This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings (such as rural, western India), is exploitative of surrogate women. Arising out of consideration of the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative.

A provocative question has emerged since the Supreme Court of Canada's decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cDCD that are of relevance to this research question are explored, and morally-relevant distinctions between cDAD and cDCD are identified. In addition, a set of morally-relevant advantages of one practice over the other is uncovered, and a few potential, theoretical issues specifically related to cDAD practice are articulated. Despite these concerns, the analysis suggests a counterintuitive conclusion: cDAD is, overall, less ethically-problematic than cDCDD. The former practice better respects the autonomy interests of the potential donor, and a claim regarding irreversibility of cessation of the donor's circulatory function in the cDAD context can be supported. Further, with cDAD, there is no possibility that the donor will have negative sensory experiences during organ procurement surgery. Although the development of appropriate policy-decision and regulatory approaches in this domain will be complex and challenging, the comparative ethical analysis of these two organ donation practices has the potential to constructively inform the deliberations of relevant stakeholders, resource persons and decision makers.

Historically, the triage of temporarily scarce health resources has served narrow utilitarian ends. The recent H1N1 pandemic experience provided an opportunity for expanding the theoretical foundations/understandings of critical care triage in the context of declared infectious pandemics. This paper briefly explores the ethics-related challenges associated with the development of modern critical care triage protocols and provides descriptions of some 'enhanced fairness' features which were developed through the use of an inclusive deliberative engagement process by a Canadian provincial Department of Health.

Medical schools recognize that they have an important social mandate beyond their primary role to educate future physicians. The instantiation of social accountability (SA) within faculties of medicine requires intentional, effective partnering with diverse internal and external stakeholders. Despite early, promising academic work in the field of SA in medical education, there remains a lack of conceptual clarity about what SA could and should entail, and a lack of practical direction regarding how it could be implemented. The paper describes the development of an innovative SA framework that incorporates both pragmatic-evaluation and collaborative-enhancement components. The framework consists of five distinct phases, uses a deliberative engagement methodology, and is meaningfully informed by a set of four SA Lenses: Diversity, Inclusion and Cultural Responsiveness; Equity; Community / Stakeholder Engagement and Partnering; and Justice-Fairness and Sustainability. In addition to using the framework to evaluate and enhance the social accountability statuses of a variety of the medical school's operational components, Dalhousie Faculty of Medicine leaders are committed to applying the framework's SA Lenses to important decision-making processes, such as the revision of the medical school's strategic directions and the allocation of limited resources to address important, emerging medical education issues and challenges.

It is often challenging for mental health-care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health-care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care-related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, there is a gap in decision-making support in other mental health-care domains. This article proposes that a set of targeted, decision-making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). K E Y W O R D Scompeting obligations, decision-making support, deliberative engagement, mental health care, moral relational space 4 Kirby, J. (2017). Medical assistance in dying for suffering arising from mental health disorders: Could augmented safeguards enhance its ethical acceptability?