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Quintal A, Hotte É, Grenier AD, Hébert C, Carreau I, Berthiaume Y, Racine E. Morally Problematic Situations Encountered by Adults Living With Rare Diseases. AJOB Empir Bioeth 2024; 15:192-205. [PMID: 38095586 DOI: 10.1080/23294515.2023.2274587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND Rare diseases are generally poorly understood from scientific and medical standpoints due, to their complexity and low prevalence. As a result, individuals living with rare diseases struggle to obtain timely diagnoses and suitable care. These clinical difficulties add to the physical and psychological impacts of living with chronic and often severe medical conditions. From the standpoint of pragmatist ethics, the morally problematic situations that adults living with rare diseases experience matter crucially. However, there is little known about these experiences. METHODS A survey study was conducted with 121 adults living with rare diseases in Québec, Canada, to identify morally problematic situations encountered in the healthcare system and everyday life as part of a participatory action research project. Morally problematic situations elicited internal tensions and constraints to agency. RESULTS Adults living with rare diseases experienced morally problematic situations of stigmatization, disbelief, and sometimes abuse in the healthcare system. These situations were compounded by diagnostic delays, inadequate care, and suboptimal follow-up, and led some individuals to opt-out of medical care. In their personal lives, these individuals sometimes found themselves in situations of physical and financial dependency. They often also had to give up professional occupations, academic training, or life projects. CONCLUSIONS Adults living with rare diseases experience important morally problematic situations navigating the healthcare system and their everyday lives, some of which could be alleviated through interventions developed through future participatory action research.
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Affiliation(s)
- Ariane Quintal
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Élissa Hotte
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Annie-Danielle Grenier
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Caroline Hébert
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Isabelle Carreau
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Yves Berthiaume
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
- Département de médecine, Université de Montréal, Montréal, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, Canada
- Ethics and Rare Diseases Working Group, Institut de recherches cliniques de Montréal, Montréal, Canada
- Department of Medicine (Division of Experimental Medicine), Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
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2
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Rydenfelt H. Pragmatism and Experimental Bioethics. Camb Q Healthc Ethics 2024; 33:174-184. [PMID: 37332165 DOI: 10.1017/s0963180123000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey's proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce's views on feelings as emotional interpretants. Finally, the connection between Dewey's experimental ethics and democracy is outlined and compared to unfettered ethical progressivism.
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Affiliation(s)
- Henrik Rydenfelt
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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3
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Anne Thamar Louis L, Fortin J, Roy CA, Brunet A, Aimé A. Body image interventions within breast cancer care: A systematic review and concept analysis. J Psychosoc Oncol 2023; 42:427-447. [PMID: 37609854 DOI: 10.1080/07347332.2023.2249879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
There needs to be a consensus regarding the definition of body image in oncology the literature. This lack of agreement leads to conflicting results in psychosocial interventions aimed to improve body image among breast cancer patients. Through an instrumentalist approach, this systematic review aims to analyze how body image as a concept is described and operationalized in breast cancer studies with the focus to enhance body image through psychosocial interventions. Databases were searched in October 2022 and updated in February 2023 to find empirical studies reporting psychosocial intervention targeting body image efficacy. The results from 24 studies show many similarities and differences between the definitions (e.g. characteristics) and questionnaires (e.g. Cronbach's alpha coefficient) used to evaluate this concept. Most definitions include thoughts, feelings, and behaviors related to body image. Finally, the psychosocial implications are discussed. This systematic review is registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022326393).
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Affiliation(s)
- Lunie Anne Thamar Louis
- Psychosocial Research Division, Research Center of the Douglas Mental Health University Institute, Verdun, Canada
| | - Justine Fortin
- Psychosocial Research Division, Research Center of the Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Carol-Anne Roy
- Psychosocial Research Division, Research Center of the Douglas Mental Health University Institute, Verdun, Canada
| | - Alain Brunet
- Psychosocial Research Division, Research Center of the Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada
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Abstract
Seeking children's assent has been put forward as a way to foster children's involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children's capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children's refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.
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Affiliation(s)
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
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5
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Montreuil M, Camden C, Genest C, Gilbert E, Laberge-Perrault E, Piché G, Rassy J, Bogossian A, Gendron-Cloutier L, Barbo G. Children and adolescents' mental health in pandemics and confinement: A scoping review of vulnerability factors and repercussions. J Child Health Care 2023:13674935231165554. [PMID: 37146991 PMCID: PMC10164454 DOI: 10.1177/13674935231165554] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Children and adolescents are a population at particular risk of experiencing adverse mental health repercussions related to pandemics. To understand vulnerability factors and repercussions of pandemics and related sanitary measures on children and adolescents' mental health, we performed a scoping review to examine and synthesize literature. In total, 66 articles were included. Results present: (1) factors that increase vulnerability to adverse mental health repercussions (e.g., having a pre-existing mental health condition, social isolation, low socio-economic status, parental distress, and overexposure to media content) and (2) specific mental health repercussions (e.g., anxiety, fear, depression, and externalizing behaviors). Addressing concerns underlined in this review could contribute to preventing further negative mental health repercussions of pandemics for children and adolescents and better prepare governments and professionals to address these highly challenging situations. Recommendations for practice include enhancing healthcare professionals' awareness about possible detrimental repercussions pandemics and sanitary measures have on children and adolescents' mental health, assessing changes for those with pre-existing mental health conditions, allocating funding for telehealth research, and providing greater support to healthcare providers.
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Affiliation(s)
| | - Chantal Camden
- School of rehabilitation, Université de Sherbrooke (Universite de Sherbrooke), Sherbrooke QC, Canada
| | - Christine Genest
- School of Nursing, Université de Montréal (Universite de Montreal), Montreal, QC, Canada
| | - Elsa Gilbert
- Department of Health Sciences, Université du Québec à Rimouski, Lévis (Universite du Quebec a Rimouski, Levis), Lévis, QC, Canada
| | | | - Geneviève Piché
- Department of Psychology and Psychoeducation, Université du Québec en Outaouais, Saint-Jérôme (Universite du Quebec en Outaouais, Saint-Jerome), Saint-Jérôme, QC, Canada
| | - Jessica Rassy
- School of rehabilitation, Université de Sherbrooke (Universite de Sherbrooke), Sherbrooke QC, Canada
| | - Aline Bogossian
- School of Nursing, Université de Montréal (Universite de Montreal), Montreal, QC, Canada
| | | | - Geneveave Barbo
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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6
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Fardeau E, Senghor AS, Racine E. The Impact of Socially Assistive Robots on Human Flourishing in the Context of Dementia: A Scoping Review. Int J Soc Robot 2023; 15:1-51. [PMID: 37359430 PMCID: PMC10115607 DOI: 10.1007/s12369-023-00980-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 06/28/2023]
Abstract
Socially assistive robots are being developed and tested to support social interactions and assist with healthcare needs, including in the context of dementia. These technologies bring their share of situations where moral values and principles can be profoundly questioned. Several aspects of these robots affect human relationships and social behavior, i.e., fundamental aspects of human existence and human flourishing. However, the impact of socially assistive robots on human flourishing is not yet well understood in the current state of the literature. We undertook a scoping review to study the literature on human flourishing as it relates to health uses of socially assistive robots. Searches were conducted between March and July 2021 on the following databases: Ovid MEDLINE, PubMed and PsycINFO. Twenty-eight articles were found and analyzed. Results show that no formal evaluation of the impact of socially assistive robots on human flourishing in the context of dementia in any of the articles retained for the literature review although several articles touched on at least one dimension of human flourishing and other related concepts. We submit that participatory methods to evaluate the impact of socially assistive robots on human flourishing could open research to other values at stake, particularly those prioritized by people with dementia which we have less evidence about. Such participatory approaches to human flourishing are congruent with empowerment theory.
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Affiliation(s)
- Erika Fardeau
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
| | - Abdou Simon Senghor
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Division of Experimental Medicine, McGill University, Montréal, QC Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Division of Experimental Medicine, McGill University, Montréal, QC Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC Canada
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7
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Senghor AS, Racine E. How to evaluate the quality of an ethical deliberation? A pragmatist proposal for evaluation criteria and collaborative research. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:309-326. [PMID: 35679005 DOI: 10.1007/s11019-022-10091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Ethics designates a structured process by which important human values and meanings of life are understood and tackled. Therein, the ability to discuss openly and reflect on (aka deliberation) understandings of moral problems, on solutions to these problems, and to explore what a meaningful resolution could amount to is highly valued. However, the indicators of what constitutes a high-quality ethical deliberation remain vague and unclear. This article proposes and develops a pragmatist approach to evaluate the quality of deliberation. Deliberation features three important moments: (1) broadening and deepening the understanding of the situation, (2) envisioning action scenarios, (3) coming to a judgment based on the comparative evaluation of scenarios. In this paper, we propose seven criteria to evaluate ethical deliberations: (1) collaborative diversity, (2) experiential literacy, (3) organization of experiences, (4) reflective capacity to instrumentalize the experiences of others, (5) interactional creativity, (6) openness of agents, (7) quality of the reformulation of scenarios. These criteria are explained and applied to the three moments of deliberation. Based on these criteria, three kinds of outcomes for deliberations are identified and discussed: good ethical deliberations, partial ethical deliberations, bad ethical deliberations. Our proposal will guide researchers and practitioners interested in the evaluation of the quality of ethical deliberations. It provides a reference tool that allows them to identify the possible limitations of a deliberation and to implement actions aimed at correcting these limitations in order to achieve the desired qualitative objectives.
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Affiliation(s)
- Abdou Simon Senghor
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada.
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.
- Department of Medicine, Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada.
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Lanteigne A, Genest M, Racine E. The evaluation of pediatric-adult transition programs: What place for human flourishing? SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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9
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Cascio MA, Weiss JA, Racine E. Person-oriented ethics for autism research: Creating best practices through engagement with autism and autistic communities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1676-1690. [DOI: 10.1177/1362361320918763] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Research ethics is an important part of any study. Ethics goes beyond ethics committee approval and consent documents. It addresses broader issues of respect, inclusion, and empowerment in the everyday context of research. This article focuses on everyday aspects of research ethics for studies involving autistic participants. It draws on a review of the literature and a process of ethical deliberation involving a task force of researchers, professionals, autistic self-advocates, and parents. These methods led to the creation of suggestions for researchers. This article describes the community engagement process, briefly presents the task force suggestions, and provides more detailed discussion of select items for illustration. Suggestions are organized around five “person-oriented research ethics” guideposts: (1) individualization (e.g. providing individualized support for participants), (2) acknowledgment of lived world (e.g. acknowledging barriers to care that impact research ethics), (3) empowerment in decision-making (e.g. creating accessible consent processes that address specific communication needs), (4) respect for holistic personhood (e.g. addressing sensory and processing needs and strengths), and (5) focus on researcher–participant relationships (e.g. involving autistic people in ways other than research participants, including but not limited to via participatory research). This project highlights the value of researcher–community partnerships in discussions about research ethics. Lay abstract Research ethics means issues that concern the welfare and wellbeing of people who take part in research. It is important in all scientific studies. Ethics helps people who do research treat people who take part in research fairly and with respect. This article is about day-to-day ethics when autistic people take part in research. We present tips for researchers who want to do this type of study. We used two methods to create these tips. First, we wanted to know what other people said about this topic. We used a literature review to find out. Second, we wanted to know what autistic people, parents, and professionals thought, and had a working group meet to discuss it. The working group provided advice that researchers could consider around day-to-day ethics in research. This article talks about these methods and advice. The advice fits into five big groups: Tailor the research process for the unique needs of each person. Think about the world in which people who take part in research live. Make it easier for people to make their own choices. Value what people who take part in research have to share and consider their needs and strengths. Think about how researchers and people who take part in research work together. This project shows why it is useful for researchers and communities to talk about research ethics together.
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Affiliation(s)
- M Ariel Cascio
- Central Michigan University, USA
- Institut de recherches cliniques de Montréal, Canada
- McGill University, Canada
| | | | - Eric Racine
- Institut de recherches cliniques de Montréal, Canada
- McGill University, Canada
- Université de Montréal, Canada
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Racine E, Cascio MA. The False Dichotomy Between Empirical and Normative Bioethics. AJOB Empir Bioeth 2020; 11:5-7. [PMID: 32096725 DOI: 10.1080/23294515.2019.1705429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eric Racine
- Pragmatic Health Ethics Unit, Institut de recherches cliniques de Montréal, Montréal, Québec, Canada.,Department of Medicine, Université de Montréal, Montréal, Québec, Canada.,Department of Medicine (Division of Experimental Medicine), McGill University, Montréal, Québec, Canada
| | - M Ariel Cascio
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan, United States
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Lajoie C, Poleksic J, Bracken-Roche D, MacDonald ME, Racine E. The Concept of Vulnerability in Mental Health Research: A Mixed Methods Study on Researcher Perspectives. J Empir Res Hum Res Ethics 2020; 15:128-142. [DOI: 10.1177/1556264620902657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The concept of vulnerability plays a central role in research ethics in signaling that certain research participants warrant more careful consideration because their risk of harm is heightened due to their participation in research. Despite scholarly debates, the descriptive and normative meanings ascribed to the concept have remained disengaged from the perspective of users of the concept and those concerned by its use. In this study, we report a survey- and interview-based investigation of mental health researcher perspectives on vulnerability. We found that autonomy-based understandings of vulnerability were predominant but that other understandings coexisted, reflecting considerable pluralism. A wide range of challenges were associated with this concept, and further training was recommended by researchers.
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Affiliation(s)
- Corinne Lajoie
- Institut de recherches cliniques de Montréal, Québec, Canada
- The Pennsylvania State University, University Park, USA
| | - Jelena Poleksic
- Institut de recherches cliniques de Montréal, Québec, Canada
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Western University, London, Ontario, Canada
| | | | - Mary Ellen MacDonald
- McGill University, Montréal, Québec, Canada
- McGill University Health Centre, Montréal, Québec, Canada
| | - Eric Racine
- Institut de recherches cliniques de Montréal, Québec, Canada
- McGill University, Montréal, Québec, Canada
- Université de Montréal, Québec, Canada
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Lajoie C, Fortin J, Racine E. Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness. Account Res 2019; 26:439-459. [PMID: 31599171 DOI: 10.1080/08989621.2019.1679121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.
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Affiliation(s)
- Corinne Lajoie
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal , Montréal , Québec , Canada
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal , Montréal , Québec , Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal , Montréal , Québec , Canada.,Department of Neurology and Neurosurgery, McGill University , Montréal , Québec , Canada.,Division of Experimental Medicine (Biomedical Ethics Unit), McGill University , Montréal , Québec , Canada.,Department of Medicine and Department of social and preventive medicine (Bioethics programs), University of Montreal , Montréal , Québec , Canada
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