Creating moral space involves actions and omissions. An important omission of solidarity is to refuse to hold or attend professional conferences in countries and American states where laws and social approbation make it uncomfortable, unwise, or dangerous for certain members of the professional community to attend. Markowitz’s Impermissible Sacrifice Principle, which she used to critique abortion policies, is employed to show why it is wrong to hold a professional conference in such a state and why solidarity requires the support of all moral persons. While this article describes the importance of this principle now in terms of LGBTQ+ persons, it may also apply soon or even now with regard to persons of colour, women, and/or visiting non-American citizens. It is also shown why solidarity against impermissible sacrifices is a better way to ground decisions about locating or attending conferences than a teleological argument about boycotts to change policy.

Professional bioethicists have gained increasing acceptance in the healthcare and academic communities of the United States over the last 50 years. However, since the current administration took office in January 2025, questions concerning the appropriate role of bioethicists in preserving the values and ethics of healthcare and academic institutions have abounded. I argue that the usual tripartite characterization of service, scholarship and education still apply but how we interpret those roles and their relative importance has changed. While our established role of influencers of institutional policies remains important, the climate of fear-induced silence challenges us to emphasize our prophetic voice in calling the healthcare professions and institutions to remain faithful to their fundamental values. Furthermore, I recommend a renewed emphasis on basic education of professionals to solidify their formation.

The understanding of disease in the dominant biomedical model involves two components, internalism and individualism, which jointly give rise to an ontological approach towards patients that can be referred to as atomism. I argue against such an approach in philosophy of medicine. I focus on internalism, showing that the inevitable presence of the notions of biological function and statistical normality in the biomedical model renders internalism about diseases untenable. Additionally, I argue that the new externalist individualism offers an alternative ontological approach that escapes the challenges to which the atomistic approach is exposed regarding both the concept of disease and medical practice. Subsequently, I focus on an implication of this new approach which relates to the idea of diseases as natural kinds, demonstrating that it proposes a concept of diseases as natural kinds that is conceptually consistent.

Ce commentaire explore le cheminement réflexif de James Dwyer en bioéthique présenté dans « Frameworks and Practices in Bioethics », marqué par un passage de la théorie de la justice de Rawls à une pratique introspective du haïku, puis au pragmatisme de Dewey. Dwyer propose une approche novatrice, utilisant des outils créatifs pour approfondir l’introspection et cultiver une attention accrue aux enjeux éthiques complexes. Toutefois, il exprime des doutes sur l’impact concret de ces pratiques, critiquant leur manque de progression tangible et leur capacité à générer des réponses applicables. Ce commentaire analyse les forces de son approche, notamment sa capacité à enrichir la réflexion bioéthique par l’ouverture et l’innovation, ainsi que ses limites, en mettant en lumière les tensions entre abstraction et application concrète. L’exploration souligne l’importance des pratiques interdisciplinaires et adaptatives pour répondre aux dilemmes bioéthiques contemporains, tout en plaidant pour une intégration harmonieuse entre introspection et pragmatisme. Malgré ses doutes, la démarche de Dwyer offre une contribution significative en réaffirmant le rôle des méthodes réflexives et créatives dans l’évolution de la bioéthique.

The Covid-19 pandemic presented numerous ethical challenges, highlighting the critical role of bioethicists in public spaces and policymaking. Bioethicists acted as guardians against systemic injustices, critics of health policy decisions, and contributors to public debate. This text draws on our experiences as North American academic bioethicists to explore the different roles that bioethicists took during the pandemic, notably through media engagement, participation in policy-making, and in research and education. The pandemic underscored the importance of bioethics in the healthcare system and in research governance, the need for interdisciplinary collaboration, the importance of applying various ethics frameworks, and the need for effective communication to ensure practical ethical decision-making. It also demonstrated the distinct yet complementary roles of academic and professional bioethicists, with the former often serving as visible public critics, due to their academic liberty and independence, while the latter worked within their institutions to support clinicians and decision-makers, and to effect policy change. But these roles could also lead to tensions between academic and professional bioethicists, due to their different mandates, and both also experienced frustrations with the continued lack of understanding by some professionals and policy-makers regarding the pertinence and utility of bioethics to support ethically-informed decision-making. Ultimately, the pandemic was a pivotal time for bioethicists to influence public debate and policy, showcasing the field’s relevance and adaptability in addressing complex ethical issues.

Although medical assistance in dying (MAiD) is legally permitted in Canada under defined statutory conditions, this legal framework does not determine when it is morally permissible for a healthcare professional to provide MAiD. This paper explicitly examines the normative distinction between legal and ethical MAiD practice. It argues that the medically related eligibility criteria, such as incurability, irreversible decline, and intolerable suffering, do not function as objective medical criteria but instead presuppose and reinforce patient autonomy. As a result, MAiD assessments are often reduced to procedural confirmations of autonomy rather than substantive medical assessments. Thus, autonomy has become the de facto justification for the provision of MAiD, even though Canadian law does not regard autonomy alone as a sufficient condition. This paper examines the discretionary structure of MAiD practice and demonstrates that every decision to provide MAiD involves a normative judgment on the part of the healthcare professional. To guide that judgment, an ethics framework grounded in the fiduciary duties of healthcare professionals is proposed. Using the four core principles of healthcare ethics, this framework holds that it is morally permissible for a healthcare professional to provide MAiD only when: 1) the patient is autonomous, understood in terms of capacity, voluntariness, and informed consent; 2) the intervention satisfies the principles of beneficence and nonmaleficence; and 3) the request arises from a context of justice, in which a medical condition renders the patient unable to act on their autonomous wish to die without assistance.

The concept of human dignity figures prominently in discussions about medical assistance in dying. Yet the notion of ‘dignity’ is often ambiguous. This paper seeks to clear up some of this ambiguity by distinguishing two different but related conceptions of dignity, the one a fundamentally moral notion (‘Dignity’—upper case) and the other a more aesthetic conception (‘dignity’—lower case). The dynamic relationship that exists between the moral notion of ‘Dignity’ and its aesthetic counterpart (‘dignity’) is examined. While a pluralistic society requires both notions, only the objective moral notion (Dignity) is adequate to serve as the foundation of a fundamental legal regime. While any pluralistic society must provide opportunities for the expression of subjective aesthetic notions of dignity, the latter can neither serve as the foundation of a comprehensive public ethic in general, nor can it set the parameters of a public policy on medicalized homicide. Indeed, the unmitigated expansion of a particular notion of ‘dignity’ threatens to expunge the more fundamental conception of Dignity that serves as the foundation of any liberal democratic society.

Disha et al., in their 2023 paper in this journal, interchangeably frame the Canadian Criminal Code’s 90-day assessment period safeguard for Medical Assistance in Dying (MAID) for people without a foreseeable natural death (Track 2) as a “waiting”, “reflection”, and “assessment” period. However, the law and formal guidance explicitly describe its purpose as an assessment period, only incidentally a reflection period, but not a waiting period. Accordingly, there is an urgent ethical, practical, and legal need to ensure MAID practitioners, their colleagues, and overseers rigorously understand and apply the law to protect patients’ lives from transgressions and stop transgressors.

This study assesses the legal and ethical frameworks for genetic testing in Lebanon, with a particular focus on paternity testing. Information collected from 16 laboratories revealed that paternity testing is performed solely in the four laboratories accredited by the Ministry of Public Health, but only half of the tests are made through the court. Interestingly, one laboratory does not require the parents’ consent prior to paternity testing, and individuals are generally not informed about the possibility of misattributed paternity (73.3%) or disease predispositions (53.3%). Moreover, the disclosure of incidental findings is done by only 37.5% of laboratories. Unfortunately, genetic findings are communicated in the absence of a psychologist in 90% of cases. When deemed necessary, results are shared in 12.5% of cases with other health professionals, without the consent of the patient. Our study highlights the need to develop comprehensive guidelines and regulations that cover paternity testing in Lebanon.

This paper argues that Canada’s Track 2 Medical Assistance in Dying (MAiD) regime is discriminatory against people with disabilities, and has a disproportionate impact on women with disabilities. It is important to expose critical gaps in pro-MAiD advocacy, which obscures how systemic marginalization shapes access to assisted death. Premised on a medical model of disability which exceptionalizes disability-related suffering as uniquely intolerable, Track 2 MAiD poses heightened risks for those already disadvantaged by structural inequalities. By framing death as a medical treatment, the law reinforces ableist assumptions that portray people with disabilities as better off dead instead of providing access to essential supports. These social inequalities are heightened for disabled women who experience alarming rates of male violence, the intersection of medical ableism and sexism, as well as the assumption that women should be caregivers and not those needing care.