Many health care professionals (HCPs) are understandably reluctant to treat patients in environments infested with bedbugs, in part due to the risk of themselves becoming bedbug vectors to their own homes and workplaces. However, bedbugs are increasingly widespread in care settings, such as nursing homes, as well as in private homes visited by HCPs, leading to increased questions of how health care organizations and their staff ought to respond. This situation is associated with a range of ethical considerations including the (...) duty of care, stigmatization, vulnerability, confidentiality, risks for third parties, and professional autonomy. In this article, we analyze these issues using a case study approach. We consider how patients whose living environments are infested with bedbugs can receive care in the community setting in a manner that supports their well-being, is consistent with fairness in care provision, and takes into account risks for HCPs and third parties. We also discuss limits and obstacles to the provision of care in these situations. (shrink)

Many physiotherapists are reluctant to treat a client with bone metastases, as treatment indications are not clearly defined. The paradigmatic case presented here, and a review of the literature, allow us to highlight some ethical and clinical issues in physiotherapy care at the end of life, particularly for patients with bone metastases. The objective of this article is not to create an ethical decision making model but rather to serve as additional guidance to existing decision models in rehabilitation. This guidance (...) is based on principlism and is specific to the oncology clients in palliative care. The proposed principles, without being exhaustive, are beneficence, non-maleficence, respect for autonomy and justice. With a review of clinical indications and precautions, the article also helps to clarify both the theoretical and the evidence-based risks. These principles provide avenues for reflection to guide the management of these patients. The physiotherapist will then be able to conduct a critical analysis, in collaboration with the interdisciplinary team, whose goal is to respect the client’s right to appropriate care at the right time and that is based on clinical need. (shrink)

With the world's population aging, hospitals are facing pressure to adequately meet the needs of a growing number of frail older patients. For this population, comorbidities combined with a limited ability to face stressful situations contribute to frailty whereby a small injury or illness can lead to significant loss of function. It is widely recognized that hospitalized older patients are more vulnerable to physical or cognitive functional decline and require increased assistance in activities of daily living (Creditor 1993; Sager et (...) al. 1996; Mahoney, Sager, and Jalaluddin 1998; Kortebein et al. 2008; English and PaddonJones 2010; Covinsky, Pierluissi, and Johnston 2011; Zisberg et al. 2011;... (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in the context of (...) rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in the context of (...) rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

Maud Boyer Arnaud Destrebecqz Axel Cleeremans.

The ambiguity of concepts is a constant obstacle faced by political scientists. Some of the most popular concepts are characterized by their imprecision and their use in very different contexts of study. This article analyses one of these equivocal notions: corporatism. Following Goertz, a conceptualization of meso-corporatism is constructed and operationalized through the case of agriculture in Quebec, Canada. This exercise highlights the theoretical, empirical and comparative contributions of conceptual analysis to scientific inquiry.

André Laliberté examines the long tradition of statecraft in China to demonstrate how the intermingling of religions and state remains a key feature of Chinese modernity despite the materialist philosophy of the Communist Party.

The contemporary books of Cassius Dio's Roman History are known for their anecdotal quality and lack of interpretive sophistication. This paper aims to recuperate another layer of meaning for Dio's anecdotes by examining episodes in his contemporary books that feature masquerades and impersonation. It suggests that these themes owe their prominence to political conditions in Dio's lifetime, particularly the revival, after a hundred-year lapse, of usurpation and damnatio memoriae, practices that rendered personal identity problematic. The central claim is that narratives (...) in Dio's last books use masquerades and impersonation to explore paradoxes of personal identity and signification, issues made salient by abrupt changes of social status at the highest levels of imperial society. (shrink)

À partir des deux théophanies de Nicolas de Cues et de Leibniz, qui donnent à l’homme une place privilégiée au sein du monde créé, du fait de son statut de miroir ou image vivante qui reflète ou exprime le monde dans sa totalité, et de conceptions qui pensent la présence de l’infini dans le fini, on s’interroge ici sur la conception de la connaissance comme perspective de la monade chez Leibniz et la connaissance « quo modo capere possunt » des (...) créatures connaissantes dans l’univers cusain afin de voir si se tissent des liens de filiation évidents. On se demandera enfin si le système de l’expression, chez Leibniz, qui fait que toute monade exprime l’univers tout entier – ce qui semble proche de l’idée cusaine de la mens comme miroir ou image vivante – ne dépasse pas le perspectivisme « restrictif » de la conception cusaine et n’inscrit pas la démarche leibnizienne dans un dessein beaucoup plus large, qui nécessite un tissu de relations entre les différentes monades que constitue la compossibilité. Tout mouvement de connaissance est connaissance de toutes choses, mais dans un système de relations qui précède l’existence de la monade et qui résulte du calcul du meilleur, soumis au principe de non-contradiction.Ainsi, si un héritage réel semble se dessiner entre Nicolas de Cues et Leibniz, qui place le sujet connaissant au centre de l’édifice créé par Dieu, ou Création, dans une démarche à la fois libre et dépendante du principe premier, il faut comprendre que les deux systèmes de pensée ne répondent pas tout à fait au même dessein. (shrink)

En 1990, Georges Didi-Huberman, filósofo e historiador del arte contemporáneo, anuncia que va a elaborar una «estética del síntoma». La expresión está cargada de consecuencias epistemológicas. Nos proponemos exponer aquí las claves de tal filosofía del arte y aclarar los problemas que plantea. ¿Cuáles son, según Didi-Huberman, los síntomas de las imágenes? Antes de responder a esta pregunta es preciso hacer un rodeo por el pensamiento crítico de Freud mostrando lo que es para él un síntoma y evocando sobre todo (...) la figura de la histeria. El concepto de síntoma, tomado en su acepción freudiana y reactualizado en los confines de la obra de arte, permite a Didi-Huberman hacer ver de qué forma compleja significaciones heterogéneas pueden resumirse, articularse en una imagen. Designa esta articulación de sentidos mediante la noción de síntoma, cuyo «pan» es una circunstancia particular. Retomando los análisis de Didi-Huberman sobre la pintura de Fra Angelico, mostramos todo el poder de los síntomas de la pintura y la apertura epistemológica que imponen a los teóricos del arte. (shrink)

¿Es posible un decálogo del agua en la era de la globalización y la liberalización de todos los mercados y recursos naturales? Maude Barlow así lo cree y nos propone 10 principios básicos para mantener un equilibrio del agua entre las necesidades humanas y el mundo natural. El agua no puede concebirse simplemente como un recurso explotable, sino como un patrimonio del planeta y para las próximas generaciones. Los 10 principios de Barlow, más que un código, representan una invitación (...) a pensar la sustentabilidad a partir de lo local. (shrink)

69 Thompson-Schill, S.L. _et al. _(1997) Role of left inferior prefrontal cortex 59 Buckner, R.L. _et al. _(1996) Functional anatomic studies of memory in retrieval of semantic knowledge: a re-evaluation _Proc. Natl. Acad._ retrieval for auditory words and pictures _J. Neurosci. _16, 6219–6235 _Sci. U. S. A. _94, 14792–14797 60 Buckner, R.L. _et al. _(1995) Functional anatomical studies of explicit and 70 Baddeley, A. (1992) Working memory: the interface between memory implicit memory retrieval tasks _J. Neurosci. _15, 12–29 and cognition (...) _J. Cogn. Neurosci. _4, 281–288 61 Bäckman, L. _et al. _(1997) Brain activation in young and older adults 71 Petrides, M. (1994) Frontal lobes and behavior _Curr. Opin. Neurobiol._ during implicit and explicit retrieval _J. Cogn. Neurosci. _9, 378–391. (shrink)

Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefits, and impacts the applicability of the study results for the larger population. While Research Ethics Committees monitor fair subject selection within each trial, no standard oversight exists for subject selection across multiple trials for the same disease. (...) Drawing on the experience of multiple clinical trials at a single academic medical centre in the USA, we posit that concurrent COVID-19 trials are liable to unfair and inequitable subject selection on account of scientific uncertainty, lack of transparency, scarcity and, lastly, structural barriers to equity compounded by implicit bias. To address the critical gap in the current literature and international regulation, we propose new ethical guidelines for research design and conduct that bolsters fair and equitable subject selection. Although the proposed guidelines are tailored to the research design and protocol of concurrent trials in the COVID-19 pandemic, they may have broader relevance to single COVID-19 trials. (shrink)

As an imperial Greek author of both cultural and stylistic interest, Aretaeus deserves to be more widely read. His most riveting disease descriptions bring before our eyes the spectacle of the human body in extreme states of suffering and dehumanization. These descriptions achieve a degree of visual immediacy and emotional impact unparalleled among ancient medical writers. This essay considers them as examples of ekphrastic rhetoric, designed to create enargeia. To intensify immediacy and impact, Aretaeus deploys a set of techniques that (...) invite the reader’s active engagement with the spectacle he describes. This engagement has the potential to generate a corporeal response that destabilizes the boundary between the body of the reader and the body in the text. The modern concept of “empathy” is perhaps too anodyne to convey the complexity of the response involved. (shrink)