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  Subjects -> HEALTH AND SAFETY (Total: 1304 journals)
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HEALTH AND SAFETY (532 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 30)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Sciences     Open Access   (Followers: 6)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 26)
American Journal of Public Health     Full-text available via subscription   (Followers: 241)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 2)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 6)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 20)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 8)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 13)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 3)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 3)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 16)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 18)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 3)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Global Security : Health, Science and Policy     Open Access  
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 16)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 9)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 55)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 2)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 16)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 41)
Health Policy and Technology     Hybrid Journal   (Followers: 3)
Health Professional Student Journal     Open Access   (Followers: 2)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 49)
Health Psychology Research     Open Access   (Followers: 19)
Health Psychology Review     Hybrid Journal   (Followers: 41)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 12)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 13)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 11)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 6)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 5)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 34)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 8)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)

        1 2 3 | Last

Journal Cover Ethics, Medicine and Public Health
  [3 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 2352-5525
   Published by Elsevier Homepage  [3120 journals]
  • Lettre ouverte : « Quelle leçon tirer de la récente controverse
           française sur l’épisiotomie ' » ou la généralisation d’une
           véritable éthique des pratiques en clinique humaine
    • Authors: Ville
      Abstract: Publication date: October–December 2017
      Source:Ethics, Medicine and Public Health, Volume 3, Issue 4
      Author(s): C. Hervé, Y. Ville

      PubDate: 2017-12-27T07:01:08Z
  • Enquête de la santé mentale. De l’importance de la santé mentale des
           étudiants et jeunes médecins
    • Authors: Valentin
      Abstract: Publication date: October–December 2017
      Source:Ethics, Medicine and Public Health, Volume 3, Issue 4
      Author(s): C. Valentin

      PubDate: 2017-12-27T07:01:08Z
  • Non-adjectival bioethics
    • Abstract: Publication date: Available online 23 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Łuków
      It has become customary to think about bioethics as populated by “adjectival bioethics” such as utilitarian bioethics, deontological bioethics, Christian bioethics, feminist bioethics, and more. The unfortunate outcome of such a designation is a perception of bioethics as incapable of offering definitive conclusions of practical or social importance, and so as useless for a modern pluralistic society. Accordingly, it is not a viable alternative to traditional ways of dealing with ethical issues associated with medicine or relations between human beings and non-human nature. Moral pluralism of the society is mirrored by the multiplicity of views of bioethicists and plurality of adjectival bioethics. The paper argues for an understanding of bioethics that is better suited to a pluralistic democratic society. On this view, bioethics is a complex of ideas, commitments, and practices, which enables the exchange of opinions of both experts of various specialities and lay citizens about ethical problems associated with medicine and relations between human beings and non-human nature. Such “non-adjectival bioethics” relies on a paradigm of intellectual engagement in the form of public debate, which is characteristic of a democratic society. The argument proceeds in two steps. The first step (which focuses on various forms of reflection on ethical issues in medicine but its conclusions apply to all fields of bioethics) starts with two distinctions. One distinction is between the medical-professional perspective and normative-theoretical together with a doctrinal perspective on ethical issues regarding medicine. The other distinction is between bioethics as academic research and education and bioethics as a practice of public debate. On the ground of these distinctions, the non-adjectival view of bioethics is offered. It is a two-layer discourse, which covers both academic research and instruction, and a social practice of public debate that involves professional, normative-theoretical, and doctrinal components. The goal of the debate is to clarify publicly recognised ethical problems and, if possible, offer their publicly shared solutions. Such a non-adjectival bioethics is normative; it functions on various forums and engages academics, the professions, and laypersons. The second part of the paper discusses normative presuppositions of non-adjectival bioethics. It is conceived of in the spirit of deliberative view of public decision-making. Non-adjectival bioethics is animated by two normative sources. One source is democratic values and ideals, such as individual liberty, equality, mutual recognition, and respect, which form the broadest normative framework for a public debate of a democratic society on publicly identified ethical issues. The other normative source of non-adjectival bioethics is doctrines, which are endorsed by citizens populating the society. These doctrines are valuable pools of reasons and arguments that can be examined in the bioethical debate. Non-adjectival bioethics is therefore a discourse and discipline, which is defined and bounded by the democratic values and ideals. Unlike adjectival bioethics, which aspire to universally bind conclusions by building their normative claims on metaphysical doctrines or to being a freestanding theory or framework, non-adjectival bioethics looks for clarifications and solutions of ethical problems recognised by pluralistic democratic societies, which are founded on such moral values and ideals as individual liberty, equality, and mutual recognition, and respect.

      PubDate: 2017-11-29T10:53:17Z
  • Principles, rules, and the deflation of the good in bioethics
    • Authors: J.P. Bishop
      Abstract: Publication date: Available online 22 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J.P. Bishop
      Prior to the Nuremberg Code, German Law had prohibited research on subjects without their consent. Yet, German Law could not restrain the Nazi research machine. Likewise, the United States Public Health Service continued research on poor black men in the southern US for 25years after the promulgation of the Nuremberg Code. Once the Tuskegee Experiments were exposed, it prompted philosophers to articulate the more general and philosophically robust norms and principles that should ground and guide all future research and practice. Yet, this move to more general principles results in the deflation of metaphysical concepts traditionally thought necessary for ethics, namely the concept of the good and the concept of persons. Put differently, modern principles of biomedical ethics that seek to avoid pluralism and relativism grounds its ideas in the philosophy of right action at the expense of the philosophy of good. This essay argues that, because medicine is aimed at health, and the goods possible for persons in health, any ethics of medicine must be grounded in a philosophy of the goods for persons and goods of persons.

      PubDate: 2017-11-29T10:53:17Z
      DOI: 10.1016/j.jemep.2017.09.012
  • The Nuremberg veil
    • Authors: Goss
      Abstract: Publication date: Available online 22 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): B. Goss
      Subject autonomy is widely considered the distinctive achievement of contemporary research ethics. Popular history claims that there were no attempts to protect subject autonomy or informed consent until the Nuremberg Doctors’ Trial brought the Nazi research abuses into infamy. This is however a false history. There were at least two research codes in Europe before the Nazis: the Prussian Decree of 1900 and the German Reichsrundschreiben of 1931. Ironically, these codes had stricter demands for subject autonomy and informed consent than contemporary research codes like the Belmont Report and the Nuremberg Code. Yet, the strict demands were overridden by the Nazi state once it faced the emergencies of war. This historical lesson reveals a fundamental flaw in political liberalism, which caused the pre-Nazi codes to fail. But during the Nuremberg Trial, Allied prosecutors were manipulated by the Nazi defence into forgetting about these pre-Nazi codes. Consequently, a frightening lesson from history was lost to modern ethicists. Modern research codes remain vulnerable to the same problem that caused pre-Nazi codes to fail. Thus, recovering this lost history is as important as ever.

      PubDate: 2017-11-29T10:53:17Z
  • ‘To whom does my body belong'’
    • Authors: Novak
      Abstract: Publication date: Available online 22 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): D. Novak
      In debates over whether a society should recognize the right of an individual person to end his or her own life (and to enlist the services of a physician to do so), the question is often formulated in terms of ownership: Who owns my body' Those who advocate for self-ownership of their body see the reason for the public enforcement of this right to be “autonomy.” Those who advocate for societal ownership of anyone's body see the reason for the public recognition of this right to be “heteronomy.” And those who advocate for God's ownership of anybody see the reason for the public enforcement of this right to be “theonomy.” Advocates of autonomy, though, have difficulty in justifying a right of self-ownership, since humans are far more dependent on others than they are on themselves. Self-ownership implies a largely fictitious self-sufficiency. Advocates of heteronomy, though, have difficulty in justifying a right of public ownership, since this has been the justification of totalitarian regimes to eliminate persons arbitrarily deemed dangerous or even useless to them. And advocates of theonomy, though, have difficulty in justifying the killing of any living being that is a creature of God. This paper will argue that the whole ownership model is morally flawed. Instead, a model of mutual care is morally more adequate. In this model, we are all both the subjects and objects of care, and that we couldn’t survive were this not so. We come into the world as infants totally dependent on the care of others. As we grow into adulthood, we become the subjects of the claims of others to care for them and for ourselves along with them. Society's task is to coordinate our mutual roles as care-receivers and caregivers. No functioning adult is only a caregiver or only a care-receiver. As caregivers we have duties; as care-receivers we have rights. Autonomy should only be invoked when society claims ownership of any of its members. Heteronomy should only be invoked when an individual person acts as if his or her decision to live or die involves nobody else, and nobody else should be concerned. And theonomy should be invoked whenever an individual person or a society claims to have created himself or itself and to have the right to do with themselves whatever they please. Therefore, individual persons have the right to call for their society to care for them when they cannot help themselves, instead of the right to call for society to help them eliminate themselves from society even when they want to do so. A society has the right to call for individuals to care for themselves and others when they can do so, instead of the right of a society to eliminate individual persons it no longer wants to care for. And religious believers can affirm both the duty of individuals to care themselves, and the societal duty to care for its individual members, are to be exercised in imitation of the God who cares for creation and who commands human creatures to act accordingly. God's unique ownership of creation, however, is another matter and, as such, it is inimitable.

      PubDate: 2017-11-29T10:53:17Z
  • On the philosophical foundations of medical ethics: Aristotle, Kant, JS
           Mill and Rawls
    • Authors: R. Cohen-Almagor
      Abstract: Publication date: Available online 22 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): R. Cohen-Almagor
      This article aims to trace back some of the theoretical foundations of medical ethics that stem from the philosophies of Aristotle, Immanuel Kant, John Stuart Mill and John Rawls. The four philosophers had in mind rational and autonomous human beings who are able to decide their destiny, who pave for themselves the path for their own happiness. It is argued that their philosophies have influenced the field of medical ethics as they crafted some very important principles of the field. I discuss the concept of autonomy according to Kant and JS Mill, Kant's concepts of dignity, benevolence and beneficence, Mill's Harm Principle (nonmaleficence), the concept of justice according to Aristotle, Mill and Rawls, and Aristotle's concept of responsibility.

      PubDate: 2017-11-29T10:53:17Z
      DOI: 10.1016/j.jemep.2017.09.009
  • The slippery slope, some remarks on the long and winding road to heaven or
    • Authors: G. Hermeren; I. de Beaufort
      Abstract: Publication date: Available online 21 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Hermeren, I. de Beaufort
      The slippery slope argument is often used in (bio)ethical debates. It is an intriguing argument: it confronts us with fears, gut feelings, and fundamental values; it invites us to think about the future, and it forces us not only to look at a technology or policy in isolation but at the whole picture. Rhetorically it is attractive with its often vivid images and sweeping statements, sometimes derived from fictional tales. The argument is based on two general assumptions: (1) the slope is slippery, if application of a policy or technology X to area A is permitted, it is not possible to stop, and (2) one will end up in final stage D which should not be allowed to happen. We do not discuss the argument in relation to a specific bioethical problem but use different examples, as we want to focus on some general issues that in our view deserve attention. We first distinguish three uses of the argument: the debate-stopper use, the disqualify-opponents use and the scenario-use, when the argument is used as an invitation to debate by using the end stage D as a possible scenario among other scenarios. We secondly discuss the following questions: can the slope be (made) more or less slippery' Is it possible to stop the sliding on the slope at one or more points' How robust is the evaluation of the final stage D' With regard to the description of initial situation A we point out that the choice of descriptions may not be ethically neutral and stress that it is important to consider the alternatives to allow X in A. With regard to the evaluation of end stage D, we argue, using the example of IVF, that after initial fear and awe people may change their minds on D. We state that critical examination of the evidence is necessary. This involves checking the tenability, the relevance and the completeness of the evidence brought forward in the slippery slope argument, both for the slipperiness of the slope as well as for the evaluation of the end stage. Claims have to be founded, albeit defenders of a slope sometimes seem to presume that this is not necessary, as it ‘obvious’ or ‘self-evident’. We finally point out that there is also a ‘road to paradise’ or ‘stairway to heaven’ version of the slippery slope argument. This argument also needs scrutiny. We summarize our discussion in stating that the following questions should always be raised and answered when using or being confronted by a slippery slope argument: Is the argument used as an incentive to have a debate' What are the alternatives to allowing X in the current situation A, and do they not lead to a slippery slope' How strong is the moral evidence for the claim that the end stage of the slope morally wrong or bad' Is the slope really slippery or are there different measures, empirical or logical, to prevent the sliding down'

      PubDate: 2017-11-29T10:53:17Z
      DOI: 10.1016/j.jemep.2017.07.008
  • The subject and power of bioethics
    • Authors: Hull
      Abstract: Publication date: Available online 21 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Hull
      The present paper argues that late work of Michel Foucault is helpful in understanding contemporary bioethics. Specifically, Foucault's writings on biopower and subjectivity are increasingly relevant as we consider the intersection of public policy and clinical ethics in a socio-political context increasingly structured by the demands of neoliberalism. Although Foucault's earlier work on the clinical gaze has been important to bioethics, that is no longer as important as his later, incomplete research into power and subjectivity. The paper develops this argument in four steps. In the first, I look at a classic phenomenological approach to clinical bioethics by Richard Zaner, starting from which I develop a Foucauldian perspective. In that section, I also offer a basic outline of what I take Foucault's primary theoretical contributions to be by way of an initial explication of the biopower-subjectification nexus. The following two sections of the paper present exemplary applications of Foucauldian theory to two areas at the intersection of public policy and clinical bioethics. The first is the procedure for testing women for the BRCA1/2 mutations, mutations that impose on carriers a significant risk of developing breast and ovarian cancer. A comparison between American and Dutch practices underscores not only the new ways that genetic testing interprets the body, but also the importance of local political and cultural contexts for understanding how the test is presented, administered and managed. The second is a consideration of the intersection of employee wellness programs and wearable technologies. In it, I develop Foucault's thought that subjects in the Christian West have long been encouraged to understand themselves confessionally, offering to authority figures the “truth” about themselves. I then interpret the compulsory use of wearables as a verification strategy for compliance with wellness programs as exemplary of such confessional strategies. The final section ties the discussion back to the clinical encounter as Zaner formulates it as an inherently moral encounter structured by vulnerabilities that matter for understanding the selfhood of patients. Based on the preceding examples, I make the case that American understandings of selfhood are increasingly separated from any sense of publicness and that this structuring of selfhood is of increasing importance in framing and adequately understanding bioethics today.

      PubDate: 2017-11-29T10:53:17Z
  • Donation decisions after death: The case for a family veto
    • Authors: Johnston
      Abstract: Publication date: Available online 21 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): Y. Johnston
      This paper argues that families should be able to refuse to donate the organs of their deceased relative, even when their relative was registered as an organ donor. Families generally hold important relational claims on the body of a decedent, claims which should be respected in the form of allowing families to “veto” postmortem organ donation. Current arguments for and against a “family veto” will first be addressed in order to demonstrate their insufficiency. Typical claims against a family veto either are overly utilitarian, or they appeal to the donor's autonomy and face the problem of explaining why informed consent should be respected after death. I offer a new approach for this issue, which considers relational autonomy and embodied relationships. Thus, I conclude that organ donation decisions should be balanced between the potential donor and their family in a double-veto system.

      PubDate: 2017-11-29T10:53:17Z
  • Value pluralism, moral diversity, moral reasoning, and the foundations of
    • Authors: Marino
      Abstract: Publication date: Available online 21 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Marino
      This paper considers how matters concerning value pluralism and moral diversity bear on issues in bioethics, with particular attention to methodology, moral reasoning, and the possibility of intractable disagreements. Drawing on work in my recent book Moral Reasoning in a Pluralistic World, I examine what methodological implications value pluralism has for coherence reasoning, then articulate some practical implications. On the theoretical side, I argue that in contexts of value pluralism, a norm of “systematicity,” which says that the principles of a theory should be as few and as simple as possible, is epistemologically unsupported. Instead, coherence should be understood as “case consistency”: finding a principled way of prioritizing conflicting considerations from one case to another. On the practical side, adopting case consistency means that multiple internally coherent sets of moral beliefs are possible. So sometimes deep value-based disagreements cannot be resolved by reasoning alone. There are also implications for pedagogy: if moral reasoning accommodates various values and requires principled compromises that can take various forms, teaching about moral issues by first introducing a range of unified theories would not be the right approach. Instead, students ought to be encouraged to bring coherence to their own, possibly pluralistic, ways of valuing.

      PubDate: 2017-11-29T10:53:17Z
  • L’identité institutionnelle au sein des outils bibliométriques : un
           enjeu stratégique
    • Abstract: Publication date: Available online 10 November 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J. Sempéré
      Tout service bibliométrique utilise les deux principaux outils disponibles : Scopus d’Elsevier et Web of Science de Clarivate Analytics. Dans le contexte français de transformation institutionnelle, quelques institutions comme l’université Paris-Saclay ont travaillé avec ces deux entreprises pour mieux définir leur identité. Ce travail de correction des données est utile pour chaque institution afin de mieux comprendre comme les classements internationaux peuvent utiliser leurs données bibliométriques et d’exposer des données plus justes. Any bibliometrics services use the two main tools available: Scopus by Elsevier and Web of Science by Clarivate Analytics. In the French context of institutional transformation, an institution such as Université Paris-Saclay works with these two providers to better define its identity. This work of data curation is useful for each institution in order to well understand how the international rankings can use its bibliometrics data and to expose more correct data.

      PubDate: 2017-11-10T18:34:19Z
  • L’humain, l’humanité et les biotechnologiesL’humain, l’humanité
           et le progrès scientifique, S. Bordet, B.M. Knoppers. Dalloz, Dunod,
           Paris (2009), 125-137
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Quelle éthique pour les hybrides 'L’humain, l’humanité et le
           progrès scientifique, B. Andrieu. Dalloz, Dunod, Paris (2009), 75-93
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • L’Homme et sa diversité : l’humanité au-delà des normes
           biologiquesL’humain, l’humanité et le progrès scientifique, S.
           Guihard-Costa. Dalloz, Dunod, Paris (2009), 139-147
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Le plagiat, le pas factice de la création
    • Authors: A. Ivasilevitch
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): A. Ivasilevitch
      Que ce soit à travers des approches étymologiques, historiques, sociologiques ou encore juridiques, les études autour du plagiat se sèment et foisonnent. Toutefois, trop souvent, reste que le véritable point d’achoppement y est négligé. Aussi, il ne s’agit plus de réfléchir autour du problème du plagiat. Il s’agit, ici, de pénétrer au cœur de la notion de plagiat, d’en élucider son centre de gravité, le noyau autour duquel il n’est par suite qu’agglomération : la création. Sur cette voie, c’est d’abord à la philosophie de répandre ses lumières, afin d’éclaircir en quoi consiste, pour un auteur, l’acte de créer. Dans une première partie est dégagée une subtilité : celle de l’œuvre et de la création. Dénouées l’une de l’autre, la création ne se confond plus avec l’œuvre. Dénouées, la création, c’est plutôt le mouvement par lequel l’auteur s’achemine vers l’œuvre, entendue comme espace de l’ineffable, voilé derrière les apparences et n’appartenant à personne et dont le fond, une fois découvert, est ramené par l’auteur au sein d’une forme, à la fois manière propre, personnelle à lui, de le révéler aux autres, et fin où se cristallise et se lit l’ensemble de son parcours créatif. Cette forme, à distinguer du simple support, est ainsi le don que l’auteur fait aux autres, le partage de son travail et de sa découverte, l’œuvre. À leur tour, c’est dans l’engendrement de cette forme que les autres reconnaissent l’auteur, en son ipséité. Ce qui revient à dire que créer, c’est découvrir une œuvre, puis la présenter dans une forme, dans laquelle se rassemble et s’exprime l’effort de l’auteur, sa personnalité. À l’inverse, ni les éléments sur lesquels il s’est appuyé pour créer – les apparences qu’il a fouillées, explorées –, ni ce qu’il tend à démontrer – l’œuvre, en tant que découverte –, ne lui appartiennent. Découvrir, former, tel est le sens de créer. Cette définition mise au clair, la deuxième partie la place face au droit, pour en vérifier la correspondance. Autant dans l’attribution du droit d’auteur que sa sanction, c’est-à-dire la contrefaçon, une concorde s’établit. D’une part, c’est bien la création de l’auteur que la loi protège, son effort, en lui attribuant un droit de propriété. Cependant, parce qu’un minimum de matérialité est nécessaire à l’application d’une norme, cet effort doit se matérialiser dans la production d’une forme, ici qualifiée d’œuvre d’esprit. Autrement dit, en droit, l’œuvre d’esprit apporte la preuve de l’effort créatif, et c’est par elle que l’auteur, encore une fois, se reconnaît. D’autre part, la création de l’auteur marque, aussi, la limite de son droit. Ainsi, tout ce qui ne relève pas de son effort ne saurait être protégé. Cela explique le champ de la contrefaçon – appréhension légale du plagiat –, dont la répression se limite au fait de reproduire la forme engendrée par un autre, expression de sa singularité, de sa recherche personnelle. En ce sens, de même que l’auteur, dans la première partie, ne se confondait ni avec les éléments sur lesquels il s’appuie pour découvrir, ni avec l’œuvre qu’il vise à démontrer, de même, ici, sont exclus de la contrefaçon les éléments de la nature, les faits historiques, les idées, les théories ou encore les découvertes scientifiques, à moins que leur démonstration ne présente quelque singularité. En bref, l’on assiste à une concorde louable entre la philosophie et le droit. La troubler par un élargissement du droit d’auteur serait en effet priver les autres créations de leurs sources et, ce faisant, vider le lit de leur possibilité. C’est pourquoi, s’agissant du plagiat dans la recherche universitaire, opportunément soulevé et étudié par l’avis 2017-34 du Comets, la troisième partie met en garde contre la tentation d’excéder cet équilibre. Plutôt que d’étendre la contrefaçon, l’accent est mis sur un renforcement de l’éthique, notamment par le développement et le prononcé des sanctions disciplinaires. À travers cette mise en œuvre, remède serait apporté à une impunité qui relève moins d’un non-droit, que d’un non-dit au sein des universités. Whether through etymological, historica...
      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.08.003
  • L’humain, l’humanité et le progrès scientifique, C. Hervé, M.S.
           Jean, P.-A. Molinari, M.-A. Grimaud, E. Laforêt. Dunod, Paris (2009)
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Le cancer comme souci de soiL’humain, l’humanité et le progrès
           scientifique, R. Mendjeli. Dalloz, Dunod, Paris (2009), 159-171
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Sciences et humanismesL’humain, l’humanité et le progrès
           scientifique, D. Jacques. Dalloz, Dunod, Paris (2009), 149-158
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • L’homme machine ou l’homme sans essence : la tentation au cœur du
           progrès techno-scientifiqueL’humain, l’humanité et le progrès
           scientifique, A. Gras. Dalloz, Dunod, Paris (2009), 63-67
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Le corps régénéré : la lutte anti-âge et la quête
           d’immortalitéL’humain, l’humanité et le progrès scientifique, C.
           Lafontaine. Dalloz, Dunod, Paris (2009), 45-61
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Le trans- et le posthumanisme, nouvelles religions ou vieilles
           idéologies 'L’humain, l’humanité et le progrès scientifique,
           A. Robitaille. Dalloz, Dunod, Paris (2009), 69-74
    • Authors: G. Maujean; B.V. Tudrej
      Abstract: Publication date: Available online 3 October 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G. Maujean, B.V. Tudrej

      PubDate: 2017-10-06T12:01:35Z
      DOI: 10.1016/j.jemep.2017.09.002
  • Vision personnelle et professionnelle d’un gériatre sur la mort et de
           la fin de vie : un parcours pédagogique d’éthique de la sollicitude
    • Authors: Piccoli
      Abstract: Publication date: Available online 19 September 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M. Piccoli
      L’art médical requière un apprentissage long et peut revêtir un caractère initiatique, en particulier grâce au compagnonnage. Une des épreuves la plus révélatrice du passage d’étudiant à celui de médecin responsable est celle de la confrontation à la mort et à la fin de vie. L’objectif de cet article est de partir de ma propre expérience de ces questions et des interrogations qui ont jalonné mon cursus pour questionner mes pratiques de la médecine gériatrique. De l’illusion d’une victoire permanente du progrès médical contre la maladie et la mort, le cursus théorique permet d’appréhender les limites de la pratique médicale, le handicap, l’inéluctable fin de la vie ainsi que la prise en charge optimale d’accompagnement. Les apprentissages pratiques et la confrontation avec les véritables limites questionnent également la place laissée aux patients dans des décisions aussi importantes que celles de leur fin de vie. Cela mobilise les compétences du médecin défenseur des droits des patients, humaniste et capable de réflexivité sur ses pratiques, qui assume d’accompagner un patient jusqu’au décès, respecte sa dignité et ses choix éclairés et ne le laisse pas seul face à l’incompréhension ultime qu’est la mort, y compris sociale. Ce cheminement personnel d’un apprentissage théorique et pratique de la gériatrie et de la médecine palliative témoigne de l’appropriation professionnelle de l’éthique de la sollicitude de Paul Ricœur, reconnaissant notre propre vulnérabilité à travers celle d’autrui. Medical art requires a long period of teaching and training through a companionship, which can be initiatory by its nature. One of the most revealing steps of the transition from student to responsible physician is experiencing a patient's death or end of life. This article aims to reveal how my personal questionings along my medical, geriatric and palliative curriculum on these topics questions my medical practice. From a false and idealized representation of a permanent victory of medical progress against sickness and death, our academic courses allows us to better grasp the limits of medical practice, disability, the unavoidable end of life as well as the optimal palliative care. Applied education, practice and confrontation with our real limits also question the patient's place in decisions as important as their end of life. This mobilizes some medical skills: patient's advocate, humanist, reflective. Doing so, a physician can undertake the care of the patient until his death, respects his dignity and informed choices and doesn’t leave him alone when he is facing the most incomprehensible experience, death, including social death. This personal path of a theoretical and applied learning of geriatrics and palliative care testifies an appropriation of Paul Ricoeur's ethics of solicitude (or ethics of care), which leads to recognize our own vulnerability by recognizing the other's one.

      PubDate: 2017-09-23T16:01:10Z
  • Clinical bioethics and core competencies of attributes, attitudes, and
           behaviors: Foundations in philosophy and literature
    • Authors: Flynn
      Abstract: Publication date: Available online 1 September 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J. Flynn
      Philosophy clearly underwrites so much of contemporary bioethics. For example, the work of John Rawls and Norman Daniels provides a foundation for conversations about justice and health care; Alan Wertheimer's conceptual analyses of coercion and exploitation are invaluable to reproductive ethics; much of research ethics relies upon the tenets of utilitarian moral theory, and the ideas of its critics; and thinking surrounding moral reasoning in bioethics draws upon philosophical work on moral particularism, virtue theory and generalist moral thought. The work of Susan Sherwin and Margaret Little has provided a foundation for feminist work in bioethics. There is an area of current bioethical discussion, though, that does not draw upon existing work in philosophy, where it could benefit from doing so. Currently, there is great interest in questions surrounding both the core competencies for healthcare ethics consultants and the appropriate training for future healthcare ethics consultants. The core competencies are currently broken down into three categories: (1) competencies of skill, (2) competencies of knowledge and (3) competencies relating to attributes, attitudes and behaviors (such as forthrightness, humility and the possession of leadership skills). My paper explores the relation between the third category of competencies and the appropriate training for healthcare ethics consultants. While training as it applies to the first two categories of competencies has been addressed, training as it applies to the third category is somewhat curiously undertreated. There may be some reason for this; for example, in contrast to certain types of knowledge, factual knowledge, attributes, attitudes and behaviors might be very challenging to teach. At any rate, I argue that a foundation on which we can rely for help with this issue – this issue of how future healthcare ethics consultants should be trained when it comes to attributes, attitudes, and behaviors – can be found in philosophical discussion about the relation between philosophy and literature. Specifically, I make use of discussion on the question of the extent to which the study of fine literature belongs within moral philosophy. This work illustrates two useful sets of points: that fine literature demands of its reader a certain moral attention (which bears a connection to the attributes and attitudes identified as core competencies for the healthcare ethics consultant) and that literature cultivates that attention as it demands it. This work provides a foundation from which we can address our question regarding the training of future HCECs and it does so in a variety of ways. For one, such work emphasizes the importance of certain attitudes and attributes to reading the moral world and builds upon them by introducing the notion of moral attention. Further, it provides groundwork for the suggestion that the reading of fine literature can inculcate certain habits of mind that I urge are important (though under-recognized) for work in clinical ethics.

      PubDate: 2017-09-06T11:13:13Z
  • Dommage associé au soin : penser et raconter la médecine
    • Authors: E. Galam; M. Michot-Casbas
      Abstract: Publication date: Available online 30 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): E. Galam, M. Michot-Casbas
      Centré sur l’exploration de la place du soignant dans les soins et la gestion de ses fragilités et dysfonctionnements, ce travail est issu d’une réflexion à partir des pratiques de terrain. Il se veut une maïeutique d’aide à la décision partagée, dans une visée d’apaisement et d’enrichissement des pratiques et des personnes. Penser la médecine, c’est aussi la raconter à l’aune de l’évacuation impérieuse et impossible, puis de la réintroduction progressive et inéluctable du sujet-médecin. Cette évolution vient ainsi éclairer le devenir médecin et sa gestion. Une réflexion est de ce fait nécessaire sur comment penser la médecine. Mais penser la médecine c’est aussi accepter qu’à l’instar des patients et de la collectivité qui l’utilisent, les soignants habitent la médecine, et que leur identité professionnelle et la façon dont ils l’habitent, est à prendre en compte si l’on veut améliorer le système de santé. Ainsi, la recherche des critères du bien-faire nécessite aussi de questionner les pratiques soignantes et la notion de savoir être, surtout lorsque ces pratiques ne sont pas optimales, posant ainsi la question des failles, défaillances et de la vulnérabilité des soignants. Mais aussi et surtout il est urgent de ressentir et de penser la médecine surtout lorsque tout défaille. Ce « pourquoi, penser la médecine », est un des outils, fondamental et nécessaire, pour pouvoir continuer à discuter sans se disputer, surtout lorsque survient le drame du dommage associé au soin, qu’il soit coupable ou non. Ces échanges dérangeant et difficiles restent féconds parce qu’ils compensent l’humilité d’une médecine pas toujours triomphante par une altérité en dialogue inscrite dans un humanisme plus large. This work is centered on the exploration of caregiver fragilities and dysfunctions in medical practice. It aims to help shared decision-making, reassurance and enrichment of patients and physicians’ well-being. Thinking medicine requires specifying doctors’ place in healthcare practices and to understand how to use wisely professional identities. Improving quality of care, patient safety and physician well-being need to find the ways to continue to speak together when medical errors occur. Beyond the drama, these disturbing and difficult exchanges remain an opportunity to question, challenge and improve humanity of medical practice.

      PubDate: 2017-09-06T11:13:13Z
      DOI: 10.1016/j.jemep.2017.07.004
  • Se parler malgré tout
    • Authors: E. Galam; M. Michot-Casbas
      Abstract: Publication date: Available online 25 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): E. Galam, M. Michot-Casbas

      PubDate: 2017-08-29T08:16:40Z
      DOI: 10.1016/j.jemep.2017.07.002
  • Habiter la médecine
    • Authors: Galam Michot-Casbas
      Abstract: Publication date: Available online 25 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): E. Galam, M. Michot-Casbas

      PubDate: 2017-08-29T08:16:40Z
  • Prise en charge des urgences en odontologie : de la nécessité d’une
           réflexion éthique
    • Authors: M. Guivarc’h; G. Maille; F. Bukiet; P. Le Coz
      Abstract: Publication date: Available online 14 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M. Guivarc’h, G. Maille, F. Bukiet, P. Le Coz
      L’urgence en odontologie implique le plus souvent pour les patients des douleurs aiguës et incontrôlables qui créent pour ces derniers une dépendance extrême vis-à-vis des chirurgiens-dentistes. Pourtant, l’accès aux soins d’urgence peut être complexe et il n’est pas rare que les patients se heurtent à la difficulté voire l’impossibilité d’obtenir une prise en charge rapide. L’objectif de cet article est d’identifier et de discuter des tensions éthiques sous-tendues par la problématique de l’accès aux soins d’urgence odontologiques dans le système de soins français et au travers de cette réflexion d’interroger la notion même d’urgence en odontologie. Emergency dental care most often involves acute and uncontrollable pain for patients making them highly dependent on dentists. Yet, access to emergency care can be a challenging one for patients: it is not uncommon that they encounter difficulty or even the impossibility of obtaining a rapid appointment. The aim of this paper is to identify and discuss the ethical tensions underlying the problem of access to emergency dental care in the French healthcare system and to question the very notion of emergency applied to odontology.

      PubDate: 2017-08-19T07:25:54Z
      DOI: 10.1016/j.jemep.2017.07.001
  • Sedation or the limits of palliative care – ethical questions
    • Authors: V. Gamblin; A. Da Silva; L. Chevalier; M. Pierrat; S. Villet; L. Touzet
      Abstract: Publication date: Available online 9 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): V. Gamblin, A. Da Silva, L. Chevalier, M. Pierrat, S. Villet, L. Touzet
      Sedation in palliative medicine continues to elicit questions that sometimes confound even the most experienced caregivers. We begin by examining the boundaries between sedation and euthanasia. The ethics at stake in palliative sedation are almost systematically constructed with the perspective of polemic debates on euthanasia, especially in situations where sedation is wrongly qualified of “terminal”. Perhaps out of fear for a possible confusion between sedation and euthanasia, current recommendations appear to be more of a formalization of the double-effect principle. But the double-effect principle and the principle of intentionality also have their limits. This will prompt us to examine the notions of consent and autonomy. Sedation questions what might be deemed “ideal care”, exposing the limits of palliative medicine: limits to defining a refractory symptom, limits to defining and relieving existential distress, limits to the ethical validity of prognosis, limits to the ideal of a “pacified” death, limits to maintaining a relational life until death. Sedation highlights a triple paradox: benevolence and autonomy vs. maintaining relationships, failure to relieve vs. idealized pacified death, clinical uncertainty vs. ultimate medicalization of the end of life. To prevent the risks of underestimating distress or hastening to relieve, two qualities should be cultivated: availability as a necessary openness to otherness and vulnerability; and resisting the temptation of reducing the ethical legitimacy of sedation to its decisional process.

      PubDate: 2017-08-19T07:25:54Z
      DOI: 10.1016/j.jemep.2017.05.007
  • Kant, autonomy and bioethics
    • Authors: Campbell
      Abstract: Publication date: Available online 9 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): L. Campbell
      The concept of autonomy has played a pivotal role in bioethics discourse since the 1970s. Yet, prior to the emergence of bioethics, autonomy had received scant mention in twentieth-century philosophy and was conspicuous by its absence from discussions of healthcare. The term was not even mentioned in the 1967 edition of the Encyclopedia of philosophy. The emergence of bioethics in the early 1970s coincided with increased attention across the western world to civil and human rights; with the rise of this new discipline the liberal emphasis on individual rights was recast in terms of respect for patient autonomy. Although its legal appeal was based on the ease with which autonomy was operationalized in the doctrine of informed consent, the power of the concept of autonomy lay in what it symbolized: the right of an individual to resist coercion or compulsion in the context of a relationship of power. Most commentators in the field of bioethics are familiar with autonomy as one of the four principles of biomedical ethics laid down by Beauchamp and Childress in their canonical text, The principles of biomedical ethics (1979). ‘Principlism’ is a mid-level theoretical tool, which has had broad appeal in facilitating analysis of ethical dilemmas in biomedicine, grasped in the abstract as conflicts between two or more of the four principles. Yet the principle of autonomy, which has had such an extraordinary influence in contemporary bioethics bears only, passing resemblance to the concept of autonomy, which emerged in early modern philosophy. Although the bioethical redrawing of autonomy owes a large debt both to the philosophical tradition and to the social upheavals of the twentieth century, the relationship between contemporary interpretations of the concept of autonomy in bioethics and its historical origins is rarely examined. The purpose of this paper is to trace the evolution of the concept of autonomy from its emergence in modern moral theory to contemporary debates about its relevance for bioethical analysis. The roots of the principle of autonomy can be traced back to the political theory of ancient Greece. Originally used to describe the capacity of the Greek polis or city-state to govern itself, the concept of autonomy received its first modern expression – and its first application to the individual – in the moral theory of Immanuel Kant. For Kant, autonomy stood for the ideal of free will: a human will be driven to action, not by appetite or desire, but by identification with a ‘higher’ or rational self. At the heart of Kant's ethics is the close association of moral action with human rationality; for Kant, autonomous action – action which is deliberately and self-consciously motivated by moral reasons – is the quintessential expression of human rationality. Although the moral universalism Kant sought to defend is no longer philosophically tenable, his insights about many of the core features of autonomous action remained influential until well into the twentieth century. This paper falls into four parts: in the first section I will explore the contextual factors which influenced the emergence of autonomy as a principle appropriate for bioethical analysis. From there, I will examine the hugely influential definition of autonomy put forward by Beauchamp and Childress in the Principles of biomedical ethics and trace the philosophical foundations of this concept. I will then provide a brief account of the concept of autonomy so central to Kant's moral theory and I will conclude by examining recent accounts of personal autonomy in contemporary philosophy with the aim of arriving at a richer understanding of autonomy, which can perhaps be of greater service to bioethics.

      PubDate: 2017-08-19T07:25:54Z
  • One corpse, two perceptions: Confrontation of sub-Saharan Africa versus
           French medical students’ attitudes toward autopsy related beliefs
    • Authors: P. Charlier; L. Brun; A. Augias; F. Bou Abdallah; Y. Boutros Yared; S. Deo; C. Hervé
      Abstract: Publication date: Available online 9 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Charlier, L. Brun, A. Augias, F. Bou Abdallah, Y. Boutros Yared, S. Deo, C. Hervé
      Dissection of a human cadaver is a particular rite of passage for medical students and, for a large majority, constitutes the students’ first confrontation with a dead human body. This process can be the subject of various reactions and concerns depending on the sensitivity of each student, due to the cultural beliefs of the individuals concerned. In order to highlight these variations of work related to personal traditions, the experiences of two groups of medical students from Benin and France in the autopsy room were surveyed via a questionnaire. Similarities and differences relating to behaviours and concerns of the physical and spiritual realms are then discussed.

      PubDate: 2017-08-19T07:25:54Z
      DOI: 10.1016/j.jemep.2017.06.001
  • Is gratuitous violence the characteristic of man'
    • Authors: P. Charlier; S. Deo; F. Bou Abdallah
      Abstract: Publication date: Available online 2 August 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Charlier, S. Deo, F. Bou Abdallah

      PubDate: 2017-08-09T06:01:56Z
      DOI: 10.1016/j.jemep.2017.06.006
  • Le nouveau paradigme de la bioéthique '
    • Abstract: Publication date: Available online 25 July 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Hervé

      PubDate: 2017-07-30T22:01:48Z
  • Fardeau des maladies chroniques en Afrique subsaharienne : plaidoyer pour
           une mise en place des soins palliatifs et d’accompagnement en fin de vie
           en République démocratique du Congo
    • Authors: J.M. Lofandjola; E. Kiswaya Sumaili; J. Petermans
      Abstract: Publication date: Available online 18 July 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J.M. Lofandjola, E. Kiswaya Sumaili, J. Petermans
      Le fardeau de maladies chroniques (surtout non transmissibles) est le défi majeur mondial de santé publique. La combinaison d’un développement économique erratique, des systèmes de santé inadaptés, manquant de capacités de diagnostic et thérapeutique, provoque dans beaucoup de pays à ressources limitées dont la République démocratique du Congo (RDC) une impossibilité à gérer l’ampleur actuelle de ces maladies. À cela s’ajoute la pauvreté répandue et les défis environnementaux. Dans ce contexte, le besoin des services de soins palliatifs (SP) pour des patients en fin de vie est énorme et indéniable. La formation et l’information des décideurs politiques, des soignants et familles sont nécessaires dans cette transition sanitaire. Les SP pourraient être la solution d’un accompagnement avec dignité, améliorant la qualité de vie des malades chroniques. Cet article présente et analyse l’ampleur de ces maladies chroniques et cherche à faire un plaidoyer pour implémenter ces soins dans les pratiques médicales à Kinshasa. Trois raisons principales (transition épidémiologique, manque de formation de soignants des approches palliatives et de priorité par les décideurs politiques de ces maladies chroniques) devraient motiver tous les acteurs (partenaires, politiques, soignants et familles) à implémenter ces soins dans les pratiques médicales et de faire que ces maladies ne soient pas négligées en Afrique subsaharienne. The burden of chronic diseases (especially non-communicable) is the world's major public health challenge. The combination of erratic economic development, inadequate health systems, lacking diagnostic and therapeutic capabilities, is provoking in many resource-limited countries including the Democratic Republic of Congo (DRC) an inability to manage the current extent of these diseases. Added to this is the widespread poverty and environmental challenges. In this context, the need for palliative care services for terminally ill patients is enormous and undeniable. Training and information for policy makers, caregivers and families are needed in the health transition. The palliative care could be the solution to a support with dignity, improving chronic patients’ quality of life. This article presents and analyzes the extent of these chronic diseases and seeks to make a place to implement this care in medical practice in Kinshasa. Three main reasons (epidemiological transition, lack of training of caregivers of palliative approaches and priority by policy makers of these chronic diseases) should motivate all stakeholders (partners, political, caregivers and families) to implement these treatments in medical practices and to these diseases are not neglected in Sub-saharan Africa.

      PubDate: 2017-07-24T18:02:02Z
      DOI: 10.1016/j.jemep.2017.06.003
  • Le dictionnaire médico-psycho-légal. Note de lecture
    • Authors: C. Ballouard
      Abstract: Publication date: Available online 17 July 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Ballouard

      PubDate: 2017-07-24T18:02:02Z
      DOI: 10.1016/j.jemep.2017.06.004
  • La vulnérabilité en question '
    • Authors: Ennuyer
      Abstract: Publication date: Available online 10 July 2017
      Source:Ethics, Medicine and Public Health
      Author(s): B. Ennuyer
      Être vulnérable, c’est pouvoir être blessé : blessé physiquement, blessé moralement et psychiquement ou blessé socialement quand on est mis au ban de la société. La vulnérabilité dans nos sociétés présente de nombreux visages : chacun d’eux constitue une expérience singulière de la fragilité ou de la dépendance, de la domination presque toujours, dans une société individualiste qui tend à rendre chacun responsable de sa vie et de son destin. En l’espace d’une décennie, la vulnérabilité est devenue une notion centrale dans la réflexion sociale et politique. Suivant les contextes et les auteurs, « vulnérabilité » renvoie à fragilité, dépendance, perte d’autonomie, exclusion, invisibilité sociale, précarité, désaffiliation, etc., et ce souvent dans la plus grande confusion. De plus, ces différents termes sont très souvent utilisés pour décrire et enfermer dans ces catégorisations, des groupes de personnes plus ou moins mises en marge de la société : les personnes âgées, les personnes déficientes ou en situation de handicap, les chômeurs, les pauvres, les immigrés, les mal-logés, etc. Enfin, ces termes s’inscrivent la plupart du temps dans une vision négative et déficitaire des populations qu’ils contribuent ainsi à stigmatiser. L’impossibilité pour certains d’entre nous de se faire entendre et de se faire comprendre par autrui est devenue une source majeure des nombreuses situations de vulnérabilité auxquelles chacun d’entre nous peut se trouver confronté. Cette vulnérabilité « linguistique ou langagière » (Paul Ricœur) est sans aucun doute, aujourd’hui, une des formes majeures des situations de vulnérabilité, tant le langage oral ou écrit est un des véhicules privilégiés de la communication entre les êtres humains. Dans la littérature courante, la vulnérabilité est considérée comme un état de la personne et le plus souvent associée, voire confondue, avec la fragilité. Logiquement, les populations les plus fragiles sont alors étiquetées systématiquement comme les plus vulnérables, telles les populations pauvres, les personnes handicapées et les personnes âgées. Il paraît donc urgent de sortir de cette confusion sémantique. Si la fragilité ou la déficience peut être vue comme une dimension intrinsèque et un état de l’individu à un moment donné de sa vie, la vulnérabilité est bien d’abord et avant tout une dynamique et une interaction entre la personne et son environnement au sens large. La vulnérabilité des individus porte avant tout la marque du rapport à l’autre, elle réside essentiellement dans l’exposition à l’autre. D’ailleurs plutôt que d’une vulnérabilité attribut d’un sujet, il est donc préférable de parler d’une situation de vulnérabilité dans laquelle se trouve engagé ce même sujet. La fragilité due à une déficience ou un déficit de l’individu peut donc ne pas conduire à une situation de vulnérabilité grâce à un environnement adéquat (au sens très large) susceptible de permettre à l’individu de choisir son mode de vie et de mettre en actes ses désirs et ses valeurs, même s’il ne peut y arriver tout seul. Cela nous permet d’aborder quelques pistes d’un fonctionnement social propre à réduire les situations de vulnérabilité grâce aux notions d’autonomie relationnelle, de capabilités et de société inclusive. Qu’on parle de société inclusive, de société accessible, de société de capabilités, l’idée commune sous-jacente à tous ces termes est celle d’une société d’individus où chaque personne soit le moins possible confrontée à des situations qui la rendraient plus vulnérable que la moyenne des individus qui composent cette société. En effet, vulnérables, nous le sommes tous, parce que chacun se constitue dans le rapport à autrui. Par ailleurs, contrairement à une idée communément reçue, la vulnérabilité et l’autonomie ne s’opposent pas, elles sont la condition l’une de l’autre et ce de façon réciproque. La vulnérabilité est notre fonds commun d’humanité et c’est seulement à partir de cette reconnaissance de notre vulnérabilité commune que nous pouvons contribuer à l’autonomie de ceux qui apparaissent plus vulnérables que nous. Being vulnerable means being hurt: physically injured, morally wounded and psychologically or socially injured when banned from society. Vulnerability in our societies presents many faces:...
      PubDate: 2017-07-13T19:30:24Z
  • Que pense le public de la prévention dans le contexte de la médecine
           prédictive ' Réflexions issues d’une série de quatre
           délibérations prospectives
    • Authors: P. Lehoux; I. Cheriet; D. Grimard
      Abstract: Publication date: Available online 21 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Lehoux, I. Cheriet, D. Grimard
      La médecine prédictive, qui s’appuie sur les avancées en génomique, a le potentiel de contribuer au développement de nouvelles interventions préventives en santé publique. Cette approche soulève toutefois plusieurs enjeux éthiques et sociaux et la participation du public est essentielle. Cette étude s’appuie sur la théorie de la structuration afin d’explorer comment des membres du public anticipent le potentiel et les limites de cette forme de prévention et de clarifier les processus de raisonnement sous-jacents. Quatre groupes de délibération, réunissant un total de 38 participants, ont été organisés à Montréal (Québec, Canada) pour débattre d’une technologie fictive de prévention basée sur le risque génétique. Les résultats indiquent que la nature préventive de ce « rectificateur » cardiaque n’est pas interprétée de manière univoque par les membres du public puisqu’il pourrait soutenir à la fois de la « bonne » et de la « mauvaise » prévention. Pour les participants, la légitimité de son utilisation varie selon les groupes qui seraient ciblés par la technologie et son potentiel et ses limites sont indissociables des dynamiques de marché et du rôle des instances publiques. Cette étude contribue aux connaissances actuelles en dégageant des pistes de réflexion quant à la place de la médecine prédictive en santé publique. Predictive medicine, which relies on progress in genomics, has the potential to contribute to the development of new public health preventive interventions. Yet, this approach raises several ethical and social issues and public participation is thus essential. This study draws on the theory of structuration to explore how members of the public anticipate the potential and limits of this form of prevention and clarify their underlying reasoning processes. Four deliberative workshops, with a total of 38 participants, were held in Montreal, Quebec, Canada to discuss a fictive prevention technology based on genetic risk. The results indicate that the preventive nature of this cardiac “rectifier” is not interpreted unequivocally by members of the public since it could support both “good” and “bad” prevention. For the participants, its legitimacy varies according to the groups that would be targeted and its potential and limits are contingent upon market dynamics and the role of public authorities. This study contributes to current knowledge by identifying avenues of reflection on the emergence of predictive medicine in public health.

      PubDate: 2017-06-23T20:00:01Z
      DOI: 10.1016/j.jemep.2017.05.006
  • The epistemic responsibilities in medicine of beneficence and respect for
           patient autonomy
    • Authors: A.P. Schwab
      Abstract: Publication date: Available online 13 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): A.P. Schwab
      Medical practitioners have foundational responsibilities to be beneficent toward patients and to respect patient autonomy. In this article, I analyze these responsibilities considering the uneven support medical science provides for practitioner judgment and the cognitive biases of judgment demonstrated by psychological science. Specifically, medical science provides the foundation for practitioner judgment about beneficent medical practice. This foundation, however, provides a limited scope of support. In some cases, medical science provides clear and unambiguous directives. But in others, it provides limited directives or only background information. In these latter cases, where practitioner recommendations are based on intuitive innovations, their judgment goes beyond the scope of medical science's conclusions, opening up these judgments to cognitive bias. As psychological science has robustly demonstrated, decision-makers, lay and expert, are subject to unconscious bias in their judgment. Accordingly, the intuitive innovations of medical practitioners will be biased in predictable ways, which threatens to undermine their efforts to make beneficent judgments on behalf of patients. These same conclusions of psychological science indicate that patient judgment will likely be biased as well. Even when practitioners offer unbiased recommendations, patient attempts to make judgments about medical care that matches their interests and values may fail because of unconscious bias. Considering these characteristics of patient and practitioner judgment, this article identifies several features of practitioner responsibilities to be beneficent and respect patient autonomy. Specifically, practitioners are obligated to be cognizant of the uneven reliability of their recommendations and the likely biases that can affect these recommendations. Further, practitioners should favor recommendations based on more reliable processes and should “nudge” patient decisions under certain circumstances. Finally, questions about the extent of practitioners’ responsibility to respect patient autonomy are raised.

      PubDate: 2017-06-14T07:30:44Z
      DOI: 10.1016/j.jemep.2017.04.015
  • Personalised medicine. Bringing narrative tools to Carpem
    • Authors: M. de Jesus Cabral; C. Hervé; M.-F. Mamzer; P. Leroy; F. Scotté
      Abstract: Publication date: Available online 13 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M. de Jesus Cabral, C. Hervé, M.-F. Mamzer, P. Leroy, F. Scotté
      How can a cutting-edge research programme with its concomitant experimental and therapeutical applications such as CAncer Research and PErsonalised Medicine (Carpem), with a strong rationalistic component and deeply focused on the disease, correspond to the ethical dimension of medicine process involving the patient as a collaborative member? The first part of this article describes the challenges and the present state of the Carpem programme, its multi-system model and the differential value of the interpersonal, relational and communicative abilities involved, emphasizing the need for the human and social sciences. In line with the multidisciplinary cross-work developed between the authors, the second part interrogates the concept of “personalised medicine” in the light of the “Narrative turn” of narrative-based medicine (NBM) and proposes a framework derived from literary studies resorting to concepts and tools such as dialogism, (close) listening, and body/language reciprocity to promote interaction, interpretation and care, towards a Patient-centred precision medicine.

      PubDate: 2017-06-14T07:30:44Z
      DOI: 10.1016/j.jemep.2017.05.003
  • Just caring: Do we need philosophical foundations?
    • Authors: L.M. Fleck
      Abstract: Publication date: Available online 9 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): L.M. Fleck
      The “Just Caring” problem asks: What does it mean to be a “just” and “caring” society when we have only limited resources (money) to meet virtually unlimited health care needs (linked to novel emerging medical technologies)? The practical implication of the “Just Caring” problem is that the need for health care rationing is inescapable. That means that some health care needs will not be met, even though those needs have moral weight, because meeting such needs is presumptively a matter of justice. How then can such rationing decisions be made justly or fairly? And who should have responsibility for making such decisions? Should such decision-making be the responsibility of legislative bodies, or administrators of health care institutions, or associations of physicians, or private insurers (in the United States), or employers (in the United States)? What should be the role of philosophers in addressing the problem of just health care rationing? After all, philosophers are supposed to be the experts when it comes to theories of justice. And, if philosophers are supposed to have such a role, are their judgments of health care justice going to be justified by appeal to ethical foundations of some sort? In this essay, I start by conceding that philosophers have had much to say about how we ought to conceptualize our understanding of the notion of justice. But the world has become enormously more complicated since Plato and Aristotle offered their reflections on justice. The same is true for Hume and Kant. Those perspectives seem remote and unhelpful about the problem of just health care rationing. The same would seem to be true about Rawls (1971) and Nozick (1974). Their theories of justice are simply too broad and too abstract to address the complex, heterogeneous problems of just health care rationing in the real world of health care we have today (though, as I show later, Rawls does have much to offer regarding the notion of public reason). 1 1 Nozick is a libertarian. For him individuals have a just claim only to that which they have justly acquired, mostly by paying for it. But even in the United States few would argue that a hospital would have acted justly if it dumped a patient in the hospital parking lot to die because they could not pay for the medical care that would have saved their life. Rawls is at the opposite end of the justice spectrum from Nozick. Rawls is especially concerned to protect the just interests of those who are least well off, in this case the medically least well off. Again, however, few would argue that a just society was ethically obligated to spend a million dollars to sustain someone terminally ill for two extra weeks of life. In both cases, more ethically nuanced judgments are required. In the first part of this essay I sketch out several concrete problems of health care rationing having to do with the allocation of targeted cancer therapies, drugs used to treat patients at risk for heart disease, drugs used to treat HIV+ patients, and drugs used to treat very rare diseases. This provides helpful context for the remainder of the essay. In the second part of this essay I argue that traditional theories of justice have only a limited role to play in addressing these problems of health care rationing. This is because no perfectly just answer can be given for the vast majority of real world problems of health care justice. Instead, what we need to settle for are non-ideal resolutions of these problems. Ultimately, I would defend a pluralistic conception of health care justice, which is another reason why we need to settle for non-ideal resolutions. Those non-ideal resolutions will have to emerge from broad, inclusive, fair processes of rational democratic deliberation. Those deliberations will be aimed at achieving a reflective balance of competing considerations of health care justice with respect to a very specific problem of health care rationing. In the third part of this essay, I argue that the role of philosophers is to protect the integrity of this public deliberative process, as opposed to seeking ethical foundations for their judgments of health care justice. This, I argue, entails three responsibilities for philosophers. First, these public deliberations need what we might call “just boundaries”. Those boundaries are defined by what I refer to as “constitutional principles of health care justice”. The role of philosophers is to articulate those constitutional principles and what counts as a reasonable balance among those principles as they are applied to specific problems of just health care rationing. Second, the role of philosophers is to articulate a specific understanding of “public reason”, which would govern those democratic deliberations. Here I have in mind the work of Rawls and his notions of “the rational” and “the reasonable” (Rawls, 1993). Third, philosophers have their traditional Socratic role of being thoughtful critics of the outcomes of these public deliberations, mindful of the fact that most outcomes will be non-ideally just. That is, philosophers must distinguish outcomes that are non-ideally “just enough” from those that are not “just enough”. Ultimately, the role of philosophers is not to construct or discover just foundations for these d...
      PubDate: 2017-06-14T07:30:44Z
      DOI: 10.1016/j.jemep.2017.04.014
  • Appliquées à la transfusion, quelles sont les bases philosophiques de la
           bioéthique ?
    • Authors: O. Garraud; J.-D. Tissot
      Abstract: Publication date: Available online 9 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): O. Garraud, J.-D. Tissot
      Cet essai explore l’espace et le temps du suffixe bio- accolé aux sciences de la vie et de la médicine, de l’économie et du pouvoir, et tente de dégager les influences intellectuelles qui ont vu ces concepts émerger. Ils revisitent particulièrement les nouveaux marchés de la bioéconomie et du vivant, proposant le concept de bioprostitution des personnes vulnérables et de bioproxénétisme des détenteurs de pouvoir. Ils s’interrogent enfin sur le bien-fondé de la séparation de la bioéthique de l’éthique. This short essay explores the temporality and spatiality of the suffix “bio-” relative to life and medical sciences, economy and power. It makes an attempt to envision intellectual influences that precluded these concepts, and particularly those relative to the new markets such as (human) body parts. They come to propose the concept of bioprostitution of the vulnerable, and bioproxenetism of the powerful. They last question the rationale for having split bioethics from ethics as a whole.

      PubDate: 2017-06-14T07:30:44Z
      DOI: 10.1016/j.jemep.2017.04.006
  • La clinique base de l’éthique dans la pratique médicale
    • Authors: C. Hamonet; C. Baeza-Velasco; C. Hervé
      Abstract: Publication date: Available online 5 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Hamonet, C. Baeza-Velasco, C. Hervé
      Le malade, la médecine, le handicap et la mort forment un ensemble homogène dont les interactions subissent constamment de profonds remaniements. Ils sont très influencés par le développement des moyens techniques utilisés pour le diagnostic et les traitements. Une des conséquences négatives est la dévalorisation de la clinique, c’est-à-dire du rôle d’une relation rapprochée avec le patient, activement impliqué dans le processus du diagnostic et les décisions thérapeutiques. C’est le moment, face à cette situation, de scruter avec un regard nouveau, l’historique de l’invention de la médecine clinique d’Hippocrate à Osler, en s’arrêtant sur Maïmonide, Sydenham et Boissier de Sauvages. Cette rétrospective permet d’organiser la poursuite de cette démarche en l’enrichissant d’une vision plus globale, plus sociale, de l’Homme en souffrance. Nous proposons une évolution de la vision de la santé mettant en valeur la personne humaine en articulant harmonieusement et positivement lésions corporelles, maladie, conséquences fonctionnelles et situations de handicap. Elle provoque une nécessaire évolution de la sémiotique médicale qui est regardée comme incompréhensible par des sémioticiens comme Barthes. Cette approche anthropologique en quatre dimensions apporte une cohérence dans la clinique et ne peut que renforcer le dialogue du patient avec son médecin. Une maladie héréditaire, fréquente (incidence 2 %), responsable d’une atteinte diffuse du tissu conjonctif, le syndrome d’Ehlers-Danlos, représente aujourd’hui un véritable défi difficile à relever dans le contexte des pratiques médicales actuelles : le diagnostic repose sur la seule clinique en l’absence de marqueur biologique. Une étude récente a pourtant permis de mettre en avant la supériorité de la clinique par la réalisation d’un modèle mathématique à partir des données cliniques collectées auprès de 626 patients. Ces considérations permettent une évolution de la notion de santé, illustrant la définition de 1947 de l’Organisation mondiale de la santé en proposant la notion d’un état relatif d’équilibre entre les capacités d’une personne et les contraintes du milieu où elle vit (René Dubos). Patient, disease, medicine and disability form a homogeneous container which interactions receive constantly important updates. They are influenced by the development of new technical aides used for diagnoses and treatments. One of the negative results of this process is the downgrading of clinic and of the role played by a close relationship with the patient, himself deeply involved in the diagnose process and the therapeutic decisions. As we are facing this situation, it is time to push for a fresh insight into the history of the invention of clinic medicine from Hippocrates to Osler, stopping by with Maïmonide, Sydenham and Boissier de Sauvages. This look back allows us to organise the future of clinic by enriching it with an understanding of the suffering of humankind both more global and more social. We propose an evolution of the future of Health based on the human personality, linking between them harmoniously and positively body injuries, diseases, functional and situational consequences of disabilities. This will trigger a necessary evolution of medial semiotic, which is considered as impossible to understand by some semioticians such as Barthes. This anthropological approach in four dimensions brings a coherence in clinic and will only improve the communication between a patient and his physician. The Ehlers-Danlos syndrome, a hereditary disease frequent (2 % incidence) causing a widespread affection of the connective tissue, represents today a real challenge, difficult to address in the current environment of medical practice. The diagnoses are entirely based on clinic as no biological tracer exists. A recent study has however evidenced the superiority of clinic through a mathematical model gathering the data collected from 626 patients. These considerations allow for an evolution of the concept of health, as defined in 1947 by the WHO proposing the concept of a state of balance between the capacity of an individual and the obligations coming from his environment (René Dubos).

      PubDate: 2017-06-09T07:05:32Z
      DOI: 10.1016/j.jemep.2017.05.001
  • Savoir dire adieu. Savoir accueillir. Éthique et théorie des
    • Authors: J.-P.
      Abstract: Publication date: Available online 3 June 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J.-P. Cléro
      Les éthiciens français ont une fâcheuse tendance à se référer à des notions et à des catégories kantiennes en éthique des soins (la personne, la personnalité, l’autonomie, la dignité, la responsabilité), tandis qu’ils négligent la valeur éthique de la théorie des jeux et celle de l’utilitarisme, confondu avec la promotion des valeurs du marché. Le propos de ce texte est de prendre le contre-pied de ce préjugé que l’on trouve jusque dans les avis du CCNE et de soutenir l’idée encore paradoxale que les valeurs d’intimité, par exemple, sont mieux préservées par l’utilitarisme d’Harsanyi que par le personnalisme d’inspiration kantienne, qui est moins une éthique qu’une morale. French philosophers of ethics have a regrettable tendency to refer to Kantian notions and categories in medical ethics (the person, personality, autonomy, dignity, responsibility), whereas they neglect the ethical value of the Game Theory and of Utilitarianism, which they mistake for bargaining on the market. Here, I would like to take the opposite view of this bias, which may be found even in the official decisions of the French Comité consultatif national d’éthique and to uphold the as yet paradoxical thesis that intimacy values are better defended by Harsanyi's Utilitarianism, for instance, than by a Kant-inspired personalism, that is less ethics than morals.

      PubDate: 2017-06-04T06:40:15Z
  • Les pièges des mots rendent-ils impossible une vision globale de la
           bioéthique ?
    • Authors: M. Stanton-Jean
      Abstract: Publication date: Available online 23 May 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M. Stanton-Jean
      En octobre 2005, l’assemblée générale de l’Unesco adoptait la Déclaration universelle sur la bioéthique et les droits de l’homme (UDBHR). Le projet de cette déclaration fut élaboré par le Comité international de bioéthique (CIB) en consultation avec les États membres, les comités interagences des Nations unies, des organisations gouvernementales et non gouvernementales, des comités nationaux d’éthique et de multiples acteurs impliqués en bioéthique. Cette déclaration qui vise le bien commun repose sur un socle de principes dont l’extension et la compréhension ont fait et font l’objet de constantes remises en question. Cet article explique comment ces principes ont pu faire l’objet d’un consensus grâce aux consultations, discussions et délibérations qui ont mené à l’adoption de la déclaration. Après avoir expliqué brièvement l’historique de l’éthique à l’Unesco et la genèse de la déclaration, l’article présente un groupe de concepts qui fondent la déclaration et les discussions dont ils ont fait l’objet durant son élaboration. Il conclut en défendant l’idée qu’au-delà des différences culturelles des régions du globe, il est possible d’avoir une vision globale de la bioéthique qui puisse prendre en compte le contexte de chaque pays. In October 2005, the UNESCO General Conference adopted the Universal Declaration on Bioethics and Human Rights (UDBHR). The draft declaration was produced by the International Bioethics Committee (IBC), in consultation with member states, United-Nations Interagency Committee, Governmental and Non-Governmental Organisations, National Bioethics Committee and other actors involved in Bioethics. This Declaration rests on a set of principles which definitions have been frequently disputed. This paper explains how these principles have reached a consensus because of the consultations, discussions and deliberations that lead to the adoption of the Declaration. After having briefly described the history of ethics at UNESCO and the genesis of the declaration, the paper describes some concepts that form the foundation of the declaration and the discussions that happened about them during the making of the declaration. The paper concludes that it is possible to have a global vision of bioethics that can consider different countries context even though regions are culturally diverse.

      PubDate: 2017-05-25T04:57:33Z
      DOI: 10.1016/j.jemep.2017.04.001
  • De l’evidence-based medicine à l’evidence-based surgery :
           extrapolons-nous ?
    • Authors: Zarzavadjian Bian; Jiao Costi Bruderer Habib
      Abstract: Publication date: Available online 23 May 2017
      Source:Ethics, Medicine and Public Health
      Author(s): A. Zarzavadjian le Bian, L. Jiao, R. Costi, A. Bruderer, N. Habib
      Objectifs L’extension de l’evidence-based medicine à la chirurgie est confrontée à divers obstacles. Nous tentons de les identifier afin d’évaluer la légitimité de l’evidence-based surgery (EBS). Patients et méthode Étude qualitative menée sur une période d’un mois dans un centre académique de chirurgie hépatobiliaire à l’aide de questionnaires remis aux patients, aux chirurgiens et des informations médicales nécessaires. Résultats Treize patients acceptèrent de participer. Cent pour cent des patients ont bénéficié d’un traitement répondant à la définition de l’EBS, dont 38,5 % justifiés par un essai contrôlé randomisé (ECR), et 76,9 % justifiés par une étude rétrospective ou plus. De plus, 23,1 % de divergence ont été observées entre le sentiment d’avoir transmis l’information scientifique par le chirurgien et celui de l’avoir reçue par le patient. Conclusion L’EBS est un progrès nécessaire dont l’application est limitée par les outils d’évaluation inadaptés à la chirurgie. L’aspect situationnel semble dénaturé. Il convient donc de ne pas accorder une valeur supérieure à celle d’une analyse rétrospective à l’EBS. Objectives The application of Evidence-Based principles to surgery is hindered by various obstacles. We tried to identify them in order to assess the legitimacy of Evidence-Based Surgery (EBS). Patients and method A qualitative study conducted over a period of one month in an academic centre of hepatobiliary surgery using questionnaires for patients, surgeons and the patients’ medical notes. Results Thirteen patients agreed to participate and were included. One hundred percent of patients received treatment fulfilling the definition of EBS, of which 38.5% are supported by a randomized controlled trial and 76.9% are supported by at least a retrospective study. In addition, discrepancy between transmitted scientific information by the surgeon and received scientific information by the patient was observed in 23.1%. Conclusion EBS should be seen as an improvement but it is still limited by inadequate assessment tools for surgery. The situational aspect seems omitted. EBS should therefore not be granted with an evidence greater than retrospective study.

      PubDate: 2017-05-25T04:57:33Z
  • La bioéthique comme sens des pratiques
    • Abstract: Publication date: Available online 23 May 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Hervé

      PubDate: 2017-05-25T04:57:33Z
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