As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

This article seeks to shed light on the beliefs that influence nurses’ intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses’ beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying (...) with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients’ wishes, nurses should be aware that they do not systematically guarantee respect of a patient’s autonomy, nor do they replace a relationship based on trust between patients and health care professionals. (shrink)

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: (...) Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. (shrink)

This book's importance is derived from three sources: careful conceptualization of teacher induction from historical, methodological, and international perspectives; systematic reviews of research literature relevant to various aspects of teacher induction including its social, cultural, and political contexts, program components and forms, and the range of its effects; substantial empirical studies on the important issues of teacher induction with different kinds of methodologies that exemplify future directions and approaches to the research in teacher induction.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

We give syntactic characterizations of1. the theories whose categories of models are closed under the formation of pullbacks, and of2. the locally ω-polypresentable categories.A somewhat typical example is the category of algebraically closed fields. Case is proved by classical model-theoretic methods; it solves a problem raised by H. Volger . The solution of case is in the spirit of the ones for the locally ω-presentable and ω-multipresentable cases found by M. Coste and P.T. Johnstone respectively. The problem was raised in (...) the context of Domain Theory by F. Lamarche. (shrink)

O texto busca refletir criticamente sobre alguns fenômenos sociais contemporâneos, fortemente imbricados, notadamente as tendências contemporâneas de entrincheiramento e achatamento do eu; o reforço da iconomania e da compulsiva produção de avatares de si, em meio a bolhas narcísicas digitais, franqueadas pelas recentes tecnologias de informação e comunicação; e a virtual destruição da intimidade e da privacidade, diante da emergência de panópticos digitais e da vigilância algorítmica. Para tanto, toma-se como ponto de partida proposições apresentadas por Christopher Lasch em sua (...) obra _The Minimal Self: Psychic Survival in Troubled Times_, publicada originalmente em 1984, em particular a própria noção de mínimo eu, as quais são, então, entretecidas com argumentos de Christophe Dejours, Günther Anders, Theodor Adorno, Hebert Marcuse, Jonathan Crary, entre outros. Em acréscimo, busca-se salientar a ancoragem desses processos à hodierna dinâmica de acumulação de capital, a partir da crítica da economia política, perspectiva que atravessa todo o texto, bem como assinalar a atualidade do pensamento de Lasch. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

Este artigo científico procurou investigar o processo de adaptação da Universidade Brasileira aos novos paradigmas impostos pelas políticas neoliberais. A análise se faz a partir de breve histórico do liberalismo e de suas imbricações no ensino. Apontando também a relativização da suposta democratização e modernização do ensino pelas novas perspectivas impostas pelo mercado. São levantadas também questões como autonomia universitária e legitimação da instituição de ensino superior.

In 1835, Alexis de Tocqueville famously called for 'a new political science' that could address the problems and possibilities of a 'world itself quite new.' For Tocqueville, the democratic world needed not just a new political science, but also new arts of statesmanship and leadership. In this volume, editors Brian Danoff and L. Joseph Hebert, Jr. have brought together a diverse set of essays which reveal that Tocqueville's understanding of democratic statesmanship remains highly relevant today.

Jean Greisch a soixante ans. A l'occasion de cet anniversaire, trente de ses collègues et amis de divers continents ont souhaité unir leurs réflexions à ce que son œuvre, désormais considérable, inspire sur les différentes scènes de la pensée. La thématique générale, qui constitue l'intitulé du présent volume, est emblématique d'une production singulière : passage entre les deux langues de son Luxembourg natal, entre la phénoménologie et la philosophie de la religion, entre la métaphysique et la théologie, entre les sciences (...) humaines et l'herméneutique, entre la poésie et l'éthique. Enseignant, traducteur, conférencier international et auteur, il continue de frayer différents types de passages : dresser des ponts, ouvrir des brèches, risquer des percées, souffrir des traversées, ménager des transitions, inventer des tracés. (shrink)

The problem of luck is advanced and defended against libertarian theories of responsibility-enabling ability. An outline of an account of ability is articulated to explore some features of the sort of ability moral responsibility requires. The account vindicates the luck objection and suggests a novel puzzle: Libertarianism is structurally barred from answering the problem of luck because responsibility requires, but inherently lacks, an explanation from reason states to actions that preserves reliability of connection between responsibility-grounding reasons-sensitivity and action.

Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of (...) morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)

Ibn al-ʻArabī, 1165-1240; views on freedom; Sufism; Islamic philosophy.

Frankfurt examples invite controversy over whether the pertinent agent in these examples lacks the specific ability to do otherwise, and whether what she does can be obligatory or permissible. We develop an account of ability that implies that this agent does not have the specific ability to refrain from performing the germane action. The account also undergirds a view of obligation that entails that it is morally required or prohibited for an agent to perform an action only if she has (...) the specific ability to do, and to do otherwise than, perform it. Therefore, in Frankfurt examples, it is neither obligatory nor impermissible for the relevant agent to do what she does. (shrink)

RésuméLa sémiotique a inventé ou utilisé plusieurs modèles logiques pour représenter la structure élémentaire de la signification. Le carré sémiotique est sans doute l’un des plus célèbres de ces modèles. Il faut se demander, devant l’importance des phénomènes triadiques, si les modèles dyadiques sont (toujours) adaptés à leur description ou s’il ne faudrait pas se tourner (aussi) vers des modèles triadiques. Or, les modèles triadiques de la structure élémentaire de la signification nous apparaissent bien moins nombreux. À notre connaissance, seule (...) la sémiotique de Peirce et le templum de Boudon occupent cet espace autrement laissé vacant. Nous voulons ici à la fois présenter et exemplifier le templum et le compléter, en nous inspirant du carré sémiotique, pour le faire évoluer vers un « prisme sémiotique ». Nous proposerons également d’autres modèles logiques, comme le pentalemme et le cube sémiotiques. Au passage, nous étudierons plusieurs questions et problèmes – dont la décidabilité – entourant les modèles logiques. Nous ferons quelques applications sommaires de certains modèles, sur le temps, l’espace et la transcendance principalement. (shrink)

Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight (...) ethical vignettes. The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rated metrics were depth (3.8/5) and acceptability (3.8/5). There was poor-to-moderate inter-rater reliability characterised by an intraclass coefficient of 0.54 (95% CI: 0.30 to 0.71). Based on panellist feedback, GPT-4 was able to identify and articulate key ethical issues but struggled to appreciate the nuanced aspects of ethical dilemmas and misapplied certain moral principles. This study reveals limitations in the ability of GPT-4 to appreciate the depth and nuanced acceptability of real-world ethical dilemmas, particularly those that require a thorough understanding of relational complexities and context-specific values. Ongoing evaluation of LLM capabilities within medical ethics remains paramount, and further refinement is needed before it can be used effectively in clinical settings. (shrink)

CB1 receptors are functionally present within brain mitochondria, although they are usually considered specifically targeted to plasma membrane. Acute activation of mtCB1 alters mitochondrial ATP generation, synaptic transmission, and memory performance. However, the detailed mechanism linking disrupted mitochondrial metabolism and synaptic transmission is still uncharacterized. CB1 receptors are among the most abundant G protein-coupled receptors in the brain and impact on several processes, including fear coping, anxiety, stress, learning, and memory. Mitochondria perform several key physiological processes for neuronal homeostasis, including (...) production of ATP and reactive oxygen species, calcium buffering, metabolism of neurotransmitters, and apoptosis. It is therefore possible that acute activation of mtCB1 impacts on these different mitochondrial functions to modulate synaptic transmission. In reviewing and integrating across the literature in this area, we describe the possible mechanisms involved in the regulation of brain physiology by mtCB1 receptors. Activation of mitochondrial CB1 but not of plasma membrane CB1 decreases brain mitochondrial activity, glutamatergic synaptic transmission, and memory performance. Several processes can be involved in this alteration of brain physiology, including mitochondrial ATP and ROS production, axonal mitochondrial transport, Ca2+ homeostasis, and/or metabolism of the neurotransmitter glutamate. (shrink)

Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians is a concise and practical guide to ethical decision-making in medicine. The text is aimed at second- and third-year one-semester ethics courses offered in medical schools, health sciences departments, and nursing programs. By taking an applied approach rather than a theoretical approach, this text serves the needs of medical and nursing students, residents, and practicing physicians by sorting through questions of moral principles relevant to the diverse and growing (...) number of healthcare professionals. The many topics covered include truth telling, refusal of treatment, assisted suicide, managing error, and reproductive choice. (shrink)

This article presents the results of a research that aimed to examine the phenomenon of student cheating on exams in faculties of education in Quebec universities. A total of 573 preservice teachers completed an online survey in 2018. The questionnaire consisted of 28 questions with a Likert scale related to individual and contextual factors associated with the propensity to cheat on exams as well as two yes/no items on the arguments for cheating. Descriptive and hierarchical linear regression analyses highlighted the (...) existence of cheating but also how three factors influenced the students’ propensity to cheat: influence of peers, methods of cheating, and institutional context. (shrink)

This article seeks to define what is semiotic and what is Semiotics. Provided first is a brief presentation of various perspectives of Semiotics. Pursuant to this, we will seek to uncover Semiotics’ particulars by evaluating various approaches. We will commence by framing the definitions of the word “Semiotic” to consider then Semiotics via eight particular anthropic – human-related – levels. This partition, derived by the author from a Rastier typology, defines the following levels: noumenophysical, phenophysical, semiotic, representational (“mental images” and (...) concepts), sens (physical), felt (affects), cognitive other and transcendental. From here, we will consider the place of Semiotics among disciplines. Finally, the text presents a typology of relationship between disciplines, including semiotics: anadisciplinarity, disciplinarity, valodisciplinarity, intradisciplinary (such as intertheoricity), multidisciplinary, interdisciplinary, transdisciplinary, metadisciplinarity). (shrink)

Saint Augustin écrit : " Qu'est-ce donc que le temps ? Si personne ne me le demande, je le sais ; mais, si on me le demande et que je veuille l'expliquer, je ne le sais plus.

Contrary to Vaesen's argument that humans are unique with respect to nine cognitive capacities essential for tool use, we suggest that although such cognitive processes contribute to variation in tool use, it does not follow that these capacities arenecessaryfor tool use, nor that tool use shaped cognition per se, given the available data in cognitive neuroscience and behavioral biology.

Deontic modals are the topic of my dissertation. All deontic modals, yes, but justification in particular, and epistemic justification even more specifically. Deontic modals operate upon performances—they appraise performances. Positively appraised, a performance is appropriate, decent, justifiable, right, permissible, or proper; negatively appraised, inappropriate, indecent, unjustifiable, wrong, impermissible, or improper. Belief and knowledge and performances in exactly the same sense that action and intention are performances: all are products of powers that are in some sense responsive to reasons. The principal (...) difference is the direction of fit between mind and world. Knowledge and belief the product of cognitive powers aimed at adapting mind to world, action and intention the product of conative powers aimed at adapting world to mind. All are normatively evaluable and the characteristic normative appraisal of each is deontic. Epistemology, ethics, and rational choice all investigate the nature of deontic modals, differing only insofar as the central aims are epistemic, moral, or prudential in nature. In this sense, the general theory of deontic modals is the parent to epistemology, ethics, and rational choice. My project is to develop and defend a schematic theory of justification. I achieve this end by developing and defending a general theory of deontic modalities. Riffing on two pithy turns of phrase, the deontic theory may be tersely sloganized: value first and one must do the best one can. It is a teleological theory that defines all deontic concepts from the theoretically foundational notions of ability and value. Roughly, a belief is epistemically justifiable if, and only if, it is part of an epistemically optimific belief set the agent is able to have. Roughly, an act is morally justifiably if, and only if, it is part of a morally optimific action set the agent is able to perform. My pet interest is in the former. The resultant framework is enormously fruitful, especially in epistemology. (shrink)

O objetivo deste texto é discutir a tarefa filosófica de elucidação do conceito de conseqüência lógica. Primeiramente, serão eleitos dois critérios de adequação para uma elucidação desse conceito: (1) preservação da verdade nas instâncias, ou adequação material e (2) garantia da verdade da conclusão na inferência válida, ou adequação epistêmica. Em seguida serão apresentadas a proposta de Tarski (1956) e as correspondentes críticas de Etchemendy (2008). Conclui-se com comentários a respeito da natureza das investigações lógicas.