IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they (...) have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)

In the shift from the balance of nature to the flux of nature paradigm, the concept of resilience has gained great traction in ecology. While it has been suggested that the concept of resilience does not imply a genuine departure from the balance of nature paradigm, I shall argue against this stance. To do so, I first show that the balance of nature paradigm and the related conception of a single-state equilibrium relies on what Eliot Sober has named the “Natural (...) State Model (NSM)”, suggesting that the NSM has instead been dismissed in the flux of nature paradigm. I then focus on resilience as the main explanatory concept of the flux paradigm. After distinguishing between two main different understandings of “resilience”, namely engineering resilience and ecological resilience, I argue that the former is close to the concept of balance or stability and still part of the NSM, while the latter is not. Finally, I claim that ecological resilience is inconsistent with the NSM, concluding that this concept–being incompatible with the NSM–is not part of the balance of nature paradigm but rather a genuinely new explanatory tool. (shrink)

The objective of this research programme is to contribute to the establishment of the emerging science of Formal Ontology in Information Systems via a collaborative project involving researchers from a range of disciplines including philosophy, logic, computer science, linguistics, and the medical sciences. The re­searchers will work together on the construction of a unified formal ontology, which means: a general framework for the construction of ontological theories in specific domains. The framework will be constructed using the axiomatic-deductive method of modern (...) formal ontology. It will be tested via a series of applications relating to on-going work in Leipzig on medical taxonomies and data dictionaries in the context of clinical trials. This will lead to the production of a domain-specific ontology which is designed to serve as a basis for applications in the medical field. (shrink)

A noção de justiça tem tido sempre uma função importante na história da humanidade e particularmente na Antiguidade. Nas civilizações pré-clássicas, a justiça é sinónimo de ordem e depende da vontade e da legitimidade que é conferida pelos deuses. No mundo clássico, na Odisseia, Homero alude à justiça, embora o poeta que na época arcaica mais se ocupa deste valor tenha sido Hesíodo. Autores posteriores, como Platão, Aristóteles, Epicuro ou Cícero, entre outros, abordam esta questão, ainda que...

Jean Hamburger is considered the founder of the concept of medical intensive care and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world, in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca (...) prize, awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service”, the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options. The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. (shrink)

Jean Hamburger (1909--1992) is considered the founder of the concept of medical intensive care (reanimation medicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix (...) Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a "golden" book, "Conseils aux etudiants en medicine de mon service" ("Advice to the Medical Students in my Service"), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. (shrink)

In this paper, my aim is to understand the origin of experimental and scientific models of pathogeny of the diseases of the nervous system in the Salpêtrière (Paris). I will analyse the role of the contexts of cell theory, microscopy and the advances in histological techniques in the creation of various pathogenic models, based on the concept of the cell, the Wallerian degeneration and the neurone concept. I argue that, as medicine and pathology remain autonomous in their methods and goals, (...) because of the evident degree of complexity of diseases, close and reciprocal interactions with sciences, their practices and theories, make it possible to establish convergences between clinical observations, pathological data and those from the experimental models of pathologies. The search for pathogenic models behaves like an engine, which is efficient in assembling facts, in testing pathogeneses and reforming nosologies, combined with the breakthroughs in biology. This paper is a case study showing the emergence of such interactions in the last decades of the nineteenth-century in Paris. (shrink)

Incorporating patients' spiritual beliefs into health care decision making is essential for ethically good care. Gadow's three-level ethical framework of ethical immediacy, ethical universalism, and relational narrative is presented as a tool for enhancing nurses' ability to explore and deepen understandings of patients' spiritual beliefs, given that these and their experiences are often expressed in a language that seems foreign to nurses. The demographic and cultural shifts that lead to the necessity to understand patients who use principles and metaphors that, (...) while commonly understood within their spiritual tradition, may seem incomprehensible to outsiders, are here set in the Canadian context. A case study on palliative sedation is used to illustrate how the ethical framework can help to reveal the spiritual certainties, principles and narratives patients bring to their health care experiences. (shrink)

The image of wine has a “spiritual sense”, which helps the faithful to understand the principles of their belief. Its mystery is connected with the theme of “sober inebriation”, developed by Philo of Alexandria and Origen, and culminating in Ambrose. The good wines that the bride enjoys before the groom’s arrival are a symbol of the good doctrines of the OT, whose teachings are however inferior to the revelation of the incarnate Christ. Good, sweet wine, meanwhile, refers to the doctrines (...) of the NT interpreted spiritually, the logos that helps us begin to know Christ, to bind ourselves to him in ecclesial unity and to love our neighbour. It also leads us to the “winepress”, i.e. renouncing superfluous land, becoming “full of must” and inebriated, so that we can dedicate ourselves to contemplation. The vine has a Christological value and catechetical function, dating back to John 15.1, which is often quoted with Saint Paul. The place where the vine is born and develops is the soul; the Logos supports its flowering in those who, by their free will, choose to flourish. The cluster of grapes refers to Christ, or to the victory of the righteous; the many grapes that he contains are believers. The vineyard is a symbol of the church formed by the pagans, of the commandments of God, or of the good things that God gave to man, who did not preserve them, having been stripped of them by the devil. The guardians of the vineyard are angels or priests. (shrink)

Gregory of Nyssa’s bearing in Qohelet 3:5b to wealth, rather than to the matrimonial “embrace”, is unusual by comparison withother ancient exegeses; it seems to be motivated not only by the acoluthia which characterizes his spiritual interpretation of the passage Qo. 3:2-8, but also by the crucial importance he gives to catharsis, as one the qualities he considered necessary for the exegete.

Em busca da felicidade do indivíduo, Epicuro aborda os diversos aspectos que considera contribuírem para ela: prazer, quietude, conhecimento, segurança, amizade, justiça. Neste texto pretendemos, de forma sucinta, mostrar de que modo estes vários elementos se relacionam entre si e, sobretudo, de que modo o conceito de justiça deste filósofo contribui para a felicidade humana, não sendo um conceito tradicional.

Analisam-se diversos aspectos do tempo nos poemas homéricos como sejam o seu uso na narrativa ou a importância da imortalidade. Em ambos os poemas estão patentes confusões entre a época do poeta e a da narrativa, o que se nota através de comparações, mas também por misturas de materiais, ou de costumes. Do mesmo modo, a narrativa não se reduz a uma única época. Seja por uma questão de economia da narrativa, como sucede na Odisseia, seja para explicar, ou justificar, (...) aspectos relacionados com a narrativa, as alusões ao passado são uma constante. Assim sendo, pode-se dizer que os poemas homéricos levantam questões como passado e presente, mortalidade e imortalidade. (shrink)