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21 results on '"KEKEWICH, MICHAEL"'

13. Contrition and Community: A Gewirthian Interpretation of State Apologies

Author

Kekewich, Michael

Subjects
Philosophy, Ethics
Abstract

This paper provides a philosophical understanding of state apologies by applying Gewirth's deontological theory. Through application of the principle of generic consistency, I contend that a state apology can be understood as a moral obligation concurrent with human rights. Subsequently, I attempt to solidify the Gewirthian understanding of state apology by integrating current understandings of the practice into the Gewirthian model of the community of rights. Here, I also suggest that the psychosocial biography of the community of rights strengthens the Gewirthian interpretation of state apology. Finally, I examine the merits of the U.S. apology for the Tuskegee Syphilis Study from this Gewirthian perspective. Ultimately, I conclude that the Gewirthian application is successful in its ability to clarify the reasons for which state apologies are given, as well as the goals they should accomplish.

Published
2013
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16. Comment les leaders en santé devraient-ils aborder les débats de fond controversés sur le plan moral?

Author

Kekewich, Michael, Landry, Joshua, and Roth, Virginia

Abstract

En raison de leurs compétences, de leur expérience et de leur influence sur les soins des patients, les leaders en santé occupent une place importante dans le système de santé. Ils doivent apporter une valeur ajoutée à leurs parties prenantes, laquelle se rattache à des objectifs moraux fondamentaux pour la prestation des soins. Dans certains cas, les leaders peuvent déterminer qu’une décision, une politique ou une directive politico-médicale entrave ces objectifs moraux. Dans de telles situations, ils peuvent soit s’y opposer expressément, soit exprimer leurs positions morales tout en en assurant la mise en œuvre. Les auteurs présentent plusieurs exemples contemporains de débats de ce type et d’expériences de leaders en santé. Ils passent ensuite en revue les parties pertinentes du Code de déontologie du Collège canadien des leaders en santé pour en extraire des directives déjà établies. Ils concluent qu’il faudra fouiller la question pour définir le rôle des leaders dans de telles situations, de même que les limites de la résistance.

Published
2018
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20. How should health leaders approach morally contentious policy issues?

Author

Kekewich, Michael, Landry, Joshua, and Roth, Virginia

Abstract

In terms of their expertise, experience, and impact on patient care, health leaders occupy an important position in our health system. These leaders are expected to provide value to their constituents, and this value is connected to moral objectives that are fundamental to the delivery of healthcare. In some cases, leaders may interpret a certain politico-medical decision, policy, or directive to interfere with these moral objectives. In these instances, leaders can either expressly object to a decision or sideline moral views while enacting these policies or directives. We present several contemporary examples of these issues as well as the experiences of health leaders. Subsequently, we review relevant sections of the Canadian College of Health Leaders’ Code of Ethics to identify existing guidance. Ultimately, we conclude that more work is needed to define the role of leaders in these circumstances, as well as the limitations of any resistance.

Published
2018
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21. Involvement of palliative care in patients requesting medical assistance in dying.

Author

Munro C, Romanova A, Webber C, Kekewich M, Richard R, and Tanuseputro P

Subjects
Canada, Humans, Medical Assistance, Ontario, Quality of Life, Retrospective Studies, Palliative Care, Suicide, Assisted
Abstract

Objective: To determine the level of palliative care involvement before and after medical assistance in dying (MAID) requests, and to compare the differences between those who completed MAID and those who requested but did not complete MAID., Design: Retrospective chart review., Setting: The Ottawa Hospital (TOH) in Ontario., Participants: Ninety-seven patients who requested MAID at TOH between February 6, 2016, and June 30, 2017., Main Outcome Measures: Completion of MAID., Results: Eighty-four patients were included in the study. Fifty patients (59.5%) completed MAID. The most common reasons for not completing MAID were death before completion of the required assessments (47.0%), ineligibility (26.5%), and loss of capacity (14.7%). The most common diagnoses were cancer (72.6%) and neurologic disease (11.9%). The most frequent reasons for requesting MAID were physical suffering (77.4%), loss of autonomy (36.9%), and poor quality of life (27.4%). Patients who completed MAID in this study were more likely to report physical suffering as the reason for their request than those who did not complete MAID (84.0% vs 67.6%; P = .08), yet only 23.8% of all patients requesting MAID had an Edmonton Symptom Assessment Scale completed. Before MAID request, 27.4% of patients had a community palliative care physician and 59.5% had palliative care involvement in any setting. The TOH palliative care team was involved in 46.4% of patients who requested MAID., Conclusion: There is still inadequate provision of palliative care for those requesting MAID. Guidelines, legislation, and guidance are needed to help physicians ensure patients are aware of and understand the benefits of palliative care in end-of-life decisions. However, the involvement of palliative care with patients who completed MAID was similar to those who did not complete MAID. Multicentre studies are needed to further explore the MAID process and clarify the role of palliative care in that process., (Copyright© the College of Family Physicians of Canada.)

Published
2020

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