Malm and colleagues (2008) consider (and reject) five arguments putatively justifying the idea that healthcare workers (HCWs) have a duty to treat (DTT) during a pandemic. We do not have sufficient...

We concur with Baum and colleagues (2009) on the importance of pandemic planners taking explicit steps to employ public engagement methodologies. Thus far, as Baum and colleagues note, there have b...

This article presents a view of bioethics in the Spanish context. We may identify several features common to Mediterranean countries because of their relatively similar social organisation. Each country has its own distinguishing features but we would point two aspects which are of particular interest¨: the Mediterranean view of autonomy and the importance of Catholicism in Mediterranean culture. The Spanish experience on bioethics field has been marked by these elements, trying to build a civic ethics alternative, with the (...) law as an important support. So, Spanish bioethics has been developed in two parallel levels: in the academic and policy maker field (University and Parliament) and in clinical practice (hospitals and healthcare ethics committees), with different paces and methods. One of the most important changes in the paternalistic mentality has been promoted through the recognition by law of the patient’s rights and also through the new generation of citizens, clearly aware on the exercise of autonomy. Now, the healthcare professionals have a new challenge: adapt their practice to this new paradigm. (shrink)

Journal Name: Apeiron Issue: Ahead of print.

One of the essential tasks of bioethics in morally pluralistic societies consists of fostering a public use of reason in its field of competence. This is the fundamental thesis of the present work. To deal with it I will try to answer two crucial questions: What is moral pluralism and why does it demand fostering the use of public reason in moral issues in the sphere of bioethics and What are the laboratories of bioethics in a pluralistic (...) society? (shrink)

Spanish culture has recently shown interest about Neuroethics, a new line of research and reflection. It can be said that two general, and somewhat opposing, perspectives are currently being developed in Spain about neuroethics-related topics. One originates from the neuroscientific field and the other from the philosophical field. We will see, throughout this article, that the Spanish authors, who I am going to select here, deal with very diverse neuroethical topics and that they analyse them from different intellectual assumptions. (...) However, I consider that there is one constant concern, which emerges extensively or briefly in each one of the books that I am going to present. I am referring to the problem of freedom. Spanish neuroscientists, in general, stress and accept the new determinism that emanates from recent research about the brain, whilst those who engage in the study of philosophy usually point in their texts to the limitations of empirical research that purport to "demonstrate" the new neurological determinism. I will dedicate the last section, which is more extensive in length, to the work that I consider the most valuable, at least until the present day, and whose title is Neuroética y Neuropolítica (Tecnos, Madrid, 2011). Professor Adela Cortina (chair of Moral Philosophy at Valencia University and member of the Spanish Royal Academy of Moral and Political Science) is its author. But, firstly, I am going to refer to the works written by neuroscientists, and then to those written by philosophers. This will enable us to obtain a global view of the neuroethics models that are being constructed in Spain. (shrink)

Civil law jurisdictions have more than others effectively resisted the commodification of gestation capacities, relying on the old Roman aphorism mater semper certa est (‘it is always certain who t...

Spain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates ‘advance directives’ and has prompted various Autonomous Regions to develop legislation in this area. Nevertheless, whilst the variety of legislations in different territories presents advantages, the disparity of criteria also presents problems.Despite significant legislative development, only 23,000 Spanish citizens have filled in an AD. Clearly, AD use is confined to a minority. (...) Several surveys, however, show that the Spanish population views these documents in a positive light. Thus, we must analyse this discrepancy between attitude and practice. A similar situation exists amongst health professionals. Whilst they generally feel that the use of ADs is positive and necessary, they are frequently unwilling to employ them.Bioethical literature and research on ADs has significantly increased in Spain over the last six years. It is likely that this trend will continue in the foreseeable future; but more resources and effort are required if ADs are to become consolidated. (shrink)

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)

This article summarily describes the arrival and establishment of Analytic Philosophy [= AP] in Spain. It first expounds the role played in that process by philosophers such José Ferrater Mora, exiled alter the Spanish Civil War, and by Manuel Garrido, Jesús Mosterín, Javier Muguerza, Josep Blasco y José Hierro, the proper introducers of AP in the Spanish university. Secondly, the article refers to the work developed by the introducers’ former students and disciples, and holds that this second wave of (...) AP in Spain largely helped to its consolidation. Finally, the current situation–a third wave of analytic philosophers in action–is reviewed. Its most actives centres are identified, the main changes in the national scientific policy, its profound effects on academic activities for the last twenty years, and the high degree of internationalization reached by Spanish AP from the 1990s, after the founding of the Sociedad Española de Filosofía Analítica (S.E.F.A.), are concisely pointed out. (shrink)

Food advertising targeted at children is associated with the development of unhealthy eating habits and childhood obesity. In Spain, where one in every three children suffers from overweight, a voluntary regulation mechanism has been adopted to control such advertising, despite evidence of its ineffectiveness. This study's stated objective was to evaluate the grounds for implementing a policy that would ban the advertising of energy-dense, nutrient-poor food and beverages targeted at children in Spain, incorporating an ethical perspective in the (...) analysis. Using a bibliographic search of various databases, we reviewed the evidence for answering the seven questions posed by Walton et al.'s ethical evaluation framework, drawn up on the basis of the Nuffield Council on Bioethics Stewardship model. The results show that the proposed intervention is cost-effective, minimally intrusive, promotes healthy environments, acts on a vulnerable population, helps children lead healthy lifestyles, reduces social health inequalities, increases parents' individual freedom of choice and enjoys the support of scientists, health professionals and consumers alike. Accordingly, we feel that the time has come for food advertising directed to children in Spain to be statutorily regulated, by banning the promotion of EDNP products. (shrink)

Objectives: To review the performance of research ethics committees in Spain in assessing multicentre clinical trial drug protocols, and to evaluate if they would comply with the requirements of the new EU Directive to be implemented by May 2004.Design and setting: Prospective study of applications of MCT submitted to RECs.Main measurements: Protocol related features and evaluation process dynamics.Results: 187 applications to be performed in 114 centres, were reviewed by 62 RECs. RECs had a median number of 14 members, (...) of which three were lay members. All applications were approved except four which were however approved by the other RECs involved. The median times from submission to approval and from submission to reception at the sponsor’s offices were 48 and 62 days, respectively. In 55% of all applications approved, 41 RECs raised 307 queries, 40% of these were protocol related issues, and 38% related to the patients’ information sheets. RECs charging an evaluation fee in advance and applications with no queries raised were statistically significantly associated with shorter evaluation times. However, there is a gap of at least 1.5 weeks between the date of the meeting and the reception of the approval letter in the sponsor’s office.Conclusions: Evaluating MCT protocols by RECs is a time consuming process. Needing 1.5 weeks for communicating the decision taken by RECs to the sponsor suggests serious administrative shortcomings within most RECs. By significantly reducing the time for communication of their decisions, the majority of RECs would comply with the Directive requirement of a maximum 60 day period for the assessment of MCT. (shrink)

From the mid-1960s onwards, a set of Spanish molecular biology research groups emerged in Spain. The factors contributing to this included: the return of a group of molecular biologists from their postdoctoral period abroad, the negotiations for the return of Spanish-born Nobel prize winner Severo Ochoa from New York, the negotiations for Spanish membership in the European Conference of Molecular Biology, and national policy towards university reform. As a result, the early molecular biologists' research groups began to be recognised (...) as research schools by Spanish authorities and postgraduate courses and new research centres for molecular biology were set up. Foreign influence in the whole process was crucial. (shrink)

Prenatal genetic diagnosis with new high-performance technologies such as genomic array adds great complexity to the ethical dilemmas that already exist in current medicine. The main objective of this study was to carry out an analysis and bioethical reflections centred on the outcome associated with the use of the genetic array technique in 185 pregnancies at the Hospital Universitario y Politécnico La Fe (Valencia, Spain). It is an observational, descriptive and cross-sectional study during the years 2014 to 2017, inclusive. (...) We analyse the results and the follow-up of the 185 cases in which this prenatal genetic study was carried out by array technique. Of the 185 prenatal genetic studies carried out, 165 showed no copy number variants (normal result) and in the 20 remaining pregnancies (10.81%), a dose change was detected. Abortion was carried out in 11 cases with pathological and/or probably pathological abnormalities. Of the 165 cases in which no dose variant was detected, an abortion was carried out in 49 cases, which represents 29.7%. The introduction of new genomic analysis techniques to invasive prenatal diagnosis highlights the ethical problems that arise above all in the interpretation of genetic variants detected and genetic counselling, while emphasising the need for correct informed consent and it adds, if possible, more controversy to a subject with great bioethical substance such as abortion. (shrink)

From the mid-1960s onwards, a set of Spanish molecular biology research groups emerged in Spain. The factors contributing to this included: the return of a group of molecular biologists from their postdoctoral period abroad, the negotiations for the return of Spanish-born Nobel prize winner Severo Ochoa from New York, the negotiations for Spanish membership in the European Conference of Molecular Biology, and national policy towards university reform. As a result, the early molecular biologists’ research groups began to be recognised (...) as research schools by Spanish authorities and postgraduate courses and new research centres for molecular biology were set up. Foreign influence in the whole process was crucial. (shrink)

ObjectiveCochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.Data sourcesWe address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.Review methodsA systematic review using (...) three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.ConclusionsThe medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.Implications for practiceSimilar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family’s desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education. (shrink)

. This paper reports the preliminary results from a semester-long ethics project at an AACSB accredited, regional comprehensive undergraduate school. This project culminated in an Ethics Awareness Week, which highlight a case study of the controversial EverQuest® multi-player online game. Issues of project planning and design are outlined, the dynamics of a business program-wide approach to ethics are social responsibility are presented, student survey results are presented and analyzed, and issues related to ongoing research are discussed. Nonparametric survey results indicate (...) that the greatest effect in student’s self reported enhanced understanding and interest in issues of business ethics is present when multiple pedagogical methods, e.g., case studies, lectures, assignments, and an Oxford-style debate, are applied by a number of faculty members over an extended time period. The paper concludes with a discussion of future research issues as well as a series of prescriptions for planning, organizing, and implementing such an extended activity. (shrink)

Objective: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. Design: Longitudinal cohort study. Setting: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. Results: 86 percent of the patients did not change preferences. Sex, age, (...) marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. Conclusion: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning. (shrink)

This study aims to analyse the legal decision-making process in the Community of Valencia (Spain) regarding contentious divorces particularly with respect to parental authority (patria potestas), custody and visiting arrangements for children, and the opinions of mothers and fathers on the impact these judicial measures have had on their lives. It also considers the biases in these decisions produced by privileging the rights of the adults over those of the children. Three particular moments are studied: (1) the situation before (...) the break-up, focusing on the invisible gender gap in care; (2) the judicial process, where we observe the impact of hidden gender-based violence and gender stereotypes; and (3) the situation post-decision, showing how any existing violence continues after divorce, by means of parental authority. The concept of ‘motherhood under threat’ is placed at the centre of these issues, where children’s voices are given the least attention. (shrink)

An exploratory survey was conducted to determine if there are differences in ethical decisions by business students based upon cultural backgrounds. Students' responses to a vignette concerning advertising of cigar products in a variety of different media provided evidence of significant cultural differences between three groups of students from different geographical locations within the United States. This article suggests that the presumption that an individuals ethical beliefs and behaviors do not change after childhood may be in error.

These photographs, essays, drawings, and original texts document the rich agit-art legacy of the Situationist International, a group of European artists and writers who emerged from such avant-garde movements as COBRA, Lettrisme, and the Imaginary Bauhaus and from the breakup of surrealism to launch a strategy of art as cultural critique.

In homes, schools, and workplaces, women and men are often separated in ways that sustain gender stratification by reducing women's access to socially valued knowledge. The fact that these spatial arrangements may be imperceptible increases their power to reproduce prevailing status differences. I use cross-cultural and historical examples to illustrate that the more pronounced the degree of spatial gender segregation, the lower is women's status relative to men's. The advantages of such a spatial perspective are its interdisciplinary foundations and its (...) creation of avenues for change. (shrink)

Background Contemporary societies are rife with moral disagreement, resulting in recalcitrant disputes on matters of public policy. In the context of ongoing bioethical controversies, are uncompromising attitudes rooted in beliefs about the nature of moral truth?Methods To answer this question, we conducted both exploratory and confirmatory studies, with both a convenience and a nationally representative sample (total N = 1501), investigating the link between people’s beliefs about moral truth (their metaethics) and their beliefs about moral value (their normative ethics).Results Across (...) various bioethical issues (e.g., medically-assisted death, vaccine hesitancy, surrogacy, mandatory organ conscription, or genetically modified crops), consequentialist attitudes were associated with weaker beliefs in an objective moral truth. This association was not explained by domain-general reflectivity, theism, personality, normative uncertainty, or subjective knowledge.Conclusions We find a robust link between the way people characterize prescriptive disagreements and their sensibility to consequences. In addition, both societal consensus and personal conviction contribute to objectivist beliefs, but these effects appear to be asymmetric, i.e., stronger for opposition than for approval. (shrink)

This article presents and reflects upon the results of a survey involving a sample of women who have experienced gender-based violence and who have turned to an institutional centre to tackle their situation. In aiming to move beyond a descriptive treatment, we consider the plurality of user types and their remote use patterns in relation to the resources offered by virtual feminist communities designed to promote increased sociopolitical mobilisation in the fight against violence against women. We will observe the progressive (...) emergence of protest actions organised by Spanish virtual feminist communities, which make use of new technologies to contribute productively to the debate and to political action in innovative organisations and formats. The article discusses how feminist virtual communities are using digital spaces for their work combatting violence against women, and whether this work is apparent to those who experience this violence. Finally, we tackle the implications of this work for online feminist activism in terms of a more interactive and social constructivist model of activism, as well as considering its relationship to institutional-legal discourse and public policies that require women to recognise themselves as victims. (shrink)

This daily diary study examined the within-person coupling between four emotion regulation strategies and both subjective well-being and perceived stress in daily life of geriatric nurses. Participants (N = 89) described how they regulated their emotions in terms of cognitive reappraisal and suppression. They also indicated their subjective well-being and level of perceived stress each day over three weeks. At the within-person level, cognitive reappraisal intended to increase positive emotions was positively associated with higher subjective well-being and negatively associated with (...) perceived stress. Suppression of the expression of positive emotions was negatively associated with subjective well-being and positively associated with perceived stress. However, cognitive reappraisal intended to down-regulate negative emotions and suppression as a strategy to inhibit the expression of negative emotions were not associated with daily well-being or perceived stress. Off-days were rated as days with higher subjective well-being and lower perceived stress in contrast to working days. At the between-person level, individuals who reported more daily negative affect reported increased suppression of positive emotions, corroborating the within-person findings. Moreover, findings indicated that nurses with more years of experience in the job reported higher subjective well-being and less perceived stress. These results provide insights into important daily emotional processes of geriatric nurses, both at workdays and in their leisure time. (shrink)

In the last decade, preimplantation genetic testing have become widely used and in 2005 constituted 5 percent of all in vitro fertilization cycles performed in Europe. Their diffusion, however, is not homogenous; while in some countries they are prohibited and in others hardly implemented, Spain performs 33 percent of all the PGD/pgs. While policy guidelines and mainstream bioethics address PGD from a patient choice perspective, disability studies insist on PGD’s potentiality for discrimination. Alternatively, other authors have explored PGD/pgs (...) from the perspective of geneticization but little work has been done on how PGD/pgs are framed by the members of national regulatory bodies. Combining the analysis of juridical documents with semistructured interviews with members of the Spanish National Assisted Reproduction Committee, this study suggests that the remarkable diffusion of PGD/pgs in Spain may be largely due to the interaction between the growing momentum enjoyed by embryonic stem cell research and a vibrant expansion of IVF business along the Mediterranean coast. In this process, genetic issues per se seem to play a minor role, although the prevention of genetic diseases now constitutes the master narrative underpinning the extension of PGD from monogenic, early onset, diseases to polygenic, late-onset, ones. (shrink)

Objective: Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients’ evaluations of their hospital care.Design: Cross-sectional survey.Setting: Fifty one hospitals in Massachusetts.Participants: Stratified random sample of adults discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.Main outcome (...) measure: Respondent would definitely be willing to recommend the hospital to family and friends.Results: In a logistic regression analysis, treatment with respect and dignity 3.4, 99% confidence interval 2.8 to 4.2) and confidence and trust in providers were more strongly associated with willingness to recommend than having enough involvement in decisions . Courtesy and availability of staff , continuity and transition , attention to physical comfort , and coordination of care were also significantly associated with willingness to recommend.Conclusions: Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients’ overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care. (shrink)