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HEALTH AND SAFETY (514 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: 20)
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: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 25)
American Journal of Health Promotion     Hybrid Journal   (Followers: 22)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 179)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 8)
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  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 2)
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: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 2)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 18)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
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: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
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  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
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: 13)
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: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
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  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
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: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     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: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 6)
Global Journal of Public Health     Open Access   (Followers: 9)
Global Medical & Health Communication     Open Access  
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
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: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 45)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 32)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 20)
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: 47)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
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: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
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: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
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: 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: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 1)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
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: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)

        1 2 3 | Last

Journal Cover Ethics, Medicine and Public Health
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   Full-text available via subscription Subscription journal
   ISSN (Print) 2352-5525
   Published by Elsevier Homepage  [3031 journals]
  • 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
  • Privacy, confidentiality and carers: India's harmonisation of national
           guidelines and international mental health law
    • Authors: R.M. Duffy; B.D. Kelly
      Abstract: Publication date: Available online 21 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): R.M. Duffy, B.D. Kelly
      Context Clear guidelines on confidentiality and privacy are essential for those receiving treatment from mental health services and their families. Good mental health care also requires suitable supporting legislation. The United Nations Convention on the Rights of Persons with Disability (UN-CRPD) seeks to protect the rights and freedoms of individuals with disabilities. Its remit includes those with long-term mental or intellectual impairments. Consequently, many of the 159 signatories to the convention are attempting to revise their mental health legislation to bring it in line with the UN-CRPD. The World Health Organisation Resource Book on Mental Health, Human Rights and Legislation (WHO-RB) provides guidelines for drafting and revising mental health legislation. This document includes a checklist detailing topics, which should be addressed, but some elements of the WHO-RB appear to be in conflict with the UN-CRPD. This paper explores the UN-CRPD and the WHO-RB with specific focus on their positions on confidentiality, privacy and the rights of care-givers. We consider how the Indian Mental Healthcare Bill 2016 (IMHB) attempts to harmonise these two perspectives. Methods References to privacy, confidentiality and carers were identified and compared in the UN-CRPD, WHO-RB and IMHB. In addition to this, eleven items were identified in the WHO-RB Checklist relating to privacy, confidentiality and carers. The IMHB was analysed to see if it was concordant with these items. Results All three documents (UN-CRPD, WHO-RB and IMHB) refer to privacy, confidentiality and care-givers. The consideration of privacy in the WHO-RB was comprehensive; the UN-CRPD and the IMHB by contrast, affirm privacy as a right but fail to explore it in detail. The consideration of family and care-givers is starkly contrasted in the three documents. The UN-CRPD gives consideration to a person's right to have a family but makes little direct reference to the role of family in delivering care or supporting capacity. Regarding care-givers and family's quality of life, it briefly considers the material consequences of caring for an individual with disability, but fails to consider the psychological impact of such care-giving or how further exploration of confidentiality and privacy could ameliorate some of these stressors. The IMHB is adherent with five out of the eleven items (45.4%) drawn from the WHO-RB's checklist relating to privacy, confidentiality and carers. The IMHB attempted to address the others using its construct of nominated representatives and we identify some of the limitations of this concept in our discussion. Conclusion The UN-CRPD affirms the key fundamental principles of privacy and confidentiality, but its consideration of these principles lacks the depth required to address the complex and varied issues that can arise in the realm of mental health. The UN-CRPD fails to consider the role of the family and carers in sufficient detail. Confidentiality, privacy and the complex role of family are, however, discussed in the WHO-RB and this document can greatly supplement the UN-CRPD. This is especially true in instances when temporary limitation of specific rights is required. The IMHB has incorporated the UN-CRPD principles and applied them to mental health, and, in doing so has addressed many of the issues raised by the WHO-RB.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.018
  • Beyond patents: Scientific knowledge, and access to vaccine
    • Authors: M. Eccleston-Turner
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M. Eccleston-Turner
      Knowledge is a public good. Patents provide property rights in knowledge, which gives the patentee the right to exclude others from utilising the knowledge for the life of the patent. Patents in the field of pharmaceuticals are controversial because of the importance of the knowledge which they exclude others from using. Patents have come under significant criticism for this very reason – with some going as far as to claim that patent protection on pharmaceutical products as the cause of developing states having poor or limited access to life-saving pharmaceutical products. Most of the academic literature regarding access to medicines goes this same way. This paper challenges this viewpoint, and considers the barriers to generic access to medicines beyond patents. This paper looks beyond intellectual property rights to determine what other mechanisms exist that allow innovative vaccine manufacturers to control access to knowledge regarding their products which can act as a barrier to the utilisation of knowledge in the pharmaceutical industry, in a similar manner to intellectual property rights. This paper takes a case study approach considering non-patent-related barriers to access to medicines, focusing on pandemic influenza vaccines and the role of proprietary, non-patented knowledge. This paper concludes that manufacturers have an exclusive monopoly, not because of their intellectual property rights, but because the knowledge required to make the drug is not accessible to generic manufacturers, and highlights why this is the case. This paper argues that it is not the patent protection which is the barrier to introducing generic pandemic influenza vaccines, but rather it is the inaccessibility of knowledge which is not in the public domain, or the inability of manufacturers in developing states to utilise this knowledge, which is the true barrier in this field.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.011
  • Can research ethics committees enable clinical trial data sharing'
    • Authors: A. Thorogood; B.M. Knoppers
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): A. Thorogood, B.M. Knoppers
      Mandatory sharing of individual-level data from clinical trials with the research community promises to accelerate medical research and improve public health. Clinical trial data sharing is fast becoming a gold standard for open science, and myriad research policies from funders, journals, and regulators now encourage or mandate sharing. Little attention, however, has been paid to the inherent trade-offs data sharing presents between openness and privacy. Even where an acceptable balance is struck, responsible data sharing will depend on explicit cooperation and trust across many stakeholders. Research Ethics Committees (RECs) play an important role in creating an environment that fosters such trust and cooperation. However, their role is circumscribed by the regulatory frameworks in which they operate and there are important differences between North America and Europe. International and national norms address data sharing to varying extents. Some enable data sharing by providing guidance on broad consent and appropriate privacy and security safeguards. There is less guidance on if and how RECs should review the effectiveness of access processes, or ensure researchers share data. Building on existing guidance, we explore how RECs could enable data sharing that benefits public health, while ensuring participant privacy and autonomous decision-making is protected. First, RECs could assess data sharing plans to ensure they adequately address privacy protection, provision of timely access, and oversight of research uses. Second, RECs could ensure consent forms provide for sufficiently broad access and reuse of data. As consent design drastically affects downstream conditions of data access and use, consent forms should adopt non-restrictive, standardized, and clear language. Consent processes should also inform participants of intended uses; safeguards; and limits to anonymity, confidentiality and withdrawal. RECs will have to consider in the context of a given trial whether data sharing should be mandatory to uphold scientific transparency, or whether participants could be able to opt-out or withdraw. Third, RECs will need to coordinate with access committees and other RECs to avoid gaps or duplication in data sharing oversight. Fourth, where participants have consented to data sharing, RECs could adopt a role – along with institutions, journals, and regulators – to hold researchers accountable for not sharing data. International efforts are currently underway to harmonize consent language, privacy protections, access processes, and research oversight across institutions and countries, in turn providing RECs more certainty, and fostering trust and cooperation across the data-sharing ecosystem.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.010
  • Balancing privacy as a human value
    • Authors: D.N. Weisstub
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): D.N. Weisstub

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.024
  • Le partage des données personnelles de santé dans les usages du
           numérique en santé à l’épreuve du consentement exprès de la
    • Authors: Lucas
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J. Lucas
      Les données personnelles de santé ne peuvent pas être traitées dans les espaces numériques sans l’accord de la personne concernée. Cet accord peut prendre deux formes juridiques : non-opposition ou consentement explicite. Dans tous les cas, le patient doit être informé afin qu’il puisse exercer son droit d’opposition ou donner son consentement. Nous avons passé en revue les situations dans lesquelles ces droits s’exercent : équipe de soins définie par la loi, dossiers médicaux informatisés et dossier médical partagé (DMP), télémédecine, situation de la personne dépendante, avant de faire une incursion sur les données circulant via les réseaux sociaux. Petit à petit se dégagent des axes éthiques, déontologiques et juridiques appliqués à la société numérique que le droit positif doit venir consolider. Personal health data cannot be processed in digital spaces without the consent of the person. The consent may have two legal forms: non-opposition or explicit consent. In all cases, the patient must be informed so that he can exercise his right to oppose or give his consent. We have reviewed the situations in which these rights are exercised: a healthcare team defined by the law, electronic medical records and shared medical records (DMP), telemedicine, the situation of a dependent person, before making an incursion into social networks data. Progressively, ethical, deontological and legal axes applied to digital society are emerging, which must be incorporated by positive law.

      PubDate: 2017-03-23T20:38:08Z
  • La mort en médecine générale, la somme de toutes les peurs.
    • Authors: B.V. Tudrej
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): B.V. Tudrej

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.015
  • Legal protections for personal health information in the age of Big
           Data – a proposal for regulatory framework
    • Authors: D. Mendelson; D. Mendelson
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): D. Mendelson, D. Mendelson
      This article outlines the need for, and possible solutions to the problem of third parties’ legally untrammelled ability to collect and use identified or identifiable personal, sometimes very sensitive, health data. A solution would be implementation of a comprehensive legal framework – from international treaties through national legislation to operationalising data privacy and ethics by design at the level computer software (algorithmic) instructions. At least since the last decade of the twentieth century, digitisation of health data and creation of national electronic health records infrastructure has held the promise of enabling the attainment of such public health goals as personal health management, health care delivery, health-related research, and population health surveillance. Great advances in Big Data technology, and even more so, the algorithmic revolution, has facilitated these four goals, though not necessarily in the ways envisaged by scholars and policy-makers of the time. Thus, personal health management is supported by apps such as Apple Health; telemedicine and teleradiology systems enable health care delivery to patients wherever they are located. Health-related medical, commercial, socio-economic and socio-political research based on Big Data is booming, while national electronic health record systems allow national and international agencies to track and scrutinize health of individuals and populations. However, unregulated and rampant “datafication” of identified or identifiable personal health information about individuals collected, managed, and disseminated without their knowledge and informed consent effectively treats data subjects – us – as mere means to an end. The law has been lagging a long way behind technical and commercial development, yet it is possible to safeguard privacy and other fundamental rights of data subjects. For example, as part of the European Union's Digital Single Market Strategy, the European Parliament adopted Regulation (EU) 2016/679 on the “protection of natural persons with regard to the processing of personal data and on the free movement of such data”, and the Directive (EU) 2016/680 on the “protection of natural persons with regard to the processing of personal data by competent authorities for the purposes of the prevention, investigation, detection or prosecution of criminal offences or the execution of criminal penalties, and on the free movement of such data”. The Regulation shall apply, and the Directive will enter into force (requiring EU Member States to transpose it into their national law) in May 2018. In the United Kingdom, the Investigative Powers Act (UK) 2016 has systemically incorporated approach to statutory controls in form of proportionality and necessity tests on powers that national security and law enforcement agencies must intercept, communications, access, collect and manage massive volumes of data (known as “bulk powers”). These controls aim to create privacy safeguards for intentionally or inadvertently targeted individuals. Thus, the law seems to be “awakening”. However, a comprehensive and systematic regulatory framework of controls and protections is yet to be postulated. This article outlines an approach consisting of vertical tiers that can be implemented separately or in total. The article has two parts. The first part provides background to the interface between developments in technology and unconsented to “datafication” of our personal health from which, unbeknown to us, third party algorithms create our digital identity. The second part outlines proposal that envisages a five-tier legal framework for protection of identifiable personal health data. Protections at each tier would be discrete yet capable of integration. At the base – the design level – it possible for software engineers and computer programmers to specify precisely defined algorithmic instructions for processing personal data in accordance with privacy laws and ethical standards. At the next level – data operators and/or analysts (whether human or an automated algorithmic program) – legal tests of proportionality and necessity and ethical conduct could be implemented by legislation and embedded in the algorithm design. At the third level – individuals and organizations storing and using the data – responsibility for its integrity and security as well as privacy and ethics could be governed by legislation. At the top level, international treaties could provide for uniform standards and approach.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.005
  • Publications en libre accès en biologie–médecine : historique et
           état des lieux en 2016
    • Authors: C. Boudry; M. Durand-Barthez
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Boudry, M. Durand-Barthez
      L’apparition du mouvement « open access » (libre accès, LA) et des archives ouvertes a bouleversé (et bouleverse encore) l’économie et l’accès aux publications scientifiques. L’objectif de cet article est de réactualiser et compléter les résultats des études antérieures qui ont tenté de quantifier l’importance du LA dans le domaine de la biologie/médecine, par le biais d’un focus sur la base de données bibliographiques PubMed. Une analyse des publications en LA dans PubMed en fonction de l’origine géographique des auteurs a également été menée (pays et continents) et un certain nombre de paramètres liés au LA (évolution du nombre de journaux en LA, nombre de mandats et d’archives ouvertes par pays et continents) ont également été étudiés et mis en perspective. Les résultats mettent en évidence que les pourcentages d’articles dont le texte intégral et disponible en LA ne cessent de progresser et concernent en 2015, 39,1 % des articles disponibles dans PubMed. L’analyse géographique des 25 pays les plus productifs et des continents montre une grande variabilité concernant le pourcentage d’articles en LA (de 21,9 % pour l’Italie à 42,08 % pour les États-Unis et de 22,80 % pour l’Océanie à 40,84 % pour l’Amérique du Nord). Par ailleurs, nos données montrent que le nombre de mandats et d’archives ouvertes n’est pas corrélé de manière significative au pourcentage d’articles en LA au niveau national et continental, confirmant ainsi que les politiques publiques successives ou les mandats relatifs au LA n’ont eu qu’une influence, sinon secondaire, du moins inférieure aux attentes. La mise en place de mandats plus coercitifs parviendra peut-être à obtenir des effets plus significatifs à plus ou moins long terme. L’augmentation régulière du nombre de journaux en LA, concomitante à l’augmentation avérée du nombre de citations des articles en LA, amplifiera certainement encore l’attrait des auteurs pour le LA. The emergence of the “Open Access” (OA) movement and OA repositories has upset (and still upsets) the economy and access to scientific publications. The aim of this article is to actualize and complement the results of previous studies that have attempted to quantify the importance of OA in the field of biology/medicine, through a focus on the PubMed bibliographic database. An analysis of OA publications in PubMed, based on the geographical localization of authors, was also conducted (countries and continents) and some parameters related to OA (evolution of the OA journals, the number of mandates and OA repositories established by countries and continents) have also been studied. The results show that the percentages of articles available in OA are still growing and reach 39.1% of articles available in the PubMed database in 2015. The geographical analysis of the 25 most productive countries and continents shows a great variability in the percentage of articles in OA (from 21.9% for Italy to 42.08% for the USA and from 22.80% for Oceania to 40.84% for North America). Furthermore, our results show that the number of mandates and OA repositories is not significantly correlated with the percentage of articles in OA at the national and continental levels, confirming that the public policies or mandates in OA have had an influence below expectations. The establishment of more coercive mandates may succeed in obtaining more significant effects in the medium or long-term. The steady increase of the number of OA journals, with the acknowledged growth of the number of citations of articles in OA, will certainly boost the attractiveness of the authors for the OA.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.021
  • Existential challenges for healthcare data protection in the United States
    • Authors: Terry
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): N. Terry
      There are increasing threats to healthcare data protection in the United States. Most federal data privacy laws apply only to specific sectors, such as healthcare, education, communications, or financial services. In the absence of comprehensive data protection legislation there are multiple, sectoral approaches. These privacy laws are noticeably limited in their vertical scope, preferring downstream protections such as confidentiality, security, and breach notification. Hardly any US laws contain upstream requirements that minimize or otherwise limit data collection. The imminent “EU General Data Protection Regulation” (GDPR) is considerably more comprehensive. Horizontally, it applies to all sectors of the economy, all broadly defined “personal data,” and all who control or process data. Vertically, it applies protective standards throughout the lifespan of data. In the US, the primary federal law applying to healthcare data comprises of regulations known as the “HIPAA Privacy and Security Rules.” The HIPAA rules provide considerably weaker protection than the GDPR, although they are far stronger that the protections applicable to other commercial sectors in the US HIPAA has relatively narrow scope, essentially only applying to data held by traditional healthcare providers and applying only downstream protections; confidentiality, security, and breach notification. Notwithstanding its weaknesses, the HIPAA rules are quite detailed and generally well enforced. Thus, HIPAA has created expectations in patients that all their healthcare data are safe. This is no longer the case, either within the HIPAA “zone” or outside of it. First, traditional providers have almost completed their transition from paper to electronic health records, during which they swap the protections inherent in unconnected file rooms for far riskier computerized longitudinal databases. Second, multiple parties outside of healthcare view healthcare data by as having great value; “big data” brokers collect healthcare data or medically-inflected data for their predictive analytics products, while cybercriminals long since have recognized the profit in stealing health records. Third, consumer electronics companies continue to disrupt healthcare data markets (and data protection) by encouraging consumers to themselves collect and curate data from mobile health apps, wearable devices and the “internet of things.” These challenges to healthcare data protection highlight the fundamental flaws of domain-limited protections and over-reliance on a limited set of protective models. The former because disruptive businesses and technological innovations can make a nonsense of narrowly-defined sectoral protections. The latter because policymakers need a broader array of tools to combat modern challenges while reliance on downstream models intrinsically concedes the correctness of unregulated data collection. The outlook for US healthcare data protection is increasingly bleak. In the aftermath of the 2016 US election, it is quite likely that HIPAA rules will be enforced with less enthusiasm, encouraging an increase in data leaks from the health care system. Further, those victorious in the election are no friends of pro-privacy regulatory agencies and some of their data protection activities may be reined in. It is also extremely unlikely that comprehensive privacy legislation will be passed by the incoming administration. Yet, technological progress and consumer choice almost inevitably will result in increasing amounts of healthcare data being created and processed outside the HIPAA-protected zone. Not surprisingly therefore, healthcare data protection in the US faces a perilous future and one that increasingly will be at odds with the protections offered by its trading partners.

      PubDate: 2017-03-23T20:38:08Z
  • Confidentiality and privacy in the setting of involuntary mental health
           care: What standards should apply'
    • Authors: B.D. Kelly
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): B.D. Kelly
      Restriction of liberty for the purpose of psychiatric treatment raises practical, ethical and philosophical issues relating to privacy and confidentiality. As a result, the issue of confidentiality in mental health care is a subject of long-standing interest. The challenges are at once medical, legal, ethical and philosophical. In 1991, the United Nations’ (UN) placed strong emphasis on confidentiality and privacy, an emphasis that was re-iterated in the World Health Organisation's “Resource book on mental health, human rights and legislation” in 2005. In 2006, the UN “Convention on the rights of persons with disabilities” articulated that “no person with disabilities [which includes at least some people with mental illness], regardless of place of residence or living arrangements, shall be subjected to arbitrary or unlawful interference with his or her privacy, family, home or correspondence or other types of communication or to unlawful attacks on his or her honour and reputation” (article 22). The Council of Europe's “Convention for the protection of human rights and fundamental freedoms” (“European convention on human rights” [ECHR]) (1950) also articulates a “right to respect for private and family life”, specifying that “everyone has the right to respect for his private and family life, his home and his correspondence” (article 8). In the setting of involuntary mental health care, however, it is apparent that this right, like the right to liberty, is a qualified right. A number of important UK cases and cases in the European court of human rights have explored this ECHR “right to respect for private and family life”, ultimately demonstrating that interference with this right can be permissible, once such interference is proportionate, predictable, in accordance with relevant codes of practice (insofar as possible), and clearly justified, for reasons set out logically at the time. While these judgments assist significantly with interpreting international human rights standards and national laws, it remains the case that the practice of psychiatry is also shaped by many factors other than law. Day-to-day clinical work continually presents dilemmas which are not adequately covered by law and require solutions based in broader principles of good medical and ethical practice. In this context, formal medical ethical guidelines in most countries permit disclosure of information without consent if required by law (e.g. court order) or for the protection of the patient or others – despite the impossibility of predicting either homicide or suicide. As a result, while guidelines on breaching confidentiality without consent might well be useful in certain, limited circumstances, it is extremely difficult to determine when to do so, given difficulties assessing risk. There are three possible responses to this situation. The first is never to breach confidentiality due to apparent risk, on the basis that the negative consequences of such an action (i.e. reduced privacy) are certain, while the benefits (i.e. possibly preventing adverse events) are uncertain. The second option is to do our best to predict risk using our imperfect prediction tools; breach confidentiality when risk appears to exceed a certain (ill-defined) threshold; and simply pay a price in terms of reduced privacy. This is the chosen option in most jurisdictions. The third option is to reduce or avoid the dilemma by reducing the amount of privacy afforded to patients in the first instance, by, for example, creating a mandatory requirement for the involvement of third parties (e.g. family) in mental health care from the outset, even when there are no particular risks identified and even when the patient does not consent to this. This option was examined with care in Ireland in 2015 and was not adopted, in favour of the second option, according considerable weight to the right to privacy. Ultimately, however, while human rights form an essential bedrock for this discussion, the vast majority of human needs are fulfilled in ways other than claiming rights (e.g. through societal relations, charity, or political, rather than judicial, allocation of resources). The human need to connect with others and to share has a complex relationship with the need for confidentiality and privacy; further philosophical reflection on these two concepts – which are not necessarily the opposites they might appear at first sight – would help clarify these issues in the complex, important setting of involuntary mental health care.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.020
  • Rethinking super-confidentiality in the age of disclosure: The ethical and
           social implications of privacy protections in mental health data
    • Authors: Gelpi
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): A. Gelpi
      Two opposing impulses have marked efforts in medicine and global health to combat stigma and discrimination. Traditionally, threat of stigma leads to efforts to protect patients by enforcing privacy and confidentiality, while more recently, anti-stigma efforts have been dominated by arguments that the best way to fight stigma is through greater disclosure of the facts of illness. By this line of argument, the act of sharing patient experiences with stigmatized conditions will help dismantle stigma. The question of whether and/or when the threat of stigma warrants more privacy or more disclosure in medicine and public health is the topic of this paper. Tracing two historical cases – HIV and mental health – illustrates the shifting pendulum between privacy and disclosure as opposing, yet both well-intentioned responses to the fact of stigma in both medicine and public health. Public health responses to both HIV and mental health can be divided into periods marked by exceptionalism that eventually yielded to calls for greater integration. That the opposite policies of both eras were each justified the same argument that combat stigma makes these historical cases ethically important. Tracing the rise and fall of exceptionalism in these two cases – HIV and mental health – raises both empirical and normative questions about the impulse toward greater privacy as a strategy for stigma protection. These questions include: When is greater privacy an appropriate or effective response to combat stigmatized conditions' Might greater privacy sometimes actually lead to perverse consequences such as exacerbating or perpetuating, rather than mitigating stigma' And if that is indeed a risk, how should public health officials determine in what circumstances disclosure or privacy offers a better strategy toward stigma reduction' This paper concludes by considering the normative aspects of the policy implications raised by such cases of privacy and anti-stigma efforts. These two cases enumerate the social and medical costs of privacy and stigma so that better policy prescriptions can be developed to advance fairness and justice. They should serve to remind or teach us that there may be social and ethical costs associated with the cure (the privacy) as well as the illness (the stigma). Policy responses must evolve with changing social circumstances. The original impulse towards extreme privacy, confidentiality or exceptionalism, noble though it was, and even appropriate for that time, does not today result in its intended goal: reduction of stigma by demonstrating through practice and policy the moral equivalence of different medical conditions. Another lesson from these cases is that in many cases extreme privacy and vertical programs may even detract from that goal of stigma reduction by signaling that the stigmatized condition is so “other” its sufferers require special treatment or to be kept apart (in the isolated clinics of HIV/AIDS for example). More protection will not always be benign, even if well intentioned. The ironic lesson for global health is that privacy practices run the risk of perpetuating the very stigma they were designed to combat.

      PubDate: 2017-03-23T20:38:08Z
  • Privacy and metadata: The hidden threat to whistle-blowers in public
           health systems
    • Authors: G.F. Tomossy; Z.J. Bending; P. Maluga
      Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): G.F. Tomossy, Z.J. Bending, P. Maluga
      A high quality public health system relies as much on a robust, accountable and transparent governance framework as it does on the integrity, professionalism and skill of its practitioners and administrators. Patients have an expectation, grounded in human rights entrenched in international law, to a reasonable quality of care and to not be exposed to exploitation, abuse or unreasonable risks of harm. A well-functioning public health system will deliver therapeutic outcomes accordingly, but must also provide a front-line defence for the public against communicable diseases or pandemics, and should also strive to facilitate medical research and innovation. The modern age of digitized personal health information, facilitated by rapid advances in telecommunications and computing technologies, presents both opportunities and hazards for public health systems. Digital collection of data assists healthcare providers by facilitating instant access to consolidated health records, and provides an abundance of information for epidemiologists and health economists alike. However, such systems have also exposed individuals to significant breaches of privacy, and threaten the viability of the doctor–patient relationship upon which a public health system depends. In Australia, the medical profession and healthcare consumers have voiced concerns regarding the general collection, use and secure storage of personal information, including data and metadata. Both forms of personal information have been the subject of high profile privacy breaches, raising questions about the legal protection of confidences between healthcare providers and patients, and whether surveillance of a physician's actions burdens their fidelity to patients in their care. For example, a data breach of the Red Cross Blood Service exposed the names, gender, addresses, dates of birth and responses to questions about ‘at-risk sexual behaviour’ of over half a million Australian blood donors. Regarding metadata, the tension between individual privacy and regulatory overreach is illustrated by powers previously granted under the Telecommunications (Interception and Access) Act 1979 (Cth) (commonly referred to as Australia's Metadata Retention Laws) to the Australian Health Practitioner Regulatory Agency to examine the metadata of health practitioners under investigation, thus encompassing communication with all their patients, not simply those pertaining to a given complaint. This tension is also readily evident in the case study presented in this article of the Australian Federal Police's alleged warrantless access to a doctor's phone metadata to determine the identity of a suspected whistle-blower. In this case, an Australian doctor was being investigated on suspicion of having disclosed details without authorization pertaining to circumstances surrounding the death of an Iranian asylum seeker in August 2014 who was being held in an offshore detention centre on Manus Island. Media reports on evidence presented at the coronial inquest into the man's death in late 2016 allege that there were unreasonable delays in transporting the patient to a healthcare facility in Brisbane where he could have received life-saving treatment. While this example did not result in a prosecution, detention centre staff, including healthcare workers, who disclosed information about operations or matters within detention centres without authorization at that time, were potentially subject to a two-year jail term under the Border Force Act 2015 (Cth). As this case study illustrates, misuse of metadata for investigating and prosecuting doctors who act as whistle-blowers within the public health system is not an isolated concern and merits careful consideration. Doctors have an ethical duty to act as whistle-blowers (i.e., grounded in virtue ethics) in a range of situations, such as to report systemic failures, review clinical outcomes of both departments and individuals, or avoid catastrophic events. Indeed, whistle-blowing serves a crucial function to promote transparency of processes in health governance and thereby improve quality of care and patient safety. As such, doctors present a special case for legal protection when they act as whistle-blowers in good faith. Legal disincentives, such as punitive measures that purport to advance the aims of secrecy in government agencies, should be avoided. A failure to do so risks undermining the very foundations of the doctor–patient relationship, with consequent negative implications for patient safety and quality of care in public health systems.

      PubDate: 2017-03-23T20:38:08Z
      DOI: 10.1016/j.jemep.2017.02.023
  • L’intimité en santé : définition, protection et
    • Abstract: Publication date: Available online 18 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): B. Bévière-Boyer
      L’intimité définie comme le « fond caché de l’intérieur de l’homme » fait l’objet de peu de dispositions législatives s’y référant expressément. Pourtant, nombre de règles sous-jacentes, permettent d’enrichir la protection des patients dans ce domaine que ce soit à l’égard des personnes malades directement ou lors de l’exercice professionnel. Intimacy defined as “the bottom hidden within man” has few legal dispositions referring directly to it. However, several implicit rules increase patient's protection in this respect, either directly towards patients or within professional duties.

      PubDate: 2017-03-23T20:38:08Z
  • L’intimité est-elle une valeur éthique ?
    • Authors: J.-P.
      Abstract: Publication date: Available online 17 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): J.-P. Cléro
      L’intimité paraît ne pouvoir se définir que par des négations (elle n’est pas le sujet, elle n’est pas le moi profond, elle n’est pas l’intérieur par opposition à l’extérieur, elle n’est pas le privé par opposition au public, elle n’est pas le secret et l’interdit par rapport à ce qui est manifeste et permis). Quand on essaie de dire positivement ce qu’elle est, on se heurte à une antinomie majeure : est-elle quelque chose qui existe en soi et qui pourrait qualifier des êtres plus ou moins intimes, des sentiments dont certains seraient intimes (tandis que d’autres ne le seraient pas) et dont on pourrait esquisser la liste (Thèse) ? Ou bien est-elle ce qui est conféré par des actes spécifiques, un principe de qualification d’êtres plutôt qu’une de leurs caractéristiques — auquel cas elle n’aurait pas besoin d’exister en soi — (Antithèse) ? Cette thèse et cette antithèse paraissent enclencher deux philosophies fort différentes de l’intimité. On retrouve la même division dans les deux autres principes de l’éthique, le principe de sympathie et le principe de dignité, si l’on admet que l’éthique, envisagée comme plus existentielle qu’essentielle se répartit entre trois principes sous-tendus par la sympathie, la dignité et l’intimité. Dans les trois cas, les antithèses (celle qui confère la possibilité de se mettre à la place de l’autre avec ses valeurs, celles qui attribuent l’intimité ou la dignité) prennent l’avantage sur les thèses (la position d’un prétendu « en soi » de l’autre à l’unisson duquel on serait ; celle d’êtres ou de comportements dignes ; celle, enfin, d’êtres, de sujets ou d’objets intimes). Se trouve esquissée ici la circularité entre ces trois principes, qui se supposent les uns les autres, se donnent un sens les uns aux autres, se corrigent les uns par les autres, s’équilibrent les uns par les autres, et surtout se donnent un sens éthique qu’ils ne sauraient avoir isolément. It seems impossible to define intimacy otherwise than negatively: it is neither the subject nor the “profound self”; it is neither the inside nor the outside; it is not private as opposed to public; it is not the secretive and the forbidden in contradistinction to the evident and licit. When trying to speak positively of it, one stumbles over a strong antinomy: does intimacy refer to something that exists per se and would it be possible for it to qualify certain beings, certain feelings, more or less intimate, sometimes not at all, of which a list may be drawn up (thesis)? Or is it what may be conferred by specific acts depending on a principle of qualification of beings rather than on identifiable characteristics of those beings? In the latter case, there would be no more need for intimacy to exist per se. The thesis and the antithesis seem to give rise to two markedly philosophies of intimacy. The same division is to be found in the other two principles of ethics: the principle of sympathy and the principle of dignity, if one concedes that ethics, considered more existential than essential, are regulated by three principles (sympathy, dignity and intimacy). In those three cases, the theses (the notion of a supposed per se of the other, with which it would be possible to be at one; the notion of a dignified being or behaviour; the notion of intimate beings, subjects or objects) are overridden by the antitheses (making it possible to take the place of another with his own values, or conferring intimacy or dignity). We present here a draft or a sketch of the circularity between three principles which suppose the existence of one another, give sense to each other, are shaped by each other, and above all introduce for each an ethical sense which it could not have in isolation.

      PubDate: 2017-03-17T20:10:53Z
  • Revue de la littérature
    • Abstract: Publication date: Available online 17 March 2017
      Source:Ethics, Medicine and Public Health

      PubDate: 2017-03-17T20:10:53Z
  • Emprises des êtres, meurtrissures des âmes : de l’identification à
           l’appropriation. Analyse médico-psychocriminologique de violences
    • Authors: I. Hanafy; B. Marc
      Abstract: Publication date: Available online 17 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): I. Hanafy, B. Marc
      L’emprise psychologique a été définie comme une pulsion de destruction, donnant lieu à une agressivité active, offensive, alimentée par l’énergie sexuelle mais aussi comme une violence fondamentale. Elle a été analysée d’un point de vue psychosocial comme sous l’angle d’une dualité intimiste, qu’elle soit régie par les affects (cf. sentiments amoureux) ou les émotions (cf. effet Pygmalion). Ce mode de relation se déploie à travers la manipulation, la perversion qui ont pour but d’assurer l’ascendance, la souffrance sur l’autre, à travers son appropriation, au moyen de violences tous azimuts qui l’assailliront, allant de la soumission à la dépersonnalisation, grâce au contrôle et à la négation de cet autre, et plus généralement, le conditionnement. Cet article reprend les définitions de l’emprise, de l’identité et de l’identification, pour une meilleure compréhension du profil de l’empriseur(e), souvent nommé(e) pervers(e) narcissique et celui de l’emprisé(e) ainsi que la relation qui les unit. Il retrace des éléments psychologiques, neurobiologiques, utiles à la prise en soins des victimes. La violence psychologique à l’origine de troubles psychotraumatiques primaires et secondaires est aussi envisagée à l’aune de son importance grandissante parmi les formes de violences observées dans les unités médicojudiciaires comme dans la société. Les mécanismes de l’emprise décrits sont aujourd’hui des clés de compréhension de la violence intime mais aussi sociétale. Grip has been defined as a destructive impulse, implementing an active, offensive aggressiveness, fuelled by sexual energy, and also as a fundamental violence. It has been analysed from a psychosocial point of view as much as from the angle of intimate duality, be it ruled by affects (cf. romantic feelings) or emotions (cf. Pygmalion effect). This type of relationship unfolds through manipulation and perversion which aim to ensure ascendance and suffering upon the other, by means of appropriation proceeding from any kind of violence that will assail the target, from submission to depersonalisation, thanks to control and negation of the other individual, and more generally, the conditioning. This article returns to the definition of grip, identity and identification for an enhanced comprehension of the gripper's profile, commonly named narcissistic pervert, the profile of the gripped, and the relationship between them. It retraces psychological and neurobiological elements, substantially useful in therapeutic care of victims. Psychological violence, at the root of primary and secondary psychotraumatic disorders, is also considered, given its expanding importance among the forms of violence observed in medical judicial units as in society. The very mechanisms of grip which are described constitute as many keys of understanding intimate and societal violence nowadays.

      PubDate: 2017-03-17T20:10:53Z
      DOI: 10.1016/j.jemep.2017.02.019
  • Témoignage sur le vécu de la mort à l’hôpital
           pour les professionnels
    • Authors: Torres
      Abstract: Publication date: Available online 17 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Torres

      PubDate: 2017-03-17T20:10:53Z
  • En ce qui concerne les données informatisées de santé
    • Authors: M.-F. Mamzer; C. Hervé
      Abstract: Publication date: Available online 17 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M.-F. Mamzer, C. Hervé

      PubDate: 2017-03-17T20:10:53Z
      DOI: 10.1016/j.jemep.2017.02.002
  • Résonances artistiques pour la santé
    • Authors: A. Torregrosa
      Abstract: Publication date: Available online 17 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): A. Torregrosa
      Penser la relation arts, sociologie, santé et éthique nous invite à ouvrir les portes des disciplines afin de trouver les liens communs et les croisements vers une pensée interdisciplinaire. Cependant, nous pourrions avant tout nous demander comment se sont perdues les correspondances évidentes entre la connaissance comme réalité complexe et diverse pour se diriger vers des savoirs toujours plus spécialisés. Aujourd’hui, ces questions d’éthique, d’art et de dimension sociale dans la santé nous invitent à nous rassembler. Rassemblement autour de différentes notions qui nous relient — accompagnement, santé, altérité, vulnérabilité — et qui démontrent la complexité et la richesse du vivre ensemble. Cette réflexion s’élabore dans le cadre du groupe de recherche sur arts, santé et éthique (GRASE, laboratoire d’éthique et droit médical, Paris Descartes V), chercheurs qui se sont réuni spontanément autour de ces thématiques afin de retrouver ces liens et initier un trajet de recherche interdisciplinaire. On s’intéressa ainsi à la dimension éthique et esthétique dans une perspective sociologique qui soulève des questionnements dans ces actions d’accompagnement et de rencontre de l’altérité et vers une santé collective. Certainement le vivre ensemble situé au cœur de nos pensées, d’autant plus actuellement, met en exergue une santé sociale fragile ; en soulignant de fait qu’elle n’est pas seulement singulière mais surtout collective. Nous pourrons nous questionner sur la place prise par ces questionnements au sein des formations pour la santé ; par exemple, la médecine qui met en évidence la nécessité de repenser la manière dont nous établissons notre rapport aux autres. Altérité qui n’est pas seulement l’autre mais aussi la nature, le mystère, l’environnement, tout ce qui nous entoure et avec qui nous déployons notre vie quotidienne. Ainsi, cette relation entre esthétique et social ouvre le dialogue entre divers domaines qui nous initie dans un cheminement commun. Thinking about the relationship between arts, sociology, health and ethics invites us to open the doors of the subjects to find out where they connect and the common links between them towards an interdisciplinary thought. Above all, however, we may ask ourselves how the obvious correspondences between knowledge as a complex and diverse reality have been lost to an even more specialized knowledge. Today, these questions of ethics, art and social dimension in health invite us to come together. Gathering around different notions which connect us — accompaniment, health, otherness, vulnerability — and which demonstrate the complexity and the wealth of living together. This reflection is carried out within the framework of the Research Group on Arts, Health and Ethics (GRASE, Laboratory of Ethics and Medical Law, Paris Descartes V), researchers who met spontaneously around these themes to rediscover these links and initiate an interdisciplinary research path. We will thus be interested in the ethical and aesthetic dimension, from a sociological perspective, which raises questions in these actions of accompanying and meeting otherness and towards a collective health. Certainly, living together which is at the heart of our thoughts, all the more so now, highlights a fragile social health; stressing in fact that it is not only singular but especially collective. We will be able to question the place taken by these questions in health training; such as the medicine, which will show that we need to rethink how we relate to others. Alterity that is not only the other but also nature, mystery, the environment, all that surrounds us and with which we deploy our daily life. Thus, this relationship between aesthetic and social opens the dialogue between various fields that leads us in a common journey.

      PubDate: 2017-03-17T20:10:53Z
      DOI: 10.1016/j.jemep.2017.02.012
  • La requalification des données de soins en données de recherche :
           enjeux éthiques et blocages normatifs
    • Authors: M.-F. Mamzer Bruneel; C. Hervé
      Abstract: Publication date: Available online 15 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): M.-F. Mamzer Bruneel, C. Hervé
      L’irruption dans les pratiques médicales des technologies du Big Data décuple les possibilités de recherche dans le domaine de la santé, au prix d’une requalification systématique des données de soins en données de recherche. L’intérêt de ces pratiques pour la progression des connaissances médicales et scientifiques est devenu incontestable. Le prix à payer est l’installation d’une porosité entre le soin et la recherche qui, dans une vision de progrès, justifie la nécessité d’ajuster les lois et règlements existant. L’émergence dans ce contexte d’une nouvelle catégorie de recherches qualifiées de « recherches n’impliquant pas la personne humaine », alors qu’elles portent sur des données de santé et des échantillons biologiques d’origine humaine, incite à réfléchir sur les contours de la personne humaine et sur la place de la réflexion éthique dans la construction des nouvelles normes de l’éthique de la recherche. Big data technologies increase the opportunities of health research, at the expense of a systematic requalification of the healthcare data in research data. There is no doubt about the interest of such practices in a vision of progress. Nevertheless, they make the frontline between care and research porous, and imply the necessity to adapt legal and regulatory frameworks. In this context, the emergence of the concept of research that does not involve human subjects is questionable when it designates research practices involving human data and biological samples. It questions both the scope of the human person and the way ethics of research is thought.

      PubDate: 2017-03-17T20:10:53Z
      DOI: 10.1016/j.jemep.2017.02.026
  • Autour de la mort : perspectives anthropologiques
    • Authors: Pottier
      Abstract: Publication date: Available online 15 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): R. Pottier
      Le rapport à la mort s’est profondément transformé dans les sociétés occidentales contemporaines. Autrefois, on mourait presque toujours chez soi, et toutes les étapes du processus qui aboutissait à faire d’un membre vivant du groupe un défunt, depuis l’agonie jusqu’à la levée du deuil, avaient une signification sociale et rituelle. Aujourd’hui, on meurt la plupart du temps à l’hôpital et la mort se trouvant largement désocialisée et déritualisée, c’est à l’individu seul qu’il revient de l’affronter. Face à ce problème, le personnel soignant se trouve en première ligne, mais il n’a sûrement pas vocation à le prendre en charge, car le véritable enjeu serait plutôt de resocialiser la mort, et d’éviter sa complète médicalisation. The way of meeting death has deeply changed in contemporary western societies. In the past, people were almost always dying at home, and all steps of the process which converted the living member of a group into a defunct, from death agony to end of mourning, were social and ritual events. Nowadays, most of the time, people are dying in a hospital, and since social and ritual significance of death is vanishing, the individual has to meet it alone. Medical personnel is the first and foremost to deal with that problem, but is not in a position for taking charge of it. The real challenge is to give to death a new social meaning instead of letting it be transformed into a pure medical issue.

      PubDate: 2017-03-17T20:10:53Z
  • Vécu de la mort à l’hôpital : témoignage d’un interne en
    • Authors: Bommier
      Abstract: Publication date: Available online 15 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Bommier

      PubDate: 2017-03-17T20:10:53Z
  • Quelques notions fondamentales sur les notions de vie et de mort et leurs
           réalités quotidiennes
    • Authors: Gorgiard
      Abstract: Publication date: Available online 15 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Gorgiard

      PubDate: 2017-03-17T20:10:53Z
  • A duty of forgetting bombers or iconoclasm? A French example for the
           Erostrate rule
    • Authors: P. Charlier; M. Touzeil-Divina; S. Deo
      Abstract: Publication date: Available online 11 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Charlier, M. Touzeil-Divina, S. Deo
      Could the Erostrate rule be applied to terrorists in France: an obligation to forget their names? Such individuals are presented by the media as iconic personalities (evil for many, but examples to follow for some). Maybe simple facts (male, 42, or initials) would suffice in order to prevent hagiographic extrapolation by followers? It would definitely be beneficial, in the sense that the religion would not be apparent, no name, no organization. An anonymous act of terrorism does not motivate others because others would not know what to be motivated from. However, theoretically, it is tantamount to taking away someone's identity and reducing them to their biology (male, 42) or initials (A.B.). So maybe the ethics of it become morally ambiguous. Although, there is certainly a benefit that they cannot be revered. But the problem is that the state has the power to remove someone's name from public and to what extent could it go? Will all criminals’ names be removed eventually? Then who gets to decide? Eventually, anyone outside the prescribed societal moral code potentially can lose his or her identity.

      PubDate: 2017-03-17T20:10:53Z
      DOI: 10.1016/j.jemep.2017.02.004
  • Quel oubli pour les patients atteints de cancer ?
    • Authors: C. Torregrosa; C. Gesbert; M. de Fallois; M.-F. Mamzer
      Abstract: Publication date: Available online 11 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Torregrosa, C. Gesbert, M. de Fallois, M.-F. Mamzer
      Attendu comme une véritable avancée sociétale, le « droit à l’oubli », inscrit dans la loi du 26 janvier 2016, contribue à changer l’image véhiculée par le cancer en introduisant une notion de « vie après le cancer ». Il est, en effet, le reflet des modifications des représentations du cancer et du désir des patients de reconnaissance pour une meilleure intégration. Cette dernière se matérialise notamment, dans notre société libérale actuelle, par la capacité d’emprunter. Jusqu’à présent, un antécédent de cancer impliquait une surprime, voire un refus de prêt par les organismes assurantiels. Si, les données de santé sont traditionnellement soumises au secret médical, dans le cadre d’une demande de prêt, le patient peut être amené à communiquer ses données de santé à la demande des organismes assurantiels au travers de questionnaires de santé. Ils seront éventuellement corroborés et complétés par des examens médicaux. Des médecins, des représentants de patients et des usagers du système de santé ont eu la possibilité de s’exprimer sur cette nouvelle loi. Le « droit à l’oubli » ne concerne pas une personne dans son individualité mais la replace au sein d’une société complexe composée de nombreuses interactions. Cette loi a ainsi contribué à réveiller et à révéler toutes les tensions autour de la prise en charge des patients atteints de cancer ainsi que sur la vie après la rémission. Dans la conception normative de la médecine moderne, les malades « guéris » sont incités à oublier leur pathologie passée pour revenir dans le « normal » d’une société n’acceptant pas de différence. Le droit à l’oubli ne serait-il donc pas un devoir d’oubli ? The “right to be forgotten”, inscribed in the law of January 26, 2016 and expected as a real societal advance, is helping to change the image conveyed by cancer trough the notion of “life after cancer”. It is, in fact, the reflection of the current representations’ modifications of the cancer and the patients’ desire for recognition and a better integration. In our current liberal society, this is materialized by the ability to borrow. Up until now, a background of cancer has implied a surcharge or even a refusal of loan by the insurance companies. Even if health data are traditionally subject to medical confidentiality, in the context of a loan application, the patient may have to communicate his health data at the request of the insurance organizations through health questionnaires. They would be corroborated and supplemented by medical examinations. Physicians, patient representatives and users of the health care system have the opportunity to comment this new law. The “right to be forgotten” does not concern a person in his or her individuality, but replaces it on a complex society composed of many interactions. This law had helped to awaken and reveal all the tensions surrounding the care of patients with cancer as well as life after remission. In the normative conception of modern medicine, “cured” patients are induced to forget their past pathology and to go back to the “normal” of a society that does not accept difference. Is the “right to be forgotten” a duty to forget?

      PubDate: 2017-03-17T20:10:53Z
      DOI: 10.1016/j.jemep.2017.02.014
  • Comment enrayer l’épidémie de suicide des peuples premiers ?
           Anthropologie médicale, médecine légale et santé publique
    • Authors: Charlier
      Abstract: Publication date: Available online 9 March 2017
      Source:Ethics, Medicine and Public Health
      Author(s): P. Charlier

      PubDate: 2017-03-10T14:42:02Z
  • La confidentialité comme problématique éthique
    • Abstract: Publication date: Available online 6 February 2017
      Source:Ethics, Medicine and Public Health
      Author(s): C. Hervé

      PubDate: 2017-02-07T06:05:25Z
  • Human enhancement and identity-affecting changes: The problem of
           controversial cases
    • Authors: J.J. Delaney
      Abstract: Publication date: Available online 23 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): J.J. Delaney
      Imagine we are able to use biotechnology for the purpose of human enhancement. We have the ability to make individuals predisposed to increased intellectual or athletic abilities, or to produce physical characteristics we think are attractive. Consider two possible ways we might accomplish this. In the first case, we use a drug on an early term fetus that makes the resulting individual predisposed to the trait we want to produce. In the second case, we select a particular pair of gametes that will result in an individual who is predisposed to the trait. Further imagine that individuals in both types of cases disvalue their conditions, and complain that the interventions should not have been performed. Perhaps, they disvalue the trait itself because it makes their lives go worse in some way, or maybe the trait brings some negative side effect. What should we make of these individuals’ complaints' Specifically, should we compensate these individuals' Some say that the two cases should be treated differently. In the drug case, the intervention is identity preserving. Had the intervention not been performed, the individual would have existed without the disvalued trait. So this individual can be said to be worse off. In the selection case, however, the intervention is identity affecting. Had the intervention not been performed, some numerically different individual would have existed without the trait. Those who think the complaint of an individual in an identity preserving case should be given more weight than the complaint of someone in an identity affecting case accept what I call the difference thesis or DT. While some interventions such as those just mentioned are either clearly identity preserving or clearly identity affecting, we can imagine other cases in which there is debate over whether or not the intervention results in the numerically identical individual. I call these controversial cases. My goal in this paper is to explore how someone who accepts DT, as well as a basic principle of compensation C, which states that only those who suffer losses should be compensated, should deal with the complaints of individuals in these controversial cases. I refer to this view as DTC. I proceed as follows. First, I give a brief survey of the nonidentity problem. I explain why some philosophers are inclined to accept the implications of the non-identity problem and therefore DTC. I also point out that reasoning based on DTC has been influential in law. Next, I explore the distinction between clear and controversial cases of identity. Some interventions such as the earlier example of the drug administered to the fetus are clearly identity preserving. Others, such as the case of selecting one pair of gametes instead of another, are clearly identity affecting. I then discuss several interventions that I think are controversial. That is, there will be philosophical disagreement over whether these interventions are identity preserving or identity affecting. I discuss the relevant features of these controversial cases and argue that disagreement over them takes place on two levels. On the first level, there could be issues of vagueness in a given theory of personal identity. That is, the theory itself does not give a definitive answer to the question of whether the intervention is identity affecting. Controversy on this first level can also take place when there is disagreement between two rival theories of personal identity (animalism versus psychological views for example), such that one theory says that an intervention is identity preserving and the other says that it is identity affecting. The second level of disagreement, what I call “deep disagreement”, takes place over whether there is a matter of fact about whether a given intervention is identity affecting. This type of disagreement takes place between reductionist and nonreductionist views of personal identity. I then consider how the holder of DTC ought to deal with controversial cases. Suppose that an individual has a disvalued trait due to an enhancement intervention in a clear identity preserving case. And given the other relevant features of the case, suppose she were due compensation. According to DTC, an individual with that same disvalued trait in a clear identity affecting case is not due compensation (since she was not made worse off). How then should controversial cases be handled' There are three broad strategies: (1) controversial cases should be dealt with as if they were identity preserving and compensation should be given; (2) controversial cases should be dealt with as if they were identity affecting and no compensation should be given; or (3) controversial cases should be dealt with in some intermediate way, meaning some amount of compensation between whatever would be due in an identity preserving case and zero should be given. I argue that none of these three strategies is obviously superior to the others. Thus, I conclude that controversial cases of identity prove a serious challenge for anyone sympathetic to DTC.

      PubDate: 2016-11-29T02:03:23Z
      DOI: 10.1016/j.jemep.2016.09.009
  • Language, self-referencing and bioethics: Can law mediate between
           evolution and religion'
    • Authors: J.C. Smith; D.N. Weisstub
      Abstract: Publication date: Available online 23 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): J.C. Smith, D.N. Weisstub
      In the field of bioethics, religious and scientific perspectives generally are in agreement on moral questions such as the value of life. But a profound gulf emerges when it comes to issues related to procreation and death. This paper attempts to analyze the basic assumptions and presuppositions that underlie the bioethical debates surrounding abortion, embryo experimentation and assisted dying. Theistic perspectives are likely to accept the evolution of the physical body, but assert that the uniqueness of human language and the differences between the Homo sapien mind and that of all other animals are not the product of Darwinian selection, but rather the consequence of an ontological lacuna marked by divine intervention. This squarely places the debate about personhood between evolutionary continuity and the creation of an immortal soul connected to the presence of a Deity. The blunt confrontation between these two universes has produced an intractable duality of solitudes in the world of bioethics. It is now widely accepted that animals are conscious, in that they do experience the qualia of sensations such as colour, sound, smell, and pain. They express emotions of fear, anger, affection and grief. It is acknowledged that animal intelligence is manifested in responses to environmental needs, and that their mental processes indicate a sense of selfhood. What then distinguishes the human mind is its unique capacity for self-reflection and meta-consciousness, or consciousness of consciousness, which together form the basis of “personhood”. The capacity for self-reflection is a necessary condition for human language. Unlike animal communication, speech presupposes the subjectivity of dialogue as in “I” and “you”. No human language omits a sign of the self. Historically, the law has formed the focal point in the bioethics divide in contest between prohibition and regulation, versus liberty and free choice. Since individual agency is the foundation of the rule of law, restrictions on choice must be justified in terms of the limitations of rights. Officially, therefore, religious doctrines such as the belief in an immortal soul are kept aside in our secular courts of law, thereby underlining our commitment to the separation of church and state. We often find, nevertheless, that there are discrete attributions through Charters of Rights and Constitutions, to the Deity as the governing force behind the legal system. Almost in all cases, the insertions of religious belief into our Western legal systems are reformulated within the discourse of legal rights. The acute challenges between religious and non religious positions in bioethics normally appear when the “religionists” superimpose their will on the “secularists” about matters that invite prohibition and sanctions. These claims according to religious belief bring passionate debate into the public forum. The conundrums that emerge when we try to use bioethics as a basis for decision making, either in the legislature, in the courts, or indeed within clinical settings, are connected to the fact that in our society, there is a no man's land where agnostic belief systems continue to confuse rather than clarify the presuppositions behind the decisions we make. Because of this, the rule of law remains in a frustrated position. To support the rule of law, we suggest that there is no better principle than that of human dignity and respect for individual right of action to contain a tendency of religion or ideology to compromise the individual “right to choose”.

      PubDate: 2016-11-29T02:03:23Z
      DOI: 10.1016/j.jemep.2016.10.013
  • Narrative, identity and the therapeutic encounter
    • Authors: M.J. Young; H.J. Bursztajn
      Abstract: Publication date: Available online 23 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): M.J. Young, H.J. Bursztajn
      This article explores the place of narrative in the constitution of selfhood, and through this lens examines its multifaceted role in the clinical encounter. It begins by explaining and critically evaluating the recent view advocated by Schachtman and others that narrative is wholly constitutive of the self. On this view, the role played by narrative is not merely a descriptive one, but serves more fundamentally as the ontological substrate upon which identity is invariably built and sustained. Understood as such, this capacity may distinctively modulate the meanings, motivations, and attitudes individuals adopt in reaction to and in anticipation of happenings in their lives. Acts of self-narrative can serve not only to describe meaningful facts about a person's life, but may also serve to reflexively influence the very states of affairs that they aim to describe. After assessing the theoretical attraction of this view, counter-evidence to this theory is adduced from clinical neuropsychiatric cases wherein lapses of narrative, such as those observed in dementia, dissociative identity disorder, autism and amnestic syndromes, do not entail wholesale losses of selfhood. Analyses of cases such as these reveal that there is more than narrative that is constitutive of selfhood and identity, and further raises the question of whether the absence of conveyed self-narrative ought to be interpreted as evidence of a failure of this capacity versus as evidence that an agent simply is no longer is motivated to express it. Rather than a monotonic construct, it is argued that narrative is one of a cadre of crisscrossing capacities sharing some family resemblance and with characteristically open texture that variably combine to produce selves with no single common denominator, but rather with dynamic clusters of commonalities. Six other symbiotic dimensions are identified that contribute to an intact scaffolding of selfhood, and disturbances within each of which might lead to distinctive pathologies. In particular, the capacities for self-other representation; diachronic unity; synchronic unity; consciousness (in particular, awareness); ecologic embededdness; and cognitive unity are explained and evaluated, along with pathologies that may arise in the setting of disturbances of each. It is contended that avenues of research studying the neural substrates corresponding to these different dimensions of selfhoold, as well as how these varied neuronal systems coalesce to produce a phenomenologically integrated and unified self is much needed. Further clarity with respect to these issues can shed further light on how particular brain lesions may differentially affect elaborations of selfhood. Such research could foreseeably include functional neuroimaging studies, non-invasive brain modulation (e.g., transcranial magnetic stimulation; transcranial direct current stimulation), and targeted neuropsychological testing of individuals with apparent disruptions of self stratified according to the different dimensions elucidated to aid in uncovering the enigmatic neuroanatomy and neurophysiology of selfhood. The cross-disciplinary nature of each of these avenues underscores the profound importance of deep and sustained collaborations among philosophers, ethicists, clinicians and researchers to optimize and advance approaches to the pathologies of the mind and the self. Neuroethical upshots of the account of selfhood developed are discussed, including implications for treatment of individuals with neurodegenerative conditions wherein the self itself is called into question, for the foundation and function living wills, and for approaches to pain management in individuals with disorders of consciousness. While narrative, when elicited, can provide a vital window into patient experience, lapses of narrative may be just as central to the psychoanalysis of the self and to the therapeutic encounter. What is not, and cannot be spoken, is often as vital as the narrative itself.

      PubDate: 2016-11-29T02:03:23Z
      DOI: 10.1016/j.jemep.2016.10.009
  • Personhood, animalism, and advanced directives: The intersubjective and
           affective heart of the matter
    • Authors: A. Benvenuti
      Abstract: Publication date: Available online 22 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): A. Benvenuti
      The concept of animalism suggests that human persons are animals, whose lives are defined as biological in a manner that is continuous with other animals, but who are also narrative animals telling a self-story, each narrating his or her own biological existence. I claim, in relation to bioethics, that the concept of animalism contains unplumbed depths in the biology of the affective and intersubjective dimensions of animal life that are fundamental features of biological living for mammals. This includes social intelligence that is largely affective, and the basic moral capacities that are required for and responsive to living in social groups. With respect to the bioethics literature on advanced directives, I note the presence of a kind of “game” mentality in which the dying subject is cast as an object for consideration. This approach creates what psychologists call intellectual distancing from the emotional feelings related to death and the dying person. I argue, in contrast, that the affective dimension of living and dying should hold a clearly articulated and central place in bioethical discussions. But in order for the affective dimension of animal cognition to be valued, it must be broadly understood, especially in relation to certain fundamental experiences shared by all mammals and central to the motivated behavior that shapes self-awareness, identity, and personhood. Animal studies have produced substantial findings that humans are similar to other animals in many dimensions of cognition and behavior that were formerly considered to be exclusively human. These findings do not, however, reduce humans to something more brutish or even mechanical; rather, they elevate other animals into humanly valued domains of thinking, feeling, moral consideration, self-awareness, and even personhood. Jaak Panksepp and Lucy Biven list primary affects experienced across mammalian species and likely also in other animals, including birds and cephalopods. These affective states are so fundamental that they are simultaneously a response to sensory perception of objects in the world and a physical propensity to respond in particular ways to that perception, and at the same time an energized feeling state motivating particular propensities to action. These primary affects—seeking, care, fear, play, grief, lust, and anger—are the affective location wherein perception, motivation, and subjective feeling of being in the world meet. In other words, these primary affects may legitimately be called the roots of identity and personhood, as experienced in the life of any given animal. It has been widely assumed, since Aristotle articulated his hierarchical organization of kinds of beings, that humans are distinct from other animals because of our capacity for abstract rational thought. But this distinction has been disproved from two directions. It is well established that other animals use abstract thought for problem solving, and also that human thought is not accurate and rational. Human cognition is fragmentary at best, and largely unconscious; it does not do a good job of accurately describing reality. The narrative self is particularly vulnerable to errors in self-knowledge. The fact that human narrative identity is insubstantial does not, however, render it without value, nor does it reduce a human person to some imagined mechanical biological state. Rather, biology and psychology are inseparable. For humans, it is our particular way of expressing inherent sociality—the intersubjective core of living a mammalian life—that makes our particular valuation of narrative identity substantial. It is the fact that we share with other humans the unique work of creating a narrated self that makes the narrated self so highly valuable. We understand empathically the work of a narrated life, and it is the fact that we have shared in this kind of living, that we have belonged with one another in the making of a narrative self and have witnessed the narrated self of the other, that binds us in a promise to honor the narrative work of the other. From this point of view, advanced directives are a matter of promising to honor the narrated self of the other, on the ground that we inherently understand the value of self-narrative work, and that we have lived together, forming one another in the process of living. Our existence is nothing if not intersubjective from first breath to last. It is our belonging to and with one another and our witnessing one another's narrative constructions, that binds us in a promise to respect the narrative of the other to the extent that we are able, including the carrying out of the advanced directive of the once narrated, but no longer narrative, other. While we cannot have moral certainty that the no longer narrative other would still want what she or he once requested, we can know that we are acting in continuity with her or his narrated self. The willingness to bear moral ambiguity is embedded in the promise to respect the narrated self of the other. There is no escape from moral ambiguity and complexity, but the willingness to bear these things is necessary to living shared self-narrated lives.

      PubDate: 2016-11-29T02:03:23Z
      DOI: 10.1016/j.jemep.2016.10.005
  • Respect for personhood in medical and psychiatric ethics
    • Authors: Matthews
      Abstract: Publication date: Available online 22 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): E. Matthews
      This paper considers a number of questions concerning a central principle of modern liberal medical ethics – that of respect for patient autonomy. This principle is generally interpreted as a consequence of the more fundamental ethical requirement of respect for personhood, defined in terms of the ‘autonomy’ of a rational being. In the context of medical ethics, this is taken to imply that patients, as persons, have the right to make decisions about their own medical treatment or non-treatment. This, it is argued, involves a misuse of the essentially Kantian concept of ‘autonomy’. For Kant, to be autonomous is to be capable of making universal moral judgements, based on impersonal reason alone. In liberal medical ethics, however, autonomy means the capacity to make decisions about non-moral matters such as one's own interests, on the basis of values which one has arrived at by free and independent thought. These are clearly different conceptions, so that a definition of personhood in terms of autonomy in the Kantian sense will be different from one in terms of liberal autonomy. This casts doubt on whether respect for patient autonomy in the liberal sense is an implication of respect for personhood. It is not clear why a patient's decisions about treatment ought to be respected simply because they are based on the patient's own (non-moral) values. There is a further difficulty. ‘Autonomy’, in the liberal conception, seems to be equivalent to ‘decision-making competence’. The elements of this are said to be: 1. The capacity to understand; 2. The capacity to reason; and 3. Possession of one's own developed structure of values. Decision-making competence in this sense is not found in all human beings, or in any human being all the time. For example, small children, adults with learning difficulties, and people with brain damage seem to lack all three elements, or to have them only to a limited extent. People with a serious illness may lack all three temporarily. And people with certain kinds of mental disorder may, just because of their disorder, deviate from their own normal structure of values. It seems to follow that not all human beings are fully persons worthy of respect in the liberal sense of personhood. This has morally undesirable implications, which suggests problems in the liberal conceptions both of personhood and of respect. It is argued that a satisfactory conception of personhood can be arrived at only by considering the use of terms such as ‘person’ in everyday, non-technical, contexts. It is argued that ‘person’, in such contexts, is almost synonymous with ‘human being’, though with particular reference to the non-biological characteristics of human beings – those in virtue of which we recognize each other as fellow-humans (as ‘one of us’). A human being does not necessarily possess decision-making competence as defined above: so respect for persons cannot depend on such competence, or require us always to accept a person's own presently expressed decisions about what is best for themselves. It does, however, require us to recognize others as separate selves, with interests of their own, which may differ from ours. A doctor is therefore morally required to give the patient's interests priority over his or her own, or those of the health care system. If doctors consider the patient's expressed decision about treatment to be not in the patient's own interests, they are morally required to engage in dialogue with the patient, in an effort to arrive at a decision which will be acceptable both to the doctor and to the patient. If the patient is unable to engage in such dialogue, because of impaired decision-making competence, then other methods of establishing the patient's interests must be tried: examples would be proxy decision-making, by someone who is close enough to the patient to be aware of, and concerned for, the patient's interests; or appeal to the patient's own advance directives, where available. The most difficult case is that of patients with certain kinds of mental disorder, where the patient's own sense of his or her interests has become distorted by the very disorder which needs treatment. Only by following an appropriate course of treatment, which the patient may currently reject, is it possible to restore the patient to a condition in which he or she can genuinely engage in dialogue. This, it is argued, makes it morally justifiable in such cases simply to override the patient's expressed wishes.

      PubDate: 2016-11-29T02:03:23Z
  • De l’individu à la personne, le changement de paradigme de la société
    • Authors: M. Maffesoli
      Abstract: Publication date: Available online 22 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): M. Maffesoli
      La société moderne s’était construite sur le primat de l’individu, un individu maître de lui comme de l’univers et lié aux autres membres de la société par le contrat social. Tout autre est la forme de lien social qui lie les uns aux autres les membres de la société postmoderne : en effet, ce qui me définit d’abord, c’est mon appartenance à une tribu, à diverses parmi les tribus qui constituent une société. Le principe individualiste a cédé la place au tribalisme, c’est-à-dire aux agrégations émotionnelles et contextuelles qui rassemblent, sans projet défini, les personnes. On passe ainsi de l’identité politique, économique, socioprofessionnelle individuelle aux identifications multiples que permet l’appartenance à diverses tribus. « Je est un autre », c’est là la caractéristique essentielle de la postmodernité. The modern society was involved from the primacy of individual, an individual, master of himself as the universe and related to the others society members through the social contract. Totally different is the form of the social link which connects the postmodern society members to each other: effectively, that defines me first is my tribal membership, to several among the tribes which constitute a society. The individualist principle has given way to tribalism, which means to emotional and contextual aggregations which collect without any definite project persons. We pass from political, economic, socioprofessional individual identity to multiple identifications which several tribes membership permits. « I is an other ». There is the postmodernity characteristic.

      PubDate: 2016-11-29T02:03:23Z
      DOI: 10.1016/j.jemep.2016.09.005
  • Dualism, panpsychism, and the bioethical status of brainless embryos
    • Authors: D. Hershenov; A.P. Taylor
      Abstract: Publication date: Available online 22 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): D. Hershenov, A.P. Taylor
      We draw upon David Chalmers (1996) and Galen Strawson's (2006) defense of the pervasiveness of experience and wed it to Peter Unger's (2006) immaterialist solution to the Problem of the Thinking Many. The idea is that the soul's thoughts depend upon physical composites that though, pace panpsychism, are themselves are unable to think, still contribute to a thinking soul whenever they exist. And they will exist wherever a living organism is found. We think the result is more plausible than either dualism or panpsychism taken by themselves, both of which we still hope to show are more compelling than most will initially think. We will proceed by first stating an argument in favor of dualism. We agree with Unger that the most compelling argument for dualism follows from the considerable troubles that can be advanced against materialism on the basis of the metaphysical Problem of the Thinking Many. Our conception of ourselves, our self-knowledge, our freedom, and our bioethics would appear in great trouble if there were overlapping thinkers, each composed of a good part of the brain that belongs to the others. The absurdity of such an abundance of thinkers enough reason to doubt that materialism is true. In addition to the absurdity of countless thinkers, a consequence is that we will lack what Unger believes is the power to be a genuine chooser. Philosophers sympathetic to libertarian free will are likely to be bothered by the threat to genuine choosing that Unger diagnoses. And even those who are not bothered, perhaps because they are of a compatibilist stripe, will likely count it as a strike against materialism that it brings with it the absurdity of uncompensated suffering at levels they never earlier expected. We then defend dualism against its two major criticisms: the neurological dependence of thought and the problem of interactionism. Next, we explore the appeal of panpsychism's critique of consciousness as emergent. We borrow a transformed version of that idea that has the result that there are far more experiences than recognized by the typical materialist or dualist. We then conclude with why this is not morally problematic. Once the morally relevant sense of potential is recognized, an abundance of minimally-minded organisms is no more morally problematic than the fact that typical materialists allow that some insects may have minimal minds. Incidentally, the final part of our paper on potentiality should be of interest as well to both those dye-in-the-wool-panpsychics who are unmoved by our marriage of their view with dualism and those orthodox materialist readers who are uninterested in making use of any aspect of panpsychism or dualism. So unreconstructed panpsychics can still help themselves to our moral conclusions about the moral significance of the potential of some minimal minds to become sophisticated minds. Likewise, even those readers who do not take panpsychism or dualism or their combination seriously, may still find compelling our arguments about the morally relevant type of potential.

      PubDate: 2016-11-29T02:03:23Z
      DOI: 10.1016/j.jemep.2016.10.012
  • Personal identity is the philosophical penumbra in which capacity must be
    • Authors: J. Spike; S.E. Karff Chair
      Abstract: Publication date: Available online 21 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): J. Spike, S.E. Karff Chair
      There is a temptation in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article, I argue that this is a mistake, not just unnecessary but wrong, and explain how to return capacity assessment to a normal part of the medical encounter. Part of how many physicians started down this path was from confusing the concepts of competence and capacity. While returning to a less technical approach to capacity assessment may seem like it should not be difficult, a tremendous amount of scholarship confusing competence and capacity has given many physicians the false opinion that psychiatry is needed for a capacity assessment, and it has become a commonly accepted hospital practice or even policy in some hospitals to request psychiatric consultation to assess a patient's decision-making capacity. The goal of this article is to return the concept of capacity to its proper historical origins in patient's rights, informed consent, and the philosophical idea of authenticity. Thus, in this chapter, I argue that personal identity is essential to the concept of decision-making capacity. Personal identity is a notion of continuity of core values and personality; consistency over time. One doesn’t act a certain way because one remembers being that way in the past, or because you can give reasons to be that way, but because acting that way comes naturally to that person as a reflection of her beliefs and values. It is a decision that represents the patient's authentic self, or reflects his (or her) true self. Hence capacity assessment, if properly understood, does not require a scientific test of a properly functioning inner psychological process, or of accurate memories of past events or actions, but a humanistic social interpersonal interaction to ascertain personal identity or consistency over time. Thus, personal identity is more important to capacity assessment and informed consent than either memory or reasoning ability. This leads to interesting results, such as the person best able to assess a patient's capacity must be someone who knows the patient's past, including (but not limited to) past medical decisions. Hence, a primary care doctor or a family member may be the best person to consult, rather than a psychiatrist meeting a patient for the first time. And there might be reason to encourage ethics consultants to include capacity assessment as a professional skill for some cases as well.

      PubDate: 2016-11-21T22:42:25Z
      DOI: 10.1016/j.jemep.2016.10.011
  • Animals, advance directives, and prudence: Should we let the cheerfully
           demented die?
    • Authors: D.G. Limbaugh
      Abstract: Publication date: Available online 21 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): D.G. Limbaugh
      This paper argues that the animalist—someone who believes we are no more than human organisms—should not be highly confident that advance directives are properly applied to patients who are cheerful and yet severely demented. Pretend that I have suffered from severe dementia for some time. Though I am cheerful and well off considering the circumstances, I live with minimal psychological continuity. Currently I am sitting in a chair gazing out a window. Question: is the individual sitting in the chair actually me? My memories, hopes, fears, interests, and ability to project myself into the future are gone. Am I also gone? Now let's imagine that the individual in the chair has been diagnosed with pneumonia. I signed an advance directive refusing treatment in such a scenario. Has the individual in the chair signed an advance directive? The answer to this question depends on what you think I am and what it takes for such a thing to persist. The animalist, who tells us we are nothing more than human organisms, says that I persist if the organism persists. I survive as long as the organism survives, and that survival has nothing to do with psychology (memories, beliefs, etc.), only with biology. So, me-last-night is identical to me-this-morning if the organism is the same as it was last night. This will be true if the organism survived (remained alive) through the night. Now, I—as the signee—sign an advance directive in the interest of consenting in advance in case there is a time when I—as the patient—cannot speak for myself in terms of medical treatment. I assume that the consent in this case is binding only if I am in fact speaking for myself in the future and not someone else. That is, I must be both the signee and the patient for the advance directive to be binding. The advocate of animalism contends that her view gives the obvious answer. That the patient and signee are identical. There is no clinical case where one would be remotely tempted to apply an advance directive where the signee and patient do not share a life. If the signee and patient share a life, then they are the same organism, and according to animalism the signee has survived and is thus identical to the patient. So, if animalism is true, then in the case of severe dementia or Alzheimer's, the organism continues to persist, which means I continue to persist. Were this problem merely theoretical, then perhaps the above argument would be satisfying, assuming the truth of animalism. However, in practice, we need more than the assumed truth of animalism. To overcome this problem of identity, we need enough justification in animalism to warrant a lethal omission of action towards a cheerful patient who cannot express her own wishes. That is, animalism is only helpful in telling you when to honor an advance directive in so much as you are confident enough in its truth to allow for the consequences of a mistake. I assume that when it comes to the risk of allowing the wrong individual to die, we should have a high level of confidence in the success of our actions before proceeding, ceteris paribus. I argue that we should not have a high level of confidence that we persist according to animalism, and thus, we should not apply lethal advance directives to the cheerfully demented. My argument is that animalism is undermined by its attempts to overcome objections. For instance, the animalist must be able to principally exclude the brain, as opposed to the animal, as what is the thinker. There is consensus among animalist that the best way to avoid the brain as the thinker is to adopt a sparse ontology denying the existence of brains, hands, tables, and chairs. However, the adoption of such an ontology reduces the justificatory force of commonsense, which is key in arguing for animalism and that we persist as long as our animal is biologically alive. This is also a loss of justification that I am the signee and the patient, that the advance directive applies to the individual in the chair, and that the directive is sufficient to let that individual die.

      PubDate: 2016-11-21T22:42:25Z
      DOI: 10.1016/j.jemep.2016.10.006
  • Introduction: Personhood: Intimity and otherness
    • Authors: D.N. Weisstub
      Abstract: Publication date: Available online 21 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): D.N. Weisstub

      PubDate: 2016-11-21T22:42:25Z
      DOI: 10.1016/j.jemep.2016.10.008
  • Personhood, preemptive suicide, and legislation
    • Authors: C.G. Prado
      Abstract: Publication date: Available online 21 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): C.G. Prado
      Recent legislation decriminalizing assisted suicide is welcome, but it suffers from a serious flaw. As formulated and presently interpreted, the legislation depersonifies some individuals. It does so by discriminating against them in denying them assistance in suicide while providing it for others. This depersonification occurs when consideration of some persons’ need and request for assistance in suicide is assessed exclusively in terms of the condition of their bodies while their self-assessments, wishes, fears, and decisions are effectively ignored. Furthermore, as the legislation requires, consideration of requests for assistance in suicide focuses on particular terminal illnesses from which appellants suffer, discounting other reasons appellants have for wanting to die. In particular, anticipated and incipient afflictions are not allowed to figure in the assessments. Better formulation of decriminalizing legislation and especially more flexible interpretation of stated conditions is called for. Interpretation of the legislation must recognize the personal complexities and threats of terminal afflictions, both present and developing, as well as the straightforward physical consequences of present ones. In pursuing this matter, I concentrate on legislation very recently passed in Canada. However, the problem I identify and discuss, and the main point I make about it, are both readily generalizable to apply to other nations that either have already decriminalized assistance in suicide or are in the process of planning legislation to do so. As will emerge, it is not my objective to have the new Canadian legislation repealed or even significantly altered. Nor is it my intention to try to offer a tidy solution to the problem I identify in legislation pertaining to assistance in suicide. Rather, my objective is, first, to review the particular problem of how the legislation and its present interpretation depersonifies individuals through discrimination, focusing on one particular condition. Second, I then attempt to clarify just how the legislation as presently interpreted most seriously fails. Third, I suggest how judicious reinterpretation of the condition at issue may come about and thereby resolve the problem that it presently poses.

      PubDate: 2016-11-21T22:42:25Z
      DOI: 10.1016/j.jemep.2016.10.010
  • Le moi et l’autre, ami et ennemi
    • Authors: Tzitzis
      Abstract: Publication date: Available online 17 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): S. Tzitzis
      Dans ce travail, c’est la personne dans la réalité actuelle qui fait l’objet de réflexion. De ce fait, force est d’étudier la présence de l’autre dans sa proximité existentielle et la valeur des rapports que la personne entretient avec lui. On sera amené par-là à scruter l’horizon humanitaire qui s’ouvre au tandem moi et l’autre comme personnes et détermine une vision commune. Cette vision marque tant la culture dont nous sommes porteurs que celles qui nous envahissent. Car la vie de la personne est inextricablement liée au défilé des valeurs qui traversent les mouvements de l’histoire. In this report, we develop the idea of person in his social reality. Consequently, it is unavoidable to miss describing the presence of the other and the preciosity or their relations as social human beings. Thereby, we are led to investigate the humanitarian horizon which is open to me and to the other conceived as persons and which determine a common view. This view marks the culture we have and the culture which overwhelms us. Because a person's life is inextricably associated to the stream of values which gets into the movements’ of history.

      PubDate: 2016-11-21T22:42:25Z
  • L’intimité psychique dans le champ de la psychologie clinique et de la
           psychopathologie : enjeux et perspectives éthiques
    • Authors: B. Verdon; M. Gargiulo; I. Gernet; M. De Luca; C. Costantino; S. Missonnier
      Abstract: Publication date: Available online 14 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): B. Verdon, M. Gargiulo, I. Gernet, M. De Luca, C. Costantino, S. Missonnier
      L’objectif de cet article est de décrire les principales questions éthiques soulevées par le respect de l’intimité dans la pratique du psychologue clinicien, du psychanalyste, de l’enseignant universitaire et du chercheur en psychologie. Sont abordés les problèmes complexes posés par le secret partagé en institution, le potentiel dévoilement de l’intime dans les présentations des cas cliniques lors des enseignements, la nécessité de ne pas ignorer qu’une plainte manifeste peut cacher une souffrance psychique. Enfin, nous soulignons que dans le domaine de la recherche, le principe de faisabilité ne comprend pas toujours celui de bienfaisance, pierre pourtant fondatrice de toute recherche sur la personne. Nous postulons que le respect de l’intimité peut être soutenu par le cadre éthique et déontologique mais également par le tact qui, au même titre que la neutralité bienveillante, est une ligne directrice pour le clinicien, l’enseignant et le chercheur. The focus of this article is to describe the major ethical issues raised by the respect for intimacy in the practice of clinical psychologists, psychoanalysts, university teachers and researchers in psychology. We describe the complex issues about the “shared secret”, the potential disclosure of the intimate relating to presentations of clinical cases during lessons, the need to not ignore that a manifest complaint may mask a mental suffering. Finally, we note that in the field of research the principle of feasibility not always implicate the principle of beneficence, cornerstone of any research involving human beings. We postulate that the respect for intimacy can be sustained by principles ethical and deontological but also by “the tact” and the “analytic neutrality” as a guideline for the clinician, the teacher and the researcher.

      PubDate: 2016-11-14T22:13:32Z
      DOI: 10.1016/j.jemep.2016.09.002
  • Individu et société : le lien social en question '
    • Authors: Ennuyer
      Abstract: Publication date: Available online 11 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): B. Ennuyer
      Comment peut-on encore faire société dans un monde où la progression de l’individualisme apparaît comme inéluctable ' Notre société devenue un agrégat d’individus singuliers et revendiquant leur indépendance, peut-elle encore former un collectif avec des droits, des règles et des contraintes acceptables par l’ensemble des individus qui la composent ' Qu’est-ce qui fait lien entre l’individu et la société des individus, telle est l’interrogation qui traverse cet article. L’individualisation, c’est-à-dire le processus de long terme de construction de l’individu comme sujet singulier a démarré au tournant du XVIIe siècle. Les conditions de possibilité de ce phénomène ont été essentiellement le desserrement de l’emprise du religieux et l’apparition de la propriété privée. Ce que d’aucuns ont appelé la première modernité de l’individu va voir peu à peu l’avènement de la « propriété sociale » qui inclut la protection sociale, le logement social, les services publics, un ensemble de biens collectifs mis à la disposition des non-propriétaires pour éviter misère, dépendance et déchéance sociale. C’est alors le collectif qui protège l’individu qui n’est pas protégé par la propriété privée. Cette protection sociale va se développer à la fin du XIXe siècle et surtout en 1945, ce sera au sens étymologique la « Sécurité sociale ». Le processus d’individualisation a connu une seconde étape de son développement, la seconde modernité de l’individu, avec la diffusion de la scolarisation, fondement objectif de l’individu moderne et la reconnaissance progressive du droit des femmes et des enfants, permettant à l’ensemble des individus composant une société de réclamer leur indépendance plus que leur autonomie. Il en est résulté la constitution d’un individu qui se pose à lui-même comme sa propre fin et qui se donne l’objectif de se réaliser sans entraves. C’est un nouveau processus d’individualisation qui vient remettre en question les appartenances collectives et avec lequel on perd à la fois des protections au travail construites par l’État mais aussi les protections rapprochées, familiales, de voisinage, d’appartenance à une communauté, perte que le sociologue Robert Castel a appelé le processus de « désaffiliation ». Dans une société où la propriété sociale et la citoyenneté sociale sont menacées, l’individu moderne ou « hyper moderne » se complexifie. Les supports collectifs se fragilisent et laissent échapper un certain nombre d’individus qui ne sont plus couverts par ces systèmes, une nouvelle forme d’individualité négative se met en place à cause de ce décrochage des collectifs et donne des « individus par défaut ». Par opposition aux précédents, les « individus par excès » sont des individus dont l’objectif principal est de se réaliser en tant qu’individu en se détachant des appartenances et des valeurs collectives. Aujourd’hui, on peut dire que tout individu est susceptible de décrochement si le collectif ne le soutient plus, d’où la peur du déclassement qui se généralise dans les générations plus jeunes pour les individus dont le statut professionnel n’est pas assuré. « L’individu ne tient pas debout tout seul » est une évidence qui s’impose. Affirmer la prééminence de la société, c’est poser que l’individu ne peut exister que dans une forme de lien social avec un collectif et qu’il a des droits et des devoirs envers ce collectif. Alors pour renforcer ces liens de l’individu avec le collectif, plusieurs pistes sont possibles : lutter sans relâche contre la montée des inégalités sociales, une des sources principales de la désaffiliation de beaucoup d’individus aujourd’hui, ensuite développer les « capabilités » des individus au sens que la philosophe Martha Nussbaum donne à ce terme, c’est-à-dire un ensemble de libertés et de réelles possibilités dans le domaine de l’éducation, de la santé, du travail, du logement, etc. et pas seulement des droits formels et enfin, permettre aux individus d’inventer de nouvelles formes de sociabilité, notamment dans une économie de partage et collaborative. Toutes ces nouvelles formes de sociabilité et de solidarité qui essaient de se mettre en place, quelquefois en tâtonnant, sont des chemins pour l’avenir de « notre » société d’individus dans laquelle nous sommes indissociablement « individu singulier » et « individu collectif » comme le dit Norbert Elias.
      PubDate: 2016-11-14T22:13:32Z
  • Éthique d’un savoir communiquer : ça va ' ou ça va ! Point
           d’exclamation ou point d’interrogation
    • Authors: Troude
      Abstract: Publication date: Available online 11 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): B. Troude
      Pour parler clair, ne doit-on pas se construire un autre monde de relations simples, un monde qui ne serait pas abstrait dont les paroles entendues seront du monde présent, en seront l’expression élémentaire, nous exigeant un effort de réflexions pour appréhender notre temps ' Le fait d’utiliser le procédé verbal très simplifié du « Ça va » afin d’entrer en communication est souvent retenu et compris comme une agression. Même sans y apporter le contenu, la seule ponctuation possible démontre le bienfait de la demande ou la non-compréhension créant la notion de refoulement. J’ai à soumettre ce qui devient dans la plupart des cas une intolérable injonction. Mais … ' Sommes-nous conditionnés à ce point qu’un terme comme le « Ça va » issu d’une méthode verbale ordinaire pour entrer en contact (méthode théoriquement correcte) soit aussi hyper efficace ' Ce conditionnement de la population, de l’humain à l’humain en particulier, se fait à son insu à l’aide de symboles opérants (lus, vus, parlés, entendus) par la connaissance de ses réflexes inconscients. Partant de cette perspective, ce texte veut faire allusion, pour la rencontre de deux personnes, au « penser son temps » qui ne peut signifier uniquement penser avec « l’esprit dominant » mais penser beaucoup d’autres temps vécus et générés quotidiennement par les humains, notamment à travers leurs multiples formes de vie. En clair, penser à l’implication d’une diversité contextuelle dans laquelle ces temps se produisent et non pas dans un seul contexte qui pourrait être qualifier de global. Il est dit très vite que nous nous trouvons souvent dans la situation à entendre cette fausse interrogation ou cette fausse affirmation et à saisir le comportement adéquat, alors que la posture de ceux et celles qui portent ce message (question/réponse) est souvent en apparente cordialité avec l’humain désigné mais pas nommé. Sauf celui ou celle qui reçoit le message et comprend rapidement que l’invective est pour sa personne. L’intonation avec le lieu où cela est prononcé est d’une dimension importante, lieu mais aussi instant présent. En tant que question, « Ça va » peut s’échanger et se comprendre en « Comment cela va ' » ou « Est-ce que ça va ' ». Et la différenciation entre le « Ça va ' » qui veut dire « comment » et celui qui demande « est-ce que », tient surtout à l’intonation de l’émetteur qui, par le rythme et l’appui tonal, indique plus ou moins d’angoisse et laisse plus ou moins de champ à la coloration de la répartie. Réponse il y aura, si la personne et l’ensemble des personnes présentes sont aptes à concorder laissant apparaître plus ou moins d’inquiétude, plus ou moins de compassion, plus ou moins d’intérêt logique ou par avance intéressés. Comprendre où cela se passe quand nous lançons « Ça va ' ». And not “How are you'”. To clear talk, should we not build another world of simple relationships, a world that is not abstract whose words will be heard in this world, will be the elementary expression, we require a reflection of effort to understand our time' Employing the very simplified verbal process of “Okay” to enter into communication is often retained and understood as aggression. Even without making the content there, the only punctuation demonstrates the benefit of the application or not understanding the concept of creating refoulement. I submit that this is in most cases an intolerable injunction. But …' Are we conditioned to the point that a term like “Okay” from a plain verbal method for contacting (theoretically correct method) is as hyperefficient' This conditioning of the population, human to human in particular, is unwittingly using operant symbols (read, seen, spoken, heard) by the knowledge of his unconscious reflexes. From this perspective, this text is referring to the meeting of two people, the “think time” that can mean only think with “the spirit dominant” but think of many other experienced time and generated daily by humans, particularly through their various life forms. Clearly, think about the implication of contextual diversity in which these times occur, not in one context could be described as global. It is said very quickly that we often find ourselves in the position to hear this false query, or the false claim and enter the appropriate behavior, while the posture of those who carry this message (question/answer) is often apparent cordiality with human nominated but not appointed. Except the one who receives the message and quickly understands th...
      PubDate: 2016-11-14T22:13:32Z
  • VIH/sida : révolutions et responsabilités
    • Authors: Lefin M.C.; Meyohas
      Abstract: Publication date: Available online 11 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): C. Lefin, M.C. Meyohas
      L’objet de cet article est de poser un regard historique, éthique et contemporain sur l’épidémie du sida, de son avènement à aujourd’hui. Cette approche diachronique permet de comprendre les enjeux en termes de responsabilités qui concernent chacun des acteurs de la société, contaminés comme non contaminés par le virus du sida. Un accent particulier est mis sur ce long parcours qui va de la mise en quarantaine des patients à la responsabilité personnelle afin de mieux cerner les révolutions qui se sont jouées durant ces trente années et leurs retombées en termes de progrès et de questionnements incessants. La clinique auprès des patients touchés par le VIH permet d’illustrer la réelle difficulté actuelle d’ajustement des uns aux autres face aux progrès thérapeutiques. Si les comportements et les mentalités ont largement évolués dans certains domaines, pour d’autres ils restent sous le sceau de préjugés négatifs et de stigmatisation. L’éthique qui sous-tend la pratique est source de questionnements fondamentaux et c’est bien cette déontologie respectueuse de l’humain dans son intégrité qui permet d’interroger ici, au terme de nombreuses révolutions, les changements actuels et à venir en lien avec cette pathologie. The purpose of this article is to look at the AIDS pandemic with an historical, ethical and contemporary eye, from its commencement to nowadays. This diachronic approach allows an understanding of the liabilities issues, which concern society players, which had been contaminated or not contaminated by AIDS. A specific emphasis is placed on this long journey, which runs from the quarantining of patients to the individual responsibility, to gain a better understanding of the revolutions that occurred during the past thirty years as well as their benefits in terms of progress and of repeated questioning. The clinic, close to patients with HIV, serves to illustrate the current real difficulty in adjusting each other in view of therapeutic advances. If behavior and mentalities have widely changed in some areas, for others it remains blocked under stigmatization and negatives prejudices. Ethics, which is the basis of the practice, is source of fundamental questionings. This is this deontology, respectful of the human in its integrity, which questioned here in terms of numerous revolutions, actual and future changes in conjunction with pathology.

      PubDate: 2016-11-14T22:13:32Z
  • La personne humaine, sa construction, sa dignité inaliénable et le
           commerce avec les autres
    • Abstract: Publication date: Available online 9 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): C. Hervé

      PubDate: 2016-11-14T22:13:32Z
  • Les droits des parents d’un malade psychique, entre toute puissance
           et impuissance
    • Authors: Doucin
      Abstract: Publication date: Available online 9 November 2016
      Source:Ethics, Medicine and Public Health
      Author(s): M. Doucin
      Le dispositif français d’hospitalisation à la demande de tiers (HDT) pour les malades psychiatriques demande au « tiers », c’est-à-dire son parent proche le plus souvent, de jouer un rôle surpuissant de juge de l’opportunité de priver de liberté une personne qu’il aime. Sitôt après, ce parent est écarté du processus de soins et tenu à distance de son proche, celui-ci étant placé en isolement. Le respect des droits fondamentaux de l’Homme et celui des lois françaises qui ont cherché à les consolider dans l’univers psychiatrique, où la pratique de « l’isolement thérapeutique » est systématique, est posé. The French forced hospitalization system on requirement of a third person for psychiatric diseases asks “the third person” (i.e. a close relative) to play the mighty role of depriving from freedom a person he cherishes. Soon after, this parent is departed from the care process and left apart from his loved one while this one is placed in an isolation room. The respect of human rights and of French laws aimed at consolidating them in the psychiatric field, where systematic use of “therapeutic isolation” is practiced, is led upon.

      PubDate: 2016-11-14T22:13:32Z
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