Introducción: el uso de la alimentación enteral en pacientes con demencia resulta un desafío ético-clínico. El objetivo de este artículo es exponer el proceso de validación de un cuestionario para conocer la opinión de los médicos al respecto y sus resultados preliminares. Metodología: se desarrolló un cuestionario anónimo para conocer la opinión de médicos acerca del uso de la alimentación enteral, dirigido a especialistas de cuidados paliativos, geriatría, medicina interna y neurología, de los ámbitos público y privado. Se (...) presentaban allí tres casos clínicos de pacientes con demencia en diferente grado de evolución. Las preguntas abordaban cuatro campos específicos: motivaciones del inicio o suspensión de la alimentación enteral, adecuación terapéutica, eutanasia y toma de decisiones. Resultados: se obtuvo un índice de respuesta del 64 %. El cuestionario resultó una herramienta con validez y fiabilidad aceptables. Los especialistas en cuidados paliativos y geriatría eran más propensos a adecuar el esfuerzo terapéutico y a integrar a la familia en las decisiones. Los profesionales de medicina interna y neurología tendían a ser más invasivos en los tratamientos. Conclusión: los resultados obtenidos permiten recomendar el cuestionario como metodología para valorar la actitud de los profesionales ante las cuestiones bioéticas más relevantes en la atención a pacientes con demencia. (shrink)

In Emotions, Values & Agency, Christine Tappolet develops a sophisticated, perceptual theory of emotions and their role in wide range of issues in value theory and epistemology. In this paper, we raise three worries about Tappolet's proposal.

O presente estudo teve como objetivo verificar a relação entre o estado nutricional e a autopercepção de saúde de professores que atuam em escolas da rede pública em um município da região norte do PR/Brasil. O estudo foi de natureza aplicada, analítica e transversal.O estado nutricional foi avaliado pelo índice de massa corporal e a obesidade abdominal pela circunferência da cintura. O Medical Outcomes Short-Form Health Survey-SF-36 determinou a autopercepção de saúde e o Beck Depression Inventory -BDI,a saúde mental. Participaram (...) do estudo 100 professores, desses 60% estavam acima do peso e 66% apresentaram obesidade abdominal. O domínio de SF – 36 que apresentou menor escore foi vitalidade (65,55) e estado geral de saúde (70,02), os domínios com maiores escores foram capacidade funcional (83,00) e aspectos sociais (78,50). Pode-se constatar que os educadores necessitam de estratégias e programas voltados para a promoção da saúde no local de trabalho. (shrink)

Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a fatal (...) disease to naturally run its course until an individual’s vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals’ wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues. (shrink)

Este estudio tiene como objetivo identificar la tipología y los patrones de los mensajes desinformativos relacionados con la salud y la nutrición que se difundieron durante la primera etapa de la pandemia COVID-19 (marzo-noviembre de 2020). Para ello, se realizó un estudio cuantitativo exploratorio con dos tipos de datos. Los primeros provienen del estudio de 95 documentos (artículos científicos) hallados en la base de datos SCOPUS a través de búsquedas booleanas con los términos desinformación, engaño, salud y nutrición. (...) A estos documentos se les aplicó un formulario de registro, indicando los siguientes ítems: a) el tema del artículo (salud o nutrición); b) el tipo de mensaje erróneo (desinformación o engaño); c) el país en el que se realizó el estudio; d) el tipo de participantes (público general, jóvenes, ancianos, profesionales de la salud, estudiantes universitarios); y e) el tipo de canal de información estudiado (Twitter, Facebook, YouTube, Instagram, periódicos impresos, periódicos digitales, plataformas web, televisión, entre otros). Por otro lado, se seleccionaron 95 ingredientes o alimentos que fueron diseminados vía WhatsApp en diferentes bulos en español durante el primer mes de confinamiento (marzo-abril de 2020). Se aplicó un formulario para evaluar el contenido de los engaños, identificando: a) el tipo de sustancia o alimento (fruta, verdura, legumbre, nuez, hierba, entre otros); y b) las fuentes de información a las que se refirió el engaño (autoridades sanitarias, público general, organismos médicos, entre otros). Finalmente, los resultados de ambos estudios cuantitativos concluyeron que el patrón internacional de difusión de bulos fue principalmente sobre la salud en general, y que la desinformación sobre nutrición fue minoritaria, y en el 91% de los casos estuvo relacionada con la ingesta de frutas y verduras, afirmando que podrían prevenir o curar la COVID-19, sin ninguna evidencia científica. (shrink)

Los avances de la biotecnología y las fascinantes perspectivas de la genómica nutricional en el escenario de la práctica clínica conducen a la consideración de distintos aspectos que impactan en el beneficio integral del ser humano. En ese sentido, la integración de la nutrición personalizada en la atención clínica requiere de un análisis bioético centrado en la unidad de la persona que, con base en su perfil nutrigenético único, contribuya al cuidado de la salud por medio del tratamiento nutricional (...) individualizado. El análisis bioético contempla los principios de totalidad terapéutica, libertad e integridad. Además, el uso de las pruebas nutrigenéticas destaca no solo la confidencialidad de datos, que se presupone, sino que lleva a considerar el derecho a la intimidad. (shrink)

Economic and sanitary crises have great repercussions on access to food and the health of the population. In this context, austerity policies can have devastating effects on social rights. The purpose of this essay is to reflect on the impact of various types of crises on the Human Right to Adequate Food and Nutrition (DHANA) and on Food and Nutritional Security (SAN) of vulnerable populations and to identify of public policies, programs and actions developed based on the relief of the (...) damage caused by the COVID-19 pandemic. From the collection of information carried out in a non-systematic way on government websites and scientific databases, documents were read in full, categorized, and critically analyzed. Three different contexts, Africa, Latin America, and Portugal, are presented by the authors who work in these realities, with the intention of contributing to mitigate the food problems that worsen and are derived from the pandemic situation. (shrink)

As a direct consequence of the sophisticated arrangement of its intrinsic neurons, the gastrointestinal tract is unique among peripheral organs, in its ability to mediate its own reflexes. Neurons of the enteric nervous system are intimately associated with enteric glial cells. These supporting cells do not resemble Schwann cells, the glial cell found in all other parts of the peripheral nervous system, but share many similarities with astrocytes of the central nervous system. Ablation of enteric glial cells in adult transgenic (...) mice has demonstrated that these cells are essential to maintain the integrity of the small intestine. Acute loss of enteric glial cells induces massive pathological changes with similarities to necrotizing enterocolitis (NEC) and early Crohn's disease. These human conditions share some mechanistic similarities. Identification of enteric glial cell dysfunction/loss as sufficient to induce necrotic/inflammatory bowel disease may be important to understand the pathogenesis of both NEC and Crohn's disease. BioEssays 24:130–140, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

How can Deleuzians make his philosophy as accessible as possible to political theorists and democratic publics? This essay provides principles to enter Deleuze's political vision, namely, to research the etymology of words, to discover the image beneath concepts, to diagram schemata using rigid lines, supple lines and lines of flight, and to construct rules that balance experimentation and caution. The essay then employs this method to explicate a fecund sentence about politics in A Thousand Plateaus and presents a case why (...) Deleuze deserves greater visibility in the political theory canon. (shrink)

Starting with some illustrative examples, I develop a systematic account of a specific type of experimentation--an experimentation which is not, as in the "standard view", driven by specific theories. It is typically practiced in periods in which no theory or--even more fundamentally--no conceptual framework is readily available. I call it exploratory experimentation and I explicate its systematic guidelines. From the historical examples I argue furthermore that exploratory experimentation may have an immense, but hitherto widely neglected, epistemic significance.

Phenomenological analyses of ageing and old age have examined themes such as alterity, finitude, and time, not seldom from the perspective of “healthy” aging. Phenomenologists have also offered detailed analyses of lived experiences of illness including lived experiences of dementia. This article offers a phenomenological account of what we label as entering the grey zone of aging between “healthy” aging and aging with a disease. This account is developed through a qualitative phenomenological philosophy analysis of elderly persons’ lived experiences of (...) being tested for dementia through primary care in Sweden, i.e., within a cultural context where dementia commonly is understood as a frightening a loss of self even though this understanding also is questioned. To enter this grey zone of aging, we argue, does not dissolve dynamic self-becoming but can involve an experience of oneself as being old. Further, in the grey zone, the self experiences itself as neither fully healthy nor as having a disease, and as needing to negotiate and live this ambiguity. To enter this grey zone is to enter an affectively charged, sociocultural and medicalized zone, and while the self can still act in different ways within it, staying in the grey zone can result in a re-orientation in the self’s mode of being, in ways that are thoroughly beyond its control. To stay in the grey zone can have detrimental effects on the self, even though the self does not have a disease: the self can become “stuck” in a reflective mode of attending to embodiment, aging, health, and disease. (shrink)

Utopia repeatedly sets forth the rhetorical strategy of using pleasant and healing words to “enter” or “flow” or “steal into” fortresses of hardened opinion and custom without arousing warlike passions to keep them out. An important part of this strategy is the creation of a character who denounces major instances and causes of injustice but who nonetheless supports war and other means of force at the expense of law in rectifying that injustice; another part of the strategy is the creation (...) of a character and a plot that embody the “indirect” rhetorical approach aimed primarily at long-term persuasion needed to improve laws and institutions. (shrink)

This paper represents an effort to distinguish between two types of guanxi prevalent in mainland China: favor-seeking guanxi that is culturally rooted and rent-seeking guanxi that is institutionally defined. Different rules of maneuvering the two types of guanxi are identified in light of Chinese cultural and business ethics. Strategies for entering guanxi in mainland China are also suggested.

In this article we focus on note taking as a practice that is fundamental to (higher) education. We argue that note-taking should not primarily be regarded as a method that supports effective learning, but as formative of the student herself (making her attentive and granting possibilities for self-transformation). Hence it is a practice that has educational meaning in and of itself. It is a pedagogical form in its own right. We go on arguing that the practice of lecturing can itself (...) be seen as a form of note taking and that both phenomena are not only closely related, but also that note making and lecturing consist of reciprocal operations. Studying on the basis of one’s notes comes down to the reverse operation the teacher had to perform when preparing her lessons. Moreover, thanks to making notes during a class students have a deeply embodied sense of what it means to generate and to construct new arguments and ideas. (shrink)

For students whose experience with science has been primarily in the classroom, it can be difficult to identify and contact potential mentors, and to navigate the transition to a one-on-one, mentor-student relationship. This is especially true for those who are new to research, or who belong to groups that are underrepresented in research. The Entering Research curriculum offers a mechanism to structure the independent research experience, and help students overcome these challenges.

None of us will escape the experience of personal loss, illness, aging, or mortality. Yet, psychoanalysis seems to shy away from a discussion of these core human experiences. Existential vulnerability is painful and we all avoid this awareness in different ways. However, when analysts fail to explore the topic of mortality, their own and their patients, they may foreclose an important exploration and short-change patient and therapist. _Entering Night Country_ focuses on the existential condition, and explores how it penetrates professional (...) lives, analytic work, and theoretical formulations. Each chapter explores this topic, shifting the lens from analytic process, to include theoretical assumptions, and professional communities. _Stephanie Brody_ shows how the analytic process is a journey, no less profound than the epic journeys depicted in the classic literature of Homer and repeated in the patient’s own heroic and painful stories. Weaving literary references into the clinical experience of psychoanalysis, Brody reveals the transformative power of the analytic process for the patient and for the analyst. By relating the ancient past to our current struggles, psychoanalyst and patient together are guided to a destination, a life of meaning in the universe of possibilities. Clinical vignettes and personal reflections intersect with motifs from the epic poems and fantasy fiction, where the despair of loss and trauma do not extinguish the wish for change and the search for intimacy. __Entering Night Country__ highlights the common themes that arise for patient and analyst as any person entering an unknown territory. It is intended for psychoanalysts, psychoanalytically oriented psychotherapists, and mental health clinicians. It will also be accessible to those outside the clinical profession, even to individuals who have little understanding of psychoanalysis. (shrink)

This book surveys the distinctions that underlie the unbound potential and existential risks of life expansion and radical modifications posed by a transhuman world. Humanness is in flux as human bodies are being hacked and altered in their quest for super wellness, super intelligence and super longevity. Now is the time to discuss how best to think about dealing with bodies that have been hacked to exceed natural physical limits or more technically, species typical functioning. Enter the advent of transhumanism (...) to take uncertainty by the horns. According to transhumanists, death is unnecessary and medical conventions undermine the possibility to radically evolve. To biohackers, there is no need to wait to explore the risks that conventional medicine dares not. This book is of interest to anyone interested in tapping into this growing movement of modifying the human body as it is right now. (shrink)

Oliver O'Donovan's Ethics as Theology project began withSelf, World, and Time, an "induction" into Christian ethics as ordered reflection on moral thinking within the life of faith. Volume 2, Finding and Seeking, shifted the focus to the movement of moral thought from a first consciousness of agency to the time that determines the moment of decision. In this third and final volume of his magnum opus, O'Donovan turns his attention to the forward horizon with which moral thinking must engage. Moral (...) experience, he argues, is necessarily two-directional, looking both back at responsibility and forward at aims. The Pauline triad of theological virtues (faith, love, and hope) describes a form of responsibility, and its climax in the sovereignty of love opens the way to a definitive teleology. Entering into Restoffers O'Donovan's mature reflections on questions that have engaged him throughout his career and provides a synoptic view of many of his main themes.". (shrink)

Today, the most powerful research technique available for assigning chronometric age to human cultural objects is radiocarbon dating. Developed in the United States in the late 1940s by an alumnus of the Manhattan Project, radiocarbon dating measures the decay of the radioactive isotope carbon-14 (C14) in organic material, and calculates the time elapsed since the materials were removed from the life cycle. This paper traces the interdisciplinary collaboration between archaeology and radiochemistry that led to the successful development of radiocarbon dating (...) in the early 1950s, following the movement of people and ideas from Willard Libby's Chicago radiocarbon laboratory to museums, universities and government labs in the United States, Australia, Denmark and New Zealand. I show how radiocarbon research built on existing technologies and networks in atomic chemistry and physics but was deeply shaped by its original private philanthropic funders and archaeologist users, and ultimately remained to the side of many contemporaneous Cold War scientific and military projects. (shrink)

To give oneself over to the essence of pain is to give oneself over to the world. Pain is a fact of the world and in accepting this fact, in entering that world, we break with the tradition of metaphysical subjectivity that dates back to the Greek determination of the human as zôon logon echon. For Heidegger, pain is the surest sign that we wholly belong to this world; in fact, pain is nothing other than our contact with the world (...) and our “openness” to it. In what follows I will first present those aspects of Heidegger's view of pain…. (shrink)

It has been said that certain scientific workers are not particularly interested in the fashionable topics of human potential studies, science of science, and futurology. I am one such worker.

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral (...) tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Large Language Models (LLMs) are generative AI systems capable of producing original texts based on inputs about topic and style provided in the form of prompts or questions. The introduction of the outputs of these systems into human discursive practices poses unprecedented moral and political questions. The article articulates an analysis of the moral status of these systems and their interactions with human interlocutors based on the Habermasian theory of communicative action. The analysis explores, among other things, Habermas's inquiries into (...) the analogy between human minds and computers, and into the status of atypical participants in the linguistic community such as genetically modified subjects and animals. Major conclusions are the LLMs seem to qualify as authors that originally participate in discursive practices but do display only a structurally derivative form of communicative competence and fail to meet the status of communicative agents. In this sense, while the contribution of AI writing systems in public discourse and deliberation can support the process of mutual understanding within the community of speakers, the human actors involved in the development, use, and diffusion of these systems share a collective responsibility for the disclosure of AI authorship and verification and adjudication of validity claims. (shrink)

The French philosopher Simone Weil (1909-1943) thought of geometry and algebra not as complementary modes of mathematical investigation, but rather as constituting morally opposed approaches: whereas geometry is the sine qua non of inquiry leading from ruthless passion to temperate perception, in accord with the human condition, algebra leads in the reverse direction, to excess and oppression. We explore the constituents of this argument, with their roots in classical Greek thought, and also how Simone Weil came to qualify it following (...) her exchange with her brother, the mathematician André Weil. (shrink)

Contemporary society needs the recognition of a moral middle ground, where human behavior can be evaluated as permissible, understandable, or even valuable. As a counterforce to polarization and divisive politics, an identity model is proposed in which individual and group identities are transcended by a human and ecological identity.

As artificial intelligence (AI) deployment is growing exponentially, questions have been raised whether the developed AI ethics discourse is apt to address the currently pressing questions in the field. Building on critical theory, this article aims to expand the scope of AI ethics by arguing that in addition to ethical principles and design, the organizational dimension (i.e. the background assumptions and values influencing design processes) plays a pivotal role in the operationalization of ethics in AI development and deployment contexts. Through (...) the prism of critical theory, and the notions of underdetermination and technical code as developed by Feenberg in particular, the organizational dimension is related to two general challenges in operationalizing ethical principles in AI: (a) the challenge of ethical principles placing conflicting demands on an AI design that cannot be satisfied simultaneously, for which the term ‘inter-principle tension’ is coined, and (b) the challenge of translating an ethical principle to a technological form, constraint or demand, for which the term ‘intra-principle tension’ is coined. Rather than discussing principles, methods or metrics, the notion of technical code precipitates a discussion on the subsequent questions of value decisions, governance and procedural checks and balances. It is held that including and interrogating the organizational context in AI ethics approaches allows for a more in depth understanding of the current challenges concerning the formalization and implementation of ethical principles as well as of the ways in which these challenges could be met. (shrink)

Abstract:Taking its cue from a resonant passage in Stanley Cavell's The Claim of Reason, this essay reflects on the necessity of the figure of the child for Cavell's philosophy and for his understanding of the differences between Austinian and Wittgensteinian criteria. It develops the difference between instruction and initiation by meditating on how we learn the words for love. Finally, I examine briefly the figure of the boy Mamillius, son of the skeptic Leontes, in William Shakespeare's The Winter's Tale, whom (...) Cavell first noticed as central to the play's energies. (shrink)

In this article we focus on note taking as a practice that is fundamental to education. We argue that note-taking should not primarily be regarded as a method that supports effective learning, but as formative of the student herself. Hence it is a practice that has educational meaning in and of itself. It is a pedagogical form in its own right. We go on arguing that the practice of lecturing can itself be seen as a form of note taking and (...) that both phenomena are not only closely related, but also that note making and lecturing consist of reciprocal operations. Studying on the basis of one’s notes comes down to the reverse operation the teacher had to perform when preparing her lessons. Moreover, thanks to making notes during a class students have a deeply embodied sense of what it means to generate and to construct new arguments and ideas. (shrink)