Ce texte a déjà paru dans L. Hébert (dir.), Signo, Rimouski (Québec), 2011. Nous remercions Louis Hébert de nous avoir autorisé à le reproduire ici. 1. Résumé Trois opérations sont nécessaires pour produire un rythme : la segmentation en unités, la disposition et la sériation de ces unités. « Disposition » désigne également la composante relative à la disposition des unités dans une étendue temporelle et/ou spatiale. Le rythme peut notamment être défini comme la configuration particulière que constituent (...) au (...) - Sur le concept de rythme – Nouvel article. (shrink)
In 1835, Alexis de Tocqueville famously called for 'a new political science' that could address the problems and possibilities of a 'world itself quite new.' For Tocqueville, the democratic world needed not just a new political science, but also new arts of statesmanship and leadership. In this volume, editors Brian Danoff and L. Joseph Hebert, Jr. have brought together a diverse set of essays which reveal that Tocqueville's understanding of democratic statesmanship remains highly relevant today.
The present study extends the study of individuals' ethical ideology withinthe context of marketing ethics issues. A national sample of marketing professionals participated. Respondents' ethical ideologies were classified as absolutists, situationists, exceptionists, or subjectivists using the Ethical Position Questionnaire (Forsyth, 1980). Respondents then answered questions about three ethically ambiguous situations common to marketing and sales. The results indicated that marketers' ethical judgments about the situations differed based on their ethical ideology, with absolutists rating the actions as most unethical. The findings (...) are consistent with those of two earlier studies that utilized samples of business students (Barnett et al., 1994, 1995). The results suggest that personal moral philosophy is an important influence on ethical decision making that should be considered in empirical studies of business ethics. The results also support the utility of the Ethical Position Questionnaire (Forsyth, 1980) as a means for researchers and practitioners to assess individuals' ethical ideology. (shrink)
An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)
Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians is a concise and practical guide to ethical decision-making in medicine. The text is aimed at second- and third-year one-semester ethics courses offered in medical schools, health sciences departments, and nursing programs. By taking an applied approach rather than a theoretical approach, this text serves the needs of medical and nursing students, residents, and practicing physicians by sorting through questions of moral principles relevant to the diverse and growing (...) number of healthcare professionals. The many topics covered include truth telling, refusal of treatment, assisted suicide, managing error, and reproductive choice. (shrink)
As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)
This article seeks to shed light on the beliefs that influence nurses’ intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses’ beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying (...) with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients’ wishes, nurses should be aware that they do not systematically guarantee respect of a patient’s autonomy, nor do they replace a relationship based on trust between patients and health care professionals. (shrink)
OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: (...) Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. (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)
Frankfurt examples invite controversy over whether the pertinent agent in these examples lacks the specific ability to do otherwise, and whether what she does can be obligatory or permissible. We develop an account of ability that implies that this agent does not have the specific ability to refrain from performing the germane action. The account also undergirds a view of obligation that entails that it is morally required or prohibited for an agent to perform an action only if she has (...) the specific ability to do, and to do otherwise than, perform it. Therefore, in Frankfurt examples, it is neither obligatory nor impermissible for the relevant agent to do what she does. (shrink)
The problem of luck is advanced and defended against libertarian theories of responsibility-enabling ability. An outline of an account of ability is articulated to explore some features of the sort of ability moral responsibility requires. The account vindicates the luck objection and suggests a novel puzzle: Libertarianism is structurally barred from answering the problem of luck because responsibility requires, but inherently lacks, an explanation from reason states to actions that preserves reliability of connection between responsibility-grounding reasons-sensitivity and action.
This article provides a review of A Buddhist Theory of Semiotics by Fabio Rambelli while also broadening the scope of its evaluation to the review author’s own considerations “around” semiotics and Buddhism. After summarizing the general structure of the book, this review provides a qualitative evaluation of the book’s treatment of these two major themes: Buddhism and semiotics. It then approaches the question of interdisciplinarity, both in general and in relation to the book in particular. It discusses the two great (...) anthropological perspectives: the emic and the etic. Finally, this review identifies three major ways of conceiving semiotics and the semiotic in relation to three spheres or levels. (shrink)
We give a syntactic characterization of (finitary) theories whose categories of models are closed under the formation of connected limits (respectively the formation of pullbacks and substructures) in the category of all structures. They are also those theories whose consistent extensions by new atomic facts admit in each component an initial structure (respectively an initial term structure), and also thoseT for whichM(T) is locally finitely multi-presentable in a canonical way. We also show that these two properties of theories are nonuniform.
BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)
We give syntactic characterizations of1. the theories whose categories of models are closed under the formation of pullbacks, and of2. the locally ω-polypresentable categories.A somewhat typical example is the category of algebraically closed fields. Case is proved by classical model-theoretic methods; it solves a problem raised by H. Volger . The solution of case is in the spirit of the ones for the locally ω-presentable and ω-multipresentable cases found by M. Coste and P.T. Johnstone respectively. The problem was raised in (...) the context of Domain Theory by F. Lamarche. (shrink)