Dans son article, l’auteur présente ses expériences comme préposée aux bénéficiaires en CHSLD. Elle témoigne ainsi des difficultés que son travail peut représenter dans le quotidien lorsqu’elle doit travailler avec des corps qui n’obéissent plus, avec des cancéreux ou des personnes atteintes d’alzheimer. Malgré ces difficultés, on rencontre un certain bonheur à travers celles-ci. Est-ce un cheminement philosophique ou un cri du cœur ?

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a (...) western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) “I’m sorry, there’s nothing else”: increasing supports for patients and families; (2) “someone will commit suicide”: improving supports for nurses: (3) “Everyone needs to be heard”: improving patient care communication; and (4) “I didn’t see it coming”: providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions. (shrink)

We have no reason to believe that reasons do not exist. Contra Bart Streumer’s recent proposal, this has nothing to do with our incapacity to believe this error theory. Rather, it is because if we know that if a proposition is true, we have no reason to believe it, then we have no reason to believe this proposition. From a different angle: if we know that we have at best misleading reasons to believe a proposition, then we have no reason (...) to believe it. This has two consequences. Firstly, coming close to believing the error theory is idle or pointless. Secondly, philosophers who argue that believing sweeping theories like determinism or physicalism is self-defeating because they are either false or believed for no reason pursue a worthwhile argumentative strategy. (shrink)

This study is unique in that it presents the first empirically developed framework for use as a tool for measuring historical empathy. The Historical Empathy Measurement Tool (HEMT) was developed using a design-based research method with three iterative macrocycles of design, experiment, and retrospective analysis. The study involved question responses from 276 students in grade 8 studying WWI trench warfare. The research resulted in a framework of seven levels. (0) Non-response, (1) Facts, (2) Assumptions and Deficits, (3) General Comparison of (...) the Past and Present, (4) Emotional Comparison of the Past and Present, (5) Understanding Motives, Behaviors, Thoughts, & Emotions in the Past, and (6) Acknowledgement of Differences from those in the Past. The inter-rater reliability at the end of macrocycle three was 95%. (shrink)

Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...) babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients. (shrink)

Productivity—the hallmark of linguistic competence—is typically attributed to algebraic rules that support broad generalizations. Past research on spoken language has documented such generalizations in both adults and infants. But whether algebraic rules form part of the linguistic competence of signers remains unknown. To address this question, here we gauge the generalization afforded by American Sign Language (ASL). As a case study, we examine reduplication (X→XX)—a rule that, inter alia, generates ASL nouns from verbs. If signers encode this rule, then they (...) should freely extend it to novel syllables, including ones with features that are unattested in ASL. And since reduplicated disyllables are preferred in ASL, such rule should favor novel reduplicated signs. Novel reduplicated signs should thus be preferred to nonreduplicative controls (in rating), and consequently, such stimuli should also be harder to classify as nonsigns (in the lexical decision task). The results of four experiments support this prediction. These findings suggest that the phonological knowledge of signers includes powerful algebraic rules. The convergence between these conclusions and previous evidence for phonological rules in spoken language suggests that the architecture of the phonological mind is partly amodal. (shrink)

Fertility preservation has become more common for various populations, including oncology patients, transgender individuals, and women who are concerned about age-related infertility. Little attention has been paid to fertility preservation for patients with differences/disorders of sex development (DSD). Our goal in this article is to address specific ethical considerations that are unique to this patient population. To this end, we present a hypothetical DSD case. We then explore ethical considerations related to patient’s age, risk of cancer, concern about genetic transmission (...) of a DSD condition to children, co-occurring gender dysphoria, and access to experimental fertility preservation procedures. Given the limitations of current technologies, we recommend offering fertility preservation to individuals living with DSD using an informed decision-making approach that instills realistic expectations and minimizes the potential for false hope. Finally, we conclude with practical recommendations for this case based on the ethical considerations. (shrink)

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions (...) of 35 nurses and midwives from three public hospitals located in the Western, Northern and North‐western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self‐improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity. (shrink)

Suppose I am a leeway sceptic: I think that, whenever I face a choice between two courses of action, I lack true alternatives. Can my practical deliberation be rational? Call this the Deliberation Question. This paper has three aims in tackling it. Its constructive aim is to provide a unified account of practical deliberation. Its corrective aim is to amend the way that philosophers have recently framed the Deliberation Question. Finally, its disputative aim is to argue that leeway sceptics cannot (...) deliberate entirely rationally about what to do, because of the connection between deliberating and deciding. (shrink)

Here is a skeptical trilemma. We know that we are responsible. We do not know that determinism is false. Yet, if we do not know that determinism is false, we do not know that we are responsible. If we want to avoid the skeptical conclusion of rejecting the first claim, we ought to reject the third. It does not follow that compatibilism is true. But it follows that libertarianism, the view that we are responsible even though responsibility requires indeterminism, is (...) unknowable, at least for now. To see this, we need to compare different forms of skepticism and their response. (shrink)

The success of fecal microbiota transplantation as a treatment for Clostrioides difficile infection has stirred excitement about the potential for microbiota transplantation as a therapy for a wide range of diseases and conditions. In this article, we discuss vaginal microbiota transplantation as “the next frontier” in microbiota transplantation and identify the medical, regulatory, and ethical challenges related to this nascent field. We further discuss what we anticipate will be the first context for testing VMT in clinical trials, prevention of the (...) recurrence of a condition referred to as bacterial vaginosis. We also compare clinical aspects of VMT with FMT and comment on how VMT may be similar to or different from FMT in ways that may affect research design and regulatory decisions. (shrink)

This co-edited volume compares Chinese and Western experiences of engineering, technology, and development. In doing so, it builds a bridge between the East and West and advances a dialogue in the philosophy of engineering. Divided into three parts, the book starts with studies on epistemological and ontological issues, with a special focus on engineering design, creativity, management, feasibility, and sustainability. Part II considers relationships between the history and philosophy of engineering, and includes a general argument for the necessity of dialogue (...) between history and philosophy. It continues with a general introduction to traditional Chinese attitudes toward engineering and technology, and philosophical case studies of the Chinese steel industry, railroads, and cybernetics in the Soviet Union. Part III focuses on engineering, ethics, and society, with chapters on engineering education and practice in China and the West. The book’s analyses of the interactions of science, engineering, ethics, politics, and policy in different societal contexts are of special interest. The volume as a whole marks a new stage in the emergence of the philosophy of engineering as a new regionalization of philosophy. This carefully edited interdisciplinary volume grew out of an international conference on the philosophy of engineering hosted by the University of the Chinese Academy of Sciences in Beijing. It includes 30 contributions by leading philosophers, social scientists, and engineers from Australia, China, Europe, and the United States. (shrink)

Free will sceptics deny the existence of free will, that is the command or control necessary for moral responsibility. Epicureans allege that this denial is somehow self-defeating. To interpret the Epicurean allegation charitably, we must first realise that it is propositional attitudes like beliefs and not propositions themselves which can be self-defeating. So, believing in free will scepticism might be self- defeating. The charge becomes more plausible because, as Epicurus insightfully recognised,there is a strong connection between conduct and belief—and so (...) between thecontent of free will scepticism (since it is about conduct) and the attitude of believing it. Second, we must realise that an attitude can be self- defeating relative to certain grounds. This means that it might be self-defeating to be a free will sceptic on certain grounds, such as the putative fact that we lack leeway or sourcehood. This charge is much more interesting because of the epistemic importance of leeway and sourcehood. Ultimately, the Epicurean charge of self-defeat fails. Yet, it delivers important lessons to the sceptic. The most important of them is that free will sceptics should either accept the existence of leeway or reject the principle that ‘“ought” implies “can”’. (shrink)

In this introduction, I briefly summarize Sophia Moreau's Faces of Inequality. I situate her monograph within two highly contemporary bodies of literature — relational egalitarianism and discrimination theory — to show how it provides important insights for understanding both what it means to treat others as equals in society and how to define wrongful discrimination. Moreau's work on discrimination is of great relevance for philosophers and socio-legal theorists alike as the commentaries from the symposium contributors demonstrate, including Dale Smith, Pablo (...) Gilabert, Andrea Sangiovanni, Daniel Viehoff, Jessica Eisen, Alysia Blackham, and Iyiola Solanke. (shrink)

Plasminogen activator inhibitor‐1 (PAI‐1) is a physiological inhibitor of urokinase (uPA), a serine protease known to promote cell migration and invasion. Intuitively, increased levels of PAI‐1 should be beneficial in downregulating uPA activity, particularly in cancer. By contrast, in vivo, increased levels of PAI‐1 are associated with a poor prognosis in breast cancer. This phenomenon is termed the “PAI‐1 paradox”. Many factors are responsible for the upregulation of PAI‐1 in the tumor microenvironment. We hypothesize that there is a breast cancer (...) predisposition to a more aggressive stage when PAI‐1 is upregulated as a consequence of Metabolic Syndrome (MetS). MetS exerts a detrimental effect on the breast tumor microenvironment that supports cancer invasion. People with MetS have an increased risk of coronary heart disease, stroke, peripheral vascular disease and hyperinsulinemia. Recently, MetS has also been identified as a risk factor for breast cancer. We hypothesize the existence of the “PAI‐1 cycle”. Sustained by MetS, adipocytokines alter PAI‐1 expression to promote angiogenesis, tumor‐cell migration and procoagulant microparticle formation from endothelial cells, which generates thrombin and further propagates PAI‐1 synthesis. All of these factors culminate in a chemotherapy‐resistant breast tumor microenvironment. The PAI‐1 cycle may partly explain the PAI‐1 paradox. In this hypothesis paper, we will discuss further how MetS upregulates PAI‐1 and how an increased level of PAI‐1 can be linked to a poor prognosis. BioEssays 29:1029–1038, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

A version of the principle of alternate possibilities claims that one is only blameworthy for actions which one was able to avoid. Much of the discussion about PAP concerns Frankfurt’s counterexamples to it. After fifty years of refined debates, progress might seem hopeless. Yet, we can make headway by asking: “what’s our reason for believing PAP?” The best answer is this: lacking eligible alternatives—alternatives whose cost is not too high to reasonably opt for—is a good excuse. Yet, this principle is (...) subject to straightforward counterexamples, unless it is given an epistemicised reading. And in this latter case, it does not support PAP. So, PAP is unsupported, at least for now. (shrink)

In this study, we conducted a pseudosign repetition task with 22 children acquiring American Sign Language as a first language from deaf parents. Thirty-nine pseudosigns with varying complexity were developed and organized into eight categories depending on number of hands, number of simultaneous movement types, and number of movement sequences. Pseudosigns also varied in handshape complexity. The children’s performance on the ASL pseudosign task improved with age, displaying relatively accurate production of location and orientation, but much less accurate handshape and (...) movement, a finding in line with real sign productions for both L1 and L2 signers. Handshapes with higher complexity were correlated with lower accuracy in the handshape parameter. We found main effects of sequential and simultaneous movement combinations on overall performance. Items with no movement sequence were produced with higher overall accuracy than those with a movement sequence. Items with two simultaneous movement types or a single movement type were produced with higher overall accuracy than those with three simultaneous movement types. Finally, number of hands did not affect the overall accuracy. Remarkably, movement sequences impose processing constraints on signing children whereas complex hands and two simultaneous movement types do not significantly lower accuracy, indicating a capacity for processing multiple simultaneous components in signs. Spoken languages, in contrast, manifest greater complexity in temporal length. Hearing children’s pseudoword repetition still displays high levels of accuracy on disyllabic words, with complexity effects affecting only longer multisyllabic words. We conclude that the pseudosign repetition task is an informative tool for studies of signing children’s phonological development and that sheds light on potential modality effects for phonological development. (shrink)

The status of indirect discrimination is ambiguous in the current literature. This paper addresses two contemporary and related debates. First, for some, indirect discrimination is not truly a distinct kind of discrimination, but it is simply a legal construct designed to address distributive inequalities between groups. Second, even if one accepts that indirect discrimination is a distinct type of discrimination, the connection between the two kinds of discrimination, direct and indirect, is debated. For some, they are distinct act-types, while for (...) others, indirect discrimination should be conceived as a side effect of prior cases of direct discrimination. In this paper, I argue that indirect discrimination is a distinct act-type that can take place without being connected to prior instances of direct discrimination. (shrink)

No one is responsible for their conduct because free will is an illusion, say some skeptics. Even when it seems that we have several options, we only have one. Hence, says the free will skeptic, we should reform our practices which involve responsibility attributions, such as punishment and blame. How seriously should we take this doctrine? Is it one that we could live by? One thorn in the side of the skeptic concerns deliberation. When we deliberate about what to do—what (...) film to go see, whom to befriend, which doctrine to follow—we must presume that our options are open to us. But then, every time that skeptics deliberate, they presume something which is incompatible with their doctrine, i.e. that they have several options. In a word, skeptics cannot deliberate qua skeptics. Some philosophers have responded that deliberators don’t have to presume that their options are open; they only have to presume that their choice will be efficacious. I argue that this proposal uses resources which, if they are available and successful, can be employed to refute skepticism. The upshot is that free will skeptics are pushing for a doctrine that is either false or in tension with deliberation. (shrink)

What is meant by "the philosophy of librarianship" -- The lack of a coherent philosophy of librarianship -- The nature of librarianship -- The ultimate aims of libraries.

I offer an unorthodox argument for the thesis that prostitution is not just a normal job. It has the advantage of being compatible with the claim that humans should have full authority over their sexual life. In fact, it is ultimately the emphasis on this authority that leads the thesis that prostitution is a normal job to collapse. Here is the argument: merchants cannot (both legally and morally) discriminate whom they transact with on the basis of factors like the ethnicity (...) or the religion of their client; but if prostitutes are ‘sex merchants’, then they cannot (both legally and morally) discriminate whom they have sex with on the basis of these factors. Yet everyone should have the full discretionary power to refuse to have sex under any circumstances. (shrink)

The use of predictive machine learning algorithms is increasingly common to guide or even take decisions in both public and private settings. Their use is touted by some as a potentially useful method to avoid discriminatory decisions since they are, allegedly, neutral, objective, and can be evaluated in ways no human decisions can. By (fully or partly) outsourcing a decision process to an algorithm, it should allow human organizations to clearly define the parameters of the decision and to, in principle, (...) remove human biases. Yet, in practice, the use of algorithms can still be the source of wrongful discriminatory decisions based on at least three of their features: the data-mining process and the categorizations they rely on can reconduct human biases, their automaticity and predictive design can lead them to rely on wrongful generalizations, and their opaque nature is at odds with democratic requirements. We highlight that the two latter aspects of algorithms and their significance for discrimination are too often overlooked in contemporary literature. Though these problems are not all insurmountable, we argue that it is necessary to clearly define the conditions under which a machine learning decision tool can be used. We identify and propose three main guidelines to properly constrain the deployment of machine learning algorithms in society: algorithms should be vetted to ensure that they do not unduly affect historically marginalized groups; they should not systematically override or replace human decision-making processes; and the decision reached using an algorithm should always be explainable and justifiable. (shrink)

Whether it is about Québec independence, French language or immigration, nationalism is a crucial feature of Québec politics. The Québec 2018 election is not an exception. Scholars have developed theories about individual identity, the nation and nationhood, but we lack a citizens’ perspective. We provide the first thorough description of Quebeckers’ nationalism, which reveals a roughly normal (i.e. non-polarized) distribution of ethnic nationalism attitudes. Most importantly, we measure ethnic nationalism with a never tested measure in Québec and we show that (...) it substantially explains vote choice in the Québec 2018 election—especially the support for the Coalition Avenir Québec. Our research builds bridges between debates in political philosophy and political science and deepens our understanding of the Québec 2018 election. (shrink)

Introduction : but is it ethics? -- Alterity : the problem of transcendence -- Singularity : the unrepresentable face -- Responsibility : the infinity of the demand -- Ethics : normativity and norms -- Scarce resources? : Levinas, animals, and the environment -- Failures of recognition and the recognition of failure : Levinas and identity politics.

ABSTRACT This essay is motivated by the seeming contradiction that Korean unification is sought after by most Koreans yet speculations about the social and cultural changes it might bring are almost absent. This may be because Korean unification denotes a series of differences contrasted to the present—because it is a potent “master symbol” with one foot in utopian speculation and the other in policy studies. In this essay, I outline some of the complexities, starting with an examination of illustrations of (...) unification in textbooks for the tensions and contradictions they introduce. I then turn to fiction and film, sketching not only what some South Koreans hope will happen after unification with the North but, indeed, the limits of their imagination regarding what the future will hold for South Korea. In the end, I concur with Grinker that representations of unification are “utopian,” but I object to the association of “utopia” with a socially engineered straitjacket. On the contrary, the utopias projected here suggest stepping off a precipice into worlds unknown, futures defined by their radical difference from today. The end of the essay locates these more imaginative dimensions of Korean unification in the “hope” of Ernst Bloch. (shrink)

Les démocraties s’articulent autour de deux pôles qui ne se réduisent pas l’un à l’autre, mais qui doivent communiquer constamment : la société civile et l’État. Or, l’équilibre à rechercher entre ces deux éléments est mis à mal par la consolidation de l’État administratif qui tend à autonomiser son action par rapport au reste de la société ; la société civile y est d’ordinaire exclue des prises de décisions. Cette exclusion peut toutefois être considérée positivement ou négativement. Comme il sera (...) discuté à partir des philosophies de John Dryzek et d’Iris Marion Young, on devrait tenter de penser à la fois l’inclusion de la société civile dans certaines prises de décisions étatiques et son indépendance pour favoriser sa dimension critique envers l’État. De là, l’État administratif peut être considéré simultanément comme une opportunité de démocratisation et comme une évolution de l’État à surveiller et à critiquer. (shrink)

This essay discusses the place of popular culture, especially visual representation, in theories of female subjectivity and examines two recent works on women and popular culture as representative of two primary critical and methodological approaches to the female subject. The essay considers the limitations and implications of both qualitative communication research and text-based feminist criticism and the need to construct a dialogue between them.