Enjeux éthiques des nouvelles technologies de la reproduction : une conception de la justice à l'interface de l'éthique du "care" et de l'approche des "capabilités"

L'émergence des nouvelles technologies de la reproduction (NTR) est allée de pair avec un certain nombre de discours. Un discours promettant d'une part une extension de la palette de choix reproductifs des individus, une extension de leur liberté et de leur autonomie reproductives, dont la forme la plus extrême peut se traduire par la formule : un enfant quand je veux et comme je veux. D'autre part, un discours annonçant une série de « catastrophes » à venir, telles que l'effondrement de l'institution de la famille et la modification de l'espèce humaine. En d'autres termes, une tension entre promesses et catastrophes qui place les sociétés contemporaines face à de nombreux défis sociaux, politiques et éthiques, notamment quant à la question de la régulation de la PMA (procréation médicalement assistée) : qui peut y avoir accès ? Quelles techniques doit-on autoriser ? Ou au contraire limiter ? Tant de questions auxquelles aucune réponse simple et évidente n'existe. La diversité des réponses législatives quant à ces questions illustre cette complexité. L'éthique peut, ici, jouer un rôle fondamental. Sans toutefois prétendre donner des réponses toutes faites et facilement applicables, elle offre un espace de réflexion, le privilège de prendre une certaine distance face à des enjeux contemporains. C'est dans cette perspective que nous avons ancré ce travail de recherche en questionnant les enjeux éthiques de la PMA à partir d'une perspective de justice. Toutefois, au sein des études en bioéthique, majoritairement issues de la tradition libérale, la tension énoncée précédemment mène la bioéthique à justifier un certain nombre d'inégalités plutôt que de veiller à les dépasser. Ainsi, une évaluation de la pratique de la PMA à partir d'une perspective de la justice, exige, au préalable, une réévaluation du concept même de justice. Ce faisant, par une articulation entre l'éthique du care de Joan Tronto et l'approche des capabilités de Martha Nussbaum qui placent la vulnérabilité au coeur de la personne, nous avons proposé une conception de la justice fondée sur une anthropologie de la vulnérabilité. Cette conception nous permet d'identifier, dans le cadre de la pratique de la PMA en Suisse et en partant de la loi sur la procréation assistée (LPMA), les constructions normatives qui mènent à la non-reconnaissance et, ce faisant, à la mise à l'écart, de certaines formes de vulnérabilité : une vulnérabilité générique et une vulnérabilité socio-économique. Traitant la question de la vulnérabilité générique principalement, nos analyses ont une incidence sur les conceptions de la famille, du bien de l'enfant, de la femme et de la nature, telles qu'elles sont actuellement véhiculées par une conception naturalisée de la PMA. Répondre aux vulnérabilités identifiées, en veillant à leur donner une place, signifie alors déplacer ces conceptions naturalisées, afin que les vulnérabilités soient intégrées aux pratiques sociales et que les exigences de justice soient ainsi remplies. - The emergence of assisted reproductive technologies (ART) came along with several discourses. On the one hand a discourse promising an extension of the individuals' reproductive choices, their procreative liberty and autonomy. On the other hand a discourse announced a series of disasters to come such as the collapse of the family institution and the modification of human kind. In other words, a growing tension appears between promises and disasters and contemporary societies are facing inevitable social, political and ethical challenges, in particular with regard to the issue of ART regulation: who has access? What procedures should be authorized? Which ones should be limited? These complex questions have no simple or obvious answers. The variety of legislative responses to these questions highlights complexity. Ethics can play a fundamental role, and without claiming to give simple answers, also offer a space for reflection as well as the privilege to distance itself with regard to contemporary issues. It is in this perspective that this study questions the ethical considerations of ART in a perspective of justice. However, in previous studies in bioethics mainly following a liberal tradition, previously mentioned tension has lead bioethics to justify some inequalities instead of trying to overcome them. As a consequence, evaluating practices of ART from a perspective of justice requires to first reevaluate the concept of justice itself. In doing so we offer a conception of justice founded on the anthropology of vulnerability. This conception draws on an articulation of the ethic of care of Joan Tronto and the capability approach of Martha Nussbaum, which places vulnerability at the center of the person. This conception allows us to identify, within the framework of ARTS in Switzerland and starting with the laws of medically assisted procreation (LPMA), some normative constructions. These constructions lead to the non-recognition and the disregard of some forms of vulnerability: a generic vulnerability as well as socio-economic counterpart. Focusing mainly on the issue of generic vulnerability, our analysis has implications for the conceptions of family, the best interests of the child, woman, and nature in the way they are defined in a naturalized conception of ART. Responding to such failures by taking into account these vulnerabilities thus means to move these conceptions in order for vulnerabilities to be integrated in social practices and requirements for justice to be fulfilled.

Infancy Gospels. Stories and Identities

Even though the canonical Jesus' infancy stories have always provoked great interest in popular culture and in the arts, they have been neglected in research during the last decades due to the relatively late date of their redaction. Since the monograph by Raymond Brown, The Birth of the Messiah , the researchers working on this topic have not attempted to consider its historical impact. In this volume, an international team of scholars proposes firstly a reconsideration of the historical background of these stories in terms of early Jewish and Christian identity quests. Secondly, they deal with early Christian questions on Jesus' infancy and childhood through canonical and apocryphal Gospels including information from Patristic and documentary literature. On the theological level, this volume illustrates the impact that these apocryphal texts, recognized as "useful for the soul" (a phrase coined by François Bovon), have had on the Christian faith.

Neurotheology: challenges and opportunities

During the last decades of the twentieth century scholars have proposed "neurotheology" as a new subdiscipline of the neurosciences. This article presents a review and discussion of different interpretations placed on neu- rotheology, and attempts to estimate the extent to which neuroscience is a challenge and/or an opportunity for theology and (for the study of) religion. On the neuroscientific side, neurotheology can be split into a reductionist and a religionist neuroscience of religion. On the theological side, it can be split into apologetic and integrative approaches. The appraisal of these differ- ent interpretations and of the relevance of neuroscience for the study of re- ligion is conducted from three points of view: philosophy and theology, cog- nitive science, psychology of religion and sciences of religions.

Pluralité des corps. 3. Les corps liés [Multifaceted body. 3. The contextualised body].

Le corps humain est l'objet privilégié d'action de la médecine, mais aussi réalité vécue, image, symbole, représentation et l'objet d'interprétation et de théorisation. Tous ces éléments constitutifs du corps influencent la façon dont la médecine le traite. Dans cette série de trois articles, nous abordons le corps sous différentes perspectives : médicale (1), phénoménologique (2), psychosomatique et socio-anthropologique (3). Ce troisième et dernier article traite successivement des approches psychosomatiques et socio-anthropologiques du corps et de certains de leurs apports respectifs. The human body is the object upon which medicine is acting, but also lived reality, image, symbol, representation and the object of elaboration and theory. All these elements which constitute the body influence the way medicine is treating it. In this series of three articles, we address the human body from various perspectives: medical (1), phenomenological (2), psychosomatic and socio-anthropological (3). This third and last article focuses on the psychosomatic and socio-anthropological facets of the body and their contribution to its understanding.

Redondances. Paul Ricoeur et ses sutures théologico-politiques

Paul Ricoeur construit la philosophie comme une hétérotopie, en la soumettant à l'ordre, juridique et théologique, d'un «aveu». En soustrayant la pensée à la compétence première de la philosophie pour l'accorder à l'ordre d'un récit, Ricoeur fait de l'exercice de la philosophie une «empirique de la volonté serve». Ce primat donné à un ordre de médiation, par le biais d'un récit, dépouille ainsi la philosophie de toute tâche inaugurale. Dans ses Valences of the Dialectic, le philosophe américain Jameson est revenu de façon critique sur ce montage, soulignant le paradoxe qui oblige Ricoeur à ôter la pensée du temps des tâches premières de la phénoménologie. Cet article vise à en exposer les conséquences (notamment le basculement vers une herméneutique), pour interroger les effets théologico-politiques de ce vaste projet. --- Paul Ricoeur has built up philosophy as a heterotopy by submitting it to the juridical and theological order of a "confession". By taking away thought as the primus competence of philosophy, and attributing it to narration, Ricoeur transforms philosophy into an "empirics of the serve-will". This priority given to mediation through narration deprives philosophy from any inaugural task. In his Valences of the Dialectic, the American philosopher Jameson has critically questioned this construction, underlining the paradox that forces Ricoeur to take away thought of time from the primus tasks of phenomenology. This paper intends to expose the consequences of such a deal (among others the swing to hermeneutics), and to inquire about the theologico-political effects of such a vast project.

Pentateuque, Hexateuque et historiographie deutéronomiste. Le problème du début et de la fin du livre de Josué

The book of Joshua is in the very center of the recent discussion about the existence of a coherent deuteronomistic redaction in Deut to 2 Kings during the exilic period. This article analyses the beginning (Josh 1.1-9) and the end (Josh 23 and 24) of Josh. Josh 1.1-2,5-7 and chapter 23 belong to the dtr edition. Josh 23 was followed by Judg 2.6ff. During the Persian period, Deuteronomists and priests intended to publish one Law for the whole community. There was probably a discussion whether the Torah should be a Penta- or a Hexateuch. This discussion may explain such a text as Josh 24 which clearly tries to construct an Hexateuch (cf. also Gen. 50.25: Exod 13.19; Josh 24.32). But since the Torah is about foundations, the main theological trends agreed to have its end with the death of Moses.

Martin Lindhart (Ed.), Practicing the Faith. The Ritual Life of Pentecostal-Charismatic Christians, Berghahn Books, Oxford, 2011, 344 p.

This edited volume examines, from a ritual perspective, Pentecostal-Charismatic groups that are the fastest growing religious movements in the world today. The authors, who are anthropologists, ethnologists or sociologists (with one theologian) collected rich and diverse material on healing, deliverance, personal devotion, public engagement. Their work covers several regions such as Chile, South California, Fiji, Kenya, and Sweden. After an introduction by the editor, eleven chapters examine various issues relevant to the field. Overcoming the diversity of subjects, the unity of the volume is provided by the general ritual perspective and by the methodological implications of employing such a perspective.

Cross-cultural clinical competence and post-graduate teaching: any impact(s) on doctors?

Context: Cross-cultural clinical competence (CCC) requires a mixtureof "knowledge" (K), "attitude" (A) and "skills" (S), in order to develop theability to give quality care to patients of different cultures. Theseattributes allow, while providing medical care, consideration of thepatient's medical, social, cultural and language needs. The LausanneUniversity Medical Policlinic (PMU) provides approximately 30000consultations per year to migrant patients and over the past five yearshas implemented a training course on CCC that focuses on trialogue,stereotypes and administrative procedures for the healthcare ofmigrants.Method: A quantitative survey of 18 new residents, was carried outusing a validated questionnaire, the "Multicultural AssessmentQuestionnaire" (the MAQ, 16 questions on K, A and S) to evaluate theimpact of CCC training. The questionnaire was distributed before theCCC course (J-1), three days after (J+3) and three months later (J+90).A descriptive univariate analysis of the difference in MAQ scoresbetween the times J-1 - J+3 and J-1 - J+90 was made. Three FocusGroups were conducted, at three months, to explore residents' thoughtsabout the course.Results: A significant increase was observed in global performancedeclared by residents. Following the intervention, the score of the MAQincreased from 31.4 points to 38.0 points at three days (p = 0.004) andto 37.7 points at three months (p = 0.003). This increase was mostnoticeable in the field of acquiring K: total score J-1: 118, J+3: 189,J+90: 190 (difference J-1 - J+3 and J-1 - J+90: p <0.005). There was nosignificant difference in acquiring A (J-1: 222, J+3: 228, J+90: 229), andS increases in a significant way at first (J-1: 222, J+3: 265, J-1 - J+3:p = 0.035), then comes back to the start value (J+90: 217). The residentswere interested by the course which they felt provides useful informationfor clinical practice. They had a great number of expectations in varyingfields (medical anthropology, cultural differences, epidemiology, etc.),hoping a "ready-made" solution for the approach of migrant patients.Conclusions: A unique training of CCC at the post-graduate level,upgraded K, and to a lesser extent A and S, for these 18 residents. Theywere interest and they had many expectations. Subsequent coursesshould consolidate these acquisitions. Future study should demonstratethe impact on patients' clinical outcome.