Este artículo tiene por objetivo analizar la relación y la recepción que cuatro filósofos de la generación de la democracia: Tomás Pollán, Javier Sádaba, Manuel Fraijó y Jesús Mosterín han mantenido y realizado respectivamente, con y sobre, el pensamiento español contemporáneo que les antecedió.

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent (...) and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using ‘social utility’ criteria, prioritising healthcare professionals or using ‘first come, first served’ policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes. (shrink)

Since 2002, legislation in Spain has allowed for the creation and documentation of end-of-life decisionmaking. Over the intervening years, the actual implementation of such documents is very low. Through extensive analysis of the literature, this article explores the current status of the use of and attitudes toward advance directives in Spain and then proposes strategies for improvement in their implementation.

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. (...) There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them, and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. (shrink)

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives. The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with (...) an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses, chronic diseases, and elderly patients. Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age. (shrink)

Background In Spain, there has been great effort by lawmakers to put Advance Directives into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little (...) impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: the training of health professionals about the end of life and AD is lacking; there has been no public process to increase awareness about AD, and therefore people know little about them; the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future. (shrink)

Background During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC (...) of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC. Methods Retrospective observational study of all patients assessed by the AFUH TC. Results There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; _p_ Conclusions The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them. (shrink)

In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals’ right to conscientious objection and the specification that it (...) makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short. (shrink)

Background No studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts. Methods Voluntary survey to the members of the Internal Medicine Association of Mexico. Results Responses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most commonplace and relevant conflicts are those (...) resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them. Conclusions 1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants. (shrink)

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain’s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through (...) protection of moral freedoms and patients’ rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied. (shrink)

Background Ethical conflicts generate difficulties in daily clinical activity. Which methods of ethical advice are most frequently used to resolve them among Spanish doctors has not been studied. The objective of this study is to describe what methods hospital internal medicine physicians in Spain use to resolve their ethical doubts and which they consider most useful. Design A cross-sectional observational study was conducted through a voluntary and anonymous survey and distributed through an ad hoc platform of the Spanish Society of (...) Internal Medicine. Measures We measured methods by which to resolve doubts, types of tools sought, frequency of consulting the Clinical Ethics Committees, and satisfaction with resolution of ethical issues. Results Of 261 internists surveyed, 86 per cent resolve their ethical doubts with assistance, the most frequently used method being consultation with colleagues (58.6 per cent), followed by using specific protocols or guides (11.8 per cent) and consultation with experts in bioethics (9.6 per cent). The most preferred tools are the creation of protocols (30.3 per cent) and the establishment of a consultant/expert in bioethics (27.8 per cent). Conclusions Internists in Spain usually seek assistance to resolve their ethical doubts. Consulting colleagues is the most frequently adopted method. The majority regard tools to resolve ethical conflicts as necessary, seeking above all protocols and consultants/experts in bioethics. (shrink)

Movies can serve valuable didactic purposes teaching clinical ethics to medical students. However, using film sequences as means to develop critical thinking is not a straightforward task. There is a significant gap in the literature regarding how to analyse the ethical content embedded in these clips systematically, in a way that facilitates the students’ transition from anecdotal reflections to abstract thinking. This article offers a pedagogical proposal to approach the ethical analysis of film sequences in a systematic fashion. This structured (...) stepwise method encourages students to identify the main ethical problem of a selected scene and to reflect on the theoretical principles involved, emphasizing the application of these norms and values in a contextually situated analysis. We believe this method in film studies both reinforces the students’ comprehension of the theoretical framework of an ethical topic, and casts light on its pertinence and limitations under the circumstances of the scene, thus proving a constructive tool to strengthen the bridge between the theoretical teaching of clinical ethics and clinical practice. (shrink)

un diálogo entre “Ante la Ley” de Kafka y La leyenda del santo bebedor de Roth, dos relatos cuya datación casi coinciden literalmente con el periodo de entreguerras, propicia una comparación de interpretaciones en las que participan nombres tan eximios como Benjamin, Arendt, Mann, Scholem, Adorno, Steiner, Magris... En el contexto de los años veinte y treinta del siglo XX, ambos autores plantean una pregunta por la justicia que en manos de autores como Hugo Bergmann, Frank Rosenzweig y Martin (...) Buber dio pie a un replanteamiento del judaísmo centroeuropeo, hoy casi olvidado, y a una revisión de la crisis de la modernidad europea en su conjunto. (shrink)

One of the ways of thinking God in contemporary philosophy is reflecting on violence. In fact, reflecting on violence implies always at the same time to refer to the difficulty of thinking about the co-implication of law and violence, a typical prerogative of divine action. From this perspec-tive, political theology is concerned with the status and the possibilities or impossibilities of rep-resenting violence in a given political order. Three are the classical texts in the backdrop of this reflection on the (...) hiatus between law and violence: Walter Benjamin Critique of Violence of 1921, Carl Schmitt’s Political Theology of 1922 and Derrida’s Force of Law of 1989. The article exam-ines another paradigm, that of Ernesto Laclau. The article concludes that only a non-presentable idea of God as a negative fundament allows for a non-authoritarian political idea. But this non-presentable character is only made possible by revolutionary politics. (shrink)

This chapter offers a proceduralist argument against capital punishment. More specifically, it contends that the possibility of irrevocable mistakes precludes the just administration of the death penalty. At stake is a principle of political morality: legal institutions must strive to remedy their mistakes and to compensate those who suffer from wrongful sanctions. The incompatibility of remedy and execution is the crux of the irrevocability argument: because the wrongly executed cannot enjoy the morally required compensation, execution is impermissible. Along with defending (...) his key premises, Yost explains the complicated role that sentencing uncertainty plays in the argument. He concludes by noting some of the flaws in substantive consequentialist and retributivist justifications of capital punishment. (shrink)

We perceive smells as perduring complex entities within a distal array that might be conceived of as smellscapes. However, the philosophical orthodoxy of Odor Theories has been to deny that smells are perceived as having a distal location. Recent challenges have been mounted to Odor Theories’ veracity in handling the timescale of olfactory perception, how it individuates odors as a distal entities, and their claim that olfactory perception is not spatial. The paper does not aim to dispute these criticisms. Rather, (...) what will be shown is that Molecular Structure Theory, a refinement of Odor Theory, can be further developed to handle these challenges. The theory is further refined by focusing on distal perception that requires considering the perceptual object as mereologically complex persisting odor against a background scene conceived of as a smellscape. What will be offered is an expansion of Molecular Structure Theory to account for distal smell perception within natural environments. (shrink)

We are immersed within an odorous sea of chemical currents that we parse into individual odors with complex structures. Odors have been posited as determined by the structural relation between the molecules that compose the chemical compounds and their interactions with the receptor site. But, naturally occurring smells are parsed from gaseous odor plumes. To give a comprehensive account of the nature of odors the chemosciences must account for these large distributed entities as well. We offer a focused review of (...) what is known about the perception of odor plumes for olfactory navigation and tracking, which we then connect to what is known about the role odorants play as properties of the plume in determining odor identity with respect to odor quality. We end by motivating our central claim that more research needs to be conducted on the role that odorants play within the odor plume in determining odor identity. (shrink)

Capital punishment—the legally authorized killing of a criminal offender by an agent of the state for the commission of a crime—stands in special need of moral justification. This is because execution is a particularly severe punishment. Execution is different in kind from monetary and custodial penalties in an obvious way: execution causes the death of an offender. While fines and incarceration set back some of one’s interests, death eliminates the possibility of setting and pursuing ends. While fines and incarceration narrow (...) one’s routes to happiness, death eliminates its possibility. Not surprisingly, there is much debate about the moral permissibility of capital punishment. This entry maps the terrain of this debate. The first section discusses justifications of the death penalty as they appear in major theories of punishment. The second section surveys moral objections to execution that apply to most justifications. The third addresses procedural criticisms, which do not target the morality of execution so much as the justice of its implementation. (shrink)

At least some of your beliefs are commitments. When you believe that P as a commitment, your stance on P is such that you believe it on the basis of your considered judgement. Sometimes, you also believe that you believe P. Such self‐beliefs can also be commissive in a sense, as when they are reflective endorsements of your lower‐order commissive beliefs. In this paper I argue that one's commissive self‐beliefs ontologically constitute one's lower‐order commissive beliefs because one's commissive self‐beliefs instantiate (...) the same inferential dispositions that are constitutive of one's lower‐order commissive beliefs. Constitutive relations between commissive self‐beliefs and first‐order commissive beliefs are maximally epistemically secure because they do not result from any epistemic procedure by which one must try (and possibly fail) to detect one's first‐order commissive beliefs. This maximal epistemic security suffices to warrant one's commissive self‐beliefs, such that one possesses commissive self‐knowledge of an especially privileged sort. (shrink)

Kant famously insists that free will is a condition of morality. The difficulty of providing a demonstration of freedom has left him vulnerable to devastating criticism: critics charge that Kant's post-Groundwork justification of morality amounts to a dogmatic assertion of morality's authority. My paper rebuts this objection, showing that Kant offers a cogent demonstration of freedom. My central claim is that the demonstration must be understood in practical rather than theoretical terms. A practical demonstration of x works by bringing x (...) into existence, and what the demonstration of freedom brings into existence is a moral will, a will regulated by the moral law and capable of acting in accordance with it. Since to act morally is to act freely, bringing a moral will into existence actualizes our capacity for freedom and demonstrates that we possess it. To confirm the viability of such a demonstration, Kant must establish that agents can regulate their wills by practical principles, and that practical judgments are efficacious of themselves (i.e., that non-Humean motivational internalism is true). Kant, I argue, is successful on both counts. (shrink)

El acceso equitativo a la energía y a la vivienda es una preocupación básica de la justicia social. A pesar de los numerosos vínculos entre estos dos bienes esenciales, los marcos teóricos de la justicia y la pobreza energética se han referido casi exclusivamente a la cuestión de la vivienda en términos de la eficiencia energética de los edificios residenciales. En respuesta a esta carencia conceptual, se propone la reintegración del factor vivienda en el marco de la justicia y pobreza (...) energética a lo largo de los siguientes tres ejes: dimensiones materiales y temporales; dimensiones políticas; y dimensiones éticas y legales. Como ejemplo empírico de la importancia del nexo vivienda-energía en la práctica de la justicia social, se presenta el caso de dos movimientos sociales surgidos en Barcelona que trabajan con una perspectiva conjunta de derecho a la vivienda y a la energía: la Plataforma de Afectados por la Hipoteca (PAH) y la Aliança contra la Pobresa Energètica (APE). El artículo subraya la importancia de la vivienda y la energía como fundamentos materiales de una vida digna y su naturaleza conflictiva como necesidades esenciales y bienes de mercado. (shrink)

Las metodologías activas son unas excelentes herramientas para la mejora del desarrollo de competencias, así como del aprendizaje del alumnado. Se recogen las percepciones y el uso que 92 profesores de educación secundaria de la Comunidad Valenciana (España) manifestaron en un cuestionario tras haber realizado una formación en las mismas. Los resultados permiten constatar que, si bien se produce un aumento en el uso y una mejora en las percepciones, sigue habiendo una considerable resistencia al cambio de este colectivo de (...) profesorado. Encuentran desventajas como considerarlas muy exigentes con el tiempo y son escépticos en el aprendizaje real del alumnado. (shrink)

Nietzsche distinguished between two forces in art: Apollonian, which represents order and reason, and Dionysian, which represents chaos and energy. Economists, Ward argues, have operated for too long under the assumption that their work reflects the scientific, Apollonian principals that inform physics when they simply do not apply to economics: 'constants' in economics stand in for variables, and the core scientific principles of prediction and replication are all but ignored by economists. Ward encourages economists to reintegrate the standard rigor of (...) the scientific method into their work while embracing the fact of the shape-shifting changeability of human beings. Economists can still aspire to scientific standards, as is demonstrated by the success of biology, in which there is considerable Dionysian variability. Economists must avoid the temptation to wish away dynamic complexity and diversity and must recognize, among other things, that the desire to take risks is fundamentally human. The second half of the book takes some first steps toward creating this new Dionysian Economics. (shrink)

This article intends to contribute to the science–religion historiography with two topics—philology and the construction of national identities—that can help provide a more complex picture of the relations between science and religion. We use the life and work of the Mallorcan Catholic priest Antoni Maria Alcover (1862–1932) as a case study that puts language, linguistics, and nationalism on the board of science and religion studies. Alcover was the main driving force of the Catalan Dictionary, a collective enterprise that set out (...) to inventory the complete oral and literary lexicon of this language, and which mobilized thousands of people, many of which were clergymen, from all over the Catalan‐speaking territories. In the article, we will explore Alcover's education; the way he established a link between language, religion, and fatherland; the shaping of his identity as a philologist in the image mainly of new German notions and practices; as well as his role in the institutionalization process of the Catalan language as a scientific language, as a language for science and for religion. (shrink)

In this paper, I will critique Paul Draper’s recent model of God’s motivational structure, according to which God can make hard choices. I will argue that this model illegitimately treats value in a purely teleological way, as something to be promoted. Following T.M. Scanlon’s work on value theory, when we consider the fact that value is to be respected rather than merely promoted, this realization will significantly foreclose on the possible cases in which hard choices can conceivably be made by (...) God. Most importantly, I challenge the idea that God can face hard choices between aesthetic and moral value in the way Draper suggests. (shrink)

Hardly anyone disputes that discrimination can be a grave moral wrong. Yet this consensus masks fundamental disagreements about what makes something discrimination, as well as precisely why acts of discrimination are wrong. Benjamin Eidelson develops systematic answers to those two questions. He claims that discrimination is a form of differential treatment distinguished by its special connection to the differential ascription of some property to different people, and goes on to argue that what makes some cases of discrimination intrinsically wrongful (...) is that they manifest an attitude of disrespect for the personhood of those who are disfavored. He endeavors to specify what this attitude consists in, and to demonstrate how attending to its character can help us to better understand the moral dimensions of different forms of wrongful discrimination. The book concludes with an extended discussion of racial profiling in law enforcement. (shrink)

This article critically examines Busk's Democracy in Spite of the Demos, which critiques the “categorical imperative of democracy.” Although Busk effectively challenges the commitment to value-neutral democratic procedures as the foundation for legitimate law, his alternative, curtailing powerful interests ability to manipulate voters using “socially necessary delusions,” risks establishing elite rule. This article instead proposes basic liberal rights as the normative foundation for legitimate public order and militant democracy as its most effective institutional safeguard, arguing that this combination better realizes (...) human emancipation. (shrink)

Around the Council of Basel, and opposing the nominalism renewal, in the University of Salamanca a whole new movement of humanistic renewal is promoted from the field of philosophy and theology, having in Pedro Martinez de Osma one of its most significant representatives. In this paper the meaning of his work, with influences from L. Bruni and L. Valla, is shown and two of his most significant texts are rescued from that fight which confronted the humanism against the nominalism.

In view of the changes and achievements which the science and technique are producing at the end of the XV and XVI centuries, fragmenting the medieval order, Fernán Pérez de Oliva, in order to bring into harmony the new Renaissance times, will offer a new image of the human being. This will must be as the well tuned vihuela wich produces sweet harmony.