L'engagement médical implique toute une philosophie. Une métaphysique, parce que la médecine trouve sa raison d'être dans le constat de la réalité des maux qui affligent les vivants. Une épistémologie, parce qu'une connaissance du normal et du pathologique est la nécessaire condition d'une lutte intelligente contre ces maux. Des dilemmes moraux, parce que cette lutte associe la recherche du bien des malades individuels, le respect de leur autonomie, et la prise en compte de l'intérêt collectif. C'est cette philosophie de l'acte (...) médical que les essais ici réunis entreprennent d'expliciter, en abordant notamment les défis méthodologiques et éthiques de cet art, tout armé de technologies et au carrefour de multiples sciences, qu'est la médecine. L'auteur, philosophe et médecin, expose avec rigueur et clarté les stratégies utilisées par la recherche médicale pour détecter, identifier et classer les éléments pathogènes, les procédures employées pour évaluer les coûts et bénéfices des interventions thérapeutiques, et les problèmes moraux soulevés par la mise à disposition de services de santé. De cette lecture, on sort convaincu que la sagesse médicale tient à un fragile équilibre entre dévouement à ceux qui souffrent, rationalité incluant l'acceptation du risque, et lucidité sur les limites de nos connaissances. (shrink)

As Aristotle stated, scientific explanation is based on deductive argument--yet, Wesley C. Salmon points out, not all deductive arguments are qualified explanations. The validity of the explanation must itself be examined. _Four Decades of Scientific Explanation_ provides a comprehensive account of the developments in scientific explanation that transpired in the last four decades of the twentieth century. It continues to stand as the most comprehensive treatment of the writings on the subject during these years. Building on the historic 1948 essay (...) by Carl G. Hempel and Paul Oppenheim, "Studies in the Logic of Explanation,” which introduced the deductive-nomological model on which most work on scientific explanation was based for the following four decades, Salmon goes beyond this model's inherent basis of describing empirical knowledge to tells us “not only _what,_ but also _why_.” Salmon examines the predominant models in chronological order and describes their development, refinement, and criticism or rejection. _Four Decades of Scientific Explanation_ underscores the need for a consensus of approach and ongoing evaluations of methodology in scientific explanation, with the goal of providing a better understanding of natural phenomena. (shrink)

This volume reflects on the effects of recent discoveries in genetics on a broad range of scientific fields. In addition to neuroscience, evolutionary biology, anthropology and medicine, contributors analyze the effects of genetics on theories of health, law, epistemology and philosophy of biology. Social and moral concerns about the relationship between genetics, society and the individual also figure prominently. Genetic discoveries fuel central contemporary public policy debates concerning, for example, human cloning, equitable access to healthcare or the role of genetics (...) in medicine. Perhaps more fundamentally, advances in genetics are altering our perception of human life and death. An interview with François Jacob by Anne Fagot-Largeault opens the volume. In this interview, Jacob, who shared a Nobel Prize with André Lwoff and Jacques Monod for their discoveries concerning genetic control of enzyme and virus synthesis, addresses many of the central methodological epistemological and ethical questions covered in the volume. The dynamic interdisciplinary character of this volume makes it relevant to scholars from many disciplines, from biology, philosophy and the social sciences. (shrink)

La notion de " qualité de la vie " est dans l'air du temps. Les réflexions qui suivent l'abordent sous l'angle médical. Prenons un exemple. Dans le traitement des maladies chroniques, il ne suffit plus de prouver qu'un schéma thérapeutique nouveau est efficace et dépourvu de toxicité. Il faut prouver qu'à efficacité et toxicité comparables à celles du traitement standard, le nouveau traitement donne aux malades une qualité de vie meilleure. Ainsi l'hypertension artérielle est facilement contrôlée par toutes sortes de (...) médicaments peu toxiques aux doses efficaces, mais leurs effets secondaires sont souvent mal supportés, occasionnant des abandons de traitement. De grands efforts ont été déployés depuis dix ans [ex. 11], avec l'aide de l'industrie pharmaceutique, pour trouver quels schémas thérapeutiques traitent l'H. T. A. de façon techniquement satisfaisante, sans détériorer la qualité de vie. On commencera par observer que faire intervenir des considérations de quantité-qualité de vie pour aider à résoudre un "dilemme" médical n'est pas une nouveauté. Ce qui est relativement nouveau, dans nos sociétés démocratiques, est l'effort fait pour rendre ces considérations explicites, les argumenter publiquement, justifier les choix qu'on est obligé de faire, en raisonnant sur le nombre et la valeur des années de vie "gagnées" selon les stratégies thérapeutiques. Tout le monde n'aime pas ce genre de calcul. Schématiquement, l'aversion pour les arguments du type quantité-qualité de la vie dénote une préférence pour des théories morales d'inspiration déontologique, tandis que le recours à ce type d'argument dénote une préférence pour des théories d'inspiration utilitariste. On suivra d'abord les utilitaristes en définissant l'action bonne, ou la décision éthique, comme celle qui maximise une quantité pondérée par une qualité. On montrera que, s'étant vaillamment lancés sur la voie de la rationalité calculatrice, les théoriciens de la lignée utilitariste ont mis en évidence les paradoxes et apories auxquels elle aboutit, dans le domaine de la santé comme ailleurs. Leurs ardeurs rationnelles en ont été tempérées de scepticisme. On rejoindra alors les tenants de la position déontologique, en posant un principe du caractère "sacré" de la vie humaine, qui exclut absolument le calcul qu'une vie a plus ou moins de valeur qu'une autre. On verra qu'en fait, par compassion ou réalisme, les partisans du respect " absolu " ont toujours subrepticement réintroduit dans la pratique les nuances relatives qu'ils récusent en théorie. Si dans les faits chacun finit par frôler la solution de l'autre, il reste qu'il y a là deux manières différentes dans leur esprit d'affronter des choix difficiles. Cela est important à considérer. En effet les solutions procédurales, qui permettent de ne pas prendre position sur le fond, et d'aboutir néanmoins à des décisions par voie négociée, restent inconfortables si les parties en présence ne comprennent pas leurs désaccords. (shrink)

Après avoir, en préambule, défini l'expérimentation humaine au sens qui est ici visé, j'identifierai le don qu'elle implique au sein d'une chaîne de solidarité, puis j'analyserai quelques difficultés auxquelles donne lieu l'intégration culturelle de cette démarche de partage, enfin je mettrai en évidence un conflit entre solidarité et autonomie.

The following topics are considered: - 1) Computer-based medical consultation: good doctors have the capacity to make right guesses. - 2) Elementary diagnostic logic: illness as a boolean combination of signs or symptoms, diagnosis as a deductive process. - 3) Clinical decision under uncertainty: partial and/or elusive evidence, overlapping types. - 4) Local heuristic strategies: (1) statistical methods, (2) probabilistic (bayesian) methods, (3) fuzzy methods and Mycin-type expert systems. - 5) General heuristic strategies: representing medical knowledge (rules, nets, frames), simulating (...) expert behavior. - 6) Diagnostic inference and pattern recognition: natural species vs. expert judgement. (shrink)

Au cours des années 1970 (qui furent, dans plusieurs pays, celles de la libéralisation de Vavortement), la question du statut de Vembryon humain fut surtout débattue en termes de libertés individuelles : droit des femmes à disposer d'elles-mêmes, vs. ‘droit à la vie' du fœtus caché dans le corps de sa mère. Dans les années 1980, avec l'application des techniques de procréation ‘artificielle' au traitement de la stérilité humaine, l'accent est mis sur une responsabilité collective à l'égard de l'embryon séparé, (...) conçu en éprouvette, mis au congélateur, convoité par la recherche lorsqu'il n'est pas rendu à un utérus maternel. « Il est urgent de déterminer le degré de sa protection juridique », dit l'Assemblée parlementaire du Conseil de l'Europe (Recommandation 1046, 1986). Mais il n'existe pas de consensus sur les fondements philosophiques d'une telle protection. Le but du présent article n'est pas d'ajouter une thèse de plus à une littérature internationale déjà considérable, mais de situer les positions et arguments en présence, pour éclairer un débat qui touche, entre autres, aux sources du respect dû à la personne humaine. The European Parliament has recently expressed the view that human embryos and fetuses are endowed with human dignity, and that a definition of the degree to which they should be protected by law is urgently needed (Recommendation 1046, 1986). There is however no consensus on the philosophical grounds for such a protection, or on the degree to which embryos and fetuses should be treated as persons. This paper contrasts the biological (natural) and ethical (cultural) criteria of person hood and their underlying ontologies, examines the arguments in favor of taking a pragmatic line rather trying to decide when human beings become persons, and suggests that the pragmatic attitude in fact implies a developmental ontology. (shrink)

Au cours des années 1970 , la question du statut de Vembryon humain fut surtout débattue en termes de libertés individuelles : droit des femmes à disposer d'elles-mêmes, vs. ‘droit à la vie' du fœtus caché dans le corps de sa mère. Dans les années 1980, avec l'application des techniques de procréation ‘artificielle' au traitement de la stérilité humaine, l'accent est mis sur une responsabilité collective à l'égard de l'embryon séparé, conçu en éprouvette, mis au congélateur, convoité par la recherche (...) lorsqu'il n'est pas rendu à un utérus maternel. « Il est urgent de déterminer le degré de sa protection juridique », dit l'Assemblée parlementaire du Conseil de l'Europe . Mais il n'existe pas de consensus sur les fondements philosophiques d'une telle protection. Le but du présent article n'est pas d'ajouter une thèse de plus à une littérature internationale déjà considérable, mais de situer les positions et arguments en présence, pour éclairer un débat qui touche, entre autres, aux sources du respect dû à la personne humaine. The European Parliament has recently expressed the view that human embryos and fetuses are endowed with human dignity, and that a definition of the degree to which they should be protected by law is urgently needed . There is however no consensus on the philosophical grounds for such a protection, or on the degree to which embryos and fetuses should be treated as persons. This paper contrasts the biological and ethical criteria of person hood and their underlying ontologies, examines the arguments in favor of taking a pragmatic line rather trying to decide when human beings become persons, and suggests that the pragmatic attitude in fact implies a developmental ontology. (shrink)

Un regard rétrospectif permet de distinguer quatre phases dans l'émergence de la bioéthique. D'abord (dans les années 1960), une phase d'indignation, qui fait suite à la découverte de conduites scandaleuses dans la recherche biomédicale. Vient ensuite une période d'institutionnalisation, qui voit naître les premières institutions nationales et internationales de régulation. Nous sommes désormais dans une phase de mise en application, où l'on s'efforce de faire passer dans la pratique les règies ainsi dégagées. Cet effort collectif de normalisation n'élimine pas le (...) pluralisme des références éthiques ultimes, mais il témoigne d d'un refus du nihilisme et d'un relatif consensus autour d'un certain nombre de grands principes. Looking back at the emergence of bioethics, four periods can be distinguished. First (during the sixties), an indignation stage, following the disclosure of scandalous misconducts in biomedical research. Then comes a period of institutionalization, where the first national and international regulation institutions were born. We are now in a stage of implementation, trying to put into practice the rules that were thus brought out. This collectively attempted normalization does not eliminate the pluralism of the ultimate ethical references, but it shows both a rejection of nihilism and an almost consensual agreement concerning a number of great principles. (shrink)

The title is meant to tease the reader and attract his/her curiosity, but the question behind the teasing is serious. The reader will gently excuse the unconventional gait of a chapter that originated as an invited lecture given in Paris, at the HOPOS 2006 June conference. Doing philosophy of science requires having been trained both in philosophy and in (at least some) science. That is already a challenge. Studying the history of philosophy of science (which is what "hopos" means) might (...) require having been trained as a historian as well. As life is short, and no one is omniscient, philosophy of science and its history can only be the endeavour of a community of researchers. A common endeavour calls for, if not a plan, at least a common rationality. What follows is about doubts and hopes, and about the reasons we have for tolerating, and even loving, a variety of styles in the ways philosophy of science is practiced. (shrink)

Ce livre présente cinq entretiens avec des philosophes pionniers dans le champ de la bioéthique francophone, Anne Fagot-Largeault et Jean-Yves Goff i (France), Gilbert Hottois et Jean-Noël Missa (Belgique) et Marie-Hélène Parizeau (Québec), cinq personnalités de renom, connues pour leur trajectoire exceptionnelle. Les entretiens menés avec ces auteurs au sujet de leurs oeuvres, de leurs expériences dans des comités de bioéthique et des différents débats soulevés ces dernières années nous permettent de connaître leur travail, mais aussi de faire (...) une incursion dans le développement fulgurant de la bio-médecine et des biotechnologies des cinquante dernières années. Les conséquences de ces applications, les problèmes éthiques générés, les jugements favorables et défavorables à l'égard des changements sociaux qui se sont produits et le bouleversement d'idées qui s'en est suivi, sont autant d'aspects abordés dans ces entretiens. L'utilisation du langage courant exige un effort de synthèse important; aussi ces entretiens sous la forme d'une conversation, offrent-ils au lecteur une large vision panoramique, rigoureuse et concise de l'évolution de la bioéthique francophone. (shrink)

In recent decades, there has been widespread debate in the human and social sciences regarding the compatibility and the relative merits of quantitative and qualitative approaches in research. In psychiatry, depending on disciplines and traditions, objects of study can be represented either in words or using two types of mathematization. In the latter case, the use of mathematics in psychiatry is most often only local, as opposed to global as in the case of classical mechanics. Relationships between these objects of (...) study can in turn be explored in three different ways: 1/ by a hermeneutic process, 2/ using statistics, the most frequent method in psychiatric research today, 3/ using equations, i.e. using mathematical relationships that are formal and deterministic. The 3 ways of representing entities (with language, locally with mathematics or globally with mathematics) and the 3 ways of expressing the relationships between entities (using hermeneutics, statistics or equations) can be combined in a cross-tabulation, and nearly all nine combinations can be described using examples. A typology of this nature may be useful in assessing which epistemological perspectives are currently dominant in a constantly evolving field such as psychiatry, and which other perspectives still need to be developed. It also contributes to undermining the overly simplistic and counterproductive beliefs that accompany the assumption of a Manichean “quantitative/qualitative” dichotomy. Systematic examination of this set of typologies could be useful in indicating new directions for future research beyond the quantitative/qualitative divide. (shrink)

In this interview, Anne Fagot-Largeault discusses with Thierry Bardini her recollections of the life and work of French philosopher Gilbert Simondon. The discussion covers Simondon’s theory of individuation and considers its influences on contemporary thinkers such as Gilles Deleuze and François Laruelle. Fagot-Largeault situates Simondon’s thinking within the broader context of 20th-century biological research and the development of life sciences. Informed by her personal association and experiences working with Simondon, her reminiscences shed light on the unique character (...) of Simondon as a person and as a thinker. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

L'art occupe dans la pensée de Deleuze une place déterminante. De la littérature au cinéma, de la lettre à l'image, Deleuze théorise le domaine de l'art avec des concepts très nouveaux, attrayants et difficiles : corps sans organes, machines désirantes, devenir-animal, rhizome, lignes de fuite... Il s'agit ici d'en exposer le fonctionnement exact en montrant pourquoi l'art, selon Deleuze, devient une machine à explorer les devenirs des sociétés : critique et clinique, il détecte et rend sensibles les forces sociales. Mais (...) l'art produit surtout des effets réels, et non pas simplement imaginaires : l'image n'est donc pas une donnée mentale mais bien une réalité existante. Cet ouvrage se propose de faciliter l'accès à l'œuvre décisive de Deleuze, en restituant ses parcours dans un souci d'extrême clarté. (shrink)

This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for (...) true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making. (shrink)

Think Like an Economist is a fun introduction to the main concepts of economics. It illustrates how the subject has a clear, practical purpose vital to our daily lives and thinking; includes stories of many of the world's greatest economists; and covers the history of economics from the early barter system through the Industrial Revolution to the emergence of globalization.

This article explores the themes of trust and ethical conduct in social research, with particular attention to the trust that can develop between the members of a research team as well as between researchers and the researched. The authors draw upon a three-year empirical study of destinations and outcomes for young people excluded from alternative educational provision. They also make reference to a contemporary exposition of Aristotle's writing on friendship in order to explore two sets of relevant distinctions that have (...) a bearing upon our understanding of relationships that emerge in the context of social research projects. These distinctions are between impartiality and selectivity on the one hand, and between universality and particularity on the other. The authors attempt to demonstrate that these distinctions influence the development of trust and the conduct of ethical research, arguing that the latter is not synonymous with compliance to ethical guidelines. (shrink)

This article focuses on the ethical implications of so-called ‘collateral damage’. It develops a moral typology of collateral harm to innocents, which occurs as a side effect of military or quasi-military action. Distinguishing between accidental and incidental collateral damage, it introduces four categories of such damage: negligent, oblivious, knowing and reckless collateral damage. Objecting mainstream versions of the doctrine of double effect, the article argues that in order for any collateral damage to be morally permissible, violent agents must comply with (...) high standards of care. In order for incidental harm to be permissible, an agent must take pains to avoid such harm even at higher cost to him- or herself. It is argued that accidentally but negligently caused collateral damage may be just as difficult to excuse as incidental harm. Only if high precautionary standards of care are met, can unintended harm to innocents – incidental or accidental – be permissible. In practice, such a strong commitment to avoiding harm to civilians may well lead us to question more generally and rethink more radically how violent conflicts ought to be fought, how military violence ought to be used and whether there are better ways of achieving those aims that we think are legitimate than those we are currently using. (shrink)

The feminist philosopher and social scientist shows how "gendering" has affected the social and natural sciences as she reconciles the long-standing dichotomy between the quantitative and qualitative methods and demonstrates the tandem use of both experimental and intuitive approaches.

A fallibilist theory of knowledge is employed to make sense of the idea that agents know what they are doing 'without observation' (as on Anscombe's theory of practical knowledge).

WINNER BEST SOCIAL PHILOSOPHY BOOK IN 2021 / NASSP BOOK AWARD 2022 -/- Together we can often achieve things that are impossible to do on our own. We can prevent something bad from happening or we can produce something good, even if none of us could do it by herself. But when are we morally required to do something of moral importance together with others? This book develops an original theory of collective moral obligations. These are obligations that individual moral (...) agents hold jointly, but not as unified collective agents. To think of some of our obligations as joint or collective is the best way of making sense of our intuitions regarding collective moral action problems. Where we have reason to believe that our efforts are most efficient as part of a collective endeavor we may incur collective obligations together with others who are similarly placed as long as we are able to establish compossible individual contributory strategies towards that goal. The book concludes with a discussion of “massively shared obligations” to large-scale moral problems such as global poverty. (shrink)

Two experiments were run to demonstrate the presence of a partial reinforcement extinction effect (PREE) and a partial punishment effect (PPE) 4 weeks after training in a 1-trial/day procedure. In the PREE paradigm, two groups of animals were trained to run a straight alley for food reward; one group was rewarded on every trial (CRF), whereas the other was rewarded on only 50% of the trials (PRF). In the test phase, extinction, no reward was present on any trial. Four weeks (...) after the end of acquisition, and subsequent to 7 days of CRF retraining, PRF animals showed greater resistance to extinction than did their CRF controls. The PPE paradigm resembled the PREE paradigm in all aspects, except that mild electric foot shock, together with the food reward, was used instead of nonreward on 50% of the acquisition trials. In the test phase, all animals were shocked and given a food reward on every trial. Four weeks after the end of acquisition and retraining, the animals with previous experience of shock in acquisition showed greater resistance to punishment than did their controls. (shrink)