Background In Spain, there has been great effort by lawmakers to put Advance Directives into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little (...) impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: the training of health professionals about the end of life and AD is lacking; there has been no public process to increase awareness about AD, and therefore people know little about them; the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future. (shrink)

En reseña de:Juana María Gil Ruiz, Las nuevas técnicas legislativas en España. Los Informes de Evaluación de Impacto de Género, Editorial Tirant Lo Blanch,Valencia, 2012.

Chile has established hybrid policies for the administrative distribution of its educational establishments, leading to significant gaps in educational results and school conditions between public, mixed, and private schools. As a result, there are high levels of segregation, and social and economic vulnerability that put public schools at a disadvantage, affecting their image and causing a constant decrease in enrollment. An abbreviated version of Luhtanen and Crocker’s collective self-esteem scale was adapted and validated for the Chilean educational context because of (...) its usefulness in studying processes of social segregation and cultural coherence, seeking to identify student perception about the appreciation of school actions in the context of belonging and identification with schools, in order to compare between groups according to types of establishment and assess the effects of school conditions on the perception of students. A representative sample of Chilean secondary students between 9th and 12th grades participated. Descriptive analyses, comparison of means between groups, confirmatory factorial analyses, and multi-group analyses were conducted to test the adjustment and invariance of the unifactorial structure of a reduced version of four items. The results indicated that the scale satisfactorily complies with the proposed adjustment indexes, presents total invariance by gender and partial invariance by administrative dependence, and allows establishing statistically significant differences in the collective self-esteem, indicating a higher score for students in the private system, and a lower score for those in the public system. These results show the negative effects of high school segregation on students’ collective self-esteem, affecting the appreciation of personal, collective, and institutional activities and the sense of belonging. Although previous research has explored some of the effects of school segregation, the present study focuses on collective self-esteem, which is closely related to identity and belonging, and allows for further innovative research on school segregation. The scale is useful as an instrument for researching social conditions of student well-being, in regards to educational management. (shrink)

This essay crystallizes some thoughts as to the effects of modern rationalism. We begin with the conception of science in its beginnings as philosophical thought linked to reason, and to the logos of a divine character. This concept was linked to a search centered on what was intelligible, and..