The recent passing of Bill C-7 has placed Advance Requests for MAID (ARMs) on Canada’s legislative agenda. We discuss how ARMs may create ethical and practical challenges for Canadian medical practice.
{"title":"Advanced Requests for MAID: Are They Compatible with Canadian Medical Practice?","authors":"J. Mellett, Cheryl Mack, B. Leier","doi":"10.7202/1084453ar","DOIUrl":"https://doi.org/10.7202/1084453ar","url":null,"abstract":"The recent passing of Bill C-7 has placed Advance Requests for MAID (ARMs) on Canada’s legislative agenda. We discuss how ARMs may create ethical and practical challenges for Canadian medical practice.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46041785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In Quebec, medical aid in dying (MAiD) is legal under certain conditions. Access is currently restricted to patients who are able to consent at the time of the act, which excludes most people with dementia at an advanced stage. However, recent legislative and political developments have opened the door to an extension of the legislation that could give them access to MAiD. Our study aimed to explore the attitudes of people with early-stage dementia toward MAiD should it become accessible to them. Methods: We used a qualitative descriptive design consisting of eight face-to-face semi-structured interviews with persons living with early-stage Alzheimer’s disease, followed by a thematic analysis of the contents of the interviews. Results and Interpretations: Analysis revealed three main themes: 1) favourable to MAiD; 2) avoiding advanced dementia; and 3) disposition to request MAiD. Most participants anticipated dementia to be a painful experience. The main reasons for supporting MAiD were to avoid cognitive loss, dependence on others for their basic needs, and suffering for both themselves and their loved ones. Every participant said that they would ask for MAiD at some point should it become available to incompetent patients and most wished that it would be legal to access it through a request written before losing capacity. Conclusion: The reasons for which persons with Alzheimer’s disease want MAiD are related to the particular trajectory of the disease. Any policy to extend MAiD to incompetent patients should take their perspective into account.
{"title":"Extending Medical Aid in Dying to Incompetent Patients: A Qualitative Descriptive Study of the Attitudes of People Living with Alzheimer’s Disease in Quebec","authors":"Vincent Thériault, D. Guay, G. Bravo","doi":"10.7202/1084452ar","DOIUrl":"https://doi.org/10.7202/1084452ar","url":null,"abstract":"Background: In Quebec, medical aid in dying (MAiD) is legal under certain conditions. Access is currently restricted to patients who are able to consent at the time of the act, which excludes most people with dementia at an advanced stage. However, recent legislative and political developments have opened the door to an extension of the legislation that could give them access to MAiD. Our study aimed to explore the attitudes of people with early-stage dementia toward MAiD should it become accessible to them. Methods: We used a qualitative descriptive design consisting of eight face-to-face semi-structured interviews with persons living with early-stage Alzheimer’s disease, followed by a thematic analysis of the contents of the interviews. Results and Interpretations: Analysis revealed three main themes: 1) favourable to MAiD; 2) avoiding advanced dementia; and 3) disposition to request MAiD. Most participants anticipated dementia to be a painful experience. The main reasons for supporting MAiD were to avoid cognitive loss, dependence on others for their basic needs, and suffering for both themselves and their loved ones. Every participant said that they would ask for MAiD at some point should it become available to incompetent patients and most wished that it would be legal to access it through a request written before losing capacity. Conclusion: The reasons for which persons with Alzheimer’s disease want MAiD are related to the particular trajectory of the disease. Any policy to extend MAiD to incompetent patients should take their perspective into account.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43018437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"L’aide médicale à mourir : défis et enjeux éthiques contemporains","authors":"Marie-Alexandra Gagné, C. Favron-Godbout","doi":"10.7202/1084447ar","DOIUrl":"https://doi.org/10.7202/1084447ar","url":null,"abstract":"","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43903975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical assistance in dying (MAiD) is unique among the arsenal of medical therapeutics though it does return us to a dilemma Hippocrates addressed 2400 years ago. It provides welcome relief for suffering patients and their families, but MAiD is not suicide – it is invited homicide. It is more like a death ritual than a therapeutic procedure. Unlike medical interventions, MAiD cures no diseases and true informed consent cannot be obtained. It separates the body from the soul and perceived doctors’ errors are punishable through criminal prosecution. If badly administered, it could undermine trust in the medical profession. The providers are also at risk for delayed remorse. As the inclusion criteria for MAiD become more relaxed, doctors who currently decide on candidates for MAiD should have access to established panels for guidance. The panels should include legal and ethical specialists.
{"title":"MAiD in Canada: Ethical Considerations in Medical Assistance in Dying","authors":"William R Nielsen","doi":"10.7202/1084456ar","DOIUrl":"https://doi.org/10.7202/1084456ar","url":null,"abstract":"Medical assistance in dying (MAiD) is unique among the arsenal of medical therapeutics though it does return us to a dilemma Hippocrates addressed 2400 years ago. It provides welcome relief for suffering patients and their families, but MAiD is not suicide – it is invited homicide. It is more like a death ritual than a therapeutic procedure. Unlike medical interventions, MAiD cures no diseases and true informed consent cannot be obtained. It separates the body from the soul and perceived doctors’ errors are punishable through criminal prosecution. If badly administered, it could undermine trust in the medical profession. The providers are also at risk for delayed remorse. As the inclusion criteria for MAiD become more relaxed, doctors who currently decide on candidates for MAiD should have access to established panels for guidance. The panels should include legal and ethical specialists.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45626040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The moral significance of the distinction between killing and allowing to die has played a key role in debates about euthanasia and physician assisted suicide. Since the withdrawal of life-sustaining treatment is held as morally permissible in the medical community, it follows that if there is no morally significant difference between killing and allowing to die, then there is no morally significant difference between withdrawing life-sustaining treatment or administering a lethal injection to end a patient’s life. Consistency then requires that voluntary active euthanasia (VAE) is also morally permissible. The debates over whether the distinction is morally significant have carried on for decades with little hope of consensus. We begin by surveying the literature to identify common argumentative strategies used in defending or rejecting the distinction’s significance. We observe, based on our review, that many of these strategies operate in ways that are conceptually removed from the concrete clinical situation of physicians involved in practices that lead to patient death (by withdrawal of treatment or VAE). We conclude by arguing for a novel way of moving the debate forward indicated by our reading of the literature, namely, by paying careful attention to the moral experience of physicians involved in end-of-life interventions to understand how they experience these practices. Exploring physician experience can reveal how the distinction may or may not be useful for moral deliberation and can provide the needed context to theorize about the distinction in a more empirically informed and practically useful way.
{"title":"Getting Real About Killing and Allowing to Die: A Critical Discussion of the Literature","authors":"Andrew Stumpf, Dominic Rogalski","doi":"10.7202/1084448ar","DOIUrl":"https://doi.org/10.7202/1084448ar","url":null,"abstract":"The moral significance of the distinction between killing and allowing to die has played a key role in debates about euthanasia and physician assisted suicide. Since the withdrawal of life-sustaining treatment is held as morally permissible in the medical community, it follows that if there is no morally significant difference between killing and allowing to die, then there is no morally significant difference between withdrawing life-sustaining treatment or administering a lethal injection to end a patient’s life. Consistency then requires that voluntary active euthanasia (VAE) is also morally permissible. The debates over whether the distinction is morally significant have carried on for decades with little hope of consensus. We begin by surveying the literature to identify common argumentative strategies used in defending or rejecting the distinction’s significance. We observe, based on our review, that many of these strategies operate in ways that are conceptually removed from the concrete clinical situation of physicians involved in practices that lead to patient death (by withdrawal of treatment or VAE). We conclude by arguing for a novel way of moving the debate forward indicated by our reading of the literature, namely, by paying careful attention to the moral experience of physicians involved in end-of-life interventions to understand how they experience these practices. Exploring physician experience can reveal how the distinction may or may not be useful for moral deliberation and can provide the needed context to theorize about the distinction in a more empirically informed and practically useful way.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42446888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper clarifies some of the longstanding difficulties in negotiating Do Not Resuscitate Orders by reframing the source of the dilemmas as not residing with either the patient or the physician but with their relationship. The recommendations are low cost and low-tech ways of making major improvements to the care and quality of life of the most ill patients in hospital. With impending physician-assisted death legislation there is an urgency to find more efficient and beneficial ways for clinicians and patients to address resuscitation issues at the bedside. Paradigmatic shifts in the nature of the patient-physician relationship will need to be encouraged by the larger community. These encouraged shifts address the concepts of passive/inferior patient – active/superior physician, patient ownership of and access to all their health care information, and treating the patient as a major participant in the delivery of health care. These recommended changes will not in themselves make any patient, physician or other healthcare provider more humane and open in the patient’s final days. The goal, instead, is to have changes to the context of the discussion provide an encouraging environment for more open communication and a balanced relationship among participants with the patient being the most important.
{"title":"Shame and Secrecy of Do Not Resuscitate Orders: An Historical Review and Suggestions for the Future","authors":"J. O'connor","doi":"10.7202/1084455ar","DOIUrl":"https://doi.org/10.7202/1084455ar","url":null,"abstract":"This paper clarifies some of the longstanding difficulties in negotiating Do Not Resuscitate Orders by reframing the source of the dilemmas as not residing with either the patient or the physician but with their relationship. The recommendations are low cost and low-tech ways of making major improvements to the care and quality of life of the most ill patients in hospital. With impending physician-assisted death legislation there is an urgency to find more efficient and beneficial ways for clinicians and patients to address resuscitation issues at the bedside. Paradigmatic shifts in the nature of the patient-physician relationship will need to be encouraged by the larger community. These encouraged shifts address the concepts of passive/inferior patient – active/superior physician, patient ownership of and access to all their health care information, and treating the patient as a major participant in the delivery of health care. These recommended changes will not in themselves make any patient, physician or other healthcare provider more humane and open in the patient’s final days. The goal, instead, is to have changes to the context of the discussion provide an encouraging environment for more open communication and a balanced relationship among participants with the patient being the most important.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48078848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justine Lepizzera, C. Caux, Annette Leibing, Jérôme Gauvin-Lepage
L’entrée en vigueur de l’aide médicale à mourir (AMM) au Québec et au Canada pose la question de l’élargissement de cette prestation à des mineurs. La présence soutenue des infirmières au chevet du patient les amène à recevoir des demandes liées à l’AMM. Le but de cette étude est d’explorer les perceptions d’infirmières oeuvrant en service d’oncologie pédiatrique au regard de la possibilité pour des adolescents de plus de 14 ans, de demander l’AMM. Six infirmières oeuvrant en soins oncologiques ou palliatifs pédiatriques ou étant en contact direct avec des adolescents en fin de vie dans le cadre de leur travail d’infirmières ont participé à une entrevue individuelle semi-dirigée. Les résultats de cette recherche mettent en exergue que : 1) les infirmières reconnaissent leur rôle de soutien dans les soins du patient en fin de vie ; 2) la plupart ont une opinion professionnelle en faveur de l’AMM pour les adultes et distinguent celle-ci de leur opinion personnelle ; 3) elles apprécient les discussions autour de l’AMM et sont préoccupées par l’établissement des critères l’encadrant ; et 4) une longue expérience comme infirmière engendre plus de préoccupations sur l’élargissement de l’AMM, mais en même temps rend les infirmières plus à l’aise de fournir des informations à ce sujet. Au vu de ces constats, les établissements universitaires et de santé pédiatrique doivent reconnaître et évaluer la nécessité d’une formation des infirmières sur l’AMM afin de les outiller davantage face à de telles situations et ainsi, mieux répondre aux besoins de leurs patients.
{"title":"« C’est en fait un peu difficile de mourir aujourd’hui » : perceptions d’infirmières au regard de l’aide médicale à mourir pour des adolescents en fin de vie au Québec","authors":"Justine Lepizzera, C. Caux, Annette Leibing, Jérôme Gauvin-Lepage","doi":"10.7202/1084451ar","DOIUrl":"https://doi.org/10.7202/1084451ar","url":null,"abstract":"L’entrée en vigueur de l’aide médicale à mourir (AMM) au Québec et au Canada pose la question de l’élargissement de cette prestation à des mineurs. La présence soutenue des infirmières au chevet du patient les amène à recevoir des demandes liées à l’AMM. Le but de cette étude est d’explorer les perceptions d’infirmières oeuvrant en service d’oncologie pédiatrique au regard de la possibilité pour des adolescents de plus de 14 ans, de demander l’AMM. Six infirmières oeuvrant en soins oncologiques ou palliatifs pédiatriques ou étant en contact direct avec des adolescents en fin de vie dans le cadre de leur travail d’infirmières ont participé à une entrevue individuelle semi-dirigée. Les résultats de cette recherche mettent en exergue que : 1) les infirmières reconnaissent leur rôle de soutien dans les soins du patient en fin de vie ; 2) la plupart ont une opinion professionnelle en faveur de l’AMM pour les adultes et distinguent celle-ci de leur opinion personnelle ; 3) elles apprécient les discussions autour de l’AMM et sont préoccupées par l’établissement des critères l’encadrant ; et 4) une longue expérience comme infirmière engendre plus de préoccupations sur l’élargissement de l’AMM, mais en même temps rend les infirmières plus à l’aise de fournir des informations à ce sujet. Au vu de ces constats, les établissements universitaires et de santé pédiatrique doivent reconnaître et évaluer la nécessité d’une formation des infirmières sur l’AMM afin de les outiller davantage face à de telles situations et ainsi, mieux répondre aux besoins de leurs patients.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42379401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L’entrée en vigueur au Québec de la loi encadrant l’aide médicale à mourir semble avoir ranimé les discussions sur le concept d’objection de conscience (OC) chez les professionnels de la santé. Afin de mieux comprendre ce concept, une revue intégrative de 39 écrits, tant nationaux qu’internationaux, a été réalisée. Pour être retenus, les écrits devaient inclure une définition de l’OC et au moins un critère justifiant son acceptabilité, ou non, en contexte occidental de soins. Une représentation théorique des données extraites des écrits a été élaborée par un processus de thématisation inductif. Cette représentation, qui illustre l’OC et ses critères d’acceptabilité dans le domaine de la santé, s’articule autour de quatre pôles interreliés. Deux d’entre eux, soin et compétence professionnelle, sous-tendent la définition même de l’OC, puisque sans l’un ou l’autre de ces pôles, cette dernière ne peut exister. Les deux autres pôles, collectif et individuel, rappellent les valeurs et pouvoirs impliqués lorsqu’il est question d’OC dans un contexte de soins. L’interaction entre ces quatre pôles permet d’illustrer les critères d’acceptabilité ou de non-acceptabilité de l’OC. Cette représentation de l’OC permet ainsi de porter un regard dynamique sur celui-ci et présente l’avantage d’être adaptable à divers types et contextes de soins, dépassant l’aide médicale à mourir. Il propose également une assise théorique pour poursuivre l’exploration de ce concept.
{"title":"L’objection de conscience des professionnels de la santé : une revue intégrative","authors":"C. Caux, Jérôme Leclerc-Loiselle, J. Lecomte","doi":"10.7202/1084449ar","DOIUrl":"https://doi.org/10.7202/1084449ar","url":null,"abstract":"L’entrée en vigueur au Québec de la loi encadrant l’aide médicale à mourir semble avoir ranimé les discussions sur le concept d’objection de conscience (OC) chez les professionnels de la santé. Afin de mieux comprendre ce concept, une revue intégrative de 39 écrits, tant nationaux qu’internationaux, a été réalisée. Pour être retenus, les écrits devaient inclure une définition de l’OC et au moins un critère justifiant son acceptabilité, ou non, en contexte occidental de soins. Une représentation théorique des données extraites des écrits a été élaborée par un processus de thématisation inductif. Cette représentation, qui illustre l’OC et ses critères d’acceptabilité dans le domaine de la santé, s’articule autour de quatre pôles interreliés. Deux d’entre eux, soin et compétence professionnelle, sous-tendent la définition même de l’OC, puisque sans l’un ou l’autre de ces pôles, cette dernière ne peut exister. Les deux autres pôles, collectif et individuel, rappellent les valeurs et pouvoirs impliqués lorsqu’il est question d’OC dans un contexte de soins. L’interaction entre ces quatre pôles permet d’illustrer les critères d’acceptabilité ou de non-acceptabilité de l’OC. Cette représentation de l’OC permet ainsi de porter un regard dynamique sur celui-ci et présente l’avantage d’être adaptable à divers types et contextes de soins, dépassant l’aide médicale à mourir. Il propose également une assise théorique pour poursuivre l’exploration de ce concept.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42828225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings. which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.
{"title":"Adverse Health and Psychosocial Repercussions in Retirees from Sports Involving Head Trauma: Looking at the Sport of Boxing","authors":"Joseph Lee","doi":"10.7202/1077632AR","DOIUrl":"https://doi.org/10.7202/1077632AR","url":null,"abstract":"Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings. which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48791915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When categories of actors are discredited, epistemic inequalities produce testimonial or hermeneutic injustices. These injustices manifest themselves in the absence of recognition of the knowledge of others and in the fact that their ability to understand is called into question. Moreover, although they are subjected to exogenous norms in which they do not find themselves, the people subjected to these injustices find it difficult to assert this and to identify their own norms. These two types of injustice alter the quality of care relationships, particularly in terms of relational ethics, by eroding the trust between caregivers and patients. In order to counteract these, a pedagogical experiment based on democratic and epistemic logics was proposed to health students. This experiment has three pillars: teaching on the partnership between health professionals and patients, patients as teachers or mentors and patients as colleagues. These three pillars are presented as interrelated, one not going without the other. On the democratic level, the aim is to rebalance the power relationships. Thus, it is patients who recruit patients and the latter have a status. At the epistemic level, the aim is to rebalance knowledge relationships, which involves questioning knowledge and standards in terms of their consequences on patients, or more precisely on the “patient experience”. Two different and complementary pedagogical programs have been implemented to create a pedagogical experience within a medical faculty (Sorbonne Paris Nord University) located in the city of Bobigny, which is now called the “Bobigny experience”. The aim of the first is to use the “patient perspective” to resolve clinical situations, while the second is to use narrative medicine to combine the experiences of students and patients on specific topics.
{"title":"Diminuer les injustices épistémiques au moyen d’enseignements par et avec les patients : l’expérience pragmatiste de la faculté de médecine de Bobigny","authors":"Olivia Gross, R. Gagnayre","doi":"10.7202/1077628AR","DOIUrl":"https://doi.org/10.7202/1077628AR","url":null,"abstract":"When categories of actors are discredited, epistemic inequalities produce testimonial or hermeneutic injustices. These injustices manifest themselves in the absence of recognition of the knowledge of others and in the fact that their ability to understand is called into question. Moreover, although they are subjected to exogenous norms in which they do not find themselves, the people subjected to these injustices find it difficult to assert this and to identify their own norms. These two types of injustice alter the quality of care relationships, particularly in terms of relational ethics, by eroding the trust between caregivers and patients. In order to counteract these, a pedagogical experiment based on democratic and epistemic logics was proposed to health students. This experiment has three pillars: teaching on the partnership between health professionals and patients, patients as teachers or mentors and patients as colleagues. These three pillars are presented as interrelated, one not going without the other. On the democratic level, the aim is to rebalance the power relationships. Thus, it is patients who recruit patients and the latter have a status. At the epistemic level, the aim is to rebalance knowledge relationships, which involves questioning knowledge and standards in terms of their consequences on patients, or more precisely on the “patient experience”. Two different and complementary pedagogical programs have been implemented to create a pedagogical experience within a medical faculty (Sorbonne Paris Nord University) located in the city of Bobigny, which is now called the “Bobigny experience”. The aim of the first is to use the “patient perspective” to resolve clinical situations, while the second is to use narrative medicine to combine the experiences of students and patients on specific topics.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42217593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：