Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Dévoilant une impressionnante galerie de portraits de femmes de la fin du xixe et du début du xxe siècle, l’ouvrage de Christine Peltre explore la collection de cartes postales acquise par Pierre de Gigord. Collectionneur passionné par les mondes ottomans et turcs, celui-ci assembla un rare éventail de cartes postales datant de l’époque où la « photographie timbrée » connaît son apogée et s’impose peu à peu comme un média de masse. Au fil des pages, où dialoguent texte et image, (...) l’ouvrage tém... (shrink)

The harvest and the pigeons. A note on the summit course of the pillar of Prusias at Delphi The remains of the pillar of Prusias, next to the temple of Apollon at Delphi, have generated much comment. Indeed, the course that supported the equestrian statue of the king of Bithynia presents 112 mortises, above and beyond the attachment holes of the statue itself. Until the present, it has been thought that these cavities served to attach vegetal elements, ears of corn (...) reaped by a laborer or, after the identification of the base as belonging to the pillar of Prusias, a field of corn signifying the beneficence of the king. A trail of textual and archaeological indications prompts a different interpretation for this enigmatic arrangement. The mortises would have served the insertion of bronze points (obeloi or meniskoi) forming a system of protection against defacement by birds, as is occasionally the case in sculpture and in temple architecture. (shrink)

L’étude du portique de Delphes attribué initialement aux Étoliens a été entreprise par A. Perrier en 2007 et les campagnes de relevés de terrain, commencées à la fin de l’année 2010 avec J.‑J. Malmary (architecte) et L. Fadin (topographe), se sont achevées en 2013 par des vérifications sur le monument, les derniers relevés ayant été mis au net en 2014. Un mémoire sur l’histoire, l’architecture et la topographie du portique et de sa terrasse a été déposé à l’Académie des inscriptions (...) et belles... (shrink)