Nous voulons mieux comprendre les lois circonscrivant le rôle social de l’Évaluation des technologies en santé (ETS) et les raisons empêchant l’inclusion de l’éthique en ETS. Nous avons ciblé un débat qui est au coeur du rôle perçu du droit réglementaire dans le développement de technologies en santé : l’opposition entre les enjeux environnementaux, sécuritaires et sanitaires (EHSI) et les enjeux éthiques, légaux et sociaux (ELSI), issus de la gouvernance technologique. La collecte de données est basée sur une revue de (...) la littérature issue de travaux antérieurs, et sur une analyse de cas où trois agences d’ETS ont été sélectionnées en utilisant différentes catégories d’obligation légale selon leur degré de force contraignante. La revue de littérature a révélé cinq thèmes relatifs au rôle social de l’ETS et une distinction entre le rôle/utilisation du droit dur et du droit souple dans le droit réglementaire, permettant ainsi de comprendre comment les agences ont utilisé le droit pour intégrer (ou non) l’éthique en ETS. Les deux approches ont démontré que le débat, EHSI/ELSI observé initialement dans la gouvernance et l’évaluation de technologies est reproduit en ETS. La principale tendance confirmée par ces analyses est la présence d’un pacte entre la science et le droit réglementaire. La demande sociale d’intégrer les ELSI, particulièrement l’évaluation éthique en ETS, n’est pas prise en compte par le droit réglementaire traditionnel régissant l’ETS et doit plutôt être considérée par le droit souple. Les difficultés d’intégration de l’éthique en ETS démontrent la nécessité de repenser la gouvernance juridique de l’ETS. (shrink)

Each year in the UK there are approximately 250,000 miscarriages, 3,000 stillbirths and 3,000 terminations following a diagnosis of fetal-abnormality. This paper draws from original empirical research into the experience of pregnancy loss and the accompanying decisionmaking processes. A key finding is that there is considerable variation across England in the range of options that are offered for disposal of pregnancy remains and the ways in which information around disposal are communicated. This analysis seeks to outline the key features of (...) what constitutes effective communication in this context, where effective communication is taken to mean that patients are provided with the key information necessary, in an appropriate manner, so that they are fully able to make a decision. A primary source of evidence includes interviews with the bereaved and pregnancy-loss support workers, in order to understand how the options available, and associated necessary procedures, are communicated. In addition, patient information leaflets are also analyzed as they offer an important tool for information delivery at a difficult and emotionally charged time. Following this, an overview is provided of the information that these leaflets should contain, along with guidance on effective presentation of this information. (shrink)

This research project investigated manifestations of critical thinking in pupils 10 to 12 years of age during their group discussions held in the context of Philosophy for Children Adapted to Mathematics. The objective of the research project was to examine, through the pupils' discussions, the development of dialogical critical thinking processes. The research was conducted during an entire school year. The research method was based on the Grounded Theory approach; the material used consisted of transcripts of verbal exchanges among the (...) pupils. Analysis of the transcripts revealed that: critical thinking appears to the extent that a 'dia-logue' is established among pupils; on the cognitive level, dialogical critical thinking is comprised of four thinking modes: logical, creative, responsible and meta-cognitive; and on the epistemological level, dialogical critical thinking is only manifested in a context where egocentricity of perspective and relativism of beliefs are transcended. (shrink)

Since the Fall of 1993, at the Centre Interdisciplinaire de Recherche sur l'Apprentissage et le D/span>veloppement en /span>ducation of the Universit/span> du Qu/span>bec /span> Montr/span>al, two mathematicians and one philosopher have collaborated to design and develop a research project involving philosophy, mathematics and sciences. Previous observations in the classroom had led the researchers to realize that, within the school curriculum, children like some subject matters and dislike others. Most of them usually succeed in arts, physical education and language arts, but (...) many have difficulties in succeeding in mathematics. Why? On the one hand, as Matthew Lipman advocates, the school curricula are not sufficiently "meaningful" for children. On the other hand, some studies in the field of mathematics suggest that there are myths and prejudices about mathematics in primary schools and that the school system is partly responsible for this. Indeed, the school system does not invite children to express emotions in class about mathematics nor does it favor creativity. It does not allow dialogue among peers about mathematical concepts and problems, nor the construction of mathematical knowledge by the students themselves. (shrink)

In this paper, we study the manifestations of what we call “dialogical critical thinking” in elementary school pupils when they are engaged in philosophical exchanges among peers: What are thecharacteristics of dialogical critical thinking? How does it develop in youngsters? Our research was conducted during an entire school year, with eight groups of pupils from three different cultural contexts: Australia, Mexico and Quebec. Our findings were constructed in an inductive manner, inspired by qualitative analysis as defined by Glaser and Strauss (...) (1967). From our analysis, a grid was developed, illustrating the process by which dialogical critical thinking developed among the pupils involved in our research. This process is manifested via four modes of thinking (logical, creative, responsible and meta-cognitive), which become increasingly complex according to three epistemological perspectives (egocentricity, relativism and inter-subjectivity oriented toward meaning). (shrink)

In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause was introduced requiring doctors with a conscientious objection to abortion to refer women to another provid...

Background Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. Methods We (...) explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. Results We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. Conclusion Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout. (shrink)

Keeping a conversation going is the social glue of friendships. The DSM criteria for autism list difficulties with back-and-forth conversation but does not necessitate that all autistic children will be equally impacted. We carried out three studies (two pre-registered) with verbally-fluent school children (age 5-9 years) to investigate how autistic and neurotypical children maintain a conversation topic. We also investigated within-group relationships between conversational ability and cognitive and socio-cognitive predictors. Study 1 found autistic children were more likely than neurotypical controls (...) to give off-topic and generic minimal responses (e.g. ‘mm’, ‘oh’) and were less likely to give non-verbal responses (e.g. nodding or use of facial affect to respond). Nonetheless, the autistic group provided topic-supporting responses 62% of the time, indicating some aspects of conversation topic maintenance are a relative strength. Studies 2 and 3 found large individual differences in topic-supporting conversational responding amongst both neurotypical and autistic children. These were positively related to theory of mind ability and age in both groups. Conversational skills lie on a continuum for the general population and differences by diagnostic group are a matter of degree. Given the importance for peer relationships, we suggest a whole-classroom approach to supporting conversation skills in all children. (shrink)

s for the Second Workshop on Implementing Machine Ethics.

Professeure d’histoire à l’université de Wisconsin (États-Unis), Mary Louise Roberts est l’auteure du classique Civilization without Sexes : reconstructing gender in Postwar France, 1917-1927, paru en 1994. Passant du premier au deuxième après-guerre, elle livre aujourd’hui une analyse de la sexualité des GIs dans la France libérée de 1944 où elle s’attache à démontrer le caractère profondément politique de leur vie sexuelle (p. 11). Car pour elle, loin d’être une affaire privée, celle-ci a é...

The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim is (...) to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompasses the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency. (shrink)

It is a cliché of self-help advice that there are no problems, only opportunities. The rationale and actions of the BSHS in creating its Global Digital History of Science Festival may be a rare genuine confirmation of this mantra. The global COVID-19 pandemic of 2020 meant that the society's usual annual conference – like everyone else's – had to be cancelled. Once the society decided to go digital, we had a hundred days to organize and deliver our first online festival. (...) In the hope that this will help, inspire and warn colleagues around the world who are also trying to move online, we here detail the considerations, conversations and thinking behind the organizing team's decisions. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

The genetically manipulated organism crisis demonstrated that technological development based solely on the law of the marketplace and State protection against serious risks to health and safety is no longer a warrant of ethical acceptability. In the first part of our paper, we critique the implicitly individualist social-acceptance model for State regulation of technology and recommend an interdisciplinary approach for comprehensive analysis of the impacts and ethical acceptability of technologies. In the second part, we present a framework for the analysis (...) of impacts and acceptability, devised—with the goal of supporting the development of specific nanotechnological applications—by a team of researchers from various disciplines. At the conceptual level, this analytic framework is intended to make explicit those various operations required in preparing a judgement about the acceptability of technologies that have been implicit in the classical analysis of toxicological risk. On a practical level, we present a reflective tool that makes it possible to take into account all the dimensions involved and understand the reasons invoked in determining impacts, assessing them, and arriving at a judgement about acceptability. (shrink)

The integration of ethical analysis in Health Technology Assessment (HTA) has proven difficult to implement even though it is explicitly recognized as an important component of such assessments in HTA literature. When compared to the standardized scientific method for systematic reviews in HTA, the diversity of ethical analysis has been characterized as a fundamental barrier to the integration of ethics. The present paper aims to identify the theoretical and practical differences between the approaches underpinning ethical analysis in HTA and clarify (...) the reasons for such diversity. Our systematic review of HTA literature pertaining to the barriers to the integration of ethics in HTA identified nine ethical approaches: Principlism, Casuistry, Coherence Analysis, Wide Reflective Equilibrium, Axiology, the Socratic approach, the Triangular model, Constructive Technology Assessment and Social Shaping of Technology. Citations pertaining to each approach were extracted and categorized according to three constitutive components of ethical argumentation established in a previous research evaluating nanotechnologies: i) the disciplinary foundation that grounds the validity of the ethical evaluation, ii) the characteristics of such evaluation, iii) the operational process involved in applying it to a particular case (i.e., its practical reasoning). This comparison shows that, 1) the difference between these approaches rests primarily on their disciplinary foundation (rooted in philosophy, philosophy/theology, or sociology), 2) their complexity can be observed in the distinct characteristics of ethical evaluation deriving from their differing disciplinary foundation, and 3) although four different types of operationalization procedure were identified, little information was available in regards to the practical reasoning associated with these approaches. (shrink)

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for (...) Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education. (shrink)

Autour de la grande conference de Jacques Derrida, intitulee Justices, prononcee en 2003 et demeuree inedite en francais a ce jour, cet ouvrage collectif convoque certains des meilleurs specialistes de son oeuvre. Il s'agit moins ici de commemorer ou de dresser un etat des lieux que de penser, a partir de Derrida et avec lui, ce qui vient et de repondre a l'appel, aux appels pluriels qui resonnent dans son travail philosophique. Sont ainsi examines les principaux legs de sa pensee (...) dans les differents domaines (philosophie, politique, science des religions, esthetique, litterature) qu'elle a profondement transformes. Autant de reponses et de responsabilites, autant de provocations a lire et a relire l'oeuvre de Jacques Derrida a sa hauteur, comme elle nous y engage toujours. Avec les textes de: Gil Anidjar, Philip Armstrong, Fernanda Bernardo, Mireille Calle-Gruber, Danielle Cohen-Levinas, Gianfranco Dalmasso, Francoise Dastur, Jacques Derrida, Silvano Facioni, Edoardo Ferrario, Jerome Lebre, Georges Leroux, Michel Lisse, Rene Major, Marie-Louise Mallet, Serge Margel, Joana Maso, Ginette Michaud, J. Hillis Miller, Raoul Moati, Jean-Luc Nancy, Evando Nascimento, Francois Nault, Laura Odello, Jean-Michel Rabate, Marta Segarra, Peter Szendy, Chantal Talagrand, Francesco Vitale et Hent de Vries. (shrink)

Intrigues politico-financières, crimes de sang, outrages aux bonnes mœurs, les années 1920 et 1930, en France, furent marquées par les scandales, savamment mis en scène par la presse à sensation. Si certaines affaires – Marthe Hanau, Stavisky, Violette Nozière – ont durablement marqué la mémoire collective, d’autres, en revanche, sont tombées dans l’oubli. C’est l’un de ces faits divers, qui défraya un temps la chronique, que ressuscite pour nous La garçonne et l’assassin. Le récit suit les...

We all have beliefs, even strong convictions, about what is just and fair in our social arrangements. How should these beliefs and the theories of justice that incorporate them guide our thinking about practical matters of justice? This wide-ranging collection of essays by one of the foremost medical ethicists in the USA explores the claim that justification in ethics, whether of matters of theory or practice, involves achieving coherence between our moral and non-moral beliefs. Amongst the practical issues addressed in (...) the volume are the design of health-care institutions, the distribution of goods between the old and the young, and fairness in hiring and firing. In combining ethical theory and practical ethics this volume will prove especially valuable to philosophers concerned with ethics and applied ethics, political theorists, bioethicists, and others involved in the study of public policy. (shrink)

Transpersonal Psychology concerns the study of those states and processes in which people experience a deeper sense of who they are, or a greater sense of connectedness with others, with nature, or the spiritual dimension. Pioneered by respected researchers such as Jung, Maslow and Tart, it has nonetheless struggled to find recognition among mainstream scientists. Now that is starting to change. Dr. Michael Daniels teaches the subject as part of a broadly-based psychology curriculum, and this book brings together the (...) fruits of his studies over recent years. It will be of special value to students, and its accessible style will appeal also to all who are interested in the spiritual dimension of human experience. The book includes a detailed 38-page glossary of terms and detailed indexes. (shrink)

Chapter I: The Geometry of Visibles 1 . The N on- Euclidean Geometry of Visibles In the chapter "The Geometry of Visibles" in Inquiry into the Human Mind, ...

Philosophical Investigations, Volume 45, Issue 2, Page 146-160, April 2022.

Name der Zeitschrift: Deutsche Zeitschrift für Philosophie Jahrgang: 65 Heft: 4 Seiten: 689-691.

The ever-growing acceptance and use of assisted human reproduction techniques has caused demand for “donated” sperm and eggs to outstrip supply. Medical professionals and others argue that monetary reward is the only way to recruit sufficient numbers of “donors”. Is this a clash between pragmatics and policy/ethics? Where monetary payments are the norm, alternative recruitment strategies used successfully elsewhere may not have been considered, nor the negative consequences of commercialism on all participants thought through. Considerations leading some countries to ban (...) the buying and selling of sperm, eggs and embryos are outlined and a case made that the collective welfare of all involved parties be the primary consideration in this, at times heated, debate. (shrink)

Bioethics' traditional focus on clinical relationships and exotic technologies has led the field away from population health, health disparities, and issues of justice. The result: a myopic view that misses the institutional context in which clinical relationships operate and can overlook factors that affect health more broadly than do exotic technologies. A broader bioethics agenda would take up unresolved questions about the distribution of health and the development of fair policies that affect health distribution.

Ackn o wledgments I owe special gratitude to Professors Hugo Adam Bedau and John Rawls for many helpful discussions of the general idea and scope, ...

Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.