Christy Simpson | Dalhousie University (original) (raw)

Papers by Christy Simpson

Canadian Family Physician, Sep 1, 2013

Exclusivement sur le web Commentaire Les défis du recrutement et du maintien des médecins dans le... more Exclusivement sur le web Commentaire Les défis du recrutement et du maintien des médecins dans les communautés rurales La fiction pour aider à expliquer la réalité

International library of ethics, law, and the new medicine, 2017

The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Hec Forum, Jun 1, 2008

Whilst clinical ethics processes are an increasingly accepted part of institutional culture in he... more Whilst clinical ethics processes are an increasingly accepted part of institutional culture in healthcare, broadening the focus of these processes to include the organization as an ethical actor (organizational ethics) remains a work in progress. Drawing from our experiences as members of the Ethics Committee at the IWK Health Centre in Canada, (the IWK) in this paper we focus on our experiences of moving organizational ethics from "theory to practice". We particularly address the operational and functional challenges associated with this transition in regard to the ethics committee's role in policy development and review. Even in a health centre with a relatively strong commitment to ethics and ethical practice, the inclusion of an organizational ethics perspective has raised new questions and challenges.

Oxford University Press eBooks, Apr 1, 2019

Rural women as a group are reported to face a “double disadvantage” due to their gender and rural... more Rural women as a group are reported to face a “double disadvantage” due to their gender and rural place of residence. Gendered and place constructions of “good” rural women and the roles “good” women should play in rural communities are shown to intersect with the values of place and community that characterize rural healthcare ethics. While gender and place stereotypes can have positive and negative implications for rural women and rural communities more generally, the intersections between these stereotypes and these values also may impact rural women and their access to health services across multiple dimensions, including availability, affordability, accessibility, acceptability, and accommodation. If the ability of rural women to access health services is influenced by gendered and place constructions of their role and the values of place and/or community, this is important when considering how health services should be designed and delivered.

In this chapter we focus on rural women, a group that is reported to face a “double disadvantage”... more In this chapter we focus on rural women, a group that is reported to face a “double disadvantage” due to their gender and rural place of residence. We argue that gendered and place constructions of ‘good’ rural women and the roles ‘good’ women should play in rural communities, intersect with the values of place and community that, in earlier work, we have argued may characterise rural health ethics. Gender and place stereotypes can have positive and negative implications for rural women and rural communities more generally. But the intersections between these stereotypes and these values may also impact on rural women and their access to health services. We examine rural women’s access to health services across multiple dimensions, including availability, affordability, accessibility, acceptability and accommodation. If the ability of rural women to access health services is influenced by gendered and place constructions of their role and the values of place and/or community, this is of importance when considering how health services should be designed and delivered

International library of ethics, law, and the new medicine, 2017

In this chapter, we demonstrate both the relevance of organisational ethics for rural health faci... more In this chapter, we demonstrate both the relevance of organisational ethics for rural health facilities and the overall contribution to rural health ethics that this approach provides. We do this, first, by describing organisational ethics and engaging in an extended discussion of the ways in which this meso level of analysis does and does not arise in the rural health ethics literature. In this chapter we also argue that health facilities are important and less visible ethical actors in the rural health sector. We then use the example of recruiting and retaining health providers to rural health facilities to demonstrate the value of utilising an organisational ethics approach. We conclude this chapter by arguing that rural health ethics will benefit from further meso level analysis where the respective values, interests and obligations at play within rural health facilities and the impacts on relationships within these facilities and between these facilities, patients and communities are examined.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter that we need use an ethics lens to critically examine stereotypes that i... more We argue in this chapter that we need use an ethics lens to critically examine stereotypes that idealise rural life and rural health care and be attentive to the ways in which they inform our thinking, including whether they have any negative impacts on rural health providers or patients. We ask whether our nostalgia about rural life and rural health care, as framed by the stereotypes of the idyll and the ideal rural health provider, may be obstructing the development of better policies and decisions about the provision of rural health services, much in the same way that the deficit or dystopia framing, discussed in Chap. 3, may limit the development of health policies and practices. It is our hope that by examining these stereotypes, we will be able to reduce injustice or inequities and make better decisions about providing health care to all citizens, wherever they reside.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter for a re-valuing of relationships. While it has long been recognised tha... more We argue in this chapter for a re-valuing of relationships. While it has long been recognised that a relationship lies at the heart of the health provider-patient interaction, latterly changes in the way in which health services are provided may have shifted the focus from the relational aspects of the interaction to the transactional and instrumental. We argue that the nature and quality of the relationship between a health provider and a patient may be particularly important and central to the provision of rural health services because of the interrelatedness and corresponding intensity of relationships that often characterises rural settings. We focus in the second half of the chapter on the issue of dual and multiple relationships which are almost inevitable when health providers are based in rural communities but which urban-centric ethical frameworks generally suggest should be avoided. We argue that the nature and quality of relationships in health care practice in general and in relation to dual and multiple relationships in particular need to be re-valued.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter for an explicit value of community in health ethics. That is to say we a... more We argue in this chapter for an explicit value of community in health ethics. That is to say we argue that health ethicists, and others, should acknowledge that people may feel connected to and identify with a particular community. This identification with community has epistemological implications. A person’s identification as a member of a community, and the potential consequent valuing of community, may create a sense of obligation to that community which may be expressed through a sense of solidarity and/or reciprocity. As with place, we believe community ought to be considered a specific value to give it the necessary weight in ethical deliberations in health care settings. We argue that the value of community is particularly relevant for rural residents as neighbours are often seen as a necessary element of their interdependent social space. The value of community may also influence health care policy, as well as the design and delivery of health services, if taken into account at the meso and macro levels of analysis.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter for an explicit value of place in health ethics. Psychologists have iden... more We argue in this chapter for an explicit value of place in health ethics. Psychologists have identified that some people feel what they term place attachment. We argue that ethicists should acknowledge that some people may feel connected to and identify with a particular place which has epistemological implications and implications for a person’s standpoint – as what we know is fundamentally influenced by where we come from. Place may also sometimes be used as a means to stereotype particular patients and their likely responses and values. In this chapter we argue for a value of place to give it the necessary weight and attention in ethical deliberations around the provision of health care at the micro, meso and macro levels of service delivery. We argue that the value of place is particularly relevant for rural residents as it may influence their health care choices, their experience of receiving care and their access to health services.

International library of ethics, law, and the new medicine, 2017

In this chapter, we undertake an overview of the rural health ethics literature. We identify and ... more In this chapter, we undertake an overview of the rural health ethics literature. We identify and describe six convergences and divergences in this literature, which point to key gaps in how this field has developed to date and provide some indicators as to further areas for development. These key gaps, for us, include the relative lack of meso and macro level of analysis in rural health ethics and a need for additional conceptual development and clarity regarding the underpinnings of much of this field. Accordingly, this chapter provides a foundation for the discussion and analysis of rural health ethics that follows in this book.

BMC Medical Ethics, Oct 21, 2021

Background: The COVID-19 pandemic has had a significant impact on the health system worldwide. Th... more Background: The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. Method: To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. Results: This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates. Conclusion: This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.

Healthcare Management Forum, Oct 1, 2004

This article describes a new model for ethics support for Capital Health (a health region in Nova... more This article describes a new model for ethics support for Capital Health (a health region in Nova Scotia). With its emphasis on building a culture of ethics, many innovative elements are integral to this model and its future success. Particular emphasis is on organizational healthcare ethics and meaningful participation. Concerns about volunteer burden, urban and rural ethics needs, and varying exposure to prior ethics support will also be met by this model.

International library of ethics, law, and the new medicine, 2017

This chapter undertakes an examination of the ways in which the deficit perspective has pervaded ... more This chapter undertakes an examination of the ways in which the deficit perspective has pervaded the rural health and rural health ethics literature. We begin by describing the deficit perspective and highlight four sets of presumptions that it is based upon. We then demonstrate how deeply the deficit perspective is embedded in the rural health literature, with a particular emphasis on the ways in which it influences and shapes rural health ethics. An analysis of the ethics of deficit shows how problematic this perspective can be and supports the conclusion of this chapter, namely that the deficit perspective should be (at the very least) balanced with a more positivist paradigm.

Healthcare Management Forum, Jul 1, 2015

Decision-making about health technologies is complex. An aspect that is not often addressed is th... more Decision-making about health technologies is complex. An aspect that is not often addressed is the potential impact of both hope and hype regarding these technologies. This article discusses the commercialization of hope and how "hope hype" can influence our decision-making. As health leaders have a pivotal role in how these types of decisions are made, opportunities for and suggestions related to structuring decision-making processes to critically engage with "hope hype" are also canvassed.

Springer eBooks, 2020

Academic medicine involves physicians, researchers, and educators in a tripartite overlapping mis... more Academic medicine involves physicians, researchers, and educators in a tripartite overlapping mission of medical education, research, and practice. Gender parity remains a serious issue in academic medicine. Women have occupied 50% or more of the seats in North American undergraduate medical programs for decades. However, despite interventions by higher education institutions globally, women have not advanced to senior leadership positions at corresponding rates. Women are also less likely to advance in their academic medicine careers than

Canadian Journal Of Anesthesia/journal Canadien D'anesthésie, Apr 1, 2023

Clarity regarding the biomedical definition of death and the criteria for its determination is cr... more Clarity regarding the biomedical definition of death and the criteria for its determination is critical to inform practices in clinical care, medical research, law, and organ donation. While best practices for death determination by neurologic criteria and circulatory criteria were previously outlined in Canadian medical guidelines, several issues have arisen to force their reappraisal. Ongoing scientific discovery, corresponding changes in medical practice, and legal and ethical challenges compel a comprehensive update. Accordingly, the A Brain-Based Definition of Death and Criteria for its Determination After Arrest of Neurologic or Circulatory Function in Canada project was undertaken to a develop a unified brain-based definition of death, and to establish criteria for its determination after devastating brain injury and/or circulatory arrest. Specifically, the project had three objectives: (1) to clarify that death is defined in terms of brain functions; (2) to clarify how a brain-based definition of death is articulated; and (3) to clarify the criteria for determining if the brain-based definition is met. The updated death determination guideline therefore defines death as the permanent cessation of brain function and describes corresponding circulatory and neurologic criteria to ascertain the permanent cessation of brain function. This article explores the challenges that prompted revisions to the biomedical definition of death and the criteria for its determination and outlines the rationales underpinning the project's three objectives. By clarifying that all death is defined in terms of brain function, the project seeks to align guidelines with contemporary medicolegal understandings of the biological basis of death.

Pediatric Blood & Cancer, Nov 1, 2007

Conditions supporting a high quality of consent for pediatric bone marrow transplantation (BMT) a... more Conditions supporting a high quality of consent for pediatric bone marrow transplantation (BMT) are suboptimal given the complexity of the procedure, lack of options, and parent emotional duress. We studied if parents perceived choice when consenting to BMT, if they felt the consent provided was valid, and how the consent process affected them. Telephone or face-to-face interviews were recorded using a semi-structured interview outline. Interview transcripts were anonymized, and independently analyzed by three reviewers. Twenty parents of twelve children participated, including five bereaved parents. There were no differences in patient transplant characteristics between the eligible and study groups. Divorced or separated parents were underrepresented in the participant group. Fifteen parents felt personally compelled to consent; most (18) denied feeling external medical pressure to do so. All parents felt their consent was valid and most reported adequate levels of freedom, capacity, and information. Expectations formulated during the consent process strongly influenced parents' experience post-BMT. Good communication during consent contributed to trust and therapeutic alliance with physicians following BMT. Late parental stress and anxiety were periodic, but very high in some families. Parents feel consent for pediatric BMT is valid, despite feeling personally compelled to consent. Strategies aimed at nurturing hope and realistic expectations may assist in improving the consent process, while diminishing long-term stressors.

Canadian Family Physician, Sep 1, 2013

Exclusivement sur le web Commentaire Les défis du recrutement et du maintien des médecins dans le... more Exclusivement sur le web Commentaire Les défis du recrutement et du maintien des médecins dans les communautés rurales La fiction pour aider à expliquer la réalité

International library of ethics, law, and the new medicine, 2017

The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Hec Forum, Jun 1, 2008

Whilst clinical ethics processes are an increasingly accepted part of institutional culture in he... more Whilst clinical ethics processes are an increasingly accepted part of institutional culture in healthcare, broadening the focus of these processes to include the organization as an ethical actor (organizational ethics) remains a work in progress. Drawing from our experiences as members of the Ethics Committee at the IWK Health Centre in Canada, (the IWK) in this paper we focus on our experiences of moving organizational ethics from "theory to practice". We particularly address the operational and functional challenges associated with this transition in regard to the ethics committee's role in policy development and review. Even in a health centre with a relatively strong commitment to ethics and ethical practice, the inclusion of an organizational ethics perspective has raised new questions and challenges.

Oxford University Press eBooks, Apr 1, 2019

Rural women as a group are reported to face a “double disadvantage” due to their gender and rural... more Rural women as a group are reported to face a “double disadvantage” due to their gender and rural place of residence. Gendered and place constructions of “good” rural women and the roles “good” women should play in rural communities are shown to intersect with the values of place and community that characterize rural healthcare ethics. While gender and place stereotypes can have positive and negative implications for rural women and rural communities more generally, the intersections between these stereotypes and these values also may impact rural women and their access to health services across multiple dimensions, including availability, affordability, accessibility, acceptability, and accommodation. If the ability of rural women to access health services is influenced by gendered and place constructions of their role and the values of place and/or community, this is important when considering how health services should be designed and delivered.

In this chapter we focus on rural women, a group that is reported to face a “double disadvantage”... more In this chapter we focus on rural women, a group that is reported to face a “double disadvantage” due to their gender and rural place of residence. We argue that gendered and place constructions of ‘good’ rural women and the roles ‘good’ women should play in rural communities, intersect with the values of place and community that, in earlier work, we have argued may characterise rural health ethics. Gender and place stereotypes can have positive and negative implications for rural women and rural communities more generally. But the intersections between these stereotypes and these values may also impact on rural women and their access to health services. We examine rural women’s access to health services across multiple dimensions, including availability, affordability, accessibility, acceptability and accommodation. If the ability of rural women to access health services is influenced by gendered and place constructions of their role and the values of place and/or community, this is of importance when considering how health services should be designed and delivered

International library of ethics, law, and the new medicine, 2017

In this chapter, we demonstrate both the relevance of organisational ethics for rural health faci... more In this chapter, we demonstrate both the relevance of organisational ethics for rural health facilities and the overall contribution to rural health ethics that this approach provides. We do this, first, by describing organisational ethics and engaging in an extended discussion of the ways in which this meso level of analysis does and does not arise in the rural health ethics literature. In this chapter we also argue that health facilities are important and less visible ethical actors in the rural health sector. We then use the example of recruiting and retaining health providers to rural health facilities to demonstrate the value of utilising an organisational ethics approach. We conclude this chapter by arguing that rural health ethics will benefit from further meso level analysis where the respective values, interests and obligations at play within rural health facilities and the impacts on relationships within these facilities and between these facilities, patients and communities are examined.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter that we need use an ethics lens to critically examine stereotypes that i... more We argue in this chapter that we need use an ethics lens to critically examine stereotypes that idealise rural life and rural health care and be attentive to the ways in which they inform our thinking, including whether they have any negative impacts on rural health providers or patients. We ask whether our nostalgia about rural life and rural health care, as framed by the stereotypes of the idyll and the ideal rural health provider, may be obstructing the development of better policies and decisions about the provision of rural health services, much in the same way that the deficit or dystopia framing, discussed in Chap. 3, may limit the development of health policies and practices. It is our hope that by examining these stereotypes, we will be able to reduce injustice or inequities and make better decisions about providing health care to all citizens, wherever they reside.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter for a re-valuing of relationships. While it has long been recognised tha... more We argue in this chapter for a re-valuing of relationships. While it has long been recognised that a relationship lies at the heart of the health provider-patient interaction, latterly changes in the way in which health services are provided may have shifted the focus from the relational aspects of the interaction to the transactional and instrumental. We argue that the nature and quality of the relationship between a health provider and a patient may be particularly important and central to the provision of rural health services because of the interrelatedness and corresponding intensity of relationships that often characterises rural settings. We focus in the second half of the chapter on the issue of dual and multiple relationships which are almost inevitable when health providers are based in rural communities but which urban-centric ethical frameworks generally suggest should be avoided. We argue that the nature and quality of relationships in health care practice in general and in relation to dual and multiple relationships in particular need to be re-valued.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter for an explicit value of community in health ethics. That is to say we a... more We argue in this chapter for an explicit value of community in health ethics. That is to say we argue that health ethicists, and others, should acknowledge that people may feel connected to and identify with a particular community. This identification with community has epistemological implications. A person’s identification as a member of a community, and the potential consequent valuing of community, may create a sense of obligation to that community which may be expressed through a sense of solidarity and/or reciprocity. As with place, we believe community ought to be considered a specific value to give it the necessary weight in ethical deliberations in health care settings. We argue that the value of community is particularly relevant for rural residents as neighbours are often seen as a necessary element of their interdependent social space. The value of community may also influence health care policy, as well as the design and delivery of health services, if taken into account at the meso and macro levels of analysis.

International library of ethics, law, and the new medicine, 2017

We argue in this chapter for an explicit value of place in health ethics. Psychologists have iden... more We argue in this chapter for an explicit value of place in health ethics. Psychologists have identified that some people feel what they term place attachment. We argue that ethicists should acknowledge that some people may feel connected to and identify with a particular place which has epistemological implications and implications for a person’s standpoint – as what we know is fundamentally influenced by where we come from. Place may also sometimes be used as a means to stereotype particular patients and their likely responses and values. In this chapter we argue for a value of place to give it the necessary weight and attention in ethical deliberations around the provision of health care at the micro, meso and macro levels of service delivery. We argue that the value of place is particularly relevant for rural residents as it may influence their health care choices, their experience of receiving care and their access to health services.

International library of ethics, law, and the new medicine, 2017

In this chapter, we undertake an overview of the rural health ethics literature. We identify and ... more In this chapter, we undertake an overview of the rural health ethics literature. We identify and describe six convergences and divergences in this literature, which point to key gaps in how this field has developed to date and provide some indicators as to further areas for development. These key gaps, for us, include the relative lack of meso and macro level of analysis in rural health ethics and a need for additional conceptual development and clarity regarding the underpinnings of much of this field. Accordingly, this chapter provides a foundation for the discussion and analysis of rural health ethics that follows in this book.

BMC Medical Ethics, Oct 21, 2021

Background: The COVID-19 pandemic has had a significant impact on the health system worldwide. Th... more Background: The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. Method: To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. Results: This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates. Conclusion: This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.

Healthcare Management Forum, Oct 1, 2004

This article describes a new model for ethics support for Capital Health (a health region in Nova... more This article describes a new model for ethics support for Capital Health (a health region in Nova Scotia). With its emphasis on building a culture of ethics, many innovative elements are integral to this model and its future success. Particular emphasis is on organizational healthcare ethics and meaningful participation. Concerns about volunteer burden, urban and rural ethics needs, and varying exposure to prior ethics support will also be met by this model.

International library of ethics, law, and the new medicine, 2017

This chapter undertakes an examination of the ways in which the deficit perspective has pervaded ... more This chapter undertakes an examination of the ways in which the deficit perspective has pervaded the rural health and rural health ethics literature. We begin by describing the deficit perspective and highlight four sets of presumptions that it is based upon. We then demonstrate how deeply the deficit perspective is embedded in the rural health literature, with a particular emphasis on the ways in which it influences and shapes rural health ethics. An analysis of the ethics of deficit shows how problematic this perspective can be and supports the conclusion of this chapter, namely that the deficit perspective should be (at the very least) balanced with a more positivist paradigm.

Healthcare Management Forum, Jul 1, 2015

Decision-making about health technologies is complex. An aspect that is not often addressed is th... more Decision-making about health technologies is complex. An aspect that is not often addressed is the potential impact of both hope and hype regarding these technologies. This article discusses the commercialization of hope and how "hope hype" can influence our decision-making. As health leaders have a pivotal role in how these types of decisions are made, opportunities for and suggestions related to structuring decision-making processes to critically engage with "hope hype" are also canvassed.

Springer eBooks, 2020

Academic medicine involves physicians, researchers, and educators in a tripartite overlapping mis... more Academic medicine involves physicians, researchers, and educators in a tripartite overlapping mission of medical education, research, and practice. Gender parity remains a serious issue in academic medicine. Women have occupied 50% or more of the seats in North American undergraduate medical programs for decades. However, despite interventions by higher education institutions globally, women have not advanced to senior leadership positions at corresponding rates. Women are also less likely to advance in their academic medicine careers than

Canadian Journal Of Anesthesia/journal Canadien D'anesthésie, Apr 1, 2023

Clarity regarding the biomedical definition of death and the criteria for its determination is cr... more Clarity regarding the biomedical definition of death and the criteria for its determination is critical to inform practices in clinical care, medical research, law, and organ donation. While best practices for death determination by neurologic criteria and circulatory criteria were previously outlined in Canadian medical guidelines, several issues have arisen to force their reappraisal. Ongoing scientific discovery, corresponding changes in medical practice, and legal and ethical challenges compel a comprehensive update. Accordingly, the A Brain-Based Definition of Death and Criteria for its Determination After Arrest of Neurologic or Circulatory Function in Canada project was undertaken to a develop a unified brain-based definition of death, and to establish criteria for its determination after devastating brain injury and/or circulatory arrest. Specifically, the project had three objectives: (1) to clarify that death is defined in terms of brain functions; (2) to clarify how a brain-based definition of death is articulated; and (3) to clarify the criteria for determining if the brain-based definition is met. The updated death determination guideline therefore defines death as the permanent cessation of brain function and describes corresponding circulatory and neurologic criteria to ascertain the permanent cessation of brain function. This article explores the challenges that prompted revisions to the biomedical definition of death and the criteria for its determination and outlines the rationales underpinning the project's three objectives. By clarifying that all death is defined in terms of brain function, the project seeks to align guidelines with contemporary medicolegal understandings of the biological basis of death.

Pediatric Blood & Cancer, Nov 1, 2007

Conditions supporting a high quality of consent for pediatric bone marrow transplantation (BMT) a... more Conditions supporting a high quality of consent for pediatric bone marrow transplantation (BMT) are suboptimal given the complexity of the procedure, lack of options, and parent emotional duress. We studied if parents perceived choice when consenting to BMT, if they felt the consent provided was valid, and how the consent process affected them. Telephone or face-to-face interviews were recorded using a semi-structured interview outline. Interview transcripts were anonymized, and independently analyzed by three reviewers. Twenty parents of twelve children participated, including five bereaved parents. There were no differences in patient transplant characteristics between the eligible and study groups. Divorced or separated parents were underrepresented in the participant group. Fifteen parents felt personally compelled to consent; most (18) denied feeling external medical pressure to do so. All parents felt their consent was valid and most reported adequate levels of freedom, capacity, and information. Expectations formulated during the consent process strongly influenced parents' experience post-BMT. Good communication during consent contributed to trust and therapeutic alliance with physicians following BMT. Late parental stress and anxiety were periodic, but very high in some families. Parents feel consent for pediatric BMT is valid, despite feeling personally compelled to consent. Strategies aimed at nurturing hope and realistic expectations may assist in improving the consent process, while diminishing long-term stressors.

The American Journal of Bioethics, 2019

This is an "open peer commentary" on a paper in the same issue: Morain et al.'s "When Is It Ethic... more This is an "open peer commentary" on a paper in the same issue: Morain et al.'s "When Is It Ethical for Physician-Investigators to Seek Consent From Their Own Patients?".