In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called “Levels of Intervention”. No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of (...) patients who had died in three Quebec hospitals with a LOI ordered. Results were analysed through a principlism ethical framework. High compliance with the level of intervention ordered at the time of death was recorded, as well as high involvement of patient and/or family, demonstrating the efficiency of LOI in promoting respect for autonomy. Other results show delays in end-of-life care discussions in the course of the hospitalization. Only a small proportion of patients who died had a palliative care consultation, which may reflect equity issues in access to care. This study highlights the importance of the LOI in Quebec and the role it is playing in respect for end-of-life preferences as well as in the involvement of patients and families in the decision-making process. Training specific to end-of-life decision-making conversations would help support the LOI form’s use, as would developing provincial or national guidelines on the use of LOI to standardize organizational policies and practice around end-of-life care. (shrink)

Au livre V de l'Éthique à Nicomaque, Aristote ne donne pas une définition unifiée de la justice. Tout en ne rejetant pas la définition traditionnelle qui identifie la véritable justice et la justice légale, ni celle qui repose sur la justice naturelle et fonde la notion d'équité, il cherche de nouvelles assises pour la justice institutionnelle et c'est la notion d'égalité qui sert à cette fin. Cet article vise à préciser les notions de stricte égalité et d'égalité proportionnelle et corrélativement (...) à analyser les définitions des justices distributive et directive qui constituent les branches de la justice particulière chez Aristote.In the Fifth Book of the Nicomachean Ethics, Aristotle does not give one unified definition of justice. He does not reject the traditional definition of legal justice nor the definition of natural justice which is necessary to dread the idea of equity. However, he wants to ground institutional justice on a new base and the idea of equality serves this end. In this paper, I want to make clear the difference between strict and proportional equality and correlatively to analyse the definitions of distributive and "directive" justices which form the two branches of the aristotelian particular justice. (shrink)