Cette introduction au actes du XXe congrès de la Société de philosophie du Québec présente celui-ci comme l'occasion d'un bilan et d'une prospective. La société nouvelle, en effet, c'est d'abord la société actuelle. que l'on peut examiner par rapport aux revendications féministes des trois décennies précédentes: lecture politique. Mais la société nouvelle, c'est aussi celle de demain, celle qu'il faut imaginer pour mesurer les insuffisances de la société actuelle et pour inciter le présent à s'humaniser: lecture hétéropolitique. Il s'agissait donc (...) d'interroger le présent à la lumière des étapes franchies et des effets pervers qu'elles ont parfois entraînés, et de "rappeler les projets mis de l'avant par le mouvement des femmes". (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in (...) a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare. (shrink)

BackgroundIn the Netherlands, patients have the legal right to make a request for euthanasia to their physician. However, it is not clear what it means in a moral sense for a physician to receive a request for euthanasia. The aim of this study is to explore the moral values of physicians regarding requests for euthanasia. MethodsSemi-structured interviews were conducted with nine primary healthcare physicians involved in decision-making about euthanasia. The data were inductively analyzed which lead to the emergence of themes, (...) one of which was about values regarding end-of-life decisions.ResultsFour clusters of values related to euthanasia requests are described: values related to 1) the patient; 2) the family; 3) the physician; and 4) life and death. The data show that the participants value patient autonomy as a necessary but not sufficient condition for meeting a euthanasia request. A good relationship with the patient and the family are important. For the physician, the values physician autonomy, responsibility, understanding the patient and relief of suffering play a role. Life as an intrinsic good and a peaceful death are also important values.ConclusionThis study shows that next to patient autonomy and the relationship with the patient and the family, it is important for the participants to act in accordance with their professional values and to do justice to values related to life and death. The awareness of going against the intrinsic value of life is crucial, even if performing euthanasia may result in a feeling of relief or gratitude afterwards. (shrink)

El presente artículo busca enfocar la correlación entre el uso de la energía, el espacio, el territorio y el desarrollo local, teniendo en cuenta la utilización del gas natural en las cerámicas de Mato Grosso del Sur/Brasil. La importancia de los hechos geográficos es pautada por muchos parámetros, como el paso del tiempo, los nuevos descubrimientos tecnológicos, las necesidades de materias primas, los objetivos nacionales e internacionales y la ética de las relaciones internacionales. El gas natural no es utilizado aún (...) como fuente alternativa de energía en gran escala en el Estado. Puede ser considerado como uno de los resultados de la valorización de la política socio económica, de la cultura local y del medio ambiente preservado como parte de la identidad local del ser humano al mejorar su calidad de vida. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed-methods study used (...) both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

Ce petit article explicite brièvement le contexte de l�article qui précède et en retrace le parcours en montrant comment le philosophe s�approche prudemment des notions clés de la théologie chrétienne.

The government-opposition scheme of a two-party system does not function that clearly in a multiparty system which is the case in Belgium. To examine to what extent the opposition parties in a multi-partysystem are functional for policymaking, the period 1965-1971 was chosen for Belgium, providing a complete scale of government and opposition parties.A content analysis of all political parties' platforms in 1965 permits to determine the policy objectives, classified in policy areas, so that at the end of the six years (...) a survey could be made about the completely andpartly realised planks of the platforms according to government and opposition parties, according to the party-strength which was congruent with the duration of government participation. In Belgium a distinctioncan also be made between the traditional opposition parties and the nonelitist opposition parties, which during the given period were not accepted as possible government parties by the political elite.To obtain a correct evaluation of the realisations, the approach took successively into account the absolute number of platform-planks, the number of specific items of a party and the degree of importance andsocial repercussion of the distinct planks that could be realised.Although respectively for 6, 4 and 2 years in the government the CVP, the BSP and the PVV realise approximately the same number of planks. The non-elitist opposition party Volksunie realised a smaller butstill considerable number of objectives. So did also, but to a smaller extent the RW, KP and FDP. The interpretation of these results could be the loss of distinctiveness of the government-opposition scheme in amultiparty system, the elite-consensus in Belgium, the function of the «zweeppartij» strategy and the definition of the opposition in terms of action. (shrink)

BackgroundThe Dutch Euthanasia Act applies to patients 12 years and older, which makes euthanasia for minors younger than 12 legally impossible. The issue under discussion specifically regards the capacity of minors to request euthanasia.ObjectiveGain insight in paediatric experts’ views about which criteria are important to assess capacity, from what age minors can meet those criteria, what an assessment procedure should look like and what role parents should have.MethodsA Delphi study with 16 experts (paediatricians, paediatric nurses and paediatric psychologists) who work (...) in Children Comfort Teams in Dutch academic hospitals. The questionnaire contained statements concerning criteria for capacity and procedural criteria. Consensus was defined as ≥80% agreement.ResultsThe experts agreed that five criteria for capacity, found in a previous literature study, are all important. They agreed that some children between ages 9 and 11 could meet all the criteria. Consensus was reached for the statements that the entire medical team should be involved in the decision making and that a second independent expert must assess the case. Experts agreed that the parents’ opinion is relevant and should always be taken into account, but it need not be decisive.ConclusionThis study shows that the age limit of 12 years in the Dutch Euthanasia Act is too strong according to paediatric experts. Letting go of the age limit or lowering the age limit combined with adequate capacity assessment for minors younger than 12 are options that should be discussed further. (shrink)

The four-yearly social elections in Belgium took place for the tenth time in june 1991.The results show a renewed victory for the christian trade union ACV; all the other unions and lists lost. The socialist union ABW, which was once the most powerful in Belgium, felt the decline most strongly. It could maintain a narrow relative majority in votes in Wallonia but was outnumbered in seats by the ACV.For many years Wallonia was considered to be a "red bastion". Another important (...) shift was that the three "general" unions together gained the majority of votes of the executive staff members, at the expense of their "specific" lists : those of organizations and groups representing only members of the executive staffs.These elections showed a further decline in attendance, in spite of all the propaganda made by the Ministry of Labour, urging the employees to take part in the elections. (shrink)

Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we present the first results of a study in which we evaluated the programme. We used a mixed methods design. One hundred and twenty trained healthcare professionals and five trainers from 16 training groups working in different (...) healthcare organisations throughout the Netherlands were included. After completion of the programme, participants feel sufficiently confident and equipped to facilitate an MCD session. Feeling competent does not mean that participants have no doubts or questions left. Rather, they are aware of their limitations and see the need for continuous learning. According to the respondents, the actual exercise of facilitating MCD during and in between the training sessions contributed most to the development of competences necessary for being an MCD facilitator. Respondents without prior experience of participating in MCD sessions felt less competent after the training than those who had participated in MCD sessions before. Self-attributed competence varied between participants with different professional backgrounds. (shrink)

Mon corps est-il un objet parmi d'autres dans l'espace ou bien crée-t-il l'étendue qu'il perçoit jusqu'à l'écho des étoiles? À quelle spatialité suis-je assujetti pour être relié de l'intérieur au monde et aux autres corps qui m'entourent? Les dimensions de l'espace sont-elles des coordonnées de la matière morte ou sont-elles des variations modales de mon esprit? C'est à la découverte de la spatialité du corps vivant que nous invite Guy-Félix Duportail dans son Analytique de la chair. il nous apprend, entre (...) autres, que la phénoménologie et la psychanalyse se rencontrent en ces lieux de la chair suivant des principes topologiques communs. Guy-Félix Duportail dessine le schéma intérieur de la subjectivité comme se donnant à l'extérieur, dans le monde. La subjectivité incarnée se retourne comme un gant et se retrouve ainsi exposée au-dehors, dans son sinthome, comme disait Lacan, dans son implexe, comme disait Merleau-Ponty. Dans tous les cas, elle se réalise dans une création réparatrice de son mal-être. L'immanence est donc dans la transcendance, et l'espace-temps se réfléchit dans la chair, dans les tourbillons de sa jouissance. La présente Analytique de la chair révèle qu'un corps sans organes (Deleuze et Guattari) est certes moins qu'un noeud, mais demeure plus qu'un emmêlement, et qu'une chair sublime mais sans corps (Levinas, Henry) ne fait du visage qu'un masque, et de la Vie glorieuse du Moi qu'un éloge de la pulsion de mort. (shrink)

Much of what we know and see of ethics support, in literature and during trainings, workshops and conferences, derives from clinical ethicists working at academic medical centers. Besides the probl...

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction and the assignment of responsibilities . This theoretical (...) framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as ‘intentionally taking the life of another person by a physician, upon that person’s request’ can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

There is considerable support for the idea that an atmosphere of safety can foster learning in groups, especially during ethics training courses. However, the question how safety dynamics works during ethics courses is still understudied. This article aims to investigate safety dynamics by examining a critical incident during a military ethics train-the trainer course during which safety was threatened. We examine this incident by means of a four-factor analysis model from the field of Theme-Centered Interaction (TCI). We show that during (...) ethics training courses a safety paradox can occur, involving a tension between honesty and openness to other perspectives and values. Finally, we discuss how trainers can foster safety during ethics training. (shrink)

Cette édition numérique a été réalisée à partir d'un support physique, parfois ancien, conservé au sein du dépôt légal de la Bibliothèque nationale de France, conformément à la loi n° 2012-287 du 1er mars 2012 relative à l'exploitation des Livres indisponibles du XXe siècle. Pages de début -- I -- Phénoménologies hégelienne et husserlienne Hegel et Husserl sur l'intersubjectivité Itinéraires phénoménologiques La dialectique de l'intentionnalité Essai de synthèse d'une méthode phénoménologique -- II -- Classes sociales selon Marx Imaginaire social et (...) creation des idéologies Production et classes sociales dans Le Capital L'évolution du concept de la lutte des classes dans la pensée de Marx Lesclasses sociales dans la philosophie de l'histoire de Marx Pages de fin. (shrink)

Le Commentaire du Traité de l'âme d'Aristote par Thomas d'Aquin est le cinquième des commentaires fondamentaux des oeuvres d'Aristote traduits en langue française. Avec celui des Physiques, de la Métaphysique, de l'Interprétation et des Analytiques, il fonde l'édifice de la philosophie de Thomas d'Aquin et assure les contreforts de sa théologie. Ce traité se présente comme un vaste essai de définition de l'âme et principalement de l'âme humaine, avec en filigrane, une question lancinante : cette âme est-elle immortelle? Si ce (...) traité est l'un des plus courts d'Aristote, et selon ses propres termes, encore à l'état d'ébauche, il est construit avec une rigueur méthodologique qui en fait une sorte de modèle pour toute réflexion philosophique. Thomas propose une explication reconnue comme des plus limpides, et introduit à un livre encore loué deux millénaires plus tard par Hegel, Marx ou Darwin. Comme le reste de l'oeuvre d'Aristote, il connaît aujourd'hui un regain d'intérêt remarquable et le commentaire de Thomas offre un guide très sûr pour son intelligence. (shrink)

Borrett, Kelly and Kwan [ Phenomenology, dynamical neural networks and brain function, Philosophical Psychology, 13, 000-000] claim that unbiased, self-evident, direct description is possible, and may supply the data that brain theories account for. Merleau-Ponty's [ Phenomenology of perception, London: Routledge] description of Schneider's apraxia is offered as a case in point. According to the authors, Schneider's apraxia justifies brain components of predicative and pre-predicative experience. The description derives from a bias, however, that parallels modularity's morphological reduction. The presence of (...) biasing presuppositions contradicts the goal of direct description. Moreover, the authors' brain account is not necessary to explain Schneider's apraxia, and morphological reduction is not sufficient to explain emergent phenomena of motor control. (shrink)

L'histoire de la rhétorique s'apparente à une peau de chagrin: d'une préoccupation pour les mots et les idées en général, elle a progressivement mis l'accent sur les mots, puis sur les tropes et figures, puis sur la métaphore et la métonymie, puis sur la seule métaphore. Mais l'intérêt pour les mots a refait surface dans des disciplines comme la linguistique et la stylistique. Et l'intérêt pour les idées caractérise l'oeuvre de Ch. Perelman, comme en témoigne, entre autres, son Traité de (...) l'argumentation. On soutient que celui-ci s'inscrit dans le champ d'une théorie générale des discours. (shrink)

Faire comprendre la genèse et la construction de la pensée de Platon, et la méthode inédite qu’il met au point pour penser, tel est l’objet de ce livre. Riche de ses débats avec de grands penseurs de l’Antiquité : Pythagore, Héraclite, Parménide, Gorgias... la dialectique platonicienne, alliant exigence de vérité et recherche d’efficacité, invente ainsi la philosophie. Découvrir la force et les enjeux de cette invention permet d’explorer, aussi, le sens qu’une histoire de la philosophie peut avoir aujourd’hui, et les (...) défis qu’elle porte en elle. (shrink)

Guy Jobin | : L’objet de cet article est l’identification de quelques linéaments d’une éthique de la parole croyante dans l’espace public des sociétés démocratiques. Cette éthique sera élaborée à partir de la notion de style, notion qui résulte de récentes recherches sur l’herméneutique du concile Vatican II. Nous proposons une démarche en trois parties sur un objet bien précis, soit la parole des évêques catholiques proposée dans le cadre de débats moraux. Le premier temps de notre démarche sera consacré (...) à la réflexion d’André Naud sur l’éthique de la parole épiscopale. Cette réflexion tardive dans la production théologique de Naud n’a pas été, à notre connaissance, l’objet d’une étude approfondie. Sans prétendre offrir une analyse complète et définitive de ce travail, mais tout en soulignant son caractère pionnier, nous en cernerons les limites pour notre réflexion. Le deuxième temps de la démarche montrera la pertinence du paradigme éthique de la responsabilité pour réfléchir à l’éthique de la parole épiscopale dans l’espace public. Enfin, penser l’éthique de la parole publique des croyants en l’inscrivant dans le paradigme de la responsabilité est un geste théologique, certes, mais il s’appuie sur une pratique, soit celle de la prise de parole à Vatican II. Plus précisément, c’est dans la Constitution pastorale Gaudium et Spes qu’une « pratique » de la responsabilité s’est manifestée. Cette pratique est en fait une pragmatique que nous mettrons en lumière, dans la troisième partie de l’article, par une analyse rhétorique de l’énonciation qui a prévalu dans la rédaction de la Constitution pastorale. | : The object of this article is the identification of some lineaments of an ethics of the believing word in the public space of our democracies. This ethics will be elaborated starting with the notion of style, a notion resulting from recent researches on the hermeneutics of the Vatican II Council. We propose a three-part approach on quite a precise object, namely the word of Catholic bishops uttered within the framework of moral debates. The first part of our approach will dwell on André Naud’s reflection upon the ethics of the episcopal word. This later reflection within Naud’s theological production has not so far been, to our knowledge, the object of a thorough study. Without pretending to offer a complete and definitive analysis of that work, but nevertheless underscoring its pioneer character, we will identify its limits for our reflection. The second part of the approach will show the relevance of the ethical paradigm of responsibility in order to reflect on the ethics of the episcopal word in the public space. Finally, to think out the ethics of the public word of believers while setting it within the paradigm of responsibility is a theological gesture, to be sure, but it is based on a practice, namely that of speaking at Vatican II. More precisely, it is in the Pastoral Constitution Gaudium et Spes that a “practice” of responsibility was manifested. That practice is in fact a pragmatic which, in the third part of the article, we will shed light on through a rhetorical analysis of the enunciation that prevailed in the wording of the Pastoral Constitution. (shrink)

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...) Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)