in Bioethics in the 21st Century, Prof. Abraham Rudnick (Ed.), ISBN: 978-953-307-270-8, InTech, Available from: http://www.intechopen.com/books/bioethics-in-the-21st-century/ethics-and-medically-assisted-procreationreconsidering- the-procreative-relationship, 2011
Since the birth of Louise Brown, the first ‘test-tube baby’ in the history of humanity, in July 1... more Since the birth of Louise Brown, the first ‘test-tube baby’ in the history of humanity, in July 1978, criticisms of MAP have not ceased. These criticisms are generally of two types. The first relates to the medico-technical dimension of MAP and questions the effectiveness and
the safety of these biotechnologies. The second, which I will discuss here, relates to the ethical dimension of MAP. I will initially review the ethical criticisms of MAP, particularly in the Francophone
literature (although this is not significantly different in the Anglophone literature), and suggest a way of classifying them, before going on to show the limits of such a classification. These criticisms can be grouped into three categories: the medicalization of procreation, the upheaval in the structures of filiation, and the status of the embryo. We will see that,
although this criticism is enlightening in certain cases, it is often excessive and, at the same time, overlooks the effectiveness of procreation technologies in relieving the suffering of sterile couples, as argued in previous work of mine (Ravez, 2006).
The suffering of the patients is an essential element in the ethical evaluation of MAP, but it is not sufficient to construct a satisfactory axiological framework. I will show that such a framework is essential. I will propose three components of such a framework, taking into
account the limits of criticism addressed at MAP, but also the limits of MAP itself.
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Papers by Laurent Ravez
discipline to be necessary wisdom for the use of techniques and knowledge specific to the life sciences, and Fritz Jahr saw it as a moral obligation towards all living beings. However, it is the most pragmatic but also the most individualistic application proposed by André Helleghersand, following him, and Childress that has been retained and widely applicated.
ideological context that prevailed in the United States in the 1960s and 1970s. Should we then abandon all hope of universality for ethical benchmarks that have proven their usefulness in illuminating health practices? By carefully distinguishing the universal from the uniform, this paper shows, that it is possible to respect the specificities of cultures around the world, while maintaining a universal goal for bioethics
some of the key ethical challenges raised by the COVID-19 pandemic in low-income countries suffering from chronic shortages in health care resources, and chronic high morbidity and mortality from non-COVID-19 causes. A parallel is drawn between the distribution of severity of COVID-19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID-19 on the ‘thick’ part of the pyramid in Low-to-Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post-COVID-19 world, we need to think strategically about how health care
systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID-19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non-pandemic times.
Ce bref article propose d’appliquer la méthodologie d’analyse de l’éthique de la santé publique à la gestion de l’épidémie de COVID-19 en Belgique. Confrontés à cette urgence sanitaire, les responsables politiques belges ont été contraints de prendre très rapidement une série de décisions dont nous allons examiner ici la portée éthique .
of the world, including Africa. Although reported
infections in sub-Saharan low- and middle-income
countries (LMICs) are relatively low, they are expected to
rise considerably as testing becomes widespread. Many local health care systems have been fragile for decades, struggle to meet existing health needs, and are likely to be rapidly overwhelmed if there are surges of critically ill patients. The Covid-19 pandemic is particularly challenging because the virus, SARS-CoV-2, is easily transmitted through respiratory droplets, including by asymptomatic persons, and both a vaccine and effective treatment are unavailable. In lowincome African countries suffering from chronic shortages in health care resources and high morbidity and mortality from non-Covid-19 causes such as HIV and tuberculosis, what are the key clinical and public health ethics challenges
raised by the Covid-19 pandemic, and what room is there
for an ethical response? We argue that context matters when it comes to Covid-19 ethical recommendations and that talk of “fair allocation” of resources, which has become a major issue in high-income countries (HICs), has a very hollow ring in settings long familiar with rationing and marked by high disease burdens, poverty, and social injustice.
Le texte qui suit entend rendre compte d'une approche particulière de ce processus formatif en éthique clinique?
discipline to be necessary wisdom for the use of techniques and knowledge specific to the life sciences, and Fritz Jahr saw it as a moral obligation towards all living beings. However, it is the most pragmatic but also the most individualistic application proposed by André Helleghersand, following him, and Childress that has been retained and widely applicated.
ideological context that prevailed in the United States in the 1960s and 1970s. Should we then abandon all hope of universality for ethical benchmarks that have proven their usefulness in illuminating health practices? By carefully distinguishing the universal from the uniform, this paper shows, that it is possible to respect the specificities of cultures around the world, while maintaining a universal goal for bioethics
some of the key ethical challenges raised by the COVID-19 pandemic in low-income countries suffering from chronic shortages in health care resources, and chronic high morbidity and mortality from non-COVID-19 causes. A parallel is drawn between the distribution of severity of COVID-19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID-19 on the ‘thick’ part of the pyramid in Low-to-Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post-COVID-19 world, we need to think strategically about how health care
systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID-19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non-pandemic times.
Ce bref article propose d’appliquer la méthodologie d’analyse de l’éthique de la santé publique à la gestion de l’épidémie de COVID-19 en Belgique. Confrontés à cette urgence sanitaire, les responsables politiques belges ont été contraints de prendre très rapidement une série de décisions dont nous allons examiner ici la portée éthique .
of the world, including Africa. Although reported
infections in sub-Saharan low- and middle-income
countries (LMICs) are relatively low, they are expected to
rise considerably as testing becomes widespread. Many local health care systems have been fragile for decades, struggle to meet existing health needs, and are likely to be rapidly overwhelmed if there are surges of critically ill patients. The Covid-19 pandemic is particularly challenging because the virus, SARS-CoV-2, is easily transmitted through respiratory droplets, including by asymptomatic persons, and both a vaccine and effective treatment are unavailable. In lowincome African countries suffering from chronic shortages in health care resources and high morbidity and mortality from non-Covid-19 causes such as HIV and tuberculosis, what are the key clinical and public health ethics challenges
raised by the Covid-19 pandemic, and what room is there
for an ethical response? We argue that context matters when it comes to Covid-19 ethical recommendations and that talk of “fair allocation” of resources, which has become a major issue in high-income countries (HICs), has a very hollow ring in settings long familiar with rationing and marked by high disease burdens, poverty, and social injustice.
Le texte qui suit entend rendre compte d'une approche particulière de ce processus formatif en éthique clinique?
En emboîtant le pas à Toulmin, ne pourrait-on pas suggérer l’hypothèse selon laquelle la pandémie de COVID-19, en dépit des innombrables malheurs qu’elle a provoqués partout dans le monde, pourrait avoir néanmoins suscité une saine remise en question de l’éthique des soins de santé ? Bien-sûr, il ne s’agit pas ici d’invoquer une quelconque action miraculeuse que la COVID-19 aurait exercé sur la culture éthique ambiante. Il faudrait plutôt parler d’un coup de pouce à un mouvement que la pandémie n’a certes pas initié mais qu’elle contribue largement à renforcer.
Comme ce fut le cas pour l’épidémie de grippe espagnole en 1918 qui décima en quelques mois des dizaines de millions d’êtres humains , l’histoire de la COVID-19 de 2020 ne se résume pas aux mesures sanitaires drastiques prises par les gouvernements du monde entier, à la gestion parfois chaotique des flux de malades, aux milliers de morts et aux terribles conséquences économiques qui en résulteront, mais évoque également un renouveau du regard critique que nous portons sur la maladie et les soins de santé.
Pour le montrer, nous soulignerons que les maladies infectieuses comme la COVID-19 ont longtemps laissé totalement indifférents les spécialistes de l’éthique des soins de santé jusqu’à ce que des fléaux comme le VIH-SIDA, le SRAS ou Ebola viennent les sortir de leur torpeur. Loin de cette apathie originelle, l’offensive du SARS-CoV-2 a immédiatement suscité l’intérêt de la communauté bioéthique, comme nous le verrons en évoquant deux articles importants. Les thèmes traités dans ceux-ci nous serviront alors de base pour esquisser la structure du renouveau paradigmatique que la pandémie semble susciter au cœur de l’éthique des soins de santé.
Trois lignes de force en lien avec ce renouveau seront évoquées dans cette contribution : le déplacement d’une conception individualiste de l’autonomie vers une approche plus relationnelle ; l’insistance sur notre responsabilité morale à l’égard de nos congénères ; une resocialisation de l’éthique des soins de santé qui passe par une réelle prise en compte des déterminants sociaux de la santé.
the safety of these biotechnologies. The second, which I will discuss here, relates to the ethical dimension of MAP. I will initially review the ethical criticisms of MAP, particularly in the Francophone
literature (although this is not significantly different in the Anglophone literature), and suggest a way of classifying them, before going on to show the limits of such a classification. These criticisms can be grouped into three categories: the medicalization of procreation, the upheaval in the structures of filiation, and the status of the embryo. We will see that,
although this criticism is enlightening in certain cases, it is often excessive and, at the same time, overlooks the effectiveness of procreation technologies in relieving the suffering of sterile couples, as argued in previous work of mine (Ravez, 2006).
The suffering of the patients is an essential element in the ethical evaluation of MAP, but it is not sufficient to construct a satisfactory axiological framework. I will show that such a framework is essential. I will propose three components of such a framework, taking into
account the limits of criticism addressed at MAP, but also the limits of MAP itself.
En tournant résolument le dos aux analyses le plus souvent négatives que l’on peut lire dans la littérature francophone, je propose d’envisager les gestations pour autrui comme une occasion unique de réfléchir à nos structures de filiation et d’en proposer un modèle plus respectueux de la complexité et de la diversité des existences humaines.
pauvres comme référentiel dans l’analyse des grandes problématiques
contemporaines en éthique des soins de santé et en bioéthique ? Deux grandes problématiques ayant donné lieu à de nombreuses prises de position éthiques seront évoquées, toutes deux d’une grande actualité. La première concerne les plantes génétiquement modifiées (PGM) qui appartiennent à l’ensemble plus large des organismes génétiquement modifiés (OGM). Ces organismes sont au centre de polémiques souvent très vives sur leur toxicité et les risques qu’ils constituent pour l’être humain et l’environnement. La seconde problématique étudiée a trait à la santé reproductive. Même si dans beaucoup de pays européens, des lois permettent aux couples et aux femmes en particulier de maîtriser leur fécondité, certains persistent à questionner ces droits, alors que d’autres, dans le monde, ne les reconnaissent simplement pas. Nous verrons concrètement comment la voix des plus pauvres peut offrir un chemin d’analyse créatif offrant une alternative aux schémas éthiques habituels.
Or, il se fait que depuis quelques temps déjà, après une brève mais intense passion, la question l’euthanasie ne m’intéresse plus guère. Il faut dire aussi que lorsque l’on tente, comme moi, de faire de l’éthique, cette question constitue presque un exercice imposé. Si par malheur, lors d’un dîner professionnel et même lors d’agapes amicales, on apprend que vous êtes « bioéthicien », vous éviterez difficilement la question considérée par certains comme essentielle : « Dis nous, bon Dieu !, si oui ou non, tu es pour l’euthanasie… parce que, quand-même, on ne peut pas laisser souffrir les gens comme ça ! ». Vous aurez alors droit très souvent à plusieurs témoignages personnels concernant tel ami, tel proche, tel parent, sur lequel les médecins se sont acharnés, tentant de le faire vivre contre son gré.