Introduction: All countries face the issue of choice in healthcare. Allocation of healthcare resources is clearly associated with the concept of distributive justice and to the existence of a right to healthcare. Nevertheless, there is still the question of whether this right should include all types of healthcare services or if it should be limited to selected types. It follows that choices must be made, priorities must be set and that efficiency of healthcare services should be maximum.

The European Union faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this (...) right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented. (shrink)

The world population aged significantly over the twentieth century, leading to an increase in the number of individuals presenting progressive, incapacitating, incurable chronic-degenerative diseases. Advances in medicine to prolong life prompted the establishment of instruments to ensure their self-determination, namely the living will, which allows for an informed person to refuse a type of treatment considered unacceptable according to their set of values. From the knowledge on the progression of Alzheimer disease, it is possible to plan the medical care, even (...) though there is still no treatment available. Irreversible cognitive incapacity underlines the unrelenting loss of autonomy of the demented individual. Such a loss requires the provision of specific and permanent care. Major ethical issues are at stake in the physician–patient–family relationship, even when dementia is still at an early stage. The authors suggest that for an adequate health care planning in Alzheimer disease the living will can be presented to the patient in the early days of their geriatric care, as soon as the clinical, metabolic or even genetic diagnosis is accomplished. They also suggest that the appointment of a health care proxy should be done when the person is still in full enjoyment of his cognitive ability, and that the existence and scope of advance directives should be conveyed to any patient in the early stages of the disease. It follows that ethical guidelines should exist so that neurologists as well as other physicians that deal with these patients should discuss these issues as soon as possible after a diagnosis is reached. (shrink)

In most western countries, there is a 'human organ shortage' with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors give their specific consent. Xenotransplantation--defined as the transplantation of animal cells, tissues or organs into human beings--is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this medical procedure. The (...) objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)

The increasing costs of healthcare delivery led to different political and administrative approaches trying to preserve the core values of the welfare state. This approach has well documented weaknesses namely with regard to healthcare rationing. The objective of this paper is to evaluate if independent healthcare regulation is an important tool with regard to the construction of fair processes for setting limits to healthcare. Methodologically the authors depart from Norman Daniels’ and James Sabin’s theory of accountability for reasonableness and try (...) to determine if new regulatory models—namely independent agencies—perform better with regard to the public disclosure of the reasons and rationales of healthcare rationing. In publicly financed healthcare systems independent regulation is an important tool to assure fair and reasonable procedures of prioritising services. In accordance with the principle of public accountability, independent regulatory agencies are particularly well suited to assure publicity of the decision-making processes, relevance of the rationale involved and particularly mechanisms for challenge and dispute resolution regarding limit setting decisions. It follows that independent healthcare regulation could be regarded not only as an instrument for performance improvement but also as a tool of social justice. The authors conclude by stating that accountability for reasonableness should be regarded as a landmark of any healthcare reform. And therefore regulators have the social task of assuring that the rationales for limit-setting decisions are clearly accessible to the public. (shrink)

Changes in modern societies originate the perception that ethical behaviour is essential in organization’s practices especially in the way they deal with aspects such as human rights. These issues are usually under the umbrella of the concept of social responsibility. Recently the Report of the International Bioethics Committee of UNESCO on Social Responsibility and Health has addressed this concept of social responsibility in the context of health care delivery suggesting a new paradigm in hospital governance. The objective of this paper (...) is to address the issue of corporate social responsibility in health care, namely in the hospital setting, emphasising the special governance arrangements of such complex organisations and to evaluate if new models of hospital management (entrepreneurism) will need robust mechanisms of corporate governance to fulfil its social responsiveness. The scope of this responsible behaviour requires hospitals to fulfil its social and market objectives, in accordance to the law and general ethical standards. Social responsibility includes aspects like abstention of harm to the environment or the protection of the interests of all the stakeholders enrolled in the deliverance of health care. In conclusion, adequate corporate governance and corporate strategy are the gold standard of social responsibility. In a competitive market hospital governance will be optimised if the organization culture is reframed to meet stakeholders’ demands for unequivocal assurances on ethical behaviour. Health care organizations should abide to this new governance approach that is to create organisation value through performance, conformance and responsibility. (shrink)

Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude that (...) cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy. (shrink)

In all countries where health care access is considered a social right, regulation is both a tool of performance improvement as well as an instrument of social justice. Both social (equity in access) and economical (promoting competition) regulation are at stake due to the nature of the good itself. Different modalities of regulation do exist and usually new regulatory cycles include the creation of stronger regulatory agencies. Indeed, health care regulation is rising steadily in most developed countries as a consequence (...) of the introduction of the New Public Management perspective to provide essential public goods.Health care is delivered by different organisations with very different cultural backgrounds—public and private (profit and non-profit)—that should be accountable for their decisions. Control by regulatory agencies is instrumental to accomplish this goal. However, there is some dispute with regards the degree of regulatory autonomy. The objective of this paper is to determine if independent regulatory agencies (IRAs) are effective in carrying out health care regulation. The authors apply Walshe’s analytical framework to the Regulatory Authority of Health (Portugal) to answer the question if independent regulation works.In conclusion, the two year experience of the Regulatory Authority of Health is important not only because the primary goals of independent regulation were achieved but also because this authority is now a full partner in the health care sector. However, independent agencies need to develop strong mechanisms of accountability because good regulatory governance is the paradigm of this institutional innovation. (shrink)

The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of (...) the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as an instrument of performance improvement and they articulate this theory with the different regulatory strategies. The authors conclude that sunshine regulation takes on a special relevance as, by promoting publicity of the performance indicators, it contributes directly and indirectly to an overall improvement of the healthcare services, namely in countries were citizens are more critical with regard to the overall performance of the system. Indeed, sunshine regulation contributes to the achievement of high levels of transparency, which are fundamental to overcoming some of the market failures that are inevitable in the transformation of a vertical and integrated public system into a decentralised network where entrepreneurialism appears to be the predominant culture. (shrink)

The health sector is facing many challenges, and there is a need to maintain the delivery of high‐quality health‐care. Issues related to equity and access to health‐care have emerged in a context of an economic recession in which the sustainability of the health system depends on everyone, including the actions and decisions of professionals. Therefore, nurses and their skills may be the answer to ethical, professional and community health management, but this recession could lead to major problems in the education (...) of nurses in daily health‐care practice. Due to the limited availability of resources, nurses are increasingly taking leadership positions, continuing to develop their critical abilities and thinking skills, and considering sciences such as deontology and ethics. The main goals of this study were to reflect on the economic recession and its impact on health‐care and to demonstrate the contribution of nursing to the sustainability of health‐care and in the promotion of individuals' dignity. The authors conclude that health‐care depends on economic redistribution and, in this context, needs to be equitable and fair. Nurses have the responsibility to develop their profession according to the underlying sciences and can therefore strategically help the healthcare system. (shrink)

Background:The theoretical framework of Jϋrgen Habermas suggests that effective communication requires competent participants with an objective attitude that complies with the rules and worlds designated as objective, social and subjective. This situation determines communicative action, which stimulates the search for mutual understanding and results in a process of interaction that promotes self-determination.Objectives:In this study, the discharge letters of patients with myocardial infarction were explored regarding the provision of information. The patient’s right to information and the duty of informing were analysed (...) according to the perspective of Jϋrgen Habermas.Research design:This was a cross-sectional analysis of all discharge letters that were directly related to nursing interventions regarding the provision of information to 106 patients. In this major study, the difficulties faced by patients who experienced a myocardial infarction and the changes in their lifestyles were analysed based on the type of information received.Ethical considerations:The hospital Ethics Committee approved the study, which complied with ethical principles and required informed consent.Findings:In the nursing letters, interventions related to the provision of information were conducted at an average of 3.59 interventions per patient. For 8.5% of the patients, however, no interventions related to the provision of information were performed. The most common area of information during hospitalisation was related to the management of signs and symptoms and applied to 90.6% patients.Discussion:The nursing interventions did not cover patient education, transition processes or awareness of the disease. Thus, the right to information can be questioned.Conclusion:Information is a right, and communication is extremely important. Health professionals should be aware of this importance regarding both care management and the satisfaction guarantee. The sharing of information by health professionals based on their competency is essential for patients to exercise their right to self-determination and decision-making. (shrink)

Explicit forms of rationing have already been implemented in some countries, and many of these prioritization systems resort to Norman Daniels’ “accountability for reasonableness” methodology. However, a question still remains: is “accountability for reasonableness” not only legitimate but also fair? The objective of this paper is to try to adjust “accountability for reasonableness” to the World Health Organization’s holistic view of health and propose an evolutionary perspective in relation to the “normal” functioning standard proposed by Norman Daniels. To accomplish this (...) purpose the authors depart from the “normal” functioning standard to a model that promotes effective opportunity for everyone in health care access, because even within the “normal” functioning criteria some treatments and medical interventions should have priority upon others. Equal opportunity function is a mathematical function that helps to hierarchize moral relevant necessities in health care according to this point of view. It is concluded, first, that accountability for reasonableness is an extremely valuable tool to address the issue of setting limits in health care; second, that what is called in this paper “equal opportunity function” might reflect how accountability for reasonableness results in fair limit-setting decisions; and third, that this methodology must be further specified to best achieve fair limit-setting decisions. Indeed, when resources are especially scarce the methodology suggested in this paper might allow not only prioritizing in an “all or nothing” basis but can contribute to a hierarchy system of priorities in health care. (shrink)

In most western countries, there is a ‘human organ shortage’ with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors gave their specific consent.Xenotransplantation – defined as the transplantation of animal cells, tissues or organs into human beings – is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this (...) medical procedure. The objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)

In Brazil, induced abortion in adolescents has been frequent in less-advantaged socioeconomic classes, and the vulnerability of these adolescents has not been addressed. Given this context, the present study sought to investigate the relationship between the practice of abortion and vulnerability in adolescents. This was a descriptive cross-sectional study of 201 adolescents who completed a structured questionnaire that allowed the analysis of variables with respect to intent to abort. The profile of the pregnant adolescents in the sample studied was the (...) following: average age, 16.1 years; stable partner; mulatas; did not use condoms during sexual relations; precocious with respect to their first sexual relations; and did not plan the pregnancy. According to the classification of the World Health Organization, 81.59% of the subjects‘ abortions were known to be induced. Twenty-one were vulnerable to induced abortion; of these, 13 reported forced sexual intercourse, of whom 8 reported that they had suffered associated violence. These results indicate that sexual violence and unwanted pregnancy subject adolescents to a context of greater vulnerability to induced abortion. Thus, it is suggested that this relationship should be considered from the perspective of bioethics and human rights, but always respecting the cultural values of the society in which the adolescents live, as well as their human dignity. (shrink)

Within common mental health treatments there exists a paradox, in which personal agency over a problem appears to increase by disownership of the problem. I endeavor to explain this paradox and by doing so, shed light on the relationships among identity, psychopathology, and therapeutic agency. The work of the philosopher Harry Frankfurt, with emphasis on his concept of externality, is used as the model for unraveling the paradox of agency.

In lieu of an abstract, here is a brief excerpt of the content:In, Out Me, You Mental, Moral Where Do I Begin?Mark D. Rego (bio)I once attended a Buddhist meditation retreat, led by an American meditation teacher. The instructor had studied and practiced is Asia for many years and was well versed in the practices and teachings of Buddhism. Among his opening remarks was something along the line of the following: "One question that is asked on every retreat is, (...) 'if there is no true self, then who is it who has come here to become free of the illusion of a self?' The answer is, I don't know, but we can start anyway."This sense of practicality in the face of unanswerable questions is built into Buddhism, as is the relationship among the particularities of each individual, a process akin to externality, mental well-being, and morality.I raise Buddhism both because of its central interest into the nature of the self (an obviously germane consideration in the papers under discussion) and because of this second feature noted, namely the comfortable integration of individuality, character building, ethical action, and mental well-being (the issue of the true self will, thankfully, have to wait). It is this theme that I raise via the discussion of externality.The commentaries of Talmadge and Graham, unintentionally I think, pull me toward a beguiling observation in my daily practice of psychiatry. Namely, patients commonly report their clinical improvements in terms of how they deal better with others, how they are more thoughtful and even handed (with themselves included), and how they better cope with the demands of their individual lives. In senses both highly individual and highly principled, and in ways both explicit and implicit, when patients feel better they often feel that they are better people (all the kinds of treatment mentioned in my paper equally apply; there is no exclusivity in this result).There is also an interesting consistency in a dual manner in which this is expressed. In one way people report the improved coping, handling, and so on mentioned. In the next breath the same person commonly says, "I feel like myself."The meditation instructor would be pleased; it appears that through a process of becoming aware of and letting go of some form of negativity an individual feels better, acts better, and feels more unified. (As the instructor was psychologically sophisticated, he would not mistake the "like myself" sentiment as a Buddhist heresy. Rather, he would understand it as a reflection of being more at ease with and aware of disparate parts of himself.) And all this without figuring out who the real self is. [End Page 331]I mention these observations about Buddhism and clinical care because when I consider the processes of evaluating, deciding, and forging identity and volition it seems to me that somewhere between the lines the individual is aligning himself with some sense of what is good. The resultant experience of volition and cohesive identity is, often but not always, experienced as good both psychologically and morally.Change, Others, and ValuesIn the two commentaries that follow my paper on Frankfurtian externality and therapeutic change (Rego 2004), Talmadge (2004) and Graham (2004) highlight different aspects of externality and therapeutics. Talmadge, an addiction psychiatrist, expands the theme of volitional change in recovery from addiction. For Talmadge, as for most in the field, the question of when and how an addict has truly committed to change (hitting "rock bottom"? accepting the first of the twelve steps?) is perennially in the air. Such knowledge would be invaluable in guiding addicts along their rocky paths.Although still far short of the mark, Talmadge finds some illustrative guidance in Frankfurt. The shift that takes place within the addict to place him on the road to recovery is not necessarily "rock bottom," or conformity to a program's dictates or a state of new knowledge. Rather, it is a shift in will. By whatever process (and Talmadge is quite aware that there seem to be many paths) the addict has come to care about sobriety in a way he or she did not before. He or she now cares in a way that is part of him or her... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Knowledge, Mental Disorders, and MedsHow to Parse the EquationMark D. Rego (bio)Keywordspsychopathology, antidepressants, suicidality, subjective experience, pre-reflectiveA few weeks, ago I was walking down the hall to my office when I spotted my brother-in-law coming the other way. This was odd on two accounts. First, he lives in Kentucky (I am in Connecticut) and second, he is at least a foot taller than the man in my (...) hallway. Nonetheless, I struggled to figure out why he was there. The resemblance was so striking it took me a minute or two to convince myself it was not him. Even after such convincing, the feeling that it was him remained.Later, I imagined that had I just returned from a crack cocaine den I would have been hypervigilant, if not paranoid, and consequently would be certain that my brother-in-law had arrived unannounced. Furthermore, I would probably assume that he was up to no good.How did I retain a strong feeling of recognition, the feeling that maybe it was really him, when I already concluded otherwise? And why, were I on crack cocaine, would the obvious facts be useless in rendering a decision about the identity of the man in the hall? Last, why would the post-cocaine man in the hall become a nefarious brother-in-law rather than a benign one?If I just computed some symbols to figure this out, wouldn't the feeling have gone away? If I activated a brother-in-law neural network, how did I come to acquire an evil brother-in-law neural network? And why wouldn't that go away either?In his article in this issue of Philosophy, Psychiatry, & Psychology, Hadreas looks at questions like these through the prism of before and after effects of people treated with selective serotonin reuptake inhibitors (SSRIs). Hadreas investigates the implications of a straightforward recomputation of self-awareness when treated with these medicines and finds such approaches unsatisfying and incomplete in their explanatory power. (My example looks at a type of awareness, but not specifically self-awareness, as does Hadreas. Furthermore, my paradigm asks about computational conclusions using language more common in psychiatric literature, whereas Hadreas uses standard philosophical terms. Although not isomorphic, I believe the interchange of the two remains true to the issues Hadreas is addressing). [End Page 57]In my example, there is clearly something else going on than the incorrect arrangement of symbols or the misfiring of nodes in a network that influences how I feel and what I think. Neither reason nor empiricism seem to serve me well here. Hadreas utilizes Husserl to begin to unpeel the layers of self-awareness and self-states that intermix to form the shifts and contradictions which are so common in psychiatric treatment (and in common experience as I describe).This is a welcome reckoning; the psychiatric literature is overflowing with unquestioned premises about the neuropsychiatric correlates of reason and empirical approaches (described more as computation and neural networks in the literature—again, not strictly analogous, but the same criticisms apply) Hadreas is critical of. Unfortunately, Hadreas has navigated through a sea of highly questionable assumptions about the psychopharmacology of depression to illustrate his points. This is due in large part to the common practice of consulting literary narratives and critics rather than one of immersion in the literature as a whole and the daily life of patients and active clinicians. He arrived at his destination despite this, because many of these details did not affect his particular analysis. However, to look forward to a continuation of this work and clarify some important issues I devote most of my commentary to these issues. The points I raise are more extensively discussed in a previous edition of this journal (Rego 2005).Affect to Reason ShiftLet's begin with the idea that SSRIs work by dampening emotions. An extension of this idea is that they dampen negative emotions and strengthen positive ones like assertiveness, confidence, and optimism. An even further development in this direction is that, by dampening strong emotions, cognitive enhancement takes place with SSRI treatment. A summary observation then is that SSRIs facilitate... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Surrender Versus Control:How Best Not to DrinkMark D. Rego (bio)Keywordsaddiction, Alcoholics Anonymous, will, St. AugustineI recall as a teenager noticing that some people modified nouns in, what sounded to me, a peculiar way. A friend's mother who was taking an automotive repair course said, " We're going to learn to fix the brakes next week." The same folks would also use the possessive for common nouns in phrases (...) like: "I'll be ready after I take my shower." Although not incorrect, I believe this type of usage reflected a different attitude about brakes, showers, and other things. These tended to be more hands-on people and thus, in my understanding at least, had a more particular relationship with things in their world than others for whom objects were examples of types of things.This brief vignette serves as an introduction to my qualified enthusiasm for the project taken up by Allison Mitchell in her paper, "Taking Mentality Seriously: A Philosophical Inquiry into the Language of Addiction and Recovery" (Mitchell, 2006). Indeed, as a practicing psychiatrist I would be hard pressed not to endorse the use of language as a key to deeper aspects of experience.My following remarks are mostly contra Mitchell's hypothesis, but before beginning I name one more reason I think this project is worthwhile. In spite of much research and recitations of the motto "treatment works," we do not presently have a reliable treatment for addiction. The linguistic portrait painted by Mitchell allows us to view our treatments in vivo and reflect upon what we see. (For the purpose of this commentary, I consider alcoholism and Alcoholics Anonymous [AA] as a general example of addiction and treatment.)Medication treatment remains almost inconsequential except when applied for comorbid psychiatric disorders rather than the primary addiction. Even then it rarely serves to undo some form of self-medication, but instead only offers an important leg up in battling the addiction.Research and much experience has shown AA to be the single best treatment for alcoholism (Vaillant and Hiller-Sturmhofel 1996). Some investigators have proposed underlying mechanisms for its efficacy (some, like "creating dependency" run very counter to Mitchell) (Vaillant 2005). AA's success is highly dependent upon attendance (McCrady et al. 2004), which can of course be a marker for getting better in the first place and not solely a cause of improvement (i.e., people who are doing better attend more meetings not vice- versa). Even within AA, the dropout rate is quite high (Martin et al. 1996). Workers in this area [End Page 223] have raised questions about AA's approach and have proposed other avenues to sobriety, including interpersonal, cognitive–behavioral, and relapse prevention programs (Witkiewitz and Marlatt 2005, 2004; O'Dwyer 2006). Lamentably, some very large studies failed to show any effective ability to match up alcoholics with a particular treatment modality (Church 2004; Read 2004).Given the lack of clarity with which we still work, I think an approach like Mitchell's is a welcome call for serious reflection. The limitations of a linguistic analysis place an unfortunate constriction on implications to be drawn.Mitchell's chief concern is that the language of recovery, as reflected in twelve-step programs, betrays and even fosters a degree of passivity, which leaves the addict without an adequate sense of agency and autonomy with which to combat addiction. From a more philosophical perspective, Mitchell believes this is due to an incomplete philosophical materialism; one that lacks "mentality" (i.e., the sense that part of our physical being is made up of mental activities such as emotions, motivations, beliefs, etc.). This attitude is manifest in a "pretheoretic conception of the self" that leaves the addict with a dearth of self-awareness as a mental agent of action and change.In place of the standard recovery model in use today, Mitchell suggests cultivating a sense of self that values and fosters engaged agency that is both capable of self-control and responsive to external obligations.A Few ConcernsFirst, I will offer a few concerns about premises at work within the paper. Then, I outline an attempt to make sense of the... (shrink)

Morality has traditionally been described in terms of an impartial and objective “moral law”, and moral psychological research has largely followed in this vein, focusing on abstract moral judgments. But might our moral judgments be shaped not just by what the action is, but who is doing it? We looked at ratings of moral wrongness, manipulating whether the person doing the action was a friend, a refugee, or a stranger. We looked at these ratings across various moral foundations, and conducted (...) the study in Brazil, US, and UK samples. Our most robust and consistent findings are that purity violations were judged more harshly when committed by ingroup members and less harshly when committed by the refugees in comparison to the unspecified agents, the difference between refugee and unspecified agents decays from liberals to conservatives, i.e., conservatives judge them more harshly than liberals do, and Brazilians participants are harsher than the US and UK participants. Our results suggest that purity violations are judged differently according to who committed them and according to the political ideology of the judges. We discuss the findings in light of various theories of groups dynamics, such as moral hypocrisy, moral disengagement, and the black sheep effect. (shrink)

We assess the perceived impact of leaders’ humility on team effectiveness, and how this relationship is mediated by balanced processing of information. Ninety-six leaders participate in the study. The findings suggest that humility in leaders is indirectly related to leaders’ perceived impact on team effectiveness. The study also corroborates literature pointing out the benefits of using other-reports to measure humility, and suggests adding humility to the authentic leadership research agenda.

Moral and financial scandals emerging in recent years around the world have created the momentum for reconsidering the role of virtuousness in organizational settings. This empirical study seeks to contribute toward maintaining this momentum. We answer to researchers’ suggestions that the exploratory study carried out by Cameron et al. :766–790, 2004 ), which related organizational virtuousness and performance, must be pursued employing their measure of OV in other contexts and in relation to other outcomes :928–958, 2007 ). Two hundred and (...) sixteen employees reported their perceptions of OV and their affective well-being at work, their supervisors reporting their organizational citizenship behaviors. The main finding is that the perceptions of OV predict some OCB both directly and through the mediating role of AWB. The evidence suggests that OV is worthy of a higher status in the business and organizational psychology literatures. (shrink)

Public extension services play a key role in the implementation of strategies for rural development based on the sustainable management of natural resources. However, the sector suffers from restricted financial and human resources. Using experiences from participatory action research, a strategy for rural extension in the Amazon was defined to increase the efficiency and the relevance of external support for local resource users. This strategy considered activities initiated and coordinated by local people. Short-term facilitation visits provided continuous external support for (...) the purpose of establishing locally based planning and learning mechanisms. In collaboration with the municipality of Muaná in the Eastern Amazon, the strategy was tested in two traditional communities – Monte Moriat and Boa Esperança. Both communities recognized as most important the need to reduce their dependence on açaí (Euterpe oleracea Mart.), the principal source of food and income. This forest resource has been overexploited, seriously affecting açaí stands and diminishing the forest benefits fundamental for survival. Two local groups decided to raise chickens as a way to reduce nutritional problems and as an alternative source of income. Supported by monthly, short-term planning and evaluation visits, the groups managed to achieve significant progress in their endeavor. The groups identified (1) the control of decision-making and information, and (2) the absence of external obligations to be the greatest advantages of the development initiative. The study confirmed the potential of participatory strategies for public extension in the Amazon. Special attention was given to realistically define the role of forests for local development. However, drastic measures are necessary to smooth the way for real participation in governmental and non-governmental organizations acting in the Brazilian Amazon. (shrink)

ARAGÃO, Ivan Rêgo. “ Vinde todas as pessoas, e vede a minha dor ”: A Festa/Procissão ao Nosso Senhor dos Passos como Atrativo Potencial Turístico em São Cristóvão-Sergipe-Brasil. 2012. 198f. Dissertação (Mestrado) Cultura e Turismo – Universidade Estadual de Santa Cruz (UESC), Ilhéus-BA. Palavras-chave: Turismo Cultural-Religioso Católico. Religiosidade Popular. Festa do Senhor dos Passos. Keywords: Catholic Religious-Cultural Tourism. Popular Religiosity. Party of Lord of the Steps.

Through a convenience sample of 260 employees, the study shows how employees’ perceptions about corporate citizenship (CC) predict their affective commitment. The study was carried out in Portugal, a high in-group and low societal collectivistic culture. Maignan et al.’s (1999, Journal of the Academy of Marketing Science27(4), 455–469) construct, including economic, legal, ethical, and discretionary responsibilities was used. The main findings are: (a) contrary to what has been presumed in the literature, the discretionary dimension includes two factors: CC toward employees (...) and toward community; (b) perceptions of CC explain 35% of unique variance of affective commitment; (c) the best predictors are perceptions of economic and legal CC and, mainly, perceptions of discretionary CC toward employees; (d) the perceptions of discretionary CC toward employees are significantly better predictors of affective commitment than are perceptions of economic, ethical, and discretionary CC toward the community; (e) perceived inconsistency of the several CC dimensions is detrimental to employees’ affective commitment. The study questions the four-dimensional model of the CC construct as operationalized by Maignan et al., suggests that culture should be included as a moderating variable in future research, and stresses that affective commitment may decrease when employees perceive that their organizations act upon the several areas of CC inconsistently. (shrink)

Sixty-eight stores of a retail chain were used for testing a model in which perceived authentic leadership predicts stores’ sales achievement through the mediating role of perceived store virtuousness and perceived store potency. Employees reported AL, store virtuousness, and store potency. Sales achievement over a period of four consecutive months subsequent to data collection was considered as dependent variable . The main findings are the following: AL predicts store potency through the mediating role of store virtuousness; store virtuousness predicts sales (...) achievement through the mediating role of store potency; AL predicts sales achievement via the mediating role of both store virtuousness and store potency. By focusing on three positive constructs, whose interrelations have scarcely been explored, and relating them to store performance, the study enriches the Positive Organizational Scholarship movement, and suggests that AL and virtuousness are good in themselves and also potential facilitators of group success. (shrink)

Through a qualitative approach, we explore the perspective of 72 CEOs of companies operating in Portugal about the definition of corporate sustainability and its facilitators, and obtain four main findings. First, most CEOs equate CS with the company’s continuity/viability. Second, the relevance ascribed to different stakeholders differs considerably: while more than 50 % of CEOs cited shareholders/profits, and more than 40 % mentioned the natural environment and employees, very few mentioned customers, society, suppliers, the State, or competitors. Third, the management (...) practices considered as most important to develop CS are the organization’s strategic alignment with a long-term orientation, and developing and energizing people within a positive organizational climate characterized by trust and ethics. Fourth, the leadership characteristics and behaviors considered as most important to foster CS are scrutinizing the future and leading people through a mobilizing vision; energizing and developing employees; and leading by example. While the whole picture is largely consistent with the “sustainable strategic management” approach suggested by Stead and Stead and with recent CS integrative approaches, the great majority of CEOs who participate in the study have not embraced such integrative and coevolutive perspectives. (shrink)

This article develops a conceptual framework for regulating Artificial Intelligence (AI) that encompasses all stages of modern public policy-making, from the basics to a sustainable governance. Based on a vast systematic review of the literature on Artificial Intelligence Regulation (AIR) published between 2010 and 2020, a dispersed body of knowledge loosely centred around the “framework” concept was organised, described, and pictured for better understanding. The resulting integrative framework encapsulates 21 prior depictions of the policy-making process, aiming to achieve gold-standard societal (...) values, such as fairness, freedom and long-term sustainability. This challenge of integrating the AIR literature was matched by the identification of a structural common ground among different approaches. The AIR framework results from an effort to identify and later analytically deduce synthetic, and generic tool for a country-specific, stakeholder-aware analysis of AIR matters. Theories and principles as diverse as Agile and Ethics were combined in the “AIR framework”, which provides a conceptual lens for societies to think collectively and make informed policy decisions related to what, when, and how the uses and applications of AI should be regulated. Moreover, the AIR framework serves as a theoretically sound starting point for endeavours related to AI regulation, from legislation to research and development. As we know, the (potential) impacts of AI on society are immense, and therefore the discourses, social negotiations, and applications of this technology should be guided by common grounds based on contemporary governance techniques, and social values legitimated via dialogue and scientific research. (shrink)

The spiritual movement of Kantianism remains sound. La Philosophie du non 106 Kantianism has left the employment of the categories incoherent. La Philosophie du non 67.

Demographic growth is a major element that hampers the sustainable future and at the same time it is proportionally associated with the human suffering. The demographic control is a way to promote the well-being, reduce the human suffering and make our planet more sustainable. In this paper we analyze from the ethical point of view the human decisions associated with the procreation, birth control, adoption and anti-natalism.

Obedience: a simple term. Stanley Milgram, the famous experimental social psychologist, shocked the world with theory about it. Another man, Pol Pot, the infamous leader of the Khmer Rouge, showed how far the desire for obedience could go in human societies. Milgram conducted his experiments in the controlled environment of the US psychology laboratory of the 1960s. Pol Pot experimented with Utopia in the totalitarian Kampuchea of the 1970s. In this article, we discuss the process through which the Khmer Rouge (...) regime created an army of unquestioningly obedient soldiers — including child soldiers. Based on these two cases, we advance a framework on how obedience can be grown or countered. (shrink)

Obedience: a simple term. Stanley Milgram, the famous experimental social psychologist, shocked the world with theory about it. Another man, Pol Pot, the infamous leader of the Khmer Rouge, showed how far the desire for obedience could go in human societies. Milgram conducted his experiments in the controlled environment of the US psychology laboratory of the 1960s. Pol Pot experimented with Utopia in the totalitarian Kampuchea of the 1970s. In this article, we discuss the process through which the Khmer Rouge (...) regime created an army of unquestioningly obedient soldiers – including child soldiers. Based on these two cases, we advance a framework on how obedience can be grown or countered. (shrink)

Business firms have been explained as internal markets or as communities. To be sustainable, however, they need to reconcile these two constituting elements that have mainly been touted as opposite and part of a dualistic relationship. We suggest that organizations may, in alternative, view market and community as part of a duality, interdependent and mutually constituting processes that may not only contradict each other but also enable one another. The implications of a duality view for business ethics, which articulates market (...) and community elements in a fruitful, mutually enabling relationship, are considered, and duality is presented as a way of transcending what is commonly viewed as opposition, moving organizations both in the direction of humane and competitive finalities. (shrink)

This article aims to discuss the contemporary activities and roles that scientific associations play in science and society. It is based on a comprehensive study of scientific associations in Portugal, relying on a multi-method, quantitative and qualitative approach. After a brief review of the literature on associations in the social studies of science, we provide an outline of the expanding field of scientific associations in Portugal. We then proceed to present and discuss the five main roles of associations identified through (...) the research: communication among peers, promotion of research, science dissemination, representation of professional interests and policy advice. We conclude that the external roles of associations have become more important than the internal ones. Whereas the internationalisation of science has moved the communication, collaboration and competition between researchers into the transnational sphere, the links that associations forge between science and other social spheres are still deeply rooted in national settings and much dependant on specific configurations and practices by government, business and other social actors. (shrink)

CONTORNOS JURÍDICOS, FILOSÓFICOS E SOCIAIS DA MONOGAMIA: PARADIGMAS DO POLIAMOR NO DIREITO DE FAMÍLIA.

The purpose of this paper is to analyse a particularly influential case of memory continuity in Portugal, that of _Padrão dos Descobrimentos_. Spaces of collective memory (such as public monuments) raise questions about what we celebrate, remember or rescue from oblivion, providing an opportunity to rethink the trauma. As such, care for public spaces is associated with ethical and cultural values. One of the difficulties with certain monuments has to do with the fact that they recall actions that today we (...) see as traumatic acts. Thus, it is important to reflect on a critical use of memory. On August 8, 2021, _Padrão dos Descobrimentos_ was the subject of a graffiti. One of the sides of the monument could read: “Blindly sailing for money, humanity is drowning in a scarlet sea”. A great controversy immediately arose around the meaning of this gesture, as well as the role played by a monument that, after being temporarily built in 1940 for the Portuguese World Exhibition, was, in its current version, inaugurated in 1960, on the occasion of the fifth centenary of the death of Infante D. Henrique. This episode reignited a deeper cleavage around the uses of history and memory, the Portuguese colonial past, and the role of the _Padrão dos Descobrimentos_ as an instrument for the reproduction of nationalism. In this sense, and with the authors proposing a new theoretical frame of reference based on the thought of Arendt and Ricoeur, its critical reading becomes relevant. (shrink)

The topic of spirituality is gaining an increasing visibility in organizational studies. It is the authors contention that every theory of organization has explicit or implicit views of spirituality in the workplace. To analyze the presence of spiritual ideologies in management theories, they depart from Barley and Kunda's Administrative Science Quarterly article and analyze management theories as spirituality theories with regard to representations of people and the organization. From this analysis, we extract two major dimensions of people (as dependent or (...) independent workers) and the organization (as spiritually informed or spiritually uninformed) that, in combination, result in a typology that advances four organizational types of spirituality: the soulful organization, the holistic organization, the ascetic organization, and the professional organization. The expression of spirituality in each of these forms is discussed with the aim of contributing to a critically informed analysis of organizational spirituality. (shrink)

La división de las causas en el De principiis naturae 5 de Tomás de Aquino establece de cuántas maneras pueden distinguirse las cuatro clásicas causas aristotélicas. El texto presenta varias dificultades y las principales son la determinación del número de las divisiones y la no necesaria contemporaneidad del ser en potencia de una causa y de su causado. Nuestro objetivo es resolverlas a través de un análisis pormenorizado del texto latino, que resulta en un comentario completo al capítulo, lo cual (...) es un aporte secundario. A través de este análisis resolvemos las dificultades principales. Primero, al descubrir una distinción tácita entre divisiones de causas en cuanto consideradas en sí mismas y en cuanto conocidas y verbalizadas por los seres humanos, el número de las divisiones es finalmente siete (cuatro fundadas en el ser y tres en el modo de conocer). Esta distinción tiene un signo lingüístico en las expresiones ‘item’ y ‘sciendum est quod’. Segundo, la eventual no contemporaneidad entre los estados potenciales de una causa y su causado se puede justificar respetando la predicación singular, al considerar que un arquitecto, una vez construida una casa, está en potencia de reconstruirla, si ésta perdiera las causas internas de su integridad. (shrink)

A partir da experiência de coordenação de um programa de oficinas de escrita acadêmica, este texto explora uma maneira de conceituar as reverberações da impureza na escrita acadêmica a partir da transformação da paisagem política no ensino superior na última década do Brasil. Ao entrelaçar entrevistas de Michel Foucault com o documentário Jogo de Cena de Eduardo Coutinho, procura-se investigar os contornos da experiência da escrita acadêmica a partir do encantamento das palavras introduzido pelo gênero ensaio, que introduz os efeitos (...) de ficção, reverbera uma imagética da incerteza, e coloca em questão a noção de verdade, realidade e sujeito. Como matéria em suspenso, sempre mutável, é impossível inscrever o movimento de transformação na forma da ordem dos discursos, a não ser que se crie um modo de viver a escrita impuramente, apta a captar a incorporação de vozes e versões sempre outras, e em processo constante de variação e mudança. (shrink)

Un análisis de las diversas pruebas de la existencia del primer moviente inmóvil, presentes en la Física de Aristóteles, nos permite inferir una serie de cualidades que emergen de aquéllas. Estas cualidades son propias de lo que suele considerarse como una substancia divina. Así, a partir de las diversas pruebas emergen dos tipos de cualidades: por un lado, en relación con la trascendencia del primer moviente inmóvil respecto de la naturaleza, se destaca su inmovilidad, su eternidad, su impasibilidad, su separación (...) con respecto a los restantes entes, su ser inteligencia, su unicidad, su poseer potencia ilimitada, su inmaterialidad, y, por otro lado, en relación con su poder sobre el mundo, se advierte su causalidad sobre el movimiento del mundo, su dominio sobre los entes, su abarcarlos y, en fin, su ser causa del ser y del no ser. Estos atributos encuentran su punto de contacto en aquel atributo, sin nombre, por el cual este agente es un ‘principio no natural que mueve naturalmente’. (shrink)

O presente trabalho discute a crítica realizada pelo filósofo Richard Rorty ao também filósofo Michel Foucault, e tem como objetivo elucidar em quais aspectos a crítica de Rorty seria ou não adequada a este último. Richard Rorty ficou conhecido pelas árduas análises que fez à filosofia tradicional, preocupada em representar o mundo e sua complexidade e desinteressada em resolver os problemas humanos, e a determinados filósofos do século XX, notavelmente Heidegger e Foucault, interessados menos em apresentar soluções viáveis aos problemas (...) sociais que em divagar sobre questões intelectuais que levam apenas à falta de esperança nos modos pelos quais a sociedade está constituída. Desse modo, Rorty concebe as análises de Foucault sobre o poder como um exemplo de tais divagações e o fato de Foucault ter se voltado para o cuidado de si como exemplo de desesperança e alheamento social, pois o que estaria em questão no cuidado de si não seria o bem comum ou a possibilidade de mudar determinada configuração social a fim de alcançar melhorias para as vidas humanas em seu seio comum, mas a perspectiva de um auto aperfeiçoamento. É certo que Foucault não menciona maneiras politicamente viáveis da sociedade alcançar um melhor desenvolvimento, para que se encontre o problema de Foucault há que se fazer um deslocamento, e não de questões mais urgentes para questões menos urgentes, mas de foco, de modo a se ter melhor discernimento sobre qual é o problema de cada um destes filósofos e quais questões cada um pretende resolver. Palavras-Chave: Crítica. Análise. Social. (shrink)

In Brazil, the epicenter of the Zika crisis, brown, black, and indigenous poor women living in municipalities with scarce resources were disproportionally affected. The gendered consequences of the epidemic exposed how intersectional lenses are central to understand the impact of public health emergencies in the lives of women and girls. The demand for Zika-affected children and women to be research participants is relevant for an ethical analysis of participant protection procedures during a crisis. We investigated how women experienced research participation (...) by analyzing their narratives. Two-year-long longitudinal qualitative study in Brazilian sites located in the epidemic's epicenter was performed using mixed methods: ethnography with women from two distinct states and individual semi-structured interviews with five women in different Zika-affected states, four of which were community leaders. All women in the study were mothers or grandmothers of Zika-affected children. Thematic analysis was used for data evaluation. Women perceived being pressured to participate in research and a lack of benefit sharing. Structural determinants of gender inequality, such as its effect on power distribution, were found to impact research participant protection. Formal procedures for research protocols approvals were insufficient in protecting participants because these instruments were unable to account for structural aspects. Communitarian mobilization, through WhatsApp groups, was found to be an important mechanism to create conditions to challenge oppressive structures. Strengthening public health, effective community-based participation in research planning and implantation of ethical strategies that promotes gender equality can have transformative effect on unequal power structures and promote participant protection. (shrink)