Marianne Labrie

Depuis plusieurs années, la gestion des risques occupe une place importante dans les établissements de santé et de services sociaux du Québec. Ce processus repose sur deux principes directeurs : la culture juste et le concept de non-responsabilité, et fait partie intégrante de la Loi sur les services de santé et les services sociaux. Cependant, malgré toute son utilité, le processus actuel de gestion des risques comporte certaines limites et critiques. Pour pallier ces faiblesses, l’association de l’éthique organisationnelle au processus de gestion des risques représente une option intéressante. L’utilisation des concepts et des outils de l’éthique organisationnelle permet de surmonter les limites de la gestion des risques et même de l’optimiser. Il s’agit dans les deux cas de processus organisationnels ayant de nombreux objectifs et liens communs, et tous deux fournissent des outils pour la prise de décision. La combinaison de l’éthique organisationnelle et de la gestion des risques élargit le champ d’application de la gestion des risques. Pour permettre la meilleure optimisation possible, une grille d’analyse est proposée et des recommandations sont faites pour l’inclusion de l’éthique dans la gestion des risques.

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation.

BackgroundThe overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.MethodsThe qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.ResultsThe results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.ConclusionsThe participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed