Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

A presente coletânea é resultado de cooperação de pesquisadores brasileiros e portugueses, envolvidos com a docência no ensino superior e a consequente formação continuada dos professores universitários. A frequência no ensino superior é vista como uma conquista social dos ideais democráticos modernos e teria trazido novos públicos aos bancos escolares, o que tornaria esse ensino uma realidade de maneira qualitativa distinta com a qual decisores políticos, gestores, professores e estudantes devem aprender a lidar. Essas preocupações pretenderam motivar e nortear os (...) temas abordados nesta obra. (shrink)

We distinguish two pathways people may follow when they join violent groups: compliance and internalization. Compliance occurs when individuals are coerced to join by powerful influence agents. Internalization occurs when individuals join due to a perceived convergence between the self and the group. We searched for evidence of each of these pathways in field investigations of former members of two renowned terrorist organizations: the Liberation Tigers of Tamil Eelam and Islamist radical groups. Results indicated that ex-fighters joined LTTE for reasons (...) associated with both compliance and internalization but that ex-fighters joined Islamist radical groups primarily for reasons associated with internalization. When compliance occurred, it often took the form of coercion within LTTE but involved charismatic persuasion agents within Islamist groups. This evidence of systematic differences in the reasons why fighters enter violent groups suggests that strategies for preventing radicalization and fostering de-radicalization should be tailored to particular groups. (shrink)

Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but (...) already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to “unlearn” what we thought was true. Complexity further increases if unconfirmed findings have been used to inform guidelines. To help achieve a balance between early access to research findings and its negative consequences, we formulated five recommendations: (a) consensus should be sought on a term clearer than ‘pre-print’, such as ‘Unrefereed manuscript’, “Manuscript awaiting peer review” or ‘’Non-reviewed manuscript”; (b) Caveats about unrefereed manuscripts should be prominent on their first page, and each page should include a red watermark stating ‘Caution—Not Peer Reviewed’; (c) pre-print authors should certify that their manuscript will be submitted to a peer-review journal, and should regularly update the manuscript status; (d) high level consultations should be convened, to formulate clear principles and policies for the publication and dissemination of non-peer reviewed research results; (e) in the longer term, an international initiative to certify servers that comply with good practices could be envisaged. (shrink)

Se analizará la manera en que la influencia teórica de las ciencias biológicas y médicas sobre la noción de “vida” imponen una transformación de las construcciones políticas, ideológicas y legales de un Estado que puede ser descrito como biopolítico. Para esto, se acudirá al análisis de la transformación de la idea operativa de “vida” desde la perspectiva agambiana de la politización de la muerte y la pretensión de disolver el umbral de decidibilidad entre vida y muerte para tomar, luego, tres (...) ejemplos de instancias legales en las que puede terminarse con la vida sin contradecir el propósito biopolítico de protegerla; esto es, instancias en las cuales no existe penalización ante la finalización de la vida. Estos tres ejemplos, que se presentarán de manera progresiva son: a) la eutanasia, b) el aborto y c) la contracepción. Es importante aclarar que no se pretende defender ni condenar en un plano moral las instancias de decisión sobre la disposición de una vida distinta de la propia, ni tampoco dar argumentos para que algo así se haga. Por el contrario, lo que aquí se pretende es aportar una dimensión explicativa –y analítica– desde el marco de la biopolítica, siguiendo, quizá, la sugerencia agambiana respecto de la necesidad de adoptar una perspectiva de este tipo para poder tener una comprensión adecuada de ciertos fenómenos políticos. (shrink)

The articles in this special edition exemplify three major issues in current debates on Sacred Plants: a) the wisdom of Indigenous understandings of sacred plants, b) beneficial emerging uses of sacred plants by non‐Indigenous people, c) the position of Indigenous wisdom for emerging uses of sacred plants.

Fichte wie auch später Sartre gewinnen vergleichbare Resultate auf der theoretischen Ebene hinsichtlich der ethischen Fundierung der Intersubjektivität im Selbstbewusstsein. Die Rolle der Ästhetik wird von beiden Denkern aufgrund ethischer Implikationen so bestimmt, dass sie die durch sie bestimmte Intersubjektivität auf praktischer Ebene zum Vorschein bringt. Die Ästhetik stellt bei beiden Autoren nicht einen Selbstzweck dar, sondern spielt eine herausragende Rolle für die Bildung der Menschen. Sartre wie auch Fichte brauchen die Ästhetik, um die Ethik zu fundieren. Während Sartre ein (...) unmittelbar lebensbezogenes ästhetisches Denken hat, in dem er ethische Aspekte in seiner Literatur anhand konkreter Beispiele verarbeitet, geht es Fichte in seinen Ausführungen zur Ästhetik vornehmlich um die Frage nach der Bedingung der Möglichkeit des ästhetischen Bewusstseins und darum, dieses als Voraussetzung des ethischen Bewusstseins zu bestimmen. Sartres Ethik offenbart sich vor allem in seinem ästhetischen Schaffen. Dem ästhetischen Moment in Sartres Ethik kommt die zentrale Aufgabe für die Entwicklung des ethischen Individualismus des Menschen und der gesamten Menschheit zu. Die Analogie zu Fichtes transzendentalkritischem Idealismus liegt in der Fundierungsrolle der Ästhetik für die Ethik in beiden philosophischen Konzeptionen, woraus eine aussagefähige Ethik in Sartres Existenzphilosophie resultiert. So zeigt sich In Sartres Literatur der direkte Wechselbezug zwischen praktischer Ethik und produktiver Ästhetik. Die Funktion der Ästhetik wird von Sartre dadurch bestimmt, dass in seinem Konzept mittels der Ästhetik die Vermittlung zwischen theoretischer und praktischer Vernunft geleistet wird. (shrink)

In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...) Analgesia, Resuscitation, and Intensive Care issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent “first come, first served” principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy. (shrink)

El presente artículo hace una lectura de la obra dramatúrgica Bandada de pájaros: segundo ensayo sobre la memoria (2016) de Jorgelina Cerritos (San Salvador, 1974) desde una perspectiva tanatopolítica. Se indaga acerca del poder que ejerce el Estado salvadoreño en la vida de la ciudadanía, representada por personajes que, desprovistos de su categoría de persona, ven interrumpidos todos sus derechos. Estos sujetos son miembros de una comunidad que se convierten en una amenaza potencial a suprimir por parte del Estado. Además, (...) se analiza la vulnerabilidad de la mujer ante el aparato bélico heteropatriarcal y las posibilidades del teatro como espacio para la construcción de una memoria que restituya el recuerdo y la identidad de los miles de desaparecidos durante la guerra civil salvadoreña. (shrink)

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Drawing on many areas of expertise, from paleontology to psychology, Tomasello offers a plausible, evolutionary story abouthow our ancestors are likely to have developed cooperative behaviors and collaborative lifeways in order to survive and thrive.He also claims that this narrative explains why they would have begun to think in characteristically cooperative and moral ways,developing a “we is greater than me” [we>me] psychological orientation. Do the arguments offered support this extra claim? Thisarticle suggests that they do not. It seeks to alleviate (...) this shortcoming by drawing upon some conceptual resources offered bySartre’s Theory of Practical Ensembles. The centerpiece of the article consists of a detailed analysis of Sartre’s account of the genesisof the “group-in-fusion,” seeking to show that the genesis of a we-way of thinking in a group made up of many requires themediation of what Sartre calls a “third party” (le tiers). After closely examining Sartre’s treatment of the “third party” in theapocalyptic genesis of the “group-in-fusion,” I evaluate the success of this notion in resolving those questions that Tomasello’saccount raises while, at the same time, addressing the ontological question concerning the nature of the individual-grouprelation, in a way that suggests new and significant alternatives to standard dilemmas in contemporary social philosophy. (shrink)

Oftentimes, reality seems to us a chaos that we try to control with our theories. This article starts from the antithetic standpoint, inspired by Antonio Rosmini’s works: reality is intelligible, and originates our thinking. From this perspective, any research that tries to reach the truth is determined by the real, not the contrary. Moreover, interdisciplinarity, far from being a solipsistic enterprise, aims at achieving truth and guaranteeing scientific advancement. Here, we analyze the distinctive character of Rosminian encyclopedism and his principles (...) for preventing human errors. We then clarify why it is impossible to achieve perfection, and why such an impossibility is not problematic for the interdisciplinary dialogue. (shrink)

Coordination between speakers in dialogue requires balancing repetition and change, the old and the new. Interlocutors tend to reuse established forms, relying on communicative precedents. Yet linguistic interaction also necessitates adaptation to changing contexts or dynamic tasks, which might favor abandoning existing precedents in favor of better communicative alternatives. We explored this tension using a maze game task in which individual participants and interacting pairs had to describe figures and their positions in one of two possible maze types: a regular (...) maze, in which the grid‐like structure of the maze is highlighted, and an irregular maze, in which specific parts of the maze are salient. Participants repeated this task several times. Both individuals and interacting pairs were affected by the different maze layouts, initially using more idiosyncratic description schemes for irregular mazes and more systematic schemes for regular mazes. Interacting pairs, but not individuals, abandoned their unsystematic initial descriptions in favor of a more systematic approach, which was better adapted for repeated interaction. Our results show communicative conventions are initially shaped by context, but interaction opens up the possibility for change if better alternatives are available. (shrink)

Considering Rosmini’s political works in comparison with his metaphysical and anthropological essays, and starting from Rosmini's project of a code of law that, in the author’s opinion, can guarantee fundamental human rights, this article discusses the concept of justice between citizens and outsiders. Its first part is an analysis of Rosmini’s juridical fundaments, which takes into account also some objections historically moved against it. Its second part examines some specific cases of conflicts between outsiders and the members of civil society, (...) as considered by the Roveretan philosopher. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Este artículo analiza algunos interesantes momentos en la recepción feminista del pensamiento de Hannah Arendt. Al igual que respecto a otros clásicos y clásicas del pensamiento contemporáneo —Beauvoir, Foucault o Habermas, por poner sólo tres ejemplos— nos hemos encontrado con una nutrida historia de encuentros y desencuentros. Tras una primera valoración negativa del pensamiento arendtiano, por parte de las teóricas feministas de la segunda ola, el juicio, posteriormente, se matizará y el estudio de la riqueza conceptual de la autora y (...) de su potencia filosófica —su novedosa concepción de la política, su apuesta por la narratividad y el juicio, su definición de la libertad en conexión con la noción de natalidad, …— harán que se desate un interesante juego de apropiaciones y reapropiaciones, de lecturas e interpretaciones, que, incluso, en el caso de Linda Zerilli, propondrá la posibilidad de pensar un feminismo adjetivado como arendtiano. Al hilo de esta reconstrucción histórico-crítica, hemos enhebrado nuestra propia estimación de la recepción feminista de la obra de Arendt en el contexto de los debates políticos feministas de las últimas décadas. La controvertida filósofa política se ha convertido, en suma, en un referente insoslayable en el decurso de la teoría feminista contemporánea. (shrink)