Introduction: Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. Aim: The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire–Critical Care Version and, second, to analyse Portuguese critical care nurses’ level of exposure to ethical conflict and its (...) characteristics. Methods: A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. Ethical Considerations: The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. Findings: The Portuguese version of the Ethical Conflict Nursing Questionnaire–Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources. (shrink)

Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables ‘frequency’ and ‘degree of conflict’. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable ‘exposure to conflict’, as well as considering six ‘types of ethical conflict’. An instrument (...) was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). (shrink)

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and (...) nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science. (shrink)

BackgroundImplementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables (...) of favourable attitudes towards advance directives.MethodsObservational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.ResultsA total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.ConclusionThere is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment. (shrink)

Many philosophers hold that if an agent acts intentionally, she must know what she is doing. Although the scholarly consensus for many years was to reject the thesis in light of presumed counterexamples by Donald Davidson, several scholars have recently argued that attention to aspectual distinctions and the practical nature of this knowledge shows that these counterexamples fail. In this paper I defend a new objection against the thesis, one modelled after Timothy Williamson’s anti-luminosity argument. Since this argument relies on (...) general principles about the nature of knowledge rather than on intuitions about fringe cases, the recent responses that have been given to defuse the force of Davidson’s objection are silent against it. Moreover, the argument suggests that even weaker theses connecting practical entities with knowledge are also false. Recent defenders of the thesis that there is a necessary connection between knowledge and intentional action are motivated by the insight that this connection is non-accidental. I close with a positive proposal to account for the non-accidentality of this link without appeal to necessary connections by drawing an extended analogy between practical and perceptual knowledge. (shrink)

Evidentialism and Reliabilism are two of the main contemporary theories of epistemic justification. Some authors have thought that the theories are not incompatible with each other, and that a hybrid theory which incorporates elements of both should be taken into account. More recently, other authors have argued that the resulting theory is well- placed to deal with fine-grained doxastic attitudes (credences). In this paper I review the reasons for adopting this kind of hybrid theory, paying attention to the case of (...) credences and the notion of probability involved in their treatment. I argue that the notion of probability in question can only be an epistemic (or evidential) kind of probability. I conclude that the resulting theory will be incompatible with Reliabilism in one important respect: it cannot deliver on the reductivist promise of Reliabilism. I also argue that attention to the justification of basic beliefs reveals limitations in the Evidentialist framework as well. The theory that results from the right combination of Evidentialism and Reliabilism, therefore, is neither Evidentialist nor Reliabilist. (shrink)

I argue for a theory that combines elements of reliabilism and evidentialism.

Munch-Jurisic’s account of perpetrator disgust raises important new questions concerning the complexity of emotions and their connection with moral actions. In this commentary, we discuss this account by applying some of the author’s ideas to the case of anger. We suggest that just as the relations between disgust and moral action are much more nuanced than previously thought, as Munch-Jurisic explains, analyses of anger can also profit from a more careful approach to such connections. Specifically, we propose that contextual factors (...) can affect the moral character of anger reactions, which in turn can provide them with moral value. We also argue that the contextual view deployed to study disgust reactions can also support distinctions between core forms and socio-moral forms of the same emotion, which in turn raises interesting questions concerning different forms of anger. Lastly, we extend the contextual approach to problems of emotion individuation and theories in emotion science, showing how current scientific emotion theories can learn from a detailed examination of disgust, anger, and other context-sensitive emotions. We aim to highlight some important contributions of Munch-Jurisic’s work to broader discussions on emotions, morality, and how to theorize about emotions overall. (shrink)

El pensamiento vivo de Juan Luis Vives, por Joaquín Xirau.--Páginas escogidas de Juan Luis Vives: De concordia y discordia. Tratado del alma. Introducción a la sabiduría. Del socorro de los pobres. Tratado de la enseñanza.

The founding operation of the American States involves a mediating mechanism that enables the connection between the ideals supporting it and the intent for its popularization among people. Such is the function assigned to the founding heroes, which is analyzed as a cultural operation that aims to enshrine these ideals, thereby eliding the violence contained in the formation of modern States.

In the international sphere, sovereignty and fundamental rights are often at odds, giving these rights little space for action and, in general, only after crisis has led to tragedy, and tragedy to disgrace. International Law, on the other hand, consistently succumbs to forms of domination and power, and its scope of action is often limited to certain codifications which are frequently suspended by political exception. Sixteenth century Dominican theologian, Francisco de Vitoria, established the principles for a Law of the people, (...) based on secular civil power that, while still exercising internal sovereignty, could defend and privilege the “rights of all men” over the exercise of power and private interest. This article focuses on this dispute to show Vitoria’s position, who long preceded the great declarations of human rights of the 18 th century, presenting an original doctrine within the framework of an emerging globalization and based on the defense of fundamental rights. (shrink)

From our everyday commuting to the gold medalist’s world-class performance, skillful actions are characterized by fine-grained, online agentive control. What is the proper explanation of such control? There are two traditional candidates: intellectualism explains skillful agentive control by reference to the agent’s propositional mental states; anti-intellectualism holds that propositional mental states or reflective processes are unnecessary since skillful action is fully accounted for by automatic coping processes. I examine the evidence for three psychological phenomena recently held to support anti-intellectualism and (...) argue that it supports neither traditional candidate, but an intermediate attention-control account, according to which the top-down, intention-directed control of attention is a necessary component of skillful action. Only this account recognizes both the role of automatic control in skilled action and the need for higher-order cognition to thread automatic processes together into a unified, skillful performance. This applies to bodily skillful action in general, from the world-class performance of experts to mundane, habitual action. The attention-control account stresses that, for intentions to play their role as top-down modulators of attention, agents must sustain the intention’s activation; hence, the need for reflecting throughout performance. (shrink)

What if what is permissible and acceptable today is anathema tomorrow? There is a whole canon of scholarly ethics books written with the express purpose of telling you what is RIGHT and what is WRONG. This is not one such book. Juan Enriquez wants to make it easier for us to talk to one another, to prod one another, to understand and guide one another without an everlasting certainty of strict RIGHT v WRONG.

Does self-control require willpower? The question cuts to the heart of a debate about whether self-control is identical with some psychological process internal to the agents or not. Noticeably absent from these debates is systematic evidence about the folk-psychological category of self-control. Here, we present the results of two behavioral studies (N = 296) that indicate the structure of everyday use of the concept. In Study 1, participants rated the degree to which different strategies to respond to motivational conflict exemplify (...) self-control. Participants distinguished between intra-psychic and externally-scaffolded strategies and judged that the former exemplified self-control more than the latter. In Study 2, participants provided various solutions to manage motivational conflict and rated their proposals on effectiveness. Participants produced substantially more intra-psychic strategies, rated them as more effective, and advised them at a higher rate than externally-scaffolded strategies. Taken together, these results suggest that while people recognize a plurality of strategies as genuine instances of self-control, purely internal exercises of self-control are considered more prototypical than their externally-scaffolded counterparts. This implies a hierarchical structure for the folk psychological category of self-control. The concept encompasses a variety of regulatory strategies and organizes these strategies along a hierarchical continuum, with purely intra-psychic strategies at the center and scaffolded strategies in the periphery. (shrink)

"Spinoza", à quoi ça sert? Et comment s'en servir? En particulier, comment penser la mise à l'épreuve du rationalisme spécifique dont il est le nom? L'objectif de ce travail est de contribuer à une réévaluation non seulement du rôle de la pratique dans la pensée de Spinoza, mais encore du système lui-même, de sa capacité à s'adapter et à communiquer avec des domaines tels que les sciences expérimentales, l'histoire, la politique ou la médecine. A travers les concepts et problèmes, tels (...) qu'ils sont formulés dans ses textes, mais également leur utilisation contemporaine, il s'agit ici d'analyser l'articulation de la philosophie de Spinoza au champ de l'action humaine, dans ses dimensions éthique, sociale, cognitive et affective - et d'apprécier la puissance de la rationalité qui en est le fondement. Les auteurs viennent d'horizons différents : professeurs, docteurs, doctorants, étudiants ou érudits originaires de divers pays, ils proposent dans les articles ici présentés des approches variées et originales des problèmes qu'ils traitent, offrant ainsi au lecteur un aperçu de la vitalité des réflexions que suscite aujourd'hui l'oeuvre de Spinoza. (shrink)