Living kidney transplantation offers the best results for patients with end-stage renal disease (ESRD). This form of transplantation is no longer restricted to genetically or emotionally related donors, as shown by the acceptance of non-directed living anonymous donors, and the development of exchange programmes (EPs). EPs make it possible to perform living kidney transplantation among incompatible pairs, but while such programmes can help increase living organ donation, they can also create a degree of unfairness. Kidney transplant recipients in the O (...) blood group are at a disadvantage when it comes to EPs because they can only receive organs from O donors, whereas O donors are universal donors. This poses a major challenge in terms of distributive justice and equity. A way to remedy this situation is through altruistic unbalanced paired kidney exchange (AUPKE), in which a compatible pair consisting of an O blood group donor and a non-O recipient is invited to participate in an EP. Although the AUPKE approach appears fairer for O recipients, it still raises ethical questions. How does this type of exchange affect the donor/recipient gift relationship? Should recipients in compatible pairs receive a ‘better organ’ than the one they would otherwise have received from their intended donor? Finally, what is the role of transplant teams in AUPKE? This article will examine the organisational and ethical challenges associated with EPs and AUPKE, and compare different EP policies in countries where such programmes exist. (shrink)

In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced (...) clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians’ duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them. (shrink)

BackgroundMedical assistance in dying (MAID) has been legal in Québec since December 2015 and in the rest of Canada since July 2016. Since then, more than 60 people have donated their organs after MAID. Such donations raise ethical issues about respect of patients’ autonomy, potential pressure to choose MAID, the information given to potential donors, the acceptability of directed donations in such a context and the possibility of death by donation. The objective of this study was to explore Québec professionals’ (...) perspectives on the ethical issues related to organ donation after MAID.MethodsWe conducted semi-directed interviews with 21 health care professionals involved in organ donation such as intensivists and intensive care nurses, operating room nurses, organ donation nurses and coordinators.ResultsThe participants were all favourable to organ donation after MAID in order to respect patients’ autonomy. They also favoured informing all potential donors of the possibility of donating organs. They highlighted the importance of assessing donors’ reasons for requesting MAID during the assessment. They were divided on directed donation, living donation before MAID and death by donation.ConclusionOrgan donation after MAID was widely accepted among the participants, based on the principle of respect for the donor’s autonomy. The findings of this study only provide the perspectives of Québec health care professionals involved in organ donation. Future studies are needed to gather other stakeholders’ perspectives on this issue as well as patients’ and families’ experiences of organ donation after MAID. (shrink)

BackgroundThe COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.MethodTo inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a (...) literature review to summarize the ethical issues.ResultsThis literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.ConclusionThis literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (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)

In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant.

Les études réunies ici en hommage à Jean-Marie Beyssade s'inspirent de sa recherche selon trois modalités : l'examen des rapports Spinoza/Descartes ou Spinoza/Bergson, l'amplification de ses thèses sur les rapports entre affect et affection, l'étude des concepts de reconnaissance, de préférence, de justification.

Marie Chantal | : Cet article fait le point sur les travaux récents abordant le problème de l’utilisation des catégories modernes dans l’étude des traditions judéennes de l’Antiquité. La dernière décennie a en effet été marquée par la publication d’une série de recherches abordant d’abord le problème du concept moderne de « judaïsme » pour décrire une réalité antique portée par le grec Ioudaismos et se questionnant ensuite sur la façon juste de traduire Ioudaios pour respecter l’ethnicité du (...) peuple se réclamant de cette appellation. | : This paper provides a picture of the recent publications concerned with the problem of using modern categories for the study of ancient traditions from the Antiquity. In the last decade, many papers have been published first addressing the problem of the modern concept “Judaism” as a way to describe the Ancient reality related to the Greek term Ioudaismos, and second raising the question of the correct way to translate Ioudaios in respect with the ethnicity of the people related to this Greek term. (shrink)

Anne Pasquier,Marie Chantal,Steeve Bélanger.

Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs (...) for Neglected Diseases Initiative, an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis. The project involved the implementation of a novel ‘pre-review’ process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process. (shrink)

Jeffery Aubin ,Marie Chantal ,Dianne Cole ,Julio Chaves ,Cathelyne Duchesne ,Christel Freu ,Steve Johnston ,Brice Jones ,Amaury Levillayer ,Stéphanie Machabée ,Paul-Hubert Poirier ,Philippe Therrien ,Jonathan von Kodar ,Martin Voyer ,Jennifer Wees ,Eric Crégheur.

Jeffery Aubin,Serge Cazelais,Marie Chantal,Julio Cesar Dias Chaves,Cathelyne Duchesne,Steve Johnston,Louis Painchaud,Paul-Hubert Poirier,Tuomas Rasimus,Gaëlle Rioual,Maryse Robert,Eric Crégheur.

Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the ‘in and out’ situation of CBRC in Canada, (...) we conducted an ethnographic study taking a ‘critically applied ethics’ approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants’ perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of ‘reproductive outsourcing’ that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders. (shrink)

How is hope to be found amid the ethical and political dilemmas of modern life? Writer and philosopher Mary Zournazi brought her questions to some of the most thoughtful intellectuals at work today. She discusses "joyful revolt" with Julia Kristeva, the idea of "the rest of the world" with Gayatri Spivak, the "art of living" with Michel Serres, the "carnival of the senses" with Michael Taussig, the relation of hope to passion and to politics with Chantal Mouffe and Ernesto (...) Laclau. A dozen stimulating minds weigh in with their visions of a better social and political order. The result is a collaboration - of writing, of thinking, and of politics - that demonstrates more clearly than any single-authored project could how ideas encountering one another can produce the vision needed for social change. (shrink)

« La femme de mon mari », ouvrage dont le titre en dit long, est l’oeuvre de deux anthropologues françaises, Sylvie Fainzang et Odile Journet. Il aborde la polygamie par une « approche de l’intérieur », ce qui fait d’ailleurs son originalité. En effet, les diverses explications des fondements de l’institution polygamique sont généralement classées en trois catégories : une explication politique : elle présente la polygamie comme un moyen de préserver le pouvoir des aînés sur les cadets. u...

Laclau and Mouffe: The Radical Democratic Imaginary is the first full-length overview of the important work of Ernesto Laclau and Chantal Mouffe. Anna Marie Smith clearly shows how Laclau and Mouffe's work has brought Gramscian, poststructuralist and psychoanalytic perspectives to revitalize traditional political theory. With clarity and insight, she shows how they have constructed a highly effective theory of identity formation and power relations that carefully draws from the criticism of political theory from postmodern anti-foundationalist political theory.

_Laclau and Mouffe: The Radical Democratic Imaginary_ is the first full-length overview of the important work of Ernesto Laclau and Chantal Mouffe. Anna Marie Smith clearly shows how Laclau and Mouffe's work has brought Gramscian, poststructuralist and psychoanalytic perspectives to revitalize traditional political theory. With clarity and insight, she shows how they have constructed a highly effective theory of identity formation and power relations that carefully draws from the criticism of political theory from postmodern anti-foundationalist political theory.

Some commentators have condemned Kant’s moral project from a feminist perspective based on Kant’s apparently dim view of women as being innately morally deficient. Here I will argue that although his remarks concerning women are unsettling at first glance, a more detailed and closer examination shows that Kant’s view of women is actually far more complex and less unsettling than that attributed to him by various feminist critics. My argument, then, undercuts the justification for the severe feminist critique of Kant’s (...) moral project. (shrink)

This book offers a defence of mathematical fictionalism, according to which we have no reason to believe that there are any mathematical objects. Perhaps the most pressing challenge to mathematical fictionalism is the indispensability argument for the truth of our mathematical theories (and therefore for the existence of the mathematical objects posited by those theories). According to this argument, if we have reason to believe anything, we have reason to believe that the claims of our best empirical theories are (at (...) least approximately) true. But since claims whose truth would require the existence of mathematical objects are indispensable in formulating our best empirical theories, it follows that we have good reason to believe in the mathematical objects posited by those mathematical theories used in empirical science, and therefore to believe that the mathematical theories utilized in empirical science are true. Previous responses to the indispensability argument have focused on arguing that mathematical assumptions can be dispensed with in formulating our empirical theories. This book, by contrast, offers an account of the role of mathematics in empirical science according to which the successful use of mathematics in formulating our empirical theories need not rely on the truth of the mathematics utilized. (shrink)

From the theory of ‘deliberative democracy’ to the politics of the ‘third way’, the present Zeitgeist is characterized by attempts to deny what Chantal Mouffe contends is the inherently conflictual nature of democratic politics. Far from being signs of progress, such ideas constitute a serious threat to democratic institutions. Taking issue with John Rawls and Jürgen Habermas on one side, and the political tenets of Blair, Clinton and Schröder on the other, Mouffe brings to the fore the paradoxical nature (...) of modern liberal democracy in which the category of the ‘adversary’ plays a central role. She draws on the work of Wittgenstein, Derrida, and the provocative theses of Carl Schmitt, to propose a new understanding of democracy which acknowledges the ineradicability of antagonism in its workings. (shrink)

Chantal Mouffe is one of the most influential political theorists at work today. Her work has influenced political parties across Europe and continues to inform the direction of left politics. In this work, Mouffe argues that liberal democracy misunderstands the problems of ethnic, religious and nationalist conflicts because of its inadequate conception of politics.

Since September 11, we frequently hear that the struggle is between good and evil and that politics is at an end. Should we welcome or fear a 'Third Way' beyond left and right? In this timely and thought provoking book, Chantal Mouffe argues that third way thinking ignores fundamental, conflictual aspects of human nature and that far from expanding democracy, globalization is undermining the combative and radical heart of democratic life. Going back first to Aristotle, she identifies the historical (...) origins of the political. She also reflects on the Enlightenment and the social contract, arguing that in spite of its good intentions, it fatally suppressed the radical core of political life. She uses many contemporary examples, including the Iraq war, racism and the rise of the far right, to argue that far from ending dangerous extremism, the political void created by the search for consensus inflames it. (shrink)

Since September 11th, we frequently hear that political differences should be put aside: the real struggle is between good and evil. What does this mean for political and social life? Is there a 'Third Way' beyond left and right, and if so, should we fear or welcome it? This thought-provoking book by Chantal Mouffe, a globally recognized political author, presents a timely account of the current state of democracy, affording readers the most relevant and up-to-date information. Arguing that liberal (...) 'third way thinking' ignores fundamental, conflicting aspects of human nature, Mouffe states that, far from expanding democracy, globalization is undermining the combative and radical heart of democratic life. Going back first to Aristotle, she identifies the historical origins of the political and reflects on the Enlightenment, and the social contract, arguing that in spite of its good intentions, it levelled the radical core of political life. Contemporary examples, including the Iraq war, racism and the rise of the far right, are used to illustrate and support her theory that far from combating extremism, the quest for consensus politics undermines the ability to challenge it. These case studies are also highly effective points of reference for student revision. _On the Political _is a stimulating argument about the future of politics and addresses the most fundamental aspects of democracy that will aid further study. (shrink)

We show that all QE rings of prime power characteristic are constructed in a straightforward way out of three components: a filtered Boolean power of a finite field, a nilpotent Jacobson radical, and the ring Z p n or the Witt ring W 2 (F 4 ) (which is the characteristic four analogue of the Galois field with four elements).