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Accueil > Colloques, journées d’étude, conférences > Healthcare, social sciences, and "philosophy in practice"

Healthcare, social sciences, and "philosophy in practice"

Journée d’étude internationale

14 mars 2022, 9h - 18h30

Université Paris Cité*



Organisation scientifique :
Marta Spranzi maîtresse de conférences HDR, UVSQ Medical School, clinical ethicsconsultant,
AP-HP, R2E Unit, CESP U1018 University Paris-Saclay/INSERM

et Catherine Dekeuwer, maîtresse de conférences HDR, Lyon 3 Jean Moulin University, IRPHIL
& SPHERE UMR 7219, Université Paris Cité/CNRS

Avec le soutien de : MSH Paris Saclay, Unité R2E CESP U1018 Université Paris Cité Saclay, IRPHIL Université de Lyon 3 Jean Moulin et laboratoire Sphère UMR 7219, Université Paris Cité


Journée en présentiel, inscription obligatoire avant le 7 mars :
inscription.philo@gmail.com

[La salle sera communiquée ultérieurement]


La journée d’étude va réunir des chercheurs qui s’intéressent au domaine de la santé avec des approches et des méthodologies empiriques différentes : les sciences sociales, la « philosophie de terrain » ou l’éthique empirique. Les intervenants explorent ces différentes perspectives ainsi que leurs avantages et difficultés respectifs. Ils s’intéressent en particulier à la façon dont les philosophes peuvent contribuer à élaborer des approches normatives innovantes dans ce domaine de recherche.


PROGRAMME

9h - 9h30 Introduction,

  • Marie Gaille (SPHERE UMR 7219, University of Paris/CNRS, Directrice de l’Institut national des sciences humaines et sociales (InSHS)

9h30 - 10h45 “Field philosophers” : what are their objectives and tools ? (résumés)

  • Digital humanism, ethics of care and individualization in light of new E-health measures,

    Giovanni Scarafile (University of Pisa) & Roberto Greco (University of Salento)

  • Collaborative research between field philosophy and medical sciences : From disappointed expectations to long-lasting collaborations,

    Agathe Camus (Post-Doc, SPHere, UMR 7219, Université Paris Cité/CNRS) & Mathilde Lancelot (maitresse de conférence, Centre François Viète, Université de Nantes)


11h - 12h15 Making new forms of justice effective : a new task for field philosophers ? (résumés)

  • Discursive justice through empirical ethics ? Possibilities and challenges of empirical approaches considering marginalized groups in health care ethics,

    Silke Schicktanz (University Medical Center, Göttingen, Medical Ethics and History) & Mark Schweda (University of Oldenburg, Ethics in Medicine)

  • Narrative methods as a safe space to facilitate affective justice in health and social care,

    Brenda Bogaert (Post-Doctoral researcher, Healthcare Values Research Chair, Léon Bérard Center Lyon, and S2HEP Research Center, University of Lyon 1, Claude Bernard)


13h30 - 14h45 Medical professionalism : How can field philosophers help bridge the gap between theory and practice ? (résumés)

  • Professional ethics in healthcare : Are we speaking about the same ?,

    Sabine Salloch (Professor,Hannover Medical School, Germany)

  • Between philosophical controversies and medical practice in intensive care : how can field philosophers contribute to both ?,

    Marta Spranzi (Associate professor, UVS Medical school,clinical ethics consultant, AP-HP, R2E Unit, CESP U1018 University Paris-Saclay/INSERM)


15h - 16h45 Patients and mental health care professionnals : can field philosophy contribute to improve practices ? (résumés)

  • Persuasion or coercion ? An empirical ethics analysis about the use of influence strategies in mentalhealth community care,

    Emanuele Valenti (Senior Research Associate in Health Care, BristolMedical School)

  • From addiction care to Pascal’s wager : how to help someone who has "fallen" to recover ?

    Margaux Dubar (PhD student and lecturer at Jean Moulin Lyon 3 University, member of IRPhiL and the Healthcare Values Research Chair)


17h - 18h15 Empirical Bioethics or “philosophy in practice” : which directions for further research ? (résumés)

  • Is empirical bioethics philosophy in practice ? Reflections on the rationale, framing and future of empirical bioethics,

    Jonathan Ives (Professor, University of Bristol)

  • A comparison between the basic assumptions of empirical ethics and the practice of empiricalresearch in philosophy,

    Catherine Dekeuwer (Associate professor, Lyon 3 Jean Moulin University,IRPhiL and SPHere UMR 7219, University of Paris/CNRS)

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RÉSUMÉS

9h30 - 10h45 “Field philosophers” : what are their objectives and tools ?
  • Giovanni Scarafile (University of Pisa) and Roberto Greco (University of Salento)
    Digital humanism, ethics of care and individualization in light of new E-health measures
    Integrating digital into healthcare models does not only mean replacing an old analogical system. If, on the one hand, reducing thecosts of current healthcare systems, digital technologies help to ensure health for all, on the other hand, they should avoid therise of a divide between citizens with and without access to digital tools.
    In line with the digitalization strategies planned at the European level[1], it is essential to reflect on the ethical impact derived fromthe implementation of solutions designed for increasingly personalized health, tailored to the patient and the caregiver. Thepersonalisation of medicine, made possible by the adoption of digital technology, should not ignore the question of the verymeaning of personalisation, leaving room for the thematization of a criterion of individualization that should constantly bepursued in the dialogue between theoretic and practical philosophy. Through the constancy of this dialogue, it will be possible tograsp in situ concrete examples of digital humanism in the field of e-health.
    In this situation, we intend to ask ourselves about the forms of rationality required to fulfill these tasks, since the forms ofdisembodied rationality do not seem suitable to meet the challenges highlighted above. Philosophy, therefore, acquires a twofoldtask. First of all, to provide always updated maps of the same criteria of individuation, taking up and updating models already inuse (think of the Leibnizian model of the identity of indiscernibles). Secondly, to reconcile the cogency of the moral norm with theincontrovertible demands of individuality.
    [1] https://digital-strategy.ec.europa.eu/en/activities/digital-programme
  • Agathe Camus (Post-Doc, SPHere, UMR 7219, Université Paris Cité/CNRS) & Mathilde Lancelot (maitresse de conférence, Centre François Viète, Université de Nantes)
    Collaborative research between field philosophy and medical sciences : From disappointed expectations to long-lasting collaborations
    Collaboration modalities within research projects between medical sciences and philosophy are multifaceted and take place invarious institutional contexts. These collaborations sometimes give rise to different expectations from the researchers and/orclinicians directly involved, but also from potential funders, or even from the research participants. Because they are not alwaysclearly stated or discussed, these expectations are sometimes disappointed.
    If “field philosophers”, in the field of healthcare research, are frequently invited to participate in so-called "integrated" researchprogrammes - often with a medical focus (although there are exceptions) – this raises methodological and epistemologicalquestions that are not always addressed upstream. How can different perspectives (i.e. clinical, biomedical, public health, but alsophilosophical, ethical, empirical, etc.) be articulated on the same research object ? What are the conditions for the emergence andpossibility of collaborative and interdisciplinary research ? Under what conditions do they allow the production of ’relevant’knowledge (Coutellec 2021) ?
    We will situate our proposal on a methodological and epistemological level, articulated with issues of research ethics in thehumanities and social sciences. On the basis of practical examples, we will examine the question of expectations in relation to the various actors involved in thiscollaboration. We will underline difficulties encountered in the context of research projects in which we have participated as researchers inphilosophy. These difficulties raise questions about the place and position of the “field philosopher”, his or her methods and theirarticulation with those more traditionally used in the healthcare research field. They also raise questions about the place ofknowledge produced within a collective and multidisciplinary research project.
    These questions are part of a context of so-called "project-based" research, accompanied by the promotion of interdisciplinarity,and based on a double movement of institutionalisation and internalisation of the ethics of research. In such a context, theinvitation to the philosopher is sometimes based on a misunderstanding.
    As a counterpoint, we will also evoke situations of durable collaboration, transformed and allowing to overcomemisunderstandings or obstacles initially encountered.


11h - 12h15 Making new forms of justice effective : a new task for field philosophers ?

  • Silke Schicktanz (University Medical Center, Göttingen, Medical Ethics and History) and Mark Schweda (University of Oldenburg, Ethics in Medicine)
    Discursive justice through empirical ethics ? Possibilities and challenges of empirical approaches considering marginalized groups in health care ethics
    Background : The discourse of healthcare ethics is still dominated by experts. Empirical research can serve as a tool to achieveepistemic justice for overheard, silenced, or dissident voices and their normative claims.
    Problem : Socio-empirical methods have certain constraints, biases and pragmatic limitations when it comes to the representationof certain marginalized voices. There can be problems regarding their collection and interpretations well as doubts about theirnormative implications and representiveness. Approach/discussion : We analyze the potentials of empirical and participatory approaches in healthcare ethics with regard toepistemic and discursive justice. In doing so, we focus in a second step on challenges arising when specific marginalized groupsare to be included, e.g., people with cognitive impairments. Outlook : Instead of a strict division of labor between philosophy and social sciences, we plead for an ethically reflected empiricalapproach and define normative-methodological requirements for a more comprehensive realization of epistemic and discursivejustice
  • Brenda Bogaert (Post-Doctoral researcher, Healthcare Values Research Chair, Léon Bérard Center Lyon, and S2HEP Research Center, University of Lyon 1, Claude Bernard)
    Narrative methods as a safe space to facilitate affective justice in health and social care
    Philosopher Amia Srinivasan, in an approach complementary to Miranda Fricker’s concept of epistemic injustice, has shown thefacilitating role emotions can play in exposing injustices. She defines affective injustice as those situations where persons areforced to choose between expressing their emotions and acting in a socially accepted manner, or acting “prudentially.”[1] Theseissues play out in health and social care as emotions are often seen as an impediment to working well in interdisciplinary teams,with patients/users, and irrelevant for monitoring and evaluation. This means that they are rarely valued either in training or in the field[2] However as Srinivasan has shown, hiding emotions may result in squashing issues of injustice central to the transformation of institutions. In this contribution, we discuss how narrative methods can function as a safe space for affective injustice. We will discuss diaries written during the first confinement in France in social and medical-social sectors and how their relatively open form helped facilitate the recognition of the lived experiences of these professionals, including bringing attention to those institutional tensions that would otherwise have been stifled.
    [1] Srinivasan, A. (2018). The Aptness of Anger. Journal of Political Philosophy, 26(2), 123 144. https://doi.org/10.1111/jopp.12130
    [2] Bogaert, B. (2020). Untangling fear and eudaimonia in the healthcare provider-patient relationship. Medicine, Health Care andPhilosophy. https://doi.org/10.1007/s11019-020-09956-1


13h30 - 14h45 Medical professionalism : How can field philosophers help bridge the gap between theory and practice ?

  • Sabine Salloch (Professor,Hannover Medical School, Germany)
    Professional ethics in healthcare : Are we speaking about the same ?
    Medical professionalism forms the subject of a wide and diverse range of academic disciplines : Historical analyses often focus onthe development of professional formations in various national contexts and eras. The sociology of the professions constitutes adistinct and theoretically rich field of research analyzing key factors of professionalization on the individual, institutional andsocietal levels. Also in healthcare education, professionalism is a major subject and the related competencies are included inteaching curricula and practical courses.
    In all academic branches mentioned professional ethics forms a key aspect of the general notion of healthcare professionalism –often without clear linkage to philosophical approaches that have been developed to clarify the specific character, scope andlimitations of professional ethics. In the presentation, key disputes from the “philosophy of professional ethics” will be introducedand their impact on physician practice will be illustrated. A special focus is laid on deontological / rule-based approaches towardsprofessional ethics and on the question whether professional ethics necessarily involves a supererogatory moment. Thepresentation ends with concrete suggestions for the further development of theories of professional ethics and for the practice ofprofessional organizations issuing ethics codices.
  • Marta Spranzi (Associate professor, UVS Medical school,clinical ethics consultant, AP-HP, R2E Unit, CESP U1018 University Paris-Saclay/INSERM)
    Between philosophical controversies and medical practice in intensive care : how can field philosophers contribute to both ?
    Controversies in medical ethics often involve philosophers and philosophical notions. Outstanding among them is the oneconcerning the similarity/difference between euthanasia and withdrawing and withholding of treatment. These issues also arevery salient on the ground. I will describe how empirical research can affect the theorical debate, and viceversa, how a philosopher can bring her competence to bear on medical practice. I’ll do so by drawing on a clinical bioethics study, I conductedwith colleagues at the Clinical ethics center (AP-HP Paris) devoted to « Practitioners’ perceptions of different kinds of withdrawingand withholding treatment (“Wd & Wh”) decisions in intensive care units ».These practices in France are founded upon twoprofessional and legal normative principles : the “discontinuity” between “Wd & Wh” and active euthanasia, and the ethical“equivalence” between all forms “Wd & Wh” decisions. Both premises are contested from the theoretical point of view and neitherdo they easily fit facts on the ground.Anecdotical observations showthat a) practitioners find certain “Wd & Wh” decisions “active”,i.e. potentially morally problematic, and b) that a great variability exists among the way different instances of “Wd & Wh” areperceived. The study results show that on both the Continuity and the Equivalence issue, practitioners vary widely (tree groupshave been identified) and that such variation depends on the values that each of them considers as the overarching guide to theirpractice : either avoiding loss of chance for the patient, or trying to maximize her future quality of life. The study exposed thereasons and origins of intensivists’ “variability” on these issues, as the phenomenon is referred to in the literature (Nadig and Ford2019), i.e. the physicians’ personal and radically different approaches to the perception of “Wd & Wh” practices. In other words, Iargue that medical professionalism has to be complemented by a richer notion of medical integrity, which is itself inseparablefrom a form of personal integrity


15h - 16h45 Patients and mental health care professionnals : can field philosophy contribute to improve practices ?

  • Emanuele Valenti (Senior Research Associate in Health Care, BristolMedical School)
    Persuasion or coercion ? An empirical ethics analysis about the use of influence strategies in mentalhealth community care
    Influence strategies such as persuasion and interpersonal leverage are used in mental health care to influence patients’ behaviour and improve adherence to the treatment. One of the ethical concerns about their use is that they may constitute informal coercion and negatively impact patients’ satisfaction and quality of care. Influence strategies may have different impacts onpatients’ perceptions, and hence an umbrella definition of informal coercion may be unsatisfactory. Furthermore, previous research (Valenti, 2015 et al.) showed that professionals perceive dissonance between theoretical reports of informal coercion provided by literature and their behaviours in clinical practice. In my presentation, I will indicate how the finding of secondary data analysis of a qualitative study identified a contradiction between the theoretical frameworks of coercion applied by medical sociology and clinical psychiatry and professionals’ experiences explored in the study. My analysis will be focussed on the contradiction between the normative account extracted by empirical studies related to informal coercion and professionals’ views examined in our qualitative study. Notably, we will explore how two different theoretical frameworks about informal coercion influenced the empirical research in mental health, e.g., the “enforcement approach” and the “pressure approach” (Anderson,2008). The former is extracted from political philosophy (Dahl, 1951), the latter by analytical philosophy (Nozick, 1967), and law (Wertheimer,1993). Finally, I will highlight how findings showed that all pressures and leverages are coercive when they have specific characteristics and how mental health professionals are rarely aware of that within their everyday practice.
  • Margaux Dubar (PhD student and lecturer at Jean Moulin Lyon 3 University, member of IRPhiL and the Healthcare Values Research Chair)
    From addiction care to Pascal’s wager : how to help someone who has "fallen" to recover ?
    Faced with a loved one who suffers from addiction, we can quickly give in to either a feeling of helplessness or a cascade of abuses for wanting to "save" them. If they no longer seem to have the strength to control their consumption and behave normally, can we decide and act in their place, even if it means locking them up ? There is a paradox in claiming to pull someone out of addiction by placing them under one’s control... this is why, against those around them who deplore the addict’s lack of willpower, caregivers prefer to push them to stimulate their motivation. Addiction care has evolved considerably since the turn of the century : risk reduction or reasoned consumption are objectives that are increasingly imposed on the imperative of abstinence, the therapeutic alliance with the healthcare professional and even the commitment of the patient as an actor in their care, which are supposed to replace the old paternalistic model. However, my field investigation in the day hospital and in a support groupled me to question this evolution of discourse and practices : does it really give the person who has fallen the means to recover ? Reading Pascal’s famous wager will allow me to get out of the impasse of physical constraint or demonstration by A + B to reflecton a reconditioning of the body supported by a "negative" persuasion.


17h - 18h15 Empirical Bioethics or “philosophy in practice” : which directions for further research ?

  • Jonathan Ives (Professor, University of Bristol)
    Is empirical bioethics philosophy in practice ? Reflections on the rationale, framing and future of empirical bioethics
    In this talk I will outline briefly the ongoing project of ‘Empirical Bioethics’ as it has played out in the UK, and reflect briefly on the similarities and differences between the framing of empirical bioethics in the UK, mainland Europe, Australia and the US.
    In so doing, I will outline the rationale for empirical bioethics as a form of practical applied ethics, and frame it as a pragmatic response in part to concerns in the academy about the limits of philosophical applied ethics, and in part to the priorities offunders and policy makers. Drawing on examples of my previous and current empirical bioethics research, I will consider what this means for the methods used in gathering and analysing data for empirical bioethics, and how this might deviate from standard approaches in other empirical disciplines.
    I end by offering a reflection on some of the challenges I foresee for the future of empirical bioethics, and the opportunities for the field offered by international collaboration around methodologies.
  • Catherine Dekeuwer (Associate professor, Lyon 3 Jean Moulin University,IRPhiL and SPHere UMR 7219, University of Paris/CNRS)
    A comparison between the basic assumptions of empirical ethics and the practice of empiricalresearch in philosophy
    P. Borry, P. Schotsmans and K. Dierickx (2004) identify four basic assumptions of empirical ethics. Among them, I will focus on the ways empirical ethics considers people’s actual moral beliefs and reasoning : should they be only the starting point of ethics or play a more substantial role ? Secondly, according to empirical ethics, the methodology of the social sciences is useful because it is a way to map these realities, as well as people‘s behaviors and moral intuitions. However, can we consider that the task to map the reality is the only or the best way to use social sciences‘ methodologies ? I will discuss these two basic assumptions in regard of my own empirical researches in philosophy and I will show to what extent ethnographic material is fruitful for philosophical purposes.
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