Marta Spranzi is associate professor of history, philosophy and ethics of science at the University of Versailles St-Quentin-en-Yvelines medical school, and a clinical ethics consultant and research at the “Center for clinical ethics” at the Paris university hospital trust AP-HP (http://ethique-clinique.aphp.fr/clinical-ethics-consultation/)Her research focuses on epistemological issues underlying empirical and clinical ethics (what is a case and what is its normative relevance, ‘ordinary humanity’, the natural and the artificial), end-of-life and other prominent clinical ethics issues, and moral philosophy (Le travail de l’éthique: decision médicale et intuitions morales, Mardaga, 2018).
Revue française d'éthique appliquée, Jun 13, 2022
La loi Leonetti sur la fin de vie de 2005 a institué la possibilité pour toute personne de rédige... more La loi Leonetti sur la fin de vie de 2005 a institué la possibilité pour toute personne de rédiger des « directives anticipées » concernant ses souhaits en matière de traitements au cas où elle serait incapable de les exprimer directement (inconscience) ou jugée « incompétente » (maladie d’Alzheimer avancée). Les directives anticipées ont été renforcées et sont devenues opposables en 2016 suite à la révision de la loi. Le médecin, pour sa part, a l’obligation d’en tenir compte si elles existent. Cette possibilité reste pour l’instant largement inexploitée, notamment parce que les personnes sont réticentes à se contraindre à un choix médical précis alors que la situation pourrait encore évoluer. Les directives anticipées sont aujourd’hui souvent préparées par des « discussions anticipées », un processus moins axé sur les décisions médicales concrètes pendant lequel les valeurs du patient et les différentes options sont discutées de façon plus informelle. Reste toutefois à traduire ce matériau narratif en une décision précise une fois qu’elle deviendra nécessaire. Je montrerai, à partir d’une réflexion épistémologique sur la structure et l’utilisation des modèles imaginaires dans les sciences, qu’un modèle mental construit à partir des exemples de « bonne mort » auxquels les personnes font souvent référence dans les discussions anticipées, peuvent servir de « médiateurs » pour traduire les valeurs de la personne dans une décision médicale concrète.
Cet article traite du rôle et du positionnement éthique de l’interprète en milieu social. Il dist... more Cet article traite du rôle et du positionnement éthique de l’interprète en milieu social. Il distingue trois modèles possibles de la fonction de l’interprète dans ces contextes : celui de porte-parole de l’usager, de médiateur et du tiers neutre. Ce dernier est le plus adéquat à construire et préserver la confiance avec les deux interlocuteurs. Il comporte la nécessité pour l’interprète d’adopter une attitude à la fois impartiale et neutre. La différence entre les deux notions est importante et peut être éclaircie par le biais de discussions de philosophie politique : l’impartialité correspond à une attitude d’indépendance vis-à-vis de ses propres engagements idéologiques ou politiques, alors que la neutralité traduit l’égale distance de l’interprète vis-à-vis des deux personnes qui communiquent entre elles. Ces deux attitudes éthiques essentielles entrainent des tensions et des dilemmes auxquels l’interprète doit faire face dans l’exercice de son travail.This article discusses the ethical positioning, attitude and role of community interpreters. Three models are presented—advocate, mediator and neutral third party. Only the latter model manages to preserve the trust of both interlocutors—the professional and the client. The interpreter’s ethical code stresses his impartiality and neutrality. These two notions, though they are often associated, are different. The way that they are discussed in the context of political philosophy clearly shows this. Impartiality refers to the interpreter’s independence with respect to her own personal commitments and ideological positions, while neutrality refers to the equal distance the interpreter has to assume with respect to each of the two interlocutors: she does not have to lean on one side or the other. However, these two essential ethical principles raise a number of tensions and dilemmas the interpreter has to deal with when performing her role.Questo articolo tratta della posizione etica et del ruolo dell’interprete sociale. Tre modelli sono discussi: quello dell’avvocato, del mediatore e del terzo neutro. Solo il terzo modello permette di mantenere la fiducia dei due interlocutori. Il codice etico dell’interprete comporta i due principi dell’imparzialità e della neutralità. La prima significa che l’interprete deve prendere le distanze delle sue proprie opinioni e posizioni ideologiche, mentre la seconda indica che l’interprete deve essere a uguale distanza da ciascuno dei due interlocutori. Questi principi etici sono essenziali ma comportano delle tensioni e dei dilemmi che rendono complesso il lavoro dell’interprete sociale
Cambridge Quarterly of Healthcare Ethics, Jul 24, 2012
In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our n... more In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our normative judgments, Daniel Callahan wrote, ‘‘What is, is all we have in the universe. We have to admit that if nature is not the source of morality, it does not have any source.’’ The attitude that Callahan has characterized in these stark terms has become a commonplace today, and efforts have shifted toward determining an adequate empirical basis for ethics, and what its acceptable uses are, rather than justifying in general terms the fact that ‘‘what is’’ is relevant for ‘‘what should be,’’ and refuting the so-called naturalistic fallacy. At a minimum, a ‘‘naturalized bioethics’’ has to ‘‘resist the pull to purity’’: it must acknowledge the complexity of ethical judgments and actions, promote curiosity for real-life dilemmas, and affirm the necessity that our ethical proposals be accountable to facts. Empirical ethics avails itself of a variety of methods. However, whereas qualitative and quantitative studies are common practice and their relevance is widely discussed, the use of individual cases has not been scrutinized with a view to assessing the reasons why, and the extent to which cases can constitute a valid empirical basis for ethical judgments. This is all the more crucial because a case anchors moral reasoning to practice in an intuitive and immediate way and often suggests insights or solutions to particular and even general issues: we are all familiar with the impact that cases have on our understanding of situations of ethical unease, with the satisfaction that we get when we feel that the solution we are suggesting accounts for several prominent cases we have encountered or read about, and with the heuristic function that cases play with respect to our common beliefs and practices. Indeed, one might argue, as Jonathan Dancy does, that cases are the only suitable tool of empiricism in ethics, because only cases can serve as tests of a sort for moral principles. Medical ethics, geared as it is toward the improvement of medical practice, is at the forefront of the naturalistic movement. It is a fact that cases do play an important role in medical ethics, and it is not surprising that they should: clinical medicine itself is rightly characterized as an art and to that extent deals primarily with particular cases rather than with general diseases. Cases are very often described in medical ethics publications: whether short or long, detailed or sketchy, current or exceptional, they capture our imagination and often provide a foundation for the authors’ conclusions. Moreover, cases, whether fictional or real, are central to narrative ethics, a prominent approach to bioethical reflection and education today: thanks to their temporal organization, the selective nature of the events recounted, and the thickness of their texture, narratives can better account for the lived experience of those involved in a medical decision, and to that extent
Revue française d'éthique appliquée, Jun 13, 2022
La loi Leonetti sur la fin de vie de 2005 a institué la possibilité pour toute personne de rédige... more La loi Leonetti sur la fin de vie de 2005 a institué la possibilité pour toute personne de rédiger des « directives anticipées » concernant ses souhaits en matière de traitements au cas où elle serait incapable de les exprimer directement (inconscience) ou jugée « incompétente » (maladie d’Alzheimer avancée). Les directives anticipées ont été renforcées et sont devenues opposables en 2016 suite à la révision de la loi. Le médecin, pour sa part, a l’obligation d’en tenir compte si elles existent. Cette possibilité reste pour l’instant largement inexploitée, notamment parce que les personnes sont réticentes à se contraindre à un choix médical précis alors que la situation pourrait encore évoluer. Les directives anticipées sont aujourd’hui souvent préparées par des « discussions anticipées », un processus moins axé sur les décisions médicales concrètes pendant lequel les valeurs du patient et les différentes options sont discutées de façon plus informelle. Reste toutefois à traduire ce matériau narratif en une décision précise une fois qu’elle deviendra nécessaire. Je montrerai, à partir d’une réflexion épistémologique sur la structure et l’utilisation des modèles imaginaires dans les sciences, qu’un modèle mental construit à partir des exemples de « bonne mort » auxquels les personnes font souvent référence dans les discussions anticipées, peuvent servir de « médiateurs » pour traduire les valeurs de la personne dans une décision médicale concrète.
Cet article traite du rôle et du positionnement éthique de l’interprète en milieu social. Il dist... more Cet article traite du rôle et du positionnement éthique de l’interprète en milieu social. Il distingue trois modèles possibles de la fonction de l’interprète dans ces contextes : celui de porte-parole de l’usager, de médiateur et du tiers neutre. Ce dernier est le plus adéquat à construire et préserver la confiance avec les deux interlocuteurs. Il comporte la nécessité pour l’interprète d’adopter une attitude à la fois impartiale et neutre. La différence entre les deux notions est importante et peut être éclaircie par le biais de discussions de philosophie politique : l’impartialité correspond à une attitude d’indépendance vis-à-vis de ses propres engagements idéologiques ou politiques, alors que la neutralité traduit l’égale distance de l’interprète vis-à-vis des deux personnes qui communiquent entre elles. Ces deux attitudes éthiques essentielles entrainent des tensions et des dilemmes auxquels l’interprète doit faire face dans l’exercice de son travail.This article discusses the ethical positioning, attitude and role of community interpreters. Three models are presented—advocate, mediator and neutral third party. Only the latter model manages to preserve the trust of both interlocutors—the professional and the client. The interpreter’s ethical code stresses his impartiality and neutrality. These two notions, though they are often associated, are different. The way that they are discussed in the context of political philosophy clearly shows this. Impartiality refers to the interpreter’s independence with respect to her own personal commitments and ideological positions, while neutrality refers to the equal distance the interpreter has to assume with respect to each of the two interlocutors: she does not have to lean on one side or the other. However, these two essential ethical principles raise a number of tensions and dilemmas the interpreter has to deal with when performing her role.Questo articolo tratta della posizione etica et del ruolo dell’interprete sociale. Tre modelli sono discussi: quello dell’avvocato, del mediatore e del terzo neutro. Solo il terzo modello permette di mantenere la fiducia dei due interlocutori. Il codice etico dell’interprete comporta i due principi dell’imparzialità e della neutralità. La prima significa che l’interprete deve prendere le distanze delle sue proprie opinioni e posizioni ideologiche, mentre la seconda indica che l’interprete deve essere a uguale distanza da ciascuno dei due interlocutori. Questi principi etici sono essenziali ma comportano delle tensioni e dei dilemmi che rendono complesso il lavoro dell’interprete sociale
Cambridge Quarterly of Healthcare Ethics, Jul 24, 2012
In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our n... more In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our normative judgments, Daniel Callahan wrote, ‘‘What is, is all we have in the universe. We have to admit that if nature is not the source of morality, it does not have any source.’’ The attitude that Callahan has characterized in these stark terms has become a commonplace today, and efforts have shifted toward determining an adequate empirical basis for ethics, and what its acceptable uses are, rather than justifying in general terms the fact that ‘‘what is’’ is relevant for ‘‘what should be,’’ and refuting the so-called naturalistic fallacy. At a minimum, a ‘‘naturalized bioethics’’ has to ‘‘resist the pull to purity’’: it must acknowledge the complexity of ethical judgments and actions, promote curiosity for real-life dilemmas, and affirm the necessity that our ethical proposals be accountable to facts. Empirical ethics avails itself of a variety of methods. However, whereas qualitative and quantitative studies are common practice and their relevance is widely discussed, the use of individual cases has not been scrutinized with a view to assessing the reasons why, and the extent to which cases can constitute a valid empirical basis for ethical judgments. This is all the more crucial because a case anchors moral reasoning to practice in an intuitive and immediate way and often suggests insights or solutions to particular and even general issues: we are all familiar with the impact that cases have on our understanding of situations of ethical unease, with the satisfaction that we get when we feel that the solution we are suggesting accounts for several prominent cases we have encountered or read about, and with the heuristic function that cases play with respect to our common beliefs and practices. Indeed, one might argue, as Jonathan Dancy does, that cases are the only suitable tool of empiricism in ethics, because only cases can serve as tests of a sort for moral principles. Medical ethics, geared as it is toward the improvement of medical practice, is at the forefront of the naturalistic movement. It is a fact that cases do play an important role in medical ethics, and it is not surprising that they should: clinical medicine itself is rightly characterized as an art and to that extent deals primarily with particular cases rather than with general diseases. Cases are very often described in medical ethics publications: whether short or long, detailed or sketchy, current or exceptional, they capture our imagination and often provide a foundation for the authors’ conclusions. Moreover, cases, whether fictional or real, are central to narrative ethics, a prominent approach to bioethical reflection and education today: thanks to their temporal organization, the selective nature of the events recounted, and the thickness of their texture, narratives can better account for the lived experience of those involved in a medical decision, and to that extent
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