Background:Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety.Objectives:The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute (...) to moral distress in undergraduate student nurses during their clinical experience and professional education.Research design:The research design was a systematic literature review.Method:The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check.Ethical consideration:Since this was a systematic review, no ethical approval was required.Findings:From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses.Conclusion:Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students. (shrink)

In recent years, scholars have sought to investigate the impact that ethical leaders can have within organisations. Yet, only a few theoretical perspectives have been adopted to explain how ethical leaders influence subordinate outcomes. This study therefore draws on social rules theory (SRT) to extend our understanding of the mechanisms linking ethical leadership to employee attitudes. We argue that ethical leaders reduce disengagement, which in turn promotes higher levels of job satisfaction and organisational commitment, as well as lower turnover intentions. (...) Co-worker social undermining is examined as a moderator of the relationship between ethical leadership and disengagement, as we suggest that it is difficult for ethical leaders to be effective when co-worker undermining prevails. To test the proposed model, questionnaires were administered to 460 nurses in Romanian hospital settings over three time points separated by two-week intervals and the hypotheses were tested using generalised multilevel structural equation modeling (GSEM) with STATA. The findings revealed that ethical leadership has a beneficial effect on employee attitudes by reducing disengagement. However, the relationship between ethical leadership and disengagement was moderated by co-worker social undermining, such that when undermining was higher, the significance of the mediated relationships disappeared. These results suggest that while ethical leaders can promote positive employee attitudes, their effectiveness is reduced in situations where co-worker undermining exists. (shrink)

The physician’s duty of confidentiality is based on the observance of the patient’s privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients’ data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. The (...) present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital. The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices. (shrink)

In early March 2014, some of the members of Culture on the Edge—a scholarly research collaboration of seven scholars of religion, interested in more theoretically sophisticated studies of identity, and all of whom are at different career stages and at a variety of North American institutions—had a conversation online on the use of the terms “critique” and “critical,” terms widely used in the field today but employed in such a variety of ways that the members of the group thought it (...) worthwhile to focus some attention on them. What follows is the transcript of their conversation. (shrink)

Background Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health. Methods A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (ethics) AND (...) (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review. Results Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners’ access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights. Conclusions Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons. (shrink)

The voices of children and young people have been largely neglected in discussions of the extent to which the internet takes into account their needs and concerns. This paper aims to highlight young people’s lived experiences of being online.

By drawing on a selection of interviews from the website Engaged Philosophy, this paper highlights the work of philosopher-activists within their classrooms and communities. These philosophers have stepped out of the ivory towers and work directly with media, community and political groups, people in prison; or they encourage their students to engage in activist projects. The variety of approaches presented here shows the many ways philosophically inspired activism can give voice to those who are marginalized, shine a light on injustices, (...) expose the root of social problems, and empower others to seek solutions. This work shows the relevance of philosophy to practical problems and the powerful effects it can have in the world. (shrink)

Communication about diagnosis and medical treatment for children suffering from life-threatening illnesses is complex. It is a primary step in involving underage patients and families in care and lays the foundation for obtaining parental permission and patient assent for treatment. In practice child participation in care is often difficult to obtain due to patients' different and sometimes fluctuating preferences, but also parents' protective strategies. Physicians may be susceptible to parental wishes to limit information and feel uncomfortable discussing issues related to (...) uncertainty of cure with patients. A qualitative study in Romanian paediatric oncology units was conducted to explore children's involvement from the perspectives of parents and oncologists. Interviews with participants discussed 18 patient cases. Data were transcribed and thematic analysis was used to interpret and mine patients' involvement during treatment. Different facets of patient participation were identified: restricting, widening and enhancing involvement. A fourth category, unintentional involvement, occurred for all patients due to children's observations during long-term hospitalisations and access to Internet. Uncertainty overarched parental attitudes regarding the extent to which children should be included. Physicians usually complied with parental wishes to limit involvement, but together with parents involved patients at least in a practical way. Adults' protective attitude may backfire, as adolescents' online searches often expose patients to worse-case scenarios. Further research should acknowledge the hazards of restricted diagnosis disclosure and develop clinician tools to support families in communicating with patients. This should be paralleled by physician efforts to elicit patients' needs regarding participation. (shrink)

BackgroundRespect for confidentiality is important to safeguard the well-being of patients and ensure the confidence of society in the doctor-patient relationship. The aim of our study is to examine real situations in which there has been a breach of confidentiality, by means of direct observation in clinical practice.MethodsBy means of direct observation, our study examines real situations in which there has been a breach of confidentiality in a tertiary hospital. To observe and collect data on these situations, we recruited students (...) enrolled in the Medical Degree Program at the University of Cordoba. The observers recorded their entries on standardized templates during clinical internships in different departments: Internal Medicine; Gynecology and Obstetrics; Pediatrics; Emergency Medicine; General and Digestive Surgery; Maxillofacial Surgery; Plastic Surgery; Orthopedics and Traumatology; Digestive; Dermatology; Rheumatology; Mental Health; Nephrology; Pneumology; Neurology; and Ophthalmology.ResultsFollowing 7138 days and 33157 h of observation, we found an estimated Frequency Index of one breach per 62.5 h. As regards the typology of the observed breaches, the most frequent were related to the consultation and/or disclosure of clinical and/or personal data to medical personnel not involved in the patient’s clinical care, as well as people external to the hospital. As regards their severity, severe breaches were the most frequent, accounting for 46.7 % of all incidents. Most of the reported incidents were observed in public areas, such as corridors, elevators, the cafeteria, stairs, and locker rooms.ConclusionsIn addition to aspects related to hospital organization or infrastructure, we have shown that all healthcare personnel are involved in confidentiality breaches, especially physicians. While most are committed unintentionally, a non-negligible number are severe, repeated breaches, thus suggesting a certain carelessness, perhaps through ignorance about certain behaviors that can jeopardize patient confidentiality. (shrink)

O presente artigo trata da relação entre teoria e prática no pensamento de Theodor W. Adorno com o objetivo de analisar as possibilidades de emancipação do sujeito no âmbito da sociedade capitalista contemporânea, questionando sobre um suposto pessimismo do autor. Para tanto, serão contextualizadas as relações entre sujeito e objeto, natureza e razão, teoria e prática e formação e semiformação, com a finalidade de pensar a importância fundamental da teoria para a transformação do mundo a partir de uma análise crítica (...) da sociedade, bem como a pertinência dessa análise ao atual momento brasileiro. A transformação do mundo será pensada a partir das possibilidades de emancipação do sujeito e o papel da formação humana nesse processo no interior de um modelo educacional cada vez mais determinados pelos interesses do capital que direcionam a educação a aspectos meramente práticos de adaptação ao mercado de trabalho. A conclusão aponta no sentido da necessidade imperativa da manutenção da formação teórica e crítica diante dos constrangimentos de ordem prática de um mundo administrado pelos valores capitalistas. Palavras-chave: Theodor W. Adorno. Relação teoria e prática. Semiformação. Pessimismo teórico. Critical Theory and Educational Practice: On the relationship between theoretical pessimism and the transformation of the world to T.W. Adorno Abstract: This article deals with the relationship between theory and practice in the thought of Theodor W. Adorno with the aim of analyzing the possibilities of the subject's emancipation in the context of contemporary capitalist society, questioning the author's supposed pessimism. Therefore, the relationships between subject and object, nature and reason, theory and practice, and Bildung and Halbbildung will be contextualized, with the purpose of thinking about the fundamental importance of theory for the transformation of the world from a thought marked by a critical analysis of the society, as well as the relevance of this analysis to the current Brazilian moment. The transformation of the world will be thought from the possibilities of emancipation of the subject and the role of human formation in this process within an educational model increasingly determined by the interests of capital that led education to merely practical aspects of adaptation to the labor market. The conclusion points towards the imperative need to maintain theoretical and critical education in the face of practical constraints in a world managed by capitalist values. Key-words: Theodor W. Adorno. Theory and practice relationship. Semi-formation. Theoretical pessimism. Teoría, Crítica y Práctica Educativa: Sobre La Relación Entre Pesimismo Teórico Y Transformación Del Mundo En T.W. Adorno Resumen: Este artículo aborda la relación entre teoría y práctica en el pensamiento de Theodor W. Adorno con el objetivo de analizar las posibilidades de emancipación del sujeto en el contexto de la sociedad capitalista contemporánea, cuestionando el supuesto pesimismo del autor. Para eso, se contextualizarán las relaciones entre sujeto y objeto, naturaleza y razón, teoría y práctica, y formación y semiformación, con el propósito de pensar la importancia fundamental de la teoría para la transformación del mundo a partir de una análisis crítica de la sociedad, así como la relevancia de este análisis para el momento brasileño actual. La transformación del mundo se pensará desde las posibilidades de emancipación del sujeto y el papel de la formación humana en este proceso dentro de un modelo educativo cada vez más determinado por los intereses del capital que dirigen la educación a aspectos meramente prácticos de adaptación al mercado laboral. La conclusión apunta hacia la imperiosa necesidad de mantener una formación teórica y crítica frente a las limitaciones prácticas en un mundo gestionado por valores capitalistas. Palabras-clave: Theodor W. Adorno. Relación teoría y práctica. Semiformación. Pesimismo teórico. Data de registro: 08/09/2021 Data de aceite: 19/01/2022. (shrink)

The spatial-temporal association indicates that time is represented spatially along a left-to-right line. It is unclear whether the spatial-temporal association is mainly related to a perceptual or a motor component. In addition, the spatial-temporal association is not consistently found using a time reproduction task. Our rationale for this finding is that, classically, a non-lateralized button for performing the task has been used. Using two lateralized response buttons, the aim of the study was to find a spatial-temporal association in a time (...) reproduction task. To account for the perceptual component, reference and target stimuli were presented in different spaces through four experiments. In all experiments, a Spatial-Temporal Association of Response Codes (STEARC) effect was found and this effect was not modulated by the spatial position of both reference and target stimuli. The results suggested that the spatial-temporal association was mainly derived from the spatial information provided by response buttons, reflecting a motor but not visuospatial influence. (shrink)

Resumen: Este artículo se propone configurar la trama saber-tropo como estrategia para desvelar ataduras coloniales que aún persisten en las vidas cotidianas de sujetos situados y encarnados, cuyas existencias se desarrollan en condiciones de precariedad material, exclusión, explotación y no reconocimiento. Con un marcado carácter epistémico-metodológico, y tomando como base los postulados de la tropología, se discute sobre la noción de tropo y saber, además de señalar las posibles relaciones que entre ellos se pueden dar, para finalmente, en términos demostrativos, (...) plantear un procedimiento orientado a identificar y analizar los tropos que permiten ir desvelando lastres coloniales en las narraciones cotidianas. La relevancia de esta propuesta se asienta en la necesidad de ir avanzado en construir herramientas metodológicas que permitan comprender los principios que configuran el pensamiento decolonial. Desde allí, se propone al tropo como expresión y discusión figurativa del saber, debido a que este puede ser utilizado persuasivamente para afectar la forma en que se habita el mundo, al tiempo que permite comprender el accionar social y, consecuentemente, las matrices coloniales con las que debemos romper.: This article proposes to configure knowledge-trope plot as a strategy to uncover colonial ties that persist in the daily lives of situated and incarnated subjects, whose existences develop in conditions of material precariousness, exclusion, exploitation and non-recognition. With a marked epistemic-methodological character, and based on the postulates of the tropology, the notion of trope and knowledge is discussed, as well as pointing out the possible relationships that can occur between them, and finally, in demonstrative terms, to propose a procedure aimed at identifying and analysing the tropes that allow us to reveal colonial ballasts in everyday narratives. The relevance of this proposal is based on the need to construct methodological tools that allow us to understand the principles of decolonial thinking. From there, the trope is proposed as an expression and figurative discussion of knowledge, because it can be used persuasively to affect the way in which the world is inhabited, while at the same time it allows us to understand social action and, consequently, colonial matrices with which we must break. (shrink)

Developing country efforts to enforce basic public health standards are often hindered by limited agency resources and poorly designed enforcement mechanisms, including excessive reliance on slow and erratic judicial systems. Traditional public health regulation can therefore be difficult to implement. This article examines innovative approaches to the implementation of public health regulations that have emerged in recent years within the OECD countries. These approaches aim to improve compliance with health standards among the different actors while reducing dependence on the legal (...) system and the administrative resources of public health agencies in developing countries. Developing countries may find some useful lessons from these approaches that can be adapted for use in their own institutional settings. (shrink)

The objective of this study was to address the paradox of citizenship cost by hypothesizing an indirect rather than a direct effect of altruistic citizenship behavior on employee work–family conflict through coworker support. Data were gathered in a three-wave longitudinal survey of employees from private commercial banks. A multiple linear autoregressive longitudinal mediation model was analyzed with partial least squares structural equation modeling. The results indicate that rather than directly, ACB affects indirectly employee WFC through CWS. This indirect effect is (...) negative, which reflects that the costs of citizenship behavior are paradoxical. The present study contributes to the ongoing debate on the positive and negative outcomes of employee citizenship behavior by providing empirical evidence on the beneficial rather than harmful effect of performing such behavior. For organizational managers, promoting a culture of CWS by encouraging altruistic behaviors can be a most viable strategy to reduce WFC among their employees. The study discusses its limitations and provides future research directions. (shrink)

The centromere is a specialized chromosomal structure that dictates kinetochore assembly and, thus, is essential for accurate chromosome segregation. Centromere identity is determined epigenetically by the presence of a centromere‐specific histone H3 variant, CENP‐A, that replaces canonical H3 in centromeric chromatin. Here, we discuss recent work by Roulland et al. that identifies structural elements of the nucleosome as essential determinants of centromere function. In particular, CENP‐A nucleosomes have flexible DNA ends due to the short αN helix of CENP‐A. The higher (...) flexibility of the DNA ends of centromeric nucleosomes impairs binding of linker histones H1, while it facilitates binding of other essential centromeric proteins, such as CENP‐C, and is required for mitotic fidelity. This work extends previous observations indicating that the differential structural properties of CENP‐A nucleosomes are on the basis of its contribution to centromere identity and function. Here, we discuss the implications of this work and the questions arising from it. (shrink)

Desde una perspectiva transnacional y comparada, que incorpora la experiencia del exilio, este trabajo analiza las tensiones identitarias que afectaron a la juventud militante de la izquierda revolucionaria española y argentina durante los años setenta. A través de las relaciones familiares y de género, estudia las formas públicas y privadas del compromiso y la transgresión. Aborda cómo la politización de lo privado marcó a hombres y mujeres dentro de un proceso global contestatario, heredero del 68, para destacar las contradicciones que (...) afloraron entre la teoría y la práctica, el deseo y la realidad, que llevaron a los jóvenes militantes a asumir un régimen emocional en constante debate entre el ser y el deber ser. (shrink)

This study tests the hypothesis that university professors (lecturers) (in the U.S. and Spain) with different money profiles (based on Factors Success, Budget, Motivator, Equity, and Evil of the Love of Money Scale) will differ in work-related attitudes and satisfaction. Results suggested that Achieving Money Worshipers (with high scores on Factors Success, Motivator, Equity, and Budget) had high income, Work Ethic, and high satisfaction with pay level, pay administration, and internal equity comparison but low satisfaction with external equity comparison. Careless (...) Money Admirers (high Success but low Budget) had low intrinsic job satisfaction and low satisfaction with pay level and life. Apathetic Money Managers (low Evil and low Motivator) had the highest intrinsic job satisfaction and life satisfaction. Money Repellent Individuals (high Evil and low Success) had low income, work experience, Work Ethic, and low satisfaction with pay administration. Money does not provide the same motivation for people in all four money profiles. Results are discussed in light of the effectiveness of using money to reward people with different money profiles, intrinsic motivation, and unethical behavior. (shrink)

As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey aimed (...) at assessing public views on when a life is not worth living, in an effort to inform ongoing legal and clinical debates about withdrawal of life-sustaining treatment for children. These findings raise important questions about how we define and measure outcomes that matter to parents as they make these tragic decisions. It is challenging to interpret these findings in the absence of context of how decision-making for infants occurs in real-time. The nature of this study and its objective required that cases be substantially simplified. As the authors acknowledge, the prognoses and function of the children involved in these cases were often deeply contested. Prognostic uncertainty is common for children with significant …. (shrink)

Representation is integral to the functioning and legitimacy of modern government. Yet political theorists have often been reluctant to engage directly with questions of representation, and empirical political scientists have closed down such questions by making representation synonymous with congruence. Conceptually unproblematic and normatively inert for some, representation has been deemed impossible to pin down analytically and to defend normatively by others. But this is changing. Political theorists are now turning to political representation as a subject worthy of theoretical investigation (...) in its own right. In their effort to rework the theory of political representation, they are also hoping to impact how representation is assessed and studied empirically. This volume gathers together chapters by key contributors to what amounts to a "representative turn" in political theory. Their approaches and emphases are diverse, but taken together they represent a compelling and original attempt at re-conceptualizing political representation and critically assessing the main theoretical and political implications following from this, namely for how we conceive and assess representative democracy. Each contributor is invited to look back and ahead on the transformations to democratic self-government introduced by the theory and practice of political representation. Representation and democracy: outright conflict, uneasy cohabitation, or reciprocal constitutiveness? For those who think democracy would be better without representation, this volume is a must-read: it will question their assumptions, while also exploring some of the reasons for their discomfort. Reclaiming Representation is essential reading for scholars and graduate researchers committed to staying on top of new developments in the field. (shrink)

The term ‘vitalism’ is most readily associated with a series of debates among 18th- and 19th-century biologists, and broadly with the claim that the explanation of living phenomena is not compatible with, or is not exhausted by, the principles of basic sciences like physics and chemistry. Scientists and philosophers have continued to address vitalism - mostly in order to reject it - well into the second half of the 20th century, in connection with classic concepts such as mechanism, reductionism, emergence, (...) complexity and artificial intelligence, and in connection with approaches such as information theory and cybernetics. This article problematizes and transforms the claim that vitalism is obsolete by evaluating it diachronically, in the spirit of the historian and philosopher of medicine, Georges Canguilhem. It discusses the contrast between classical vitalism and Canguilhem’s own claim that vitalism is ‘an imperative rather than a method and more of an ethical system, perhaps, than a theory’. At the same time, it argues that Canguilhem’s position cannot be reduced to a ‘polemical vitalism’ devoid of compromising references to reality or ontology. In relation to contemporary forms of engagement between social theory and biotechnoscience, Canguilhem’s vitalism continues to provide the critical corrective that is proper to its ‘vitality’. (shrink)

Through cultural transmission, repeated learning by new individuals transforms cultural information, which tends to become increasingly compressible . Existing diffusion chain studies include in their design two processes that could be responsible for this tendency: learning and reproducing . This paper manipulates the presence of learning in a simple iterated drawing design experiment. We find that learning seems to be the causal factor behind the increase in compressibility observed in the transmitted information, while reproducing is a source of random heritable (...) innovations. Only a theory invoking these two aspects of cultural learning will be able to explain human culture's fundamental balance between stability and innovation. (shrink)

Gadamer's Ethics of Play examines the ethical dimensions of understanding by focusing on the concept of dialogical "play" in Hans-Georg Gadamer's Truth and Method. The book is accessible to an undergraduate audience, while also being relevant to ongoing debates among Gadamer scholars.

In the paper “Categoricity in abstract elementary classes with no maximal models”, we address gaps in Saharon Shelah and Andrés Villavecesʼ proof in [4] of the uniqueness of limit models of cardinality μ in λ-categorical abstract elementary classes with no maximal models, where λ is some cardinal larger than μ. Both [4] and [5] employ set theoretic assumptions, namely GCH and Φμ+μ+).Recently, Tapani Hyttinen pointed out a problem in an early draft of [3] to Villaveces. This problem stems from the (...) proof in Shelah and Villavecesʼ [4] that reduced towers are continuous. Residues of this problem also infect the proof of Proposition II.7.2 in VanDieren [5]. We respond to the issues in Shelah and Villaveces [4] and VanDieren [5] with alternative proofs under the strengthened assumption that the abstract elementary class is categorical in μ+. (shrink)

Discussions of the framework and terminology associated with the right to health tend to treat the indeterminacy of ‘health’ as conceptual noise that the construction of effective policy must not focus on, but find ways of bracketing out. On this basis, the right to health is broadly regarded as a social and economic, rather than a civil and political right. This article draws critically on literature about the implications of developments in medical biotechnologies, to argue that a positive acknowledgement of (...) the indeterminate character of health should transform, rather than simply hinder, the quality of debate over what is to be understood and expected in connection with a right to health. A focus on indeterminacy allows for the perception and the formulation of health-related demands that may not stem from the scarcity of material resources or technical means, but from the misplaced authority of particular voices in defining what possibilities are to be seriously envisaged. This proposition only becomes politically effective, it is argued, when ‘indeterminacy’ (and the capacity for normativity) is referred to life itself and not merely to social and moral judgements about life. Although more immediately pertinent to the concerns of relatively privileged populations, the focus on indeterminacy provides a key to generating a certain symmetry and complementarity of interest, across the privileged/underprivileged divide, in promoting health as a (human) right. (shrink)