Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

A Second level Master in “Clinical Bioethics Consultation” has been organized in Italy to offer an opportunity to offer an adequate training to carry out an ethics consultation in different health fields. The master has been promoted and realized by different institutions: Catholic University of Sacred Hearth in Rome, Insubria University in Varese, “Federico II” University in Naples, Lanza Foundation in Padua and the Local Health and Social Care Unit n.7 in Veneto Region. The aim of the master is train (...) ethics consultants to offer help regarding a correct decision, which will take by others. The choice must be as much as possible shared between patient, family and health care team. Ethics consultation can be primarily request by the physicians, nurses and health care staff such as support about a choice that wants to be the most appropriate and to clarify a dilemma between different options. Secondly an ethics consultation can be demand by the patient and the family members to find a clarification about their dilemmas and future choices. Also the administrative staff could ask the consultation, when it need to better explain ad example about a specific clinical case or a question concerned the health policy. (shrink)

I grandi interrogativi sul significato della vita umana - sull'origine e la fine di ognuno - sull'origine e la fine dell'esistenza di ognuno - sono al cuore della riflessione filosofica e teologica, ma interpellano in maniera nuova anche le discipline scientifiche, psicologiche, sociali e giuridiche. Soprattutto toccano il nostro agire; è la sfera dell'etica ad essere coinvolta, come valori, principi e norme che guidano le decisioni da prendere. Le religioni e le tradizioni culturali hanno sempre accompagnato queste realtà, elaborando principi (...) e norme etiche, esperienze rituali e assistenziali. Al loro significato per la bioetica è dedicato il progetto di ricerca della Fondazione Lanza, che ha già trovato una prima espressione nel volume Bioetica e religioni. Un confronto dall'inizio della vita, a cura di Lorenzo Biagi e Renzo Pegoraro. In questo secondo testo, l'attenzione è sulle questioni legate alla fase terminale della vita umana, così profondamente toccata dai progressi della scienza e della medicina. Vi si trovano documentate le posizioni delle diverse confessioni cristiane (Cattolicesimo, Ortodossia, Protestantesimo, Anglicanesimo) e delle altre grandi fedi dell'umanità (Ebraismo, Islam, Buddismo, Induismo), illustrate da esponenti qualificati. Ad ampliare l'orizzonte, viene presentato l'approccio delle “nuove religioni” alla fine della vita, mentre un contributo esplora il rapporto tra religioni, etica e dialogo. (shrink)

While much work has been done on improving undergraduate education in bioethics, particularly in medicine, less has been said about continuing education of health care workers, particularly non-medical and nursing personnel. Hospitals bring together a variety of professional and non-professional groups in the place where clinical dilemmas are daily events, and would seem ideal places to conduct an ongoing bioethics dialogue. Yet evidence that this is being achieved is sparse.The European Hospital (-Based) Bioethics Program (EHBP) brings together both current and (...) aspirant members of the EU as partners in a project that aims to assess the current situation with regard to bioethics education in hospitals, identify shortfalls, and address these. In order to achieve the first objective of the EHBP a survey of the current training activities (focused on activities in hospitals) in clinical bioethics in Europe was carried out. The results are presented in this paper, along with a discussion about the implications for the EHBP to address these issues. (shrink)

Due to the recent gains in biomedical sciences, the fetus1 is more exposed and subjected to increasing possibilities of intervention, becoming a full-fledged patient, and entering more often into a...

El uso de la Inteligencia Artificial (IA) y su desarrollo en los últimos años, así como el papel que jugó durante la pandemia en 2020 ha suscitado, por un lado, un gran interés en sus aplicaciones en favor de la vida y, por el otro, temores respecto a su apego a criterios éticos que promueven y defienden la dignidad humana, la justicia, el principio de sociabilidad y de subsidiaridad. Por ello surge la intención del papa Francisco y de monseñor Paglia, (...) desde la Academia Pontificia para la Vida, de lanzar el llamado a reflexionar sobre la incorporación de la ética en la IA; a la par, la fundación RenAIssance alberga el llamado para que, desde una perspectiva global y en todos los sectores, se incorporen principios éticos en las diferentes aplicaciones de la IA. (shrink)

"Williams's masterful translation satisfies (at last!) a long-standing need. There are lots of good translations of Augustine's great work, but until now we have been forced to choose between those that strive to replicate in English something of the majesty and beauty of Augustine's Latin style and those that opt instead to convey the careful precision of his philosophical terminology and argumentation. Finally, Williams has succeeded in capturing both sides of Augustine's mind in a richly evocative, impeccably reliable, elegantly readable (...) presentation of one of the most impressive achievements in Western thought--Augustine's Confessions." --Scott MacDonald, Professor of Philosophy and Norma K. Regan Professor in Christian Studies, Cornell University. (shrink)

Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights—privacy versus fatherhood, in our case—is unsubstantial, in a given context, because of the groundlessness of (...) the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of ‘ethical-based root-cause analysis’, linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process. (shrink)

Biobanks are an important resource for medical research. Genetic research on biological material from minors can yield valuable information that can improve our understanding of genetic–environmental interactions and the genesis and development of early onset genetic disorders. The major ethical concerns relating to biobanks concern consent, privacy, confidentiality, commercialisation, and the right to know or not to know. However, research on paediatric data raises specific governance and ethical questions with regard to consent and privacy. We have considered the Italian normative (...) context focusing on what is mentioned in each document on the ethical and legal requirements that guarantee the rights of minors. We found out that there is no systematic reflection on the ethical and policy issues arising from the participation of minors in biobank research. Moreover, we have focused on the same aspects for the new Italian Law on the National Forensic Biobank. (shrink)

The Moral Nexus develops and defends a new interpretation of morality—namely, as a set of requirements that connect agents normatively to other persons in a nexus of moral relations. According to this relational interpretation, moral demands are directed to other individuals, who have claims that the agent comply with these demands. Interpersonal morality, so conceived, is the domain of what we owe to each other, insofar as we are each persons with equal moral standing. The book offers an interpretative argument (...) for the relational approach. Specifically, it highlights neglected advantages of this way of understanding the moral domain; explores important theoretical and practical presuppositions of relational moral duties; and considers the normative implications of understanding morality in relational terms. The book features a novel defense of the relational approach to morality, which emphasizes the special significance that moral requirements have, both for agents who are deliberating about what to do and for those who stand to be affected by their actions. The book argues that relational moral requirements can be understood to link us to all individuals whose interests render them vulnerable to our agency, regardless of whether they stand in any prior relationship to us. It also offers fresh accounts of some of the moral phenomena that have seemed to resist treatment in relational terms, showing that the relational interpretation is a viable framework for understanding our specific moral obligations to other people. (shrink)

The tissue biobanking of specific biological residual materials, which constitutes a useful resource for medical/scientific research, has raised some ethical issues, such as the need to define which kind of consent is applicable for biological residual materials biobanks.

The Italian debate about the role of clinical ethics and ethics consultation has brought about the need to create a working group of Healthcare Ethics Consultation. The group began to take shape an...

In 2001 the Italian Government defined Essential Assistance Levels (LEA), which can be considered as an important step forward in the health care system. The Italian health care system would provide payment of essential and uniform aid services in order to safeguard many values such as human dignity, personal health, equal assistance and good health practices. The Ministry of Health has worked to rationalize the National Formulary and to define evaluation methods for drugs in order to choose what to reimburse (...) without penalizing the rights of the individual and society.This paper describes how this job of rationalization was done and tries to illustrate the choices made in Italy by the use of two meaningful examples (statins and rivastigmine). (shrink)

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation (...) of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

We should approach this topic with great fear and respect. It is not a merely “academic” issue. Human rights are trampled upon in the East as in the West, in the North as in the South of our planet. Granting the part of human greed and sheer evil in this universal transgression, could it not also be that Human Rights are not observed because in their present form they do not represent a universal symbol powerful enough to elicit understanding and (...) agreement? (shrink)

Publicou-se pela editora Appris no ano de 2019 o livro Nas trilhas de Edith Stein:gênero em perspectiva fenomenológica e teológica, da pesquisadora Clélia Peretti,professora do curso de Bacharelado em Teologia e do Programa de Pós-Graduação(Mestrado e Doutorado) em Teologia da PUCPR. Resultado do seu doutorado, o livropossui como tema as contribuições nos campos da filosofia e da teologia na perspectivafeminina a partir da filósofa e mística Edith Stein, uma das grandes mulheres do séculoXX. Escrito por uma mulher sobre uma das (...) grandes mulheres do século XX, um dosseus méritos consiste no fato de assumir a defesa da feminilidade à luz da fé.Prefaciado pelo professor, pesquisador e tradutor Renato Kirchner e apresentado peloprofessor Ezequiel Westphal, o livro está dividido em cinco capítulos. (shrink)

Chemical structures are among the trademarks of our profession, as surely chemical as flasks, beakers and distillation columns. When someone sees one of us busily scribbling formulas or structures, he or she has no trouble identifying a chemist. Yet these familiar objects, which accompany our work from start to end, from the initial doodlings (Fig. I) to the final polished artwork in a publication (Fig. II), are deceptively simple. They raise interesting and difficult questions about representation. It is the intent (...) of this article to reflect upon molecular graphics. (shrink)

Ethics and Decision Making in Counseling and Psychotherapy has a distinct and timely focus on counseling as a profession. Chapters address the mental health professions, values in counseling, decision making, ethical principles, ethical standards, technology, ethical climate, and office/administrative practices. The early chapters present a foundation for ethical practice of the profession and provides solid building blocks to the more advanced perspectives in later chapters. Chapters on specialty practice are lively and contemporary overviews of these practice areas in counseling that (...) reflect more recent trends to increased differentiation of these areas of practice. Each specialty has its own chapter to allow for an extended discussion of the unique aspects of the field that provide clarity to understanding the particular ethical issues and standards that apply in each specialty. The specialty areas recognized by CACREP are included: mental health counseling; school counseling; couple, marital, and family counseling; rehabilitation counseling; addictions counseling; career counseling; and group counseling. This book is broad in its coverage of the most practiced specialties in mental health practice, and provides an efficient and effective overview of the broad scope of particular areas addressed in counseling. (shrink)

I investigate the consequences of Nietzsche's perspectivism for notions of truth and objectivity, and show how the metaphor of visual perspective motivates an epistemology that avoids self-referential difficulties. Perspectivism's claim that every view is only one view, applied to itself, is often supposed to preclude the perspectivist's ability to offer reasons for her epistemology. Nietzsche's arguments for perspectivism depend on “internal reasons”, which have force not only in their own perspective, but also within the standards of alternative perspectives. Internal reasons (...) allow a perspectivist argument against dogmatism without presupposing aperspectival criteria for theory choice. Nietzsche also offers “internal” conceptions of truth and objectivity which reduce them to a matter of meeting our epistemic standards. This view has pluralistic implications, which conflict with common sense, but it is nevertheless consistent and plausible. Nietzsche's position is similar to Putnam's recent internalism, and this is due to their common Kantian heritage. (shrink)

Is the essay literature or philosophy? A form of art or a form of knowledge? The contemporary essay is torn between its belletrist ancestry and its claim to philosophical legitimacy. The Spanish philosopher Eduardo Nicol captured the genre's uncertain status when he dubbed it “almost literature and almost philosophy” (Nicol 1961:207). The problem is hardly a new one. It goes back to what Plato called the “ancient quarrel” between poetry and philosophy, and more recently to the German Romantic theorist, Friedrich (...) Schlegel, who called for a mode of criticism which would be at once philosophical and poetic. But today, when the status of critical discourse is up for grabs, reflecting the crisis of knowledge in the universities, the question of the essay takes on a new urgency. Now the predominant form of writing in the human sciences, it cannot avoid the challenge to define itself according to the prevailing standards of scientific knowledge and method. (shrink)

It is tempting to think that all of normativity, such as our reasons for action, what we ought to do, and the attitudes that it is fitting for us to have, derives from what is valuable. But value-first approaches to normativity have fallen out of favour as the virtues of reasons- and fittingness-first approaches to normativity have become clear. On these views, value is not explanatorily prior to reasons and fit; rather the value of things is understood in terms of (...) the pro-attitudes it is fitting to have, or that we have reasons to have, towards these things. The value-first accounts of reasons and fit that have been proposed have been direct accounts of reasons and fit. On these views, the fittingness of an attitude is explained in terms of the value of having it or the value of the object of that attitude. This chapter details and surveys these problems, explaining which are yet to be overcome, and explaining which problems direct value-first accounts can overcome. This chapter then explores the prospects of an indirect value-first account of reasons and fit. It argues that it avoids the problems that direct value-first accounts face and may be as explanatorily powerful as fittingness- and reasons-first accounts of value and normativity more generally. (shrink)

Esta pesquisa tem como objetivo discutir, com fundamentação teórica na Psicologia Analítica de C. G. Jung, as concepções de médicos e psicólogos sobre o processo saúde-doença e a formação do profissional para atuar em contexto hospitalar. A partir de uma pesquisa em campo qualitativa-descritiva, est..