Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much‐needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision‐making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in (...) a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision‐making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self‐determination. (shrink)

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. (...) There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them, and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. (shrink)

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives. The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with (...) an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses, chronic diseases, and elderly patients. Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age. (shrink)

Background: This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. Materials and Methods: A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. Results: Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have (...) expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. Conclusion: Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain. (shrink)

This paper investigates the norm of presupposition, as one pervasive type of indirect speech act. It argues against the view that sees presuppositions as an indirect counterpart of the direct speech act of assertion and proposes instead that they are much more similar to the direct speech act of assumption. More concretely, it suggests that the norm that governs presuppositions is not an epistemic or doxastic attitude such as knowledge, justified belief, or mere belief; it's a practical attitude, most plausibly (...) the attitude of rational acceptance. This view has important ramifications well beyond debates in philosophy of language and linguistics. It affects not only our view of which speech act sequences are fine and which are off; it bears on whether presuppositions can function as testimony, whether they can be lies, and whether they are ontologically committal, thus addressing central topics in epistemology, ethics, and metaphysics. (shrink)

Contiene: el discurso de recepción del autor como Miembro Académico de la Facultad de Filosofía y Educación de la Universidad de Chile.

In this article, I offer a theoretical account of a central yet surprisingly overlooked form of legal influence or control, one that I refer to as the law’s ‘exhortative’ influence. The law exercises an ‘imperative’ influence when it purports to control agents’ behavior by imposing on them legal duties to act or refrain from acting in the legally desired or repelled way. By contrast, it exercises what I call an exhortative form of influence when it aims at impacting agents’ reasons (...) for action whilst refraining from mandating or prohibiting the legally desired or repelled conduct. The law’s exhortative control or influence must be distinguished not only from its imperative influence, but also from what I call the law’s merely ‘instructive’ form of influence, such as the one provided by so-called power-conferring laws. Though I illustrate the functioning of this special form of legal control—the law’s exhortative influence—by using primarily the example of the law of contracts, the article offers novel insights about law in general as a mode of social ordering by developing a theory of the structure of ‘legal incentives’. Legal incentives, I contend, are the means through which the law exercises its exhortative influence. Clearly distinguishing different techniques of legal influence is not only of analytical interest, but should invite us to think of accounts of the justification of legal authority that consider the similarities but also the differences in the moral significance of these diverse techniques. (shrink)

The Uniform Determination of Death Act (UDDA) provides that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions.” By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the (...) other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency. (shrink)

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

Looks at the psychological nature of depression and discusses its portrayal in literature and art.

Discussions about the morality of slavery are a central part of the history of early modern philosophy. This book explores the philosophical ideas, theories, and arguments that occur in eighteenth-century debates about slavery, with a particular focus on the role that race plays in these debates. This exploration reveals how closely Blackness and slavery had come to be associated and how common it was to believe that Black people are natural slaves, or naturally destined for slavery. The book examines not (...) just well-known authors like David Hume, Immanuel Kant, and Jean-Jacques Rousseau, but also less widely studied philosophers like Quobna Ottobah Cugoano, Lemuel Haynes, and Olympe de Gouges. By presenting philosophically important aspects of debates about slavery in eighteenth-century North America and Europe, the book aims to be a valuable resource for scholars, instructors, and students who are curious about a topic that historians of philosophy have so far neglected. (shrink)

This entry provides an overview of the current state of the debate between epistemic permissivists and impermissivists. Three important choice points for the permissivist are identified, and implications are discussed for plausibility of the resulting versions of permissivism.

The format of this volume in the Library of Living Philosophers series provides for a detailed interaction between those who interpret and critique Julia Kristeva's work and Kristeva herself, giving broad coverage, from diverse viewpoints, of all the major topics establishing her reputation. This work begins with her autobiography, which provides an excellent introduction to her work, situating it in relation to major political, intellectual, and cultural movements of the time. The major part of the book is comprised of (...) thirty-six essays by Kristeva's foremost interpreters and critics, together with her replies to the essays. These encounters cover an exceptionally wide range of theoretical and literary writing. The strong international and multidisciplinary focus includes authors from over ten countries, and spans the fields of philosophy, semiotics, literature, psychoanalysis, feminist thought, political theory, art, and religion. A comprehensive bibliography of works by Kristeva is included. (shrink)

This paper argues that the vitalist monisms of Anne Conway and Margaret Cavendish. Even though Conway is often cited as a proponent of a thoroughgoing ‘spiritualist’ ontology and Cavendish as the advocate of a similarly thoroughgoing materialism, their views turn out to be much closer than they may initially seem. Apart from highlighting the more radical nature of Conway’s position, such a reframing also has the added advantage of bringing the similarities between her own ‘spiritual’ monism and the vitalist ‘materialisms’ (...) of her time into sharper relief. As F. Wunderlich emphasizes, the notion of subtle matter pervaded the natural sciences of the seventeenth and the eighteenth centuries. The chapter provides a brief sketch of Cavendish’s ‘materialism’ and compares it to Conway’s view of created substance, drawing out a number of relevant similarities. It asks what may have motivated Conway and Cavendish to move beyond the materialism-immaterialism divide by ‘spiritualizing’ matter in this way. (shrink)

Ausgehend von Lucian Freuds Bild »Painter Working, Reflection« (1993) entwirft Julia Regina Meer eine korporale Philosophie der Bilder. Das Bild avanciert dabei zum Ausgangspunkt des Denkens, was eine methodische Abgrenzung zu den Bildwissenschaften wie auch zur Bildtheorie ermöglicht. In Anlehnung an die Philosophie von Jean-Luc Nancy schlägt sie ein affirmatives Konzept von Körperlichkeit vor, das auf dem Grenzbegriff der Expeausition - der körperlichen Ausgesetztheit entlang der Haut - beruht. Wie der Selbstakt von Freud zeigt, potenzieren Bilder dieses Ausgesetztsein, da (...) sie nicht nur einen Bildinhalt ausstellen, sondern immer auch den Bildkörper mitaussetzen. (shrink)

This article develops the argument that non-cosmopolitan considerations of justice justify relief of sovereign debt for highly indebted poor states. In particular, the article claims that considerations of national determination warrant some debt-forgiveness in the backdrop of unfair terms of global interaction. In a context of inequality, poor countries cannot generally afford to disregard the costs of ignoring the interests of the wealthiest states. Patterns of unbalanced interaction undermine national self-determination by limiting the poor countries' effective capacity to choose between (...) different policies to achieve development and other worthy goals. In concrete, this article suggests that unequal terms of interaction constrain national self-determination by making of sovereign debt an 'escape mechanism' in the absence of rival alternatives to palliate the effects of underdevelopment and related afflictions, despite the causes of sovereign debt being partly domestic, possibly. Thus, this paper views national self-determination as dependent on the availability of acceptable (non-unbearably burdensome) policy options on the part of states. (shrink)

On Moral Certainty, Justification and Practice presents a view of morality that is inspired by the later Wittgenstein. Hermann explores the ethical implications of Wittgenstein's remarks on doubt, justification, rule-following, certainty and training, offering an alternative to interpretations of Wittgenstein's work that view it as being intrinsically ethical. The book scrutinises cases in which doubt and justification do not make sense, and contrasts certain justificatory demands made by philosophers with the role of moral justification in concrete situations. It offers an (...) account of moral certainty, which is linked to a view of moral competence. Contrary to the views propounded by philosophers who emphasise the importance of moral principles, it is argued that moral agency is first and foremost a matter of having certain capacities. The book takes an anti-intellectualist stance and remains close to concrete practices. The practice-based view of morality it endorses has implications for moral education, intercultural moral dialogue and the prospects for moral agreement, change and progress. (shrink)

El estudio examina mediante una revisión sistemática la literatura científica. La metodología se basó en la aplicación de los principios de la declaración PRISMA. Los resultados indicaron que la mayor producción de estudios fue en 2021, con predominancia de idioma inglés, España como el mayor productor, Reino Unido con el mayor número de revistas y el uso de realidad aumentada como la estrategia más estudiada. La producción científica en educación, y más particularmente en metodologías aplicada a la educación, ha generado (...) una serie de estudios bibliométricos, los cuales han demostrado la evolución de las mismas en lapsos de tiempo diversos. (shrink)

En este artículo se presenta un abordaje general de la teoría de la justicia social de John Rawls. Revisamos algunas críticas desde diversos frentes teóricos. Consideramos que la justicia social permite enjuiciar las consecuencias regresivas para la humanidad del capitalismo en su fase neoliberal y comenzar a imaginar otros mundos posibles.

Bayesian epistemology provides a popular and powerful framework for modeling rational norms on credences, including how rational agents should respond to evidence. The framework is built on the assumption that ideally rational agents have credences, or degrees of belief, that are representable by numbers that obey the axioms of probability. From there, further constraints are proposed regarding which credence assignments are rationally permissible, and how rational agents’ credences should change upon learning new evidence. While the details are hotly disputed, all (...) flavors of Bayesianism purport to give us norms of ideal rationality. This raises the question of how exactly these norms apply to you and me, since perfect compliance with those ideal norms is out of reach for human thinkers. A common response is that Bayesian norms are ideals that human reasoners are supposed to approximate – the closer they come to being ideally rational, the better. To make this claim plausible, we need to make it more precise. In what sense is it better to be closer to ideally rational, and what is an appropriate measure of such closeness? This article sketches some possible answers to these questions. (shrink)

We undergo a traumatic experience, such as a life-threatening accident or a brutal attack. We survive a period of relentless stress, perhaps because we are in a war zone and witness or commit atrocities. Raised by parents who are alcoholic or mentally ill, we endure traumatic experiences on a daily basis. Or, we are ignored, neglected, or treated as playthings by narcissistic parents, who themselves were ignored and neglected, and on and on through generations. To survive these experiences, perhaps we (...) dissociate. This can take various forms. In the extreme form, we remove ourselves, psychically speaking, from the situation, perhaps by adopting the role... (shrink)

Julia Markovits develops a desire-based, internalist account of what normative reasons are--an account which is compatible with the idea that moral reasons can apply to all of us, regardless of our desires. She builds on Kant's formula of humanity to defend universal moral reasons, and addresses the age-old question of why we should be moral.

Drawing on phenomenological aesthetics and on the haptic aesthetics of eating as a form of everyday aesthetics, I examine the phenomenon of eating our own as meaningful in three dimensions: vital/natural, somatic/individual, and cross-cultural. Usually conceived as a concrete, rare, and foreign practice, I show how cannibalism is present in our daily lives, both symbolically and as a liminal possibility towards which – as Freud noticed in 1913 – we all tended as children. Cannibalism is present not only in cinematic, (...) literary, or visual art, and in anthropological research that situates it far from “us,” but through narratives and carnal dispositifs of differentiation/assimilation of the Same and the Other, fundamental for our subjective constitution. I conclude with a reflection on how the classical aesthetics of the sovereign subject develops towards alternative models like Pelluchon’s gourmet ego that re-establish the connexion and moral engagement lost by solipsism by means of alimentary metaphors, but also romanticizing them, failing to address the problem of voracity and overconsumption, both at a social and at an individual level. This is more suitably addressed by Viveiros de Castro’s idea of a cannibal cogito, but even better understood by Emmanuel Levinas’ enjoyment-contact model of subjectivity. (shrink)