Le processus de positionnement éthique du travailleur social dans la détermination de l’inaptitude d’une personne âgée, dans le cadre des régimes de protection du majeur

L’importance accordée à la reconnaissance des droits fondamentaux des personnes en matière d’intégrité physique et de consentement aux soins dans notre société fait que le travailleur social appelé à participer à l’ouverture de régimes de protection du majeur doit développer une expertise multidimensionnelle. De plus, le travailleur social se retrouve à confronté à différentes logiques d’action (juridique et procédurale, médicale, psychosociale, pragmatique) dont il doit tenir compte dans le processus d’évaluation. Ceci nous amène à aborder la position difficile dans laquelle se trouve généralement le travailleur social qui oscille entre la possibilité de favoriser l’autonomie de la personne et la volonté de protéger celle-ci. L’objectif de ce mémoire est donc d’accroître notre compréhension du processus de prise de décision du travailleur social dans la détermination de l’inaptitude d’une personne âgée, dans le cadre des régimes de protection du majeur. D’une manière plus spécifique, cette étude consiste à retracer et à théoriser, par l’analyse de sa logique d’action, le processus à travers lequel le travailleur social se positionne lorsqu’il se retrouve confronté à des dilemmes éthiques par rapport à la détermination de l’inaptitude d’une personne âgée. L’analyse de l’expérience du travailleur social a été réalisée à travers le paradigme de l’individualisme méthodologique tel que définit par Raymond Boudon. Les données furent recueillies lors d’entrevues semi-dirigées réalisées auprès de sept intervenants. Les témoignages recueillis par le biais de cette recherche exploratoire montrent à quel point il peut être difficile et éprouvant pour le travailleur social de devoir se positionner dans la détermination de l’inaptitude d’une personne âgée, dans le cadre des régimes de protection du majeur et comment ces interventions s’inscrivent dans un jeu infiniment complexe d’interactions multiples entre acteurs et actants. Les principaux obstacles à la prise de décision éthique dont ont fait part les travailleurs sociaux interrogés sont liés au contexte de pratique. Il s’agit du manque de ressources financières et humaines disponibles ainsi que le fait que les décisions ne soient pas toujours prises en équipe interdisciplinaire et dans un climat qui soit non menaçant. La reconnaissance de l’expertise des travailleurs sociaux en matière d’ouverture de régimes protection est d’ailleurs ressortie comme un enjeu important.

Telling the truth about HIV? Testing and disclosure in a culture of stigma

Étude de cas / Case study

La bioéthique et les conflits armés : la réflexion éthique des médecins militaires

Le but de la recherche est d’étudier les tensions éthiques que peuvent vivre les médecins militaires, qui doivent agir à la fois comme soignants, militaires (même s’ils sont non combattants) et parfois comme acteurs humanitaires. Parmi la littérature sur l’éthique de la médecine militaire, les dilemmes la concernant sont souvent présentés comme le fruit de pressions réelles ou perçues provenant de l’institution militaire, des règles, codes, lois ou de politiques, ceci afin de détourner le médecin de son but premier, soit l’intérêt du patient. Pour mieux comprendre les défis éthiques auxquels sont confrontés les médecins militaires canadiens et comment ceux-ci les traitent, la recherche utilise une approche de bioéthique empirique. À partir d’une analyse de la littérature, nous examinons les dilemmes éthiques des médecins militaires, le concept de profession, ainsi que les codes d’éthique (médicaux et militaires) canadiens. L’expérience éthique est ensuite explorée à partir d’entrevues semi-directives effectuées auprès de quatorze médecins militaires ayant participé à des missions opérationnelles, notamment à Kandahar en Afghanistan, entre 2006 et 2010. Les résultats, tant conceptuels qu’empiriques, nous indiquent que plusieurs nuances s’imposent. Tout d’abord, les médecins militaires canadiens ne vivent pas les dilemmes tels qu’ils sont présentés dans la littérature, ni en nombre ni en fréquence. Ils sont conscients qu’ils doivent à la fois tenir compte de l’intérêt du patient et du bien commun, mais n’en ressentent pas pour autant un sentiment de double loyauté professionnelle. De plus, ils ont l’impression de partager l’objectif de la mission qui est de maintenir la force de combat. Des distinctions s’imposent aussi entre les médecins eux-mêmes, dans la conception qu’ils se font de leur profession, ainsi que dans les contextes (opération ou garnison), selon le type de travail qu’ils exercent (généraliste ou spécialiste). Les principaux défis éthiques rapportés portent sur les inégalités de soins entre les soldats de la coalition et les victimes locales (soldats et civils), ainsi que sur le manque de ressources, engendrant des décisions cliniques éprouvantes. Un résultat étonnant des entrevues est la présence de deux groupes distincts au plan de l’identification professionnelle. Huit médecins militaires se considèrent avant tout comme médecin, alors que les six autres ne sont pas arrivés à accorder une priorité à l’une ou l’autre des professions. Ces deux groupes se différencient également sur d’autres plans, comme le nombre et le type de défis éthiques identifiés, ainsi que les mécanismes de résolution des dilemmes utilisés. Malgré les formations éthiques offertes par l’institution, des lacunes subsistent dans la capacité d’identification des expériences éthiques et des valeurs impliquées, de même que des mécanismes de résolution utilisés. Compte tenu du faible échantillonnage, ces résultats sont difficilement généralisables. Néanmoins, ils peuvent nous inspirer au niveau théorique en faisant ressortir le caractère multidimensionnel de la médecine militaire, ainsi qu’au niveau pratique en nous permettant de suggérer des éléments de formation facilitant la réflexion éthique des médecins militaires.

La adolescencia: retos para la investigación y para la sociedad europea de cara al sigol XXI

A lo largo de la última década, la adolescencia ha sido un tema de discusión política en distintos espacios europeos al más alto nivel. En una sociedad aceleradamente cambiante se percibe que la adecuada socialización de las generaciones más jóvenes constituye un reto socio-histórico que nos afecta a todos. Los cambios en que estamos sumergidos son tan plurales (demográficos, sociales, tecnológicos, económicos, políticos, etc.) que generan un amplísimo frente de nuevos dilemas éticos. La opinión de los ciudadanos de la Unión Europea se muestra preocupada por nuevos valores y destaca la preferencia por la responsabilidad en coherencia con dicha situación cambiante. Todo este macrocontexto psicosocial viene planteando nuevos retos teóricos y de investigación a la comunidad científica. De hecho las ciencias humanas y sociales han empezado a desarrollar nuevas líneas de investigación para comprender mejor las nuevas relaciones entre adultos y adolescentes y las nuevas culturas que emergen entre estos últimos, impulsadas por nuevas aspiraciones sociales compartidas por grupos más o menos amplios de la población joven. El desarrollo de técnicas e instrumentos que nos permitan comprender mejor la perspectiva del adolescente se hace más evidente si analizamos su relación con las nuevas tecnologías de la información y la comunicación. Dichas tecnologías comportan nuevos riesgos, pero también nuevas oportunidades, entre las que destaca la posibilidad de establecer nuevas formas de relación. La motivación que muestran los más jóvenes por las nuevas tecnologías constituye un gran reto a los investigadores aplicados para sugerir formas de maximizar las potencialidades latentes

Ús de problemàtiques ètiques per l'ensenyança del codi deontològic de la psicologia: una sessió il·lustrativa

El present treball exposa el contingut i procediment d’una sessió emmarcada en un taller–seminari sobre ètica aplicada als àmbits professionals de la psicologia. L’objectiu de la mateixa és introduir als estudiants en els fonaments del Codi Deontològic, així com la reflexió d’alguns dels articles que aquest conté. El mètode expositiu consisteix en presentar i discutir tres situacions, èticament problemàtiques, a partir de les quals s’il·lustra el contingut normatiu de diferents articles que regulen l’exercici professional en l’àmbit de la psicologia

Desenvolvimento da formação ética no quadro da ação docente dos professores de Biologia

A escola, até alguns anos atrás, era considerada como uma instituição baluarte de ética e de valores, que era necessário preservar e difundir. Mas, a realidade escolar alterou bastante, acompanhando as transformações sociais. Para se adaptarem às mudanças num mundo com dificuldade em situar-se relativamente à ética e aos valores, os professores precisam de adquirir novas competências e conhecimentos. O domínio da ética afigura-se, assim, crucial, para o desenvolvimento pessoal e profissional e para um mais eficaz desempenho da profissão docente. Os professores de Biologia enfrentam, em sala de aula, muitas questões éticas problemáticas, pelos conteúdos programáticos que lecionam e que os suscitam, como por exemplo, a clonagem, o aborto, a reprodução medicamente assistida, a manipulação genética. Tendo em conta esta realidade, e atendendo a que os professores intervenientes neste projeto não tiveram formação na área da ética, este trabalho de projeto tem como objetivo responder à seguinte questão: como se poderá desenvolver a dimensão ética da ação docente dos professores de Biologia através da formação? O projeto será desenvolvido mediante a concretização de um curso de formação que pretende levar à reflexão e ao desenvolvimento de atitudes mais estruturantes e positivas face a situações éticas problemáticas e à valorização da dimensão ética da ação docente destes profissionais. A ação de formação a desenvolver, constará de um conjunto de atividades: brainstorming, análise e reflexão de textos sobre conceções de ética, valores e questões éticas problemáticas, palestras, powerpoint, filme, textos com opiniões de vários cientistas acerca destas temáticas. A ação docente, para além de proporcionar aos alunos conhecimentos, deve ser também direcionada para o desenvolvimento de atitudes ético-morais, essenciais na formação integral dos discentes. Skillen (1997) sublinha que é fundamental que o professor adote uma prática docente que implique os alunos em atividades de cariz moral que visem a prática de valores.

The hanging man: death, indeterminacy and the event

This article discusses approaches to the interpretation and analysis an event that is poised between reality and performance. It focuses upon a real event witnessed by the author while driving out of Los Angeles, USA. A body hanging on a rope from a bridge some 25/30 feet above the freeway held up the traffic. The status of the body was unclear. Was it the corpse of a dead human being or a stuffed dummy, a simulation of a death? Was it is tragic accident or suicide or was it a stunt, a protest or a performance? Whether a real body or not, it was an event: it drew an audience, it took place in a defined public space bound by time and it disrupted everyday normality and the familiar. The article debates how approaches to performance can engage with a shocking event, such as the Hanging Man, and the frameworks of interpretation that can be brought to bear on it. The analysis takes account of the function of memory in reconstructing the event, and the paradigms of cultural knowledge that offered themselves as parallels, comparators or distinctions against which the experience could be measured, such as the incidents of self-immolation related to demonstrations against the Vietnam War, the protest by the Irish Hunger Strikers and the visual impact of Anthony Gormley’s 2007 work, 'Event Horizon'. Theoretical frameworks deriving from analytical approaches to performance, media representation and ethical dilemmas are evaluated as means to assimilate an indeterminate and challenging event, and the notion of what an ‘event’ may be is itself addressed.

Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Rapport från projektet Multimodala uppgifter och bedömning i matematik : Video och kollaborativa samtal som metod vid lärares bedömning av elevers matematiska kunskaper

This research will discuss some experiences from a four year school research study. It was conducted in cooperation with teachers from four municipalities in Dalarna. The aim of the research was to examine teachers´ professional development when they participated in collaborative discussions based on video recordings and video edited material from specific lessons in their own practice. The study had two foci one was to investigate methods and tools that teachers can use to develop their ability to assess their students while working on multimodal tasks. The other was to examine how video can be used by teachers wanting to obtain knowledge about assessing students. The study is based on several theories about when teachers collaborate to create new knowledge. The first is the design theoretical approach – where visual ethnography and a semiotic approach contribute to problematize the use and mixture of different modes. A basic assumption of the framework here is that meanings are made and communicated in mathematics through a wide range of semiotic modes. By using video as an essential tool in the research the framework theories concerning visual ethnography, video documentation and individuals as reflective practitioners were also needed. The findings can be divided into the following themes: the use of tasks for assessment, collaborative discussion, equipment, ethical dilemmas. Collaborative discussions were evaluated as a meaningful way of sharing knowledge. The use of video recordings in association with these discussions raised important ethical issues. Working with the assessment framework was of great interest to the teachers but it took a lot of time from their ordinary work. In this way the project highlighted more general aspects of school development. The research also concerns teachers´ use of collaborative discussions in assessment work, multimodal tasks in mathematics and video as a research tool in general.

Roman concept of mental capacity to make end-of-life decisions

When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62–c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers.

Zero impact: are lawyers' values affected by law school?(Survey)

In 2001 approximately 700 Australian final-year undergraduate law students were surveyed as the first part of a three-year study of Australian lawyers' values. This study is being undertaken in an effort to understand what values are important in determining lawyers' attitudes to difficult behavioural choices confronting them in legal practice. It is hoped that knowledge of the actual values held by lawyers (in the context of critical professional choices) will enable better targeted values awareness education in both pre- and post-admission contexts.

The main quantitative survey employed a number of hypothetical scenarios. These were designed through the use of ethical dilemmas to examine issues of conflicting loyalties within a context of self-interest and lawyers' perceived obligations to the community, employers, family, friends and clients. (1)

Our approach in this paper is to set the scene by providing basic frequencies to responses in each scenario, followed by an analysis of themes elicited from respondents during the focus groups. Our immediate objective is to provide representative interviewee (that is, respondent) commentary designed to throw some light on the major choices of those respondents in the first year of the main quantitative survey. (2) Note that these focus groups were conducted some months after the quantitative analyses, and in particular after respondents had left law school. All respondents were, by that stage, working within a variety of legal workforce environments. In this analysis, it must be stressed, we have not attempted to match and compare individual respondents' comments with their earlier choices in the quantitative survey. That task awaits the longitudinal analysis now under way for the whole period of data collection during the three-year study.

Ethics handbook : questions and answers

A prominent characteristic of the modern legal profession is the need for lawyers to deal with challenging ethical dilemmas. It is an aspect of practice that has developed due to the increasing complexity of client arrangements, commercial realities and national and international responsibilities. This book is based on rulings of the Law Institute's Ethics Committee, which meets monthly to deliberate on requests for guidance from practising lawyers facing ethical dilemmas in their day-to-day working lives.

Competing on the higher ground : social expectations and sport

Research in sport ethics has traditionally focused on the ethical dimensions of the sport event and athletes, however the examination of the principles of ethics to the management and organisation of sport is a relatively recent phenomenon. The tension between the roles and responsibilities of sport as a business, and sport as an ethical and moral aspect of society has forced sport organisations to face an increased number of complex ethical dilemmas. As sport systems throughout the world become further professionalised and bureaucratised, the community understanding of what is ‘good’ is challenged. It is a commonly held expectation that there should be a high level of moral behaviour from those participating directly in the sport event (athletes, coaches, referees), however this expectation has extended to the sporting clubs and organisations which govern the sport itself.

Often used interchangeably, ethics and morality are complex terms concentrating on issues of right and wrong behaviour. Beauchamp and Bowie (1993) stated that the term morality suggests a social institution, composed of a set of standards which are pervasively acknowledged by the members of a culture, or alternatively a social construction. The application of ethics and moral values to the business environment applies across all sectors, including for-profit, non-profit and government, however Rubin (1990) found that the normative ethics, those which society accepts as ethical behaviour, varies from sector to sector. In the non-profit sector, to which many sport organisations belong, Rubin (1990) found that because the community expects more ‘good’, they accept less ‘bad’. As many sport organisations throughout the world remain largely non-profit, linked with the commonly held belief that sport is a foundation for moral behaviours, the idealistic expectation of ethical conduct placed upon them may be different to those of more mainstream business organisations.

Mewett (2003) noted the importance of sport as a social phenomenon which ramifies widely through society to become an intrinsic part of culture and community life. The different expectations of ethical conduct and moral value placed on sport organisations increases the public interest in the ethical dilemmas faced by these organisations. Using the concept of conflict of interest as an example, this paper will examine the tension and difference between the community and social understanding and expectations of sport, and those of the sport organisations themselves.

Marginalising the marginal in holocaust films : fictional representations of jewish policeman

This paper explores the issue of how Jewish victims who occupied so-called 'privileged' positions during the Holocaust are represented in fictional films. Such figures, particularly Jewish policemen in the ghettos, may be seen to inhabit the 'marginal' in two ways, both in terms of the unprecedented ethical dilemmas they faced, and the relative lack of attention such figures have received. Taking Primo Levi's paradigmatic essay on the 'grey zone' as a point of departure, this paper analyses how Jewish policemen are represented in mainstream, 'Hollywood' fictional films, namely Steven Spielberg's Schindler's List, in order to reveal that the narrative concerns of such works preclude any serious engagement with themes of moral ambiguity and 'compromise'. Attention will also be given to a more recent trend in the genre of Holocaust film that directly confronts these issues, nonetheless such films may themselves be viewed as marginalised due to their subject matter.

The moral reasoning abilities of Australian and Malaysian accounting students : a comparative analysis

If national culture is a significant determinant of ethical attitudes, it is not unreasonable to expect ethical decision-making to be influenced by one's culture. However, problems arise when the notion of right differs from one culture to another. The question addressed in this paper is whether the moral reasoning abilities of Australian and Malaysian accounting students in their final year of study differ because of their cultural upbringing. This study uses primary data collected from 34 final year accounting students (12 Australian and 22 Malaysian) enrolled in an Australian degree program. The test scores collected at the beginning and end of the academic year indicate that culture and other explanatory variables do not have an affect on students' moral judgment. The findings in this study suggest that culture as an independent variable does not influence the way accounting students analyse and resolve ethical dilemmas.