. Yet this ends (...) up being inconsistent, for it implies that God definitely lacks that power. Following Aquinas, perhaps Beall & Cotnoir could accept this lack and still uphold omnipotence, suggesting that the power to avoid gaps is impossible for God. Yet the Aquinian stratagem is enough to block the original paradox, which saps the motivation to proffer truth-value gaps in addition. I conclude that the gappy solution is either inadequate or insufficiently motivated. (shrink)

In this paper a close look is taken at van Fraassen's use of the concept of truth. It is shown that the rather deflationist understanding of the term in his more recent publications differs considerably from the one referred to in his earlier writings, where the truth of a scientific theory is construed as its correspondence to the world. As will be argued, his more recent remarks call for a reevaluation of the difference between scientific realism and constructive empiricism and (...) force him - for the sake of consistency - to give up his realist commitments regarding the world and the observable. (shrink)

This paper begins with a problem stemming from Hume regarding credences about credences. Suppose one has a credence of .95 in p, and suppose one assesses the credence to be such. But suppose one’s second-order credence in this assessment is less than 1. Then, by a standard conditionalization rule, one’s credence in p becomes less than .95. Moreover, such “erosion” can iterate by considering one’s, third-, fourth-, fifth-order credences, etc. (In light of this, some have rejected higher-order credences; however, it (...) is argued that Lewis’ “Principal Principle” forbids this.) The paper then offers a partial solution by describing circumstances under which a person has reason to assign credence 1 to a first-order credence. The solution takes the form of a “transparency” view of self-knowledge from Parent (2017, chapter 8). Briefly, it is argued that when one “reflex-like” utters a sentence “The probability of p is n”, then as a matter of psychological law, the utterance is an expression of one’s own judgment. The Principal Principle then necessitates that one’s credence in p is n, assuming one is being rational. Thus, upon perceiving such an utterance, one can thereby have a reason to assign a second-order credence of 1. (shrink)

While philosophers hold that it is patently absurd to blame robots or hold them morally responsible [1], a series of recent empirical studies suggest that people do ascribe blame to AI systems and robots in certain contexts [2]. This is disconcerting: Blame might be shifted from the owners, users or designers of AI systems to the systems themselves, leading to the diminished accountability of the responsible human agents [3]. In this paper, we explore one of the potential underlying reasons for (...) robot blame, namely the folk's willingness to ascribe inculpating mental states or "mens rea" to robots. In a vignette-based experiment (N=513), we presented participants with a situation in which an agent knowingly runs the risk of bringing about substantial harm. We manipulated agent type (human v. group agent v. AI-driven robot) and outcome (neutral v. bad), and measured both moral judgment (wrongness of the action and blameworthiness of the agent) and mental states attributed to the agent (recklessness and the desire to inflict harm). We found that (i) judgments of wrongness and blame were relatively similar across agent types, possibly because (ii) attributions of mental states were, as suspected, similar across agent types. This raised the question - also explored in the experiment - whether people attribute knowledge and desire to robots in a merely metaphorical way (e.g., the robot "knew" rather than really knew). However, (iii), according to our data people were unwilling to downgrade to mens rea in a merely metaphorical sense when given the chance. Finally, (iv), we report a surprising and novel finding, which we call the inverse outcome effect on robot blame: People were less willing to blame artificial agents for bad outcomes than for neutral outcomes. This suggests that they are implicitly aware of the dangers of overattributing blame to robots when harm comes to pass, such as inappropriately letting the responsible human agent off the moral hook. (shrink)

Byzantine Empire; economic and social conditions; history.