Background: Under Quebec’s Act respecting end-of-life care, physicians may refuse to provide medical aid in dying because of personal convictions, also called conscientious objections. Before legalisation, the results of our survey showed that the majority of physicians were in favour of medical aid in dying (76%), but one-third (28%) were not prepared to perform it. After 18 months of legalisation, physicians were refusing far more frequently than the pre-Act survey had anticipated. Aim: To explore the conscientious objections stated by physicians so as to understand why some of them refuse to get involved in their patients’ medical aid in dying requests. Design/participants: An exploratory qualitative study based on semi-structured interviews with 22 physicians who expressed a refusal after they received a request for medical aid in dying. Thematic descriptive analysis was used to analyse physicians’ motives for their conscientious objections and the reasons behind it. Results: The majority of physicians who refused to participate did not oppose medical aid in dying. The reason most often cited is not based on moral and religious grounds. Rather, the emotional burden related to this act and the fear of psychological repercussions were the most expressed motivations for not participating in medical aid in dying. Conclusion: The originality of this research is based on what the actual perception is of doing medical aid in dying as opposed to merely a conceptual assent. Further explorations are required in order to support policy decisions such as access to better emotional supports for providers and interdisciplinary support.
Genetic information can be used to target interventions that improve health and prevent disease. Indeed, the results of population genomics research could be useful for public health and national pandemic plans. Yet, firm scientific evidence originating from such research and the indicators of the role of health determinants, gene-gene and gene-environment interaction remain to be assessed and validated before being integrated into pandemic plans or public health programmes. It is not clear what is the role of the State in research on the elucidation of the determinants of gene-gene and gene-environment interactions and how, when, and if such data can be accessed and used for such planning. Over a period of 3 years, we sought to address these questions by gathering data and literature relevant to research in public health genomics, preparing issues papers and, finally, consulting with stakeholders on a provisional ‘points to consider’ document at various times. Examining in turn the issues of privacy, State powers, stakeholder perceptions, and public participation, we propose in this article, for each of these themes, a series of recommendations aiming to provide guidance on the role of the State in the use of genomic information for public health research, prevention and planning.
Desmosterol and its sulfate are the major components (60%) of the sterol fraction of hamster spermatozoa obtained from the cauda epididymis. Cholesterol represents only 10% of this fraction. The concentration of desmosteryl sulfate associated with the spermatozoa increases 18-fold during their transit through
Steroid sulfotransferase activity has been assayed in cytosol extracts obtained from the male hamster reproductive tract. Dehydroisoandrosterone and desmosterol were used as substrates in the presence of phosphoadenosine phosphosulfate-35S as sulfate donor. No significant sulfotransferase activity was found in the testis. In the epididymis, a severalfold increase in activity was found in the tissue from the caput to the caudal regions. A lower but significant activity was detected in the vas deferens. The enzyme appears to be secreted into the luminal fluid while little activity is associated with the spermatozoa. This increase in activity along the epididymis is undoubtedly responsible for the accumulation of sterol sulfates reported previously. In view of the fact that sterol sulfates are potent and specific inhibitors of acrosin, as reported for the porcine and confirmed herein for hamster acrosin, the epididymal production of steroid and sterol sulfates may represent a protective mechanism against the premature release of proteolytic activity within the male reproductive tract.
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