This section welcomes submissions addressing literature as a means to explore ethical issues arising in healthcare. “Literature” will be understood broadly, including fiction and creative nonfiction, illness narratives, drama, and poetry; film studies might be considered if the films are adaptations from a literary work. Topics include in-depth analysis of literary works as well as theoretical contributions, discussions, and commentary about narrative approaches to disease and medicine, the way literature shapes the relationship between patients and healthcare professionals, the role of (...) speculative fiction as a testing ground for future scenarios in healthcare, and so on. Articles discussing the uses of literature for bioethics education and outreach will be particularly appreciated. Research on literature not originally written in English will be considered as long as it has also been published in translation. Submissions should include an abstract and should conform to theCQGuidelines for Contributors. To submit an article or discuss a suitable topic, write to Antonio Casado da Rocha atantonio.casado@ehu.es.:This article proposes a concept of narrative autonomy to supplement existing accounts in healthcare ethics. This is done by means of a comparison between three end-of-life scenarios: Tolstoy’sThe Death of Ivan Ilyichand two related contemporary stories by Lorrie Moore and Bernhard Schlink, which explore some problems arising when extremely individualistic notions of patient autonomy are put into practice. It is argued that the best model for palliative care is a cooperative one in which patient autonomy is understood as essentially social, and that involves decisional, executive, informational, and narrative dimensions. (shrink)

This critical notice argues for the existence of a new trend in bioethics, a complex and dynamic field of philosophical enquiry that goes beyond applied ethics and professional deontological codes. This trend supplements their traditionally “minimalist” ethics—and its concern with harm, rights or justice—with “inflationary” positions open to an integration of medicine with the humanities. By comparing and contrasting the views of two quite different philosophers, Diego Gracia and Alfred Tauber, and placing them within the theoretical background delineated by George (...) Khushf, I argue that the main contribution of this “inflationary bioethics” is an understanding of health and disease as intrinsically normative concepts, which in turn brings about a blurring of the distinction between facts and values. By refusing to construe the distinction as a dichotomy, a post-positivist philosophy of medicine must become more epistemological in order to help us clarify concepts in which the evaluative and the factual are impossible to separate. As a result, the “language of principles” in standard bioethics is being substituted by a more encompassing “language of values”; health and disease are increasingly understood as biopsychosocial phenomena; and the field is open to a process of moralization that challenges traditional models of patient autonomy and physician responsibility. (shrink)

By means of a survey of Thoreau's writings, this article analyses his thoughts on health, emphasising some features that fit well with contemporary debates in the philosophy of medicine. Thoreau understands health as an environmental value, one that cannot be achieved without a personal relation to nature, but he does not provide a static definition of health within a fixed hierarchy of values. Thus he avoids a certain degree of essentialism that, when imposed on his work, makes it seem more (...) utopian and anti-scientific than it really is. The meaning of health for Thoreau is often contradictory and hard to disambiguate, and his context was different in many respects to ours, but his ideas on this topic still serve to criticise some of modern medicine's views on health and disease, and to steer it towards a more environmentally-informed approach to these phenomena. (shrink)

RESUMEN: El uso de analogías en bioética es muy frecuente. Dado que son instrumentos especialmente eficaces desde un punto de vista retórico, resulta fundamental determinar bajo qué condiciones la formulación de analogías constituye un recurso discursivo legítimo. En este artículo, distinguimos entre usos no-discursivos y usos discursivos de las analogías, y dentro de estos últimos, entre usos explicativos y usos argumentativos. En base a esta clasificación, proponemos distintos conjuntos de criterios para determinar si una analogía particular constituye un recurso discursivo (...) legítimo o no. Para ello, ilustramos brevemente nuestra clasificación mediante algunos ejemplos tomados del reciente debate sobre los biobancos.ABSTRACT: Analogies are frequently used in bioethics. As they are particularly effective as rhetorical tools, it is essential to determine under which conditions they can be said to be a legitimate discursive resource. In this paper we distinguish between nondiscursive uses and discursive uses of analogies and, within the latter, between explanatory uses and argumentative uses. Taking this classification as a basis, we provide different sets of criteria for determining whether or not a particular analogy constitutes a legitimate discursive resource. In distinguishing between legitimate and illegitimate analogies, we briefly illustrate our classification by some examples from recent literature on biobanks. (shrink)

In our research group on the philosophy of biology (www.ehu.es/ias-research), we are developing an understanding of autonomy as the maintenance of an identity over time by means of interaction with...

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models more (...) favourable to research in a post‐genomic context. (shrink)

Biobanks challenge the traditional model in research ethics, in which the autonomy of subjects donating samples for biomedical research is to be protected by means of informed consent. This paper identifies a global trend towards governance models more favourable to research, in which a single act of consent is used to authorize a wide range of research projects. It argues that the protection of autonomy is often understood just as the requirement to sign an informed consent form; but the autonomy (...) of research subjects is neither an isolated decision nor a purely individual one, as it affects groups of people along time. Some ways out of this problem are discussed, both by re-conceptualizing autonomy and by expanding the informed consent process. Taking into account the relationship between public trust and donor participation, the possibility of respecting autonomy by means of narrative is suggested, with the aim of promoting the scientific culture of a population and debating the ethical issues raised by biobanks. (shrink)

Although bioethics is a lively and expanding interdisciplinary field, there is not enough research about the patient‐doctor relationship, a central issue in philosophy of medicine. This article surveys the state of the field, paying attention to recent work by Alfred Tauber, and supplementing it with insights from Hans Jonas's philosophy of technology in order to propose a principle of responsible autonomy for health care. Based on a comparative look across different sub‐fields in bioethics, the resulting model claims that physician responsibility (...) is essential to professional integrity, providing an alternative to other active trends emphasizing patient autonomy, such as Robert Veatch's contractual model. (shrink)

This paper aims to study from the perspective of bioethics the controversy about door-to-door waste collection (DtD). Three goals are pursued: (1) to provide terms of comparison between different systems of urban waste management, (2) to distinguish the specifically ethical issues introduced by DtD, and (3) analyze its innovative character as a social technology. After briefly considering the state of the art, in which a bibliographical revision shows that the ethics literature has relatively neglected this topic, Siurana’s “moral compass” is (...) applied to the question concerning waste. Next this proposal is used to describe and assess the two main models being discussed. After introducing the most innovative features of DtD, some recommendations are issued and plausible objections answered. (shrink)

Tras una revisión bibliográfica, el artículo proporciona una presentación de la filosofía política de Henry D. Thoreau, enfatizando en su obra un concepto de autodeterminación cívica que Habermas descompone en una autonomía pública y otra privada. Sostengo que Thoreau no era un anarquista antisocial, ni tampoco un mero liberal individualista, sino que su liberalismo presenta elementos propios de la teoría democrática e incluso del comunitarismo político. Finalmente, identifico y describo una tensión entre esos temas liberales y democráticos, tanto en la (...) obra de Thoreau como en la vida política de las sociedades occidentales, mostrando así la relevancia de este autor. (shrink)

Reseña de: Siurana, Juan Carlos (2009) La sociedad ética. Indicadores para evaluar éticamente una sociedad, Barcelona, Proteus.

RESUMEN: El uso de analogías en bioética es muy frecuente. Dado que son instrumentos especialmente eficaces desde un punto de vista retórico, resulta fundamental determinar bajo qué condiciones la formulación de analogías constituye un recurso discursivo legítimo. En este artículo, distinguimos entre usos no-discursivos y usos discursivos de las analogías, y dentro de estos últimos, entre usos explicativos y usos argumentativos. En base a esta clasificación, proponemos distintos conjuntos de criterios para determinar si una analogía particular constituye un recurso discursivo (...) legítimo o no. Para ello, ilustramos brevemente nuestra clasificación mediante algunos ejemplos tomados del reciente debate sobre los biobancos.ABSTRACT: Analogies are frequently used in bioethics. As they are particularly effective as rhetorical tools, it is essential to determine under which conditions they can be said to be a legitimate discursive resource. In this paper we distinguish between nondiscursive uses and discursive uses of analogies and, within the latter, between explanatory uses and argumentative uses. Taking this classification as a basis, we provide different sets of criteria for determining whether or not a particular analogy constitutes a legitimate discursive resource. In distinguishing between legitimate and illegitimate analogies, we briefly illustrate our classification by some examples from recent literature on biobanks. (shrink)

The target article by Alexander Kon (2009) offers an excellent conceptual toolkit to analyze the current literature on empirical bioethics, a topic which has attracted so much attention in the bioe...

Ethics committees are one of the main agents in the governance of science and technology, especially in the field of health care. This paper analyses some aspects of their nature, which show the internal relationship between the moral and the scientific-technological domains. Being both knowledge providers and users thereof, ethics committees deliberate and decide on complex contemporary ethical issues. To pursue their aims, they require adequate technical tools in order to deliberate and choose using new technologies of communication and information. (...) These tools carry new problems with themselves, so committees must acquire a mixed nature, dynamic, interdisciplinary and inclusive. Ethics committees do not only constitute a control device, rather they are an interactive means for the creation of value in society. (shrink)

El uso de analogías en bioética es muy frecuente. Dado que son instrumentos especialmente eficaces desde un punto de vista retórico, resulta fundamental determinar bajo qué condiciones la formulación de analogías constituye un recurso discursivo legítimo. En este artículo, distinguimos entre usos no-discursivos y usos discursivos de las analogías, y dentro de estos últimos, entre usos explicativos y usos argumentativos. En base a esta clasificación, proponemos distintos conjuntos de criterios para determinar si una analogía particular constituye un recurso discursivo legítimo (...) o no. Para ello, ilustramos nuestra clasificación mediante ejemplos tomados del reciente debate ético y jurídico sobre los biobancos. (shrink)

This paper introduces a formal concept of ideology and ideological system. The formalization takes ideologies and ideological systems to be situated in agent societies. An ideological system is defined as a system of operations able to create, maintain, and extinguish the ideologies adopted by the social groups of agent societies. The concepts of group ideology, ideological contradiction, ideological dominance, and dominant ideology of an agent society, are defined. An ideology-based concept of social group is introduced. Relations between the proposed formal (...) concept of ideology and the classical concepts of ideology elaborated in social sciences are examined. A computational notation is presented, to support the realization of ideological systems in computationally implemented agent societies. The adequacy of the approach for the formal modeling and analysis of ideological issues is illustrated through three case studies. (shrink)

Este artigo traz uma apresentação operatória formal da derivação do conceito Ser para si apartir do conceito Finito, derivação que está desenvolvida na Doutrina do Ser, da Ciência da Lógica deHegel. Mostra-se que a derivação do conceito intermediário Infinito Verdadeiro requer, além damacrooperação progressão de etapa, com que se dão todas as etapas de derivação do conceito Finito,uma operação adicional, que é identificada como a operação de determinação do menor ponto-fixo demicrorrelações. Já a derivação do conceito Ser para si a (...) partir do conceito Infinito Verdadeiro requersomente a microoperação suprassunção. O método geral de execução do primeiro momento damacrooperação progressão de etapa é detalhado, evidenciando um dos papéis que desempenha, nodesenvolvimento da Lógica de Hegel, a análise lógica das representações do Entendimento. (shrink)

Este artigo traz, desde uma perspectiva lógico-hegeliana, uma proposta de articulação operatória das noções de interseccionalidade e lugar de fala, com as quais, muitas vezes, se realizam análises de discursos e de situações sociais. O fundamento da proposta é a sequência de silogismos de ideias que, derivados da Lógica de Hegel, estratificam a noção de mundo em três níveis: mundo do sujeito, mundo do gênero e mundo do espírito. O artigo complementa esse fundamento introduzindo duas operações, particionamento de ideias e (...) superposição de partições de ideias, com as quais é derivado o conceito geral mundo setorial. O artigo mostra, então, como as noções de interseccionalidade e lugar de fala podem ser articuladas operatoriamente pelas três formas particulares e estratificadas desse conceito geral: mundo do sujeito setorial, mundo do gênero setorial e mundo do espírito setorial. (shrink)

In this paper, we present a formal interpretive account of Jean Piaget’s theory of the morality that regulates social exchanges, which we call interactional morality. First, we place Piaget’s conception in the context of his epistemological and sociological works. Then, we review the core of that conception: the two types of interactional moralities that Piaget identified to be usual in social exchanges, and the role that the notion of respect-for-the-other plays in their definition. Next, we analyze the main features of (...) social exchanges that are subject to each of those two types of interactional moralities. Following, we formalize Piaget’s account of how the two types of interactional moralities can be put to regulate social exchanges in which values, norms, beliefs, and goals are exchanged, so that interactional commitments can be established among the participants. Then, we sketch a moral reasoning system able to support formal reasonings about interactional moralities. Finally, we illustrate the usefulness of the overall formal model of interactional moralities that resulted from our study by applying it to the explication of some of the conclusions achieved by Piaget in his moral studies about children games. (shrink)

The paper introduces the concept of relativistic ontological realism, and the corresponding notion of relativistic realization of objects. The conditions that allow for the relativistic realization of objects are determined. In particular, the paper indicates the way the imposition of organizational structures on already existent objects supports the relativistic realization of new, more complex ones. A type-theoretic presentation of the principles of relativistic ontological realism is given in the language of predicate calculus, making use of the notion of typed world (...) and the condition of effectiveness in the determination of the existence of objects. Two case studies illustrating the way the notion of relativistic ontological realism supports ontological analysis are presented, both concerning the ontology of computations, more specifically, the relativistic realization of computational levels in computational systems. The first case study deals with the realization of logical circuits through structural arrangements of electrical circuits. The second, with the realization of software systems through computer programming. A conception of the mechanics of the relativistic realization of objects, taking the imposition of organizational structures on previously extant objects as its basis, is proposed and briefly analyzed. (shrink)

This work adopts H. Kelsen’s concept of legal system, proposes a formal definition for such notion, and introduces an operational semantical framework for legal systems that are situated in agent societies. Agent societies are defined. Relevant formal properties of situated legal systems are discussed; the way they are exposed in the operational semantical framework is explained, and their truth formally proved. Also, for the sake of a better understanding of the legal-theoretic assumptions of the paper, recurring issues regarding Kelsen’s theory (...) of law are briefly reviewed. They are put in confrontation with the points of view of R. Dworkin, H. Hart, and J. Raz, and an attempt is made to clarify them from the perspective of the provided formalization. A brief case study in agent-based modeling and simulation of public policy processes is presented, as an illustration of the way of using situated legal systems, and the proposed operational semantical framework, in a practical application. (shrink)

En la intersección entre la ética aplicada y los estudios sobre divulgación científica en los medios, este trabajo propone un concepto de «cultura bioética» y lo aplica a la exitosa serie de televisión House. Nuestro análisis de la serie muestra la relación existente entre la tensión entre autonomía del paciente y paternalismo médico presente en la teoría bioética y la práctica asistencial, por un lado, con el debate abierto en filosofía de la medicina entre posiciones naturalistas y normativistas sobre los (...) conceptos de salud y enfermedad, por el otro. Se propone también una ampliación del concepto de autonomía que permita avanzar en la resolución de esta tensión, tanto a nivel teórico como práctico. (shrink)

This paper presents an exercise in the formalization of political principles, by taking as its theme the concept of distributive justice that Karl Marx advanced in his Critique of the Gotha Programme. We first summarize the content of the Critique of the Gotha Programme. Next, we transcribe the core of Marx’s presentation of the concept of distributive justice. Following, we present our formalization of Marx’s conception. Then, we make use of that formal analysis to confront Marx’s principle of distributive justice (...) with John Rawls’ conception of justice as fairness, and the principles of distributive justice that derive from it. Finally, we discuss methodological issues relative to, and implications of, the way of formalizing political principles introduced here. (shrink)

Reseña de Nys, T., Denier, Y., Vandevelde, T. (eds.): 2007, Autonomy and Paternalism. Reflections on the Theory and Practice of Health Care. Lovaina: Peeters.

AimTo evaluate the cognitive functioning of subjects practicing trance mediumship in Brazil.MethodThe study was based on the measurement of cognitive functions of 19 spirits mediums through neuropsychological tests such as the Brief Cognitive Screening Battery, the Verbal Fluency Test, the digit span test, the cube test, the five digit test and an evaluation of mental health through scales such as the Beck Depression Inventory, the Self-Report Questionnaire, and the Trauma History Questionnaire. The sample included the participation of spirit mediums divided (...) into two groups. The more experienced group with 11 subjects had more than 10 years of mediumistic practice, while the other less experienced group with 8 subjects had 1–5 years of experience. The inclusion criteria were psychophonic mediums with regular trance practices for at least one year. The data collected were analyzed using the SPSS statistical package.ResultsRegarding performance on the BCSB and digit span test, all subjects reached scores at the median or higher in comparison to standardized scores of Brazilians. Scores of 90% on the cube test and 42% on the FAS were reached in comparison to median or higher values, versus the median of standardized scores among Brazilians. On the FDT, we found statistical significance in the choice stage, with higher performance of subjects whose initial age of trance recognition occurred before 21 years old. On the BDI scale, no participant met the criteria for major depression. The SRQ showed an incidence of common mental disorders in 21% of the sample, which was more prevalent in the LEG.ConclusionThe cognitive functioning of subjects who practice trance mediumship in Brazil is associated with cognitive health. Executive dysfunction may be a tendency in LEG. However, an incidence of common mental disorders in the LEG was observed. Executive processing was higher in the subgroup with early practices of recognizing the phenomenon. (shrink)