What if human joy went on endlessly? Suppose, for example, that each human generation were followed by another, or that the Western religions are right when they teach that each human being lives eternally after death. If any such possibility is true in the actual world, then an agent might sometimes be so situated that more than one course of action would produce an infinite amount of utility. Deciding whether to have a child born this year rather than next is (...) a situation wherein an agent may face several alternatives whose effects could well ramify endlessly on such suppositions, for the child born this year would be a different person—one who preferred different things, performed different actions, and had different descendants—from a child born next year. It has recently been suggested that traditional utilitarianism stumbles on such cases of infinite utility. Specifically, utilitarianism seems to require, for its application, that all experience of pleasure and pain cease at some time in the future or asymptotically approach zero.2 If neither of these conditions holds, then the utility produced by each of two alternative actions may turn out to be infinite, and utilitarianism thus loses its ability to discriminate morally between them. (shrink)
Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our objective was (...) to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)
The American Society for Bioethics and Humanities promulgated standards for clinical ethics consultants and is currently developing a national Quality Attestation in Clinical Ethics Consultation to assist facilities in ensuring that those performing clinical ethics consultations meet minimum standards. As the field moves towards such professionalization, there is a need to provide access to qualified clinical ethicists at a broad range of medical facilities. Currently, however, there are insufficient numbers of trained clinical ethicists to staff all healthcare facilities, and many (...) facilities lack the necessary resources to hire staff clinical ethicists. In this review, we describe several models for providing expert clinical ethics support to remote facilities that lack access to qualified clinical ethicists. Based on this analysis, we recommend telemedicine as the optimal model providing expert support to local ethics committee members tasked with providing clinical ethics consultation services. (shrink)
Drawing chiefly on recent sources, in Part One I sketch an untraditional way of articulating what I claim to be central elements of traditional Catholic morality, treating it as based in virtues, focused on the recipients (“patients”) of our attention and concern, and centered in certain person-to-person role-relationships. I show the limited and derivative places of “natural law,” and therefore of sin, within that framework. I also sketch out some possible implications for medical ethics of this approach to moral theory, (...) and briefly contrast these with the influential alternative offered by the “principlism” of Beauchamp and Childress. In Part Two, I turn to a Catholic understanding of the nature and meaning of human suffering, drawing especially on writings and addresses of the late Pope John Paul II. He reminds us that physical and mental suffering can provide an opportunity to share in Christ's salvific sacrifice, better to see the nature of our earthly vocation, and to reflect on the dependence that inheres in human existence. At various places, and especially in my conclusion, I suggest a few ways in which this can inform bioethical reflection on morally appropriate responses to those afflicted by physical or mental pain, disability, mental impairment, disease, illness, and poor health prospects. My general point is that mercy must be informed by appreciation of the person's dignity and status. Throughout, my approach is philosophical rather than theological. (shrink)
This paper shows that, for a large range of parameters, the journal editor prefers to delegate the choice to review the manuscript to the biased referee. If the peer review process is informative and the review reports are costly for the reviewers, even biased referees with extreme scientific preferences may choose to become informed about the manuscript’s quality. On the contrary, if the review process is potentially informative but the reviewer reports are not costly for the referees, the biased reviewer (...) has no incentive to become informed about the manuscript. Furthermore, if the reports are costly for referees but the peer review processes are not potentially informative, the biased reviewers will never become informed. In this paper, we also present a web resource that helps editors to experiment with the review process as a device for information transmission. (shrink)
Why is it so difficult to achieve universal health coverage in the United States? First and foremost, as Richard Kirsch points out in his book, Fighting for Our Health, health care is deeply personal. Since most people in the United States have health insurance, efforts to modify the system understandably cause a certain amount of unease regarding how changes could impact their access to trusted doctors or necessary care.
The idea that democracy is under threat, after being largely dormant for at least 40 years, is looming increasingly large in public discourse. Complex systems theory offers a range of powerful new tools to analyse the stability of social institutions in general, and democracy in particular. What makes a democracy stable? And which processes potentially lead to instability of a democratic system? This paper offers a complex systems perspective on this question, informed by areas of the mathematical, natural, and social (...) sciences. We explain the meaning of the term 'stability' in different disciplines and discuss how laws, rules, and regulations, but also norms, conventions, and expectations are decisive for the stability of a social institution such as democracy. (shrink)
Myles Brand's rather audacious goal in his new book is nothing less than "to usher in the next... stage of philosophical action theory," which stage he understands as its "naturalization". Hence the subtitle. Naturalization will consist, he explains, in showing that action theory is "continuous with scientific theory", especially with cognitive science and motivational psychology. One familiar with Stich's view that one moves from "folk psychology" to cognitive science by eliminating such mentalistic concepts as belief might think one naturalizes action (...) theory by eliminating from it such concepts as belief, desire, motive, and intention. This, however, is not Brand's game. He thinks that "an understanding of human action depends on a scientific reading of intention". While he thinks that the cognitive psychology he discusses in chapters 7 and 8 has advanced our comprehension of what he calls the "cognitive component" in intention, the motivational psychology discussed in chapter 9 is in such "disarray" today that "there is presently no tenable scientific theory into which" what he calls the "conative component" of intention "can be transformed". These last three chapters range widely through the scientific literature on ideo-motor, program, script, drive, and expectancy theories. This discussion is detailed, technical, and sensitive to philosophical problems raised by the psychologists' claims and assumptions. Rare will be the philosopher who is not humbled, impressed, and informed by Brand's evident command and cogent critique of this material. Whether this work is of much philosophical value, I cannot say, but Brand is to be commended for taking "conceptual [philosophical] psychology [to be] the common base of scientific and folk psychology" and for holding that "a scientific psychological model is adequate only if it is compatible with the [philosophically] transformed conceptual claims of folk psychology". After Rorty, it takes courage to call both folk and scientific psychology before the bar of philosophy. (shrink)
Belandria, Margarita Artículos El erotismo como experiencia vinculada a lo sagrado Eroticism as an experience linked to the sacred order Castrejón, Gilberto Laberintos de sabiduría: Entre la razón y el mito Labyrinths of the knowledge: Between the reason and the myth Espar, Teresa Hacia una noción de "globalización" Towards a globalization notion González R., Javier y Belandria, Margarita Filosofía, semiótica, y ritmo Philosophy, semiotics, and rhythm Hocevar, Drina Más allá del pensamiento determinante, el pensamiento reflexionante Beyond deterministic thought, reflexive thought (...) Maldonado, Rebeca La muerte como imaginario social: una mirada de la modernidad a la postmodernidad cultural Death as a social imaginary: A view modernity to cultural postmodernity Mora García, José Pascual El impacto de la ideología y la política en la cultura y el arte de la América Latina Ideological and political interference related to artistic and cultural creations in the Latin American ambit Peña, Edilio Ontología de la trascendencia Metaphysics of Transcendence Ramis Muscato, Pompeyo Sentido de una reforma general de la educación The meaning of a general reform on education Suzzarini, Andrés Traducciones H. Arendt y la idea del derecho moderno Renaut, Alain y Sosoe, Lukas Interdisciplinares Los personajes femeninos en las novelas de Alejo Carpentier Márquez Rodríguez, Alexis Gobernabilidad y constituciones (De la colonización a la emancipación Zambrano Labrador, Laurencio Recensiones Conozca al investigador: Elías Capriles Acercamiento a la obra: Individuo Sociedad y Ecosistema Velasco, Fabiola CDCHT. (shrink)
The philosopher's paper Alonso, Ángel Castigo y derecho sin libre albedrío ni responsabilidad Punishment and law without free will and no responsibility López Corredoira, Martín De los metarrelatos a la "muerte de los intelectuales". Una mirada al "Humanismo impenitente" desde la reconstrucción neonietzscheana postmoderna From meta - reports to the "demise of intellectuals". A view of "impenitent humanism" from post-modern neo-Nietzschean deconstruction Mora García, José Pascual Kant y el método de trascender en la filosofía de Karl Jaspers Kant and (...) the transcendental method in the Karl Jaspers philosophy Portuondo Pajón, Gladys L. La creatio ex Nihilo y sus implicaciones fenomenológicas en Levitas La creatio ex Nihilo and it's phenomenology implications in Levinas Ramírez, Gustavo ¿Qué significa meditar? What does it mean to meditate? Ramis Muscato, Pompeyo Sobre la violencia: Orígenes y antídoto Regarding violence: Origens and antidotes Vasquez, Eduardo Interdisciplinares Louis Kahn: Filosofía, arte y arquitectura Louis Kahn: Philosophy, arte and architecture Arellano Spinetti, Leonardo La oligarquía venezolana en el siglo XXI: Del estereotipo al anacronismo The Venezuelan oligarchy in the XXI century: From the stereotype to the anachronism Varela Manrique, Luz Coromoto Traducciones El arte de pensar Maurois, André Friedrich Nietzsche. 1844-1900. (shrink)
Abstract This paper reports the results obtained in an aid project designed to improve transport in the municipal area of Jocotán (Guatemala). The rural road network of an area occupied by indigenous people was analysed and a road chosen for repair using the labour-intensive method–something never done before in this area. The manpower required for the project was provided by the population that would benefit from the project; the involvement of outside contractors and businesses was avoided. All payment for labour (...) went into the pockets of the local people. The small earth movements made and the use of local materials guaranteed the project’s environmental sustainability, while the on-site training of the local community prepared its members for the continued maintenance of the road, thus investing the project with social sustainability. Content Type Journal Article Pages 1-24 DOI 10.1007/s11948-011-9290-2 Authors Rodrigo Ares, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain José-María Fuentes, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Eutiquio Gallego, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Francisco Ayuga, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Ana-Isabel García, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Journal Science and Engineering Ethics Online ISSN 1471-5546 Print ISSN 1353-3452. (shrink)
Se examinan de modo sistemático las críticas de Merleau-Ponty, en la Phénoménologie de la perception, a la teoría kantiana de la experiencia, atendiendo al papel de los conceptos en la conformación de la experiencia objetiva, la relación entre la sensibilidad y el entendimiento, así como la redefinición del carácter formal de la sensibilidad. Se discuten posibles objeciones a la interpretación merleau-pontiana de la teoría kantiana y se evalúa, así mismo, el alcance relativo de ciertas referencias positivas de Merleau-Ponty a nociones (...) kantianas tales como afinidad, sinopsis e imaginación. (shrink)
This paper critically examines a formal argument against deducing ‘ought’-judgments from ‘is’-judgments, an argument suggested by a literal reading of a famous passage in Hume'sTreatise of Human Nature. According to this argument, judgments of the two kinds have different logical structures (i.e., their subjects are differently related to their predicates) and this difference disallows cross-categorical deductive inferences. I draw on Fregean accounts of the ‘is’- copula and on syntactical interpretations of ‘ought’-judgments that have become standard in deontic logic to argue (...) that twentieth century work in philosophical grammar and logic casts doubt on all three of the argument's premises. (shrink)
Se plantean los problemas y algunas temáticas características de la "independencia literaria" en Hispanoamérica, a la luz de la coyuntura de la emancipación política de España. Este tema desborda los marcos temporales o la periodización de las guerras de independencia; recorre todo el siglo XIX y pa..
El presente trabajo, escrito en ocasión del centenario de García Bacca, pretende poner de manifiesto la dimensión pedagógica del Maestro. Y ello, a propósito de su trabajo como estudioso de la Filosofía Colonial Venezolana, tema frecuentemente obviado cuando se valora el trabajo de este filósofo.
Janet Smith has written an important, imposing, and ambitious book. In what began life as a translation of, and commentary on, Paul VI's controversial 1968 encyclical Humanae Vitae, those two elements now form but two of the book's four appendices.
This paper presents the notion of transfinite developed by García Bacca in his «Infinito, transfinito, finito». This concept is a reaction to the Aristotelian concepts of «nature» and «finite», making man a historical being. García Bacca argues that man has lost his nature and his finitude through technology. So, strictly speaking, is not finite, nor infinite.
Trope theory is an increasingly prominent contender in contemporary debates about the existence and nature of properties. But it suffers from ambiguity concerning the nature of a trope. Disambiguation reveals two fundamentally different concepts of a trope: modifier tropes and module tropes. These types of tropes are unequally suited for metaphysical work. Modifier tropes have advantages concerning powers, relations, and fundamental determinables, whereas module tropes have advantages concerning perception, causation, character-grounding, and the ontology of substance. Thus, the choice between modifier (...) tropes and module tropes is significant and divides the advantages of trope theory simpliciter. In addition, each resulting trope theory is unstable: modifier trope theory threatens to collapse into realism and module trope theory threatens to collapse into austere nominalism. This invites reflection on the stability of trope theory in general. (shrink)
In this paper I explore Michael Loux’s important distinction between “tropes” and “tropers”. First, I argue that the distinction throws into relief an ambiguity and discrepancy in the literature, revealing two fundamentally different versions of trope theory. Second, I argue that the distinction brings into focus unique challenges facing each of the resulting trope theories, thus calling into question an alleged advantage of trope theory—that by uniquely occupying the middle ground between its rivals, trope theory is able to recover and (...) preserve the insights of these views. Ultimately, the distinction suggests that trope theory is a divided house. (shrink)
The goal of this paper is to examine whether business performance is affected by the adoption of practices included under the term Corporate Social Responsibility (CSR). To achieve this goal, we analyse the relation between CSR and certain accounting indicators and examine whether there exist significant differences in performance indicators between European firms that have adopted CSR and others that have not. The effects of compliance with the requirements of CSR were determined on the basis of firms included in the (...) Dow Jones Sustainability Index (DJSI), and specific accounting indicators were applied to measure performance. For the purposes of this study, we selected one group of firms belonging to the DJSI and another comprised of firms quoted on the Dow Jones Global Index (DJGI) but not on the DJSI. The sample was made up of two groups of 55 firms, studied for the period 1998–2004. Empirical analysis supports the conclusion that differences in performance exist between firms that belong to the DJSI and to the DJGI and that these differences are related to CSR practices. We find that a short-term negative impact on performance is produced. (shrink)
I aim to synthesize two issues within theistic metaphysics. The first concerns the metaphysics of creaturely properties and, more specifically, the nature of unshareable properties, or tropes. The second concerns the metaphysics of providence and, more specifically, the way in which God sustains creatures, or sustenance. I propose that creaturely properties, understood as what I call modifier tropes, are identical with divine acts of sustenance, understood as acts of property-conferral. I argue that this *theistic conferralism* is attractive because it integrates (...) trope theory and the doctrine of sustenance in a mutually enhancing way. Taking modifier tropes to be divine acts mitigates certain weaknesses of trope theory and safeguards divine sustenance from the threat of both deism and occasionalism. (shrink)
Recent neuroscientific evidence brings into question the conclusion that all aspects of consciousness are gone in patients who have descended into a persistent vegetative state (PVS). Here we summarize the evidence from human brain imaging as well as neurological damage in animals and humans suggesting that some form of consciousness can survive brain damage that commonly causes PVS. We also raise the issue that neuroscientific evidence indicates that raw emotional feelings (primary-process affects) can exist without any cognitive awareness of those (...) feelings. Likewise, the basic brain mechanisms for thirst and hunger exist in brain regions typically not damaged by PVS. If affective feelings can exist without cognitive awareness of those feelings, then it is possible that the instinctual emotional actions and pain "reflexes" often exhibited by PVS patients may indicate some level of mentality remaining in PVS patients. Indeed, it is possible such raw affective feelings are intensified when PVS patients are removed from life-supports. They may still experience a variety of primary-process affective states that could constitute forms of suffering. If so, withdrawal of life-support may violate the principle of nonmaleficence and be tantamount to inflicting inadvertent "cruel and unusual punishment" on patients whose potential distress, during the process of dying, needs to be considered in ethical decision-making about how such individuals should be treated, especially when their lives are ended by termination of life-supports. Medical wisdom may dictate the use of more rapid pharmacological forms of euthanasia that minimize distress than the de facto euthanasia of life-support termination that may lead to excruciating feelings of pure thirst and other negative affective feelings in the absence of any reflective awareness. (shrink)
In their ‘Ethical and Technical Challenges in Compensating for Harm Due to Solar Radiation Management Geoengineering’ (2014), Toby Svoboda and Peter Irvine (S&I) argue that there are significant technical and ethical challenges that stand in the way of crafting a just solar radiation management (SRM) compensation system. My aim in this article is to contribute to the project of addressing these problems. I do so by focusing on one of S&I’s important ethical challenges, their claim that the polluter pays principle (...) (PPP) is too problematic to be useful in determining responsibility for SRM compensation. Their argument for the latter claim consists in a series of allegations, mostly in the form of questions, that are thought to indicate serious difficulties standing in the way of using the PPP to craft a just compensation system. I argue that S&I fail to substantiate these allegations: the PPP is not as problematic as S&I suggest, and moreover, is a viable candidate for determining responsibility for SRM compensation. S&I raise five allegations against the PPP. I discuss each in turn. (shrink)
In this dissertation I consider the merits of certain nominalist accounts of phenomena related to the character of ordinary objects. What these accounts have in common is the fact that none of them is an error theory about standard cases of predication and none of them deploys God or uniquely theistic resources in its explanatory framework. -/- The aim of the dissertation is to answer the following questions: -/- • What is the best nominalist account on offer? • How might (...) it be improved? • Does it ultimately succeed? -/- I will argue that while so-called trope theory is the best account on offer, it can be significantly improved—or replaced—by a novel version of nominalism that is modeled after trope theory. Ultimately, however, I will argue that even the novel version fails. -/- The dissertation unfolds as follows. In Chapter 1, I introduce Austere Nominalism (AN), which is perhaps the most extreme version of nominalism that falls within the scope of the dissertation. AN is often described as the view that there exist only concrete particulars. According to AN, it is unnecessary to posit any entities other than ordinary objects—turkeys, tables, and the like—in order to account for explananda related to the character of those objects. (Such explananda include the phenomenon of attribute agreement, of attribute possession, of true subject-predicate sentences, etc.) In this chapter I argue that AN fails to provide an adequate account of these explananda. In addition, introducing and criticizing AN serves an important heuristic role for the rest of the dissertation. To understand this role, we must distinguish between the basic explanatory strategy deployed by the austere nominalist and the type of explananda for which she deploys that strategy. The austere nominalist deploys the strategy to account for the character of ordinary objects. As I argue in Chapter 1, this deployment is a failure. As I go on to show in Chapter 2, the widespread rejection AN has led to a variety of rival accounts of the character of ordinary objects. In rejecting AN, however, these accounts also tacitly reject its basic explanatory strategy. Thus goes the baby with the bathwater, since, arguably, there are some attractive features of AN’s basic explanatory strategy. Indeed, those who defend the most prominent version of nominalism—trope theory—seem to overlook the advantages of AN’s basic strategy, and by so doing, make an unnecessary concession to the realist. Or so I argue in Chapter 3. And, as I will argue in Chapter 4, the strongest version of nominalism is a novel account, modeled after trope theory, that deploys AN’s basic strategy at a more fundamental level than that of ordinary objects. This novel account—troper theory—is closer in spirit to AN than is traditional trope theory. (Thus, AN serves as a foil for the discussion of other nominalist views.) Finally, in the Afterword I indicate how troper theory is equally vulnerable to some of the traditional objections that plague trope theory. Thus, if you are not convinced that traditional objections to trope theory are conclusive and you want to be a nominalist, then you should abandon trope theory and adopt troper theory. If you take traditional objections against trope theory to have significant force, then you should reject both theories. (shrink)
Does home-based family involvement influence academic performance? To answer this question, a case study research was carried out with 96 children from all six levels of primary education at a public school, and their families. Data regarding home-based family involvement were collected using a questionnaire. Academic achievement was measured from school marks. The results reveal that, apart from two of the factors considered, home–family involvement as a whole is not significantly related to academic achievement. These two factors are access to (...) informal education resources and parents’ employment. Family involvement related to the access of children to informal education resources is significantly related to a better academic achievement. Those students with both parents working perform best, and those with none working, worst. Although gender does not appear to significantly influence academic achievement and family involvement, the results show that girls attain better school performance and re... (shrink)
Morality and religion: intimately wed, violently opposed, or something else? Discussion of this issue appears in pop culture, the academy, and the media—often generating radically opposed views. At one end of the spectrum are those who think that unless God exists, ethics is unfounded and the moral life is unmotivated. At the other end are those who think that religious belief is unnecessary for—and even a threat to—ethical knowledge and the moral life. -/- This volume provides an accessible, charitable discussion (...) that represents a range of views along this spectrum. The book begins with a lively debate between Paul Kurtz and William Lane Craig on the question, Is goodness without God good enough? Kurtz defends the affirmative position and Craig the negative. Following the debate are new essays by prominent scholars. These essays comment on the debate and advance the broader discussion of religion and morality. The book closes with final responses from Kurtz and Craig. (shrink)
Leibniz is commonly labeled a foe of Molinism. His rejection of robust libertarian freedom coupled with some explicit passages in which he distances himself from the doctrine of middle knowledge seem to justify this classification. In this paper, I argue that this standard view is not quite correct. I identify the two substantive tenets of Molinism. First, the connection between the conditions for free actions and these free actions is a contingent one: free actions follow contingently from their sufficient conditions. (...) Second, God knows what creatures would freely do in different possible circumstances prevolitionally—that is, prior to God willing anything. I argue that Leibniz himself endorses a version of both tenets and utilizes them for theoretical purposes similar to those of Molinists. I conclude that Leibniz is much closer to Molinism than is typically acknowledged. Leibniz is best characterized as a friend—rather than a foe—of Molinism. (shrink)
El Foro Global de Bioética en Investigación (GFBR por sus siglas en inglés) se reunió el 3 y 4 de noviembre en Buenos Aires, Argentina, con el objetivo de discutir la ética de la investigación con mujeres embarazadas. El GFBR es una plataforma mundial que congrega a actores clave con el objetivo de promover la investigación realizada de manera ética, fortalecer la ética de la investigación en salud, particularmente en países de ingresos bajos y medios, y promover colaboración entre países (...) del norte y del sur.a Los participantes en el GFBR provenientes de Latinoamérica incluyeron a eticistas, investigadores, miembros de comités de ética y representantes de autoridades sanitarias provenientes de Argentina, Brasil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panamá, Perú, Nicaragua y la República Dominicana. Una legítima preocupación por la protección de las mujeres embarazadas y sus embriones o fetos ha llevado a la mayoría de los países de la Región de las Américas a limitar la realización de estudios con mujeres embarazadas exclusivamente a aquellos estudios específicos sobre el embarazo, y a requerir la exclusión sistemática de las mujeres embarazadas o de las mujeres que quedan embarazadas en el curso del estudio. Ciertamente, a lo largo de la historia de la ética de la investigación, se ha creído erróneamente que proteger a una población es sinónimo de excluirla de los estudios. Se sabe ahora que proceder así implica exponer a riesgos mucho mayores a la población que se busca proteger. El embarazo implica cambios fisiológicos sustantivos e impacta profundamente la manera como el cuerpo metaboliza los medicamentos. Sin embargo, por evitar hacer investigación con mujeres embarazadas, no se ha producido la evidencia científica necesaria para tomar decisiones sobre tratamientos e intervenciones preventivas con dosis eficaces y seguras para ellas y sus embriones o fetos. A manera de ilustración, en el 2001 había en los Estados Unidos apenas más de una docena de medicamentos aprobados para uso en el embarazo (1) y en el 2011 la Food and Drug Administration (FDA) aprobó por primera vez en 15 años un medicamento para su uso en el embarazo (2). Como consecuencia de no haber producido la evidencia necesaria, se pone en riesgo la salud de las mujeres embarazadas cada vez que se les da atención médica. Las mujeres embarazadas se enferman y las mujeres enfermas se embarazan, y no se sabe si los medicamentos que se les da son eficaces o siquiera seguros para ellas y sus embriones o fetos. (shrink)
In contrast to most Western countries, routine offer of prenatal screening is considered problematic in the Netherlands. The main argument against offering it to every pregnant woman is that women would be brought into a moral dilemma when deciding whether to use screening or not. This paper explores whether the active offer of a prenatal screening test indeed confronts women with a moral dilemma. A qualitative study was developed, based on a randomised controlled trial that aimed to assess the decision-making (...) process of women when confronted with a test offer. A sample of 59 women was interviewed about the different factors balanced in decision-making. Participants felt themselves caught between a need for knowledge and their unwillingness to take on responsibility. Conflict was reported between wishes, preferences and ethical views regarding parenthood; however, women did not seem to be caught in a choice between two or more ethical principles. Participants balanced the interests of the family against that of the fetus in line with their values and their personal circumstances. Therefore, we conclude that they are not so much faced with an ethical dilemma as conflicting interests. We propose that caregivers should provide the opportunity for the woman to discuss her wishes and doubts to facilitate her decision. This approach would help women to assess the meaning of testing within their parental duties towards their unborn child and their current offspring. (shrink)
Biomedical research policy in recent years has often tried to make such research more ‘translational’, aiming to facilitate the transfer of insights from research and development to health care for the benefit of future users. Involving patients in deliberations about and design of biomedical research may increase the quality of R&D and of resulting innovations and thus contribute to translation. However, patient involvement in biomedical research is not an easy feat. This paper discusses the development of a method for involving (...) patients in biomedical research aiming to address its main challenges. (shrink)
The term 'therapeutic misconception' (TM) was introduced in 1982 to conceptualize how some psychiatry trial participants perceived and interpreted their involvement in research. TM has since been identified in many settings and is a major component in research ethics discussions. A qualitative study included a subgroup of interviews with five parents (two couples, one mother) who declined to enrol their baby in a neonatal trial. Analysis suggested the possibility of a counterpart to TM which, given the original terminology, we term (...) the 'injurious misconception' (IM). While TM is closely linked to the elision of care and research, and involves an over-stated sense of benefit and protection, IM may be a product of a particularly keen and discomforting sense of distinctions between care and research and a correspondingly over-stated sense of risk and threat. (shrink)
George Pattison’s Heidegger on Death aims at critically assessing Heidegger’s analysis of death included in his magnum opus Being and Time . Given the peculiar status of Heidegger’s analysis, tightly interwoven into a complex argumentative narrative touching on an array of foundational issues in philosophy, Pattison must first of all spell out for his reader Heidegger’s overall project in BT and show how Heidegger’s analysis of death fits in it. As the author makes clear, HD isn't meant to be a (...) piece of Heidegger scholarship but rather ‘… an essay about death that uses Heidegger … as a way of thinking about the question of death in a Christian and theological perspective’ . This self-imposed task places a second burden on Pattison, i.e., to draw on theological premises to examine Heidegger’s analysis of death and find it ultimately wanting. An implicit third burden, which the author only occasionally seems to intend to meet, is to state in exactly what sense .. (shrink)