La Segunda Guerra Mundial y las atrocidades cometidas en investigaciones con los prisioneros en los campos de concentración nazis y japoneses, despertaron la conciencia por el desarrollo de los derechos humanos que se habían conquistado paulatinamente a lo largo de la historia. Por ello se conforman una serie de leyes, normas y declaraciones donde se tratan los aspectos bioéticos en los ensayos clínicos. Se debe prestar vital atención a la relación médico-paciente en el curso de las investigaciones y considerar la (...) relación beneficio/riesgo cuando se va a experimentar en seres humanos. La retinopatía diabética proliferativa es una de las afecciones oftalmológicas que más ensayos ha suscitado. El objetivo de este trabajo consiste en analizar algunos aspectos éticos en la experimentación en pacientes con esta afección. The Second World War and the atrocities committed in research with prisoners in Japanese and Nazi concentration camps, awakened consciousness for the development of human rights that had gradually been conquered throughout history. That´s why a series of laws, rules and statements that deal with bioethical aspects in clinical trials, were passed. Special attention must be given to the doctor-patient relationship during the research and consider the benefit/risk ratio when conducting experiments on human beings. Proliferative Diabetic Retinopathy is one of the ophthalmological disorders that has given rise to more trials. The research goal is to analyze some ethical aspects when experimenting on patients with this condition. (shrink)

Background Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents’ concepts of death and related aspects, their reactions and actions in situations (...) pertaining to death in their practice, and their perceptions about existing and necessary training conditions. Methods A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. Results Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. Conclusions Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. Trial registration Not applicable. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Aims: Attentional bias, alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder. The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content.Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. (...) The protocol consisted of six VR-CET booster sessions and two assessment sessions over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking and VR technologies at different time points.Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB.Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed. (shrink)

Este artículo es una respuesta a la crítica de Noé Expósito Ropero —que se basa en gran medida en la visión de Javier San Martín— a mi interpretación de la filosofía de José Ortega y Gasset. El resultado del argumento de Expósito Ropero es que Ortega es más fenomenólogo de lo que yo considero, que me equivoco al pen-sar que existen los “objetos reales” más allá de los objetos intencionales de Edmund Husserl, y que ningún objeto inanimado puede (...) ser tratado como un “yo”. Como réplica, respondo a cada una de estas acusaciones.This article is a response to Noé Expósito Ropero’s critique—which draws heavily on the views of Javier San Martín—of my interpretation of the philosophy of José Ortega y Gasset. The upshot of Expósito Ropero’s argument is that Ortega is more of a phenomenologist than I realize, that I am wrong to think there is any such thing as “real objects” beyond Edmund Husserl’s intentional objects, and that no inanimate object can be treated as an “I.” In response, I answer each of these charges. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Many scholars have contended that Clare of Assisi’s original intention upon leaving her family home to take up religious life sometime around 1211 was to lead a life essentially like that of the mendicant friars.1 She and the women who soon joined her would be not only poor and penitential, but also itinerant and apostolic. Like the friars their life would be marked by both insertion into the world (...) and seclusion from it as they alternated between active service and recollected contemplation. The important proof text for this claim is a passage in a letter composed by Jacques de Vitry in 1216, just five years after Clare’s conversion. Many scholars, including Paul Sabatier, Luigi Pellegrini, Roberto Rusconi, Marco Bartoli, Ingrid Peterson, Chiara Frugoni, Giovanni Boccali, and Chiara Augusta Lainati believe the text to be the earliest witness to the manner of life led by Clare and her followers during their initial years.2 The letter has been used to argue further that the women were explicitly grouped together with the Lesser Brothers, were known by the parallel title of “Lesser Sisters,” and had the freedom to come and go as they wished during their early years in San Damiano.Since claims about the women’s early likeness to the friars’ mendicant way of life are often made as brief assertions resting on Jacques’s letter, I think it important to consider in a more detained fashion the provocative passage thought to support them. Closer scrutiny of Jacques’s text shows that while none of these claims can be entirely ruled out, importantly, none can be supported with any solid evidence. I agree essentially with scholars such as Lilly Zarncke, Ernest McDonnell, Maria Pia Alberzoni, Jacques Dalarun, and Lezlie Knox who consider the letter’s language too general to know if it refers specifically to Clare and her sisters.3 I suggest, furthermore, that there are reasons to conclude that this is certainly unlikely if the passage is interpreted to mean, specifically, that Clare and her sisters carried on an active apostolate outside of San Damiano.Jacques de Vitry is generally recognized as one of the most astute and forward-thinking observers of his time in terms of recognizing the importance of new religious groups. A Parisian master, canon regular, and bishop, Jacques had the opportunity to live in a variety of settings, including his native France, the Low Countries, Italy, and the holy land.4 In 1216, he traveled from Liège in the Low Countries to Perugia to be consecrated bishop by Honorius III, who himself had just been elevated to the papacy.5 Along with observations about other matters, Jacques shared the following comment about religious men and women in a letter that he sent almost certainly to a group of his friends back in Liège. He was writing in the early days of October 1216 as he was leaving Italy on a boat that would carry him to his new episcopal see in Acre. The letter, the first of six that survive, is prized not only for its reference to the Lesser Sisters, but also as the very first written testimony regarding the Franciscan movement in general. The great nineteenth-century historian Paul Sabatier thought it provided a more vivid and precise description of Francis’s ministry than any single passage contained in his early biographies.6 The passage, which represents less than seven percent of the entire letter, is rendered thus in a widely available English translation:I found one consolation in those parts, nevertheless: many men and women [multi enim utriusque sexus], rich and worldly, after renouncing everything for Christ, fled the world. They are called Lesser Brothers and Lesser Sisters [fratres minores et sorores minores]. They are held in great esteem by the Lord Pope and the cardinals. They do not occupy themselves with temporal affairs, but work each day with great desire and.. (shrink)

In den letzten Jahrzehnten sind die Emotionen zu einem der zentralen Themen der Philosophie des Geistes geworden. Erstaunlich ist in diesem Kontext einer neuen Entdeckung der Gefühle, dass die frühen phänomenologischen Beiträge der ersten Schüler Husserls zu dem Thema in Vergessenheit geraten sind. Dabei können die Gefühlskonzeptionen und Analysen emotionaler Phänomene von Pfänder, Voigtländer, Haas, Geiger, Scheler, Stein, Walther, Kolnai, Ortega y Gasset wegen ihrer einzigartigen Präzision und Erfahrungsnähe die heutige Debatte entscheidend bereichern. In diesem Buch wird einerseits die (...) Rekonstruktion einer Theorie der Emotionen unternommen, welche implizit in den Texten der ersten Phänomenologen liegt. Andererseits werden systematische Antworten auf Fragen und Problemstellungen gegeben, welche die aktuelle Diskussion bestimmen. Was sind Emotionen? Inwiefern kann man von emotionaler Realität und Irrealität, Echtheit und Unechtheit sprechen? Kann es Emotionen über Fiktionen geben? Gibt es unterbewusste Emotionen? Welche Rolle spielen leibliche Aspekte? Was bedeutet es, dass Emotionen intentional sind? In welcher Beziehung stehen sie zu den Werten? Dies sind die Leitfragen des Buches. (shrink)

This chapter examines the critiques of sentimentalism developed by Moritz Geiger and José Ortega y Gasset within the field of phenomenological aesthetics. It explores and evaluates the main arguments behind this critique: namely the existence of an aesthetic attitude, an intellectualized view of appreciation, and the predominance of form over content. Though both authors utilize Kant’s idea of “aesthetic disinterestedness”, they endorse a view of appreciation which differs from the Kantian one in substantial respects.

This chapter examines the critiques of sentimentalism developed by Moritz Geiger and José Ortega y Gasset within the field of phenomenological aesthetics. It explores and evaluates the main arguments behind this critique: namely, the existence of an aesthetic attitude, an intellectualized view of appreciation, and the predominance of form over content. Though both authors utilize Kant’s idea of “aesthetic disinterestedness,” they endorse a view of appreciation that differs from the Kantian one in substantial respects.

Recent feminists have critiqued G.W. Leibniz’s Theodicy for its effort to justify God’s role in undeserved human suffering over natural and moral evil. These critiques suggest that theodicies which focus on evil as suffering alone obfuscate how to thematize evil, and so they conclude that theodicies should be rejected and replaced with a secularized notion of evil that is inextricably tied to the experiences of the victim. This paper argues that the political philosophy found in the writings of Catherine (...) Macaulay (1731–1791) can serve as a support to Leibniz’s larger claims and can also offer a more concrete, situated notion of evil that escapes the contemporary feminist critique. Macaulay’s work on natural and moral political evil, especially, will be presented as an early modern precursor to feminism, which defends divine perfection and a pre-established harmony in the face of political evil. I then identify three unique theodicical arguments in Macaulay’s work: the pragmatically beneficial defense, the eschatalogical defense, and the redemptive defense. (shrink)

This work tries to give the possible most suitable vision of the Generation of 98 regarding the purposes and interest of the main authors: Azorín, Pío Baroja, Miguel Unamuno, Antonio Machado and José Ortega y Gasset.

¿Puede ser racional creer algo porque se quiere creerlo? Prima facie no, puesto que una creencia racional se basa en razones, y la voluntad de creer puede ser una causa, pero no una razón de la creencia. Sin embargo, algunos intentos de autoinducirse creencias causalmente pueden verse como el ejercicio de una racionalidad de segundo orden. En este artículo, se esboza una visión de esta racionalidad de segundo orden basada en la tesis de Davidson de la división de la mente (...) y la distinción de Ortega entre ideas y creencias. La inquietante conclusión del análisis es que la capacidad de tener deseos de segundo orden sobre nuestras creencias es lo que hace posibles tanto la autocrítica y la autosuperación como el dogmatismo y la autocorrupción y que la condición de posibilidad de la racionalidad y la libertad es la misma que la de la irracionalidad y la alienación. Is it rational to believe something because one wants to believe it? Prima facie it is not, for a rational belief is based on reasons, and the will to believe can be a cause, but not a reason for the belief. Nevertheless, some attempts of causally self-inducing beliefs can be viewed as a sort of second-order rationality. This paper sketches a view of this second-order rationality based on Davidson's thesis of the divided mind and Ortega's distinction between ideas and beliefs. The uncomfortable conclusion of the discussion is that the ability to have second-order beliefs about our beliefs is what makes possible both self-criticism and self-improvement and dogmatism and self-corruption and that the possibility condition of rationality and freedom and of irrationality and alienation are the same. (shrink)

The current times call for reforms in educational processes. The Covid-19 pandemic had an unforeseen impact on the educational system in all countries. This need for change requires new pedagogies and new methods for teaching and learning. Understanding the need for change is essential for the formulation of adaptive proposals, as well as for the generation of training activities to complement the teaching curriculum. New educational practices lead to a vision of educational quality, with new approaches that allow the continuous (...) integration of knowledge and permanent interaction with the student. This paper presents an analysis of the new teaching methodologies in times of confinement due to the pandemic caused by Covid-19. Keywords: Teaching methodologies, educational system, learning process. References [1]É. Tremblay-Wragg, C. Raby, L. Ménard y I. Plante, «El uso de estrategias didácticas diversificadas por cuatro profesores universitarios: ¿qué contribución a la motivación de aprendizaje de sus alumnos?,» Docencia en educación superior, vol. 26, nº 21, 2021. [2]L. Czerniewicz, R. Mogliacci, S. Walji, A. Cliff, B. Swinnerton y N. Morris, «Enseñanza y aprendizaje académico en el nexo: desagregación, mercantilización y digitalización en la educación superior,» Teaching in Higher Education, vol. 26, nº 2021, p. 16, 2021. [3]S. Dogan y A. Adam, «Aumentar el efecto del desarrollo profesional en la instrucción efectiva a través de comunidades profesionales,» Docentes y docencia: teoría y práctica, vol. 26, nº 3-4, pp. 326-349, 2020. [4]I. M. Torres Salas, «La enseñanza tradicional de las ciencias versus las nuevas tendencias educativas,» Educare, vol. 14, nº 1, pp. 131-142, 2010. [5]B. Fabio, J. Antonio Palomino y J. González Henríquez, «Evaluación y contraste de los métodos de enseñanza tradicional y lúdico,» Revista de Educación física y deportes, vol. 13, nº 94, pp. 29-36, 2008. [6]Y. Benítez y C. Mora, «Enseñanza tradicional vs aprendizaje activo,» Revista Cubana de Física, vol. 27, nº 2A, pp. 175-179, 2010. [7]P. Morales Bueno y V. Landa Fitzgerald, «Aprendizaje basado en problemas,» Theoria, vol. 13, nº 1, pp. 145-157, 2004. [8]R. Gil-Galván, I. Martín-Espinosa y F. Gil-Galván, «University student perceptions of competences acquired through problem-based learning,» Educación XXI, vol. 24, nº 1, pp. 271-295, 2020. [9]E. Ortiz Cermeño, «El aprendizaje basado en problemas,» Perfiles Educativos, vol. 41, nº 164, pp. 208-213, 2019. [10]E. Araos-Baeriswyl, C. Moll-Manzur, Á. Paredes y J. Landeros, «Aprendizaje invertido: un enfoque pedagógico en tiempos de pandemia,» Rev. Atención Primaria, vol. 53, nº 1, p. 117, 2021. [11]V. León-Carrascosa, M. Belando-Montoro y S. Sánchez-Serrano, «Design and validation of a questionnaire to evaluate the service-learning methodology,» Rev.Estudios sobre educación, vol. 39, nº 1, pp. 247-266, 2020. [12]J. Collado-Ruano, M. Ojeda, M. Malo y D. Amino, «Educación, arte e interculturalidad: El cine documental como lenguaje comunicativo y tecnología innovadora para el aprendizaje de la metodología I + D + I,» Rev. Texto livre, vol. 13, nº 3, pp. 376-393, 2020. [13]P. M. Bueno y V. Landa Fitzgerald, «Aprendizaje basado en problemas,» Theoria, vol. 13, nº 1, pp. 145-157, 2004. [14]J. A. Martí, M. Heydrich, M. Rojas y A. Hernández, «Aprendizaje basado en proyectos: Una experiencia de innovación docente,» Universidad EAFIT, vol. 46, nº 158, pp. 11-21, 2010. [15]L. Rojas y N. M. Jaimes, «Canvas LMS y el trabajo colaborativo como metodología de aprendizaje en entornos virtuales,» de Congreso Ibérico de Sistemas y Tecnologías de la Información, CISTI, Bogotá, Colombia, 2020. [16]B. Bordel y P. Mareca, «Results and Trends in educational MOOCs in the engineering area with MIRIADAX platform. A case study,» de 15th Iberian Conference on Information Systems and Technologies, CISTI 2020; Seville; Sevilla, España, 2020. [17]K. Vermeir y G. Kelchtermans, «Innovative practice as interpretative negotiation.A case-study on the kamishibai in Kindergarten.,» Teachers and Teaching: Theory and Practice, vol. 26, nº 3-4, pp. 248-263, 2020. [18]B. Tucker, «The Flipped Classroom: Online instruction at home frees class time for learning,» Education Next, vol. 1, nº 1, pp. 82-84, 2012. [19]M. V. Ledo, N. R. Michelena, N. N. Cao, I. d. R. M. Suárez y M. N. Vialart Vidal, « Aula invertida, nueva estrategia didáctica,» Educación Médica Superior, vol. 30, nº 3, pp. 678-688, 2016. [20]Metodologías activas por medio de las TIC, [Online]. Available: https://www.campuseducacion.com/blog/recursos/articulos-campuseducacion metodologias-activas-por-medio-de-las-tic/?cn-reloaded=1. [Last access: February 14, 2021]. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility (...) of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions. (shrink)

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played (...) the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be. (shrink)

En quoi le corps participe-t-il de l'entente que l'homme a du monde? Que signifie dès lors écouter? Comment établir un rapport juste à l'animal? Quel sens prêter aux couleurs? Pourquoi la tonalité décisive de notre rapport au monde peut-elle advenir à la faveur d'expériences olfactives et gustatives? En quoi la tactilité incite-t-elle à considérer le corps vif comme une donnée originaire et à reconnaître qu'il est bien une vulnérabilité dotée d'aptitudes qui nous dispose au monde? Comment l'angoisse, révélée et cachée (...) tout à la fois par la maladie, est-elle chevillée au corps de l'être-au-monde, le Dasein? Qu'en est-il du corps dans la nostalgie, dans la mélancolie, dans l'ennui et dans la joie? Pourquoi la coexistence, supposant relations et rencontres, implique-t-elle l'articulation des corporéités vives comme dans le tact sensitif ou dans la jalousie amoureuse et dans l'amour pensé en terme de tonalité érotique? Comment comprendre la mobilité et parvenir ainsi jusqu'à l'éminente dignité ontologique du mouvement? De quoi la pensée est-elle redevable au corps? Telles sont les questions qui jalonnent cet ouvrage. Par son orientation résolument phénoménologique, l'Intelligence du corps entend renouveler l'entente du phénomène le plus proprement humain et, cependant, le plus malmené par la métaphysique. Prenant librement appui sur les vues inouïes de Martin Heidegger, consciente de l'actuelle soumission du corps de l'homme à l'arraisonnement technique, Ingrid Auriol ouvre une voie d'accès à l'intelligence du corps libérée de cette violence. (shrink)

This paper offers a critique of Martha Nussbaum’s description of the capability approach, and offers an alternative. I will argue that Nussbaum’s characterization of the capability approach is flawed, in two ways. First, she unduly limits the capability to two strands of work, thereby ignoring important other capabilitarian scholarship. Second, she argues that there are five essential elements that all capability theories meet; yet upon closer analysis three of them are not really essential to the capability approach. I also offer (...) an alternative description of the capability approach, which is called the cartwheel view of the capability approach. This view is at the same time radically multidisciplinary yet also contains a foundationally robust core among its various usages, and is therefore much better able to make the case that the capability approach can be developed in a very wide range of more specific normative theories. Finally, the cartwheel view is used to argue against Nussbaum's claim that all capabilitarian political theory needs to be politically liberal. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

A IDENTIFICAÇÃO DO DIREITO AMBIENTAL MARÍTIMO.

A IMPORTÂNCIA DE TRATAMENTO DE ÁGUAS RESIDUAIS ATRAVÉS DA BIORREMEDIAÇÃO: UMA ANÁLISE PRINCIPIOLÓGICA.

Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

My dissertation, “Love, Self-Constitution, and Practical Necessity,” offers an interpretation of love between people. Love is puzzling because it appears to involve essentially both rational and non-rational phenomena. We are accountable to those we love, so love seems to participate in forms of necessity, commitment, and expectation, which are associated with morality. But non-rational attitudes—forms of desire, attraction, and feeling—are also central to love. Consequently, love is not obviously based in rationality or inclination. In contrast to views that attempt to (...) fit love into existing models of practical reasoning, I argue that love participates in a unique form of practical necessity, different from both moral and psychological necessity, yet bearing resemblances to each. Distinctive to this type of practical necessity is a direct appeal to another particular person that cannot be delivered in third-personal terms—that is, a non-moral yet normative type of expectation on another person. This type of expectation is predominant in loving relationships, but can also make better sense of the experiences of humor and beauty, as well as attitudes like forgiveness, gratitude, and agent-regret. I treat Immanuel Kant’s discussion of the experience of beauty in the Critique of Judgment and Christine Korsgaard’s work on self-constitution as fruitful starting points for this account of love. I conclude that our loving relationships enable us to have distinctive personal selves, and provide support for this account of love by offering a complementary theory of grief. In Part One of the dissertation, I focus on two prominent approaches to love characteristic of the sentimentalist and rationalist traditions. I begin with the work of David Hume, which treats desire (understood as something like a simple impulse or craving) as the paradigmatic mental state, and emphasizes our personal and affective dimensions. Hume has the valuable insight that loving someone affects our sense of ourselves. But Hume’s view becomes unsatisfying when he claims that love is essentially enfeebling, implying that to love is to be passive toward and readily overcome by another person. While this indicates Hume’s awareness that love involves being open and receptive to another person, the problem is that love is also a demanding attitude. Hume lacks the conceptual resources to offer a nuanced view of the self, in which we can—with one attitude—be both demanding of and vulnerable to another person. Hume’s model of a desire-based deliberative process has recently been revived in Harry Frankfurt’s discussions on love and rationality. Frankfurt, however, goes beyond Hume’s picture of the self by introducing a notion of “identification,” which he offers to make sense of our apparent ability to commit ourselves decisively to certain projects or people. I argue that active powers like identification and commitment cannot be accommodated within any basically Humean moral psychology. Such abilities, and with them the possibility of love, depend on something closer to a Kantian conception of rational agency. I next focus on the work of Kant, who provides the substantial counterpart to Humean-inspired moral theories, but is not known for his insight into our emotional lives. In the Metaphysics of Morals, Kant divides love into “practical love”—what we experience when we are morally motivated to help someone—and “pathological love”—what we experience when we feel fond of something. But in reality, we experience love neither as a mere preference for another person, nor as something that generates the kind of demands that would be binding on any rational creature. David Velleman attempts to remedy the deficiency of Kant’s dichotomy. Velleman offers a Kantian theory in which he describes love and respect as two ends of a continuum of attitudes that it is morally appropriate to have toward people. Velleman’s view has the peculiar implication that everyone deserves the love of everyone else, and I argue that this is a fatal flaw. Like Kant and Velleman, Korsgaard characterizes personal love as involving the treatment of other people as Kantian ends-in-themselves to a heightened degree. Korsgaard, though, also contends that our individual identities depend upon our personal relationships, and I take this position seriously for the remainder of the dissertation. Ultimately, however, characterizations of loving relations as subsets of moral relations can account for the authority of the demands of love, but not its particularity. The major conclusion of Part One is that any attempt to understand love primarily on a model of practical reasoning with which we are already familiar is doomed to fail. Our experience of love calls for a theory of a unique type of practical necessity. In Part Two I take seriously the possibility that love is simultaneously inescapable (in something like the way morality is supposed to be), and yet ineluctably personal. In love, we experience an engagement with a person as essentially particular, rather than as an instance of a rational agent in general. To make sense of this direct attachment to an individual, I argue that love involves distinctive forms of expectation and disappointment. When those we love let us down, they hurt our feelings, which is not a response to a failed prediction, but nor is it a reaction to a moral insult or offense. According to Peter Strawson and Stephen Darwall, second-personal moral reactive attitudes (such as resentment) always have third-personal analogues (such as indignation). In contrast, I argue that the type of hurt feelings associated with love is a second-personal reactive attitude that does not have a third-personal corollary. I take this as evidence that the expectations involved in love are not objective in the way that the moral is objective. Nor, however, is love a matter of mere preference. On my interpretation, Kant introduces this different type of expectation in the Critique of Judgment. Whereas he characterizes moral judgments as universally communicable, judgments of beauty implicitly involve only second-personal address: I appeal to your direct experience with a particular object. This provides the conceptual space for an account of love according to which it involves a uniquely second-personal form of practical necessity. I contend that the second-personal addresses we make in love are appeals to strengthen the intimacy implicit in the loving relationship, and I identify three interrelated dimensions of that intimacy. First, those we love have the standing to interpret us in a constitutive manner. We fine-tune and make determinate the character of our concerns and interests in part by accepting the interpretations provided by those we love. In that way, the people we love have the normative power to constitute who we are. Second, we share a perspective with those we love in a way that is not reducible to or derivative of our independent perspectives. Loving someone centrally involves the activity of forming concerns together, and we do this in a mode best understood on the model of playing a spontaneous game or improvising music. Finally, being loved enables us to see ourselves as distinctive and special, because the concern those who love us have for us does not track the objective merit of our characteristics. These dimensions of the intimacy that characterizes a loving relationship reveal what it is that we appeal for in love, and how we are hurt when our appeals are rebuffed. In broad terms, this dissertation advocates the recognition of a non-moral yet normative type of expectation, which is predominant in loving relationships. Humor and beauty, too, make more sense when understood in terms of this non-moral yet normative type of expectation, as they involve appeals to others that are more than mere predictions of, but less than rational demands for, a certain kind of response. Introducing this alternative notion of expectation into the discourse of moral philosophy can shed light on other common attitudes that are clearly normative, but defy translation into objective, third-personal terms. Such attitudes include certain experiences of pride and shame, apology and forgiveness, the bestowing of mercy, gratitude, agent-regret, and perhaps a basic sense of trust we have in others. Ultimately, I situate love in respect to grief, which demonstrates my theory’s ability to make sense of related dimensions of our emotional lives. The people we love and grieve over give us a sense of who we are as distinctive, particular individuals, as the three interrelated dimensions of intimacy in loving relationships reveal. Consequently, grief is best understood as a type of practical disorientation—namely, a disorientation that involves the loss of the personal self. I present my account of grief against the type of account that would draw philosophical conclusions about the nature of love and grief from empirical psychological data alone. In particular, these data indicate that we recover quickly from the deaths of loved ones, and Dan Moller draws the philosophical conclusion that those we love fulfill certain roles in our lives and are replaceable. In contrast, I contend that while we should acknowledge the truth of the objective judgment, made in the third-person, that we will likely recover after the deaths of those we love, it does not follow that we must affirm such a claim from the internal perspective of one person who loves another. As a result, the case of love and grief supports a general claim concerning the proper work of moral philosophy, which is that the understanding of ourselves gained through empirical data is not a substitute for the normative conclusions that are revealed through first-personal reflections on our relationships. (shrink)

Journal of Economic Methodology, Volume 19, Issue 2, Page 159-163, June 2012.

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

For many, the Holocaust made thinking about ethics in traditional ways impossible. It called into question the predominance of speculative ontology in Western thought, and left many arguing that Western political, cultural and philosophical inattention to universal ethics were both a cause and an effect of European civilization's collapse in the twentieth century. Emmanuel Levinas, Elie Wiesel and Richard Rubenstein respond to this problem by insisting that ethics must be Western thought's first concern. Unlike previous thinkers, they locate humanity's source (...) of universal ethical obligation in the temporal world of experience, where human suffering, rather than metaphysics, provides the ground for ethical engagement. All three thinkers contend that Judaism’s key lesson is that our fellow human is our responsibility, and use Judaism to develop a contemporary ethics that could operate with or without God. _Ethics and Suffering since the Holocaust_ explores selected works of Levinas, Wiesel, and Rubenstein for practical applications of their ethics, analyzing the role of suffering and examining the use each thinker makes of Jewish sources and the advantages and disadvantages of this use. Finally, it suggests how the work of Jewish thinkers living in the wake of the Holocaust can be of unique value to those interested in the problem of ethics in the twentieth and twenty-first centuries. Presenting a thorough investigation of the work of Levinas, Wiesel and Rubinstein, this book is of key interest to students and scholars of Jewish studies, as well as Jewish ethics and philosophy. (shrink)

La construcción de la nación y la transformación de lo político / Ingrid Johanna Bolívar.

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)