Clinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid (...) MEDLINE, Scopus, Philosopher’s Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs’ functions. We did not find standardized tools for measuring CECs’ efficacy, but 33% of studies considered “user satisfaction” as an indicator, with 94% of them reporting an average positive perception of CECs’ impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs’ evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation. (shrink)

The need for the political empowerment of women, and the role played by the media in both promoting and hindering it are well-known problems. A new opportunity to consider these problems as regards the Italian case was afforded by the 1999 presidential election. During that selection process, the proposal to appoint a woman as head of the nation was, for the first time, brought into the arena for debate. Neither of the two women who were candidates – European Commissioner Emma (...) Bonino and Minister of the Interior Rosa Russo Jervolino – were elected. Using the `public arenas model' and the concept of `framing', the article explores the rise and fall of the two female candidatures by highlighting the limits in the social construction of the women's agenda. Considered from this point of view, the campaign offers an interesting case study in order to better understand the mechanisms of gender exclusion. (shrink)

In this article we show that, even though the classification and diagnosis of Psychiatric Disorders are performed according to essentialist terms, the psychiatric diagnoses currently employed, do not actually meet these criteria. Diagnosis is performed operationally. In this paper, we suggest a change of perspective. We reject essentialism relating to PDs and argue for the Homeostatic Property Cluster model, which allows a greater insight into the ontology of PDs than the operational perspective. More specifically, we argue that the HPC model (...) allows for a synthesis of continuous and discrete methods of understanding the boundaries between PDs. Finally, we specify in a more general manner, the kind of ontology we deal with when adopting the HPC model, arguing that this model can be viewed as a mirror device, reflecting the ontological features of PDs. (shrink)

Cancer derives from a cell clone that has accumulated genetic and epigenetic changes that influence its phenotype and finally enable it to escape from the normal controls of proliferation. A recent paper shows that, in myc‐induced tumours, the inactivation of this oncogene produces the regression of the tumours and the differentiation of the tumour cells into mature osteocytes.1 In addition, a further reactivation of myc in these cells does not restore the malignant phenotype but induces apoptosis. This discovery could lead (...) to an innovative therapeutic strategy. BioEssays 25:104–107, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

O artigo propõe abordar a construção da imagem de Isabel, a Católica aproximando Luiz de França foi um dos mais significativos mestres de maracatu nação. Dirigiu e articulou o maracatu Nação Leão Coroado, entre os anos de 1950 até sua morte, em 1997. Ainda hoje a sua memória é reivindicada por grupos de maracatus existentes no Recife. Tal questão indica diferentes aspectos nos processos de construção das memórias, e da forma como estas são usadas no presente. Este artigo objetiva discutir (...) e analisar as performances de Luiz de França, bem como suas estratégias cotidianas a partir das memórias dos maracatuzeiros pernambucanos. Entendendo a memória como fruto dos processos históricos, também é objetivo deste trabalho analisar as diferentes formas como a memória é construída, trazendo à tona questões de ordem teórico-epistemológica a respeito da cultura negra, dos maracatus e dos maracatuzeiros recifenses. (shrink)

CRIMINALIDADE E DIREITO: DIÁLOGO ENTRE A EVOLUÇÃO DO SISTEMA PUNITIVO E A MENTALIDADE SOCIAL.

The paper advances the hypothesis that René Descartes presents a skeptical system of philosophy in Thomas Reid’s reading. There is a sort of ‘involun-tary’ or ‘accidental’ skepticism that results from the adoption by Descartes of both a skeptical method and a skeptical principle. The first section shows to what extent the Cartesian method of doubt – which focuses on the reliability of the faculties of the mind - is a skeptical demand that cannot be satisfied. The second section shows how (...) the principle of the Cartesian system – which establishes that ideas are the immediate objects of the operations of the mind – is not only skeptic but leads exactly and naturally to the most radical form of skepticism, namely, solipsism. The third section discusses the Cartesian sources of the doubt on the existence of external world according to Reid. (shrink)

The paper discusses Thomas Reid's objection to David Hume's theory of personal identity. The hypothesis states that this criticism is not effective because it is based on a misunderstanding of Hume’s theory, namely, that Hume would have admitted a negative ontological thesis - the inexistence of a mind beyond perceptions - and a positive ontological thesis - a mind reduced to a bundle of perceptions. After explaining in what measures Reid’s objection is based upon this misunderstanding, the paper shows why (...) Hume does not accept those theses,. (shrink)

The paper presents and discusses how Thomas Reid's philosophy of common sense replies to the skepticism about the epistemic reliability of the faculties of mind. The hypothesis presented establishes that Reid’s reply has three arguments. First, Reid shows why it is impossible to prove the reliability of the faculties of mind and why philosophers may begin their investigations by accepting the truth of the beliefs due to these faculties. Secondly, Reid shows that it is inconsistent to choose one of these (...) faculties as the only source of true beliefs. This is arbitrary. Those authors, who choose, for example, consciousness as the only source of reliable knowledge, only reinforce the claim that all faculties of mind are equally reliable. Thirdly, if the faculties of the mind operate properly, that is, when our mind is not affected by any disorder or disease, there is no good reason to call them into question and to doubt the truth of their beliefs. (shrink)

We present a description of the Stern–Gerlach type experiments using only the concepts of classical electrodynamics and the Newton’s equations of motion. The quantization of the projections of the spin (or the projections of the magnetic dipole) is not introduced in our calculations. The main characteristic of our approach is a quantitative analysis of the motion of the magnetic atoms at the entrance of the magnetic field region. This study reveals a mechanism which modifies continuously the orientation of the magnetic (...) dipole of the atom in a very short time interval, at the entrance of the magnetic field region. The mechanism is based on the conservation of the total energy associated with a magnetic dipole which moves in a non uniform magnetic field generated by an electromagnet. A detailed quantitative comparison with the (1922) Stern–Gerlach experiment and the didactical (1967) experiment by J.R. Zacharias is presented. We conclude, contrary to the original Stern–Gerlach statement, that the classical explanations are not ruled out by the experimental data. (shrink)

The paper covers the discussion of three aspects of Thomas Reid’s political thought. Initially, it presents and discusses Reid’s understanding of Politics. Secondly, it is argued that, unlike the first principles of other branches of knowledge, such as Mathematics, Philosophy of Mind and Morals, the first principles of Politics are not the first principles of common sense. Politics is founded on a form of empirical knowledge that cannot be identified with common sense, with the judgments and beliefs due to the (...) original constitution of mind that are shared by most humans. Finally, it is argued, from a parallel with the philosophy of nature, that common sense has only a methodological role in Politics. (shrink)

We give an example in which it is possible to understand quantum statistics using classical concepts. This is done by studying the interaction of chargedmatter oscillators with the thermal and zeropoint electromagnetic fields characteristic of quantum electrodynamics and classical stochastic electrodynamics. Planck's formula for the spectral distribution and the elements of energy hw are interpreted without resorting to discontinuities. We also show the aspects in which our model calculation complement other derivations of blackbody radiation spectrum without quantum assumptions.

This article reports on the development of the managerial ethical profile (MEP) scale. The MEP scale is a multilevel, self-reporting scale measuring the perceived influence that different dimensions of common ethical frameworks have on managerial decision making. The MEP scale measures on eight subscales: economic egoism, reputational egoism, act utilitarianism, rule utilitarianism, self-virtue of self, virtue of others, act deontology, and rule deontology. Confirmatory factor analysis (CFA) was used to provide evidence of scale validity. Future research needs and the value (...) of this measure for business ethics are discussed. (shrink)

In their contribution, Kok et al raise a relevant, though often underestimated, issue: clinical ethics support services are often assumed to lead to an improvement of quality of care at the organisational level, but evidence in support of this claim is weak, if not completely lacking.1 Therefore, the authors propose a complex theoretical model connecting a specific kind of CESS, moral case deliberation, with mechanisms for quality of care improvement at the individual and the organisational level. The proposal is original, (...) and the topic discussed of great interest not only to practitioners and researchers dealing with CESS, but also to health policy-makers and managers of healthcare system, for all of whom it is indeed crucial to understand whether and how ethics support can positively impact quality of care. However, despite its undoubtful merits, we feel that some claims and model’s underlying assumptions might require in-depth scrutiny and more solid justification. i. First, the authors discuss two different approaches to understanding quality of care: the first approach, which they define as reductionist, interprets quality as an outcome-oriented, quantitative, and therefore, measurable function. The second approach defines quality …. (shrink)

BackgroundClinical Ethics Support Services have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting (...) in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders’ expectations about a potential CESS to be implemented within the Institution.MethodsThe study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders’ professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory.ResultsTwenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases.ConclusionsThe interviewees showed a limited degree of ‘ethical awareness’: despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients. (shrink)