Pour une doctrine actuellement majoritaire, le contrat désigne l’acte juridique donnant exclusivement naissance à des obligations, soit une contrainte pesant sur la seule personne des parties. Cette approche subjectiviste du contrat fait obstacle à ce qu’il puisse être justifié que certains actes relatifs à une chose se doublent d’un effet réel, c'est-à-dire, d’une limite assignée au libre exercice des prérogatives juridiques relatives à la chose objet du contrat. En consentant à l’acte, le débiteur ne s’oblige pas seulement ; il s’engage à permettre la réalisation du contrat. Le sujet renonce à une part d’autonomie juridique, laquelle se traduit notamment par l’affectation du bien et donc par une perte du libre exercice de sa prérogative sur la chose. À l’effet personnel du contrat s’ajoute un effet réel. La prise en compte de l’effet réel du contrat permet de résoudre, par exemple, les difficultés liées à la détermination de la portée de l’engagement consenti par le propriétaire engagé à une promesse unilatérale, d’expliquer la situation du bailleur ou encore celle de l’apporteur d’un bien en propriété à une société. Inconnu du Code civil et des divers projets de réforme du droit des obligations, mais encore de la doctrine, l’effet réel du contrat ne peut être traduit à l’aide d’une notion existante. L’étude menée suppose donc de procéder à l’élaboration tant de la notion d’effet réel du contrat que d’un régime spécifique. Au terme de cette étude, il est conclu que la consécration de la notion d’effet réel du contrat permet d’appréhender l’ensemble des manifestations de l’engagement contractuel. / For the dominant legal doctrine, a contract is an act creating obligations between parties. This subjective approach, centered on the parties’ personal liability tends to preclude any justification of a potential effect in rem – i.e. a limit to the free exercise of legal powers on the subject matter of the contract. By agreeing to the contract, the contractor not only takes on an obligation, but also pledges to allow the completion of the contract, which implies his submission to a limitation of his rights, especially those relevant to the subject matter of the contract. In addition, as it may carry an assignment of property, a contract cannot be reduced to a simple creation of obligations. The admission of effets in rem makes it possible to establish the duties of an owner bound by a unilateral promise to sell and to explain the commitment of a lessor or of a shareholder bringing assets into the business. Ignored by law and by doctrine, the in rem effect of a contract cannot be fully understood through pre-existing notions. The subject of the study therefore consists in developing an entire theory of effect in rem of contract. In conclusion, it will appear that its recognition is a necessity to fully measure the scope of contractual liability.

This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis. / QC 20100714

No description available.

AIDS has had a negative impact on developing countries. Because most developing countries cannot afford the new antiretroviral drug therapies, it has been suggested that preventive vaccines might reduce the spread of the HIV/AIDS epidemic (Bloom, 1998). The clinical trials of AIDS vaccines do, however, present with complex ethical issues such as informed consent. Informed consent is primarily grounded on the Western principle of respect for individuals as autonomous agents. This may be at variance, however, with African societies' emphasis on the social embeddedness of the individual. The current study forms part of the HIVNET vaccine trials to be conducted in Hlabisa, in Northern Zululand, under the auspices of the South African Medical Research Council. The main aim of the study was to explore key informants' cultural conceptions of research and informed consent in order to facilitate community consultation and cultural sensitivity. Maximum variation sampling was used to select twenty-three key informants, who are in leadership positions within Hlabisa. An interview guide was used to facilitate narrative disclosure of cultural conceptions of research and informed consent. Perceptions of research, conceptions of the informed consent process, and projected motivations for why individuals agree to participate in studies were explored during interviews. Results suggest that members of the Hlabisa community have a limited understanding of the Western research process. Community education about research is therefore warranted. Informants indicated that community members would value the establishment of a relationship characterised by mutual respect for cultural differences between researchers and participants. This was perceived as likely to facilitate shared decision-making, and the reduction of the power differentials that exist between researchers and participants. While the involvement of key community leaders and family members was recommended by most informants, a few informants felt that participants could also make individual decisions about participation. The theoretical implications of the study are considered last. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 1999.

In the history of public health vaccines have proven to be among the most effective disease prevention tools. It is clear that in the fight against HIV that new and powerful preventive technology such as a vaccine is badly needed. Ethically, however the processes of developing a vaccine against HIV have been distinctly different from that of any previous pharmaceutical products. HIV vaccine trials can be ethically complex for a number of reasons. In 2004 the HIV I AIDS Vaccine Ethics Group undertook a research initiative that aimed to collect data from various South African stake holders of HIV vaccine trials to ascertain what they perceived as the ethical challenges related to HIV vaccine trials. A quantitative content analysis on the data from 31 semistructured interviews revealed that the ethical issue listed spontaneously by most of the respondents was that of informed consent. Further probing and discussion on informed consent identified a number of sub issues which the respondents thought would pose important challenges to HIV vaccine trials in the South African context. This study undertook to do a more in-depth qualitative analysis of the data to ascertain whether the challenges and concerns the stakeholders have are consistent with or different to those already identified in the literature and ethical guidelines on informed consent in medical research. What variables may be impacting on the position stakeholders take was also of interest. Results indicated that many concerns relating to the substantive and procedural elements of informed consent were consistent with those debated in the literature. These issues related to first person consent, the voluntariness of participants' consent, practicing cultural sensitivity, dealing with language issues, promoting and assessing understanding of material disclosed, issues around the vulnerability of .. participants, children and adolescents' capacity to consent and the role of the media. More specific to the South African context, stakeholders were concerned about the legal framework under which the trials take place, the general lack of education and training about HIV vaccine trials, a lack of communication and coordination between stakeholder groups, and the historical influences of apartheid on black South African participants' capacity to consent. The main variables that appeared to impact on the position stakeholders took related to the role the stakeholders play within the trials, the philosophical position underpinning their ethical viewpoints, stakeholders' understanding of vulnerability and capacity to consent, and how they view the universality or relativity of ethical issues. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

La recherche biomédicale réalisée en situation d'urgence traduit la confrontation entre différents principes conducteurs éthiques. Le respect de l'autonomie de la personne, illustré à travers l'obtention du consentement libre et éclairé du sujet pressenti, peut sembler un concept vide de sens dans le cas des malades présentant une condition médicale critique. Pour ces patients en proie à une crise médicale, et donc vulnérables, une protection individuelle accrue s'impose. Une surprotection irait, toutefois, à la fois à l'encontre du principe de justice distributive et du principe de bienfaisance, impliquant de ne pas exclure totalement un groupe de sujets des expectatives élevées de bénéfices d'une recherche correctement balisée. Ce texte a pour objectif de cerner quel est le fondement - éthique - des textes législatifs, réglementaires et normatifs qui permettent l'enrôlement de ces malades atteints de pathologies foudroyantes dans des protocoles de recherche, alors même qu'aucun consentement, qu'il soit autonome ou substitué, n'a été donné. Inspirée du modèle de réflexion éthique pluraliste, l'auteur pose comme hypothèse que c'est le principe de justice distributive qui sous-tend la politique éthique de tels textes, puisque contribuant au développement des avancées thérapeutiques en urgence et à la nécessité d'augmenter l'efficacité des traitements disponibles. Ce texte cherche finalement à définir une démarche d'approbation des protocoles de recherche qui seront réalisés en situation d'urgence. / Biomedical research performed under emergency conditions highlights the conflict between competing ethical principles. The respect for the autonomy of the person, illustrated by the need to obtain a subject's informed consent, can seem an empty concept in the case of a patient presenting severe medical conditions. For those patients in a midst of a medical crisis, and therefore vulnerable, particular protection is necessary. An overprotection would, however, contravene both the principles of distributive justice and of beneficence, principles that hold that an entire group of subjects ought not to be excluded from the expectations of the benefits of properly controlled research. The object of this text is to discem the ethical foundation of the legislative, regulatory and normative texts that permit those stricken with devasting diseases to participate in research projects without consent having been granted. Based on the pluralist ethical model, the author asserts as a hypothesis that it is the principle of distributive justice which supports the ethical policies underlying such texts, since contributing to the development of therapeutic advances in emergencies and to the necessity of increasing the effectiveness of available treatments. This text attempts ultimately to establish procedures to be followed in obtaining approval in research projects in the case of an emergency. / "Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de maîtrise en droit option Droit et Biotechnologies". Ce mémoire a été accepté à l'unanimité et classé parmi les 15% des mémoires de la discipline.

Tout employeur qui fournit l'accès Internet au sein de son entreprise a intérêt à surveiller l'usage qui en est fait par ses employés, que ce soit pour maximiser les avantages ou pour réduire les risques liés à l'utilisation d'Internet au travail. Tout employeur a d'ailleurs le droit d'exercer une telle surveillance, sous réserve toutefois des droits des personnes surveillées. La mise en place d'une surveillance de l'utilisation d'Internet au travail peut porter atteinte à la vie privée des employés ou à leur droit à des conditions de travail justes et raisonnables, et peut également porter atteinte au droit à la vie privée des tiers indirectement visés par la surveillance. Dans ce contexte, afin de s'assurer que la surveillance est exercée dans les limites de ses droits, l'employeur doit franchir deux étapes de réflexion essentielles. L'employeur doit en premier lieu déterminer le niveau d'expectative raisonnable de vie privée des personnes surveillées, lequel niveau s'apprécie à la lumière d'une série de facteurs. L'employeur doit par ailleurs respecter les critères de rationalité et de proportionnalité. Ces critères requièrent notamment que l'employeur identifie les motifs sous-jacents à la surveillance ainsi que la manière dont la surveillance sera exercée. Une fois ces deux étapes franchies, l'employeur sera en mesure d'identifier les obligations auxquelles il est soumis dans le cadre de la mise en place de la surveillance. / All employers providing Internet access to their employees should implement Internet monitoring in the workplace, to increase the benefits and reduce the risks related to Internet use at work. Employers have the right to implement this kind of monitoring subject, however, to the rights of employees and third parties. The implementation of Internet monitoring within the workplace can affect employees' privacy and the right to fair and reasonable conditions of employment, as well as the rights of third parties who may be indirectly subject to monitoring. In this context, the employer should go through two steps of reasoning. The employer should first determine the level of reasonable expectation of privacy of all individuals monitored, which level is assessed in the light of numerous factors. The employer must also meet the criteria of rationality and proportionality. These criteria require that the employer identifies the reasons behind monitoring, and how monitoring will be exercised. After these two steps, the employer will be able to identify the obligations to which he is submitted through the implementation of Internet monitoring.

Introduction: Stigma associated with HIV/AIDS creates a barrier to prevention, care and treatment of HIV/AIDS. It further restricts PLWHA from learning about their status, disclosing their status, adopting safe behaviour and accessing services such as antiretroviral treatment. Disclosure of HIV status and a reduction in stigma may contribute to the decrease in new HIV cases. Purpose: The purpose of the study was to develop a community-based framework that would encourage people living with HIV/AIDS to disclose their HIV status and reduce the stigma associated with the disease. Method: This study used the action research method to explore the experiences of stigma and disclosure of HIV status and to develop a community based framework with PLWHA who encouraged disclosure and promoted the reduction of stigma in a community-based setting. The research setting was Bhambayi, an informal settlement in the district of Inanda. Non-probability purposive sampling was used. In-depth interviews with PLWHA that had disclosed their HIV status and focus group discussions with family members, adult children and community members were conducted. Findings: The data was analyzed manually and the following categories and subcategories emerged. The categories were experience of disclosure, stigmatizing reactions, lifestyle changes after disclosure and supports to reduce stigma. Some of the sub-categories were ‘opens out the illness’, gossiping and pointing fingers, discrimination against PLWHA by family and community, changes in relationships, community awareness and formation of support groups. The findings revealed that PLWHA that had disclosed their HIV status had changed their lifestyles. Recommendations were made on the need for nurses to develop community engagement projects and establish partnerships in order to reach out to communities regarding HIV/AIDS. Incorporate HIV/AIDS stigma and discrimination into the current nurses’ curriculum. The need for research is expressed on the evaluation of the framework and conducting similar research in larger communities. Conclusion: PLWHA who had disclosed their HIV-status shared their experience of being HIV-positive and encouraged other people to get tested. The community-based framework to facilitate disclosure and reduce stigma among PLWHA can be operationalised in other informal community-settings. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

This paper analyses mental patient’s rights. Mental patient has all political, economic, social and cultural rights. Mental patient with a mental illness has a right to appropriate, accessible and suitable medical aid provided free of charge at state health-care institutions. The paper further discusses such patients’ rights as the right to confidentiality with regard to information concerning their health. Involuntary hospitalization is studied in consideration of the constitutional right to liberty of an individual. Paper analyses criteria for involuntary hospitalization. The institute of guardianship is also discussed.

Problématique : Implanté en 2004 au Bénin, le programme national de prévention de la transmission du VIH de la mère à l’enfant (PTME) semble globalement bien implanté. Toutefois une enquête, en 2005, révèle certaines difficultés, particulièrement au niveau de la couverture du programme: seulement 70 à 75 % des femmes enceintes vues en consultations prénatales ont été dépistées et 33 % des 1150 femmes dépistées séropositives ont accouché suivant le protocole de PTME. En outre, d’un site à un autre, on relève une grande variation dans la couverture en termes de dépistage et de suivi des femmes enceintes infectées. Cette faiblesse dans la couverture nous a amené à questionner le contexte organisationnel dans lequel le programme est implanté. Objectif : L’objectif général de cette thèse est d’analyser l'implantation de la PTME au Bénin. Le premier objectif spécifique consiste à identifier et comprendre les enjeux reliés à la façon de rejoindre les femmes enceintes dans le cadre du dépistage. Le second consiste à comprendre le contexte d’implantation et son influence sur la mise en œuvre de la PTME. Méthodologie : Cette recherche évaluative s’appuie sur une étude de cas. Six maternités ont été sélectionnées avec le souhait de représenter les différents contextes d’organisation des services. Les données ont été collectées par observation non participante, entrevues semi-dirigées (n=41) réalisées avec des prestataires de services, analyse documentaire des rapports d’activités des maternités et par questionnaires administrés aux femmes enceintes en consultations prénatales (n=371). Résultats : Le premier article a permis d'apprécier le caractère libre et éclairé du consentement au dépistage. Une majorité des femmes enceintes, suivies dans les centres privés, ont été dépistées sans être effectivement informées de la PTME alors que les femmes fréquentant les autres maternités connaissent mieux les composantes de la PTME. Le caractère volontaire du consentement des femmes est généralement respecté sur tous les sites. Le deuxième article porte sur l'analyse de la qualité du conseil pré-test. Seulement 54% des femmes enceintes ont participé à un conseil en groupe et 80% à un conseil individuel. Dans les centres où sont dispensées des séances d'information de groupe, la qualité est meilleure que dans les centres qui dispensent un conseil individuel exclusif. Le troisième article analyse l'influence du contexte d'implantation sur la mise en œuvre du programme. Parmi les facteurs qui contribuent favorablement à la mise en œuvre on relève la proximité d’un centre de référence et la coordination des activités de PTME dans une zone géographique, la responsabilisation du prestataire dédié à la PTME, la supervision formative régulière accompagnée de séances de discussion collective et l’implication des médiatrices dans la recherche active des perdues de vues. A l’opposé, la responsabilisation des médiatrices pour la réalisation du conseil individuel et du dépistage ne favorise pas une bonne mise en œuvre de la PTME. Conclusion : Nos résultats montrent qu'il est possible de jouer sur l'organisation des services de santé dans le cadre du programme du PTME pour améliorer la façon dont le programme est implanté tant dans les centres privés que publics, sans que cela ne représente un ajout net de ressources. C'est le cas de l’amélioration de la qualité du conseil et du dépistage, de l’implantation du processus interne d’apprentissage organisationnel et de la coordination des services. / Problem: Launched in 2004 in Benin, the national program for prevention of mother-to-child transmission (PMCTC) of HIV appears to have been well implemented. Nevertheless, a 2005 survey revealed certain problems, particularly with respect to the program’s coverage: only 70% to 75% of pregnant women seen in prenatal consultation were screened, and only 33% of the 1,150 women found to be HIV-infected were delivered according to the PMCTC protocol. In addition, there was great variation in coverage from one site to another in terms of screening and of follow-up for infected pregnant women. This inadequate coverage raised questions about the organizational context in which the program is implemented. Objectives: The overall objective of this thesis is to analyze the implementation of the PMTCT program in Benin. The first specific objective is to identify and understand the issues related to how pregnant women are contacted as part of the screening process. The second is to understand the implementation context and its influence on how the PMTCT program is carried out. Methodology: This evaluative research is based on a case study. Six maternity units were selected in order to provide a representative sample of the different service organization settings. Data were collected through non-participant observation, semi-structured interviews (n=41) with service providers, documentary analysis of the maternity centres’ activity reports, and questionnaires administered to pregnant women at prenatal consultations (n=371). Results: The first article, whose objective was to appreciate the free and informed nature of consent to screening, revealed differences between maternity. A majority of pregnant women followed in private centres were screened without being adequately informed about the PMTCT program, whereas the women in others centres were better informed about the specifics of the program. The voluntary nature of the consent was generally respected. The second article analyzes the quality of the pre-test counselling. Only 54% of the pregnant women in our sample participated in group pre-test counselling sessions and 80% in individual counselling. In centres, which organize group information sessions, the quality is better than in centres, where counselling is provided exclusively to individuals. The third article analyzes the influence of the implementation context on how the program is carried out. Among the factors that contribute positively to implementation are: the proximity of a referral centre and the coordination of PMTCT activities within a geographic area; designating a care provider to oversee the PMTCT program; conducting regular formative supervision with group discussion sessions; and involving mediators—HIV-positive women hired by the program to provide psychological accompaniment—in actively seeking out women who have been lost to follow-up. Conversely, putting mediators in charge of individual counselling or of screening does not foster good implementation of the PMTCT program. Conclusion: Our results show that it is possible to adjust the organization of healthcare services for the PMTCT program in order to improve implementation in both the private and public sectors with no net increase in resources. This is the case for improving the quality of counselling and of screening, the implementation of the internal process of organizational learning, and the coordination of services.