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This paper presents the proposal of an empirical approach to ethics derived from a psychological theory of human judgment proposed by Norman Anderson. It shows how the methodology specific to this theory —functional measurement— makes it possible to characterize the various personal positions that exist in all societies regarding public health problems. The main results of three studies carried out in three different countries (Guinea, France, and Colombia) on various problems are presented as an illustration of what this approach can offer. These analyses focused on three deliberately very different problems: (a) the duty to care for infected patients in the event of a pandemic that puts at risk the lives of the health professionals, (b) the acceptability of postmortem reproduction in the specific context of fallen soldiers, and (c) the acceptability of physicianassisted suicide., Este artigo propõe uma abordagem empírica da ética derivada da teoria psicológica do julgamento humano proposta por Norman Anderson. Mostra como a metodología dessa teoria —denominada medição funcional— pode ser utilizada para caracterizar as diversas posições pessoais que existem em todas as sociedades em relação aos problemas de saúde pública. Os principais resultados de três estudos, realizados em três países diferentes (Guiné, França e Colômbia), são apresentados como uma ilustração do que esta abordagem pode contribuir. Esses estudos se concentraram em três problemas deliberadamente muito diferentes: (a) o deber de cuidar de pacientes infectados no caso de uma epidemia que ponha em risco a vida dos cuidadores, (b) a aceitabilidade da reprodução postmortem no caso de soldados que morrem em combate, e (c) a aceitabilidade do suicidio assistido por médicos., El presente artículo propone un enfoque empírico de la ética derivado de la teoría psicológica del juicio humano propuesta por Norman Anderson. Muestra cómo la metodología de esta teoría —denominada medición funcional— puede utilizarse para caracterizar las diversas posiciones personales que existen en todas las sociedades respecto a los problemas de salud pública. Los principales resultados de tres estudios realizados en tres países diferentes (Guinea, Francia y Colombia) se presentan como ilustración de lo que puede aportar este enfoque. Dichos análisis se centraron en tres problemas deliberadamente muy diferentes: (a) el deber de atender a los pacientes infectados, en caso de una epidemia que ponga en peligro la vida de los cuidadores; (b) la aceptabilidad de la reproducción postmortem, en el caso de los soldados que mueren en combate, y (c) la aceptabilidad del suicidio asistido por un médico.

Progress is being made in the development of an effective HIV vaccine. Once the vaccine is available, an important public health goal will be its widespread uptake in sub-Saharan Africa, home to 70% of new HIV infections worldwide. It is important, therefore, to begin planning how to promote its widespread uptake there. The aim of this study was to map the different personal positions regarding HIV vaccination of people living in Togo, West Africa. From January to April 2014, we recruited 363 adult participants who were asked to indicate their level of willingness to receive a future HIV vaccine under different conditions varying as a function of five factors: perceived susceptibility to HIV infection; effectiveness of the vaccine; perceived severity of AIDS; cost of the vaccine; and influence of the family. Five qualitatively different positions were found, which were labelled Unconditional acceptance (49%), Depends on cost/effectiveness ratio (20%), Depends on cost (18%), Total indecision (10%) and Complete reluctance (3%). Members of the wealthier segment of society were less often members of the unconditional acceptance cluster and more often members of the cost/effectiveness cluster than others. The diversity of people’s positions regarding a future HIV vaccine implies that HIV vaccination strategies in Togo and other African countries will need to be tailored in design and implementation rather than “one size fits all” interventions. Keywords: HIV vaccine; acceptability; lay people; positions; Togo

The aim of this study was to map Togolese people’s positions regarding the breaking of bad news to elderly patients. Two hundred eleven participants who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the acceptability of the physician’s conduct in each case. The vignettes were all combinations of five factors: (a) the severity of the disease, (b) the patient’s wishes about disclosure, (c) the level of social support during hospitalization, (d) the patient’s psychological robustness, and (e) the physician’s decision about how to communicate the bad news. Five qualitatively different positions were found. Two percent of the participants preferred that the physician always tell the full truth to both the patient and her relatives, 8% preferred that the truth be told depending on the physician’s perception of the situation, 15% preferred that the physician tell the truth, but understood that in some cases, nondisclosure to the patient was not inappropriate, 33% preferred that the physician tell the full truth to the relatives but not as much information to the patient, and 42% preferred that the physician tell the full truth to the relatives only. These findings present a challenge to European physicians taking care of African patients living in Europe or working in African hospitals, and to African physicians trained in Europe and now working in their home countries. If these physicians respect the imperative of always telling the truth directly to their patients, their behavior may trigger anger and considerable misunderstanding among African patients and their families.