Margaret A. Somerville

The ethics of social risk reduction in the era of the biological brain

In keeping with our transdisciplinary orientation, in this article we try to do several things at once. We address research on preventing mental illness and its relation to existing conceptions of public health, a topic to which insufficient attention has been paid in the era of the biological brain, while using this case study to illustrate the limits of conventional approaches in bioethics. After identifying the crucial need for methodological self-consciousness in prevention research and policy, we explore the implications as they relate to (i) the values embedded in the choice of research designs and strategies, and (ii) contrasting intellectual starting points regarding the biological plausibility of preventing mental illness. We then draw attention to the need for more thoughtful analysis of the appropriate role and limits of economics in making choices about prevention of mental illness.

Donor conception and children’s rights: “First, do no harm”

As Tom Ellis, a donor-conceived adult and doctoral candidate, puts it, “The interests of those people created by donor-conception should be paramount.” Ethically, he’s right. Children’s rights and “best interests” must be at the centre of decision-making about donor conception[1][1] and

HIV/AIDS and school boards: A policy approach

In general, there is a low incidence of HIV infection in members of school communities. Moreover, all available evidence supports the conclusion that HIV is not transmitted by the everyday contacts which occur in family, social, employment and educational settings. Despite this, the presence, in a school community, of persons infected with HIV or who have an HIV related disease have been perceived by some as presenting a threat to their childrens, and even to their own health and well-being, which, in turn, has led to serious conflicts between various participants in that community. Experience, however, has shown that the fears of many persons and the risks of conflict and confrontation can be minimized, if not negated, if a school board has adopted policies and procedures in relation to HIV/AIDS. Such policies and procedures must be based on current medical knowledge and clearly identified ethical and legal principles, including identification of the rights, interests and needs of all persons and development of appropriate analyses, especially where these are required to resolve conflicts. In this text, educational authorities and their advisors are provided both with a comprehensive model HIV/AIDS policy, and a commentary which examines, amongst other matters, the fundamental ethical and legal considerations which have guided its formulation and the justifications for each of the principles contained therein.

TOWARDS UNIVERSITIES FOR THE TWENTY‐FIRST CENTURY∗

The future of higher education as the twenty‐first century is approached is discussed. The knowledge explosion requires the development of methodologies for the integration of transdisciplinary integrated knowledge entities, best visualized as a helix. The future will call for active tolerance among academics working in varying disciplinary specializations, transdisciplinary synergism, official recognition of the importance of networking, and the need for restructuring. New relationships must be formed both within the university and between it and its partners in the community, these based on earned trust. Meeting these new challenges can be facilitated by applied ethics. * The original version of this article, which has been slightly edited by the CEPES editorial staff, was first presented by the author at the Presidential Colloquium on Research of the University of Toronto (Ontario, Canada) on 20 September 1989.

Professional Intervention in the Family

Maltreatment of children, including child abuse, and the often related problem of juvenile delinquency are serious and disturbing issues. Juvenile delinquency has been regarded for some time by federal Canadian law, as an area needing special consideration, treatment and rules.1 Likewise, there have been provincial child welfare acts. But recently the law has been used to set up special structures to deal with child abuse and neglect, for example in the provinces of Quebec2 and Ontario.3

The pregnant minor: contraception and abortion under Canadian law.

Regulation of access to contracep tion or abortion by minors has been a major issue in many jurisdictions over the past decade. This article will investigate the current law in Canada and will enable comparisons to be drawn with the situation in otherjurisdictions, particularly those in the United States in light of the United States Supreme Court’s recent decision upholding the Hyde Amendment which restricts the use of federal funds for abortions. Some of the legal issues present are common to both contraception and abortion. However, because abortion is expressly regulated by the Criminal Code of Canada,’ there are also signifcant differences. The two major issues are the legality of the procedures themselves and consent. These questions are both separate and related: they are separate because the legality of a medical intervention must be looked at apart from consent, and related because conSent is one of the factors upon which legality depends.’

“Law, Marching with Medicine but in the Rear and Limping a Little”: Ethics as “First Aid” for Law

The quotation in the title of this paper, “Law, marching with medicine but in the rear and limping a little”, comes from a judgment of Justice Windeyer of the High Court of Australia in the case Mount Isa Mines v Pusey1.

Commentary: Social-ethical values issues in the political public square: principles vs. packages.

Margaret Somerville his article explores decision making about social-ethical values issues by members of the T public in the context of the recent Canadian federal election, held in late June 2004. All of these issues are sensitive and controversial, and I hesitated to address them in an article that I dedicate, with respect and admiration, to my friend and fellow medical lawyer-ethicist, Bernard Dickens. Over the years Bernie and I have discussed, debated and disagreed on many of them. It speaks to his tolerance, reasonableness and wisdom that those occasions were for me always ones of learning and respect, colored by his inimitable sense of humor. I hope that Bernie feels that, in some small measure, this article reflects those same characteristics, ones that he has modeled for so many of us over the years of his distinguished career. There has been much puzzling and pondering over why many people who were polled one week before the election indicated that they had decided to vote for the socially conservative Conservative party, but apparently changed their minds on the way to the ballot box and elected the socially liberal Liberal party. I suggest that one cause was the packages of stances on social-ethical issues related to very important values taken by each of the parties. Leaving aside such interesting issues as whether human decision making is primarily emotionally or rationally based, (I believe it’s emotion based and rationality is a secondary verification mechanism’) and that our choices in hypothetical situations are ofien not the same as when the same situation is real, I would suggest many ofthese people had a powem experience of cognitive dissonance (such as when two people, each with a bone, walk in opposite directions away from a dog, the dog goes round in circles). This experience was precipitated by needing to choose among the packages of stances on social issues each of the parties took or were alleged by their opponents to have taken. These voters could not find any party‘s package with which they could agree in its entirety. That meant trying to choose the least bad package. I believe many last minute vote-changers had initially decided that was the Conservative package, but in the last days of the campaign changed their minds and switched to the Liberal one. The Liberals ran an “attack ad” campaign on the eve of the election, focusing on social-ethical values issues. These ads showed dramatic footage and asked in voice over, ‘Would you want your son to go to Iraq? Your daughter to be unable to obtain an abortion?

Examination on Discovery of “Death at a New York Hospital”: Searching for the Governing Values, Policies, and Attitudes

There is one statement made by almost every person who enters my office to discuss a case of medical malpractice: “Even if nothing can be done for me, I want to make sure, as far as I am able, that this doesn’t happen to somebody else.” There are good psychological reasons for such an approach; the person is converting a negative event, the consequences of which are often irreversible, into some positive value. This is therapeutic for the person; but it may also prove to be therapeutic for a wider group, those who are helped as a result of the awareness raised by the publicity surrounding the case of a victim of medical malpractice. “Death at a New York Hospital” is a particularly forceful and moving example of the phenomenon just described, although the situation Prof. Schucking encountered does not necessarily involve medical malpractice in the strict sense of that concept. The article communicates strongly, at both cognitive and em* tional levels, many of the issues that need to be addressed in such situations.