A Sceptics Report: Canada's Five Years Experience with Medical Termination (MAiD).

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.

Transhumanism, Moral Perfection, and Those 76 Trombones.

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.

Professionalism: An Archaeology.

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.

Problematic Ethics: Public Opinion Surveys in Medico-legal Disputes.

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.

Disabling disability amid competing ideologies.

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.

Enabling Choice: Aid in Living as a Predicate to Aid in Dying.

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.

The Hippocratic thorn in bioethics' hide: cults, sects, and strangeness.

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.

The ethicist as language czar, or cop: "end of life" v. "ending life".

Bioethics promises a considered, unprejudicial approach to areas of medical decision-making. It does this, in theory, from the perspective of moral philosophy. But the promise of fairly considered, insightful commentary fails when word choices used in ethical arguments are prejudicial, foreclosing rather than opening an area of moral discourse. The problem is illustrated through an analysis of the language of The Royal Society Expert Panel Report: End of Life Decision Making advocating medical termination.

Back to the future: Covid-19 and the recurring debate over social determinants of disease, and health.

Since the 1980s, a large literature has developed on the social determinants of health, primarily non-communicable diseases for which mortality and morbidity can be shown to change across a socioeconomic gradient. Primarily regional or national in focus, they are joined, today, with an increasing focus on international health and the effect of inequalities between nations effect disease generation and spread. Similar and earlier literatures first considered socioeconomic factors influencing disease incidence and intensity primarily at local and regional levels. One such literature was primarily "sanitarian," focusing on general infrastructure needs (safe water, for example) to create a beter health environment. A second, primarily nineteenth century literature focused on social inequalities and the epidemic diseases in specific populations. This paper seeks to review these separate foci and then combine them into a more comprehensive understanding of both the general and specific determinants of health and disease at local, national, and international scales of address. It notes that while disease dynamics have been long known that current literatures typically consider socioeconomic determinants at local, national, and global scales as a new phenomenon.

Disease mapping and innovation: A history from wood-block prints to Web 3.0.

This paper presents a point in the transition of publicly available data and the means of its presentation. With syndromic mapping and new systems of data collection and distribution at all levels, previously privileged materials are now generally available. At the same time, the means of their analysis and presentation are being transformed by new systems of digital collaboration and presentation. With the coronavirus disease 2019 COVID-19) dashboard as an example, the history of both data and their presentation is presented as the backcloth against which the evolving systems of data collection and graphic presentation can be understood in a world of interactive research and Web 3.0.

Welcome to the revolution: COVID-19 and the democratization of spatial-temporal data.

On January 22, 2020, Johns Hopkins University launched its online COVID-19 dashboard to track in real time what began in December as the regional outbreak of a novel coronavirus first identified in Wuhan, China. The dashboard and its format were quickly adopted by other organizations, making global, national, and regional data on the pandemic available to all. The wealth of data freely offered in this way was collected by syndromic programs whose precise algorithms search official and popular sources for data on COVID-19 and other diseases. The dashboard signals a new phase in the maturation of the "digital revolution" from paper resources and, in their popular employ, a "democratizion" of data and their presentation. This perspective thus uses the COVID-19 experience as an example of the effect of this digital revolution on both expert and popular audiences. Understanding it permits a broader perspective on not simply the pandemic but also the cultural and socioeconomic context in which it has occurred.

The practitioner as endangered citizen: a genealogy.

Medical practice has always involved at least three roles, three complimentary identities. Practitioners have been at once clinicians dedicated to a patient's care, members of a professional organization promoting medicine, and informed citizens engaged in public debates on health issues. Beginning in the 1970s, a series of social and technological changes affected, and in many cases restricted, the practitioner's ability to function equally in these three identities. While others have discussed the changing realities of medical practice in recent decades, none have commented on their effect on their effect on rights of practitioners as citizens. Here several cases begin an analysis of the manner in which those changes have limited the physician's right to act conscientiously and speak publicly in the face of organizational agendas and political priorities.

The ethical professional as endangered person: blog notes on doctor-patient relationships.

In theory, physicians subscribe to and in their actions personify a set of virtues whose performance demands personal engagement. At the same time, they are instructed in their professional roles to remain emotionally and personally distant from those they are called to treat. The result, the authors argue, is an ethical conflict whose nature is described through an analysis of two narratives drawn from an online blog for young physicians. Confusion over professional responsibilities and personal roles were found to affect physicians' perceptions of their clinical duties and their social roles. In addition, it sets in sharp relief contemporary debates on physician training and the ethical nature of medical professionalism. Practically, the authors suggest, the confusion may contribute to early physician burnout. Methodologically, this paper promotes the use of online discussion sites as rich repositories providing an insight into real dilemmas and the actual perception of physicians' attempts to address them. It thus promotes use of such sites as a resource in which assumptions about physicians' own perceptions about the nature of their role in contemporary society can be tested.

Enhancing who? Enhancing what? Ethics, bioethics, and transhumanism.

Transhumanists advance a "posthuman" condition in which technological and genetic enhancements will transform humankind. They are joined in this goal by bioethicists arguing for genetic selection as a means of "enhancing evolution," improving if not also the species then at least the potential lives of future individuals. The argument of both, this paper argues, is a new riff on the old eugenics tune. As ever, it is done in the name of science and its presumed knowledge base. As ever, the result is destructive rather than instructive, bad faith promoted as high ideal. The paper concludes with the argument that species advancement is possible but in a manner thoroughly distinct from that advanced by either of these groups.

Populations, megapopulations, and the areal unit problem.

Models of epidemic disease and programs for their management require accurate population data as a critical component of most studies. But the traditional definitions of urban places assumed discrete borders and localized populations. The vast increase in urban travel at all scales has raised the problem of how we define those urban populations. This paper reviews the issues as an areal unit problem within the context of the evolving idea of "megaregions" and their defintion.