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)
¿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)
Espace d'expression et de discussion, les forums médiatiques font se rencontrer des individus aux opinions et appartenances variées. Il s'agit d'observer le rôle du dispositif communicationnel et la manière dont ses membres en usent: privilégient-ils la dimension conversationnelle ou publicitaire? quelle est la nature de cet espace public et des échanges qui s'y déroulent? L'analyse statistique et de contenu des courriels révèle un espace interactionnel de groupe où la publicité l'emporte sur la sociabilité, ainsi qu'une parole publique dégradée marquée par (...) l'incommunication et une dérive ethniciste.Space for expression and discussion forums are media meet individuals with varied opinions and affiliations. It is to observe the role of communicative device and how its members wear: they prefer the conversational dimension or advertising? What is the nature of public space and exchanges that take place? Statistical analysis and content of emails reveals a group interactional space where advertising outweighs sociability, and a degraded public speech marked by miscommunication and a drift ethnocentric. (shrink)
Dans la Dissertation de 1770, Kant écrit que la « totalité absolue, bien qu’elle ait l’apparence d’un concept courant et facile […] est une croix pour le philosophe ». Alors que l’ensemble total (universitas) de tout ce qui existe semble saisissable par le concept de tout (totum), sa synthèse effective sous la condition du temps est inaccessible. Déchirée entre simplicité du tout abstrait et complexité infinie de la totalité synthétique, la rais...
En 2013, à l’occasion du tricentenaire de Diderot, l’équipe « Identité et Subjectivité » consacrait, le 23 janvier, une journée d’étude à l’esthétique de l’encyclopédiste et philosophe français, à laquelle participèrent tous les auteurs de ce recueil. On pourrait s’étonner qu’une équipe de recherche dont l’axe principal porte sur la métaphysique, ait choisi de s’intéresser aux réflexions esthétiques de Diderot plutôt qu’à ses textes plus proprem...
La psychologie de Thomas d’Aquin articule un concept néoplatonicien de totalité avec un concept aristotélicien de totalité. Au cœur de l’analyse hylémorphique, Thomas d’Aquin recourt à un concept d’inspiration néoplatonicienne, pour répondre à une question qui n’est ni celle de la prédication ni celle de l’inhérence, mais celle de la présence de l’âme au corps. Le holenmérisme naît de cette rencontre entre une interrogation d’inspiration néoplatonicienne et un hylémorphisme aristotélicien.
Background In June 2016, the Parliament of Canada passed federal legislation allowing eligible adults to request Medical Assistance in Dying (MAID). Since its implementation, there likely exists a degree of hesitancy among some healthcare providers due to the law being inconsistent with personal beliefs and values. It is imperative to explore how nurses in Quebec experience the shift from accompanying palliative clients through “a natural death” to participating in “a premeditated death.” Research question/aim/objectives This study aims to explore how Quebec (...) nurses personally and professionally face the new practice of MAID and their role evolution. Research design A grounded theory design was used. Participants and research context We recruited 37 nurses who participated in or coordinated at least one MAID. Semi-structured interviews and focus groups were conducted and audiotaped. Data collection and analysis followed Strauss and Corbin steps. Ethical considerations Ethics approval was received from the investigator’s affiliated University. Participants were informed regarding the research goal, signed a written consent, and were assigned pseudonyms. Findings/results Results show that nurses experienced the wide range of paradoxe during MAID centering around the following eight elements: 1) confrontation abouth death, 2) choice, 3) time of death, 4) emotional load, 5) new Bill, 6) relationship with the person, 7) communication skills, and 8) healthcare setting. The shifting of views and values in this new role is presented by the contradiction of opposites. Conclusions A better understanding of the paradox experienced by nurses involved with MAID paves the way for the development of interventions. (shrink)
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.
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)
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)
By the time Baudelaire starts his work-in-progress prose-poems project, the Petits Poëmes en prose, also known as Le spleen de Paris,1 the poor, a recurrent protagonist of these short narratives, have already achieved a successful literary career of three decades. This evolution has mainly taken place in the rising genre of the novel, which, from the 1830s onward, interacts with an emerging mass public, whether one thinks of Dickens' Oliver Twist; or, the Parish Boy's Progress, the Newgate novels, Eugène Sue's (...) likewise widely popular Les mystères de Paris, George Sand's La mare au Diable or Francois le Champi. At that time, Hugo's masterpiece, Les... (shrink)
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)
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)
Originally published in 1944, this book presents a study of the life and work of Roman Catholic priest and scholar Alfred Loisy, written by fellow Modernist Maude Petre. Petre died shortly after completing this short biography, and the text begins with a note on her life by James A. Walker. This book will be of value to anyone with an interest in this important figure in the controversial Catholic Modernist movement.
