O intuito deste texto é demonstrar que o estudo arendtiano sobre as catástrofes políticas e morais do século XX, representadas em grande medida pela dominação totalitária, envolve-se na tarefa de compreensão dos nossos tempos sem recorrer a quaisquer tipos de fundamentos últimos e tradicionais. A partir de alguns temas presentes em Origens do Totalitarismo, a tentativa é revelar como a constatação da ruptura do fio da tradição do pensamento ocidental – tradição política e ética – proporcionou a Arendt uma nova (...) forma de reflexão a respeito da própria atividade de refletir e, não obstante, um novo entendimento sobre o papel do juízo reflexionante no âmbito dos assuntos humanos e das experiências mundanas. (shrink)
Este artigo pretende caracterizar de forma geral os posicionamentos fisicalistas na filosofia da mente e indicar como a questão do livre-arbítrio surge e pode ser crucial para tal corrente de pensamento. Primeiramente pretende mostrar a diferença entre a posição reducionista e a não-reducionista e depois salientar suas potencialidades e dificuldades na abordagem da questão do livre-arbítrio. Enfim, mesmo que a questão ainda fique em aberto, verificar-se-á que o livre-arbítrio parece não encontrar espaço no cenário apresentado pelas correntes fisicalistas.
Changes in modern societies originate the perception that ethical behaviour is essential in organization’s practices especially in the way they deal with aspects such as human rights. These issues are usually under the umbrella of the concept of social responsibility. Recently the Report of the International Bioethics Committee of UNESCO on Social Responsibility and Health has addressed this concept of social responsibility in the context of health care delivery suggesting a new paradigm in hospital governance. The objective of this paper (...) is to address the issue of corporate social responsibility in health care, namely in the hospital setting, emphasising the special governance arrangements of such complex organisations and to evaluate if new models of hospital management (entrepreneurism) will need robust mechanisms of corporate governance to fulfil its social responsiveness. The scope of this responsible behaviour requires hospitals to fulfil its social and market objectives, in accordance to the law and general ethical standards. Social responsibility includes aspects like abstention of harm to the environment or the protection of the interests of all the stakeholders enrolled in the deliverance of health care. In conclusion, adequate corporate governance and corporate strategy are the gold standard of social responsibility. In a competitive market hospital governance will be optimised if the organization culture is reframed to meet stakeholders’ demands for unequivocal assurances on ethical behaviour. Health care organizations should abide to this new governance approach that is to create organisation value through performance, conformance and responsibility. (shrink)
Ethical principles are fundamental for the exercise of any profession. Portuguese psychologists have waited for 30 years for professional validation. This paper will define the Portuguese psychologists’ ethical principles, with a universal view as a starting point and then an adaptation to the cultural and professional reality in Portugal. The level of acceptability of these principles will be ascertained in a later paper.
Explicit forms of rationing have already been implemented in some countries, and many of these prioritization systems resort to Norman Daniels’ “accountability for reasonableness” methodology. However, a question still remains: is “accountability for reasonableness” not only legitimate but also fair? The objective of this paper is to try to adjust “accountability for reasonableness” to the World Health Organization’s holistic view of health and propose an evolutionary perspective in relation to the “normal” functioning standard proposed by Norman Daniels. To accomplish this (...) purpose the authors depart from the “normal” functioning standard to a model that promotes effective opportunity for everyone in health care access, because even within the “normal” functioning criteria some treatments and medical interventions should have priority upon others. Equal opportunity function is a mathematical function that helps to hierarchize moral relevant necessities in health care according to this point of view. It is concluded, first, that accountability for reasonableness is an extremely valuable tool to address the issue of setting limits in health care; second, that what is called in this paper “equal opportunity function” might reflect how accountability for reasonableness results in fair limit-setting decisions; and third, that this methodology must be further specified to best achieve fair limit-setting decisions. Indeed, when resources are especially scarce the methodology suggested in this paper might allow not only prioritizing in an “all or nothing” basis but can contribute to a hierarchy system of priorities in health care. (shrink)
During the last few decades we have witnessed a proliferation of exercises dealing with the public participation of citizens in various different dimensions of their societies, including issues of science and technology. On the one hand, these mechanisms provide more robust forms of public engagement with matters that were traditionally dealt with by experts; on the other hand, they raise concerns relating to their design, efficiency or potential for the empowerment of citizens. As part of the EC-funded project DEEPEN (Deepening (...) Ethical Engagement and Participation in Emerging Nanotechnologies) a research team in Coimbra, Portugal, was put in charge of identifying the ethical and social “impacts” of emerging nanotechnologies, transforming the traditional focus groups through the incorporation of two methodological innovations: the Pedagogy of the Oppressed and the Theatre of the Oppressed. This article reflects on the outcomes and complexities of the introduction of these two methodologies. Since the participants had little or no information on nanotechnologies, we reflect on the politics of these focus groups by exploring how issues of intervention, subjectivity, representation and agency were interconnected during this exercise of public participation in Science and Technology, analyzing the role of social sciences in developing nanoethics. (shrink)
The increasing costs of healthcare delivery led to different political and administrative approaches trying to preserve the core values of the welfare state. This approach has well documented weaknesses namely with regard to healthcare rationing. The objective of this paper is to evaluate if independent healthcare regulation is an important tool with regard to the construction of fair processes for setting limits to healthcare. Methodologically the authors depart from Norman Daniels’ and James Sabin’s theory of accountability for reasonableness and try (...) to determine if new regulatory models—namely independent agencies—perform better with regard to the public disclosure of the reasons and rationales of healthcare rationing. In publicly financed healthcare systems independent regulation is an important tool to assure fair and reasonable procedures of prioritising services. In accordance with the principle of public accountability, independent regulatory agencies are particularly well suited to assure publicity of the decision-making processes, relevance of the rationale involved and particularly mechanisms for challenge and dispute resolution regarding limit setting decisions. It follows that independent healthcare regulation could be regarded not only as an instrument for performance improvement but also as a tool of social justice. The authors conclude by stating that accountability for reasonableness should be regarded as a landmark of any healthcare reform. And therefore regulators have the social task of assuring that the rationales for limit-setting decisions are clearly accessible to the public. (shrink)
This article analyzes a deliberative forum on nanotechnologies, organized in Portugal within the scope of the research project DEEPEN—Deepening Ethical Engagement and Participation in Emerging Nanotechnologies. This event included scientists, science communicators and members of the “lay public”, and resulted in a position document which summarizes collective aspirations and concerns related to nano. Drawing upon our previous experience with focus groups on nanotechnologies—characterized by methodological innovations that aimed at suspending epistemological inequalities between participants—this paper delves into the performativity of the (...) deliberative event, exploring some of the tensions and power/knowledge asymmetries generated by the forum. Recognizing that the design of participatory assemblages matters, we reflect on our role as facilitators and explore the difficulties in organizing exercises of upstream engagement with emerging technologies. (shrink)
We define a notion of realizability, based on a new assignment of formulas, which does not care for precise witnesses of existential statements, but only for bounds for them. The novel form of realizability supports a very general form of the FAN theorem, refutes Markov's principle but meshes well with some classical principles, including the lesser limited principle of omniscience and weak König's lemma. We discuss some applications, as well as some previous results in the literature.
Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude that (...) cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy. (shrink)
This paper compares the theses of physicalism and functionalism – particularly the computacionalist line – with the biological naturalism of John Searle regarding the possibility of free will. In such contrast, each line is decomposed into its statements so that they can be reviewed. It is argued that the searlean biological naturalism can explain more than the other two philosophies on how free action can have the source of its motivation in what is external to the mental state that makes (...) it beperformed. Finally, even if the issue of free will still is open, I shall argue that free will does not find any room in the scenario that the lines of physicalism and functionalism present. (shrink)
The world population aged significantly over the twentieth century, leading to an increase in the number of individuals presenting progressive, incapacitating, incurable chronic-degenerative diseases. Advances in medicine to prolong life prompted the establishment of instruments to ensure their self-determination, namely the living will, which allows for an informed person to refuse a type of treatment considered unacceptable according to their set of values. From the knowledge on the progression of Alzheimer disease, it is possible to plan the medical care, even (...) though there is still no treatment available. Irreversible cognitive incapacity underlines the unrelenting loss of autonomy of the demented individual. Such a loss requires the provision of specific and permanent care. Major ethical issues are at stake in the physician–patient–family relationship, even when dementia is still at an early stage. The authors suggest that for an adequate health care planning in Alzheimer disease the living will can be presented to the patient in the early days of their geriatric care, as soon as the clinical, metabolic or even genetic diagnosis is accomplished. They also suggest that the appointment of a health care proxy should be done when the person is still in full enjoyment of his cognitive ability, and that the existence and scope of advance directives should be conveyed to any patient in the early stages of the disease. It follows that ethical guidelines should exist so that neurologists as well as other physicians that deal with these patients should discuss these issues as soon as possible after a diagnosis is reached. (shrink)
The paper identifies three recent lines of interpretation of the politics that can be derived from Deleuze and Guattari, all of which share a way of reading the dualisms in their work that can be traced back to how they understand the actual/virtual partition, and to an alleged pre-eminence of the virtual over the actual. It is argued that this reading is not only inaccurate, but obscures the political dimension of Deleuze and Guattari's work. Clarifying the latter requires a reinterpretation (...) of the dualisms involved (as dyads rather than binaries), of the relation between virtual and actual (as a formal distinction where one acts back upon the other), and the drawing of a clear distinction between what Deleuze calls a ‘transcendent exercise’ of thought and sensibility and the properly metaphysical exercise that sets up the distinction between virtual and actual. What then appears is an image of Deleuze's and Guattari's thought that is far more concerned with practical questions and with a situated political practice of intervention. (shrink)
In all countries where health care access is considered a social right, regulation is both a tool of performance improvement as well as an instrument of social justice. Both social (equity in access) and economical (promoting competition) regulation are at stake due to the nature of the good itself. Different modalities of regulation do exist and usually new regulatory cycles include the creation of stronger regulatory agencies. Indeed, health care regulation is rising steadily in most developed countries as a consequence (...) of the introduction of the New Public Management perspective to provide essential public goods.Health care is delivered by different organisations with very different cultural backgrounds—public and private (profit and non-profit)—that should be accountable for their decisions. Control by regulatory agencies is instrumental to accomplish this goal. However, there is some dispute with regards the degree of regulatory autonomy. The objective of this paper is to determine if independent regulatory agencies (IRAs) are effective in carrying out health care regulation. The authors apply Walshe’s analytical framework to the Regulatory Authority of Health (Portugal) to answer the question if independent regulation works.In conclusion, the two year experience of the Regulatory Authority of Health is important not only because the primary goals of independent regulation were achieved but also because this authority is now a full partner in the health care sector. However, independent agencies need to develop strong mechanisms of accountability because good regulatory governance is the paradigm of this institutional innovation. (shrink)
In congenitally or prelingually deaf childrencochlear implantation is open to seriousethical challenge. The ethical dimension ofthis technology is closely related to both asocial standard of quality of life and to theuncertainty of the overall results of cochlearimplantation. Uncertainty with regards theacquisition of oral communicative skills.However, in the western world, available datasuggest that deafness is associated with thelowest educational level and the lowest familyincome. Notwithstanding the existence of aDeaf-World, deafness should be considered as ahandicap. Therefore, society should provide themeans for the (...) fulfilment of a deaf child'sspecific needs.For the time being there is no definitiveanswer with regard the best way to rehabilitatea particular deaf child. Therefore,communitarian values may be acceptable. If thedeaf child parents' decide not to implant,their decision should be respected. Guardiansare entitled to determine which standard ofbest interest to use in a specificcircumstance. They are the proper judges ofwhat (re)habilitation process is best for theirdeaf child. However, most deaf children areborn to two hearing parents. Probably, theywill not be acculturated in the Deaf-World. Itfollows that cochlear implantation is awelcomed (re)habilitation technology.If auditory (re)habilitation will in the futureprovide the necessary communicative skills, inparticular oral language acquisition, customs,values and attitudes of the hearing worldshould be regarded as necessary to accomplish adeaf child's right to an open future. Ifcochlear implantation technology will provideall deaf children with the capacity to developacceptable oral communicative skills –whatever the hearing status of the family andthe cultural environment – then auditory(re)habilitation will be an ethical imperative. (shrink)
The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of (...) the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as an instrument of performance improvement and they articulate this theory with the different regulatory strategies. The authors conclude that sunshine regulation takes on a special relevance as, by promoting publicity of the performance indicators, it contributes directly and indirectly to an overall improvement of the healthcare services, namely in countries were citizens are more critical with regard to the overall performance of the system. Indeed, sunshine regulation contributes to the achievement of high levels of transparency, which are fundamental to overcoming some of the market failures that are inevitable in the transformation of a vertical and integrated public system into a decentralised network where entrepreneurialism appears to be the predominant culture. (shrink)
It has been argued by some authors that our reaction to deaf parents who choose deafness for their children ought to be compassion, not condemnation. Although I agree with the reasoning proposed I suggest that this practice could be regarded as unethical. In this article, I shall use the term “dysgenic” as a culturally imposed genetic selection not to achieve any improvement of the human person but to select genetic traits that are commonly accepted as a disabling condition by the (...) majority of the social matrix; in short as a handicap. As in eugenics, dysgenics can be achieved in a positive and a negative way. Positive dysgenics intends to increase the overall number of people with a particular genetic trait. Marriage between deaf people or conceiving deaf children through reproductive technology are examples of positive dysgenics. Negative dysgenics can be obtained through careful prenatal or pre-implantation selection and abortion (or discarding) of normal embryos and foetuses. Only deaf children would be allowed to live. If dysgenics is seen as a programmed genetic intervention that undesirably shapes the human condition – like deliberately creating deaf or dwarf people – the professionals involved in reproductive technologies should answer the question if this should be an accepted ethical practice because the basic human right to an open future is violated. (shrink)
A latência é o período do desenvolvimento menos abordado pela literatura psicanalítica e menos compreendido, apesar de corresponder à idade na qual ocorre a maior procura por atendimento psicológico. Além disso, questiona-se um possível encurtamento do período da latência em nossa cultura. Partindo ..
In most western countries, there is a 'human organ shortage' with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors give their specific consent. Xenotransplantation--defined as the transplantation of animal cells, tissues or organs into human beings--is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this medical procedure. The (...) objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)
Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. Nevertheless, (...) in many European countries as well as the United States, this integration of the best evidence from systematic research with clinical expertise and patient values appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of democratic accountability to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare â namely expensive innovative treatments and medicines âmay be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system. (shrink)
Analisa-se a articulação entre a proposição de políticas públicas de saúde mental e as estratégias para a reorientação do modelo assistencial em saúde mental a partir dos movimentos pela Reforma Psiquiátrica brasileira. Parte-se da perspectiva genealógica de Michel Foucault, o que implica descrever ..
Introduction: All countries face the issue of choice in healthcare. Allocation of healthcare resources is clearly associated with the concept of distributive justice and to the existence of a right to healthcare. Nevertheless, there is still the question of whether this right should include all types of healthcare services or if it should be limited to selected types. It follows that choices must be made, priorities must be set and that efficiency of healthcare services should be maximum.
O artigo apresenta dados referentes a pacientes que abandonaram tratamento psicoterápico. Os dados foram coletados nos protocolos de uma clínica psicoterápica. Pesquisaram-se as razões verbalizadas pelos pacientes ao abandonarem a terapia. A partir do levantamento dos registros, verificou-se um índi..
Public extension services play a key role in the implementation of strategies for rural development based on the sustainable management of natural resources. However, the sector suffers from restricted financial and human resources. Using experiences from participatory action research, a strategy for rural extension in the Amazon was defined to increase the efficiency and the relevance of external support for local resource users. This strategy considered activities initiated and coordinated by local people. Short-term facilitation visits provided continuous external support for (...) the purpose of establishing locally based planning and learning mechanisms. In collaboration with the municipality of Muaná in the Eastern Amazon, the strategy was tested in two traditional communities – Monte Moriat and Boa Esperança. Both communities recognized as most important the need to reduce their dependence on açaí (Euterpe oleracea Mart.), the principal source of food and income. This forest resource has been overexploited, seriously affecting açaí stands and diminishing the forest benefits fundamental for survival. Two local groups decided to raise chickens as a way to reduce nutritional problems and as an alternative source of income. Supported by monthly, short-term planning and evaluation visits, the groups managed to achieve significant progress in their endeavor. The groups identified (1) the control of decision-making and information, and (2) the absence of external obligations to be the greatest advantages of the development initiative. The study confirmed the potential of participatory strategies for public extension in the Amazon. Special attention was given to realistically define the role of forests for local development. However, drastic measures are necessary to smooth the way for real participation in governmental and non-governmental organizations acting in the Brazilian Amazon. (shrink)
Pesquisa acerca das mudanças das relações de trabalho no cenário mundial da economia neoliberal atual, marcada pelos passos e descompassos entre a matriz legal advinda da Direito do Trabalho e a flexibilização dos direitos laborais da atualidade. Pretende-se, a partir da compreensão da denominada “crise do trabalho”, definir argumentos que permitam responder a questão central: qual o futuro das relações de trabalho e, principalmente, do direito do trabalho nas sociedades modernas. Na seqüência, reflete-se sobre o Novo Plano Nacional de Direitos (...) Humanos do Brasil – PNDH-3, sua importância para a defesa dos direitos humanos dos trabalhadores e para a conquista do trabalho decente. Research on the changing labor relations in the global scenario of current neoliberal economy, marked by steps and gaps between the matrix arising from the Legal Right to Work and flexibility of labor rights today. It is intended, from the understanding of socalled "crisis of work", set arguments for addressing the central question: what is the future of labor relations, and especially of labor law in modern societies. Subsequently, reflects on the New National Plan for Human Rights of Brazil - PNDH-3, its importance to the human rights of workers and for the achievement of decent work. (shrink)
O objetivo do estudo é revisar a literatura brasileira sobre a problemática de desenvolvimento de crianças assistidas em clínicas-escola de 1980 a 2008, para avaliar mudanças nos problemas desenvolvimentais em relação ao sexo da criança. Os artigos são oriundos das bases eletrônicas Bvs, Indexpsi, L..
O hipotireoidismo congênito (HC) é uma doença endócrina resultante da carência de hormônios tireoidianos no organismo. Os programas de rastreamento neonatal para HC possibilitam evitar a maior parte das conseqüências neuropsicológicas, permitindo que as crianças tenham um desenvolvimento normal. Est..
Este estudo investigou a prevalência de problemas de comportamento, medidos através do CBCL, em uma amostra de 366 crianças, estudantes de primeira a quarta série do ensino fundamental da cidade de Porto Alegre, RS. Os dados foram coletados a partir das informações obtidas por pais, mães ou demais c..