The mechanisms of longevity have been the subject of investigations for a number of years. Although the role of genetic factors is generally acknowledged, important questions persist regarding the relative impact of environmental exposures, lifestyle characteristics, and genes. The BALSAC population register offers a unique opportunity to study longevity from an intergenerational and genealogical point of view. Individuals from the Saguenay-Lac-St-Jean population who died at age 90 or older between 1950 and 1974 were selected from this database (n (...) = 576), along with a control group of individuals born in the same period who died between 50 and 75 years of age. For these subjects and controls, spouses’ ages at death and parental ages at death and at their birth were investigated using regression analysis. Genealogical reconstructions were carried out for each individual, and various analyses were performed on both groups. Both fathers’ and mothers’ mean ages at death were significantly higher among the longer-lived cases than among controls whereas spouses’ ages at death and parental ages at birth had no effect. Regression analysis confirmed the positive effect of both fathers’ and mothers’ age at death. Mean kinship coefficients for the parents’ generations displayed significant differences, indicating that kinship was higher among subjects than controls (this effect was stronger among the oldest 10% of the subjects). Frequencies and genetic contributions of ancestors were very similar for the two groups, and none of these ancestors appeared more likely to have introduced genetic variants involved in longevity patterns in this French Canadian population. (shrink)

The aim of this paper is to account for the effect of mother's death on child survival in a historical population. Using comprehensive data on the early French Canadian population of Quebec, evidence is provided for a higher risk of dying for motherless children that remains significant over all childhood and long after the death of the mother. The specific effect of the loss of maternal care was estimated by comparing mortality before and after mother's death, furnishing (...) a means to control for family heterogeneity. No differential in investment between genders was detected before age 3, but older girls suffered a three-fold higher susceptibility to mother's death than their male counterparts. This suggests that grown-up girls assuming the responsibilities of the missing mother had a lower chance of survival. (shrink)

This article explores the contemporary scientific practice of human genome science in light of Michel Foucault’s articulation of the problem of population. Rather than transcending the politics of social categories and identities, human genome research mobilizes many different kinds of populations. How then might we aim to avoid overgeneralized readings of the refiguring of human difference in the life sciences and grapple with the multiple and contradictory logics of population classification? In exploring the study of human variation through (...) the case of the ‘Quebec founder population’ at a private genome research laboratory in Canada, the article argues that the power to define and shape meanings of human variation and to organize vitality is not held by any one institution or form of scientific practice. While molecular genomics may be transforming conceptions of human difference, the laboratory is only one of many places where human genomic variation accrues value, meaning and relevance. Molecular configurations of human difference gain meaning through a traffic in populations that extends beyond the laboratory. In the case explored here this traffic in populations is constituted within a nexus of empire, national census practices and contemporary articulations of multicultural policies. (shrink)

In genomic research, cohort and large-scale population studies are proliferating along with accompanying infrastructures (databases and biobanks). Population-based research links samples and data from multiple sources often obtained for other purposes. The normative frameworks of many countries are largely based on 1980 OECD principles which limit the uses of personal data, especially for secondary purposes. These limits, now found in legislation, policies and research guidelines, pose major barriers to population-based research.This text examines similarities and differences between epidemiology, (...) public health research and genomics. It also distinguishes between primary and secondary uses of personal information. In a comparative and critical analysis of the normative landscapes of five countries, Québec (Canada), Germany, Australia, the United States and the United Kingdom, three barriers are identified: the impracticability of re-consent; the shortcomings of the review process (ethics and privacy) and certain multi-jurisdictional issues. Recommendations are proposed. (shrink)

BackgroundThe advent of learning healthcare systems (LHSs) raises an important implementation challenge concerning how to request and manage consent to support secondary use of data in learning cycles, particularly research activities. Current consent models in Quebec were not established with the context of LHSs in mind and do not support the agility and transparency required to obtain consent from all involved, especially the citizens. Therefore, a new approach to consent is needed. Previous work identified the meta-consent model as a (...) promising alternative to fulfill the requirements of LHSs, particularly large-scale deployments. We elicited the public’s attitude toward the meta-consent model to evaluate if the model could be understood by the citizens and would be deemed acceptable to prepare for its possible implementation in Quebec.MethodsEight focus groups, with a total of 63 members of the general public from various backgrounds were conducted in Quebec, Canada, in 2019. Explicit attention was given to literacy levels, language spoken at home and rural vs urban settings. We assessed attitudes, concerns and facilitators regarding key components of the meta-consent model: predefined categories to personalized consent requests, a dynamic web-based infrastructure to record meta-consent, and default settings. To analyse the discussions, a thematic content analysis was performed using a qualitative software.ResultsOur findings showed that participants were supportive of this new approach of consent as it promotes transparency and offers autonomy for the management of their health data. Key facilitators were identified to be considered in the implementation of a meta-consent model in the Quebec LHSs: information and transparency, awareness campaigns, development of educational tools, collaboration of front-line healthcare professionals, default settings deemed acceptable by the society as well as close partnerships with recognized and trusted institutions.ConclusionsThis qualitative study reveals the openness of a sample of the Quebec population regarding the meta-consent model for secondary use of health data for research. This first exploratory study conducted with the public is an important step in guiding decision-makers in the next phases of implementing the various strategies to support access and use of health data in Quebec. (shrink)

Through Quebec universities, the population of students with emerging disabilities is higher than the population of students with physical disabilities. Within our university, the social work’s departement has the largest proportion of students with emerging disabilities. The varied challenges faced by these students with mental or neurodevelopmental disorders during their theoretical training tend to increase during internships, leading to extensions, dropouts or failures. The aim of this article is to describe the structure that has been developped to (...) support these social work students. (shrink)

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: (...) Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reaching the Age of Majority:The Life Trajectory of the CIHR Institute of AgingYves Joanette, Anne Martin-Matthews, Réjean Hebert, and Joanne GoldbergThe Canadian Institutes of Health Research (CIHR) was created in 2001 under the Canadian Institutes of Health Research Act S.C. 2000, c. 6 (Government of Canada, 2000). The creation of CIHR was in follow-up to the Canadian Medical Research Council (MRC) as well as to the National Health Research (...) and Development Program of Health Canada that, up until that point in time, had supported the breadth of health research in Canada. Two important characteristics of CIHR were crucial for the development of research on aging. The first was that CIHR, unlike MRC, was entrusted with the challenge of supporting the whole spectrum of health research, from the basic biomedical perspective to clinical research, research on health services and policies as well as social aspects of health research, not to mention research on ethics and other perspectives (including the science of research). The second characteristic of the nascent CIHR that impacted the community of research on aging was the decision that a small part of the overall CIHR budget would be used to address priority-driven questions or topics (strategic competitions), while the majority of the budget would be invested in grants and awards programs that would be investigator-initiated, as in the time of the MRC (open competition). Since its inception, CIHR has included 13 institutes that are central to the priority-driven actions. Institutes not only play an important convener role within their communities and among their stakeholders, but they are also expected to listen to the needs, gaps and opportunities in their area and to introduce initiatives---most of the time involving more than one Institute---in order to tackle these needs and gaps and to seize upon the opportunities.The Institute of Aging was introduced at the same time as the other 12 Institutes and it is clear that many challenges were awaiting the new Institute since, at that time, research on aging was still in its early years. This article is about the trajectory of the CIHR Institute of Aging in its first 18 years of existence. Having now reached an age that is either the age of majority or quite close to it, it is important to be able to provide a reflection on the evolution of the priorities over this period, while also taking a peek at some of the priorities that will surely come in the near future.The Early Years (2001-2004)The founding Scientific Director of the Institute of Aging was Dr. Réjean Hébert. A well-known and prolific [End Page 1] geriatrician and researcher, Dr. Hébert was the perfect person to launch the Institute. One of his first actions was, in fact, to harmonize the French and English names of the Institute. In French, the name of the Institute focused on Aging (Institut du vieillissement) while, in English, the name of the Institute focused on Healthy Aging. The CIHR Institute of Healthy Aging thus became the CIHR Institute of Aging in all versions of its documentation. But above and beyond this important name change, the real work of Dr. Hebert, accompanied by the first Institute Advisory Board1, chaired by Prof. Dorothy Pringle, was to identify the gaps, the needs and the opportunities. After a rigorous process came the first Strategic Plan of the CIHR Institute of Aging, which was clearly influenced by Dr. Réjean Hébert's vision of the aging population as an opportunity, instead of a catastrophe, for our society that comes, of course, with its own challenges. Dr. Hébert left CIHR during his first mandate as he was called upon to become the Dean of his Faculty, and then went on to become the first CIHR Scientific Director to sit as a Minister of Health and Social Services in the Québec Government. The main outcomes of Dr. Hebert's years (2001-2004) can be summarized as follows2.• Organizing many workshops and meetings to ensure that the Institute of Aging would become the premier national convener for research on aging, bridging between disciplines... (shrink)

Health care resource allocation is a complex governmental task involving political decisions that are bound to be influenced by the various needs of the population and the demands of health professionals. What influence should these different interests have on the integration of new technologies into the health care system? Pharmacogenomics, a new field in the pharmacological sciences that integrates into the drug development process genomic information developed through the Human Genome Project, has been proposed as a technology that promises (...) to make medical practices more personalized. Its integration in drug development or prescription processes could help reduce the risk of adverse drug reactions characteristic of pharmaceutical treatments. Considering the actual allocation of health care resources in Quebec, should the provincial government invest in the integration of pharmacogenomics as a new tool for drug development or drug specification? This question will be addressed using the criteria previously described by Caulfield and colleagues in order to assess the justification of public financing for genetic testing[1], i.e., moral acceptability, utility, safety and the requirement of a noticeable benefit at an acceptable cost for society. Given the proximity of the fields of genetics and genomics, these criteria are applicable to our discussion. (shrink)

Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of (...) morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 29.4 (1999) 116-127 [Access article in PDF] Authority, Solidarity, and the Political Economy of Identity: The Case of the United States David A. Hollinger Theorists of nationalism tend to circle around the United States like boy scouts who have spotted a clump of poison oak. The nationalism of the United States has figured small in the robust and wide-ranging discourse about nationalism that has involved sociologists, historians, political (...) scientists, philosophers, and literary scholars during the past two decades. Although there are significant exceptions to this pattern of avoidance--David Miller and Liah Greenfeld are convenient examples--several prominent cases illustrate the pattern. The United States is mentioned in only a single footnote in Ernest Gellner's Nations and Nationalism. The United States is given short shrift in three of the most important collections of the 1990s: Homi Bhabha's Nation and Narration, John Hutchinson and Anthony D. Smith's Nationalism, and Geoff Eley and Ronald G. Suny's Becoming National. Montserrat Guibernau mentions the United States only twice, and in passing, in her Nationalisms: The Nation-State and Nationalism in the Twentieth Century. The United States gets less attention than Canada and the Ukraine in John A. Hall's rich, state-of-the-art collection of 1998, The State of the Nation. Ronald Beiner's Theorizing Nationalism has much more to tell us about Quebec than about the United States, which is alluded to even in passing by only half the contributors to this valuable anthology of 1999. That "nationalism is unknown" in the United States is claimed by Elie Kedouri, even in the fourth edition of his classic text Nationalism [143]. But the most interesting case of all is that of nationalism's most creative and influential theorist, Benedict Anderson.Anderson provides only episodic treatment of the United States while discussing "creole nationalism" in his influential book Imagined Communities. To be sure, Anderson's demonstration of the similarities between a large number of similarly situated, comparably developing national projects among creole populations in the New World is no cause for complaint. It is a signal contribution, and still insufficiently absorbed by a persistently Europe-centered discourse about nationalism. Anderson's recent book, The Spectre of Comparisons, also deals episodically with the United States, which Anderson now tells us explicitly has proved "too sui generis for ready-to-hand" [336] comparisons with other national projects in the Western Hemisphere. Most of Spectre of Comparisons is about Southeast Asia, just as the preponderance of Imagined Communities is about Latin America. Fair enough. [End Page 116]My point is not to find fault with Anderson for being an Area Studies specialist in so many areas of the world outside the United States. Nor do I have any significant quarrel with what little Anderson does say about the United States. What is worth remarking upon is simply that even the least Eurocentric of our era's leading theorists of nationalism in general has emerged not from the study of the United States, but from the study of Southeast Asia and Latin America. This is less a comment about Anderson than about the class of theorists of which he is a member. The scholars whose careers focus on the United States are "area studies specialists" of a kind, but few of them have intervened tellingly in the cross-disciplinary discussion of nationalism. One who did was the historian David Potter, whose still-powerful article "Historian's Use of Nationalism and Vice Versa" was published nearly forty years ago but is rarely cited today.The poison oak effect among theorists of nationalism would not be worthy of notice were it not for one fact that might be expected to attract rather than repel these theorists: the United States is the most successful nationalist project in all of modern history. What makes it "successful" is its longevity, its absorption of a variety of peoples, and its sheer power. Two-and-one-quarter centuries after its founding and 135 years after its Civil War, it is by far the most powerful nation-state... (shrink)

L’érosion actuelle de la confiance du public envers les campagnes de vaccination et les décisions de politiques publiques qui y sont associées, aggravée par des scandales comme ceux relatifs à la pandémie H1N1 et l’utilisation du Tamiflu™, risque de diminuer de façon significative l’efficacité de ces interventions importantes pour la santé publique. Un manque de confiance de la population envers les acteurs de santé publique peut conduire à une méfiance accrue face aux interventions, pouvant ainsi compromettre l’atteinte des objectifs (...) recherchés par une intervention spécifique et, conséquemment, avoir un impact important sur les bénéfices attendus pour la population visée par cette intervention. Dans la production des avis d’experts, les membres des comités consultatifs d’experts en immunisation (CCEI) peuvent avoir une influence importante sur la prise de décision publique, notamment, sur la sélection par les décideurs de santé publique de vaccins en particulier et la façon dont les campagnes de vaccination seront déployées. En contrepartie de cette influence sur les décisions publiques, une indépendance et une transparence sont attendues de leur part puisque des mécanismes de divulgation et de gestion de conflits d’intérêts (CI) imparfaits peuvent affecter négativement la confiance du public à l’égard de telles décisions. Il apparaît donc important de s’assurer que des mécanismes de gestion des CI, transparents et robustes, existent pour ces comités. Dans cette étude, les avis ou rapports d’évaluation de la pertinence de la vaccination préparés par un CCEI au Québec ont été examinés pour quatre types de maladies évitables par la vaccination (infections invasives à méningocoques et à pneumocoques, coqueluche et virus du papillome humain). Le but était de : 1) identifier les CI divulgués par les membres du CCEI dans leurs rapports comparativement à ceux déclarés dans leurs publications scientifiques pour ces mêmes infections ; 2) analyser la nature des CI (réel, potentiel, apparent, personnel, financier, institutionnel, etc.) et l’impact potentiel (risque) sur la prise de décision impartiale et sur la confiance du public ; et 3) évaluer les mécanismes de gestion de CI actuellement utilisés par ce CCEI. Les résultats de cette étude montrent que très peu de rapports du CCEI contiennent une section sur les CI par rapport à la pléthore divulguée dans les publications scientifiques publiées par les membres du CCEI. De plus, les CI divulgués dans les rapports fréquemment ne correspondent pas à ceux décrits dans les publications scientifiques. Il serait donc important d’introduire des mesures visant à accroître la transparence des experts en immunisation et d’améliorer les mécanismes de divulgation et de gestion des CI afin de veiller à ce que la confiance du public envers les décideurs en santé publique soit maintenue et améliorée. (shrink)

La naissance constitue pour toute famille un bouleversement identitaire. Dans ce contexte, le « devenir grand-parent » est encore peu étudié. Les auteurs ont mené plusieurs entretiens conjointement chez des parents et grands-parents dans une population tout-venant au Québec. Les résultats illustrent les enjeux identitaires qui surgissent autour de la naissance entre les parents et leurs propres parents. Les parents s’expriment sur l’attente quant au soutien que pourraient apporter ces derniers. Les grands-parents, qui semblent plutôt en attente de relations (...) avec le bébé, passeraient par ce soutien pour trouver leur propre place dans l’économie familiale. Avec des différences selon les sexes, les grands-parents concourent ainsi à construire grâce à cet étayage un berceau psychique familial qui réunit dans un premier cercle les parents avec leur bébé. En périnatalité, cette « fonction » grand-parentale permettrait d’envisager la spécificité d’un second cercle autour du bébé, propre également aux interventions des professionnels. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A COMMENT ON POLANYI AND KUHN MABEN WALTER POIRIER Concordia University Montreal, Quebec FOR SOME TIME NOW we have noted tha:t the names Michael Polanyi and Thomas S. Kuhn are frequently mentioned together in articles and books dealing with specialized topics in the philosophy of science. And if we genera.Ily accept what is said in these publications, there appears to be a belief afield, which is broadly shared (...) amongst students of scientific thought, to the effect that the philosopher of science, Michael Polanyi, and the historian of science, Thomas Kuhn, are in some fundametal manner in accord with one another as to the chara.cter and nature of scientific thinking. In fact, there seems to be no disputing this question amongst some of the most prestigious philosophers of science, nor does there seem to be even the slightest suspicion that maybe Polanyi does not belong to the same school of thought as Kuhn. We are told explicitly, or we are led to believe, that PoJanyi and Kuhn are in lea;gue to do battle against empiricism and empiricists, and that as a result they share a number of perspectives on scientific thinking. This is taken to mean tha;t they broadly hold the same point of view when it comes to thinking about various issues. Now, it is largely true that both are opposed to empiricism, and to the understanding that empiricists have about the way that scientific knowledge is advanced. However, this does not mean that Polanyi and Kuhn are in funOLANYI AND KUBN ~6'/ cessive the,ories grow ever closer to, or approximate more and more closely to, the truth. Apparently generalizations like that refer not to the puzzle-solutions and the concrete predictions derived from a theory but rather to its ontology, to the match, that is, b~tween the entities with which theory populates nature and what is " really there." · Perhaps there is some other way of salvaging the notion of ' truth' for application to whole theories, but this one will not do. There is, I think, no theory-independent way to reconstruct phrases like 'really there'; the notion of a match between the ontology of a theory and its "real" counterpart in nature now seems to me illusive in principle.6 This is no afterthought with Kuhn, nor is it a course correction which he may have felt was required when he wrote "Postscript-1969," for we read the following in the main part of his magnum opus1 in which there are many similar passages: We may,... have to relinquish the notion, explicit or implicit, that changes of paradigm carry scientists and those who learn from them closer and closer to the truth [and to the real].1 Clearly this is not Michael Polanyi's point of view on this matter. Polanyi may not be an empiricist, but he is by no means a relativist either, radical or otherwise. He is simply not prepared to deny the existence of reality, or to claim that it is nothing more than a fabrication of the creative imagination of practicing natural scientists, great though they ma.y be. He repeatedly makes it very clear that natural scientists investigate what is real-what exists independently of themselves, in the world 'beyond their minds-and not some subjective entity which is a construction of their minds. It is true that Polanyi believ,es that it is very difficult to establish beyond a doubt that this is what the natural scientist investigates, but the fact is that at no point does Polanyi sa.y or even imply that the natural scientist is exploring, either in an arbitrary or reasonable manner, his imaginative constructions. For Polanyi, scientists are simply not engaged in the exploration of s Thomas S. Kuhn, The Btruoture of Boientifio Revolutions, p. 206. 1 Ibid., p. 170. 268 MABEN W.ALTER POIRIER imaginative constructions which are resident in the mind. They are involved in the exploration of what is other and of what is real. He makes this point in many ways and on a number of different occasions during his career as a philosopher of ·science. For example, in the following paissage from his work The... (shrink)

Resumen: El espacio dramático de Michel Tremblay, “tesoro nacional” de Quebec, está poblado por personajes que se enfrentan casi siempre a la alienación y al deseo de encontrar, o incluso de crear, su propia identidad. Los héroes tremblayanos, cualquiera que sea su orientación sexual y posición en la sociedad, realizan un paso desde la inactividad hasta la acción para desgajarse del orden preestablecido. A veces incapaces de cambiar su situación, a veces felices al poder, por fin, contestar a la (...) pregunta “¿quién soy yo?”, los personajes del teatro de Tremblay siguen siendo representativos de la sociedad quebequense que, durante el período de la llamada Revolución tranquila, se vio sometida a unos profundos cambios identitarios. A lo largo de la evolución social del Quebec de los años sesenta y setenta del pasado siglo, se fueron estableciendo paralelismos entre la toma de conciencia identitaria de la sociedad y la de los personajes dramáticos de Trembley. Así, estos últimos se convertirían en alegorías de la estructura social en por lo menos dos dimensiones, moral y cultural, en el caso de Belles-Sœurs y À toi, pour toujours, ta Marie-Lou, donde se incuban las frustraciones propias de unas heroínas abrumadas por la cultura patriarcal (impotente en todos los ámbitos y ante todo el sexual), representada a su vez por la pieza Hosanna, a la que se la puede considerar como el símbolo de la expresión social de la homosexualidad y de la identidad sexual en general. En consecuencia, la finalidad de este artículo sería la reflexión misma acerca de unas (r)evoluciones teatrales que reflejarían las llevadas a cabo por la Revolución tranquila dentro de toda la sociedad. Abstract: Michel Tremblay's dramatic space, Quebec’s “national treasure”, is populated by characters who are almost always confronted with alienation and the desire to rediscover, and even to create, their own identity. The heroes of Tremblay, whatever their sexual orientation and social positions are, have the story of a passage from inaction till the act of tearing themselves away from the pre-established order. Sometimes incapable of changing their situation, sometimes happy to finally be able to answer the question “Who am I?”, the characters in the Tremblayan theatre are at all times representatives of the Quebec society, which, during the Quiet Revolution, suffered profound changes in identity. Throughout the social evolution in Quebec in the 1960s and 1970s, the awareness of the identity of the society and that of the dramatic characters are two matters that coexist in parallel manner. Thus, the latter become allegories of the social structure on at least two levels: moral and cultural, in the case of the Belles-Sœurs and À toi, pour toujours, ta Marie-Lou representing several frustrations: of the heroines, overwhelmed by the powerless patriarchal culture; sexual, represented for example by Hosanna being the symbol of the social expression of homosexuality and sexual identity in general; and finally, actional, as in the case of Sainte Carmen de la Main, which constitutes a message to Québécois to take their destiny in their hands. The main objective of the article is to bring some reflections on theatrical (r)evolutions which reflected the changes of the Quiet Revolution within the entire society. (shrink)

Despite being the primary homeland of Quebec's Inuit people, Nunavik's health care is typically planned and provided by non-Inuit newcomers. This retrospective case study investigates the effects of ethical leadership on the Westernized local Nunavik health care system's cultural sensitivity to its disproportionately Inuit populations. An integrative framework is developed that considers the dimensions of ethical leadership and the omnibus and discrete dimensions of context. This study shows that some Nunavik health care managers seek to improve and adapt the (...) system to the needs of their Inuit populations, while others do not. Unfortunately, the context restricts the former managers' ability to act consistently with their moral responsibilities and beliefs. Specifically, the findings show various institutional barriers to providing respectful and sensitive health care to Inuit. This study contributes to the scientific literature on ethical leadership by proposing an integrative conceptual framework. This framework illustrates how ethical leadership is inseparable from organizational context, identifying 16 contextual factors influencing managers' ethical behavior. Finally, three practical recommendations are proposed to highlight the omnibus and discrete context elements. (shrink)

BackgroundThe spread of COVID-19 has disrupted the lifestyles of the world’s population. In the workplace, the pandemic has affected all sectors and has changed the way work is organized and carried out. The health sector has been severely impacted by the pandemic and has faced enormous challenges in maintaining healthcare services while providing care to those infected by the virus. At the heart of this battle, healthcare managers were key players in ensuring the orchestration of operations and the physical (...) and mental availability of employees during the crisis. Although few studies have been conducted to identify organizational practices or leadership skills to be adopted in a crisis context, the concrete behaviors of managers have not been documented yet. Therefore, this study aims at filling this gap by studying middle managers’ behaviors facing COVID-19 crisis in the healthcare sector.MethodsUsing a qualitative approach, eight focus groups were conducted online during the pandemic with 37 middle managers from the healthcare community of a Quebec health establishment from April to June 2020. Thematic analyses were conducted, and a mixed-methods approach was used to analyse the data based on Viitala’s hierarchical model of management skills.ResultsBased on the six managerial skills proposed in the model of Viitala, 21 specific management behaviors were identified as having been deployed by middle managers at the beginning of the pandemic. Considering that the health sector has been profoundly shaken by this health crisis, in addition to being an environment likely to experience other crises, managers need to develop practical skills in various crisis management situations. Thus, the results guide practitioners by highlighting the importance of team-oriented management behaviors, especially in a crisis context. (shrink)

Quand le gouvernement de René Lévesque mit fin au financement occulte des partis politiques en 1977, les démocrates de tous les horizons se mirent à croire qu’il était possible d’éliminer la corruption systémique qui gangrène la vie publique partout dans le monde. Pendant un temps, on a cru que le Québec était devenu un havre unique d’intégrité avec son financement populaire des partis, ses limites de contributions, ses règles de transparence, auxquels on avait ajouté des normes sévères dans l’octroi des (...) contrats publics d’achats de biens et services. Ce paradis terrestre de la pureté politique n’a malheureusement pas duré longtemps et nous savons aujourd’hui que les assoiffés de pouvoir et d’argent gravitant dans et autour des formations politiques ont rapidement décelé les failles de la nouvelle Loi et se sont immédiatement organisés pour la contourner. Leurs stratagèmes se sont déployés pendant une trentaine d’années en toute impunité intoxiquant toutefois, il faut le dire, certains plus que d’autres. Heureusement, ces combines ont fini par être mises au jour et devenir objet d’intérêt prioritaire de la population, obligeant ainsi l’Assemblée nationale à refaire ses devoirs. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

According to Critical-Level Views in population axiology, an extra life improves a population only if that life’s welfare exceeds some fixed ‘critical level.’ An extra life at the critical level leaves the new population equally good as the original. According to Critical-Range Views, an extra life improves a population only if that life’s welfare exceeds some fixed ‘critical range.’ An extra life within the critical range leaves the new population incommensurable with the original. -/- In (...) this paper, I sharpen some old objections to these views and offer some new ones. Critical-Level Views cannot avoid certain Repugnant and Sadistic Conclusions. Critical-Range Views imply that lives featuring no good or bad components whatsoever can nevertheless swallow up and neutralise goodness or badness. Both classes of view entail that certain small changes in welfare correspond to worryingly large differences in contributive value. -/- I then offer a view that retains much of the appeal of Critical-Level and Critical-Range Views while avoiding the above pitfalls. On the Imprecise Exchange Rates View, the quantity of some good required to outweigh a given unit of some bad is imprecise. This imprecision is the source of incommensurability between lives and populations. (shrink)

This is a review of contemporary philosophical discussions of population policies. The focus is on normative justification, and the main question is whether population policies can be ethically justified. Although few analytical philosophers have directly addressed this question – it has been discussed more in other academic fields – many arguments and considerations can be placed in the analytical philosophical discourse. This article offers a comprehensive review and analysis of ethically relevant aspects of population policies evaluated on (...) the basis of the main ethical theories. This analysis is preceded by a brief historical contextualisation of when and how population policies became ethically contentious and how this relates to philosophical debates in environmental ethics, population ethics and political philosophy. The article also includes a conceptual analysis of population policies in which the empirical intricacies around individual fertility decisions are sorted out and the different ways in which they can be affected are categorised in a taxonomy which highlight the most relevant ethical aspects of population policies. The ethical analysis shows that while population policies can be justified on the basis of most ethical theories, it all depends on what prior assumptions are made about what is at stake. (shrink)

This paper traces the background to R. A. Fisher's multi-factorial theory of inheritance. It is argued that the traditional account is incomplete, and that Karl Pearson's well-known pre-Fisherian objections to the theory were in fact overcome by Pearson himself. It is further argued that Pearson's stated reasons for not accepting his own achievement has to be seen as a rationalization, standing in for deeper-seated metaphysical objections to the Mendelian paradigm of a type not readily discussed in a formal scientific paper. (...) The apparent, post-Fisherian, continued acceptance of Pearson's objections is presented as an interesting problem for the historian and sociologist. (shrink)

Population axiology concerns how to evaluate populations in regard to their goodness, that is, how to order populations by the relations “is better than ” and “is as good as”. This field has been riddled with paradoxes and impossibility results which seem to show that our considered beliefs are inconsistent in cases where the number of people and their welfare varies. All of these results have one thing in common, however. They all involve an adequacy condition that rules out (...) Derek Parfit’s Repugnant Conclusion. Moreover, some theorists have argued that we should accept the Repugnant Conclusion and hence that avoidance of this conclusion is not a convincing adequacy condition for a population axiology. As I shall show in this chapter, however, one can replace avoidance of the Repugnant Conclusion with a logically weaker and intuitively more convincing condition. The resulting theorem involves, to the best of my knowledge, logically weaker and intuitively more compelling conditions than the other theorems presented in the literature. As such, it. (shrink)

This paper questions the prevailing historical understanding that scientific racism “retreated” in the 1950s when anthropology adopted the concepts and methods of population genetics and race was recognized to be a social construct and replaced by the concept of population. More accurately, a “populational” concept of race was substituted for a “typological one”—this is demonstrated by looking at the work of Theodosius Dobzhansky circa 1950. The potential for contemporary research in human population genetics to contribute to racism (...) needs to be considered with respect to the ability of the typological-population distinction to arbitrate boundaries between racist society and nonracist, even anti-racist, science. I point out some ethical limits of “population thinking” in doing so. (shrink)

Advances in genomics have led to calls for developing population-based preventive genomic sequencing programs with the goal of identifying genetic health risks in adults without known risk factors. One critical issue for minimizing the harms and maximizing the benefits of PGS is determining the kind and degree of control individuals should have over the generation, use, and handling of their genomic information. In this article we examine whether PGS programs should offer individuals the opportunity to selectively opt out of (...) the sequencing or analysis of specific genomic conditions or whether PGS should be implemented using an all-or-nothing panel approach. We conclude that any responsible scale-up of PGS will require a menu approach that may seem impractical to some, but that draws its justification from a rich mix of normative, legal, and practical considerations. (shrink)

Some philosophers argue that we should limit procreation – for instance, to one child per person or one child per couple – in order to reduce our aggregate carbon footprint. I provide additional support to the claim that population size is a matter of justice, by explaining that we have a duty of justice towards the current generation of children to pass on to them a sustainable population. But instead of, or, more likely, alongside with, having fewer children (...) in in each family, we could also create families with more than two parents. I explore this possibility by pointing out the ways in which multi-parenting can advance children’s interests: in higher levels of well-being, in non-monopolistic child-rearing, and in a future opportunity to become themselves parents. (shrink)

This paper develops a largely neglected parallel between prudence and population ethics. Prudence is generally understood to be concerned with the balancing of well-being over time. How, precisely, well-being ought to be balanced over time, however, is a fervently debated question. I argue that developing a standard guiding such evaluations is exceedingly challenging. This is due to an often overlooked fact about prudence, namely that it shares a structural similarity with population ethics: In both contexts, we assess the (...) comparative value of populations of personstages/people, which may vary in number and level of well-being. Based on this analogy, I show that the development of an adequate theory of prudence runs into very similar impossibility results as obtain in population ethics. In particular, I prove that Arrhenius’ fifth impossibility theorem can be applied to prudence. I develop and compare four possible answers to this challenge. First, I discuss the possibility of accepting the very repugnant conclusion intrapersonally. Second, I present and further develop Donald Bruckner’s Minimax Regret approach, which gives up Transitivity. Third, I apply Jacob Nebel’s Lexical Threshold View to prudence and critically evaluate it. Lastly, I introduce what I call the Negative Lexicality View, which is based on Lexical Threshold View but overcomes some of its problems. (shrink)

In this paper, we explore the stability of the aggregation procedure of individual preferences. In particular, we propose the stability under the addition of social preference, which is a normative property of democratic collective decision making. We establish impossibility and possibility theorems for non-dictatorial aggregation procedures.

In the 1960s molecular population geneticists used Monte Carlo experiments to evaluate particular diffusion equation models. In this paper I examine the nature of this comparative evaluation and argue for three claims: first, Monte Carlo experiments are genuine experiments: second, Monte Carlo experiments can provide an important meansfor evaluating the adequacy of highly idealized theoretical models; and, third, the evaluation of the computational adequacy of a diffusion model with Monte Carlo experiments is significantlydifferent from the evaluation of the emperical (...) adequacy of the same diffusion model. (shrink)

In 1974, John Maynard Smith wrote in his little book Models in Ecology, A theory of ecology must make statements about ecosystems as a whole, as well as about particular species at particular times, and it must make statements that are true for many species and not just for one… For the discovery of general ideas in ecology, therefore, different kinds of mathematical description, which may be called models, are called for. Whereas a good simulation should include as much detail (...) as possible, a good model should include as little as possible. (1974. (shrink)

The COVID-19 outbreak has seen people in many countries asked to radically modify their way of life in compliance with sweeping safety measures. During the current crisis, technology is turning out to be key, in that it allows practitioners to deliver psychological services to people who would otherwise be unreachable. However, professionals cannot solely rely on their traditional modes of practice, in that different methods are required to bring to light the needs of those affected by the emergency. People are (...) being overwhelmed by a cascade of unusual and unexpected events that are putting a strain on their everyday routines and usual meaning-making systems; ongoing challenges to their employment and financial status will likely divert personal resources away from psychological well-being. We therefore argue that psychologists should also consider the needs of the general population. Among those who may require help – aside from the main targets of psychological intervention, such as healthcare personnel and COVID-19 patients and their relatives – specific attention should be paid to those who are not at the center of the crisis. We suggest that this large segment of potential users may benefit from a non-medical approach focused on the promotion of meaning-making processes. Indeed, the disruptive nature of the current situation hinders sense-making and threatens to undermine psychological balance and well-being, at an individual as well as at a societal level. The present article proposes a methodological perspective based on the reconstruction of meaning-making processes (sense of coherence, predictability, metaphors, narratives). Specifically, psychological interventions should promote personal and collective resources with a view to: “normalizing” current distressful experiences (i.e., acknowledging that such reactions are normal in light of the present situation); widening the observational field, taking relational contexts into account, and promoting an understanding of distressful experiences as coping strategies; fostering meaning-making/reconstruction processes through the use of appropriate metaphors and narratives; promoting a sense of coherence. We present two clinical vignettes to illustrate how these principles might be applied in practice. In conclusion, the exceptional psychological challenges posed by the COVID-19 pandemic require practitioners to adopt a broad and flexible perspective on clinical intervention. (shrink)

Rapid Ethical Assessment is an approach used to design context tailored consent process for voluntary participation of participants in research including human subjects. There is, however, limited evidence on the design of ethical assessment in studies targeting cancer patients in Ethiopia. REA was conducted to explore factors that influence the informed consent process among female cancer patients recruited for longitudinal research from Addis Ababa Population-based Cancer Registry. Qualitative study employing rapid ethnographic approach was conducted from May–July, 2017, at the (...) Tikur Anbessa Specialized Referral Hospital. In-depth and key informants’ interviews were conducted among purposively selected 16 participants. Regular de-briefings among the study team helped to identify emerging themes and ensure saturation. Interviews and debriefings were tape recorded in Amharic, and transcribed and translated to English. Coding of the transcripts was facilitated by use of NVivo software. Thematic analysis was employed to respond to the initial questions and interpret findings. Perceived barriers to voluntary study participation included lack of reporting back study results of previous studies, the decision making status of women, hopelessness or fatigue in the patients, shyness of the women, data collectors approach to the patient, and patient’s time constraints. Most of the patients preferred oral over written consent and face-to-face interview over telephone interview. Provision of detail information about the study, using short and understandable tool, competent, compassionate and respectful enumerators of the same gender were suggested to assure participation. Due to the perceived severity, the use of the term “cancer” was associated with fear and anxiety. Alternatively, uses of phrases like “breast or cervical illness/disease” were suggested during patient interviews. Voluntary participation is not straight forward but affected by different factors. Using competent, compassionate and respectful enumerators, short and precise questioning tools to limit the time of the interview could improve voluntary participation. Moreover, careful consideration of the patients and families concept of the disease such as wording and information has to be taken into account. This assessment helped in improving the consent process of the ongoing project on breast and cervical cancer patients. (shrink)

Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.

In the interwar years the Gran Paradiso ibex population followed two subsequent, contrasting trends: a steady rise once the national park was established in 1922, followed by a precipitous fall after the Fascist regime took direct control of conservation in 1934, which almost led to the colony’s extinction. This paper addresses the issue of how models taken from population ecology may inform historical narratives. The data for the interwar years were analyzed using a statistical model based on climate (...) and population density, which has proved reliable for most of the post-World War II period. The article highlights the pivotal role of anthropic variables in determining the inter-war trends and how these are best analyzed using historical scholarship. (shrink)

Although the category “race” fails as a postulated natural kind, racial, ethnic, national, linguistic, religious, and other group designations might nonetheless be considered projectible insofar as they support inductive inferences in biomedicine. This article investigates what it might mean for group concepts in population genetics and genomics to be projectible and whether the projectibility of such predicates licenses the representation of their corresponding classes as natural kinds according to currently prevailing projectibility-based accounts of natural kinds. The article draws on (...) a case study from cancer genetics, specifically, breast cancer risk in Ashkenazi Jewish women. (shrink)