Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send (...) a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

Chronic deficiencies of the Greek welfare state and the introduction of austerity measures as part of the international financial bailout agreements have created an explosive cocktail of poverty and social exclusion that severely tested the resilience of the frail social safety net and the demands of equity. The score on the indicators of social quality has worsened considerably as the Greek welfare system was overhauled. This article examines the four conditional factors of social quality from the viewpoint of socio-economic policies (...) and everyday experiences in Greece during the crisis. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social‐based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory (...) to explore the phenomenon of social‐based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social‐based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower‐class workers and subsequently improving resident care delivery. (shrink)

This is a welcome reprint of a book that continues to grow in importance.

This article aims to research on Carl Schmitt’s foundations of the individual and his reserve of consciousness. Nowadays, the main researchers of Schmitt’s works asseverates that the German jurist was an antiliberal and, therefore, an antiindividualist. However, we argue that is possible to find not only a critique to liberal conception of the individual, but a purposeful conception through his reflections on criticism against authority and public authority. In order to demonstrate it, we propose an hermeneutical approach to his work (...) —mainly to The Leviathan in the State Theory of Thomas Hobbes and “The Visibility of the Church. A Scholastic Consideration”. Particularly, we attend the human action as the founder of the political order and the individual’s ability to criticize the authority. This article claims that Schmitt formulates a notion of individuality of a different sign than the liberal one and that is closely linked to the idea of Law, the institutionalstate framework and the community substrate. (shrink)

1. Grecia y Roma.-2. El judaísmo y la filosofía. El cristianismo y la filosofía. El Islam y la filosofía.-3. Del humanismo a la ilustración (siglos XV-XVIII).-4. Siglo XIX, Kant, idealismo y espiritualismo.;;;;;;;;;.

El objetivo de este artículo es indagar en la fundamentación schmittiana del individuo y de la reserva de conciencia. En la actualidad, buena parte de la recepción contemporánea considera al jurista renano como un antiliberal y, por lo tanto, como un antiindividualista. Sin embargo, nuestra hipótesis es que es posible encontrar en su obra no solo una crítica a la noción liberal de individuo, sino también una concepción propositiva a través de sus reflexiones sobre la crítica frente a la autoridad (...) y al poder público. Para demostrarla, se propone un abordaje hermenéutico-exegético de sus obras —principalmente, de las conferencias sobre El Leviatán en la teoría del Estado de Thomas Hobbes y del artículo "La visibilidad de la Iglesia. Una reflexión escolástica”— para indagar la acción humana como fundadora del orden político y las posibilidades del individuo de criticar a la autoridad. El artículo sostiene que Carl Schmitt formula una noción de individualidad de signo distinto a la liberal y que se vincula íntimamente con la idea de Derecho, el entramado institucional-estatal y el sustrato comunitario. (shrink)

El presente artículo es la primera traducción española de un artículo del jurista alemán Hermann Heller titulado "¿Liberalismo autoritario?", en el que pretende dar cuenta de una nueva forma de articulación política que se desarrolla al comienzo de los años 30 en Alemania y que combina el autoritarismo político con el liberalismo económico.

Randomized controlled trials test new drugs using various debiasing devices to prevent participants from manipulating the trials. But participants often dislike controls, arguing that they impose a paternalist constraint on their legitimate preferences. The 21st Century Cures Act, passed by US Congress in 2016, encourages the Food and Drug Administration to use alternative testing methods, incorporating participants’ preferences, for regulatory purposes. We discuss, from a historical perspective, the trade-off between trial impartiality and participants’ freedom. We argue that the only way (...) out is considering which methods improve upon the performance of conventional trials in keeping dangerous or inefficacious compounds out of pharmaceutical markets. (shrink)

La sociedad del conocimiento y la introducción en los procesos de enseñanza-aprendizaje de las tecnologías de la información y la comunicación, están exigiendo de quienes nos dedicamos a la educación en el ámbito universitario, la utilización de nuevas estrategias didácticas y la reinvención de algunas antiguas o no tan nuevas. Se trata de dar respuesta a la demanda social de “aprender de otra manera” para mejorar la inserción de los nuevos egresados en su ámbito profesional. Esta nueva forma de aprender (...) debe tener en consideración las exigencias de los nuevos contextos de enseñanza-aprendizaje, donde el protagonismo de los estudiantes es un elemento esencial y la relación de lo aprendido con sus posibilidades de aplicación en el contexto profesional es el otro. Casualmente el modelo de formación basado en competencias desde el enfoque socioformativo coincide en ambos protagonismos y el portafolio como estrategia didáctica que puede utilizarse en este modelo puede ayudar a dotar de protagonismo al que aprende haciéndole tomar conciencia de que el aprendizaje no se produce de manera automática sino a través de una serie de pasos y etapas que a la vez que se van consiguiendo nos permiten reflexionar el proceso. Una vez llevado a cabo este proceso de reflexión general, puede aplicarse en el ámbito médico para iniciar al estudiante a tomar conciencia de su semejanza con el diagnóstico clínico. Palabras clave: portafolio; estrategias de enseñanza-aprendizaje; diagnóstico clínico; enfoque socioformativo. (shrink)

El artículo pretende mostrar la razón por la que la curaduría experimental puede ser considerada una práctica artística bajo la mira de teorías del arte contemporáneo. Para ello se presenta una genealogía de la curaduría experimental para, posteriormente, mostrar su semejanza con las produc-ciones artísticas contemporáneas en lo atenido a su relación con el espectador y su vínculo con los contextos sociales extraartísticos.

This book presents G. A. Cohen's Gifford Lectures, delivered at the University of Edinburgh in 1996. Focusing on Marxism and Rawlsian liberalism, Cohen draws a connection between these thought systems and the choices that shape a person's life. In the case of Marxism, the relevant life is his own: a communist upbringing in the 1940s in Montreal, which induced a belief in a strongly socialist egalitarian doctrine. The narrative of Cohen's reckoning with that inheritance develops through a series of sophisticated (...) engagements with the central questions of social and political philosophy. In the case of Rawlsian doctrine, Cohen looks to people's lives in general. He argues that egalitarian justice is not only, as Rawlsian liberalism teaches, a matter of rules that define the structure of society, but also a matter of personal attitude and choice. Personal attitude and choice are, moreover, the stuff of which social structure itself is made. Those truths have not informed political philosophy as much as they should, and Cohen's focus on them brings political philosophy closer to moral philosophy, and to the Judeo-Christian ethical tradition, than it has recently been. (shrink)

This study explores the effects of the shift to emergency remote teaching on teachers’ levels of well-being, emotions, and motivation. A total of 936 Spanish teachers participated in this nationwide survey from all educational levels, thus allowing comparison among levels, which is a novelty and strength of our study. Four aspects were explored: instructional adaptation to ERT; well-being changes and the main challenges in this regard; changes in emotions; and changes in motivation and the main factors. Importantly, we explored a (...) number of teacher characteristics for the three last aspects. Our results show that teachers felt the impact of ERT on their well-being, emotions, and motivation. Additionally, female teachers, teachers with students of low socioeconomic status, in public schools, and primary and secondary teachers were the most affected groups. This indicates that the impact of ERT differed and some populations of teachers are more at risk of suffering burnout because of ERT. (shrink)

A highly original reading of Immanuel Kant that demonstrates his interest in the social realm of human interaction.

Containing selected papers on the fundamentals and applications of Complexity Science, this multi-disciplinary book presents new approaches for resolving complex issues that cannot be resolved using conventional mathematical or software models. Complex Systems problems can occur in a variety of areas such as physical sciences and engineering, the economy, the environment, humanities and social and political sciences. Complexity Science problems, the science of open systems consisting of large numbers of diverse components engaged in rich interaction, can occur in a variety (...) of areas such as physical sciences and engineering, the economy, the environment, humanities and social and political sciences. The global behaviour of these systems emerges from the interaction of constituent components and is unpredictable but not random. The key attribute of Complex Systems is the ability to self-organise and adapt to unpredictable changes in their environment. (shrink)

A leading figure in neuroaesthetics makes the case that aesthetic experience can be meaningfully measured by the tools of neuroscience.

G.E. Moore, more than either Bertrand Russell or Ludwig Wittgenstein, was chiefly responsible for the rise of the analytic method in twentieth-century philosophy. This selection of his writings shows Moore at his very best. The classic essays are crucial to major philosophical debates that still resonate today. Amongst those included are: * A Defense of Common Sense * Certainty * Sense-Data * External and Internal Relations * Hume's Theory Explained * Is Existence a Predicate? * Proof of an External World (...) In addition, this collection also contains the key early papers in which Moore signals his break with idealism, and three important previously unpublished papers from his later work which illustrate his relationship with Wittgenstein. (shrink)

Fichte assigns ‘intellectual intuition’ a new meaning after Kant. But in 1799, his doctrine of intellectual intuition is publicly deemed indefensible by Kant and nihilistic by Jacobi. I propose to defend Fichte’s doctrine against these charges, leaving aside whether it captures what he calls the ‘spirit’ of transcendental idealism. I do so by articulating three problems that motivate Fichte’s redirection of intellectual intuition from being to acting: (1) the regress problem, which states that reflecting on empirical facts of consciousness leads (...) only to further facts and so cannot yield a first principle; (2) the rhapsody problem, which states that the categories form a haphazard set and so lack necessity unless they derive from a first principle; and (3) the nihilism problem, which states that a first principle cannot lie outside our cognition of it, lest it be the cause of our cognition and, being first, the cause of all our actions, reducing us to machines. Crucially, Fichte’s three motivating problems are in fact aspects of a single problem. Leaving any aspect unsolved spoils putative solutions to the other two. Consequently, Fichte requires a single unified solution to all three, which his doctrine of intellectual intuition provides. (shrink)

This chapter contains section titled: I II III IV V VI VII VIII IX X XI XII Coda Appendix Acknowledgements.

A model for the ideal state includes discussions of the nature and application of justice, the role of the philosopher in society, the goals of education, and the effects of art upon character.

El presente artículo pretende elucidar las insuficiencias de la denominada economía del bienestar a partir del enfoque de las capacidades de Amartya Sen y Martha C. Nussbaum. En el primer bloque presentamos los lineamientos fundamentales de ambas propuestas con el fin de concretar y dotar de autonomía sus respectivos modelos basados en el enfoque de las capacidades, contrastándolos con los modelos convencionales de medición de la calidad de vida relativa de la ciudadanía. En el segundo bloque incidimos en la justificación (...) de sus aportaciones para profundizar en la perspectiva de la capacidad desde una vertiente comparada, esto es, desde dos áreas de estudio (Sen desde el ámbito económico y Nussbaum desde el filosófico) que han aunado sus fuerzas e intereses bajo este paradigma. (shrink)

This essay challenges the widely accepted principle that a person is morally responsible for what he has done only if he could have done otherwise. The author considers situations in which there are sufficient conditions for a certain choice or action to be performed by someone, So that it is impossible for the person to choose or to do otherwise, But in which these conditions do not in any way bring it about that the person chooses or acts as he (...) does. In such situations the person may well be morally responsible for what he chooses or does despite his inability to choose or to do otherwise. Finally the author considers certain suggestions for revising the principle he rejects or for replacing it with a principle of an altogether different kind. (shrink)

There is growing interest in the use of neurointerventions to reduce the risk that criminal offenders will reoffend. Commentators have raised several ethical concerns regarding this practice. One prominent concern is that, when imposed without the offender’s valid consent, neurointerventions might infringe offenders’ right to bodily integrity. While it is commonly held that we possess a moral right to bodily integrity, the extent to which this right would protect against such neurointerventions is as-yet unclear. In this paper, we will assess (...) whether, why, and how severely three forms of neurointervention might infringe the right to bodily integrity. We show that the severity of the infringement of the right to bodily integrity differs across different forms of neurointervention. Moreover, we argue that mental and behavioral effects of neurointerventions could in some cases be relevant to determining the severity of infringements of the right to bodily integrity. (shrink)

In the Vocation of Man, Fichte makes the striking claim that life is eternal, rational, our true being, and the final cause of nature in general and of death in particular. How can we make sense of this claim? I argue that the public lectures that compose the Vocation are a popular expression of Fichte’s pre-existing commitment to what I call immortalism, the view that life is the unconditioned condition of intelligibility. Casting the I as an absolutely self-active or living (...) power enables his philosophical account of both the intelligibility of objects and of what it means to die. This explains his characterization of the Wissenschaftslehre as a system in which ‘all is act, movement, and life’. In Sect. 1, I explain the context of Jacobi’s use of ‘caput mortuum’ as a term for the thing in itself. In Sects. 2 and 3, I reconstruct two immortalist arguments from Fichte’s Jena period. The first is that the I’s self-activity rules out the existence of the thing in itself and thereby vanquishes ‘death’s head’. The second is that, insofar as the I charges us with the moral perfection of nature, it is the final cause of our entire life, including its end. This is to say that the I puts our every moment into question, even our last. In Sect. 4, I use these immortalist arguments to interpret the striking claim from the Vocation. (shrink)

Philosophy of Tsong-kha-pa Blo-bzang-grags-pa's Lam rim chen mo.

Conference proceedings on Mongolian contributions to Buddhist knowledge.

Throughout his career, Schelling assigns knowledge of the absolute first principle of philosophy to intellectual intuition. Schelling's doctrine of intellectual intuition raises two important questions for interpreters. First, given that his doctrine undergoes several changes before and after his identity philosophy, to what extent can he be said to “hold onto” the same “sense” of it by the 1830s, as he claims? Second, given that his doctrine of intellectual intuition restricts absolute idealism to what he calls a “science of reason”, (...) which he says cannot prove the absolute’s existence, what other doctrine does he require in order to prove this? I will answer these questions by tracing the shifts in Schelling’s doctrine of intellectual intuition from the 1790s to the 1830s and drawing out its evolving methodological role within his science of intelligibility. (shrink)

Modern science faces a series of problems that undermine confidence in its reliability. To solve these problems, we must reflect on what makes science work and what leads it astray. This book is about Science, its strengths and weaknesses. The papers that scientists write form a vast resource of evidence and theory that is doubling about every ten years, along with the number of scientists. The size of this resource makes it hard for it to be used effectively by scientists, (...) and along with this are growing concerns about its integrity and reliability. This book looks at the scientific method, as currently applied and as understood philosophically by scientists, the social structure of science, and the structure of scientific communication through journals. It includes case studies of controversies, and looks at how fields develop over time. (shrink)

The concept of facticity denotes conditions of experience whose necessity is not logical yet whose contingency is not empirical. Although often associated with Heidegger, Fichte coins ‘facticity’ in his Berlin period to refer to the conclusion of Kant’s metaphysical deduction of the categories, which he argues leaves it a contingent matter that we have the conditions of experience that we do. Such rhapsodic or factical conditions, he argues, must follow necessarily, independent of empirical givenness, from the I through a process (...) of ‘genesis.’ I reconstruct Fichte’s argument by tracing the origin of his neologism, presenting his Jena critique of Kant’s rhapsodic appeal to the forms of judgment, and illustrating the Jena period’s continuity with the Berlin period’s genetic method, while noting a methodological shift whereby Fichte directs his critique against his own doctrine of intellectual intuition in order to eliminate its ‘factical terms.’. (shrink)

Fichte argues that the conclusion of Kant’s transcendental deduction of the categories is correct yet lacks a crucial premise, given Kant’s admission that the metaphysical deduction locates an arbitrary origin for the categories. Fichte provides the missing premise by employing a new method: a genetic deduction of the categories from a first principle. Since Fichte claims to articulate the same view as Kant in a different, it is crucial to grasp genetic deduction in relation to the sorts of deduction that (...) Kant offers. I propose to interpret genetic deduction as the simultaneous fulfillment of two tasks: answering the question quid facti by deriving the categories from the I and answering the question quid juris by establishing our entitlement to the categories as conditions of experience. While the second task represents Fichte’s agreement with Kant’s transcendental deduction, the first reflects his correction of Kant’s metaphysical deduction. (shrink)

A precursor to the hard problem of consciousness confronts nihilism. Like physicalism, nihilism collides with the first-personal fact of what perception and action are like. Unless this problem is solved, nature’s inclusion of conscious experience will remain, as Chalmers warns the physicalist, an “unanswered question” and, as Jacobi chides the nihilist, “completely inexplicable". One advantage of Kant’s Copernican turn is to dismiss the question that imposes this hard problem. We need not ask how nature is accompanied by the first-person standpoint (...) because “I think” is an apperceptive form of thinking that must be able to accompany any cognition of nature. Kant’s formal conception of apperception worries Fichte in his Nova Methodo lectures. This conception arguably cannot exhaust the ground of experience, for it does not show why we posit objects “at all". For Fichte, it is our agency that first opens a world of objects, viz., as subjects, means, ends, and obstacles. In what follows, I argue that, for Fichte, the I poses no hard problem because it collides exclusively with nihilistic views like Spinozism, which are refuted by a properly transcendental idealist conception of apperception, according to which the first-person standpoint is the absolute ground of our experience of nature. If transcendental idealism refutes nihilism, nature is no more explicable than that there is something it is like for me to perceive and act. In Section 1, I show why Kantian apperception is necessary for possible experience. In Section 2, I reconstruct Fichte’s argument that a modified conception of apperception refutes guises of nihilism, thereby solving the hard problem of consciousness. In Section 3, I suggest that transcendental idealism undermines Chalmers’ proposed solution to and Dennett’s dismissal of this problem. (shrink)

Panel de discusión del Cuerpo Académico de Estética y Arte realizado en los marcos del Tercer Coloquio Nacional de la Asociación Mexicana de Estudios en Estética, en el que fueron expositores los doctores José Ramón Fabelo Corzo, Gerardo de la Fuente Lora e Isabel Fraile Martín. El doctor Fabelo realizó una presentación general sobre los antecedentes del tema, su significación y perspectivas de desarrollo, en particular sobre las posibilidades de introducción de nuevas categorías, entre ellas la de la “colonialidad (...) del valer”. El doctor De la Fuente, por su parte, centró su intervención en las contradicciones que debe resolver la teoría de la colonialidad para no terminar realizando ella misma una apología a la colonialidad, refiriéndose al papel que en ello puede y debe desempeñar la estética. La doctora Fraile llama la atención sobre lo que podría considerarse el lado positivo de las relaciones de colonialidad que permitieron, entre otras consecuencias, un mutuo enriquecimiento cultural, algo que muestra mediante el análisis del traspaso de imaginarios visuales para los artistas de América Latina. (shrink)

In the Freedom essay, Schelling charges that (1) idealism fails to grasp human freedom’s distinctiveness and that (2) this failure undermines idealism's attempt to refute pantheism, as exemplified by Spinoza. This raises two questions, which I will answer in turn: what, for Schelling, is distinctive of human freedom; and how does the idealists’ failure to grasp it render them unable to refute pantheism? To answer these questions, I will reconstruct Schelling’s argument that freedom has the distinctness of being the unconditioned (...) condition of the world’s intelligibility. My reconstruction will illustrate how Schelling’s notion of freedom as primal will grounds the alleged primacy of practical reason as Kant and Fichte conceive it. I will then consider three objections to Schelling’s argument. Throughout, I will develop the Schellingian idea that freedom is enacted in an unprethinkable decision that cannot be anticipated by any law or principle. (shrink)