The Clinical ethics centre in Paris offers its services equally to doctors and patients/proxies. Its primary goal is to re-equilibrate doctor–patient roles through giving greater voice to patients individually in medical decisions. Patients are present at virtually all levels, initiating consults, providing their point of view and receiving feedback. The implications of patients' involvement are threefold. At an operational level, decision-making is facilitated by repositioning the debate on ethical grounds and introducing a dynamic of decisional partnership, although contact with patients (...) can make it difficult to deny their demands and set the limits of our role. Ethically, it reinforces patients' autonomy and grants them a place of veritable ethics ‘actors’, with the danger that this may become excessively autonomy oriented. Finally, at a collective level, the programme fulfils its political purpose in promoting patients' rights and the ideal of démocratie sanitaire, but complicates balancing individual demands with collective values. (shrink)

This article investigates the concept of the ground truth as both an epistemic and technical figure of knowledge that is central to discussions of machine vision and media techniques of visuality. While ground truth refers to a set of remote sensing practices, it has a longer history in operational photography, such as aerial reconnaissance. Building on a discussion of this history, this article argues that ground truth has shifted from a reference to the physical, geographical ground to the surface of (...) the images echoing earlier points raised by philosopher Jean-Luc Nancy that there is a ground of the image that is central to the task of analysis beyond representational practices. Furthermore, building on the practices of pattern recognition, composite imaging, and different interpretational techniques, we discuss contemporary practices of machine learning that mobilizes geographical earth observation datasets for experimental purposes, including tests such as “fake geography” as well as artistic practices, to show how ground truth is operationalized in such contexts of AI and visual arts. (shrink)

Volume 1: The Dance of Civa Collum Originally published in 1927. "It has substance and thought to it." Spectator "A very interesting account of the work of Sir Jagadis Bose." Oxford Magazine This essay suggests that recognition of the ceaseless flow of the Dance of Civa is the most promising cure for the misunderstandings that have arisen from a Western habit of assuming that conventional categories have tangible existence. Quo Vadimus? Glimpses of the Future E E Fournier d’Albe Originally (...) published in 1925. "A wonderful vision of the future. A book that will be talked about." Daily Graphic "Interesting and singularly plausible" Daily Telegraph This volume discusses the possible advances of life on earth and asks whether a new race will arise or whether the earth will remain the dominant planet in the solar system for human life. 92pp. Ethnos or the Problem of Race Arthur Keith Originally published in 1931 The author argues that the global unrest of the 1930s arises from qualities inherent in human races and he maintains that if the world is to have peace the problems engendered by diversity of race must first be understood. 86pp Tantalus Or the Future of Man F C S Schiller Originally published in 1924. "…brilliantly clever…" Morning Post "Immensely valuable and infinitely readable" Daily News This volume discusses the threats which face mankind and ways in which destruction may be avoided. 66pp. (shrink)

Depuis les années 1970, les fouilles de Thasos ont mis au jour deux inscriptions en rapport avec la famille impériale. La première, datée entre 14 et 29 apr. J.-C., est due à Komis, prêtresse de Livie. Gravée sur la façade arrière du portique Nord-Ouest, elle était la dédicace de l'exèdre des abords Ouest de l'agora. La deuxième, complétée par un fragment découvert en 2006, est la dédicace d'une statue pour Agrippa Postumus, fils adoptif d'Auguste honoré comme bienfaiteur par tradition ancestrale. (...) Les deux textes témoignent des transformations de la monumentalité et de la société thasiennes au début de l'Empire. (shrink)

A pilot center for clinical ethics in France opened with the establishment of the “Centre d'éthique clinique” at Cochin Hospital in Paris, September 2002. Unlike the longer history in the United States of providing ethics consultation for ethical issues deriving from physician–patient interactions, this center marks a new development in bringing clinical ethics to Europe.

Research involving and impacting Indigenous Peoples is often of little or no benefit to the communities involved and, in many cases, causes harm. Ensuring that Indigenous research is not only ethical but also of benefit to the communities involved is a long-standing problem that requires fundamental changes in higher education. To address this necessity for change, the authors of this paper, with the help of graduate and Indigenous community research assistants, undertook community consultation across their university to identify the local (...) and national ethical needs of Indigenous researchers, communities, and Elders. This paper provides an overview of the consultation process, the themes that emerged from the consultations, and a model of the Wholistic Indigenous Research Framework that emerged. (shrink)

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable health policy and practice remains a challenge. In particular, there is limited understanding of ways to respond to situations in which conventional practices mandated by the state and regulated by its legal apparatus (...) come into direct conflict with the values and autonomy of Indigenous individuals, communities, and nations. In this paper, we consider two cases of conflict between Indigenous and biomedical perspectives to clarify some of the competing values. We argue for the importance of person‐ and people‐centered approaches to health care. These value conflicts must be understood at multiple levels to clarify their personal, social, cultural, and political dimensions. Taking into account the divergence between epistemic cultures and communities allows us to understand the multiple narratives deployed in decision‐making processes in clinical, community, and juridical contexts. Recognizing the knowledge claims of Indigenous peoples in health care can help clinicians avoid reinforcing the divides created by the structural and institutional legacy of colonialism. This analysis also provides ways to adjudicate conflicts in health care decision‐making by disentangling cultural, political, medical, and pragmatic issues to allow for respectful dialogue. Insofar as the engagement with cultural pluralism in health care rights is conducted with reciprocal recognition, the medical community and Indigenous peoples can address together the difficult question of how to integrate different epistemic cultures in the health care system. (shrink)

Cet essai développe une analyse critique de la mondialisation basée sur des recherches de terrains entreprises dans la décennie 2010 à Cuba, plus particulièrement à La Havane. L’enseignement de la mondialisation dans les universités anglo-saxonnes au Canada et en Grande-Bretagne dans les années 2000 se caractérisait par une peur de l’homogénéisation de la culture, puis de l’application d’une approche ethnographique pour l’exploration du processus d’appropriation culturelle engendrée par les interactions entre le local et le transnational. Des recherches de terrain ont (...) cependant montré, parfois de manière concrète, comment la vision de la mondialisation composée de systèmes de circulations fluides et sans tension était utopique et non pertinente dans le contexte cubain (et probablement dans tous les pays de l’hémisphère Sud). L’histoire du « dossier dubstep » racontée ici permet d’illustrer le sentiment de décalage tel qu’exprimé par des DJs et producteurs de musique électronique à La Havane et leur désir d’entrer dans la danse. Enfin, cet essai jette un regard critique sur une vision fluide des échanges, souvent associée au concept de circulation et, par extension, au phénomène de la mondialisation. (shrink)

Since the early 1990s, Steven Reed and Gary Cox have changed our understanding of Japan's multimember SNTV electoral system, by highlighting its institutional effects similar to what is known as Duverger's law in the Anglo-American context. While we offer some additional evidence to consolidate their findings, we also address an issue left unexplored in these studies, namely the role of partisan information. Under Japan's system, party labels matter in elections. We show that, while Japanese voters are generally willing to abandon (...) the candidates without affiliation with established parties, the partisan effects produce constraints for strategic coordination. (shrink)

Conçues pour des biens ayant une consistance matérielle, nombre d'infractions pénales ont été sollicitées ces dernières années pour s'appliquer à des biens immatériels tels qu'un numéro de carte bancaire, un projet de borne informatique, du temps de travail ou encore des données informatiques. Au-delà de la matière répressive, l'ambition de cet ouvrage est de se livrer à une étude plus générale de l'adaptation du droit au développement de l'immatériel pour déterminer jusqu'où l'on peut juridiquement aller dans sa prise en compte. (...) C'est un fait indéniable que l'immatériel prend une place de tout premier plan dans la société contemporaine. Le droit des siècles passés connaissait, certes, déjà l'incorporalité, mais nul doute que les potentialités actuelles ouvrent des perspectives nouvelles. L'ouvrage propose tout d'abord de préciser la notion d'immatériel en recourant à des approches non juridiques. Le point de vue du philosophe et celui du physicien peuvent fournir des clés pour percer un concept que le juriste pourra ensuite aborder de manière pragmatique. S'agissant de l'appréhension juridique de l'immatériel, deux mouvements peuvent être observés. D'une part, l'immatériel est un objet que le droit s'efforce d'intégrer ; d'autre part, il est un outil que le droit peut exploiter. Sur le premier point, il s'agit d'examiner comment le droit parvient à s'adapter à l'émergence de nouvelles formes d'objet et surtout d'identifier les limites qui ne pourront ou ne devront pas être dépassées. Même lorsque l'on s'intéresse à des matières qui ont été conçues pour régir l'immatériel, telle que la propriété intellectuelle, on observe en effet que tout objet ne peut être saisi et on devine alors que de telles limites doivent a fortiori exister lorsque l'on est en présence de branches du droit qui n'étaient originairement pas destinées à s'appliquer à de tels biens et qui ne peuvent y parvenir qu'au terme d'une adaptation. Sur le second aspect, il s'agit d'observer les perspectives qu'ouvre l'immatériel comme moyen d'accéder au droit et de mettre en relation les acteurs de la scène juridique. Là aussi, certains aspects ne sont pas totalement nouveaux et si la prolifération des contrats conclus par voie électronique ne constitue que le développement récent du phénomène ancien des contrats à distance, la dématérialisation des procédures et des échanges entre professionnels du droit va être relayée par un accès direct du justiciable aux services judiciaires qui est de nature à changer de manière significative le mode de relation au juge et à l'institution judiciaire. (shrink)

In the original publication of the article, the following paragraphs have been indented wrongly in the published article.

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation (...) of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position. (shrink)

Au cours des dernières décennies, les théoriciens des actes de discours ont amorcé l’analyse des discours afin de décrire la logique qui gouverne l’usage et la compréhension du langage en contexte d’interlocution. Cet article s’inscrit dans la foulée de ces études. Il interroge la fécondité de la notion d’actes de discours en pragmatique littéraire, analyse quelques genres littéraires et propose une typologie des discours composée de huit catégories génériques qui font état des relations logiquement possibles entre les discours factuels et (...) fictionnels, en guise de réponse à une question qu’un théoricien littéraire a posé autrefois aux théoriciens des actes de discours. (shrink)

Parmi les découvertes notables du site d’Hagios Vassileios, à l’Ouest de la cité antique de Thasos, figure la base d’un ambon appartenant à la plus septentrionale des deux basiliques protobyzantines mises au jour. Dans un état précédent, le bloc était mis en oeuvre dans un monument funéraire inscrit : cinq noms, trois d’hommes et deux de femmes, étaient gravés sur sa face antérieure. Ces noms apparaissent dans d’autres inscriptions thasiennes d’époque impériale : tous appartiennent à une famille importante, où les (...) noms d’Hérodès fils de Samos et de Samos fils d’Hérodès paraissent avoir alterné d’une génération à l’autre. La confrontation de ces textes permet une reconstitution du stemma de la famille, ainsi que l’étude de son insertion dans les sphères supérieures de la société thasienne. (shrink)

Discovering high-utility itemsets (HUIs) consists of finding sets of items that yield a high profit in customer transaction databases. An important limitation of traditional high-utility itemset mining (HUIM) is that only the utility measure is used for assessing the interestingness of patterns. This leads to finding several itemsets that have a high profit but contain items that are weakly correlated. To address this issue, this paper proposes to integrate the concept of correlation in HUIM to find profitable itemsets that are (...) highly correlated, using the all-confidence and bond measures. An efficient algorithm named FCHM (fast correlated high-utility itemset miner) is proposed to efficiently discover correlated high-utility itemsets (CHIs). Two versions of the algorithm are proposed: FCHM|$_{all\text{-}confidence}$| and FCHM|$_{bond}$|⁠, which are based on the all-confidence and bond measures, respectively. An experimental evaluation was done using four real-life benchmark datasets from the HUIM literature: mushroom, retail, kosarak and foodmart. Results show that FCHM is efficient and can prune a huge amount of weakly CHIs. (shrink)

Les mathématiciens et philosophes du xix e siècle ont souligné l’incapacité de la doctrine kantienne de l’espace à prendre en charge la fondation des géométries non euclidiennes, et cette difficulté semble pouvoir être rapportée à une tension interne à la notion kantienne d’extériorité : en cherchant à « exposer » l’espace comme condition de possibilité de la géométrie comme science a priori, Kant s’interdirait en réalité de rendre compte de sa fonction de possibilisation de l’expérience externe en général. Le même (...) problème se manifeste lorsqu’on cherche à rendre compte, comme nous le faisons ici, de l’extériorité des phénomènes sonores. À travers la description du rapport du son au temps, mais aussi à l’espace, et à la lumière de la musique savante contemporaine et en particulier d’une œuvre de Pierre Boulez dans laquelle la spatialisation du son joue un rôle majeur, nous montrons qu’il est nécessaire, pour sauver le transcendantal, de lui imposer un reformatage – et plus précisément un déplacement. Car dans la tension entre fondation des axiomes géométriques et ouverture du sujet à l’extériorité, ce qui se joue n’est pas autre chose que le sens même de la question transcendantale. (shrink)

" Pourquoi demandons-nous avec tant d'empressement au cerveau d'expliquer ce qui nous arrive et ce que nous devons faire? On se dit, n'est-ce pas dans ses replis que nous devons désormais chercher notre sort? La philosophie peut-elle rester indifférente à un tel sujet? [...] Mais avons-nous éclairci notre monde et résolu nos questions de vie en les enracinant dans nos cerveaux? A-t-on rendu la conscience moins mystérieuse? Et penser? L'organe de la pensée va-t-il enfin nous en dispenser? " L'auteur s'interroge (...) avec une douce ironie sur les espoirs et les fragilités qui s'expriment dans cette nouvelle quête de fondement que nous avons entreprise. Qu'on ne s'attende pas à trouver ici une théorie du fonctionnement cérébral, mais mille interrogations, mille formulations des questions qui surgissent dès lors qu'on interpose l'idée de cerveau entre nous et le monde. L'ensemble compose une suite de méditations, ramassées en brefs chapitres, pour trouver une place au cerveau et varier notre distance à son égard. (shrink)

Philippe Fournier | : Le point de départ de ma proposition est que la responsabilité est un terme plus approprié que la vertu pour désigner les exhortations au devoir civique dans l’ère contemporaine. De même, à défaut de voir l’implication citoyenne comme l’expression de la rationalité individuelle ou de la conscience morale dans la sphère publique, je propose de comprendre la responsabilité comme une matrice discursive et gouvernementale qui perpétue des modèles comportementaux bien spécifiques. J’entends ainsi démontrer que la (...) responsabilité est devenue une modalité indispensable du « gouvernement de la conduite » au sein d’une rationalité néolibérale. En plus de constituer une série de dispositions morales qui remédierait aux failles et aux lacunes de l’individualisme libéral, la responsabilité se matérialise dans les incitations à une citoyenneté active et participe de ce fait à la rationalisation du retranchement de l’État de la sphère sociale. Comme l’illustrent des courants aussi divers que le néoconservatisme, le communautarisme et l’économie sociale, la responsabilité se présente moins comme une solution de rechange aux créneaux du néolibéralisme qu’une série de techniques et de standards comportementaux visant à compléter et renforcer l’application élargie d’une logique micro-économique. Je montrerai que le recours à la notion de responsabilité est particulièrement visible dans les politiques d’aide sociale et au sein des nouveaux partenariats entre l’État, le milieu communautaire et les communautés locales. En effet, l’aide étatique est de plus en plus conditionnelle à la démonstration de certaines dispositions morales et psychologiques comme la volonté, la ténacité et la probité. L’article se divise en quatre parties. La première s’attarde à définir brièvement la « gouvernementalité », concept initialement développé par Michel Foucault. La deuxième se penche sur des travaux plus contemporains, notamment ceux du sociologue britannique Nikolas Rose qui se préoccupe de la responsabilité en tant que modalité gouvernementale au sein du néolibéralisme. La troisième partie met en relief les particularités du néolibéralisme américain. En vue de cerner les pratiques et discours associés à la responsabilité de façon plus précise, la dernière partie examine l’un des principaux programmes d’aide sociale aux États-Unis, l’Aid to Families with Dependent Children, devenu le Temporary Assistance for Needy Families en 1996, des années 1980 jusqu’à aujourd’hui. | : Our point of departure is that responsibility is a more appropriate term than virtue to designate the contemporary exhortations to civic duty. Instead of seeing civic engagement as a means to express individual rationality or moral conscience in the public sphere, this paper suggests that we should understand responsability as a discursive and governmental matrix that perpetuates specific behavioral standards. More specifically, the article aims to show that responsability has become an indispensable instrument of rule within a neoliberal rationality of government. As well as pointing to a range of moral dispositions that can offset neoliberalism’s shortcomings, the notion of responsibility is mobilised in the repeated public calls to active citizenship and plays a strategic role in the discursive justification of the state’s withdrawal from the social sphere. As illustrated by strands of thought as diverse as neoconservatism, communitarianism and social economy, responsibility is less an alternative to neoliberal tenets than a series of techniques and behavioral standards that complement and reinforce the extension of a microeconomic logic to all spheres of human activity. The appeals to responsibility are particularly visible in contemporary social policies and in the strategic partnerships between the state, community organisations and local communities. Indeed, state assistance has become increasingly conditional on the demonstration of aptitudes and moral qualities like earnestness, tenacity and willpower. The article proceeds in four parts. The first part briefly defines governmentality, a concept initially developed by Michel Foucault. The second part explores Nikolas Rose’s work on advanced liberalism and takes a look at contemporary articulations of responsibility. The third part examines the specificities of American neoliberalism. In order to identify the practices and discourses linked to the notion of responsibility, the final part of the article looks at one of the main social programs in the United States, namely the Aid to Families with Dependent Children, renamed the Temporary Assistance for Needy Families in 1996, from the early 1980s to our day. (shrink)

After the ‘empirical turn’ in bioethics, few specific approaches have been developed for doing clinical ethics research in close connection with clinical decision-making on a daily basis. In this paper we describe the ‘committed researcher’ approach to research in clinical ethics that we have developed over the years. After comparing it to two similar research methodological approaches, the ‘embedded researcher’ and ‘deliberative engagement’, we highlight its main features: it is patient-oriented, it is implemented by collegial and multidisciplinary teams, it uses (...) an ethical grid to build the interview guide, and it is geared towards bringing the results to bear on the public debate surrounding the issue at stake. Finally, we position our methodological approach with respect to the ‘is vs. ought’ distinction. We argue that our ‘commitment researcher’ approach to clinical ethics research takes concerned people’s life-building values as the main data, and compares them to the larger normative framework underlying the medical practice at stake. (shrink)

The aim of this article is to flesh out gender by drawing connections between the experience of pain and the experience of womanhood. The article builds upon two themes in feminist work (the constitution of woman through her effacement, and the inscription of gender on the body) and proposes to analyse `effacement' in terms of an embodied sense of being `gutted out', or made `immaterial'. I use this imagery of `gutting out' to suggest that effacement is experienced through the body, (...) and in terms of the presence of pain rather than merely in terms of lack or absence (of voice or subjectivity). Thus I share the view that gender is performed through inscriptions on the body, but I argue that this work of gendering involves hurting and injuring women's bodies; and it is this pain that I attend to in the article. I draw upon Scarry's analysis of the body in pain as a symbolic framework to discuss the pain of womanhood in terms of the annihilation of the self as it is engulfed in a mass of hurting flesh. (shrink)

We consider logical expressions built on the single binary connector of implication and a finite number of literals . We prove that asymptotically, when the number of variables becomes large, all tautologies have the following simple structure: either a premise equal to the goal, or two premises which are opposite literals.

War-orphans from Thasos: a new fragment of the « Agathoi Decree » (ca 360-350 B. C). A new fragment of the « Agathoi Decree » is here published (J. POUILLOUX, Recherches sur Thasos I, 141), which contains arrangements for the public funerals of citizens killed in war. The twenty-two new lines contain three additional clauses. The city guarantees the maintenance of war-orphans through a daily allowance, provided that they are genuinely needy. The sons of metics will receive a fixed grant (...) of 17,5 staters. A third, unspecified, category (the sons of nothoi? freedmen?) are entitled to certain privileges, specified in an earlier decree. The decree is to be published near the prytaneion. The document reveals, among other things, the existence of a board of prytaneis. It also allows for a reexamination of monetary questions, in particular the denominations of the new currency system introduced in Thasos in the early fourth century B.C. The whole decree is strongly influenced by the Athenian model. It was probably adopted in exceptionally grave military circumstances, very likely the Datos/Krenides war of 360-356 B.C. (shrink)

This article sets out the rationale for a United Nations Regulation for Artificial Intelligence, which is needed to set out the modes of engagement of the organisation when using artificial intelligence technologies in the attainment of its mission. It argues that given the increasing use of artificial intelligence by the United Nations, including in some activities considered high risk by the European Commission, a regulation is urgent. It also contends that rules of engagement for artificial intelligence at the United Nations (...) would support the development of ‘good artificial intelligence’, by giving developers clear pathways for authorisation that would build trust in these technologies. Finally, it argues that an internal regulation would build upon the work in artificial intelligence ethics and best practices already initiated in the organisation that could, like the Brussels Effect, set an important precedent for regulations in other countries. (shrink)

Five major claims are made in our paper on strategic voting within the context of Japan's multimember single non-transferable vote (SNTV) electoral system (Fournier and Kohno, 2000). Two claims deal with the reconciliation of Steven Reed's (1990) and Gary Cox's (1997) important work on extending Duverger's law to the Japanese case, and three claims deal with the informational effects of partisan labels on strategic voting.

Cette étude constitue la première publication complète de tous les éléments associés à l’autel des Césars au cœur de l’agora de Thasos : les vestiges architecturaux, la dédicace à Lucius César et la tête sculptée mises au jour lors de la fouille du monument. L’identification de l’édifice à un autel est désormais assurée et l’appartenance du bloc inscrit à ce dernier confirmée. La présence d’une seconde dédicace, vraisemblablement à Caius César, est rendue très probable par la structure du monument, dont (...) une restitution est proposée pour la première fois. L’association à la construction de l’autel des deux soubassements de bases qui le flanquent à l’Est est démontrée, ce qui conforte l’identification de la tête à l’un des deux princes de la jeunesse, dans lequel il faut reconnaître Caius plutôt que Lucius. Ces nouveaux éléments permettent de dater précisément le monument entre 4 et 6 apr. J.‑C. et de lui donner sa juste place dans l’histoire des relations entre Thasos et la famille impériale. (shrink)

This article reads The Second Sex from the perspective of transmasculinity, using gender dysphoria as a critical approach. Following the threads of an intergenerational history of feminist and queer thinkers, the author is led to examine the particular position of trans men regarding feminism. How does one acknowledge that the category of woman is rooted in oppression without failing to support those who align with it? The true legacy of The Second Sex is a feminist transmasculine ethics.

I. Le problème de Strawson et la phénoménologie Dans le deuxième chapitre de Individuals, Peter Strawson pose la question du rapport du son à l’espace, et à travers elle, celle de la cohérence de la notion kantienne de sens externe. Le son serait un objet essentiellement temporel, auquel une spatialité ne pourrait être ajoutée que par analogie ou de manière seulement synesthésique ou kinesthésique. L’analyse de Strawson repose sur l’opposition entre les représentations sonores et tactiles de...

This article aims to expose the main governmental shifts in recent American history (1961-2000) by examining two programs: the Assistance to Families with Dependent Children (AFDC) and the Agency for International development (US-AID). Through the exploration of primary and secondary sources, we analyse the production, organisation and circulation of governmental practices in the realms of both domestic and foreign policy. In the American context, practices of government typically revolve around freedom, efficiency models and individual responsibility. Throughout the analysis, we find (...) that the general critiques which have guided reforms and experiments in both areas converge around the same elements. This testifies to the fact that the reflexions and technical models directed at the optimal management of populations are more far-reaching than they first appear. Moreover, the historical transformations in welfare and foreign aid practices bear out the increasingly disciplinary nature of the administration and objectification of the poor, both within the United States and internationally. (shrink)

Advance directives have been hailed for two decades as the best way to safeguard patients’ autonomy when they are totally or partially incompetent. In many national contexts they are written into law and they are mostly associated with end-of-life decisions. Although advocates and critics of ADs exchange relevant empirical and theoretical arguments, the debate is inconclusive. We argue that this is so for good reasons: the ADs’ project is fraught with tensions, and this is the reason why they are both (...) important and deeply problematic. We outline six such tensions, and conclude with some positive suggestions about how to better promote patients’ autonomy in end-of-life decision. We argue that ADs should continue to be an option but they cannot be the panacea that they are expected to be. (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)

In the French language, it sounds very odd indeed to associate the word futility with serious things, and especially with medicine. The term is most often used to speak of “frivolities,” such as trinkets or any other bling-bling. “On parle à Paris et on ne pense guère, la journée se passe en futilités”, Voltaire wrote in a 1765 letter ; or “De cette indigne classe où nous rangent les hommes, de borner nos talents à des futilités”, said Molière in his (...) 1672 play, Les Femmes savantes. It looks as though the term... (shrink)