Maxwell J Smith
University of Western Ontario, Health Studies, Faculty Member
- Clarkson University, Bioethics, AdjunctSunnybrook Health Sciences Centre, Ethics Centre, Department Memberadd
- Research and teaching in the area of public health ethics and health policyedit
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The labor market is undergoing a rapid artificial intelligence (AI) revolution. There is currently limited empirical scholarship that focuses on how AI adoption affects employment opportunities and work environments in ways that shape... more
The labor market is undergoing a rapid artificial intelligence (AI) revolution. There is currently limited empirical scholarship that focuses on how AI adoption affects employment opportunities and work environments in ways that shape worker health, safety, well‐being and equity. In this article, we present an agenda to guide research examining the implications of AI on the intersection between work and health. To build the agenda, a full day meeting was organized and attended by 50 participants including researchers from diverse disciplines and applied stakeholders. Facilitated meeting discussions aimed to set research priorities related to workplace AI applications and its impact on the health of workers, including critical research questions, methodological approaches, data needs, and resource requirements. Discussions also aimed to identify groups of workers and working contexts that may benefit from AI adoption as well as those that may be disadvantaged by AI. Discussions were ...
Research Interests:
Research Interests:
Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide... more
Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whetherexistingemployees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not behiredif they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk beingfired. The latter seems worse than the former. Hence, objections to vaccination mandates commonly centre on the harms that will be visited on existing employees who are unwilling to be vaccinated. However, because this objection does not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of certain jobs, those making this objection should have less of an objection, or no objection at all (at least on these grounds), to introducing vaccination r...
Research Interests:
Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these... more
Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these technologies have been used, and their efficacy in supporting public health goals. Following the five-stage scoping review framework, we conducted a scoping review of the peer-reviewed and grey literature to identify the types and nature of digital technologies used for surveillance during the COVID-19 pandemic and the success of these measures. We conducted a search of the peer-reviewed and grey literature published between 1 December 2019 and 31 December 2020 to provide a snapshot of questions, concerns, discussions, and findings emerging at this pivotal time. A total of 147 peer-reviewed and 79 grey literature publications reporting on digital technology use for surveillance across 90 countries and regions were retained for analysis. The most frequen...
Research Interests:
Research Interests:
Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of... more
Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedures vary considerably among cDCDD centers and that despite existing recommendations, the conflict of interest in the W-LST decision and process might be difficult to avoid, the process of W-LST might interfere with usual end-of-life care, and there is a risk of hastening death. In order to ensure that the practice of W-LST meets already well-established ethical recommendations, we suggest that W-LST should be managed in the ICU by an ICU physician who has been part of the W-LST decision. Recommending extubation for W-LST, when this is not necessarily the preferred procedure, is inconsistent with the recommendation to follow usual W-LST protocol. As the risk of conflicts...
Research Interests: Nursing, Decision Making, Informed Consent, Organ Donation, Conflict of Interest, and 11 moreMedicine, Humans, Donation, Clinical Sciences, Intensive Care Medicine, Intensive Care Units, Terminal care, Guideline Adherence, Medical and Health Sciences, Tissue and organ procurement, and withholding treatment
IntroductionThe COVID-19 pandemic prompted a surge in digital public health surveillance worldwide, with limited opportunities to consider the effectiveness or impact of digital surveillance. The news media shape public understanding of... more
IntroductionThe COVID-19 pandemic prompted a surge in digital public health surveillance worldwide, with limited opportunities to consider the effectiveness or impact of digital surveillance. The news media shape public understanding of topics of importance, contributing to our perception of priority issues. This study investigated news media reports published during the first year of the pandemic to understand how the use and consequences of digital surveillance technologies were reported on.MethodsA media content analysis of 34 high- to low-income countries was completed. The terms “COVID-19,” “surveillance,” “technologies,” and “public health” were used to retrieve and inductively code media reports.ResultsOf the 1,001 reports, most were web-based or newspaper sources on the development and deployment of technologies directed at contact tracing, enforcing quarantine, predicting disease spread, and allocating resources. Technology types included mobile apps, wearable devices, “smart” thermometers, GPS/Bluetooth, facial recognition, and security cameras. Repurposed data from social media, travel cards/passports, and consumer purchases also provided surveillance insight. Media reports focused on factors impacting surveillance success (public participation and data validity) and the emerging consequences of digital surveillance on human rights, function creep, data security, and trust.DiscussionDiverse digital technologies were developed and used for public health surveillance during the first year of the COVID-19 pandemic. The use of these technologies and witnessed or anticipated consequences were reported by a variety of media sources worldwide. The news media are an important public health information resource, as media outlets contribute to directing public understanding and shaping priority public health surveillance issues. Our findings raise important questions around how journalists decide which aspects of public health crises to report on and how these issues are discussed.
Research Interests:
Research Interests:
Research Interests:
Drug regulatory bodies aim to ensure that patients have access to safe and effective drugs; however, no matter the quality of pre-licensure studies, uncertainty will remain regarding the safety and effectiveness of newly approved drugs... more
Drug regulatory bodies aim to ensure that patients have access to safe and effective drugs; however, no matter the quality of pre-licensure studies, uncertainty will remain regarding the safety and effectiveness of newly approved drugs until a large and diverse population uses those drugs. Recent analyses of Canada’s post-market drug surveillance (PMDS) system have found that Canada’s PMDS system requires strengthening and that efforts must be improved to monitor and address the safety and effectiveness of approved drugs among vulnerable populations. Given the uncertainty that exists when drugs enter the market, some have suggested that the precautionary principle is relevant to guiding decision-making in this context. This paper responds to recommendations that the Canadian PMDS system should be responsive to the health needs of vulnerable populations by assessing the utility of deploying the precautionary principle to guide a post-market strategy for vulnerable populations.
Research Interests:
Research Interests:
Omics researchers have grand aspirations for their work. In high-level review articles, they propose that the future of the omics holds nothing short of a revolution in personalized medicine. With this in mind, they acknowledge the need... more
Omics researchers have grand aspirations for their work. In high-level review articles, they propose that the future of the omics holds nothing short of a revolution in personalized medicine. With this in mind, they acknowledge the need to combine the individual omics disciplines to create a comprehensive sequence of biology’s potential permutations, which we call the “permutome”. However, we argue that such lofty goals are a far cry from the present state of omics research. Not only do most high-level review articles ignore the problems complicating the formation of the permutome, but they also lack legitimate theory-hypothesis models. We therefore challenge omics researchers to proceed with greater prudence and methodology in both their data collection and analysis.
Research Interests: Ethics, Epistemology, Genomics, Evidence Based Medicine, Public Health Ethics, and 11 morePublic Health, Medicine, Humans, Biomedical Research, Big Data, Genome, Public health systems and services research, Omics, Practice Education/Clinical Evaluation, Cooperative Behavior, and interprofessional relations
Research Interests:
Research Interests: Bioethics, Political Science, Social Justice, Public Health Ethics, Public Health Policy, and 12 moreSocial Determinants of Health, Health Justice, Qualitative Research, Health Equity, Public Health, Health Policy, Medicine, Social Determinants of Health and Health Equity, Public health systems and services research, Curriculum and Pedagogy, Equity and Inequity In Health, and Canadian Public Health Policy
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
IntroductionIn donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted... more
IntroductionIn donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessation of brain activity and circulatory arrest during the dying process threatens public and healthcare provider trust in deceased organ donation.Methods and analysisIn this cohort study, we will prospectively record cerebral and brainstem electrical activity, cerebral blood flow velocity and arterial blood pressure using electroencephalography (EEG), brainstem evoked potentials, transcranial doppler and bedside haemodynamic monitors in adult patients undergoing planned withdrawal of life sustaining measures in the intensive care units at five hospital sites for 18 months. We will use MATLAB to synchronise waveform data and compute the time of ...
Research Interests:
Background: To reopen society, various countries are planning or have implemented differential public health and social measures (PHSMs) for COVID-19-vaccinated individuals, by exempting these individuals from some of the measures. Aims:... more
Background: To reopen society, various countries are planning or have implemented differential public health and social measures (PHSMs) for COVID-19-vaccinated individuals, by exempting these individuals from some of the measures. Aims: To examine the ethical considerations raised by differential PHSMs by differrnt countries based on individual vaccination status verified by vaccination certificates. Discussion: Decisions on whether and when measures should be lifted specifically for vaccinated individuals should be guided by scientific and ethical considerations. These considerations include the public health risks of differential lifting, particularly in a context where a substantial portion of society is not vaccinated; mitigation of inequities and unfair disadvantages for unvaccinated individuals; and whether to permit other health certificates or credentials besides proof of vaccination as alternative options to access specific activities or services, as a way to balance publi...
Research Interests:
We finally have a vaccine for the COVID-19 crisis. However, due to the limited numbers of the vaccine, states will have to consider how to prioritise groups who receive the vaccine. In this paper, we argue that the practical... more
We finally have a vaccine for the COVID-19 crisis. However, due to the limited numbers of the vaccine, states will have to consider how to prioritise groups who receive the vaccine. In this paper, we argue that the practical implementation of human rights law requires broader consideration of intersectional needs in society and the disproportionate impact that COVID-19 is having on population groups with pre-existing social and medical vulnerabilities. The existing frameworks/mechanisms and proposals for COVID-19 vaccine allocation have shortcomings from a human rights perspective that could be remedied by adopting an intersectional allocative approach. This necessitates that states allocate the first COVID-19 vaccines according to (1) infection risk and severity of pre-existing diseases; (2) social vulnerabilities; and (3) potential financial and social effects of ill health. In line with WHO’s guidelines on universal health coverage, a COVID-19 vaccine allocation strategy that it ...
Research Interests:
Research Interests:
South Africa shared with the world the warning of a new strain of SARS-CoV2, Omicron, in November 2021. As a result, many high-income countries (HICs) instituted complete travel bans on persons leaving South Africa and other neighbouring... more
South Africa shared with the world the warning of a new strain of SARS-CoV2, Omicron, in November 2021. As a result, many high-income countries (HICs) instituted complete travel bans on persons leaving South Africa and other neighbouring countries. These bans were unnecessary from a scientific standpoint, and they ran counter to the International Health Regulations. In short, South Africa was penalized for sharing data. Data sharing during pandemics is commonly justified by appeals to solidarity. In this paper, we argue that solidarity is, at best, an aspirational ideal to work toward but that it cannot ground an obligation to share data. Instead, low-and-middle income countries (LIMCs) should be guided by the principle of reciprocity, which states that we ought to return good for good received. Reciprocity is necessarily a conditional principle. LMICs, we argue, should only share data during future pandemics on the condition that HICs provide enforceable assurances that the benefit...
Research Interests: Law and Applied Ethics
BACKGROUND The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies has curtailed opportunities to fully consider their... more
BACKGROUND The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies has curtailed opportunities to fully consider their potential impacts (e.g., for human rights, civil liberties, privacy, marginalization of vulnerable groups, etc.). OBJECTIVE We conducted a scoping review of the peer-reviewed and grey literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance. METHODS Our methodology was informed by the five-stage methodological framework to guide scoping reviews: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and grey literature published between December 1, 2019 and December 31, 2020. We focus...
Research Interests:
Research Interests:
This chapter explores how to combine insights from public health and political science to explain and adapt to policymaking in preventive public health. First, it describes public health approaches to policy change, focusing on the social... more
This chapter explores how to combine insights from public health and political science to explain and adapt to policymaking in preventive public health. First, it describes public health approaches to policy change, focusing on the social determinants of health and the need for high political commitment to health equity. Second, it suggests that, while governments often use the right language to describe public health aims, there is a major gap between commitment, policy, and policy outcomes. We draw on public policy theories to explain this gap, with reference to the ambiguity of preventive policy initiatives, exacerbated by policymaking complexity in which no actor or organisation has strong coordinative capacity. Third, it relates these insights to a qualitative systematic review of ‘Health in All Policies’ (HiAP) research. We compare two different ways to use policy theories for practical lessons: to improve the HiAP playbook and programme logic or to prompt critical reflection ...
Research Interests:
While the degree of COVID-19 vaccine accessibility and uptake varies at both national and global levels, increasing vaccination coverage raises questions regarding the standard of prevention that ought to apply to different settings where... more
While the degree of COVID-19 vaccine accessibility and uptake varies at both national and global levels, increasing vaccination coverage raises questions regarding the standard of prevention that ought to apply to different settings where COVID-19 vaccine trials are hosted. A WHO Expert Group has developed guidance on the ethical permissibility of conducting placebo-controlled trials in the context of expanding global COVID-19 vaccine coverage. The guidance also considers alternative trial designs to placebo controlled trials in the context of prototype vaccines, modified vaccines, and next generation vaccines.
Research Interests:
ABSTRACT Background: Several sets of principles have been proposed to guide global health research partnerships and mitigate inequities inadvertently caused by them. The existence of multiple sets of principles poses a challenge for those... more
ABSTRACT Background: Several sets of principles have been proposed to guide global health research partnerships and mitigate inequities inadvertently caused by them. The existence of multiple sets of principles poses a challenge for those seeking to critically engage with and develop their practice. Which of these is best to use, and why? To what extent, if any, is there agreement across proposed principles? Objective: The objectives of this review were to: (1) identify and consolidate existing documents and principles to guide global health research partnerships; (2) identify areas of overlapping consensus, if any, regarding which principles are fundamental in these partnerships; (3) identify any lack of consensus in the literature on core principles to support these partnerships. Methods: A scoping review was conducted to gather documents outlining ‘principles’ of good global health research partnerships. A broad search of academic databases to gather peerreviewed literature was conducted, complemented by a hand-search of key global health funding institutions for grey literature guidelines. Results: Our search yielded nine sets of principles designed to guide and support global health research partnerships. No single principle recurred across all documents reviewed. Most frequently cited were concerns with mutual benefits between partners (n = 6) and equity (n = 4). Despite a lack of consistency in the inclusion and definition of principles, all sources highlighted principles that identified attention to fairness, equity, or justice as an integral part of good global health research partnerships. Conclusions: Lack of consensus regarding how principles are defined suggests a need for further discussion on what global health researchers mean by ‘core’ principles. Research partnerships should seek to interpret the practical meanings and requirements of these principles through international consultation. Finally, a need exists for tools to assist with implementation of these principles to ensure their application in research practice.
Research Interests:
Research Interests:
"The dead donor rule —that individuals must not be killed by organ retrieval— describes a moral standard implicitly guiding organ procurement legislation around the world. Despite ongoing controversies regarding the vital status of both... more
"The dead donor rule —that individuals must not be killed by organ retrieval— describes a moral standard implicitly guiding organ procurement legislation around the world. Despite ongoing controversies regarding the vital status of both brain-dead organ donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule remains the standard moral framework for organ procurement. The dead donor rule increases the organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement.
Virtually all modern countries currently allow the declaration of death to occur following either the irreversible cessation of circulatory and respiratory function or the irreversible loss of all brain function. In practice, either of these two conditions is considered sufficient for an individual to be declared dead and, if there is no family objection, to be treated as an organ donor.
The justification for each criterion, in addition to a number of medical and philosophical issues regarding the relationship between them, generate concern that the legal standards for declaring death may be allowing organ procurement in ways that already violate the dead donor rule. The claim that perhaps the dead donor rule is not being respected, despite the fact that donors are commonly described as “deceased”, is the tautological result of assuming that these individuals may be alive. Thus, it is important to evaluate both if and how these practices may be currently violating the dead donor rule and examine whether such a violation is acceptable.
The objective of this presentation is to discuss whether the dead donor rule is needed to protect donors from harm at the moment of organ procurement. We will suggest that the assumption according to which individuals cannot be harmed once they have been declared dead is not only unsound but, in the case of DCD, also dangerous for donors’ safety. While the objective of increasing the donor pool without undermining public trust has been the main reason to frame international policies of organ procurement within the limits of the dead donor rule, we argue that this strategy is problematic as it neglects to meet two essential requirements: ensuring that the donor is sufficiently protected and respected, and ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death.
This proposal has an important implication on how the theoretical debates about the definition of death should be framed. We believe that the fundamental question regarding the criteria used for the procurement of vital organs ought to be posed not as an objective question regarding when death occurs —as the dead donor rule necessitates— but rather as a moral question regarding the conditions under which it could be morally acceptable to procure vital organs from dying patients. By shifting the focus in this way, discussions of organ procurement would centre more on the interests of donors and less on the seemingly unanswerable question of when death occurs."
Virtually all modern countries currently allow the declaration of death to occur following either the irreversible cessation of circulatory and respiratory function or the irreversible loss of all brain function. In practice, either of these two conditions is considered sufficient for an individual to be declared dead and, if there is no family objection, to be treated as an organ donor.
The justification for each criterion, in addition to a number of medical and philosophical issues regarding the relationship between them, generate concern that the legal standards for declaring death may be allowing organ procurement in ways that already violate the dead donor rule. The claim that perhaps the dead donor rule is not being respected, despite the fact that donors are commonly described as “deceased”, is the tautological result of assuming that these individuals may be alive. Thus, it is important to evaluate both if and how these practices may be currently violating the dead donor rule and examine whether such a violation is acceptable.
The objective of this presentation is to discuss whether the dead donor rule is needed to protect donors from harm at the moment of organ procurement. We will suggest that the assumption according to which individuals cannot be harmed once they have been declared dead is not only unsound but, in the case of DCD, also dangerous for donors’ safety. While the objective of increasing the donor pool without undermining public trust has been the main reason to frame international policies of organ procurement within the limits of the dead donor rule, we argue that this strategy is problematic as it neglects to meet two essential requirements: ensuring that the donor is sufficiently protected and respected, and ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death.
This proposal has an important implication on how the theoretical debates about the definition of death should be framed. We believe that the fundamental question regarding the criteria used for the procurement of vital organs ought to be posed not as an objective question regarding when death occurs —as the dead donor rule necessitates— but rather as a moral question regarding the conditions under which it could be morally acceptable to procure vital organs from dying patients. By shifting the focus in this way, discussions of organ procurement would centre more on the interests of donors and less on the seemingly unanswerable question of when death occurs."
An increasingly large proportion of pregnancies in recent years have been multifetal pregnancies, most significantly attributable to the increase of assisted reproductive technologies (ARTs) and the transfer of multiple embryos.... more
An increasingly large proportion of pregnancies in recent years have been multifetal pregnancies, most significantly attributable to the increase of assisted reproductive technologies (ARTs) and the transfer of multiple embryos. Associated with the increasing number of multifetal pregnancies are increased rates of adverse perinatal outcomes when compared to spontaneously conceived children, including instances of preterm delivery, low birth weight, and perinatal mortality. In an attempt to understand the cause of these adverse outcomes, studies have indicated that perinatal risk increases with higher starting and finishing numbers of fetuses in a pregnancy.
In light of this, some physicians and patients opt for multifetal pregnancy reduction (MFPR) and selective termination procedures. Both procedures involve the termination of one or more fetuses during a multifetal pregnancy in an attempt to improve perinatal and obstetric outcomes. Selective terminations aim to terminate biologically or genetically anomalous fetuses that may threaten a pregnancy, whereas MFPR aims to reduce a pregnancy with otherwise healthy fetuses in order to increase the likelihood of successful gestation and delivery.
MFPR is most common in higher-order pregnancies (triplets or more) but increasingly women are choosing to reduce lower-order (twin) pregnancies. Further, individuals are increasingly citing non-medical reasons for reduction, including personal convenience or lack of economic means to raise multiples. Where advocates of MFPR initially cited necessity for the reduction of higher-order pregnancies, ethical tensions have now heightened in the consideration of more 'elective' reductions and the reductions of lower-order pregnancies.
Like abortion, fetal reduction has advocates and opponents. Beyond current debates regarding singleton abortion, however, recent discussions of fetal reductions have been rather limited in their moral scope and analysis. Some opponents of these procedures, for example, claim that a woman’s right to the determination of whether she is pregnant does not extend to the right to determine how many fetuses she is pregnant with. Alternatively, proponents of these procedures claim that it is illogical to deny a woman the right to reduce the number of fetuses in her pregnancy when she has the right to terminate the entire pregnancy.
As a result of the political and personal sensitivity regarding fetal reduction, those who practice these procedures do so without much ethical discussion or guidance. As the utilization of ARTs increases, there is a moral impetus to provide these stakeholders with ethical guidance regarding MFPR and selective termination. Does the improvement in perinatal health justify MFPR and selective termination, and are there any limits to how and when they are performed?
These procedures represent a significant step to mitigating the adverse perinatal outcomes subsequent to multifetal pregnancies. In an attempt to better inform practitioners, patients, and policy, this presentation strives to assess the ethical dimensions of fetal reduction practices and whether improved perinatal outcomes justify their use. Finally, this presentation seeks to start a more robust discussion regarding these measures that seek to improve perinatal outcomes, as the ethical milieu in which the procedures operate has not nearly had the rigorous moral evaluation or deliberation that it deserves.
http://www.royalcollege.ca/portal/page/portal/rc/common/documents/bioethics/section4/case_4_3_5_e.html
In light of this, some physicians and patients opt for multifetal pregnancy reduction (MFPR) and selective termination procedures. Both procedures involve the termination of one or more fetuses during a multifetal pregnancy in an attempt to improve perinatal and obstetric outcomes. Selective terminations aim to terminate biologically or genetically anomalous fetuses that may threaten a pregnancy, whereas MFPR aims to reduce a pregnancy with otherwise healthy fetuses in order to increase the likelihood of successful gestation and delivery.
MFPR is most common in higher-order pregnancies (triplets or more) but increasingly women are choosing to reduce lower-order (twin) pregnancies. Further, individuals are increasingly citing non-medical reasons for reduction, including personal convenience or lack of economic means to raise multiples. Where advocates of MFPR initially cited necessity for the reduction of higher-order pregnancies, ethical tensions have now heightened in the consideration of more 'elective' reductions and the reductions of lower-order pregnancies.
Like abortion, fetal reduction has advocates and opponents. Beyond current debates regarding singleton abortion, however, recent discussions of fetal reductions have been rather limited in their moral scope and analysis. Some opponents of these procedures, for example, claim that a woman’s right to the determination of whether she is pregnant does not extend to the right to determine how many fetuses she is pregnant with. Alternatively, proponents of these procedures claim that it is illogical to deny a woman the right to reduce the number of fetuses in her pregnancy when she has the right to terminate the entire pregnancy.
As a result of the political and personal sensitivity regarding fetal reduction, those who practice these procedures do so without much ethical discussion or guidance. As the utilization of ARTs increases, there is a moral impetus to provide these stakeholders with ethical guidance regarding MFPR and selective termination. Does the improvement in perinatal health justify MFPR and selective termination, and are there any limits to how and when they are performed?
These procedures represent a significant step to mitigating the adverse perinatal outcomes subsequent to multifetal pregnancies. In an attempt to better inform practitioners, patients, and policy, this presentation strives to assess the ethical dimensions of fetal reduction practices and whether improved perinatal outcomes justify their use. Finally, this presentation seeks to start a more robust discussion regarding these measures that seek to improve perinatal outcomes, as the ethical milieu in which the procedures operate has not nearly had the rigorous moral evaluation or deliberation that it deserves.
http://www.royalcollege.ca/portal/page/portal/rc/common/documents/bioethics/section4/case_4_3_5_e.html
Research Interests:
During the Ebola virus disease outbreak in West Africa, an advisory panel to the World Health Organization (WHO) argued that it can be ethically appropriate to offer individual patients experimental interventions on an emergency basis... more
During the Ebola virus disease outbreak in West Africa, an advisory panel to the World Health Organization (WHO) argued that it can be ethically appropriate to offer individual patients experimental interventions on an emergency basis outside clinical trials provided that certain conditions are met (WHO 2014a). The panel referred to the use of experimental interventions under these circumstances as “monitored emergency use of unregistered and experimental interventions” (MEURI) (WHO 2014b). In the ethical framework subsequently developed to guide policy and practice related to MEURI, it was acknowledged that compounds qualifying for MEURI may not be available in large quantities, and so choices would have to be made about who receives each intervention (WHO 2016). While the MEURI framework offered some general considerations for allocating scarce unproven interventions (WHO 2016), it was largely silent on the specifics of allocation. As the current WHO working group struck to evaluate the utility of MEURI in the context of the COVID-19 pandemic, we commend Webb et al. (2020) for advancing detailed thinking around the allocation of scarce unproven interventions for COVID-19. In the spirit of finding common ground in the area of using unproven interventions during public health emergencies, in what follows we will (1) provide a brief introduction to MEURI, (2) compare Webb et al.’s proposal to the existing MEURI framework, and (3) outline key areas where the use and allocation of unproven interventions can be enhanced.
Research Interests:
As the world reflects upon one year since the first cases of coronavirus disease 2019 (COVID-19) and prepare for and experience surges in cases, it is important to identify the most crucial ethical issues that might lie ahead so that... more
As the world reflects upon one year since the first cases of coronavirus disease 2019 (COVID-19) and prepare for and experience surges in cases, it is important to identify the most crucial ethical issues that might lie ahead so that countries are able to plan accordingly. Some ethical issues are rather obvious to predict, such as the ethical issues surrounding the use of immunity certificates, contact tracing, and the fair allocation of vaccines globally. Yet, the most significant ethical challenge that the world must address in the next year and beyond is to ensure that we learn the ethical lessons of the first year of this pandemic. Learning from our collective experiences thus far constitutes our greatest moral obligation. Appreciating that decision-making in the context of a pandemic is constrained by unprecedented complexity and uncertainty, beginning in June 2020, an international group of 17 experts in bioethics spanning 15 countries (including low-, middle-, and high-income countries) met virtually to identify what we considered to be the most significant ethical challenges and accompanying lessons faced thus far in the COVID-19 pandemic. Once collected, the group met over the course of several virtual meetings to identify challenges and lessons that are analytically distinct in order to identify common ethical themes under which different challenges and lessons could be grouped. The result, described in this paper, is what this expert group consider to be the top five ethical lessons from the initial experience with COVID-19 that must be learned.