The first lines of defense during an epidemic are behavioral interventions, including stay-at-home measures or precautionary health training, aimed at reducing contact and disease transmission. Examining the psychosocial variables that may lead to greater adoption of such precautionary behaviors is critical. The present study examines predictors of precautionary practices against coronavirus disease 2019 in 709 Mexican participants from 24 states. The study was conducted via online questionnaire between the end of March and the beginning of April 2020, when the pandemic (...) response was in its initial stages in Mexico. The instrument included demographic items, as well as scales assessing COVID-19-resembling symptoms, empathy, impulsivity, anhedonic depression, general health practices, alcohol consumption, and COVID-19-associated precautionary behaviors. Most participants reported adopting limited social distancing or other precautionary behaviors against COVID-19. The results of a structural equation model demonstrated that the presence of COVID-19 symptoms was related to impulsivity and general health behaviors. However, no direct association between precautionary behaviors and the presence of COVID-19 symptoms was found. In turn, precautionary behaviors were more prevalent among participants who reported higher empathy and general health behaviors and were inhibited indirectly by impulsivity via alcohol consumption. Furthermore, the model suggests that anhedonic depression symptoms have a negative indirect effect on precautionary behaviors via general health behaviors. Finally, impulsivity showed a negative direct effect on general health behavior. These results highlight the role that general physical health and mental health play on precautionary behavior and the critical importance of addressing issues such as depression, general health behaviors, and impulsivity in promoting safe actions and the protection of self and others. (shrink)

Theoretically, a positive environment (PE) includes (a) tangible and intangible resources that satisfy human needs, (b) enablers of healthy, pro-social, and pro-environmental behaviors that guarantee socio-environmental quality and wellbeing, and (c) environmental challenges that must be faced and solved. One of the most salient challenges is the global COVID-19 pandemic. This study sought to investigate whether PEs can stimulate responsible actions (i.e., self-care and precautionary behaviors against COVID-19), while maintaining personal wellbeing. Nine hundred and forty-nine Mexicans participated in an online (...) survey encompassing five primary factors: resources, enablers, challenges, responsible health behaviors, and wellbeing. The first three factors examine “resources” such as physical infrastructure as well as family and social support, “enablers” which include information about protective health practices and perceived legitimacy of authorities in handling the pandemic, and “challenges” encompassing threat perception and social pressure to not engage in precautionary measures. Participants also self-reported hedonic wellbeing as well as self-care and precautionary behaviors, which formed the “responsible (health) behavior” factor. Structural equations model (n= 714 after list-wise deletion) showed that “resources,” “challenges,” and “enablers” form a second-order factor, “positive environments,” and this factor strongly covaries with “responsible behavior” and “wellbeing.” These results suggest that PEs are not only buffers against the negative impact of the COVID-19 pandemic but can also stimulate effective responses against a threat while maintaining individual wellbeing. These results can be used to inform the development and maintenance of PE frameworks aimed at minimizing the spread of COVID-19 and encouraging mental and physical health. (shrink)

The Emergent Metaphysics in Plato's Theory of Disorder presents for the first time Plato's theory of disorder as it pertains to his understanding of powerful causal forces at work within and outwith the cosmos and the soul of man. Divided into two Parts and presenting passages in both Greek and English, Plato's cosmology, the Timaeus, and his chief theological work, Laws X, are discussed in detail.

El presente trabajo busca establecer conexiones entre los diagnósticos del arte en la sociedad por parte de Benjamin, Rancière y Perniola para entender la crisis estética contemporánea caracterizada por ser un régimen del sentir impersonal. Para ello, se busca esclarecer el concepto de aura de Benjamin y establecer una conexión con el arte y la política que será amplificada con Rancière. El artículo abordará las causas de la falta de autonomía de la estética contemporánea, mencionadas por Perniola, para ver de (...) qué manera es posible la emancipación del espectador al jugar con lo vacío, lo indecible o con la sombra del arte. (shrink)

Sabemos que desde una perspectiva científica, al activar determinados estímulos musicales se produce una activación a nivel cerebral. Con las agrupaciones musicales escolares se requiere previamente activar las técnicas de audición e interpretación de forma individual para lograr en el grupo, aptitudes motoras, perceptivas, cognitivas y activar procesos afectivos y de socialización. De esta forma, la atención a la diversidad no quedaría excluida. La música, en definitiva, favorece el desarrollo de la persona en todas sus dimensiones, lo cual redunda en (...) una mejora de la calidad de vida y es un gran avance a nivel personal, familiar, escolar, clínico y social. La actividad musical es como un sistema de introducción en el marco cultural insustituible. (shrink)

Recent work suggests a strong connection between intuitions regarding our own free will and our moral behavior. We investigate the origins of this link by asking whether preschool-aged children construe their own moral actions as freely chosen. We gave children the option to make three moral/social choices (avoiding harm to another, following a rule, and following peer behavior) and then asked them to retrospect as to whether they were free to have done otherwise. When given the choice to act (either (...) morally or immorally), children avoided harm and abided by rules, but they endorsed their freedom to have done otherwise. When choice was restricted by adult instruction, children did not endorse their free choice and indicated feeling constrained by moral obligation in their explanatory responses. These results suggest that children believe that their moral actions afford free will, but this belief is dependent on their experience of choice. (shrink)

Notwithstanding the potential danger to security and privacy, sharing and publishing data has become usual in Data Science. To preserve privacy, de-identification methodologies guided by risk estimation have been designed. Two issues associated with classical risk metrics are, on the one hand, the adequacy of the metric and, on the other hand, its static nature. In this paper, we present metrics for estimating risk based on the emerging semantics provided by Formal Concept Analysis. The metrics are designed to estimate the (...) a priori risk of compromised data deletion. Furthermore, by applying specialized variable forgetting methods for association rules, it is shown how to reflect the effect of deleting attributes belonging to potentially dangerous quasi-identifier sets. Additionally, a study of the role of the risk metric in confidence-based reasoning for re-identification is presented. (shrink)

The most recent work by Jürgen Habermas tries to revalue religion in today's society. For this he tries to find genealogical connections between secular content and the worldviews that emerged in the Axial Age, including Jewish monotheism. In this article we try to propose that a genealogical approach to monotheism from the perspective of those involved would have to start from the context of undetected origin that constitutes the ethical universalism of Judaism: the Noahide code. To do this, we analyze (...) narrative and conceptual elements of axial and non-axial cultures and show their parallels with the seven laws of the children of Noah as the moral core of humanity. (shrink)

Recent work has shown that preschool-aged children and adults understand freedom of choice regardless of culture, but that adults across cultures differ in perceiving social obligations as constraints on action. To investigate the development of these cultural differences and universalities, we interviewed school-aged children (4–11) in Nepal and the United States regarding beliefs about people's freedom of choice and constraint to follow preferences, perform impossible acts, and break social obligations. Children across cultures and ages universally endorsed the choice to follow (...) preferences but not to perform impossible acts. Age and culture effects also emerged: Young children in both cultures viewed social obligations as constraints on action, but American children did so less as they aged. These findings suggest that while basic notions of free choice are universal, recognitions of social obligations as constraints on action may be culturally learned. (shrink)

This article conceptualizes corporate accountability under international law and introduces an analytical framework translating corporate accountability into seven core elements. Using this analytical framework, it then systematically assesses four models that could be used in a future business and human rights treaty: the United Nations Guiding Principles on Business and Human Rights model, the Universal Declaration of Human Rights model, the progressive model, and the transformative model. It aims to contribute to the BHR treaty negotiation process by clarifying different options (...) and possible trade-offs between them, while taking into account political realities. Ultimately, the article argues in favour of the BHR treaty embracing a progressive model of corporate accountability, which combines ambitious development of international law with realistic prospects of state support. (shrink)

Earlier this year, the U.S. Department of Health and Human Services announced its intent to strengthen enforcement of legal protections for health care providers' conscience rights. It proposed regulations that would give the DHHS Office of Civil Rights greater authority to ensure that recipients of federal funding comply with federal conscience laws. This recent development creates an opportunity for scholars and policy‐makers to revisit the perennial debate about whether and how law should protect health care providers' rights of conscience. Arguments (...) about who should be protected, what actions should be protected, and whether there should be any limitations on the exercise of conscience rights have brought us no closer to a resolution. However, there is one remaining avenue for analysis that has, surprisingly, received very little attention—the question of how providers are protected, and from what consequences. Existing U.S. conscience laws immunize health care providers from a wide range of adverse consequences—including civil liability, criminal prosecution, administrative penalties, adverse action by employers, and discrimination by private actors, among others. However, academic and public policy debates rarely acknowledge the breadth of these protections. It is essential to disentangle this network of possible protections. (shrink)

The present paper tries to answer the question Is religious education compatible with the purposes of liberal education? This work argues that it is possible, and desirable, that democratic states built on liberal ideals include religious education in all schools since increasing the number of options among which the future citizen may choose the conception of the good with which he or she wishes to live is a condition for autonomy as one of its educational purposes. However, the proposal is (...) not based on religious confessional education, which by itself does not satisfy the liberal educational goals, but is redefined from the common principles compatible both religious confessions and non-religious views of morality and citizenship. (shrink)

The objective of this article is to provide a discussion that counters the infinite particle disappearance conclusion argued by Shackel, 417–433, 2018). In order to do this, clear criteria to disprove the results of the applications of his continuity principles are provided, in addition to the consideration of the fundamental Classical Mechanical principle of mass conservation as an independent and clear basis for this disproof.

In a number of very influential publications, Epstein and Hoover (among other authors) have recently argued that a thoroughly micro-foundationalist approach towards economics is unconvincing for metaphysical reasons. However, as we show in this article, this metaphysical/social ontological approach to the debate fails to resolve the status of micro-foundations in the practice of economic modelling. To overcome this, we argue that endogenizing a model—that is, providing micro-foundations for it—correlates with making that model more complex. Specifically, we show that models with (...) more micro-foundations tend to have more parameters or variables. This matters, as there are well-established methodological reasons for preferring models with fewer parameters or variables—ceteris paribus. We therefore conclude that, from a practice-based point of view, micro-foundations are only defensible to the extent that they significantly improve the ability of the relevant model to fit the data of interest. In this way, we arrive at a practice-based, methodological reconceptualization of the debate surrounding the need for micro-foundations in economics. (shrink)

Se realizó un diagnóstico de la autonomía biótica en pacientes oncológicos, evidenciando que la mayoría no conocen, y no comprenden la carta de CI afectando la autonomía bioética. Ante esta problemática este proyecto crea dos cuadernillos uno para niños y uno para adultos. Estos cuadernillos parten y responden al reconocimiento de la condición del paciente, sus afectaciones cognitivas y emocionales, su nivel de escolaridad y su nivel de comprensión lectora. Los cuadernillos centrados en estrategias de comprensión lectora, incluyen actividades dialógicas (...) y de reconocimiento emocional para apoyar los procesos de comprensión del CI. (shrink)

This paper investigates the formation and propagation of wavefunction `branches' through the process of entanglement with the environment. While this process is a consequence of unitary dynamics, and hence significant to many if not all approaches to quantum theory, it plays a central role in many recent articulations of the Everett or `many worlds' interpretation. A highly idealized model of a locally interacting system and environment is described, and investigated in several situations in which branching occurs, including those involving Bell (...) inequality violating correlations; we illustrate how any non-locality is compatible with the locality of the dynamics. Although branching is particularly important for many worlds quantum theory, we take a neutral stance here, simply tracing out the consequences of a unitary dynamics. The overall goals are to provide a simple concrete realization of the quantum physics of branch formation, and especially to emphasise the compatibility of branching with relativity; the paper is intended to illuminate matters both for foundational work, and for the application of quantum theory to non-isolated systems. (shrink)

The COVID-19 emergency has hit the whole world, finding all countries unprepared to face it. The first studies focused on the medical aspects, neglecting the psychological dimension of the populations that were forced to face changes in everyday life and in some cases to stay forcedly at home in order to reduce contagion. The present research was carried out in Italy, one of the countries hardest hit by the pandemic. The aim was to analyze the perception of happiness, mental health, (...) and the sense of loneliness experienced by adults during the lockdown due to the COVID pandemic. Specifically, the variables will be examined in relation to gender difference, living alone, with partner, or with partner and children. The research followed a quantitative approach using an online questionnaire. The project involved 1100 subjects from whom 721 participants were extrapolated. Of them, 17.3% claimed to live alone, 39.5% with their partner, and 43.1% with their partner and children. The results show that people in general experienced a lower level of happiness and mental health and higher levels of loneliness compared to normative sample. The lockdown and pandemic condition due to COVID-19 seems to have canceled the gender differences in the perception of happiness and mental health, while it seems to have increased the perception of loneliness experienced by males compared to the pre-pandemic condition. In addition, those who lived alone perceived a greater level of loneliness than those who lived with their partner or partner and children. Unexpectedly, no significant differences emerged regarding the level of happiness and mental health between those who had direct contact with the virus and those who did not. These data should make political decision-makers reflect on the need to pay more attention to the implications that such drastic measures as a lockdown can have on people’s psychological well-being. (shrink)

In view of recent studies that identified certain interest groups as potential whistleblowers, we propose an integrative conceptual framework to examine whistleblower behavior by whistleblower type. The framework, dubbed the whistleblowing triangle, is modeled on the fraud triangle and is comprised of three factors that condition the act of whistleblowing: pressure, opportunity, and rationalization. For a rich examination, we use a qualitative research framework to analyze 11 whistleblowing cases of corporate financial statement fraud in Canada that were publicly denounced between (...) 1995 and 2012. Our analysis indicates that whistleblowers are not only insiders but also outsiders [financial analysts, auditing firms, journalists, politicians, customers, and investors]. It also suggests that a dynamic relation may exist between whistleblowers. In addition, our findings show that most whistleblowers opt for external channels when they fail to receive an adequate response from management, seek media exposure, are interested in financial benefits resulting from the act of whistleblowing, or are interested in protecting their investment. Lastly, we propose categorizing whistleblowers into four conceptual types: protective, skeptical, role-prescribed, and self-interested. (shrink)

Background The wide proliferation of Covid-19 has impacted billions of people all over the world. This catastrophic pandemic outbreak and ostracism at work have posed challenges for all healthcare professionals, especially for nurses, and have led to a significant increase in the workload, several physical and mental problems, and a change in behavior that is more negative and counterproductive. Therefore, leadership behaviors that are moral in nature serve as a trigger and lessen the adverse workplace effects on nurses’ conduct. Aim (...) this research is directed to explore the impact of post-COVID-19 workplace ostracism on nurses’ counterproductive behavior and examine the role of moral leadership as a mediating factor in post-COVID-19 workplace ostracism and nurses’ counterproductive behavior. Ethical consideration Ethical review and approval Was received from Ethical Committee at the Faculty of Nursing, Alexandria University, Egypt. Methods A cross-sectional and correlation study was implemented in all units of medical, surgical, critical and intensive care units by using three tools; moral leadership questionnaire, Workplace Ostracism Instrument (WOS), and Counterproductive Work Behaviors Questionnaire (CWBs). A convenient sample of 340 from 699 bedside nurses was granted. Results This study revealed that nurses’ perceived moderate mean percent (55.49 ± 3.46) of overall workplace ostracism and counterproductive behavior (74.69 ± 6.15). However, they perceived a low mean percentage of moral leadership. There was a significant positive correlation between workplace ostracism and counterproductive behavior. Otherwise, a significant negative correlation was found between moral leadership, workplace ostracism and counterproductive behavior. Also, this study proved the mediating effect of moral leadership in decreasing workplace ostracism by 79.3% and counterproductive behavior by 36.7%. Conclusion Hospital administrators need to be aware of the significance of moral leadership and apply integrity in the clinical setting to reduce the drawback of isolation on nurses' conduct and increase value for the organization as a whole and nurses in particular. (shrink)

Consumer-targeted sleep tracking applications (STA) that run on mobile devices (e.g., smartphones) promise to be useful tools for the individual user. Assisted by built-in and/or external sensors, these apps can analyze sleep data and generate assessment reports for the user on their sleep duration and quality. However, STA also raise ethical questions, for example, on the autonomy of the sleeping person, or potential effects on third parties. Nevertheless, a specific ethical analysis of the use of these technologies is still missing (...) so far. The aim of the current analysis is to identify the characteristics of sleep tracking apps and to explore the specific ethical aspects associated with this form of self-tracking. Firstly, the field of mobile health applications was screened for STA to explore their typical functions and target user groups. Secondly, an ethical analysis was conducted focusing on the three ethical dimensions: (1) medicalization, (2) vulnerability, and (3) relationality. The analysis indicates that these three normative dimensions are decisive for assessing STA and that the ethical profile of this technology varies greatly depending on the respective user group. As the three dimensions medicalization, vulnerability, and relationality play a distinguishing role in the use of STA, they should be especially addressed in responsible development and implementation of STA. In addition, the analysis helps to evaluate the use of STA, in terms of different risks for specific user groups, the sensitive contexts of usage, and potential interference with the intimacy of third parties. (shrink)

Le décryptage du génome humain autorise désormais une manipulation du vivant humain. Mû par un souci de perfection, l'homme exploite aujourd'hui ce qui participe à son essence même, son génome. La diversité intraspécifique humaine s'en trouve perturbée, la vulnérabilité génétique augmentée. Le droit se trouve donc investi d'un rôle : préserver la nature humaine. Dès lors, faut-il penser d'autres voies pour prémunir notre humanité contre les risques d'une manipulation irréfléchie de notre génome.

Data sharing – broadly defined as the exchange of health-related data among multiple controllers and processors – has gained increased relevance in the health sciences over recent years as the need and demand for collaboration has increased. This includes data obtained through healthcare provisions, clinical trials, observational studies, public health surveillance programs, and other data collection methods. The practice of data sharing presents several notable challenges, however. Compliance with a complex and dynamic regulatory framework is essential, with the General Data (...) Protection Regulation being a prominent example in a European context. Recent regulatory developments related to clinical trial transparency, trade secrecy, data access, AI training data, and health data spaces further contribute to the difficulties. Simultaneously, government initiatives often encourage scientists to embrace principles of “open data” and “open innovation.” The variety of regulations in this domain has the potential to impede widespread data sharing and hinder innovation. This edited volume, therefore, compiles comparative case studies authored by leading scholars from diverse disciplines and jurisdictions. The book aims to outline the legal complexities of data sharing. By examining real-world scenarios from diverse disciplines and a global perspective, it explores the normative, policy, and ethical dilemmas that surround data sharing in the health sciences today. Chapter Patient Perspectives on Data Sharing, Chapter Supplementary Measures and Appropriate Safeguards for International Transfers of Health Data after Schrems II are available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

The phenomenon of malaise is on the rise at universities, reflecting a deteriorating psychological state that is a combination of anxiety and stress factors. This psychological and emotional upheaval within students is indicative of a fundamental existential issue. In fact, hidden behind the choice of an educational program is the significance given by the student to their life goals. It is this dimension of attributing meaning to one’s education and, more broadly, to one’s life (the existential dimension) that we have (...) sought to explore. We hypothesized that a stable investment in one’s life goals and a sense of psychological wellbeing during one’s studies could be fostered by reflective work done alongside the educational process. Our research took the form of a mixed methodological approach to the attribution of meaning to education, including an interpretive phenomenological analysis (IPA), and the experimentation of support for the meaning of education. Four dimensions of meaning were found to be observable in varying degrees in all students, each playing a specific role. Moreover, this research has confirmed that the meaning of studies is not to be understood solely in terms of education, but is part of a singular life story. Reflective work, developing meaning, facilitated by others (advisor, teacher, etc.) can help preserve/restore the feeling of wellbeing. It should be noted that, as the work presented in this article predates the pandemic, we will not address the amplifying effects of this health crisis on existential issues, which some recent studies are beginning to highlight. (shrink)

This article traces the development of the theory and practice of what is known as ‘community of inquiry’ as an ideal of classroom praxis. The concept has ancient and uncertain origins, but was seized upon as a form of pedagogy by the originators of the Philosophy for Children program in the 1970s. Its location at the intersection of the discourses of argumentation theory, communications theory, semiotics, systems theory, dialogue theory, learning theory and group psychodynamics makes of it a rich site (...) for the dialogue between theory and practice in education. This article is an exploration of those intersections, and a prospectus of its possible role in the formation and reformulation of school curriculum. It will be argued here that, when formulated as community of philosophical inquiry in particular, it offers the possibility of ‘philosophising’ the school curriculum in general, by extending the concept-work that doing philosophy entails to all of the disciplines. The article begins with an attempt at an operational definition of the term as, move to an analysis of its dynamics, offers an example of its use in a mathematics classroom, and finishes with a schematic view of its whole-curriculum and whole-school possibilities. (shrink)

La sección de literatura de esta edición N.° 31, nos brinda un paisaje poético dibujado por el escritor Adriano (de San Martín) Corrales Arias, oriundo de Costa Rica, territorio cuyo relieve y herencia mesoamericana recorre a través de palabras sinuosas, vertidas en los poemas 12, 29 y 34 de su libro Vanitas, publicado en la capital costarricense por la Editorial Arlekín, en 2021.

Dans cette contribution, nous nous proposons d’aborder la perception multisensorielle du rythme du français par la réalisation d’un codage qui s’appuie sur un système de couleurs et de symboles d’extraits filmiques ayant pour objectif l’appropriation du rythme du français. Il s’agira donc d’apporter un éclairage théorique et pédagogique sur l’enseignement/apprentissage du rythme du Français Langue Étrangère en classes de langue pour des apprenants de FLE non-spécialistes de langues. Dans un premier temps, nous présenterons les fondements théoriques sur lesquels repose notre (...) approche pédagogique. Ensuite, nous mettrons en pratique le codage rythmique avec des exemples issus d’une expérimentation dans le cadre d’une recherche-action par un dispositif hybride ayant pour objectif l’appropriation de la prononciation du français au niveau C1 du Cadre européen commun de référence pour les langues en contexte universitaire. (shrink)

Este artículo estudia la sección de la recopilación de adab del 'Iqd al-farid de Ibn 'Abd Rabbih llamada "El Libro de Lamentaciones, Condolencias y Elegías". Se analiza la función ideológica del 'Iqd, concretamente la manera en que se organiza el género con ocasión de la muerte. Localiza lo que parece haberse «reprimido» en el texto en un intento por determinar el material que fue pasado por alto, enterrado o alterado, y estudia la organización de sus prioridades. El artículo sostiene que (...) el 'Iqd, en su función de texto ejemplar, no se limita a reflejar una ideología dominante sino que hace una contribución al discurso dominante por su manera de dar forma a la vida intelectual y social. (shrink)

Mitotic entry and exit are switch‐like transitions that are driven by the activation and inactivation of Cdk1 and mitotic cyclins. This simple on/off reaction turns out to be a complex interplay of various reversible reactions, feedback loops, and thresholds that involve both the direct regulators of Cdk1 and its counteracting phosphatases. In this review, we summarize the interplay of the major components of the system and discuss how they work together to generate robustness, bistability, and irreversibility. We propose that it (...) may be beneficial to regard the entry and exit reactions as two separate reversible switches that are distinguished by differences in the state of phosphatase activity, mitotic proteolysis, and a dramatic rearrangement of cellular components after nuclear envelope breakdown, and discuss how the major Cdk1 activity thresholds could be determined for these transitions. (shrink)

Introduction: "are you a feminist?" -- Three waves of feminism -- All things equal -- Violence against women -- Sex and beauty -- Reproductive justice -- What's next? -- Feminist terms -- Source notes -- Selected bibliography -- For further information -- Index.

Reasons are of the wrong kind if, despite appearing of the right kind, are not able to justify nor to motivate the formation of a mental attitude. Initially, this problem was thought to apply only within the theoretical realm of reason, but Kavka's Toxin Puzzle showed that reasons of the wrong kind are also found in the practical realm. The aim of this paper is to analyze the scope of this problem, in order to determine the kind of reasons it (...) affects. I will examine two possible solutions to this problem, and I will argue that the most promising solution, proposed by Hieronymi, is based on a conception of reasons and attitudes that is too narrow. (shrink)

Die deutschen Richtlinien zur Lebertransplantation sehen vor, dass Patient*innen mit alkoholbedingten Lebererkrankungen in der Regel eine sechsmonatige Karenz nachweisen müssen, bevor sie auf die Warteliste für eine Lebertransplantation aufgenommen werden können. Die international weit verbreitete Karenzregel wurde von Beginn an sehr kritisch diskutiert, da hiermit Patient*innen eine wirksame und potentiell lebensrettende Therapie zumindest vorübergehend vorenthalten wird. Sie kommt in der Praxis einer Eingrenzung der Indikation zur Lebertransplantation gleich. Aus der medizinischen Fachliteratur lassen sich vier Interpretationsrahmen rekonstruieren, die mittels Herausstellung bestimmter (...) Aspekte eine jeweils unterschiedliche Wahrnehmung und Konzeptualisierung der sechsmonatigen Karenzregel begründen. Diese sprachlich vermittelten Deutungsmuster werden von Akteur*innen zur Eingrenzung der Indikation zur Lebertransplantation genutzt. Innerhalb dieser Interpretationsrahmen wird die sechsmonatige Karenzzeit jeweils 1) als diagnostisches Werkzeug zur Bestimmung der Regenerationsfähigkeit der Leber, 2) als prognostisches Werkzeug zur Bestimmung der Erfolgsaussichten einer Transplantation, bzw. 3) zur Bestimmung des Trinkverhaltens nach Transplantation dargestellt. In einem weiteren Rahmen wird die Karenzregel 4) als Ausdruck einer Verpflichtung zur Vermeidung von gesundheitsschädlichem Verhalten interpretiert. Aus diesen vier Interpretationsrahmen ergeben sich unterschiedliche ethische Fragestellungen, die eine systematische ethische Beurteilung der Karenzregel ermöglichen. In den ersten drei Interpretationsrahmen wird wiederum selbst die Frage nach der medizinischen Indiziertheit der Karenzregel aufgeworfen. (shrink)

BackgroundThe German guidelines for liver transplantation stipulate that every patient with alcohol-related liver disease needs to prove evidence of a 6-month abstinence period before they can be admitted to the waiting list for liver transplantation. This internationally widespread abstinence rule has been criticised as it prevents patients at least temporarily from receiving an effective and potentially life-saving therapy. This poses the question of how this abstinence rule is depicted and justified by transplantation professionals.ArgumentsIn case of the 6‑month abstinence rule, guidelines (...) are used as a tool for rationing health care. Four frames of interpretation can be reconstructed from the ethical and medical literature. Each linguistically mediated frame offers a different representation of the 6‑month abstinence rule. According to these different framings, the 6‑month waiting period is depicted (1) as a diagnostic tool to determine the regenerative capacity of the liver, (2) as a prognostic tool to determine the prospects of success of a transplantation, and (3) to determine the drinking behaviour after transplantation. In a further context, the abstinence rule (4) is interpreted as an expression of an obligation to avoid behaviour harmful to health.ConclusionThese four frames provide linguistically mediated patterns of interpretation that are used by different actors to limit the indication for liver transplantation. They give rise to different ethical questions that allow a systematic ethical assessment of the 6‑month abstinence rule. (shrink)