Background: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. Objectives: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. Research design: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat (...) room platform. A thematic, inductive analysis was performed of the information gathered. Participants and research context: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. Ethical considerations: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. Results: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. Conclusions: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine. (shrink)

This paper intends to explore an aspect of Blumenberg’s metaphorology as memory of mankind and the ethical commitment derived from it. It is seen as the culmination of the fight that the human being maintains against the senselessness of reality. It manifests itself and it is perceived by a human being as theimmensurability of world time and life time (i.e. that the human being is born and dies), that impedes the human being from having all of the world i.e. the (...) satisfaction of its infinite desires. In the fight against finity technology and money play a vital role. They have in common the power to enable an expansion of human capacities over the boundaries of factual existence: through technology and money the human being can do more or, do the same in less time. That is: tobring closer life time and world time. But in this process the instrumental character of technology and money causes homogenisation in the societies where they thrive. That’s one of the characteristics of globalization. This homogenisation is to be understood as the forgetting of other essential possibilities of the human creation of meaning. Thus, what technological and monetary processes construct on one side, come to be destroyed on the other side. Blumenberg’s metaphorology is the adequate response: it is understood both as the self-consciousness of the process of reason in its making sense of the universe, and as an “ideal store” of everything the human being has come to make in this process. (shrink)

Science fiction cinema proposal for Bioethic education Proposta do cinema de ficção científica para educar em Bioética Posthumanism state that technologies will eliminate aging, improve cognitive, physical and psychological skills and keep alive human minds by uploading them in machines as artificial intelligence. These beliefs, as constant features in science fiction films, could be useful to educate medical students in Bioethics. We propose some of these science fiction films related with technological changes of humans and the noxious consequences: Being turned (...) into a humanoid created by genetic engineering; a slave or a merchandize without rights; discrimination because of eugenesic genetic manipulation; and/or the creation of cyborgs of mass destruction. Also, the movies can show the reader issues of ethnic supremacy dilemmas, identity impersonate and ambition, impersonal intelligence and conscience and identity transpass after death. These films will help teachers to analyze with students the moral limits of science and technologies. Para citar este artículo / To reference this article / Para citar este artigo Alerm-González AJ, González-Pérez U. Propuesta del cine de ciencia ficción para educar en Bioética. Pers Bioet. 2019; 22: 14-33. DOI: https://doi.org/10.5294/pebi.2019.23.1.2 Recibido: 10/11/2017 Aceptado: 20/10/2018. (shrink)

El objetivo del presente artículo es fortalecer el aprendizaje y la calidad educativa en el trabajo colaborativo, evaluando estrategias didácticas y aplicando la estrategia de diseño de textos académicos en la licenciatura de Mercadotecnia, respondía a la cuestión ¿De qué manera la debilidad en el aprendizaje y baja calidad educativa en el trabajo colaborativo repercuten en las deficiencias de la aplicación de la estrategia didáctica del diseño de textos académicos? La investigación es de tipo mixto, la metodología de la Investigación–Acción. (...) El estudio dio resultados en el trabajo colaborativo porque ayudo a los alumnos a adquirir conocimientos. (shrink)

Brings together a range of practitioners and academics from the world of business who examine corporate social responsibility in policy and practice in a series of case studies from across the globe.

Several objections against the morality of researching or employing mitochondrial replacement techniques have been advanced recently. In this paper, I examine three of these objections and show that they are found wanting. First I examine whether mitochondrial replacement techniques, research and clinical practice, should not be carried out because of possible harms to egg donors. Next I assess whether mitochondrial replacement techniques should be banned because they could affect the study of genealogical ancestry. Finally, I examine the claim that mitochondrial (...) replacement techniques are not transferring mitochondrial DNA but nuclear DNA, and that this should be prohibited on ethical grounds. (shrink)

This paper examines whether there are moral differences between the mitochondrial replacement techniques that have been recently developed in order to help women afflicted by mitochondrial DNA diseases to have genetically related children absent such conditions: maternal spindle transfer and pronuclear transfer. Firstly, it examines whether there is a moral difference between MST and PNT in terms of the divide between somatic interventions and germline interventions. Secondly, it considers whether PNT and MST are morally distinct under a therapy/creation optic. Finally, (...) it investigates whether there is a moral difference between MST and PNT from a human embryo destruction point of view. I conclude, contra recent arguments, that regarding the first two points there is no moral differences between PNT and MST; and that regarding the third one MST is morally preferable to PNT, but only if we hold a gradualist account of the moral value of human embryos where zygotes have slight moral value. (shrink)

In this work I present a detailed critique of the dignity-related arguments that have been advanced against the creation of human–nonhuman chimeras that could possess human-like mental capacities. My main claim is that the arguments so far advanced are incapable of grounding a principled objection against the creation of such creatures. I conclude that these arguments have one, or more, of the following problems: they confuse the ethical assessment of the creation of chimeras with the ethical assessment of how such (...) creatures would be treated in specific contexts, they misrepresent how a being could be treated solely as means towards others’ ends, they fall short of demonstrating how humanity’s dignity would be violated by the creation of such entities, and they fail to properly characterise the moral responsibilities that moral agents have towards other moral agents and sentient beings. (shrink)

El propósito central enfatiza la comprensión histórico-cultural de la diversidad y la diferencia como productoras de escenarios donde la tolerancia debe redimir la exclusión y fomentar la equidad; explica, reflexiva y críticamente, algunas ideas que subrayan la urgen te necesidad de replantear los d..

The aim of this paper is to critically examine David Shaw, Wybo Dondorp, and Guido de Wert’s arguments in favour of the procurement of human organs from human/nonhuman-primate chimeras, specifically from great-ape/human chimeras. My main claim is that their arguments fail and are in need of substantial revision. To prove this I first introduce the topic, and then reconstruct Shaw et al.’s position and arguments. Next, I show that Shaw et al.: (1) failed to properly apply the subsidiarity and proportionality (...) principles; (2) neglected species overlapping cases in their ethical assessment; (3) ignored the ethics literature on borderline persons; and (4) misunderstood McMahan’s two-tiered moral theory. These mistakes render an important part of their conclusions either false or problematic to the point that they would no longer endorse them. Finally I will briefly mention a possible multipolar solution to the human organ shortage problem that would reduce the need for chimeras’ organs. (shrink)

Several European countries are approving legislative reforms moving to a presumed consent system in order to increase organ donation rates. Nevertheless, irrespective of the consent system in force, family's decisional capacity probably causes a greater impact on such rates. In this contribution we have developed a systematic methodology in order to analyse and compare European organ procurement laws, and we clarify the weight given by each European law to relatives' decisional capacity over individual's preferences (expressed or not while alive) regarding (...) the destination of his or her organs after death. In this sense, the results constitute the first comprehensive and comparative legislative mapping on European transplantation laws. (shrink)

Recent breakthroughs in stem cell differentiation and reprogramming suggest that functional human gametes could soon be created in vitro. While the ethical debate on the uses of in vitro generated gametes (IVG) was originally constrained by the fact that they could be derived only from embryonic stem cell lines, the advent of somatic cell reprogramming, with the possibility to easily derive human induced pluripotent stem cells from any individual, affords now a major leap in the feasibility of IVG derivation and (...) in the scope of their potential applications. In this paper we develop an ethical framework, rooted in recent scientific evidence, to support a robust experimental pipeline that could enable the first-in-human use of IVG. We then apply this framework to the following objectives: (1) a clarification of the genetic parenting options afforded by IVG, along with their ethical underpinnings; (2) a defence of the use of IVG to remedy infertility, broadening their scope to same-sex couples; (3) an assessment of the most far-reaching implications of IVG for multiplex parenting. These include, first, the liberation of parenting roles from the constraints of biological generations in vivo, allowing multiple individuals to engage in genetic parenting together, thus blurring the distinction between biological and social generations. Second, we discuss the conflation of IVG with sequencing technology and its implications for the possibility that prospective parents may choose among a hitherto unprecedented number of potential children. In view of these perspectives, we argue that, contrary to the exhausted paradigm according to which society lags behind science, IVG may represent instead a salient and most visible instance where biotechnological ingenuity could be used in pursuit of social experimentation. (shrink)

In this paper I argue that some human reproductive genome editing interventions can be therapeutic in nature, and thus that it is false that all such interventions just create healthy individuals. I do this by showing that the conditions established by a therapy definition are met by certain reproductive genome editing interventions. I then defend this position against two objections: (a) reproductive genome editing interventions do not attain one of the two conditions for something to be a therapy, and (b) (...) some reproductive genome editing interventions are therapeutic but in a nonstandard way. In the Conclusion I call for a more nuanced discussion of the nature of reproductive genome editing interventions. (shrink)

Monika Piotrowska has defended a new account of reproduction. Her account seems able to answer the question of whether reproduction takes place, and who reproduces, when we employ biotechnologies that bear little to no resemblance to naturally occurring human sexual reproduction. Piotrowska's account also seems to increase our understanding of biological individuality and seems to be compatible with the theory of evolution via natural selection. In this paper, I do two things. First, I show that Piotrowska's account is found wanting, (...) because it is extensionally inadequate. Second, I show that her criticism of James Grisemer's account of reproduction is mistaken. (shrink)

Clinical photography is an important tool for medical practice, training and research. While in the past clinical pictures were confined to the stringent controls of surgeries and hospitals technological advances have made possible to take pictures and share them through the internet with only a few clicks. Confronted with this possibility I explore if a case could be made for using clinical photography in tandem with social media. In order to do this I explore: if patient’s informed consent is required (...) for the publication of any clinical images that depicts her, irrespective of whether the patient can be identified from the image or not, if social media is an adequate place for clinical images to be displayed, and finally if there are special considerations that should be taken into account when publishing clinical images on social media. (shrink)

Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from (...) countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals. (shrink)

News about the first baby born after a mitochondrial replacement technique (MRT; specifically maternal spindle transfer) broke on September 27, 2016 and, in a matter of hours, went global. Of special interest was the fact that the mitochondrial replacement procedure happened in Mexico. One of the scientists behind this world first was quoted as having said that he and his team went to Mexico to carry out the procedure because, in Mexico, there are no rules. In this paper, we explore (...) Mexico's rule of law in relation to mitochondrial replacement techniques and show that, in fact, certain instances of MRTs are prohibited at the federal level and others are prohibited at the state level. According to our interpretation of the law, the scientists behind this first successful MRT procedure broke federal regulations regarding assisted fertilization research. (shrink)

The expressivist account of knowledge attributions, while claiming that these attributions are nonfactual, also typically holds that they retain a factual component. This factual component involves the attribution of a belief. The aim of this work is to show that considerations analogous to those motivating an expressivist account of knowledge attributions can be applied to belief attributions. As a consequence, we claim that expressivists should not treat the so-called factual component as such. The phenomenon we focus on to claim that (...) belief attributions are non-factual is that of normative doxastic disagreement. We show through several examples that this kind of disagreement is analogous to that of the epistemic kind. The result will be a doxastic expressivism. Finally, we answer some objections that our doxastic expressivism could seem to face. (shrink)

In a recent publication Tom Douglas and Katrien Devolder have proposed a new account of genetic parenthood, building on the work of Heidi Mertes. Douglas and Devolder’s account aims to solve, among other things, the question of who are the genetic parents of an individual created through somatic cell nuclear transfer (i.e. cloning): (a) the nuclear DNA provider or (b) the progenitors of the nuclear DNA provider. Such a question cannot be answered by simply appealing to the folk account of (...) genetic parenthood, according to which the genetic parents of an individual are those individuals who produced the egg and sperm, respectively, which fused to create the embryo. It cannot be so as in cloning there is no fertilization as such. In this article I critically examine Douglas and Devolder’s new account of genetic parenthood and demonstrate that it is vulnerable to counterexamples that exploit the lack of a condition specifying that genetic parents should cause a child’s coming into existence. (shrink)

Some Comments on de Melo-Martin and Harris.

One of the main challenges in medicine is to guarantee an appropriate drug supply according to the real needs of patients. Closed-loop strategies have been widely used to develop automatic solutions based on feedback variables. However, when the variable of interest cannot be directly measured or there is a lack of knowledge behind the process, it turns into a difficult issue to solve. In this research, a novel algorithm to approach this problem is presented. The main objective of this study (...) is to provide a new general algorithm capable of determining the influence of a certain clinical variable in the decision making process for drug supply and then defining an automatic system able to guide the process considering this information. Thus, this new technique will provide a way to validate a given physiological signal as a feedback variable for drug titration. In addition, the result of the algorithm in terms of fuzzy rules and membership functions will define a fuzzy-based decision system for the drug delivery process. The method proposed is based on a Fuzzy Inference System whose structure is obtained through a decision tree algorithm. A four-step methodology is then developed: data collection, preprocessing, Fuzzy Inference System generation, and the validation of results. To test this methodology, the analgesia control scenario was analysed. Specifically, the viability of the Analgesia Nociception Index as a guiding variable for the analgesic process during surgical interventions was studied. Real data was obtained from fifteen patients undergoing cholecystectomy surgery. (shrink)

The capability approach is gaining momentum as a theory of corporate responsibility and business ethics at a time when the UN Guiding Principles have become a most important framework. A novel approach is now emerging that seeks to understand and specify human rights obligations of businesses within the framework provided by the capability approach. This article partially examines the triad corporate responsibility–human rights–capability approach by exploring the relationship between human rights and capabilities. Thus, it offers conceptual and practical implications for (...) a human rights perspective on corporate responsibility. The bulk of our thesis focuses on studying Nussbaum’s and Sen’s claim that human rights are entitlements to capabilities by means of a discussion of the notion of human dignity. In particular, we show the capability approach’s ability to dissipate theoretical and practical challenges posed by the notion of dignity. This article does not offer a detailed explanation of the implications of our investigation for human rights responsibilities of business. However, an outline of its potential contribution toward unfolding those obligations, conceptually and practically, is provided. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...) higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

Children created through mitochondrial replacement techniques (MRTs) are commonly presented as possessing 50% of their mother’s nuclear DNA, 50% of their father’s nuclear DNA and the mitochondrial DNA of an egg donor. This lab-engineered genetic composition has prompted two questions: Do children who are the product of an MRT procedure have threegeneticparents? And, do MRT egg donors have parental responsibilities for the children created? In this paper, I address the second question and in doing so I also address the first (...) one. First, I present a brief account of mitochondrial diseases and MRTs. Second, I examine how MRTs affect the numerical identity of eggs and zygotes. Third, I investigate two genetic accounts of parenthood and MRT egg donation. Fourth, I explore three causal accounts of parenthood and MRT egg donation. My conclusion is that, under the appropriate circumstances, MRT egg donors are parentally responsible for the children created under genetic accounts of parenthood and under causal accounts of parenthood. (shrink)

Mitochondrial replacement techniques (MRTs) are a new group of biotechnologies that aim to aid women whose eggs have disease-causing deleteriously mutated mitochondria to have genetically related healthy children. These techniques have also been used to aid women with poor oocyte quality and poor embryonic development, to have genetically related children. Remarkably, MRTs create humans with DNA from three sources: nuclear DNA from the intending mother and father, and mitochondrial DNA from the egg donor. In a recent publication Françoise Baylis argued (...) that MRTs are detrimental for genealogical research via mitochondrial DNA because they would obscure the lines of individual descent. In this paper, I argue that MRTs do not obscure genealogical research, but rather that MRT-conceived children can have two mitochondrial lineages. I argue for this position by showing that MRTs are reproductive in nature and, thus, they create genealogy. (shrink)

Extrapolation of causal claims from study populations to other populations of interest is a problematic issue. The standard approach in experimental research, which prioritises randomized controlled trials and statistical evidence, is not devoid of difficulties. Granted that, it has been defended that evidence of mechanisms is indispensable for causal extrapolation. We argue, contrarily, that this sort of evidence is not indispensable. Nonetheless, we also think that occasionally it may be helpful. In order to clarify its relevance, we introduce a distinction (...) between a positive and a negative role of evidence of mechanisms. Our conclusion is that the former is highly questionable, but the latter may be a trustworthy resource for causal extrapolation. (shrink)

Análisis de la noción de retórica en Blumenberg.

Resumen: En el presente artículo se evidencia la vinculación que establece Rama entre lengua/literatura y espacio/poder en La ciudad letrada. Este nuevo paradigma ha permitido pensar y repensar la literatura latinoamericana y los estudios culturales, sin embargo, entraña contradicciones dentro del mismo pensamiento del uruguayo. La tajante división que el autor establece entre ciudad real y ciudad letrada hace imposible pensar el rol de la literatura fuera de la esfera del poder institucional, al mismo tiempo que relega ontológicamente la realidad (...) de esta última a una meramente instrumental. Nuestra propuesta es leer a la luz del concepto de transculturación esta oposición, para establecer una dialéctica que permita considerar la politicidad propia de la ciudad real y su rol activo en la expresión de una literatura de resistencia política. Abstract: In the present article we show the relationship that Rama establish between language/power and space/power in the Ciudad Letrada. This new paradigm has allowed us to think and rethink Latin American literature and cultural studies, non the less, it also brings out contradictions inside the own thinking of the Uruguayan author. The strong division that the author establishes between the real city and the literate city does not allow one to think of the role of literature outside the field of institutionalized power, at the same time that he relegates the ontological reality of the latter to a merely instrumental one. Our proposal is to read this opposition in the light of the notion of transculturation, establishing a dialectic that allows us to consider the very policy of the real city and its active role in the expression of a political resistance literature. (shrink)

In a recent paper –Lesbian motherhood and mitochondrial replacement techniques: reproductive freedom and genetic kinship– we argued that lesbian couples who wish to have children who are genetically related to both of them should be allowed access to mitochondrial replacement techniques (MRTs). Françoise Baylis wrote a reply to our paper –‘No’ to lesbian motherhood using human nuclear genome transfer– where she challenges our arguments on the use of MRTs by lesbian couples, and on MRTs more generally. In this reply we (...) respond to her claims and further clarify our position. (shrink)