Neuroethics Now welcomes papers addressing the ethical application of neuroscience in research and patient care, as well as its impact on society.

Documenting capacity assessments and identifying substitute decisionmakers (SDMs) in healthcare facilities is ethically required for optimal patient care. Lack of such documentation has the potential to generate confusion and contention among patients, their family members, and members of the healthcare team. An overview of our research at the Ottawa Hospital and issues that influence the consistency of documentation in the Canadian context are presented here, as well as ideas for the mitigation of these issues and ways to encourage better documentation.

In recent years the Australian parliament has been considering the rights to protection from discrimination of intersex and gender identity disorder (GID) people. In 2013 such protections were made law in the amendment to the Sex Discrimination Act 1984, which in turn has influenced Senate inquiries into the medical treatment of intersex people. This year’s Australian report describes the purview and the potential ramifications of the inquiry of the Senate Standing Committees on Community Affairs, published in October 2013, into the involuntary or coerced sterilization of intersex people in Australia.

This section provides reactions to current and emerging issues in bioethics.

This report describes the system of ethical review that was adopted in New Zealand based on the findings and recommendations from the Cartwright Inquiry in 1988. It discusses the changes made to this system under recent governmental initiatives enacted by the National Party, and some of the implications of those changes.

This article investigates recent reforms of the Greenland coastal fisheries in order to contribute to the general lessons on reform and policy networks in the context of a changing Arctic stakeholdership. It analyses participation in fisheries governance decision-making by examining the emergence of discourses and policy networks that come to define the very need for reform. A policy network is identified across state ministries, powerful officials, banks and large scale industry that defined the need for fisheries reform within a ‘grand reform’ discourse. But inertia characterised the actual decision-making process as reform according to this ‘grand reform’ discourse was blocked by a combination of small-scale fishers’ informal networks and the power of the parliamentary majority. After a parliamentary shift in power the new government implemented the ‘grand reform’ gradually whilst new patterns of participation and exclusion emerged. In this process, the identities of the participating participants were reinterpreted to fit the new patterns of influence and participation. The article argues that fishery reform does not necessarily start with the collective recognition of a problem in marine resource use and a power-neutral process of institutional learning. Instead, it argues that fishery reform is likely to be the ‘reform of somebody’ and that this ‘somebody’ is itself a changing identity.

This article analyses the historical conditions and technical, social, commercial and political factors that have contributed to the revival of longline fishing in Iceland. Longline fishing practices have had important consequences at both the local and the national levels. This article deals, firstly, with the juridical and historical conditions of the development of small boat fishing practices since the beginning of the 1990s and the process through which small boats became progressively larger. Secondly, the paper describes the evolution of longline fishing practices and focuses more specifically on the technical, commercial, social and professional aspects of a new version of longline fishing that was developed in response to new marine management rules. It then deals with a specific kind of competitiveness that those living in coastal villages established to re-boost the local economy and discusses what has happened to small boat owners since 2000. The conclusion highlights the way longline fishing, by reconnecting social ties, takes part in the construction of contemporary Icelandic culture.

An anonymous survey distributed to doctors in Poland revealed the troublesome relationship between physicians and pharmaceutical sale representatives in terms of the frequency of visits, the trust of physicians in information supplied by sales reps, gifts accepted, and the general influence of marketing strategies on physician decisions. Challenges remain, despite laws enacted to address the problem.

In Alaska, fishing provides important economic and socio-cultural benefits for rural communities. This paper presents some of the findings from a research project that investigated the role of commercial and subsistence fishing in the maintenance of economic and social viability, and the ways in which residents of rural communities in Alaska value fishing. Three rural fishing communities in Alaska served as case studies for this project: Chenega Bay in Prince William Sound, Kokhanok in Bristol Bay, and Tyonek in Cook Inlet. In all three communities, both old and young residents note that younger people are not participating in fishing as much as they did in the past, and there is concern that fishing traditions will not continue. However, research findings show how important fishing is as a social, cultural, and community activity for families. Residents noted fishing provided for a quality of life that included values associated with family, community, culture, and freedom.

In Qeqertarsuaq (Disco Island), northwest Greenland, local disputes about the allocation of annual whaling quotas for beluga and narwhals feature as a source of conflict between state-imposed categories of occupational and non-occupational hunters. The national authorities’ co-management regime for the regulation of whale quotas has triggered the creation of new socio-economic groupings and compartmentalised respective groups of hunters in the process. Although the rigid legal categories have impacted upon the social unity and conduct of whaling in Qeqertarsuaq, and remain difficult to navigate, local whalers and their families nevertheless improvise and mould their interests around the legal frameworks in everyday interpretations of national and municipal quota allocations. The article argues that, in the process of receiving and interpreting annual quota allocations, hunters and their families draw on locally varying environmental and ecological circumstances and that their negotiation of current regulations, in turn, suggests a further consideration of the social aspects as these inform local knowledge about whales and wider socio-economic circumstances governing whaling in Qeqertarsuaq. In reviewing local receptions of annual quota allocations, the article assesses how whaling regulations are not just about the management of whale stocks but also about the management of whalers and their families and how this then calls for increased recognition of the fact that issues of social sustainability are intricately tied to contemporary concerns for environmental sustainability in Arctic whaling.

This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients’ unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board (INCB), which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions.

This article examines two current debates in Denmark—assisted suicide and the prioritization of health resources—and proposes that such controversial bioethical issues call for distinct philosophical analyses: first-order examinations, or an applied philosophy approach, and second-order examinations, what might be called a political philosophical approach. The authors argue that although first-order examination plays an important role in teasing out different moral points of view, in contemporary democratic societies, few, if any, bioethical questions can be resolved satisfactorily by means of first-order analyses alone, and that bioethics needs to engage more closely with second-order enquiries and the question of legitimacy in general.

Southern Bering Sea fishermen are vulnerable to losing access to key fisheries due largely to policy changes, permit loss, and the expense of fishing operations. Local residents generally do not have fishing rights in many of the high value commercial fisheries. They must continuously shape policy and explore alternative economies in order to stay fishermen. We were contracted by the U.S. Bureau of Ocean Energy Management to study the role of subsistence and commercial fisheries, land use, socioeconomics, and sharing networks in Alutiiq and Aleut/Unangan villages. Through an exploration of these data using innovative social network analysis that presents relationships, social stratification, commercialisation, and other dependencies in the maintenance of fisheries, sharing, trading, and revenue streams, this paper shows that in two of the most socioeconomically valuable fisheries, king crab (Paralithodes sp. and Lithodes sp) and cod (Gadidae), local peoples have had to gain access to these foods by using means outside of what are academically perceived as their traditional subsistence and commercial allocation, resulting in adaptive networks of distribution. This work shows the range of networks surrounding these key foods and their associated vulnerabilities and resilience. Those sharing networks that demonstrate greater interconnectedness are much more stable and resilient.