Patient engagement in healthcare is increasingly discussed in the literature, and initiatives engaging patients in quality improvement activities, organizational design, governance, and research are becoming more and more common and have even become mandatory for certain health institutions. Here we discuss a number of ethical challenges raised by this engagement from patients from the perspectives of research, organizational/quality improvement practices, and patient experiences, while offering preliminary recommendations as to how to address them. We identified three broad categories of ethical issues (...) that intersect between the different types of patient engagement: (1) establishing a shared vision about goals of patient engagement and respective roles; (2) the process and method of engaging with patients; and (3) practical aspects of patient engagement. To explain these issues, we build from our personal, professional, and academic experiences, as well as traditions such as pragmatism and hermeneutics that stress the importance of participation, empowerment, and engagement. Patient engagement can be highly valuable at numerous levels, but particular attention should be paid to the process of engaging with patients and related ethical issues. Some lessons from the literature on the ethics of participatory research can be translated to organizational and quality improvement practices. (shrink)

Context: In most jurisdictions where medical-aid-in-dying is available, this option is reserved for individuals suffering from incurable physical conditions. Currently, in Canada, people who have a mental illness are legally excluded from accessing MAiD. Methods: We developed a questionnaire for mental health care providers to better understand their perspectives related to ethical issues in relation to MAiD in the context of severe and persistent suffering caused by mental illness. We used a mixed-methods survey approach, using a concurrent embedded model with (...) both closed and open-ended questions. Findings: 477 healthcare providers from the province of Québec completed the questionnaire. One third of the sample were nurses, one quarter psychologists and one quarter psycho-educators. Nearly half of the respondents considered that people with a severe mental illness should be granted the right to opt for MAiD as a way to end their suffering. Respondents were more likely to feel comfortable listening to the person and participating in discussions related to MAiD for a mental illness than offering care or the means for the person to access MAiD. Most reported that they had not received adequate/sufficient training, education or preparation in order to address ethical questions surrounding MAiD. Conclusions: The findings highlight how extending MAiD to people with a mental illness would affect daily practices for mental healthcare providers who work directly with people who may request MAiD. The survey results also reinforce the need for adequate training and professional education in this complex area of care. (shrink)

The mental health of young people is a growing public health concern. With socio-emotional difficulties in youth often resulting in psychiatric disorders later in life and most with mental health conditions rather stabilizing in time, it is essential to support healthy socio-emotional development. With a comprehensive definition of mental health, since emotion regulation plays a critical role in prevention, it becomes imperative to better understand how children effectively manage their emotions from an early age. Determining effective use of ER skills (...) relies on adequate measurements. Typical methods of data collection in children present consistent shortcomings. This review addresses research findings considering the suitability of the late positive potential measured through electroencephalogram as a neural indicator of ER in children and youth. There is growing evidence, as reported in this review, that indicates that the late positive potential may be a reliable neural indicator of children's cognitive reappraisal abilities more specifically. Results generally suggest that the late positive potential amplitudes are sensitive to directed reappraisal in children. However, given the scant research, questions remain regarding developmental trends, methodology, interindividual variability, reappraisal of various stimuli, and how the late positive potential may relate to more traditional measures of ER. Directions for future research are provided, which are expected to address unanswered research questions and fill literature gaps. Taken together, the findings reviewed indicate that the late positive potential is generally sensitive to directed cognitive reappraisal in children and that there is promise of establishing this neural marker as an indicator of ER. (shrink)

Background:The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied.Purpose:This study examined the moral experiences of caregivers related to challenging behaviours’ management and alternatives to control measures.Research design:Using Charles Taylor’s hermeneutic framework, a 2-month focused ethnography with a participatory (...) approach was used.Participants and research context:Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity.Ethical considerations:The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants.Findings:By accounting for caregivers’ moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver’s vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures.Discussion:A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability.Conclusion:The recognition of caregiver’s vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers’ self-concern can be understood as fostering mutual respect. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

Living labs are interdisciplinary and participatory initiatives aimed at bringing research closer to practice by involving stakeholders in all stages of research. Living labs align with the principles of participatory research methods as well as recent insights about how participatory ways of generating knowledge help to change practices in concrete settings with respect to specific problems. The participatory, open, and discussion‐oriented nature of living labs could be ideally suited to accompany ethical reflection and changes ensuing from reflection. To our knowledge, (...) living labs have not been explicitly trialed and reported in ethics literature. In this discussion paper, we report and discuss four initial issues that marked the process of setting up a living lab in ethics: (1) determining the goals and expected outcomes of an ethics living lab; (2) establishing operational procedures; (3) selecting communities and defining pilot projects; and (4) adopting a lens to tackle emerging questions and challenges. We explain these four issues and present the paths taken based on the novel and specific orientation, that is, living ethics, at the basis of this project. In alignment with living ethics and É‐LABO, we approach challenges as learning opportunities to ask not only “how” questions but also “why” questions. We hope that this discussion paper informed by our experience helps to clarify the theoretical, methodological, and practical approaches necessary to successfully adopt and employ living labs in ethics. (shrink)

Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics—and the specific role it can or should play—remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three (...) methodological steps according to which the meaning of ethics concepts can be refined based on experience and empirical research: function identification, function enrichment, and function testing. These steps are explained and situated within the broader commitment of pragmatic ethics to a perspective of moral growth and human flourishing. We hope that this proposal will give specific direction to the bridging of theoretical and empirical research in ethics and thus support stronger actualization of ethics concepts. (shrink)

Cambrai, Bibl. munic. 940, ff. 1-59 [integralement reproduit]--Bibl. Vatic. Reg. Lat. 689 A, ff. 334-353.--Bibl. Vatic. Reg. Lat. 1653, ff, 1v-2v (feuilles de garde), ff. 3r, 29r-35r.--Pièces justificatives.

The four talks collected here transcribe lectures delivered to an audience of children between the ages of ten and fourteen, under the auspices of the little dialogues series at the Montreuil's center for the dramatic arts. Modeled on Walter Benjamin's Aufklrung for Kinderradio talks, this series aims to awaken its young audience to pressing philosophical concerns. Each talk in God, Justice, Love, Beauty explores what is at stake in these topics as essential moments in human experience. (Indeed, the book (...) argues that they are constitutive of human experience.) Following each, Nancy's audience is given a chance to engage with him in a process of philosophical questioning; the texts of these touching and probing exchanges are included in the volume. Despite the fact that these lectures were delivered to an audience of children, the intellectual level they achieve-while remaining easily comprehensible-is astounding. No attempt is made to simplify Nancy's positions or to resolve the complexities that arise in the course of the talks or the question periods that follow. The work of opening performed here is fully in keeping with the strategy of Nancy's philosophy as a whole. Thus, for readers unfamiliar with his work, God, Justice, Love, Beauty will function as an excellent introduction to Nancy's larger corpus. As varied as the individual talks are, they share the motif of incalculability or the immeasurable. Broadly speaking, one could say that the various ways in which Nancy approaches this motif exemplify his deconstructive approach to think of human existence. As well, those treatments exemplify his conviction that the task of thinking is to develop original ways of communicating the incalculable.God, Justice, Love, Beauty is thus a skillful reminder that philosophy is important to all of us. The book is also a model of intellectual generosity and openness. Seamlessly moving from Schwarzenegger to Plato, from Kant, Roland Barthes, and Caravaggio to Caillou, Harry Potter, and the pages of Gala magazine, Nancy's wide-ranging references bear witness to his commitment to think of culturein its broadest sense. (shrink)

The practice of inserting bits of lyric verse within Old French narrative romances appears to have begun with Jean Renart, the supposed author of the Roman de la rose ou de Guillaume de Dole, which most scholars date around 1228. It was soon imitated by Gerbert de Montreuil in his Roman de la violette and became widespread during the balance of the thirteenth and fourteenth centuries, appearing in upwards of fifty works. This technique of lyric insertions in romance continues (...) the earlier use of variable refrains within lyric songs and anticipates, perhaps, the insertion of snatches from Latin poetry in the Essais of Montaigne. Little studied until recently, the phenomenon was the focus of a colloquium at the Newberry Library in Chicago, in October 1991, with the title “Music and Narrative in Medieval Romance: The Poetics of Lyric Insertions.” The present study was read at that colloquium. (shrink)

N Rennes le 10 janvier 1716, dom Deschamps entra dans les ordres le 8 septembre 1733. Il resta au prieur de Montreuil-Bellay, pr s de Saumur le 19 avril 1774. Il fut nomm procureur du couvent, c'est- -dire simplement conome. A partir de 1761, il r sida au ch teau des Ormes o le marquis d'Argenson lui donna asile. En 1774 il mourut au couvent muni des sacraments. Il entreprit une r futation du syst me de la nature du (...) baron d'Holbach et une r futation de Spinoza. Il tenta beaucoup de d marches, ce qu'il appelle ses tentatives, aupr s des principaux esprits de son temps, Helv tius, Alembert, Voltaire, Rousseau; c'est surtout avec Robinet qu'il eut une longue correspondance. Dans cet uvre Jean Wahl montre que ce moine qui pr tend au titre d'ath e clair, cet homme qui tait en contact avec Voltaire et Rousseau et dont les id es ont gagn l'admiration de Diderot, m rite plus d'attention et d'int r t qu'il n'a re u jusqu'ici. (shrink)