Guider la pratique et la formation éthique des professionnels de la santé : établir les fondements du modèle de la déontologie réflexive (MDR)

Si l’approche par compétences au Canada et aux États-Unis est particulièrement valorisée pour orienter la pratique des professionnels de la santé (PDS) – et en bioéthique clinique –, les travaux permettant de mieux comprendre les fondements psychologiques, ontologiques et philosophiques de ces compétences sont peu présents dans la littérature en bioéthique. Les principaux outils actuellement disponibles se divisent généralement en quatre principales catégories : 1) les documents officiels (codes de déontologie, règlements institutionnels, etc.); 2) les principales théories éthiques (éthique de la discussion, éthique de la vertu, principisme, etc.); 3) les ouvrages de référence scientifiques; 4) les outils de prise de décision éthique. Ces documents sont des incontournables pour les bioéthiciens et les PDS, mais leur disparité, voire leur contenu parfois contradictoire, jumelée à une compréhension limitée de l’éthique, est souvent source de confusion dans les processus décisionnels et peut être la cause de comportements ne répondant pas aux standards éthiques des pratiques professionnelles. Notre recherche constitue une réflexion qui s’inscrit en amont de ces outils dont le caractère pragmatique a le désavantage de simplifier la réflexion théorique au profit de données plus concrètes. Nos travaux visent à développer les bases d’un modèle flexible et inclusif – le modèle de la déontologie réflexive (MDR) – permettant de : 1) poser les principaux repères philosophiques, sociaux et déontologiques des problématiques éthiques rencontrées en pratique; 2) saisir les principales tensions éthiques inhérentes à cette complexité; 3) mieux comprendre, dans une perspective psychologique et développementale, les exigences personnelles et professionnelles qu’impose le statut de professionnel de la santé dans le contexte actuel des soins de santé. Entreprise théorique, ce projet consiste principalement à mettre en relation dynamique un ensemble de dimensions (légale, éthique, clinique, sociale, psychologique) à l’oeuvre dans la rencontre du bioéthicien et du PDS avec la complexité des situations éthiques, en s’inspirant du concept de sensibilité éthique de la « petite éthique » de Paul Ricoeur (1990), du modèle des quatre composantes de Rest (1994) et de la théorie du soi et des modes identitaires d’Augusto Blasi (1993). Ce processus implique trois étapes successives : 1) une mise en ii perspective de la posture épistémologique particulière du bioéthicien et du PDS à la lumière de la « petite éthique » de Ricoeur; 2) une revue de la littérature interdisciplinaire sur le concept de sensibilité éthique afin d’en proposer une définition et de le mettre en perspective avec d’autres compétences éthiques; 3) le développement d’un cadre de référence en matière d’identité éthique professionnelle (professional ethics identity tendencies, PEIT), inspiré de la théorie du soi et des modes identitaires de Blasi. Ces PEIT proposent un repère normatif aux exigences liées à la construction de l'identité en contexte de pratique des PDS et suggèrent des pistes de réflexion quant à la formation et à la recherche en éthique professionnelle. Cette recherche souhaite établir des fondements théoriques pour le développement ultérieur du modèle de la déontologie réflexive (MDR).

La modification des pratiques journalistiques et du contenu des nouvelles télévisées, du quotidien à la situation de crise : analyse France/Québec

Thèse réalisée en cotutelle avec l'Institut d’études politiques d'Aix-en-Provence, École doctorale de Sciences Po, Programme doctoral en sciences de l’information et de la communication

What is reflection? A conceptual analysis of major definitions and a proposal of a five-component definition and model

La réflexion est considérée comme un élément significatif de la pédagogie et de la pratique médicales sans qu’il n’existe de consensus sur sa définition ou sur sa modélisation. Comme la réflexion prend concurremment plusieurs sens, elle est difficile à opérationnaliser. Une définition et un modèle standard sont requis afin d’améliorer le développement d’applications pratiques de la réflexion. Dans ce mémoire, nous identifions, explorons et analysons thématiquement les conceptualisations les plus influentes de la réflexion, et développons de nouveaux modèle et définition. La réflexion est définie comme le processus de s’engager (le « soi » (S)) dans des interactions attentives, critiques, exploratoires et itératives (ACEI) avec ses pensées et ses actions (PA), leurs cadres conceptuels sous-jacents (CC), en visant à les changer et en examinant le changement lui-même (VC). Notre modèle conceptuel comprend les cinq composantes internes de la réflexion et les éléments extrinsèques qui l’influencent.

Coherent patterns and self-induced diffraction of electrons on a thin nonlinear layer

Electron scattering on a thin layer where the potential depends self-consistently on the wave function has been studied. When the amplitude of the incident wave exceeds a certain threshold, a soliton-shaped brightening (darkening) appears on the layer causing diffraction of the wave. Thus the spontaneously formed transverse pattern can be viewed as a self-induced nonlinear quantum screen. Attractive or repulsive nonlinearities result in different phase shifts of the wave function on the screen, which give rise to quite different diffraction patterns. Among others, the nonlinearity can cause self-focusing of the incident wave into a beam, splitting in two "beams," single or double traces with suppressed reflection or transmission, etc.

Ética sexual y estética de la existencia en la antigua Grecia. Aproximaciones para una reflexión sobre la homosexualidad desde Michel Foucault

Esta tesis estudia el conjunto de valores que llevaron a que la relación erótica entre hombres se constituyera en el foco principal de reflexión en la ética sexual griega. También intenta responder cuál es la propuesta de Michel Foucault respecto a la experiencia de la homosexualidad hoy.

Formative Research. An Integral Vision for Health Professionals

These writing conceive formation in formative research as a complex process that demands simultaneous and congruent actions in the objective, subjective and intersubjective fields, adjusted to a careful and progressive planification in order to form teachers, students and management staff as university actors of research processes. Integral formation in formative research into health area demands a comprehensive and broad perspective encompassing science, moral and art, or objective truth, subjective veracity and intersubjective equity. All means must meet towards a strong and developmental formative research culture capable of nourishing subjects engaged in systematic self-questioning, interaction and argumentated debate at the interior of communities of pairs. In the same way, they must have rigorous methodological formation in order to approach the study objects.

Análisis de la ayuda oficial al desarrollo. estudio de caso: programa conjunto de UNICEF y UNFPA sobre la mutilación genital femenina en Kenia (2008-2012)

El interés de este estudio de caso es analizar el Programa Conjunto de UNFPA y UNICEF sobre MGF/E en Kenia bajo la luz de los postulados poscolonialistas. Partiendo de la idea de que la MGF es una manifestación de las desigualdades de género, se argumenta que el PC reproduce la imagen de la mujer keniana como una víctima del poder masculino. A partir de esta imagen se deslegitima el orden cultural de los grupos que siguen esta tradición, afectando las lógicas de unidad y cohesión de la sociedad. El análisis de este tipo de dinámicas permite comprender mejor los procesos de intervención de las organizaciones internacionales sobre las estructuras sociales de actores frágiles del sistema internacional.

La pelota no se mancha: Un estudio histórico sobre el desarrollo y la política en FIFA

Esta investigación se centra en la Fédération Internationale de Football Association (FIFA) como organización política. Intenta responder dos interrogantes primordiales: 1) ¿cómo la FIFA ha constituido el poder que tiene actualmente y, así, hacerse del monopolio indiscutido del fútbol? Y 2) ¿cómo ha cambiado en el tiempo la política interna de FIFA y su vínculo con la política internacional? Para lograr esto, se realiza un estudio histórico, basado principalmente en documentos, que intenta caracterizar y analizar los cambios de la organización en el tiempo. Se enfatizan las últimas dos presidencias de FIFA, de João Havelange y Joseph Blatter, como casos de estudio.

Contributos da supervisão pedagógica para a promoção de uma educação ambiental

A educação ambiental apresenta-se hoje como mais uma valência de formação e de responsabilidades atribuídas à escola, dada a importância da dimensão da sustentabilidade na relação do homem com a natureza. A supervisão e a liderança podem desempenhar nesta pro-blemática um papel importante na promoção de uma visão humana e ética da abordagem da temática ecológica – que parece não estar a ter o sucesso desejado e necessário. Nas culturas tradicionais, e em todas as sociedades em que uma visão religiosa do mundo domina sobre o livre arbítrio de cada um, a natureza era objeto de um respeito ou mesmo veneração como obra divina. Mas com a relevância dos direitos individuais, sobretudo a partir do século XVIII, e com a crise de valores comunitários, aumento do individualismo e uma visão hedonista da existência, a usufruição imediata dos recursos tornou-se hábito e até paradigma de organização social. Uma análise crítica sobre o passado docente e uma consciência de responsabilidade ambiental desperta pela experiência de infância juntaram-se a uma reflexão sobre a responsa-bilidade educativa no sentido de desenvolver nos alunos não só as aprendizagens cognitivas mas também uma dimensão formativa global em que as perspetivas de responsabilidade soli-dária por um futuro sustentável pudessem estar presentes. É para estes valores que este projeto aponta.

Design and formative evaluation of an information kiosk on cattle health for landless cattle owners

This paper describes and analyses the experience of designing, installing and evaluating a farmer-usable touch screen information kiosk on cattle health in a veterinary institution in Pondicherry. The contents of the kiosk were prepared based on identified demands for information on cattle health, arrived at through various stakeholders meetings. Information on these cattle diseases and conditions affecting the livelihoods of the poor was provided through graphics, text and audio back-up, keeping in mind the needs of landless and illiterate poor cattle owners. A methodology for kiosk evaluation based on the feedback obtained from kiosk facilitator, critical group reflection and individual users was formulated. The formative evaluation reveals the potential strength this ICT has in transferring information to the cattle owners in a service delivery centre. Such information is vital in preventing diseases and helps cattle owners to present and treat their animals at an early stage of disease condition. This in turn helps prevent direct and indirect losses to the cattle owners. The study reveals how an information kiosk installed at a government institution as a freely accessible source of information to all farmers irrespective of their class and caste can help in transfer of information among poor cattle owners, provided periodic updating, interactivity and communication variability are taken care of. Being in the veterinary centre, the kiosk helps stimulate dialogue, and facilitates demand of services based on the information provided by the kiosk screens.

Influence of the solvent on the self-assembly of a modified amyloid beta peptide fragment. I. Morphological investigation

The solvent-induced transition between self-assembled structures formed by the peptide AAKLVFF is studied via electron microscopy, light scattering, and spectroscopic techniques. The peptide is based on a core fragment of the amyloid beta-peptide, KLVFF, extended by two alanine residues. AAKLVFF exhibits distinct structures of twisted fibrils in water or nanotubes in methanol. For intermediate water/methanol compositions, these structures are disrupted and replaced by wide filamentous tapes that appear to be lateral aggregates of thin protofilaments. The orientation of the beta-strands in the twisted tapes or nanotubes can be deduced from X-ray diffraction on aligned stalks, as well as FT-IR experiments in transmission compared to attenuated total reflection. Strands are aligned perpendicular to the axis of the twisted fibrils or the nanotubes. The results are interpreted in light of recent results on the effect of competitive hydrogen bonding upon self-assembly in soft materials in water/methanol mixtures.

Tenenbaum and Raffaman on vague projects, the Self-Torturer, and the sorites

Sergio Tenenbaum and Diana Raffman contend that ‘vague projects’ motivate radical revisions to orthodox, utility-maximising rational choice theory. Their argument cannot succeed if such projects merely ground instances of the paradox of the sorites, or heap. Tenenbaum and Raffman are not blind to this, and argue that Warren Quinn’s Puzzle of the Self-Torturer does not rest on the sorites. I argue that their argument both fails to generalise to most vague projects, and is ineffective in the case of the Self-Torturer itself.

The metaphysics of self in Praśastapāda's differential naturalism

In A Compendium of the Characteristics of Categories (Padārthadharmasaṃgraha) the classical Vaiśeṣika philosopher Praśastapāda (6th c. CE) presents an innovative metaphysics of the self. This article examines the defining metaphysical and axiological features of this conception of self and the dualist categorial schema in which it is located. It shows how this idea of the self, as a reflexive and ethical being, grounds a multinaturalist view of natural order and offers a conception of agency that claims to account for all the reflexive features of human mental and bodily life. Finally, it discusses the ends of self’s reflexivity and of human life as a return to the true self. It argues that at the heart of Praśastapāda’s metaphysics of self is the idea that ethics is metaphysics, and that epistemic practice is ethical practice.

Ethics in a capitalistic society

The problem of semantics is inherent in any discussion of ethics. The general term "ethics" is itself commonly confused. In addition, systems of ethics must be built upon assumptions, and assumptions are necessarily subject to lengthy debate. These two problems are encountered in my investigation of the ethical practices of the modern business community and to remedy the situation I have taken two steps: the first being an attempt to clarify the meaning of terms used therein;-and the second being a clear description of the assumptions utilized to further my analysis. To satisfy those who would disagree with these assumptions, I have attempted to outline the consequences of differing premises. The first assumption in my discussion is that the capitalistic economy is powered by the motivation supplied by man's self-interest. We are conditioned to basing our courses of action upon an orientation toward gratifying this self-interest. Careers are chosen by blending aptitude, interest, and remuneration. of course, some people are less materially inclined than others, but the average member of our capitalistic society is concerned with the physical rewards derived from his employment. Status and happiness are all-important considerations in pursuing a chosen course of action, yet all too often they are measured in physical terms. The normal self-interest natural to mankind is heightened in capitalism, due to the emphasis placed upon material compensation. Our thinking becomes mechanistic as life devolves into a complex game played by the rules. We are accustomed to performing meaningless or unpleasant duties to fulfill our gratifications. Thought, consequently, interferes with the completion of our everyday routines. We learn quickly not to be outspoken, as the outspoken one threatens the security of his fellow man. The majority of the people are quite willing to accept others views on morality, and indeed this is the sensible thing to do as one does not risk his own neck. The unfortunate consequence of this situation has been the substitution of the legal and jural for the moral and ethical. Our actions are guided by legal considerations and nowhere has this been more evident than in the business community. The large legal departments of modern corporations devote full time to inspecting the legality of corporate actions. The business community has become preoccupied with the law, yet this is necessarily so. Complex, modern, capitalistic society demands an elaborate framework of rules and regulations. Without this framework it would be impossible to have an orderly economy, to say nothing of protecting the best interests of the people. However, the inherent complexities, contradictions, and sometimes unfair aspects of our legal system can tempt men to take things into their own hands. From time to time cases arise where men have broken laws while acting in good faith, and other cases where men have been extremely unethical without being illegal. Examples such as these foster the growth of cynicism, and generally create an antagonistic attitude toward the law on the part of business. My second assumption is that the public, on the whole, has adopted an apathetic attitude toward business morality. when faced with an ethical problem, far too many people choose to cynically assume that, if I don't do it someone else will. "The danger of such an assumption lies in that it eliminates many of the inhibitions that normally would preclude unethical action. The preventative factor in contemplating an unethical act not only lies in it going against the "right course of action", but also in that it would display the actor as one of the few, immoral practitioners. However, if the contemplator feels that many other people follow the same course of action, he would not feel himself to be so conspicuous. These two assumptions underly my entire discussion of modern business ethics., and in my judgment are the two most important causal factors in unethical acts perpetrated by the business community. The future elimination of these factors seems improbable, if not futile, yet there is no reason to consider things worse than they ever have been before. The heightened public interest in business morality undoubtedly lies in part in the fact that examples of corporate malpractice are of such magnitude in scope, and hence more newsworthy.

Tear identitário:a prática docente em arte como conhecimento compartilhado

This investigative tissue is about the formation of identification processes of teachers and pedagogical practice of Art, in Teresina city. This search comprised the sum of the needs presented, agreed upon with the teachers engaged in the process, it was developed through the establishment of interactive environment Loom Team where collaboration and critical reflection were steering actions to promote the understanding of existing connections or relations within the processes of identifications and the pedagogical practice of Art. The tissue is formed by the polyphonic plot of the critical reflection of nine teachers of Art who engaged voluntarily and this investigation of formative nature and a production of knowledge. All these teachers have degree and the course of artistic education and especial qualification in Fine Arts and/or Drawing. The texture, which we denominated Identification Loom: The pedagogical practice of Art as share knowledge is (de) (re) construction of knowledge resulting from the critical reflection, in an environment of collaboration, which may have implications and ethical political attitudes in the pedagogical practice of the group. Within this context, we pose the following question: - How does the pedagogical practice in Art influence and/or be influenced by the identification processes of the teachers, and how do they interfere with the search and manifestation of the knowledge involved and the investment in professionalization? In view of this query, we make use of the cooperative investigation, having social history as theoretical reference and as analytic perspective of interactive and dialogical-reflexive processes. Thus, social historic theory, cooperative approach and pedagogical practice were the major components of the plot. The methodological texture counted on the threads of dialogical reflexion, of mediation and of collaboration. The conceptual formulation, the recording in videos of classes and the narratives of formations were the main threads of the analytic substrate of the investigation. With this articulation, theses threads appear as developers of processes leading to a major approximation of the thought on the identity/alterity dialectical pair of the participants involved. The language within this plot had a decisive importance in all the moments of the search of signification, embracing and connecting the identification/alterative processes, the pedagogical practice of Art and the knowledge shared. In such processes involving (de) (re) construction, one can notice a close correlation of the triad social identity, pedagogical practice and knowledge shared. For this reason, the vigotskian, guetmanovian and kopnian theoretizations were the major framework for the analysis of conceptual formulations; and, as for discourse analysis, Baktin and Orlandi were our masters. For these teachers, the experience shared throughout the process of this typology of tri-axial investigation focused the experience of many theoretical and practical assumptions. Such an experience enabled them to state that this, with collaboration, can make reflection on the practice a starting and promoting element, within the individual level of self-management, in addition to being a space of (de)(re)construction of meanings, of knowledge and of reinvention per se