The Center conducts several empirical ethics research projects, that are sometimes funded by governmental agencies or academic institutions. The results of the projects are published in French and/or in English. Recent and current projects include:
Outline of the research method
Beneath spontaneous consultations initiated by patients, relatives or nurses in a special case, the clinical team also consults us for recurrent ethical concerns in their everyday work at the hospital. The CEC can also be interested in specific topics drawn from its own work on ethics.
Therefore we conduct research projects concerning clinical ethics on a regular basis. We examine a serial of cases that evoke the same ethical question. For this we encounter all the persons that are concerned by the decisions that are made: Patients, the clinical team and relatives. The encountering research team consists of multidisciplinary members from the fields of medicine, nursing, philosophy, law, sociology, psychology …
Our approach can be described as “empirical ethics”. We are interested in the following questions: How is the decision taken? Who is the decision maker? What arguments are used? Which issue is discussed? What is the underlying ethical question and the arguments that are brought up? To answer this we use a qualitative method that’s close to “anchored theory”. There are no a priori hypotheses. We let the strings of interest come up by the values that are shown by the patient itself. Using an ethical scheme to analyze what is said, we can not only describe the clinical decision making but also give indications about the underlying norms.
Parts of the results can help to feed the public discussions on bioethical questions. The work of research is also distributed in national journals, international papers and booklets.
Until now the CEC has worked on a large number of topics and is constantly working on current topics.
Covid-19 : ethical questions regarding patient care before and after the pandemic
This study focuses on the ethical questioning of professionals, proxies and patients before, during and after the Covid-19 health crisis. The study’s first section is constituted by a review of clinical ethics consultations and calls made to the Cec during the first national lockdown. Its second section consists of ethical debriefings with health care professionals willing to come back after the fact on their experiences and questioning they might have had during the first wave of the pandemic. The third and final section of the study aims to complete the data collected in the two previous sections by conducting clinical ethics’ interviews in selected hospital services and medico-social establishments. For each site, interviews will be carried out with professionals and particularly with patients and proxies affected by Covid or the pandemic. The first section is done and about to be published. For the second section, 32 interviews have been conducted between May and September 2020 and are currently being analyzed. The interviews for the third section started in December 2020.
Controlled donation after circulatory death (cDCD — Maastricht III type donors). A clinical ethics exploratory stud
The Centre for Clinical Ethics actually conduct an exploratory clinical ethics study on Controlled Donation After Circulatory Death (cDCD — Maastricht III type donors) with diverse healthcare teams which are differently involved in such practice. Its mains goal is to examine the ethical reasons of healthcare professionals for being reluctant or convinced by the cDCD. In addition, two secondary goals will be to understand why and how these resistances may sometimes change with experience and to verify through a few additional clinical ethics interviews whether the opinion from cDCD donors’ relatives are the same or not.
Behavioural problems of people in old age and their handling in special care units (UCC): What ethical questions of professionals and relatives
UCC stands for “Unité Cognitivo Comportementale”. It is a special care unit that is dedicated to handle patients with cognitive impairment that are often presenting behavioral problems. In France they exist since about 10 years. There are some studies concerning the efficacy of this services but there is little known about its ethical problems. However this units seem to pool ethical questions of psychiatry and old age. The aim of the present prospective qualitative study is to accompany several special care units with their ethical reflections on the handling of patient with cognitive impairment.
The use of “PrEP” as a new preventive treatment against HIV: Which expectations? Which perceptions? What underlying arguments for the choice of the person and the professional?
The preventive treatment against HIV (PrEP or Pre Exposure Prophylaxis) for persons at risk is a new in Europe and France. The present study regards specialized or non-specializes consulting for the prescription of this new medication. It aims to capture the ethical arguments that are brought up by the concerned persons and the involved professionals.
The handling of limitations and cease from live supporting treatment (LATA) at intensive care units and its ethical perception of clinical practitioners
LATA stands for “limitations et arrêt de thérapeutiques actives“. It is an operation that is frequently concerning intensive care units in France. In current philosophical discussions it is understood as a “passive” action that could for example mean not to give an antibiotic treatment in the case of an infection. In the French law and in traditional ethical discussions this actions are considered as clearly distinct to « active » actions like to give a lethal substance that rise heavy ethical problems. However the difference between ”passive” and “active” is not always that simple. It can also be seen as a continuum in between the one and the other. Therefore the present study is aiming to better understand the experiences of junior and senior practitioners that are confronted with this issue.
The institutionalization of people in old age that are about to be dependent.
Following recent research of the CEC about the topics of old age, medicine and autonomy, this experimental project starts from the thought that the institutionalization of people in old age is not always the best answer to the social or medical problems that come up with dependency. The study started 2017. The goal is to meet people older than 85 years that are “on the border” of being institutionalized, without wanting it, for social or medical reasons. The idea is to accompany them for several months to understand their ethical reflections on this situation and to let them be actor of a change that should potentially be encompassed by society.
Discussions concerning “advance directives” with institutionalized persons in old age: What practices? Which expectations? Which benefit? What conséquences?
« Love, fertility, kilos ». What about access to gynaecology, obstetrics and assisted reproductive technology (ART) for obese women?
Study on autologous oocyte preservation for societal reasons
The decision to hospitalize without consent in psychiatry
The doctor-patient relationship in the face of progress in cancer disease, and in particular the possible transition from curative to palliative care
The experiences of family members and caregivers when making decisions about a patient’s diet and/or hydration at the end of life
A study on « Advance Directives”
A study on “Assisted Reproduction”
Study on the relational difficulties between caregivers and patients and/or their relatives in long-term geriatric care
Elements of decision making leading to a decision on whether or not to continue a pregnancy after a pejorative genetic diagnosis has been made
Studies on liver donation from people alive
Study of the ethical determinants in medico-social strategies for elderly people living in institutions
Management of colorectal cancer for elderly patients. Study of practices and their ethical determinants.
Management of coronary artery disease for the « very-old » (over 80 years old). Study of practices and their ethical determinants.
Study of the ethical determinants leading to the decision to place a gastrostomy for an elderly population.
Study on the autonomy of homeless people and their relations with the hospital system.
Respect for confidentiality, intimacy, privacy in the hospital. Is this a dimension that has been properly addressed during your recent stay at our hospital? Do you think this is an important question?
A study on « transsexualism »
A study on « special care units for patients in a chronic vegetative state or pauci-relational »
Study on the value of a mediation in providing the medical record to the patient or relatives