Les nouvelles technologies de l'information et de la communication (NTIC) sont en train de transformer l'exercice de la médecine. Les systèmes d'information (SI) paraissent complexes à la plupart des usagers. Quelles sont les données hébergées ? A qui peut-on les transférer ? Force est de constater que les patients autant que les professionnels de santé ont du mal à se repérer dans ces nouveaux dispositifs tentaculaires d'échanges dématérialisés. Les médecins doivent-ils communiquer au moyen de supports électroniques avec les patients ? Comment communiquent-ils entre eux ? Les données de santé qui circulent sur les réseaux sont-elles sécurisées ? A coup sûr, le perfectionnement des outils de communication constitue une chance d'améliorer la qualité du suivi et de la prise en charge des patients. Cependant, nous manquons encore de recul et de lisibilité. Or, cette relative opacité électronique présente des risques à terme pour l'exercice de la médecine qu'il faut savoir anticiper, à commencer par le soupçon jeté sur le secret médical qui est la pierre angulaire du colloque singulier. Sur un plan méthodologique, la présente recherche délimite son objet d'étude, en se cantonnant au « parcours patient » de la filière cancérologie. Un travail d'enquête sur les besoins des professionnels de santé a été mené dans des établissements de santé des Bouches-du-Rhône. Il a servi à la mise en œuvre d'une modélisation éthique des SI en s'appuyant sur la base des quatre principes de l'éthique biomédicale: autonomie, bienfaisance, non-malfaisance, justice. / New information and communication technologies (NICT) are transforming the practice of medicine. Information systems (IS) appear complexes to most of users. What are the data hosted? Who can I transfer them? It is clear that patients as well as health professionals are struggling to locate in these new devices sprawling computerized exchanges. Physicians have to communicate through electronic media with patients? How do they communicate with each other? The health information circulating on the networks are secure? Certainly, development of communication tools is a chance to improve the quality of monitoring and management of patients. However, we still lack a step back and readability. However, this relative electronic opacity presents, at the end, risks to the practice of medicine need to know ahead, starting with the suspicion cast on medical confidentiality is the cornerstone of the special dialogue. On a methodological level, this research defines its object of study, being confined to the "patient circuit" of the cancer sector. Survey work on the needs of health professionals was conducted in health facilities in the Bouches-du-Rhone. He served in the implementation of an ethical model of IS based on the basis of four principles of biomedical ethics: autonomy, beneficence, non-maleficence, justice. The interest of this model is generating scores and ethical charter on initial expectations, the final realization and the means involved in the development of an IS in oncology. This thesis attempts to show that it is possible to reconcile ethics and technology by converting the technical language in the terminology of ethics.

IntroductionPreimplantation Genetic Diagnosis (PGD) was developed in the 1990s and has been used since to diagnose and discard embryos with genetic conditions or chromosomal abnormalities. CRISPR-Cas9 was discovered in 2012 and has been used in research, but has not become clinical practice on humans yet. CRISPR-Cas9 could potentially be applied to treat and prevent genetic disorders.AimThe aim was to investigate the ethical dilemmas of each method through a set of research questions. The ethics of applying PGD according to Swedish guidelines and applying CRISPR-Cas9 on humans was investigated.MethodologyThis was not a systematic literature review. Instead, articles have been selected based on their explanation of each method and uniqueness or volume of ethical arguments surrounding each method, that is of relevance for the discussed issues.ResultsArguments in favour of PGD addressed among other things the somatic and psychological health of future children and parents along with the economical benefits. Arguments against PGD addressed different dilemmas of discarding an embryo and thereby a future individual. Arguments against CRISPR-Cas9 addressed technical limitations, our limited knowledge of genetics and more. Arguments in favour addressed benefits in clinical medicine and research.ConclusionsPGD according to Swedish guidelines was found to be ethically acceptable, since its restrictive use that have not given room for ethically dubious applications. CRISPR-Cas9 was found not to be safe enough for human applications at this moment due to technical limitations. If these were to be solved, caution and restraint must be urged.

Text in English / Health Studies / M.A. (Nursing Science)

Text in English / Health Studies / M.A. (Nursing Science)

Même si composée par un nombre réduit de membres, à peu près 20.000 personnes, pendent le XIXe siècle l’Eglise vaudoise italienne a réussi à se doter d’une grande quantité d’œuvres sociales, grâce à un réseau de relations dense et vaste avec l’Internationale protestante, en Europe et dans l’Amérique du Nord. Hôpitaux, maisons de retraites, orphelinats, écoles professionnelles, colonies de vacances et diaconats ont été les principales réalisations de cet effort social. Suivant trois axes de recherche (les liens entre église et œuvres, les rapports entre l’action sociale ecclésiastique et celui de l’Etat, le problème du financement), le travail traverse environ un siècle d’histoire religieuse et de la sécurité sociale en Italie - entre la Restauration et la législation de Crispi -, en essayant d’expliquer les étapes qui ont permis à cette petite église réformé de se transformer, d’objet de l’assistance étrangère, à un des principaux sujets italiens de services sociaux. / Despite being composed of a limited number of members (about 20000), during the XIXth century the Italian Waldensian Church succeeded in developing a great amount of social works, thanks to a network of relations with the “Protestant International” in Europe and Northern America. This social effort resulted in the development of hospitals, retirement houses, orphanages, professional schools, summer schools and monetary assistance to the poor. This thesis explores a century of Italian social and religious history – from the Restauration to the birth of national legislation on welfare in the Crispinian period – a long three axes of research (the link between church and social works, the relationship between the ecclesiastic and national social intervention, the issue of funding). Its main aim is to identify the steps that allowed this little reformed church to undergo such a significant transformation: from being the recipient of foreign assistance to being one of the key agents in Italian social assistance. / Anche se composta da un numero esiguo di membri, circa 20.000 persone, durante l’Ottocento la Chiesa valdese italiana è riuscita a dotarsi di una grande quantità di opere sociali, grazie a una fitta e ampia rete di relazioni con l’Internazionale protestante, in Europa e Nord America. Ospedali, ospizi, orfanotrofi, scuole professionali, colonie estive e borse dei poveri furono i principali risultati di questo sforzo sociale. Attraverso tre assi di ricerca (il legame tra chiesa e opere, i rapporti tra l’azione sociale ecclesiastica e quella statale, il problema del suo finanziamento), il lavoro percorre circa un secolo di storia religiosa e assistenziale in Italia - dalla Restaurazione alla nascita di una legislazione statale in materia assistenziale in epoca crispina –, cercando di mostrare le tappe che hanno permesso a questa piccola chiesa riformata di trasformarsi, da oggetto dell’assistenza straniera, a una delle principali soggetti italiani di servizi sociali.

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The therapeutic privilege is a defence in terms of which a doctor may withhold information from a patient if disclosure of such information could harm the patient. This study explores the defence of therapeutic privilege and provides a critical evaluation. A comparative investigation is undertaken, while arguments springing from a variety of disciplines are also incorporated. A number of submissions are made for limiting the ambit of the defence. The main submission is that the therapeutic privilege should comply with all the requirements of the defence of necessity. In addition, it should contain some of the safeguards afforded to the patient by the requirements of the defence of negotiorum gestio so that therapeutic privilege is out of the question if medical treatment is administered against the patient's will, or the doctor has reason to believe (or knows) that the patient will refuse to undergo an intended intervention once properly informed. / Jurisprudence / L.L.M. (Jurisprudence)

This thesis is a context-sensitive study of key epistemological commitments and concerns presented in Philo’s two series of exegetical writings. The major conclusion advanced in this thesis is that two theological epistemologies, distinct yet related, can be detected among these writings. The first epistemology is specific to the Allegorical Commentary. The second epistemology is specific to the ‘Exposition of the Law.’ The epistemology of the Allegorical Commentary reflects a threefold conviction: the sovereignty of God, the creaturely contingency of the human mind and its inescapable limitations. In conversation with key epistemological notions of his day, Philo develops this threefold conviction in exegetical discourses that are grounded in Pentateuchal texts portraying the God of Moses as both possessing epistemic authority and aiding the aspiring mind to gain purification and perfection in the knowledge of God. Guided by this threefold conviction, Philo enlists key metaphors of his day – initiation into divine mysteries and divine inspiration, among others –in order to capture something of the essence of Moses’ twofold way of ascending to the divine, an approach which requires at times the enhancement of human reason and at other times the eviction of human reason. The epistemology of the ‘Exposition’ reflects Philo’s understanding of the Pentateuch as a perfect whole partitioned into three distinct yet inseverable parts. Philo’s knowledge discourses in the ‘creation’ part of the ‘Exposition’ reflect two primary movements of thought. The first is heavily invested with a Platonic reading of Genesis 1.27 while the second invests Genesis 2.7 with a mixture of Platonic and Stoic notions of human transformation and well-being. Philo’s discourses in the ‘patriarchs’ segment reflect an interest in portraying the three great patriarchs as exemplars of the virtues of instruction (Abraham), nature (Isaac), and practice (Jacob) which featured prominently in Greek models of education. In the ‘Moses’ segment of the ‘Exposition,’ many of Philo’s discourses on knowledge are marked by an interest in presenting Moses as the ideal king, lawgiver, prophet and priest who surpasses Plato’s paradigm of the philosopher-king. In keeping with this view, Philo insists that the written laws of Moses represent the perfect counterpart to the unwritten law of nature. The life and laws of Moses serve as the paradigm for Philo to understand his own experiences of noetic ascent and exhort readers to cultivate similar aspirational notions and practices.

The therapeutic privilege is a defence in terms of which a doctor may withhold information from a patient if disclosure of such information could harm the patient. This study explores the defence of therapeutic privilege and provides a critical evaluation. A comparative investigation is undertaken, while arguments springing from a variety of disciplines are also incorporated. A number of submissions are made for limiting the ambit of the defence. The main submission is that the therapeutic privilege should comply with all the requirements of the defence of necessity. In addition, it should contain some of the safeguards afforded to the patient by the requirements of the defence of negotiorum gestio so that therapeutic privilege is out of the question if medical treatment is administered against the patient's will, or the doctor has reason to believe (or knows) that the patient will refuse to undergo an intended intervention once properly informed. / Jurisprudence / L.L.M. (Jurisprudence)

This thesis explores how the general public understands and responds to dementia. In the context of this study the word ‘understanding' is used to convey the complex co-construction of knowledge and establishing of beliefs that constitutes public understandings of dementia. The study also examines the responses of members of the public to dementia, in the context of their understanding. Data were collected over a 12 month period and included a module in the Northern Ireland Life and Times (NILT) survey, five focus groups and nine interviews with participants from the focus groups. The survey module included thirty measures examining levels of knowledge and attitudes towards dementia. 1200 participants were targeted and the survey was administered by the Northern Ireland Research & Statistics Agency with a response rate of 58%. The focus groups and interviews provided the mechanism to gather a more nuanced picture, exploring the beliefs behind the attitudes and the self-reported responses of participants to people with dementia. Findings indicate that the general public has a reasonable knowledge of the symptoms and pathway of dementia in line with a bio medical model. However the findings also indicate that the general public holds a mix of theoretical and empirical knowledge and that this is often contradictory. A complex mix of scientific or medical information, experience, anecdote and assumptions contribute to the discourse. This information is stored and conveyed in the form of stories and a consequence of this interplay is that individual experiences told in the form of stories are generalised to become building blocks in the construction of what the general public understands dementia to be. The current construction of dementia among the general public is found to be both nihilistic and ageist with clear evidence that dementia is stigmatised. I will argue that that the relationship between dementia and ageing in the minds of the general public is a symbiotic one. Dementia has become a cultural metaphor for unsuccessful ageing marking entry to the fourth age. The stigmatising response of the general public is the result of a complex interplay of multiple factors. I have expanded on previous ideas of multiple jeopardy and intersectionality, suggesting that the stigma associated with dementia is unique and driven as much by emotional responses as by the social location of the person with dementia. I have borrowed Brooker’s (2003) term “Dementia-ism’ to describe this stigma. This thesis argues for a more complex and sophisticated approach to changing public attitudes and reducing stigma. Dementia-ism must be addressed with the same strength of purpose currently applied to sexism, racism and ageism.