Recent studies reported the development of psychological distress symptoms in patients who recovered from COVID-19. However, evidence is still scarce and new data are needed to define the exact risk and protective factors that can explain the variability in symptoms manifestation. In this study, we enrolled 257 patients who recovered from COVID-19 and we evaluated the levels of psychological distress through the Symptoms Checklist-90-R scale. Data concerning illness-related variables were collected from medical records, while the presence of subjective cognitive difficulties, (...) both before and after the illness, as well as the level of the cognitive reserve, were assessed over a clinical interview. Results revealed that being female and reporting the presence of subjective cognitive difficulties after COVID-19 were associated with higher levels of psychological distress. At the same time, being admitted to the hospital and having a high CR were protective factors. Adding new information to this emerging research field, our results highlight the importance of a complete psychological and cognitive assessment in patients with COVID-19. (shrink)

Two potentially lifesaving protocols, emergency preservation and resuscitation and uncontrolled donation after circulatory determination of death, currently implemented in some U.S. emergency departments, have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to “buy time”: one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations (...) and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR. (shrink)

Razón, poesía, historia.--La cuestión del estoicismo español.--El querer.

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding (...) these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. (shrink)

Dibujar el pensamiento de Seneca es dibujar su figura viva, trazar el esquema de su persona. Seneca es un mediador que para alzarse sobre nosotros necesita de nuestra necesidad, pues solo apoyado en nuestra indigencia tiene sentido. Maria Zambrano lleva a cabo un lucido estudio de la figura y significacion del pensador cordobes y presenta una seleccion de sus escritos.

Physicians are taught that the foundation of the physician-patient relationship is trust, and trust is based in part on truthfulness. While drawing important Òlines in the sandÓ regarding whether and why to tell the truth, ethics codes promulgating honesty fail to provide clinicians with guidance regarding what is the truth, as well as when and how to disclose it. These issues may be at the core of why an adverse event is left undisclosed. Consistently being truthful in the setting of (...) an error is particularly difficult and requires overcoming a number of institutional and personal barriers. The article concludes that if delivering Òthe truthÓ is important, then articulation of criteria for determining what should be told, by whom, and when is essential. A policy that considers the practical issues and provides guidance may be useful. (shrink)

When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, (...) and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice had been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. IOM speculated that (...) more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

In 1991, the University of Pittsburgh Medical Center implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria. This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy, and after the patient is pronounced dead, procuring organs.

Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later (...) only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. (shrink)

The first reported successful kidney transplantation occurred in 1954, between twins. Since then, organ donation and transplantation has become less a medical marvel than a common expectation of patients with a variety of diseases resulting in organ failure. Those expectations have caused demand for organs to skyrocket far beyond available supply, fueling an organ shortage and resulting in over 60,000 patients on transplant waiting lists. In this special issue, our contributors attempt to shed new light on some of the many (...) old ethical questions raised by transplant in the contemporary context of extreme scarcity. (shrink)

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to (...) significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure. (shrink)

Hilary Putnam is one of the world’s leading philosophers. His highly original and often provocative ideas have set the agenda for a variety of debates in philosophy of science, philosophy of mind and philosophy of language. His now famous philosophical thought experiments, such as the ‘Twin earth’ and ‘the brains in the vat’ have become part of the established canon in philosophy and cognitive science. _Reading Putnam_ is an outstanding overview and assessment of Hilary Putnam’s work by a team of (...) international contributors, and includes replies by Putnam himself. Divided into clear sections, it contains chapters on key aspects of Putnam’s large body of writing, including: Scientific realism and the changes that Putnam’s thought has undergone on this topic analyticity and ontology, including the important interconnections between the views of Putnam and Quine Putnam’s arguments concerning externalist views of meaning and reference, questions of conceptual relativity, and his preoccupation with ethics through a denial of the fact–value dichotomy Putnam’s developing views on perception. Offering an excellent survey of Putnam’s work, _Reading Putnam_ is essential for those studying philosophy of mind, philosophy of language, and philosophy of science, as well as for anyone interested in contemporary philosophy. (shrink)

: Research involving the dead, especially heart-beating cadavers, may facilitate the testing of potentially revolutionary and life-saving medical treatments. However, to ensure that such research is conducted ethically, it is essential to: (1) identify appropriate standards for this research and (2) assign institutional responsibility and a mechanism for oversight. Protocols for research involving the dead should be reviewed by a special committee and assessed according to nine standards intended to ensure scientific merit, to protect deceased patients and their families, and (...) to promote institutional integrity and responsibility. Federal regulation of research involving the dead will foster appropriate standards and, equally importantly, help establish the acceptability of such research. (shrink)

Drawing on recent findings, this study examines whether valence concordant electromyography (EMG) responses can be explained as an unconditional effect of mere stimulus processing or as somatosensory simulation driven by task-dependent processing strategies. While facial EMG over the Corrugator supercilii and the Zygomaticus major was measured, each participant performed two tasks with pictures of album covers. One task was an affective evaluation task and the other was to attribute the album covers to one of five decades. The Embodied Emotion Account (...) predicts that valence concordant EMG is more likely to occur if the task necessitates a somatosensory simulation of the evaluative meaning of stimuli. Results support this prediction with regard to Corrugator supercilii in that valence concordant EMG activity was only present in the affective evaluation task but not in the non-evaluative task. Results for the Zygomaticus major were ambiguous. Our findings are in line with the view that EMG activity is an embodied part of the evaluation process and not a mere physical outcome. (shrink)

_Jane and Louise Wilson_ With Essays by Jeremy Millar and Claire Doherty London: Ellipsis, 2000 ISBN 1-84166-027-2 84 pp., inc. 120 b/w photograph.

The coloniality of power is understood by Anibal Quijano as at the constituting crux of the global capitalist system of power. What is characteristic of global, Eurocentered, capitalist power is that it is organized around two axes that Quijano terms “the coloniality of power” and “modernity.” The coloniality of power introduces the basic and universal social classification of the population of the planet in terms of the idea of race, a replacing of relations of superiority and inferiority established through domination (...) with naturalized understandings of inferiority and superiority. In this essay, Lugones introduces a systemic understanding of gender constituted by colonial/modernity in terms of multiple relations of power. This gender system has a light and a dark side that depict relations, and beings in relation as deeply different and thus as calling for very different patterns of violent abuse. Lugones argues that gender itself is a colonial introduction, a violent introduction consistently and contemporarily used to destroy peoples, cosmologies, and communities as the building ground of the “civilized” West. (shrink)

Scholars have long been intrigued by the Buddha's defining action (karma) as intention. This book explores systematically how intention, agency, and moral psychology were interpreted in all branches of early Theravada thought, paying special attention to the thought of the 5th-century commentator Buddhaghosa.

The coloniality of power is understood by Anibal Quijano as at the constituting crux of the global capitalist system of power. What is characteristic of global, Eurocentered, capitalist power is that it is organized around two axes that Quijano terms “the coloniality of power” and “modernity.” The coloniality of power introduces the basic and universal social classification of the population of the planet in terms of the idea of race, a replacing of relations of superiority and inferiority established through domination (...) with naturalized understandings of inferiority and superiority. In this essay, Lugones introduces a systemic understanding of gender constituted by colonial/modernity in terms of multiple relations of power. This gender system has a light and a dark side that depict relations, and beings in relation as deeply different and thus as calling for very different patterns of violent abuse. Lugones argues that gender itself is a colonial introduction, a violent introduction consistently and contemporarily used to destroy peoples, cosmologies, and communities as the building ground of the “civilized” West. (shrink)

Ignorance is often a perfectly good excuse. There are interesting debates about whether non-culpable factual ignorance and mistake subvert obligation, but little disagreement about whether non-culpable factual ignorance and mistake exculpate. What about agents who have all the relevant facts in view but fail to meet their obligations because they do not have the right moral beliefs? If their ignorance of their obligations derives from mistaken moral beliefs or from ignorance of the moral significance of the facts they have in (...) view, should they be excused for failing to meet their moral obligations? It is not obvious that they should. In this paper we argue that the best non-skeptical accounts of moral responsibility acknowledge that factual ignorance and mistake will diminish moral responsibility in a way that moral ignorance and mistake will not. That is because factual ignorance is often non-culpable so long as it meets certain merely procedural epistemic standards but the same is not true of moral ignorance. Our argument is that the assumption that it is gets the standards of culpability for moral ignorance wrong, and that the mistake is encouraged by the thought that culpability in general requires an instance of known wrongdoing: that acting wrongly requires de dicto unresponsiveness to one’s obligations at some stage. We deny this and conclude that, therefore, ignorance and mistaken belief are indeed often perfectly good excuses – but far less often than some philosophers claim. (shrink)

Mental causation is notoriously threatened by the causal exclusion argument. A prominent strategy to save mental causation from causal exclusion consists in subscribing to an interventionist account of causation. This move has, however, recently been challenged by several authors. In this paper, we do two things: We (i) develop what we consider to be the strongest version of the interventionist causal exclusion argument currently on the market and (ii) propose a new way how it can in principle be overcome. In (...) particular, we propose to replace strict supervenience in the assumption that the mental supervenes on the physical by probabilistic supervenience and show how this move has the potential to license the inference to mental causation. Finally, we argue that probabilistic supervenience captures some of the most important intuitions that strict supervenience captures and discuss possible objections to weakening strict supervenience in the way we suggest. (shrink)

This essay examines liminality as space of which dominant groups largely are ignorant. The limen is at the edge of hardened structures, a place where transgression of the reigning order is possible. As such, it both offers communicative openings and presents communicative impasses to liminal beings. For the limen to be a coalitional space, complex communication is required. This requires praxical awareness of one's own multiplicity and a recognition of the other's opacity that does not attempt to assimilate it into (...) one's own familiar meanings. Refusing the assumption of transparency and operating with relational identities, the complex communication that occurs in the limen—often invisible to dominant groups—can enable genuine coalition and effective resistance to domination. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

Most of us are familiar with the phenomenology of mental effort accompanying cognitively demanding tasks, like focusing on the next chess move or performing lengthy mental arithmetic. In this paper, I argue that phenomenology of mental effort poses a novel counterexample to tracking intentionalism, the view that phenomenal consciousness is a matter of tracking features of one’s environment in a certain way. I argue that an increase in the phenomenology of mental effort does not accompany a change in any of (...) the following candidate representational contents: representation of externally presented features, e.g. brightness, contrast, and so on representation of task difficulty, representation of the possibility of error, representation of trying to achieve some state of affairs, representation of bodily changes like muscle tension, or representation of change in cognitive resource availability and lost opportunity cost. While tracking intentionalism about some phenomenal experiences like pains might obtain, it does not seem to obtain for all phenomenal experiences. This puts the intentionalist into an uncomfortable position of trying to explain why some phenomenal experiences have representational content and not others. Since many believe that tracking intentionalism or something like it provides the best chance of naturalizing consciousness, these arguments deserve detailed consideration. (shrink)

Situating narrative: philosophical and theological context -- Ethical being: the storied self as moral agent -- Reconciled being: narrative and pardon -- Pedagogies of pardon in praxis -- Towards a narrative pedagogy of reconciliation -- Ricoeur's legacy: A Praxis of Peace.

In this conceptual article, we argue that defining corporate social responsibility and corporate social irresponsibility as opposite constructs produces a lack of clarity between responsible and irresponsible acts. Furthermore, we contend that the treatment of the CSR and CSI concepts as opposites de-emphasizes the value of CSI as a stand-alone construct. Thus, we reorient the CSI discussion to include multiple aspects that current conceptualizations have not adequately accommodated. We provide an in-depth exploration of how researchers define CSI and both identify (...) and analyze three important gray zones between CSR and CSI: the role of harm and benefit, the role of the actor and intentionality, and the role of rectification. We offer these gray zones as factors contributing to the present lack of conceptual clarity of the term CSI, as a concept in its own right, leading to difficulties that researchers and managers experience in categorizing CSI acts as distinct from CSR. (shrink)

'Ethics' was not developed as a separate branch of philosophy in Buddhist traditions until the modern period, though Buddhist philosophers have always been concerned with the moral significance of thoughts, emotions, intentions, actions, virtues, and precepts. Their most penetrating forms of moral reflection have been developed within disciplines of practice aimed at achieving freedom and peace. This Element first offers a brief overview of Buddhist thought and modern scholarly approaches to its diverse forms of moral reflection. It then explores two (...) of the most prominent philosophers from the main strands of the Indian Buddhist tradition – Buddhaghosa and Śāntideva – in a comparative fashion. (shrink)

In South Asia, the period between 1100 and 1300 CE was a particularly prolific time for theorists from India's three main indigenous religions - Hinduism, Buddhism, and Jainism - to articulate their views on the face-to-face gift encounter. Their gift theories shaped a cosmopolitan sensibility that shared ethical and aesthetic values that reached across regional, sectarian, and religious boundaries. This book explores the ethical and social implications of unilateral gifts of esteem, offering a perceptive guide to the uniquely South Asian (...) contributors to theoretical work on the gift. (shrink)

Certain emotional processes “bypass the will” and even awareness, whereas others arise due to the deliberative evaluation of objects, states, and events. It is important to differentiate between the automatic versus reflective origins of emotional processes, and sensory versus conceptual bases of diverse negative and positive emotions. A taxonomy of emotions based on different origins is presented. This taxonomy distinguishes between negative and positive automatic versus reflective emotions. The automatic emotions are connected with the (a) homeostatic and (b) hedonistic regulatory (...) mechanisms. The reflective emotions—uniquely human—are described in reference to deliberative processes and appraisals based on two types of conceptual and verbalized evaluative standards: (a) ideal self-standards and (b) general, axiological standards of good and evil. (shrink)