The private letter, one of the most representative expressions of mass literacy, was the product of improved postal services and epistolary manuals. In the nineteenth century, which also witnessed the new phenomenon of mass emigration, letter writing became one of the most common practices. This article discusses the correspondence of José Moldes, an Asturian who left Spain for Puerto Rico at the age of fourteen and settled shortly afterwards in Chile. He died in his native Asturias at the age of (...) sixty-one. Throughout these fifty or so years, José wrote letters to keep in contact with members of his family, to control them when he became head of the household or to manage his businesses and investments. About 120 of his letters survived in the Moldes-Barreras family archive, through which we can reconstruct his experiences. The essential characteristics of this epistolary corpus emerge from an analysis of its material and graphic aspects, suggesting the profound influence of immigration on personal writing. (shrink)

Jecker and colleagues open (2024) a critical and needed dialogue about the ethics of international conferencing. In particular, they focus on proposing a set of principles in selecting the location...

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)

Digital contact tracing, in combination with widespread testing, has been a focal point for many plans to “reopen” economies while containing the spread of Covid‐19. Most digital contact tracing projects in the United States and Europe have prioritized privacy protections in the form of local storage of data on smartphones and the deidentification of information. However, in the prioritization of privacy in this narrow form, there is not sufficient attention given to weighing ethical trade‐offs within the context of a public (...) health pandemic or to the need to evaluate safety and effectiveness of software‐based technology applied to public health. (shrink)

After the November 2020 U.S. presidential election, many political analysts looked at the voting patterns of Latinx communities with consternation and surprise. Some analysts noted that “Latinx” ha...

Digital mental health technologies have been promoted with the promise of delivering wide-scale access to more efficient and effective mental health diagnosis and care. During the pandemic, the rap...

To prevent domains from cyber-piracy, the WIPO offers private and confidential procedures tasked to address the legitimate use of a domain name. WIPO domain name arbitration consists of an alternative dispute resolution process in which one or more panelists make a binding decision over the legitimacy of a domain. This article investigates the structure of the discourse of this professional genre. Following Maley, this study focuses, first, on spotting the generic moves of WIPO domain name arbitration decisions. Second, the analysis (...) unveils patterns shaping WIPO domain name arbitration decisions, hence exploring how discursive features work within this specialized discourse. Third, it examines whether corpus data reveal that this type of professional discourse has entered into a process of standardization. The study is based on Bhatia’s multi-perspective four-space model of discourse. This analytical framework emphasizes a multidisciplinary and multidimensional perspective which highlights that discourse is indistinguishable from constructing reality. (shrink)

Kant sobre las definiciones matemáticas, de Mirella Capozzi.

As an alternative dispute resolution procedure, Domain Name Arbitration addresses not only contentions regarding the ownership of web pages, but also infringements of the Intellectual Property law such as cyber squatting or Internet piracy. In this spirit, panelists of the World Intellectual Property Organization enact law in accordance with what the involved parties provide them as burden of proof. Following this line of thought, we can assume that one party may remain unrepresented when it is not able to accomplish legal (...) procedures successfully. Nevertheless, does this kind of asymmetry always function in the way that we presume? This paper sets out to study how WIPO panelists tackle knowledge asymmetries when being manifested in Domain Name Arbitration. In particular, this paper concentrates on comparing two Domain Name Arbitration processes in which knowledge asymmetries play a significant role in the panelist’s final-and legally binding- decision. This analysis also examines how specific text-internal features give us a hint of unbalanced relationships between the Complainant and the Respondent of a Domain Name Arbitration process. It endeavors, thus, to understand how lexical, rhetorical-grammatical and discursive features work within discourse and may reach to influence the communicative act itself. Following Vijay K. Bhatia’s critical discourse analysis as main theoretical framework, this paper tries to comprehend the role asymmetries play in enacting Domain Name law. (shrink)

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search (...) and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse–patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge. (shrink)

Big data and artificial intelligence (“AI”) promise to transform virtually all aspects of biomedical research and health care (Matheny et al. 2019), through facilitation of drug development, diagno...

Ian Hacking has defined himself as a philosopher in the analytic tradition. However, he has also recognized the profound influence that Michel Foucault had on much of his work. In this article I analyse the specific imprint of certain works by Foucault—in particular Les mots et les choses—in two of Hacking’s early works: Why Does Language Matter to Philosophy? and The Emergence of Probability. I propose that these texts not only share a debt of Foucauldian thought, but also are part (...) of what I believe is Hacking’s central project: the analysis of the historical and situated conditions of possibility for the emergence of concepts and of objects, inspired also by the French philosopher’s thought. (shrink)

This article identifies philosophical tensions and limitations within contemporary intersectionality theory which, it will be argued, have hindered its ability to explain how positioning in multiple social categories can affect life chances and influence the reproduction of inequality. We draw upon critical realism to propose an augmented conceptual framework and novel methodological approach that offers the potential to move beyond these debates, so as to better enable intersectionality to provide causal explanatory accounts of the ‘lived experiences’ of social privilege and (...) disadvantage. (shrink)

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed‐methods study was conducted that included a closed‐question survey and in‐depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in‐depth interviews. The main findings of the survey were related to workload and limited time for (...) nursing care. Six themes emerged from the in‐depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing. (shrink)

Lorraine Daston ha señalado la influencia que The emergence of probability de Ian Hacking ha tenido en su trayectoria intelectual y en su elección de la etiqueta epistemología histórica para describir su trabajo. Hacking, por su parte, ha respondido a estos señalamientos que, en primer lugar, Daston y sus colegas no hacen epistemología, sino que más bien estudian conceptos epistemológicos como objetos que evolucionan y mutan; en segundo lugar, que su trabajo sobre la probabilidad no es epistemología histórica sino, en (...) todo caso, lo que él llama metaepistemología histórica o, mejor aún, ontología histórica. En el presente trabajo, analizo en qué forma entienden Daston y Hacking el tipo de investigación que denominan respectivamente epistemología y metaepistemología histórica, y exploro sus convergencias y divergencias con el fin de establecer posibles relaciones, intereses y antecedentes compartidos. Por último, sostengo que la obra de Hacking puede ser visualizada como resultado de investigaciones que caracterizan a la epistemología histórica, como consecuencia de su interés, estimulado por la lectura de Michel Foucault, en el análisis de las condiciones históricas de posibilidad para la emergencia de conceptos y objetos científicos. (shrink)

For almost 50 years, the Council of Europe through a series of documents has been helping to build up a set of rules, principles, and strategies related to culture, environment, ethics, and sustainable development. At the moment, one of the most important aims of the Council of Europe’s agenda deals with the elaboration of the General Principles for the Protection of the Environment and Sustainable Development, as raised in document CO-DBP (2003)2 related to the environmental subject. The intention of the (...) Council of Europe is to encourage national authorities to implement these General Principles into their national environmental policies. These principles should have an important effect, especially in those countries which are new members of the European Union. The primary target of this paper is the study of these principles and the setting of their entailed implications in order to establish a relation between values and policy making. Quite often, the conclusions adopted by the agreements generated within the framework of the European Union are controversial. Therefore, a study aiming to lay the foundations of these principles will make the exchange of ideas easier, providing a wider and more detailed scope in the European environmental policy. (shrink)

Advances in neurotechnologies, artificial intelligence (AI) and Big Data analytics are allowing interpretation of patterns from brain data to identify and even predict and manipulate mental states. Furthermore, there are avenues through which brain data can move into the consumer sphere, be reidentified and brokered. In response to these developments, there have been a number of approaches proposed to strengthen protections of brain data. To better understand the landscape of brain data protection discussions, we conducted a scoping review to identify (...) the rationales for establishing brain data protections and the proposals for protecting brain data offered in the ethics and neuroscience literature. To draw comparisons, we also surveyed the rationales given in the literature for the protection of sensitive behavioral inferences drawn from other types of personal data and associated approaches to achieving protection. This systematic examination of the rationale behind heightened protection for brain data should be useful to clarify the functional and conceptual bases given for brain data protection and to provide a better grounding for evaluating how the different approaches to brain data protection address these concerns. (shrink)

The latest advances in quantum computing forced the National Institute of Standards and Technology (NIST) to launch an initiative for selecting quantum-resistant cryptographic algorithms. One of the best-known proposals is NewHope, an algorithm that was initially designed as a key exchange algorithm. In its original design, NewHope presented a reconciliation mechanism that is complex and represents an entry barrier for potential implementers. This contribution presents equivalent schemes in one, two and three dimensions, which allow anyone to make the transition to (...) the 4D NewHope algorithm easier to undertake. In addition to that, the effect of modifying some of the parameters associated to NewHope’s reconciliation mechanism is studied, which has allowed us to propose different sets of parameters that could increase the security of NewHope implementations. (shrink)

Se analizan las creencias y mitos de 30 jóvenes sobre los sentimientos de una mujer víctima de violencia de género. Se emplean como materiales los anuncios de una campaña gubernamental. Los resultados dibujan una víctima principalmente avergonzada o culpable; en segundo lugar triste e impotente, y en tercer lugar valiente y motivada. Además, sólo un 40% considera que los anuncios ayudan a la mujer. Se detecta una importante pervivencia del mito que responsabiliza a la víctima por ser incapaz de cambiar (...) su situación. Sin embargo, también se detecta un cuestionamiento de dicho mito, y una evolución hacia creencias menos distorsionadas. (shrink)

Sedlakova and Trachsel (2023) advocate for a holistic approach to assessing ethical application of conversational artificial intelligence (CAI) in mental health therapy. They first describe CAI as...

Design bioethics, as defined by Pavarini et al. is “purpose-built, technology-driven research tools” that provide “the chance to leverage technological advances at the interface of engin...

Nowadays, there is a quite considerable amount of literature on the use of analogy or more generally of inferences by parallel reasoning in contemporary legal reasoning, and particularly so within Common Law. These studies are often motivated by researches in artificial intelligence seeking to develop suitable software-support for legal reasoning. Recently; Rahman/Iqbal/Soufi (2020) developed a dialogical approach in the framework of Constructive Type Theory to what in Islamic Jurisprudence was called qiyās or correlational inferences. In their last chapter the authors (...) suggested that such an approach contributes to the study of patterns of reasoning by precedent cases within contemporary common Law. In the present paper we will further motivate the deployment within Civil and Common Law of the dialogical framework developed in Rahman/Iqbal/Soufi (2020). After a presentation of Scott Brewer's take on analogy within Common Law, that has striking structural similarities to reasoning by precedent case rooted in ratio legis (known in Islamic Jurisprudence as qiyās al-'illa or correlational inference by the occasioning factor), we will illustrate the implementation of the framework with a brief discussion of some cases of legal reasoning based in Spanish Civil Law but where the accent is put in the emerging ruling rather than in the existing of a case as in Common Law. Moreover; quite surprisingly, the case under study suggests that even cases of Law-interpretation fit the argumentation pattern of qiyās al-'illa. A caveat: in the present paper we will focus mainly in discussing the dynamics of the meaning constitution involved rather than in setting the rules of the underlying dialogical framework, the latter is the subject of a follow-up paper. (shrink)

McCradden et al. propose to close the “AI chasm” between algorithms and clinically meaningful application using the norms of evidence-based medicine and clinical research, with the rat...

Volume 20, Issue 10, October 2020, Page 79-81.

This article describes and proposes the “environmental subsidiarity principle” as a guiding ethical value in forestry governance. Different trends in environmental management such as local participation, decentralization or global governance have emerged in the last two decades at the global, national and local level. This article suggests that the conscious or unconscious application of subsidiarity has been the ruling principle that has allocated the level at which tasks have been assigned to different agents. Based on this hypothesis this paper describes (...) the principle of subsidiarity and its application to environmental policies within forest governance and proposes the “environmental subsidiarity” principle as a critical conceptual tool for sustainable resource management. The paper explains as an example how “environmental subsidiarity” is the key principle that can link payment for ecosystem services (PES) with environmental public policies and applies this principle with all its political consequences to reducing emissions from deforestation and forest degradation, and enhancing forest carbon stocks in developing countries (REDD+) architecture. It concludes by showing how the adoption of “environmental subsidiarity” as a ethical principle could help to maximize benefits to all stakeholders involved in PES schemes such as REDD+. (shrink)

We show how Berry phase can be used to construct a precision quantum thermometer. An important advantage of our scheme is that there is no need for the thermometer to acquire thermal equilibrium with the sample. This reduces measurement times and avoids precision limitations. We also discuss how such methods can be used to detect the Unruh effect.

This research presents an analysis of the learning strategies employed by students during confinement due to Covid-19 in the year 2021. The study sample consisted of 200 students from the Licenciado Benito Juárez García high school of the morning shift of the Benemérita Universidad Autónoma de Puebla. A survey was applied to measure the degree of satisfaction in relation to their use and impact on the acquisition of knowledge, allowing them to be more self-taught.The results show that the hypothesis was (...) partially fulfilled, since practice and organization are the learning strategies that most supported them in learning. (shrink)

IntroductionThe COVID-19 pandemic has forced changes in patient care in Mental Health Day Hospitals.ObjectivesTo study the interventions performed in MHDHs during the pandemic in comparison with those performed in other facilities and to analyze the new hospital admissions in both groups.MethodA retrospective multicenter cohort study comparing the interventions received by a group of 161 patients admitted in MHDHs during the lockdown period in Spain with the interventions of another group of 109 patients who were treated at other facilities during lockdown.ResultsMHDHs (...) reduced their face-to-face interventions during lockdown just as much as other facilities but implemented telematic intervention methods to a greater extent. Patients attached to MHDHs during lockdown were admitted significantly less and presented fewer urgent consultations in the following 6 months.ConclusionThe use of telepsychiatry made it feasible to adapt MHDHs to periods of lockdown, being useful to improve the continuity of care during the pandemic. In addition, it was possible to maintain a reduction in hospital admissions in patients treated at MHDHs. (shrink)

Background:There is growing awareness that patient care suffers when nurses are not respected. Therefore, to improve outcomes for patients, it is crucial that nurses operate in a moral work environment that involves both recognition respect, a form of respect that ought to be accorded to every single person, and appraisal respect, a recognition of the relative and contingent value of respect modulated by the relationships of the healthcare professionals in a determined context.Research question/aim:The purpose of this study was to develop (...) better understandings of perceptions of nursing’s professional respect in community and hospital settings in England.Research design:The research design was qualitative. Focus groups were chosen as the most appropriate method for eliciting discussion about nursing’s professional respect.Participants and research context:A total of 62 nurses who had been qualified for at least a year and were working in two localities in England participated in this study.Methods:Data were collected using 11 focus group sessions. The data were analysed by means of an inductive content analysis, extracting meaning units from the information retrieved and classifying the arising phenomena into conceptually meaningful categories and themes.Ethical considerations:To conduct the research, permission was obtained from the selected universities.Results:Recognition respect of human beings was perceived as ingrained in the innermost part of nurses. Regarding appraisal respect, a great importance was placed on: the interactions among healthcare professionals, the time to build trust in these relationships, the influences of the workplace characteristics and nurses’ professional autonomy and decision-making.Conclusion:Recognition respect of persons was embedded in the inmost part of nurses as individuals. Concerning appraisal respect, it was thought to be deeply enshrined in the inter- and intra-healthcare professional interactions. The forging of trusting relationships over time was deemed to be strongly associated with good quality interactions with other healthcare professionals. (shrink)

Identifying the expression of anger in a foreign language and reproducing it appropriately and precisely are skills whose relevance and lack of satisfying proposals have been pointed by research on the pedagogy of emotions (Dewaele, 2010; Toya & Kodis, 1996). This paper combines an identification of lacks in the pedagogy of emotional intonation with an analysis of spontaneous samples of anger as a basis to didactic guidelines for the introduction of the contextualized teaching of anger expression in Spanish. Through colloquial (...) samples, key features for the expression of anger in Spanish are identified. A selection of technical features is adapted in an accessible didactic proposal that is conformed of the stages of identification, induction of recurrent patterns, guided and free production. The proposal offered here is a starting point for the design of didactic units on emotional and expressive speech, an area that lacks didactic guidelines. (shrink)

En confrontación con las interpretaciones que asignan un significado religioso o teológico a las referencias a los dioses, a lo sagrado, o al “último dios” presentes en la obra de Martin Heidegger, este trabajo defiende una lectura en clave estrictamente ontológica de tales referencias. Para ello, se remite al diálogo que Heidegger mantiene con la poesía de Hölderlin y se argumenta que el significado que atribuye a la invocación hölderliniana a los “dioses huidos” depende del carácter ontológico que, en otro (...) contexto, concede a la nominación de los dioses característica del decir poético griego. Ese mismo carácter se pone de manifiesto en el sentido que, según Heidegger, ostenta la apelación a “lo sagrado” de la poesía de Hölderlin como nombre poético del ser en su despliegue histórico. Finalmente, dicha interpretación se hace extensiva a la figura del “último dios”, resaltando que su comprensión pasa por atender a la exégesis heideggeriana de la cuestión de la huida de los dioses en la obra poética de Hölderlin. (shrink)

This article explores the proposal offered by Ian Hacking for the distinction between natural and social sciences—a proposal that he has defined from the outset as complex and different from the traditional ones. Our objective is not only to present the path followed by Hacking’s distinction, but also to determine if it constitutes a novelty or not. For this purpose, we deemed it necessary to briefly introduce the core notions Hacking uses to establish his strategic approach to social sciences, under (...) the assumption that they are less well known that the ones corresponding to his treatment of natural sciences. (shrink)

While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts (...) in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

Background: Pain has been associated with structural changes of the brain. However, evidence regarding white matter changes in response to acute pain protocols is still scarce. In the present study, we assess the existence of differences in brain white matter related to pain intensity reported by patients undergoing surgical removal of a mandibular impacted third molar using diffusion tensor imaging analysis.Methods: 30 participants reported their subjective pain using a visual analog scale at three postsurgical stages: under anesthesia, in pain, and (...) after the administration of an analgesic. The diffusion data were acquired prior to surgery.Results: DTI analysis yielded significant positive associations of fractional anisotropy in white matter areas related to pain processing with the differences in pain between the three postsurgery stages. Extent and location of these associations depended on the magnitude of the subjective pain differences. Tractography analysis indicated that some pain–tract associations are significant only when pain stage is involved in the contrast, while others are only when anesthesia is involved in the contrast.Conclusions: The association of white matter fractional anisotropy and connectivity, measured before the pain stages, with subjective pain depends on the magnitude of the differences in pain scores. (shrink)

In April 2015, an international team of researchers announced the measurement, for the first time, of the first ionization energy of lawrencium, a superheavy element of atomic number 103. The experimental result, published in the prestigious scientific journal Nature, led to the reopening of a long-standing debate that concerns the elements that should be part of group 3 of the periodic table. The aim of this paper is to introduce a new line of argumentation to elucidate this problem.

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a (...) positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. (shrink)

Introduction: The Binge Eating Scale (BES) is a widely-used self-report questionnaire to identify compulsive eaters. However, research on the dimensions and psychometric properties of the BES is limited. Objective: The aim of this study was to examine the properties of the Spanish version of the BES. Method: Confirmatory Factor Analyses (CFAs) were carried out to verify the BES factor structure in a sample of Spanish college students (N = 428, 75.7% women; age range = 18–30). An invariance measurement routine was (...) carried out across sexes, the latent means were compared, and estimates of reliability and convergent and discriminant validity were presented. Results: A one-factor model fit the data best and was also equivalent between sexes. The scalar invariance model showed statistically significant differences across sexes, with a higher prevalence in women. Regarding reliability, the results were excellent. Finally, high statistically significant correlations were obtained with other measures of binge eating (BE), food addiction, impulsivity, binge drinking, and body mass index (BMI). Conclusions: The Spanish 16-item BES is a valid and reliable scale to evaluate BE in the youth population. (shrink)

Este trabajo parte de la pregunta por la posibilidad de deducir un planteamiento estrictamente político de los análisis ontológicos de la modernidad llevados a cabo por Martin Heidegger. Con este fin, se examina su interpretación del fenómeno griego de la pólis, así como la distinción que en ella se establece entre esta forma de comunidad y el Estado moderno, fundado para Heidegger en la esencia metafísica de la modernidad. Para clarificar esta cuestión se atiende a la proclamación de valores que (...) Heidegger observa en los diferentes modos de organización estatal que aparecen en la época de la consumación técnica de la metafísica. En conexión con ello, se estudia su visión del nihilismo y se ofrece finalmente una hipótesis sobre la forma de Estado que resultaría coherente con la renuncia a los valores que, a su juicio, exige la manifestación del ente en la modernidad como objeto por entero producible. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)