The issues involved in deciding whether to use artificial methods of delivering hydration and nutrition are often very difficult for patients, families, and health care providers. Once private and personal matters, these decisions now frequently involve the judicial system. Five years ago, Hospice of Washington recognized the need for a written policy and wrote the one published here. Its goal is to respect individual preferences and family concerns while addressing the nutrition and hydration needs of dying patients. The policy sets (...) parameters on the issue, provides basic information, and encourages crafting the most fitting resolution to each situation. (shrink)

En la Biblia de Ávila se encuentra el ciclo pictórico de la vida y la pasión de Cristo más completo del Románico español. Cada escena viene acompañada por una inscripción en latín añadida poco después de que se completaran las imágenes. Sin embargo, no todas las inscripciones identifican los personajes o las escenas correctamente. Uno de los errores se encuentra en el último folio del ciclo que, habiendo sido identificado como Pentecostés o la bajada del Espíritu Santo, no presenta ninguna (...) de las características iconográficas típicas de este tema. Este artículo investiga otras alternativas iconográficas que puedan explicar la peculiaridad de la imagen y la posición final del folio. (shrink)

In today’s society, models of God are challenged to account for more than the postmodern context in which Western Christianity finds itself; they should also consider the reality of religious pluralism. Non-monotheistic religions present a particular challenge to Western theological and philosophical God-modeling because they require a model of Gods. This paper uses an African traditional religion as a case study to problematize the effects of monotheism on philosophical models of God. The desire to uphold the image of a singular (...) God tends to invalidate religious experiences that deviate from a given scientifically-verifiable norm. It also mischaracterizes the concept of divinity in religions that maintain divine multiplicity. That is, scholars of African traditional religions affirm that “polytheism” is not an accurate naming of their traditions; rather these religions affirm a community of gods. I propose a Whiteheadian process model that describes a community of gods that has active interaction with the temporal world. Such a model not only broadens conversations of religious pluralism for Western-trained religious scholars, but also acknowledges the Western context in which many practitioners of African traditional religions live. (shrink)

Gratitude is both expected and problematic in live organ donation. Are there grounds to require it, and to forbid access to live donor transplantation to a recipient who fails to signal that he feels any form of gratitude? Recipient gratitude is not currently required for organ donation, but it is expected and may be a moral requirement. Despite this, we argue that making it a condition for live organ transplantation would be unjustified. It would constitute a problematic and disproportionate punishment (...) for perceived immoral behaviour on the part of the recipient. It would also bar the donor from positive aspects of organ donation that remain even in the absence of recipient gratitude. A potential recipient's lack of gratitude should be explored as a possible symptom of other morally problematic issues and integrated into the information provided to the potential donor. Recognition of the donor's gift and gratitude for it may also need to be expressed in part by others. This last aspect is relevant even in cases where the recipient feels and expresses gratitude. (shrink)

We introduce a multimodal logic for order of magnitude reasoning which considers a new logic-based alternative to the notion of closeness, we provide an axiom system and prove its soundness and completeness.

We study logical systems for reasoning about equations involving recursive definitions. In particular, we are interested in "propositional" fragments of the functional language of recursion FLR [18, 17], i.e., without the value passing or abstraction allowed in FLR. The "pure," propositional fragment FLR 0 turns out to coincide with the iteration theories of [1]. Our main focus here concerns the sharp contrast between the simple class of valid identities and the very complex consequence relation over several natural classes of models.

Background Advance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with (...) differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings. Methods We conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group. Results Analysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans. Conclusion Greater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates. (shrink)

Volume 19, Issue 5, May 2019, Page 62-63.

Ethical leadership matters in the context of organizational change due to the need for followers to trust the integrity of their leaders. Yet, there have been no studies investigating ethical leadership and organizational change. To fill this gap, we introduce a model of the moderating role of involvement in change. Organizational change and involvement in change are proposed as context-level moderators in the relationships of ethical leadership and work-related attitudes and performance. We employ a sample of 199 supervisor–subordinate pairs from (...) a wide variety of organizations. Results support a three-way interaction (ethical leadership, organizational change, and involvement in change) for performance and OCBs. Our results have important implications for organizational change since ethical leadership appears to complement follower involvement when change is happening. (shrink)

Mass-marketing frauds are on the increase. Given the amount of monies lost and the psychological impact of MMFs there is an urgent need to develop new and effective methods to prevent more of these crimes. This paper reports the early planning of automated methods our interdisciplinary team are developing to prevent and detect MMF. Importantly, the paper presents the ethical and social constraints involved in such a model and suggests concerns others might also consider when developing automated systems.

Esta obra está organizada en tres partes, en las que se indaga la plausibilidad del discurso de la Bioética y Teológica. En la primera de ellas, se estudia el vínculo que existe entre esta disciplina científica, el mensaje evangélico y la tradición cristiana, punto de partida y origen de todo este entramado bioético que aspira a sal-vaguardar valores humanos fundamentales. En la segunda, se trata de la relación que debe regir entre esta rama de la Teología y el polifacético mundo (...) científico (biomedicina, bioderecho, etc.). Por su parte, en la tercera, se analiza el estatuto epistemológico que configura a la Bioética Teológica, es decir, sus señas de identi-dad; asimismo, en esta sección, se indaga igualmente acerca del papel que, por derecho propio, corresponde en la vida pública a esta disciplina científica. (shrink)

As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey aimed (...) at assessing public views on when a life is not worth living, in an effort to inform ongoing legal and clinical debates about withdrawal of life-sustaining treatment for children. These findings raise important questions about how we define and measure outcomes that matter to parents as they make these tragic decisions. It is challenging to interpret these findings in the absence of context of how decision-making for infants occurs in real-time. The nature of this study and its objective required that cases be substantially simplified. As the authors acknowledge, the prognoses and function of the children involved in these cases were often deeply contested. Prognostic uncertainty is common for children with significant …. (shrink)

The present paper explores the phenomenology of disorientation and its relationship with self-consciousness. Section 1 discusses previous literature on the links between self-location and self-consciousness and proposes a distinction between minimal self-location and integrated self-location. The double aim of the paper is to use this distinction to deepen our understanding of spatial disorientation, and to use the phenomenology of disorientation to elucidate the role that integrated self-location plays in shaping self-consciousness. Section 2 starts by looking at the experience of being (...) “turned around”, which is a common experience of disorientation. This analysis leads to the conclusion that integrated self-location is transmodal and depends on all three egocentric axes, and that disorientation destabilizes this integrated self-location. Section 3 explores a corpus of reports of disorientation episodes and highlights four key characteristics of these experiences and their links to self-consciousness, focusing on the transformations in both the lived body and the experience of space. The central thesis of this paper is that during disorientation a destabilization of integrated self-location results in a diminished form of self-consciousness. (shrink)

Research has shown that both physical exercise and cognitive training help to maintain cognition in older adults. The question is whether combined training might produce additive effects when the group comparisons are equated in terms of exercise intensity and modality. We conducted a systematic electronic search in MEDLINE, PsycInfo, and Cochrane Central Register of Controlled Trials databases to identify relevant studies published up to February 2021. Seven hundred and eighty-three effect sizes were obtained from 50 published intervention studies, involving 6,164 (...) healthy older adults, and submitted to a three-level meta-analysis. Results showed that combined training produced a small advantage in comparison to single cognitive training on executive functions, whereas both types of training achieved similar effects on attention, memory, language, processing speed, and global cognition. Combined training achieved higher training gains in balance than single physical training, indicating a transfer from cognitive training to balance. Performing cognitive and physical exercise simultaneously, and interactive training produced the largest gains in executive functions, speed, and global cognition, as well as the largest improvements in physical functions. Aerobic training was associated with higher effects in attention and fitness, whereas non-aerobic training produced larger effects in global cognition and balance. For all cognitive and physical outcomes, training resulted more advantageous when performed in a social context, even though individual training obtained similar results in balance as group training.Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier: CRD42020175632. (shrink)

"The contributions to this book offer a broad vision of the relationships that were established between Greek Philosophy and the Mystery Cults. The authors centre their attention on such thinkers as Plato, Aristotle, and the Stoic and the Neoplatonist philosophers, who used - and in some cases criticised - doctrinal elements from Mystery Cults, adapting them to their own thinking. Thus, the volume provides a new approach to some of the most renowned Greek philosophers, highlighting the influence that Mystery Cults, (...) such as Orphism, Dionysianism, or the Eleusinian rites, had on the formation of fundamental aspects of their thinking. Given its interdisciplinary character, this book will appeal to a broad academic readership interested in the origin of Hellenic thinking and culture. It will be especially useful for those eager for a deeper approach to two fundamental domains that attract the attention of many Antiquity scholars: Greek philosophy and religion. (shrink)

A pesar de que los filósofos modernos se caracterizan por ser versados en muchas disciplinas y ciencias, pocos son los intelectuales que, como Leibniz, logran formular una comprensión del mundo en la que cada una de estas disciplinas se articula con las demás. Esto hace que la propuesta filosófica y científica del hannoveriano, a diferencia de otras propuestas filosóficas de la modernidad, sea lo suficientemente compleja y robusta como para responder muchas problemáticas contemporáneas. Dada la amplia diversidad de temáticas que (...) aborda Leibniz a lo largo de su vida, sin embargo, el presente libro pretende reflexionar tan sólo sobre los alcances de algunas de estas problemáticas, las cuales se encuentran divididas en cinco grupos o ejes temáticos.El primer grupo de textos, así, aborda problemas relacionados con su metafísica y su caracterización dinámica del mundo. El segundo comprende aquellos textos relacionados con lógica, argumentación y filosofía del lenguaje, mientras que en el tercero se hace alusión a su caracterización de la belleza cara a su noción de orden y armonía. En el cuarto grupo nos encontramos una serie de textos que exploran la relación entre su propuesta filosófica y otras disciplinas, tales como las ciencias naturales, la literatura y la psicología. Finalmente nos encontramos con aquellos textos relacionados con su filosofía práctica, en particular con sus escritos sobre jurisprudencia y filosofía política. (shrink)

This paper aims to offer an account of affective experiences within Predictive Processing, a novel framework that considers the brain to be a dynamical, hierarchical, Bayesian hypothesis-testing mechanism. We begin by outlining a set of common features of affective experiences that a PP-theory should aim to explain: feelings are conscious, they have valence, they motivate behaviour, and they are intentional states with particular and formal objects. We then review existing theories of affective experiences within Predictive Processing and delineate two families (...) of theories: Interoceptive Inference Theories and Error Dynamics Theories. We highlight the strengths and shortcomings of each family of theories and develop a synthesis: the Affective Inference Theory. Affective Inference Theory claims that valence corresponds to the expected rate of prediction error reduction. In turn, the particular object of a feeling is the object predicted to be the most likely cause of expected changes in prediction error rate, and the formal object of a feeling is a predictive model of the expected changes in prediction error rate caused by a given particular object. Finally, our theory shows how affective experiences bias action selection, directing the organism towards allostasis and towards optimal levels of uncertainty in order to minimise prediction error over time. (shrink)

El martes 26 de abril de 2016 en la Universidad Pontificia Bolivariana de Medellín, en el curso “De la analítica a los acto de habla” del Doctorado en Filosofía, tuvimos la oportunidad de compartir y hacer una conversatorio con el filósofo mexicano Dr. Alejandro Tomasini Bassols, investigador del Instituto de Investigaciones Filosóficas y profesor de filosofía en la Facultad de Filosofía y Letras de la UNAM. El profesor Tomasini es uno de los investigadores más reconocidos en la obra del Filósofo (...) austriaco Ludwig Wittgenstein, además de haber desarrollado una importante obra alrededor de la tradición analítica y de algunos problemas actuales como la discusión sobre la pena capital. También el profesor Tomasini en su visita a Colombia, inicialmente participó en Medellín con una conferencia titulada “Derecho y objetividad”, en la Universidad Pontificia Bolivariana y luego en la Feria del Libro de Bogotá –FILBO- realizó la presentación y conferencia del libro Hacer mundos: el nombrar y la significatividad. Previo a su viaje a Bogotá, interactuó con el curso doctoral en filosofía y de este encuentro académico presentamos el siguiente diálogo. (shrink)

An individual's health, genetic, or environmental-exposure data, placed in an online repository, creates a valuable shared resource that can accelerate biomedical research and even open opportunities for crowd-sourcing discoveries by members of the public. But these data become “immortalized” in ways that may create lasting risk as well as benefit. Once shared on the Internet, the data are difficult or impossible to redact, and identities may be revealed by a process called data linkage, in which online data sets are matched (...) to each other. Reidentification, the process of associating an individual's name with data that were considered deidentified, poses risks such as insurance or employment discrimination, social stigma, and breach of the promises often made in informed-consent documents. At the same time, re-ID poses risks to researchers and indeed to the future of science, should re-ID end up undermining the trust and participation of potential research participants. The ethical challenges of online data sharing are heightened as so-called big data becomes an increasingly important research tool and driver of new research structures. Big data is shifting research to include large numbers of researchers and institutions as well as large numbers of participants providing diverse types of data, so the participants’ consent relationship is no longer with a person or even a research institution. In addition, consent is further transformed because big data analysis often begins with descriptive inquiry and generation of a hypothesis, and the research questions cannot be clearly defined at the outset and may be unforeseeable over the long term. In this article, we consider how expanded data sharing poses new challenges, illustrated by genomics and the transition to new models of consent. We draw on the experiences of participants in an open data platform—the Personal Genome Project—to allow study participants to contribute their voices to inform ethical consent practices and protocol reviews for big-data research. (shrink)

The umbrella-term ‘executive functions’ includes various domain-general, goal-directed cognitive abilities responsible for behavioral self-regulation. The influential unity and diversity model of EF posits the existence of three correlated yet separable executive domains: inhibition, shifting and updating. These domains may be influenced by factors such as socioeconomic status and culture, possibly due to the way EF tasks are devised and to biased choice of stimuli, focusing on first-world testees. Here, we propose a FREE test battery that includes two open-access tasks for (...) each of the three abovementioned executive domains to allow latent variables to be obtained. The tasks were selected from those that have been shown to be representative of each domain, that are not copyrighted and do not require special hardware/software to be administered. These tasks were adapted for use in populations with varying SES/schooling levels by simplifying tasks/instructions and using easily recognized stimuli such as pictures. Items are answered verbally and tasks are self-paced to minimize interference from individual differences in psychomotor and perceptual speed, to better isolate executive from other cognitive abilities. We tested these tasks on 146 early adolescents of both sexes and varying SES, because this is the age group in which the executive domains of interest become distinguishable and in order to confirm that SES effects were minimized. Performance was determined by Rate Correct Scores, which consider speed-accuracy trade-offs. Scores were sensitive to the expected improvement in performance with age and rarely/inconsistently affected by sex and SES, as expected, with no floor or ceiling effects, or skewed distribution, thus suggesting their adequacy for diverse populations in these respects. Using structural equation modeling, evidence based on internal structure was obtained by replicating the three correlated-factor solution proposed by the authors of the model. We conclude that the FREE test battery, which is open access and described in detail, holds promise as a tool for research that can be adapted for a wide range of populations, as well as altered and/or complemented in coming studies. (shrink)

Although the field of surgical ethics focuses primarily on informed consent, surgical decision‐making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment. The ethic of accompaniment is born (...) from a theological tradition that has motivated work to improve health outcomes in those at the margins through its emphasis on listening, solidarity against systemic drivers of disease, and proximity to individuals and communities. Through a review of surgical ethics and exploration of a central patient case, we argue for applying an ethic of accompaniment to the care of surgical patients and their communities. (shrink)

Common ancestry is a central feature of the theory of evolution, yet it is not clear what “common ancestry” actually means; nor is it clear how it is related to other terms such as “the Tree of Life” and “the last universal common ancestor”. I argue these terms describe three distinct hypotheses ordered in a logical way: that there is a Tree of Life is a claim about the pattern of evolutionary history, that there is a last universal common ancestor (...) is an ontological claim about the existence of an entity of a specific kind, and that there is universal common ancestry is a claim about a causal pattern in the history of life. With these generalizations in mind, I argue that the existence of a Tree of Life entails a last universal common ancestor, which would entail universal common ancestry, but neither of the converse entailments hold. This allows us to make sense of the debates surrounding the Tree, as well as our lack of knowledge about the last universal common ancestor, while still maintaining the uncontroversial truth of universal common ancestry. (shrink)

This article is an attempt to develop a measure of ethical sensitivity to racial and gender intolerance that occurs in schools. Acts of intolerance that indicate ethically insensitive behaviors in American schools were identified and tied to existing professional ethical codes developed by school-based professional organizations. The Racial Ethical Sensitivity Test consists of 5 scenarios that portray acts of racial intolerance and ethical insensitivity. Participants viewed 2 videotaped scenarios and then responded to a semistructured interview protocol adapted from Bebeau and (...) Rest. After a 2-week interval, this procedure was repeated. Stability of the REST across time was determined by using the overall test-retest coefficient. Internal as well as interrater consistency was also calculated for each scenario. Overall findings indicate promise for the REST as a reliable measure to assess racial and ethnic sensitivity. (shrink)

El propósito de la “Dialéctica trascendental” es exponer cómo la razón es el origen de la ilusión trascendental, para prevenir los errores que puedan derivarse de ella. Sin embargo, en el “Apéndice”, Kant sostiene que la razón no sólo tiene este aspecto negativo o problemático, también es una facultad que le proporciona al entendimiento la meta de lograr una unidad sistemática de todo conocimiento. En el presente texto abordaré dos preocupaciones interpretativas en torno al “Apéndice”. La primera cuestiona si Kant (...) se contradice a sí mismo en esta sección al plantear que el principio de unidad sistemática es, simultáneamente, subjetivo y objetivo. La segunda reflexiona si se trata de una sección que contradice las tesis centrales de la “Analítica trascendental”, al presentar una nueva condición necesaria para el conocimiento, más allá de las establecidas por el entendimiento y la sensibilidad. (shrink)

Research based on construal level theory (CLT) suggests that thinking about the distant future can prime people to solve problems by insight (i.e., an “aha” moment) while thinking about the near future can prime them to solve problems analytically. In this study, we used a novel method to elucidate the time-course of temporal priming effects on creative problem solving. Specifically, we used growth-curve analysis (GCA) to examine the time-course of priming while participants solved a series of brief verbal problems. Participants (...) were tested in two counterbalanced sessions in a within-subject experimental design; one session featured near-future priming and the other featured far-future priming. Our results suggest high-level construal may temporarily enhance analytical thinking; far-future priming caused transient facilitation of analytical solving while near-future priming induced weaker, transient facilitation of insightful solving. However, this effect is short-lived; priming produced no significant differences in the total number of insights and analytical solutions. Given the fleeting nature of these effects, future studies should consider implementing methodology that allows for aspects of the time-course of priming effects to be examined. A method such as GCA may reveal mild effects that would be otherwise missed using other types of analyses. (shrink)

This paper considers whether and how ‘vitalism’ might be considered relevant as a concept today; whether its relevance should be expressed in terms of disciplinary demarcations between the life sciences and the natural sciences; and whether there is a fundamental incompatibility between a ‘vitalism of process’ and a ‘vitalism as pathos’. I argue that the relevance of vitalism as an epistemological and ontological problem concerning the categorical distinction between living and non-living beings must be contextualized historically, and referred exclusively to (...) the epistemic horizon defined by classical physics. In contrast to this, drawing on the philosophies of Canguilhem, Whitehead, and Atlan, I propose an appreciation of the contemporary relevance of vitalism premised on the pathic and indeterminate character of nature as a whole. From this perspective vitalism expresses a politically significant ethos concerning the relationship between life, knowledge, problems and their solutions. (shrink)

The promise of genomic medicine lies in the opportunity to improve health outcomes via a personalized approach to management, grounded in genetic and genomic variation unique to an individual. However, disparities and inequities mar this remarkable landscape of genomic innovation. Prior efforts to understand these inequities have focused on populations for which genetic testing is relatively protocolized or where test utility varies greatly by ancestry groups, where equitable outcomes are more clearly defined. We therefore consider the current landscape of rare (...) disease genomics, in which diagnostic approaches vary widely and utility remains to be fully understood, and suggest a path forward: how ecosocial theory may be used to guide novel equity‐focused initiatives that incorporate illness narratives to improve population health. We present examples of narrative medicine in rare disease and reimagine the role this discipline may play in genomic sequencing studies, toward incorporation of the unique illness narrative into clinical genetics and genomics practice. Approaches that broaden the definitions of disease and of outcomes of interest will force the field to grapple with its racist history and begin to advance health equity and promote justice so that genomic medicine may truly deliver on its promise. (shrink)

California has focused on health equity in the state’s COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California’s 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier’s test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must (...) meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans. (shrink)