Journal international de bioethique et d'ethique des sciences最新文献

Patient autonomy as a fundamental principle of modern bioethics is considered in the context of the legal status of a minor in medical law. The authors discuss the specifics of the autonomy of a minor patient, which is determined by the age factor. The following international legal standards defining the bioethical foundations of the legal status of a minor in the medical field are considered: the right to informed voluntary consent, the right to information and confidentiality. The content of the legal concept of “autonomy of a minor patient” is revealed. The autonomy of a minor patient is considered by the authors as the ability to act and make health-related decision independently, and is presented in several aspects: first, the ability to seek medical help; second, the right to provide information in an accessible form; third, the right to decide on consent or refusal of medical intervention; fourth, the right to confidentiality. Foreign experience is provided and features of fixing the principle of autonomy of a minor in Russian legislation in the field of health care are analyzed. Main problems of implementing of the principle of patient autonomy and directions for further research in this area are outlined.

High mortality rates in the Russian Federation in all age cohorts, which are exacerbated nowadays due to the risk of contracting a new coronavirus infection, indicate the lack of programs to promote a healthy lifestyle in society, as well as the preservation of negative attitudes of society associated with any aspects of taking care of one’s health.Switching the public’s attention to self-preservation practices is not viable without considering the socio-economic and psychological conjuncture. Maintaining health requires both time and money, so for many people it remains a secondary task for many years, if the disease does not make itself felt.By appealing to the individual’s choice of a voluntary strategy of the preservation of their health, the state should make sure that they are ready to show a high level of self-awareness and culture. However, there is a stable tradition of risky behaviors in Russian society, in which ignoring the first signs of the disease, the transition of the disease to severe forms, and indifferenceе to the outcome of treatment became a social norm. In this vein, individuals show a disregard for new approaches and often aggravate their problem by resorting to alcohol and drugs, which leads to serious health related consequences.The study of aspects of an individual’s choice of risky life strategies showed the interdependence of the level of health preservation on the material and psychological well-being of a social group (i.e., family). The lower the satisfaction of an individual’s needs in society, the higher the apathy and tendency to addiction, which is often followed by crimes against the life and health of others or a tendency to suicide.

Genetic research today is largely based on the reuse of data from care for the benefit of research. This evolution of practices, which involves an increasingly marked communication between care and research, questions the place given to the patient seen as a potential participant in research. In order to promote the circulation of genetic data generated and to allow their reuse for the benefit of different research, the French legislator reaffirmed the use of the opt-out mechanism (“non-opposition”) in the last bioethics law of the 2 August 2021. If the reasons that led the legislator to make this shift from the concept of consent to the opt-out mechanism are legitimate, the conditions of implementation of this mechanism seem to need to be questioned in order to ensure the effectivity of the balance sought by the legislator between preserving the autonomy of the individual with regard to the sharing of his/her genetic data and encouraging the development of medical knowledge; one should not be to the detriment of the other.

Law n° 2021-1017 of August 2nd. 2021 allows children born of assisted reproduction with a third party donor to have access, as of their majority, to non-identifying data and the identity of this third party. Without calling into question the principle of anonymity, it enshrines the right of access to origins. The reasons for this development are to be found in the evolution of European law, rather than in a logical evolution of French bioethics law. However, such an enshrinement is not without difficulties, both in terms of the concrete and technical implementation of this access to origins and in terms of the practical consequences in the realisation of access to this right for the children benefiting from this system.

Bioethics laws have many particularities because of the technicity and sensitivity of the questions tackled. First, their revision is planned to be made within seven years. Second, since 2011, this revision must be preceded by a public debate called “États généraux de la bioéthique” which aims to involve all part of the society, from experts to uninitiated.The law regarding bioethics enacted on the 2nd of august 2021, is relevant on this point in two ways. First, it is the first law made after the requirements of 2011. It is therefore possible to assess the mild impact of public debate on law-making and decisions. Second, the changes made by the law enacted in 2021 allow us to identity the means mobilized to reinforce and perpetuate public participation in the field of bioethics.

The COVID 19 has produced a renewal of the working conditions likely to affect mental health, a professional risk that psychosocial risks (RPS) helps to prevent. The article links stress, one of the components of this legal regime in training, and teleworking, the solution chosen to protect workers. To characterize an RPS, stress must be pathogenic. An essential question arises: how to avoid it?As an extension, on the one hand, of the various sources of RPS law applicable to telework, it is, on the other hand, to assess the instruments available to the actors required to optimize risk prevention. Although RPS law continues to increase security for mental health, some tracks are proposed for the benefit of teleworkers.

The right to visit our next of kin and friends has been challenged since the beginning of COVID epidemic. In Health and social care services, the visits’ limitation has and continues to have consequences on the persons under care, their relatives and the care workers. This article aims to review the investigations of the Normandy Ethical Support Unit who has set up at the beginning of the COVID crisis, in response to the referrals from the fields in connection with the visits’ restrictions. This crisis served as a reminder of the importance of physical contact in maintaining social interactions. It also drew collective attention to the implementation of digital tools to counterbalance geographical distance, lack of time, and more broadly the evolution of society. The deployment of the digital tool raises many ethical questions and must be considered without neglecting physical contact.

The CОVID-19 pandemic became a catalyst for the transformation of the ideas of the existence of global ethics in favor of real moral pluralism, exposed the problem of abandoning the principles of personalized medicine in favor of public health ethics (collective ethics of civil society). The authors sequentially analyze the objective factors that influenced the change in the moral paradigm of the clinical medicine in Russia: the peculiarities of the course of infection, the lack of resources in the health-care sector, the inability to use advanced treatment methods in different groups of patients, the protection of medical workers, the provision of emergency and planned surgical interventions, and the prevention of further spread of infection. In addition, the moral consequences of the use of administrative measures to limit the spread of the pandemic are given: restriction of social contacts, the use of personal protective equipment, retraining of specialists, re-profiling of the bed fund, leveling problems of communication with colleagues, patients and students. Special attention is paid to the problem of “anti-vaxxers”, representing a significant part of society and hindering the implementation of the vaccination program of the population. We believe that active and passive protest against vaccinations lie not in a rational plane, but in an emotional one, in an immanent distrust of the state and its institutions. Thus arises a secondary ethical problem of the state’s responsibility for the life and health of every citizen, regardless of their beliefs. Contradictions in the moral principles of individual strata of the population (including groups like those who agree to get vaccinated, those who doubt, the indifferent ones, “active anti-vaccinators”) currently seem irreconcilable due to the state’s detachment from solving moral problems.Ethic divergence in the context of the pandemic has become real, stable and difficult to overcome, while the claims of a single, global, global bioethics are being questioned. The COVID-19 pandemic has formulated the ethical task of the 21st century, which will have to be the development of public policy and practice of clinical medicine in the context of serious moral contradictions and significant bioethical differences.

Bioethics laws have many particularities because of the technicity and sensitivity of the questions tackled. First, their revision is planned to be made within seven years. Second, since 2011, this revision must be preceded by a public debate called “États généraux de la bioéthique” which aims to involve all part of the society, from experts to uninitiated.The law regarding bioethics enacted on the 2nd of august 2021, is relevant on this point in two ways. First, it is the first law made after the requirements of 2011. It is therefore possible to assess the mild impact of public debate on law-making and decisions. Second, the changes made by the law enacted in 2021 allow us to identity the means mobilized to reinforce and perpetuate public participation in the field of bioethics.

The law on bioethics of 2 August 2021 introduced a number of innovations that have raised many questions for professionals. For the medical teams at assisted reproduction centres, the disappearance of the notion of medical indication represents a real paradigm shift. Should there be limits on access to MAP methods? The legal texts set certain limits. Are these limits related to human physiology, to the benefit-risk ratio or to social or medico-economic considerations? We will discuss the issues of the age at which a person can benefit from PGM, self-preservation of gametes for his or her own benefit, access to the donor’s identity and special interviews with the multidisciplinary team. Finally, the need for clear, objective information will be emphasised, especially as article 4 of the law provides for a public health plan: prevention/public education, information/female and male fertility, which to date has not been mentioned.