Introduction Currently, The nature and scope of Clinical Ethics Protocols in Madrid are not well understood.Objectives The main objective is to describe the features of ‘guideline/recommendation’ type CEPs that have been or are being developed by existing Clinical Ethics Committees in Madrid. Secondary objectives include characterisation of those CECs that have been the most prolific in reference to CEP creation and implementation and identification of any trends in future CEP development.Methods We collected CEPs produced and in process by CECs accredited (...) in the public hospitals in Madrid, Spain, from 1996 to 2008.Results CECs developed 30 CEPs, with 10 more in process. The most common topic is refusal of treatment . If CEPs addressing terminal illness, Do-Not-Resuscitate orders and advance directives are placed into a separate ‘ethical problems at the end of life’ category, this CEP subject emerges as the most common . There is a relationship between the age of the CEC and the development of CEPs . CECs now seem to be more likely to engage in CEP development.Conclusions The CECs in Madrid, Spain, have developed a significant number of CEPs and there is a trend towards continued development. The most frequent topics are ethical problems at the end of life and refusal of treatment by the patient. (shrink)

O presente artigo busca fazer uso de conceitos presentes na produção intelectual do filósofo francês Jacques Rancière para pensar a obra fonográfica do popular grupo de rap paulistano conhecido como Racionais MC’s. Especialmente no que diz respeito à distinção elaborada pelo pensador entre uma lógica pedagógica embrutecedora e uma outra lógica pedagógica que seria emancipatória, sendo essa diferenciação também válida para se analisar práticas e produções artísticas. Propõe-se aqui que ao longo de sua trajetória, os rappers citados se aproximaram tanto (...) de uma lógica quanto de outra, sendo oportuno identificar essas relações assim como apontar suas respectivas potencialidades e limitações. (shrink)

BackgroundBeta thalassemia major is a severe inherited form of hemolytic anemia that results from ineffective erythropoiesis. Allogenic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative therapy. Unfortunately, the subgroup of adult thalassemia patients with hepatomegaly, portal fibrosis and a history of irregular iron chelation have an elevated risk for transplantation-related mortality that is currently estimated to be about 29 percent.DiscussionThalassemia patients may be faced with a difficult choice: they can either continue conventional transfusion and iron chelation therapy or (...) accept the high mortality risk of HSCT in the hope of obtaining complete recovery.Throughout the decision making process, every effort should be made to sustain and enhance autonomous choice. The concept of conscious consent becomes particularly important. The patient must be made fully aware of the favourable and adverse outcomes of HSCT. Although it is the physician's duty to illustrate the possibility of completely restoring health, considerable emphasis should be put on the adverse effects of the procedure. The physician also needs to decide whether the patient is eligible for HSCT according to the "rule of descending order". The patient must be given full details on self-care and fundamental lifestyle changes and be fully aware that he/she will be partly responsible for the outcome.SummaryOnly if all the aforesaid conditions are satisfied can it be considered reasonable to propose unrelated HSCT as a potential cure for high risk thalassemia patients. (shrink)

Riassunto: L’articolo di Caterina Villani intende mostrare come, per risolvere la “sfida dei concetti astratti”, all’ Embodied Cognition occorra concepire l’astrattezza da una prospettiva “multidimensionale”. Questo commento contiene due considerazioni. La prima riguarda il nesso logico tra la sfida dei concetti astratti e il cosiddetto “problema della generalizzazione”. La seconda discute alcune possibili tensioni dell’approccio multidimensionale stesso. Parole chiave: Concetti astratti; Concetti concreti; Embodied Cognition; Approccio multidimensionale; Generalizzazione Two Challenges for the Multidimensional Approach: Caterina Villani’s paper aims to show how, (...) in order to solve the “challenge of abstract concepts”, the paradigm of Embodied Cognition might have to conceive of abstractness from a “multidimensional” perspective. The present commentary includes two considerations. The first addresses the logical relationship that is supposed to hold between the challenge of abstract concepts and what is called the “generalization problem”. The second concerns possible tensions involved in the multidimensional approach itself. Keywords: Abstract Concepts; Concrete Concepts; Embidied Cognition; Multidimensional Approach; Generalization. (shrink)

The informed consent process is the legal embodiment of the fundamental right of the individual to make decisions affecting his or her health., and the patient’s permission is a crucial form of respect of freedom and dignity, it becomes extremely important to enhance the patient’s understanding and recall of the information given by the physician. This statement acquires additional weight when the medical treatment proposed can potentially be detrimental or even fatal. This is the case of thalassemia patients pertaining to (...) class 3 of the Pesaro classification where Allogenic hematopoietic stem cell transplantation remains the only potentially curative treatment. Unfortunately, this kind of intervention is burdened by an elevated transplantation-related mortality risk , equal to 30% according to published reports. In thalassemia, the role of the patient in the informed consent process leading up to HSCT has not been fully investigated. This study investigated the hypothesis that information provided by physicians in the medical scenario of HSCT is not fully understood by patients and that misunderstanding and communication biases may affect the clinical decision-making process. (shrink)