Il s’agit dans cet article de montrer que l’éthique ricoeurienne exposée dans Soi-même comme un autre peut et doit être pensée par rapport à l’anthropologie et l’ontologie que le philosophe a progressivement développées depuis son premier grand projet philosophique phénoménologique jusqu’à son œuvre de maturité. Dans le but d’esquisser cette approche des fondements onto-anthropologiques de l’éthique ricœurienne, nous partons d’abord des textes de jeunesse de Ricœur dans lesquels il développe une longue méditation sur le risque qu’implique l’acte de la liberté: (...) risque d’être soi-même, de décider et d’agir sur le monde avec et pour les autres. Puis, notre analyse s’intéresse à la conception ricœurienne du consentement et de l’affectivité afin de voir dans quelle mesure elle est susceptible d’éclairer le développement de l’éthique et de la notion de sujet éthique dans le cadre de la phénoménologie herméneutique de Ricœur. L’article conduit ainsi une analyse de la question du “je peux” et du “je veux” dans Le volontaire et l’involontaire, en passant par L’homme faillible pour déboucher enfin sur un examen de “l’homme agissant et souffrant” dans Soi-même comme un autre. (shrink)

Plusieurs sagesses démotiques de l’Égypte ancienne rédigées entre le ve et le ier siècle avant notre ère déconseillent à leur lecteur d’entretenir des relations sexuelles avec des femmes mariées. Si la perception négative de l’adultère est évidente dans les extraits étudiés, qu’en est-il du consentement des femmes? Est-il possible d’établir si ces relations étaient consenties ou non? L’analyse de la terminologie et du contexte des occurrences ainsi que la comparaison avec d’autres textes issus de la littérature démotique permettent à (...) l’auteure de souligner qu’en réalité, ce n’est pas le consentement des partenaires qui doit être interrogé mais la prise en compte de ce consentement par les auteurs des textes. Ces documents nous renseignent ainsi sur la perception de la sexualité féminine dans la société égyptienne aux époques tardives. (shrink)

L’affaire Weinstein et le mouvement #MeToo ont mis la question des violences sexuelles au premier plan. Depuis, le consentement renvoie naturellement au consentement sexuel et amoureux, envisagé comme un sésame de l’égalité entre femmes et hommes. Pourtant, il est bien difficile à définir, et soulève trois problèmes. Le problème juridique, bien connu de celles et ceux qui suivent l’actualité, peut être résumé ainsi: que faire pour que les cas de viol, d’agression et de harcèlement sexuels soient efficacement punis (...) ? Le deuxième problème est moral : comment penser des relations amoureuses et sexuelles qui ne soient pas fondées sur des normes sociales sexistes et inégalitaires ? Enfin, le problème politique : comment ne pas reconduire les injustices de genre qui se manifestent dans les rapports amoureux et sexuels ? La magistrale analyse du consentement que propose Manon Garcia revisite notre héritage philosophique, plongeant au cœur de la tradition libérale, mettant à nu ses impensés et ses limites. De John Locke aux théoriciennes féministes françaises et américaines, en passant par Michel Foucault et les débats sur la pratique du BDSM, c’est une nouvelle cartographie politique de nos vies privées que dessine cet essai novateur. Au terme de ce livre, il s’agira en somme, pour reprendre la formule de Gloria Steinem, d’« érotiser l’égalité » plutôt que la domination : en ce sens, le consentement sexuel, conçu comme conversation érotique, est sans doute l’avenir de l’amour et du sexe. (shrink)

Contre l’éternelle utopie, thème des conservateurs et des contrerévolutionnaires, postulant que le discours de l’utopie, identique à lui-même, revient toujours pour légitimer une société close, autoritaire et statique, négatrice de toute temporalité, et de la pluralité et de la singularité des individus, Miguel Abensour atteste de la persistance des utopies, recherche asymptotique, volontariste et sans cesse renouvelée d’en finir avec la domination, la servitude volontaire et l’exploitation, comme si chaque moment de lutte suscitait une nouvelle sommation utopique au non-consentement (...) à l’ordre des choses et à la recherche d’un tout autre social, sous l’impératif d’une conversion qui lie indistinctement philosophie, utopie et émancipation humaine. (shrink)

Audrey Ghali-Lachapelle et Sabrina Maiorano.

Les raisons pour lesquelles Durkheim a pris parti contre le rétablissement du divorce par consentement mutuel ne sauraient se réduire à son désintérêt pour la cause des femmes : il y va de l’institution du statut de personnes à chacun. Si la division sexuelle du travail au sein du couple marié possède cette vertu et si l’institution du mariage protège les partenaires, tel n’est pas le cas au niveau de la division du travail social. Ceci a des effets sur (...) la sexualité des hommes, engendrant une souffrance toute particulière tandis que les femmes n’en sont pas affectées. Leur interdire le divorce semble alors une exigence de justice sociale tant que la division du travail reste anomique et/ou n’intègre pas les femmes. Les analyses de Durkheim constituent une conceptualisation nouvelle du terme de liberté moderne qui permet encore aujourd’hui d’éclairer les demandes d’un élargissement de l’état matrimonial. (shrink)

Cet ouvrage vient conclure l’aventure d’un collectif – CONTRAST – animé par Benoît Eyraud et Livia Velpry pendant cinq ans sur les questions cruciales de la place du consentement et du recours à la contrainte en santé mentale. Après une présentation rapide du collectif, l’introduction générale (Livia Velpry et Pierre Vidal-Naquet) rappelle que la dynamique de promotion des droits initiée au début des années 2000 fait que l’avis des personnes “tend à devenir incontournable, voire un prérequis”...

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

In a community that takes rights seriously, consent features pervasively in both moral and legal discourse as a justifying reason: stated simply, where there is consent, there can be no complaint. However, without a clear appreciation of the nature of a consent-based justification, its integrity, both in principle and in practice, is liable to be compromised. This book examines the role of consent as a procedural justification, discussing the prerequisites for an adequate consent -- in particular, that an agent with (...) the relevant capacity has made an unforced and informed choice, that the consent has been clearly signalled, and that the scope of the authorisation covers the act in question. It goes on to highlight both the Fallacy of Necessity (where there is no consent, there must be a wrong) and the Fallacy of Sufficiency (where there is consent, there cannot be a wrong). Finally, the extent to which the authority of law itself rests on consent is considered. If the familiarity of consent-based justification engenders confusion and contempt, the analysis in this book acts as a corrective, identifying a range of abusive or misguided practices that variously under-value or over-value consent, that fictionalise it or that are fixated by it, and that treat it too casually or too cautiously. In short, the analysis in Consent in the Law points the way towards recognising an important procedural justification for precisely what it is as well as giving it a more coherent application. (shrink)

Marie-Hélène Desmeules recalls how phenomenology, although being an essentially descriptive method, has from its beginnings tried to elucidate the normative aspects of our experience. According to the first phenomenologists, intentionality – a key notion of phenomenology – has been at the basis of many experiments with a normative content. However, by thinking of normativity in terms of the intentional structure, phenomenologists have often reduced the former to a form of theoretical normativity. In this paper, she aims to demonstrate that intentionality (...) is still a relevant notion when it comes to thinking about the constitution of practical normativities that are irreducible to a form of theoretical normativity. I take the intentional act of consenting as a guiding example, and identify its specific practical normative effects by comparing it to the intentional acts of promising, accepting and approving, as described by Adolf Reinach and Edmund Husserl. (shrink)

Qu'est-ce qui oriente la philosophie? Depuis Platon, le philosophe est celui qui tourne son regard vers le Bien et qui adopte une manière de vivre en accord avec sa pensée. Qu'est devenue cette manière de vivre comme exigence philosophique, pour un philosophe qui se laisse inspirer par la révélation chrétienne? Faut-il la nommer "sainteté"? Cet ouvrage présente six philosophes du XXe siècle qui ont cherché à accorder leur pensée et leur manière de vivre : Maurice Blondel, Erich Przywara, Simone Weil, (...) Aimé Forest, Michel Henry, Edith Stein. Des philosophes à l'écoute d'une inspiration qui oriente leur existence. La philosophie comme un acte de résistance spirituelle. Il y a là beaucoup à apprendre. (shrink)

Valid consent requires the potential research participant understands the information provided. We examined current practice in 50 proposed Clinical Trials of Investigational Medicinal Products to determine how this understanding is checked. The majority of the proposals ( n = 44) indicated confirmation of understanding would take place during an interactive conversation between the researcher and potential participant, containing questions to assess and establish understanding. Yet up until now, research design and review have not focussed upon this, concentrating more on written (...) material. We propose ways this interactive conversation can be documented, and the process of checking understanding improved. (shrink)

In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. (...) The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process. (shrink)

In order to involve children in the decision-making process about participation in medical research it is widely recommended that the child’s assent be sought in addition to parental consent. However, the concept of assent is fraught with difficulties, resulting in confusion among researchers and ethics committees alike.

Hypothetical consent is puzzling. On the one hand, it seems to make a moral difference across a wide range of cases. On the other hand, there seem to be principled reasons to think that it cannot. In this article I put forward reasonably precise formulations of these general suspicions regarding hypothetical consent; I draw several distinctions regarding the ways in which hypothetical consent may make a moral difference; I distinguish between two autonomy-related concerns, nonalienation and sovereignty; and, utilizing these distinctions, (...) I show that—and in a preliminary way, when—the objections to the moral significance of hypothetical consent fail. (shrink)

My starting point is what I call the Normative Authority Conception of justification, where S is justified in their belief that p at t (to some degree n) if and only if their believing that p at t is not ruled out by epistemic norms that have normative authority over S at t. With this in mind, this paper develops an account of doxastic justification by first developing an account of the normative authority of epistemic norms. Drawing from work in (...) political philosophy, I argue that (a) the cognitive and evaluative commitments and concerns behind our actual practices of holding each other and ourselves accountable for our beliefs reveal which epistemic norms we have consented to be under, and that (b) it is because we have consented to be under the authority of these norms – by actually holding ourselves and others accountable to them – that they in turn have normative authority over us. By connecting the authority of epistemic norms to the authority we have over ourselves in this way, the resulting account of doxastic justification (i) explains why it can be appropriate to criticize, resent, or sanction someone for having unjustified beliefs, (ii) avoids the phenomena of normative alienation and normative parochialism, and (iii) respects the social and collective nature of epistemic justification. (shrink)

In this article we provide an in-depth description of a new model of informed consent called ‘meta consent’ and consider its practical implementation. We explore justifications for preferring meta consent over alternative models of consent as a solution to the problem of secondary use of health data for research. We finally argue that meta consent strikes an appropriate balance between enabling valuable research and protecting the individual.

The practice around informed consent in clinical medicine is both inconsistent and inadequate. Indeed, in busy, contemporary health care settings, getting informed consent looks little like the formal process developed over the past sixty years and presented in medical textbooks, journal articles, and academic lectures. In this article, members of the Society of Teachers of Family Medicine (STFM) Collaborative on Ethics and Humanities review the conventional process of informed consent and its limitations, explore complementary and alternative approaches to doctor‐patient interactions, (...) and propose a new model of consent that integrates these approaches with each other and with clinical practice. The model assigns medical interventions to a consent continuum defined by the discrete categories of traditional informed consent, assent, and nondissent. Narrative descriptions and clinical exemplars are offered for each category. The authors invite colleagues from other disciplines and from the academic ethics community to provide feedback and commentary. (shrink)

People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in turn lead to limited (...) abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person’s health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process. (shrink)

Since its advent in the 20th century, informed consent has become a cornerstone of ethical healthcare, and obtaining it a core obligation in medical contexts. In my dissertation, I aim to examine the theoretical underpinnings of informed consent and identify what values it is taken to protect. I will suggest that the fundamental motivation behind informed consent rests in something I’ll call bodily self-sovereignty, which I argue involves a coupling of two groups of values: autonomy and non-domination on the one (...) hand, and self-ownership and personal integrity on the other. I will then go on to consider two 'case studies' I take to shed light on what is at stake in securing informed consent - consent in psychiatrically ill populations, and consent to interventions that involve the modification of the genetic germline. (shrink)

Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching (...) Hospitals in a low resource setting. (shrink)

The article explores the challenges of ensuring voluntary and informed consent which is obtained from potential research subjects in the north‐eastern part of Romania. This study is one of the first empirical papers of this nature in Romania. The study used a quantitative survey design using the adapted Quality of Informed Consent (QuIC) questionnaire. The target population consisted of 100 adult persons who voluntarily enrolled in clinical trials. The informed consent form must contain details regarding the potential risks and benefits, (...) the aim of the clinical trial, study design, confidentiality, insurance and contact details in case of additional questions. Our study confirmed that although all required information was included in the ICF, few clinical trial participants truly understood it. We also found that the most important predictive factor for a good subjective and objective understanding of the clinical trial was the level of education. Our study suggests that researchers should consider putting more effort in order to help clinical trials participants achieve a better understanding of the informed consent. In this way they will ensure that participants’ decision‐making is meaningful and that their interests are protected. (shrink)

The acquisition of fully informed consent presents a central ethical problem for the procurement and storage of human tissue in biobanks. The tension lies between the apparent necessity of obtaining informed consent from potential research subjects and the projected future use of the tissue. Specifically, under the doctrine of informed consent medical researchers are required to inform their potential research subjects about the relevant risks and purposes of the proposed research (Declaration of Helsinki, 2008, “Section 24.” Accessed November 1, 2009. (...) http://www.wma.net/en/30publications/10policies/b3/index.html). However, because human tissue – when stored in biobanks – can be put to multifarious uses, the information that medical researchers are expected to divulge to their subjects is epistemologically inaccessible. Biobank researchers are thus thought to be unable to obtain informed consent from their subjects, making the practice ethically suspicious. We propose that such suspicions of ethical failure should be reconsidered by presenting two possible solutions. Firstly we argue that the epistemological difficulty might be partially solved by adopting the “waiver model” of informed consent. Secondly, we put forward an argument that individual consent can be supplemented by group ethical models. We thus conclude that while informed consent is problematic for biobank researchers, alternative ethical solutions are available. (shrink)