This section welcomes submissions addressing literature as a means to explore ethical issues arising in healthcare. “Literature” will be understood broadly, including fiction and creative nonfiction, illness narratives, drama, and poetry; film studies might be considered if the films are adaptations from a literary work. Topics include in-depth analysis of literary works as well as theoretical contributions, discussions, and commentary about narrative approaches to disease and medicine, the way literature shapes the relationship between patients and healthcare professionals, the role of speculative fiction as a testing ground for future scenarios in healthcare, and so on. Articles discussing the uses of literature for bioethics education and outreach will be particularly appreciated. Research on literature not originally written in English will be considered as long as it has also been published in translation. Submissions should include an abstract and should conform to the CQ Guidelines for Contributors. To submit an article or discuss a suitable topic, write to Antonio Casado da Rocha at antonio.casado@ehu.es.

The aim of this section is to expand and accelerate advances in methods of teaching bioethics. Bioethics educators are invited to send submissions to T. Kushner at kushnertk@gmail.com.

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.

This CQ department is dedicated to bringing noted bioethicists together in order to debate some of the most perplexing contemporary bioethics issues. Readers are invited to contact editors D. Micah Hester at hesterm@uams.ed or Alissa H. Swota at aswota@unf.edu with their thoughts on this debate or with suggestions for debate topics and interlocutors.

The Caduceus in Court welcomes readers to submit articles on legal updates and discussions of issues in healthcare law to Ben Rich at barich@ucdavis.edu.

To submit a case that has been reviewed by an ethics committee or to submit papers on related topics in clinical ethics, readers are invited to contact section editor Ruchika Mishra at ruchika.mishra@gmail.com.

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.

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.

Bioethics and Defense offers information and commentary on ethical issues arising at the interface between healthcare and warfare. For submissions, contact Griffin Trotter at trotter@slu.edu.

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.

To submit a case that has been reviewed by an ethics committeeor to submit articles on related topics in clinical ethics, readers are invited to contact section editor Ruchika Mishra at ruchika.mishra@gmail.com.

As Croatia makes the transition from one political system and type of economy to another, there are inevitable social and political changes that have a profound affect on the healthcare system. This article charts some of the progress of change with respect to patients’ rights and informed consent.