Summary Absolute uterine factor infertility (UFI) refers to the refractory causes of female infertility stemming from the anatomical or physiological inability of a uterus to sustain gestation. Today, uterine factor infertility affects 3–5% of the population. Traditionally, although surrogacy and adoption have been the only viable options for females affected by this condition, the uterine transplant is currently under investigation as a potential medical alternative for women who desire to go through the experience of pregnancy. Although animal models have shown promising results, human transplantation cases have only been described in case reports and a successful transplant leading to gestation is yet to occur in humans. Notwithstanding the intricate medical and scientific complexities that a uterine transplant places on the medical minds of our time, ethical questions on this matter pose a similar, if not greater, challenge. In light of these facts, this article attempts to present the ethical issues in the context of experimentation and standard practice which surround this controversial and potentially paradigm‐altering procedure; and given these, introduces “The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation”, a set of proposed criteria required for a woman to be ethically considered a candidate for uterine transplantation.

No abstract

Medical schools and residency programs have become very adept at teaching medical students and residents an enormous amount of information. However, it is much less clear whether they are effective at fostering virtuous qualities like empathy or professionalism in trainees. This would come as no surprise to Plato, who famously argued in the Meno that virtue cannot be taught. This pedagogical challenge threatens to stymie medical educators, who increasingly recognize the importance of professionalism, compassion, and empathy in the practice of good medicine. As medical educators, we are motivated to demonstrate that virtue is teachable and to find a way to do so, as this is how we will be able to improve the conduct of physicians and the quality of their care of patients. As such, we address the question of the teachability of virtue in the realm of medicine, analysing Plato's contradictory analyses in the Meno and Protagoras, and drawing upon modern neuroscience to turn an empirical lens on the question. We explore the ways in which Noddings' Ethic of Care may offer a way forward for medical educators keen to foster virtue in trainees. We conclude by demonstrating how, by harnessing the power of caring relationships, the principles of Noddings' Ethic of Care have already been applied to medical education at a university in Israel.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Background:Patient-centered care requires knowledge of patients’ goals of care (GoC) on the part of health care providers (HCPs). Whether HCPs caring for in-center hemodialysis patients meet this criterion is uncertain.Objective:We designed and conducted a GoC survey among patients and HCPs within a single in-center hemodialysis (ICHD) program to determine whether HCPs have an understanding of their patients’ GoC.Design:This was a prospective comparative quantitative survey study.Setting:The study included a single Canadian maintenance ICHD center.Participants:These included hemodialysis patients and their primary nephrologists, nurses, social workers, pharmacists, and dietitians.Methods and Measurements:Two surveys, one for patients and another for primary HCPs, were designed, piloted, and administered. For each participating patient, HCPs consisted of the primary nephrologist, nurse, social worker, pharmacist, and dietitian. Surveys included questions pertaining to 7 GoC themes. Patient-HCP agreement on the importance of each domain individually and the most important domain overall was assessed with kappa statistics. Factors influencing agreement were assessed with logistic regression in a secondary analysis.Results:A total of 173 patients were invited to participate, of whom 137 (79%) completed surveys. Fifty HCPs completed 623 corresponding surveys: 132 by physicians, 112 by nurses, 126 by pharmacists, 127 by social workers, and 126 by dietitians. A total of 70.1% and 78.8% of patients agreed with the importance of and would feel comfortable having GoC discussions, respectively, with their HCPs; 42.7% of physicians reported not having provided prognostic information to the corresponding patient. Patient-HCP agreement regarding GoC was poor (all κ < .25, all P values > .05). In adjusted analyses, only patients choosing “Be Cured” as the most important GoC was significantly associated with poorer HCP-patient agreement than expected (odds ratio, 0.04; 95% confidence interval, 0.01-0.18).Limitations:This is a single-center study involving only ICHD patients.Conclusions:HCP perceptions of GoC did not agree with patients’ reported GoC. This study suggests the need for the design and validation of interventions to improve HCPs’ understanding of their patients’ GoC.

A 59-year-old man with diabetes and alcoholic cirrhosis presented to the emergency department after three weeks of difficulty in walking and two weeks with impaired speech. He had been taking moxifloxacin (400 mg taken orally daily) and metronidazole (750 mg taken orally every six hours) for osteomyelitis for six weeks. On examination, he had dysarthria, ataxia, and symmetric dysmetria and dysdiadochokinesia, but his strength, sensation and reflexes were all normal. On magnetic resonance imaging (MRI) of the brain, he had diffusion restriction and fluid-attenuated inversion recovery (FLAIR) signal changes in the dentate nuclei bilaterally ( Figure 1A), structures that are involved in voluntary movement and cognition.This pattern on imaging has a broad differential diagnosis, but is typical of metronidazole neurotoxicity 1 and is partially or completely reversible after withdrawal of the offending agent. 2 After discontinuation of metronidazole and intensive physiotherapy, the patient's symptoms had improved substantially. Four weeks after stopping treatment with metronidazole, his symptoms had completely resolved, and repeat MRI of the brain showed resolution of the abnormalities in the bilateral dentate nuclei ( Figure 1B). Although both diabetes and alcoholic cirrhosis can cause or contribute to neuropathy, the rapid onset and pattern of injury seen in our patient are not typical of these conditions, and the complete resolution of symptoms after stopping the antibiotics is more suggestive of drug toxicity. Wernicke encephalopathy may also affect the dentate nuclei; however, our patient had been abstinent from alcohol for nine years.Despite being in common use, metronidazole rarely causes cerebellar neurotoxicity. 2 Damage can occur even at therapeutic doses, and although our patient received a higher dose than typically prescribed (125 g in total), the literature suggests that cerebellar neurotoxicity is unrelated to cumulative dose exposure or duration of treatment. 3 Metronidazole toxicity can be diagnosed clinically or with an MRI demonstrating characteristic findings of symmetrically increased signal intensity for T 2 -, FLAIR-and diffusion-weighted imaging signal intensity in the supratentorial white matter and the deep cerebellar nuclei, in particular the dentate nuclei. 1,4 Other neurologic adverse effects include peripheral neuropathy, encephalopathy, seizures and optic neuropathy, which are partially or completely reversible within weeks of stopping the medication. 2,3

No abstract

In response to calls to increase patient involvement in health professions education (HPE), educators are inviting patients to play a range of roles in the teaching of clinical trainees. However, there are concerns that patients involved in educational programs are seen as representing a demographic larger than themselves: their disease, their social group or even patients as a whole. This leads to difficult ethical challenges related to representation, including problems of tokenistic inclusion and of inadvertently essentializing marginalized groups. We propose that conceptualizing patients as experts in their illness experience can help resolve these dilemmas of representation equitably and effectively. Just as clinical experts are involved in HPE to share their expertise and represent their clinical experience, so too should patients be invited to participate in HPE explicitly for their expertise in their illness experience. This framing clarifies the goals of patient involvement as technocratic rather than tokenistic, mandates meaningful contributions by patients, and helps frame patient involvement for learners as the presentation of expert perspectives.