Several approaches to clinical ethics consultation (CEC) exist in medical practice and are widely discussed in the clinical ethics literature; different models of CECs are classified according to their methods, goals, and consultant’s attitude. Although the “facilitation” model has been endorsed by the American Society for Bioethics and Humanities (ASBH) and is described in an influential manual, alternative approaches, such as advocacy, moral expertise, mediation, and engagement are practiced and defended in the clinical ethics field. Our Clinical Ethics Center in (...) Paris was founded in 2002 in the wake of the Patients’ Rights Act, and to date it is the largest center that provides consultation services in France. In this article we shall describe and defend our own approach to clinical ethics consultation, which we call the “Commitment Model,” in comparison with other existing models. Indeed commitment implies, among other meanings, continuity through time, a series of coherent actions, and the realization of important social goals. By drawing on a recent consultation case, we shall describe the main steps of our consultation procedure: interviews with major stakeholders, including patients and proxies; case conferences; and follow up. We shall show why we have chosen the term “commitment” to represent our approach at three different but interrelated levels: commitment towards patients, within the case conference group, and towards society as a whole. (shrink)

Withdrawing Artificial Nutrition and Hydration in the neonatal intensive care units has long been controversial. In France, the practice has become a legal option since 2005. But even though, the question remains as to what the stakeholders’ experience is, and whether they consider it ethically appropriate. In order to contribute to the debate, we initiated a study in 2009 to evaluate parental and health care professionals perspectives, after they experienced WAHN for a newborn. The study included 25 cases from 5 (...) different clinical neonatology departments. We interviewed both the parents and some of the HCP who cared for the baby, at least 6 months after this latter deceased. We proceeded through in-depth individual qualitative interviews. Content was analyzed for themes and patterns that emerged from the data. Some parents expressed that WANH offered an opportunity to the family to spend a few demedicalized days with the baby before she dies, without any tubes and machines, and to be well supported by the HCP during this palliative stage. But others evaluated the practice in retrospect as a terrible ordeal. All said that, at least, the time of waiting for death to ensue should not last too long. After a few days, it becomes unbearable because of the transformation of the baby’s appearance and because they, as parents, began to wonder if she was not dying from starvation rather than from her initial disease. An important proportion of HCP also expressed some kind of ethical unease. This was due to the psychological violence involved in the decision for a human being to stop feeding a little one, and also to the difficulty to deal with the fundamental intention behind the decision of WANH: indeed, could it be claim that it does not presuppose the intention of provoking the infant’s death? The discussion focuses on the point to know if WANH can be considered as a source of progress from an ethical point of view, particularly in comparison with earlier practices—that in France could involve active euthanasia by lethal injection. We argue that when HCP are merely focused on avoiding that WAHN could be construed as a way of intending to hasten the baby’s death, the practice is at risk to be implemented in a way that becomes ethically counterproductive. Focusing on this intention easily distract the clinical teams from what should be their ultimate concern, namely the baby’s comfort during the dying process, as well as the support owned to her parents. To conclude, we suggest that the ethical priorities, when WANH is decided, should be the support due to the patient and her family on the one hand, and, on the other hand to implement it in such a way that at least the baby seems to have died of her initial disease and never of starvation. This means that HCP have a duty to control the timing of death, even though this might be incompatible with the worry to avoid the intention of hastening the baby’s death. (shrink)

Punctuated by joy, disappointments, and conflicts, research evaluation constitutes an intense, emotional moment in scientific life. Yet reviewers and research institutions often expect evaluations to be conducted objectively and dispassionately. Inspired by the scholarship describing the role of emotions in scientific practices, we argue instead, that reviewers actively define, display and manage their emotions in response to the structural organization of research evaluation. Our article examines reviewing practices used in the European Research Council’s (ERC) Starting and Consolidator grants and in (...) the Marie Skłodowska-Curie Action’s (MSCA) Individual Fellowships. These two European funding mechanisms offer different perspectives on the organization of grant evaluation. We conducted interviews with review panel members and analyzed various institutional documents. By drawing on the sociological concepts of feeling rules and emotional work, we demonstrate that reviewers define rules concerning how emotions should be experienced and expressed to ensure the proper functioning of evaluation, and that reviewers experience the need to actively regulate their emotions to comply with these rules. We present four feeling rules concerning the experience and expression of: (1) excitement for novelty during individual evaluation; (2) respect for others’ opinions and the absence of anger in review panels; (3) attentiveness and interest, which are seen as missing in online evaluations. Reviewers also expect ERC candidates to (4) avoid pride and manifest modesty during interviews. These rules demonstrate that proposal peer review is governed by emotional norms, and show the influence of organizational settings and moral requirements on research evaluation. (shrink)

The French bioethics laws of 1994 contain the principles of the anonymity and non commodification of all donations of body parts and products including gametes in medically assisted reproduction. The two revisions of the law, in 2004 and 2011 have upheld the rule. In view of the latest revision process, the French government organized a large public consultation in 2009. Within the event a “consensus conference” was held in Rennes about different aspects of assisted reproduction. In what follows we shall (...) first describe the anonymity clause for gamete donations in the French law and the debates surrounding it. We shall then analyse the procedure used for the 2009 public consultation and the related consensus conference, as well as its upshot concerning the anonymity doctrine. In this respect we shall compare the citizens’ own recommendations on the gamete anonymity issue and its translation in the consultation’s final report drafted by a philosopher mandated by the organizing committee. Whereas the final report cited some fundamental ethical arguments as reason for upholding the provisions of the law—most notably the refusal of the ‘all biological’ approach to reproductive issues—citizens were more careful and tentative in their position although they also concluded that for pragmatic reasons the anonymity rule should continue to hold. We shall argue that the conservative upshot of the public consultation is due to some main underlying presuppositions concerning the citizens’ role and expertise as well as to the specific design of the consensus conference. Our conclusion will be that public consultations and consensus conferences can only serve as an empirical support for devising suitable bioethics norms by using second-order normative assumptions. (shrink)

A commentary on “The Ethics of Anonymous Gamete Donation: Is There a Right to Know One's Genetic Origins?” by Inmaculada de Melo‐Martín, in the March‐April 2014 issue.

This article, corresponding to a part of the restitution of a financed international research project between France, Brazil, Canada, Italy and Belgium, aims to offer a modelisation and qualitative evaluation of mediation care settings based on an original methodological tool that involves identifying the typical games at the foundations of creativity, following a multidisciplinary perspective. Therapeutic mediations are settings or devices organised around a “pliable medium”, often artistic, like painting, modeling, writing, ​and theatre, which are very widespread in institutional practices, (...) both in France and abroad. The scientific objectives of this research consist in a multi-disciplinary exploration (anthropology, criminology, neuroscience, clinical psychology) of the process of creative symbolisation understood as a process of transformation involving play. According to this orientation, play can be defined as a psychic process whereby a subjective experience can be explored with pleasure, and consequently symbolised and appropriated. Our fundamental and original hypothesis is that play is at the source of the creative process, conceived as a work of metabolisation by the psyche of playful experiences during the different stages of life. The review of the understanding of play in psychoanalysis, anthropology, criminology and neuroscience emphasises the richness of this model and the importance of reflecting on the typical games in the field of psychic care. A clinical example of treatment in a pictorial therapeutic mediation setting of a child with psychotic disorders makes it possible to identify a number of typical games as well as the modalities of interpretation of the therapists through play. These multidisciplinary studies lead to the presentation of a general table of typical games, and these first results highlight the richness of identifying typical games in clinical settings. Ultimately, the multidisciplinary approach shows the interest of the model of play in the evaluation of therapeutic mediation settings, with a convergence of the different disciplines emphasising the pertinence of this model. The scientific impact of this research overlaps with its societal impact, through the development of innovative tools for evaluating therapeutic mediations, in order to take account of the evolution of the different forms of social expression of psychic suffering. (shrink)

Les travaux de Jean Piaget sur le développement cognitif ont largement mis en relief ce que comporte de génétique toute acquisition de connaissance sensible ou intellectuelle. Bien plus: le pere de la psychologie dite justement genetique voit dans la genése, entendue au sens de processus selon lequel le sujet connaissant construit l'objet, ce qui definit essentiellement toute connaissance. On sait que cette these piagetienne s'oppose á l'enseignement d'Aristote, qui conçoit la connaissance comme adaptation sui generis d'une faculte a un objet (...) donne independamment du sujet et voit l'essence du connaitre dans une simple copie des choses, dans un acte ou l'intelligence devient l'objet. Ne serait-ce qu'en raison de cette opposition, on n'aura pas tort de qualifier d'anti-genetique la psychologie de la connaissance d'Aristote. D'autant plus que la psychologie aristotelicienne n'est pas une psychologie scientifique au sens moderne du terme, de sorte qu'on y chercherait en vain des concepts a caractere operationnel tel le concept piagetien de genese. Pourtant, comme cet article tachera de le mettre en evidence, Aristote est loin d'avoir neglige l'aspect genese que comporte la connaissance sensible et intellectuelle. Conjointement a ses prises de position sur la nature de la connaissance, on trouve chez Aristote une description des activites sensibles et intellectuelles qui laisse au sujet bien plus d'initiative et s'avere bien plus « genetique » qu'on ne le suppose habituellement. (shrink)

Les auteurs "font le point sur des concepts fondamentaux: éducation, enseignement, connaissance, art, science, pédagogie".

In France, since the approval of the first bioethics laws in 1994, the principle of the anonymity of sperm donors has prevailed. This choice is regularly challenged, namely by children who have been conceived under these conditions and have now reached adulthood. In this paper, we will briefly describe the reasons that led practitioners of assisted reproduction to endorse the anonymity principle in 1994. Secondly, we will elaborate on the reasons why this principle is becoming so controversial today. Finally, we (...) shall examine two possible outcomes of the debate, highlighting their respective legitimacy as well as their consequences, as far as the rights of children, the notion of the family, and medical practice are concerned. (shrink)