Quality of Life Reach in Medical Care Alcance da qualidade de vida no atendimento médico The term quality of life has increasingly widespread use in biomedical practice, especially in end-of-life situations. Experience shows that the expression is often used with very different —and sometimes conflicting— scopes. The present article presents the results of a literature review that show diverse positions, while delimitating the subject. The analysis compares the terms “quality of life,” “human dignity,” and “value of human life.” Para citar (...) este artículo / To reference this article / Para citar este artigo Páez G, López-Gabeiras MP, Moreno-D’Anna M. Alcance de la “calidad de vida” en atención médica. Pers Bioet. 2020;24:14-27. DOI: https://doi.org/10.5294/pebi.2020.24.1.2 Recibido: 06/11/2019 Aceptado: 04/03/2020 Publicado: 07/05/2020. (shrink)

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

Name der Zeitschrift: Cultura. International Journal of Philosophy of Culture and Axiology Jahrgang: 8 Heft: 2 Seiten: 51-61.

CONTENTS: -/- SEZIONE I IL TUTTO E' UNO? IL RISVEGLIO DI UN PROBLEMA TRA SCOLASTICA E RINASCIMENTO Il principio omne causatum est compositum fra Tommaso e Cajetano Igor Agostini, p. 25 Parti e tutto in Montaigne. La natura e l'individuo tra frammentazione e integrazione Raffaele Carbone 45 Le minuzzarie e il tutto. Giordano bruno e la conoscenza universale Maurizio Cambi 75 -/- SEZIONE II A PARTIRE DA CARTESIO. COME PUO' ESSERE UN TUTTO L'UOMO? -/- Mente/Corpo in Cartesio. Spunti per un'interpretazione (...) mereologica Stefano Di Bella 93 Nos sumus ex Deo et pertinemus ad Deum. Appartenenza, dipendenza e relazione nel pensiero e nel lessico di Arnold Guelincx Cristina Santinelli 115 L'integrità di corpo e mente nell'"invenire" terapeutico di E. W. von Tschirnhaus Manuela Sanna 133 L'indivisibilità della natura umana e della società in Francesco Longano. Un episodio della ricezione di Locke in Italia Roberto Evangelista 147 -/- SEZIONE III L'IRROMPERE DELL'ORGANICO. LA BIOLOGIA FILOSOFICA TRA SEI E SETTECENTO -/- Convenienza e discrepanza. Parti e tutto nella Lettera 32 di Baruch Spinoza Francesco Toto 169 Mereologia della sostanza e mereologia del vivente in Leibniz Enrico Pasini 197 Teleologia e mereologia dell’organismo da Leibniz a Bonnet Francesco Piro 209 Il nesso delle parti: mereologia e scienza secondo Christian Wolff Matteo Favaretti Camposampiero 239 Il problema del tutto e delle parti. il caso del vitalismo di Montpellier Charles T. Wolfe 257 -/- SEZIONE 4 TOTALITA' CRITICHE: DALLA CRISI DEL NATURALISMO ILLUMINISTICO ALLA FILOSOFIA DELLE CULTURE -/- La logica del tutto (e delle parti di tutto, vale a dire niente) in Dom Deschamps Jean-Claude Bourdin 273 l’(in)afferabile forma. Totalità e contingenza nel pensiero di Kant tra Critica della ragion pura e Critica del giudizio Luigi Imperato 303 la relazione Parte-Tutto nel primo Schelling Giuseppe D’Anna 327 Hegel o della totalizzazione dello spazio di interiorità Vittorio Morfino 343 A partire da Kant: Begriffsbiìldung teleologica e relazione Parti-Tutto nelle indagini di Rickert sulla logica delle scienze storiche della cultura Edoardo Massimilla 359 . (shrink)

In anticipation of a new edition of the Passio apostolorum Petri et Pauli, this article analyzes the recensio conducted by Lipsius for his edition of 1891. The review of the main variants highlighted by the editor reverses his thesis: they depend on innovations by reduction, not by interpolation. Such innovations could perhaps depend on early medieval liturgical use of the work. With regard to the methodology, the comparison with the Greek tradition of the work, as an external criterion of evaluation, (...) appears misleading, since it is unlikely that Greek is the original language. (shrink)

In Tullock contests in which the common value of the prize is uncertain and the elasticity of the marginal cost of effort is increasing, the effect of changes of players’ information on the equilibrium efforts and payoffs is unambiguous: if information is symmetric, then expected effort decreases as players become better informed; in two-player contests, the expected effort of a player with information advantage is less than that of his opponent. Sharper results arise when the cost of effort is linear: (...) Under symmetric information, expected effort and payoff are invariant to changes in the players’ information. In two-player contests, both players exert the same expected effort regardless of their information, although expected effort is smaller when one player has information advantage than when both players have the same information. Interestingly, the expected payoff of a player with information advantage is larger than that of his opponent, even though he wins the prize less frequently. (shrink)

El artículo constituye un acercamiento a las razones que sustentan la necesidad de elevar la calidad de la orientación a las familias de niños en la primera infancia y su objetivo consistió en capacitar al personal de la salud para desarrollar la orientación familiar en función de la prevención de desviaciones en el desarrollo en esta etapa. En él se aborda el rol que tiene la familia en la formación de los niños y la incidencia de los médicos y enfermeras (...) en su orientación; se encuentran reflexiones y comentarios sobre cómo elevar la calidad de la orientación para que la familia pueda desarrollar, en las condiciones de convivencia familiar, la prevención de desviaciones en el desarrollo mediante la realización de un proceso educativo de calidad. The article is an approach to the reasons that support the need to improve the quality of the guidance given to families of early childhood children and its objective consisted on training health staff to develop family guidance according to the prevention of deviations in development during this stage. It deals with the role family plays in children's education and the impact of doctors and nurses on its guidance. Thoughts and comments on how to improve the quality of guidance can also be found so that the family can develop, on family living conditions, the prevention of deviations in development through a quality educational process. (shrink)

Consensus is commonly identified as the goal of ethics committee deliberation, but it is not clear what is morally authoritative about consensus. Various problems with the concept of an ethics committee in a health care institution are identified. The problem of consensus is placed in the context of the debate about realism in moral epistemology, and this is shown to be of interest for ethics committees. But further difficulties, such as the fact that consensus at one level of discourse need (...) not imply consensus at another, oblige us to look more closely at the deliberative process itself. That yields two complementary methods of deliberation that have proven their worth. Finally, placing ethics committees in the context of Dewey's philosophy of social intelligence suggests that consensus should be regarded primarily as a condition rather than as the goal of inquiry. Keywords: ethics committee, consensus, moral authority CiteULike Connotea Del.icio.us What's this? (shrink)

Western society today is less unified by a set of core values than ever before. Undoubtedly, the concept of moral consensus is a difficult one in a liberal, democratic and pluralistic society. But it is imperative to avoid a rigid majoritarianism where sensitive personal values are at stake, as in bioethics. Bioethics has become an influential part of public and professional discussions of health care. It has helped frame issues of moral values and medicine as part of a more general (...) effort to find consensus about some of the most perplexing questions of our time. But why is it thought that a moral consensus is important or that it deserves respect? How does moral consensus acquire legitimacy in a society that includes diverse value systems? How is moral consensus possible and how do small groups help create or distort consensus processes? Written by a medical school professor trained in philosophy, this timely work tackles these questions from philosophical, historical, and social scientific standpoints. It begins by describing the traditional ambivalence about consensus in Western culture as well as the uncertain relationship in modernity between consensus and expertise. After outlining the current bioethical consensus, the book gives philosophical and political analyses of the idea of consensus, then assesses the role of consensus in national ethics commissions and in the ethics committee movement. Moreno constructs an original, naturalistic philosophy of moral consensus, referred to as "bioethical naturalism", and then applies sociology and social psychology to actual consensus processes. The book concludes with an account of bioethics as a consensus-oriented social reform movement. This insightful volume will be essential reading for bioethicists, philosophers, physicians, members of ethics committees, and all those concerned with ethical and social issues in health care. (shrink)

This article is based on a public lecture hosted by the Monash University Centre for Human Bioethics in Melbourne, Australia on 11 April 2013. The lecture recording was transcribed by Vicky Ryan; and, the original transcript has been edited — for clarity and brevity — by Vicky Ryan, Michael Selgelid and Jonathan Moreno.

Henry Knowles Beecher, an icon of human research ethics, and Timothy Francis Leary, a guru of the counterculture, are bound together in history by the synthetic hallucinogen lysergic acid diethylamide. Beecher was a U.S. Army Lieutenant Colonel who received five battle stars, was inducted into the Legion of Merit, held the first endowed chair in his discipline, wrote at least three path-breaking papers, and is honored by two prestigious ethics awards in his name. Leary was a West Point dropout who (...) was obliged to leave a research assistant professorship, was convicted of violating the Marihuana Tax Act, was sentenced to 20 years in prison and broke out with the... (shrink)

Book reviewed in this article: The Insanity Defense and the Trial of John W. Hinckley, Jr. By Lincoln Caplan.

In lieu of an abstract, here is a brief excerpt of the content:Notes on Psychodramatic Treatment of a Person with SchizophreniaJonathan D. Moreno, PhD (bio)I have enjoyed reflecting on Mr. Chapy’s account of work in psychodrama with a patient with schizophrenia.Although at one time many years ago I was interested in phenomenological psychiatry, and especially the writings of Ludwig Binswanger and Medard Boss, I am not an authority on dasein-analysis, so I have nothing to add to the discussion. I (...) should say, however, that my father had little interest in this approach, which was far too abstract for his taste. He proceeded from the standpoint of the theater, of action and enactment. He believed that the drama itself provided the insight.For the purposes of this response, I take it as a given that the patient in question has been accurately diagnosed, although in the description of the scene with his father he does not exhibit the usual symptoms, such as auditory hallucinations. People with schizophrenia often find it difficult to manage the voices they are hearing without substantial preparation for a psychodrama. According to psychodramatic method, one way to prepare them is to externalize the voices, allowing a different therapist to take the role of each one as the protagonist instructs them how to play that role. Chair may be set up so that each “voice,” personified by an auxiliary ego, can sit in each chair in an array. This preparation may require a number of sessions. If the scene is to be enacted with a significant other, like the father in this instance, the patient may not be able to warm up to a direct encounter, especially with all the different voices competing for his internal attention. So he may be directed to observe each voice in the encounter with his father, preferably played by a therapist of his choosing and trained for the role, usually by giving the father-player certain lines so that they can learn something about the father and the way he addresses his son.Or consider the patient whose illness manifests itself as delusions, often of a megalomaniac character. They may be a messiah, for example, or the rightful heir of a royal line whose identity is being suppressed by governmental forces. The patient might be invited to choose key therapists to play the roles of key members of their circle, [End Page 225] enacting critical scenes like the sermon on the mount or speeches to their oppressed followers. In this way the patient’s “act hunger” may be to some degree satiated and have a calming effect on their anxiety and irritation with the frustrating world around them that refuses to accept their “authentic” identity and belief system.In these ways, psychodrama therapy can take advantage of one of the remarkable advantages of this method for such patients, who are generally recalcitrant to talk therapy alone and for whom medication is at best modestly effective. Still, these disorders are among the most challenging for psychotherapists. Although the process of treating them may open up insights into the nature of the human mind, as Chapy has pursued in this paper, we await the neuroscience that can affect the kind of long-term remission they and their families so desperately wish. [End Page 226]Jonathan D. MorenoUniversity of Pennsylvania [email protected] D. Moreno Jonathan D. Moreno is a philosopher and historian who specializes in the intersection of bioethics, culture, science, and national security, and has published seminal works on the history, sociology and politics of biology and medicine. He is an elected member of the National Academy of Medicine.submitted on January 27, 2023Accepted on January 30, 2023Copyright © 2023 Johns Hopkins University Press... (shrink)

Convinced that armed conflict with the Soviet Union was all but inevitable, that such conflict would involve unconventional atomic, biological, and chemical warfare, and that research with human subjects was essential to respond to the threat, in the early 1950s the U.S. Department of Defense promulgated a policy governing human experimentation based on the Nuremberg Code. Yet the policymaking process focused on the abstract issue of whether human experiments should go forward at all, ignoring the reality of humans subjects research (...) already under way and leaving unanswered ethical questions about how to conduct such research. Documents newly released to the Advisory Committee on Human Radiation Experiments tell the story of the Pentagon policy. (shrink)

It has been a pleasure to read these papers and to contemplate their importance for what I believe to be a useful and provocative prism though which to view the field of bioethics: the nature of moral consensus. In my own most extended contribution to this literature, DecidingTogether, I did not attempt to prescribe so much as to understand the role of moral consensus in the practice of bioethics. At the end of the book, I expressed the hope that it (...) might help trigger an examination of bioethics and moral consensus. Though a few others shared my interest at that time (in particular Tris Engelhardt, for whose early encouragement I remain deeply grateful), with this set of stimulating papers the conversation has finally begun in earnest. (shrink)

Bioethics as a field has been fortunate that its values and concerns have mirrored the values and concerns of society. In light of the September 11th attacks, it is possible that we are witnessing the beginning of a transition in American culture, one fraught with implications for bioethics. The emphasis on autonomy and individual rights may come to be tempered by greater concern over the collective good. Increased emphasis on solidarity over autonomy could greatly alter public response to research abuses (...) aimed at defense from bioterrorism, to privacy of genetic information, and to control of private medical resources to protect the public health. (shrink)

On September 4, 2001, press reports indicated that the Defense Intelligence Agency of the U.S. Department of Defense planned to reproduce a strain of anthrax virus suspected of being held in Russian laboratories. According to the same reports, the Central Intelligence Agency, under the auspices of Project Clear Vision, is engaged in building replicas of bomblets believed to have been developed by the former Soviet Union. These small bombs were designed to disperse biological agents, including anthrax. Government attorneys were said (...) to be confident that, because these projects were designed to develop defensive measures, they were not in violation of the 1972 Biological and Toxin Weapons Convention. (shrink)

If economics has been the “dismal science” of the past century, health policy promises to be that of the next. Health policy issues evoke far less passion than the emotion-laden immediacies of bedside decision making. Nevertheless, it is patent that “macro” issues in all their obscurity and complexity are unavoidable if the health care delivery system of the future is to be fiscally sound and publicly acceptable. In addition, as Americans are now learning, options for care at the bedside are (...) ineluctably constrained by seemingly distant societal choices. (shrink)

Mental state reasoning or theory-of-mind has been the subject of a rich body of imaging research. Although such investigations routinely tap a common set of regions, the precise function of each area remains a contentious matter. With the help of functional magnetic resonance imaging (fMRI), we sought to determine which areas are involved when processing mental state or intentional metarepresentations by focusing on the relational aspect of such representations. Using non-intentional relational representations such as spatial relations between persons and between (...) objects as a contrast, the results ascertained the involvement of the precuneus, the temporal poles, and the medial prefrontal cortex in the processing of intentional representations. In contrast, the anterior superior temporal sulcus and the left temporo-parietal junction were implicated when processing representations that refer to the presence of persons in relational contexts in general. The right temporo-parietal junction, however, was specifically activated for persons entering spatial relations. The level of representational complexity, a previously unexplored factor, was also found to modulate the neural response in some brain regions, such as the medial prefrontal cortex and the right temporo-parietal junction. These findings highlight the need to take into account the critical roles played by an extensive network of neural regions during mental state reasoning. (shrink)

Executive Summary There is a general perception that biomedical research has not given the same attention to the health problems of women that it has given ...

Justifying his proposal for “health savings accounts,” which would allow individuals to set aside tax-free dollars against future healthcare needs, President Bush has said that “Health savings accounts all aim at empowering people to make decisions for themselves.” Who could disagree with such a sentiment? Although bioethicists may be among those who express skepticism that personal health savings accounts will be part of the needed “fix” of our healthcare financing system, self determination has long been part of their mantra. Indeed, (...) the field of bioethics played an important role in advancing this idea in the medical world when physician paternalism was regnant. Has its popularity caused it to become so vapid as to be ripe for misuse? (shrink)

Bioethics literature on national security issues is surprisingly sparse and the implications of neuroscience for national security are of increasing public and scholarly interest. This article elaborates one important source of evidence that can be found in reports by US government advisory committees over the past few years. It demonstrates that the growing interest in neuroscience on the part of national security agencies can be discerned in part by reviewing recent reports from the US National Academies. The relationship between national (...) security concerns and neuroscience is complex. Primary questions are discussed in the anthropomorphic terms of concerns and goals, and there is no inference to any particular sort of deliberations within these systems that leads ineluctably to a certain science policy agenda. This article also assesses the cultural underpinnings of neuroscience and ethical implications of evolving neurotechnologic capacity. (shrink)