Leibniz, in order to avoid both determinism and indifferentism, says that knowledge inclines the agent towards the best action without necessitating it. According to his modal theory, an action is contingent if the opposite is (logically) possible. The article examines the coherence of Leibniz’s notion of «inclining but not necessitating» in the context of contemporary philosophy of action, profiting from the distinction between reasons and causes. The kind of freedom which is possible according to Leibniz philosophy depends on this question.

An analysis of the particular kind of determinism that is to be found in the moral election according to Leibniz shows the model of practical reason held in his philosophy. The hermeneutical clue used in the article is to make a parallelism between the model of rationality of God’s election to create the best possible world and that of human moral election.

Introduction: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. Aim: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and (...) guidelines. Methodology: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. Ethical consideration: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Results: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. Discussion: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care. Conclusion: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice. (shrink)

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and (...) triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Though Wittgenstein's On Certainty has been influential in analytic epistemology, its interpretation has been enormously controversial. It is true that exegesis has been mainly concerned with the proper characterization of Wittgenstein's very notion of ?certainty?; however, some important questions remain unanswered regarding this notion. On the one hand, I am above all referring to the study of the possibilities we have of retaining a certainty when it has seemingly been placed into question and, on the other hand, of regaining a (...) certainty once it has been lost. In this paper, I attempt to provide a detailed answer to both questions. In so doing, some important features of the picture of ourselves which emerges from Wittgenstein's On Certainty are also revealed. (shrink)

This work contemplates how Aquinas´s introductions to Aristotle´s works present passages which are capable of combining themselves in a way that results in a map of Knowledge. This map establishes a hierarchy of sciences whose beginning is given in human contemplation, thisis, the differences that Nature shows in itself for the basis for this hierarchical division. Therefore, from this map we can summarize three topics: the order of sciences, the Aristotle's works which sustain it and the contemplation of that order.

In this paper I outline the most relevant traits of the term ‘trust’ understood as one of the synonyms for ‘certainty’ that Ludwig Wittgenstein used in his posthumous work On Certainty. To this end, I analyze the paragraphs of On Certainty in which reference is made to pupils who are expected to trust what is taught by their teacher: in addition, I note that such a process is largely based on the attitude of rejection and bewilderment that teachers promote towards (...) people who call into doubt those certainties that pupils are expected to assimilate. Subsequently, after emphasizing the importance that Wittgenstein attached to the ineffability of certainties, I explain how such certainty or trust can be staged. Lastly, I clarify why an appropriate contemplation of this staging can be of great help for pupils to achieve at least four goals of educational interest: thus, children can not only strengthen their capacity for wonder, but also experience what things are ineffable, glimpse the limits of rationality, and become more tolerant of people who are partakers of a different world-picture. (shrink)

Hegel's main criticisms of Spinoza are well‐known both among Spinoza and Hegel scholars. The role of Spinozism in Hegel's conception of philosophy turns out to be significantly more crucial than the rest of philosophies. This chapter argues that Spinoza's acosmism constitutes for Hegel the necessary condition for the rise and development of philosophy, and hence for the realization of human freedom, insofar as philosophy is the highest form of human freedom. It outlines the general conception of philosophy behind Hegel's statement (...) that Spinozism constitutes “the essential beginning of all philosophizing.” In Hegel's view, the greatness of Spinozism lies precisely in the radical de‐substantialization of finite things that it carries out, that is, in its acosmism.” Spinoza's acosmism clears the ground for the free exercise and unfolding of philosophical thinking. (shrink)

El análisis detenido del pensamiento teológico-musical de Isidoro de Sevilla ha sido repetidamente ignorado por la crítica, hecho que ha provocado que el estado de la cuestión sobre la materia sea prácticamente inexistente. Debido a ello, este trabajo tiene un cuádruple objetivo. En primer lugar, fijar con precisión el citado estado de la cuestión. En segundo lugar, sistematizar el estudio del pensamiento teológico-musical isidoriano dentro de la totalidad de su pensamiento musical para que el primero pueda ser estudiado exhaustivamente y (...) de manera generalizada en el futuro. En tercer lugar, localizar, clasificar e introducir por primera vez todos los textos litúrgico-musicales de Isidoro de Sevilla de cara a su posterior estudio en futuras publicaciones. En cuarto lugar, exponer, también por primera vez, algunas de las ideas más relevantes del pensamiento teológico-musical isidoriano como ejemplo de la sistematización propuesta y como punto de partida para el establecimiento de futuras líneas de investigación. (shrink)

Este artículo reseña: Oscar Celador Angón, Entidades locales y libertad religiosa, Ed. Dykinson, Madrid 2023, 214 pp.

Las universidades se enfrentan a múltiples retos que tienen ver con la misión que llevan a cabo en la sociedad en que se encuentran. La Compañía de Jesús en las últimas décadas ha renovado y reformulado de manera actualizada su misión. Es titular de casi doscientas instituciones de educación superior. Ha renovado también el entronque de dichas instituciones en la misión de la misma Compañía. El concepto de liderazgo ignaciano surge estos años como eje de renovación de personas e instituciones. (...) Puede ser también, para las universidades jesuitas, ocasión de profundización en su identidad y de mejora en su servicio apostólico. (shrink)

El autor realiza una lectura de las Enéadas de Plotino partiendo de la noción de procesión, pieza clave para comprender la arquitectura del universo plotiniana ordenado jerárquicamente alrededor del Uno-Bien.Del primer principio proceden todos los seres y en él convergen. Cuatro son fundamentalmente los aspectos tratados: 1) El axiomade la procesión. 2) Los dos momentos de la procesión: el ascendente y el descendente. 3) Las imágenes de la procesión.4) Dentro de estas metáforas, privilegia el centro y el círculo, núcleo en (...) el análisis de la noción de procesión. (shrink)

El artículo examina el papel de Crescas y Spinoza en la transición de la concepción medieval a la concepción moderna del universo. Crescas es presentado como ejemplo ilustrativo de la tensión entre aristotelismo y religión revelada y de cómo esta última provoca la disolución del aquel, allanando así el camino a la concepción moderna del universo. A continuación, se muestra cómo la concepción moderna se plasma en el pensamiento de Spinoza, el cual radicaliza algunos de sus rasgos definitorios. Esta radicalización (...) socava la noción tradicional del _Deus absconditus_ y conduce en Spinoza al remplazo de la religión por la filosofía como auténtica revelación divina. (shrink)

Many authors have already observed that the Tractatus Theologico-Politicus of Baruch Spinoza was, in its time, the most discussed and most vehemently refuted book. Indeed, at the dawn of the Enlightenment, and almost until the end of the nineteenth century, Spinoza's Theological-Political Treatise was an assertive and powerful appeal to freedom of expression and thought, a bold claim of religious tolerance and freedom of conscience in a Europe that was unaccustomed to the exercise of free thought. But, what is after (...) all the subject of the Theological-Political Treatise, a book maligned for so long and by so many as ultra pestilential and immoral? The present volume, collecting essays by notable European scholars, attempts to address some of the problems created by the broad spectrum of topics included in Spinoza's Theological-Political Treatise. (shrink)

Rationale, aims and objectives Given the increasing prevalence of cataract and demand for cataract extraction surgery, patients must often wait to undergo this procedure. We validated a previously developed priority scoring system in terms of clinical variables, pre-intervention health status, appropriateness of surgery and gain in visual acuity (VA) and health-related quality of life (HRQoL).Methods Explicit prioritization criteria for cataract extraction created by a variation of the Research and Development (RAND) and University of California Los Angeles appropriateness methodology were retrospectively (...) applied to a prospective cohort of 5257 patients on waiting lists to undergo cataract by phacoemulsification at 17 hospitals in Spain. Demographic data, clinical data and data related to surgical technique were collected by trained ophthalmologists. Patients were evaluated by their ophthalmologist before the intervention and 6 weeks afterward. They also completed, by mail, the Visual Function Index (VF-14) before the intervention and 3 months afterward.Results High-priority patients experienced greater improvement in VA and HRQoL than those classified as intermediate or low-priority (P < 0.0001), even after adjusting by VA and the VF-14 score at baseline. The time to intervention was the same for high-priority patients as it was for intermediate and low-priority patients.Conclusions The priority score we developed identified patients most likely to experience the greatest improvements from cataract extraction. Use of this tool could provide a fairer and more rational way to prioritize patients for cataract extraction. (shrink)

Hasta mediado s del siglo pasado, el tema que nos ocupa, la presencia de Cristo en los sacramentos, se resumía y concentraba, po r no deci r que se agotaba, en la presencia real eucanstica. O sea el concept o 'presencia' de Cristo se reservaba en la practica únicamente para su realización máxima en la Eucaristía; era la presencia real somática la que absorbía cualquier otra forma de presencia sacramental, que en todo caso quedaba en la sombra. Subrayo lo de (...) presencia sacramental, porque obviamente la presencia divina llenándolo todo, abarcando el cosmo s y la historia, no era desconocida Po r lo que a mi se m e alcanza, la primera vez que en un documento eclesiástico se hace explícita referencia a la presencia de Cristo en los sacramentos es precisamente en la única encíclica enteramente consagrada a la liturgia que hasta hoy conocemos : la Mediator Dei promulgada por Pío XII el 20 de noviembre de 1947. La doctrina aquí propuesta ha tenido tal aceptación o recepción que pertenece ya, podríamos decir, al tesoro de la Tradición. (shrink)

In this paper, I argue that the certainty about the wrongness of killing must not be considered as a universal, but as a local one. Initially, I show that there exist communities in which the wrongness of killing innocents is not a moral certainty and that this kind of case cannot be justified by arguing that such people are psychopaths. Lastly, I argue that universal certainties do not admit of exceptions: thus, the fact that some exceptional cases affect the certainty (...) that killing innocents is wrong, leads me to conclude that it is a local certainty. (shrink)