Biomedical Ethics

Die Vereinbarkeit von Suizidbeihilfe und ärztlichem Ethos stellt eine der dringlichsten Fragen der modernen Medizin dar. Die vorliegende Studie greift die aktuelle Diskussion dieser Frage mit Blick auf die schweizerische Situation auf. Aus der Einsicht, dass der gefühlte Verlust von persönlicher Autonomie den Suizidwunsch hervorruft, wirft die Studie die bioethische Folgefrage auf, ob alle Menschen Personen sind. Unter Bezug auf das Denken von Paul Ricœur erklärt die Studie, weshalb jeder Mensch, unabhängig von seinen realen Fähigkeiten, als autonome Person zu betrachten und als solche mit der Herausforderung konfrontiert ist, die eigene Einsamkeit zu überwinden. Die Suizidbeihilfe erweist sich jedoch gerade hier als problematisch, da sie die wechselseitige Anerkennung zerstört und die Einsamkeit des Einzelnen bestätigt. Die richtige, dem ärztlichen Ethos entsprechende Antwort auf die menschliche Not, die dem Suizidwunsch zugrunde liegt, ist hingegen die Palliative Care. Denn sie ermöglicht ein Sterben, das Selbstschätzung und Selbstachtung fördert und damit die Anerkennung des Menschen als autonome Person verwirklicht. Jeder Mensch sollte diese Anerkennung in seinem gesamten Leben erfahren. Sie zu realisieren, stellt eine gesellschaftliche Herausforderung dar, zu deren Bewältigung gerade auch der christliche Glaube beitragen kann, bildet er doch eine Ressource, Menschen zusammenzuführen und Anonymität zu überwinden.
http://bookview.libreka.de/preview/82458/9783796538407?session=f51d776ab704970b809f0c27cb5044836b080a50

The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse–patient interactions, thereby decreasing the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse–patient relationships, as signalled by the American Nurses Association’s first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs.

Non-invasive prenatal testing (NIPT) using cell-free fetal DNA (cffDNA) from maternal blood has recently entered clinical practice in many countries, including Canada. This test can be performed early during pregnancy to detect Down syndrome and other conditions. While NIPT promises numerous benefits, it also has challenging ethical, legal and social implications (ELSI). This paper reviews concerns currently found in the literature on the ELSI of NIPT. We make four observations. First, NIPT seems to exacerbate some of the already existing concerns raised by other prenatal tests (amniocentesis and maternal serum screening) such as threats to women’s reproductive autonomy and the potential for discrimination and stigmatization of disabled individuals and their families. This may be due to the likely upcoming large scale implementation and routinization of NIPT. Second, the distinction between NIPT as a screening test (as it is currently recommended) and as a diagnostic test (potential...

Qu’apporte une approche par la « gouvernance de l’intervention éthique » ? Elle apprend que c’est dans l’embrigadement des pratiques éthiques (couplage) dans les interstices ouverts par la compétition des logiques d’utilité que peut se jouer une confrontation à ces logiques capable de déjouer leur manque en ramenant l'attention collective sur la puissance des sujets  engagés dans le cours d’action des soins.

Among all human practices, procreation seems the most paradoxical. It starts as a fully personal choice and ends with the creation of a new subject of rights and responsibilities. Advances in reproductive genetics pose new ethical and legal questions. They are expected to prevent the transmission of genetic diseases to progeny and also to improve genetically-endowed mental and physical attributes. Genetic selection and enhancement may affect a child’s identity, as well as the parent-child relationship. The authors are committed to a pluralistic approach that captures all aspects of this relationship in terms of moral virtues and principles. They elucidate that most of the conflicts between parental preferences and a child’s rights could be resolved with reference to the meaning and nature of procreation.

Social work can help to restore a balance towards humanity. We are and always have been critical thinking innovators with a comprehensive grasp of issues, a thorough knowledge of human situations and environments. We also possess the ability to craft policy that is meaningful while at the same time realize a moral obligation towards ourselves and to the populations we serve.

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a “physician-qua-friend model” of the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying.

Biobanking of residual human biological materials (HBMs),
usually obtained from surgeries, is crucial in biomedical
research for the advancement of science and public health.
[1] Research results obtained from studies using HBMs improve drug
discovery, clinical management and current treatment of various
diseases. However, biobanking of residual HBMs comes with ethical,
legal and social implications (ELSI) that require attention. On the
requirement of consent, there are on-going discussions about the
various models of informed consent concerning the collection,
storage and use of human biological materials (HBMs) for future
research [2]. This paper provides an analysis of the approach to
consent-taking by the Tissue Repository of the National University
Hospital (NUH TR).

In their 2004 New England of Journal of Medicine article, attorneys Julie Cantor and Ken Baum M.D. present opposing views for and against a pharmacist’s ethical right of refusal in filling prescriptions for emergency contraception and blocking a patient’s access to obtaining prescriptions by other means.

A common argument for abortion involves denial of the personhood of the unborn embryo or fetus. Mary Anne Warren pioneered this type of argument in her influential 1973 article on abortion. However, her understanding of the concept of personhood reveals both ignorance of Western philosophy and a deficient metaphysics.

In recent discussions about whether the use of a love pill to enhance love in our romantic relationships is desirable, one argument centres on the question whether this love pill would secure the final value we attribute to love. Sven Nyholm argues that it would not, because one thing we desire for its own sake is to be at the origin of the love others feel for us. In a reply, Hichem Naar argues against Nyholm that a love pill does not need to be incompatible with the final value we attribute to love and that a love pill can have a facilitating role in the creation and sustainment of loving attachment. I think Naar is right but does not address Nyholm's worry completely. I will argue that Naar and Nyholm are speaking of different ends for which the love pill is used as a means, and that whether the love pill would fail or not fail to secure the final value we attribute to love, depends on this particular end.

In the last decades "shared decision-making" has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of "shared decision-making". Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the 'instrumental'; (ii) the 'paternalistic'; (iii) the 'informative'; (iv) the 'interpretative'; and (v) the 'persuasive' models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons-and their unique lives and philosophies-rather than around abstract frameworks.

This is a pre-proof version of a paper, co-authored with Joseph Wu, forthcoming in Social Theory and Practice

Screening for asymptomatic disease is a routine aspect of contemporary public health practice. However, it is also controversial, because it leads to overdiagnosis and overtreatment, with many arguing that programmes are "ineffective", i.e. the "costs" outweigh the "benefits". This paper explores a more fundamental objection to screening programmes: that, even if they are effective, they are ethically impermissible because they breach the principle of non-maleficence. In so doing, it suggests a new approach to the ethics of risk, justifying a concern with how policies affect individuals' absolute ex-ante prospects. Part 1 sets up the tension between screening and non-maleficence. Part 2 introduces and motivates a novel interpretation of the non-maleficence principle, "ex-ante Do No Harm", which resolves this tension. Part 3 defends and clarifies this principle by discussing its relationship to the ex-ante Pareto principle. Part 4 discusses the worry that risk estimates are too "subjective".

"Tıp felsefesinin incili," Beauchamp & Childress'tan Principles of Biomedical Ethics, şimdi Türkçe. Türkçe prensipler BETİM, D&R ve diğer anlaşmalı tedarikçilerde satışta: http://www.dr.com.tr/Kitap/Biyomedikal-Etik-Prensipleri/urunno=0001712510001
http://www.kitapyurdu.com/kitap/biyomedikal-etik-prensipleri/431187.html

Turkish translation of Beauchamp & Childress' Principles of Biomedical Ethics, now on sale at BETIM, D&R, and other contracted stores: http://www.dr.com.tr/Kitap/Biyomedikal-Etik-Prensipleri/urunno=0001712510001
http://www.kitapyurdu.com/kitap/biyomedikal-etik-prensipleri/431187.html

Animals and Ethics 101 helps readers identify and evaluate the arguments for and against various uses of animals, such:

- Is it morally wrong to experiment on animals? Why or why not?
- Is it morally permissible to eat meat? Why or why not?
- Are we morally obligated to provide pets with veterinary care (and, if so, how much?)? Why or why not?

And other challenging issues and questions.

Developed as a companion volume to an online "Animals & Ethics" course, it is ideal for classroom use, discussion groups or self study. The book presupposes no conclusions on these controversial moral questions about the treatment of animals, and argues for none either. Its goal is to help the reader better engage the issues and arguments on all sides with greater clarity, understanding and argumentative rigor.

Nathan Nobis, Ph.D., is an Associate Professor of Philosophy at Morehouse College in Atlanta, GA USA.

NathanNobis.com

Nathan Nobis. Animals & Ethics 101: Thinking Critically About Animal Rights. Open Philosophy Press, 2016.

Buy the book on Amazon in paperback for $5.99 or Kindle for $2.99, or download the book for free.

Reviews on Amazon and the Open Textbook Library.

Available through www.AnimalEthics101.com

People who enter the biomedical field and have felt empathy for animals, but who learn to suppress those feelings and to accept and engage in animal research, are sociopaths.

People who happily experiment on animals with no empathy for the suffering they cause are psychopaths.

Being able to conduct animal experiments by being either a psychopath or sociopath is a selection filter for the fields of medicine and biomedical research.

It is very disturbing to realize that our medical system selects out sensitive, empathic, caring people, and is run by and for psychopaths and sociopaths. Anyone who enters the field of biomedical science or medicine must either become desensitized to animal suffering caused by vivisection, or leave the field, as I have done.

And I can tell you one truth that you should already know. The way we treat animals is the way we treat people.

“We live in an upside down world,” remarks director Ang Lee, “biblically, we lost Paradise.”  This comment, I believe, is central to Lee’s vision for his 2003 movie Hulk, based on the Marvel comic book series The Incredible Hulk. In past films, Lee demonstrated an array of philosophical approaches, but in this movie, the philosophical themes and concepts are religious ones, especially Judeo-Christian ones. For example, when Bruce Banner (a.k.a. the Hulk) blows up a frog during a lab test, his long-time love, Betty Ross, jokes that now they know who they can turn to when a “plague [of] frogs start falling from the sky.” The allusion to the ten biblical plagues is clear, as is the implication that Bruce is a kind of Moses figure who, on the side of the spiritual and the age-old normative, will be a future hero. Further allusions to, not to mention direct statements about, Bruce being like the biblical Isaac and being “predestined” to a certain life path are sown throughout, yet all in service to the general theme of losing paradise. 

What is “paradise” in this movie such that it can be lost? Probably drawing on the general ethos of Daoist and Mahayana Buddhist sympathies with the natural world, but fleshing these out in more Judeo-Christian terms, Lee seems to suggest that “paradise” is the state of peace or harmony that exists when the laws of nature are discerned and respected. The heroes are those who obey objective natural laws, especially those pertaining to what is natural to humanity, and the villains are those who, in the words of Banner’s father, David, aspire for the “power to go beyond God’s boundaries!” In the movie, Lee makes it clear that the villains are the metaphysical materialists, who reduce human nature and personal identity to mere bundles of matter and then treat them accordingly, while the heroes are those who recognize that human nature is an immaterial essence and treat it as such. In strict metaphysical terms, the vision of human nature and natural laws in Hulk is also at odds with most Chinese conceptions of human nature and natural laws, but this, I believe is accidental to Lee’s purpose in the film. What I shall argue, then, is that Hulk can be seen as a polemic against materialistic reductionism of human nature and ethics.

This essay explores the degree to which the "Principle of Totality" (TPoT) non-univocally guides our use of both artifacts and bodies. We argue that a careful analysis of these distinct kinds of totalities suggests the application of TPoT to artifacts and bodies is strongly isomorphic, which is what tempts advocates of the Principle of Autonomy to invalidly infer the absolute dominium of the individual over her body. The inference is invalid because this isomorphism also includes a principle of intrinsic value whose function is sometimes to resist the instrumentalization of both artifacts and bodies. Thus, we are not even related to artifacts as advocates of absolute autonomy believe we are, let alone to our bodies. We argue the limits of human dominium are determined by the nature and finalities, inherent or acquired, of the objects in question, and it will be argued that articulating these limits raises important and understudied questions about the permissibility of various kinds of human enhancement.

"The doctrine of informed consent, defined as respect for autonomy, is the tool used to govern the relationship between physicians and patients. Its framework relies on rights and duties that mark these relationships. The main purpose of informed consent is to promote human rights and dignity. Some researchers claim that informed consent has successfully replaced patients'¹ historical predispositions to accept physicians' advice without much explicit resistance.

Although the doctrine of informed consent promotes ideals worth pursuing, a successful implementation of these ideals in practice has yet to occur. What has happened in practice is that attorneys, physicians, and hospital administrators often use consent forms mainly to protect physicians and medical facilities from liability. Consequently, ethicists, legal theorists, and physicians need to do much more to explain how human rights and human dignity relate to the practice of medicine and how the professionals can promote them in practice.

This is especially important because patients' vulnerability has increased just as the complexity and power of medical science and technology have increased. Certain health care practices can shed light on the difficulties of implementing the doctrine of informed consent and explain why it is insufficient to protect patients' rights and dignity. Defining a normal biological event as a disease, and routinely prescribing hormone drug therapy to menopausal women for all health conditions related to menopause, does not meet the standards of free informed consent.

Clinicians provide insufficient disclosure about risks related to long-term use of hormone therapies and about the absence of solid evidence to support their bias toward hormone therapies as a treatment of choice for menopause related health conditions. The contributing problem is women's failure to act as autonomous agents because they either choose not to take an active part in their own therapy or because they fear to question physicians' medical authority. To insure that patients' autonomy and free choice are a part of every physician-patient interaction, physicians and patients need actively to promote them as values that are absolutely indispensable in physicians' offices, clinics, and hospitals."

A growing number of posthuman neuroprosthetic devices are under development that will provide their users with sensory, motor, and cognitive capacities that radically differ from those of ‘natural’ human beings. Specialized organizations such as military agencies and departments are fashioning plans to proactively deploy such neurotechnologies among their personnel. While the use of such devices has been studied from biomedical and ethical perspectives, substantive analysis has not yet been carried out from the perspective of organizational management. In this text we investigate the implications of integrating such advanced neurotechnologies into the structures, processes, and systems of an organization through the lens of enterprise architecture (EA), a management discipline that is designed to facilitate the incorporation of innovative IT into an organization and which is a favored management approach of the kinds of large, complex, and technology-intensive organizations expected to be ‘early adopters’ of posthuman neuroprosthetics.

We identify and analyze two primary ways in which the practice of enterprise architecture will change within organizations that deploy posthuman neuroprosthetics. First, it is argued that EA will be forced to adapt as the introduction of posthuman neuroprosthetics results in: 1) blurring distinctions between human personnel and electronic information systems; 2) changes in the nature of HCI and interpersonal communication; 3) an extension of the functional scope of an organization’s IT systems into the bodies and minds of its workers; 4) legal and ethical constraints limiting an organization’s ability to impose an EA on implanted neuroprostheses; and 5) changes to the fundamental capacities of a workforce. Second, the deployment of posthuman neuroprosthetics will impact an organization’s ability to address four challenges facing contemporary EA: 1) fragmentation of the field; 2) underutilization of EA products; 3) the requirement for ‘soft’ skills in implementing EAs; and 4) the ongoing need to collect large quantities of real-time organizational data.

We further argue that EA is well-positioned to facilitate the technological aspects of integrating posthuman neuroprosthetics into an organization but ill-suited to address the non-technological aspects of that process. Finally, we suggest that EA should draw on fields such as biomedical engineering, management cybernetics, and organization development in order to more effectively design and maintain architectures that incorporate posthuman neuroprosthetics.

Abstract: "Although two CDF documents have given instruction on the moral problems of artificial reproductive technologies and the importance of respecting the lives of cryopreserved embryos, no definitive judgment has been made regarding the possibility of rescuing those embryos by means of embryo transfer into the uterus of a willing woman.  This essay offers an analysis of the morality of embryo transfer in light of the ethical principles of St. Thomas Aquinas and argues that the proper use of our generative potential is only safeguarded by being restricted to marital intercourse.  The arguments of those who favor the adoption model are considered and rejected in light of a Thomistic analysis of the categories of paternity, maternity, and filiation."

In this short essay, I explain why we might think of personal narratives of illness and disability as "quality-of-life writing": because they furnish testimony that one can have a satisfying quality of life despite impairment and illness. Granted, such narratives need to be carefully taught, but they should be required reading in medical schools.

Legal outcomes often depend on the adjudication of what may appear to be straightforward distinctions. In this article, we consider two such distinctions that appear in medical and family law deliberations: the distinction between religion and culture, and between therapeutic and non-therapeutic. These distinctions can impact what constitutes ‘reasonable parenting’ or a child’s ‘best interests’ and thus the limitations that may be placed on parental actions. Such distinctions are often imagined to be asocial facts, there for the judge to discover. We challenge this view, however, by examining the controversial case of B and G [2015]. In this case, Sir James Munby stated that the cutting of both male and female children’s genitals for non-therapeutic reasons constituted ‘significant harm’ for the purposes of the Children Act 1989. He went on to conclude, however, that while it can never be reasonable parenting to inflict any form of non-therapeutic genital cutting on a female child, such cutting on male children was currently tolerated. We argue that the distinctions between religion/culture and therapeutic/non- therapeutic upon which Munby LJ relied in making this judgment cannot in fact ground categorically differential legal treatment of female and male children. We analyse these distinctions from a systems theoretical perspective - specifically with reference to local paradoxes - to call into question the current legal position. Our analysis suggests that conventional distinctions drawn between religion/culture and the therapeutic/non-therapeutic in other legal contexts require much greater scrutiny than they are usually afforded.

There are many things that we might feel obligated to justify to other people, but having a child is not usually one of them. It is difficult to imagine a decision more personal, or more apparently within one’s rights to make. Yet in recent decades a number of thinkers have raised questions and doubts about whether procreation and the obligations of parenthood are as morally uncomplicated and unquestionable as might be presumed. In this project, I specifically focus on how the challenges raised to procreation and parenthood apply to morally reflective and financially secure individuals living in affluent nations. These challenges can be roughly broken down into two broad categories.

The first category involves concerns about how a person is impacted by being brought into existence. Focusing on this side of things means wondering whether the chance that a person brought into existence will experience bad things in her life might be a reason that counts against bringing her into existence. It also might mean worrying about how we can bring people into existence, and so expose them to harms, without their consent. We can call these sorts of concerns “child-centered concerns”. They involve how an individual who is brought into existence might be wronged as a result of coming into existence.

The second category involves concerns which focus on how other people are impacted when someone is brought into existence. Focusing on this side of things means wondering whether other people might be made worse off by bringing someone into existence, directly or indirectly. We might worry that having more children in affluent nations with high emitting lifestyles will increase the burden we place on our planet’s ecosystem. We might also worry about the amount of money it takes to raise a child in the developed world, money which might have been donated to reliable aid agencies with considerably greater impact, perhaps saving the lives of many children. I shall call these “third party concerns”. Both sorts of concerns play a role in developing an approach to understanding the ethical issues surrounding procreation.

I find these challenges alarming and I believe they are sufficiently weighty to deserve consideration by any morally reflective and financially secure person, particularly those who plan to procreate and parent themselves and live in affluent nations. When and how can we say that procreation is morally permissible on the part of morally reflective and financially secure citizens of affluent nations when considering the arguments arrayed against it? My project seeks to offer an answer to this question. I investigate the different arguments against procreation. I argue that their shared conclusion—that having children in a world like our own is either always wrong or at least morally problematic—should be rejected.

In my response to these arguments, I aim to find a way between those who would say that procreation is always morally problematic or even morally impermissible and those who would embrace the common assumption that bringing new life into being is a practice to be accepted uncritically. I defend a view where procreation is permissible provided that certain conditions are met. First, that there is a reasonable expectation that the child will have a life that contains overall more benefits than harms. This condition also involves the understanding that there are strong reasons to benefit existing people, meaning that benefits must be pursued for the child, and costs avoided, once existing. Second, that the child will be prepared by parents with character education to provide her with resources for resilience which better enable her to face and endure the tragedies of life. Their provision of these is what in my view distinguishes “typical” procreation from cases of wrongful life. And, third, that (at most) children be prepared to be able to work toward leaving the world a better place than it would be had their parents not had them, a condition aimed at answering third party concerns driven by environmental destruction and global poverty.

Medical professionals seem to interpret their uses of humor very differently from those out-side their profession. Nurses and physicians argue that humor is necessary for them to do their jobs well. Many (potential) patients are horrified that they could one day be the butt of their physician’s jokes. The purpose of this paper is to encourage the respectful use of humor in clinical practice, so as to support its importance in medical practice, while simultaneously protecting against its poten-tial abuse. I begin by examining two extremes of supporting or chastising the use of medical humor. I look at these views through the lenses of popular theories of humor to help explain their theoreti-cal bases. In this second section, I explain the emotional aspect of humor as an embodied and em-bedded transformation of the world. This clarifies the role that humor plays in our daily lives, as well as why the ethical or unethical nature of its use is dependent on context. Third, I address the potential problems in the relationship between humor and clinical sympathy, and how this further affects the relationship between medical professionals and their patients. I conclude by arguing that humor can conflict with clinical sympathy, but this need not be the case. If medical professionals actively engage with clinical sympathy and focus on using humor in a way that is respectful towards their patients, then humor can continue to be a positive force in their lives while still providing the best care for their patients.

Depuis une vingtaine d’années, le projet a pris une place toujours plus grande dans la manière de soigner les patients psychiatriques : à leur entrée dans l’institution, ils se doivent de décider d’un but à atteindre avant de quitter l’hôpital. Cependant, cette méthodologie semble ne pas marcher à tous les coups : de nombreux patients n’arrivent pas à trouver un projet, ou à s’y tenir. Dès lors, nous nous interrogeons sur les raisons de cet échec : est-ce une question de manque de volonté, ou y a-t-il un élément qui pourrait nous permettre de mieux cerner le problème ? Cet élément semble être la temporalité, ou plutôt le conflit entre les temporalités qui structurent notre existence. En effet, nous postulons trois temporalités : la temporalité de la société, marquée par l’instantanéité, la temporalité de l’institution dans laquelle le patient est soigné et la temporalité de la maladie. La temporalité de l’instantanéité sera expliquée à l’aide des travaux de Stanghellini et Muscelli à travers leur analyse de l’instantanéité comme toile. Pour montrer la temporalité de l’institution et de la maladie nous utiliserons Minkowski et son concept de temps vécu, Binswanger et son étude de la manie et de la mélancolie, ainsi que Blankenburg avec la perte de l’évidence naturelle. Enfin, nous utiliserons Marquis pour comprendre les logiques sociales derrière le projet. Ces trois temporalités entrent en conflit, et empêchent le patient de se projeter, élément pourtant essentiel à la réussite du projet. La temporalité de la société, instantanée, prétend à l’hégémonie de l’instant de par sa structure en toile, où l’instant surgit sans cesse, en mettant à mal le passé et le futur. La temporalité de l’institution est plutôt dans une optique de l’accélération, c’est-à-dire une temporalité linéaire, futuriste. La temporalité de la maladie est influencée par celle-ci, et dépend donc des symptômes propres à la maladie. Schizophrénie pauci-symptomatique, mélancolie ou manie : chaque maladie a sa propre temporalité, qui peut s’axer soit sur un passé trop envahissant, soit sur un futur fermé, soit sur une impossibilité de former un monde commun. Les trois temporalités se focalisent sur des éléments différents, il est dès lors difficile de les combiner, et de faire place à certains idéaux tels que l’autonomie, qui sont pourtant nécessaires à la réalisation du projet.