Introduction: Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. Aim: The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire–Critical Care Version and, second, to analyse Portuguese critical care nurses’ level of exposure to ethical conflict and its (...) characteristics. Methods: A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. Ethical Considerations: The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. Findings: The Portuguese version of the Ethical Conflict Nursing Questionnaire–Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources. (shrink)

The use of black box algorithms in medicine has raised scholarly concerns due to their opaqueness and lack of trustworthiness. Concerns about potential bias, accountability and responsibility, patient autonomy and compromised trust transpire with black box algorithms. These worries connect epistemic concerns with normative issues. In this paper, we outline that black box algorithms are less problematic for epistemic reasons than many scholars seem to believe. By outlining that more transparency in algorithms is not always necessary, and by explaining that (...) computational processes are indeed methodologically opaque to humans, we argue that the reliability of algorithms provides reasons for trusting the outcomes of medical artificial intelligence. To this end, we explain how computational reliabilism, which does not require transparency and supports the reliability of algorithms, justifies the belief that results of medical AI are to be trusted. We also argue that several ethical concerns remain with black box algorithms, even when the results are trustworthy. Having justified knowledge from reliable indicators is, therefore, necessary but not sufficient for normatively justifying physicians to act. This means that deliberation about the results of reliable algorithms is required to find out what is a desirable action. Thus understood, we argue that such challenges should not dismiss the use of black box algorithms altogether but should inform the way in which these algorithms are designed and implemented. When physicians are trained to acquire the necessary skills and expertise, and collaborate with medical informatics and data scientists, black box algorithms can contribute to improving medical care. (shrink)

Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables ‘frequency’ and ‘degree of conflict’. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable ‘exposure to conflict’, as well as considering six ‘types of ethical conflict’. An instrument (...) was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). (shrink)

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and (...) nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science. (shrink)

One of the major arenas for debate within generative grammar is the nature of paradigmatic relations among words. Intervening in key debates at the interface between syntax and semantics, this book examines the relation between structure and meaning, and analyses how it affects the internal properties of words and corresponding syntactic manifestations. Adapting notions from the Evo-Devo project in biology (the idea of 'co-linearity' between structural units and behavioural manifestations) Juan Uriagereka addresses a major puzzle: how words can be (...) both decomposable so as to be acquired by children, and atomic, so that they do not manifest themselves as modular to adults. (shrink)

BackgroundImplementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables (...) of favourable attitudes towards advance directives.MethodsObservational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.ResultsA total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.ConclusionThere is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment. (shrink)

The paper argues that there are resources within theories of corrective justice to make the case against the deportation of immigrants, including those accused of committing criminal actions. More specifically, the argument defended here is that a nation acts impermissibly by deporting criminal immigrants who belong to countries that the nation itself wronged in a manner that contributed to create the migratory flow that led the immigrants in question there. In that case, admission and, equally important, permanent residence in the (...) host nation must be understood as a form of compensation for past wrongs, the interruption of which represents a breach of its duties of rectification, and is therefore unjust. Put in slightly different terms, some migrants have a retributive right-claim against their host state (which they may or may not exercise) to be admitted into the host state and not be deported. (shrink)

This edition is designed to open the enchanting book to all readers of modern Spanish. Raymond Willis has regularized and brought the medieval text as close as possible, without falsification, to modern canons. The text is printed integrally, without annotation. Mr. Willis' English paraphrase, printed on facing pages, is written in syntactical constructions that exactly parallel the Spanish verses, and thus functions as both a glossary and a key to puzzling constructions. Originally published in 1972. The Princeton Legacy Library uses (...) the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

From our everyday commuting to the gold medalist’s world-class performance, skillful actions are characterized by fine-grained, online agentive control. What is the proper explanation of such control? There are two traditional candidates: intellectualism explains skillful agentive control by reference to the agent’s propositional mental states; anti-intellectualism holds that propositional mental states or reflective processes are unnecessary since skillful action is fully accounted for by automatic coping processes. I examine the evidence for three psychological phenomena recently held to support anti-intellectualism and (...) argue that it supports neither traditional candidate, but an intermediate attention-control account, according to which the top-down, intention-directed control of attention is a necessary component of skillful action. Only this account recognizes both the role of automatic control in skilled action and the need for higher-order cognition to thread automatic processes together into a unified, skillful performance. This applies to bodily skillful action in general, from the world-class performance of experts to mundane, habitual action. The attention-control account stresses that, for intentions to play their role as top-down modulators of attention, agents must sustain the intention’s activation; hence, the need for reflecting throughout performance. (shrink)

This book studies the notions of order and universe in the philosophy of Thomas Aquinas. It provides an overview of an array of metaphysical concepts in Aquinas such as relation, proportion, types of order, composition, whole and part. It is claimed that Aquinas' metaphysics is mainaly a metaphysics of the order of the universe.

Functionalism as a philosophical position has been recently applied to the case of emotion research. However, a number of objections have been raised against applying such a view to scientific theorizing on emotions. In this article, I argue that functionalism is still a viable strategy for emotion research. To do this, I present functionalism in philosophy of mind and offer a sketch of its application to emotions. I then discuss three recent objections raised against it and respond to each of (...) them. These objections claim that functionalism is intractable because (i) it does not support a scientifically interesting taxonomy of emotions for experimental settings, (ii) it is inherently teleological, and (iii) it cannot be falsified. I argue that these objections either rely on a simplified version of functionalism as a philosophical position or they pose challenges that functionalists can readily address. Lastly, I conclude by drawing some lessons these objections suggest for a tractable functionalist account of emotions. (shrink)

Does self-control require willpower? The question cuts to the heart of a debate about whether self-control is identical with some psychological process internal to the agents or not. Noticeably absent from these debates is systematic evidence about the folk-psychological category of self-control. Here, we present the results of two behavioral studies (N = 296) that indicate the structure of everyday use of the concept. In Study 1, participants rated the degree to which different strategies to respond to motivational conflict exemplify (...) self-control. Participants distinguished between intra-psychic and externally-scaffolded strategies and judged that the former exemplified self-control more than the latter. In Study 2, participants provided various solutions to manage motivational conflict and rated their proposals on effectiveness. Participants produced substantially more intra-psychic strategies, rated them as more effective, and advised them at a higher rate than externally-scaffolded strategies. Taken together, these results suggest that while people recognize a plurality of strategies as genuine instances of self-control, purely internal exercises of self-control are considered more prototypical than their externally-scaffolded counterparts. This implies a hierarchical structure for the folk psychological category of self-control. The concept encompasses a variety of regulatory strategies and organizes these strategies along a hierarchical continuum, with purely intra-psychic strategies at the center and scaffolded strategies in the periphery. (shrink)

Researchers often claim that self-control is a skill. It is also often stated that self-control exertions are intentional actions. However, no account has yet been proposed of the skillful agency that makes self-control exertion possible, so our understanding of self-control remains incomplete. Here I propose the skill model of self-control, which accounts for skillful agency by tackling the guidance problem: how can agents transform their abstract and coarse-grained intentions into the highly context-sensitive, fine-grained control processes required to select, revise and (...) correct strategies during self-control exertion? The skill model borrows conceptual tools from ‘hierarchical models’ recently developed in the context of motor skills, and asserts that self-control crucially involves the ability to manage the implementation and monitoring of regulatory strategies as the self-control exercise unfolds. Skilled agents are able do this by means of flexible practical reasoning: a fast, context-sensitive type of deliberation that incorporates non-propositional representations into the formation and revision of the mixed-format intentions that structure self-control exertion. The literatures on implementation intentions and motivation framing offer corroborating evidence for the theory. As a surprising result, the skill of self-control that allows agents to overcome the contrary motivations they experience is self-effacing: instead of continuously honing this skill, expert agents replace it with a different one, which minimizes or prevents contrary motivations from arising in the first place. Thus, the more expert you are at self-control, the less likely you are to use it. (shrink)

Effort and the feeling of effort play important roles in many theoretical discussions, from perception to self-control and free will, from the nature of ownership to the nature of desert and achievement. A crucial, overlooked distinction within the philosophical and scientific literatures is the distinction between theories that seek to explain effort and theories that seek to explain the feeling of effort. Lacking a clear distinction between these two phenomena makes the literature hard to navigate. To advance in the unification (...) and development of this area, this article provides an overview of the main theories of the nature of effort and the nature of the feeling of effort, and then discusses how efforts and their feelings are related. Two key takeaways emerge. First, there is widespread agreement that efforts are goal-directed actions. Second, one of the main philosophical issues to be decided is whether feelings of effort should be defined by reference to efforts (effort-first approach), or whether efforts are defined by reference to the feeling of effort (feeling-first approach). (shrink)

Las guerras centroamericanas de la década de 1980 provocaron giros analíticos en las agendas intelectuales. En este trabajo estudio el caso de Ignacio Martín-Baró, psicólogo social y sacerdote jesuita de la Universidad Centroamericana (UCA) de El Salvador. Postulo que su propuesta de imprimir una perspectiva latinoamericana al pensamiento psicosocial derivó de la necesidad de comprender las crisis sociales surgidas con la guerra. Martín-Baró se interesó por el ‘mundo desgarrado de la vida cotidiana’ como lugar de análisis de los principales conflictos (...) sociales, entre los que destacó la tortura y la alta dosis de crueldad manifestada en el ejercicio de la violencia. Por último, analizo sus reflexiones sobre los impactos de la guerra en la salud mental, especialmente en la niñez, y subrayo su llamado de atención sobre el carácter cultural de la violencia y los desafíos que ello implicaba para la imaginación de un nuevo futuro de convivencia. Si bien fue un pensador en constante alerta sobre la importancia del análisis históricamente sustentado para comprender las crisis sociales, sus intervenciones intelectuales imaginaron un futuro de viabilidad histórica y de sostenibilidad de la vida para las mayorías con las que comprometió su quehacer. (shrink)

Self-control is deemed crucial for reasons-responsive agency and a key contributor to long-term wellbeing. But recent studies suggest that effortfully resisting one’s temptations does not contribute to long-term goal attainment, and can even be harmful. So how does self-control improve our lives? Finding an answer requires revising the role that overcoming temptation plays in self-control. This paper distinguishes two forms of self-control problems: temptation (the presence of a strong wayward motivation) and apathy (the lack of commitment-advancing motivation). This distinction makes (...) it possible to separate negative self-control (aimed at overcoming temptation) from positive self-control (aimed at overcoming lack of motivation). The paper argues that temptation should not play a central role in our conception of self-control, since overcoming temptation is neither necessary nor sufficient for successful self-control. (shrink)

In this paper I will critically assess a very popular interpretation of Heidegger’s early thought, according to which meaning (Bedeutung) is conceived as ontologically dependent on human existence (Dasein). In order to criticize this subjectivist understanding of meaning, I will offer an interpretation of Heidegger’s analysis of signs in Being and Time (§17). This will reveal two main things: first, that the ubiquity of sign-phenomena is founded on the universality of the structure known as reference (Verweisung); second, that Heidegger’s idea (...) of reference offers a non-substantialist understanding of meaning and its relation to the world. (shrink)

What if what is permissible and acceptable today is anathema tomorrow? There is a whole canon of scholarly ethics books written with the express purpose of telling you what is RIGHT and what is WRONG. This is not one such book. Juan Enriquez wants to make it easier for us to talk to one another, to prod one another, to understand and guide one another without an everlasting certainty of strict RIGHT v WRONG.

In this paper we prove that the free algebras in a subvariety equation image of the variety equation image of semi-Heyting algebras are directly decomposable if and only if equation image satisfies the Stone identity.

Current theories of management have difficulty overcoming certain problems and limitations related to some features of the field itself multiplicity, midtidisciplinarityt fragmentation, presence or lack of paradigms, se/freferentiality, and ethnocentrism. This paper first reviews these issues broadly. Then, it emphasises the preponderance of the scientific method and the exclusion of philosophy as theoretical foundations for management. It proposes taking philosophy as the science to provide the foundations of management. It explains how philosophy — especially philosophy that has its roots in (...) Aristotelian thought - can be of help to management through four different functions: admirative, globalising, political, and critical. In this way, Aristotelian philosophy is shown to be a superior basis for solving the present problems in management theory and a fruitful option for integrating ethics in organisational and management theories. (shrink)

The founding operation of the American States involves a mediating mechanism that enables the connection between the ideals supporting it and the intent for its popularization among people. Such is the function assigned to the founding heroes, which is analyzed as a cultural operation that aims to enshrine these ideals, thereby eliding the violence contained in the formation of modern States.

In the international sphere, sovereignty and fundamental rights are often at odds, giving these rights little space for action and, in general, only after crisis has led to tragedy, and tragedy to disgrace. International Law, on the other hand, consistently succumbs to forms of domination and power, and its scope of action is often limited to certain codifications which are frequently suspended by political exception. Sixteenth century Dominican theologian, Francisco de Vitoria, established the principles for a Law of the people, (...) based on secular civil power that, while still exercising internal sovereignty, could defend and privilege the “rights of all men” over the exercise of power and private interest. This article focuses on this dispute to show Vitoria’s position, who long preceded the great declarations of human rights of the 18 th century, presenting an original doctrine within the framework of an emerging globalization and based on the defense of fundamental rights. (shrink)

The De concordia, published by Juan Luis Vives in 1529 and dedicated to the Holy Roman Emperor, Charles V, is a comprehensive analysis of the social and political problems which were then afflicting Europe. It is the only such analysis undertaken by any of the Renaissance humanists. The De concordia merits a much more important place in Vives' oeuvre than scholars have hitherto given it. It is structured around the Augustinian concept of concordia and its antithesis, discordia. As such, (...) it is an explicit attempt to understand current history in metaphysical terms. Vives' intention is not to give strategic or tactical advice to Charles V, but to examine the general disorder of Europe with a view to determining its fundamental nature and significance. This is the first critical edition of the De concordia and the first English translation. (shrink)