BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

Bioethics, Volume 36, Issue 5, Page 500-510, June 2022.

When conflicts regarding industrial operations erupt between countries, relationships between corporations and stakeholders may be affected. We combine insights from stakeholder theory and studies on government and corporate social responsibility to investigate how intergovernmental politics shapes stakeholder engagement. Relying on attribution theory and a qualitative analysis of the Finnish Metsä-Botnia (hereafter Botnia) company during the intergovernmental conflict between Uruguay and Argentina, we explore the mediating role of political attributions—defined as the stakeholder network actors’ inferences regarding governmental motives—in the process by (...) which intergovernmental politics shapes stakeholder engagement. We induce three types of political attributions: instrumentalizing, which points to the undeclared instrumental motives of governments; radicalizing, which refers to the beliefs that governments immoderately intensify confrontation; and acting in bad faith, which relates to the perceptions that governments act in inconsistent and/or morally inappropriate ways. Our results show how these attributions combine in specific configurations to explain how intergovernmental politics shapes stakeholder engagement throughout the conflict. Our study theorizes the role of governments as stakeholders in stakeholder engagement and expands organizational studies of attribution to the stakeholder and global levels. (shrink)

Therapeutic strategies capable of inducing and enhancing prosthesis embodiment are a key point for better adaptation to and acceptance of prosthetic limbs. In this study, we developed a training protocol using an EMG-based human-machine interface that was applied in the preprosthetic rehabilitation phase of people with amputation. This is a case series with the objective of evaluating the induction and enhancement of the embodiment of a virtual prosthesis. Six men and a woman with unilateral transfemoral traumatic amputation without previous use (...) of prostheses participated in the study. Participants performed a training protocol with the EMG-based HMI, composed of six sessions held twice a week, each lasting 30 mins. This system consisted of myoelectric control of the movements of a virtual prosthesis immersed in a 3D virtual environment. Additionally, vibrotactile stimuli were provided on the participant’s back corresponding to the movements performed. Embodiment was investigated from the following set of measurements: skin conductance response, crossmodal congruency effect, ability to control the virtual prosthesis, and reports before and after the training. The increase in the skin conductance response in conditions where the virtual prosthesis was threatened, recalibration of the peripersonal space perception identified by the crossmodal congruency effect, ability to control the virtual prosthesis, and participant reports consistently showed the induction and enhancement of virtual prosthesis embodiment. Therefore, this protocol using EMG-based HMI was shown to be a viable option to achieve and enhance the embodiment of a virtual prosthetic limb. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

Résumé La fondation anthropologique de la fonction critique – socialement endossée par l’imaginaire utopique – et son lien dynamique avec la tâche intégrative de l’idéologie permettent à Ricœur de repenser sur le plan socio-politique la double nécessité du soupçon et de l’espérance. En reliant l’analyse de la structure contradictoire et analogisante de l’imaginaire social aux perspectives antérieurement développées sur “la liberté selon l’espérance,” notre propos vise à expliciter ses enjeux émancipateurs. Les apories auxquelles les médiations symboliques contraignent l’agir (...) doivent nourrir la double nécessité d’un “devoir de vigilance” et d’une “timide espérance”: telle est à la fois la difficulté irréductible et la force critique de l’analyse ricœurienne de l’imagination socialisante. Mots-clés: imaginaire social, critique, idéologie, utopie, espérance.The anthropological foundation of the critical function—endorsed by the utopian imaginary—and its dynamic relation with the integrative task of ideology allow Ricœur to rethink, at a social and political level, the necessity of both suspicion and hope. Linking Ricœur’s analysis of the contradictory and analogizing structure of the social imaginary to perspectives on “freedom in the light of hope,” which were developed earlier, it is my intention to make explicit certain emancipatory issues. The aporiae to which symbolic mediations constrict acting must provide for the necessity of both an “obligation for vigilance” and a “tentative hope.” Such is the irreducible difficulty but also the critical force of Ricœur’s analysis of the socializing imagination. Keywords: Social Imaginary, Criticism, Ideology, Utopia, Hope. (shrink)

Cet article, au titre de prolégomènes à toute recherche future, entend relever quelques paramètres de la recherche sur l'espérance dans toute la Bible, en la reconduisant à la condition anthropologique de l'humain. Parmi ces paramètres, sont retenus en particulier: la conception du temps supposée par l'espérance, l'espérance comme intentionnalité et comme objet ou terme de cette intentionnalité, l'espérance comme articulation entre temporalité et altérité, l'espérance vue au temps de son élan et au temps de sa (...) vérification, la distinction entre espérance et illusion, le rapport entre espérance et désespoir, l'espérance personnelle et communautaire, pour soi et pour autrui, les modes d'expression de l'espérance, par des mots, des symboles et des actes, les représentations de l'espéré, les raisons de l'espérance, la manière dont Dieu, et le Christ, modèlent l'espérance. (shrink)

Within the philosophy of science there has been a great deal of rather vague talk about the 'heuristic fruitfulness' (or what Peirce called the 'esperable uberty') of theories. It is my aim in the present paper to add some precision to these discussions by linking this 'fruitfulness' to the satisfaction of certain heuristic criteria. In this manner the demarcation between 'discovery' and 'pursuit' becomes blurred. As a case study, I present the competition between the paraparticle and colour models of quarks (...) in the late 1960s. I argue that the eventual appraisal of the latter as the more fruitful of the two was based on the incorporation of a particular symmetry principle, regarded as a heuristic guideline, rather than on non-epistemic factors concerning 'cognitive resources' and the like. (shrink)

La création physique peut-elle être sujet d’espérance? Quelle est l’aspiration de la création matérielle et que signifie-t-elle pour les croyants? Écouter le cri de la Terre et le « gémissement de la création » dévoile nos péchés systémiques contre elles. En prenant appui sur la Lettre aux Romains, il est toutefois possible d’entendre aujourd’hui la plainte de la création, pas tant comme une accusation que comme un Évangile ; à savoir une heureuse annonce et un appel à la conversion. (...) La création et nous, nous partageons la même espérance de la gloire. Le cri de la création, qui dénonce nos péchés contre elle, est aussi paradoxalement un témoignage de notre aspiration commune vers la gloire filiale, selon l’argument de Paul en Romains 8. L’issue de cette espérance est avant tout suspendue à la fidélité de Dieu. Relier la plainte de la création au cri du Fils de Dieu dans notre chair confirme la solidité d’une telle espérance de la gloire. (shrink)

Occidental philosophy tends to subordinate the individual to the general. The mystical marxism of Ernst Bloch seems to value the individual more than does orthodox marxism. This article shows that after all Bloch falls in line with the tendency of occidental philosophy.

Partant du constat que l’évolution biologique, qui privilégie les naissances et les disparitions rapides, et l’évolution culturelle, qui exige un temps de vie adulte long, sont en conflit d’intérêts, l’auteur montre les moyens de lutter contre le vieillissement. Toutefois en rappelant que la survie, même prolongée, n’implique pas la valeur de la vie, il pose la question de la finalité et des risques du processus.

Valeroso ha sido el esfuerzo de Arno Münster, filósofo franco-alemán, profesor de la Universidad de Amiens, por hacer conocer la obra de Ernst Bloch. Esta lucha, larga de muchos años de enseñanza e investigación, a veces solitaria, a veces a contracorriente de ciertas tendencias dominantes en la filosofía universitaria continental europea, se materializa una vez más con ocasión de la publicación de su último libro que reagrupa de una serie de conferencias de diverso contenido temático sobre el pensamiento de Bloch, (...) pronunciadas en distintos escenarios a lo largo de los últimos cinco años. La primera, establece una especie de cuadro comparativo entre la idea de “comprenderse a sí mismo en la existencia” de Kierkegaard, el concepto de angustia en Heidegger y la ontología del todavía-no de Bloch. (shrink)

L’article se penche sur la question de savoir si l’allongement de l’espérance de vie peut faire partie des principes de base de la constitution d’une société bien ordonnée, que ce soit en tant que droit à protéger ou en tant qu’interdit. Plus précisément, si on décide de l’interdire, la question est de savoir s’il existe des fondements sur lesquels puisse s’appuyer une interdiction de recherches scientifiques ou technologiques qui visent à allonger sensiblement l’espérance de vie, dans les institutions (...) législatives fondamentales d’une société, et avec l’idée d’en faire un principe constitutionnel de l’Etat. Il pourrait sembler évident que, si la réponse à cette question n’est pas positive, la liberté de s’engager dans de telles activités en découle. Néanmoins, cela n’est pas vrai. Même s’il n’y a pas de possibilité d’établir une telle interdiction au niveau constitutionnel, il est toujours possible de légiférer à un niveau inférieur. En conséquence se pose un autre problème, celui de savoir si l’on peut inscrire, dans les fondements de la constitution, le droit de développer la recherche, financée par exemple par des fonds privés, et utiliser les ressources technologiques dans le dessein d’allonger sensiblement l’espérance de la vie humaine. Deux types d’arguments sont analysés. L ’un avance que l’allongement de l’espérance de vie est dangereux car il compromet l’essence même de l’humanité. L ’autre estime que l’allongement de l’espérance de vie n’est pas utile car il aurait pour résultat une vie ennuyeuse et monotone. (shrink)

Résumé Un paradoxe domine aujourd’hui l’utopie. La place de l’ « esprit jeune » dans notre société, au-delà des classes d’âge traditionnelles, devrait correspondre à une forte émergence de projets utopiques, pour autant que la jeunesse est l’âge de la remise en cause du monde tel qu’il est, et de la reconstruction idéaliste du futur. Et cependant, il y a une paralysie de l’imagination optimiste du futur. C’est l’imprévisibilité de l’avenir, dans un monde qui fait de la création du nouveau (...) dans tous les domaines son moteur même qui rend si périlleuse et incertaine toute imagination d’une société future. L’exigence de diversité et la dimension esthétique sont cependant deux traits qui pourraient caractériser la visée contemporaine, par opposition aux vieilles utopies rigoristes qui ont fait faillite. (shrink)

The aim of this article is to show that the “attestation of evil and testimony of hope” are characterized by the genitive that accompanies them. This places them both, each no less than the other, in two different horizons: while the horizon of attestation is Heideggerian, the horizon of testimony is a legacy of Jean Nabert. Both of these horizons are present in the thought of Ricoeur, and characterize the entire spectrum of his work. However, we are not dealing here (...) with a syncretism resulting from the co-presence of a hermeneutic source and of the philosophy of reflection. On the contrary, I attempt to show that the copresence of attestation and testimony results from the fact that Ricoeur never stopped “walking on two legs,” given what he writes in a conversation published in the Critique and Conviction, and that this presence is rooted in Ricoeur’s formation, which is at the same time philosophical, literary and biblical, as he never renounced either the former one, or the latter ones. (shrink)