To support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in (...) the Euro-MCD Instrument from 2014, to further validate this Instrument. The concept mapping method was used and involves qualitative and quantitative steps including brainstorming, individual structuring, computation of concept maps (by principal component analysis and cluster analysis), group interpretation and utilization. In total, 12 experienced MCD participants from a variety of professional backgrounds participated in two sessions. The focus group brainstorm resulted in a list of 85 possible MCD outcomes, of which a point map and concept maps were constructed. After a thorough discussion of each cluster, final consensus was reached on the names and position of 8 clusters of MCD outcomes: 1) Organisation and Policy; 2) Team development; 3) Personal development focused on the Other Person; 4) Personal development as Professional, focused on Skills; 5) Personal development as Professional, focused on Knowledge; 6) Personal development as an Individual; 7) Perception and Connection; and 8) Concrete action. This study explored and categorized MCD outcomes in a concept mapping focus group. When comparing the results with the Euro-MCD Instrument, our study confirms that outcomes of MCD can be categorized in clusters referring to the organisational level, team development, personal development (both as an individual and a professional) and the concrete case-level. In developing CES evaluation tools, it is important to be explicit if an outcome refers to the individual or the team, to knowledge or skills, to the organisation or the specific case. The findings will be used in the further validation of the Euro-MCD Instrument. The current study further contributes to the field of evaluating CES in general and defining outcomes of MCD in particular. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey (...) among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed-methods study used (...) both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less standard. While (...) PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (shrink)

Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist (...) care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care. Results Care providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions. Discussion Developing an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support. (shrink)

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...) Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

Much of what we know and see of ethics support, in literature and during trainings, workshops and conferences, derives from clinical ethicists working at academic medical centers. Besides the probl...

BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...) and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...) Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)

The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators’. We aim to describe facilitators’ perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. (...) Facilitators’ perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD. (shrink)

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...) intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

La parution récente en français du livre de M. Denton : “Evolution. Une théorie en crise” , qui traite des theories explicatives actuelles de l'évolution, nous amine à rappeler les caracteres généraux des grandes theories biologiques et à présenter une critique sommaire du livre en question.La science West pas une simple accumulation de connaissances. Le scientifique ne doit pas se contenter de decrire et de mesurer des faits. Son but eat d'essayer de les relier et de construire des théories qui (...) tentent de nous faire comprendre le “reel”, objet de ses recherches.Cependant, la nature du matériel biologique — c'est-à-dire les espèces vivantes et les catégories qu'on y a reconnues, classe ou ordre par exemple — est si complexe qua la biologie actuelle est fort loin encore Wavoir réalisé une synthèse qui ressemble, méme très approximativement, à la classification de Mendéleiev pour les éléments chimiques.Malgré cette complexité, les biologques ont réussi à construire la th6orie du fait de l'evolution et ils proposent aujourd'hui une théorie explicative de cette évolution qui, bien qua critiquée, est incontestablement bien étayee. Nous allons essayer de définir la structure des grandes théories biologiques; ensuite nous analyserons sommairement quelques-unes des critiques qui sont adressees aux theories de l'évolution.Considering the publication in French version of Michael Denton's book, Evolution : A Theory in crisis , in which he critizes the synthetical theory of the biological evolution, we thought it useful to point out the main errors of argumentation contained in that book by first referring to the characteristics of general biological theories.In biology, there exist elementary theories - such as that dealing with the extinction of giant Reptiles - and general theories - such as the chromosomic theory of heredity and the explanatory theory of evolution. The latter generally consist of a group of elementary theories imbricated so that they form a whole like a jig-saw puzzle. An example is provided by the synthetic theory of evolution that can be defined in 20 propositions divided into two categories : the propositions relating to the naturalists' observations - which correspond to descriptive concepts - and those relating to the data of the population genetics - which correspond to explanatory concepts . The general scheme of the theory is formed by a network of relations between the descriptive concepts and the explanatory concepts. There also exist other theories in general biology supported by thousands of minor facts which only together can be of proof of validity. These theories are quite reliable and cannot be questioned by facts still to be explained. Questioning can only happen if they are confronted to well-established data in nearly equal numbers.In his work, Denton does not deny the phenomenon of biological evolution, but he criticizes the syntheticians' ideas by emphasizing that no great evolutive changes can be accounted for by the complex mechanism of random mutations and selection. He goes back to a typological concept of the zoological classification in some way similar to that of Vialleton's. However, Denton agrees with the phenomenon of the biological evolution and accepts the existence of "saltations" among the great zoological groups. The arguments used by Denton merely show that he is not conversant with the complexity of sciences particularly in comparative anatomy and zoology, the teaching of which is being somehow neglected today.By giving as an example the structure of the aortic arches in Amphibians and by a summary of the variations of those structures and the evolution of the blood-circulation in Vertebrates, we proved that the typological argument is of no value. As a matter of fact, a study of the now living beings clearly shows the gradual transition - e.g. a transition by a very large number of feasible stages - from the Lower Vertebrates to the Higher Vertebrates. In particular, there have been several attempts at double circulation and there still exist many species in which the blood of the double circulation is mixed. It seems therefore obvious that the double circulation has been achieved, stage by stage, with many intermediate schemes; we are inclined, therefore, to conclude that this succession of small transformations was produced by a huge mechanism of selected small mutations.Our present-day biological knowledge includes a number of examples large enough to consider the “argument of the impossible” used by Denton is due to inadequate fossil data and not to any mysterious mechanism such as macromutations. Let us say again that the typological structures seem to occur only when the data of comparative anatomy and zoology are over-simplified. (shrink)

Mães exercem papel importante no processo de hospitalização das crianças. As intervenções em psicologia positiva podem contribuir com o fortalecimento dos recursos positivos delas, o que por sua vez auxilia na recuperação da saúde das crianças. Este estudo teve por objetivo apresentar o relato da aplicação e avaliação de uma intervenção em psicologia positiva para mães de crianças hospitalizadas, visando demonstrar evidências de utilidade clínica da intervenção. A intervenção buscou diminuir sintomas de estresse, ansiedade e depressão, aumentar os níveis de (...) bem-estar subjetivo e promover o uso de estratégias de enfrentamento adaptadas ao contexto da hospitalização infantil entre as mães. Os resultados mostraram que o procedimento pode ter auxiliado as mães usarem estratégias favorecedoras durante a hospitalização, bem como alternarem o seu uso conforme a demanda. Além disso, elas puderam vislumbrar elementos positivos presentes e sentirem-se apoiadas. (shrink)

Traditionally, in Spain bullfighting represents an ancient and well-respected tradition and a combined brand of sport, art and national identity. However, bullfighting has received considerable criticism from various segments of society, with the concomitant rise of the animal rights movement. The paper reports a survey of the Spanish citizens using a face-to-face survey during January 2016 with a total sample of 2522 citizens. The survey asked about degree of liking and approving; culture, art and national identity; socio-economic aspects; emotional perception (...) and animal welfare. The hypothesis proposed that the perception of bullfights may be affected by gender, age, occupation, origin and nationality of the persons surveyed. The hypothesis was confirmed. The majority of citizens surveyed do not like bullfights and great majorities do not attend or watch such events. Two extreme clusters were described: one representing favorable attitude towards bullfighting and other against bullfighting. The proportion of indifferent persons was important. Women and young people showed a more favorable attitude towards animal welfare issues associated with these events. Rural people were more accepting bullfights than urban people. Students were more anti-bullfight than those in other occupations. Additionally, technical economic factors made people favor more bullfights. The growth of claim against bullfights establishes an element of a far more multifaceted phenomenon that animal cruelty per se and support of a new paradigm called social change in countries as Spain. (shrink)

Este artigo apresenta e aprofunda a importância do Diário de Bordo, na Academia, como ensaio estético autoral, possibilitando ao estudante fortalecer-se em seu espaço epistêmico, de enunciação e criação, através de registros provisórios de seu processo cognitivo relacional – suas interrogações, sínteses, suas questões, seus autores de referência, seu diálogo interdisciplinar.

Varro's De lingua Latina is a treasure trove of information. Of the originally twenty-five books, six have come down to us more or less complete. Among these, Books 5–7 give us many hundreds of etymologies, and Books 8–10 discuss the question whether Latin morphology is regular or not. What Varro rarely comments on is sociolinguistic variation. The sociolinguistic comments in Varro's work can almost be counted on one hand. For instance, in 5.162 Varro remarks that cenaculum, from cena ‘dinner’, means (...) ‘attic’ in Roman Latin, but that the original meaning was, as one might expect, ‘dining-room’, a meaning preserved in the non-Roman dialects of Latium, Falerii and Corduba in Spain; the meaning also lives on in religious uses in Lanuvium. In 7.96, Varro tells us that some words are pronounced with -ae- by some, but with -ē- by others. We know that non-Roman varieties of Latin monophthongized -ae- earlier than the Roman dialect did. Varro mentions pairs like scaena / scēna ‘stage’, a loan from Greek σκηνή, which shows that -ae- is hypercorrect here. Interestingly, only in one such pair is the variant with -ē- ascribed to country people, in the name Maesius / Mēsius, and this is indeed the only pair where the diphthong -ae- is original rather than the result of hypercorrection. (shrink)

El texto presenta algunas consideraciones acerca de las principales relaciones que se establecen en el momento presente entre la ética, la política y la educación, tres dimensiones fundamentales e interrelacionados en la existencia humana, analizándolas en su expresión en las circunstancias características de los ámbitos socioeconómico, político y cultural. A partir del análisis de estas interrelaciones, se pretende delinear algunas propuestas para una convivencia armónica y respetuosa entre los seres humanos en el siglo XXI, a través de una formación ciudadana (...) que posibilite la convivencia multicultural y el acceso a una auténtica sociedad del conocimiento. En este sentido, se examinan algunos de los dilemas y demandas éticos para alcanzar dichas formas de organización social ideales.The text presents some considerations about main relations that are established in the present moment, between ethics, politics and education, three essential and related dimensions in human existence, analyzing it in its characteristics expressions in the social, economic, cultural and political fields. Starting from the exam of those relations, it pretends to outline some proposals in order to get a harmonious and respectful coexistence between human beings in the XXI century, through a civic formation that makes possible multicultural coexistence and the access to an authentic knowledge society. In this sense, it examines some of the ethical dilemma and requests in order to access those ideal social organizations forms. (shrink)

This paper examines the problem of dying alone in the context of no-visitors hospital policy during the COVID-19 pandemic. It critically analyses a rights-based solution, offering a democratized vi...

This commentary defines what shared yet differentiated ethical responsibilities to tackle antimicrobial resistance (AMR) mean, by introducing a threefold principled account of AMR global governance. It argues that the principles of solidarity, subsidiarity, and stewardship can be especially helpful for further justifying some of the universal, differentiated, and individual responsibilities that Van Katwyk et al propose. The upshot of my threefold principled account of AMR global governance is a less ambitious AMR treaty, one that can only justify (i) universal duties (...) of global coordination (as per the principle of solidarity); (ii) differentiated duties to local communities, which bear the primary AMR responsibilities (as per the principle of subsidiarity); and (iii) individualized duties for ensuring truthful, evidence-based, consistent, and timely shared accountable communication (as per the principle of stewardship). (shrink)

Neste estudo, com base nos principais escritos políticos de D. Frei Álvaro Pais O. Min. (c. 1270- c.1350) analisamos sua concepção a respeito da origem ou causa eficiente do poder espiritual e, igualmente, seu pensamento no tocante à finalidade ou causa final do referido poder. Quanto ao primeiro tópico, o Bispo de Silves quer principalmente refutar algumas das teses de Marsílio de Pádua contidas na 2ª Parte do seu Defensor da Paz, completamente opostas à teologia do sacerdócio católico e seus (...) graus hierárquicos e à do Primado Petrino. Para tanto, quase literalmente, haure-se, entre outras fontes, particularmente no De regimine christiano (1301) de Tiago de Viterbo OSA. Com respeito à finalidade do poder sacerdotal, de um lado, Álvaro sustenta a doutrina tradicional da Igreja a seu respeito e, de outro, em conseqüência, como partidário da hierocracia, defende a tese de que na, Societas Christiana, os detentores do poder espiritual, particularmente o Sumo Pontífice, ocupam uma posição mais eminente em relação aos governantes seculares. (shrink)

Taxonomy Based modeling was applied to describe drivers' mental models of variable message signs (VMS's) displayed on expressways. Progress in road telematics has made it possible to introduce variable message signs (VMS's). Sensors embedded in the carriageway every 500m record certain variables (speed, flow rate, etc.) that are transformed in real time into 'driving times' to a given destination if road conditions do not change. VMS systems are auto-regulative Man-Machine (AMMI) systems which incorporate a model of the user: if the (...) traffic flow is too high, then drivers should choose alternative routes. In so doing, the traffic flow should decrease. The model of the user is based on suppositions such as: people do not like to waste time, they fully understand the displayed messages, they trust the displayed values, they know of alternative routes. However, people also have a model of the way the system functions. And if they do not believe the contents of the message, they will not act as expected. We collected data through interviews with drivers using the critical incidents technique (Flanagan, 1985). Results show that the mental models that drivers have of the way the VMS system works are various but not numerous and that most of them differ from the 'ideal expert' mental model. It is clear that users don't have an adequate model of how the VMS system works and that VMS planners have a model of user behaviour that does not correspond to the behaviour of the drivers we interviewed. Finally, Taxonomy Based Modeling is discussed as a tool for mental model remediation. (shrink)

In this contribution I wish to tackle two corruptions in Book 7 of Varro's De lingua Latina that have hitherto gone unnoticed or been corrected inadequately.

D. Álvaro Pelayo, nombrado obispo de Silves, hoy diócesis de Faro, Algarve, en el año 1334, entró en conflicto con el rey de Portugal, Alfonso IV (1325-57). Le escribió dos cartas en las que se puede observar que también tuvo que defender la autonomía jurisdiccional del poder espiritual, con vistas a la política centralizadora a la que el rey, siguiendo los pasos de su padre. D. Dinis (1279-1325), daba continuidad, con el propósito de restringir el espacio político del alto clero (...) lusitano. Unos pocos años después (1347), por la misma razón, el conflicto de las relaciones de poder entre las dos autoridades volvió a recrudecerse. Nuestro propósito aquí es doble: analizar los hechos históricos relacionados con los dos mencionados conflictos, por una parte, y los aspectos doctrinales contenidos en las dos referidas cartas, por otra, con vistas a mostrar la coherencia de pensamiento y actitud de D. Álvaro Pelayo. (shrink)

Direct-to-consumer advertising (DTCA) of prescription drugs has been a heavily contested issue over the past decade, touching on several issues of responsibility facing the pharmaceutical industry. Much research has been conducted on DTCA, but hardly any studies have discussed this topic from a corporate social responsibility (CSR) perspective. In this article, we use several elements of CSR, emphasising consumer autonomy and safety, to analyse differences in DTCA practices within two different policy contexts, the United States of America and the European (...) Union (EU). Doing so results in an alternative analysis of the struggle between proponents and opponents of DTCA from a CSR perspective, adding an alternative view on this debate. (shrink)