Ethique & sante最新文献

{"title":"L’oncogénétique – concepts théorico-cliniques et enjeux psychosociaux – Une revue de la littérature narrative","authors":"A. Müller ,&nbsp;C. Martin-Krumm ,&nbsp;L. Kern ,&nbsp;S. Barbot ,&nbsp;S. Dolbeault ,&nbsp;A. Brédart","doi":"10.1016/j.etiqe.2025.06.004","DOIUrl":"10.1016/j.etiqe.2025.06.004","url":null,"abstract":"<div><div>Le cancer du sein est le cancer le plus répandu au monde. Certains cas de cancer peuvent avoir une origine génétique. C’est pourquoi les patients peuvent parfois, s’ils le souhaitent, bénéficier de consultations en oncogénétique. Il s’agit d’un domaine en plein essor et de ce fait à complexité croissante. Cette revue de littérature narrative s’intéresse à ce contexte médical particulier dans le cas de cancers du sein et/ou des ovaires en résumant quelques éléments-clés. S’engager dans une prise en charge en oncogénétique peut susciter anxiété ou détresse chez certains patients. Dès lors, il est pertinent de s’intéresser aux enjeux de cette démarche et aux ressources des patients. Il s’agit d’un thème qui peut avoir des conséquences au niveau individuel, social ou familial. Par ailleurs, il est sous-tendu par de nombreux questionnements éthiques. Cette revue de littérature propose de résumer quelques points-clés concernant le thème de l’oncogénétique.</div></div><div><div>Breast cancer is the most prevalent cancer in the world. Some cancers have a genetic origin. In this context, patient can sometimes benefit from oncogenetic consultations, if they wish so. This is a fast-developing field, and one of increasing complexity. This narrative literature review looks at this specific medical context in the case of breast and/or ovarian cancers, summarizing a few key points. For some patients, the process of oncogenetic consultations can be a source of anxiety and distress. Therefore, it seems important to address the implications of this approach and the institutional and personal resources available to patients. It's a topic that can have consequences at individual, social or family level. Moreover, it is subject to numerous ethical issues. This literature review aims to summarize a few key points concerning oncogenetics.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 153-162"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding domestic violence in rural south India: Prevalence and associated risk factors in married women","authors":"H.V. Nair ,&nbsp;A. Dinesh ,&nbsp;S. Sidharthan ,&nbsp;R. Bhaskaran","doi":"10.1016/j.etiqe.2025.04.001","DOIUrl":"10.1016/j.etiqe.2025.04.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Domestic violence is a significant public health and human rights concern disproportionately affecting rural women, where socio-cultural norms often heighten vulnerability. Although Kerala, India, demonstrates high literacy and positive gender indicators, domestic violence remains prevalent, especially in rural areas. This study examines the one-year prevalence and associated factors of domestic violence among married women in a rural community in Ernakulam district, Kerala, through the lenses of the Social Ecological model, Feminist theory, and Patriarchal theory.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A cross-sectional survey was conducted from April to June 2022 with 330 married women selected through multistage cluster random sampling. Data were gathered using a structured questionnaire adapted from validated scales, including the Revised Conflict Tactics Scale and the Indian Family Violence and Control Scale. Descriptive statistics, chi-square tests, and logistic regression were used to assess prevalence and predictors of domestic violence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The one-year prevalence of domestic violence was 12.4%, with psychological abuse (10.6%) being most common, followed by physical (6.7%) and sexual violence (1.8%). Key predictors included dowry demands (AOR: 12.95; 95% CI: 3.9–43.11) and controlling behaviors (AOR: 131.95; 95% CI: 14.35–1213), while self-help group membership and having male children reduced the likelihood of violence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;These findings highlight the need for targeted interventions challenging patriarchal norms, promoting economic independence, and empowering rural women living in rural environment to reduce domestic violence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Contexte&lt;/h3&gt;&lt;div&gt;La violence domestique est une problématique majeure de santé publique et de droits humains, touchant de manière disproportionnée les femmes rurales, souvent exposées à des normes socioculturelles qui exacerbent leur vulnérabilité. Au Kerala, en Inde, malgré des indicateurs élevés en matière de littératie et d’égalité des genres, la violence domestique reste un problème répandu, en particulier dans les zones rurales. Cette étude explore la prévalence sur un an et les facteurs associés à la violence domestique chez les femmes mariées dans une communauté rurale du district d’Ernakulam.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Méthodes&lt;/h3&gt;&lt;div&gt;Une enquête transversale a été réalisée entre avril et juin 2022 auprès de 330 femmes mariées, sélectionnées par échantillonnage en grappes à plusieurs niveaux. Les données ont été recueillies à l’aide de questionnaires structurés basés sur des échelles validées, telles que l’Échelle révisée des tactiques de conflit et l’Échelle indienne de la violence familiale et du contrôle. Les analyses incluaient des statistiques descriptives, des tests du chi carré et des régressions logistiques.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Résultats&lt;/h3&gt;&lt;div&gt;La prévalence annuelle de la violence d","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 202-212"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les limites éthiques du droit à l’oubli pour les personnes atteintes d’un risque aggravé de santé","authors":"M. Bourhis","doi":"10.1016/j.etiqe.2025.02.002","DOIUrl":"10.1016/j.etiqe.2025.02.002","url":null,"abstract":"<div><div>Le cancer est la première cause de mortalité en France. Pour des raisons de justice sociale, le domaine de l’assurance en lien avec des associations de patients a permis d’inscrire dans le cadre légal, le droit à l’oubli, la préservation de l’intimité, notamment en ce qui concerne les informations médicales. Ce droit permet aux personnes ayant souffert de maladies graves, comme le cancer, de ne plus subir de discrimination tarifaire ou d’exclusion de garanties, facilitant ainsi l’accès à une assurance emprunteur. Encadré par la convention AERAS, ce droit a évolué pour intégrer les progrès médicaux et répondre aux demandes des assureurs et des associations de patients. Cependant, il pose des questions quant à la conciliation entre la sauvegarde des droits personnels et les impératifs économiques du secteur des assurances. Ce double standard peut nous interroger : le droit à l’oubli parvient-il à concilier les principes de justice sociale avec les impératifs financiers du marché des assurances ? Sommes-nous devant un droit conventionnel, un droit de réserve utile ou devant un droit subjectif qui tend à protéger les personnes ciblées ? L’article examine les notions de risques dans l’assurance et l’historique juridique et administratif de ce droit si particulier. L’article aborde ensuite les considérations éthiques que soulèvent de tels objets juridiques et administratifs.</div></div><div><div>Cancer is the leading cause of mortality in France. In the interest of social justice, the insurance sector, in collaboration with patient associations, has incorporated into the legal framework the “right to be forgotten”, which safeguards privacy, particularly regarding medical information. This right allows individuals who have suffered from serious illnesses, such as cancer, to avoid facing tariff discrimination or exclusion from insurance coverage, thereby facilitating access to borrower insurance. Governed by the AERAS Convention, this right has evolved to reflect medical advancements and meet the demands of insurers and patient associations. However, it raises important questions about balancing the protection of personal rights with the economic imperatives of the insurance industry. This duality prompts reflection: does the right to be forgotten successfully reconcile the principles of social justice with the financial requirements of the insurance market? Are we dealing with a conventional right, a useful reservation, or a subjective right aimed at protecting targeted individuals? The article explores risk concepts in insurance and the legal and administrative history of this unique right, followed by an examination of the ethical considerations raised by such legal and administrative measures.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 185-191"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"A. de Broca","doi":"10.1016/j.etiqe.2025.06.005","DOIUrl":"10.1016/j.etiqe.2025.06.005","url":null,"abstract":"","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 213-214"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les réseaux sociaux en « Anapath » : considérations éthiques et légales","authors":"S. Ben Rejeb ,&nbsp;S. Sakly ,&nbsp;D. Beltaifa ,&nbsp;N. Hadj Salem","doi":"10.1016/j.etiqe.2025.04.002","DOIUrl":"10.1016/j.etiqe.2025.04.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Les plateformes numériques ont gagné en importance parmi les pathologistes comme outils d’apprentissage, mais soulèvent des questions éthiques et légales majeures. Cette étude vise à explorer leurs applications en anatomie pathologique et à analyser leurs implications.</div></div><div><h3>Méthodes</h3><div>Une revue de la littérature a permis d’identifier les usages pédagogiques des médias sociaux en pathologie. Un questionnaire a été diffusé auprès des pathologistes tunisiens pour évaluer leurs perceptions éthiques et légales.</div></div><div><h3>Résultats</h3><div>Les plateformes numériques servent à promouvoir la spécialité, discuter des cas cliniques, former les résidents et constituer une bibliothèque d’images ouverte. Parmi les répondants, la majorité utilise ces outils pédagogiques, souvent régulièrement, et encourage leur adoption. Cependant, beaucoup estiment que le consentement des patients n’est pas nécessaire pour partager des images, et certains réutilisent du contenu en citant les auteurs. Une proportion significative sollicite des avis professionnels en ligne, influençant leurs diagnostics.</div></div><div><h3>Conclusion</h3><div>Les médias sociaux offrent un potentiel éducatif prometteur en pathologie, mais leur usage nécessite un cadre éthique et juridique clair pour éviter les risques, notamment liés au consentement et à la responsabilité. L’élaboration de réglementations adaptées est urgente pour encadrer ces pratiques innovantes.</div></div><div><h3>Introduction</h3><div>The use of digital platforms has surged among pathologists as a learning tool, yet it raises significant ethical and legal concerns. This study aims to explore their benefits in pathology education and discuss related considerations.</div></div><div><h3>Methods</h3><div>A literature review assessed the role of social media in pathology learning. A survey questionnaire collected Tunisian pathologists’ views on its ethical and legal implications.</div></div><div><h3>Results</h3><div>Digital platforms are widely used to promote pathology, discuss clinical cases, train residents, and provide an open-access image library. Most respondents reported using these tools for education, often frequently, and encouraged their peers to do the same. Many deemed patient consent unnecessary for sharing images, while some reused online content, typically citing authors. A notable portion sought professional opinions online, influencing their diagnostic decisions.</div></div><div><h3>Conclusion</h3><div>Social media holds promise for pathology education, but its use demands a clear ethical and legal framework to mitigate risks, particularly regarding consent and accountability. Developing tailored regulations is critical to support these innovative practices safely.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 192-201"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dire les mots justes : pour une éthique clinique de la parole soignante","authors":"E. Soormally","doi":"10.1016/j.etiqe.2025.05.003","DOIUrl":"10.1016/j.etiqe.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the ethical and existential significance of speech in the caregiving relationship—not merely as a vehicle for information, but as an act of unveiling, a promise, and a way of sustaining the patient's world.</div></div><div><h3>Approach</h3><div>Drawing on an emblematic clinical scene, the analysis weaves together insights from Damasio, Heidegger, Aristotle, Gadamer, and Arendt to conceive clinical speech as an attuned, embodied gesture—one that helps establish a shared world.</div></div><div><h3>Reflection</h3><div>The patient's cry is not a disruption to be corrected, but a meaningful event. The right word, rooted in phronesis, seeks not theoretical truth, but a situated response to suffering. It becomes a promise—that is, an act through which a fragile world is held together.</div></div><div><h3>Perspectives</h3><div>In an era of technologized medicine, where hospitals can sometimes feel disconnected from humanity, it is urgent to restore the ontological value of clinical speech—as a space where a shared and still inhabitable world can emerge.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 149-152"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sommaire","authors":"","doi":"10.1016/S1765-4629(25)00058-3","DOIUrl":"10.1016/S1765-4629(25)00058-3","url":null,"abstract":"","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Page iii"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Au Village Landais Alzheimer, écrire pour partager et transmettre","authors":"G. Marie-Bailleul ,&nbsp;M. Bailleul","doi":"10.1016/j.etiqe.2025.05.001","DOIUrl":"10.1016/j.etiqe.2025.05.001","url":null,"abstract":"<div><div>Au sein du Village Landais Alzheimer Henri-Emmanuelli, structure innovante implantée à Dax, dans les Landes, des personnes vivant avec la maladie d’Alzheimer, des professionnels de l’accompagnement et des aidants-aimants ont, pendant six mois, partagé une aventure d’écriture commune, décrite en première partie. Des pas de côté réflexifs, éclairés par une nécessaire éthique d’inclusion et de solidarité, nous amènent à formaliser cette expérience comme intégrée à une démarche plus globale d’innovation sociale.</div></div><div><div>At the Village Landais Alzheimer Henri-Emmanuelli, an innovative structure based in Dax, in the Landes region of France, people living with Alzheimer's disease, support professionals and caregivers shared a six-month adventure of writing together, described in part one. Reflexive steps aside, informed by a necessary ethic of inclusion and solidarity, lead us to formalize this experience as part of a more global approach to social innovation.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 177-184"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L’âgisme dans notre système de soin : il est temps de lever le silence éthique","authors":"C. Hazif-Thomas ,&nbsp;A. Gentric","doi":"10.1016/j.etiqe.2025.06.003","DOIUrl":"10.1016/j.etiqe.2025.06.003","url":null,"abstract":"<div><div>L’âgisme s’insinue dans de nombreuses institutions et secteurs de la société, souvent de façon banalisée, y compris dans les secteurs de la santé et les services sociaux, sur le lieu de travail, dans les médias et dans le système juridique. Le critère d’âge peut servir au rationnement des soins de santé pour les plus vulnérables. Une relative « <em>indésirabilité</em> » des personnes vieillissantes peut être une porte ouverte à la maltraitance décomplexée et concourir à l’abaissement de la démocratie en santé. Il importe de lever le silence éthique sur une réalité source de moins bonne santé physique et mentale pour les personnes âgées, à leur plus grand isolement social et à une solitude accrue, à plus d’insécurité financière aussi, d’où des décès prématurés et la baisse de la qualité de vie. Dans ce contexte, il est problématique de continuer de regarder nombre de séjours dans cette tranche d’âge comme relevant de <em>bed-blockers</em>, des patients qui bloquent des lits au détriment des adultes et des plus jeunes et altèrent la productivité hospitalière. Une réorganisation des lieux de soins et des modes de prise en charge, des actions innovantes doivent accompagner un changement de représentations parmi les managers hospitaliers.</div></div><div><div>Ageism permeates many institutions and sectors of society, often in a trivialized way, including the health and social service sectors, the workplace, the media and the legal system. The age criterion can be used to rationing health care for the most vulnerable. A relative \"undesirability\" of elderly people can be an open door to uninhibited abuse and contribute to the undermining of healthy democracy. It is important to break the ethical silence on a reality that is a source of poorer physical and mental health for elderly people, their greater social isolation and increased loneliness, as well as more financial insecurity, hence sometimes premature deaths and very often the decline in quality of life. In this context, it is problematic to continue to consider many stays in this age group as bed-blockers, patients who block beds at the expense of adults and younger ones and alter hospital productivity. A reorganization of care facilities and modes of care, innovative actions must accompany a change in representations among hospital managers.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 169-176"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La « juste » dose des chimiothérapies anticancéreuses. Entre traitements classiques, standardisation et médecine de précision","authors":"M. Closset ,&nbsp;P. Odou ,&nbsp;L. Galanti","doi":"10.1016/j.etiqe.2025.02.003","DOIUrl":"10.1016/j.etiqe.2025.02.003","url":null,"abstract":"<div><div>Les chimiothérapies anticancéreuses constituent une ressource essentielle de l’arsenal thérapeutique en matière de maladies oncologiques. Compte tenu des différentes approches possibles, l’établissement de la dose « juste » représente un défi autant éthique que médical. Cette contribution a pour objectif de développer un concept de « juste dose » dans ses dimensions individuelle (celle du patient), institutionnelle (l’établissement de soin) et sociétale. À cette fin, les stratégies de définition de doses ont été envisagées au regard de leurs fondements et de leurs spécificités tandis que le concept d’une dose « juste » a été exploré dans une perspective pluridimensionnelle pour être ensuite articulé à ces différentes stratégies.</div></div><div><div>Cancer chemotherapies are an essential part of the treatments for oncological diseases. Given the different approaches available, establishing the “right” dose is as much an ethical challenge as a medical one. The aim of this contribution is to develop a concept of “right dose” in its individual (patient), institutional (healthcare establishment) and societal dimensions. To this end, strategies for defining doses have been considered in terms of their foundations and specificities, while the concept of a “right” dose has been explored from a multidimensional perspective and then articulated to these different strategies.</div></div>","PeriodicalId":72955,"journal":{"name":"Ethique & sante","volume":"22 3","pages":"Pages 163-168"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}