La référence à l'ordinaire, dans l'ordre du discours, dans les pratiques politiques, ou dans le domaine des sciences sociales, est moins fréquente que celle au " commun ", au " populaire ", ou au " quotidien ". La notion d'ordinaire est pourtant à la fois plus immédiate, et plus centrale. Elle s'oppose à la fois au " savant ", au " théorique ", à l' " historique " et au " tragique ". Mais l'ordinaire est-il si aisé à connaître et (...) à comprendre? Les analyses rassemblées dans ce volume partent, non d'une évidence partagée de l'ordinaire, mais d'une difficulté à penser l'ordinaire. Elles proposent, dans une démarche exploratoire, de clarifier l'idée d'une " politique de l'ordinaire ", et de confronter à cet effet des points de vue issus de plusieurs disciplines : philosophie, science politique, sociologie, anthropologie. Ce travail collectif rejoint des préoccupations récemment apparues pour le commun comme concept des sciences sociales. Sur le plan politique, la revendication de l'ordinaire et du commun permet de considérer autrement les problèmes de la démocratie, de la communauté, de l'égalité, et d'examiner à nouveaux frais les termes du débat qui opposent, depuis longtemps, libertariens et communautariens. Sur le plan éthique, l'examen attentif des pratiques sociales communes, de nos conversations et gestes ordinaires, de l'ordre des interactions publiques ou privées, permet de réorienter le questionnement moral. (shrink)

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, in which actions (...) are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training. (shrink)

Philosophers and physicians alike tend to discuss the physician-patient relationship in terms of physician privilege and patient autonomy, stressing the duty of the physician to respect the autonomy and the variously elaborated rights of the patient. The authors of this article argue that such emphasis on rights was initially productive, in a first generation of debate on medical ethical issues, but that it is now time for a second generation effort that will stress the importance of the unique experiential aspects (...) of the physician-patient relationship — mutual trust, suffering and healing. We attempt here to initiate this second-generation discussion, presenting the first generation's philosophical background, criticizing it from the perspective of clinical experience, and seeking a synthesis in the relational qualities of patient and physician interacting in a medical context. (shrink)

Aujourd'hui, des malades atteints de pathologies graves pour lesquelles les alternatives therapeutiques sont limitees ou inexistantes reclament, non plus tant une protection contre les essais cliniques, qu'un droit d'y participer. Cette nouvelle revendication est le point de depart de la presente enquete, a la fois historique, juridique et sociologique, qui montre comment s'est formee, dans les normes et dans les pratiques, du XVIIIe au XXe siecle, la distinction entre l'animal de laboratoire et le sujet humain. Entre les cobayes et les (...) hommes. La premiere partie de l'ouvrage decrit la formation, de part et d'autre du proces des medecins de Nuremberg, d'un consensus normatif international en reponse aux crises sanitaires, accidents et scandales qui emaillent l'histoire des essais medicaux sur l'etre humain. La seconde partie detaille la situation en France, l'emergence d'une legislation sur les recherches biomedicales, les paradoxes qui persistent dans la loi et les realites nouvelles, sociologiques et scientifiques, qu'elle doit affronter. L'ouvrage montre l'urgence d'un nouveau contrat social en matiere de recherche biomedicale, articulant respect de l'autonomie, equite d'acces et protection des personnes. Et il propose des solutions. (shrink)

Are there distinctly European values in bioethics, and if there are, what are they? Some Continental philosophers have argued that the principles of dignity, precaution, and solidarity reflect the European ethos better than the liberal concepts of autonomy, harm, and justice. These principles, so the argument goes, elevate prudence over hedonism, communality over individualism, and moral sense over pragmatism. Contrary to what their proponents often believe, however, dignity, precaution, and solidarity can be interpreted in many ways, and it is not (...) clear which reading would, or should, be favored by popular opinion. It is therefore dangerous to think that any one understanding of ``European'', or any other, values could be legitimately imposed on those who have different ideas about morality in health care and related fields. Bioethical principles should be employed to promote discussion, not to suppress it. (shrink)

Solidarity can be conceived in multiple ways. This article probes possible underlying ontological and normative assumptions of solidarity. In order to conceptually clarify the notion of solidarity, we distinguish between five types of solidarity. We suggest that solidarity is either grounded in the Enlightenment ideas of liberty, or a category of loyalty and allegiance. If the former is the case, solidarity can be justified on rational grounds. If the latter is the case, it is contingent on narratives of historical continuity (...) and a non-rational sense of belonging. Moreover, we show that different types of solidarity can be derived from Anglo-Saxon and continental thought, which hints at different conceptions of community. (shrink)

This paper presents the results of a qualitative interview study exploring English and French physicians’ moral perspectives and attitudes towards end-of-life decisions when patients lack capacity to make decisions for themselves. The paper aims to examine the importance physicians from different contexts accord to patient preferences and to explore the role of advance directives in each context. The interviews focus on problems that emerge when deciding to withdraw/-hold life-sustaining treatment from both conscious and unconscious patients; decision-making procedures and the participation (...) of proxies/relatives; previous experience with ADs and views on their usefulness; and perspectives on ways in which the decision-making processes in question might be improved. The analysis reveals differences in the way patient preferences are taken into consideration and shows how these differences influence the reasons physicians in each country invoke to justify their reluctance to adhering to ADs. Identifying cultural differences that complicate efforts to develop the practical implementation of ADs can help to inform national policies governing ADs and to better adapt them to practice. (shrink)

A political sociologist examines the concept of universal, egalitarian citizenship and assesses the prospects for developing democratic solidarity at the global level.

A communitarian approach to bioethics adds a core value to a field that is often more concerned with considerations of individual autonomy. Some interpretations of liberalism put the needs of the patient over those of the community; authoritarian communitarianism privileges the needs of society over those of the patient. Responsive communitarianism’s main starting point is that we face two conflicting core values, autonomy and the common good, and that neither should be a priori privileged, and that we have principles and (...) procedures that can be used to work out this conflict but not to eliminate it. This discussion uses the debate in the US over funding for entitlements as a case study to apply the values of communitarian bioethics. (shrink)

The doctors -- The patients -- "Misunderstandings".