Bernard Morris Dickens

Bernard Morris Dickens
University of Toronto | U of T

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281
Publications
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Introduction
Skills and Expertise

Publications

Publications (281)
Article
Claims that human embryos are “human beings” or “persons” cannot be agreed, because philosophies and approaches differ, awarding them statuses from full human to property. In 1984, the UK (Warnock) Committee of Inquiry into Human Fertilisation and Embryology made recommendations that still offer legal and ethical guidance. It is widely agreed, for...
Article
The clinically detailed report of a successful uterus transplantation and live birth in Sweden, in which a family friend donated her uterus, provides a basis for expanded practice. Family members and friends can serve as living donors without offending legal or ethical prohibitions of paid organ donation, even though family members and friends ofte...
Article
When patients require information to decide whether to accept recommended treatments, a question in both law and ethics is whether the same information is adequate whether they consent or refuse, or whether refusal requires more or repeated information. Refusals of recommended treatment can carry increased risks for patients' well-being and so requ...
Article
This Special Editorial questions whether hymenoplasty ("re-virgination") before marriage, where lawful, is ethically or medically appropriate, recognizing that in some cultures, the lives or well-being of patients may be at stake.
Article
Healthcare providers require prior consent to treat patients. Consent can be different for legal purposes, and be expressed in different ways. Simple consent affords providers protection from liability for assault, but negligence can arise if the consent is inadequately informed. Providers cannot coerce or improperly induce consent; patients’ agree...
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Full-text available
The Inter-American Court of Human Rights has ruled that the Supreme Court of Costa Rica's 2000 judgment prohibiting in vitro fertilization (IVF) violated the human right to private and family life, the human right to found and raise a family, and the human right to non-discrimination on grounds of disability, financial means, or gender. The Court's...
Article
Stigmatization marks individuals for disgrace, shame, and even disgust—spoiling or tarnishing their social identities. It can be imposed accidentally by thoughtlessness or insensitivity; incidentally to another purpose; or deliberately to deter or punish conduct considered harmful to actors themselves, others, society, or moral values. Stigma has p...
Article
It is increasingly implausible to speak of a purely domestic abortion law, as the legal debates around the world draw on precedents and influences of different national and regional contexts. While the United States and Western Europe may have been the vanguard of abortion law reform in the latter half of the twentieth century, Central and South Am...
Article
The new technology that will allow genetic testing of a fetus within the first trimester of pregnancy by isolating cell-free fetal DNA (cffDNA) in the mother's blood raises a range of ethical and legal issues. Considered noninvasive, this test is safe and reliable, and may avoid alternative genetic testing by amniocentesis or chorionic villus sampl...
Article
The Inter-American Court of Human Rights (the Court) has ruled that the Supreme Court of Costa Rica's judgment in 2000 prohibiting in vitro fertilization (IVF) violated the human right to private and family life, the human right to found and raise a family, and the human right to non-discrimination on grounds of disability, financial means, or gend...
Article
Female genital cosmetic surgery is surgery performed on a woman within a normal range of variation of human anatomy. The issues are heightened by a lack of long-term and substantive evidence-based literature, conflict of interest from personal financial gain through performing these procedures, and confusion around macroethical and microethical dom...
Article
Recent decisions of the Committee on the Elimination of Discrimination against Women (CEDAW), the Inter-American Court of Human Rights, and the High Court of Delhi have shown how the pregnancy-related deaths of individual women have been bases on which these authoritative tribunals have held Brazil, Paraguay, and India respectively accountable for...
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This FIGO Committee Report focuses on female contraceptive sterilization in terms of human rights and ethical aspects. It provides a background on the subject and discusses recommendations on female contraceptive sterilization guidelines and procedures. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ir...
Article
Recent research in the USA has shown the advantages for children's welfare of open fetal surgery over postnatal treatment for myelomeningocele. However, a balance must be struck between complications of premature birth risked by prenatal surgery and the long-term advantages for affected children's health, including mobility and neurologic capacity....
Article
Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women's health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accep...
Article
Unlabelled: In Canadian law, pregnant women are held to owe no enforceable duties of care to their children before birth, but healthcare providers may be held accountable once children are born alive for causing injuries prenatally. When children are born in hospitals, recovered meconium may be tested without consent, but there may be an ethical d...
Article
This FIGO Committee Report focuses on cross-border reproductive services which refers to individuals crossing national borders to obtain fertility treatment outside their home countries and to individuals leaving their own countries to facilitate reproduction elsewhere. It discusses: reasons for crossing borders treatment referrals autonomy potenti...
Article
Judicial approaches to stored (cryopreserved) human embryos, in western jurisprudence, tend not to reflect approaches within systems of moral ordering or particular religious traditions, which differ among themselves. The emerging judicial approach is pragmatic, protecting individuals' rights of control and their interests in parenthood. Embryos ar...
Article
Stereotypes are generalized preconceptions defining individuals by group categories into which they are placed. Women have become stereotyped as homemakers and mothers, with the negative effect of precluding them from other roles and functions. Legislation and judicial constructions show a history, and often a continuing practice, of confining wome...
Article
Policy on reinfibulation exposes the interface between individual or micro-ethics and population-wide or macro-ethics. If, following childbirth, an infibulated woman requests reinfibulation, a gynecologist may respectfully advise her of its negative implications, but would not act in breach of ethical or usually legal requirements in undertaking th...
Article
The new American College of Obstetricians and Gynecologists' (ACOG) monitoring guidelines introduce a new category of interpretation of fetal heart rate tracings between reassuring and nonreassuring, namely intermediate. The purpose is to reduce unnecessary cesarean deliveries. The legal role of medical guidelines is ambivalent. Providers are expec...
Article
A hymen may be ruptured by sexual intercourse and several other means. In cultures prizing unmarried women's virginity, premarital rupture may shame a woman, and her family. Women, including brides whose virginity is not proven at marriage, face humiliation, ostracism, divorce, and violence-at the extreme, "honor" killing. Nevertheless, gynecologis...
Article
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive...
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Full-text available
The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). Multiple pregnancy entail an increased risk of, at times life threatening, maternal complications i.e. pre-eclampsia, eclampsia or abruptio placenta, of serious neonatal hazards, i.e. extreme prematu...
Article
Intimate partner violence (IPV), usually men's violence against women, appears universal. It may be associated with pregnancy, but this may be because pregnant women receive more medical attention. Violence may cause bruises, abrasions, and cuts, but its extremes include hospitalization, death, and suicide. IPV is often disclosed when women are ask...
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Full-text available
This editorial outlines the principle of protection of health service providers' personal conscience, and the limit necessary to protect the health and freedom of their patients' rights of access to lawful health services. The balance protecting both providers' rights of conscience and patients' rights of care is the providers' duty to refer their...
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Full-text available
The right to conscientious objection is founded on human rights to act according to individuals' religious and other conscience. Domestic and international human rights laws recognize such entitlements. Healthcare providers cannot be discriminated against, for instance in employment, on the basis of their beliefs. They are required, however, to be...
Article
This paper presents an analysis of the contrast between public health practice and public health research, and an explanation of why ethical assessment of biomedical research is inappropriate for ethical review of public health practice. The bulk of public health activity is routine practice, but, in default of other means of ethical review, propos...
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Full-text available
During Assisted Reproductive Technology (ART) procedures, the transfer of a single embryo dramatically reduces the rate of multiple pregnancy. Proper information, therefore, should be delivered to patients before embryo transfer. In many countries, regulations limit, according to age of the patient, the number of embryos to be transferred. Selectiv...
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Full-text available
Sinopsis Examen de las cuestiones legales y éticas, en la experiencia internacional, del manejo del embarazo con un feto anencefálico dentro del contexto del aborto o parto inducido. Resumen Alrededor de un tercio de los fetos anencefálicos nacen vivos, pero no son conscientes o viables y fallecen rápidamente. Este defecto del tubo neural puede red...
Article
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers, hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers' duties to refer patients to non-objecting providers, and that hospitals, cl...
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Full-text available
There is continuing historical and social ambivalence about whether human reproduction and indulgence of human sexuality are primarily private rights or public concerns. Family creation is essentially a private matter, involving the most personal, intimate motivations and occasions. However, when medical science replaced herbal medicine for the art...
Article
Multiple pregnancy is increasingly considered a complication of in vitro fertilization (IVF) and ovarian stimulation for natural fertilization. Harms to fetuses, newborn and older children, mothers, families, and healthcare systems are encouraging single embryo transfer. When patients knowingly accept multiple pregnancy risks from IVF or ovarian st...
Article
Robotic surgery fits within the general framework of Canadian medical law regarding such issues as patients' consent and suitability of medical equipment. Its two distinctive features are its relative novelty, and practice by practitioners in one jurisdiction on patients in another. Novelty raises issues of how courts determine legally-set standard...
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Full-text available
Within our health care and social welfare framework there is an increasing emphasis on the right of individuals to control decisions affecting their daily lives. For instance, medical care, residential care, and property dispositions typically require that the interested individual give consent to the proposed arrangements. Those found incompetent...
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Professor Keith Simpson's career as a highly distinguished British forensic pathologist took him to the scenes of many of the most sensational homicides and criminal trials of recent decades. He pioneered forensic dentistry, and was prominent in alerting physicians and others to the reality of the battered baby syndrome. The first Professor of Fore...
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About a third of anencephalic fetuses are born alive, but they are not conscious or viable, and soon die. This neural tube defect can be limited by dietary consumption of foliates, and detected prenatally by ultrasound and other means. Many laws permit abortion, on this indication or on the effects of pregnancy and prospects of delivery on a woman'...
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Full-text available
Fresh embryos resulting from in vitro fertilization, including many of poor quality, can provide sources of human embryonic stem cell lines. We consider why some donate such embryos for this research, address relevant ethical and policy issues, and present core guidelines for fresh embryo donation based on those of Canada.
Article
Courts have been quite consistent in allowing ex-partners in marriages or similar relationships, usually men, to veto the other partner's reproductive use of jointly-created IVF embryos. This supports the principle of voluntary parenthood. In contrast, child custody disputes following surrogate motherhood may favor the commissioning couple or the s...
Article
The International Society for Stem Cell Research (ISSCR) Guidelines for the Conduct of Human Embryonic Stem Cell Research, prepared by an international group of leading stem cell scientists, bioethicists and lawyers, build on the proposals previously drafted by agencies active in the conduct and funding of stem cell science. They aim not to duplica...
Article
National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because...
Article
This editorial addresses historical judicial and ethical ambivalence regarding non-consensual sterilization. Some courts and commentators view this as an oppressive human rights violation, but others as a legitimate option to spare vulnerable intellectually compromised people, usually women, from suffering or causing harm. The editorial also consid...
Article
Individuals' reproductive choices are private matters, but sexual conduct and pregnancy impose significant public health burdens. Ethical principles of public health are distinguishable from principles applied in modern bioethics. Bioethical principles have been developed at the clinical or microethical level, affecting relations among individuals,...
Article
Adolescents, defined as between 10 and 19 years old, present a growing challenge to reproductive health. Adolescent sexual intercourse contributes to worldwide burdens of unplanned pregnancy, abortion, spread of sexually transmitted infections (STIs), including HIV, and maternal mortality and morbidity. A barrier to contraceptive care and terminati...
Article
Human tissue engineering and regenerative medicine may be considerably advanced by embryonic stem-cell research and cell line development, to provide preventive means, cures and treatment strategies for a range of debilitating conditions and injuries. Research may result in embryos from which stem-cells are derived losing viability, which offends s...
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Dedication of this issue of the Journal to the theme of “Rights and Ethics” complements this month’s Annual Meeting and Exposition of the American Public Health Association, titled “Public Health and Human Rights,” and highlights the congruence of inclusion of both human rights norms and ethical standards in public health work. Historically, the pr...
Article
This paper addresses laws and practices urged by conservative religious organizations that invoke conscientious objection in order to deny patients access to lawful procedures. Many are reproductive health services, such as contraception, sterilization and abortion, on which women's health depends. Religious institutions that historically served a...
Article
Modern medical concerns with telemedicine and robotics practiced across national or other jurisdictional boundaries engage the historical, complex area of law called conflict of laws. An initial concern is whether a practitioner licensed only in jurisdiction A who treats a patient in jurisdiction B violates B's laws. Further concerns are whether a...
Article
Courts and legal tribunals increasingly decline to serve as religious or moral guardians, and require social evidence to support litigants' claims. Recent cases on emergency contraception and abortion are examined to show how judicial interpretations can take account of evidence of the impact that different understandings of the law will have for h...
Article
Two legal experts argue that in order for physicians to exercise their right to conscientious objection, they should explain why they are refusing to treat a patient and then refer the patient to another professional for medical treatment. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
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Full-text available
The management of patients with severe brain injury falls within the disciplines of emergency medical services, trauma, critical care, neurology and neurosurgery. Consultation and collaboration between professionals in these disciplines and those involved in end-of-life care and organ donation and transplantation are required to standardize and opt...
Article
Conflicts of interest arise when those who owe conscientious duties to others appear to have personal interests that might tempt them to subordinate those duties to their self-interest. Conflicts of interest are distinguishable from conflicts of commitment, which arise when individuals bear two or more mutually exclusive duties to others. If person...
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Article
Recognizing sexual abuse to be universal, in stable as well as disordered societies and directed predominantly but not only against younger women, this article first considers legal definitions of sexual abuse and the forensic evidence health care providers may be expected to gather. It explores the impact on victims of historic definitions of rape...
Article
Controversies affecting reproductive choice can often be resolved within interactions of legal and ethical decision-making. This paper addresses three topics, following the methodology presented in Reproductive Health and Human Rights: Integrating Medicine, Ethics, and Law, by R.J. Cook, B.M. Dickens and M.F. Fathalla (Oxford University Press, 2003...
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This paper contrasts ethical approaches to sex selection in countries where discrimination against women is pervasive, resulting in selection against girl children, and in countries where there is less general discrimination and couples do not prefer children of either sex. National sex ratio imbalances where discrimination against women is common...
Article
Adolescents, defined by WHO as 10 to 19 years old, can give independent consent for reproductive health services if their capacities for understanding have sufficiently evolved. The international Convention on the Rights of the Child, almost universally ratified, limits parental powers, and duties, by adolescents' "evolving capacities" for self-det...
Article
From its emergence, preimplantation genetic diagnosis (PGD) has been opposed by religious, feminist, and disability-rights advocates. PGD has developed, however, to extend beyond genetic diagnosis of embryos to diagnose chromosomal abnormalities. Evidence shows that PGD is safe, children born after in vitro fertilization (IVF) and PGD having no hig...
Chapter
The term value system refers to the personal and societal qualities that individuals and communities consider worthy of holding within themselves and in contrast to the lesser worth of alternative qualities. For instance, those inspired by religious or spiritual values find them more worthy than secular or worldly values, and those who find religio...
Article
Obstetric fistula can be explained to result from different causes. These holes in the tissue wall between the vagina and bladder and/or rectum are most prevalent in resource-poor countries, attributable to prolonged obstructed labour and absent or inaccessible remedial prenatal services. Obstructed labour is often due to small pelvic size, resulti...
Article
In 2003, the World Health Organization published its well referenced handbook Safe Abortion: Technical and Policy Guidance for Health Systems to address the estimated almost 20 million induced abortions each year that are unsafe, imposing a burden of approximately 67 thousand deaths annually. It is a global injustice that 95% of unsafe abortions oc...
Article
Modern law approaches patients' consent to treatment not only through liability for unauthorized touching, namely criminal assault and/or civil (non-criminal) battery, but also through liability for negligence. Physicians must exercise appropriate skill in conducting procedures, and in providing patients with information material to the choices tha...
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This article presents findings and recommendations of an international conference held in Cairo, Egypt in 2003 concerning issues of ethical practice in how information is provided to and by medical practitioners. Professional advertising to practitioners and the public is necessary, but should exclude misrepresentation of qualifications, resources,...

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