OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send (...) a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

Chronic deficiencies of the Greek welfare state and the introduction of austerity measures as part of the international financial bailout agreements have created an explosive cocktail of poverty and social exclusion that severely tested the resilience of the frail social safety net and the demands of equity. The score on the indicators of social quality has worsened considerably as the Greek welfare system was overhauled. This article examines the four conditional factors of social quality from the viewpoint of socio-economic policies (...) and everyday experiences in Greece during the crisis. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social‐based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory (...) to explore the phenomenon of social‐based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social‐based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower‐class workers and subsequently improving resident care delivery. (shrink)

1. Grecia y Roma.-2. El judaísmo y la filosofía. El cristianismo y la filosofía. El Islam y la filosofía.-3. Del humanismo a la ilustración (siglos XV-XVIII).-4. Siglo XIX, Kant, idealismo y espiritualismo.;;;;;;;;;.

El objetivo de este artículo es indagar en la fundamentación schmittiana del individuo y de la reserva de conciencia. En la actualidad, buena parte de la recepción contemporánea considera al jurista renano como un antiliberal y, por lo tanto, como un antiindividualista. Sin embargo, nuestra hipótesis es que es posible encontrar en su obra no solo una crítica a la noción liberal de individuo, sino también una concepción propositiva a través de sus reflexiones sobre la crítica frente a la autoridad (...) y al poder público. Para demostrarla, se propone un abordaje hermenéutico-exegético de sus obras —principalmente, de las conferencias sobre El Leviatán en la teoría del Estado de Thomas Hobbes y del artículo "La visibilidad de la Iglesia. Una reflexión escolástica”— para indagar la acción humana como fundadora del orden político y las posibilidades del individuo de criticar a la autoridad. El artículo sostiene que Carl Schmitt formula una noción de individualidad de signo distinto a la liberal y que se vincula íntimamente con la idea de Derecho, el entramado institucional-estatal y el sustrato comunitario. (shrink)

Hume's Reception in Early America: Expanded Edition brings together the original American responses to one of Britain's greatest men of letters, David Hume. Now available as a single volume paperback, this new edition includes updated further readings suggestions and dozens of additional primary sources gathered together in a completely new concluding section. From complete pamphlets and booklets, to poems, reviews, and letters, to extracts from newspapers, religious magazines and literary and political journals, this book's contents come from a wide variety (...) of sources published in colonial America and the early United States between 1758 and 1850. As well as classics by Thomas Jefferson, John Adams and Alexander Hamilton, it contains scores of unknown and hard-to-locate items, many of which have not been reprinted since their original publication. These responses are divided into four parts covering Hume's Essays; his Philosophical Writings; his History of England; and his Character and Death. Each of those parts has a separate introductory essay, and every selection is introduced by a short headnote that sets the piece in its historical context and provides bibliographical references. Packed with new insights into Hume and American thought and culture, Hume's Reception in Early America reveals the relevance and impact of Hume on American political, philosophical, historical, religious, and aesthetic debates. (shrink)

El presente artículo es la primera traducción española de un artículo del jurista alemán Hermann Heller titulado "¿Liberalismo autoritario?", en el que pretende dar cuenta de una nueva forma de articulación política que se desarrolla al comienzo de los años 30 en Alemania y que combina el autoritarismo político con el liberalismo económico.

El artículo pretende mostrar la razón por la que la curaduría experimental puede ser considerada una práctica artística bajo la mira de teorías del arte contemporáneo. Para ello se presenta una genealogía de la curaduría experimental para, posteriormente, mostrar su semejanza con las produc-ciones artísticas contemporáneas en lo atenido a su relación con el espectador y su vínculo con los contextos sociales extraartísticos.

Randomized controlled trials test new drugs using various debiasing devices to prevent participants from manipulating the trials. But participants often dislike controls, arguing that they impose a paternalist constraint on their legitimate preferences. The 21st Century Cures Act, passed by US Congress in 2016, encourages the Food and Drug Administration to use alternative testing methods, incorporating participants’ preferences, for regulatory purposes. We discuss, from a historical perspective, the trade-off between trial impartiality and participants’ freedom. We argue that the only way (...) out is considering which methods improve upon the performance of conventional trials in keeping dangerous or inefficacious compounds out of pharmaceutical markets. (shrink)

Biological evolution is a complex blend of ever changing structural stability, variability and emergence of new phe- notypes, niches, ecosystems. We wish to argue that the evo- lution of life marks the end of a physics world view of law entailed dynamics. Our considerations depend upon dis- cussing the variability of the very ”contexts of life”: the in- teractions between organisms, biological niches and ecosys- tems. These are ever changing, intrinsically indeterminate and even unprestatable: we do not know ahead of (...) time the ”niches” which constitute the boundary conditions on selec- tion. More generally, by the mathematical unprestatability of the ”phase space”, no laws of mo- tion can be formulated for evolution. We call this radical emergence, from life to life. The purpose of this paper is the integration of variation and diversity in a sound concep- tual frame and situate unpredictability at a novel theoretical level, that of the very phase space. Our argument will be carried on in close comparisons with physics and the mathematical constructions of phase spaces in that discipline. The role of symmetries as invariant preserving transformations will allow us to under- stand the nature of physical phase spaces and to stress the differences required for a sound biological theoretizing. In this frame, we discuss the novel notion of ”enablement”. Life lives in a web of enablement and radical emergence. This will restrict causal analyses to differential cases. Mutations or other causal differ- ences will allow us to stress that ”non conservation princi- ples” are at the core of evolution, in contrast to physical dynamics, largely based on conservation principles as sym- metries. Critical transitions, the main locus of symmetry changes in physics, will be discussed, and lead to ”extended criticality” as a conceptual frame for a better understanding of the living state of matter. (shrink)

La sociedad del conocimiento y la introducción en los procesos de enseñanza-aprendizaje de las tecnologías de la información y la comunicación, están exigiendo de quienes nos dedicamos a la educación en el ámbito universitario, la utilización de nuevas estrategias didácticas y la reinvención de algunas antiguas o no tan nuevas. Se trata de dar respuesta a la demanda social de “aprender de otra manera” para mejorar la inserción de los nuevos egresados en su ámbito profesional. Esta nueva forma de aprender (...) debe tener en consideración las exigencias de los nuevos contextos de enseñanza-aprendizaje, donde el protagonismo de los estudiantes es un elemento esencial y la relación de lo aprendido con sus posibilidades de aplicación en el contexto profesional es el otro. Casualmente el modelo de formación basado en competencias desde el enfoque socioformativo coincide en ambos protagonismos y el portafolio como estrategia didáctica que puede utilizarse en este modelo puede ayudar a dotar de protagonismo al que aprende haciéndole tomar conciencia de que el aprendizaje no se produce de manera automática sino a través de una serie de pasos y etapas que a la vez que se van consiguiendo nos permiten reflexionar el proceso. Una vez llevado a cabo este proceso de reflexión general, puede aplicarse en el ámbito médico para iniciar al estudiante a tomar conciencia de su semejanza con el diagnóstico clínico. Palabras clave: portafolio; estrategias de enseñanza-aprendizaje; diagnóstico clínico; enfoque socioformativo. (shrink)

El presente artículo pretende elucidar las insuficiencias de la denominada economía del bienestar a partir del enfoque de las capacidades de Amartya Sen y Martha C. Nussbaum. En el primer bloque presentamos los lineamientos fundamentales de ambas propuestas con el fin de concretar y dotar de autonomía sus respectivos modelos basados en el enfoque de las capacidades, contrastándolos con los modelos convencionales de medición de la calidad de vida relativa de la ciudadanía. En el segundo bloque incidimos en la justificación (...) de sus aportaciones para profundizar en la perspectiva de la capacidad desde una vertiente comparada, esto es, desde dos áreas de estudio (Sen desde el ámbito económico y Nussbaum desde el filosófico) que han aunado sus fuerzas e intereses bajo este paradigma. (shrink)

This study explores the effects of the shift to emergency remote teaching on teachers’ levels of well-being, emotions, and motivation. A total of 936 Spanish teachers participated in this nationwide survey from all educational levels, thus allowing comparison among levels, which is a novelty and strength of our study. Four aspects were explored: instructional adaptation to ERT; well-being changes and the main challenges in this regard; changes in emotions; and changes in motivation and the main factors. Importantly, we explored a (...) number of teacher characteristics for the three last aspects. Our results show that teachers felt the impact of ERT on their well-being, emotions, and motivation. Additionally, female teachers, teachers with students of low socioeconomic status, in public schools, and primary and secondary teachers were the most affected groups. This indicates that the impact of ERT differed and some populations of teachers are more at risk of suffering burnout because of ERT. (shrink)

This is a welcome reprint of a book that continues to grow in importance.

Editor James Fetzer presents an analytical and historical introduction and a comprehensive bibliography together with selections of many of Carl G. Hempel's most important studies to give students and scholars an ideal opportunity to appreciate the enduring contributions of one of the most influential philosophers of science of the 20th century.

This entirely new work guides the reader through the most basic systems of modal propositional logic up to systems of modal predicate with identity, dealing with both technical developments and discussing philosophical applications.

Includes bibliographical references and index.