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Flesh, Foil, and Authenticity: Reflections on Johann AR Roduit’s “Flesh and Foil”

Martin Gunderson
Johann AR Roduit’s poem, “Flesh and Foil,” raises a number of issues regarding enhancement, especially the need for principles to guide the process of human enhancement. The guidance that the poem seeks can be found in a combination of virtue ethics and authenticity.

Compte-rendu de L’éthique clinique : pour une approche relationnelle dans les soins, 2014, Hubert Doucet, Paramètres, Les Presses de l’Université de Montréal

Delphine Roigt
In his book L’éthique clinique pour une approche relationnelle (Clinical Ethics: A Relational Approach), Hubert Doucet proposes an approach to clinical ethics that includes various theoretical and practical perspectives, notably that of the philosopher Paul Ricoeur. Doucet argues for a relational vision of clinical ethics practice, an ethics of caregivers that, in his words, “needs to be built from the experience of the disease and adapted to the ill person.”

Facteurs influençant la multiplication de traitements en physiothérapie : une analyse thématique de la jurisprudence québécoise

Maude Laliberté
Physical therapy is affected by a problem of multiplication of treatments; the frequency and the length of treatments can be inappropriate or disproportionate in the face of a patient’s needs. The multiplication of treatments can have financial, physical, psychological and social consequences. To explore the factors that influence the frequency and the total treatment duration in situations where there is a multiplication of treatments, a thematic analysis of the jurisprudence was conducted. Clinical and non-clinical factors influencing the frequency and the treatment duration were identified. Clinical factors mean that resource allocation is guided by the condition and the evolution of the patient. Non-clinical factors can include: pressure from the employer, requests of other health professionals or financial conflict of interests. This thematic analysis of the jurisprudence is a first step to understanding what motivates the clinical decisions of physical therapists regarding the allocation of physical therapy resources. This approach is essential to establishing policies and standards of practice that are attentive to the context of practice and the ethical, deontological and legal standards that shape the profession.

BRCA Previvors: Medical and Social Factors That Differentiate Them From Previvors With Other Hereditary Cancers

Lisa Campo-Engelstein
In this paper, I outline some of the reasons why BRCA “previvors” (i.e., “survivors of a predisposition to cancer”) are different from previvors with other hereditary cancers. I examine how the absence of a standard of care for breast cancer risk for women with a BRCA mutation, coupled with a broad range of genetic penetrance and lower mortality, makes BRCA different than other hereditary cancers that have clear and established guidelines. In addition to these medical differences, social factors like the cultural prominence of breast cancer and the social significance of breasts have engendered a more complicated individual previvor identity for and cultural response to women with a BRCA mutation.

Plaidoyer pour une reconnaissance de l’enfant comme agent moral : une réponse à Verpaelst et Couture

Aliya O. Affdal
Although a vulnerable human being, a child can be considered as a moral agent in certain circumstances. Thus, a child can and should be more involved in medical decisions about him/herself.

Les enjeux éthiques de la pratique privée de l’ergothérapie : perceptions d’ergothérapeutes

Marie Goulet and Marie-Josée Drolet
In Quebec, 31% of occupational therapists work in the private sector, which is constantly growing. To date, no studies have specifically documented the ethical issues involved in this practice. The objective of this study was to explore these issues, that is, situations that could compromise the respect of an ethical value. Using a phenomenology-inspired research protocol, seven occupational therapists were interviewed in semi-directed individual interviews. Based on the conceptual framework of Swisher and colleagues, the interview questionnaire permitted the identification of different types of ethical issues. The results show that several values are likely to be compromised: patient well-being, patient autonomy, public safety, distributive justice, quality of interventions, competent practice, professional independence, honesty and professionalism. Although occupational therapists are concerned about the well-being of patients, there are a number of factors that appear to contribute to compromised values, including dual-loyalty situations experienced by occupational therapists, third-party interference in the clinical process, and the funding of clinics. Moreover, the ethical issues of private practice occupational therapy are mainly macroscopic. The ability of occupational therapists to perceive some of these issues seems to be related to some of their characteristics, that is, their ethical sensitivity and the fact that they are novices. The results of this study are generally in line with those documented in the physiotherapy literature and demonstrate the lack of support available to occupational therapists, notably novices, to help effectively overcome these issues.

A Procedure for Managing Conflict of Interest When Forming Thesis Juries

Bryn Williams-Jones
Conflicts of interest in thesis juries, when not identified and appropriately managed, can lead to an uncritical and unfair evaluations that can then undermine trust in the process and threaten academic credibility and institutional reputation. This Commentary presents and justifies the choices made in developing a practical procedure to identify and manage conflicts of interest in the formation of Masters and PhD juries in the School of Public Health (ÉSPUM) at the University of Montreal.

L’ergothérapeute : un professionnel de la santé? Vraiment? Dans quelle mesure?

Marie-Josée Drolet
As with many rehabilitation professionals, the occupational therapist is immediately considered as a health professional. However, this association between occupational therapy and health may be nuanced or even contested.

Quand la transparence ne crée pas nécessairement la lumière

Sabrina Fortin
This review outlines certain themes discussed in the book Autour de l’intégrité scientifique, la loyauté et la probité – Aspects cliniques, éthiques et juridiques (About scientific integrity, loyalty, and probity – Clinical, ethical and legal aspects), published by Dalloz. Some critical comments are provided regarding the normative process that aims to sanction scientific misconduct and the biases of the recognition system that permits an evaluation of the impact of publications.

Exploration des dilemmes éthiques entourant le traitement de la dysphagie à l’enfance et leurs solutions : perceptions d’intervenants

Anne-Marie Brûlé and Marie-Josée Drolet
A review of the literature reveals that there is little knowledge about the ethical dilemmas (and their solutions) surrounding the treatment of childhood dysphagia. The aim of this study is to explore and describe the ethical dilemmas faced by practitioners in the treatment of feeding problems in children with dysphagia and the ways in which these problems are solved. Semi-directed interviews were conducted with eight health practitioners working in an integrated university health and social services centre (CIUSSS) in Quebec. All the practitioners mentioned that they had encountered ethical dilemmas, on average twice a year, and these had caused them some distress. These dilemmas have three main causes: refusal of treatment by some parents, partial follow-up of professional recommendations and differences of opinion with external partners. To resolve these dilemmas, practitioners say they rely on team discussions and the help of superiors, external partners or parents. The majority of participants mentioned that they needed additional means to resolve these dilemmas and proposed some avenues in that direction. The results of the research generally correspond to those documented in the literature. More attention should be paid to these dilemmas, given the scarcity of ethical resources currently available, that are adapted to and able to address these situations, and the distress that these cause.

“Invasive” and “Non-invasive” Technologies in Neuroscience Communication

Maxence Gaillard
This paper analyzes a common distinction in neuroscience communication: the labels “invasive” and “non-invasive” attributed to brain-observation technologies. Because an implicit or explicit value judgment accompanies the term “non-invasive,” it has been used to promote technological progress, especially new brain-imaging techniques that have appeared in recent decades. This study’s material comes from interactions between some expert scientists and the political sphere. Expert reports on neuroscience from different advisory bodies in the French public sector have been collected and analyzed for use of the distinction between invasive and non-invasive. The paper shows that the meaning of these widely used labels varies according to the context, e.g., status of discourse, technologies compared, or stakeholders engaged in the discussion. The definition of what is understood as invasive or non-invasive becomes a strategic issue and can thus vary according to the methodologies favoured by experts participating in national advisory boards or councils.

Fair Innings: Equality and Children’s Healthcare

Katherine Long and Randi Zlotnik Shaul
This commentary assesses the ethical implications of a fair innings inspired approach to healthcare through the lens of the equality guarantee contained in the Canadian Charter of Rights and Freedoms.

La lenteur ethnographique traduite pour les comités d’éthique de la recherche

Karine St-Denis
This case study aims to explain ethnographic slowness for members of the Research Ethics Boards (REBs). I will show that despite recent efforts to recognize the specificity of so-called qualitative research in research ethics, a misunderstanding remains between the experimental rationalization deployed by several REBs and the practice of ethnography, a method of research involving slow and sustained immersion that is inseparable from human relations of trust and mutual respect.

Des enjeux éthiques liés à l’utilisation des données de recherches en collaboration internationale

Valéry Ridde
This global health case study uncovers the ethical issues associated with the use of research data collected in the context of international collaboration involving research assistants.