Este artículo tiene por objetivo analizar la relación y la recepción que cuatro filósofos de la generación de la democracia: Tomás Pollán, Javier Sádaba, Manuel Fraijó y Jesús Mosterín han mantenido y realizado respectivamente, con y sobre, el pensamiento español contemporáneo que les antecedió.

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent (...) and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using ‘social utility’ criteria, prioritising healthcare professionals or using ‘first come, first served’ policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes. (shrink)

Since 2002, legislation in Spain has allowed for the creation and documentation of end-of-life decisionmaking. Over the intervening years, the actual implementation of such documents is very low. Through extensive analysis of the literature, this article explores the current status of the use of and attitudes toward advance directives in Spain and then proposes strategies for improvement in their implementation.

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. (...) There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them, and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. (shrink)

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives. The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with (...) an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses, chronic diseases, and elderly patients. Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age. (shrink)

Background In Spain, there has been great effort by lawmakers to put Advance Directives into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little (...) impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: the training of health professionals about the end of life and AD is lacking; there has been no public process to increase awareness about AD, and therefore people know little about them; the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future. (shrink)

Background During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC (...) of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC. Methods Retrospective observational study of all patients assessed by the AFUH TC. Results There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; _p_ Conclusions The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them. (shrink)

In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals’ right to conscientious objection and the specification that it (...) makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short. (shrink)

Background Ethical conflicts generate difficulties in daily clinical activity. Which methods of ethical advice are most frequently used to resolve them among Spanish doctors has not been studied. The objective of this study is to describe what methods hospital internal medicine physicians in Spain use to resolve their ethical doubts and which they consider most useful. Design A cross-sectional observational study was conducted through a voluntary and anonymous survey and distributed through an ad hoc platform of the Spanish Society of (...) Internal Medicine. Measures We measured methods by which to resolve doubts, types of tools sought, frequency of consulting the Clinical Ethics Committees, and satisfaction with resolution of ethical issues. Results Of 261 internists surveyed, 86 per cent resolve their ethical doubts with assistance, the most frequently used method being consultation with colleagues (58.6 per cent), followed by using specific protocols or guides (11.8 per cent) and consultation with experts in bioethics (9.6 per cent). The most preferred tools are the creation of protocols (30.3 per cent) and the establishment of a consultant/expert in bioethics (27.8 per cent). Conclusions Internists in Spain usually seek assistance to resolve their ethical doubts. Consulting colleagues is the most frequently adopted method. The majority regard tools to resolve ethical conflicts as necessary, seeking above all protocols and consultants/experts in bioethics. (shrink)

Background No studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts. Methods Voluntary survey to the members of the Internal Medicine Association of Mexico. Results Responses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most commonplace and relevant conflicts are those (...) resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them. Conclusions 1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants. (shrink)

Movies can serve valuable didactic purposes teaching clinical ethics to medical students. However, using film sequences as means to develop critical thinking is not a straightforward task. There is a significant gap in the literature regarding how to analyse the ethical content embedded in these clips systematically, in a way that facilitates the students’ transition from anecdotal reflections to abstract thinking. This article offers a pedagogical proposal to approach the ethical analysis of film sequences in a systematic fashion. This structured (...) stepwise method encourages students to identify the main ethical problem of a selected scene and to reflect on the theoretical principles involved, emphasizing the application of these norms and values in a contextually situated analysis. We believe this method in film studies both reinforces the students’ comprehension of the theoretical framework of an ethical topic, and casts light on its pertinence and limitations under the circumstances of the scene, thus proving a constructive tool to strengthen the bridge between the theoretical teaching of clinical ethics and clinical practice. (shrink)

un diálogo entre “Ante la Ley” de Kafka y La leyenda del santo bebedor de Roth, dos relatos cuya datación casi coinciden literalmente con el periodo de entreguerras, propicia una comparación de interpretaciones en las que participan nombres tan eximios como Benjamin, Arendt, Mann, Scholem, Adorno, Steiner, Magris... En el contexto de los años veinte y treinta del siglo XX, ambos autores plantean una pregunta por la justicia que en manos de autores como Hugo Bergmann, Frank Rosenzweig y Martin (...) Buber dio pie a un replanteamiento del judaísmo centroeuropeo, hoy casi olvidado, y a una revisión de la crisis de la modernidad europea en su conjunto. (shrink)

One of the ways of thinking God in contemporary philosophy is reflecting on violence. In fact, reflecting on violence implies always at the same time to refer to the difficulty of thinking about the co-implication of law and violence, a typical prerogative of divine action. From this perspec-tive, political theology is concerned with the status and the possibilities or impossibilities of rep-resenting violence in a given political order. Three are the classical texts in the backdrop of this reflection on the (...) hiatus between law and violence: Walter Benjamin Critique of Violence of 1921, Carl Schmitt’s Political Theology of 1922 and Derrida’s Force of Law of 1989. The article exam-ines another paradigm, that of Ernesto Laclau. The article concludes that only a non-presentable idea of God as a negative fundament allows for a non-authoritarian political idea. But this non-presentable character is only made possible by revolutionary politics. (shrink)

El acceso equitativo a la energía y a la vivienda es una preocupación básica de la justicia social. A pesar de los numerosos vínculos entre estos dos bienes esenciales, los marcos teóricos de la justicia y la pobreza energética se han referido casi exclusivamente a la cuestión de la vivienda en términos de la eficiencia energética de los edificios residenciales. En respuesta a esta carencia conceptual, se propone la reintegración del factor vivienda en el marco de la justicia y pobreza (...) energética a lo largo de los siguientes tres ejes: dimensiones materiales y temporales; dimensiones políticas; y dimensiones éticas y legales. Como ejemplo empírico de la importancia del nexo vivienda-energía en la práctica de la justicia social, se presenta el caso de dos movimientos sociales surgidos en Barcelona que trabajan con una perspectiva conjunta de derecho a la vivienda y a la energía: la Plataforma de Afectados por la Hipoteca (PAH) y la Aliança contra la Pobresa Energètica (APE). El artículo subraya la importancia de la vivienda y la energía como fundamentos materiales de una vida digna y su naturaleza conflictiva como necesidades esenciales y bienes de mercado. (shrink)

This article explores the possibilities offered by Collins’ model of interaction rituals to an understanding of the emotional dynamics of art auctions. It argues that whilst it explains how the art object becomes the focus of attention, and thus the repository of solidarity and emotional energy, it also obliterates some of the institutional aspects of the auction market that can influence such outcomes. It discusses the need to include an examination of the specific practices of auction houses operating in an (...) international market in their capacity to target specific audiences for their sales. (shrink)

Hardly anyone disputes that discrimination can be a grave moral wrong. Yet this consensus masks fundamental disagreements about what makes something discrimination, as well as precisely why acts of discrimination are wrong. Benjamin Eidelson develops systematic answers to those two questions. He claims that discrimination is a form of differential treatment distinguished by its special connection to the differential ascription of some property to different people, and goes on to argue that what makes some cases of discrimination intrinsically wrongful (...) is that they manifest an attitude of disrespect for the personhood of those who are disfavored. He endeavors to specify what this attitude consists in, and to demonstrate how attending to its character can help us to better understand the moral dimensions of different forms of wrongful discrimination. The book concludes with an extended discussion of racial profiling in law enforcement. (shrink)

Kiesewetter defends the normativity of rationality by presenting a new solution to the problems that arise from the common assumption that we ought to be rational. He provides a defence of a reason-response conception of rationality, an evidence-relative account of reason, and an explanation of structural irrationality in relation to these accounts.

Las metodologías activas son unas excelentes herramientas para la mejora del desarrollo de competencias, así como del aprendizaje del alumnado. Se recogen las percepciones y el uso que 92 profesores de educación secundaria de la Comunidad Valenciana (España) manifestaron en un cuestionario tras haber realizado una formación en las mismas. Los resultados permiten constatar que, si bien se produce un aumento en el uso y una mejora en las percepciones, sigue habiendo una considerable resistencia al cambio de este colectivo de (...) profesorado. Encuentran desventajas como considerarlas muy exigentes con el tiempo y son escépticos en el aprendizaje real del alumnado. (shrink)

Sometimes our intentions and beliefs exhibit a structure that proves us to be irrational. This dissertation is concerned with the question of whether we ought (or have at least good reason) to avoid such irrationality. The thesis defends the normativity of rationality by presenting a new solution to the problems that arise from the common assumption that we ought to be rational. The argument touches upon many other topics in the theory of normativity, such as the form and the content (...) of rational standards or requirements, the preconditions of criti¬cism, and the function of reasons in deliberation and advice. Over and above an exten¬sive assessment of the problems discussed in the literature, the thesis provides a detailed defence of a reason-response conception of rationality, a novel, evidence-relative account of reasons, and an explanation of structural irrationality in terms of these accounts. (shrink)

El tema que trata este libro persigue dos objetivos principales. Por una parte, estudiar los saberes en el Renacimiento y en el Barroco, acercándose, entre otros autores, a Werner Rolewinck, Alfonso de la Torre, Pico de la Mirándola, Tomás Moro, Francisco de Vitoria y la escolástica, el Brocense, Montaigne, Descartes-San Agustín, Sebastián Izquierdo, Hobbes, hasta llegar a Leibniz. Y, por otra, elaborar una teoría de los saberes, esto es, considerarlos como modelos de significación y de ordenación del mundo, que van (...) configurando Europa y la modernidad europea. Así este libro reconstruye la historia de las variaciones de un discurso, el de los saberes en general y de sus disciplinas en particular. Muestra ese incesante esfuerzo por ordenar y comprender la realidad, que acabará sustituyendo un modelo teológico, o relaborando sus fundamentos, al ir pasando a primer plano la existencia, el sujeto moderno, encarnada en hombres concretos de «carne y hueso», con nombre y rostro. Y expresa la ensoñación de Europa, que a través de los mismos, fue buscando y ensayando: la concordia racional y mejor república que cabía esperar. (shrink)

This article intends to contribute to the science–religion historiography with two topics—philology and the construction of national identities—that can help provide a more complex picture of the relations between science and religion. We use the life and work of the Mallorcan Catholic priest Antoni Maria Alcover (1862–1932) as a case study that puts language, linguistics, and nationalism on the board of science and religion studies. Alcover was the main driving force of the Catalan Dictionary, a collective enterprise that set out (...) to inventory the complete oral and literary lexicon of this language, and which mobilized thousands of people, many of which were clergymen, from all over the Catalan‐speaking territories. In the article, we will explore Alcover's education; the way he established a link between language, religion, and fatherland; the shaping of his identity as a philologist in the image mainly of new German notions and practices; as well as his role in the institutionalization process of the Catalan language as a scientific language, as a language for science and for religion. (shrink)

Consider the following 'principles':2(Norm of Belief Schema) Necessarily, a belief of is correct (relative to some scenario) if and only if p (at that scenario) — where 'p' has the aforementioned content .(Generalized Norm of Belief) Necessarily, for all propositions , a belief of is correct (relative to some scenario) if and only if is true (at that scenario).Both 'principles' appear to capture the aim(s) of belief. (NBS) particularizes the aims to beliefs of distinct content-types. (GNB) generalizes these aims of (...) beliefs as truth. Properly understood, the instances of (NBS) appear to be at least approximately true as does (GNB). Of course, one might harbor concerns about whether these are mere .. (shrink)

According to a widely held view, epistemic reasons are normative reasons for belief – much like prudential or moral reasons are normative reasons for action. In recent years, however, an increasing number of authors have questioned the assumption that epistemic reasons are normative. In this article, I discuss an important challenge for anti-normativism about epistemic reasons and present a number of arguments in support of normativism. The challenge for anti-normativism is to say what kind of reasons epistemic reasons are if (...) they are not normative reasons. I discuss various answers to this challenge and find them all wanting. The arguments for normativism each stress a certain analogy between epistemic reasons and normative reasons for action. Just like normative reasons for action, epistemic reasons provide partial justification; they provide premises for correct reasoning; they constitute good bases for the responses they are reasons for; and they are reasons for which agents can show these responses without committing a mistake. In each case, I argue that the relevant condition is plausibly sufficient for the normativity of a reason, and that normativism is in any case in a much better position to explain the analogy than anti-normativism. (shrink)

According to an attractive and widely held view, all practical reasons are explained in terms of the (instrumental or final) value of the action supported by the reason. I argue that this theory is incompatible with plausible assumptions about the practical reasons that correspond to certain moral rights, including the right to a promised action and the right to an exclusive use of one’s property. The argument is an explanatory rather than extensional one: while the actions supported by the relevant (...) reasons (e.g. keeping a valid promise or respecting property) can be argued to have a certain kind of value, I argue that this value presupposes a moral right, and therefore cannot explain the reason. Reflection on such cases suggest the conclusion that reasons that are subject to normative powers are generally not value-based. This also has important implications for the dialectic between ‘value-first’ and ‘reasons-first’ approaches to normativity. (shrink)

An increasing number of regulations propose the notion of ‘AI audits’ as an enforcement mechanism for achieving transparency and accountability for artificial intelligence (AI) systems. Despite some converging norms around various forms of AI auditing, auditing for the purpose of compliance and assurance currently have little to no agreed upon practices, procedures, taxonomies, and standards. We propose the ‘criterion audit’ as an operationalizable compliance and assurance external audit framework. We model elements of this approach after financial auditing practices, and argue (...) that AI audits should similarly provide assurance to their stakeholders about AI organizations’ ability to govern their algorithms in ways that mitigate harms and uphold human values. We discuss the necessary conditions for the criterion audit, and provide a procedural blueprint for performing an audit engagement in practice. We illustrate how this framework can be adapted to current regulations by deriving the criteria on which ‘bias audits’ for hiring algorithms can be performed, as required by the recently effective New York City Local Law 144 of 2021. We conclude by offering critical discussion on the benefits, inherent limitations, and implementation challenges of applying practices of the more mature financial auditing industry to AI auditing where robust guardrails against quality assurance issues are only starting to emerge. Our discussion as informed by experiences in performing these audits in practice highlights the critical role that an audit ecosystem plays in ensuring the effectiveness of such methodology. (shrink)

If you ought to perform a certain act, and some other action is a necessary means for you to perform that act, then you ought to perform that other action as well – or so it seems plausible to say. This transmission principle is of both practical and theoretical significance. The aim of this paper is to defend this principle against a number of recent objections, which (as I show) are all based on core assumptions of the view called actualism. (...) I reject actualism, provide an alternative explanation of its plausible features, and present an independent argument for the transmission principle. (shrink)

This book presents the idea of Nomos of the Earth as the key idea that organizes the whole of Schmitt’s discourse about politics.