L’éthique de l’intelligence artificielle (IA) constitue un domaine de recherche pluridisciplinaire en expansion. Cette thèse s’inscrit dans le champ de l’éthique de l’IA et en propose une nouvelle interprétation. D’entrée de jeu, les nombreux liens qu’entretiennent les défis et opportunités que présentent les systèmes employant l’intelligence artificielle avec le domaine politique y sont exposés. Une hypothèse clé animant cette thèse est que, puisque la politique consiste à répondre au conflit par le dialogue, les décideurs politiques aux prises avec des questions concernant l’IA peuvent tirer profit des orientations fournies par différentes traditions éthiques. Afin de faciliter un dialogue optimal, une prise de position métaéthique particulière est avancée au niveau théorique, soit le « monisme non orthodoxe », tandis qu’une série de questions ciblées est proposée au niveau de la pratique. Divisée en trois sections, la thèse débute avec une exploration métaéthique des fondements des approches éthiques principales qui sont à l’œuvre dans les réflexions contemporaines concernant l’IA. Les écoles éthiques étudiées, en faisant appel au continuum qui distingue le monisme et le pluralisme, sont l’éthique de la vertu, l’utilitarisme et l’éthique déontologique. Ces démarches monistes sont ensuite placées en contraste avec le pluralisme des valeurs, une approche souvent employée, mais rarement nommée de manière explicite. La deuxième section consiste en une analyse métaéthique d’une vingtaine de directives éthiques émises par des compagnies privées, la société civile ainsi que des organisations à multiples partenaires, de même que par des instances gouvernementales ou intergouvernementales. C’est ce portrait qui révèle à quel point le pluralisme des valeurs est récurrent dans ces directives. En outre, il se mêle souvent à d’autres approches éthiques pour générer des versions en situation de « tension métaéthique », bien que cela ne se produise souvent que de manière implicite. En conséquence, les propositions associées à ces approches sont parfois contradictoires, tant en ce qui concerne leur formulation que dans la manière dont elles seraient mises en œuvre. Une approche éthique alternative est proposée dans la troisième section. Cette approche est formée d’éléments dérivés spécialement de l’éthique de la vertu et du pluralisme. Ils fondent le socle sur lequel, dans le chapitre final de la thèse, un « guide dialogique » est développé pour l’usage des décideurs politiques. La prudence, une sensibilité profonde au contexte, une orientation téléologique « douce » vers le bien commun ainsi que l’ouverture à la possibilité de dilemmes insolubles caractérisent cette approche éthique. La philosophie herméneutique est également mise à contribution pour justifier l’articulation d’une série de questions destinées à guider le dialogue des décideurs politiques. En effet, l’herméneutique encourage une logique de questions, plutôt qu’une logique dérivée de principes ou de théories. / The ethics of artificial intelligence (AI) is a growing field of multidisciplinary research. This thesis falls within AI ethics and suggests a new interpretation. The numerous challenges and opportunities generated by AI systems are described at the outset. A key assumption of the thesis is that, given that politics consists of responding to conflict with dialogue, policy-makers dealing with the questions surrounding AI can benefit from the guidance provided by different ethical traditions. Furthermore, in order to facilitate an optimal dialogue, this thesis puts forward a particular metaethical position, that of “unorthodox monism” at the theoretical level, and one consisting of a series of pertinent questions at the practical level. Divided into three main sections, the thesis begins by exploring the metaethical foundations at work in most contemporary thinking about AI. Using a continuum that distinguishes between monism and pluralism in ethics, the particular schools examined are virtue ethics, utilitarianism, and deontology. These monistic approaches are then contrasted with value pluralism, which is an approach that is often employed and yet rarely identified explicitly. The second section consists of a metaethical analysis of a sample of some twenty sets of AI ethical guidelines produced within private companies, civil society and by multi-partner organizations, as well as by governmental and intergovernmental bodies. It is this portrait which reveals how value pluralism recurs in many of these sets of guidelines. Moreover, it is also often implicitly combined with other ethical approaches to generate “mixed” versions, which exhibit metaethical tensions. As a result, the proposals associated with these approaches are sometimes contradictory, both in regards to how they are formulated as well as to how they are to be implemented. Third, an alternative ethical approach is proposed. It consists of elements derived in particular from virtue ethics and value pluralism. They form the basis upon which, in the thesis’ final chapter, a “dialogical guide” is formulated for use by policy-makers. Prudence, a deep sensitivity to context, a “soft” teleological orientation towards a common good, along with openness to the possibility of intractable dilemmas characterize this approach. Hermeneutical philosophy is also drawn upon in order to justify the articulation of a series of questions meant to guide the dialogue of policy-makers. Indeed, hermeneutics calls forth a logic of questions rather than one based on principles or theories.

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.