MEDECINE LEGALE DROIT MEDICAL

THE USE OF CLINICAL PRACTICE GUIDELINES IN ONCOLOGY: THE CHALLENGE OF HARMONIZATION

Brenda BOGAERT — Wed, 16 Apr 2025 00:00:00 +0000

A growing tendency in medicine is the use of clinical practice guidelines to harmonize clinical practice. Researchers have noted the tension between the clinician’s individual autonomy and the constraints imposed by these guidelines. However, research on their use and appropriation by local actors deserves to be developed to better understand what is happening on the ground. The aim of our research was to better understand how they are used and appropriated in oncology. Even though the research focuses on the COVID crisis, it explores factors important to guideline use both during epidemics and in normal practice. The methodology consisted of qualitative, semi-structured interviews with clinicians and management in oncology in two hospitals in Lyon, France during the COVID pandemic. Our results indicate the ethical and epistemological reasons that guidelines were followed (or not) during the pandemic and the active role of clinicians in their formulation and implementation. We will discuss the question of trust in a guideline, how a flexible use of guidelines may safeguard institutional agility, and for what reasons a deviation may be justified in an ethics of care. The research contributes to better understandings of the dynamic role that local actors play in guideline development, appropriation, and use. It shows that while guidelines remain a standard from which their practices are to be compared (and justified), clinicians use them in a flexible manner and are active in evaluating and deciding how they will be implemented in their structures.

STATE OF THE ART OF DIGITALIZATION OF EVALUATION RESEARCH ETHICS COMMITTEES IN BENIN

Binet WEWE — Wed, 16 Apr 2025 00:00:00 +0000

Many Research Ethics Committees (RECs) in Africa still operate in the traditional way, which limits their effectiveness. In 2016 in Benin although a digital transition had begun, RECs had not yet jumped on this bandwagon. However, COVID-19 exacerbated the shortcomings of the manual operation of the RECs, highlighting the need for their digitization. Thus, the AMELIORER project was implemented from 2021 to 2023 thanks to EDCTP support to strengthen the ethical capacities of the RECs. Several phases were implemented to initiate the process of digitizing the RECs. The RHInnO Ethics platform was chosen for its ability to meet the specific needs of African RECs, offering security and efficiency. The effects observed from the digitization of RECs were an increase in the number of protocols evaluated and a significant reduction in the time taken to obtain ethics opinions. However, challenges remain, not least concerns about data security.

RESEARCH ETHICS IN BENIN: ISSUES AND CHALLENGES OF A DECADE OF PRACTICE WITHIN THE RESEARCH ETHICS COMMITTEES

Roch Appolinaire HOUNGNIHIN — Wed, 16 Apr 2025 00:00:00 +0000

In Benin, the history of research ethics dates back about a decade. It finds its origins in the democratic context, the scientific climate in favor of the promotion of research and the influence of financial partners. This is a relatively recent process marked by numerous issues and challenges that this research aims to examine through the practices promoted within Research Ethics Committees (RECs). The methodological approach is based on a review of the literature, interviews with actors of different profiles and observations during the RECs deliberation sessions. In Benin, any research project involving human beings should be approved and monitored by a regularly constituted REC. But in reality, few projects are subject to ethical evaluation. The reasons for requesting an ethical opinion relate to the requirements of the financial partner (often foreign) and the obligation to respect the editorial standards of an international journal. Made up of a heterogeneous group of actors, the RECs are not always the place for the expression of an open discussion which takes into account the plurality of its members and the divergent level of understanding and appreciation of the phenomena. Finally, the method of recruiting research participants, the methods of obtaining consent, the question of risks and disadvantages and benefits for participants, are specific issues that deserve to be apprehended.

WHAT LEGAL STRUCTURE FOR HEALTH PRODUCT ASSESSMENT AUTHORITIES?

Vincent DAËL — Wed, 16 Apr 2025 00:00:00 +0000

In France, the highly sensitive issues surrounding the evaluation of healthcare products are placed in the hands of two bodies. The HAS, characterized as an independent public scientific authority, evaluates healthcare technologies in order to guide the reimbursement of costs by the national health system. The ANSM, a public body under government supervision, assesses the benefits and risks of healthcare products. This contribution questions the legal distinction between these two bodies, and raises the idea of bringing them together to form a public health product expertise center to meet the new challenges facing this sector.

ANALYSIS OF BODY MODELLING PRACTICES: A CROSS-SECTION OF PHARMACEUTICAL SCIENCES, PHILOSOPHY AND LAW

Joséphine JUET — Wed, 16 Apr 2025 00:00:00 +0000

Medicines occupy a central place in our society. While it is a health good, it is when it interacts with society’s aspirations that it becomes a social good. This article examines the interaction between medicine and society, using the example of body-shaping practices. Foucauldian theories of normalization will help us understand the link that is established when medicine and society’s expectations interact.

REFLECTIONS ON THE POSSIBILITY OF PLURAL EPISTEMOLOGIES: “EXPERTISE” AND “TRADITIONAL KNOWLEDGE”

Charlotte VYT — Wed, 16 Apr 2025 00:00:00 +0000

This reflection aims to investigate the possibility of thinking plural epistemologies in contexts of suffering, using standpoint epistemology as its guiding framework. To initiate this inquiry, I will first introduce the concept of standpoint epistemology by clarifying its two main commitments. Next, I will ground this reflection in a concrete context by examining a specific case within the realm of asylum seeking. Finally, I will clarify the concept of plural epistemologies and highlight its importance in uncovering some of the foundational structures of injustice. The challenge, then, is to develop a concept of truth that is plural, pragmatic and situated—one that is ultimately more in line with the complexity of reality.

THE DIFFICULT COHABITATION OF TRADITIONAL MEDICINE AND BIOMEDICINE IN MADAGASCAR: WHAT ARE THE ETHICAL BENCHMARKS?

Laurent RAVEZ — Wed, 16 Apr 2025 00:00:00 +0000

In Madagascar, as in many countries around the world, traditional medicine has to coexist with biomedicine. Such cohabitation is not easy, given the very different ways in which these two medical practices operate. On the one hand, traditional practitioners offer an integrated approach to the suffering human being, including the material, psychological, environmental, and spiritual aspects of health. On the other hand, biomedical professionals focus on the strictly biological dimension of disease, insisting on the rationality of the causal explanations proposed and the implementation of treatments. However, given the needs of primary health care in Madagascar, it is essential that these two types of medicine coexist. Based on a concrete situation, we will explore the ins and outs of this cohabitation, highlighting its ambiguities.

RICHNESS AND SCIENTIFIC VALUE OF TRADITIONAL PHARMACOPOEIAS: THE EXAMPLE OF WEST AFRICA

Florence TABOULET — Wed, 16 Apr 2025 00:00:00 +0000

Traditional African pharmacopoeias are associated with a rich cultural heritage, as traditional practitioners have been using medicinal plants for centuries to treat patients. The use of traditional medicine is increasingly regulated by national health policies and is guided by WHO (World Health Organization) recommendations. The scientific evaluation of these practices is a vast undertaking. The regulatory approaches should not be the same for improved traditional medicines, manufactured on an industrial scale and registered by health authorities, and for artisanal preparations. In both cases, optimizing the quality of products should be a priority.

SALUTOGENESIS AS EMPOWERMENT. HEALTH PROMOTION AND THE ROLE OF THE MEDICAL HUMANITIES

Giovanni RUBEIS, Florian STEGER — Sun, 15 Jun 2025 00:00:00 +0000

Within recent years, health promotion has increasingly become an important topic in the public debate. More and more people follow a health conscious lifestyle, including a balanced diet, sports activities, and selfmeasurement through smart wearable sensors. There is a growing public demand for services and information regarding health promotion. However, health, its creation and maintenance which can be defined as salutogenesis play only a minor role in modern medicine. In our paper, we analyze the relation between medicine and health promotion form a historical as well as ethical perspective. We show that the pathocentric paradigm is a relatively recent development whereas salutogenesis has been a core task of medicine for most of its history. In a further step, we show that salutogenesis has an ethical dimension as well insofar as it may empower individuals to take health matters in their own hands. Finally, we suggest concrete measures for clinical practice in order to achieve an empowering health promotion.