BackgroundLittle is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational (...) or vocational variables?MethodsAn observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: Physiotherapist and patient interaction, Physiotherapist and other health professionals including other physiotherapists, Physiotherapists and the system and Professional and economic ethical situations.ResultsThe two most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ and ‘Physiotherapy not accessible to all people in society who need it’. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of ‘Physiotherapists and the system’ were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts.ConclusionThis study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists’ ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice. (shrink)

Some theories of personal identity allow some variation in what it takes for a person to survive from context to context; and sometimes this is determined by the desires of person-stages or the practices of communities.This leads to problems for decision making in contexts where what is chosen will affect personal identity.‘Temporal Phase Pluralism’ solves such problems by allowing that there can be a plurality of persons constituted by a sequence of person stages. This illuminates difficult decision making problems when (...) persons have to choose between different life-altering choices. (shrink)

L'ouvrage publié réunit les actes d'une journée d'étude consacrée à L'imprévu et le droit, souhaitée par les doctorants et organisée par l'Ecole doctorale de droit comparé de l'Université Paris 1 Panthéon-Sorbonne. Le sujet est immédiatement apparu très riche. Si le terme d'imprévu n'est pas essentiellement juridique, il fait écho à des critères du droit tels que la prévisibilité d'une situation ou d'un texte, ou l'imprévisibilité d'un événement comme cause exonératoire de responsabilité. Il renvoie plus généralement à l'exigence de sécurité juridique (...) qui s'opposerait à l'imprévu juridique. En outre le contexte était des plus propices, quelle que soit la discipline concernée, droit public, droit privé et/ou droit pénal. L'imprévu est entendu comme tout ce qui n'a pas été prévu, tout ce qui arrive lorsqu'on ne s'y attend pas. Prévoir, c'est admettre comme probable. La question de l'imprévu confronté au droit est intéressante car les deux concepts semblent antinomiques. Le droit apparaît en effet comme quelque chose de figé, permettant de régler par anticipation les comportements humains. Il doit permettre à chacun de régler sa conduite puisque nul n'est censé ignorer la loi. Le droit doit donc être à la fois connu et prévisible dans ses effets même s'il n'en est pas toujours ainsi. La notion d'imprévu semble rencontrer le droit de deux manières. D'une part, il existe la norme imprévue : la norme nouvelle, la coutume en formation ou l'interprétation surprenante. Se posent alors les questions de la prévisibilité du droit, et corrélativement celle de la sécurité juridique. D'autre part, il y a le fait imprévu. La norme doit se saisir de comportements humains ou de situations de fait qui n'avaient pas été anticipés. L'appréhension du risque et de la survenance d'événements inattendus par des règles de droit préexistantes devient alors un enjeu essentiel. (shrink)

Recent neuroscientific research has caused a paradigm shift in our understanding of the meaning and scope of compassion. Derived from the Latin root compassiō, compassion used to be a religious emotion that implied suffering with the perceived sufferer, whereas now it is examined as a psychological, neuroscientific, neurobiological, and thus natural, phenomenon. The newly arisen research interest in compassion led to the development of secular compassion training programs that follow closely in the footsteps of the “mindfulness revolution.” Whereas the latter (...) has been criticized for its reductionist appropriation of Buddhist thought by the capitalist west, in this paper, I demonstrate that the secularization of compassion is the result of innovative activities by representatives of the Buddhist traditions. I argue that some of the causes for the recent secularization and sciencization can be traced back into the fourteenth century Tibet, namely to the innovative exegetical activities of the scholars of the Tibetan Lojong tradition. I argue that from the perspective of the tradition, the sciencization of compassion resembles a deliberate purposeful “translation” effort that fits into the “two-track approach” of Buddhist propagation. (shrink)

Wijdicks and colleagues1 recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS)2 in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care) and claimed that “the FOUR score detects a locked-in syndrome, as well as the presence of a vegetative state.”1 We fully agree that the FOUR is advantageous in identifying locked-in patients given that it specifically tests for eye movements (...) or blinking on command. This is welcomed given that misdiagnosis of the locked-in syndrome has been shown to occur in more than half of the cases (see Laureys and colleagues3 for review). As for the diagnosis of the vegetative state, the scale explicitly tests for visual pursuit, and hence can disentangle the vegetative state from the minimally conscious state (MCS). The diagnostic criteria for MCS have been proposed4 only recently, but Wijdicks and colleagues1 do not mention the existence of this clinical entity in their article. As for the vegetative state, MCS can be encountered in the acute or subacute setting as a transitional state on the way to further recovery, or it can be a more chronic or even permanent condition. The MCS refers to patients showing inconsistent, albeit clearly discernible, minimal behavioral evidence of consciousness (eg, localization of noxious stimuli, eye fixation or tracking, reproducible movement to command, or nonfunctional verbalization).4 The FOUR scale does not test for all of the behavioral criteria required to diagnose MCS.4 It is known from the literature (see Majerus and colleagues5 for review) that about a third of patients diagnosed with vegetative state are actually in MCS, and this misdiagnosis can lead to major clinical, therapeutic, and ethical consequences. We tested the ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting.. (shrink)

Circadian rhythm abnormalities in bipolar disorder have led to a search for genetic abnormalities in circadian "clock genes" associated with BD. However, no significant clock gene findings have emerged from genome-wide association studies. At least three factors could account for this discrepancy: complex traits are polygenic, the organization of the clock is more complex than previously recognized, and/or genetic risk for BD may be shared across multiple illnesses. To investigate these issues, we considered the clock gene network at three levels: (...) essential "core" clock genes, upstream circadian clock modulators, and downstream clock controlled genes. Using relaxed thresholds for GWAS statistical significance, we determined the rates of clock vs. control genetic associations with BD, and four additional illnesses that share clinical features and/or genetic risk with BD. Then we compared the results to a set of lithium-responsive genes. Associations with BD-spectrum illnesses and lithium-responsiveness were both enriched among core clock genes but not among upstream clock modulators. Associations with BD-spectrum illnesses and lithium-responsiveness were also enriched among pervasively rhythmic clock-controlled genes but not among genes that were less pervasively rhythmic or non-rhythmic. Our analysis reveals previously unrecognized associations between clock genes and BD-spectrum illnesses, partly reconciling previously discordant results from past GWAS and candidate gene studies. (shrink)

Eye gaze is a ubiquitous cue in child–caregiver interactions, and infants are highly attentive to eye gaze from very early on. However, the question of why infants show gaze-sensitive behavior, and what role this sensitivity to gaze plays in their language development, is not yet well-understood. To gain a better understanding of the role of eye gaze in infants' language learning, we conducted a broad systematic review of the developmental literature for all studies that investigate the role of eye gaze (...) in infants' language development. Across 77 peer-reviewed articles containing data from typically developing human infants in the domain of language development, we identified two broad themes. The first tracked the effect of eye gaze on four developmental domains: vocabulary development, word–object mapping, object processing, and speech processing. Overall, there is considerable evidence that infants learn more about objects and are more likely to form word–object mappings in the presence of eye gaze cues, both of which are necessary for learning words. In addition, there is good evidence for longitudinal relationships between infants' gaze following abilities and later receptive and expressive vocabulary. However, many domains are understudied; further work is needed to decide whether gaze effects are specific to tasks, such as word–object mapping or whether they reflect a general learning enhancement mechanism. The second theme explored the reasons why eye gaze might be facilitative for learning, addressing the question of whether eye gaze is treated by infants as a specialized socio-cognitive cue. We concluded that the balance of evidence supports the idea that eye gaze facilitates infants' learning by enhancing their arousal, memory, and attentional capacities to a greater extent than other low-level attentional cues. However, as yet, there are too few studies that directly compare the effect of eye gaze cues and non-social, attentional cues for strong conclusions to be drawn. We also suggest that there might be a developmental effect, with eye gaze, over the course of the first 2 years of life, developing into a truly ostensive cue that enhances language learning across the board. (shrink)

Humans can follow different social learning strategies, sometimes oriented toward the models’ characteristics. The goal of the present study was to explore which who-strategy is preferentially followed in the technological context based on the models’ psychological characteristics. We identified three potential who-strategies: Copy the pedagogue, copy the engineer, and copy the friend. We developed a closed-group micro-society paradigm in which participants had to build the highest possible towers. Participants began with an individual building phase. Then, they were gathered to discuss (...) the best solutions to increase tower height. After this discussion phase, they had to make a new building attempt, followed by another discussion phase, and so forth for a total of six building phases and five discussion rounds. This methodology allowed us to create an attraction score for each participant. We also assessed participants’ theory-of-mind skills, technical-reasoning skills, and prosocialness to predict participants’ attraction scores based on these measures. Results show that we learn from engineers because they are the most successful. Their attraction power is not immediate, but after they have been identified as attractors, their technique is copied irrespective of their pedagogy or friendliness. These findings open avenues for the study of the cognitive bases of human technological culture. (shrink)

Despite general agreement within philosophy that peer review is indispensable, its fairness and reliability is often questioned. This article suggests that such worries can to a large extent be met by adopting the practice that reviews as well as earlier versions of papers are made publicly available when the final version of a paper is published. This suggestion combines the advantages of transparency with the merits of anonymity of reviewers. While there are obstacles to this suggestion, the article argues that (...) it would be worthwhile to implement it because it can help map patterns of conduct and secure confidence in the fairness and reliability of review procedures and journal editing within philosophy. (shrink)

We define an easily verifiable notion of an atomic formula having uniformly bounded arrays in a structure M. We prove that if T is a complete L-theory, then T is mutually algebraic if and only if there is some model M of T for which every atomic formula has uniformly bounded arrays. Moreover, an incomplete theory T is mutually algebraic if and only if every atomic formula has uniformly bounded arrays in every model M of T.

We agree with Rendell and Whitehead that cetaceans acquire knowledge from caretakers and peers, and that a clear understanding of this process can provide insight into the evolution of mammalian cognition. The passive observational methods they advocate, however, are inadequate for determining what cetaceans know. Only by experimentally investigating the cognition of cetaceans can we hope to understand what they learn through social interactions.

Este artigo aborda as motivações para a docência e os desafios enfrentados por licenciandos em psicologia. A metodologia utilizada foi a abordagem qualitativa, e o instrumento de coleta de dados questionário online com questões abertas e fechadas. Participaram do estudo, onze estudantes de cursos de licenciatura em psicologia de quatro instituições universitárias das regiões sul e sudeste do Brasil. Os resultados demonstraram que a escolha pela licenciatura se deu, sobretudo, pelo interesse e curiosidade na área da educação, apropriação dos saberes (...) pedagógicos, ampliação do mercado de trabalho, bem como as possibilidades de atuação profissional. As dificuldades apontadas revelaram: a falta de informações sobre as especificidades do curso de licenciatura e da atuação do professor de psicologia e a ausência de docentes com saberes pedagógicos para atuar na licenciatura em psicologia. Embora seja considerada formação complementar entre os estudantes, observou-se possibilidades de um ensino-aprendizagem de psicologia engajada e inventiva. (shrink)

Mitochondrial donation poses the latest regulatory challenge for policy-makers in the context of assisted conception. Since 2010 the Human Genetics Commission, the Human Fertilisation and Embryology Authority and the Nuffield Council on Bioethics have all considered the policy implications of permitting use of these techniques in treatment. The Nuffield Council on Bioethics reported its recommendations in June 2012 following a consultation on the ethical issues raised by these techniques; and a separate consultation by the Human Fertilisation and Embryology Authority in (...) conjunction with Sciencewise-ERC followed in September 2012. Matters for consideration included the potential relationships created by the use of three parties’ genetic material and the associated ramifications, eg whether or not there is a need to establish records of such donations and, if so, to whom should information later be provided? Thus, mitochondrial donation poses both novel and familiar questions about the ‘genetic family’, ‘parentage’ and ‘identity’. This article explores some of the ways in which mitochondrial DNA is constructed as relatively significant in recent Parliamentary debates, policy and consultation documents. It reflects on the ways in which the role of some genetic connections, or lack thereof, are mediated in law and policy. (shrink)

Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

This volume maps the areas of ethical concern in the debate regarding the governance of genetic information, and suggests alternative ethical frameworks and models of regulation in order to inform its restructuring. Genetic governance is at the heart of medical and scientific developments, and is connected to global exploitation, issues of commodification, commercialisation and ownership, the concepts of property and intellectual property and concerns about individual and communal identity. Thus the decisions that are made in the next few years about (...) appropriate models of genetic governance will have knock-on effects for other areas of governance. In short the final answer to 'Who Decides?' in the context of genetic governance will fundamentally shape the ethical constructs of individuals and their networks and relationships in the public sphere. (shrink)

Background In this qualitative analysis we aimed to explore addiction physicians’ perspectives on safer injection education for people who inject drugs, especially: (1) on possible means of introducing safer injection education in the medical environment, (2) on the compatibility of safer injection education with each physician’s core values and goals, and (3) on possible reasons for the ethical dilemma in safer injection education. Methods We conducted semi-structured interviews with eleven physicians practicing addiction medicine in France in clinical and harm reduction (...) settings. Results All participants were in favor of educational interventions for people who inject drugs. Nonetheless, these interventions varied from simple advice to injection supervision and they were seen as less acceptable when they concerned the practical and material aspects of injection. Some participants found that physicians practicing in clinical settings, where patients consult mostly to stop their drug use, should not practice safer injection education. On the contrary, other participants claimed that safer injection education was essential in all settings and was not a choice but rather a duty for addiction physicians. The ethical dilemma of such intervention when delivered by medical staff was viewed as a complex phenomenon, related to the representations of intravenous drug use and to societal expectations from physicians. Conclusion Physicians’ views on safer injection education for people who inject drugs reveal an emotionally charged subject related to the structural organization of addiction management in France. Such education is marked by an arduous history of harm reduction policies in France. IRB registration: #00011928. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative interview (...) study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

Le verbe croire renvoie à des réalités diverses et contradictoires. Croire c'est à la fois être certain, tenir pour vrai, adhérer avec conviction, mais c'est aussi, penser, admettre comme probable, envisager comme possible, et donc ouvrir la voie au doute, à l'opinion, au débat. Le verbe croire possède de multiples usages. Songeons que l'on croit en Dieu alors que l'on croit au diable. On croit à, on croit en, on croit que. Les historiens mobilisés dans cet ouvrage s'interrogent sur ces (...) modalités complexes de la croyance dans tous les domaines du champ social. Privilégier les temps de ruptures, de déconstruction des croyances, les seuils épistémologiques fut le fil conducteur de cette recherche entre "croire" et "ne pas croire". (shrink)

Parte do cinema brasileiro pensado e elaborado nos anos 2010 produziu gestos sintomáticos da corrida desenvolvimentista e imobiliária em grandes cidades brasileiras a partir de leituras temporais não-lineares. A partir de uma constelação de imagens acionadas por um grupo de cinco filmes, este artigo busca aproximar sequências a partir de três conceitos temporais distintos: a perspectiva ecobiótica andina de tempo, o tempo espiralar em rituais do Congado e o tempo Exu. Com eles, é possível percebemos parte do cinema brasileiro revelando, (...) em suas cidades, a estrutura fóssil em projetos de futuro. (shrink)

We consider here how cultural and socioeconomic dimensions of justice beyond the state are related. First we examine cosmopolitan theories that have drawn on John Rawls's egalitarian liberal framework to argue that a just global order requires substantive, transnational redistribution of material resources. We then assess the view, ironically put forward by Rawls himself, that this perspective is ethnocentric and insufficiently tolerant of non-liberal cultures. We argue that Rawls is right to be concerned about the danger of ethnocentrism, but wrong (...) to assume that this requires us to reject the case for substantive redistribution across state boundaries. A more compelling account of justice beyond the state will integrate effectively socioeconomic and cultural aspects of justice. We suggest that this approach is best grounded in a critical theory of recognition that responds to the damage caused to human relations by legacies of historical injustice. (shrink)

The production of complex sequences like music or speech requires the rapid and temporally precise production of events (e.g., notes and chords), often at fast rates. Memory retrieval in these circumstances may rely on the simultaneous activation of both the current event and the surrounding context (Lashley, 1951). We describe an extension to a model of incremental retrieval in sequence production (Palmer & Pfordresher, 2003) that incorporates this logic to predict overall error rates and speed—accuracy trade-offs, as well as types (...) of serial ordering errors. The model—assumes that retrieval of the current event is influenced by activations of surrounding events. Activations of surrounding events increase over time, such that both the accessibility of distant events and overall accuracy increases at slower production rates. The model's predictions were tested in an experiment in which pianists performed unfamiliar music at 8 different tempi. Model fits to speed—accuracy data and to serial ordering errors support model predictions. Parameter fits to individual data further suggest that working memory contributes to the retrieval of serial order and overall accuracy is influenced in addition by motor dexterity and domain-specific skill. (shrink)

O estudo apresenta o resultado da experiência em mediação familiar desenvolvida em um Núcleo de Práticas Judiciárias numa instituição pública de ensino, através de projeto de extensão. O objetivo deste trabalho é compartilhar as vivências do serviço de psicologia inserido em um espaço eminentemente ..

Plus qu'un ouvrage concernant les rapports ombrageux et controversés de l'art et de la pathologie, ce recueil est d'abord une rencontre, un creuset entre des champs, la clinique et la théorie qui, pour s'y confronter, excèdent les limites du " prêt-à-penser ". C'est pourquoi ici les divergences de méthodes et de perspectives entre des approches phénoménologique et psychanalytique ne dressent pas de strictes délimitations, mais font résonner des dissonances capables de laisser penser l'écart entre l'art et la pathologie comme établi (...) sur une entr'appartenance plus essentielle, ne livrant rien de son secret à celui qui s'en tient à des distinctions de principe. Encore faut-il entendre pathologie en son sens grec, au sens où la rencontre avec le monde ouvre, dans le réel, une brèche incolmatable dont seul l'art peut authentiquement rendre compte et dans laquelle la psychose s'engouffre si aucune mise en œuvre ne vient l'endiguer ou la ressourcer. " Aussi ne faut-il pas s'étonner que penser l'art et penser la folie puissent converger dans la mesure où ni l'un ni l'autre ne sont conceptualisables. Finalement, penser l'art ou penser la folie, c'est avoir ouverture à eux, à travers les œuvres, à travers les êtres malades et cela n'est possible précisément que dans une rencontre. Qu'est-ce qu'une rencontre? C'est cette situation qui n'a pas d'antécédent, qui n'a pas d'espace ni de temps qui puisse la précéder. L'épiphanie de quelqu'un dans le regard d'un autre implique nécessairement l'autophanie de celui-ci. L'échec de la rencontre, récusant tout passage lucide à l'ouvert, rejette le thérapeute sur sa facticité. C'est pour se dérober à l'épreuve sans partage de cette absence de soi, que la psychiatrie médicale, scientifico-médicale fait l'impasse sur la présence de l'autre, en objectivant tout ce qui touche à l'homme, en faisant de lui un cas particulier de cette objectivation universelle qui est la caractéristique de la culture de notre époque. ". (shrink)