Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically (...) on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

Chaque jour, les professionnels de la santé doivent prendre des décisions dans des environnements complexes où s'affrontent de multiples normes qu'il n'est pas toujours facile de départager ni de mettre au clair afin de prendre une décision éclairée. Pourtant, les modèles de prise de décision dont disposent actuellement les éthiciens cliniques ou les comités de bioéthique comportent souvent des lacunes lorsqu'il s'agit d'aborder des problèmes à plusieurs niveaux (micro, méso et macro). Les décisions reposent ainsi trop souvent sur l'intuition plutôt (...) que sur une démarche systématique rigoureuse et facilement reproductible. Afin de pallier la situation, cet ouvrage fournit des outils théoriques et pratiques facilitant la prise de décision. Fondé sur l'étude collective d'un cas complexe ayant trait aux dimensions tragiques des choix éthiques en fin de vie (doit-on ou non administrer un médicament coûteux pour le traitement d'un cancer au stade avancé?), il réunit les contributions de plusieurs experts reconnus travaillant dans le système de santé (cliniciens, éthiciens, chercheurs, gestionnaires et décideurs publics). En raison de l'actualité des enjeux qui y sont traités et de la qualité des textes qui y sont rassemblés, cet ouvrage sera un outil pédagogique efficace pour les étudiants, les enseignants et les professionnels de la santé et aura certainement une incidence importante sur le mode de prestation des soins. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

BackgroundMedical aid in dying was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two (...) Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend. (shrink)

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically (...) on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

A lo largo de más de tres décadas, la obra de Lluís Duch (Barcelona, 1936) se ha ido consolidando en el ámbito de los estudios de historia de la cultura europea con una voz verdaderamente singular. Sus estudios sobre el mito son ya un referente ineludible en nuestro país y en Latinoamérica. Empalabrar el mundo, título de este volumen, es una de las expresiones más conseguidas de Lluís Duch, ya que en ella se da cita el alcance de su compromiso (...) intelectual y espiritual con el ser humano que habita un aquí y un ahora ineludibles. Empalabrar el mundo dota de sentido a todo cuanto contiene este volumen: además de una introducción general al pensamiento de Lluís Duch, un conjunto de aportaciones centradas en momentos principales de su obra o que entran en diálogo con la misma, así como dos textos del propio Duch relativos a la cuestión del mito, una breve biografía del autor y una bibliografía completa de sus publicaciones. Este libro quiere ser una invitación a la lectura de la peculiar antropología desarrollada por Lluís Duch a lo largo de más de cuarenta libros y de centenares de artículos científi cos, y quiere constituir, con ocasión de su setenta y cinco cumpleaños, un homenaje al pensador, al antropólogo y al monje. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

Drug exceptional access programs (DEAPs) exist across Canada to address gaps in access to pharmaceuticals. These programs circumvent standard procedures, raising epistemic, economic, social and political issues. This commentary provides insights into these issues by revealing the context and procedures on which these programs depend.

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)

In the contemporary context of increasing inequality and various forms of segregation, this volume analyzes the transition to neoliberal politics in Santiago de Chile. Using an innovative methodological approach that combines georeferenced data and multi-stage cluster analysis, Méndez and Gayo study the old and new mechanisms of social reproduction among the upper middle class. In so doing, they not only capture the interconnections between macro- and microsocial dimensions such as urban dynamics, schooling demands, cultural repertoires and socio-spatial trajectories, but also (...) offer a detailed account of elite formation, intergenerational accumulation, and economic, cultural, and social inheritance dynamics. (shrink)

Il y a chez Thomas d'Aquin une autre morale que celle que nous connaissons. Si elle n'a pas été développée, c'est que les options et les sensibilités du temps ne la réclamaient pas. Cette autre morale, dont les assises ne font aucun doute, se trouve, elle, en rapport avec le meilleur des options et des sensibilités de notre temps. La morale de Thomas d'Aquin est celle du chemin qui conduit à Dieu. Les humains sont ici-bas des voyageurs, en quête de (...) leur fin bienheureuse. Si riche soit-elle, cette morale ne promeut pas pour elles-mêmes les valeurs proprement terrestres et humaines. L'autre morale se définit comme une manifestation de ce qui nous habite : Dieu est en nous et pas seulement dans un au-delà, et notre vie éternelle est déjà commencée. En manifestant ce qui en nous est vie et valeur, nous les faisons nôtres et nous les développons; en les engageant dans des tâches terrestres et humaines, nous prenons au sérieux la création de Dieu remise entre nos mains. Et nous travaillons au vœu que celle-ci porte : la promotion des peuples et l'instauration d'une société juste et fraternelle dès ici-bas. Le livre articule, en finale, ces deux morales dans un nouvel ensemble."--From the publisher. (shrink)

Que se cache-t-il aujourd'hui derrière l'expression « bons sentiments », résolument péjorative et dépréciative, reflet d'un état d'esprit contemporain qui semble refuser toute place aux émotions et à la sensibilité? Il est de bon ton, aujourd'hui, de parler à tout propos et pour s'en moquer de « bons sentiments ». Mériam Korichi s'interroge sur les raisons de ce rejet dans le monde des médias, des intellectuels, des historiens, des artistes, notamment. Afin de retracer et de cerner l'origine de ce sens (...) négatif, elle entreprend un voyage dans l'histoire de la langue commune et philosophique : comment en est-on venu à donner à ces mots un sens contraire à ce que, littéralement, ils sembleraient vouloir dire. Le dénigrement systématique des bons sentiments par l'usage courant – aujourd'hui la chose du monde la mieux partagée, de l'homme de la rue à l'Académicien, en passant par l'homme politique et le philosophe – sonne comme une contradiction, un paradoxe que cette enquête stimulante se propose d'examiner, en redonnant sa juste place à la sentimentalité. (shrink)

Dom Léger-Marie Deschamps élabora un système philosophique profondément subversif et novateur, intitulé : La Vérité, ou Le Vrai Système. Il s'agit d'une philosophie de la totalité, fondée sur une logique des contraires et du contradictoire. La métaphysique de Deschamps annonce l'avènement d'une nouvelle humanité, qui induit nécessairement une nouvelle société, dans lequel l'État, les lois, les idéologies, la religion, la propriété sont abolis, chacun étant égal à tous. Au XVIIIe siècle cette doctrine ne pouvait être diffusée sans risques très graves (...) pour son auteur: l'amitié et la protection du marquis de Voyer d'Argenson évitèrent à Dom Deschamps toute persécution. (shrink)

Festschrift for Maḍiniyavela Śrī Mēdhaṅkara, Sri Lankan Buddhist monk; contributed articles chiefly on economic and ethical aspects of Buddhism.

Classical commentary on the Mīmāṃsāsūtra, basic work of the Mimamsa school in Hindu philosophy by Jaimini.

Previous theoretical accounts have predicted that warfare and intergroup conflict are environmental factors that contribute to the emergence of a fast life-history strategy. However, this assumption has never been directly empirically tested. We examined youth who grew up in a territory that experienced violent intergroup conflict and compared them with a control group on various life-history measures: age of first sexual intercourse, mating behavior, desired timing of marriage and first reproduction and desired number of children. We also measured other characteristics (...) to explore the congruence between them and exposure to conflict. Participants from the postconflict society showed indications of faster life-history strategy: greater mating effort, a tendency to marry and have their first child sooner, and a larger desired number of children. Furthermore, interactions between exposure to conflict and participants’ sex were found: females from a postconflict society want to have their child earlier, and males have elevated short-term mating success. Finally, the exposure to violent conflict turned out to have congruent effects with economic poverty but not troublesome family relations. The findings are in accordance with life-history theory and show the adaptiveness of human behavior related to fitness optimization in hostile and dangerous environments. (shrink)