Background Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units . A quantitative, multicentre, correlational study was conducted among 300 professionals.Results The most crucial ethical decisions made by professionals working in ICU were related to (...) communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments , to withhold treatments and to proceed to terminal sedation . This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses , it was the physicians who more keenly felt the need to proceed to ethical decisions in ICU.Conclusions Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout. (shrink)

BackgroundIn the last 2 weeks of January 2021, Portugal was the worst country in the world in incidence of infections and deaths due to COVID-19. As a result, the pressure on the healthcare system increased exponentially, exceeding its capacities and leaving hospitals in near collapse. This scenario caused multiple constraints, particularly for hospital medical staff. Previous studies conducted at different moments during the pandemic reported that COVID-19 has had significant negative impacts on healthcare workers’ psychological health, including stress, anxiety, depression, (...) burnout, post-traumatic stress symptoms, and sleep disturbances. However, there are many uncertainties regarding the professional quality of life of hospital nurses and physicians. To address gaps in previous research on secondary traumatic stress, we focused on healthcare workers working in hospitals affected by a major traumatic event: the third wave of COVID-19.ObjectivesThe aim of the present study was to identify the contribution of personal and work-related contextual variables on professional quality of life of healthcare workers.MethodsCross-sectional study with a web-based questionnaire given to physicians and nurses working in a hospital setting. A total of 853 healthcare professionals participated in the survey assessing professional quality of life compassion satisfaction, secondary traumatic stress, and burnout. Factors of professional quality of life were assessed using regression analysis.ResultsMost of the participants showed moderate or high levels of compassion satisfaction, whereas the majority of them experienced moderate levels of burnout and secondary traumatic stress. The analyzed variables demonstrated no differences between professionals who were directly or not involved in the care of COVID-19 patients. Parental status was found to be a significant factor in compassion satisfaction. Female gender was significantly associated with more susceptibility to secondary traumatization. Factors that may potentially contribute to burnout include years of professional experience and the number of work hours per week.ConclusionThe COVID-19 pandemic has created a new challenge for the healthcare system. Burnout and secondary traumatic stress can lead to medical errors and impact standards of patient care, particularly compromising compassionate care. It is therefore recommended that hospitals develop psychoeducational initiatives to support professionals in dealing with barriers to compassion. (shrink)

Ethical review systems need to build on their experiences of COVID-19 research to enhance their preparedness for future pandemics. Recommendations from representatives from over twenty countries include: improving relationships across the research ecosystem; demonstrating willingness to reform and adapt systems and processes; and making the case robustly for better resourcing.

São escassas as investigações sobre problemas internalizantes em adultos brasileiros. Estudos epidemiológicos apontam que ansiedade e depressão são mais comuns em mulheres. Este estudo apresenta uma investigação com 240 adultos de diferentes municípios da Região Metropolitana da Baixada Santista, com uso do Adult Self Report. Dados foram analisados por estatística descritiva e inferencial, considerando a variável sexo. Não foram encontradas diferenças significativas entre homens e mulheres da amostra em termos de problemas internalizantes, ansiedade/depressão, retraimento e queixas somáticas. Resultados são discutidos (...) à luz de dados epidemiológicos sobre transtornos mentais em outros recortes populacionais brasileiros. Ficam sugeridos novos estudos com ampliação de amostra. (shrink)

Resumo: O presente artigo tem como objetivo propor uma hipótese para superação das críticas feitas por Robert Nozick e Michael Sandel à teoria da justiça de John Rawls, no que concerne à necessidade de se considerar aspectos históricos e práticos, na formulação de princípios na posição original. Para tanto, é preciso analisar inicialmente as correntes filosóficas do liberalismo, do libertarianismo e do comunitarismo, a fim de fundar as bases necessárias ao desenvolvimento do estudo. Na sequência, será apresentada a teoria da (...) justiça de John Raws, seguida das críticas formuladas pelo libertário Robert Nozick, no que se refere à necessidade de se levar em conta o princípio histórico. Nozick comprova, por meio do exemplo de Wilt Chamberlain, como aspectos históricos podem alterar as estruturas pré-estabelecidas pelas teorias de estado final. Após, serão examinados os apontamentos feitos por Michael Sandel, especialmente no que concerne ao individualismo metodológico. Sandel também chama a atenção para o fato de que, para garantir efetividade aos princípios, é preciso que os indivíduos se utilizem de sua experiência e das particularidades da comunidade e de seus integrantes. Ao final, será sugerida uma proposta de superação das críticas dirigidas a Rawls, mediante a relativização da abstração da posição original.: The present article aims to overcome the criticisms made by Robert Nozick and Michael Sandel of John Rawls’ theory of justice, specifically with regard to the need for considering historical and practical aspects in the formulation of principles in the original position. We first analyze the philosophical currents of liberalism, libertarianism, and communitarianism, in order to lay the foundations necessary for the development of the study. Next, Rawls’ theory of justice is presented, followed by the critique made by the libertarian Robert Nozick of the need to consider the historical principle. Nozick proves, through the example of the American basketball player Wilt Chamberlain, how historical aspects can alter structures that are pre-established by theories of final state. Michael Sandel’s observations are then analyzed, especially with regard to methodological individualism. Sandel draws attention to the fact that to ensure the effectiveness of principles, individuals need to draw on their experience and on the particularities of the community and its members. Finally, a proposal is made for overcoming the criticisms directed at Rawls; this is achieved by relativizing the abstraction of the original position. (shrink)

Several countries maintain universal health coverage, which implies responsibility to organize delivery formats of healthcare services and products for citizens. In Brazil, the health system has a principle of universal access for more than 30 years, but many deficiencies remain and the country observes a day practice for those seeking judicial decisions to determine provision of healthcare.

This article aims to make public part of the research on the concept of ‘light’ in the theological and, above all, liturgical tradition of the Greek Orthodox Church, based on its representation of the concept of ‘hypostasis’. Taking as a point of departure the interpretation of the expression ‘light of light’ [φῶς ἐκ φωτός (phôs ek phōtos)] of the text of the Niceno-Constantinopolitan Symbol, the article presents a proposal for the interpretation of the concept of ‘representation’ for this specific case, (...) based on the idea of apomímesis, and applies this concept to a reading of the place of ‘light’ in the Holy Scripture, in the Patrology and in the Greek Eastern Liturgies. (shrink)

According to Iris Murdoch, the chief experience in morality is the recognition of others, and this is the experience of loving attention. Love is an independent source of moral authority, distinct from the authority of reason. It is independent because it can be attained through moral experiences that are not certified by reason and cannot be achieved by rational deliberation. This view of love calls into question a cluster of concepts, such as rational agency and principled action, which figure prominently (...) in the Kantian characterization of the moral experience and resound through Kant’s account of virtue as an endured but never-ending struggle. But it would be a mistake to conclude that Murdoch’s philosophical project opposes Kant’s without further qualifications. In this chapter, I illustrate some convergence between Kant and Murdoch at the methodological level, in their polemic against reductivism. They both oppose reductivist empiricism on epistemological and moral grounds, because they define the standard of proof in relation to the experience of morality. In Murdoch’s words, the philosophical proof, if there is one, is the same as the moral proof (Murdoch 1997: 361). This is where Kant and Murdoch part ways. While Kant argues that the moral experience is the experience of the impact of reason, which provides self-discipline by constraint, Murdoch holds that the moral standard of proof is love. The transformative power of love allows us to engage with reality and recognize others for what they are, that in which consists the primal moral experience. Murdoch’s argument against Kant’s appeal to principles brings to the fore a crucial issue, which concerns the source of moral authority and the possibility of practical reason. Some of her most popular arguments against Kant are based on an oversimplified view of the impact of reason in moral life, and perhaps they owe part of their fortune to this oversimplification. I shall argue that such arguments miss their intended target, but I also hope to show that Murdoch sketches a distinctive model of the moral proof, which establishes a genuine alternative both to theories of practical reason and to reductivist accounts of the mind and its activities. (shrink)

Este texto busca levantar reflexões sobre a importância e necessidades da educação para as relações étnico-raciais e promoção da educação antirracista. A partir do uso conceitual de letramento racial crítico e, da análise de legislações que consideramos oportunas para o enfrentamento do racismo, tais como a Lei nº 14.532, de 11 de janeiro de 2023, Lei nº 7.716, de 5 de janeiro de 1989, que visam criminalizar o racismo, e da Lei nº 10.639, de 9 de janeiro de 2003 sobre (...) a obrigatoriedade do ensino de história e cultura da população afro-brasileira e africana, as compreendemos como avanços no combate ao racismo. Em vista de levantarmos possibilidades para o desenvolvimento de um ensino pautado na luta antirracismo a partir e de que promova o letramento racial crítico, levantamos algumas observações sobre a música Bluesman, de Baco Exu do blues, como alternativa para o levantamento reflexivo em sala de aula para a valorização da história e identidade da população negra. (shrink)

Procurou-se, e esse foi o objetivo essencial, que este volume fosse marcado pelo discurso questionador e crítico de historiadores, de filósofos, de especialistas da ciência política, das ideias, do direito, da economia, da educação, da comunicação, da informação, das ciências, das artes. Surgiram assim interpretações, quadros, configurações e reconfigurações, ângulos de análise diversificados que fomentarão, por certo, uma reflexão viva dos leitores. É fundamental — continua a sê-lo — repensar e questionar campos temáticos à luz das análises teóricas e concetuais, (...) mas também dos processos, das dinâmicas, das relações, das potencialidades explicativas da nossa contemporaneidade. É assim que se entende este livro, com muitas contribuições, que vêm propiciar e enriquecer a reflexão sobre Outros Combates pela História. Combates pela História é, como se sabe, o título de um livro famoso de Lucien Febvre dos anos cinquenta. Através de uma recomposição, de novo se deu importância a todas as modalidades da História, mantendo, todavia, o sentido do rigor que era algo perseguido nos «combates pela História». Quer-se, pois, analisar o sentido da História, nas suas várias áreas. Contudo, ao propor-se este tema, não se desejou que os autores apresentassem tanto as suas investigações nas suas áreas próprias — embora elas estivessem subentendidas e devessem ser expressas —, mas que refletissem sobre o seu sentido no âmbito da História entendida como Ciência Social e Humana. Para tal, desejou-se que discutissem o objeto e o método da História das diversas áreas, equacionando os seus vários problemas. Foi isso que também sucedeu — estamos disso convencidos. Mas será o leitor, melhor do que ninguém, a ajuizá-lo. (shrink)

The volume “Conceptualizing Friendship in Time and Place” brings together reflections on the meaning and practice of friendship in a variety of social and cultural settings in history and in the present time, focusing on Asia and the Western world.

According to Iris Murdoch, the chief experience in morality is loving attention. Her view calls into question the Kantian account of the standard of moral authority, and ultimately denies that reason might provide moral discernment, validate moral experience or drive us toward moral progress. Like Kant, Murdoch defines the moral experience as the subjective experience of freedom, which resists any reductivist approach. Unlike Kant, she thinks that this free agency is unprincipled. Some of her arguments are based on an oversimplified (...) account of Kant’s theory of reflective agency and discount the discipline of reason, thereby nullifying its practical import. However, Murdoch’s work offers a distinctive view of the standard of proof as a ‘moral proof’, which rehabilitates the transformative power of love and represents a genuine alternative to theories of practical reason as well as to reductivist empiricist views of the mind. (shrink)

Neoliberal ideology and exclusionary policies based on racialized identities characterize the current contexts in North America and Western Europe. Nursing knowledge cannot be abstracted from social, political and historical contexts; the task of examining the influence of race and racial ideologies on disciplinary knowledge and inquiry therefore remains an important task. Contemporary analyses of the role and responsibility of the discipline in addressing race‐based health and social inequities as a focus of nursing inquiry remain underdeveloped. In this article, we examine (...) nursing's engagement with ideas about race and racism and explore the ways in which nursing knowledge and inquiry have been influenced by race‐based ideological discourses. Drawing on Henry and Tator's framework of democratic racism, we consider how strategic discursive responses—the discourses of individualism, multiculturalism, colour‐blindness, political correctness and denial—have been deployed within nursing knowledge and inquiry to reinforce the belief in an essentially fair and just society while avoiding the need to acknowledge the persistence of racist discourses and ideologies. Greater theoretical, conceptual and methodological clarity regarding race, racialization and related concepts in nursing inquiry is needed to address health and social inequities. (shrink)

ABSTRACT As we strive for a more polyvocal history of science, historians have placed increasing emphasis on local case studies as a way to globalize the field. This tension between the local and the global extends to the practice as well as the content of the history of science, as the field has begun to pay more attention not just to local case studies, but also to local cultures of historiography. Many historians of science want multiple historiographical voices that take (...) seriously the concerns and literatures in different linguistic and national contexts. As more journals urge translation into what are perceived as the dominant languages in “global” humanities discourses and scholars are encouraged to facilitate the Englishing of their historical research, many questions remain: In what ways does it make sense to nationalize or culturally locate individual cultures of the history of science? Is translation a democratic and positive force in the discipline, and/or does it kill local difference? Will it continue to be meaningful to talk about the history of science? A collective dialogue within the field depends on finding a way to take local diversity in historiography and epistemology seriously while translating that local difference into a meaningful common conversation. This essay considers the challenges of embracing multiple ways of knowing that might fall under the purview of the history of science, while wondering what that means for the coherence of the field as we move forward into the next century of work in Isis. (shrink)

Brian C. Ribeiro’s _Sextus, Montaigne, Hume: Pyrrhonizers_ invites us to view the Pyrrhonist tradition as involving all those who share a commitment to the activity of Pyrrhonizing and develops fresh, provocative readings of Sextus, Montaigne, and Hume as radical Pyrrhonizing skeptics.

The author- following his own research on the subject- argues that Wittgenstein ignores argumentation theory and in general, the problems of rhetoric and argumentation. From this point of view, he frames Stephen Toulmin’s reading of Wittgenstein, arguing that the British philosopher- who was a student of the Austrian- advocates precisely the same thesis. He explains that this happens in a very peculiar (rhetorical) context on Toulmin’s part; a context in which, in essence, Wittgenstein’s philosophy is being rehabilitated.

This article explores twelve short narrative films created by women and trans people living with disabilities and embodied differences. Produced through Project Re•Vision, these micro documentaries uncover the cultures and temporalities of bodies of difference by foregrounding themes of multiple histories: body, disability, maternal, medical, and/or scientific histories; and divergent futurities: contradictory, surprising, unpredictable, opaque, and/or generative futures. We engage with Alison Kafer's call to theorize disability futurity by wrestling with the ways in which “the future” is normatively deployed in (...) the service of able-bodiedness and able-mindedness, a deployment used to render bodies of difference as sites of “no future”. By re-storying embodied difference, the storytellers illuminate ongoing processes of remaking their bodily selves in ways that respond to the past and provide possibilities for different futures; these orientations may be configured as “dis-topias” based not on progress, but on new pathways for living, uncovered not through evoking the familiar imaginaries of curing, eliminating, or overcoming disability, but through incorporating experiences of embodied difference into time. These temporalities gesture toward new kinds of futures, giving us glimpses of ways of cripping time, of cripping ways of being/becoming in time, and of radically re-presencing disability in futurity. (shrink)

While foregrounding the historiography of HIV and AIDS in the South African context, this article analyses AIDS as simultaneously existing in three spheres: first, virtually – as the subject matter of electronically measurable research; second, academically – as a topic of research in the discipline of History; and third, actually – as a complex health concern and signifier that, via the field of Medical and Health Humanities, could allow for new collaborations between historians and others interested in understanding AIDS. Throughout, (...) the central focus is the discipline of History and the global trends that become evident when examining metrics about AIDS research, particularly those that show the hierarchies of knowledge ‘production’, the reinforcement of disciplinary boundaries, and the discrepancy between the amount of research ‘produced’ by scientific and humanities disciplines. Overall, the article suggests that ‘post-AIDS’ is not currently helpful to health historians working on South African and other majority world contexts. More specifically, the article reflects on what AIDS histories still need to be written, and I argue that Medical and Health Humanities could provide a space for historians to work within and across disciplinary boundaries given the ever evolving remit of AIDS histories, temporalities, and narratives. (shrink)

We argue that there are names with de se contents and that they are theoretically fruitful. De se names serve to challenge intuitive and otherwise plausible orthodoxies such as Stalnaker's view of communication and Bayesian views of belief update. These implications are also significant for those already sympathetic to the irreducibility of de se content.

Research on children’s ability to attribute false mental states to others has focused exclusively on false beliefs. We developed a novel paradigm that focuses instead on another type of false mental state: false perceptions. From approximately 4 years of age, children begin to recognize that their perception of an illusory object can be at odds with its true properties. Our question was whether they also recognize that another individual viewing the object will similarly experience a false perception. We tested 33 (...) preschool children with a task in which distorting lenses caused a small object to appear large and a large object to appear small. To succeed, children needed to recognize that a naive agent would falsely perceive the relative size of the objects and to correctly anticipate the agent’s actions on that basis. Children performed significantly better than chance in our false perception test, and there was a developmental progression in performance from 4 to 5 years of age similar to that seen in standard false belief tests. Our findings demonstrate that preschool children are capable of understanding that other individuals will be perceptually misled by illusory objects and that these false perceptions will influence their actions in predictable ways. (shrink)

This essay examines phrenological tools as instruments of matchmaking and focuses on the personal ad as a site for producing and exchanging knowledge about individuals. It shows how cranial measurement produced character profiles for the purpose of judging suitable marriage partners and how users integrated those profiles into personal advertisements published in the Water-Cure Journal. A popular but contested science of the mind, phrenology maintained that one could truly know others and oneself through measuring “organs” of the mind via protrusions (...) on the skull. While much has been written about phrenology, less attention has been paid to its focus on marriage and mating and to how users enrolled phrenology to find and judge the viability of a mate. Focused on the American context in the 1850s, this essay will show that notions of race and gender, heredity, and marital “relations” were embedded in the shorthand of phrenological measurements and personal ads. (shrink)

Perceptual experience and visual imagination both offer a first-person perspective on visible objects. But these perspectives are strikingly different. For it is distinctive of ordinary perceptual intentionality that objects seem to be present to the perceiver. I term this phenomenal property of experience ‘presence’. This paper introduces a positive definition of presence. Dokic and Martin (2017) argue that presence is not a genuine property of perceptual experience, appealing to empirical research on derealisation disorders, Parkinson’s disease, virtual reality and hallucination. I (...) demonstrate that their arguments fall short of establishing that presence is not perceptual. (shrink)

This article explores the production and consumption of phrenological knowledge for and by middle-class women in the USA during the early and middle decades of the 19th century. At a time when science itself had few boundaries, women became readers, consumers, proselytizers and practitioners of this knowledge system, outside of a scientific academy. This paper argues that phrenological beliefs about sex differences enabled and encouraged women to be users. Phrenology allowed women to negotiate gender and by encouraging followers to ‘know (...) thyself,’ phrenology blurred the lines of expertise, creating a fluid interplay between users and producers of knowledge. This article then shows how categories of women users–practitioners, consumers and feminists–implemented or rejected elements of phrenology as they sought to affirm or amend prescribed gender roles. As the industrial economy seemed to divide public and private, production and consumption, masculine and feminine, phrenology allowed women and men to stand within and between these binaries. At the same time, some women used phrenology to classify themselves and others in a socio-natural hierarchy and further engrained scientific racism in American culture. (shrink)

On Kant's view, the feeling of respect is the mark of moral agency, and is peculiar to us, animals endowed with reason. Unlike any other feeling, respect originates in the contemplation of the moral law, that is, the idea of lawful activity. This idea works as a constraint on our deliberation by discounting the pretenses of our natural desires and demoting our selfish maxims. We experience its workings in the guise of respect. Respect shows that from the agent's subjective perspective, (...) morality is the experience of being bound and necessitated, but also of being free and emancipated from inclinations. (shrink)

According to the standard objection, Kantian constructivism implicitly commits to value realism or fails to warrant objective validity of normative propositions. This paper argues that this objection gains some force from the special case of moral obligations. The case largely rests on the assumption that the moral domain is an eminent domain of special objects. But for constructivism there is no moral domain of objects prior to and independently of reasoning. The argument attempts to make some progress in the debate (...) by defending a robust conception of construction, which names a distinctive view of practical reasoning as transformative. (shrink)

According to a widely accepted philosophical model, agent-regret is practically significant and appropriate when the agent committed a mistake, or she faced a conflict of obligations. I argue that this account misunderstands moral phenomenology because it does not adequately characterize the object of agent-regret. I suggest that the object of agent-regret should be defined in terms of valuable unchosen alternatives supported by reasons. This model captures the phenomenological varieties of regret and explains its practical significance for the agent. My contention (...) is that agent-regret is a mode of valuing: a way in which the agent expresses and confers value. (shrink)

This study presents the first neuroimaging investigation of female psychopathy in an incarcerated population. Prior studies have found that male psychopathy is associated with reduced limbic and paralimbic activation when processing emotional stimuli and making moral judgments. The goal of this study was to investigate whether these findings extend to female psychopathy. During fMRI scanning, 157 incarcerated and 46 non-incarcerated female participants viewed unpleasant pictures, half which depicted moral transgressions, and neutral pictures. Participants rated each picture on moral transgression severity. (...) Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R) in all incarcerated participants. Non-incarcerated participants were included as a control group to derive brain regions of interest associated with viewing unpleasant vs. neutral pictures (emotion contrast), and unpleasant pictures depicting moral transgressions vs. unpleasant pictures without moral transgressions (moral contrast). Regression analyses in the incarcerated group examined the association between PCL-R scores and brain activation in the emotion and moral contrasts. Results of the emotion contrast revealed a negative correlation between PCL-R scores and activation in the right amygdala and rostral anterior cingulate. Results of the moral contrast revealed a negative correlation between PCL-R scores and activation in the right temporo-parietal junction. These results indicate that female psychopathy, like male psychopathy, is characterized by reduced limbic activation during emotion processing. In contrast, reduced temporo-parietal activation to moral transgressions has been less observed in male psychopathy. These results extend prior findings in male psychopathy to female psychopathy, and reveal aberrant neural responses to morally-salient stimuli that may be unique to female psychopathy. (shrink)

This paper explores cultural understandings of virtual sexual ageplay in the online world of Second Life. Online sexual ageplay is the virtual simulation of child abuse by consensual adults operating in-world with child computer characters. Second Life is primarily governed by Community Standards which rely on residents to recognise sexual ageplay and report it, which requires an appreciation of how residents view, understand and construct sexual ageplay. The research presented drew on 12 months of resident blog posts referring to sexual (...) ageplay: 263 total, with 91 residents. The analysis of this talk explores the cultural understandings of this banned behaviour and beliefs about the nature of Second Life which underpin residents’ likelihood to report sexual ageplay and so comply with the Community Standards. In considering these issues the paper is able to highlight issues regarding the unique cultural position of abuse against children and key concerns which underpin the reporting behaviour of residents. Key considerations relate to defining online sexual activity and child avatars; the moral status of ‘reporters’, and sexual ageplay as a form of edgeplay; belief in the harmfulness of sexual ageplay and its relationship to real world behaviours. (shrink)