Charles Dupras

CHARLES DUPRAS | : L’épigénétique est un champ d’études qui s’intéresse aux modifications biochimiques et aux changements dans la structure tridimensionnelle de l’ADN ayant pour effet de contraindre ou de faciliter la lecture et l’expression des gènes. Au cours des dix dernières années, l’épigénétique a attiré l’attention d’un nombre croissant de chercheurs en sciences sociales, puisqu’elle semble venir confirmer, cette fois sur le plan moléculaire, le rôle déterminant de l’environnement développemental des personnes dans la configuration de leur individualité biologique et dans la programmation de leur santé future. Cet article se penche sur les implications épistémologiques potentielles de l’épigénétique. Nous distinguons et décrivons trois perspectives socio-anthropologiques complémentaires, adoptées par différents auteurs, sur le rapprochement des concepts de « nature » et de « culture » par l’épigénétique : la socialisation du biologique, la biologisation du social et la superposition nature-culture. | : Epigenetics is a field of study that focuses on biochemical modifications and changes in the tridimensional structure of DNA that have the effect of constraining or facilitating the reading and expression of genes. Over the last ten years, epigenetics has captured the attention of several social scientists since it appears to confirm, this time at the molecular level, the determining role of the developing environment of people in configurating their biological individuality and programming their future health. This article discusses the potential epistemological implications of epigenetics. It distinguishes and describes three complementary socio-anthropological perspectives, taken by different authors, on the rapprochement of the concepts “nature” and “nurture” by epigenetics: the socialization of the biological, the biologization of the social, and the superimposition nature-nurture.

Artificial womb (AW) prototypes are currently being developed with the aim of improving the medical care of extremely premature infants. Despite the seemingly imminent reality of partial ectogenesis (i.e., gestation partially outside a human womb), there is persisting debate about the moral status of the fetus transferred in an AW—henceforth, the “developing entity.” For some, AWs are simply another neonatal intensive cares’ technology. Thus, developing entities in AWs should deserve the same protections as newborns in incubators. Others consider that AWs are fundamentally different technologies than incubators. Therefore, they believe that developing entities in AWs are new moral entities. These differences in perception generate disagreement about how developing entities in AWs should be treated and how decisions about them should be made. We argue that developing entities in AWs should be considered patients by transposing Chervenak and McCullough's “The fetus as a patient” proposition to the context of partial ectogenesis. As pregnant persons will have to consent to transfer their fetuses in AWs, and this technology will ultimately present itself as a beneficial medical intervention for viable developing entities in AWs, these latter would be patients, even if they are not legally and morally recognized as person. Thus, the moral obligations of beneficence and non‐maleficence owed by physicians to their patients would apply to entities in AWs, ethically guiding their treatment and decision‐making toward them.

Health care professionals assigned to critical care are confronted on a daily basis with particularly trying situations. Their hard work conditions can become anxiety-provoking, affect their physical and/or psychological condition, decrease their performance and increase their absenteeism rate at work. To face this particularly stressful and sometimes depressing context, some professionals fall back on “gallows humour”, a sort of black humour with a morbid overtone, which is likely to shock certain people. Although gallows humour is very widespread, its use in critical care is extremely controversial and most of the time reprimanded by professional orders. Based on the codes of ethics that govern them, professional orders assume that gallows humour violates the duties and responsibilities of their members towards their patients, rejecting its use straightaway. In this article, we contest the categorical rejection of gallows humour in critical care. We adopt a consequentialist perspective based on the study of scientific literature on the benefits of using humour in the workplace, to defend its ethical acceptability. By enabling us to be better prepared to provide care despite the tragic events experienced by professionals, we will see how the use of gallows humour can ultimately have a positive effect on patients. A consequentialist ethics is not only interested in maximizing the benefits of gallows humour but also in reducing the risk of harm to others related to its use. This important criterion will therefore lead us to define the terms and suggest certain conditions that must be respected for an ethical use of this important defense mechanism by health care professionals in critical care.

A rich literature in public health has demonstrated that health is strongly influenced by a host of environmental factors that can vary according to social, economic, geographic, cultural or physical contexts. Bioethicists should, we argue, recognize this and – where appropriate – work to integrate environmental concerns into their field of study and their ethical deliberations. In this article, we present an argument grounded in scientific research at the molecular level that will be familiar to – and so hopefully more persuasive for – the biomedically-inclined in the bioethics community. Specifically, we argue that the relatively new field of molecular epigenetics provides novel information that should serve as additional justification for expanding the scope of bioethics to include environmental and public health concerns. We begin by presenting two distinct visions of bioethics: the individualistic and rights-oriented and the communitarian and responsibility-oriented. We follow with a description of biochemical characteristics distinguishing epigenetics from genetics, in order to emphasize the very close relationship that exists between the environment and gene expression. This then leads to a discussion of the importance of the environment in determining individual and population health, which, we argue, should shift bioethics towards a Potterian view that promotes a communitarian-based sense of responsibility for the environment, in order to fully account for justice considerations and improve public health.

The development of research ethics in the college environment raises specific concerns given the particularities of this environment. This study focuses on three priority issues for the college research ethics community: 1) the question of resources for ethics review by college network research ethics boards; 2) the review of multi-jurisdictional research projects; and 3) the review of student course-based research activities. In order to sound out this community on its concrete realities with regard to these issues, we carried out a mixed real time Delphi study using the Surveylet platform, during which we engaged 31 panelists in dialogue over a total period of five weeks. This article presents the results of our statistical and thematic analysis of the responses obtained, the main consensuses and dissensus identified on the three issues, as well as possible solutions to overcome these issues inspired by the panelists’ proposals.

Despite increased efforts to ensure diversity in genomic research, the exclusion of minority groups from data analyses and publications remains a critical issue. This paper addresses the ethical implications of these exclusions and proposes accountability for reasonableness (A4R) as a framework to promote fairness and equity in research. Originally conceived by Norman Daniels and James Sabin to guide resource allocation in the context of health policy, A4R emphasizes publicity, relevance of reasons, enforcement, and revision as essential for legitimacy and trust in the decision‐making process. The authors argue that A4R is also relevant to resource allocation in research and that, if adequately informed and incentivized by funding agencies, institutional review boards, and scientific journals, researchers are well‐positioned to assess data‐selection justifications. The A4R framework provides a promising foundation for fostering accountability in genomics and other fields, including artificial intelligence, where lack of diversity and pervasive biases threaten equitable benefit sharing.

Epigenetics – the study of mechanisms that influence and modify gene expression – is providing unique insights into how an individual’s social and physical environment impact the body at a molecular level, particularly in populations that experience stigmatization and trauma. Researchers are employing epigenetic studies to illuminate how epigenetic modifications lead to imbalances in health outcomes for vulnerable populations. However, the investigation of factors that render a population epigenetically vulnerable present particular ethical and methodological challenges. Here we are concerned with demonstrating how, in targeting certain populations for epigenetic research, this research may be pathologizing socio-cultural and medical practices in those populations in a way that increases their vulnerability. Using a case study approach, this article examines three vulnerable populations currently of interest to epigenetic researchers – Indigenous, autistic, and transgender populations – in order to highlight some of the challenges of conducting non-stigmatizing research in epigenetics.

Recent findings in epigenetics have been attracting much attention from social scientists and bioethicists because they reveal the molecular mechanisms by which exposure to socioenvironmental factors, such as pollutants and social adversity, can influence the expression of genes throughout life. Most surprisingly, some epigenetic modifications may also be heritable via germ cells across generations. Epigenetics may be the missing molecular evidence of the importance of using preventive strategies at the policy level to reduce the incidence and prevalence of common diseases. But while this “policy translation” of epigenetics introduces new arguments in favor of public health strategies and policy-making, a more “clinical translation” of epigenetics is also emerging. It focuses on the biochemical mechanisms and epigenetic variants at the origin of disease, leading to novel biomedical means of assessing epigenetic susceptibility and reversing detrimental epigenetic variants. In this paper, we argue that the impetus to create new biomedical interventions to manipulate and reverse epigenetic variants is likely to garner more attention than effective social and public health interventions and therefore also to garner a greater share of limited public resources. This is likely to happen because of the current biopolitical context in which scientific findings are translated. This contemporary neoliberal “regime of truth,” to use a term from Michel Foucault, greatly influences the ways in which knowledge is being interpreted and implemented. Building on sociologist Thomas Lemke's Foucauldian “analytics of biopolitics” and on literature from the field of science and technology studies, we present two sociological trends that may impede the policy translation of epigenetics: molecularization and biomedicalization. These trends, we argue, are likely to favor the clinical translation of epigenetics—in other words, the development of new clinical tools fostering what has been called “personalized” or “precision” medicine. In addition, we argue that an overemphasized clinical translation of epigenetics may further reinforce this biopolitical landscape through four processes closely related to neoliberal pathways of thinking: the internalization and isolation of socioenvironmental determinants of health and increased opportunities for commodification and technologicalization of health care interventions.

Background Noninvasive prenatal testing (NIPT) provides important benefits yet raises ethical concerns. We surveyed Canadian pregnant women and their partners to explore their views regarding pressure to test and terminate a pregnancy, as well as other societal impacts that may result from the routinization of NIPT.Methods A questionnaire was offered (March 2015 to July 2016) to pregnant women and their partners at five healthcare facilities in four Canadian provinces.Results 882 pregnant women and 395 partners completed the survey. 64% of women anticipated feeling no pressure to take the test if it were offered routinely, and 39% were not concerned about routinization leading to increased pressure to terminate a pregnancy of a fetus with Down Syndrome. Regarding other social concerns possibly resulting from routinization, pregnant women were most concerned regarding a reduction in resources available for people with Down Syndrome and their families and least concerned regarding a decrease in the population of people with Down Syndrome.Conclusions Our findings reflect the concerns expressed by pregnant women and their partners, both personal (pressure to test, pressure to terminate) and societal (e.g., regarding potential negative impact on people with disabilities and their families). Even if most women were not concerned about feeling pressured to test due to NIPT routinization, a large minority express concerns that should not be taken lightly. Moreover, a majority of respondents were concerned regarding pressure to terminate pregnancies due to NIPT routinization as well as regarding most societal impacts they were queried on, especially the possible future reduction in resources available for people with DS and their families. Canadian policy-makers should consider these potential negative ramifications of NIPT and ensure that appropriate social policies accompany its implementation.

Lee (2017) calls for greater attention to the shared epistemological and normative grounds of both public health ethics and environmental ethics, and to Potter’s original conception of bioethics, which, as she rightly observes, has been largely disregarded in contemporary North American bioethics scholarship and practice. In a previous publication we also argued in favor of reviving the Potterian approach to bioethics; we built a case grounded in “the relatively new field of molecular epigenetics [that] provides novel information that should serve as additional justification for expanding the scope of bioethics to include environmental and public health concerns.”

Imagine that you are part of the editorial board of a young bioethics journal committed to publishing open access (OA) and to ensuring accessibility to high quality and innovative scholarship. To support junior and interna- tional scholars who might not otherwise find places for their work in the leading Western bioethics journals, you do not charge author fees. Imagine also that you have no financial resources to pay for a professional website, auto- mated submissions manager, or even a part-time coordina- tor: Your government has cut all grants for journals, you cannot go to industry for private funding because of the evident risk of apparent conflicts of interest, and your strapped-for-cash institution cannot afford to offer you any support. If one of the major publishers were to approach you to sign a deal, the temptation would be strong to accept. However, this would likely mean putting aside your ideals: It would be impossible to stay a “Green OA” publication (i.e., free of author publication charges) or supportive of junior and international scholars (because of pressures to “increase credibility” through artificially high rejection rates, for example).

While much attention has gone towards ethical, legal, and social implications of direct-to-consumer genetic testing over the past decades, the rise of new forms of consumer omics has largely escaped scrutiny. In this paper, we analyze the product descriptions, promotional messages, terms of service, and privacy policies of five epigenetic and seven microbiomic testing companies. The advent of such tests online represents a significant shift in consumer omics, from a focus on inherited molecules with genetic tests, to broader interest for information about the lives of individuals, such as chronological and biological age, exposures, and lifestyle. Building on previous literature about direct-to-consumer genetic testing, and taking this shift into account, we identify limitations, gaps and inconsistencies in current practices and policies of the new companies. Best practice standards and regulations applicable across different omic sample and data types is a necessary first step in the promotion of responsible consumer omics.

Epigenetic research has brought several important technological achievements, including identifying epigenetic clocks and signatures, and developing epigenetic editing. The potential military applications of such technologies we discuss are stratifying soldiers’ health, exposure to trauma using epigenetic testing, information about biological clocks, confirming child soldiers’ minor status using epigenetic clocks, and inducing epigenetic modifications in soldiers. These uses could become a reality. This article presents a comprehensive literature review, and analysis by interdisciplinary experts of the scientific, legal, ethical, and societal issues surrounding epigenetics and the military. Notwithstanding the potential benefit from these applications, our findings indicate that the current lack of scientific validation for epigenetic technologies suggests a careful scientific review and the establishment of a robust governance framework before consideration for use in the military. In this article, we highlight general concerns about the application of epigenetic technologies in the military context, especially discrimination and data privacy issues if soldiers are used as research subjects. We also highlight the potential of epigenetic clocks to support child soldiers’ rights and ethical questions about using epigenetic engineering for soldiers’ enhancement and conclude with considerations for an ethical framework for epigenetic applications in the military, defense, and security contexts.

Health care professionals assigned to critical care are confronted on a daily basis with particularly trying situations. Their hard work conditions can become anxiety-provoking, affect their physical and/or psychological condition, decrease their performance and increase their absenteeism rate at work. To face this particularly stressful and sometimes depressing context, some professionals fall back on “gallows humour”, a sort of black humour with a morbid overtone, which is likely to shock certain people. Although gallows humour is very widespread, its use in critical care is extremely controversial and most of the time reprimanded by professional orders. Based on the codes of ethics that govern them, professional orders assume that gallows humour violates the duties and responsibilities of their members towards their patients, rejecting its use straightaway. In this article, we contest the categorical rejection of gallows humour in critical care. We adopt a consequentialist perspective based on the study of scientific literature on the benefits of using humour in the workplace, to defend its ethical acceptability. By enabling us to be better prepared to provide care despite the tragic events experienced by professionals, we will see how the use of gallows humour can ultimately have a positive effect on patients. A consequentialist ethics is not only interested in maximizing the benefits of gallows humour but also in reducing the risk of harm to others related to its use. This important criterion will therefore lead us to define the terms and suggest certain conditions that must be respected for an ethical use of this important defense mechanism by health care professionals in critical care.

After six years (2012-2017) of publishing innovative bioethics scholarship, BioéthiqueOnline becomes the Canadian Journal of Bioethics/Revue canadienne de bioéthique. As executive editors of BioéthiqueOnline, we frequently heard from members of the Canadian bioethics community of the need to develop a platform with the right branding to showcase the value and the richness of our collective reflections, both locally and internationally. Following discussions with colleagues across the country, we came to the conclusion that BioéthiqueOnline had developed a unique expertise publishing bioethics scholarship, but that the original name, created to convey the bilingual and open access mission of the journal, was not enthusiastically received. So the time has come to upgrade and rebrand as the Canadian Journal of Bioethics (CJB).

For graduate students and junior researchers alike, organising a science café may seem a simple and relatively harmless academic activity. However, organising such an event, especially when it aims to share complex and sophisticated thinking with the general public, can raise challenges from conception to completion. In this text, we share our reflections on the challenges and other lessons learned by the members of the organising team of a bioethics café funded by the Canadian Institutes of Health Research, in the hope that our experience can be of use to others in organising similar events.

Healthcare systems are increasingly committing to climate action, yet efforts to reduce their environmental footprint raise operational challenges. Decarbonization initiatives can generate concerns about cost, patient safety, care quality, and equitable access, revealing tensions that complicate implementation. This study examines how experts assess the impact and feasibility of climate-related interventions in healthcare, identifying key challenges and enablers. Using a Real-time Delphi approach, we consulted 14 specialists with ethics, sustainability, biomedical sciences, and public health backgrounds, who evaluated the relevance and applicability of five social tipping elements within the healthcare context. Interventions targeting energy systems and infrastructure were viewed as potentially high-impact but limited by regulatory complexity, infrastructural constraints, and ethical concerns. In contrast, strategies centered on education and shifts in values were perceived as more feasible, though questions about operationalization remain. Experts also noted potential issues, such as patient mistrust or clinician disengagement, if environmental goals are seen as misaligned with core commitments of healthcare practice. Overall, these findings underscore the need for inclusive, ethically robust, evidence-informed, and context-sensitive strategies that integrate sustainability goals with patient, professional, and institutional priorities. Improving access to environmental impact data and supporting shared decision-making emerged as key enablers for fostering acceptable ecological transitions in healthcare.

Bioethics experts played a key role in ensuring a coherent ethical response to the COVID-19 pandemic in the fields of healthcare, public health, and scientific research in Canada. In the province of Quebec, a group of academic and practicing bioethicists met periodically in the early months of the pandemic to discuss approaches and solutions to ethical dilemmas encountered during the crisis. These meetings created the opportunity for a national survey of bioethics practitioners from different fields. The survey, in which forty-five Canadian bioethics practitioners (clinical ethicists, ethicist members of REBs and government health policy ethicists, or any bioethicist practicing outside of academia) participated, explored their concerns, challenges and opportunities during the first wave of the pandemic, with the objective of informing bioethics research about the difficulties experienced by bioethicists “in the field”. Participants reported increased stress levels, increased workloads, and a greater proportion of their work being devoted to public health ethics. Most of their concerns focused on groups other than themselves, such as health professionals, patients, research participants, and people in vulnerable socio-economic situations. An optimism about the future of bioethics was noted due to an increased awareness of the importance of bioethics by the public and by health and research institutions.

This article highlights the emerging ethical issues related to reducing the environmental cost of medicines, health technologies and health services, taking as an example the situation of inhalation devices for the relief of various respiratory disorders, i.e., “inhalers”. Inhalers emit greenhouse gases that contribute to climate change. Recently proposed regulatory changes aim to control the use of greenhouse gases, but exceptions are necessary for inhalers due to the lack of less polluting substitutes and their vital importance for certain patients. Healthcare professionals and medical associations are actively campaigning for greater awareness and better education on the subject. On the political front, there are calls for legislation to encourage a rapid transition to cleaner inhalers. Long-term solutions include the use of low-carbon inhalers, such as those that use dry powder, as well as changes in prescribing and use practices. Stakeholders agree on the need to reduce environmental impact while prioritizing patient health, but ethical tensions can arise around possible real or perceived trade-offs between therapeutic efficacy, risk and inhaler durability. Our case study highlights the importance of integrating environmental considerations into health policy and clinical practice while recognising the ethically sensitive issues at this intersection, areas of uncertainty and other challenges to be overcome.