[Nursing science put to the epistemological test]. / La science infirmière à l'épreuve de l'épistémologie.

Today, we are witnessing the emergence of a nursing discipline that is clearly seeking to base its legitimacy primarily on science. However, only an epistemological approach can assure us of the relevance of such an approach. While the nursing discipline must unquestionably be based on a rational, scientific approach, can we not nevertheless assume that an irreducible element of mystery will forever remain at the heart of care?

[Dreaming madly or escaping reality through dreams?] / Rêver à la folie ou échapper au réel par le rêve ?

Dreams can be seen as a way of letting your mind wander while you're awake, an act of imagination that occurs during sleep, or a more or less chimerical imaginary representation of what you ardently hope for. In all three cases, it questions both our relationship with reality (what exists in itself) and with reality (what I perceive and understand of reality). From this point of view, dreams and madness are undeniably two experiences that radically question our access to reality.

[The question of others put to the test by philosophy and care. Who are others? Who am I to others? What encounter is possible?] / La question d'autrui à l'épreuve de la philosophie et du soin. Qui est autrui ? Qui suis-je pour autrui ? Quelle rencontre possible ?

The concept of others, central in philosophy, is of utmost interest in care. As an active form of concern for others, the care relationship represents a particular form of encounter with the other because of its irreducible uniqueness. What can philosophy tell us about this issue, and, in particular, what can we draw from it and use in day-to-day care practice ? Who are others ? Who am I to others ? What encounter is possible ? These three questions will therefore constitute the main theme of this article.

[An introduction to the thought of Emmanuel Levinas. The care or irreducible worry of infinite responsibility.] / Introduction à la pensée d'Emmanuel Levinas. Le soin ou l'irréductible inquiétude d'une responsabilité infinie.

Despite a particularly difficult approach, Emmanuel Levinas remains a philosopher who « speaks ¼ quite naturally to caregivers. The reason is simple ; he is interested in an issue that has long been hidden in philosophy, but that directly affects care : vulnerability.However, it seems that his thinking has too often been watered down. By presenting it as a form of benevolent altruism, the radical, even subversive, aspect of the approach that he proposes to us is erased. Indeed, Levinassian responsibility is experienced first of all as a rupture, a violence that makes me the « hostage of others. ¼ According to Levinas, only the intrusion of the third imposes a limit on the relationship with the face of others. More precisely, the demand for justice vis-à-vis the third party places me in the difficult situation of having to « weigh, to think, to judge, in comparing the incomparable. ¼Levinas therefore proposes an ethics of the absolute, a hyperbolic morality that takes little account of circumstances. Would it then be betraying Levinas to seek to mitigate this responsibility, which may seem, in many respects, out of reach ?

[Quality, an ethical dimension in nursing care]. / La qualité, un souci éthique pour prendre soin.

Care cannot simply be summed up as a standardised practice. It constitutes an ethical obligation which drives us to respond actively to the call for help from a person suffering and in need. A real call to action, this practice, both relational and technical, strives to care about others, first and foremost in terms of their ability to be in the world.

[Rethinking ethics with Paul Ricœur. Nursing: between responsibility, care and justice]. / Repenser l'éthique avec Paul Ricœur. Le soin: entre responsabilité, sollicitude et justice.

In this article, the purpose is less praising Paul Ricoeur's work than enlightening how the reader may actually find some practical, even operative help in this philosophical thought. This is particularly true regarding the fields of medicine and care. Paul Ricœur is now worldwide renowned as a major philosophical figure of the 20th century, and with books such as "Oneself as another", he occupies a very peculiar place at the crossroads of phenomenology and hermeneutics. Through both these philosophical traditions, Paul Ricœur offers some narrative ethics which may greatly sustain caregivers in their reflexion. Yet, the aim of this article is to focus on this philosopher who invites us to inhabit and play a role in this world. The goal is also to bring out the pragmatic ethics that this thinker developed, based on Aristotelian and Kantian traditions. Then, this piece seeks to demonstrate how the three stages of Ricoeur's "petite éthique" (his "small ethics"), which are the self's aim "for the good life with and for others in just institutions" can shed some light on the ethical consideration of politicals and caregivers.

[Complementary care approaches, towards more humanity]. / Les approches soignantes complémentaires, vers plus d'humanité.

Modern medicine, with its cutting-edge technology, questions the notions of dehumanisation, over-medicalisation, the relationship to care. It seems to be aimed more at the disease than the patient. Complementary care approaches, which also encompass conventional medicine, guide and support the patient. Today, they have a role in giving back to the patient a feeling of being present in the world and testify to different approaches.

[Care between ethics, work and political]. / Le care entre éthique, travail et politique.

Down to the roots, the ethics of care have stood up a "different voice". Building on Carol Gilligan's works, the concept was developed widely in opposition with the rational and universalist aspect of Kant's moral philosophy. However, it also appears that this vision of care runs counter sets the three other main dominant moral theories, ie, utilitarism, John Rawls' procedural ethics and the Aristotelian virtue ethics. We may assert that the care theory presents itself as a contextualized moral theory aiming at taking into account others' vulnerability, in a practical way. Hence, the general term of "care" may encompass the notions of "help", "support" and "healing process", which, in France, for have often been opposed for varied reasons--historical, economical, psychological, professional etc... Switching from a moral position to a professional and practical activity, the concept of care has now undeniably taken on now a social and political dimension.

[The ethical approach applied to the TV series ER]. / La démarche ethique appliquée a la série Urgences.

The television series ER presents an opportunity to reflect on ethical dilemmas. This article discusses the example of an episode in which a patient suffering from an incurable disease, unable to express his views clearly, has a tracheotomy performed on him without the consent of the team or his health care proxy.

[Care as a language]. / Le soin est langage.

Addressing the body, nursing practice involves caring for another and the possibility for this person to be in the world. It enables the person, in spite of illness, suffering or disability, to find his or her place in the community of people. Through language, care is hospitality.

[The gift in caregiving. Is it possible for a gift to be a purely free, no-strings act?]. / Le don dans les soins.

It is not easy to answer this philosophical and moral question. Care situations however unfold in a place where the spontaneity of a gift can be expressed in all simplicity through the gestures of care.

[Pain and suffering, in the footsteps of Paul Ricoeur]. / Douleur et souffrance, sur les pas de Paul Ricoeur.

Understanding pain, enduring it, accepting it or detaching oneself from it: numerous philosophers have tackled this task. For suffering is existing. Suffering is part of life. Paul Ricoeur postulates a distinction between pain and suffering which relates pain to the body and suffering to reflexivity, language or the relationship with oneself. Suffering thereby becomes that through which I recognize myself and I recognize the Other.

[Cultivating the ability of patient autonomy]. / Cultiver la capacité d'autonomie.

Confronted with a patient still able to express desires but not always able to act on them, caregivers are faced with certain questions: Should they decide for the patient and force him or her to act, as far as is possible? Should they take into account how the patient was in the past, or detach themselves from the patient's past preferences? Some answers and developments arising from a practical case.

[The components of an ethical approach]. / Repères méthodologiques a la recherche de la juste voie.

A new bi-monthly feature in La revue de l'Infirmière on the theme of ethics and the resulting dilemmas, so often encountered in nursing contexts. Far from being prescriptive and giving turnkey solutions, we will open the debate on ethical questioning. One which envisages the scope of possibilities and searches for the best decision for each particular situation. This first article offers elements of methodology.

[Care under stress]. / Le soin sous tension?

Care has recently become a topical subject namely through the notion of care. We are quite happy with this evolution and still wonder about the reasons for this sudden interest for this essential human activity that goes back to the dawn of time. Beyond this debate, we propose to understand why care, as an essential form of response to the vulnerability of the others is necessarily in tension between three unsubstitutable elements : technics, relation and justice. The question whether our techno-scientific medicine and sanitary organization of today really contribute to care is still raised

[A theory on care]. / Un regard sur le soin.

Trying to define the nature of care when you are a health care professional, means, inevitably, going back to the very source of your professional commitment. Caring, an essential form of responsibility for the other, is thus revealed as a way of behaving towards other people, as an active and concrete commitment testifying as much to the humanity of the one who gives it as to that of the one who receives it. Starting with the notion of the phenomenology of human capacity, Paul Ricoeur thinks of independence in terms of capacity. He calls upon work of the Indian economist Amartya Sen published in the 1980s on the notion of capabilities. This leads to conceiving disease or disability as a lack of elementary or basic capacity. According to Ricoeur, this notion of capacity can only be understood by looking at its contrary: vulnerability. In this way, only a weakened frail person can be called upon to become independent. Thus the human being, and particularly the ill human being, must be looked upon as both vulnerable, and thus suffering, and capable, and thus active.