« La fin du SIDA » prévue en 2030 par le plan 90-90-90 de l’ONUSIDA est-elle possible au Québec? L’offre universelle proportionnée et systématique de dépistage avec consentement opt-out (consentement présumé) apparait comme la politique sanitaire la plus pertinente et équitable à mettre en place en vue d’identifier les personnes vivant avec le VIH ignorant leur statut sérologique. Cette démarche à première vue contraignante vis-à-vis des libertés individuelles peut être largement compensée par des bénéfices sanitaires, sociaux, économiques et structurels à l’échelle individuelle et populationnelle. Dans la mesure où le VIH/SIDA reste un révélateur puissant des inégalités sociales, cette approche ne sera prolifique qu’en présence d’une ambition politique d’amélioration de l’accès aux soins et de couverture sanitaire universelle et inclusive à l’égard des individus échappant au dépistage. L’approche opt-out au sein des groupes à forte prévalence est une stratégie éthiquement pertinente pour augmenter les taux de dépistage. Bien que le consentement n’y soit pas explicite, la présomption tiendrait compte de « l’injustice structurelle » auxquels les groupes clés – présentant de forts taux de prévalence – sont soumis initialement. Cette dernière est responsable de leurs difficultés d’accès aux soins et aux dépistages. Cet article propose d’uniformiser l’offre de dépistage. Le Comité des Infections Transmissibles Sexuellement et par le Sang du Québec recommande actuellement l’approche opt-in pour les groupes-clés et le consentement opt-out en population générale. Nous pensons que cette différenciation constitue une barrière dans l’accès au dépistage et produit un effet d’éviction des groupes-clés craignant la stigmatisation.

How might an ombudsperson respond to an equity concern? Using a real-to-life case study about student / faculty conflict brought to a university ombudsperson, we consider the value of a fairness lens that an ombuds can bring to EDI ethical discussions.

Si la question de juste répartition des ressources traverse les sociétés depuis même l’Antiquité, celle de la répartition équitable des ressources médicales prend de nos jours une toute autre ampleur dans le contexte de pandémie mondiale actuelle. Cette table ronde tente d’analyser et de comprendre comment concilier les principes de justice distributive dans des conditions de ressources limitées. Elle permet d’ouvrir plus largement la réflexion sur la différence fondamentale qui se trouve entre la prise de décision éthique ou politique auprès du patient, et à l’échelle macroscopique. Enfin, une discussion ouvrira la réflexion sur l’autonomie des patients et la légitimité de la réanimation – pour ceux qui ne souhaitent pas continuer à vivre – sur la valeur du « sauver à tout prix » et de la place du triage dans la pratique de la médecine.

Recent evidence shows significant potential for therapies involving psychedelic substances such as psilocybin and MDMA to improve clinical outcomes for patients experiencing various mental disorders. However, research to date focuses almost exclusively on adults. I argue that adolescents should be included in research into psychedelic therapies. First, I demonstrate the pressing need for novel interventions to address the growing mental health burden of adolescents, and I draw on empirical evidence to show that research into psychedelic therapies presents an opportunity to address this shortfall. Secondly, I argue that psychedelics pose low risk to young patients, particularly relative to existing psychiatric medications. I then address two major concerns specific to adolescent contexts. First, I address the risks of using psychedelic substances at earlier stages of physiological and cognitive development. I note that the lack of understanding of the risks underscores the need for including adolescents in research. I then address the added complexity of consent in the adolescent context. I highlight some additional concerns that should be addressed in an “enhanced” informed consent process for adolescents and defend the view that capable adolescents should be able to consent to psychedelic interventions. I ultimately hold that including adolescents in emerging psychedelic research has the potential to substantiate innovative treatments that could improve their clinical outcomes, long-term mental health and quality of life.

Bioethics has become a framework for debate throughout the world and, as such, it is an indispensable subject in scientific fields, especially in those related to life sciences. Nowadays, there is a need for its teaching to include not only the identification of ethical problems but also deliberation and critical reflection on those problems in order, among other things, to participate in decision-making processes. The methodological strategies for this are crucial. This article provides an analytical description of the use of learning logs as a tool of reflection and metacognition in bioethics courses, based on the experience of professors at the Faculty of Sciences of the Universidad de la República (Uruguay). An analysis of students’ learning logs shows that this tool promotes complex reflective and self-reflective processes in which the development of skills such as abstraction, argumentation and problematization is manifested in an integrated way.

Background: In Quebec, medical aid in dying (MAiD) is legal under certain conditions. Access is currently restricted to patients who are able to consent at the time of the act, which excludes most people with dementia at an advanced stage. However, recent legislative and political developments have opened the door to an extension of the legislation that could give them access to MAiD. Our study aimed to explore the attitudes of people with early-stage dementia toward MAiD should it become accessible to them. Methods: We used a qualitative descriptive design consisting of eight face-to-face semi-structured interviews with persons living with early-stage Alzheimer’s disease, followed by a thematic analysis of the contents of the interviews. Results and Interpretations: Analysis revealed three main themes: 1) favourable to MAiD; 2) avoiding advanced dementia; and 3) disposition to request MAiD. Most participants anticipated dementia to be a painful experience. The main reasons for supporting MAiD were to avoid cognitive loss, dependence on others for their basic needs, and suffering for both themselves and their loved ones. Every participant said that they would ask for MAiD at some point should it become available to incompetent patients and most wished that it would be legal to access it through a request written before losing capacity. Conclusion: The reasons for which persons with Alzheimer’s disease want MAiD are related to the particular trajectory of the disease. Any policy to extend MAiD to incompetent patients should take their perspective into account.

Although Canada recently expanded access to medical assistance in dying, intolerably suffering Canadians with dementia still face seven obstacles to qualify for MAID. Advance directives for VSED are an important, yet under-appreciated, alternative.

Ce compte rendu examine le livre de Laurent Ravez, Introduction à l’éthique de la santé publique et souligne l’importance d’être familier avec l’éthique en santé publique, autant pour les gens oeuvrant en bioéthique que celles et ceux qui travaillent en santé publique.

Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it.

This short perspective piece is about the documentation of clinical ethics consultation in Canada. It is written at a time when the Canadian Association of Practicing Health Care Ethicists (CAPHE) is endeavoring to develop standards of practice for clinical ethics in Canada. This brief commentary is informed by my experience working in clinical ethics in three different provinces, but it is primarily an attempt to draw attention to the normative questions: How much and what kinds of information should be included in clinical ethics documentation? Where should ethics consultation reports be saved, and who should have access to them? These questions are, more fundamentally, about how we should balance concern for privacy, confidentiality, professional integrity, accountability and the promotion of trust. They are also about where clinical ethics fits within the broader Canadian health system.