Ken Kirkwood

Considering Harm Reduction as the Future of Doping Control Policy in International Sport

Since the 1960s, major international sporting organizations enforced a prohibition on performance-enhancing drugs. The scope of this enforcement expanded to the current system regulated by the World Anti-Doping Agency. Although the sophistication of the detective sciences and the comprehensive enforcement of these prohibitions have improved over time, supporters of the ban on drug use in sport still struggle with 3 issues: Doping is still quite common; the ability to detect established drugs have driven users to newer, more experimental substances; and the prohibition policy lacks sufficient moral justifications. This article suggests that the debate over doping has bifurcated between those who continue to support antidoping measures with insufficient ethical grounds and those who would potentially permit the unregulated use of performance-enhancement technologies in sport because of insufficient justifications for prohibition. A third way, posed herein, suggests the most ethically defensible policy is a harm-reduction approach.

Constructing the meaning of survivor with former pediatric brain tumor patients.

Although the term survivor is frequently used in cancer discourse, the meaning of survivor and how people identify with this term can be difficult to understand. The purpose of this qualitative study is to explore the meaning of the term survivor from the perspective of young adults who have experienced a pediatric brain tumor (PBT). A constructivist grounded theory was utilized in this study with 6 young adults who had a PBT. This study also used semistructured interviews with participants who also completed reflective journals, which were focused on the survivor concept. Data were analyzed through coding strategies and constant comparative methods. Findings present 4 major themes of process: (a) reviewing the illness experience, (b) qualifying as a survivor, (c) thinking positive, and (d) being changed. These themes are important to consider in the construction, interpretation, and understanding of how the majority of this population do not identify with the current social use of the term survivor. Clearly, there is a need for a clearer understanding of survivor and how it specifically applies to those who have had a PBT. Everyone should remain conscious and consider how a broad, generalizing term such as survivor may influence a person’s attitude and advocacy toward their health.

What do you mean I wasn’t cheating? Testing the concept of cheating through a case of failed doping

Using a case of intended but failed doping, the author seeks to answer the question of if an agent cheated when they intended to but failed in the case of doping due to inert, counterfeit drugs. The examination looks at the case using the concept of cheating and concludes by dividing the results of cheating into primary and secondary effects.

Conscientious objection and nurses: Results of an interpretive phenomenological study:

Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. Research question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Research design: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Conscience, conscientious objection, and nursing: A concept analysis:

Background: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses’ ethical care provision. Conscientious objection is one such strategy for addressing nurses’ personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. Research aim: To analyze the concepts of conscience and conscientious objection in the context of nurses. Design: Concept analysis using the method by Walker and Avant. Research context: Data were retrieved from Philosopher’s Index, PubMed, and CINAHL with no date restrictions. Ethical consideration: This analysis was carried out per established, scientific guidelines. Findings: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. Discussion and conclusion: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

The geographic scope of opiate substitution therapy in an urban area in Canada

Abstract Opiate substitution therapy (OST) is an interdisciplinary treatment method for individuals experiencing opiate addictions. Municipalities internationally are working through a process of responding to both the need for OST clinics and community concerns around these clinics. The purpose of this quantitative descriptive study was to better understand the geographic spread of those currently accessing OST in an urban area in Canada. This will serve to assist related policy-making. Postal codes of 796 individuals accessing OST were obtained from one clinic and one dispensing pharmacy. Representing 581 unique data points, these were mapped across the 26 residential neighbourhoods in the city of study. Individuals accessing OST were located within an 11 km radius of the clinic and pharmacy. Situated in every neighbourhood in this radius, individuals accessing OST were in 24 of the 26 possible residential neighbourhoods. Ultimately, data support the hypothesis that individuals accessing OST are located in all residential neighbourhoods in the urban area of study. This supports current literature indicating that addiction exists throughout all urban areas rather than being limited to only certain neighbourhoods. This has implications for zoning of OST clinics and pharmacies, as municipalities must balance neighbourhood concerns while not overly restricting access throughout the municipality.

Does the Existence of Steroid Addiction Alter the View That Steroid Use in Sport is Cheating

It is widely accepted that doping in sports is, by definition, cheating. If we allow that cheating is advantage-seeking behavior utilized by one party in an agreement-defined activity that disallows that behavior, then taking drugs when others do not is cheating. The focus of this definition is on the intentions and purpose of the actor, which is primarily about advantage seeking. This article will argue that the effect of anabolic steroid addiction on the volition of the actor caeteris paribus invalidates the adequacy of cheating to describe this behavior.

A numbered day in the life

A story of Jim, a man who begins to habituate himself to hospital culture as that outsider known as the patient.