La Segunda Guerra Mundial y las atrocidades cometidas en investigaciones con los prisioneros en los campos de concentración nazis y japoneses, despertaron la conciencia por el desarrollo de los derechos humanos que se habían conquistado paulatinamente a lo largo de la historia. Por ello se conforman una serie de leyes, normas y declaraciones donde se tratan los aspectos bioéticos en los ensayos clínicos. Se debe prestar vital atención a la relación médico-paciente en el curso de las investigaciones y considerar la (...) relación beneficio/riesgo cuando se va a experimentar en seres humanos. La retinopatía diabética proliferativa es una de las afecciones oftalmológicas que más ensayos ha suscitado. El objetivo de este trabajo consiste en analizar algunos aspectos éticos en la experimentación en pacientes con esta afección. The Second World War and the atrocities committed in research with prisoners in Japanese and Nazi concentration camps, awakened consciousness for the development of human rights that had gradually been conquered throughout history. That´s why a series of laws, rules and statements that deal with bioethical aspects in clinical trials, were passed. Special attention must be given to the doctor-patient relationship during the research and consider the benefit/risk ratio when conducting experiments on human beings. Proliferative Diabetic Retinopathy is one of the ophthalmological disorders that has given rise to more trials. The research goal is to analyze some ethical aspects when experimenting on patients with this condition. (shrink)

Background Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents’ concepts of death and related aspects, their reactions and actions in situations (...) pertaining to death in their practice, and their perceptions about existing and necessary training conditions. Methods A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. Results Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. Conclusions Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. Trial registration Not applicable. (shrink)

Aims: Attentional bias, alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder. The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content.Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. (...) The protocol consisted of six VR-CET booster sessions and two assessment sessions over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking and VR technologies at different time points.Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB.Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

In this article, I examine the possible thought experimenting qualities of Soren Kierkegaard's novel Fear and Trembling and in which way it can be explanatory. Kierkegaard's preference for pseudonyms, indirect communication, Socratic interrogation, and performativity are identified as features that provide the narrative with its thought experimenting quality. It is also proposed that this literary fiction functions as a Socratic-theological thought experiment due to its influences from both philosophy and theology. In addition, I suggest three functional levels of the fictional (...) narrative that, in different ways, influence its possible explanatory force. As a theoretical background for the investigation, two accounts of literary cognitivism are explored: Noel Carroll's Argument Account and Catherine Elgin's Exemplification Account. In relation to Carroll's proposal, I conclude that Fear and Trembling develops a philosophical argumentation that is dependent on the reader's own existential contribution. In relation to Elgin's thought, the relation between truth and explanatory force is acknowledged. At the end of the article, I argue that it is more accurate to see the explanatory force of Fear and Trembling in relation to its exploratory function. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Many scholars have contended that Clare of Assisi’s original intention upon leaving her family home to take up religious life sometime around 1211 was to lead a life essentially like that of the mendicant friars.1 She and the women who soon joined her would be not only poor and penitential, but also itinerant and apostolic. Like the friars their life would be marked by both insertion into the world (...) and seclusion from it as they alternated between active service and recollected contemplation. The important proof text for this claim is a passage in a letter composed by Jacques de Vitry in 1216, just five years after Clare’s conversion. Many scholars, including Paul Sabatier, Luigi Pellegrini, Roberto Rusconi, Marco Bartoli, Ingrid Peterson, Chiara Frugoni, Giovanni Boccali, and Chiara Augusta Lainati believe the text to be the earliest witness to the manner of life led by Clare and her followers during their initial years.2 The letter has been used to argue further that the women were explicitly grouped together with the Lesser Brothers, were known by the parallel title of “Lesser Sisters,” and had the freedom to come and go as they wished during their early years in San Damiano.Since claims about the women’s early likeness to the friars’ mendicant way of life are often made as brief assertions resting on Jacques’s letter, I think it important to consider in a more detained fashion the provocative passage thought to support them. Closer scrutiny of Jacques’s text shows that while none of these claims can be entirely ruled out, importantly, none can be supported with any solid evidence. I agree essentially with scholars such as Lilly Zarncke, Ernest McDonnell, Maria Pia Alberzoni, Jacques Dalarun, and Lezlie Knox who consider the letter’s language too general to know if it refers specifically to Clare and her sisters.3 I suggest, furthermore, that there are reasons to conclude that this is certainly unlikely if the passage is interpreted to mean, specifically, that Clare and her sisters carried on an active apostolate outside of San Damiano.Jacques de Vitry is generally recognized as one of the most astute and forward-thinking observers of his time in terms of recognizing the importance of new religious groups. A Parisian master, canon regular, and bishop, Jacques had the opportunity to live in a variety of settings, including his native France, the Low Countries, Italy, and the holy land.4 In 1216, he traveled from Liège in the Low Countries to Perugia to be consecrated bishop by Honorius III, who himself had just been elevated to the papacy.5 Along with observations about other matters, Jacques shared the following comment about religious men and women in a letter that he sent almost certainly to a group of his friends back in Liège. He was writing in the early days of October 1216 as he was leaving Italy on a boat that would carry him to his new episcopal see in Acre. The letter, the first of six that survive, is prized not only for its reference to the Lesser Sisters, but also as the very first written testimony regarding the Franciscan movement in general. The great nineteenth-century historian Paul Sabatier thought it provided a more vivid and precise description of Francis’s ministry than any single passage contained in his early biographies.6 The passage, which represents less than seven percent of the entire letter, is rendered thus in a widely available English translation:I found one consolation in those parts, nevertheless: many men and women [multi enim utriusque sexus], rich and worldly, after renouncing everything for Christ, fled the world. They are called Lesser Brothers and Lesser Sisters [fratres minores et sorores minores]. They are held in great esteem by the Lord Pope and the cardinals. They do not occupy themselves with temporal affairs, but work each day with great desire and.. (shrink)

In den letzten Jahrzehnten sind die Emotionen zu einem der zentralen Themen der Philosophie des Geistes geworden. Erstaunlich ist in diesem Kontext einer neuen Entdeckung der Gefühle, dass die frühen phänomenologischen Beiträge der ersten Schüler Husserls zu dem Thema in Vergessenheit geraten sind. Dabei können die Gefühlskonzeptionen und Analysen emotionaler Phänomene von Pfänder, Voigtländer, Haas, Geiger, Scheler, Stein, Walther, Kolnai, Ortega y Gasset wegen ihrer einzigartigen Präzision und Erfahrungsnähe die heutige Debatte entscheidend bereichern. In diesem Buch wird einerseits die (...) Rekonstruktion einer Theorie der Emotionen unternommen, welche implizit in den Texten der ersten Phänomenologen liegt. Andererseits werden systematische Antworten auf Fragen und Problemstellungen gegeben, welche die aktuelle Diskussion bestimmen. Was sind Emotionen? Inwiefern kann man von emotionaler Realität und Irrealität, Echtheit und Unechtheit sprechen? Kann es Emotionen über Fiktionen geben? Gibt es unterbewusste Emotionen? Welche Rolle spielen leibliche Aspekte? Was bedeutet es, dass Emotionen intentional sind? In welcher Beziehung stehen sie zu den Werten? Dies sind die Leitfragen des Buches. (shrink)

This chapter examines the critiques of sentimentalism developed by Moritz Geiger and José Ortega y Gasset within the field of phenomenological aesthetics. It explores and evaluates the main arguments behind this critique: namely the existence of an aesthetic attitude, an intellectualized view of appreciation, and the predominance of form over content. Though both authors utilize Kant’s idea of “aesthetic disinterestedness”, they endorse a view of appreciation which differs from the Kantian one in substantial respects.

This chapter examines the critiques of sentimentalism developed by Moritz Geiger and José Ortega y Gasset within the field of phenomenological aesthetics. It explores and evaluates the main arguments behind this critique: namely, the existence of an aesthetic attitude, an intellectualized view of appreciation, and the predominance of form over content. Though both authors utilize Kant’s idea of “aesthetic disinterestedness,” they endorse a view of appreciation that differs from the Kantian one in substantial respects.

Recent feminists have critiqued G.W. Leibniz’s Theodicy for its effort to justify God’s role in undeserved human suffering over natural and moral evil. These critiques suggest that theodicies which focus on evil as suffering alone obfuscate how to thematize evil, and so they conclude that theodicies should be rejected and replaced with a secularized notion of evil that is inextricably tied to the experiences of the victim. This paper argues that the political philosophy found in the writings of Catherine (...) Macaulay (1731–1791) can serve as a support to Leibniz’s larger claims and can also offer a more concrete, situated notion of evil that escapes the contemporary feminist critique. Macaulay’s work on natural and moral political evil, especially, will be presented as an early modern precursor to feminism, which defends divine perfection and a pre-established harmony in the face of political evil. I then identify three unique theodicical arguments in Macaulay’s work: the pragmatically beneficial defense, the eschatalogical defense, and the redemptive defense. (shrink)

This work tries to give the possible most suitable vision of the Generation of 98 regarding the purposes and interest of the main authors: Azorín, Pío Baroja, Miguel Unamuno, Antonio Machado and José Ortega y Gasset.

¿Puede ser racional creer algo porque se quiere creerlo? Prima facie no, puesto que una creencia racional se basa en razones, y la voluntad de creer puede ser una causa, pero no una razón de la creencia. Sin embargo, algunos intentos de autoinducirse creencias causalmente pueden verse como el ejercicio de una racionalidad de segundo orden. En este artículo, se esboza una visión de esta racionalidad de segundo orden basada en la tesis de Davidson de la división de la mente (...) y la distinción de Ortega entre ideas y creencias. La inquietante conclusión del análisis es que la capacidad de tener deseos de segundo orden sobre nuestras creencias es lo que hace posibles tanto la autocrítica y la autosuperación como el dogmatismo y la autocorrupción y que la condición de posibilidad de la racionalidad y la libertad es la misma que la de la irracionalidad y la alienación. Is it rational to believe something because one wants to believe it? Prima facie it is not, for a rational belief is based on reasons, and the will to believe can be a cause, but not a reason for the belief. Nevertheless, some attempts of causally self-inducing beliefs can be viewed as a sort of second-order rationality. This paper sketches a view of this second-order rationality based on Davidson's thesis of the divided mind and Ortega's distinction between ideas and beliefs. The uncomfortable conclusion of the discussion is that the ability to have second-order beliefs about our beliefs is what makes possible both self-criticism and self-improvement and dogmatism and self-corruption and that the possibility condition of rationality and freedom and of irrationality and alienation are the same. (shrink)

The current times call for reforms in educational processes. The Covid-19 pandemic had an unforeseen impact on the educational system in all countries. This need for change requires new pedagogies and new methods for teaching and learning. Understanding the need for change is essential for the formulation of adaptive proposals, as well as for the generation of training activities to complement the teaching curriculum. New educational practices lead to a vision of educational quality, with new approaches that allow the continuous (...) integration of knowledge and permanent interaction with the student. This paper presents an analysis of the new teaching methodologies in times of confinement due to the pandemic caused by Covid-19. Keywords: Teaching methodologies, educational system, learning process. References [1]É. Tremblay-Wragg, C. Raby, L. Ménard y I. Plante, «El uso de estrategias didácticas diversificadas por cuatro profesores universitarios: ¿qué contribución a la motivación de aprendizaje de sus alumnos?,» Docencia en educación superior, vol. 26, nº 21, 2021. [2]L. Czerniewicz, R. Mogliacci, S. Walji, A. Cliff, B. Swinnerton y N. Morris, «Enseñanza y aprendizaje académico en el nexo: desagregación, mercantilización y digitalización en la educación superior,» Teaching in Higher Education, vol. 26, nº 2021, p. 16, 2021. [3]S. Dogan y A. Adam, «Aumentar el efecto del desarrollo profesional en la instrucción efectiva a través de comunidades profesionales,» Docentes y docencia: teoría y práctica, vol. 26, nº 3-4, pp. 326-349, 2020. [4]I. M. Torres Salas, «La enseñanza tradicional de las ciencias versus las nuevas tendencias educativas,» Educare, vol. 14, nº 1, pp. 131-142, 2010. [5]B. Fabio, J. Antonio Palomino y J. González Henríquez, «Evaluación y contraste de los métodos de enseñanza tradicional y lúdico,» Revista de Educación física y deportes, vol. 13, nº 94, pp. 29-36, 2008. [6]Y. Benítez y C. Mora, «Enseñanza tradicional vs aprendizaje activo,» Revista Cubana de Física, vol. 27, nº 2A, pp. 175-179, 2010. [7]P. Morales Bueno y V. Landa Fitzgerald, «Aprendizaje basado en problemas,» Theoria, vol. 13, nº 1, pp. 145-157, 2004. [8]R. Gil-Galván, I. Martín-Espinosa y F. Gil-Galván, «University student perceptions of competences acquired through problem-based learning,» Educación XXI, vol. 24, nº 1, pp. 271-295, 2020. [9]E. Ortiz Cermeño, «El aprendizaje basado en problemas,» Perfiles Educativos, vol. 41, nº 164, pp. 208-213, 2019. [10]E. Araos-Baeriswyl, C. Moll-Manzur, Á. Paredes y J. Landeros, «Aprendizaje invertido: un enfoque pedagógico en tiempos de pandemia,» Rev. Atención Primaria, vol. 53, nº 1, p. 117, 2021. [11]V. León-Carrascosa, M. Belando-Montoro y S. Sánchez-Serrano, «Design and validation of a questionnaire to evaluate the service-learning methodology,» Rev.Estudios sobre educación, vol. 39, nº 1, pp. 247-266, 2020. [12]J. Collado-Ruano, M. Ojeda, M. Malo y D. Amino, «Educación, arte e interculturalidad: El cine documental como lenguaje comunicativo y tecnología innovadora para el aprendizaje de la metodología I + D + I,» Rev. Texto livre, vol. 13, nº 3, pp. 376-393, 2020. [13]P. M. Bueno y V. Landa Fitzgerald, «Aprendizaje basado en problemas,» Theoria, vol. 13, nº 1, pp. 145-157, 2004. [14]J. A. Martí, M. Heydrich, M. Rojas y A. Hernández, «Aprendizaje basado en proyectos: Una experiencia de innovación docente,» Universidad EAFIT, vol. 46, nº 158, pp. 11-21, 2010. [15]L. Rojas y N. M. Jaimes, «Canvas LMS y el trabajo colaborativo como metodología de aprendizaje en entornos virtuales,» de Congreso Ibérico de Sistemas y Tecnologías de la Información, CISTI, Bogotá, Colombia, 2020. [16]B. Bordel y P. Mareca, «Results and Trends in educational MOOCs in the engineering area with MIRIADAX platform. A case study,» de 15th Iberian Conference on Information Systems and Technologies, CISTI 2020; Seville; Sevilla, España, 2020. [17]K. Vermeir y G. Kelchtermans, «Innovative practice as interpretative negotiation.A case-study on the kamishibai in Kindergarten.,» Teachers and Teaching: Theory and Practice, vol. 26, nº 3-4, pp. 248-263, 2020. [18]B. Tucker, «The Flipped Classroom: Online instruction at home frees class time for learning,» Education Next, vol. 1, nº 1, pp. 82-84, 2012. [19]M. V. Ledo, N. R. Michelena, N. N. Cao, I. d. R. M. Suárez y M. N. Vialart Vidal, « Aula invertida, nueva estrategia didáctica,» Educación Médica Superior, vol. 30, nº 3, pp. 678-688, 2016. [20]Metodologías activas por medio de las TIC, [Online]. Available: https://www.campuseducacion.com/blog/recursos/articulos-campuseducacion metodologias-activas-por-medio-de-las-tic/?cn-reloaded=1. [Last access: February 14, 2021]. (shrink)

Este artículo es una respuesta a la crítica de Noé Expósito Ropero —que se basa en gran medida en la visión de Javier San Martín— a mi interpretación de la filosofía de José Ortega y Gasset. El resultado del argumento de Expósito Ropero es que Ortega es más fenomenólogo de lo que yo considero, que me equivoco al pen-sar que existen los “objetos reales” más allá de los objetos intencionales de Edmund Husserl, y que ningún objeto inanimado puede (...) ser tratado como un “yo”. Como réplica, respondo a cada una de estas acusaciones.This article is a response to Noé Expósito Ropero’s critique—which draws heavily on the views of Javier San Martín—of my interpretation of the philosophy of José Ortega y Gasset. The upshot of Expósito Ropero’s argument is that Ortega is more of a phenomenologist than I realize, that I am wrong to think there is any such thing as “real objects” beyond Edmund Husserl’s intentional objects, and that no inanimate object can be treated as an “I.” In response, I answer each of these charges. (shrink)

Introduction: Platonic dramatology -- The political and philosophical problems. Using pre-Socratic philosophy to support political reform: the Athenian stranger ; Plato's Parmenides: Parmenides' critique of Socrates and Plato's critique of Parmenides ; Becoming Socrates ; Socrates interrogates his contemporaries about the noble and good -- Paradigms of philosophy. Socrates' positive teaching ; Timaeus-Critias: completing or challenging Socratic political philosophy? ; Socratic practice -- The trial and death of Socrates. The limits of human intelligence ; The Eleatic challenge ; The trial (...) and death of Socrates -- Conclusion: Why Plato made Socrates his hero. (shrink)

This landmark study examines the role played by the rediscovery of the writings of the ancient atomists, Epicurus and Lucretius, in the articulation of the major philosophical systems of the seventeenth century, and, more broadly, their influence on the evolution of natural science and moral and political philosophy. The target of sustained and trenchant philosophical criticism by Cicero, and of opprobrium by the Christian Fathers of the early Church, for its unflinching commitment to the absence of divine supervision and the (...) finitude of life, the Epicurean philosophy surfaced again in the period of the Scientific Revolution, when it displaced scholastic Aristotelianism. Both modern social contract theory and utilitarianism in ethics were grounded in its tenets. Catherine Wilson shows how the distinctive Epicurean image of the natural and social worlds took hold in philosophy, and how it is an acknowledged, and often unacknowledged presence in the writings of Descartes, Gassendi, Hobbes, Boyle, Locke, Leibniz, Berkeley. With chapters devoted to Epicurean physics and cosmology, the corpuscularian or "mechanical" philosophy, the question of the mortality of the soul, the grounds of political authority, the contested nature of the experimental philosophy, sensuality, curiosity, and the role of pleasure and utility in ethics, the author makes a persuasive case for the significance of materialism in seventeenth-century philosophy without underestimating the depth and significance of the opposition to it, and for its continued importance in the contemporary world. Lucretius's great poem, On the Nature of Things, supplies the frame of reference for this deeply-researched inquiry into the origins of modern philosophy. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Leibniz has often been described as holding to a kind of phenomenalism. Yet Leibniz did not have a single account of perception, or of the embodied mind, or of the monad, but a set of conflicting and mutually inconsistent accounts that preclude the possibility that there is any such thing as “Leibniz's System.” This difficulty raises problems of interpretation, since it is sometimes maintained that the principle of charity precludes the assignment of frankly inconsistent views to a philosopher. The essay (...) argues that we should not be misled by the intentionalist fallacy into looking for order within a text as opposed to order commentators can impose by making a philosopher's inconsistencies intelligible. (shrink)

The aim of this study is to understand how governance mechanisms in cross-sector collaborations (CSCs) for sustainability affect value creation and capture and subsequently the survival of this organizational form. Drawing on a longitudinal, participatory, single-case study of collaborative action in the textile industry, we identify three governance mechanisms—safeguarding, bundling and connecting—that coevolve with the rising and waning of collaborative tensions and the shifting levels of action in the CSC we studied. These mechanisms aided value creation and helped facilitate private (...) value capture. We integrate these insights into a process model that visualizes the interplay between governance mechanisms of tensions and systems of value creation and capture in CSCs for sustainability. Our study contributes to the cross-sector collaboration literature by providing a dynamic and nuanced understanding of how governance mechanisms influence outcomes in CSCs for sustainability. We also add to the business model for sustainability literature by theorizing the value creation and capture system of collaborative rather than individual organizations. Our findings have important implications for policymakers who fund collaborative organizations and practitioners who manage or participate in them. (shrink)

Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Abstract.Klaus Günther's (1988) book developed the distinction between two kinds of discourse, the foundation discourse and the application discourse. In an article (Günther 1989a) following the publication of the book, he used this basic distinction as the starting point for a criticism of the special case‐thesis as defended by Robert Alexy (1978, 32ff., 263ff.; Alexy 1989, 16ff., 213ff.). The aim of this article is to criticize this criticism in its turn and to show that the special case‐thesis does not need (...) the reformulation which Günther proposes. It should be clear from the outset that this concerns an internal discussion in the field of discourse theory; certain discourse‐theoretical premises are taken for granted. In order to understand Giinther's criticism I will first give a brief account of the distinction he has made. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

The development of genomics has dramatically expanded the scope of genetic research, and collections of genetic biosamples have proliferated in countries with active genomics research programs. In this essay, we consider a particular kind of collection, national biobanks. National biobanks are often presented by advocates as an economic ‘‘resource’’ that will be used by both basic researchers and academic biologists, as well as by pharmaceutical diagnostic and clinical genomics companies. Although national biobanks have been the subject of intense interest in (...) recent social science literature, most prior work on this topic focuses either on bioethical issues related to biobanks, such as the question of informed consent, or on the possibilities for scientific citizenship that they make possible. We emphasize, by contrast, the economic aspect of biobanks, focusing specifically on the way in which national biobanks create biovalue. Our emphasis on the economic aspect of biobanks allows us to recognize the importance of what we call clinical labor—that is, the regularized, embodied work that members of the national population are expected to perform in their role as biobank participants—in the creation of biovalue through biobanks. Moreover, it allows us to understand how the technical way in which national biobanks link clinical labor to databases alters both medical and popular understandings of risk for common diseases and conditions. (shrink)

Truth is standardly considered a requirement on epistemic acceptability. But science and philosophy deploy models, idealizations and thought experiments that prescind from truth to achieve other cognitive ends. I argue that such felicitous falsehoods function as cognitively useful fictions. They are cognitively useful because they exemplify and afford epistemic access to features they share with the relevant facts. They are falsehoods in that they diverge from the facts. Nonetheless, they are true enough to serve their epistemic purposes. Theories that contain (...) them have testable consequences, hence are factually defeasible. (shrink)