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The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim is to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompasses the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency.

The integration of ethical analysis in Health Technology Assessment (HTA) has proven difficult to implement even though it is explicitly recognized as an important component of such assessments in HTA literature. When compared to the standardized scientific method for systematic reviews in HTA, the diversity of ethical analysis has been characterized as a fundamental barrier to the integration of ethics. The present paper aims to identify the theoretical and practical differences between the approaches underpinning ethical analysis in HTA and clarify the reasons for such diversity. Our systematic review of HTA literature pertaining to the barriers to the integration of ethics in HTA identified nine ethical approaches: Principlism, Casuistry, Coherence Analysis, Wide Reflective Equilibrium, Axiology, the Socratic approach, the Triangular model, Constructive Technology Assessment and Social Shaping of Technology. Citations pertaining to each approach were extracted and categorized according to three constitutive components of ethical argumentation established in a previous research evaluating nanotechnologies: i) the disciplinary foundation that grounds the validity of the ethical evaluation, ii) the characteristics of such evaluation, iii) the operational process involved in applying it to a particular case (i.e., its practical reasoning). This comparison shows that, 1) the difference between these approaches rests primarily on their disciplinary foundation (rooted in philosophy, philosophy/theology, or sociology), 2) their complexity can be observed in the distinct characteristics of ethical evaluation deriving from their differing disciplinary foundation, and 3) although four different types of operationalization procedure were identified, little information was available in regards to the practical reasoning associated with these approaches.

Objective To describe the type and level of ethical integration in published health technology assessment (HTA) reports and systematically identify the ethical approaches utilized. Methods A literature search was conducted with the Google™ search engine using the keyword “ethic” between 1 January 2015 and 20 August 2019. Only HTA assessment reports with a section on ethics were retained and classified according to their level of ethical integration: no ethical analysis, ethical issues highlighted, assessments according to legal or social norms, and assessments from a moral or axiological perspective—using a qualitative methodology to distinguish such integration. Results This review yielded 188 reports with a section identified as being on ethics, produced by seventeen HTA agencies in eleven countries. One hundred and thirty-six reports did not develop an ethical analysis, thirty-one highlighted ethical issues, seventeen conducted a norm-based ethical assessment using a descriptive approach grounded in social norms, and four developed an assessment grounded in a moral or axiological perspective. The bioethical “four-principles” framework was used, but mainly for presenting ethical issues and not as a moral framework. Conclusions The majority of reports featuring a section on ethics mention ethical considerations without ethical analysis. Ethical issues are grouped with legal, social, and organizational issues and treated as contextual considerations that decision makers should be aware of. When reports present systematic norm-based ethical assessments from a descriptive perspective or ethical assessment based on a moral or axiological perspective, there is a tendency to ground these analyses in frameworks created for the purpose and reliant on a concept of ethics supporting them.

Objectives Integration of ethics into technology assessment in healthcare (HTA) reports is directly linked to the need of decision makers to provide rational grounds justifying their social choices. In a decision-making paradigm, facts and values are intertwined and the social role of HTA reports is to provide relevant information to decision makers. Since 2003, numerous surveys and discussions have addressed different aspects of the integration of ethics into HTA. This study aims to clarify how HTA professionals consider the integration of ethics into HTA, so an international survey was conducted in 2018 and the results are reported here. Methods A survey comprising twenty-two questions was designed and carried out from April 2018 to July 2018. Three hundred and twenty-eight HTA agencies from seventy-five countries were invited to participate in this survey. Results Eighty-nine participants completed the survey, representing a participation rate of twenty-seven percent. As to how HTA reports should fulfill their social role, over 84 percent of respondents agreed upon the necessity to address this role for decision makers, patients, and citizens. At a lower level, the same was found regarding the necessity to make value-judgments explicit in different report sections, including ethical analysis. This contrasts with the response-variability obtained on the status of ethical analysis with the exception of the expertise required. Variability in stakeholder-participation usefulness was also observed. Conclusions This study reveals the importance of a three-phase approach, including assessment, contextual data, and recommendations, and highlights the necessity to make explicit value-judgments and have a systematic ethical analysis in order to fulfill HTA's social role in guiding decision makers.

Philosophers engaged in the field of applied ethics are often challenged to revisit certain philosophical debates in order to clarify the background concepts involved in a given undertaking at stake. This is particularly evident in the field of Health Technological Assessment (HTA) where the integration of ethics has been a debate for many years. Interdisciplinary technological assessment involves a head-on discussion between the frame of reference of natural sciences and those of philosophy, which often reproduce the fact/value dichotomy debated in the field of philosophy. The challenge for a philosopher is then to explain how the fact/value dichotomy has been criticized by philosophers in such a way that the distinction between “verifiable facts” and “unverifiable values” cannot be accounted for anymore. The critiques of H. Putnam and S. E. Toulmin were the first steps towards the understanding of the dichotomy. A speech act approach, based on J. L. Austin illocutionary acts, can shed a new light on this issue by clarifying the difference between assertions, evaluations and prescriptions. By using a speech-act approach we can define the respective role of scientific evaluation and ethical evaluation in the HTA process and offer a better guide for the decision-makers on all aspects of adopting a technological development in health.

Objectives:Integration of ethics into health technology assessment (HTA) remains challenging for HTA practitioners. We conducted a systematic review on social and methodological issues related to ethical analysis in HTA. We examined: (1) reasons for integrating ethics (social needs); (2) obstacles to ethical integration; (3) concepts and processes deployed in ethical evaluation (more specifically value judgments) and critical analyses of formal experimentations of ethical evaluation in HTA.Methods:Search criteria included “ethic,” “technology assessment,” and “HTA”. The literature search was done in Medline/Ovid, SCOPUS, CINAHL, PsycINFO, and the international HTA Database. Screening of citations, full-text screening, and data extraction were performed by two subgroups of two independent reviewers. Data extracted from articles were grouped into categories using a general inductive method.Results:A list of 1,646 citations remained after the removal of duplicates. Of these, 132 were fully reviewed, yielding 67 eligible articles for analysis. The social need most often reported was to inform policy decision making. The absence of shared standard models for ethical analysis was the obstacle to integration most often mentioned. Fairness and Equity and values embedded in Principlism were the values most often mentioned in relation to ethical evaluation.Conclusions:Compared with the scientific experimental paradigm, there are no settled proceedings for ethics in HTA nor consensus on the role of ethical theory and ethical expertise hindering its integration. Our findings enable us to hypothesize that there exists interdependence between the three issues studied in this work and that value judgments could be their linking concept.

How can technological development, economic development, and the claims from society be reconciled? How should responsible innovation be promoted? The “responsible social uses” approach proposed here was devised with these considerations in view. In this article, a support procedure for promoting responsible social uses (RSU) is set out and presented. First, the context in which this procedure emerged, which incorporates features of both the user-experience approach and that of ethical acceptability in technological development, is specified. Next, the characteristic features of the procedure are presented, that is, its purpose, fundamental orientation, and component parts as experimented by partners. Third, the RSU approach is compared with other support approaches and considered in term of how each approach assumes responsible innovation. Briefly, the RSU procedure is a way of addressing the issue of responsible innovation through an effective integration of social concerns.

Introduction:The fact that HTA is a value-laden process is recognized in the literature. This is one of the reasons for promoting a better integration of ethics in HTA processes. Although what is meant by value-judgment (VJ) and how it can be used in HTA is not clear for some authors; others have proposed the elicitation of implicit VJs, to make them more explicit, as one way for clarifying the role ethics may play in HTA. In order to clarify what a VJ is, a conceptual analysis is needed to distinguish it from a factual-judgment and see how they diverge on certain aspects and converge on others.Methods:The distinction between VJs and factual-judgments was debated in the fifties. At the core of the philosophy of language was a distinction between factual-scientific assertions about facts, considered objective, and VJs on what is right/wrong-good/bad, considered subjective. In speech-act theory these distinctions were treated as two different operations: assertive and evaluative. A conceptual analysis of VJs, considering them as specific speech-acts, was used for clarifying/deciphering the role of VJs in HTA.Results:VJs are intrinsically embedded in decision-making since they are the reasons justifying decisions. This is why implicit VJs can be identified at every decision-step in the HTA process. Assessment is usually considered objective while appraisal seems subjective. Since VJs are entrenched in the decisions taken throughout the assessment process, the results are not completely objective. Ethical analysis also distinguishes two types of VJs, those based on normative criteria and those based on various degrees of value actualization. Furthermore, since evaluation requires criteria based on a rational process, VJs are not totally subjective.Conclusions:Elicitation of VJs in HTA is one way of integrating ethics in HTA and offers decision-makers a more thorough picture of the ethical issues involved in their decision.

IntroductionAfter surveying its members on ethical issues (2003), the International Network of Agencies for Health Technology Assessment (INAHTA) mandated its Ethics Working Group (2005) to reflect on the role of health technology assessment (HTA) organizations in meeting social expectations. Some aspects of these have since been clarified by two studies addressing either the official position of INAHTA's members or the publication authors. An international survey was carried out on the perception of HTA professionals’ expectations when producing HTA reports: how to fulfil HTA's social role, which value judgments should be made explicit and what should be the status of ethical analysis.MethodsA twenty-two question, web-based, anonymous survey was devised from our recent systematic review on the integration of ethics into HTA and carried from April to July 2018. The information on 328 HTA agencies/contact persons from seventy-five countries was collected from the website of INAHTA, Health Technology Assessment International (HTAi), the European Network for Health Technology Assessment (EUnetHTA), EuroScan International Network, the HTA Network of the Americas (RedETSA) and the HTA Network of Asia (HTAsiaLink), a 2015 World Health Organization survey, HTAi members, and our local HTA network (Québec, Canada).ResultsEighty-nine participants completed and submitted a finalized survey for a 27 percent participation rate representing thirty-three countries. Regarding how the HTA reports should fulfil their social role, our results showed that over 84 percent of the respondents agreed upon the necessity to address it to decision makers, patients and citizens. At a lower and more variable level, the same result was found about the necessity to make value judgements explicit in different sections of the report, including ethical analysis. This contrasts with the variability of responses obtained on the status of ethical analysis although an agreement on the expertise required was observed. Variability in the usefulness of patient, public or stakeholder participation was observed.ConclusionsAt the dawn of this decade, this study reveals high expectations on context-dependent decisions in HTA: the necessity to integrate the ‘explicitation’ of value judgements and systematic ethical analysis to fulfil HTA's social role.

When philosophers participate in the interdisciplinary ethical, environmental, economic, legal, and social analysis of nanotechnologies, what is their specific contribution? At first glance, the contribution of philosophy appears to be a clarification of the various moral and ethical arguments that are commonly presented in philosophical discussion. But if this is the only contribution of philosophy, then it can offer no more than a stalemate position, in which each moral and ethical argument nullifies all the others. To provide an alternative, we must analyze the reasons behind the prevailing individual and cultural relativism in ethics. The epistemological investigation of this stalemate position will guide us to the core problem of the relation between theory and action (“Part 1: From a conceptual to a speech act analysis of moral arguments”). The stalemate can be overcome from a pragmatic philosophical standpoint, which combines epistemology, philosophy of language—that is, the philosophy of speech acts—and practical reasoning—that is, reasoning about decision-making (“Part 2: Moral argumentation from a pragmatist perspective”). From this philosophical standpoint, it will be possible to show how philosophy can accompany and support the development of nanotechnologies (“Part 3: Philosophy and the evaluation of the development of nanotechnologies”).

INTRODUCTION:The main difficulties encountered in the integration of ethics in Health Technology Assessment (HTA) were identified in our systematic review. In the process of analyzing these difficulties we then addressed the question of the diversity of ethical approaches (1) and the difficulties in their operationalization (2,3).METHODS:Nine ethical approaches were identified: principlism, casuistry, coherence analysis, wide reflexive equilibrium, axiology, socratic approach, triangular method, constructive technology assessment and social shaping of technology. Three criteria were used to clarify the nature of each of these approaches: 1.The characteristics of the ethical evaluation2.The disciplinary foundation of the ethical evaluation3.The operational process of the ethical evaluation in HTA analysis.RESULTS:In HTA, both norm-based ethics and value-based ethics are mobilized. This duality is fundamental since it proposes two different ethical evaluations: the first is based on the conformity to a norm, whereas the second rests on the actualization of values. The disciplinary foundation generates diversity as philosophy, sociology and theology propose different justifications for ethical evaluation. At the operational level, ethical evaluation's characteristics are applied to the case at stake by specific practical reasoning. In a norm-based practical reasoning, one must substantiate the facts that will be correlated to a moral norm for clearly identifying conformity or non-conformity. In value-based practical reasoning, one must identify the impacts of the object of assessment that will be subject to ethical evaluation. Two difficulties arise: how to apply values to facts and prioritize amongst conflicting ethical evaluations of the impacts?CONCLUSIONS:Applying these three criteria to ethical approaches in HTA helps understanding their complexity and the difficulty of operationalizing them in HTA tools. The choice of any ethical evaluations is never neutral; it must be justified by a moral point of view. Developing tools for ethics in HTA is operationalizing a specific practical reasoning in ethics.

INTRODUCTION:One of the barriers of integrating ethics in Health Technology Assessment (HTA) relates to the social role of HTA (1). The aim of this study is to provide a better understanding of the way by which law circumscribes the social role of HTA. Our hypothesis: HTA's social role is embedded within a mixed governance based on hard law and soft law.METHODS:Three HTA agencies were conveniently selected for our study: Haute Autorité de santé (HAS) (France), National Institute for Health and Care Excellence (NICE) (United Kingdom) and Institut national d'excellence en santé et en services sociaux (INESSS) (Québec, Canada). Our analysis of the legal, administrative and procedural documents relating to the existence and assessment processes of these three agencies is guided by the following criteria: 1.The normative strength of the documents (categories of hard law or soft law) (2)2.The definition of the agencies’ social role (1)3.The integration of ethics in the agencies’ mandate.RESULTS:Hard law contributes to establish a general mandate and some legal legitimacy for these agencies. Soft law, grounded in the HTA producers' practices, plays a major role in the legal governance of HTA. Our results demonstrate that these agencies existing practices seem to circumscribe their social role further than their constitutive laws. In this context, social actors become responsible to define, structure and operationalize the implementation of HTA.In addition, the legal framework (hard law) through which HTA unfolds does not clearly support its structural and social role. Despite existing legal frameworks, the normative legitimacy of HTA is not entirely established, as it depends on soft law. Taken altogether, this maintains a persisting conceptual vagueness in HTA governance.CONCLUSIONS:The social role of HTA should be defined either through modifying existing legislations (hard law) or through harmonization of the agencies internal policies and regulations (soft law). Such legal initiatives would help clarify the aims of HTA evaluations: assessments (scientific) or appraisal (value-laden), and therefore give a clearer indication on how best to integrate ethics in HTA.

INTRODUCTION:The objective was to identify the conceptual and methodological issues surrounding integration of ethics in Health Technology Assessment (HTA). We conducted a systematic review examining: (i) social needs, (ii) methodological and procedural barriers, (iii) concepts or processes of ethics assessment used and (iv) results of experimentations for integrating ethics in HTA.METHODS:Search criteria included ‘ethic’, ‘technology assessment’ and ‘HTA’. The literature search was done up to 21 November 2016 in Medline/Ovid, SCOPUS, CINAHL, PsycINFO and international HTA Database. Screening of citations, screening of full-text and data extraction were performed by two subgroups of two independent reviewers. The first group was constituted of HTA experts, and the second of ethics and philosophy experts. Data extracted from articles were regrouped in categories for each objective.RESULTS:A list of 2,420 citations was obtained while 1,646 remained after the removal of duplicates. Of these, 132 were fully reviewed, yielding 67 eligible articles for analysis. Eight categories were identified within the social needs. The mostly evoked were ‘Informed policy decision making’ (n = 16) and 'Informed public/patient decision making’ (n = 12). Ten categories of methodological and procedural barriers were identified. The most mentioned were 'Lack of standardized and recognized proceedings for ethical analysis’ (n = 28) and ‘Lack of shared consensus on the role of ethical theory and ethical expertise’ (n = 17). Within the concepts or processes of ethics assessment, thirteen categories were identified. The most mentioned were ‘Fairness and Equity’ (n = 12), ‘Beneficence and Non-maleficence’ (n = 10) and, ‘Autonomy’ (n = 10). Within results of experimentations, five categories were identified. The most mentioned was ‘Usefulness of ethics for identifying relevant problems’ (n = 3). While few experimentations were identified, no clear operational method was found in our research.CONCLUSIONS:This study confirms the necessity to design an operational method integrating ethics and addressing social needs of HTA. Our results constitute the basis for developing a new theoretical and practical method.

The emergence and development of convergent technologies for the purpose of improving human performance, including nanotechnology, biotechnology, information sciences, and cognitive science (NBICs), open up new horizons in the debates and moral arguments that must be engaged by philosophers who hope to take seriously the question of the ethical and social acceptability of these technologies. This article advances an analysis of the factors that contribute to confusion and discord on the topic, in order to help in understanding why arguments that form a part of the debate between transhumanism and humanism result in a philosophical and ethical impasse: 1. The lack of clarity that emerges from the fact that any given argument deployed (arguments based on nature and human nature, dignity, the good life) can serve as the basis for both the positive and the negative evaluation of NBICs. 2. The impossibility of providing these arguments with foundations that will enable others to deem them acceptable. 3. The difficulty of applying these same arguments to a specific situation. 4. The ineffectiveness of moral argument in a democratic society. The present effort at communication about the difficulties of the argumentation process is intended as a necessary first step towards developing an interdisciplinary response to those difficulties.

L'article a pour objectif de poser les accords premiers et nécessaires à l'élaboration de la parole éthique aujourd'hui. Revenant sur la distinction langage - parole, l'A. propose d'orienter la recherche sur la parole (mode dialogique), où le recours aux fondements de la véracité du dire est remplacé par le partage de sens et les raisons de croire. Cette orientation exige de définir le rôle de la philosophie, d'orienter la recherche en éthique sur la délibération humaine et de tenter la corroboration avec des sciences humaines telles la psychologie du développement moral et la psychanalyse., This article aims to trace the basic agreements necessary to the articulation of ethics today. The A. proposes that research be oriented on the dialogical aspect of speech, proposing to insist thus upon reasons to believe and upon the sharing of meaning sharing rather than upon the foundational aspect of ethical language. The orientation supposes that the role of philosophy be redefined, that ethics be centered on human deliberation and that corroborations be searched with other human sciences, namely moral développement psychology and psychoanalysis.

The ethical issues raised by nanoengineering stem from the social reaction to bioengineering and challenge researchers, governments, and regulators. In this chapter, we focus on the differences between, on one hand, distinguishing between environmental, health, and safety issues and ethical, legal, and social issues, and, on the other hand, conducting an integrated analysis of ethical, environmental, economic, legal, and social (NE3LS) issues in nanotechnology. We show these approaches’ distinct modes of risk and impact determination, risk and impact assessment, and adoption of stances on technologies’ social acceptability. Further, we discuss the relationship between the natural sciences, the humanities, and the social sciences. This discussion helps clarify the challenges involved in the social communication of risk and the public discussion of the social acceptance of nanotechnology. Finally, it helps in understanding the gap between Europe and America regarding the social and democratic governance of the development of nanotechnologies.

RésuméComment analyser et comprendre l'importance que prend l'éthique notamment avec la prolifération des codes de déontologie et d'éthique dans notre société? L'auteur nous propose d'analyser ce phénomène social à partir des codes, des discours les légitimant, et de leur application. Cette analyse permet de cerner deux approches en tension dans cette forme de régulation sociale. La première s'inscrit dans la tradition juridique de la sanction des conduites; la seconde propose, malgré le contexte légal de son apparition, une avancée éthique d'actualisation de valeurs partagées. La tension existante entre ces deux modes de régulation sociale de l'activité occupationnelle permet d'éclairer un des aspects de la critique du droit dans la modernité: l'hégémonie du droit sur toute autre forme de régulation sociale.

This paper presents an overview of the functioning principles of CNTs and their electrical and mechanical properties when used as strain sensors and describes a system embodiment for a wearable monitoring and biofeedback platform for use in pressure ulcer prevention and rehabilitation. Two type of CNTs films (multi-layered CNTs film vs purified film) were characterized electrically and mechanically for potential use as source material. The loosely woven CNTs film (multi-layered) showed substantial less sensitivity than the purified CNTs film but had an almost linear response to stress and better mechanical properties. CNTs have the potential to achieve a much higher sensitivity to strain than other piezore-sistors based on regular of conductive particles such as commercially available resistive inks and could become an innovative source material for wearable strain sensors. We are currently continuing the characterization of CNTs based strain sensors and exploring their use in a design for 3-axis strain sensors.

Depuis le milieu du XXe siecle, les progres technologiques n’ont cesse de soulever autant des promesses d’avenir que des craintes pour l’environnement et les generations futures. Dans ce contexte, le principe de precaution est apparu d’abord comme interpellation morale devant les nouveaux dangers, ensuite comme principe juridique international et, enfin, comme droit communautaire en Europe et droit constitutionnel en France. Comment comprendre le principe de precaution, ses forces et ses limites, notamment avec le developpement actuel des nanotechnologies ? L’objectif poursuivi dans cet ouvrage interdisciplinaire est de contribuer a apporter une reponse eclairee et nuancee. Dans un premier temps, il aide a comprendre, du point de vue philosophique, ce que signifie aujourd’hui appeler un principe pour gouverner l’action et a saisir, par une etude interdisciplinaire, la geometrie variable du principe de precaution dans ses usages moraux et legaux. Dans un second temps, il cherche a mieux definir la force legale du principe de precaution en droit quebecois et canadien en comparaison avec le droit communautaire europeen a partir des cas de l’utilisation de nanomateriaux dans divers produits et en analysant la place de la precaution dans l’autorisation des brevets. Les auteurs de cet ouvrage esperent ainsi participer au dialogue entre les perspectives americaines et europeennes sur le principe de precaution et sur le choix du meilleur encadrement du developpement des nanotechnologies.

How are we to understand the fact that the philosophical debate over nanotechnologies has been reduced to a clash of seemingly preprogrammed arguments and counterarguments that paralyzes all rational discussion of the ultimate ethical question of social acceptability in matters of nanotechnological development? With this issue as its starting point, the study reported on here, intended to further comprehension of the issues rather than provide a cause-and-effect explanation, seeks to achieve a rational grasp of what is being said through the appeals made to this or that principle in the range of arguments put forward in publications on the subject. We present the results of the study’s analyses in two parts. In the first, we lay out the seven categories of argument that emerged from an analysis of the literature: the arguments based on nature, dignity, the good life, utility, equity, autonomy, and rights. In the second part, we present the background moral stances that support each category of argument. Identifying the different categories of argument and the moral stance that underlies each category will enable a better grasp of the reasons for the multiplicity of the arguments that figure in discussions of the acceptability of nanotechnologies and will ultimately contribute to overcoming the tendency towards talking past each other that all too often disfigures the exchange. Clarifying the implications of the moral arguments deployed in the debate over nanotechnologies may make it possible to reduce the confusion observable in these exchanges and contribute to a better grasp of the reasons for their current unproductiveness.

In 1998 in Canada and Quebec, two policies regarding research ethics transformed the evaluation approach of clinical research following the Code of Nuremberg and subsequent Declarations of the World Medical Association. Even after almost ten years of implementation, these policies still arouse debate in the research milieu. If for many, these debates essentially reflect the inherent difficulties in any implementation process, in which resistance to change and the modification of policies and action plans, we believe that there is a more fundamental stake, rarely mentioned or debated, that of the choice of governance. In this article we start by proposing a classification of the different modes of governance: professional deontology, and ethical and administrative rights. Secondly, we show how the debates and criticisms addressed to the Research Ethics Committee of Quebec and Canada attains their full meaning in light of this basic stake: the divergence of the mode of governance to favour ethics in research.

L’émergence des nouveaux modes de règlement des différends, plus spécifiquement celle de la médiation, peut être vue comme un élément de déjudiciarisation des différends. Dans cet article, le rapport entre l’émergence des nouveaux modes de règlement des différends et la transformation de la fonction de juger est analysé à la lumière de la montée du droit administratif comme première étape de déjudiciarisation. La médiation est par la suite examinée en tant que réponse à la procéduralisation de la justice non judiciaire du droit administratif. La médiation est alors posée comme une manière d’assurer une justice non judiciaire et non procédurale, c’est-à-dire une justice informelle. The arrival of ADR on the professional market seems to confirm the trend of finding an alternative to the importance of the judicial resolution of conflicts in our democratic societies. In this article, ARD, more precisely mediation, is looked at in the context of the rise of the administrative law. The importance of mediation of conflicts is attributed to the need of less procedural justice. An informal justice is required because of the incapacity of procedural justice to correctly address the resolution of certain conflicts in society.

En 1998 deux politiques en éthique de la recherche étaient implantées au Canada modifiant ainsi le paysage de cette éthique. Au niveau fédéral, c’est la politique des trois conseils qui subventionnent la recherche au Canada ; et au Québec, c’est un plan d’action ministériel sur l’éthique et l’intégrité de la recherche. Quels changements ces politiques apportent-elles à la manière de considérer les fonctions d’un comité éthique de la recherche ? La présente analyse cherche à comprendre les rationalités éthiques véhiculées dans les politiques de la recherche notamment par le biais de l’évaluation éthique des protocoles. Or, depuis Nuremberg, où naît le principe de l’évaluation éthique de la recherche, il est possible de déceler trois rationalités éthiques différentes qui apparaissent au cours de l’histoire, dans un contexte des logiques sociales, mais qui sont encore omniprésentes dans les évaluations : l’évaluation morale, la protection des droits et la saine gestion. Il est important, devant les défis de la technoscience, de s’interroger sur la portée éthique de nos dispositifs afin d’en cerner les forces et les limites. In 1998 two policies in research ethics were adopted. In Canada it was the Policy of the Three Funding Councils and in Quebec the Ministerial Plan on Ethics and Integrity of Research. Have the policies changed the functions of the ethical committees? In the present the author analyses the trends in ethical evaluations, focusing primarily on the logical of the ethical evaluation of the protocols. Since Nuremberg, birthplace of research ethics evaluation, three major trends can be traced in the policies according to the evolution of the society. These three basic logics of evaluation are still present in current deliberations: moral evaluation, protection of rights and good administration. In the present context where applied sciences and business meet, a closer look at the forces and the limits of our ethical committees is necessary.

In 1998 in Canada and Quebec, two policies regarding research ethics transformed the evaluation approach of clinical research following the Code of Nuremberg and subsequent Declarations of the World Medical Association. Even after almost ten years of implementation, these policies still arouse debate in the research milieu. If for many, these debates essentially reflect the inherent difficulties in any implementation process, in which resistance to change and the modification of policies and action plans, we believe that there is a more fundamental stake, rarely mentioned or debated, that of the choice of governance. In this article we start by proposing a classification of the different modes of governance: professional deontology, and ethical and administrative rights. Secondly, we show how the debates and criticisms addressed to the Research Ethics Committee of Quebec and Canada attains their full meaning in light of this basic stake: the divergence of the mode of governance to favour ethics in research.

Une enquête sur les conceptions de la profession a été réalisée auprès d’un échantillon représentatif du personnel enseignant québécois du primaire et du secondaire. Elle aborde les éléments suivants de la pratique enseignante : le savoir privilégié dans la pratique, les types de stratégies éducatives mises en oeuvre, l’approche globale ou individualisée retenue pour l’enseignement en classe, le rapport au savoir qui guide l’agir, les qualités personnelles indicatrices des valeurs professionnelles, le rapport aux professions reconnues et l’intérêt pour un ordre professionnel, etc. Les résultats montrent que les enseignants considèrent majoritairement leur pratique professionnelle comme une aide au développement des personnes., A survey regarding conceptions of the teaching profession was administered to a representative sample of primary and secondary teachers in Québec. The following elements of teaching practices were included : knowledge underlying practices, types of educational strategies selected, a global or individualized approach to class teaching, the types of knowledge that guide actions, personal qualities indicative of professional values, the relationship to recognized professions and interest in the teaching profession, etc. The results show that most teachers consider their professional practice as an aid to the development of individuals., Una encuesta acerca de las concepciones de la profesión fue realizada con una muestra representativa del personal docente de Quebec a nivel de la primaria y de la secundaria. Se trata de los siguientes elementos de la práctica docente : el saber privilegiado en la práctica, los tipos de estrategias educativas empleadas, el enfoque global o individualizado elegido para la enseñanza en la aula, la relación con el saber que orienta el actuar, las cualidades personales indicadoras de los valores profesionales, la relación con las profesiones reconocidas y el interés por un orden profesional, etc. Los resultados demuestran que la mayoría de los docentes consideran su práctica profesional como una ayuda al desarrollo de las personas.

This paper aims to provide a better understanding of the law circumscribing the social role of Health Technology Assessment (HTA) and gain insight into the reasons challenging the inclusion of ethics into HTA. We focused on a debate at the core of the perceived role of regulatory law in health technology development, namely: Environment, Health and Safety Issues (EHSI) vs Ethical, Legal and Social Issues (ELSI) that arose in technology governance. Data collection was based on a literature review and a case study analysis. The former was founded on previous work. Three HTA agencies were selected for the latter using categories ranging from a greater to a lesser level of legal obligatory intensity. Our literature review revealed five different themes relating to the social role of HTA and a distinction between the role/use of “hard law” and “soft law” in regulatory law, thus providing an understanding of how agencies used law for handling ethics in HTA. Both approaches revealed that the debate, first observed in the EHSI/ELSI technology-governance and assessment, is reproduced in HTA. The main trend revealed by the literature review and the case study, is the presence of a pact between science and regulatory law. The social demand for integrating ELSI, and more precisely, ethical evaluation into HTA, is not the main preoccupation of the traditional legal frameworks governing HTA and remains to be considered primarily by alternative, soft law initiatives. The reported difficulties in integrating ethics into HTA demonstrate the need for rethinking legal governance in HTA., Nous voulons mieux comprendre les lois circonscrivant le rôle social de l’Évaluation des technologies en santé (ETS) et les raisons empêchant l’inclusion de l’éthique en ETS. Nous avons ciblé un débat qui est au coeur du rôle perçu du droit réglementaire dans le développement de technologies en santé : l’opposition entre les enjeux environnementaux, sécuritaires et sanitaires (EHSI) et les enjeux éthiques, légaux et sociaux (ELSI), issus de la gouvernance technologique. La collecte de données est basée sur une revue de la littérature issue de travaux antérieurs, et sur une analyse de cas où trois agences d’ETS ont été sélectionnées en utilisant différentes catégories d’obligation légale selon leur degré de force contraignante. La revue de littérature a révélé cinq thèmes relatifs au rôle social de l’ETS et une distinction entre le rôle/utilisation du droit dur et du droit souple dans le droit réglementaire, permettant ainsi de comprendre comment les agences ont utilisé le droit pour intégrer (ou non) l’éthique en ETS. Les deux approches ont démontré que le débat, EHSI/ELSI observé initialement dans la gouvernance et l’évaluation de technologies est reproduit en ETS. La principale tendance confirmée par ces analyses est la présence d’un pacte entre la science et le droit réglementaire. La demande sociale d’intégrer les ELSI, particulièrement l’évaluation éthique en ETS, n’est pas prise en compte par le droit réglementaire traditionnel régissant l’ETS et doit plutôt être considérée par le droit souple. Les difficultés d’intégration de l’éthique en ETS démontrent la nécessité de repenser la gouvernance juridique de l’ETS.