The doctor-patient relationship -- Consent, choice, and refusal : adults with capacity -- Treating adults who lack capacity -- Children and young people -- Confidentiality -- Health records -- Contraception, abortion, and birth -- Assisted reproduction -- Genetics -- Caring for patients at the end of life -- Euthanasia and physician assisted suicide -- Responsibilities after a patient's death -- Prescribing and administering medication -- Research and innovative treatment -- Emergency situations -- Doctors with dual obligations -- Providing treatment and (...) care in detention settings -- Education and training -- Teamwork, referral, delegation, and shared care -- Public health dimensions of medical practice -- Reducing risk, clinical error, and poor performance. (shrink)

At the outset of an ethnographic inquiry, we navigated national and international resources to search for theoretical and practical guidance on obtaining parents and children’s informed consent/assent. While much theoretical guidance debating ethical issues to children’s participation in research was found, a paucity of published papers offering practical guidance on assent processes and/or visual representations of child assent forms and information sheets was discovered. The purpose of this article is to describe our experiences, both theoretically and practically, of negotiating the (...) process of obtaining informed consent and assent with parents and children for a non-therapeutic qualitative research study. We hope this article instigates a platform for others to explicate their experience and contributes to the construction of a coherent body of knowledge which will clearly delineate important elements that must be considered when negotiating children’s agreement to participate in research. (shrink)

Deep brain stimulation (DBS) is a developing technology. New generations of DBS technology are already in the pipeline, yet this particular fact has been largely ignored among ethicists interested in DBS. Focusing only on ethical concerns raised by the current DBS technology is, albeit necessary, not sufficient. Since current bioethical concerns raised by a specific technology could be quite different from the concerns it will raise a couple of years ahead, an ethical analysis should be sensitive to such alterations, or (...) it could end up with results that soon become dated. The goal of this analysis is to address these changing bioethical concerns, to think ahead on upcoming and future DBS concerns both in terms of a changing technology and changing moral attitudes. By employing the distinction between inherent and noninherent bioethical concerns we identify and make explicit the particular limits and potentials for change within each category, respectively, including how present and upcoming bioethical concerns regarding DBS emerge and become obsolete. Many of the currently identified ethical problems with DBS, such as stimulation-induced mania, are a result of suboptimal technology. These challenges could be addressed by technical advances, while for instance perceptions of an altered body image caused by the mere awareness of having an implant may not. Other concerns will not emerge until the technology has become sophisticated enough for new uses to be realized, such as concerns on DBS for enhancement purposes. As a part of the present analysis, concerns regarding authenticity are used as an example. (shrink)

Body representations are known to be dynamically modulated or extended through tool use. Here, we review findings that demonstrate the importance of a user's tool experience or expertise for successful tool embodiment. Examining expert tool users, such as individuals who use tools in professional sports, people who use chopsticks at every meal, or spinal injury patients who use a wheelchair daily, offers new insights into the role of expertise in tool embodiment: Not only does tool embodiment differ between novices and (...) experts, but experts may experience enhanced changes to their body representation when interacting with their own, personal tool. The findings reviewed herein reveal the importance of assessing tool skill in future studies of tool embodiment. (shrink)

Background:Ethical competence in nursing practice helps clinical nurses to think critically, analyse issues, make ethical decisions, solve ethical problems and behave ethically in their daily work. Thus, ethical competence contributes to the promotion of high-quality care. However, studies on ethical competence in Malawi are scanty.Objectives:The aim of this study was to explore ethical competence among clinical nurses in selected hospitals in Malawi.Methodology:A cross-sectional survey was conducted in four selected hospitals in Malawi with a sample of 271 clinical nurses. Data were (...) collected using self-administered questionnaires, which included a Moral Competence Scale for Home Care Nurses. Descriptive statistics and logistic regression were computed for the dataset using STATA version 12.0.Ethical consideration:The study protocol complied with all ethical requirements and was approved by the College of Medicine Research Ethics Committee under the University of Malawi.Results:The clinical nurses in Malawi are ethically competent. However, there is a significantly high number (p 0.05). Three determinants of high ethical competence level (strong will, judgement skills and recognition of discrepancy of intention) were identified through a reduced model after stepwise logistic regression analysis. Furthermore, results show that indicators of ethical competence include caring, confidentiality and observance of nurses dressing code. The study has also confirmed that the Moral Competence Scale for Home Care Nurses is a reliable tool to assess ethical competence in low-resource settings.Conclusion:The majority of nurses who completed the survey had low ethical competence. However, clinical nurses with high ethical competence level are required to competently manage complex ethical challenges in health facilities. Strategies for enhancing ethical competence such as continuing ethics education, establishment of ethics committees and provision of supportive supervision are recommended to enable nurses in Malawi attain a high level of ethical competence. (shrink)

In this paper, we examine the scientific, legal, and ethical foundations for inclusion of transgender women athletes in competitive sport, drawing on IOC principles and relevant Court of Arbitration for Sport decisions. We argue that the inclusion of trans athletes in competition commensurate with their legal gender is the most consistent position with these principles of fair and equitable sport. Biological restrictions, such as endogenous testosterone limits, are not consistent with IOC and CAS principles. We explore the implications for recognizing (...) that endogenous testosterone values are a ‘natural physical trait’ and that excluding legally recognized women for high endogenous testosterone values constitutes discrimination on the basis of a natural physical trait. We suggest that the justificatory burden for such prima facie discrimination is unlikely to be met. Thus, in place of a limit on endogenous testosterone for women, we argue that ‘legally recognized gender’ is most fully in line with IOC and CAS principles. (shrink)

The presence of stigmatizing language in the electronic health record (EHR) has been used to measure implicit biases that underlie health inequities. The purpose of this study was to identify the presence of stigmatizing language in the clinical notes of pregnant people during the birth admission. We conducted a qualitative analysis on N = 1117 birth admission EHR notes from two urban hospitals in 2017. We identified stigmatizing language categories, such as Disapproval (39.3%), Questioning patient credibility (37.7%), Difficult patient (21.3%), (...) Stereotyping (1.6%), and Unilateral decisions (1.6%) in 61 notes (5.4%). We also defined a new stigmatizing language category indicating Power/privilege. This was present in 37 notes (3.3%) and signaled approval of social status, upholding a hierarchy of bias. The stigmatizing language was most frequently identified in birth admission triage notes (16%) and least frequently in social work initial assessments (13.7%). We found that clinicians from various disciplines recorded stigmatizing language in the medical records of birthing people. This language was used to question birthing people's credibility and convey disapproval of decision‐making abilities for themselves or their newborns. We reported a Power/privilege language bias in the inconsistent documentation of traits considered favorable for patient outcomes (e.g., employment status). Future work on stigmatizing language may inform tailored interventions to improve perinatal outcomes for all birthing people and their families. (shrink)

many symbols. We define o, as the probability that an arbitrary machine be circular and we prove that o, is a random number that goes beyond..

Husserlian phenomenology of time, as it is developed on theLectures on the Phenomenology of Inner Time Consciousness, shows some difficulties to explain certain temporal experiences. This is the case of the incompatibility between the rigidity of the retentional modification and the effective approach that a subject may have with his memories. On the one hand, according to the Lectures’ explanation, the darkening of the past occurs in an homogeneous way: The more distant an experience is, the lower the clarity of (...) the associated retention. However, our relation with the past is not so direct. Complementing the studies of the Lectureswith those of the Analysis concerning passive synthesiscould allow to explain this kind of temporal phenomena. (shrink)

RESUMEN Aunque las Lecciones de fenomenología de la conciencia interna del tiempo tienen pocas referencias al marco metódico, ciertos pasajes apuntan a la reducción fenomenológica, de modo que su status se diferenciaría del de las Investigaciones lógicas y se acercaría al de Ideas i. Se ha señalado que aun si la reducción es empleada en este texto, no lo sería en su "versión madura". Se busca determinar el estatus metodológico de las Lecciones a partir de una comparación entre los desarrollos (...) metódicos y las descripciones fenomenológicas que se presentan allí y aquellos consignados en Investigaciones e Ideas, teniendo como idea regulativa el esclarecimiento del papel del tiempo en la ampliación del dominio de la fenomenología como conjunto. ABSTRACT Although there are few references to the methodological framework in On the Phenomenology of the Consciousness of Internal Time, certain passages point to the phenomenological reduction. Therefore, its status would differ from that of the Logical Investigations and approach that of Ideas I. Some have argued that the reduction used in this text is not the "mature version" of the same. The article seeks to determine the methodological status of PCIT on the basis of the comparison between the methodological developments and phenomenological descriptions found in this work and those found in Investigations and Ideas. The regulative idea guiding the analysis is the clarification of the role of time in broadening the sphere of phenomenology as a whole. (shrink)

Este trabajo examina diferentes perspectivas docentes para externalizar criterios de evaluación. Se presentan hallazgos de una investigación doctoral que abordan, por una parte, una metodología analítica, que cautela la claridad y transparencia en la comunicación de criterios, segmentando la meta de aprendizaje en pequeñas secuencias, transmitiendo de este modo una idea atomizada acerca del conocimiento. Por otra parte, se explora una visión más holística, sustentada en la interdependencia de los criterios de evaluación, favoreciendo la comprensión del propósito de la tarea (...) en su conjunto. Se analiza la significancia de estos enfoques para la retroalimentación y evaluación formativa. (shrink)

We contribute to feminist and gender scholarship on cultural notions of motherhood by analyzing the importance of motherhood among mothers and non-mothers. Using a national probability sample of U.S. women ages 25-45, we find a continuous distribution of scores measuring perceptions of the importance of motherhood among both groups. Employing OLS multiple regression, we examine why some women place more importance on motherhood, focusing on interests that could compete with valuing motherhood, and controlling for characteristics associated with becoming a mother. (...) Contrary to cultural schemas that view mother and worker identities as competing, we find that education level is not associated with the importance of motherhood for either group and that valuing work success is positively associated with valuing motherhood among mothers. Consistent with feminist explanations for delayed fertility, valuing leisure is negatively associated with valuing motherhood for non-mothers. (shrink)

El canon literario implica un proceso de selección sistemático y jerárquico de escritores, obras y géneros con el fin de delimitar un corpus modélico imitableligado fuertemente a la instrucción pedagógica. En el presente trabajo se analizará el particular proceso de formación y conformación del canon –así como surecepción y transformación respecto de los cánones previos– establecido por Quintiliano en el Libro 10 de la Institutio Oratoria, a fin de demostrar que los criterios de selección que guían dicho canon exceden la (...) mera función didáctica. (shrink)

The article discusses a relatively obscure but significant aspect of work of the Russian and Soviet thinker Alexander Bogdanov—his science fiction novels. The author points out that, using the form...

En este trabajo presentamos el proceso del ordenamiento, catalogación y curaduría de los materiales fotográficos de un antropólogo estadounidense que realizó trabajo de campo en Atlixco, Puebla, México, con indígenas de la etnia nahua en las décadas de 1970 y 1980La metodología utilizada para este trabajo se basó en una propuesta propia de catalogación mínima de materiales fotográficos.Concluimos que la catalogación mínima es adecuada para la interoperabilidad con los estándares internacionales y resulta fácil de aplicar en los contextos universitarios y (...) de archivos locales. (shrink)

O objetivo deste artigo é apresentar uma argumentação sobre a possibilidade de se pensar a justiça como uma experiência do i m possível. Parte-se da distinção derridiana entre justiça e direito. Essa distinção trará algumas implicações no que tradicionalmente é entendido como ética. Partindo do jogo ou da différance marcada entre a presença/ausência, pretende-se estabelecer um ponto de diálogo entre Derrida e Levinas. O ponto de aproximação é a questão do terceiro na relação do face a face. Nesse sentido, problematiza-se (...) se a desconstrução pode ser adotada como um possível modo filosófico que fundamente a compreensão da justiça. (shrink)

Offers a historical-cultural context for the ethos of service in libraries and critically examines this professional value as it intersects with gender, sexuality, race and ethnicity, class, and (dis)ability"--Provided by publisher.

It is commonly thought that that the best system account of lawhood ((Mill (1843), Ramsey (1978)[fp. 1928], Lewis (1973)) makes available a nice explanation for why laws are ‘distinctively appropriate targets of scientific inquiry’ (Hall, 2015). The explanation takes the following general form: laws are especially valuable for agents like us because they efficiently encode a lot of valuable (non-nomic) information in a tractable format. The goal of this paper is to challenge this style of explanation: I argue that the (...) general principle it presupposes is in conflict with our best account of practical rationality. After considering and rejecting a number of proposals for dissolving the tension, I conclude that BSA proponents may need to scale back the explanatory ambitions of their theory; in particular, they may need to give up the hope of non-circular explanations of the value of nomic information. I end by outlining some challenges for the humean world-view that results after this shift. (shrink)

Abstract:Brain–computer interfaces (BCIs) can enable communication for persons in severe paralysis including locked-in syndrome (LIS); that is, being unable to move or speak while aware. In cases of complete loss of muscle control, termed “complete locked-in syndrome,” a BCI may be the only viable solution to restore communication. However, a widespread ignorance regarding quality of life in LIS, current BCIs, and their potential as an assistive technology for persons in LIS, needlessly causes a harmful situation for this cohort. In addition (...) to their medical condition, these persons also face social barriers often perceived as more impairing than their physical condition. Through social exclusion, stigmatization, and frequently being underestimated in their abilities, these persons are being locked out in addition to being locked-in. In this article, we (1) show how persons in LIS are being locked out, including how key issues addressed in the existing literature on ethics, LIS, and BCIs for communication, such as autonomy, quality of life, and advance directives, may reinforce these confinements; (2) show how these practices violate the United Nations Convention on the Rights of Persons with Disabilities, and suggest that we have a moral responsibility to prevent and stop this exclusion; and (3) discuss the role of BCIs for communication as one means to this end and suggest that a novel approach to BCI research is necessary to acknowledge the moral responsibility toward the end users and avoid violating the human rights of persons in LIS. (shrink)

It’s relatively easy to say that the debates about whether trans and intersex women athletes deserve full and equal inclusion in women’s sport is a contentious contemporary issue. I’ve already argued for the legal, ethical, and scientific basis for full and equal inclusion of trans and intersex women in women’s sport. In this paper, I want to analyze what I take to be a representative selection of recent arguments against full and equal inclusion of trans and intersex women in women’s (...) sport. In short, these arguments tend to be based on mere assumption, unsupported “common sense,” straw arguments, fallacious question begging, and a number of hypotheticals and unsupported counterfactuals rather than established fact. Essentially, they’re based on a lot of “ifs.”. (shrink)

The introduction of new medical treatments based on invasive technologies has often been surrounded by both hopes and fears. Hope, since a new intervention can create new opportunities either in terms of providing a cure for the disease or impairment at hand; or as alleviation of symptoms. Fear, since an invasive treatment involving implanting a medical device can result in unknown complications such as hardware failure and undesirable medical consequences. However, hopes and fears may also arise due to the cultural (...) embeddedness of technology, where a therapy due to ethical, social, political and religious concerns could be perceived as either a blessing or a threat. While Deep Brain Stimulation (DBS) for treatment resistant depression (TRD) is still in its cradle, it is important to be proactive and try to scrutinize both surfacing hopes and fears. Patients will not benefit if a promising treatment is banned or avoided due to unfounded fears, nor will they benefit if DBS is used without scrutinizing the arguments which call for caution. Hence blind optimism is equally troublesome. We suggest that specificity, both in terms of a detailed account of relevant scientific concerns as well as ethical considerations, could be a way to analyse expressed concerns regarding DBS for TRD. This approach is particularly fruitful when applied to hopes and fears evoked by DBS for TRD, since it can reveal if our comprehension of DBS for TRD suffer from various biases which may remain unnoticed at first glance. We suggest that such biases exist, albeit a further analysis is needed to explore this issue in full. (shrink)

Machine generated contents note: Chapter 1 -- The Prison of the Known -- Chapter 2 -- Can We Live without Conflict? -- Chapter 3 -- The Meaning of Dialogue -- Chapter 4 -- Practice and Solidarity: We Are the World -- Chapter 5 -- Science and the Religious Mind -- Chapter 6 -- A Call for Active Being: Being at Home in the World.

We live in dangerous times, ruled by the imperatives of what Hannah Arendt calls “the catastrophic interiority of the selfish I” 1 which threatens the planet and the survival of humanity. But I believe, nevertheless, that it is possible to reinvent the world since, by and large, it is evident that its shape reflects our notions of reality and value, the way we weave together the various strands of existence. Antonio Gramsci may have had something like this in mind when (...) he wrote that it is only by “the conquest of greater consciousness” that we will be able to bring a different kind of culture into being because, “man is above all spirit,” a creature, that is, with imagina- tion, the ability to reconfigure the way we see ourselves and the world. Just as importantly, he argues that this may mean returning to some things we once knew but have now forgotten or ignored. Poetry or, to be more accurate, poetic ways of seeing, may be one of these things, to the extent that it generates ways of seeing beyond the merely rational. In this essay I therefore want to explore the work of Judith Wright and the ways in which it explores the possibilities of being ‘true to the earth’. 2. (shrink)

Un invito a vedere nella vita e nelle opere di don Sturzo delle risposte alle difficoltà del mondo attuale, approfondendo le ragioni di un impegno cristiano per il recupero della dimensione etica dell’economia, della politica e delle istituzioni.

This dissertation is the first comprehensive study of human freedom in the philosophy of Pierre Gassendi, a 17th century natural scientist, Catholic priest, and one of the founders of Early Modern philosophy. The key postulate of this dissertation is that the epistemology of probabilism, which represents Gassendi's skeptical stance toward the possibility of certain knowledge, is also the foundation of human freedom: the uncertain and merely probable nature of all our knowledge serves as a guarantee of the multiplicity of options (...) open to us, and thereby ensures freedom. ;The first part of the dissertation investigates the sources on which Gassendi drew to elaborate his notion of freedom. The main sources are Aristotle's ethical theory and discussion of necessity, chance, and choice, as well as the Epicureans' theory of freedom. In conjunction with the latter, I consider the possibility that Gassendi conceives of the human mind---the seat of freedom---as corporeal, and thereby capable of generating autonomous developments on the basis of the natural motions of its atoms. ;The second part is devoted to studying Gassendi's epistemology of probabilism as the foundation of freedom. I look at the process of judgment that underlies choice, and consider the various manifestations of the freedom of indifference in the process of acquiring knowledge or preparing for a practical decision. I also look at the roles of the will and the intellect throughout these activities. ;The third part looks at theological issues in Gassendi's philosophy that relate to human freedom: divine concurrence with created beings, divine providence, and the limitations that faith imposes on the scope of our inquiry. ;The fourth and final part presents a study of Gassendi's ethics from the perspective of freedom. I investigate the role of temperament, passions, and opinions in human behaviour, and study the role of freedom in shaping these factors. I also consider the concept of pleasure as the central motive of human actions, and its various manifestations in Gassendi's ethics. (shrink)

The central problem of the ‘normativity of law’ concerns how legal rules or directives give us reasons for actions. The core of this question is how something that is external to the agent, such as legal rules or directives, can be ‘part of the agent’, and how they can guide the agent in performing complex actions (such as legal rule-following) that persist over time. David Enoch has denied that the normativity of law poses any interesting challenge to theories of law. (...) He argues that law provides reasons for actions in terms of what he calls triggering-reasons and he advances the view that because there are many circumstances in which reasons are triggered, law does not pose a special challenge. According to Enoch, once we understand the way that triggering reasons operate, we can understand how legal rules and directives provide us with reasons for actions. In §II of this paper, I set the stage for the debate and establish a set of principles that emerge from the common sense of view of reasons for actions and argue that any theory of reasons for action should provide a coherent explanation of these key principles. I focus on the idea that a satisfactory account of reasons for action should also explain reasons in actions. In §III I explain briefly the different theories of reasons for action and locate Enoch’s conception of reasons for action as triggering-reasons within this theoretical framework. In §IV I show that Enoch’s conception of reasons for actions does not explain some of the key features or principles that emerge from our common sense view of reasons for action and nor does it explain reasons in actions.Resumen:El problema central de la ‘normatividad del derecho’ versa sobre cómo las reglas o directrices jurídicas nos dan razones para la acción. El núcleo de esta cuestión reside en cómo algo que es externo al agente, tal como las reglas o directrices jurídicas, pueden ser ‘parte del agente’, y cómo pueden guiar a ese agente al llevar a cabo acciones complejas (tal como la obediencia de las reglas) que persisten en el tiempo. David Enoch ha negado que la normatividad del derecho presente algún reto interesante a las teorías del derecho. Arguye que el derecho provee razones para la acción en términos de lo que él llama razones detonantes (triggering-reasons) y propone la perspectiva de que, dado que hay muchas circunstancias bajo las cuales se detonan las razones, el derecho no plantea ningún reto especial. De acuerdo con Enoch, una vez que entendemos la manera en que operan las razones detonantes, podemos comprender cómo las reglas y directrices jurídicas nos proveen razones para la acción. En la sección II de este artículo, fijo el escenario para el debate y establezco una serie de principios que emergen de la visión de sentido común sobre las razones para las acciones, y sostengo que cual- quier teoría de las razones para la acción debería proporcionar una explicación coherente de estos principios clave. Me centro en la idea de que una concepción satisfactoria de las razones para la acción también debe- ría explicar las razones en las acciones. En la sección III, explico brevemente las diferentes teorías de las razones para la acción y ubico la concepción de Enoch de razones para la acción como razones detonantes (triggering-reasons) dentro de este marco teórico. En la sección IV muestro que la concepción de Enoch de razones para las acciones no explica algunas de las principales características o principios que emergen de nuestra visión de las razones para la acción basada en el sentido común, ni tampoco explica las razones en las acciones. (shrink)