Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including interventional (...) and observational studies. WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues are presented. To accelerate study approval in future public health emergencies, we recommend: internally consistent and complete submissions with information documents in language participants are likely to understand, close collaboration between local and international researchers from research inception, generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, direct information exchange between the chairs of advisory, safety review and ethics committees, more Ethics Committee support for investigators than is standard and a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care. (shrink)

Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation. More specifically, clinical ethics needs both theoretical tools to analyze and practical strategies to address structural discrimination within clinical ethics consultations. (...) Intersectionality, a concept developed in Black feminist scholarship, is increasingly considered in bioethical theory. It stresses how social structures and practices determine social positions of privilege and disadvantage in multiple, mutually co-constitutive systems of oppression. This article aims to investigate how intersectionality can contribute to addressing structural discrimination in clinical ethics consultations with a particular focus on mental healthcare. To this end, we critically review existing approaches for clinical ethics consultants to address structural racism in clinical ethics consultations and extend them by intersectional considerations. We argue that intersectionality is a suitable tool to address structural discrimination within clinical ethics consultations and show that it can be practically implemented in two complementary ways: 1) as an analytic approach and 2) as a critical practice. (shrink)

This paper draws on an in-depth phenomenological analysis of some interviews taken from volunteers, inviting them to reflect on their lived experiences of meaningfulness in the context of volunteering and citizenship. It is found that while some testimonies reinforce the standard conceptions of meaningfulness, other testimonies vary from it. The main challenge of this contribution consists in phenomenologically describing this alternative picture of meaningfulness, depicted as the event of wit(h)nessing. In a final part, the authors consider how volunteering is at (...) times especially prone to further experiences of wit(h)nessing. (shrink)

Peter Singer est un philosophe utilitariste de renommée internationale. Il est titulaire de la chaire de bioéthique à Princeton. Depuis une trentaine d’années il s’intéresse à des questions éthiques telles que le statut moral des animaux, la bioéthique, l’environnement, et la manière de lutter contre la pauvreté dans le monde. C’est à cette question qu’il consacre son dernier ouvrage, paru en France en 2009 : Sauver une vie. Agir maintenant pour éradiquer la pauvreté.Sauver une vie n’est pas ..

Many students have experienced the death of a loved one, which increases their risk of grief and mental health problems. Formal and social support can contribute to better coping skills and personal growth in bereaved students. The purpose of this study was to examine the support that students received or wanted to receive and its relation to students’ mental health. We also looked at students’ needs when receiving support and barriers in seeking formal and social support. Participants completed an online (...) survey consisting of questions about their sociodemographic characteristics, the support they received or wanted to receive, and support needs and barriers in seeking support. The survey also included three scales assessing grief, mental health distress, and personal growth. First, we analyzed the data descriptively. Next, we used MANCOVA to examine whether students who did or did not receive or wanted more support differed in terms of their grief, mental health distress, or personal growth. About 30% of students needed more support and experienced more grief and mental health distress than students who had their support needs met. Students who received support experienced more personal growth and grief than students who did not receive support. Students indicated a need for feeling acknowledged and safe. Feeling like a burden to others and perceiving their problems as not serious enough to warrant support were common barriers to seeking support. Our results indicate that support should be provided actively to students after the death of a loved one, and support being available on an ongoing basis. (shrink)

Patočka has never developed the political and historical concept of dissidence. But trying to sketch its phenomenological foundation in the writings of the Czech philosopher, who experienced human liberty as an act of dissidence, could be an original way in qualifying his alternative idea of the modern subjectivity in phenomenology: between finitude and autonomy. The first part of the article presents the radical criticism aimed by Patočka to the transcendental subjectivism of Husserl, and thinks the requirement of a split between (...) autofoundation and autonomy. Then, it is analysed the articulation between the movement of life and the movement of existence, in which lies the very idea of dissidence. In a third and final part, one shows to what extent the dissident subjectivity fully reveals itself in the political life. (shrink)

Background Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including (...) interventional and observational studies. WHO-ERC reviews WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues are presented. Conclusions To accelerate study approval in future public health emergencies, we recommend: internally consistent and complete submissions with information documents in language participants are likely to understand, close collaboration between local and international researchers from research inception, generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, direct information exchange between the chairs of advisory, safety review and ethics committees, more Ethics Committee support for investigators than is standard and a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care. (shrink)

When the grounded theory appears in the 60s, it is presented and received as methodological innovation in break by the scientific traditional model. Though it is novel in several aspects, the TA is also tributary of the American sociology and the phenomenology, a double heredity that was, and contin..

Background To characterize patients dying in a community hospital with or without attempting cardiopulmonary resuscitation and to describe patient involvement in, documentation of, and compliance with decisions on resuscitation. Methods All patients who died in Kalmar County Hospital during January 1, 2016 until December 31, 2016 were included. All information from the patients’ electronic chart was analysed. Results Of 660 patients female), 30 were pronounced dead in the emergency department after out-of-hospital CPR. Of the remaining 630 patients a DNAR order (...) had been documented in 558 patients. Seventy had no DNAR order and 2 an explicit order to do CPR. In 43 of these 70 patients CPR was unsuccessfully attempted while the remaining 27 patients died without attempting CPR. In 2 of 558 patients CPR was attempted despite a DNAR order in place. In 412 patients the DNAR order had not been discussed with neither patient nor family/friends. Moreover, in 75 cases neither patient nor family/friends were even informed about the decision on code status. Conclusions In general, a large percentage of patients in our study had a DNAR order in place. However, 27 patients died without CPR attempt or DNAR order. DNAR orders had not been discussed with the patient/surrogate in almost three fourths of the patients. Further work has to be done to elucidate the barriers to discussions of CPR decisions with the patient. (shrink)

Dans un régime comme celui de la République populaire de Chine, où prévaut la suprématie d’un Parti-État unique, la politique et le politique constituent, a fortiori plus qu’ailleurs, la chasse gardée de l’élite dirigeante du pays, à savoir les cadres du Parti communiste. Cet article tente de saisir qui sont les élites politiques aux commandes de la Chine d’aujourd’hui à travers l’analyse du modus operandi de l’École des cadres du Parti de Shanghai. L’étude de cette institution, qui participe à la (...) régulation de la circulation des élites et constitue l’un des lieux privilégiés de la transmission et de l’exercice du pouvoir, permet, par-delà son propre fonctionnement, d’éclairer la nature et le devenir même du régime. S’il apparaît que les forces modernisatrices, en assimilant davantage l’École du Parti à un institut d’administration publique, œuvrent à la professionnalisation du métier de cadre, c’est également et avant tout afin de mieux perpétuer l’hégémonie du Parti-État unique.In a regime where the one Party-State rule still prevails, as is the case in the People’s Republic of China, the polity and politics constitute – here more than anywhere else – the private ground of the country’s ruling elite, i.e. the cadres of the Communist Party. This article attempts to grasp who the political elites in control of contemporary China are, by analyzing the modus operandi of the Shanghai Party School for Cadres. The study of an institution that takes part in the circulation of the elites and hence constitutes one of the privileged playing fields for the transmission and the exercise of power, allows, beyond the understanding of its own working, to shed light on the very nature and evolution of the regime. If the modernizing forces appear to work towards the professionalization of the cadres’ craft by equating the Party School to an institute of public administration, they ultimately do so in order to better perpetuate the supremacy ofthe one-Party system. (shrink)

Este artículo tiene como objetivo explorar las identidades matemáticas de 33 mujeres jóvenes en su encuentro con las matemáticas de la escuela secundaria superior post-obligatoria. Todas han optado por avanzar en matemáticas hasta el nivel A, separándolas de muchas otras estudiantes jóvenes de todo el mundo. A través de un marco de identidad que consta de cuatro componentes interrelacionados (competencia, desempeño, interés y reconocimiento) se realizaron y analizaron entrevistas narrativas con ellas para explorar la interacción entre las mujeres jóvenes y (...) el contexto educativo disciplinar. Los hallazgos muestran una idealización de una vía estrecha para identificarse con las matemáticas para los seleccionados que pueden producir respuestas correctas. Sin embargo, la variación en la ruta hacia el éxito se relaciona con la forma como se ven a sí mismas como arduas trabajadoras o como poseedoras de habilidades especiales para las matemáticas. La identificación de estas diferencias ofrece una comprensión más amplia de la identificación de mujeres jóvenes exitosas con las matemáticas. (shrink)

Après avoir présenté l’institution récente de la kafâla, qui fut légalisée en Algérie en 1984 et au Maroc en 1993 en faveur des enfants abandonnés et en substitution au modèle prohibé de l’adoption, l’article propose une analyse des données recueillies lors d’une enquête ethnographique menée de 2005 à 2009. Elle révèle que l’enfant illégitime encourt davantage le risque d’être abandonné à la naissance s’il est de sexe masculin. En revanche, s’il est de sexe féminin, il bénéficie de plus de chances (...) de faire l’objet d’un don provisoire, direct et négocié, et surtout d’être adopté ou recueilli en kafâla suite à son abandon en institution. (shrink)

Although beef and dairy production in Alberta, Canada, enjoys strong public support, there are enduring public concerns, including farm animal welfare. Evolving codes of practice and animal care councils prescribe changes and improvements to many areas of farm management, and may be seen by farmers as an appropriate response to public animal welfare concerns. However, codes of practice do not address every animal welfare concern, and new concerns can arise over time. Drawing on social practice theory and in-depth field research (...) with 36 cattle and dairy farmers, this paper explores the materials, competencies, and meanings of four animal husbandry practices: branding, dehorning, weaning, and on-farm handling and moving. Findings show that branding and dehorning are evolving slowly with attention to pain management, but remain firmly rooted in ranching tradition and communities of practice. Weaning and animal handling practices are evolving more quickly with attention to changing materials, attitudes, and values that are more prevalent within producer communities. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in the context of (...) rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

Contexte : L’autonomie est un concept central tant en bioéthique qu’en réadaptation. La bioéthique a mis l’accent sur l’autonomie en tant qu’auto-gouvernance et sur son application dans la prise de décision en matière de traitement. En plus de discuter de l’autonomie décisionnelle, la réadaptation met aussi l’accent sur l’autonomie en tant qu’indépendance fonctionnelle. Dans la pratique, la prise en charge des patients en perte d’autonomie est une composante importante des soins de réadaptation, mais elle engendre aussi des tensions et des (...) défis. Notre objectif était de mieux comprendre les façons complexes et distinctes dont l’autonomie est comprise et maintenue dans le contexte des soins de réadaptation en examinant comment l’autonomie est abordée dans la littérature sur la réadaptation. Méthodes : Nous avons effectué une étude de la portée des questions d’autonomie dans le contexte de la réadaptation mentale et physique. Notre processus s’est déroulé en trois étapes séquentielles. Nous avons extrait et analysé des informations bibliométriques. Nous avons ensuite examiné comment l’autonomie était définie et conceptualisée. Enfin, nous avons examiné la façon dont les articles traitaient du rôle des professionnels de la santé en réadaptation dans l’autonomie des patients. Résultats : Les articles comprennent 16 rapports empiriques, 17 études de cas et 30 articles théoriques. Les récits conceptuels les plus courants sur l’autonomie s’appuyaient sur le principisme, les analyses fondées sur les droits et les analyses juridiques et les approches relationnelles/sociales. Nous avons identifié quatre grandes approches pour répondre à l’autonomie du patient : le soutien, la promotion, le respect et la promotion. Conclusion : Cet examen aide à clarifier certaines des ambigüités et des distinctions conceptuelles qui sous-tendent les discussions et les pratiques liées à l’autonomie en réadaptation. Il attire également l’attention sur un large éventail d’activités que les professionnels de la santé peuvent entreprendre dans le but de soutenir, de promouvoir, de respecter et de promouvoir l’autonomie des patients dans les soins de réadaptation. (shrink)

"Literature and the Right to Marriage," which bears the same title as the special issue that it introduces, takes up the challenge of the claim that marriage is a universal right. Framing the questions that traverse the five essays in the collection with a close reading of the sections on marriage from Hegel's Elements of the Philosophy of Right, the authors argue that if marriage can be considered a right, this right both guarantees access to and is founded upon each (...) partner's vow to abide by his or her vows to the other. Hegel's text is important because it underscores the linguistic dimension of the marriage ceremony; and it thus helps to show that, if the right to marriage were universal, it must be understood as the right to an irreplaceable kind of ritual speech. Moreover, this text is remarkably modern in its emphasis upon love as the condition of rightful marriage. Hegel considered the exchange of marriage vows to be a political event at which love becomes ethical , and ethics becomes political ; and thus also the point at which the model for "ethical love" becomes the verbally solemnized love between a man and a woman rather than the priestly love of the neighbor. Marriage, for Hegel, is always a turning point, both in the lives of the couple and in the history of the state. But this means that the importance of any marriage cannot be measured in terms of a norm; it can only be measured in terms of the amorous situation that precedes the event of marriage. Hegel's analyses are indispensable for grasping the stakes of the essays collected in this special issue and for addressing contemporary questions about which couples have the right to marry and what marriage becomes when those who would marry already have shared long and complex lives together. (shrink)

In the present context of aging populations, the question of how to support older workers who want to stay in employment longer is of particular importance, especially from a social justice perspective with regards to income. The challenges faced by organizations and governments are unprecedented. Interesting conclusions can be drawn from our research with regard to these challenges. First of all, the perception of retirement appears more or less unchanged over the years and remains very positive. Consequently, one of the (...) barriers to the employment of older workers may be the image of retirement itself, since it is still perceived as a gift or a right. Secondly, our results confirm that forcing people to stay longer in the labour market is a largely unpopular measure. Consequently, if public retirement plans offer limited income, governments and organizations should adopt a more voluntary approach to encourage older workers to stay in employment longer for a better income. Our results highlight the importance of the sector and type of job in the measures or incentives that could encourage older workers to stay in employment longer. Consequently, governments and organizations will probably have to adopt a contingent approach; i.e., all incentives do not necessarily fit all jobs or all sectors and social justice would require this be taken into account. We identified three sets of measures that could encourage older workers to stay in employment longer, and thus have access to better economic security: the reduction of working time, the flexibility of working time, and the individualization of retirement options and working time. The progressive reduction of their working time appears most interesting to our respondents. These measures appear to favour social justice in terms of income and right to employment at the end of active careers. (shrink)

Contre toute attente, si l’on adopte la perspective d’un « augustinisme politique », les concepts de « cité céleste » et de « cité terrestre » ne font justement l’objet d’aucune interprétation politique dans les milieux intellectuels franciscains du xiii e siècle. Jérusalem et Babylone représentent d’abord des manières d’être et de vivre ensemble, et font donc l’objet d’une lecture spirituelle. Les frères mineurs n’en ont pas moins essayé d’esquisser, à l’écart des deux cités mystiques, un espace intermédiaire, cité des (...) hommes, qui pouvait prendre la forme d’une république chrétienne universelle (Roger Bacon), d’une théocratie juridique dont le pape est le sommet terrestre (Bonaventure), ou plus radicalement d’une anticipation de la Jérusalem céleste. Cette dernière voie est celle du joachimisme, dont Bonaventure a tenté de présenter une version orthodoxe à travers l’image de la Jérusalem d’en bas. (shrink)

This paper examines Irish campaigns for condom access in the early 1990s. Against the backdrop of the AIDS crisis, activists campaigned against a law which would not allow condoms to be sold from ordinary commercial spaces or vending machines, and restricted sale to young people. Advancing a conception of ‘transformative illegality’, we show that illegal action was fundamental to the eventual legalisation of commercial condom sale. However, rather than foregrounding illegal condom sale as a mode of spectacular direct action, we (...) show that tactics of illegal sale in the 1990s built on 20 years of everyday illegal sale within the Irish family planning movement. Everyday illegal sale was a long-term world-making practice, which gradually transformed condoms’ legal meanings, eventually enabling new forms of provocative and irreverent protest. Condoms ‘became legal’ when the state recognised modes of condom sale, gradually built up over many years and publicised in direct action and in the courts. (shrink)

From Italian physician Hieronymus Mercurialis’s contention that the stomach was ‘the king of the belly’, to its promotion by the end of the nineteenth century to the ‘monarch of humanity’ in patent medicine, to Byron Robinson’s discovery of the enteric nervous system in 1907 (a mesh of neural connectivity that led him to dub the gut ‘the second brain’), there has historically been a longstanding awareness of the expansive reach of the gut in the functions of the body. In the (...) nineteenth century, the authority of the gut and its allyship with the brain became a focus for writers thinking about the intersections of illness and ‘modern life’. In medical texts, domestic health manuals, patent medicine, and fiction, the electric telegraph in particular became a way of envisaging what we would now call the ‘gut-brain axis’. The telegraphic metaphor enabled a view of digestion as not simply a mechanical or chemical process, but one that was understood in terms of time, space, and communication. However, such a framework also suggested problems of connection that were common to both systems, emphasising not only the healthy body’s quasi-telegraphic networks but also its vulnerability to delay, disruption, and pathological incoherence. This article will explore the use of telegraphic technologies as proxies for theorising gastric connection and more broadly the concept of ‘gastric time’ as a key conceit for understanding digestion as a process that was and is subject to the idiosyncrasies of bodily rhythms. (shrink)

In recent years, humans’ ability to selectively modify genes has increased dramatically as a result of the development of new, more efficient, and easier genetic modification technology. In this paper, we argue in favor of using this technology to improve the welfare of agricultural animals. We first argue that using animals genetically modified for improved welfare is preferable to the current status quo. Nevertheless, the strongest argument against pursuing gene editing for welfare is that there are alternative approaches to addressing (...) some of the challenges of modern agriculture that may offer ethical advantages over genetic modification; namely, a dramatic shift towards plant-based diets or the development of in vitro meat. Nevertheless, we provide reasons for thinking that despite these possible comparative disadvantages there are important reasons for continuing the pursuit of welfare improvements via genetic modification. (shrink)

Fertility preservation has become more common for various populations, including oncology patients, transgender individuals, and women who are concerned about age-related infertility. Little attention has been paid to fertility preservation for patients with differences/disorders of sex development (DSD). Our goal in this article is to address specific ethical considerations that are unique to this patient population. To this end, we present a hypothetical DSD case. We then explore ethical considerations related to patient’s age, risk of cancer, concern about genetic transmission (...) of a DSD condition to children, co-occurring gender dysphoria, and access to experimental fertility preservation procedures. Given the limitations of current technologies, we recommend offering fertility preservation to individuals living with DSD using an informed decision-making approach that instills realistic expectations and minimizes the potential for false hope. Finally, we conclude with practical recommendations for this case based on the ethical considerations. (shrink)

In “A Public Health Ethics Framework for Populations with Limited English Proficiency,” Chipman and colleagues present a valuable framework for addressing health disparities linked to limited Engli...

Translation for this volume by Lydia Patton of Chapter 9 (pages 179-200) of Émilie du Châtelet's Institutions de Physique (Foundations of Physics). Original publication date 1750. Paris: Chez Prault Fils.

This paper draws on an in-depth phenomenological analysis of some interviews taken from volunteers, inviting them to reflect on their lived experiences of meaningfulness in the context of volunteering and citizenship. It is found that while some testimonies reinforce the standard conceptions of meaningfulness, other testimonies vary from it. The main challenge of this contribution consists in phenomenologically describing this alternative picture of meaningfulness, depicted as the event of witnessing. In a final part, the authors consider how volunteering is at (...) times especially prone to further experiences of witnessing. (shrink)

Paul Henri Thiry d'Holbach financed and contributed to Diderot's Encyclopedia. He hosted many of Europe's best minds in the eighteenth century. The first half of this chapter describes these roles with a focus on atheism in Enlightenment France. Holbach was also a prolific writer. The second half of this chapter defends an interpretation of his atheism. Holbach held that God does not exist and that the knowledge of this fact is a great benefit to those who come to have it.

Adaptive phenotypic plasticity allows organisms to cope with environmental variability, and yet, despite its adaptive significance, phenotypic plasticity is neither ubiquitous nor infinite. In this review, we merge developmental and population genetic perspectives to explore costs and limits on the evolution of plasticity. Specifically, we focus on the role of modularity in developmental genetic networks as a mechanism underlying phenotypic plasticity, and apply to it lessons learned from population genetic theory on the interplay between relaxed selection and mutation accumulation. We (...) argue that the environmental specificity of gene expression and the associated reduction in pleiotropic constraints drive a fundamental tradeoff between the range of plasticity that can be accommodated and mutation accumulation in alternative developmental networks. This tradeoff has broad implications for understanding the origin and maintenance of plasticity and may contribute to a better understanding of the role of plasticity in the origin, diversification, and loss of phenotypic diversity. (shrink)