Jennifer A. Chandler

iPS Cells: Mapping the Policy Issues

Given the explosion of research on induced pluripotent stem (iPS) cells, it is timely to consider the various ethical, legal, and social issues engaged by this fast-moving field. Here, we review issues associated with the procurement, basic research, and clinical translation of iPS cells.

The value and pitfalls of speculation about science and technology in bioethics: the case of cognitive enhancement

Abstract In the debate on the ethics of the non-medical use of pharmaceuticals for cognitive performance enhancement in healthy individuals there is a clear division between those who view “cognitive enhancement” as ethically unproblematic and those who see such practices as fraught with ethical problems. Yet another, more subtle issue, relates to the relevance and quality of the contribution of scholarly bioethics to this debate. More specifically, how have various forms of speculation, anticipatory ethics, and methods to predict scientific trends and societal responses augmented or diminished this contribution? In this paper, we use the discussion of the ethics of cognitive enhancement to explore the positive and negative contribution of speculation in bioethics scholarship. First, we review and discuss how speculation has relied on different sets of assumptions regarding the non-medical use of stimulants, namely: (1) terminology and framing; (2) scientific aspects such as efficacy and safety; (3) estimates of prevalence and consequent normalization; and (4) the need for normative reflection and regulatory guidelines. Second, three methodological guideposts are proposed to alleviate some of the pitfalls of speculation: (1) acknowledge assumptions more explicitly and identify the value attributed to assumptions; (2) validate assumptions with interdisciplinary literature; and (3) adopt a broad perspective to promote more comprehensive reflection. We conclude that, through the examination of the controversy about cognitive enhancement, we can employ these methodological guideposts to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.

The use of neuroscientific evidence in Canadian criminal proceedings

This article addresses the question of how neuroscientific evidence is currently used in the Canadian criminal justice system, with a view to identifying the main contexts in which this evidence is raised, as well as to discern the impact of this evidence on judgements of responsibility, dangerousness, and treatability. The most general Canadian legal database was searched for cases in the five-year period between 2008 and 2012 in which neuroscientific evidence related to the responsibility and recidivism risk of criminal offenders was considered. Canadian courts consider neuroscientific evidence of many types, particularly evidence of prenatal alcohol exposure, traumatic brain injury, and neuropsychological testing. The majority of the cases are sentencing decisions, which is useful given that it offers an opportunity to observe how judges wrestle with the tension that evidence of diminished capacity due to brain damage tends to reduce moral blameworthiness, while it also tends to increase perceptions of risk and dangerousness. This so-called double-edged sword of the biological explanation of criminal behavior was reflected in this study, and raises questions about whether and when the pursuit of such evidence is advisable from the defense perspective.

Stem cell tourism: doctors' duties to minors and other incompetent patients.

Zarzeczny and Caulfield (2010) have provided an excellent paper considering the duties of physicians where it appears that the parents of their minor patients intend to take them abroad for unprove...

Public attitudes toward legally coerced biological treatments of criminals

Abstract How does the public view the offer of a biological treatment in lieu of prison for criminal offenders? Using the contrastive vignette technique, we explored this issue, using mixed-methods analysis to measure concerns regarding changing the criminals personality, the coercive nature of the offer, and the safety of the proposed treatment. Overall, we found that of the three variables, the safety of the pill had the strongest effect on public acceptance of a biological intervention. Indeed, it was notable that the public was relatively sanguine about coercive offers of biological agents, as well as changing the personality of criminals. While respondents did not fully endorse such coercive offers, neither were they outraged by the use of biological treatments of criminals in lieu of incarceration. These results are discussed in the context of the retributive and rehabilitative sentiments of the public, and legal jurisprudence in the arena of human rights law.

Attitudes toward reciprocity systems for organ donation and allocation for transplantation.

Many of those who support organ donation do not register to become organ donors. The use of reciprocity systems, under which some degree of priority is offered to registered donors who require an organ transplant, is one suggestion for increasing registration rates. This article uses a combination of survey and focus group methodologies to explore the reaction of Canadians to a reciprocity proposal. Our results suggest that the response is mixed. Participants are more convinced of the efficacy than they are of the fairness of a reciprocity system. Those more positive about donation (decided donors and those leaning toward donation) rate the system more positively. Although there is general endorsement of the notion that those who wish to receive should be prepared to give (the Golden Rule), this does not translate into universal support for a reciprocity system. In discussions of efficacy, decided donors focus on the positive impact of reciprocity, whereas undecided donors also reflect on the limits of reciprocity for promoting registration. The results demonstrate divided support for reciprocity systems in the Canadian context, with perceptions of efficacy at the cost of fairness. Further studies are warranted prior to considering a reciprocity system in Canada.

Priority in organ allocation to previously registered donors: public perceptions of the fairness and effectiveness of priority systems

A priority system is one in which previously registered donors receive a preference in the allocation of organs for transplant ahead of those who have not registered. Supporters justify these systems on the basis that they are fair and will encourage donor registration. This article reviews existing studies of public reactions to priority systems, as well as studies of the extent to which the moral principle of reciprocity affects decision making in organ donation. The role of reciprocity in the public discourse surrounding the enactment of priority systems in Singapore and Israel is described. One factor that seems to have been relevant in these countries is the existence of a religious minority that is perceived as willing to take an organ but not to donate one. Although this perception may have fueled a resentment of perceived “free-riders,” concerns were raised about the social divisiveness of priority systems. In sum, people appear to be sensitive to the principle of reciprocity in the context of organ donation, but this sensitivity does not always translate into support for priority systems. Further research into whether public messaging about organ donation could be modified to encourage registration by appeal to the golden rule would be worthwhile.

“Effective” Requesting: A Scoping Review of the Literature on Asking Families to Consent to Organ and Tissue Donation

Background Families are often asked to consent to the donation of their deceased relative’s organs or tissues. These end-of-life conversations are important because they affect consent rates as well as the psychological impact of the decision for families. This scoping review of the literature on requesting family consent was prepared to support of the development of leading practice recommendations for end-of-life conversations with families of potential donors. A scoping review maps research activity in a field across a range of commentary and empirical study designs but does not attempt meta-synthesis of empirical data or quality assessment. Methods We performed a scoping review of the peer-reviewed literature from January 2000 to February 2015 on the questions of what constitutes an “effective” request and the factors that affect consent rates and family satisfaction with their decision and the process. This review includes a final set of 168 articles addressing (a) whether, when, and how to ask families for consent to donation or (b) characteristics of families or decedents that affect families’ decisions or family satisfaction with their decisions. Results Six main themes were identified: (1) the objectives of requesting and encouraging family consent to donation, (2) the effect of the donation decision on family well-being, (3) the process of requesting family consent, (4) the impact of the quality of the care for the deceased and for the family, (5) the content and manner of the request for family consent, and (6) the characteristics of the family and deceased that affect the request for family consent. Conclusion This scoping review found that there is a large literature on how to modify the process and manner of the request to increase family consent rates. Another important line of inquiry focuses on the psychological impact of the decision on the family. Although a scoping review does not attempt to synthesize results or draw evidence-based conclusions, the literature generally supports the intuitive expectations that compassionate and respectful care for the deceased and family, listening for and addressing family concerns, and an attitude to donation that is positive (but not solely procurement-focused) and is best for both consent rates and family well-being. Although the presumption is often that the primary objective of asking for family consent is to secure consent and donation, some ethical commentary on requesting consent emphasizes that this objective must be balanced with the parallel obligation to protect the psychological well-being of families. This places some constraints on the approaches used in family consent discussions.

“Obligatory Technologies” Explaining Why People Feel Compelled to Use Certain Technologies

The ideas of technological determinism and the autonomy of technology are long-standing and widespread. This article explores why the use of certain technologies is perceived to be obligatory, thus fueling the fatalism of technological determinism and undermining our sense of freedom vis-à-vis the use of technologies. Three main mechanisms that might explain “obligatory technologies” (technologies that must be adopted) are explored. First, competition between individuals or groups drives the adoption of technologies that enhance or extend human capacities. Second, individuals and groups may become dependent on technologies. Third, technologies induce changes in social norms and values that may come to be enforced through various social mechanisms, including the law. The widespread ideology of the beneficence and inevitability of technological progress in our culture helps this process along.

Lifetime Probabilities of Needing an Organ Transplant Versus Donating an Organ After Death

The lifetime probabilities of becoming a deceased organ donor and requiring or receiving an organ transplant are unknown. An actuarial analysis was performed in a representative Canadian sample. Using Canadian organ donation data 1999–2007, provincial waiting list and population census data, actuarial rates were produced that provide the probabilities, by age band and gender, of (1) becoming a deceased organ donor, (2) needing an organ transplant and (3) receiving all organs needed. Regardless of age, the lifetime probability of needing a transplant for males is approximately twice that of females. Depending on age, Canadians are five to six times more likely to need an organ transplant than to become a deceased organ donor. The lifetime probabilities of not receiving a required organ transplant, expressed as a percentage of individuals on the waiting list, ranges from approximately 30% at birth, 20 years and 40 years to approximately 40% at 60 years. Across provinces and genders, Canadians at all ages are much more likely to need an organ transplant than to become an organ donor. Approximately one‐third of those in need of a transplant will never receive one. How this information may influence organ donation decisions is currently under study.