_Introducción_: la Limitación del Esfuerzo Terapéutico (LET) busca reorientar las medidas del acompañamiento terapéutico durante el final de la vida; actualmente existe legislación sobre este tema. _Objetivo: _caracterizar el conocimiento y la claridad conceptual y jurídica del personal de salud del Hospital de San José (HSJ) de Bogotá sobre la LET. _Métodos: _estudio descriptivo transversal usando encuesta de libre preparación. Se estableció claridad conceptual con resultado superior al 70% de respuestas correctas. Datos levantados con cuestionario de selección múltiple (...) vía Formularios Google, tabulados en Microsoft Excel ® y analizados con Stata ® vía estadística descriptiva. _Resultados:_ 36 % de encuestados tuvo claridad conceptual y jurídica sobre LET; el 82,3 % de encuestados diferenciaron LET de eutanasia y el 95,6 %, LET de cuidados paliativos. El 61 % de los encuestados no tuvo conflicto moral/jurídico con LET; el 60 % y el 70 % de los encuestados creen, respectivamente, que suspender el oxígeno y la ventilación mecánica no hacen parte de la LET. Finalmente, el 78,9 % expresó no haber recibido suficiente información sobre el tema. _Conclusiones_: el personal encuestado carece de claridad conceptual suficiente sobre la LET,lo que señala la necesidad de mayor educación al respecto. (shrink)

En la atención médica y en la investigación en salud resulta indispensable favorecer la toma de decisiones de los pacientes y/o participantes bajo el principio de autonomía. En particular, esta capacidad, consignada en la Convención de los Derechos de las Personas con Discapacidad, se concreta mediante la detección de necesidades de asistencia, ajustes y apoyos que dan paso a una plena y efectiva capacidad de ejercicio. Las reflexiones bioéticas hechas desde la perspectiva principialista, personalista y de los Derechos Humanos (...) ofrecen elementos para potenciar la autonomía de las personas con discapacidad, promoviendo la figura de asistencia personal y enfatizando el interés superior, la gradualidad y la revisión judicial permanente como principios de figuras sustitutivas. (shrink)

Actualmente los avances biotecnológicos han superado los fines clásicos de la medicina. Se han producido cambios conceptuales importantes que han impactado en el constructo médico de la relación médico/paciente, como son: a) La diversidad del concepto de naturaleza humana; b) El concepto de corporeidad humana; c) El concepto subjetivo de autonomía; y, d) El valor de la calidad de vida. El análisis bioético de estos conceptos lleva a la comprensión de porqué la medicina actual podría encaminarse hacia una ‘medicina del (...) perfeccionamiento’ o ‘transhumanista’. La conclusión muestra que la medicina acepta la aplicación de los avances en la biotecnología bajo los postulados clásicos enfocados al campo de la salud y que es preciso emprender una profunda reflexión sobre la aplicación de los mismos, con la finalidad de aportar mejoras o nuevas funciones a sujetos sanos. (shrink)

When events such as a pandemic occur, and the entire population’s health must be ensured, the focus is on public health. Despite several criteria for decision-making, it is advisable to delve into the weighting beyond the mere consideration of plainly visible factors. We propose weighting as a mechanism instead of chance since, given the person’s substantial unity and intrinsic dignity, their destiny cannot be subject to anything less than the exercise of intelligible judgment inherent to human reason.

Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa Profesionales de salud y el proceso de muerte y morir de los pacientes: una revisión integrativa Objective: To know the scientific production on the relationship between the health professionals and patient’s death. Methodology: Integrative literature review using analysis through thematic proximity. Resuts: Four categories were elaborated: Unprepared health professionals to deal with death; Challenges to deal with the process of dying and death in different (...) scenarios; Types of death and their interpretations and Health professionals and their aspects on dealing with death. Conclutions: Health professionals are unprepared to deal with the end of life process, beyond that, they feel a lack of attention to the theme, especially relating to coping strategies. Para citar este artigo / Para citar este artículo / To reference this article Siqueira J, Zilli F, Griebeler S. Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa. pers. bioét. 2018; 22: 288-302. DOI: 10.5294/pebi.2018.22.2.7. (shrink)

RESUMEN Con un enfoque cualitativo y alcance descriptivo, el presente artículo tiene como objetivo sintetizar aspectos de materiales publicados en diversas fuentes relacionados con el estrés para lo cual se emplea el método de revisión bibliográfica. Durante el estudio se encontraron aspectos teóricos que permiten entender la evolución del concepto, acceder a modelos, evaluar la repercusión del fenónemo y constatar instrumentos para su evaluación, así como obtener sugerencias para controlarlo. Se concluye que el estrés puede ser percibido como positivo o (...) negativo según el manejo que hace cada individuo y su estilo de afrontarlo, es una manifestación relacionada con el proceso salud enfermedad en el que, para algunos, contribuye al crecimiento personal y en otros, a su malestar o enfermedad. ABSTRACT With a qualitative approach and descriptive scope, the present article takes as an objective to synthesize aspects of materials published in diverse sources related to the stress for which uses the method of bibliographical review. During the study there were theoretical aspects that allow understanding the evolution of the concept, gaining access to models, evaluating the aftereffect of the phenomenon and state instruments for their evaluation, as well as obtaining suggestions to control it. It was concluded that the stress can be perceived as positive or negative according to the handling that there does every individual and its style of confronting it, a declaration related to the process is a health illness in the one that, for some, contributes to the personal growth and in others, to its discomfort or illness. (shrink)

Evaluating the Knowledge and Practice of Limitation of Therapeutic Effort in Health Workers at a Health Care Institution for Cancer Patients in Medellín, 2018Avaliação do conhecimento e da prática da limitação de esforço terapêutico em equipe de atendimento de uma instituição prestadora de serviços de saúde para pacientes oncológicos de Medellín, 2018Limitation of therapeutic effort is any action that involves suspending or not initiating medical treatment or therapeutic measures in patients who will not receive any clinical benefit. In Latin America, (...) some research has proven a lack of familiarization and disagreement with the subject and its practices. The present study tried to objectify the knowledge of LTE of healthcare personnel at an institute in Medellín using a self-administered survey that allowed conducting a cross-sectional descriptive study with non-probabilistic sampling. Within the results, 56.5 % of respondents understood the concept of LTE, and 90 % applied it actively. However, there were discrepancies regarding the core concepts of the definition and practice.Para citar este artículo / To reference this article / Para citar este artigoVallejo LI, Palacio AM, Marulanda V, Restrepo A, Yepes LA, Valencia NL, Cruz MA. Evaluación del conocimiento y práctica de la limitación del esfuerzo terapéutico en personal asistencial de una institución prestadora de servicios de salud para pacientes oncológicos de Medellín, 2018. 2020;24:177-87. DOI: https://doi.org/10.5294/pebi.2020.24.2.5Recibido: 19/07/2019Aceptado: 08/08/2020Publicado: 27/11/2020. (shrink)

Bioethical Proposals to Face Social and Ethical Problems Generated by Neglected Infectious Diseases Propostas bioéticas ante os problemas sociais e éticos que geram as doenças infecciosas desatendidas This review article appointed to the topic of Neglected Tropical Diseases, a group of 18 disabling pathologies, which are sometimes fatal, and often deforming, that prevail in the populations of Asia, Africa and the tropical areas of South America. We presented, categorized, and analyzed, through a bibliographical review, the elements that relate to these (...) diseases from the Universal Declaration of Bioethics and Human Rights, 2005, in terms of equality, justice and equity, the non-discrimination and stigmatization, social responsibility and health approach. Throughout the review, we concluded that the problem around NTDs is multifactorial and we propose solutions to mitigate and to attend the NTDs, from a perspective of focused bioethics around the dignity of the human person and the affected population. We proposed including bioethics in the debate about the care of the NTDs to analyze the problems and examine solutions through transdisciplinary research projects that involve collaborative and formative work among the affected communities, government entities, health professionals and veterinary sciences. Para citar este artículo / To reference this article / Para citar este artigo Sáenz V, Mazzanti di Ruggiero MA. Propuestas bioéticas frente a los problemas sociales y éticos que generan las enfermedades infecciosas desatendidas. Pers Bioet. 2019; 23: 84-110. DOI: https://doi.org/10.5294/pebi.2019.23.1.6 Recepción: 27/09/2018 Aceptación: 06/02/2019. (shrink)

Con la promulgación de la Ley 30 de 1986, se incluyó el concepto del consumo de la dosis personal de drogas. La Corte Constitucional, mediante sentencia C-221 de 1994, resolvió la demanda de constitucionalidad presentada por el ciudadano Alexandre Sochandamandou, ratificando el concepto de “dosis personal de consumo de drogas”, y despenalizando el mismo. En este artículo se plantea el desconocimiento de la legislación y la jurisprudencia acerca de la opinión técnico-científica en cuanto a esta temática, que originó (...) diversas inconveniencias, inconsistencias, vacíos e imprecisiones técnico-científicas que riñen con normas y tratados internacionales de ética médica, al igual que con evidencia médica encontrada sobre los efectos adversos ocasionados por las drogas en la salud de los consumidores de estas sustancias. (shrink)

La investigación pretende implementar una propuesta de intervención psicológica que fortalezca las estrategias de afrontamiento y habilidades sociales de las personas privadas de la libertad [PPL], internas en el complejo penitenciario y carcelario de Jamundí, que aporte al proceso de resocialización y prevención de conductas disruptivas y suicidas en el marco del programa institucional INPEC “Preservación de la vida”. La metodología cuenta con un enfoque mixto, diseño explicativo secuencial, alcance explicativo – exploratorio de corte transversal. La muestra: conformada por 80 (...) PPL seleccionada por conveniencia. Resultados esperados: Fortalecimiento estrategias de afrontamiento y habilidades para la vida, disminución de conductas disruptivas. (shrink)

La violencia en México, específicamente en algunos estados de la República mexicana en donde la población se enfrenta a situaciones de peligro, tiene como una de tantas consecuencias la ausencia de personal médico que se desempeñe como profesional y proporcione servicios de salud en estas zonas rurales. En este sentido, es de considerar que la asignación de recursos humanos en salud es fundamental para el funcionamiento de un sistema eficiente y observar las causas por las que médicos (...) que desde el servicio social hasta el desempeño de su especialidad no consideran trabajar en lugares en donde se sienten vulnerables. En este proceso, es importante visibilizar los cuestionamientos éticos que pueden surgir por lo que este trabajo pretende dar importancia al tema de la exposición de circunstancias, hechos y cifras dentro de esta problemática y plantear las cuestiones normativas pertinentes dentro de este contexto. (shrink)

Las TIC son herramientas para la información y el conocimiento que los adolescentes y adultos jóvenes utilizan para adquirir aprendizajes que permitan orientar y mejorar su calidad de vida. Con el objetivo de mejorar el grado de conocimiento, se desarrolla la metodología en tres fases: la primera fase, revisión bibliográfica; segunda fase, construcción del cuestionario (pretest) y la tercera fase, elaboración de la guía educativa: “Hablemos sobre sexualidad”; posteriormente, se aplicó un postest. Los datos obtenidos se comparan por la Prueba (...) t de Student de muestras relacionadas y se afirma que la guía educativa mejoró el aprendizaje conceptual en salud sexual reproductiva. (shrink)

Objeto: la crisis de la COVID-19 ha causado un cambio profundo en el estilo de vida de la ciudadanía. Las olas previas han demostrado que en régimen de confinamiento se pueden desarrollar problemas de salud mental y hay efectos sobre la actividad física y cambios en los hábitos dietéticos. Tema y metodología: se envió a los trabajadores del Consejo Superior de Investigaciones Científicas (CSIC) un cuestionario en línea sobre sus costumbres relacionadas con la salud durante el confinamiento en (...) España. Resultados: en general se observó una mejora en los patrones dietéticos, excepto por la ingesta de aperitivos y de productos de panadería y bollería. La actividad física quedó sustancialmente reducida, especialmente en los hombres, al contrario que los cambios psicológicos, que fueron mayores en las mujeres, manifestados principalmente como ansiedad y desorden del sueño. Además, las conductas de ingesta alimentaria como escape emocional se detectaron principalmente en las mujeres, aunque la ingesta relacionada con el aburrimiento se observó en ambos géneros. Conclusión: los patrones dietéticos de los trabajadores del CSIC siguieron en general las recomendaciones para el confinamiento de la COVID-19, aunque la mitad de los participantes disminuyeron la práctica de actividad física. Con respecto a los cambios psicológicos, las conductas de ingesta alimentaria como escape emocional aparecieron asociadas a la ansiedad, especialmente en las mujeres, y al aburrimiento en ambos géneros. (shrink)

Given many meanings that the school has adopted for each person, we have found the need to provide some reflections on the subject, supported in a philosophical perspective, in order to enlarge the debate on the values of the school for teachers and students, especially. This brief paper aims to make a cut about the value that the figure of the object "school" has adopted for teachers and students. We refer to the school, involving only the institutions of the levels (...) from elementary to secondary school, not including the institutes or other levels. The work has as scientific foundations philosophical contributions of authors like Herbart, Wittgenstein, MacIntyre, Deleuze, Aristotle, Dewey, Foucault, and orientations coming from the linguistics of Saussure, which supports us in the understanding and management of language. (shrink)

Proponents of mindshaping argue that third-person folk psychology is not primarily about "reading" mental states for the purpose of behavior prediction and explanation. Instead, they claim that third-person folk psychology is first and foremost a regulative practice -- one that "shapes" mental states in accordance with the norms of a shared folk psychological framework. This paper investigates to what extent the core assumptions behind the mindshaping hypothesis are compatible with an account of first-person folk psychology that is based on the (...) notion of "self-regulative agency.". (shrink)

Belgium is one of very few countries where euthanasia on the basis of psychiatric illness is legally possible. Three physicians involved in the euthanasia of a 38-year-old woman suffering from psychiatric illness recently faced a criminal trial for “murder by poisoning”, for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law. Although none of the physicians were convicted, the case generated extensive debate, in the media and the general public as well as in the medical profession (...) and among policy makers. In this chapter, we take this trial as the starting point for a critical analysis of the clinical-psychiatric, ethical, and legal issues involved in evaluating euthanasia requests in cases of complex psychiatric disorders. In these cases, the requirements of the Belgian Euthanasia Law could be improved by mandating the advice of two psychiatrists, who are experts in the treatment of the specific condition of the person requesting euthanasia. Simultaneously with the process of evaluating the euthanasia request, there should be a parallel treatment track in which all therapeutic and recovery-oriented options are explored. These two tracks should not be in the hands of the same physician. (shrink)

Brazilian writer Carolina Maria de Jesus (1914–1977) was born in a rural community and spent most of her life in a slum. Despite this, her literary work achieved remarkable editorial success, having its value recognized by critics and academic circles. This paper analyzes Carolina Maria de Jesus’s autobiographical narratives in the light of John Dewey’s aesthetic theory, with the purpose of investigating the factors responsible for the development of her aesthetic sensitivity – intellectual and emotional dispositions favorable to involvement with (...) artistic practices. The results suggest that Carolina Maria de Jesus’s literary skills, which express not only individual but also collective yearnings, resulted from the incentive she received to think about things that do not exist and from her relationship with people who favored the formation of a personality open to varied experiences. Such results are presented as requirements for a democratic and humanist education that aims at the flowering of aesthetic sensitivity and encourages educators and students to believe in their creative potential. (shrink)

Work on global ethics looks at ethical connections on a global scale. It should link closely to environmental ethics, recognizing that we live in unified social-ecological systems, and to development ethics, attending systematically to the lives and interests of contemporary and future poor, marginal and vulnerable persons and groups within these systems and to the effects on them of forces around the globe. Fulfilling these tasks requires awareness of work outside academic ethics alone, in other disciplines and across disciplines, in (...) public debates and private agendas. A relevant ethics enterprise must engage in systematic description and understanding of the ethical stances that are expressed or hidden in the work of influential stakeholders and analysts, and seek to influence and participate, indeed embed itself, in the expressed and hidden choice-making involved in designing and conducting scientific research and in policy analysis and preparation; it will contribute in value-critical and interpretive policy analysis. It will explore how the allocation of attention and of concern in research and policy depend on perceptions of identity and of degrees of interconnection, and are influenced by the choice or avoidance of humanistic interpretive methodologies. The paper illustrates these themes with reference to the study of climate change. (shrink)

The number of people suffering from dementia will rise considerably in the years to come. This will have important implications for society. People suffering from dementia have to rely on relatives and professional caregivers when their disorder progresses. Some people want to determine for themselves their moment of death, if they should become demented. They think that the decline in personality caused by severe dementia is shocking and unacceptable. In this context, some people consider euthanasia as a way to avoid (...) total deterioration. In this article, we discuss some practical and ethical dilemmas regarding euthanasia in persons with severe dementia based on an advance euthanasia directive. We are using a personalist approach in dealing with these ethical dilemmas. (shrink)

Taking regular walks when living with Parkinson’s disease has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, (...) usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application. The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242. (shrink)

In this classic introduction to existentialist thought, French philosopher Simone de Beauvoir’s The Ethics of Ambiguity simultaneously pays homage to and grapples with her French contemporaries, philosophers Jean-Paul Sartre and Maurice Merleau-Ponty, by arguing that the freedoms in existentialism carry with them certain ethical responsibilities. De Beauvoir outlines a series of ways of being (the adventurer, the passionate person, the lover, the artist, and the intellectual), each of which overcomes the former’s deficiencies, and therefore can live up to the responsibilities (...) of freedom. Ultimately, de Beauvoir argues that in order to achieve true freedom, one must battle against the choices and activities of those who suppress it. The Ethics of Ambiguity is the book that launched Simone de Beauvoir’s feminist and existential philosophy. It remains a concise yet thorough examination of existence and what it means to be human.--Description from an alternate version. (shrink)

This is the first study of business ethics to take into consideration the plethora of issues raised by the Information Age. The first study of business ethics to take into consideration the plethora of issues raised by the Information Age. Explores a wide range of topics including marketing, privacy, and the protection of personal information; employees and communication privacy; intellectual property issues; the ethical issues of e-business; Internet-related business ethics problems; and the ethical dimension of information technology on society. (...) Uncovers previous ignored ethical issues. Underlines the need for public discussion of the issues. Argues that computers and information technology have not necessarily developed in the most ethical manner possible. (shrink)

El derecho a migrar, como el derecho a la salud del migrante, se encuentran reconocidos en la Ley de Migraciones Nro. 25871/2003 de Argentina. Dicha ley constituye un avance legislativo en derechos humanos; resultado de un largo proceso constituyente, deliberativo, que dio lugar a un modelo inclusivo de migración sin precedentes internacionales en su momento. Sin embargo, recientemente asistimos a un giro en políticas migratorias (DNU 70/2017). Como consecuencia, se produce un retroceso en derechos sociales y políticos. En lo (...) que hace al derecho a la salud, la instauración de políticas neoconservadoras (Cobertura Universal de la Salud –CUS-) impulsó leyes provinciales (Ley 6119/2019) destinadas a exigir seguros pagos de salud para migrantes, contrarios a nuestra constitución. El objetivo del presente trabajo es analizar las raíces de éstos cambios en las normativas citadas sobre migraciones y salud; aplicando un marco de justicia social que nos permita comprender, críticamente, cómo la bifurcación de políticas distributivas y de reconocimiento en las mismas legislaciones habilitó el desarrollo de políticas neoconservadoras impuestas a través de decretos autoritarios; cuyas consecuencias trascienden la esfera de los migrantes, haciendo peligrar al mismo sistema de salud argentino como bien público. (shrink)

Economist-philosopher Amartya Sen's writings on social and political issues have attracted wide audiences. Section 2 introduces his contributions on: how people reason as agents within society; social determinants of people's (lack of) access to goods and of the effective freedoms and agency they enjoy or lack; and associated advocacy of self-specification of identity and high expectations for ‘voice’ and reasoning democracy. Section 3 considers his relation to social theory, his tools for theorizing action in society, and his limited degree of (...) attention to work by sociologists and to capitalism and power structures. Section 4 characterizes a style marked by conceptual refinement, emphases on complexity and individuality, including personal individuality, and reformist optimism. Section 5 shows the features from Sections 3 and 4 at work in his conception of personhood that advocates freedom to make a reasoned composition of personal identity. Similarly, Section 6 addresses his conception of public reasoning and neglect of the sociology of democracy. It contrasts the ideal of a reasoning polity with features in many countries. Sen's programmes for critical autonomy in personhood and for reasoned politics play, nevertheless, a normic role, while his analytical formats help investigation of obstacles to more widespread agency, voice, and democratic participation. (shrink)

En el presente artículo se busca exponer sintéticamente el meta-modelo de la Psicología integral de la persona. A partir de seis preguntas fundamentales se intenta mostrar sus principales planteamientos: (1) qué es la Psicología clínica, (2) qué es la salud psíquica, (3) qué es el desorden psíquico, (4) en qué consiste el diagnóstico clínico, (5) en qué consiste el proceso de sanar psíquicamente y (6) cuál es el rol del terapeuta.

Empirical evidence suggests that people often confabulate when they are asked about their choices or reasons for action. The implications of these studies are the topic of intense debate in philosophy and the cognitive sciences. An important question in this debate is whether the confabulation studies pose a serious threat to the possibility of self-knowledge. In this paper we are not primarily interested in the consequences of confabulation for self-knowledge. Instead, we focus on a different issue: what confabulation implies for (...) the special status of self-attributions, i.e. first-person authority. In the first part of the paper, we propose that FPA is based on a capacity for self-regulation. Accordingly, FPA depends on the extent to which we are able to bridge the gap between our sayings and doings by aligning our actions with our avowed self-ascriptions and vice versa. FPA is withheld when we fail at such re-alignment. In the second part of the paper, we contrast our view with the accounts of Scaife and Bortolotti :227–249, 2018). We claim that the apparent fact that we cannot reliably distinguish, from a first-person perspective, when we are confabulating and when we are not, does not necessarily undermine FPA. We argue that a systematic failure to align our actions with our self-ascriptions and vice-versa is a genuine threat to FPA. In the last part of the paper, we introduce the concept of self-know-how—the know-how embodied in the way one is disposed to relate to oneself in making sense of oneself with or in the face of others—and briefly explored the importance of diminished or absent self-know-how in clinical cases. (shrink)

The objective of the work is to analyze the intersectional discriminations that operate in the multiple identities of regional migrant women in the field of health in Argentina during the present pandemic. We will begin with the critical study of key categories and the origin of the inequalities of law of the aforementioned discrimination in migration policies. Second, we will address de facto inequalities, particularly examining the socio-economic inequalities suffered by migrants during the pandemic. Thirdly, in order to enable alternative (...) forms of care and self-care from the recognition of their ethnicity and the inseparable care of the earth, we propose the application of the concept of territorial participatory justice as a condition of intercultural dialogue in health. As a proposal, it seeks to promote dialogues of knowledge located outside the bureaucratic councils and expanding the social base of health rights from the pluriculturality exercised in care networks of migrant women in the territory and not from their domesticated participation. (shrink)

The social determinants of mental health with respect to the role of a person’s religiosity are examined in this paper, based on personal experience and a review of the literature. The objective is to hypothesize that religiosity can influence a person’s mental health through three factors: a sense of moral value, support from a community of faith, and exercise of spirituality. The Medline and SciElo databases were reviewed as of 1990, in English and Spanish, using the keywords: spirituality, belief, (...) religion and social determinants of mental health. The references related to the subject were taken into account as well. The article concludes that it is important in bioethics to incorporate the theme of religiosity as a factor in mental health, based on deliberative dialogue and considering the patient’s position as an interlocutor. It also is imperative to bear in mind the support provided by a community of faith that has embraced the virtues of solidarity and acceptance of others. (shrink)

Humanización de los servicios de salud en Iberoamérica: una revisión sistemática de la literatura Humanização dos serviços de saúde na Ibero-América: uma revisão sistemática da literatura Humanization is an ethical imperative that contributes to safeguarding human dignity in harmony with bioethical principles and deontological regulations that govern health care practices. The present study aims to explore the advances in the humanization of Ibero-American health care in the last ten years through a systematic review. Results show that such advances point (...) to understanding the phenomenon based on theoretical approaches, a growing interest in the subject in recent years, and the creation of policies, programs and strategies that should be strengthened from a comprehensive view of the human being. Para citar este artículo / To reference this article / Para citar este artigo Carlosama DM, Villota NG, Benavides VK, Villalobos-Galvis FH, Hernández EL, Matabanchoy SM. Humanización de los servicios de salud en Iberoamérica: una revisión sistemática de la literatura. Pers Bioet. 2019;23:245-262. DOI: https://doi.org/10.5294/pebi.2019.23.2.6 Recibido: 21/06/2019 Aceptado: 04/09/2019. (shrink)

People sometimes explain behavior by appealing to an essentialist concept of the self, often referred to as the true self. Existing studies suggest that people tend to believe that the true self is morally virtuous; that is deep inside, every person is motivated to behave in morally good ways. Is this belief particular to individuals with optimistic beliefs or people from Western cultures, or does it reflect a widely held cognitive bias in how people understand the self? To address this (...) question, we tested the good true self theory against two potential boundary conditions that are known to elicit different beliefs about the self as a whole. Study 1 tested whether individual differences in misanthropy—the tendency to view humans negatively—predict beliefs about the good true self in an American sample. The results indicate a consistent belief in a good true self, even among individuals who have an explicitly pessimistic view of others. Study 2 compared true self-attributions across cultural groups, by comparing samples from an independent country and a diverse set of interdependent countries. Results indicated that the direction and magnitude of the effect are comparable across all groups we tested. The belief in a good true self appears robust across groups varying in cultural orientation or misanthropy, suggesting a consistent psychological tendency to view the true self as morally good. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

I have little to say on this passage, where it seems necessary to maintain the vulgate notwith standing its obvious defects. My only reason for discussing it is to call attention to the strangeness of Jebb's proceeding when seeking to support Hermann's conjecture παλλλοιν which he admits into the text. The objection to Hermann's view is that, as he himself admits, there is no evidence that πáλληλος could be used in the sense of λληλιφóνος. For that, I suppose, is the (...) meaning of ‘mutual hands,’ which both Jebb and Campbell suggest as a translation, although ‘mutual violence’ would be better. But the chief purpose of this note is to protest against the mode of interpretation applied to Philo de Mose 3. 36. II. p. 175 M. διà τàς ν δασι καí πνρì γνιμéνας συνχς καì παλλλονς φθορáς Turnebu s rightl yrenders ‘alternas interneciones,’ and why Jebb supposes him to have meant ‘mutual’ I do not know. Anyhow he admits that Philo used the word in its ordinary sense of successive, and proceeds to paraphrase ‘owing to the continuous and rapid succession of calamities by flood and fire’ . All this is quite beside the mark, for the reference is to the alternate destruction of the world at the κπρωσις by fire and at the ξγρωσιςby water. I must take leave to refer to the evidence collected in my book on Zeno and Cleanthes, p. 253, to which should be added a most instructive passage of Origen : περì τν κακν λóγος ο μνóντων ì ν τατᾦ διà τν τοι τηροσαν τà πì γ$$$ς πρóνοιαν κατακλνσμο καì κπνρ03CE;σσι καθαíρονσαν.Add the passages from Lucan quoted by Mr. Heitland in his Introduction, p. xliii. (shrink)

Many theorists have argued that the meaningfulness of a life is related in some way to the narrative or story that can be told about that life. Relationists claim that a life gains in meaning when a particular set of “narrative relations” obtain between the events that constitute it. Recountists claim that it is the telling of a story about those relations, not the relations themselves, that confers meaning. After identifying problems with existing versions of both of these positions, this (...) paper introduces a new and more satisfying variant of Recountism, centered on the old-fashioned idea that a meaningful life is, in part, an intelligible one. I argue that personal narration does play a role in a meaningful life and that my “Fitting Story” account provides the best explanation of how and why that is so. (shrink)

Background We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. Methods Two rounds of in-depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). The (...) second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six-step method developed by de Miranda is called SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Results All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self-interested altruism and solidarity with disabled peers. Conclusions To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma. (shrink)

A partir del comentario hecho por José L. L. Aranguren sobre «puede» y «debe» en ética, aquí se plantea el significado de los principios de ética en la situación de retroceso democrático del siglo XXI. Ha sido analizada por la filosofía y la teoría política recientes. En los años sesenta, las críticas de D. Sternberger al modelo de polis, de política cívica en las obras de H. Arendt, se apoyaban en la imagen de la ciudad hundida. Pero las preguntas sobre (...) el alcance del realismo («puede») y el lugar de los principios («debe») siguen abiertas. ¿Ultra posse nemo obligatur? Aquella imagen de la polis puede ser reemplazada por otra algo distinta, la ciudad sumergida. Se encuentra en la literatura, sería también la metáfora de la necesaria reconstrucción de las políticas democráticas, con el «deber ser» como núcleo de la cultura cívica. Los principios éticos y, en especial, justicia como equidad será aquí la referencia en dos situaciones: (1) la política de salud pública, (2) los procesos de paz. En conclusión, el marco normativo cuenta o ha de contar, tanto en la paz como en la guerra. Decir «nunca más» es también una forma de recordar el papel crucial de los principios. (shrink)

Objetivo. Introducir en la reflexión bioética el concepto de “reconocimiento recíproco”, como herramienta para la fundamentación de la bioética y el análisis de casos problemáticos. Hipótesis. Para entender y buscar soluciones a los nuevos problemas surgidos en el contexto de la atención a la salud, no resulta suficiente el positivismo jurídico ético. El reconocimiento bidireccional, concepto desarrollado por Honneth en su matiz de reciprocidad, denominado mutuo por Ricoeur y Cortina, permite construir un modelo de justicia aplicable al ámbito sanitario, (...) tanto en lo relativo a relaciones entre pacientes y personal, cuanto a las relaciones entre los profesionales, o de todos ellos con la organización sanitaria. Su ausencia en la relación clínica, en la gestión sanitaria, o en la salud pública, es un buen factor explicativo de los conflictos. Aplicado al análisis de conflictos, el concepto de reconocimiento ofrece posibilidades para transformar las relaciones conflictivas en relaciones de cooperación. Todo ello es novedoso, ya que hasta ahora apenas se ha investigado sobre reconocimiento recíproco como fundamento de la bioética. (shrink)

While COVID-19 spreads aggressively and rapidly across the globe, many societies have also witnessed the spread of other viral phenomena like misinformation, conspiracy theories, and general mass suspicions about what is really going on. This study investigates how exposure to and trust in information sources, and anxiety and depression, are associated with conspiracy and misinformation beliefs in eight countries/regions during the COVID-19 pandemic. Data were collected in an online survey fielded from May 29, 2020 to June 12, 2020, resulting in (...) a multinational representative sample of 8,806 adult respondents. Results indicate that greater exposure to traditional media is associated with lower conspiracy and misinformation beliefs, while exposure to politicians and digital media and personal contacts are associated with greater conspiracy and misinformation beliefs. Exposure to health experts is associated with lower conspiracy beliefs only. Higher feelings of depression are also associated with greater conspiracy and misinformation beliefs. We also found relevant group- and country differences. We discuss the implications of these results. (shrink)

Deepfake technology presents significant ethical challenges. The ability to produce realistic looking and sounding video or audio files of people doing or saying things they did not do or say brings with it unprecedented opportunities for deception. The literature that addresses the ethical implications of deepfakes raises concerns about their potential use for blackmail, intimidation, and sabotage, ideological influencing, and incitement to violence as well as broader implications for trust and accountability. While this literature importantly identifies and signals the potentially (...) far-reaching consequences, less attention is paid to the moral dimensions of deepfake technology and deepfakes themselves. This article will help fill this gap by analysing whether deepfake technology and deepfakes are intrinsically morally wrong, and if so, why. The main argument is that deepfake technology and deepfakes are morally suspect, but not inherently morally wrong. Three factors are central to determining whether a deepfake is morally problematic: whether the deepfaked person would object to the way in which they are represented; whether the deepfake deceives viewers; and the intent with which the deepfake was created. The most distinctive aspect that renders deepfakes morally wrong is when they use digital data representing the image and/or voice of persons to portray them in ways in which they would be unwilling to be portrayed. Since our image and voice are closely linked to our identity, protection against the manipulation of hyper-realistic digital representations of our image and voice should be considered a fundamental moral right in the age of deepfakes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Cogito, Ergo Sum: The Life of René DescartesDennis Des CheneRichard Watson. Cogito, Ergo Sum: The Life of René Descartes. Boston: David R. Godine, 2002. pp. viii + 375. Cloth, $35.00.Somewhere between hagiography and debunking lies truth. Or so we may think: the biographer's sources are almost always tipped one way or the other, and it is his or her job to establish, or divine, the way of authentic (...) fact and, if facts fall short, then of sturdy sober hypothesis. In general the debunker has more fun, especially when the weight of tradition favors the ennobling, if not the beatification, of its subject.Descartes is a case in point. Until a few years ago, there was in English no satisfactory biography. Now there are three: an "intellectual biography" by Stephen Gaukroger, the Descartes of Geneviève Rodis-Lewis, and Watson's. Gaukroger dwells on Descartes's natural philosophy, especially in the early years. Only after 300 pages does he reach the period of the Discourse, Descartes's first published work. Rodis-Lewis offers a more even-handed treatment, the fruits of a lifetime of study. Her Descartes resembles, not the modern scientist or professional philosopher, but the ancient sage for whom metaphysics is a once-in-a-lifetime affair, and even natural philosophy subordinate to wisdom. Watson's Descartes is an altogether more worldly type, born into a family of lawyers, well-connected, touchy [End Page 113] about his place in social and scientific circles, and not all that interested in what we think of now as philosophy. Nor, for that matter, is Watson: you will look in vain for an analysis of the Meditations, a discussion of method, or a definition of générosité. (Watson does conclude, I should note, with a discussion of Descartes's doctrine on the soul, whose title might well have been "The future of an illusion" if Freud had not used it already.)If you like your philosophy uncluttered by context, if you find it worthwhile to read or write about "Cartesian skepticism" or "Cartesian dualism" without troubling yourself to understand who the historical Descartes was, or what might have moved him to confront the skeptics and save the soul, then Watson is not for you. It is emphatically a Life, not a Life and Works. It is, moreover, a life in the manner of many modern biographers, in which the biographer, rather than conceal himself behind the curtains of scholarly convention, figures into the narrative, retracing the steps of Descartes's passage to Italy, examining the baptismal certificate of Descartes's illegitimate daughter Francine, and eating lunch at the Queen Kristina restaurant "next door to the house in which Descartes died" (303). The quality of a biography thus written depends in part on the personality of its author (and in the case of Cogito Ergo Sum, the author's wife, who intervenes more than once on the side of common sense during their peregrinations). Watson is, to my mind, an agreeable companion, dedicated to the search for biographical truth, impatient with hagiographic fog and time-hallowed error, down-to-earth in his assessment of Descartes's motives and circumstances.One example to show the differences among the three biographies. In November 1618 Descartes met the future Latin schoolmaster Isaac Beeckman in Breda. Beeckman records with enthusiasm their joint endeavors in physico-mathematics over the next few months (Gaukroger has the details). It seems clear that the impetus for studying the various problems mentioned in Beeckman's Journal came from Beeckman, who had been pondering physical questions since 1613 or before. Descartes's contribution, at least at first, was his immense mathematical skill. Their interests lay largely within the "mixed mathematics" of the period, especially hydrostatics and mechanics. They also discussed music, an aspect of the "new science" now often neglected (but see H. F. Cohen, Quantifying Music [Dordrecht, 1984]). On New Year's day 1619 Descartes presented Beeckman with his Compendium musicæ (Gaukroger 74, Rodis-Lewis 51/29). A decade later, Descartes, having heard that Beeckman had appropriated the Compendium to himself, became angry and eventually, late in 1630, dismissed Beeckman with a masterpiece of de haut... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Cogito, Ergo Sum: The Life of René DescartesDennis Des CheneRichard Watson. Cogito, Ergo Sum: The Life of René Descartes. Boston: David R. Godine, 2002. pp. viii + 375. Cloth, $35.00.Somewhere between hagiography and debunking lies truth. Or so we may think: the biographer's sources are almost always tipped one way or the other, and it is his or her job to establish, or divine, the way of authentic (...) fact and, if facts fall short, then of sturdy sober hypothesis. In general the debunker has more fun, especially when the weight of tradition favors the ennobling, if not the beatification, of its subject.Descartes is a case in point. Until a few years ago, there was in English no satisfactory biography. Now there are three: an "intellectual biography" by Stephen Gaukroger, the Descartes of Geneviève Rodis-Lewis, and Watson's. Gaukroger dwells on Descartes's natural philosophy, especially in the early years. Only after 300 pages does he reach the period of the Discourse, Descartes's first published work. Rodis-Lewis offers a more even-handed treatment, the fruits of a lifetime of study. Her Descartes resembles, not the modern scientist or professional philosopher, but the ancient sage for whom metaphysics is a once-in-a-lifetime affair, and even natural philosophy subordinate to wisdom. Watson's Descartes is an altogether more worldly type, born into a family of lawyers, well-connected, touchy [End Page 113] about his place in social and scientific circles, and not all that interested in what we think of now as philosophy. Nor, for that matter, is Watson: you will look in vain for an analysis of the Meditations, a discussion of method, or a definition of générosité. (Watson does conclude, I should note, with a discussion of Descartes's doctrine on the soul, whose title might well have been "The future of an illusion" if Freud had not used it already.)If you like your philosophy uncluttered by context, if you find it worthwhile to read or write about "Cartesian skepticism" or "Cartesian dualism" without troubling yourself to understand who the historical Descartes was, or what might have moved him to confront the skeptics and save the soul, then Watson is not for you. It is emphatically a Life, not a Life and Works. It is, moreover, a life in the manner of many modern biographers, in which the biographer, rather than conceal himself behind the curtains of scholarly convention, figures into the narrative, retracing the steps of Descartes's passage to Italy, examining the baptismal certificate of Descartes's illegitimate daughter Francine, and eating lunch at the Queen Kristina restaurant "next door to the house in which Descartes died" (303). The quality of a biography thus written depends in part on the personality of its author (and in the case of Cogito Ergo Sum, the author's wife, who intervenes more than once on the side of common sense during their peregrinations). Watson is, to my mind, an agreeable companion, dedicated to the search for biographical truth, impatient with hagiographic fog and time-hallowed error, down-to-earth in his assessment of Descartes's motives and circumstances.One example to show the differences among the three biographies. In November 1618 Descartes met the future Latin schoolmaster Isaac Beeckman in Breda. Beeckman records with enthusiasm their joint endeavors in physico-mathematics over the next few months (Gaukroger has the details). It seems clear that the impetus for studying the various problems mentioned in Beeckman's Journal came from Beeckman, who had been pondering physical questions since 1613 or before. Descartes's contribution, at least at first, was his immense mathematical skill. Their interests lay largely within the "mixed mathematics" of the period, especially hydrostatics and mechanics. They also discussed music, an aspect of the "new science" now often neglected (but see H. F. Cohen, Quantifying Music [Dordrecht, 1984]). On New Year's day 1619 Descartes presented Beeckman with his Compendium musicæ (Gaukroger 74, Rodis-Lewis 51/29). A decade later, Descartes, having heard that Beeckman had appropriated the Compendium to himself, became angry and eventually, late in 1630, dismissed Beeckman with a masterpiece of de haut... (shrink)