Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically (...) on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

Chaque jour, les professionnels de la santé doivent prendre des décisions dans des environnements complexes où s'affrontent de multiples normes qu'il n'est pas toujours facile de départager ni de mettre au clair afin de prendre une décision éclairée. Pourtant, les modèles de prise de décision dont disposent actuellement les éthiciens cliniques ou les comités de bioéthique comportent souvent des lacunes lorsqu'il s'agit d'aborder des problèmes à plusieurs niveaux (micro, méso et macro). Les décisions reposent ainsi trop souvent sur l'intuition plutôt (...) que sur une démarche systématique rigoureuse et facilement reproductible. Afin de pallier la situation, cet ouvrage fournit des outils théoriques et pratiques facilitant la prise de décision. Fondé sur l'étude collective d'un cas complexe ayant trait aux dimensions tragiques des choix éthiques en fin de vie (doit-on ou non administrer un médicament coûteux pour le traitement d'un cancer au stade avancé?), il réunit les contributions de plusieurs experts reconnus travaillant dans le système de santé (cliniciens, éthiciens, chercheurs, gestionnaires et décideurs publics). En raison de l'actualité des enjeux qui y sont traités et de la qualité des textes qui y sont rassemblés, cet ouvrage sera un outil pédagogique efficace pour les étudiants, les enseignants et les professionnels de la santé et aura certainement une incidence importante sur le mode de prestation des soins. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

Background: In psychiatry, the issue of providing palliative and end-of-life care for what would be a “terminal psychiatric condition” or considering a palliative approach to severe and persistent mental health problems is still a taboo. Methodology: This question is addressed through an analysis of a case arising during a clinical ethics consultation, using Hubert Doucet’s scenario method. It is about Mrs. Sanchez, a patient over 90 years of age with a psychiatric profile, expressing the desire to die by suicidal gestures, (...) refusing the proposed treatments, and refusing as well to drink and eat. Her clinical history is told through the filter of reflexive support offered in clinical ethics to the various stakeholders. Results: The case analysis, far from responding to the challenges posed by the concept of palliative and end-of-life care in a psychiatric context, nevertheless presents an opportunity to name its main ethical issues: psychic suffering, refusal to eat and drinking as well as refusal of treatment, palliative sedation and medical assistance in dying, wishes and advanced medical directives and clinical-organizational challenges for geriatric psychiatry clients. Conclusion: There are still many challenges for professionals and decision-makers to meet the needs of older mental health clients. We call for further development of knowledge on this specific topic. (shrink)

BackgroundMedical aid in dying was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two (...) Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend. (shrink)

Festschrift for Maḍiniyavela Śrī Mēdhaṅkara, Sri Lankan Buddhist monk; contributed articles chiefly on economic and ethical aspects of Buddhism.

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically (...) on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

A relevância deste artigo se deve ao fato de ser apriori uma leitura fenomenológica de Jesus, em sua historia singular e universal. A temática do texto apresentado diz respeito às questões relacionadas com o pensamento teológico, no diálogo com a filosofia, enfatizando fenômeno-lógicamente a historicidade de Jesus sob a perspectiva hermenêutica. Portanto, um hori-zonte analítico-filosófico se abre para a fenome-nologia do corpo de Jesus, considerando toda história, do nascimento até seu conflito na cruz, como história de amor, doação e amizade, (...) com-tinuada fenomenológica-mente em seu corpo doado. (shrink)

Jean-Paul Sartre is a man who lived half his life in the limelight of extreme notoriety. An intellectual who already in 1945 had to protest against attempts aimed at institutionalizing the writer, turning his works into 'national goods', exclaiming: 'it is not pleasant to be treated in one's lifetime as a public monument'. What must be equally unpleasant is to be constantly subjected to abuse. And the fact is that no writer in his lifetime has been the target of so (...) many attacks, from the most varied and rather powerful quarters, as Jean-Paul Sartre. What are the reasons? How should we approach the work of this man, our contemporary? (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

In recommending a book like this, one is tempted to fall back on cliches such as 'brilliant insights', 'original perspectives', etc. The origina lity of this book is on a different plane. The problem of subject and object has been central to Western philo sophic thinking at least since the time of Descartes. So much so that many students of philosophy see it as the philosophical problem. In his Mundus Cognobilis and Mundus Causalis Mr. Mes offers an ontological-epistemological view, the (...) originality of which consists precisely in the fact that it is not an innovation. Rather, it seeks to put 'in order' the elements already at hand in such a way as to show the subject-object paradox to be non-existent where it seems to be significant and trivial where it really does occur. He has a new and interesting perspective both on what 'materialism' might mean and on how a 'scientific' view of the world has to be constructed. 'Energy-patterns' emerge as explanatory ulti mates, although there is no effort to arrive at any sort of ultimate meta physics. (shrink)

[1] Ḥeleḳ ha-moʻadim -- [2] Ḥeleḳ parashiyot ha-Torah -- ḥeleḳ 3. Be-ʻinyene midot.

O mistério das relações divinas com o homem, no pensamento do teólogo Suiço Hans Urs von Balthasar, sempre focou a kenosis de Deus como uma renúncia a Sua divindade. Mas o sofrimento do homem comum e a injustiça que a sociedade lhe impôs, em tantos momentos da história, obrigam a ir mais além. A personali-dade do homem Jesus não apenas revela o mistério das relações trinitárias, mas no assu-mir a dor humana, e o risco da própria vida em favor da (...) justiça, Jesus revela também o verda-deiro homem contido no sonho da criação e chamado à vida plena no mundo. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

In the contemporary context of increasing inequality and various forms of segregation, this volume analyzes the transition to neoliberal politics in Santiago de Chile. Using an innovative methodological approach that combines georeferenced data and multi-stage cluster analysis, Méndez and Gayo study the old and new mechanisms of social reproduction among the upper middle class. In so doing, they not only capture the interconnections between macro- and microsocial dimensions such as urban dynamics, schooling demands, cultural repertoires and socio-spatial trajectories, but also (...) offer a detailed account of elite formation, intergenerational accumulation, and economic, cultural, and social inheritance dynamics. (shrink)