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)

Objective:Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and (...) uncertainty in the breast cancer survivorship literature to improve research and practice.Inclusion Criteria:We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs.Methods and Analysis:The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings.Findings:After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty.Conclusion:While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted. (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)

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)

Despite the rapid adoption of technology in human resource departments, there is little empirical work that examines the potential challenges of algorithmic decision-making in the recruitment process. In this paper, we take the perspective of job applicants and examine how they perceive the use of algorithms in selection and recruitment. Across four studies on Amazon Mechanical Turk, we show that people in the role of a job applicant perceive algorithm-driven recruitment processes as less fair compared to human only or algorithm-assisted (...) human processes. This effect persists regardless of whether the outcome is favorable to the applicant or not. A potential mechanism underlying algorithm resistance is the belief that algorithms will not be able to recognize their uniqueness as a candidate. Although the use of algorithms has several benefits for organizations such as improved efficiency and bias reduction, our results highlight a potential cost of using them to screen potential employees during recruitment. (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)

¿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)

« Il y a 9 mois, pour que les choses changent et après avoir travaillé sur mon sujet depuis plus de 15 ans, je fais le choix d'abandonner mon confort en devenant (bénévolement) la nouvelle déléguée nationale à l'Environnement chez Les Républicains. Je l'ai accepté dans le but unique de porter mes convictions. J'y ai proposé un programme précis, destiné à être appliqué. Puis je suis partie en campagne pour les régionales et j'ai été élue vice-présidente au développement durable, à (...) l'énergie et à la mer en PACA. J'ai la volonté de transformer ma région en un laboratoire d'idées. Je suis déterminée pour qu'elle devienne le porte-drapeau d'une écologie qui rime avec économie. Je veux agir dans ma région sans langue de bois, faire progresser l'écologie en étant réaliste et cohérente. Il est temps de dire la vérité. Je veux donner les vrais chiffres, arrêter le catastrophisme, « l'écologiquement correct », ne pas faire de calcul populiste. On est en 2016, il serait temps de secouer les choses et de changer de modèle. Je suis prête à en payer le prix, ma cause en vaut la peine : des tempêtes j'en ai vu d'autres. Je veux aussi parler de la place des femmes en politique, du sexisme. De l'intérieur, je vais vous raconter ce basculement d'une vie de sportive ayant été nommée personnalité de l'année par le Times magazine, à un milieu d'hommes auxquels seule la loi impose la mixité. Je veux agir pour la qualité de notre environnement et sur nos choix énergétiques comme on monte une entreprise, avec sérieux mais sans oublier qui je suis. Osons! J'ai décidé de remettre en jeu tout ce que j'avais construit/acquis ces dernières années pour faire avancer mes convictions pour l'environnement. L'avenir me dira si le jeu en valait la chandelle. » Maud Fontenoy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Confidentiality and Its LimitsMaude Laliberté, John D. Lantos, and Sonia GowdaMultiple sclerosis is believed to be an autoimmune disease of the central nervous system. However, according to Italian physician Paolo Zamboni, it is related to cerebrospinal vascular insufficiency. Zamboni claims that MS can be treated by remedying this condition with venous angioplasty. This surgery is offered as treatment for MS in various countries—Poland, Bulgaria, and Costa Rica, for example. (...) But the Medical Board of Quebec, Canada, does not allow its members to perform the surgery and strongly advises patients against seeking it elsewhere. This opposition is based on the lack of evidence to support the procedure and the serious risks associated with it (including venous thrombosis, stroke, and pulmonary embolism). As a result, many Canadian MS patients have traveled to other countries to receive the surgery. Quebec physicians have been reluctant to provide surgical follow-up for patients who undergo the surgery in other countries due to the lack of information regarding the procedure. No alternative treatments are effective to partially or completely cure MS, and so the treatments available in Canada aim only to manage its symptoms.Jade is a forty-year-old Canadian woman with MS. She is on long-term disability leave, complains of growing fatigue and muscle stiffness, and has painful sensations in her limbs. She has been followed by an interdisciplinary team in a specialized hospital in Quebec for the past twenty years, since she was diagnosed. At her last appointment, Jade told her physical therapist that she recently underwent the experimental Zamboni surgery in Poland, despite her physician’s strong recommendation not to. Jade fears her physician’s reaction, so she asks the physical therapist to keep this information from the rest of her medical team.Jade is shy and tends to distrust health care professionals. It took many years for her physical therapist to gain her trust and to develop a positive therapeutic relationship with her. However, the physical therapist knows that serious complications can occur in patients who have had Zamboni’s surgery. Not telling Jade’s physician about the surgery could result in harm; Jade could have complications that are not recognized. Providing the information to the rest of the team would allow them to adjust her treatment to respond to the surgery and give her information and postoperative education that she will need. Moreover, keeping this secret could threaten team cohesion and trust if they find out about it later.Jade decided to undergo a risky surgery against her doctor’s advice in the hope of improving her quality of life. This was her autonomous choice. How should the physical therapist respond?CommentaryMaude Laliberte (bio)Laws and professional codes of ethics direct clinicians to respect their patients’ autonomy through confidentiality and informed consent unless there are compelling reasons not to do so. Health professionals are deeply committed to helping patients; above all, they want to avoid harming them. Therefore, a key component of this case is the possibility that respecting Jade’s desire to conceal information from the team may put her at direct risk if any postoperative complications are not detected, and at indirect risk if Jade’s trust in her medical team is undermined to the point where she turns away from them.The physical therapist must determine if the possible physical risks to Jade are imminent and serious enough to go against her autonomous choice. One risk that can occur following Zamboni’s surgery is inflammation of a vein caused by a blood clot. This is a life-threatening situation (although it may not be a likely complication for Jade). But the physical therapist can teach Jade to recognize the physical signs that can alert her to this problem, giving her ample time to seek treatment. Thus, even though she may be in danger from a life-threatening risk, there may be ways to manage it besides violating her confidentiality.The respect for autonomous choice is a crucial aspect of our democratic values. It promotes a process of exchange in the therapeutic alliance: the professional guides and informs the patient, but the patient is a partner in care planning and treatment. An important... (shrink)

En comparant sur plusieurs scènes la réception de mes recherches sur le travail bénévole – désenchantement pour les un.es, truisme pour les autres – et en prenant au sérieux le processus de politisation par l’enquête qui a été le mien, cet article propose une analyse située à la fois socialement et politiquement du désenchantement que produirait la sociologie catégorisée comme critique. Il met en lumière deux défenses de l’autonomie de l’engagement, au cœur de la critique de la critique : celui (...) de l’autonomie de « l’engagement citoyen » des acteur.trices et de leur rapport au travail, et celui de l’autonomie du travail du chercheur.se et de ses « engagements », généralement présenté sous le topos de la « neutralité » de la recherche. Ce retour réflexif sur les effets de l’enquête sur les autres, mais aussi sur moi-même, vient questionner in fine la portée sociale et politique de cette « conception des mondes antagonistes » inscrite dans une « doctrine de la séparation des sphères » du travail et de l’engagement qui concerne ici tant l’objet que la pratique de recherche. (shrink)

Maud Boyer Arnaud Destrebecqz Axel Cleeremans.

Cet ouvrage collectif est issu d’un colloque international qui s’est tenu à l’École française de Rome en 2016, pour marquer le vingt-cinquième anniversaire de la publication des cinq volumes de L’Histoire des femmes en Occident (en italien : Storia delle donne in Occidente) dirigés par Michelle Perrot et Georges Duby, et de Storia delle donne in Italia, paru cinq ans plus tard. Les directrices de ce volume mettent la publication de ces deux sommes en perspective et proposent une première tent...

Le diptyque « Corps/Guerre(s) » s’impose comme une problématique essentielle au cœur du renouvellement de la connaissance du phénomène guerrier. La réflexion autour de la corporéité de la guerre a ouvert de nouveaux territoires afin de repenser l’expérience guerrière, notamment par une réévaluation des expériences collectives et intimes des violences. Les deux numéros de la revue Quasimodo s’inscrivent dans cet axe – au travers d’une démarche comparatiste, pluridisciplinaire et chronologique...

Décrire adéquatement la signification d’un terme, ou d’un énoncé, suppose souvent de faire appel au co-texte ou au contexte. Le linguiste doit alors recourir à des corpus authentiques et proposer des procédures de contextualisation. Une telle démarche, que l’on peut à bon droit qualifier d’étique, est loin d’être suffisante. Elle ne tient pas compte des stratégies de contextualisation et de recontextualisation des discours par les locuteurs eux-mêmes, sans aucun doute liées à l’existence d’une compétence métalinguistique et métapragmatique. La contextualisation est (...) donc aussi un problème émique. Dans le cadre d’une enquête ethnographique au sein d’une troupe de théâtre, incluant l’observation et l’enregistrement audiovisuel des différentes activités des comédiens, on s’est intéressé aux phases de travail théâtral – lecture à la table et répétitions – pendant lesquelles les participants se confrontent à des textes qui leur posent des difficultés d’interprétation. Face à des énoncés dont la signification ne fait pas nécessairement problème, mais dont le sens en contexte peut sembler problématique, les comédiens et les metteurs en scène sont amenés à devoir recontextualiser. Nous étudierons ces pratiques de contextualisation, leur émergence – soit parce que les participants l’exigent, soit parce que les locuteurs eux-mêmes en éprouvent la nécessité pour parvenir à une pertinence communicative plus forte – en en soulignant la dimension collective. (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)

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)

Este artigo científico procurou investigar o processo de adaptação da Universidade Brasileira aos novos paradigmas impostos pelas políticas neoliberais. A análise se faz a partir de breve histórico do liberalismo e de suas imbricações no ensino. Apontando também a relativização da suposta democratização e modernização do ensino pelas novas perspectivas impostas pelo mercado. São levantadas também questões como autonomia universitária e legitimação da instituição de ensino superior.

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)

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)

Jean Greisch a soixante ans. A l'occasion de cet anniversaire, trente de ses collègues et amis de divers continents ont souhaité unir leurs réflexions à ce que son œuvre, désormais considérable, inspire sur les différentes scènes de la pensée. La thématique générale, qui constitue l'intitulé du présent volume, est emblématique d'une production singulière : passage entre les deux langues de son Luxembourg natal, entre la phénoménologie et la philosophie de la religion, entre la métaphysique et la théologie, entre les sciences (...) humaines et l'herméneutique, entre la poésie et l'éthique. Enseignant, traducteur, conférencier international et auteur, il continue de frayer différents types de passages : dresser des ponts, ouvrir des brèches, risquer des percées, souffrir des traversées, ménager des transitions, inventer des tracés. (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)

La reprise des travaux aux « Magasins Dessenne » au cours des années 2012 et 2013 avait permis de réévaluer l’histoire de l’édifice à l’aune de nouvelles observations architecturales. Certaines des hypothèses émises par le fouilleur A. Dessenne et par différents chercheurs concernant le phasage de l’édifice avaient été revues. Nous proposions en effet de voir dans la ruine non pas deux édifices distincts de part et d’autre d’un corridor central, mais plutôt un noyau initial auquel se seraient...

L’article présente les résultats des sondages menés dans les niveaux néopalatiaux sous le Quartier Nu à Malia (Crète) entre 1988 et 1993. La stratigraphie, les vestiges architecturaux et le matériel décrits permettent d’identifier plusieurs unités domestiques détruites par un incendie à un stade avancé du Minoen Récent IA, peut-être lié à l’éruption du volcan de Santorin. L’architecture et les fragments d’enduits peints témoignent de la qualité de l’habitat néopalatial, qui reprend en partie les murs de l’occupation antérieure, protopalatiale, et dicte (...) ensuite l’orientation du Quartier Nu au Minoen Récent IIIA2-B. (shrink)