Since 1968, a brain-based criterion of death has been adopted in medical practice and passed into law or national guidelines in most countries worldwide. In some countries, such as Australia, Spain, and the United States, death can be determined by either the circulatory and respiratory criterion or by the neurological criterion. This practice corresponds to recommendations by the World Health Organization and the World Medical Association. In the USA, the Uniform Determination of Death Act (UDDA) provides that “an individual who (...) has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions”. By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency. (shrink)

Background: Several countries have recently changed their model of consent for organ donation from opt-in to opt-out. We undertook a systematic review to determine public knowledge and attitudes towards these models in Europe. Methods: Six databases were explored between 1 January 2008 and 15 December 2017. We selected empirical studies addressing either knowledge or attitudes towards the systems of consent for deceased organ donation by lay people in Europe, including students. Study selection, data extraction, and quality assessment were conducted by (...) two or more reviewers independently. Findings: Awareness of the consent model was lower in opt-out countries than in opt-in countries. A majority of the public agrees with opt-in, regardless of the law in their own country. There are ambivalent attitudes regarding the opt-out system. The public tend to prefer opt-in and mandatory choice over opt-out when several options are offered. Interpretation: The assumption that people in opt-out countries are aware of the legal requirements to be excluded from the pool of potential donors is not supported by the results of this review. This is a concern, since ignorance hinders people's autonomy regarding organ donation decision-making. Higher awareness of consent model in opt-in countries may reflect greater efforts to inform the public through campaigns to motivate donation. Legal moves towards opt-out are at odds with people's expressed preferences. Main limitations of this review are the lack of data from some countries, study population heterogeneity, and methodological shortcomings. (shrink)

Most technology is used properly for their intended purpose, but certain technological breakthroughs have a dual-use nature, pose risks or lead to unintended consequences when applied in some areas...

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection (...) were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

This dissertation focuses on teleology and functions in biology. More precisely, it focuses on the scientific legitimacy of teleofunctional attributions and explanations in biology. It belongs to a multi-faceted debate that can be traced back to at least the 1970s. One aspect of the debate concerns the naturalization of functions. Most authors try to reduce, translate or explain functions and teleology in terms of efficient causes so that they find their place in the framework of the natural sciences. Our approach (...) here is radically different, as we question the premise that teleological explanations are disguised causal explanations. On the contrary, we defend that they are acceptable in natural sciences and in biology in particular. We challenge the idea that teleological explanations are immature causal explanations, as well as the idea that teleology and functions are some sort of intentional explanations. We therefore reject the accusations of anthropomorphism, vitalism and finalism. On the contrary, we defend that teleology, causality and intentionality correspond to different, autonomous and complementary modes of representation of the outside world. -/- ———[FRANÇAIS]——— -/- Ce travail de thèse porte sur la téléologie et les fonctions en biologie. Plus précisément, il porte sur la légitimité scientifique des attributions et des explications téléofonctionnelles en biologie. Il s’inscrit dans le cadre d’un débat à plusieurs facettes que l’on peut faire remonter au moins jusqu’aux années 1970 et qui est encore très actif aujourd’hui. L’un des aspects du débat porte sur la naturalisation des fonctions, c’est-à-dire sur la manière de les réduire, de les traduire ou de les expliciter en termes de causes efficientes de sorte qu’elles trouvent leur place dans le cadre des sciences de la nature. Notre approche ici est radicalement différente, car nous remettons en question la prémisse selon laquelle les explications téléologiques seraient des explications causales déguisées. Nous défendons au contraire qu’elles sont acceptables en tant que telles aussi bien de façon générale que dans le domaine scientifique et en particulier en biologie. De façon générale, nous remettons en question l’idée selon laquelle la pensée téléologique serait une pensée causale immature, ainsi que sa dépendance présumée vis-à-vis de la psychologie, c’est-à-dire de l’intentionnalité. Nous rejetons donc les accusations d’anthropomorphisme, de vitalisme et de finalisme formulées contre elle. Nous défendons au contraire que la téléologie, la causalité et l’intentionnalité correspondent à des modes différents, autonomes et complémentaires de représentation du monde extérieur. (shrink)

Is the boundary between the normal and the pathological real or fiction? Are health and disease just a matter of fact or are they value-laden? Here we present some examples of how alleged diseases can be invented and propagated by the industry (disease mongering) or by the methodology of medical science itself. We show that the boundary between health and disease is blurred and depends on individual and social representations, culture relative ways of categorising things and people, and by the (...) society’s degree of medicalisation. However, we do not mean that it is not real, rather that it is more complex than expected, as the subjectivity of social constructions and individual experiences makes them no less real. Finally, we conclude that health and disease belong to both objective and subjective kinds of reality, so the fictional can be real. (shrink)

Background Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. -/- Methods Between 2017–2019, we conducted a convenience sample survey of students (n = 2006) in (...) Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. -/- Results Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support–either informed or uninformed–in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence–either informed or uninformed–among opt-out countries. -/- Conclusion Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data. (shrink)

Alireza Bagheri supports a policy on organ procurement where individuals could choose their own definition of death between two or more socially accepted alternatives. First, we claim that such a policy, without any criterion to distinguish accepted from acceptable definitions, easily leads to the slippery slope that Bagheri tries to avoid. Second, we suggest that a public discussion about the circumstances under which the dead donor rule could be violated is more productive of social trust than constantly moving the line (...) between life and death. (shrink)

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. Second, families (...) can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

Requiring family authorization for apnea testing subtracts health professionals control over death determination, a procedure that has traditionally been considered a matter of clinical expertise alone. In this commentary, we first provide evidence showing that health professionals’ (HPs) disposition to act on death determination without family’s prior consent could be much lower than that referred to by Berkowitz and Garrett (2020). We hypothesize that HPs may have reservations about their own expertise as regards death, and may thus hesitate to impose (...) their views on patients’ families. We then address the theoretical question of clinical expertise in death determination by distinguishing judgments about facts (e.g., the presence or absence of spontaneous breathing) from interpretations given of these facts (i.e., their meaning for the vital status of an individual). We argue that, while clinicians may claim some expert authority on the former, they hold no particular authority on the latter. (shrink)

Finality, design and purpose have started to be excluded from the language of the natural sciences since the XVIIth century. Darwin succeeded in excluding them from his theory of evolution appealing to a blind and mechanical natural selection. Today, the most usual definitions for the concept of biological function take for granted that functions: 1) are not dependent on a goal; 2) are not dependent on observers, but only on nature; 3) are explicable in causal terms, either with reference to (...) the causal history of the organ (etiological definition), or with reference to its present structure and causal capabilities (dispositional definition). However, we shall see that such presuppositions cannot take into account the normative character of the concept of biological function. We show that a generalization of the concept of scientific objectivity lets us affirm that functions: 1’) are dependent on a goal; 2’) are dependent on both observers and nature; 3’) cannot be reduced to causality, nor break the laws of physics; and yet, 4) are truly objective. (shrink)

The aim of this article is to show the way in which film director Josefina Molina dissects the effect traditional education had on Spanish women. In Evening Performance, Molina deconstructs the life of a wife as an individual, while in Most Naturalshe centres on the family as a social unit. Once both, wife and family, are torn and displayed ‘in pieces’, the director reconstructs them as a new, hopeful whole. These films study the difficult transition Spanish women had (...) to undergo from a society enchained by a national-Catholic education into contemporary, European Spain, and from monolithic thinking to plurality. Spanish women were defined as ‘wives and mothers’ till the 1980s, and it was not easy, either individually or as a group, to reach the status of independent citizen. (shrink)

This paper analyses the arguments for and against what we have called automatic organ procurement model in relation to the organs of the deceased. For this purpose, this work provides empirical evidence to assess the potential impact of this model on donation rates and on public opinion. Specifically, we examine first the reasons supporting this model, with special reference to utilitarian and justice arguments. On the other hand, we analyse both the approaches based on the violation of pre mortem and (...) post mortem interests opposing this theoretical model and the rejection the model would generate in the population. Finally, we point out the aspects that, in our opinion, should be exhaustively regulated if this model were implemented. In particular, we refer to the legal status of the human body, the treatments for end-of-life patients, the incentives for health professionals and the recognition of the right to conscientious objection. (shrink)

Several European countries are approving legislative reforms moving to a presumed consent system in order to increase organ donation rates. Nevertheless, irrespective of the consent system in force, family's decisional capacity probably causes a greater impact on such rates. In this contribution we have developed a systematic methodology in order to analyse and compare European organ procurement laws, and we clarify the weight given by each European law to relatives' decisional capacity over individual's preferences (expressed or not while alive) regarding (...) the destination of his or her organs after death. In this sense, the results constitute the first comprehensive and comparative legislative mapping on European transplantation laws. (shrink)

Since 1968, the irreversible loss of functioning of the whole brain, called brain death, is assimilated to individual’s death. The almost universal acceptance of this neurological criterion of death had decisive consequences for the contemporary medicine, such as the withdrawal of mechanical ventilation in these patients and organ retrieval for transplantation. The new criterion was successfully accepted in part because the assimilation of brain death state to death was presented by medicine --and acritically assumed by most of societies-- as a (...) scientific and objective fact. Nevertheless, many people do not think that the patients suffering brain death are actually dead. We show here that those people are not necessarily wrong. It can be argued that, in fact, the justification of the neurological criterion is not scientific but moral. We outline the thesis that the problem surrounding the vital status of brain dead patients is due to a confusion between factual and normative questions. Furthermore, we claim that the donation of organs and the withdrawal of life-support could be ethically acceptable even if the patients suffering brain death are considered as alive. As an alternative to the dead donor rule, we propose a justification for organ donation of brain-dead patients based on the (moral) concepts of harm and consent : what truly justifies the procurement of organs on those patients is not that they are dead, but that they wish to donate their organs and that, since they have irreversibly lost their brain, they cannot be harmed. (shrink)

O objetivo do presente artigo é discutir algumas das características da Filosofia da Matemática de Lakatos. Na primeira parte do artigo, o pensamento de Lakatos sobre a Matemática é situado dentro do quadro geral da Filosofia da Matemática do século XX. Na segunda parte, é discutida a interpretação oferecida por Lakatos do método de análise e síntese na Geometria e na Filosofia Moderna. Essa interpretação é comparada com outras interpretações desse mesmo método. Na terceira parte deste artigo, são analisados o (...) método de provas e refutações de Lakatos e suas aplicações à reconstrução racional da história da Matemática.The goal of the present paper is to discuss some of the aspects of Lakato's philosophy of Mathematics. The first part of this article is devoted to describe the main caracteristics of Lakato.s Epistemology of Mathematics. In the second part the lakatosian interpretation of the old method of analysis and synteses of greek Geometry is discussed .In the third part the method of proof and refutations is analysed and evaluated as a possible rational reconstruction of the History of Mathematics. (shrink)

En el presente libro, Carlos Molina centra su análisis en el desarrollo y la evolución histórica que tuvieron las instituciones sanitarias en nuestro país desde finales del siglo XIX hasta la actualidad, ya que busca comprender las maneras en que el Estado chileno ha respondido a las necesidades y problemas de salud de la sociedad. Para abordar estos temas, el autor se remonta a 1889, año en que el Estado comenzó a intervenir de una manera más directa en esta (...) materia gracias a la creación del.. (shrink)

Este artigo tem por objetivo expor algumas ideias para elaborar uma perspectiva teórica sobre a negaçáo que permita comparar as abordagens dos filósofos, lógicos e linguistas sobre esse tema. Na introduçáo sáo apresentadas algumas das questões discutidas sobre a negaçáo. Na primeira parte é feita a distinçáo entre frase, enunciado e proposiçáo. Essa análise nos permitirá por um lado diferenciar entidades linguísticas (frases, enunciados) de entidades lógicas (proposições), e pelo outro separar três planos na abordagem das questões sobre a negaçáo: (...) o plano do código linguístico, o do uso do código linguístico ou plano da enunciaçáo, e o plano da lógica. Na segunda parte distinguimos entre os conceitos de oposiçáo, de negaçáo e de expressáo intrínsecamente negativa. Na terceira parte abordamos a teoria fregeana da negaçáo a partir das distinções feitas anteriormente. Na quarta parte discutimos as concepções de Platáo e de Aristóteles sobre a negaçáo. Na quinta parte distinguimos entre a negaçáo de um enunciado, a negaçáo de uma componente de enunciado, a negaçáo proposicional e a negaçáo predicativa. Na sexta parte discutimos a questáo de se haveria um ato ilocucionário de negar oposto ao ato de afirmar. Na última parte apresentamos nossas conclusões. (shrink)

Resenha do livro de Tindale, C. Rhetorical argumentation. Principles of Theory and Practice. Thousand Oaks: SAGE Publications, 2004.

How should automated vehicles react in emergency circumstances? Most research projects and scientific literature deal with this question from a moral perspective. In particular, it is customary to treat emergencies involving AVs as instances of moral dilemmas and to use the trolley problem as a framework to address such alleged dilemmas. Some critics have pointed out some shortcomings of this strategy and have urged to focus on mundane traffic situations instead of trolley cases involving AVs. Besides, these authors rightly point (...) out the political nature of the most interesting debates involving AVs. However, in our view, they do not offer an adequate account of the distinction between ethics and politics and still see their proposals as contributions to the ethics of AVs. We argue that many of the interesting questions about how AVs should behave, both in emergency and other situations, are of political, and not moral, nature. This view is based on a conception of politics and political normativity that we have developed elsewhere and that we call “political minimalism.” Additionally, we show that this proposed perspective has significant consequences for the design, management, and regulation of transport systems. (shrink)

La reflexión sobre los derechos en cuanto a su naturaleza y límites nos instala habitualmente en un campo muy complejo. Podemos abordar esta reflexión ya sea afirmando la existencia de ciertas propiedades innatas de las personas o de ciertas cualidades morales que les son propias; o bien podemos simplemente limitarnos a señalar la presencia de un campo normativo que es el producto de un acuerdo social. En ambos casos los derechos se aplican a personas dotadas tanto de razón como de (...) capacidade.. (shrink)