_Introducción_: la Limitación del Esfuerzo Terapéutico (LET) busca reorientar las medidas del acompañamiento terapéutico durante el final de la vida; actualmente existe legislación sobre este tema. _Objetivo: _caracterizar el conocimiento y la claridad conceptual y jurídica del personal de salud del Hospital de San José (HSJ) de Bogotá sobre la LET. _Métodos: _estudio descriptivo transversal usando encuesta de libre preparación. Se estableció claridad conceptual con resultado superior al 70% de respuestas correctas. Datos levantados con cuestionario de selección múltiple (...) vía Formularios Google, tabulados en Microsoft Excel ® y analizados con Stata ® vía estadística descriptiva. _Resultados:_ 36 % de encuestados tuvo claridad conceptual y jurídica sobre LET; el 82,3 % de encuestados diferenciaron LET de eutanasia y el 95,6 %, LET de cuidados paliativos. El 61 % de los encuestados no tuvo conflicto moral/jurídico con LET; el 60 % y el 70 % de los encuestados creen, respectivamente, que suspender el oxígeno y la ventilación mecánica no hacen parte de la LET. Finalmente, el 78,9 % expresó no haber recibido suficiente información sobre el tema. _Conclusiones_: el personal encuestado carece de claridad conceptual suficiente sobre la LET,lo que señala la necesidad de mayor educación al respecto. (shrink)

Actualmente los avances biotecnológicos han superado los fines clásicos de la medicina. Se han producido cambios conceptuales importantes que han impactado en el constructo médico de la relación médico/paciente, como son: a) La diversidad del concepto de naturaleza humana; b) El concepto de corporeidad humana; c) El concepto subjetivo de autonomía; y, d) El valor de la calidad de vida. El análisis bioético de estos conceptos lleva a la comprensión de porqué la medicina actual podría encaminarse hacia una ‘medicina del (...) perfeccionamiento’ o ‘transhumanista’. La conclusión muestra que la medicina acepta la aplicación de los avances en la biotecnología bajo los postulados clásicos enfocados al campo de la salud y que es preciso emprender una profunda reflexión sobre la aplicación de los mismos, con la finalidad de aportar mejoras o nuevas funciones a sujetos sanos. (shrink)

En la atención médica y en la investigación en salud resulta indispensable favorecer la toma de decisiones de los pacientes y/o participantes bajo el principio de autonomía. En particular, esta capacidad, consignada en la Convención de los Derechos de las Personas con Discapacidad, se concreta mediante la detección de necesidades de asistencia, ajustes y apoyos que dan paso a una plena y efectiva capacidad de ejercicio. Las reflexiones bioéticas hechas desde la perspectiva principialista, personalista y de los Derechos Humanos (...) ofrecen elementos para potenciar la autonomía de las personas con discapacidad, promoviendo la figura de asistencia personal y enfatizando el interés superior, la gradualidad y la revisión judicial permanente como principios de figuras sustitutivas. (shrink)

When events such as a pandemic occur, and the entire population’s health must be ensured, the focus is on public health. Despite several criteria for decision-making, it is advisable to delve into the weighting beyond the mere consideration of plainly visible factors. We propose weighting as a mechanism instead of chance since, given the person’s substantial unity and intrinsic dignity, their destiny cannot be subject to anything less than the exercise of intelligible judgment inherent to human reason.

Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa Profesionales de salud y el proceso de muerte y morir de los pacientes: una revisión integrativa Objective: To know the scientific production on the relationship between the health professionals and patient’s death. Methodology: Integrative literature review using analysis through thematic proximity. Resuts: Four categories were elaborated: Unprepared health professionals to deal with death; Challenges to deal with the process of dying and death in different (...) scenarios; Types of death and their interpretations and Health professionals and their aspects on dealing with death. Conclutions: Health professionals are unprepared to deal with the end of life process, beyond that, they feel a lack of attention to the theme, especially relating to coping strategies. Para citar este artigo / Para citar este artículo / To reference this article Siqueira J, Zilli F, Griebeler S. Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa. pers. bioét. 2018; 22: 288-302. DOI: 10.5294/pebi.2018.22.2.7. (shrink)

RESUMEN Con un enfoque cualitativo y alcance descriptivo, el presente artículo tiene como objetivo sintetizar aspectos de materiales publicados en diversas fuentes relacionados con el estrés para lo cual se emplea el método de revisión bibliográfica. Durante el estudio se encontraron aspectos teóricos que permiten entender la evolución del concepto, acceder a modelos, evaluar la repercusión del fenónemo y constatar instrumentos para su evaluación, así como obtener sugerencias para controlarlo. Se concluye que el estrés puede ser percibido como positivo o (...) negativo según el manejo que hace cada individuo y su estilo de afrontarlo, es una manifestación relacionada con el proceso salud enfermedad en el que, para algunos, contribuye al crecimiento personal y en otros, a su malestar o enfermedad. ABSTRACT With a qualitative approach and descriptive scope, the present article takes as an objective to synthesize aspects of materials published in diverse sources related to the stress for which uses the method of bibliographical review. During the study there were theoretical aspects that allow understanding the evolution of the concept, gaining access to models, evaluating the aftereffect of the phenomenon and state instruments for their evaluation, as well as obtaining suggestions to control it. It was concluded that the stress can be perceived as positive or negative according to the handling that there does every individual and its style of confronting it, a declaration related to the process is a health illness in the one that, for some, contributes to the personal growth and in others, to its discomfort or illness. (shrink)

Bioethical Proposals to Face Social and Ethical Problems Generated by Neglected Infectious Diseases Propostas bioéticas ante os problemas sociais e éticos que geram as doenças infecciosas desatendidas This review article appointed to the topic of Neglected Tropical Diseases, a group of 18 disabling pathologies, which are sometimes fatal, and often deforming, that prevail in the populations of Asia, Africa and the tropical areas of South America. We presented, categorized, and analyzed, through a bibliographical review, the elements that relate to these (...) diseases from the Universal Declaration of Bioethics and Human Rights, 2005, in terms of equality, justice and equity, the non-discrimination and stigmatization, social responsibility and health approach. Throughout the review, we concluded that the problem around NTDs is multifactorial and we propose solutions to mitigate and to attend the NTDs, from a perspective of focused bioethics around the dignity of the human person and the affected population. We proposed including bioethics in the debate about the care of the NTDs to analyze the problems and examine solutions through transdisciplinary research projects that involve collaborative and formative work among the affected communities, government entities, health professionals and veterinary sciences. Para citar este artículo / To reference this article / Para citar este artigo Sáenz V, Mazzanti di Ruggiero MA. Propuestas bioéticas frente a los problemas sociales y éticos que generan las enfermedades infecciosas desatendidas. Pers Bioet. 2019; 23: 84-110. DOI: https://doi.org/10.5294/pebi.2019.23.1.6 Recepción: 27/09/2018 Aceptación: 06/02/2019. (shrink)

Evaluating the Knowledge and Practice of Limitation of Therapeutic Effort in Health Workers at a Health Care Institution for Cancer Patients in Medellín, 2018Avaliação do conhecimento e da prática da limitação de esforço terapêutico em equipe de atendimento de uma instituição prestadora de serviços de saúde para pacientes oncológicos de Medellín, 2018Limitation of therapeutic effort is any action that involves suspending or not initiating medical treatment or therapeutic measures in patients who will not receive any clinical benefit. In Latin America, (...) some research has proven a lack of familiarization and disagreement with the subject and its practices. The present study tried to objectify the knowledge of LTE of healthcare personnel at an institute in Medellín using a self-administered survey that allowed conducting a cross-sectional descriptive study with non-probabilistic sampling. Within the results, 56.5 % of respondents understood the concept of LTE, and 90 % applied it actively. However, there were discrepancies regarding the core concepts of the definition and practice.Para citar este artículo / To reference this article / Para citar este artigoVallejo LI, Palacio AM, Marulanda V, Restrepo A, Yepes LA, Valencia NL, Cruz MA. Evaluación del conocimiento y práctica de la limitación del esfuerzo terapéutico en personal asistencial de una institución prestadora de servicios de salud para pacientes oncológicos de Medellín, 2018. 2020;24:177-87. DOI: https://doi.org/10.5294/pebi.2020.24.2.5Recibido: 19/07/2019Aceptado: 08/08/2020Publicado: 27/11/2020. (shrink)

Con la promulgación de la Ley 30 de 1986, se incluyó el concepto del consumo de la dosis personal de drogas. La Corte Constitucional, mediante sentencia C-221 de 1994, resolvió la demanda de constitucionalidad presentada por el ciudadano Alexandre Sochandamandou, ratificando el concepto de “dosis personal de consumo de drogas”, y despenalizando el mismo. En este artículo se plantea el desconocimiento de la legislación y la jurisprudencia acerca de la opinión técnico-científica en cuanto a esta temática, que originó (...) diversas inconveniencias, inconsistencias, vacíos e imprecisiones técnico-científicas que riñen con normas y tratados internacionales de ética médica, al igual que con evidencia médica encontrada sobre los efectos adversos ocasionados por las drogas en la salud de los consumidores de estas sustancias. (shrink)

La violencia en México, específicamente en algunos estados de la República mexicana en donde la población se enfrenta a situaciones de peligro, tiene como una de tantas consecuencias la ausencia de personal médico que se desempeñe como profesional y proporcione servicios de salud en estas zonas rurales. En este sentido, es de considerar que la asignación de recursos humanos en salud es fundamental para el funcionamiento de un sistema eficiente y observar las causas por las que médicos (...) que desde el servicio social hasta el desempeño de su especialidad no consideran trabajar en lugares en donde se sienten vulnerables. En este proceso, es importante visibilizar los cuestionamientos éticos que pueden surgir por lo que este trabajo pretende dar importancia al tema de la exposición de circunstancias, hechos y cifras dentro de esta problemática y plantear las cuestiones normativas pertinentes dentro de este contexto. (shrink)

La investigación pretende implementar una propuesta de intervención psicológica que fortalezca las estrategias de afrontamiento y habilidades sociales de las personas privadas de la libertad [PPL], internas en el complejo penitenciario y carcelario de Jamundí, que aporte al proceso de resocialización y prevención de conductas disruptivas y suicidas en el marco del programa institucional INPEC “Preservación de la vida”. La metodología cuenta con un enfoque mixto, diseño explicativo secuencial, alcance explicativo – exploratorio de corte transversal. La muestra: conformada por 80 (...) PPL seleccionada por conveniencia. Resultados esperados: Fortalecimiento estrategias de afrontamiento y habilidades para la vida, disminución de conductas disruptivas. (shrink)

La humanidad ya dispone de vacunas eficaces contra el COVID‐19. En Perú se administraron 86 millones de dosis para cubrir la demanda de 33 millones de peruanos. Para ello, se ha priorizado la vacunación en grupos clave: personal de salud, sujetos con condiciones de salud preexistentes y mayores de 65 años. Sin embargo, dada la problemática social y la situación de la salud pública en Perú, este trabajo defiende que la prioridad de la vacunación debe centrarse (...) en la población que vive en extrema pobreza. El método utilizado fue una argumentación ética sobre la distribución de la vacuna contra el COVID‐19 en Perú. Esta argumentación se basa en el análisis de la población peruana que vive en extrema pobreza, la cual presenta diferentes estratos de vulnerabilidad, y que, ante una eventual infección por SARS‐CoV‐2, se irían agravando uno tras otro, a través de un efecto en cascada. Este escenario daría lugar a nuevas vulnerabilidades de las ya existentes, causando mayores daños. Los esfuerzos de vacunación en esta población clave les brindaría oportunidad de seguir encontrando formas de llevar alimentos a sus hogares, reduciendo significativamente el riesgo de contagio en su entorno y mitigando el efecto devastador de las enfermedades locales a las que ya está expuesta. Se plantean cuatro objeciones relacionadas con este argumento, con sus correspondientes respuestas. El acceso prioritario a la vacuna reduciría significativamente el daño a las personas que viven en la extrema pobreza, haciendo prevalecer los principios de justicia y equidad. (shrink)

The social determinants of mental health with respect to the role of a person’s religiosity are examined in this paper, based on personal experience and a review of the literature. The objective is to hypothesize that religiosity can influence a person’s mental health through three factors: a sense of moral value, support from a community of faith, and exercise of spirituality. The Medline and SciElo databases were reviewed as of 1990, in English and Spanish, using the keywords: spirituality, belief, (...) religion and social determinants of mental health. The references related to the subject were taken into account as well. The article concludes that it is important in bioethics to incorporate the theme of religiosity as a factor in mental health, based on deliberative dialogue and considering the patient’s position as an interlocutor. It also is imperative to bear in mind the support provided by a community of faith that has embraced the virtues of solidarity and acceptance of others. (shrink)

This chapter describes how philosophical theorizing about justice can be connected with empirical research in the social sciences. We begin by drawing on some received distinctions between ideal and non-ideal approaches to theorizing justice along several different dimensions, showing how non-ideal approaches are needed to address normative aspects of real-world problems and to provide practical guidance. We argue that there are advantages to a transitional approach to justice focusing on manifest injustices, including the fact that it enables us to set (...) aside some reasonable disagreements about justice. The ‘bottom-up’ approach we advocate, for which we borrow Wolff’s term ‘real-world political philosophy’, is an empirically-informed normative analysis that attends to specific, identifiable injustices, and thus is partial, though not isolationist. We illustrate our approach by considering how different models of the nature of disability suggest different kinds of remedy for injustices faced by persons living with disabilities. We reflect on the nature and significance of vulnerabilities, and we assess the role of public opinion in normative theorizing, suggesting a particular significance for the opinions and experiences of marginalized groups. We finally reflect on the relevance of European legal and institutional frameworks for theorizing justice in Europe. (shrink)

I have little to say on this passage, where it seems necessary to maintain the vulgate notwith standing its obvious defects. My only reason for discussing it is to call attention to the strangeness of Jebb's proceeding when seeking to support Hermann's conjecture παλλλοιν which he admits into the text. The objection to Hermann's view is that, as he himself admits, there is no evidence that πáλληλος could be used in the sense of λληλιφóνος. For that, I suppose, is the (...) meaning of ‘mutual hands,’ which both Jebb and Campbell suggest as a translation, although ‘mutual violence’ would be better. But the chief purpose of this note is to protest against the mode of interpretation applied to Philo de Mose 3. 36. II. p. 175 M. διà τàς ν δασι καí πνρì γνιμéνας συνχς καì παλλλονς φθορáς Turnebu s rightl yrenders ‘alternas interneciones,’ and why Jebb supposes him to have meant ‘mutual’ I do not know. Anyhow he admits that Philo used the word in its ordinary sense of successive, and proceeds to paraphrase ‘owing to the continuous and rapid succession of calamities by flood and fire’ . All this is quite beside the mark, for the reference is to the alternate destruction of the world at the κπρωσις by fire and at the ξγρωσιςby water. I must take leave to refer to the evidence collected in my book on Zeno and Cleanthes, p. 253, to which should be added a most instructive passage of Origen : περì τν κακν λóγος ο μνóντων ì ν τατᾦ διà τν τοι τηροσαν τà πì γ$$$ς πρóνοιαν κατακλνσμο καì κπνρ03CE;σσι καθαíρονσαν.Add the passages from Lucan quoted by Mr. Heitland in his Introduction, p. xliii. (shrink)

Las naciones y pueblos indígenas presentan preocupantes índices respecto a la salud, así como otras carencias como la pérdida de sus tierras, la alimentación, la educación y, en general, el ejercicio de sus derechos, consagrados por organizaciones internacionales como la ONU y la OMS-OPS. En Ecuador, de acuerdo con el orden jurídico constitucional, se han instrumentado políticas de salud que incluyen el lineamiento general de un enfoque intercultural de la atenciónprimaria que incorpora los saberes y prácticas ancestrales. Mediante (...) una revisión documental se examina la situación actual de la salud y la atención primaria entre las etnias indígenas del Ecuador. De este análisis se desprenden consideraciones para las políticas públicas de salud, la formación intercultural de los profesionales de los equipos de salud y, en especial, la articulación de las creencias, saberes y prácticas de la cultura de las etnias para la atención primaria de salud. Palabras Clave: Etnia, nacionalidad indígena, pueblo indígena, derecho a la salud, atención primaria. Referencias [1]Asamblea General de la Organización de las Naciones Unidas, «Resolución 48/134 de la Asamblea General de las Naciones Unidas sobre los Derechos de los pueblos y naciones indígenas,» de Asamblea General Resolución 48/134, New York, 2009. [2]Organización Panamericana de la Salud, «Derechos Humanos y Salud de los pueblos indígenas,» Organización Panamericana de la Salud, New York, 2008. [3]Alto Comisionado para los Derechos Humanos de la Organización de las Naciones Unidas, Declaración de las Naciones Unidas sobre los derechos de los pueblos indígenas. Manual para las instituciones nacionales de Derechos Humanos, Nueva York: Alto Comisionado de los Derechos Humanos de la Organización de las Naciones Unidas, 2013. [4]C. Torres Parodi y M. Bolis, «Evolución del concepto etnia/raza y su impacto en la formulación de políticas públicas para la equidad,» Revista Panamericana de Salud Pública, vol. 22, nº 3, pp. 405-414, 2007. [5]IIDH-OPS, «Salud indígena y derechos humanos,» OPS, Quito, 2006. [6]Organización Panamericana de la Salud, «Iniciativa de la Salud para los Pueblos Indígenas. Lineamientos estratégicos. Plan de acción 2003-2007,» Organización Mundial de la Salud, Quito, 2003. [7]Consejo Mundial de las Iglesias, «Segunda Asamblea Mundial de la Salud de los Pueblos,» Consejo Mundial de las Iglesias, Quito, 2005. [8]Grupo Internacional de Trabajo sobre asuntos indígenas, Instituto de Promoción de Estudios Sociales, Fundación Diversidad, «El Derecho a la Salud de los pueblos indígenas en aislamiento y en contacto inicial,» Grupo Internacional de Trabajo sobre Asuntos Indígenas, Quito, 2007. [9]Organización Panamericana de la Salud, «Salud de los pueblos indígenas de las Américas,» OPS, Quito, 1998. [10]Organización Inernacional del Trabajo, «Convenio número 169 de la OIT. sobre pueblos indígenas y tribales: hacia un futuro inclusivo, sostenible y justo.,» OIT, New York, 2019. [11]L. Almeida Vera, «Fundamentación del modelo de gestión intercultural ecuatoriana en la atención primaria desalud,» Medisam, vol. 8, nº 18, pp. 46-61, 2014. [12]Organización Internacional del Trabajo, «Implementación del Convenio núm 169 de la OIT sobre los pueblos indígenas y tribales: Hacia un futuro inclusivo, sostenible y justo,» OIT, New York, 2019. [13]C. Eysaguirre, Proceso de incorporación de la medicina tradicional, alternativa y complementaria en las prácticas oficiales de la salud. Tesis Magister Antropología, Lima: Universidad Nacional Mayor de San Marcos, 2016. [14]Organización de las Naciones Unidas para la Agricultura y la Alimentación, «Sobre la salud y la seguridad de los pueblos indígenas en riesgo debido al coronavirus,» FAO, New York, 2020. [15]Enlace Continental de Mujeres Indígenas de las Américas, Alianza de Mujeres Indígenas de Centroamérica y México, Red de Mujeres Indígenas Asiáticas, Organización de Mujeres Indígenas Africanas, «Llamado colectivo de las mujeres indógenas ante el COVID 19. Foro Internacional de Mujeres Indígenas,» ONU, New York, 2020. [16]Laboratorio de interculturalidad FLACSO Ecuador, Etnohistoria de los pueblos y nacionalidades originarias del Ecuador, Quito: FLACSO Ecuador, 2015. [17]UNICEF, Nacionalidades y pueblos indígenas. Políticas interculturales en Ecuador, Quito: UNICEF, 2009. [18]República del Ecuador, «Constitución de la República del Ecuador,» de 2008, Quito, 2008. [19]S. Ramírez Hita, «Políticas de salud basadas en el concepto de multiculturalidad: los centros de salud intercultural en el altiplano boliviano,» Avá Revista de Antropología, vol. 14, nº 2, pp. 1-28, 2009. [20]E. Arteaga, M. San Sebastián y A. Amores, «Construcción participativa de indicadores de la implementación del modelo de salud intercultural en el cantón Loreto, Ecuador,» Saúde em Debate, vol. 36, nº 94, pp. 402-413, 2012. [21]L. Véliz Rojas, A. Bianchetti Saavedra y M. Silva Fernández, «Competencias interculturales en la atención primaria de salud: un desafío para la educación superior frente a contextos de diversidad cultural,» Cuadernos de Saúde Pública, vol. 35, nº 1, pp. 62-71, 2019. [22]C. Walsh, Interculturalidad: Estado, sociedad: luchas decoloniales de nuestra época, Quito: Abya Yala UASB, 2015. [23]E. Ortiz Prado y G. Ceballos Serra, «Marco estratégico para la protección de los pueblos indígenas en aislamiento voluntario y contacto inicial. Consultoría sobre situación de salud de los pueblos indígenas en aislamiento y contacto inicial en el Ecuador,» Organización del Tratado de Cooperación Amazónica, Quito, 2014. [24]J. Betancurt, A. Green, J. Carrillo y Anane-Firempong, «Defining Cultural competence: a practical framework for adressing racial/ethnic disparities in health and health care,» Public Health, vol. 118, nº 2, pp. 293-302, 2016. [25]R. Ceballos, A. Amores y R. Rojas, Prestación de servicios de salud en zonas con pueblos indígenas, Quito: Programa Regional de Salud de los Pueblos Indígenas, 2009. [26]L. Pereira de Melo, «A contemporaneidade da teoría do cuidado cultural de Madeleine Leininger: una perspectiva geohistórica,» Ensaios e Ciencia: ciencias biológicas, agrarias e da Saúde, vol. 14, nº 2, pp. 21-32, 2010. [27]C. Rohrbach-Viadas, «Introducción a la teoría de los cuidados culturales enfermeros de la diversidad y la universalidad de Madeleine Leininger,» Revista Cultura del cuidado, vol. 2, nº 3, pp. 32-46, 1998. [28]O. Aguilar Guzmán, I. Carrasco González, M. García Piña, A. Saldívar y R. Ostiguín Meléndez, «Madeleine Leininger: análisis de sus fundamentos teóricos,» Revista de Enfermería Universitaria, vol. 4, nº 2, pp. 26-32, 2007. (shrink)

The notion of “responsibility gap” with artificial intelligence (AI) was originally introduced in the philosophical debate to indicate the concern that “learning automata” may make more difficult or impossible to attribute moral culpability to persons for untoward events. Building on literature in moral and legal philosophy, and ethics of technology, the paper proposes a broader and more comprehensive analysis of the responsibility gap. The responsibility gap, it is argued, is not one problem but a set of at least four interconnected (...) problems – gaps in culpability, moral and public accountability, active responsibility—caused by different sources, some technical, other organisational, legal, ethical, and societal. Responsibility gaps may also happen with non-learning systems. The paper clarifies which aspect of AI may cause which gap in which form of responsibility, and why each of these gaps matter. It proposes a critical review of partial and non-satisfactory attempts to address the responsibility gap: those which present it as a new and intractable problem (“fatalism”), those which dismiss it as a false problem (“deflationism”), and those which reduce it to only one of its dimensions or sources and/or present it as a problem that can be solved by simply introducing new technical and/or legal tools (“solutionism”). The paper also outlines a more comprehensive approach to address the responsibility gaps with AI in their entirety, based on the idea of designing socio-technical systems for “meaningful human control", that is systems aligned with the relevant human reasons and capacities. (shrink)

Este trabajo tuvo como objetivo evaluar los resultados del proyecto educativo en estudiantes de enfermería de salud reproductiva de licenciatura en enfermería, periodo agosto 2021 enero 2022, se empleó una metodología mixta, participaron 66 estudiantes, 64 familias. el resultado fue que los estudiantes; brindaron charlas educativas, abordaron temas de prevención de cáncer cervical, prevención de cáncer mamario y prevención de enfermedades de trasmisión sexual, se sintieron en confianza, los integrantes de las familias realizaron diversas preguntas, solicitaron más temas de (...) interés personal y fue agradable su experiencia de enseñar y compartir información en el ámbito familiar. (shrink)

We review the history of the philosophy of fondue since Aristotle so as to arrive at the formulation of the paradox of Swiss fondue. Either the wine and the cheese cease to exist (Buridan), but then the fondue is not really a mixture of wine and cheese. Or the wine and the cheese continue to exist. If they do, then either they continue to exist in different places (the chemists), but then a fondue can never be perfectly homogenous (it is (...) a French fondue). Or the wine and the cheese continue to exist in the same place (the Stoïcs), but then wine and cheese have to be, oddly, penetrable and spatially expansible. Aristote attempted to solve this paradox by arguing that the cheese and wine continue to exist, but only potentially in the fondue. We sketch an alternative answer. The wine and the cheese continue to exist, but only non-spatially in the fondue. Wine and cheese, once mixed, become non-spatial constituents of the fondue, a bit like character traits are non-spatial constituents of persons. The wine and the cheese are in the fondue, but only the fondue is there in the fondue pot. (shrink)

Objetivo. Introducir en la reflexión bioética el concepto de “reconocimiento recíproco”, como herramienta para la fundamentación de la bioética y el análisis de casos problemáticos. Hipótesis. Para entender y buscar soluciones a los nuevos problemas surgidos en el contexto de la atención a la salud, no resulta suficiente el positivismo jurídico ético. El reconocimiento bidireccional, concepto desarrollado por Honneth en su matiz de reciprocidad, denominado mutuo por Ricoeur y Cortina, permite construir un modelo de justicia aplicable al ámbito sanitario, (...) tanto en lo relativo a relaciones entre pacientes y personal, cuanto a las relaciones entre los profesionales, o de todos ellos con la organización sanitaria. Su ausencia en la relación clínica, en la gestión sanitaria, o en la salud pública, es un buen factor explicativo de los conflictos. Aplicado al análisis de conflictos, el concepto de reconocimiento ofrece posibilidades para transformar las relaciones conflictivas en relaciones de cooperación. Todo ello es novedoso, ya que hasta ahora apenas se ha investigado sobre reconocimiento recíproco como fundamento de la bioética. (shrink)

Humanización de los servicios de salud en Iberoamérica: una revisión sistemática de la literatura Humanização dos serviços de saúde na Ibero-América: uma revisão sistemática da literatura Humanization is an ethical imperative that contributes to safeguarding human dignity in harmony with bioethical principles and deontological regulations that govern health care practices. The present study aims to explore the advances in the humanization of Ibero-American health care in the last ten years through a systematic review. Results show that such advances point (...) to understanding the phenomenon based on theoretical approaches, a growing interest in the subject in recent years, and the creation of policies, programs and strategies that should be strengthened from a comprehensive view of the human being. Para citar este artículo / To reference this article / Para citar este artigo Carlosama DM, Villota NG, Benavides VK, Villalobos-Galvis FH, Hernández EL, Matabanchoy SM. Humanización de los servicios de salud en Iberoamérica: una revisión sistemática de la literatura. Pers Bioet. 2019;23:245-262. DOI: https://doi.org/10.5294/pebi.2019.23.2.6 Recibido: 21/06/2019 Aceptado: 04/09/2019. (shrink)

The number of people suffering from dementia will rise considerably in the years to come. This will have important implications for society. People suffering from dementia have to rely on relatives and professional caregivers when their disorder progresses. Some people want to determine for themselves their moment of death, if they should become demented. They think that the decline in personality caused by severe dementia is shocking and unacceptable. In this context, some people consider euthanasia as a way to avoid (...) total deterioration. In this article, we discuss some practical and ethical dilemmas regarding euthanasia in persons with severe dementia based on an advance euthanasia directive. We are using a personalist approach in dealing with these ethical dilemmas. (shrink)

Taking regular walks when living with Parkinson’s disease has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, (...) usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application. The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242. (shrink)

ABSTRACT In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral (...) experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

Scanlon's distinction between well-being and other personal values cannot be made out clearly if well-being is understood, as it commonly is, to consist in whatever is intrinsically good for a person. Two other accounts of well-being, however, might be able to explain this distinction. One is a version of the rational care view proposed by Stephen Darwall; another is a rational sympathy view suggested by some of Brad Hooker's work.

In the text Critique of the Foundations of Psychology (1928) Georges Politzer (1903-1942) sought to investigate the epistemological bases of some currents of psychology. His intention was to reorient psychological studies toward a concreteconception. By analyzing Gestalt theory, Behaviorism, and Psychoanalysis, Politzer outlined a project of concrete psychology with some principles that guide possible perspectives of studies on psychological phenomena. His principles consist instudying psychological facts through the prism of the first person and consider man in his drama. Despite being (...) Hungarian, the author walked his political and intellectual path in France in the 20th century, a time when Jean Paul Sartre (1905-1980) focusedon psychological phenomena under the prism of phenomenology, proposing an Existential Psychoanalysis at the end of Being and Nothingness (1943). In this sense, we will verify to what extent the Sartrian theory can contemplate Politzer’s principlesof a concrete psychology. (shrink)

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact upon the (...) inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

While COVID-19 spreads aggressively and rapidly across the globe, many societies have also witnessed the spread of other viral phenomena like misinformation, conspiracy theories, and general mass suspicions about what is really going on. This study investigates how exposure to and trust in information sources, and anxiety and depression, are associated with conspiracy and misinformation beliefs in eight countries/regions during the COVID-19 pandemic. Data were collected in an online survey fielded from May 29, 2020 to June 12, 2020, resulting in (...) a multinational representative sample of 8,806 adult respondents. Results indicate that greater exposure to traditional media is associated with lower conspiracy and misinformation beliefs, while exposure to politicians and digital media and personal contacts are associated with greater conspiracy and misinformation beliefs. Exposure to health experts is associated with lower conspiracy beliefs only. Higher feelings of depression are also associated with greater conspiracy and misinformation beliefs. We also found relevant group- and country differences. We discuss the implications of these results. (shrink)

The distinction between personal level explanations and subpersonal ones has been subject to much debate in philosophy. We understand it as one between explanations that focus on an agent’s interaction with its environment, and explanations that focus on the physical or computational enabling conditions of such an interaction. The distinction, understood this way, is necessary for a complete account of any agent, rational or not, biological or artificial. In particular, we review some recent research in Artificial Life that pretends (...) to do completely without the distinction, while using agent-centred concepts all the way. It is argued that the rejection of agent level explanations in favour of mechanistic ones is due to an unmotivated need to choose among representationalism and eliminativism. The dilemma is a false one if the possibility of a radical form of externalism is considered. (shrink)

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences (...) of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions?In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 55-59 [Access article in PDF] One Stage Is Not Enough Andrew W. Young and Karel W. de Pauw Keywords: delusions, Cotard delusion, Capgras delusion, cognitive neuropsychiatry. WE WELCOME THE OPPORTUNITY to offer our reflections on Philip Gerrans' interesting paper. Our opinion is that on fundamental issues we agree quite a bit—but there are clear differences when it comes to details.The most basic issue (...) concerns the nature of the enterprise. Like Gerrans, we think that it is possible to create testable accounts of the formation and maintenance of what would otherwise seem bizarre and inexplicable delusions, and that these accounts should be grounded in theoretical models of factors that underpin our everyday perception and reasoning. This general approach certainly forms part of what has been called cognitive neuropsychiatry. However, we disagree with Gerrans in that we see cognitive neuropsychiatry as an attempt to draw on the underlying logic of cognitive neuropsychology, rather than (as Gerrans implies) its current methods. The underlying logic of cognitive neuropsychological approaches has been to try to understand the effects of brain injury in terms of disruption of different components of theoretical models of normal abilities. In this approach, a model of normal performance is tested by its ability to account for the effects of brain injury. Where the model of normal performance also provides a convincing account of brain injury it is retained, and when it fails to account for effects of brain injury, it is revised or abandoned. In cognitive neuropsychiatry, the key theoretical move has been to argue that an adequate model of normal performance should be able to account for any disordered pattern (Ellis and Young 1990). The same logic of seeking to explain disordered performance by reference to models of normal function is then attempted, but for disorders that would usually fall within the province of psychiatry.In our opinion, however, cognitive neuropsychiatry will not simply involve importing the methods of cognitive neuropsychology into the new domain; they will need to be developed and adapted to fit the new agenda (Young 2000).In cognitive neuropsychology, progress has often come from the careful investigation of people with stable, selective deficits of fundamental cognitive functions involved in sensory analysis, memory, and verbal or motor output. In contrast, delusional beliefs can be relatively unstable; often they are only held for a few weeks or even days. When the delusions change, patients may modify or abandon them as suddenly as they seemed to form them, or they may give them up much more slowly and reluctantly. At the very least, this creates difficulties in the timing of investigations and in interpreting the relation of deficits and symptoms, which may be recorded on separate dates. These methodological problems [End Page 55] are exacerbated by the fact that deficits linked to complex abnormal experiences such as delusions may be multifaceted and diffuse, even when the delusions themselves have a specific content or theme. Such complications do not invalidate cognitive neuropsychiatry, but they do mean it will need to develop its own methods for dealing with them and making appropriate inferences.One of the key complexities that has surfaced already involves the idea that delusional beliefs might reflect the interaction of two or more contributory factors. Gerrans discusses a particular variant of this idea, which had been suggested by Young and Leafhead (1996) as an approach to understanding the Cotard delusion: The Cotard delusion represents a depressed person's attempt to account for abnormal perceptual experiences. It follows that the delusion is based on an unfortunate interaction between different contributory factors. One set of factors creates the abnormal perceptual experiences, which are characterised by lack of emotional responses and feelings of emptiness, depersonalisation and derealisation. The other factors result in a misinterpretation of these perceptual changes, in which the patients' depressed moods lead them correctly to attribute the changes to themselves, but to exaggerate their consequences. (Young and Leafhead, 1996, 166) Gerrans describes this as a two-stage account, but argues that a one-stage account based only on abnormal perceptual... (shrink)

Starting from the analysis of a phenomenological reading of the parable of the Good Samaritan and arriving at the idea of the World Person in Chiara Lubich, this article will discuss two topics: union in difference and the model of the neighbor in the Gospel. For Christians this is the confirmation that the meeting with the stranger is possible. Christ founded a community that co-exists with the stranger. It is within this path that the intuition the figure of the World (...) Person in Chiara Lubich arises. In the tension between interpretation and Truth, Lubich puts the question: was there anyone that went through the trial of doubt about the Truth, but has been able to create a new world? She says that was Jesus Forsaken, who opens up the possibility of differentiation without exclusion. (shrink)

This paper outlines and defends a notion of 'tragic-remorse'. This moral emotion properly accompanies those actions that involve unavoidable moral wrongdoing in general and dirty hands scenarios in particular. Tragic-remorse differs both phenomenologically and conceptually from regret, agent-regret and remorse. By recognising the existence of tragic-remorse, we are better able to account for our complex moral reality which at times makes it necessary for good persons to act in ways that although justified leave the agent with a moral stain and (...) a particular emotional response. (shrink)

ABSTRACT This article invites us to consider the task of education as we face the end of the world as we have known it. The first part of the article gives an overview of global and educational challenges, drawing attention to how formal education has been complicit in the reproduction of historical and systemic violence, as well as unsustainability. This section also offers a distinction between educational approaches that focus on personal empowerment and the mastery of knowledge and skills, (...) and educational approaches that see the role of education in association with the non-coercive re-arrangement of desires and with responsibility before will. The second part of the paper presents a psychoanalytic experiment that attempts to create a space and the dispositions necessary for difficult conversations about the role of education in preparing us all to confront the potential for social and ecological collapse in our lifetime. (shrink)

John Locke's account of personal identity is one of his most discussed theories. Opposing the Cartesian ontology of mind, Locke argued that the soul does not always think - for thinking is simply one of its operations, but not its essence -, and that personal identity consists in consciousness alone. Against Locke, an anonymous commentator published the Remarks upon an Essay concerning Humane Understanding charging Locke's view with possible immorality. Catharine Cockburn rebuffed the Remarker's objections, in her Defence (...) of Mr. Locke's Essay, depicting his view as more dangerous for morality than Locke's. This paper shifts the focus from Cockburn's defence of Locke's moral thought, to her apology for his theory of personal identity, including his probabilistic arguments in favour of the immortality of the soul. This shift of focus yields an alternative account of Cockburn's originality: first, because she offered a non-substance interpretation of Locke's theory of personal identity, that, for its time, was unusual, and remains relevant for contemporary philosophical debates over Locke; and second, because, following Kristeller, in the very act of defending and articulating anew Locke's theory, Cockburn in some sense appropriated it. (shrink)

En el presente artículo se busca exponer sintéticamente el meta-modelo de la Psicología integral de la persona. A partir de seis preguntas fundamentales se intenta mostrar sus principales planteamientos: (1) qué es la Psicología clínica, (2) qué es la salud psíquica, (3) qué es el desorden psíquico, (4) en qué consiste el diagnóstico clínico, (5) en qué consiste el proceso de sanar psíquicamente y (6) cuál es el rol del terapeuta.

En este artículo se exponen las conclusiones de un estudio cuyo objetivo principal fue describir y analizar las situaciones de discriminación, violencia y desigualdad contra enfermeros/as gays y lesbianas con pretexto de su orientación sexual y/o expresión de género en organizaciones de salud públicas y privadas de Ciudad Autónoma de Buenos Aires (en adelante, CABA). Aquí se analizan las estrategias y los modos en que gays y lesbianas gestionan la información personal relativa a su orientación sexual en sus (...) intercambios socio-laborales para evitar el estigma.Este escrito se centra en dos categorías principales que ordenaron la investigación: (a) las posibilidades de expresar la propia orientación sexual en los respectivos espacios de trabajo y su vinculación con el estigma real o anticipado en las interacciones con compañeros/as, superiores y pacientes; y (b) el heterosexismo internalizado como una categoría vinculada tanto con el estigma anticipado y experimentado como con los distintos grados de apertura sobre la propia orientación sexual en el trabajo.Para alcanzar el objetivo propuesto, se adoptó un enfoque cualitativo y se analizaron 20 entrevistas a enfermeros y enfermeras gays, lesbianas y heterosexuales, sumado a la indagación de diversas fuentes secundarias, desde los lineamientos de la teoría fundamentada en datos. Como conclusión, se destaca la asociación entre el grado de asunción de la propia identidad sexual, el uso de estrategias de gestión de la información personal y el heterosexismo internalizado, que repercuten en la reproducción de la opresión y el estigma entre gays y lesbianas en comparación con la población heterosexual. Por lo tanto, este trabajo pretende hacer un aporte significativo a las discusiones y los estudios sobre diversidad sexual en los espacios de trabajo de Argentina y la región. (shrink)

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

Second person social cognition cannot be restricted to dyadic interactions between two persons (the and the ). Many instances of social communication are triadic, and involve a third person (the ), which is the object of the interaction. We discuss neuropsychological and brain imaging data showing that triadic interactions involve dedicated brain networks distinct from those of dyadic interactions.

This work was carried out with the objective of presenting an integral vision of the person necessary for a healthy experience of objectivity/subjectivity in Emmanuel Mounier and rationality in José Saramago. Such approaches will be initiated by the corporeality that shows the body as an essential part of the person, that is, through it she expresses herself as such and exposes herself to the world and to others. However, this same person is beyond the body, the exteriority, he is interiority (...) and there he finds the strength that favors the leap of his own personal reality, that is, he favors the interior-exterior dynamic. In this dynamic, the great gift of freedom emerges, which, although interior, manifests itself in human acts. For the elaboration of the research, a bibliographic exploratory methodology was used in the main works of the authors. Finally, we conclude that Mounier and Saramago's proposal about freedom are really near on there principles, which ideas are sorely needed in today's world. Knowing that freedom is not pure objectivity, that we should live it instead of seeing it, nor pure subjectivity, because the world does not suit only my will; therefore, the human experience is lived under conditions, what surely puts us down to earth. We are free as we make others free, this is the great challenge! (shrink)