Marta Spranzi

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Marta Spranzi is associate professor of history, philosophy and ethics of science at the University of Versailles St-Quentin-en-Yvelines medical school, and a clinical ethics consultant and research at the “Center for clinical ethics” at the Paris university hospital trust AP-HP (http://ethique-clinique.aphp.fr/clinical-ethics-consultation/)Her research focuses on epistemological issues underlying empirical and clinical ethics (what is a case and what is its normative relevance, ‘ordinary humanity’, the natural and the artificial), end-of-life and other prominent clinical ethics issues, and moral philosophy (Le travail de l’éthique: decision médicale et intuitions morales, Mardaga, 2018).

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Papers by Marta Spranzi

L’éthique clinique, son rôle et sa pertinence pour un travail de terrain

Revue française d'éthique appliquée, Nov 29, 2023

The Nature and Purpose of Aristotelian Dialectic Revisited: Argumentation Theory, Scientific Controversies and Epistemology

Springer eBooks, 2012

ABSTRACT

Chapitre 3. Les cas sauvages, les concepts éthiques et l’évolution des normes

Arrêts de traitement et mort « naturelle » : une dissonance cognitive

Presses universitaires de Franche-Comté eBooks, 2021

Chapitre 1. Expérience morale et rôle « heuristique » de l’éthique

Le Dialogue et le dialogue

Philosophies, Jun 1, 2004

Directives anticipées et modèles imaginaires de la bonne (ou mauvaise) mort

Revue française d'éthique appliquée, Jun 13, 2022

La loi Leonetti sur la fin de vie de 2005 a institué la possibilité pour toute personne de rédige... more La loi Leonetti sur la fin de vie de 2005 a institué la possibilité pour toute personne de rédiger des « directives anticipées » concernant ses souhaits en matière de traitements au cas où elle serait incapable de les exprimer directement (inconscience) ou jugée « incompétente » (maladie d’Alzheimer avancée). Les directives anticipées ont été renforcées et sont devenues opposables en 2016 suite à la révision de la loi.  Le médecin, pour sa part, a l’obligation d’en tenir compte si elles existent. Cette possibilité reste pour l’instant largement inexploitée, notamment parce que les personnes sont réticentes à se contraindre à un choix médical précis alors que la situation pourrait encore évoluer. Les directives anticipées sont aujourd’hui souvent préparées par des « discussions anticipées », un processus moins axé sur les décisions médicales concrètes pendant lequel les valeurs du patient et les différentes options sont discutées de façon plus informelle. Reste toutefois à traduire ce matériau narratif en une décision précise une fois qu’elle deviendra nécessaire. Je montrerai, à partir d’une réflexion épistémologique sur la structure et l’utilisation des modèles imaginaires dans les sciences, qu’un modèle mental construit à partir des exemples de « bonne mort » auxquels les personnes font souvent référence dans les discussions anticipées, peuvent servir de « médiateurs » pour traduire les valeurs de la personne dans une décision médicale concrète.

Situations de soins appelant un « travail de l’éthique »

Médecine Palliative, Dec 1, 2020

Manuscript_e9a7c9fefd0ab591886bba90024525a3 servante, qui s'attache à rendre faire émerger les en... more Manuscript_e9a7c9fefd0ab591886bba90024525a3 servante, qui s'attache à rendre faire émerger les engagements substantiels qui sont implicites dans les concepts qu'elles utilisent »[17]. Liens d'intérêts L'auteur déclare n'avoir aucun lien d'intérêt. Financement Ce travail n'a bénéficié d'aucune subvention spécifique émanant d'organismes de financement publics, commerciaux ou à but non lucratif.

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Le « long argument » en faveur du mouvement de la Terre

Philosophies, Jun 1, 2004

Galilée

L’éthique de l’interprète en milieu social : neutralité et engagement

Presses de l’Inalco eBooks, 2020

Cet article traite du rôle et du positionnement éthique de l’interprète en milieu social. Il dist... more Cet article traite du rôle et du positionnement éthique de l’interprète en milieu social. Il distingue trois modèles possibles de la fonction de l’interprète dans ces contextes : celui de porte-parole de l’usager, de médiateur et du tiers neutre. Ce dernier est le plus adéquat à construire et préserver la confiance avec les deux interlocuteurs. Il comporte la nécessité pour l’interprète d’adopter une attitude à la fois impartiale et neutre. La différence entre les deux notions est importante et peut être éclaircie par le biais de discussions de philosophie politique : l’impartialité correspond à une attitude d’indépendance vis-à-vis de ses propres engagements idéologiques ou politiques, alors que la neutralité traduit l’égale distance de l’interprète vis-à-vis des deux personnes qui communiquent entre elles. Ces deux attitudes éthiques essentielles entrainent des tensions et des dilemmes auxquels l’interprète doit faire face dans l’exercice de son travail.This article discusses the ethical positioning, attitude and role of community interpreters. Three models are presented—advocate, mediator and neutral third party. Only the latter model manages to preserve the trust of both interlocutors—the professional and the client. The interpreter’s ethical code stresses his impartiality and neutrality. These two notions, though they are often associated, are different. The way that they are discussed in the context of political philosophy clearly shows this. Impartiality refers to the interpreter’s independence with respect to her own personal commitments and ideological positions, while neutrality refers to the equal distance the interpreter has to assume with respect to each of the two interlocutors: she does not have to lean on one side or the other. However, these two essential ethical principles raise a number of tensions and dilemmas the interpreter has to deal with when performing her role.Questo articolo tratta della posizione etica et del ruolo dell’interprete sociale. Tre modelli sono discussi: quello dell’avvocato, del mediatore e del terzo neutro. Solo il terzo modello permette di mantenere la fiducia dei due interlocutori. Il codice etico dell’interprete comporta i due principi dell’imparzialità e della neutralità. La prima significa che l’interprete deve prendere le distanze delle sue proprie opinioni e posizioni ideologiche, mentre la seconda indica che l’interprete deve essere a uguale distanza da ciascuno dei due interlocutori. Questi principi etici sono essenziali ma comportano delle tensioni e dei dilemmi che rendono complesso il lavoro dell’interprete sociale

Is There a Difference Between Passive and Active Euthanasia

Books & ideas, Apr 14, 2014

Active euthanasia, which is defined as the intentional act of causing the death of a patient expe... more Active euthanasia, which is defined as the intentional act of causing the death of a patient experiencing great suffering, is illegal in France, whereas allowing patients to die (by withholding or withdrawing treatment) is authorized by law under certain conditions. However, the distinction between the different end-of-life decisions that healthcare professionals can make is perhaps less clearly defined than we might think; administering a lethal injection is far from being the only method by which a doctor can 'kill'. Oh, you who prolonged my life, Take back a gift that I detest! Diana I beg you, Stop the course of my days! (Iphigénie in C.W. Gluck's Iphigénie en Tauride) According to a study carried out across six European countries by EURELD (European end-of-life decisions) between 2001-2002, between 36% and 51% of all deaths were the direct result of medical end-of-life decisions (apart from Italy, where the figure was 22%) 1. In almost half of these cases, healthcare professionals decided to stop, limit or withhold treatment, whether or not the patient had explicitly requested it. In the other half of cases, they decided to alleviate pain and symptoms by intensifying medication to a level which may hasten death. Even in countries where euthanasia is legal, only a small percentage of all deaths (0.1% in Italy, and from 0.2% in Sweden up to 3.4% in Holland) occurred as a result of the administration of lethal drugs, whether voluntary or involuntary 2. What these figures show is not only how often such end-of-life decisions are made by physicians, but also that they are carried out in very different ways, which often fall outside the scope of our current definition of euthanasia. 1 A. I. van der Heide et alii, « End-of-life decision-making in six European countries: descriptive study »,

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1. Aristotle and the art of dialectic

The Normative Relevance of Cases

Cambridge Quarterly of Healthcare Ethics, Jul 24, 2012

In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our n... more In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our normative judgments, Daniel Callahan wrote, ‘‘What is, is all we have in the universe. We have to admit that if nature is not the source of morality, it does not have any source.’’ The attitude that Callahan has characterized in these stark terms has become a commonplace today, and efforts have shifted toward determining an adequate empirical basis for ethics, and what its acceptable uses are, rather than justifying in general terms the fact that ‘‘what is’’ is relevant for ‘‘what should be,’’ and refuting the so-called naturalistic fallacy. At a minimum, a ‘‘naturalized bioethics’’ has to ‘‘resist the pull to purity’’: it must acknowledge the complexity of ethical judgments and actions, promote curiosity for real-life dilemmas, and affirm the necessity that our ethical proposals be accountable to facts. Empirical ethics avails itself of a variety of methods. However, whereas qualitative and quantitative studies are common practice and their relevance is widely discussed, the use of individual cases has not been scrutinized with a view to assessing the reasons why, and the extent to which cases can constitute a valid empirical basis for ethical judgments. This is all the more crucial because a case anchors moral reasoning to practice in an intuitive and immediate way and often suggests insights or solutions to particular and even general issues: we are all familiar with the impact that cases have on our understanding of situations of ethical unease, with the satisfaction that we get when we feel that the solution we are suggesting accounts for several prominent cases we have encountered or read about, and with the heuristic function that cases play with respect to our common beliefs and practices. Indeed, one might argue, as Jonathan Dancy does, that cases are the only suitable tool of empiricism in ethics, because only cases can serve as tests of a sort for moral principles. Medical ethics, geared as it is toward the improvement of medical practice, is at the forefront of the naturalistic movement. It is a fact that cases do play an important role in medical ethics, and it is not surprising that they should: clinical medicine itself is rightly characterized as an art and to that extent deals primarily with particular cases rather than with general diseases. Cases are very often described in medical ethics publications: whether short or long, detailed or sketchy, current or exceptional, they capture our imagination and often provide a foundation for the authors’ conclusions. Moreover, cases, whether fictional or real, are central to narrative ethics, a prominent approach to bioethical reflection and education today: thanks to their temporal organization, the selective nature of the events recounted, and the thickness of their texture, narratives can better account for the lived experience of those involved in a medical decision, and to that extent

2. Dialectic in the Latin world

Introduction: Dialectic and the notion of tradition

L'énigme du Dialogue

Philosophies, Jun 1, 2004

F ERNAND H ALLYN , Les Structures rhétoriques de la science. De Kepler à Maxwell. Collection «Des travaux». Paris: Editions du Seuil, 2004. Pp. 323. ISBN 2-02-063249-7. €24.00

The British Journal for the History of Science, Jun 1, 2006

Humanity and "Ordinary Abuse": Learning from Hospital Patients' Letters of Complaint

Perspectives in Biology and Medicine, 2018

The prevention of abuse is a crucial issue in medical ethics. At the very least, the hospital set... more The prevention of abuse is a crucial issue in medical ethics. At the very least, the hospital setting should respect basic human rights, including dignity and life. In this respect, the normative reference to the concept of humanity plays a crucial role. However, the public as well as health-care professionals need to be aware of a more subtle and invisible form of abuse, "ordinary abuse." It can be defined as the undue suspension of the implicit rules of ordinary interactions, whose importance has been stressed by Erving Goffman and Harold Garfinkel. Moreover, the respect of "ordinary humanity" has an important ethical value, both in promoting "considerateness" and in sustaining a world of experience common to all human beings. Excerpts from a few letters of complaint from hospitalized patients will serve as an illustration of this important phenomenon and its ethical relevance. I n 2009, an influential and remarkable report to the French highest health authorities (Haute Autorité de Santé) written by Claire Compagnon, a patients' advocate, and Véronique Ghadi, a legal scholar, has brought to public attention a phenomenon that had gone unnoticed in medical ethics: the report's authors called it "ordinary abuse" (maltraitance ordinaire) (Compagnon and Ghadi

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When Patients’ Values Challenge Professional Integrity: Which Way Out?

Perspectives in Biology and Medicine, 2016

Patients' values and choices sometimes conflict with health-care providers' professional integrit... more Patients' values and choices sometimes conflict with health-care providers' professional integrity. Increasingly, health-care teams face requests for care they deem inappropriate, particularly around decisions near the end of life. Professional standards are useful in some ways, but are insufficient from an ethical point of view. Indeed, it can be important to remember that patients' values do not necessarily lose their legitimacy when they conflict with physicians' professional integrity. By examining a paradigmatic clinical ethics consultation case, this essay explores a possible way to address situations in which doctors' integrity and patients' values clash. In order for professional integrity to play a constructive rather than adversary role in decision making, it should be understood in an inclusive way, as a combination of interconnected values in play: professional, contextual, and personal.

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L’éthique clinique, son rôle et sa pertinence pour un travail de terrain

Revue française d'éthique appliquée, Nov 29, 2023