The COVID-19 pandemic has had a deleterious impact on the lives of nurses who work in long-term care; however, the moral conditions of their work have been largely unexamined. The purpose of this qualitative study, therefore, was to explore registered practical nurses’ (RPNs) experiences of the moral habitability of long-term care environments in Ontario, Canada during the COVID-19 pandemic. Four themes were identified: (1) Striving to meet responsibilities in a failed system; (2) bearing the moral and emotional weight of residents’ isolation and dying in a context of strict public health measures; (3) knowing the realities of the work, yet failing to be heard, recognized, or supported by management; and (4) struggling to find a means of preservation for themselves and the profession. Attention to the moral habitability of RPNs’ work environments is necessary to achieve a high-quality, ethically attuned, and sustainable nursing workforce in long-term care.

L'hédonisme axiologique a une longue histoire en philosophie. Pourtant, il garde une mauvaise réputation qui lui vaut d’être parfois écarté sans ménagement de la discussion philosophique. Cet article se propose de défendre l'hédonisme axiologique en exposant les principaux arguments en sa faveur et en répondant aux principales critiques et confusions dont il fait l'objet. Une attention particulière sera portée aux arguments établissant la spécificité du plaisir et du déplaisir par rapport à toutes les autres choses — amitié, savoir, justice, etc. — dont on pourrait argumenter la valeur finale.

Novateur à plusieurs égards, l'ouvrage influent de Richard Bodéüs, Le philosophe et la cité, paru en 1982, propose notamment une réinterprétation de la notion complexe de phrónēsis. C'est dans cette foulée que se situe la présente contribution, dont l'objectif est d'analyser une de ses formes plus modeste, l’économie, dans sa partie qui implique le rapport avec les personnes non-libres. À la lumière des observations de Richard Bodéüs sur le commandement, les positions aristotéliciennes concernant la relation maître-esclave seront remises en perspective. Cette démarche conduira, en deuxième partie, à montrer l'extension de la notion servilité, plus large qu'on ne l'admet généralement, ce qui donnera à voir en quoi la nature humaine est esclave, selon le mot du Stagirite (Métaphysique A 2, 982b29-30).

Si la psychiatrie a pour objet la subjectivité (normale et pathologique) et pour outil l’intersubjectivité, la méthodologie ou, sur un autre plan également nécessaire, la déontologie du soin psychiatrique garantissent-elles l’éthique? L’accès au statut de psychothérapeute via la formation autorise-t-il les psychiatres à se penser éthiciens ou, à tout le moins, à se présupposer plus compétents en éthique que les autres spécialistes, lesquels n’auraient jamais envisagé le sujet? Si l’herméneutique du sujet (Foucault) ne se réduit pas à la psychologie, la problématique subjectivité/vérité appelle de facto à un questionnement sur les mœurs, sur la société du malaise (Ehrenberg). Et si intersubjectivité et soins du psychisme étaient le lieu de tous les risques de violation de l’éthique du fait de la normativité inhérente au pouvoir psychiatrique (Foucault)? Et si l’éthique en psychiatrie appelait à un surcroît de questionnement, de prudence en lien avec les impensés ou les pré-jugés de la profession? Nous proposerons mettre ces problématiques en perspective avec quelques-uns des enjeux particuliers de la psychiatrie post-moderne: l’évolution législative, les outils motivationnels, la notion de handicap psychique…

Le tournant sensoriel en droit nous invite à vivre différemment le droit en reconnaissant la centralité de tous nos sens dans l’étude et la pratique d’une vocation qui nous appelle à la quête de sens. Il vise à renverser l’anesthésie générale qui afflige les études en droit, et en droit et société : la juridicité elle-même, c’est-à-dire l’essence du droit – les sens du droit – est une question sensorielle et sensuelle.

Delirium is a major health care problem with potentially serious consequences. Sub-optimal management is an unfortunate but pervasive hallmark of the disorder. We argue that lapses in the care of delirious patients are related to the peculiarities of delirium as a disorder that affects the “self” of the sufferer. Therefore, corruption of self renders behaviour outside the control of the delirious individual and places the person at risk of mechanistic dehumanisation. A proposed solution is to foster an expanded view of the self, taken from recent philosophy and cognitive science, which would allow the clinician to understand pathological behaviour as indicative of disruption to thought. An ethics of care approach that reframes the patient/carer relationship is proposed. These unique propositions could, together, facilitate the development of a framework of more caring and effective practices and relationships for delirium treatment.

The literature on ethics in health care that explores the moral concerns of care providers typically focuses on registered health professionals and ethical dilemmas in acute and primary care. Far less attention has been paid to the long-term care (LTC) environment and non-registered, direct care workers. To address this gap, this research examined the moral concerns of personal support workers (PSWs) who provide direct care to residents. Data were collected during a 5-year participatory action research project to formalize palliative care programs in LTC homes. Eleven focus groups explored PSWs’ experiences providing palliative care in LTC homes, their challenges and learning needs (n = 45). In-depth secondary analysis of these focus groups found that PSWs experienced moral dilemmas. Two main moral dilemmas were ensuring that residents don’t die alone; and providing the appropriate care based on residents’ wishes. Their organizational constraints coalesced around policies, hierarchy, time, and balancing residents’ needs.

What do archaeologists do when approached by groups or individuals with unorthodox, or even simply inappropriate, approaches to, and ideas about the past? What should they do? While much guidance and literature points to education and engagement, in some of the more sensitive or difficult cases it is often more appealing, and simpler, to ignore the issue, in the hopes that it will simply go away. Similarly, on occasions when archaeologists step forward to criticize alternative approaches to archaeological heritage, this does not always meet with positive or desired results. In this paper, in light of recent personal experience with a controversial piece of television programming, I discuss different approaches to responding to challenges to the expertise (and authority) of archaeologists by problematic encounters with concepts of the past. I suggest that while there are arguments in support of (and against) all three of the approaches that I identify (collaboration, condemnation, or ignoring), none provide an absolute solution. In order to discuss these approaches, I draw upon key cases from the literature, as well as personal reflection.

Dementing illnesses, such as Alzheimer's disease, cause great changes in individuals – sometimes even leading us to say that they are “different persons”. Professional caregivers to these individuals may better understand them and their suffering (and thus provide more compassionate care), if they look at the illness in the context of the individual's life. Although their personhood has been threatened by dementia, appreciating the gestalt, or integrity of their lives may help preserve it. The clinical focus, which currently looks only at problems, should also assess the individual's remaining strengths, positive functions and characteristics. A case scenario helps to illustrate these suggestions. Some recommendations to researchers, clinicians and bioethicists for further study in this area are included.

Efforts to address the “paradox of autonomy in long-term care” attempt to salvage an ethic of autonomy by redefining the central concept, and then applying it to the long-term care environment. Such attempts are critiqued, and an alternative ethic of dignity for long-term care is developed. Autonomy, it is argued, is crucial to certain aspects of dignity, but should not be confused with the whole of it. Indeed, long after the capacity for autonomy has diminished or vanished, basic dignity continues to exert normative force.

Every public-policy problem can be defined in terms of its empirical (“facts”) and normative (“values”) dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the application of an analytical framework based on the concept of “narrative frame” analysis. The literature on home care policy reports and recommendations is examined within this conceptual structure – including especially publications and reports from the federal government, national organizations, and the aging and disability communities. Finally, observations and conclusions about the significance of home care policy discourse, and of the differences between the aging and disability constituencies in this debate, are offered as a guide for deconstructing the public-policy process.

This study examines the decision of institutionalizing an elderly parent suffering from cognitive impairments and the various people involved in this process: the elderly person, the informal caregiver, certain family members and health and social service professionals. Based on a qualitative analysis of interviews conducted with 16 elderly people and their family networks, this study reveals the importance of considering the point of view of everyone involved. The results show that one of the main reasons behind the decision to institutionalize an elderly person is the appearance of disturbing behaviours related to his or her cognitive impairments. Diverse strategies used by family members and health and social service professionals in order to bring about the institutionalization of an elderly person when he or she is opposed to it are presented as well as the ethical dilemmas this raises. We conclude with a presentation of research and intervention recommendations.

Elderly adults often pose, or are perceived to pose, a risk to themselves or others. Others often also have the will, and sometimes the ability, to intervene in their lives: to take them from their homes, force medical treatment on them, and prevent them from spending their money as they see fit. Thus the question “To what extent, and for what purposes, can others interfere with the liberty of the individual?” takes on particular relevance for elderly adults. This is the question John Stuart Mill addressed in his essay On Liberty, and our aim is to adapt his theory of liberty to guide those who must make decisions about the old. We argue that individuals can be interfered with in their own interest and in the interest of others. It is apt to interfere in their own interest if and only if they are putting themselves at significant risk, are encumbered, i.e. are incompetent or subject to some other judgement-distorting condition, and interference will be: (a) effective, (b) not generative of evils greater than those it prevents, (c) the mildest possible to curb the evil, (d) not discriminatory, and (e), unless the interference has utility approaching absolute necessity, thought justified. It is apt to interfere in the interest of others if and only if they are putting others at significant risk and the same five conditions are satisfied. As we hope our adaptation of Mill's theory of liberty will have practical effect, we illustrate it with examples, relate it to the law in British Columbia, and state it in the form of a decision-tree.