Since 2002, legislation in Spain has allowed for the creation and documentation of end-of-life decisionmaking. Over the intervening years, the actual implementation of such documents is very low. Through extensive analysis of the literature, this article explores the current status of the use of and attitudes toward advance directives in Spain and then proposes strategies for improvement in their implementation.

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. (...) There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them, and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. (shrink)

Die Phänomenologie stellt eine der Hauptströmungen der Gegenwartsphilosophie dar und findet in zahlreichen Wissenschaften sowie in Praxis und Therapeutik starke Resonanz. Nach 120 Jahren Wirkungsgeschichte füllt die Bibliothek phänomenologischer Werke zahllose Bücherregale und selbst für Expert:innen ist die Forschungsliteratur mittlerweile unüberschaubar geworden. An allgemeinen Einführungen sowie spezialisierter Fachliteratur mangelt es dabei keineswegs, wohl aber an einem Handbuch, in dem sowohl der Vielfalt der historischen Entwicklungen als auch dem berechtigten Wunsch nach innerer systematischer Kohärenz Rechnung getragen wird. Das Handbuch Phänomenologie schließt (...) diese Lücke. Ausgewiesene Autor:innen bereiten in eigens für diesen Band verfassten Artikeln komplexe sachliche Zusammenhänge übersichtlich auf. Durch seinen Aufbau eignet sich das Handbuch sowohl für Anfänger:innen als auch für Fortgeschrittene. Anhand bündig präsentierter Grundbegriffe und Verfahren konturiert das Handbuch die Spezifik der phänomenologischen Methode, spart dabei jedoch nicht die Kontroversen und methodologischen Neuausrichtungen aus, die von ihrer Lebendigkeit und Vielstimmigkeit zeugen. Ein umfangreicher Schlussteil ist der Rezeption und Anwendung in einzelnen Wirkfeldern gewidmet. Als Hilfsmittel zur eigenständigen Erschließung der phänomenologischen Denkrichtung und zu ihrer Anwendung auf aktuelle Probleme zeichnet sich das Handbuch durch seine Leser:innenfreundlichkeit und einen stark forschungspraktischen Bezug aus. Ein Kompendium, das sich bald als ABC der Phänomenologie etablieren dürfte. (shrink)

Epigenetic research has brought several important technological achievements, including identifying epigenetic clocks and signatures, and developing epigenetic editing. The potential military applications of such technologies we discuss are stratifying soldiers’ health, exposure to trauma using epigenetic testing, information about biological clocks, confirming child soldiers’ minor status using epigenetic clocks, and inducing epigenetic modifications in soldiers. These uses could become a reality. This article presents a comprehensive literature review, and analysis by interdisciplinary experts of the scientific, legal, ethical, and societal issues (...) surrounding epigenetics and the military. Notwithstanding the potential benefit from these applications, our findings indicate that the current lack of scientific validation for epigenetic technologies suggests a careful scientific review and the establishment of a robust governance framework before consideration for use in the military. In this article, we highlight general concerns about the application of epigenetic technologies in the military context, especially discrimination and data privacy issues if soldiers are used as research subjects. We also highlight the potential of epigenetic clocks to support child soldiers’ rights and ethical questions about using epigenetic engineering for soldiers’ enhancement and conclude with considerations for an ethical framework for epigenetic applications in the military, defense, and security contexts. (shrink)

Philosophers have argued that stakes affect knowledge: a given amount of evidence may suffice for knowledge if the stakes are low, but not if the stakes are high. By contrast, empirical work on the influence of stakes on ordinary knowledge ascriptions has been divided along methodological lines: “evidence‐fixed” prompts rarely find stakes effects, while “evidence‐seeking” prompts consistently find them. We present a cross‐cultural study using both evidence‐fixed and evidence‐seeking prompts with a diverse sample of 17 populations in 11 countries, speaking (...) 14 languages. Our study is the first to use an evidence‐seeking prompt cross‐culturally, and includes several previously untested populations (including indigenous populations). Across cultures, we do not find evidence of a stakes effect with our evidence‐fixed prompt, but do with our evidence‐seeking prompt. We argue that the divergent results reveal a tension within folk epistemology: people's beliefs about when it is appropriate to ascribe knowledge differ significantly from their actual practice in ascribing knowledge. (shrink)

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? (...) A scoping review methodology guided by Arksey and O’Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was “Ethics and Human Rights Boundaries to Mental Health Nursing practice”. Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse. (shrink)

This article sheds light on Grotius’s writings on slavery and the polyvalent ways in which his ideas have been interpreted and applied throughout history. The article focuses, in particular, on a tension at the heart of the Grotian theory of natural rights, as articulated in De iure belli ac pacis (ibp). Grotius’s views on slavery have attracted the attention of generations of legal scholars, who debated and explored them in courts of justice, in international disputes, and on the margins of (...) their own copies of Grotius’s magnum opus. Overall, this article shows that despite the rise in popularity of other authors and new ideologies, Grotius’s influence in debates about slavery and abolitionism endured well into the modern age. (shrink)

Background Health advocacy is crucial for both patients and healthcare professionals. However, nurses who recognize the importance of health advocacy may experience heightened moral distress, particularly in complex donation and transplantation cases where patient autonomy, respect, and advocacy are paramount. Aim To identify the factors contributing to moral distress among nurses working in solid organ transplant units at a university hospital in São Paulo, with a focus on health advocacy. Research Design This descriptive, cross-sectional study employs both quantitative and qualitative (...) methods. For this, the quantitative phase of the study was conducted utilizing the Moral Distress Scale, while the qualitative phase was executed through focus group discussions. Participants and Research Context The quantitative phase involved 15 nurses using the Moral Distress Scale. The qualitative phase consisted of a focus group with 5 nurse managers/coordinators from the transplant units. Quantitative data were analyzed using R® software, while qualitative data were analyzed using Bardin’s Content Analysis. Ethical Considerations The study was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing, University of São Paulo. Participation was voluntary and confidentiality was ensured. Results A significant correlation was found between moral distress and the factors of “disregard for patient autonomy” ( p =.0100) and “therapeutic obstinacy” ( p =.0492). Conclusion The primary determinants associated with moral distress in the context of health advocacy were identified as “disregard for patient autonomy” and “therapeutic obstinacy.”. (shrink)

Background In Spain, there has been great effort by lawmakers to put Advance Directives into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little (...) impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: the training of health professionals about the end of life and AD is lacking; there has been no public process to increase awareness about AD, and therefore people know little about them; the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future. (shrink)

Background Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health. Methods A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (ethics) AND (...) (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review. Results Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners’ access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights. Conclusions Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons. (shrink)

Our goal in this paper is to establish a set of criteria for understanding the meaning and sources of attributing (un)fairness to AI algorithms. To do so, we first establish that (un)fairness, like other normative notions, can be understood in a proper primary sense and in secondary senses derived by analogy. We argue that AI algorithms cannot be said to be (un)fair in the proper sense due to a set of criteria related to normativity and agency. However, we demonstrate how (...) and why AI algorithms can be qualified as (un)fair by analogy and explore the sources of this (un)fairness and the associated problems of responsibility assignment. We conclude that more user-driven AI approaches could alleviate some of these difficulties. (shrink)

In the last decade, robustness has been extensively mentioned and discussed in biology as well as in the philosophy of the life sciences. Nevertheless, from both fields, someone has affirmed that this debate has resulted in more semantic confusion than in semantic clearness. Starting from this claim, we wish to offer a sort of prima facie map of the different usages of the term. In this manner we would intend to predispose a sort of “semantic platform” which could be exploited (...) by those who wish to discuss or simply use it. We do this by starting from a core distinction between the robustness of representations, which is a philosophy of science issue, and the representations of robustness, which instead pertains to science. We illustrate our proposal with examples from biology, physics and mathematics. (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

Describing his creative process, David Bowie stated: “I’ll take articles out of newspapers, poems that I’ve written, pieces of other people’s books, and put them all into this little warehouse, thi...

This volume reviews examples and notions of robustness at several levels of biological organization. It tackles many philosophical and conceptual issues and casts an outlook on the future challenges of robustness studies in the context of a practice-oriented philosophy of science. The focus of discussion is on concrete case studies. These highlight the necessity of a level-dependent description of robust biological behaviors.Experts from the neurosciences, biochemistry, ecology, biology, and the history and the philosophy of life sciences provide a multiplex perspective (...) on the topic. Contributions span from protein folding, to cell-level robustness, to organismal and developmental robustness, to sensorimotor systems, up to the robustness of ecological systems.Several chapters detail neurobiological case-studies. The brain, the poster child of plasticity in biology, offers multiple examples of robustness. Neurobiology explores the importance of temporal organization and multiscalarity in making this robustness-with-plasticity possible. The discussion also includes structures well beyond the brain, such as muscles and the complex feedback loops involved in the peculiar robustness of music perception. Overall, the volume grounds general reflections upon concrete case studies, opening to all the life sciences but also to non-biological and bio-inspired fields such as post-modern engineering. It will appeal to researchers, students, as well as non-expert readers. (shrink)

The dual career allows elite athletes to attain their maximum competitive and academic performance, but the COVID-19 pandemic hindered their development and changed their perception of the importance given to the sporting and educational environment. For this reason, the aim of the present study was to determine the differences in the motivations and perceived barriers, the importance given to academic qualifications, and the perception of the dual career from a multifactorial perspective, of elite athletes according to sex, type of sport (...) practiced, job performance, time of sports career, type of athlete, and type of scholarship received. A total of 100 student-athletes participated in the research study by completing the “Perceptions of dual career student-athletes” questionnaire. The results showed that athletes from individual modalities and those who did not receive any scholarships described more barriers. In addition, women studied more because they enjoyed it ; athletes from individual modalities studied to work later ; athletes who do not work perceived a greater influence between study and sports performance ; at the beginning and at the best stage of their sports career, a greater influence of academics on performance was perceived ; and athletes who considered themselves professionals, and athletes who did not receive any scholarships, reported that the conciliation between sports and academic life was difficult. The results obtained point to the importance of dual career scholarships for student-athletes, as well as the need for the programs implemented for these athletes to consider sex, sport modality or type of scholarship granted. (shrink)

Fostering research integrity (RI) increasingly focuses on normative guidance and supportive measures within institutions. To be successful, the implementation of support should be informed by stakeholders’ experiences of RI support. This study aims to explore experiences of RI support in Dutch, Spanish and Croatian universities. In total, 59 stakeholders (Netherlands n = 25, Spain n = 17, Croatia n = 17) participated in 16 focus groups in three European countries. Global themes on RI support experiences were identified by thematic analysis. (...) Themes identified were: ‘RI governance and institutional implementation’, ‘RI roles and structures’, ‘RI education and supervision’, and ‘Infrastructure, technology and tools supporting daily practice’. Experiences of support differed between countries in relation to: the efforts to translate norms into practice; the extent to which RI oversight was a responsibility of RE structures, or separate RI structures; and the availability of support close to research practice, such as training, responsible supervision, and adequate tools and infrastructure. The study reinforces the importance of a whole institutional approach to RI, embedded within local jurisdictions, rules, and practices. A whole institutional approach puts the emphasis of responsibility on institutions rather than individual researchers. When such an approach is lacking, some stakeholders look for intervention by authorities, such as funders, outside of the university. (shrink)

The aim of this cross-sectional study is to investigate the role of psychological inflexibility in the relationship between anxiety and depression and emotional eating in a sample of 123 inpatient Italian adult individuals with obesity. Participants completed the Anxiety and Depression subscales of the Psychological General Well-Being Inventory, the Acceptance and Action Questionnaire, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire to assess anxiety and depression, psychological inflexibility, and emotional eating, respectively. Results showed that the indirect effect (...) of PGWBI-A on DEBQ-EE through AAQ-II was significant [b = −0.0155; SE = 0.076; 95% BC-CI ]. Similarly, the indirect effect of PGWBI-D on DEBQ-EE through AAQ-II was significant [b = −0.0383; SE = 0.0207; 95% BC-CI ]. These findings may help to plan and develop specific psychological interventions aimed at addressing emotional eating through targeting psychological inflexibility to be included in obesity treatment programs. (shrink)

If well-designed, the results of a Randomised Clinical Trial can justify a causal claim between treatment and effect in the study population; however, additional information might be needed to carry over this result to another population. RCTs have been criticized exactly on grounds of failing to provide this sort of information Evidence, inference and enquiry. Oxford University Press, New York, 2011), as well as to black-box important details regarding the mechanisms underpinning the causal law instantiated by the RCT result. On (...) the other side, so-called In Silico Clinical Trials face the same criticisms addressed against standard modelling and simulation techniques, and cannot be equated to experiments Philosophy of molecular medicine: foundational issues in research and practice, Routledge, New York, 2017; Parker in Synthese 169:483–496, 2009; Parke in Philos Sci 81:516–536, 2014; Diez Roux in Am J Epidemiol 181:100–102, 2015 and related discussions in Frigg and Reiss in Synthese 169:593–613, 2009; Winsberg in Synthese 169:575–592, 2009; Beisbart and Norton in Int Stud Philos Sci 26:403–422, 2012). We undertake a formal analysis of both methods in order to identify their distinct contribution to causal inference in the clinical setting. Britton et al.’s study :E2098–E2105, 2013) on the impact of ion current variability on cardiac electrophysiology is used for illustrative purposes. We deduce that, by predicting variability through interpolation, ISCTs aid with problems regarding extrapolation of RCTs results, and therefore in assessing their external validity. Furthermore, ISCTs can be said to encode “thick” causal knowledge —as opposed to “thin” difference-making information inferred from RCTs. Hence, ISCTs and RCTs cannot replace one another but rather, they are complementary in that the former provide information about the determinants of variability of causal effects, while the latter can, under certain conditions, establish causality in the first place. (shrink)

Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (...) plays in moderating the link between patient and partner cardiac illness-related distress and partner support. The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support. With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping. (shrink)

This research note offers a contextual overview of the printing history of Johann Blaeu’s 1646 octavo edition of Hugo Grotius’s De iure belli ac pacis (ibp). The note examines the printing process of the last edition that was prepared while Grotius was still alive, though it was published after his death. The note also sheds light on the theological dimension of some readers’ annotations, and concludes by discussing the impact this edition had on the modern versions of the text.

The Fibromyalgia Survey Questionnaire was self-administered by a sample of 207 Italian individuals with obesity to screen for fibromyalgia. We aimed to investigate the inter-rater reliability and the agreement in the detection of FM symptomatology between the self-administered FSQ and the clinical interview conducted by a rheumatologist. All the patients were divided randomly into two groups : a rheumatologist first interviewed patients of group A and after 48 h, the patients completed the self-report FSQ. Patients of group B first completed (...) the FSQ and 48 h later were interviewed by a rheumatologist. The agreement between the measurements was good with the Bland-Altman analysis showing low bias scores for the two subscales of the FSQ. Results showed that 33% of the sample satisfied the criteria for a diagnosis of fibromyalgia. The FSQ is a self-reporting measure that showed substantial reliability providing fast screening for FM symptomatology. (shrink)

Thomas C. Vinci argues that Kant's Deductions demonstrate Kant's idealist doctrines and have the structure of an inference to the best explanation for correlated domains. With the Deduction of the Categories the correlated domains are intellectual conditions and non-geometrical laws of the empirical world. With the Deduction of the Concepts of Space, the correlated domains are the geometry of pure objects of intuition and the geometry of empirical objects.

This work investigates the relationship between goals and mitigation behaviors during the COVID-19 pandemic in Italy. Study 1 identified goals ascribed to following and violating mitigation-related indications. Study 2 investigated the structure of and link between COVID-related goals and behaviors in a large community sample. Our results showed substantial relationships between goals and behaviors. Goals were best described by a bi-dimensional structure, whereas behaviors clustered into a three-component structure. Hierarchical multiple regressions demonstrated the incremental validity of goals in the prediction (...) of behaviors. Network analysis suggested that goals imbued with social content were more directly related to both risky and preventive behaviors. Motivational aspects emerged as important contributors to the organization of behaviors in the context of the COVID-19 pandemic. (shrink)

This article aims to analyze how the so-called ‘pedagogy of work’ attempts to answer the challenges of unemployment and job insecurity characterizing the labor market in contemporary society. The authors reflect on the concepts of nihilist pedagogies and the ‘end of work’ by distinguishing two approaches: an active and a passive nihilist pedagogy. The passive approach, based on resignation, is opposed to an active attitude in which labor pedagogy offers tools to address current challenges. The authors support the idea that (...) pedagogy as a human-improving science cannot adopt the position of passive nihilism in interpreting work in contemporary society. To better understand the dynamics related to job insecurity and corrective solutions by pedagogy, the authors analyzed the thoughts of three contemporary philosophers: Zygmunt Bauman, Jeremy Rifkin, and Dominique Méda. These authors redefined the concept of work in connection with the transformations because of globalization, the advent of new communication technologies, and digital work. These changes have redefined not only the concept of work but also the models of work pedagogy in the Western world: capitalism and Marxism. Considering the current challenges, the pedagogy of work needs to be rethought, starting from the problem of employability and focusing on the new occupations in demand in the Internet age. By integrating ideas on interpreting work from the theories of Bauman, Rifkin, and Méda, it is possible to propose a pedagogy of work in the age of change and to outline possible values of education inspired by it. (shrink)