Desde la Guerra contra el narcotráfico implementada por Felipe Calderón, se produce un auge en el “espectáculo de la violencia” (Berlanga “El espectáculo”), es decir, una exhibición desmedida de la violencia tanto en medios de comunicación como en los productos culturales. Esta estética corre el riesgo de naturalizar la violencia por lo que se vuelve necesario pensar en otras formas de representar lo irrepresentable. Este artículo se centra en las películas Noche de fuego (2021) de Tatiana Huezo y Sin señas (...) particulares (2020) de Fernanda Valadez. En ellas, se establecen mecanismos de resistencia a través de contra-pedagogías (Segato) como la empatía y las comunidades de afectos. A partir del uso del fuera de campo, los filmes dan cuenta de la incapacidad de representar el horror y se distancian de la representación común de la violencia. (shrink)

ABSTRACT Peter Hägel's Billionaires in World Politics undoubtedly fills a gap in the literature of international relations and global governance. My comment seeks to highlight that Hägel's (2020. Billionaires in World Politics. 1st ed. Oxford Scholarship Online. Oxford: Oxford University Press) work allows us to advance our understanding of how these private actors can be understood as legitimate authorities and how they can contribute to the legitimacy of the international order. I divide my commentary into three points: the first concerns (...) the approach to billionaires from their individual agency (the individual approach), the second relates to the separation between the state and the global levels (the division approach), and the third presents questions on political legitimacy that arise from his case studies (the legitimacy question). (shrink)

Marcel Proust ha passat a la història de la cultura occidental com un escriptor, principalment novelista. Amb tot, la seva obra mestra. A la recerca del temps perdut, un dels cims de la literatura mundial, conté nombroses reflexions que permeten identificar clarament també un Proust pensador. Reconstruir la filosofia de Proust tot resseguint la mirada sobre el món que representa a la recerca?. és l'objectiu d'aquest assaig. A partir dels aforismes, sovint metafòrics, del Narrador proustià, Jaume Urgell ens ofereix una (...) anàlisi de la posició de l'escriptor francès en el context de la filosofia del segle XX. Expressant-se de vegades com a hereu d'un pensament anti-racionalista, en ocasions com a a coetani del existencialisme europeu i sovint precursor tant del pensament ironista com de mites de la quotidianitat més contemporània, Marcel Proust ens llega una obra plena de significats i alhora lliure de qualsevol convencionalisme, cosncient de les seves pròpies màscares i alhora innocent en el seu desenvolupament. Aquest assaigpresenta també algunes de les contribucions més rellevants en l'estudi de l'obra proustiana, com són les de Samuel Beckett, Gilles Deleuze i Richard Rorty, i desbrossa les incursions de Proust en el camp de la psicologia, l'ètica i l'estètica. Jaume Urgell És llicenciat en ciències empresarials i MBA per ESADE i Màster en Administració Pública per la Universitat de Harvard. Té un Diploma d'Estudis Avançats en Filosofia i Literatura per la UB. Dedica la seva vida intel·lectual a la literatura, la filosofia, la política i les relacions internacionals, i ha publicat diversos llibres i articles sobre aquestes matèries. (shrink)

Background: Adolescence is a period with physical, psychological, biological, intellectual, and social changes in which there is usually little perception of risk. COVID-19 has generated constant situations of change and uncertainty worldwide. During the pandemic, the acquisition of preventive behaviors has been relevant. Various studies carried out with adults associate risk perception and the implementation of preventive behaviors with knowledge about the COVID-19 and with age, but there are not many studies with adolescents. Therefore, the objective is to validate, in (...) Spanish, the questionnaire of the knowledge, attitudes, risk perceptions, and practices of adolescents toward the pandemic, and analyze it according to sociodemographic characteristics.Method: This study was a descriptive cross-sectional study, which included adolescents between the ages of 12–18. First, a translation and a back-translation of the questionnaire were performed. The questionnaire was presented in several high schools chosen by convenience sampling and following a non-probabilistic snowball sampling. Reliability and validity analyses were then carried out and the relationships between the different sociodemographic variables were analyzed.Results: The reliability of the questionnaire is acceptable. Knowledge was higher in women, and in those with a higher level of education; and were lower in those who lived in smaller towns, as well as in those who had a member of their family receiving financial aid. In terms of attitudes and risk perceptions, younger adolescents had higher scores, and those who had a member of their family receiving financial aid, lower.Conclusion: The questionnaire is a reliable tool in the Spanish adolescent population. Knowledge was influenced by gender, place of residence, level of education, and financial aid. Attitudes and risk perceptions were influenced by age and financial aid. For practices, no predictors were found. In general, adolescents scored lower on knowledge about COVID-19, but they scored higher on COVID-19 safety practices. (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)

BackgroundDepression is a prevalent condition that has a significant impact on psychosocial functioning and quality of life. The onset and persistence of depression have been linked to a variety of biological and psychosocial variables. Many of these variables are associated with specific lifestyle characteristics, such as physical activity, diet, and sleep patterns. Some psychosocial determinants have an impact on people’ health-related behavior change. These include personal factors such as sense of coherence, patient activation, health literacy, self-efficacy, and procrastination. This study (...) aims to analyze the association between the severity of depression, lifestyle patterns, and personal factors related to health behavior. It also aims to analyze whether personal factors moderate the relationship between lifestyles and depression.MethodsThis study is a secondary data analysis of baseline data collected at the start of a randomized controlled trial. A sample of 226 patients with subclinical, mild, or moderate depression from primary healthcare centers in two sites in Spain was used, and descriptive, bivariate, multivariate, and moderation analyses were performed. Depression was the primary outcome, measured by Beck II Self-Applied Depression Inventory. Lifestyle variables such as physical exercise, adherence to Mediterranean diet and sleep quality, social support, and personal factors such as self-efficacy, patient activation in their own health, sense of coherence, health literacy, and procrastination were considered secondary outcomes.ResultsLow sense of coherence, poor sleep quality, low patient activation, and sedentarism are predictors of having more depressive symptoms. Moderation analyses were not significant.DiscussionLifestyle and personal factors are related to depressive symptomatology. Our findings reveal that sense of coherence, patient’s activation level, sedentarism, and sleep quality are associated with depression. Further research is needed regarding adherence to Mediterranean diet, minutes walking per week and the interrelationship between lifestyles, personal factors, and depression. (shrink)

There is much evidence, both in humans and rodents, that while navigating males tend to use geometric information whereas females rely more on landmarks. The present work attempts to alter the geometry bias in female rats. In Experiment 1 three groups of female rats were trained in a triangular-shaped pool to find a hidden platform, whose location was defined in terms of two sources of information, a landmark outside the pool and a particular corner of the pool. On a subsequent (...) test trial with the triangular pool and no landmark, females with prior experience with two other pool shapes–with a kite-shaped pool and with a rectangular-shaped pool, were significantly more accurate than control rats without such prior experience. Rats with a short previous experience–with the rectangular-shaped pool only did not differ from Group NPE. These results suggest that the previous experience with different shaped-pools could counteract the geometry bias in female rats. Then, Experiment 2A directly compared the performance of LPE males and females of Experiment 1, although conducting several test trials. The differences between males and females disappeared in the three tests. Moreover, in a final test trial both males and females could identify the correct corner in an incomplete pool by its local, instead of global, properties. Finally, Experiment 2B compared the performance of NPE rats, males and females, of Experiment 1. On the test trial with the triangular pool and no landmark, males were significantly more accurate than females. The results are explained in the framework of selective attention. (shrink)

The main aim of this article is to analyze the social circulation of discourses on non-hegemonic cultural practices, in particular, on what is called “trash TV”, and how they are connected to struggles over cultural and social hierarchies. To do so, it takes a specific event as starting point: the injunction that the CNMC filed against Mediaset to adjust the contents of Sálvame Diario to the requirements of what is known as the “child protection time slot”. This paper uses constructionist (...) framing to analyze how this event was discussed by different social actors. Our analysis shows that while the CNMC and the press painted the conflict as a legal issue, Sálvame and social media users focused their discussion on the social acceptability of celebrity gossip media and their viewers. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.

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)

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)

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

This article presents an alternative understanding of corporations from the two problematic visions that see corporations as either the shareholders’ property or as nexuses of contracts. The alternative proposed here is based on the theories of pre-eighteenth-century philosophers, particularly Aristotle’s political philosophy, which Thomas Aquinas later refined. The article aims to advance a theory of corporate legal and moral responsibility for human rights based on the conception of corporations as imperfect communities whose purpose is to produce a good or service (...) through participatory work that allows individuals to self-develop while contributing to the community by satisfying consumers’ needs through collaborative work. The critical account of corporations presented here provides a sound foundation upon which to build a justification of corporate responsibility for human rights violations, providing a more accurate description of the reality of a corporation than most mainstream contemporary accounts do. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (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)

Pragmatic difficulties are considered a hallmark of autism spectrum conditions (ASC), but remain poorly understood. We discuss and evaluate existing hypotheses regarding the literalism of ASC individuals, that is, their tendency for literal interpretations of non‐literal communicative intentions. We present evidence that reveals a developmental stage at which neurotypical children also have a tendency for literalism and suggest an explanation for such behaviour that links it to other behavioural, rule‐following, patterns typical of that age. We discuss evidence showing that strict (...) adherence to rules is also widespread in ASC, and suggest that literalism might be linked to such rule‐following behaviour. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Wandering the Magnetosphere*Ingrid Koenig (bio)Navigation notes: These emergent drawings–excerpts from a visual essay–take up the complex network of impacts across physical forces entangled with bio-geo-political time. A key element for this work is a living cosmography to depict movement across time, and to visualize wandering on a planet, in the magnetosphere, and between the internal energy of Earth and the solar energy of the cosmos. Physicists say there (...) are no things, there are only relations between things.Q: Hello ancient stone - may I unfold you like a book? Do you carry a message from deep time? A: Yes, what you’re holding is not a thing, but a process. Click for larger view View full resolutionDrawing from Svalbard, Day 17 expedition, 2019[End Page 97]Drifting on a rocky planet, between the internal energy of Earth and the solar energy of the cosmos–we live within a “cosmo-tectonic circulation” —Jerome Gaillardet, geo-chemist. Click for larger view View full resolutionGeocosmic Logic[End Page 98] Click for larger view View full resolutionHow Entropy is Time (detail) Click for larger view View full resolutionMagnetic Story[End Page 99] Click for larger view View full resolutionMessage From Deep Time 3 Click for larger view View full resolutionMessage From Deep Time 1[End Page 100] Click for larger view View full resolutionLooping Matters 1 (Litli-Hrutur, Iceland) Click for larger view View full resolutionLooping Matters 2[End Page 101] Click for larger view View full resolutionMother Rock Waves (Miradalir Valley, Iceland) Click for larger view View full resolutionMother Rock in Time[End Page 102] Click for larger view View full resolutionVolcanic Logic (Miradalir Valley, Iceland) Click for larger view View full resolutionSonic Lava (Miradalir Valley, Iceland)[End Page 103] Click for larger view View full resolutionWaves Across Time (Miradalir Valley, Iceland) Click for larger view View full resolutionDisorientations[End Page 104] Click for larger view View full resolutionMessage From Deep Time 2 Click for larger view View full resolutionGravitational Thought[End Page 105] Click for larger view View full resolutionMagnetic Thought (Miradalir Valley, Iceland) Click for larger view View full resolutionDistance Ladder Collapse[End Page 106] Click for larger view View full resolutionMattering Logic 3 Click for larger view View full resolutionMattering Logic 4[End Page 107] Click for larger view View full resolutionHow We Make Time into Space Click for larger view View full resolutionHow Entropy is Time (detail 2–Svalbard)[End Page 108]Ingrid Koenig Ingrid Koenig is Associate Professor at Emily Carr University of Art + Design, Vancouver, Canada. She was the inaugural Artist in Residence (2011 to 2021) at TRIUMF, Canada’s particle accelerator center, and co-organizes processes of collaboration between artists and physicists in a project called Leaning Out of Windows. Her studio and research practices traverse the fields of physics, social history, feminist theory, and narratives of science. Her drawings explore the complex phenomena of physics and involve intuitive responses to specific sites through fieldwork in Canada’s Rocky Mountains, Germany, Iceland, Arctic Circle art + science expeditions, and through collaborations with physicists. She has received grants from the Canada Council for the Arts, the Goethe Institute, and the Social Science and Humanities Research Council. She co-edited the recently published book, Leaning Out of Windows: An Art and Physics Collaboration (Figure 1 Publishing, 2023).Footnotes* Excerpts from Wandering the Magnetosphere–drawings by Ingrid Koenig, 2019 to 2023, and ongoingCopyright © 2023 Johns Hopkins University Press and SubStance, Inc... (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)

Having Too Much is the first academic volume devoted to limitarianism: the idea that the use of economic or ecosystem resources should not exceed certain limits. This concept has deep roots in economic and political thought. One can find similar statements of such limits in thinkers such as Plato, Aquinas, and Spinoza. But Having Too Much is the first time in contemporary political philosophy that limitarianism is explored at length and in detail. Bringing together in one place the best writing (...) from key theorists of limitarianism, this book is an essential contribution to political philosophy in general, and theories of distributive justice in particular. Including some of the key published articles as well as new chapters, Having Too Much is necessary reading for scholars and students of political theory and philosophy, as well as anyone interested in questions of distributive justice. (shrink)

A IDENTIFICAÇÃO DO DIREITO AMBIENTAL MARÍTIMO.

Background: Studies from Western countries show that doctors working in neonatal intensive care units find withdrawal of treatment to be their most difficult ethical dilemma. There is less knowledge of how this is experienced in other economic, cultural, religious and educational contexts.Objectives: To explore and describe how Indian doctors experience ethical dilemmas concerning the withdrawal of treatment among critically sick and/or premature neonates.Method: Qualitative data from interviews was analysed according to Giorgi's phenomenological approach. The subjects were 14 doctors with various (...) levels of neonatal experience, recruited from two state‐owned NICUs in India. Main outcome measures: description reflecting the nature of ethical dilemmas and how they are experienced.Results: All doctors reported situations where the question of withdrawal of treatment was experienced as the worst part of their job. They felt that they lacked training in how to handle such dilemmas, and some had never talked about ethics before. They were especially concerned about non‐medical considerations that do not feature in current treatment guidelines. In describing their personal experiences, the informants mentioned their sense of responsibility in situations where they were aware that their decisions would influence a family's economy and reputation, availability of food and education for siblings, other children's access to equipment in the unit, and the use of resources in an underprivileged population. Sometimes lack of resources, usually ventilators, forced them to make decisions about which babies should get the chance to live. Other reported dilemmas included difficulties co‐operating with uneducated and poor parents.Conclusion: While Western doctors seem to focus on the rights and problems of the individual child, Indian doctors tend to refer to consequences for other children, for parents and society. There is a need for further research in this field, and for the development of guidelines on how to cope with differences in resources, and how to handle different patient groups’ cultural and religious concerns. (shrink)

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent (...) that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must (...) call bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

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)

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

Paradoxically, the practical necessity of love seems to combine the personal character of psychological necessity with the inescapable and authoritative quality of moral necessity. Traditionally, philosophers have avoided this paradox by treating love as an amalgam of impersonal evaluative judgments and affective responses. On my account, love participates in a different form of practical necessity, one characterized by a non-moral yet normative type of expectation. This expectation is best understood as a kind of second-personal address that does not support derivative (...) third-personal demands. It is revealed when we react with hurt feelings instead of resentment upon its disappointment. (shrink)