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Over the last decade a group of moral philosophers concerned with medicine have argued, some stridently, that conscience has no place in the conscientious practice of medicine. And yet, it is hard to separate conscience from conscientiousness. This paper reviews and critiques the argument against conscience and the assumptions underlying it. It argues that it is often difficult to separate conscience, a moral perspective on appropriate practice, from the clinical knowledge and experience that practitioners possess and patients do not. The result is not paternalistic although it challenges the assumption that the patient in distress often knows best. The focus in this paper shifts from simple autonomy as a reflexive rule to the social and broadly clinical context in which decisions about procedures like abortion and medically assisted death are made.

Wellness depends on health and that, in turn, depends on the absence of disease. Analogous models based on physical laws have long been utilized by researchers to understand epidemic expansion in urban communities. Perhaps the most significant of this class is the gravity model in which population size is equated with planetary mass and distance between cities to that separating planets. While the model assumes homogeneity among different bodies, cities or planets, in epidemiology the likelihood of disease spread may depend on other heterogeneous, non-constant factors. The study used a public dataset of H1N1 Influenza in 2009 as the focus. A natural log regression was applied in an attempt to sort the relative importance of gravity model variables as predictors of influenza occurrence and diffusion. It was found that while the model population size serves as a general predictor of disease expansion that distance failed as an indicator of disease dynamics. Furthermore, findings from the study show that disease progression was irregular and not, as one might expect from the gravity model, consistent in space or over time. The study concludes that the gravity model may serve only as a coarse predictor of disease expansion over time. By extension, this raises similar questions about other models in which homogeneity between populations or network of populations is assumed. Key words: Gravity model, H1N1influenza, regression, spatial epidemiology.

This article seeks to assess the results of legislation legalizing medical termination, known in Canada as "medical aide in dying" in 2016. Its focus, like that of previous authors, is to ask if the concerns of skeptics opposed to legalization have been realized or were they unfounded. These include the likelihood of a "slippery slope" with an expanding definition of eligibility and of MAiD deaths. Of similar concern at least since 1995 was the likelihood that, in the absence of the provision of palliative, rehabilitative, psychological and social services that medical termination would be a substitute for good medical care. These and other concerns are the basis for the review of MAiD in Canada clinically, legally and as an ethical construct.

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.

Transhumanism advances an ideology promising a positive human advance through the application of new and as yet unrealized technologies. Underlying the whole is a libertarian ethos married to a very Christian eschatology promising a miraculous transformation that will answer human needs and redress human failings. In this paper, the supposedly scientific basis on which transhumanist promises are built is critiqued as futurist imaginings with little likelihood of actualization. Transhumanists themselves are likened to the affable con man Professor Harold Hill who, in The Music Man, describes as dire social problems whose solution is a youth band he seeks to sell but has no intention of building. Even were some of the transhumanist imaginings to be realized, I argue, the result would be a dystopia in which the few received benefits denied to the many. In advancing imaginary technologies as a solution to human needs, transhumanists and their bioethical fellow travelers handily avoid discussion of or advocacy for the kind of pedestrian social actions that demonstrably could achieve many of their purported goals. So their enthusiasms, I conclude, are not merely fanciful but damaging to the humanist goals they pretend to advance.

In recent decades there has been an extraordinary growth in and acceptance of automatic data systems that collect official and popular reports of epidemic occurrence. While different systems employ one or another proprietary algorithms to collect and parse disease reports all include, at a minimum, spatial locators, the date of a report, and the number of individual cases reported. These systems have been increasingly vital in both the study of individual epidemics and the exposition of expanding epidemics in real time. To date, however, there has been little analysis of the nature and quality of the data collected in these “big-net” programs or the degree to which redundancies and uncertainties may limit their utility. Here data on the 2009 H1N1 Type-A influenza epidemic gathered by a single system, healthmap.org, is parsed to determine where problems exist and how they might be rectified.

Public opinion surveys and polls have a long history as tools for the reportage of public sentiment. Born in the "straw polls" of nineteenth century politics, their use expanded in the last century to include a range of commercial and social subjects. In recent decades, these have included issues of medico-legal uncertainty including, in a partial list, abortion, fetal tissue research, and the propriety of medical termination. Because public opinion surveys are assumed to be "scientific," and thus unbiased, there has been little discussion of either their suitability in areas of complex, medico-legal uncertainty or the ethics of their use in these areas. This paper reviews their general history and then their use in the debate over medical termination, often called "medical aid in dying." In this review, two problems are highlighted. First, there is the ambiguous nature of polls and the manner of their construction. Second, there is the manner in which they are deployed as simple and definitive statements in areas of complex medico-legal debate. The result calls for caution in their use by ethicists and a clear duty by both academics and journalists to understand the limits of the medium in areas of medico-legal debate and discussion.

In 2005 discussions at the NACIS meeting in Salt Lake City, Utah, forced me to think differently and more clearly about issues of ethics and morals both in cartography but also elsewhere in the "knowledge professons." An article in Cartographic Perspectives became a tool for this exploration. The result, after a decade of thinking and rethinking, is a new book titled Ethics in Everyday Life. This brief piece is a thank-you to members whose questions and comments were so critical in forcing me to new ways of thinking both about maps and about the ideas they present.

For more than two decades, classes on "professionalism" have been the dominant platform for the non-technical socialization of medical students. It thus subsumes elements of previous foundation courses in bioethics and "medicine and society" in defining the appropriate relation between practitioners, patients, and society-at-large. Despite its importance, there is, however, no clear definition of what "professionalism" entails or the manner in which it serves various purported goals. This essay reviews, first, the historical role of the vocational practitioner in society, and second, the introduction of "professionalism" as a newly constituted, core value in teaching. The structure of the paper is as an archaeology, a Foucauldian term for an investigation of seemingly separate but related antecedent contexts and ideas whose result is a perspective or point of view. The goal thus is an attempt to precisely locate "professionalism" within the greater history of medicine and its contemporary role in medical socialization.

Disaster medicine is characterized by shortages of everything but patients. There are never enough beds, equipment, personnel, or supplies. In the 2014 Ebola epidemic, another scarcity was maps. The need for maps of the affected areas, and the ways the maps were used, serve to emphasize the way maps have always served in both disaster medicine and public health preparedness. Those lessons are reviewed here in the context of the Ebola epidemic. (Disaster Med Public Health Preparedness. 2015;0:1-8)

This paper critiques current arguments advancing the potential for transhumanism and a range of biological and pharmacological enhancements to better human flourishing. It does so from a historical perspective weighing the individualistic and competitive evolutionary theories of Darwin with the cooperative and communal theories of Prince Peter Kropotkin a generation later. In doing so it proposes the transhumanist and enhancement enthusiasts operate within a paradigm similar to Darwin’s, one that is atomist and individualistic. The critique, which considers the status of those with cognitive, sensory and physical limits, advances a vision of society as a cooperative and communal rather than individualistic and competitive. Within this framework the argument is not one of either/or but on the lexicographical superiority of the communal and social over the individualistic and competitive ethos underlying both Darwin and most contemporary transhumanist literature. This reordering of priorities, it is argued, reflects advances in contemporary biology and evolutionary thinking.

Today we take for granted the idea of global health, of disease as an international event. Increasingly, we assume as well that the international spread of disease can be traced to human travel patterns as well as to recurring environmental conditions. Perversely, the idea of ‘global health’ and its inverse, global disease, owes little to the three-dimensional imaging of the planet and almost everything to the two-dimensional plane of the map. Here the idea of global disease is traced from its beginnings in the 18th century to its 19th-century introduction in maps of the first cholera pandemic. This global perspective, and the responsibilities it promoted among civil officials, can be seen in modern studies of cancer, influenza and other conditions with both environmental foundations and international presence.

Bioethicists have typically disdained where they did not simply ignore the Hippocratic tradition in medicine. Its exclusivity--an oath of and for physicians--seemed contrary to the perspective that bioethicists have attempted to invoke. Robert M. Veatch recently articulated this rejection of the Hippocratic tradition, and of a professional ethic of medicine in general, in a volume based on his Gifford lectures. Here that argument is critiqued. The strengths of the Hippocratic tradition as a flexible and ethical social doctrine are offered in its stead.

Science isn’t about being right. It is about convincing others of the correctness of an idea through a methodology all will accept using data everyone can trust. New ideas take time to be accepted because they compete with others that already have passed the test. New thinking needs a strongly favoured methodology and an iron-clad application if it is to triumph, replacing the old. Journal critics are the first line of defence against ideas and research projects that seem promising but have yet to be vetted, their methods analysed carefully. Despite the importance of that service, the critic’s role is typically disparaged because—let us be frank here— nobody likes critics. If they praise something they’re assumed to be sycophants and if they disparage published work they’re dismissed as merely grumblers. History is not kind to critics. Its writers typically dismiss where they do not simply ignore those whose careful reviews argue caution in the face of works destined to become, in the future, classics. Think, here, Prince Peter Kropotkin whose naturalist studies focused upon the limits of Charles Darwin’s evolutionary theory and the direction in which research based upon it would be best directed. Only today—more than 130 years later—is the importance of his critique being acknowledged. There are good critics, of course, even great ones. The best are not only prominent in their field but also stylish essayists whose careful insights educate the general and the professional reader alike. Harvard biologist Richard Lewontin is a current example, an essayist who enfolds each review within an erudite recital of the state of the science being discussed. The result leaves the reader (and author) gasping: ‘I wish I had said that.’ As an example of a good critic unfairly dismissed by history think Edmund A Parkes, the British physician and researcher who reviewed John Snow’s famous 1855 opus, On the Mode of Communication of Cholera. In a seven-page, approximately 7800-word essay, Parkes carefully considered and found wanting Snow’s argument that cholera (and plague, and typhoid fever) was solely waterborne. Although the myth of Snow’s brilliance insists his critics were wrong, a careful reading of Parkes’ concerns insists that the myth of Snow is overstated. Yes, cholera is a waterborne disease. But were we to read Snow’s work with attention but without foreknowledge we, too, would find its argument incomplete. This review of the 19th century debate over cholera has more than historical significance. It pits a simplistic, focused explanation against one that was broad and multifactorial. And, too, it demands attention be paid to the researcher’s methodologies and their sufficiency, not just results. Finally, it pits the myth of the lone researcher against the reality of science as a complex, communal, interactive process. In a time of rapidly evolving, epidemic zoonotics, the lessons of that earlier debate are as contemporary as the evolving state of the mutating coronavirus that so concerns us today.

In February 2016, the Canadian Supreme Court argued in a unanimous decision that criminal statutes prohibiting physician-assisted or -directed termination violated the Charter of Rights and Freedoms. In the unanimous judgment, they argued that the promise of "life, liberty, and sanctity of person" in s. 7 enshrined patient choice as a principal Canadian virtue. But for choice to be real, that requires a set of predicate conditions assuring fragile Canadians have free and ready access to a range of medical services including, in a partial list, expert counseling, home care aides, palliative treatment, rehabilitative services, and social support for themselves and familial carers. Where those are absent, choice is illusory and the promise of real choice illusory.

Dashiell Hammett’s reaction was “sharp and angry, snarling” when he read, at her request, a work in progress by his friend and lover, Lillian Hellman. “He spoke as if I had betrayed him.”1 His judgment was absolute and his advice unsparing: “Tear this up and throw it away. It’s worse than bad—it’s half good.”2 That is exactly what I thought of Matti Hayry’s Rationality and the Genetic Challenge3 as, for the third time in the evening, I penned a note in its margins and sent it sailing across the room in disgust. Cambridge University Press knows its book binding, however, and the spine of the text was undamaged. I have no doubt this is the best book on its subject to date, one whose excellence builds from the work of a short list of bioethicists and philosophers who have argued one or another element of the “genetic challenge” that Hayry and his authors believe is exigent, real, and requiring their expert response. The authors he has chosen as the principal resources for this review roughly divide into three separate camps, each representing “normative doctrines of Western moral philosophy.”4 Jonathan Glover5 and John Harris6 are consequentialists with a “rational tangibility approach” that is more or less utilitarian in its essence. Leon R. Kass7 and Michael J. Sandel8 are the Aristotelians, representatives of a more or less teolological ethics. Jurgen Habermas9 and Ronald M. Green10 are harder to pigeonhole, especially Habermas, who is a philosopher but not a bioethicist (thank God!) and thus someone Harris loves to criticize. These are the voices Hayry marshals to fashion his discussion of issues arising from the genetic challenge whose management is the subject of this book. He does this so well that it is often difficult to separate his argument from that of the authors and especially Glover and Harris, whom he especially admires.11 The issues Hayry engages through his authors’ works include, in a partial list, the idea of building “better babies” by genetic selection, the use of genetic screening to assure the birth of a child with specific characteristics, the conception of “saviour siblings” brought to term for the body parts they offer, embryonic stem cell research, genetic therapies, and the possibility of continued life extension. Other voices are safely lodged in footnotes and asides, a kind of shadow text whispering on occasion that other perspectives are available.

There are in two assumptions inherent in this issue's theme, both inimical to the traditional goals of medicine and to the standards of care it proposed. First, the idea that treatment must be limited for some (but not others) on the basis of cost was born in the early literature of bioethics. Second, that there is a quantifiable and diagnostically predictable period at the "end-of-life" where treatment is "futile," and therefore not worth supporting in a context of scarcity grew out of bioethics's construction of allocative protocols in the 1990s. This paper traces the history of these ideas as constructs grounded in neither natural scarcity nor in firm diagnostic categories. Their relation to issues of care is therefore suspect.

For more than a century John Snow's iconic map of an 1854 cholera outbreak in the Broad Street area of Soho, London, has been the very definition of how to discover the source of a disease. Some now argue, however, that the map was merely an illustrative and not very imaginative graphic. Here we argue that this position is incorrect. Snow's mapping of the Broad Street outbreak produced a spatial argument that was a critical evidentiary statement. This position requires us to ask, If that is true, is the map in part responsible for Snow's inability to convince contemporaries of his argument that cholera was water-borne and not airborne? In doing so, we use mid-nineteenth-century methodologies to demonstrate that the problem was not in the map but in Snow's handling of the data. This review of a seminal study in the history of disease studies not only informs historical perspective but, in its conclusions, speaks to the utility of medical mapping in contemporary disease studies, where spatialization of a disease event remains a critical method of investigation.

There is something very traditional about Nancy Krieger’s decidedly modern work. She advances a social epidemiology that is multidisciplinary, advancing a “quantitative population science” that is also spatial in its approach and method of analysis. Many geographers see their work as affirming the potential of medical cartography and geography as disciplines critical to public health studies of disease incidence. This article argues that the history of epidemiology and public health are historically spatial and geographic, a link lost in the research of many twentieth century health researchers. A review of the history of medical geography, and of public health, insists upon the spatiality of disease studies as a critical groundwork not simply for contemporary disease studies but for the history of disease studies as they have slowly developed over for more than 200 years.

Teaching GIS is relatively simple, a matter of helping students develop familiarity with the software. Mapping as an aid to thinking is harder to instruct. This article presents a laboratory and lecture package developed to teach the utility of mapping in a course on spatial data analysis. Following a historical review of the use of surface mapping in medicine, it investigates a recent outbreak of salmonella. The lab teaches two different analytic techniques, hierarchical buffers and a surface kerneling approach. The result is a historically grounded program in which different means of address are compared and considered by students.

The problem is not uncertainty—proposed here as an inevitable condition—but the chimera of certainty asserted by most contemporary researchers. Problems of data definition, collection, and their use are reviewed in terms of spatial epidemiology and health data with examples drawn from several areas of contemporary health research. The argument is that preconceptions limit data modeled in a manner assuming its completeness. The result, as the West Nile Virus example seeks to demonstrate, may obscure other patterns and limit avenues of research.

For all its apparent debate bioethical discourse is in fact very narrow. The discussion that occurs is typically within limited parameters, rarely fundamental. Nor does it accommodate divergent perspectives with ease. The reason lies in its ideology and the political and economic perspectives that ideology promotes. Here the ideology of bioethics' fundamental axioms is critiqued as arbitrary and exclusive rather than necessary and inclusive. The result unpacks the ideological and political underpinnings of bioethical thinking and suggests new avenues for a broader debate over fundamentals, and a different approach to bioethical debate.

Think about this: You and your partner are the owners and operators of a struggling cartographic firm, Map-Off, Ltd. You are offered a lucrative contract, with more to come if they like your work, to make a map based on publicly available data (http://apps.nccd.cdc.gov/brfss). The client asks you to map healthy smokers over 70 years of age in the United States. You are free to find and use statistics (a barchart, for example), graphic images (of tobacco, of smokers, etc.) and anything else that will make your map the best statement possible. Your perspective client is the American Association of Tobacconists (AAT). Knowing that tobacco is a carcinogen responsible for the deaths of some but not all users, and some non-users affected by second-hand smoke, do you take the contract? Do you make the map?

The acceptance of military directives violating medical ethics and international covenants encouraged by the demonisation of the enemy by the US president in 2002 has effectively removed the right of medical personnel to refuse participation in internationally proscribed actions Medicine and its traditional ethic of care is today a victim of the current conflict in Iraq and Afghanistan, its uniquely humanising mission rejected by US President George W Bush and his advisors. In denying the applicability of international agreements guaranteeing medicine’s ecumenical role in this conflict they have transformed medicine into just another weapon of tactical significance. The result, predictable in retrospect, has been to make military physicians and nurses complicit—actively or passively—in what Litton calls an “atrocity-producing situation”, resulting in detainee or prisoner abuse.1 From the first revelations of detainee torture in US detention camps (2004) to recent allegations of continued abuse (2006), the focus of international attention has shifted from the US prosecution of low ranking, non-commissioned military personnel to the context in which the atrocities they committed occurred. “No one up the chain of command has ever been held accountable for what is in these horrifying images,” Center for Constitutional Rights Director Bill Goodman said of recently published photographs of 2004 prisoner torture and abuse.2 “The situation in several areas violates international law and conventions on human rights and torture,” said the UN Special Rapporteur on Torture following a 2006 investigation.3 The denial of international law and convention involved the overt disavowal of covenants and conventions that for almost 150 years required medical personnel in the US military to act within the guidelines of a Hippocratic vision of medicine. To understand how fundamental this change has been requires a brief review of the history of medicine’s previously protected status and then a description of …

Medical mapping is broadly assumed to have been a nineteenth century reaction both to the appearance of cholera and the social consciousness of principally British reformers. It is however older, more embedded in the scientific enterprise than the social critique, and in the end, more central to both than researchers typically recognize. This paper argues that medical mapping was from its start in the late 1600s principally a tool for the self-conscious testing of spatial propositions, arguing a relationship between health and place, and between the locus of specific disease incidence and suspected sites of local infectious generation. Through the nineteenth century the resulting work--social and medical— typically advanced a miasmatic theory that argued that infectious diseases were generated spontaneously and diffused naturally through the air. This paper reviews the history of medical cartography as a scientific enterprise in the age of miasma, and the importance of this work to social reformers as an outcome rather than a principal impetus to mapping as a critical tool.

Organizational change in education, as manifested by school reform, is indeed complex. In this article, we describe our experience with organizational change and analyse it using organizational change theories common in education. An evaluation of the reform initiative yielded unexpected problems related to sustainability. As a result, this article revisits the assumptions from the organizational change literature that guided our change strategy. This reflection led to the discovery of key theoretical ideas that, although less familiar, may have more practical utility for those engaged in organizational change within schools.

As a result of advances in GIS, students from a range of disciplines (epidemiology, public health, medical sociology, and anthropology) are seeking to learn how to apply a mapped, spatial perspective to issues of disease and health. This paper describes a pilot program whose intent has been to develop an interdisciplinary, skills-based course in medical mapping using a case-based approach. The focus of its first module is the famous nineteenth-century case of a cholera epidemic in Soho, London. Here, however, that case–critical to a range of disciplines—is an opportunity to introduce modern GIS tools and their applicability to the issues surrounding the mapping of diseases in general.

Two rival paradigms permeate bioethics. One generally favors eugenics, euthanasia, assisted suicide and other methods for those with severely restricting physical and cognitive attributes. The other typically opposes these and favors instead ample support for "persons of difference" and their caring families or loved ones. In an attempt to understand the relation between these two paradigms, this article analyzes a publicly reported debate between proponents of both paradigms, bioethicist Peter Singer and lawyer Harriet McBryde Johnson. At issue, the article concludes, are two distinct axiomatic sets of values resulting in not simply different styles of rhetoric but different vocabularies, in effect two different languages of ethics.