Living kidney transplantation offers the best results for patients with end-stage renal disease (ESRD). This form of transplantation is no longer restricted to genetically or emotionally related donors, as shown by the acceptance of non-directed living anonymous donors, and the development of exchange programmes (EPs). EPs make it possible to perform living kidney transplantation among incompatible pairs, but while such programmes can help increase living organ donation, they can also create a degree of unfairness. Kidney transplant recipients in the O (...) blood group are at a disadvantage when it comes to EPs because they can only receive organs from O donors, whereas O donors are universal donors. This poses a major challenge in terms of distributive justice and equity. A way to remedy this situation is through altruistic unbalanced paired kidney exchange (AUPKE), in which a compatible pair consisting of an O blood group donor and a non-O recipient is invited to participate in an EP. Although the AUPKE approach appears fairer for O recipients, it still raises ethical questions. How does this type of exchange affect the donor/recipient gift relationship? Should recipients in compatible pairs receive a ‘better organ’ than the one they would otherwise have received from their intended donor? Finally, what is the role of transplant teams in AUPKE? This article will examine the organisational and ethical challenges associated with EPs and AUPKE, and compare different EP policies in countries where such programmes exist. (shrink)
In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced (...) clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians’ duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them. (shrink)
BackgroundThe COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.MethodTo inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a (...) literature review to summarize the ethical issues.ResultsThis literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.ConclusionThis literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve. (shrink)
BackgroundMedical assistance in dying (MAID) has been legal in Québec since December 2015 and in the rest of Canada since July 2016. Since then, more than 60 people have donated their organs after MAID. Such donations raise ethical issues about respect of patients’ autonomy, potential pressure to choose MAID, the information given to potential donors, the acceptability of directed donations in such a context and the possibility of death by donation. The objective of this study was to explore Québec professionals’ (...) perspectives on the ethical issues related to organ donation after MAID.MethodsWe conducted semi-directed interviews with 21 health care professionals involved in organ donation such as intensivists and intensive care nurses, operating room nurses, organ donation nurses and coordinators.ResultsThe participants were all favourable to organ donation after MAID in order to respect patients’ autonomy. They also favoured informing all potential donors of the possibility of donating organs. They highlighted the importance of assessing donors’ reasons for requesting MAID during the assessment. They were divided on directed donation, living donation before MAID and death by donation.ConclusionOrgan donation after MAID was widely accepted among the participants, based on the principle of respect for the donor’s autonomy. The findings of this study only provide the perspectives of Québec health care professionals involved in organ donation. Future studies are needed to gather other stakeholders’ perspectives on this issue as well as patients’ and families’ experiences of organ donation after MAID. (shrink)
BackgroundThe overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.MethodsThe qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal (...) of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.ResultsThe results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.ConclusionsThe participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed. (shrink)
In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant.
Les études réunies ici en hommage à Jean-Marie Beyssade s'inspirent de sa recherche selon trois modalités : l'examen des rapports Spinoza/Descartes ou Spinoza/Bergson, l'amplification de ses thèses sur les rapports entre affect et affection, l'étude des concepts de reconnaissance, de préférence, de justification.
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)
MarieChantal | : Cet article fait le point sur les travaux récents abordant le problème de l’utilisation des catégories modernes dans l’étude des traditions judéennes de l’Antiquité. La dernière décennie a en effet été marquée par la publication d’une série de recherches abordant d’abord le problème du concept moderne de « judaïsme » pour décrire une réalité antique portée par le grec Ioudaismos et se questionnant ensuite sur la façon juste de traduire Ioudaios pour respecter l’ethnicité du (...) peuple se réclamant de cette appellation. | : This paper provides a picture of the recent publications concerned with the problem of using modern categories for the study of ancient traditions from the Antiquity. In the last decade, many papers have been published first addressing the problem of the modern concept “Judaism” as a way to describe the Ancient reality related to the Greek term Ioudaismos, and second raising the question of the correct way to translate Ioudaios in respect with the ethnicity of the people related to this Greek term. (shrink)
Family Medicine Groups (FMGs) are the most recently developed primary care organizations in Quebec (Canada). Nurses within FMGs play a central role for patients with chronic diseases (CD). However, this complex role and the nursing activities related to this role vary across FMGs. Inadequate knowledge of nursing activities limits the implementation of exemplary nursing practices. This study aimed to describe FMG nursing activities with patients with CD and to describe the facilitators and barriers to these activities. A multiple‐case study was (...) performed with ten nurses practicing among patients with CD in FMGs. Five data sources were used to provide an in‐depth description of nursing activities and the facilitators and barriers to the development of these activities. After qualitative data analysis, findings show that nursing activities are clustered into five domains: Global assessment of the patient, Care management, Health promotion, Nurse–physician collaboration, and Planning services for patients with CD. Activities vary depending on contextual factors identified in each case. This multiple‐case study provides a clear description of nursing activities with patients with CD. There is a need for improved nursing activities and expertise in domains of activities that are less present in FMGs, such as case management and interprofessional collaboration. (shrink)
Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs (...) for Neglected Diseases Initiative, an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis. The project involved the implementation of a novel ‘pre-review’ process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process. (shrink)
« La femme de mon mari », ouvrage dont le titre en dit long, est l’oeuvre de deux anthropologues françaises, Sylvie Fainzang et Odile Journet. Il aborde la polygamie par une « approche de l’intérieur », ce qui fait d’ailleurs son originalité. En effet, les diverses explications des fondements de l’institution polygamique sont généralement classées en trois catégories : une explication politique : elle présente la polygamie comme un moyen de préserver le pouvoir des aînés sur les cadets. u...
Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the ‘in and out’ situation of CBRC in Canada, (...) we conducted an ethnographic study taking a ‘critically applied ethics’ approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants’ perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of ‘reproductive outsourcing’ that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders. (shrink)
How is hope to be found amid the ethical and political dilemmas of modern life? Writer and philosopher Mary Zournazi brought her questions to some of the most thoughtful intellectuals at work today. She discusses "joyful revolt" with Julia Kristeva, the idea of "the rest of the world" with Gayatri Spivak, the "art of living" with Michel Serres, the "carnival of the senses" with Michael Taussig, the relation of hope to passion and to politics with Chantal Mouffe and Ernesto (...) Laclau. A dozen stimulating minds weigh in with their visions of a better social and political order. The result is a collaboration - of writing, of thinking, and of politics - that demonstrates more clearly than any single-authored project could how ideas encountering one another can produce the vision needed for social change. (shrink)
Laclau and Mouffe: The Radical Democratic Imaginary is the first full-length overview of the important work of Ernesto Laclau and Chantal Mouffe. Anna Marie Smith clearly shows how Laclau and Mouffe's work has brought Gramscian, poststructuralist and psychoanalytic perspectives to revitalize traditional political theory. With clarity and insight, she shows how they have constructed a highly effective theory of identity formation and power relations that carefully draws from the criticism of political theory from postmodern anti-foundationalist political theory.
_Laclau and Mouffe: The Radical Democratic Imaginary_ is the first full-length overview of the important work of Ernesto Laclau and Chantal Mouffe. Anna Marie Smith clearly shows how Laclau and Mouffe's work has brought Gramscian, poststructuralist and psychoanalytic perspectives to revitalize traditional political theory. With clarity and insight, she shows how they have constructed a highly effective theory of identity formation and power relations that carefully draws from the criticism of political theory from postmodern anti-foundationalist political theory.
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)
This is the first full-length English translation of Benjamin Constant's massive study of humanity's religious forms and development, published in five volumes between 1824 and 1831. Constant (1767-1830) regarded On Religion, worked on over the course of many years, as perhaps his most important philosophical work. He called it "the only interest, the only consolation of my life," and "the book that I was destined by nature to write." While the recent revival of interest in Constant's thought has been welcome (...) and fruitful, it has been incomplete, tending to leave out of account his writings on religion. In this connection, On Religion is essential reading and of interest for many reasons. As an analysis of humanity's religious experience, the work is notable for its methodology. Unlike previous writers with dogmatic commitments, whether theological or philosophical, Constant aimed to work with well-established facts and to relate religious forms to their historical contexts and civilizational developments. In this way, he was a precursor of the scientific study of religion. This objectivity, however, was not tantamount to moral-political neutrality. In the aftermath of the French Revolution, he wanted partisans of the new order to recognize that the religious impulse was natural to the human heart: to extirpate religion was therefore a fool's errand and worse. Likewise, he instructed religious reactionaries that history had left them behind: now the natural state of the religious sentiment was an unfettered "spirituality" left free to find new forms of expression. His counsel to contemporaries has proven prescient concerning subsequent religious developments in democratic and totalitarian societies. In his day, Constant was a consistent liberal, a life-long advocate of representative government, as well as of the central liberal arrangement concerning religion: separation of church and state. But On Religion demonstrates that principled liberalism can turn a sympathetic as well as analytic eye toward religion and, in an unbegrudging way, find an important place for it in free society. There are signs that this is a lesson that contemporary liberalism would do well to relearn. Peter Paul Seaton Jr. teaches philosophy at St. Mary's Seminary and University in Baltimore. His scholarly interests focus on the intersection of religion, politics, and philosophy. He has translated a number of works in French thought, especially political philosophy. These include works by Pierre Manent, Democracy without Nations? and Modern Liberty and Its Discontents (with Daniel J. Mahoney), Chantal Delsol, Unjust Justice, and Rémi Brague, On the God of the Christians and The Legitimacy of the Human. (shrink)
In the foreword to the Mercure de France edition of de Staël., Chantal Thomas, French historian and writer, writes that this apology in favor of Marie-Antoinette did not help the queen nor the author herself; on the contrary it only made the latter more unpopular. So why did Germaine de Staël write it? Mme de Staël and Marie-Antoinette did not share many interests; however, at the moment of The Women’s March on Versailles in October 1789, the situation (...) had changed. It was at this moment, when Mme de Staël witnessed people’s hatred for the Queen, that she for the first time felt that she was on her side. She had the feeling that the Queen would be a victim to a public opinion that had been “manipulated” in a systematic way, and to which she herself had been a victim. Pursuing some ideas formulated by Reddy and in their work on emotion and empathy in history and philosophy respectively, I hope to offer some suggestions, with the aid of cultural semiotics. More specifically I hope to be able to provide some answers to the question whether Mme de Staël’s apology might be regarded as an act of compassion. (shrink)
This paper identifies, develops, and argues for an interpretation of Mary Astell’s understanding of self-government. On this interpretation, what is essential to self-government, according to Astell, is an agent’s responsiveness to her own reasoning. The paper identifies two aspects of her theory of self-government: an “authenticity” criterion of what makes our motives our own and an account of the capacities required for responsiveness to our own reasoning. The authenticity criterion states that when our motives arise from some external source without (...) validation by our own understanding of the reasons supporting them, then they are not our own. The capacities requisite for responsiveness to our own reasoning are those of examining and evaluating our own motives and of resisting the social pressure to conform to others’ opinions. An upshot of this interpretation of Astell’s theory of self-government is that it reveals her insights into the ways “custom” can undermine an individual’s ability to govern oneself. (shrink)
This is the first modern edition of the works of Lady Mary Shepherd, one of the most important women philosophers of the early modern period. Shepherd has been widely neglected in the history of philosophy, but her work engaged with the dominant philosophers of the time - among them Hume, Berkeley, and Reid. In particular, her 1827 volume Essays on the Perception of an External Universe outlines a theory of causation, perception, and knowledge which Shepherd presents as an alternative to (...) what she sees as the mistaken views of Berkeley and Hume. What she ultimately presents is an original and systematic metaphysics and epistemology. Shepherd's Essays consists of two parts. The first is a theory of perception and knowledge of the external world, which is designed to rebut idealism and skepticism about the external world and show that our ordinary beliefs are based on reason. The second is a collection of essays on topics in metaphysics and epistemology, including the immateriality and eternity of the mind, the relationship between mind and body, the possibility of miracles, the association of ideas, the relationship between physical and mathematical reasoning, and the epistemology of testimony. Antonia LoLordo's edition of Shepherd's Essays includes scholarly notes throughout the text that provide historical and philosophical context and expand on the major concepts of Shepherd's system. Her extensive introduction to Shepherd's life and works surveys some of the major points of Shepherd's system, points out directions for future research, and offers guidance for readers planning to teach her work in their courses. This volume is an invaluable primary resource for scholars, graduate students, and undergraduates interested in metaphysics, epistemology, and early modern philosophy. (shrink)
In Fratelli Tutti, Pope Francis writes that Mary “wants to give birth to a new world... where there is room for all those whom our societies discard, where justice and peace are resplendent.” This essay explores the significance of Mary for a Christian vision of peace and justice through ethnographic research on the role of Mary in the lives of Palestinian Christian women and in popular religion in Palestine more broadly. Utilizing the methodology of theological ethnography, this essay centers the (...) personal experiences of Palestinian Christians and considers the implication their understanding of Mary has for Fratelli Tutti and Christian ethics. (shrink)
Les modèles traditionnels de la masculinité et de la féminité ont été bouleversés au cours des trente dernières années. On observe ainsi des rapprochements entre les expériences sociales féminines et masculines, une certaine porosité des frontières entre les sexes et l’élaboration d’identités sexuées aux contours mouvants. Partant de ces constats, le livre de Marie-Laure Déroff, confronte des modèles médiatisés de la masculinité et de la féminité et des récits de vie centrés sur la sexualité....
Mary Wollstonecraft (1759-1797) est une auteure majeure de la fin du dix-huitième siècle et on se réjouit de voir la première traduction en français de ses Lettres de Scandinavie, plus de deux siècles après leur parution en 1796. L’ouvrage se présente sous la forme d’une narration épistolaire. Wollstonecraft y fait le récit du séjour de trois mois qu’elle passa en Scandinavie durant l’été de 1795. Elle y avait été envoyée par son amant, que l’on supposait être son mari, un homme (...) d’affaires am... (shrink)