[First analysis of the deployment of the ethical approach in the field of mental health in the Nord Pas-de-Calais region]. / Première analyse du déploiement de la démarche éthique dans le champ de la santé mentale en région Nord Pas-de-Calais.

For 3 years, the Regional Federation of Mental Health Research (F2RSM) has led a space ethics reflexion Department of mental health (ERESM) to federate structures that ethical institutions and mental health services have been creating in the Nord-Pas de Calais. This approach is, in many ways, revealing issues that involve the institutionalisation of ethical reflection in care facilities. In this article, after referring to the major developments in this field, we describe the conditions for the emergence of ethical bodies in the region. Through the choice of development and operation of the ethical reflexion department, we highlight a number of points of attention that illustrate the complex articulation between institutional expectations and concerns of professionals. The trajectory of the ERESM is thus revealed as a process of reflective learning open to all stakeholders, providers and users of mental health.

Irritability and sensibility: key concepts in assessing the medical doctrines of Haller and Bordeu.

This article addresses the doctrinal controversy over the various characterizations of irritability and sensibility. In the middle of the eighteenth century, this scientific debate involved some encyclopaedist physicians, Albrecht von Haller (1709-1777), Jean-Jacques Ménuret de Chambaud (1733-1815), and Théophile de Bordeu (1722-1776). The doctor from Bern described irritability as an experimental property of the muscle fibers and made it the basis of a neo-mechanism in which organic reactions are related to the degree of irritation of the fibers. The practitioners from Montpellier considered sensibility, a property of living matter, to be a spontaneous activity of the organ and developed around this notion an original conception of the organism as the sum of the specific lives of each part. Beyond conceptual divergences, two ways of thinking whose philosophical presuppositions (conception of living matter, mechanism, and organicism), were in opposition, while their epistemological principles (experience versus observation) and their medical practices (active medicine and expectant medicine) went on to evolve in different directions. The privileged place granted to experimentation and assessment enabled physiology to be articulated as an autonomous scientific discipline; the pre-eminence of observation and attention to the radical specificity of the living being constituted the bases of clinical medicine.

Bioinformatics: The philosophical and ethical issues at stake in a new modality of research practices.

This article deals with the integration of ethical reflection into the research practices of the project at the Lille Nord-Pas-de-Calais genopole: "Multifactorial genetic pathologies and therapeutic innovations". The general hypothesis of this text is that changes in research practices in biology (mainly through the use of bioinformatics) imply changes in medical practices, which require critical reflection. This hypothesis could be broken down into three sub-hypotheses: (1) Research in biology is undergoing a complete transformation; (2) Research in biology is a cultural practice, which cannot be reduced to a simple cognitive action; (3) Research in biology is a techno-scientific practice. As for the method, the aim of our research at the Medical Ethics Centre is to elucidate the philosophical and ethical range of biomedical practices. This work entails a double task for reflection. On the one hand, from the revelation of ethical tensions present in these practices, we have to think about what is at stake in these practices, and more broadly in society. On the other hand, we have to analyse the conditions enabling the actors to assume the significance of ethical reflection in their practices. The method set up to undertake this double task could be qualified as "narrative hermeneutics", as its aim is to attempt to interpret the stakes in practices from proximity with these practices and from what their actors have to say about them. The text then goes on to analyse more specifically the emergence and place of bioinformatics in present-day biomedical research.