While there is significant consensus that undergraduate medical education should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that (...) medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME. (shrink)

Religion and faith are often central aspects of an individual’s self-concept, and yet they are typically avoided in the workplace. The current study seeks to replicate the findings about the role of religious beliefs and practices in shaping an employee’s reactions to stress/burnout and job attitudes. Second, we extend the literature on faith in the workplace by investigating possible relationships between religious beliefs and practices and citizenship behaviors at work. Third, we attempted to study how one’s perceived freedom to express (...) his/her religious identity at work was related to workplace attitudes and behaviors. Mixed results suggest that religiosity can be related to stress and burnout, job satisfaction, organizational commitment, and Organizational Citizenship Behavior. More research is needed to further qualify the results and explore the effects of one’s perceived freedom to express his/her religious identity in the workplace. (shrink)

Psychophysical studies of change blindness indicate that, at any instant, human observers are aware of detail in few parts of the visual field. Such results suggest, to some theorists, that human vision reconstructs only a few portions of the visual scene and that, to bridge the resulting representational gaps, it often lets physical objects serve as their own short-term memory. We propose that human vision reconstructs no portion of the visual scene, and that it never lets physical objects serve as (...) their own short-term memory. (shrink)

Several studies have explored differences between North American and European doctor patient relationships. They have focused primarily on differences in philosophical traditions and historic and socioeconomic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultural studies have been carried out to identify in practice these cultural differences. This lack of standard comparative empirical studies led us to compare differences between France and the (...) USA regarding end-of-life decision-making. We tested certain assertions put forward by bioethicists concerning the impact of culture on the acceptance of advance directives in such decisions. In particular, we compared North American and French intensive care professional's attitudes toward: (1) advance directives, and (2) the role of the family in decisions to withhold or withdraw life-support. (shrink)

This study builds upon the top management literature to predict and test antecedents to firms’ engagement in corruption. Building on a survey of 341 executives in India, we find that if executives have social ties with government officials, their firms are more likely to engage in corruption. Further, these executives are likely to rationalize engaging in corruption as a necessity for being competitive. The results collectively illustrate the role that executives’ social ties and perceptions have in shaping illegal actions of (...) their respective firms. (shrink)

This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the (...) context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed. (shrink)

As innovations in the field of vascular composite allotransplantation (VCA) progress, whole-eye transplantation (WET) is poised to transition from non-human mammalian models to living human recipients. Present treatment options for vision loss are generally considered suboptimal, and attendant concerns ranging from aesthetics and prosthesis maintenance to social stigma may be mitigated by WET. Potential benefits to WET recipients may also include partial vision restoration, psychosocial benefits related to identity and social integration, improvements in physical comfort and function, and reduced surgical (...) risk associated with a biologic eye compared to a prosthesis. Perioperative and postoperative risks of WET are expected to be comparable to those of facial transplantation (FT), and may be similarly mitigated by immunosuppressive protocols, adequate psychosocial support, and a thorough selection process for both the recipient and donor. To minimize the risks associated with immunosuppressive medications, the first attempts in human recipients will likely be performed in conjunction with a FT. If first-in-human attempts at combined FT-WET prove successful and the biologic eye survives, this opens the door for further advancement in the field of vision restoration by means of a viable surgical option. This analysis integrates recent innovations in WET research with the existing discourse on the ethics of surgical innovation and offers preliminary guidance to VCA programs considering undertaking WET in human recipients. (shrink)

This paper concludes a special feature of Sustainability Science that explores a broad range of social value theoretical traditions, such as religious studies, social psychology, indigenous knowledge, economics, sociology, and philosophy. We introduce a novel transdisciplinary conceptual framework that revolves around concepts of 'lenses' and 'tensions' to help navigate value diversity. First, we consider the notion of lenses: perspectives on value and valuation along diverse dimensions that describe what values focus on, how their sociality is envisioned, and what epistemic and (...) procedural assumptions are made. We characterise fourteen of such dimensions. This provides a foundation for exploration of seven areas of tension, between: (1) the values of individuals vs collectives; (2) values as discrete and held vs embedded and constructed; (3) value as static or changeable; (4) valuation as descriptive vs normative and transformative; (5) social vs relational values; (6) different rationalities and their relation to value integration; (7) degrees of acknowledgment of the role of power in navigating value conflicts. In doing so, we embrace the 'mess' of diversity, yet also provide a framework to organise this mess and support and encourage active transdisciplinary collaboration. We identify key research areas where such collaborations can be harnessed for sustainability transformation. Here it is crucial to understand how certain social value lenses are privileged over others and build capacity in decision-making for understanding and drawing on multiple value, epistemic and procedural lenses. (shrink)

This article explores the role that repetition plays in symbolic healing through a close examination of the speech patterns and actions performed by a healer in a Chol Maya ritual aimed at curing a woman of kisiñ—the “embarrassment-sickness.” The authors examine the repetition of speech patterns in the healing chant and the frequency with which other paralinguistic elements, such as taps, co-occur with the chant verses. The sound patterns generated during the ritual, specifically those created by the rhythmic tapping of (...) the patient's body with a bough bouquet, are yet another form of repetition often overlooked in analyses of healing rituals, which have concentrated on other symbolic elements used by healers. It is argued that the repetition of phrases in parallel verses serves as metapragmatic commentary on the healing process as a restructuring of the patient's body, which has been unstructured by the disease. (shrink)

SummaryIntense, sustained nursing lengthens inter-birth intervals and is causally linked with low natural fertility. However, in traditional settings, the effects of such nursing on fertility are difficult to disentangle from those of nutrition. Results from an prospective, direct observational study of reproductive function in well-nourished Amele women who nurse intensively and persistently but who also have high fertility are here presented. Endocrine measures show that ovarian activity resumes by median 11·0 months postpartum. Median duration of postpartum amenorrhoea is 11·3 months, (...) time to next conception is 19·0 months, and the inter-birth interval is 28·0 months. Average life time fertility is 6·8. High fertility in Amele women is due both to refractoriness of reproductive function to suckling stimuli, and to maintenance of equivalent age-specific fertility rates across the reproductive life span. (shrink)

This paper concludes a special feature of Sustainability Science that explores a broad range of social value theoretical traditions, such as religious studies, social psychology, indigenous knowledge, economics, sociology, and philosophy. We introduce a novel transdisciplinary conceptual framework that revolves around concepts of ‘lenses’ and ‘tensions’ to help navigate value diversity. First, we consider the notion of lenses: perspectives on value and valuation along diverse dimensions that describe what values focus on, how their sociality is envisioned, and what epistemic and (...) procedural assumptions are made. We characterise fourteen of such dimensions. This provides a foundation for exploration of seven areas of tension, between: (1) the values of individuals vs collectives; (2) values as discrete and held vs embedded and constructed; (3) value as static or changeable; (4) valuation as descriptive vs normative and transformative; (5) social vs relational values; (6) different rationalities and their relation to value integration; (7) degrees of acknowledgment of the role of power in navigating value conflicts. In doing so, we embrace the ‘mess’ of diversity, yet also provide a framework to organise this mess and support and encourage active transdisciplinary collaboration. We identify key research areas where such collaborations can be harnessed for sustainability transformation. Here it is crucial to understand how certain social value lenses are privileged over others and build capacity in decision-making for understanding and drawing on multiple value, epistemic and procedural lenses. (shrink)

We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those in (...) need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

This handbook offers a deep analysis of the main forms of legal reasoning and argumentation from both a logical-philosophical and legal perspective. These forms are covered in an exhaustive and critical fashion, and the handbook accordingly divides in three parts: the first one introduces and discusses the basic concepts of practical reasoning. The second one discusses the main general forms of reasoning and argumentation relevant for legal discourse. The third one looks at their application in law as well as at (...) the different areas of legal reasoning. The handbook’s division in three parts reflects its conceptual architecture, since legal reasoning and argumentation are considered in relation to the more general types of reasoning. (shrink)

JANET DELGADO RODRIGUEZ | : The concept of vulnerability is central to current developments in bioethics, not only because of its analytic nature, but also due to its capacity for criticism. However, this concept has not been sufficiently developed, neither in the area of moral philosophy nor in bioethics. For this reason, it is necessary to define and analyze the conceptual framework in which the notion of vulnerability has been developed within the scope of bioethics. Thus, the purpose of (...) this paper is to indicate how the concept of vulnerability in the field of bioethics has been developed and what the main problems that derive from this approach are. Secondly, the paper analyzes some of the main philosophical approaches that I consider should be articulated in the expansion of a critical bioethics approach focused on the notion of vulnerability. To address this issue, I analyze the reflections that we find in the work of Martha Fineman, emphasizing the main relevant aspects for bioethics. Finally, I highlight the main implications of a theory of vulnerability for bioethics. | : Le concept de vulnérabilité est au coeur des développements actuels de la bioéthique, non seulement en raison de sa nature analytique, mais aussi en raison de son potentiel critique. Cependant, ce concept n’a pas été suffisamment développé, que ce soit dans le domaine de la philosophie morale ou de la bioéthique. Pour cette raison, il est nécessaire de définir et d’analyser le cadre conceptuel dans lequel la notion de vulnérabilité a été développée en bioéthique. Ainsi, le but de cet article est d’indiquer comment le concept de vulnérabilité a été développé dans le domaine de la bioéthique et quels sont les principaux problèmes découlant de cette approche. Deuxièmement, l’article analyse certaines des principales approches philosophiques qui devraient selon moi être articulées à une approche bioéthique critique centrée sur la notion de vulnérabilité. Pour traiter ce problème, j’analyse la réflexion de Martha Fineman, en soulignant les principaux aspects pertinents pour la bioéthique. Enfin, je souligne les principales implications d’une théorie de la vulnérabilité pour la bioéthique. (shrink)

Para entender esta creación literaria indeformable debemos reflexionar sobre el concepto de semejanza en la obra barroca. La semejanza entendida como búsqueda de creación espiritual del hombre que se va haciendo a medida que las inquietudes intelectuales y científicas trabajan para retratar su alma. Siguiendo el pensamiento de M. Foucault la semejanza, con sus cuatro similitudes, guiará este estudio de triángulos invisibles que les propongo. La parodia, crea una écfrasis en la que la imagen del alma de Cervantes y el (...) texto literario no pueden separarse. El triángulo de la semejanza se moverá en la metaficción combinando los tres conceptos fundamentales de la mimesis: la representación, la interpretación y la recreación, que va a sacar a la luz una historia escrita en árabe titulada Historia de don Quijote de la Mancha.Un duelo entre dos autores mantendrá el misterio del alma retratada. (shrink)

Abstract:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury (...) in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation. (shrink)

In Italy, judicial and extrajudicial requests for paternity testing have increased in recent years. A retrospective analysis of such private extrajudicial requests received by the legal medicine unit of the Department of Environmental Medicine and Public Health of Padua University was conducted to identify problem areas most helpful in determining whether to accept private parties’ requests for paternity testing. Such testing is most delicate when a presumptive father may be seeking to disown paternity and when testing is wanted without the (...) consent of a member of the mother–child–father triangle. Tests that could establish paternity where none has been recognised are less problematic, as the child will not lose out. Legal and ethical–deontological aspects of consent, of the protection of minors and of children’s and parents’ need for follow-up interviews to deal with the outcome of such testing are carefully considered by the Padua University team when deciding whether to accept a request for testing. It is argued that because such issues are not dealt with by mail-order laboratories, the use of such services is inappropriate. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

La «démythologisation» est une herméneutique philosophique forgée par Hans Jonas au début de son itinéraire intellectuel, afin d'interpréter existentiellement les récits mythologiques ainsi que les textes théologiques et philosophiques de l’Antiquité tardive. Il s’agissait d’abord d’une méthodologie d’objectivation et subjectivation pour comprendre l’expérience existentielle de l’homme gnostique face à la divinité et l’être dans le monde. Dans la suite, Jonas a développé l’herméneutique de la démythologisation par l’objectivation et la subjectivation par rapport aux textes néotestamentaires. Le mot démythologisation (Entmythologisierung) est (...) utilisé par lui pour la première fois en 1930 dans une étude philosophique, «Sur la structure herméneutique du dogme», pour comprendre le problème existentiel de la liberté chrétienne. Quelques années plus tard, il a développé une phénoménologie herméneutique, également par l’objectivation et la subjectivation, afin de comprendre l’être vivant et la particularité de l’homme dans la nature. Entre-temps, Hans Jonas a aussi utilisé l’herméneutique de la démythologisation par l’objectivation et la subjectivation pour critiquer la philosophie de Martin Heidegger et la théologie de Rudolf Bultmann dans plusieurs articles philosophiques par rapport au gnosticisme, à la théologie et à la démythologisation bultmannienne, ainsi que pour rédiger Le Concept de Dieu après Auschwitz. (shrink)

Cet article propose une lecture critique du Despotisme de la Chine, un texte riche mais peu commenté, où Quesnay expose explicitement le contenu de sa pensée politique. Par l’analyse de Despotisme de la Chine nous voudrions défendre trois idées qui font sens autour de la représentation de la Chine qui est faite par Quesnay. La première est naturellement de montrer en quoi ce texte est représentatif de la pensée de Quesnay (et, plus largement, de l’école des physiocrates). La deuxième est (...) de souligner que le cas de la Chine, tel qu’il est vu par Quesnay, permet de penser l’économie en tant qu’activité, discipline, ou même science qui se situe au cœur du fondement de la philosophie politique qu’il avance. La troisième est d’indiquer comment la compréhension des logiques économiques d’après Quesnay relève finalement d’une observation intelligente du réel, de lier la loi positive (le politique fondé par l’économique, pour ce qui est alors connu de la Chine) et la loi naturelle (en somme : ce qui est et ce qui doit être). Au cœur de ces trois vues se trouve une réflexion sur ce pays lointain et nul autre (sinon la France). Loin d’être un simple prétexte pour avancer ses arguments, la Chine est surtout une façon de voir, de révéler, de saisir la nature d’une pensée (la physiocratie), d’une discipline (l’économie), et de sa portée (la science et le politique). Codes JEL : A11, A12, B11, K10. (shrink)

We prove strong completeness of the □-version and the ◊-version of a Gödel modal logic based on Kripke models where propositions at each world and the accessibility relation are both infinitely valued in the standard Gödel algebra [0,1]. Some asymmetries are revealed: validity in the first logic is reducible to the class of frames having two-valued accessibility relation and this logic does not enjoy the finite model property, while validity in the second logic requires truly fuzzy accessibility relations and this (...) logic has the finite model property. Analogues of the classical modal systems D, T, S4 and S5 are considered also, and the completeness results are extended to languages enriched with a discrete well ordered set of truth constants. (shrink)

Fundamento: El Plan D de la carrera de Estomatología concibe la existencia de una disciplina principal integradora denominada Estomatología Integral, sobre la base de la concepción de interdisciplinariedad y la mayor flexibilización curricular. Objetivo: Realizar una valoración de la asignatura Atención Integral a la Familia II del plan D de la carrera de Estomatología. Métodos: Se realizó un estudio descriptivo transversal en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Camaguey en Mayo 2015, mediante el análisis documental (...) del plan de estudio D y programa de la disciplina integradora, se exploraron criterios de profesores sobre las potencialidades y limitaciones del diseño curricular. Fueron encuestados directivos del proceso docente y profesores de experiencia. Resultados: En los objetivos instructivos de la carrera no se incluye el referente a la Estomatología Legal, pero está recogido en los problemas de salud, en los modos de actuación del modelo del profesional y en los objetivos del 4to año donde se imparte la asignatura. La formulación del primer objetivo instructivo se considera muy general y amplia. Conclusiones: La ubicación de la asignatura es correcta en la malla curricular. Tiene suficientes horas de Educación en el trabajo y es adecuada la proporción de las actividades teóricas; como aspectos negativos contenido resalta la extensión y amplitud del tercer tema y la escasez y pobre actualización de la literatura docente. Introduction: The Curriculum D of Dentistry career conceives the existence of a main integrated discipline called Comprehensive Dentistry on the basis of the multi-disciplinary conception and the most curricular flexibility. Objective: To make an assessment of the subject Family Comprehensive Attention II Curriculum D of Dentistry career. Methods: A descriptive-transverse study was performed in the Dentistry Faculty of the University of Medical Sciences in May 2015 by means of the documentary analysis of the Curriculum D and the syllabus of the comprehensive discipline, different professors´criteria were explored about the potencialities and limitations of the curricular design. The board of directors of the teaching process as well as experienced professors were interviewed. Results: The instructive objectives of the career are not included in Legal Dentistry but they are taken into account when dealing with heath problems, the ways of behavior of the future professional and the objectives of the 4th-year subject. The formulation of the first instructive objective is considered very general and broad. Conclusions: Its location is correct bearing in mind the curricular design. It contains enough hours for the practice at dental clinics and a correct gradation of the theoretical activities, a very broad and lengthy content in topic III as well as scarce and not updated literature were the negative aspects. (shrink)

In this paper l deal with the substantiva! theory of space and time and I examine its consequences with respect to the problem of the differentiation of indiscernible particulars (the so called "problem of individuation"). I distinguish two versions: the "standard" theory and the "substratist" theory. According to the "standard" theory, space and time ( or spacetime) are substances made of points and instants (or point-instants) which hold a contingent relation with the physical substances which occupy those points and instants. (...) According to the "substratist" theory, which may be attributed to D.M. Armstrong, space and time ( or spacetime) are also substances made of points and instants (or point-instants), but those points and instants hold a necessary relation with the physical objects which "occupy" them. This is so because those points (or point-instants) are, as substrata, essential constituents of physical objects, which support and hold together their properties. I argue that in these theories we cannot appeal to the difference in spaciotemporal position in order to ground the numerical diversity of indiscernible particulars and, in this sense, they dont allow us to use space and time as "principies of individuation". (shrink)

_Real Metaphysics_ brings together new articles by leading metaphysicians to honour Hugh Mellor's outstanding contribution to metaphysics. Some of the most outstanding minds of current times shed new light on all the main topics in metaphysics: truth, causation, dispositions and properties, explanation, and time. At the end of the book, Hugh Mellor responds to the issues raised by each of the thirteen contributors and gives us new insight into his own highly influential work on metaphysics.