This article traces the way autonomy has become a recognised value in health care in France. In a country that based its social fundamentals on the very idea of solidarity for many years, autonomy has long been considered a foreign ‘Anglo-American principle’. Taking the example of the end-of-life debate, the article shows, however, how the use of the French term ‘accompagnement’ allowed autonomy to be redefined and to be associated with the concept of solidarity. Exploring the arguments used over the (...) past 25 years in professional guidelines, parliamentary reports, ethics committee reports, and legal texts, the authors describe the shift that took place in public and legal discourses on end-of-life care. The analysis demonstrates how the scope of autonomy has been limited by other social values, such as the protection of the dying person, in order to become an accepted social value in its own right. The example of the French end-of-life debate shows that depending on how the concept of autonomy is adapted and applied in a specific context, it can be compatible with the idea of solidarity. Such compatibility has been challenged previously in the international bioethics debate. By demonstrating the possibility of combining autonomy and solidarity, this article makes an important contribution to the international bioethics debate and to the dialogue between countries that are often perceived as significantly different. (shrink)

Solidarity has for a long time been referred to as the core value underpinning European health and welfare systems. But there has been debate in recent years about whether solidarity, with its alleged communitarian content, can be reconciled with the emphasis on individual freedom and personal autonomy. One may wonder whether there is still a place for solidarity, and whether the concept of justice should be embraced to analyse the moral issues regarding access to health care. In this article, I (...) will answer this question by analysing the normative foundations of the concept of justice, followed by a deeper examination of the concept of solidarity in continental philosophy. More specifically, I will compare the philosophical traditions rooted in Kant to approaches rooted in Hegel. In addition, I will present the work of Avishai Margalit on the decent society to criticize a predominantly liberal approach to access to health care. The importance of solidarity lies particularly in its emphasis on relational aspects and the role of recognition in care practices, which are usually ignored in liberal approaches to justice. However, the article will argue that solidarity is not an alternative to a rights-based concept of justice, but must be considered as a necessary complement to it. (shrink)

BackgroundThe discovery of biomarkers of ageing has led to the development of predictors of impending natural death and has paved the way for personalised estimation of the risk of death in the general population. This study intends to identify the ethical resources available to approach the idea of a long-lasting dying process and consider the perspective of death prediction. The reflection on human mortality is necessary but not sufficient to face this issue. Knowledge about death anticipation in clinical contexts allows (...) for a better understanding of it. Still, the very notion of prediction and its implications must be clarified. This study outlines in a prospective way issues that call for further investigation in the various fields concerned: ethical, psychological, medical and social.MethodsThe study is based on an interdisciplinary approach, a combination of philosophy, clinical psychology, medicine, demography, biology and actuarial science.ResultsThe present study proposes an understanding of death prediction based on its distinction with the relationship to human mortality and death anticipation, and on the analogy with the implications of genetic testing performed in pre-symptomatic stages of a disease. It leads to the identification of a multi-layered issue, including the individual and personal relationship to death prediction, the potential medical uses of biomarkers of ageing, the social and economic implications of the latter, especially in regard to the way longevity risk is perceived.ConclusionsThe present study work strives to propose a first sketch of what the implications of death prediction as such could be - from an individual, medical and social point of view. Both with anti-ageing medicine and the transhumanist quest for immortality, research on biomarkers of ageing brings back to the forefront crucial ethical matters: should we, as human beings, keep ignoring certain things, primarily the moment of our death, be it an estimation of it? If such knowledge was available, who should be informed about it and how such information should be given? Is it a knowledge that could be socially shared? (shrink)

This editorial presents a special issue gathering four contributions about the patient’s lived experience in the context of deep-brain stimulation. It aims at clarifying the meaning of such an experience and its scope for medical practice, the health system and its legal frame.

This book has been defined around three important issues: the first sheds light on how people, in various philosophical, religious, and political contexts, understand the natural environment, and how the relationship between the environment and the body is perceived; the second focuses on the perceptions that a particular natural environment is good or bad for human health and examines the reasons behind such characterizations ; the third examines the promotion, in history, of specific practices to take advantage of the health (...) benefits, or avoid the harm, caused by certain environments and also efforts made to change environments supposed to be harmful to human health. The feeling and/or the observation that the natural environment can have effects on human health have been, and are still commonly shared throughout the world. This led us to raise the issue of the links observed and believed to exist between human beings and the natural environment in a broad chronological and geographical framework. In this investigation, we bring the reader from ancient and late imperial China to the medieval Arab world up to medieval, modern, and contemporary Europe. This book does not examine these relationships through the prism of the knowledge of our modern contemporary European experience, which, still too often, leads to the feeling of totally different worlds. Rather, it questions protagonists who, in different times and in different places, have reflected, on their own terms, on the links between environment and health and tries to obtain a better understanding of why these links took the form they did in these precise contexts. This book targets an academic readership as well as an “informed audience”, for whom present issues of environment and health can be nourished by the reflections of the past. (shrink)

Parmi d’autres, cet ouvrage témoigne que nous sommes dans une époque de collaboration active entre la communauté médicale, notamment hospitalière, et la communauté philosophique. Son auteur, J.-P. Cléro, s’appuie en effet sur un travail mené dans le cadre de divers espaces éthiques ou écoles de soin médical et sur des échanges nourris avec plusieurs médecins. Comme il l’indique lui-même, ce contexte l’a incité à revenir à la philosophie morale et à proposer en son sein un parcours orienté par..

La pensée de Machiavel a fait l’objet, ces dernières décennies, de nombreuses références dans les réflexions sur les processus de démocratisation, sur la signification et les conditions de la liberté politique ou encore sur la participation civique. La présente contribution défend la thèse d’une actualité indirecte de Machiavel pour la théorie contemporaine de la démocratie, à travers le questionnement que son œuvre suscite sur le rôle du désir de liberté dans l’approfondissement de la démocratie. Sa pensée nous invite à nuancer (...) le rôle que nous attribuons communément à l’institution de la citoyenneté en lien avec la Déclaration des droits de l’homme et du citoyen et la signification donnée à la « modernité » politique. Elle permet d’éclairer les ambivalences de la citoyenneté démocratique et d’interroger les limites de la conception participative de la démocratie. (shrink)

Machiavelli’s thought has been referred to in numerous ways in the past decades in political theory. His work has grounded various comments about the process of democratization, the meaning and the conditions of political liberty and about civic participation. This paper advocates the thesis of an indirect relevance of Machiavelli’s work for contemporary political thought. It stresses the importance given by Machiavelli to the desire for liberty and its meaning for the understanding of the deepening of democracy. From then on, (...) it argues that his thought invites us to qualify the scope of citizenship understood in relationship with the Déclaration des droits de l’homme et du citoyen and with political modernity. It allows us to highlight the ambivalence of democratic citizenship and to question the limits of the participatory conception of democracy. (shrink)

This article presents a part of the results of an empirical study conducted at a Parisian hospital between 2011 and 2014. It aimed at understanding the women and couples’ motivations to terminate or not a pregnancy once a prenatal diagnosis has revealed a genetically related disease in the embryo or fetus. The article first presents the social and legal context of the study, the methodology used and the pathologies that were encountered. Then, it examines the results of the interviews conducted (...) with 5 women alone and 23 couples explaining their reasons for deciding to terminate or not the pregnancy. Finally, it explores the patients’ views about the doctor’s involvement in the decision-making process. The findings reveal the reasons they formulate when they ponder whether to terminate or not the pregnancy. It highlights the process of their deliberation, their hierarchisation of arguments and concerns. They also show how patients, though often consumed in sorrow, claim to be the legitimate decision-makers, especially women, in a social and legal context in which the rejection of eugenics is viewed as an undisputable principle. (shrink)

La maladie et la souffrance, la fragilite et la finitude de la condition humaine, le corps, le savoir medical, le pouvoir du medecin, les techniques de soin, la recherche biomedicale et les biotechnologies, la sante: tout cet ensemble constitue un objet d'interrogation majeur pour la philosophie. Le present volume s'interesse de maniere specifique a la relation entre la philosophie et la medecine. Il part du constat que la relation de la philosophie avec la medecine a contribue a la determination des (...) taches et des visees propres a la philosophie, pour s'interesser ensuite a la constitution du savoir medical et a son inscription sociale. Le choix de textes reunis ici, celebres, moins celebres, inedits ou traduits pour la premiere fois en francais, propose une approche a la fois historique et conceptuelle et met l'accent sur l'interaction entre l'evolution du savoir et des technologies et les questions ethiques, politiques et juridiques posees par la medecine. (shrink)

Today, French public debate and bioethics research reflect an ongoing controversy about eugenics. The field of reproductive medicine is often targeted as pre-implantation genetic diagnosis (PGD), prenatal diagnosis, and prenatal detection are accused of drifting towards eugenics or being driven by eugenics considerations. This article aims at understanding why the charge against eugenics came at the forefront of the ethical debate. Above all, it aims at showing that the charge against prenatal diagnosis is groundless. The point of view presented in (...) this article has been elaborated jointly by a geneticist and a philosopher. Besides a survey of the medical, bioethical, philosophical and social sciences literature on the topic, the methodology is founded on a joint analysis of geneticist’s various consults. Evidence from office visits demonstrated that prenatal diagnosis leads to case-by-case decisions. As we have suggested, this conclusion does not mean that prenatal diagnosis is devoid of ethical issues, and we have identified at least two. The first is related to the evaluation of a decision to abort. The second line of ethical questions arises from the fact that the claim for “normality” hardly hides normative and ambiguous views about disability. As a conclusion, ethical dilemmas keep being noticeable in the field of reproductive medicine and genetic counselling, but an enquiry about eugenic tendencies probably does not allow us to understand them in the proper way. (shrink)

Il n’est pas rare, en philosophie, de se tourner, quand besoin est, vers les traductions en italien d’ouvrages en langues étrangères qui n’ont pas encore bénéficié d’un tel effort en français. Il est plus inhabituel de le faire lorsqu’il s’agit d’un texte à l’origine en français. Michele Cammelli, qui mène ses recherches au fonds Canguilhem, nous en offre cependant l’occasion, avec une remarquable édition d’un court texte politique de Georges Canguilhem, publié de façon anonyme à Cahors en 19..