Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, (...) such as parents or judges, if lower level decision-makers are incapable of satisfactorily addressing the issue even with support and the higher level decision-maker is better positioned to satisfactorily address the issue than all lower level decision-makers. Because gender uniquely pertains to personal identity and self-realisation, parents and judges are rarely better positioned to make complex medical decisions. Instead of taking away trans youth’s authority over their healthcare decisions, we should focus on supporting their ability to take the best possible decision for themselves. (shrink)

"An impressively reasoned and startlingly unorthodox treatise on religion." - Belles Lettres Florence Nightingale (1820-1920) is famous as the heroine of the Crimean War and later as a campaigner for health care founded on a clean environment and good nursing. Though best known for her pioneering demonstration that disease rather than wounds killed most soldiers, she was also heavily allied to social reform movements and to feminist protest against the enforced idleness of middle-class women. This original edition provides bold (...) new insights into Nightingale's beliefs and a new picture of the relationship between feminism and religion. Suggestions for Thought to the Searchers after Truth Among the Artisans of England (1860), which contains the novel Cassandra , is a central text in 19th-century history of feminist thought and is published here for the first time. Nightingale argues that work was the means by which every individual sought self-fulfillment and served God. She wrote influentially about the group most Victorians declared to be above work: unmarried, middle-class women. (shrink)

By attending to how people speak about their gender, we can find diverse answers to the question of what it is like to have a gender identity. To some, it is little more than having a body whereas others may report it as more attitudinal or dispositional—seemingly contradictory views. In this paper, I seek to reconcile these disparate answers by developing a theory of how individual gender identity comes about. In the simplest possible terms, I propose that gender identity is (...) how we make sense of our gender subjectivity, the totality of our gendered experiences of ourselves. Gender identity is constituted by gender subjectivity, but this constitutive relationship is underdetermined. While gender subjectivity may narrow the range of inhabitable gender identities, it is always compatible with more than one. To arrive at a gender identity, we arrange gender subjectivity like building materials. My theory helps us understand how different people offer seemingly incompatible accounts of their gender identity without questioning their authenticity or validity. They simply arrange similar building materials differently. (shrink)

Scholars have noted persistent high rates of agricultural health and safety incidents and the need to develop more effective interventions. Participatory research provides an avenue to broaden the prevailing research paradigms and approaches by allowing those most impacted to illuminate and work to solve those aspects of their lives. One such approach is photovoice, an emancipatory visual narrative approach. Yet, despite its broad appeal, photovoice can be hard to implement. In this article, we leverage our experience using photovoice for a (...) farm children safety project to describe and reflect on the ethical and methodological aspects broadly relevant to agricultural health and safety topics. We first contextualize the tensions of navigating between photovoice, the research ethics committees (RECs) regulatory frameworks, and competing views on visual representations in agriculture. We then discuss the sources of risks to participants and researchers, how we addressed these risks, and how these risks unfolded during the research phase of the photovoice activity. We conclude with three lessons we (re)learned: the importance of collaborating with RECs, the need to increase preparation to limit psychological risks to participants and researchers, and avenues to augment the emancipatory power of photovoice in a virtual environment. (shrink)

A recent paper by Teresa Baron and Geoffrey Dierckxsens argues that puberty blockers and hormone therapy should be disallowed before adulthood on prudential and consent-related grounds. This response contends that their argument fails because it is predicated on unsupported premises and misinterpretations of the available evidence. There is no evidence that a large proportion of pubertal and postpubertal youths later discontinue medical transition. Meaningful assent is a viable and commonly accepted alternative to meaningful consent in paediatric bioethics. And finally, the (...) primary purpose of transition-related interventions is to actualise youths’ gendered self-image, not treat an underlying mental illness. (shrink)

Background Seeking assent from children for participation in medical research is an ethical imperative of numerous institutions globally. However, none of these organizations provide specific guidance on the criteria or process to be used when obtaining assent. The primary objective of this scoping review was to determine the descriptions of assent discussed in the literature and the reported criteria used for seeking assent for research participation in pre-adolescent children. Methods Medline and Embase databases were searched until November 2020 using the (...) term “assent” in the title or abstract. Inclusion criteria were (1) studies enrolling children which specifically described operationalization of the assent process and (2) studies of the assent process which provided a description of assent. Data collected included participant information, patient criteria for seeking assent, guidelines referenced, description of assent reported, how assent was obtained and assent information presented, and reported assent rate. For qualitative articles focusing on the assent process, important themes were identified. Results A total of 116 articles were included of which 79 (68.9%) operationalized assent and 57 studies (%) described the assent process. The most commonly reported criterion used to determine the ability of a child to assent was age (35.4%, 28/79). The reported minimal age for obtaining pediatric assent varied considerably across and within jurisdictions (5–13 years; median 7.5 years, IQR 7.0, 9.75). Cognitive ability was reported as a criterion for obtaining assent in 5.1% (4/79) of studies. Assent rates were only reported in 17.7% (14/79) of citations and ranged from 32.0 to 100%. Analysis of the 57 studies describing the assent process identified several themes, including age thresholds, assessment of capacity, variable knowledge of pediatric assent and parental roles. Conclusion We found significant variation in criteria used for assessment of patient capacity, delivery of information used to obtain assent and documentation of the assent process. While we acknowledge that individual children, settings and jurisdictions may require different approaches to obtaining assent, there should be agreement on important principles to be followed with resulting common guidance on assessing capacity, delivering information and documentation of the assent process for publication. (shrink)

Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical (...) care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care. (shrink)

Florence Chiew interviews Maurizio Meloni on his new book, Impressionable Biologies: From the Archaeology of Plasticity to the Sociology of Epigenetics. The conversation reflects on a number of key themes and arguments in Meloni’s work, such as the use of the term ‘impressionability’ to explore longstanding ideas of the permeable body in constant flux in response to cosmological changes. This notion of the body-porous is one whose history Meloni traces back to ancient traditions and systems of medicine, such as (...) humoralism. In this important book, Meloni makes a compelling argument for questioning the current emphasis on the novelty of biological plasticity as an exclusively contemporary phenomenon, and urges us to take a longer genealogical perspective to appreciate how histories of corporeal plasticity have always been part of deeply gendered, racialized and classed discourses in which social hierarchies have been made through physiological distinctions. (shrink)

This is an open access title available under the terms of a CC BY NC ND 4.0 International license. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations. In Contentious Minds, Florence Passy and Gian-Andrea Monsch explain how cognitive and relational processes allow activists participate in and sustain their commitment to activism. Based on a wide array of survey and interview data with activists engaged in (...) protest, volunteering and unions, they highlight how a commitment community develop shared values, identities, and meanings through interaction. (shrink)

Introduction Les femmes n'ont eu véritablement accès au pastorat dans les Églises protestantes françaises qu'en l966. Certes, une femme avait été consacrée en 1948, mais à condition de rester célibataire et sans enfants. Celles qui dans les années suivantes exercèrent exceptionnellement la fonction pastorale ne furent pas consacrées. L'accès des femmes au ministère féminin vient couronner de succès les efforts de plusieurs générations de partisans de l'égalité des sexes au sein du pro..

Introduction Les femmes n'ont eu véritablement accès au pastorat dans les Églises protestantes françaises qu'en l966. Certes, une femme avait été consacrée en 1948, mais à condition de rester célibataire et sans enfants. Celles qui dans les années suivantes exercèrent exceptionnellement la fonction pastorale ne furent pas consacrées. L'accès des femmes au ministère féminin vient couronner de succès les efforts de plusieurs générations de partisans de l'égalité des sexes au sein du pro...

As global warming continues to attract growing levels of attention, various stakeholders have put climate change on corporate agendas and expect firms to disclose relevant greenhouse gas information. In this paper, we investigate the consistency of the GHG information voluntarily disclosed by French listed firms through two different communication channels: corporate reports and the Carbon Disclosure Project. More precisely, we contrast the amounts of GHG emissions reported and the methodological explanations provided in each channel. Consistent with a stakeholder theory perspective, (...) we find that GHG amounts are significantly lower in the CR than in the CDP. We also find that firms increase the CR figures’ traceability when there is a discrepancy between disclosures in the two channels. We suggest that the aim of this greater traceability is to enhance information credibility across the different channels used. (shrink)

" Les romans devraient être interdits par l'État " selon le professeur Kien, savant solitaire dans " Auto-da fé " d'Elias Canetti. En quoi la littérature est-elle dangereuse? Elle ne connaît de vérité que de passage. Elle se plaît à décliner les formes changeantes que l'imagination fait percevoir ou disparaître. Le charme qu'elle exerce menace ainsi l'identité. S'il est une séduction littéraire, elle réside dans l'invention d'une subjectivité impersonnelle: on ne parle pas de soi en littérature. Écrire procède d'un effort (...) exceptionnel pour sortir du carcan de la personne, briser le miroir, s'évader de la psyché en faisant résonner, dans et par le style, une parole défigurée. L'autofiction se situe aux antipodes de l'enjeu littéraire majeur, lorsqu'elle prend la forme d'un déballage des émois dérisoires qui composent une vie. Dès lors, notre réflexion relève d'un double défi : extraire la littérature de la gangue du savoir critique qui risque de l'asphyxier sans que le refus de l'objectivité ne coïncide avec un retour au mirage de l'expression de soi. Cette défense et illustration du pouvoir des fables implique un regard déniaisé sur le plaisir de l'imagination. La fiction ne demande pas un " oui " servile, adhésion à un monde cohérent qui comblerait les fissures de la réalité ; elle fait éprouver jusqu'au vertige de l'idée inattendue, dans l'exploration de mondes logiquement autonomes. Déployant une pensée déconcertante, la fiction met la raison à la question, égarée au-delà des terres familières de l'argumentation. Détournons la voix du poète : " Vous qui entrez ici, abandonnez toute espérance " ; la littérature est enfer pour l'esprit de sérieux qui s'y effraie, s'accrochant à son identité, faute de tenter la quête de soi. La passion littéraire commence par l'abandon de réponses dépassées en vue d'une imagination en liberté, déculpabilisée. À l'heure où tout le monde prétend raconter sa vie et la publier, comptons que ce livre, réveillant le questionnement, servira la force littéraire, invitation à lire et écrire des livres dignes d'être brûlés. (shrink)

Have I made a mistake in my Anarchism, or has the editor of Liberty himself tripped? At any rate, I must challenge the Anarchism of one sentence in his otherwise masterful paper upon 'State Socialism and Anarchism.' If I am wrong, I stand open to conviction. It is this. 'They [Anarchists] look forward to a time...when the children born of these relations shall belong exclusively to the mothers until old enough to belong to themselves.'.

Although it has been recognized that employees regularly engage in non-green behaviors, little research has been conducted to explain how these behaviors may be avoided. Using data from a three-wave study, this study tested a moderated-mediation model in which trust in the immediate manager was expected to increase the indirect effect of supervisory support for the environment on non-green behaviors through employee environmental commitment. While the findings showed, as predicted, that exchange relationships with the immediate manager reduce the tendency of (...) employees to engage in non-green behaviors, the indirect effect of supervisory support on non-green behaviors through employee environmental commitment was moderated at a low level of trust in the manager, contrary to predictions. Though unexpected, this result seems less surprising when discussed in the light of negotiated exchange, suggesting that employee efforts to avoid non-green behaviors need to be seen as the result of a deal between managers and subordinates. The findings of this study contribute to the emerging literature on social exchange in an environmental context and have implications for organizations seeking to achieve environmental sustainability. (shrink)

Au xviiie siècle, la figure insistante de la «femme philosophe» s'articule à un imaginaire ambivalent de la différence des sexes, entre hantise d'une confusion délétère et quête d'un modèle d'harmonie. La femme travestit-elle la philosophie? Les Lumières ont-elles un genre?

À la Renaissance se substitue au paradigme de la musica mundana une musique proprement humaine, qui renoue un dialogue avec l'âme, retisse un lien vivant avec la parole et l'éthique, assure la revalorisation de la corporéité, se faisant l'expression d'un chant capable de dire tout l'humain.

Face à des enjeux planétaires qui se multiplient et à leurs pronostics de plus en plus inquiétants, les injonctions à agir vite s’imposent avec une certaine évidence. Si la proposition semble tenir du bon sens et ne pas nécessiter qu’on s’y arrête, il convient de prendre un peu de recul, au contraire. S’autoriser à prendre le temps : le temps de la déconstruction des évidences, à commencer par celle de la définition de l’urgence qui invite à de nouveaux engagements, suivi (...) d’un temps nécessaire à l’élaboration d’une réponse appropriée, et ainsi de suite… Sans parler du temps du partage nécessaire, dès lors que la cause se doit d’être collective et non simplement individuelle et personnelle. Sans remettre en cause la légitimité des alertes écologiques, il convient de réfléchir à des modalités d’action permettant tout à la fois des engagements fermes en matière de transformation sociale et la prise en compte d’imprévus. L’article conclut par la présentation de quelques innovations dans le domaine des projets urbains qui tentent de combiner ces deux enjeux. La discussion s’oriente pour finir par une réflexion sur la nécessité de renouer avec un art menacé, celui de faire société. (shrink)

La contractualisation du vivant, tous règnes confondus, est aujourd'hui une réalité incontestable. Puisant ses racines dans la révolution scientifico-technique qui a constitué le vivant en réservoir de ressources biologiques exploitées à des fins diverses, le phénomène se matérialise par un foisonnement d'opérations dont le contrat est le maillon emblématique. Fondé sur l'analyse d'un corpus de quelque 120 contrats, l'ouvrage présente cette évolution selon une triple entrée. Une première partie brosse le contexte dans lequel se déploie la chaîne du vivant. Dans (...) une deuxième partie, les contrats sont analysés pour eux-mêmes, de façon technique. La troisième partie propose d'appréhender la contractualisation du vivant en termes de politique juridique. Trois constats ressortent de cette analyse. D'une part, la contractualisation contribue à uniformiser le vivant : il apparaît que par le prisme du contrat, les ressources biologiques végétales, animales et humaines sont, mutatis mutandis, l'objet d'opérations très similaires. D'autre part, et contre toute attente, les opérations scandant la circulation des ressources biologiques se coulent pour la plupart dans les catégories du droit des contrats, en dépit de l'irréductible spécificité de l'objet matériel, qui contraint souvent les parties à faire preuve d'inventivité dans l'élaboration de stipulations contractuelles adaptées à leurs besoins. Enfin, si originalité il y a, elle se manifeste tout particulièrement quand il s'agit de déterminer les enjeux de la contractualisation en termes de politique juridique, spécialement dans un domaine fortement empreint d'intérêt général. A cet égard, même si la loi demeure, à l'évidence, le cadre de référence obligé de la circulation des ressources biologiques, le contrat en apparaît comme un indispensable relais. (shrink)

During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot (...) express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported – terminating an already initiated treatment – we propose the concept of ‘evidence shift’ to clarify the ambiguous position of uncertainty in decision making. (shrink)

L’étude de l’empire a connu récemment un regain d’intérêt, même si (et peut-être parce que) sa définition pose problème. Elle permet en effet d’étudier plusieurs aspects du pouvoir symbolique : les formes d’administration, les modes d’appropriation d’un territoire, les intensités de la souveraineté, les marquages spatiaux de la domination, etc. L’empire de Charles Quint représente de ce point de vue un modèle heuristique, dans la mesure où l’empereur s’est rapidement trouvé confronté au gouvernement de territoires éloignés, de statuts différents, mais (...) rassemblés dans l’aspiration universelle de l’empire chrétien. (shrink)

L’étude de l’empire a connu récemment un regain d’intérêt, même si (et peut-être parce que) sa définition pose problème. Elle permet en effet d’étudier plusieurs aspects du pouvoir symbolique : les formes d’administration, les modes d’appropriation d’un territoire, les intensités de la souveraineté, les marquages spatiaux de la domination, etc. L’empire de Charles Quint représente de ce point de vue un modèle heuristique, dans la mesure où l’empereur s’est rapidement trouvé confronté au gouvernement de territoires éloignés, de statuts différents, mais (...) rassemblés dans l’aspiration universelle de l’empire chrétien. (shrink)

Face à des enjeux planétaires qui se multiplient et à leurs pronostics de plus en plus inquiétants, les injonctions à agir vite s’imposent avec une certaine évidence. Si la proposition semble tenir du bon sens et ne pas nécessiter qu’on s’y arrête, il convient de prendre un peu de recul, au contraire. S’autoriser à prendre le temps : le temps de la déconstruction des évidences, à commencer par celle de la définition de l’urgence qui invite à de nouveaux engagements, suivi (...) d’un temps nécessaire à l’élaboration d’une réponse appropriée, et ainsi de suite… Sans parler du temps du partage nécessaire, dès lors que la cause se doit d’être collective et non simplement individuelle et personnelle. Sans remettre en cause la légitimité des alertes écologiques, il convient de réfléchir à des modalités d’action permettant tout à la fois des engagements fermes en matière de transformation sociale et la prise en compte d’imprévus. L’article conclut par la présentation de quelques innovations dans... (shrink)

The question of the imperatives induced by the Gandhian concept of non-violence towards animals is an issue that has been neglected by specialists on the thinking of the Mahatma. The aim of this article is to highlight the systematic – and significant – character of this particular aspect of his views on non-violence. The first part introduces the theoretical foundations of the duty of non-violence towards animals in general. Gandhi's critical interpretation of cow-protection, advocated by Hinduism, leads to a general (...) reflection on the duty of non-violence towards animals, the cow being transformed into the representative of all dumb creation. The approach adopted by Gandhi to solving the problem of cow-protection focuses on its practical dimensions and is based primarily on reforming animal husbandry. What limits should be imposed on the exploitation of farm animals within the framework of non-violence? Gandhi devoted nearly 30 years to elaborating an animal husbandry system that would be both economically viable and in conformity with the universal ethical principles he drew from religions (especially Hinduism). The interdiction to kill is absolute, since Gandhi not only rejects the breeding of farm animals for the purposes of butchery but also the slaughtering of animals that are no longer capable of providing the services required of them. He therefore concentrated his efforts on drawing up a scheme to reorganize this activity on a national scale while taking into consideration these constraints, which are less contradictory than they may seem to be at first sight. Reviewing the age-old activity of animal husbandry in the light of non-violence is clearly based on the specific nature of Hindu traditions. However, it goes far beyond cultural or religious relativism, since it is also founded on universal ethical principles. (shrink)