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The question of whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying has recently come to the fore in debates about the legalisation of assisted dying. For example, it was central to critiques of the 2021 amendments made to Canada’s assisted dying law. The question of whether changes to a country’s assisted dying legislation lead to descents down slippery slopes has also come to the fore—as it does any time a jurisdiction changes its laws. We explore these two questions through the lens of Canada’s experience both to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law. Canada’s Medical Assistance in Dying (MAiD) law has evolved through a journey from the courts to Parliament, back to the courts, and then back to Parliament. Along this journey the eligibility criteria, the procedural safeguards, and the monitoring regime have changed. In this article, we focus on the eligibility criteria. First, we explain the evolution of the law and what the eligibility criteria were at the various stops along the way. We then explore the ethical justifications for Canada’s new criteria by looking at two elements of the often-corrosive debate. First, we ask whether problems with the social determinants of health that might impact decision-making justify denying eligibility for assisted dying of decisionally capable people with mental illnesses and people with disabilities as their sole underlying medical conditions. Second, we ask whether Canada’s journey supports slippery slope arguments against permitting assisted dying.

Schuklenk discusses expertise and expert authority. Public trust in both their government's ability to respond to COVID-19-like pandemics, as well as in their government's scientific agencies evidence-based response, has dramatically decreased during the pandemic, if representative public opinion surveys in OECD countries are anything to go by. Giubilini et al suggest that this can be (partly) explained by a lack of transparency and by these scientific government scientific expert agencies' refusal to publicly acknowledge uncertainty and disagreement among experts when that should have happened. Giubilini et al are right to flag this communication failure, but it remains actually an open question whether or not that is the cause of their reported increase in vaccine hesitancy. It is arguable that it matters practically for someone to be recognized or respected as an expert authority in an area with public policy import. Giubilini et al might be correct that in such cases it might also matter that one is seen to have particular technical specialist expertise, and also that an expert is someone who is seen to be conscientious in the way how they discharge of their work obligations.

As more jurisdictions permit a medically assisted death (MAiD)—and none of the jurisdictions that introduced MAiD has seen any serious attempts at reversing it—the focus of debate has turned to the question of what is a morally defensible access threshold for MAiD. This permits us to rethink the moral reasons for the legalization or decriminalization of assisted dying. Unlike what is assumed in many legislative frameworks, unbearable suffering caused by terminal illness is not what oftentimes motivates decisionally capable people to request MAiD. This matters when access thresholds are considered. The argument advanced in this essay is that because MAiD is less destructive to people’s relationships and less harmful than medically unsupervised suicide, access to medical assistance in dying should be open to anyone who is legally capacitated and who persistently requests such assistance.

The COVID-19 pandemic brought about at least two normative challenges on unprecedented scale for liberal democracies. One concerned prioritization decisions when health care resources were constrained. The other, which arguably led to lasting damage to social cohesion and citizens’ trust in government and government public health institutions, concerned policies introduced with the aim of reducing the spread of SARS-CoV2, some of which turned out to be mistaken. I discuss in this essay a few examples of misguided, liberty-limiting public health policies and describe how public health and public health ethics principlism provided cover for such policies. Citizens had reasons to be concerned about the duration of such liberty-infringing policies, the absence of predictable government policies, and the absence of transparent justifications for the policies that were implemented.

Healthcare professionals’ capacity to protect themselves, while caring for infected patients during an infectious disease pandemic, depends on their ability to practise universal precautions. In turn, universal precautions rely on the availability of personal protective equipment (PPE). During the SARS-CoV2 outbreak many healthcare workers across the globe have been reluctant to provide patient care because crucial PPE components are in short supply. The lack of such equipment during the pandemic was not a result of careful resource allocation decisions in the global north, where the short supply could be explained through their high cost. Instead, they were the result of democratically elected governments prioritising low tax regimes over an adequate resourcing of their healthcare delivery systems. Such decisions were made despite global health experts warning about the high probability of pandemics like SARS-CoV2 occurring during our lifetimes. Avoidable allocation decisions by democratically elected political leaders resulted in a lack of sufficient PPE for healthcare professionals. After discussing and discounting various ethical arguments in support of a professional obligation to treat, even without or with suboptimal PPE, I conclude that these policy decisions were sufficiently grave that they provide a sound ethical rationale to justify healthcare workers’ refusal to provide care to infected patients.

We describe a number of conscientious objection cases in a liberal Western democracy. These cases strongly suggest that the typical conscientious objector does not object to unreasonable, controversial professional services—involving torture, for instance—but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive. We analyse the conflict between these patients' access rights and the conscientious objection accommodation demanded by monopoly providers of such healthcare services. It is implausible that professionals who voluntarily join a profession should be endowed with a legal claim not to provide services that are within the scope of the profession's practice and that society expects them to provide. We discuss common counterarguments to this view and reject all of them.

Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended.

The ethics of research into the genetics of sexuality is not straightforward. A new study by Zietsch et al. investigates a hypothesis for the evolutionary basis of same-sex sexual behaviour. This increases our understanding of the genetics of complex behaviour, raising questions about whether and how such knowledge should be used.

London and colleagues, for instance, flag the ethical issues that arise when medical professionals also, and at the same time, serve in the military, as healthcare professionals.2 When the American Medical Association, in the 1840s, drafted its first code of ethics, it explicitly rejected the view that religion had a role to play in professional patient care. [...]when doctors are seeing a patient in their professional role, the healthcare professionals’ private life, and that includes their ideological, non-professional commitments, should be kept out of their professional life and conduct. [...]it does not belong in the healthcare professional–patient relationship.

This article analyses, from a bioethics journal editor's perspective, the threats to academic freedom and freedom of expression that academic bioethicists and academic bioethics journals are subjected to by political activists applying pressure from outside of the academy. I defend bioethicists’ academic freedom to reach and defend conclusions many find offensive and ‘wrong’. However, I also support the view that academics arguing controversial matters such as, for instance, the moral legitimacy of infanticide should take clear responsibility for the views they defend and should not try to hide behind analytical philosophers’ rationales such as wanting to test an argument for the sake of testing an argument. This article proposes that bioethics journals establish higher-quality requirements and more stringent mechanisms of peer review than usual for iconoclastic articles.