L’article présente et analyse deux représentations de l’agent économique : celle de l’ homo œconomicus chez John Stuart Mill (1806-1873) puis celle de l’ animal laborans, expression que l’on trouve chez Hannah Arendt (1906-1975). Chacun des deux auteurs se situe en opposition à une conception de Jeremy Bentham (1748-1832) qui identifie l’être humain à un agent économique, être rationnel, apte au calcul et au raisonnement logique pour son cas personnel mais qui n’est cependant pas un être raisonnable, c’est-à-dire susceptible de (...) vivre en harmonie avec les autres sans le couperet d’une législation qui borne sa liberté. Mill, en désaccord avec la conception du bonheur de Bentham, attribue à l’être économique des aspirations plus élevées, lesquelles seraient à même de se réaliser dans le futur, pourvu qu’une égalité politique authentique, notamment entre hommes et femmes, soit enfin établie. Arendt, née un siècle plus tard, s’inquiète, pour sa part, de la dégradation de l’image que l’être humain a de lui-même en s’identifiant à un animal laborans. Archétype de l’individu dont toutes les occupations se pensent sur le modèle d’une activité nécessaire à sa satisfaction personnelle, enfermé dans le privé de son corps, l’ animal laborans qui n’éprouve que des sensations, de la peine ou du plaisir, s’apparente tout à fait aux êtres insuffisants, non raisonnables, que Bentham avait en tête pour concevoir la législation comme un moyen de les faire vivre ensemble. Si l’on suit Arendt, il n’est pas exclu que la conception benthamienne de l’homme, contre laquelle Mill s’était élevé, puisse devenir la réalité de demain, autrement dit que le règne de l’ animal laborans, être esseulé, ayant perdu jusqu’au besoin de guider lui-même sa propre conduite à l’égard des autres puisse finir par s’imposer. (shrink)

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. (...) But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies. (shrink)

Le conseil conjugal et familial propose un premier travail avec les personnes, les couples ou les familles qui rencontrent des difficultés d’ordre conjugal, parental ou familial. Il favorise, dans un cadre sécurisé, la mise en mots des ressentis et la remise en route de la pensée pour permettre aux personnes d’accéder à une représentation de leur situation et de ce qui les fait souffrir. Le conseiller conjugal et familial, de par la contenance qu’il offre, apporte ainsi une aide pour sortir (...) du chaos intérieur et pour entrer en dialogue avec soi-même ainsi qu’à l’intérieur du couple ou de la famille. Cette prise en charge peut se révéler suffisante pour surmonter des difficultés passagères ; elle pourra aussi, par le travail d’élaboration psychique qu’elle favorise, déboucher sur un travail thérapeutique à proprement parler auprès d’un thérapeute individuel, conjugal ou familial. (shrink)

Objective To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. Materials and methods Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed (...) using χ2 tests and multivariate logistic regression. Results Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, p<0.001). This effect persisted on multivariate regression analysis (OR 7.00, 95% CI 3.97 to 12.36, p<0.001). Female gender, being married or in a committed relationship, being highly religious, experiences with prematurity, and favouring sanctity of life were significantly associated with decisions to resuscitate. Discussion Presenting delivery room options for extremely premature infants as defaults exert a significant effect on decision makers. The information structure of the choice task may act as a subtle form of manipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy. Conclusion Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making. (shrink)

Background: It is not known how neonatologists address the affective and cognitive loads on parents deciding whether to resuscitate infants born extremely preterm. This study explores expert neonatologists' views on these decision-making processes and their own roles in counseling parents. Methods: Semistructured interviews asked internationally recognized experts to share their perspectives on perinatal consultations. Their responses were subjected to thematic analysis. Results: Eighteen of 22 invited experts participated. Approximately equal numbers reported employing a physician-driven approach, a parent-driven approach, and a (...) combined approach during these consultations. Those who followed a physician-driven approach typically focused on conveying standard information about adverse outcomes. Those who followed a parent-driven approach typically focused on addressing parents' information requests, guiding their decision making, and providing affective support. Nearly all experts, in each group, endorsed addressing the child's quality of life, in terms of functionality, when discussing long-term outcomes. Although many believed that families adjusted to life with a disabled child, few discussed the topic during prenatal consultations. Most, in each group, reported trying to alleviate future “decisional regret” for parents whose premature infants subsequently became disabled. None spoke to parents about possible decisional regret after deciding to forgo resuscitation. Conclusions: Expert neonatologists are deeply concerned that parents understand the decision facing them. However, they differ on what information they offer and how they balance parents' need for cognitive and affective support. They expressed more concern about parents' decisional regret should their child survive resuscitation, but have severe disability, than about decisional regret after foregoing resuscitation. (shrink)