[Integrating environmental health into our nursing practices]. / Intégrer la santé environnementale dans les pratiques infirmières.

The healthcare sector accounts for 8% of the national carbon footprint in France. It is imperative to integrate climate and environmental issues into modern healthcare management. Many health professionals are advocating for more eco-responsible care. Each caregiver can reduce the environmental and health impact of their activity, while evolving in a healthy environment. Nurses have a particular responsibility to contribute to sustainable development.

The Love Problem of a Student-Revisited: A Psycho-Ethical Map for Cases of Anima Projection.

In its typical form, an "anima projection" is a psychic experience in which a heterosexual man is caught up by an intense, almost magical attraction for a woman. What sets these numinous experiences apart from a common "crush" is a pattern of specific phenomenological characteristics. Anima projections are particularly common in late adolescence and early adulthood, when they can cause a deep sense of disorientation. Little education exists for young men on how to deal with these experiences and to actualize the developmental opportunity that underlies them. In this paper, I frame anima projections as an ethical problem and outline a psycho-ethical "map" that is intended for use by disoriented young men, or by any practitioner who may be tasked with helping them navigate this challenge along the path of individuation. The map considers four solutions to the love problem: the "concretistic-literal", the "fearful-avoidant", the "rational-depressive", and the "transitional-developmental" solution, and indicates the latter as the one that is conducive to optimal psychic development. Although developed with a focus on young men, the map may apply to other relations based on projection, regardless of age, sex, gender, or sexual orientation.

Dans sa forme typique, une "projection de l'anima" est une expérience psychique dans laquelle un homme hétérosexuel est pris dans une attirance intense, presque magique, pour une femme. Ce qui distingue les expériences numineuses de simples béguins, c'est un ensemble de caractéristiques phénoménologiques spécifiques. Les projections de l'anima sont particulièrement fréquentes à la fin de l'adolescence et au début de l'âge adulte, où elles produisent un profond sentiment de désorientation. Il n'existe que peu de formation pour les jeunes hommes en ce qui concerne comment faire face à de telles expériences et comment utiliser de manière profitable l'opportunité de développement qui les sous­tend. Dans cet article, je considère les projections de l'anima comme étant un problème éthique et j'esquisse une "carte" psycho­éthique visant à aider les jeunes hommes désorientés ­ ou tout praticien dont la tâche est d'aider ces jeunes hommes ­ à relever ce défi sur le chemin de l'individuation. Cette carte envisage quatre solutions au problème de l'amour: la solution "concrète­littérale", celle de "l'évitement angoissé", la "dépressive­rationnelle" et la "transitionnelle­développementale". La carte indique que cette dernière solution est celle qui permet un développement psychique optimal. Bien que conçue pour les jeunes hommes, cette carte peut également être utilisée pour d'autres relations fondées sur la projection, quel que soit l'âge, le sexe, le genre ou l'orientation sexuelle.

En su forma típica, una "proyección del ánima" es una experiencia psíquica en la que un hombre heterosexual se ve atrapado por una atracción intensa, casi mágica, hacia una mujer. Lo que diferencia a estas experiencias numinosas de un "flechazo" común es un patrón de características fenomenológicas específicas. Las proyecciones del ánima son especialmente frecuentes al final de la adolescencia y al principio de la edad adulta, cuando pueden causar una profunda sensación de desorientación. Existe poca educación para los hombres jóvenes sobre cómo tratar estas experiencias y dar lugar a la oportunidad de crecimiento y desarrollo que subyace a las mismas. En este artículo, planteo las proyecciones del ánima como un problema ético y esbozo un "mapa" psico­ético destinado a ser utilizado por jóvenes desorientados o por cualquier profesional que tenga la tarea de ayudarles a navegar este desafío en el camino de la individuación. El mapa considera cuatro soluciones al problema del amor: la "concreta­literal", la "temerosa­evitativa", la "racional­depresiva" y la "transicional­del desarrollo", e indica esta última como la que conduce a un desarrollo psíquico óptimo. Aunque se ha elaborado centrándose en los hombres jóvenes, el mapa puede aplicarse a otras relaciones basadas en la proyección, independientemente de la edad, el sexo, el género o la orientación sexual.

Eating at Risk within Long-Term Care: A Case for the Relational Ethics Lens.

Within long-term care homes (LTCHs), conflicts occur between residents' desires, LTCH constraints, and healthcare providers' concerns about risks of harm. Due to the high prevalence of dysphagia and malnutrition in these settings, decisions regarding food choices are a common source of such tensions. Existing biomedical ethical models fail to capture the complexity of the interprofessional chronic care environment. This article proposes an alternative ethical lens, the relational ethics model. We describe a case illustrating the application of a decision-making framework with a relational ethics lens for a resident with severe dysphagia and malnutrition. We highlight how the bioethics model excludes important actors from ethical decision making. We encourage registered dietitians working in LTCH to incorporate a relational ethics model into their practice to help identify resident's values and bring attention to the interconnectedness of caring relationships and contextual factors. This approach can inform difficult decisions regarding the food and nutrition choices of residents and may facilitate meaningful outcomes for both individuals and the long-term care community.

On Theoretical Edges and Exclusionary Borders: Towards a Genealogy of "Analyzability" in Jungian Psychoanalysis1.

An oft-repeated and largely unexamined assumption in Jungian psychoanalysis is the notion of "analyzability", that is, of an individual's ability or present capacity to think symbolically. It is often taught that if someone is unable to think symbolically, a depth analysis is not possible. Such an individual may be more aptly suited for supportive psychotherapy, the argument goes, an experience that may very well lead to the development of the ego's capacity for symbolic thought but is not, in and of itself, a Jungian analysis. While this sort of categorical thinking has, at times, crossed over into ontological claims about individuals and groups, the notion of analyzability encountered in psychoanalytic theory and praxis is often cloaked in facially neutral language. The impact, however, has been anything but neutral in effect. In this paper, I propose a softening of our theoretical edges through a genealogy of the category of analyzability within the broader history of psychoanalysis. Through this excavation, I explore the contingent nature of the category of analyzability, how it has constricted knowledge, perpetuated inequality, and, more broadly, obscured ways of knowing. In so doing, I recover the radically democratic potential that lies at the heart of Jungian psychoanalysis.

Notre tente jungienne est peut­être grande et ses contours théoriques indispensables, mais que se passe­t­il lorsque nos contours théoriques se durcissent, devenant des frontières inhospitalières, des frontières servant à exclure et des zones d'occlusion? Une hypothèse souvent mise en avant et peu remise en question dans la psychanalyse jungienne est la notion d'« analysabilité ¼, c'est­à­dire de l'aptitude d'une personne, ou de sa capacité actuelle, à penser symboliquement. On enseigne souvent que si quelqu'un est incapable de penser symboliquement, une analyse en profondeur n'est pas possible. A une telle personne on proposerait plutôt une psychothérapie de soutien, une expérience qui peut très bien conduire au développement de la capacité de pensée symbolique de l'ego, mais qui n'est pas, en soi, une analyse jungienne. Alors que ce type de pensée catégorique a, en certaines occasions, rejoint des revendications ontologiques sur les individus et les groupes, la notion d'analysabilité rencontrée dans la théorie et la pratique psychanalytiques est souvent enveloppée dans un langage apparemment neutre. L'impact, cependant, a été tout sauf neutre dans ses effets. Dans cet article, je propose un assouplissement de nos frontières théoriques à travers une généalogie du concept d'analysabilité au sein de l'histoire plus large de la psychanalyse. À travers cette plongée, j'ai pour but d'explorer la nature contingente de la notion d'analysabilité, de voir comment elle a limité la connaissance, perpétué des inégalités et, plus largement, obscurci les modes de connaissance. Par cette démarche, je crois que nous pourrions nous rendre compte du potentiel radicalement démocratique qui se trouve au cœur de la psychanalyse jungienne.

Nuestra tienda junguiana puede ser amplia y sus bordes teóricos vitales, pero ¿qué ocurre cuando nuestros bordes teóricos se endurecen, agudizándose en fronteras inhóspitas, límites de exclusión y zonas de oclusión? Un supuesto a menudo repetido y en gran medida no examinado en el psicoanálisis Junguiano es la noción de "analizabilidad", es decir, de la habilidad o capacidad actual de un individuo para pensar simbólicamente. A menudo se enseña que si alguien es incapaz de pensar simbólicamente, no es posible un análisis en profundidad. Tal individuo, se argumenta, puede ser más adecuado para una psicoterapia de apoyo, una experiencia que puede muy bien conducir al desarrollo de la capacidad del ego para el pensamiento simbólico, pero no es, en sí misma, un análisis Junguiano. Aunque este tipo de pensamiento categórico se ha extendido, en ocasiones, a afirmaciones ontológicas sobre individuos y grupos, la noción de analizabilidad encontrada en la teoría y práctica psicoanalíticas suele estar envuelta en un lenguaje aparentemente neutro. Sin embargo, su impacto no ha sido neutro en absoluto. En este artículo, propongo suavizar nuestros bordes teóricos a través de una genealogía de la categoría de analizabilidad dentro de la historia más amplia del psicoanálisis. A través de esta excavación, propongo explorar la naturaleza contingente de la categoría de analizabilidad, cómo ha restringido el conocimiento, perpetuado la desigualdad y, más ampliamente, oscurecido las formas de conocer. Al hacerlo, creo que podríamos darnos cuenta del potencial radicalmente democrático que yace en el corazón del psicoanálisis Junguiano.

[Ethical stakes of psychosocial rehabilitation]. / Les enjeux éthiques de la réhabilitation psychosociale.

Psychosocial rehabilitation (PSR) is a therapeutic approach which aims to improve the overall functioning of people with severe mental disorders. We detail the principles of bioethics applied to care and seek to demonstrate how PSR meets the requirements of a humanistic psychiatry. The four fundamental principles of the ethics of care - autonomy, beneficence, non-maleficence and justice - are found in the practice of PSR. The practice and implementation of PSR is strongly encouraged in universal codes of ethics.

[What place for ethics in psychiatry?] / Quelle place pour l'éthique en psychiatrie ?

At a time when healthcare establishments are facing sensitive financial and institutional challenges, how can ethics be given a place in psychiatry? In society, ethical debates focus on surrogate motherhood, active euthanasia or assisted suicide, and embryo research. In psychiatry, the question often crystallizes around violent incidents that are hardly representative of the daily lives of professionals and patients. Militant discourse prevails over listening to the people concerned. The law requires establishments to reflect on the ethical issues raised by the reception and medical care of patients, without specifying the boundaries. Ethics in healthcare facilities focuses on care situations - what is possible or desirable - with no single theoretical model to serve as an example to follow.

[Autonomy and medical aid in dying: the place of psychiatry]. / Autonomie revendiquée et aide médicale à mourir, la place de la psychiatrie.

Autonomy has become the highest value in our society, and while it is having an impact on the debate on a future law on medical assistance in dying, it is also opening the door to a reflection on vulnerability. Although seemingly unaffected, at least initially, psychiatry could join the field of this reflection and bring out the avenues of renewal.

[Ethical considerations for children living with their imprisoned mothers]. / Réflexions éthiques autour des enfants vivant auprès de leurs mères incarcérées.

In France, pregnant women or women with children under the age of 18 months, and in exceptional cases 24 months, can serve their prison sentences in specially equipped nurseries or mother-child cells. This situation is likely to have a negative impact on the child's health, and on the quality of the bond with the mother over the longer or shorter term. The benefits of maintaining this bond are indisputable, whatever the setting. Improvements to this system could be considered and implemented.

[From psychiatric care to psychic care, for an ethic of restraint]. / Du soin psychiatrique au soin psychique, pour une éthique de la retenue.

This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.

[Using restraint during treatment: Definitions, contexts and benchmarks]. / User de la contention au cours d'un soin : définitions, contextes et repères.

The clinical practice of nursing sometimes leads to physically restraining the patient while carrying out a therapeutic or diagnostic procedure. This laconic observation says little about the many questions raised by the use of restraint on a person during treatment. The questions are professional, institutional, philosophical, ethical, legal and deontological. The role of the nurse in the decision to use coercion to provide care is preponderant, and the moral dilemmas that this decision provokes are most often carried out individually by the professionals.

[Restraint, a clinical philosophy of body-to-body combat?] / La contention, une philosophie clinique du corps-à-corps ?

Restraint is an extremely controversial practice, symbol of crucial debates on developments in care. This is about trying to think about this painful reality where care is at its limit and carries many dangers. The ethical issues raised by restraint will thus be described, and the responses that can be provided to them.

[Restraint in child psychiatry]. / La contention en pédopsychiatrie.

In child psychiatry, there are significant ethical challenges when patients put themselves at risk or refuse to cooperate in their care. This article illustrates two situations of violence and restraints and looks at how the vulnerability of caregivers can be acknowledged in order to find the best balance between the imperatives of protection and the respect of young inpatients in child psychiatry.

[Ethical principles for the design of a clinical trial in oncology]. / Règles éthiques pour la conception d'un essai clinique en oncologie.

Clinical research in the area of cancer is of utmost importance in order to improve patient care, both in terms of overall survival and quality of life. The implementation of clinical trials on medicinal products, now falling under EU Regulation 536/2014, is conditioned on prior scientific authorisation from the French National Agency for the Safety of Medicines and Health Products and a favorable ethical opinion from a Research Ethics Committee (REC). OBJECTIVE: The objective of this work is to report on the main problematic issues identified during the evaluation of oncology dossiers by the REC in order to present the expected elements and thus optimise the evaluation procedures. METHODS: The National Conference of the Research Ethics Committees analysed the questions raised by the REC during their evaluation of clinical trials of oncology drugs submitted to the European information system in 2022. RESULTS: Out of a total of fourteen dossiers, nine were subject to ethical questions on the protocol and all dossiers required modifications to the information documents. DISCUSSION: The heterogeneous quality of the dossiers reminds the need to submit well-argued, methodologically robust protocols with supervised research procedures that are safe for the participants. The drafting of information documents needs to be thoroughly reconsidered in order to present clear, concise, loyal and respectful documents for patients' rights.

[Sexuality in the cognitive-behavioral unit]. / La sexualité en unité cognitive et comportementale.

Sexuality in geriatrics poses ethical dilemmas, particularly for patients with cognitive disorders. What is the place of consent, presumption of competence and caregiver responsibility? A tool structuring these questions has facilitated collective decisions in the cognitive-behavioral unit to ensure respectful support for intimate relationships between patients. Ongoing reflection remains essential for optimal care.

[Ethical issues surrounding death in pre-hospital medicine]. / Enjeux et éthique face à la mort en médecine préhospitalière.

Mobile emergency and resuscitation teams are confronted with death on a daily basis. In the home, the management of a death is complex. It raises ethical questions and sometimes destabilizes personal or collective values. Our single-center qualitative survey, conducted over a one-month period (2022), questioned 64/154 caregivers about the moral burden and challenges of such situations. The consequences of operational experience are discussed: time, fatigue, emotions and training. The quality of presence is an alternative to the success or failure of cardiac arrest care at home.

[Restraint in geriatrics: France's backwardness]. / Contention en gériatrie : le retard de la France.

In the absence of legal provisions, passive physical restraint methods in geriatrics were defined at the start of this century, accompanied by recommendations relating to their use. Despite the frequency of these measures of restraint, there are few French publications on this subject. It seems that this practice varies according to the geriatric establishments and prevails in hospital more than in nursing home. The most widespread method is the dual barrier on the bed, as well as in hospital than in nursing home. To this should be added restraint provided by the premises themselves, intended to secure access to a facility, found in 90% of residences for the dependent elderly, and also medication. Passive physical restraint, mainly implemented to prevent falls, has however clearly shown its deleterious effects, particularly in the USA where it is thought to be responsible for 1/1000 deaths in nursing homes, although when it is absent there appears to be no increased risk of falls. Medication-based restraint is more readily used to sedate in case of disruptive behaviors (agitation, aggressiveness) although no clear data is available to date. Restraint provided by the premises themselves, used preventively in case of wandering and straying, is nevertheless a deprivation of freedom, and seems to concern the majority of geriatric facilities today. In the absence of legislation to regulate these practices, the present authors discuss the need for ethical reflection before the implementation of measures of restraint, whatever their nature, and they propose certain ideas on possible methods for passive physical restraint: raising awareness among caregivers and family members who often call for these measures, the existence of alternative measures, and the delaying of implementation as long as possible and/or sequentially.

[Which place has experimentation in ethology?] / Quelle place pour l'expérimentation en éthologie ?

The experimental approach has been at the center of my thoughts since my baccalaureate of "experimental sciences". Trained in neurosciences, I very quickly chose the field of ethology, thinking I would escape certain experimental approaches and offer myself research more respectful of animal life. Today, I have to note that this option did not necessarily lead to what I had imagined. I have been both the witness and the actor of practices that deserve attention. This path, punctuated by an evolution of the conceptions of our relations with living beings, leads me to question the ethics, sometimes contradictory, of action and knowledge.

Title: Quelle place pour l'expérimentation en éthologie ? Abstract: La démarche expérimentale est au centre de mes réflexions depuis mon baccalauréat « sciences ex ¼. Formé aux neurosciences, j'ai très vite choisi l'éthologie de terrain, pensant échapper à certaines démarches expérimentales et m'offrir des activités de recherche plus respectueuses de la vie animale. Aujourd'hui, je dois constater que cette option n'aboutit pas forcément à ce que j'avais imaginé. J'ai été à la fois le témoin et l'acteur de pratiques qui méritent attention. Ce parcours, jalonné par une évolution des conceptions de nos relations avec les être animés, me conduit à questionner les éthiques, parfois contradictoires, de l'action et de la connaissance.

[ICU admission for cancer patients with respiratory failure: An ethical dilemma]. / Admission aux soins intensifs du patient cancéreux avec une atteinte respiratoire : un dilemme éthique.

In medicine, each decision is the result of a trade-off between medical scientific data, the rights of individuals (protection of persons, information, consent), individual desires, collective values and norms, and the economic constraints that guide our society. Whether or not to admit a cancer patient to an intensive care unit is very often an ethical dilemma. It is necessary to distinguish patients who would benefit from admission to an intensive care unit (ICU) from those for whom it would be futile. In this review, we will discuss the appropriateness of ICU admission and the concept of unreasonable admission, along with the different levels of intensity of ICU care and the alternatives to intensive care. We will then consider how and when to initiate reflection leading to a reasonable decision for the patient.

[Fundamentals of organ and tissue procurement]. / Les fondamentaux concernant le prélèvement d'organes et de tissus.

Transplantation is the treatment of choice for the terminal evolution of many organ failures. This recent solution has been deployed in France, essentially from deceased donors, in a state of encephalic death or after circulatory arrest. The ethical issues raised by these practices are strictly regulated. The Agence de la biomédecine, in conjunction with healthcare professionals and supervisory authorities, is the public operator in charge of organizing and developing the procurement activities. The volume of activity, severely disrupted by the Covid-19 pandemic, is now back on the rise. The 2022-2026 transplant plan sets ambitious but realistic targets to meet the needs of waiting patients.