Spain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates ‘advance directives’ and has prompted various Autonomous Regions to develop legislation in this area. Nevertheless, whilst the variety of legislations in different territories presents advantages, the disparity of criteria also presents problems.Despite significant legislative development, only 23,000 Spanish citizens have filled in an AD. Clearly, AD use is confined to a minority. Several (...) surveys, however, show that the Spanish population views these documents in a positive light. Thus, we must analyse this discrepancy between attitude and practice. A similar situation exists amongst health professionals. Whilst they generally feel that the use of ADs is positive and necessary, they are frequently unwilling to employ them.Bioethical literature and research on ADs has significantly increased in Spain over the last six years. It is likely that this trend will continue in the foreseeable future; but more resources and effort are required if ADs are to become consolidated. (shrink)

This paper evaluates the content of the syllabi of postgraduate courses on public health ethics within accredited schools and programs of public health in the United States in order to gain an awareness of the topics addressed within these courses. Methods: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health for 2012. The (...) “Epidemiology and PHE Syllabi” project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. Results: Data was obtained from 25 schools and 36 accredited programs ; 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. Conclusions: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi. (shrink)

The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had (...) occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken. (shrink)

Objective: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. Design: Longitudinal cohort study. Setting: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. Results: 86 percent of the patients did not change preferences. Sex, age, marital status, (...) hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. Conclusion: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning. (shrink)

The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of (...) patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form. (shrink)

The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of (...) patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form. (shrink)

Cancer is a singular cellular state, the emergence of which destabilises the homeostasis reached through the evolution to multicellularity. We present the idea that the onset of the cellular disobedience to the metazoan functional and structural architecture, known as the cancer phenotype, is triggered by changes in the cell's external environment that occur with ageing: what ensues is a breach of the social contract of multicellular life characteristic of metazoans. By integrating old ideas with new evidence, we propose that with (...) ageing the environmental information that maintains a multicellular organisation is eroded, rewiring internal processes of the cell, and resulting in an internal shift towards an ancestral condition resulting in the pseudo‐multicellular cancer phenotype. Once that phenotype emerges, a new local social contract is built, different from the homeostatic one, leading to tumour formation and the foundation of a novel local ecosystem. (shrink)

Principles of procreative beneficence (PPBs) hold that parents have good reasons to select the child with the best life prospects. Sparrow (2010) claims that PPBs imply that we should select only female children, unlesswe attach normative significance to “normal” human capacities. We argue that this claim fails on both empirical and logical grounds. Empirically, Sparrow’s argument for greater female wellbeing rests on a selective reading of the evidence and the incorrect assumption that an advantage for females would persist even when (...) a serious gender imbalance is obtained. Logically, PPBs cite only pro tanto reasons and allow that the good of an individual child could be outweighed by other morally relevant considerations, such as those which take collectively suboptimal outcomes into account. There is thus no need to attach value to the “normal.”. (shrink)

O dendê, símbolo peculiar e relevante da culinária nacional, tem sido objeto de investigação em diferentes vertentes, e neste trabalho será abordado pelo campo da visualidade e da cultura baiana. Buscou-se evidenciar o histórico do dendê, a tipologia e a classificação da estrutura formal, bem como a sua validação na religião de matriz africana do Candomblé. Nesse sentido, observa-se a existência do dendê na cultura material e imaterial das pessoas, sobretudo da população baiana, que interage nos modos de viver, trabalhar, (...) conceber imagens e repertórios. A metodologia adotada é a revisão de literatura que compreende a identidade cultural, a identidade baiana, a cultura e o cultivo do dendê, e seu simbolismo no âmbito sagrado, que se consolidou com pensadores centrais como Munanga (2020), Mariano (2009), Barreto e Freitas (2008), Bolini (2012), Lody (1992, 2009), Moraes e Pachêco (1985), Correa (2012), Oliveira (2009). Desse modo, conclui-se que o dendê é um elemento interdisciplinar presente em diversos contextos do cotidiano como na cultura, na arte, nas relações de fé, em produtos, as ações efêmeras e o imaginário coletivo. (shrink)

This study compares the balance of newspaper and television news coverage about migration in two countries that were differently affected by the so-called “refugee crisis” in 2015 in terms of the geopolitical involvement and numbers of migrants being admitted. Based on a broad consensus among political elites, Germany left its borders open and received about one million migrants mainly from Syria during 2015. In contrast, the conservative British government was heavily attacked by oppositional parties for closing Britain’s borders and, thus, (...) restricting immigration. These different initial situations led to remarkable differences between the news coverage in both countries. In line with news value theory, German media outlets reported much more on migration than did their British counterparts. In line with indexing theory, German news coverage consonantly reflected the consensual view of German political elites, while British news media reported along their general editorial lines. (shrink)

Human decisions are increasingly supported by decision support systems (DSS). Humans are required to remain “on the loop,” by monitoring and approving/rejecting machine recommendations. However, use of DSS can lead to overreliance on machines, reducing human oversight. This paper proposes “reflection machines” (RM) to increase meaningful human control. An RM provides a medical expert not with suggestions for a decision, but with questions that stimulate reflection about decisions. It can refer to data points or suggest counterarguments that are less compatible (...) with the planned decision. RMs think against the proposed decision in order to increase human resistance against automation complacency. Building on preliminary research, this paper will (1) make a case for deriving a set of design requirements for RMs from EU regulations, (2) suggest a way how RMs could support decision-making, (3) describe the possibility of how a prototype of an RM could apply to the medical domain of chronic low back pain, and (4) highlight the importance of exploring an RM’s functionality and the experiences of users working with it. (shrink)

Un tipo de prolepsis, utilizado frecuentemente en Argonáuticas, es el discurso-programa en el cual un personaje anticipa la narración posterior. De esta manera funciona el relato de Fineo como guía de navegación para los Argonautas. Con el ineludible modelo de los relatos de viajes de Odisea, esta narración interna guarda una relación especular con la obra que la contiene y conlleva una cuasi-identificación entre narrador interno y narrador principal. Este artículo tiene como objetivo el análisis de los niveles narrativos en (...) este relato, para mostrar el modo en que esa técnica anticipatoria funciona en el poema en un nivel metaliterario. One type of prolepsis, frequently used in the Argonautica, is the programmatic speech in which a character anticipates the subsequent story. In this manner works the story of Phineus as navigation guidance for the Argonauts. With the inevitable model of travel stories of Odyssey, this internal narrative keeps a mirror-relationship with the work that contains it and carries a quasi-identification between internal narrator and main narrator. This article aims to analyze the narrative levels in this story, to show how this anticipatory technique works in the poem on a metaliterary level. (shrink)

El presente artículo aborda las connotaciones y los fundamentos de la paráfrasis cum canere vellem en Serv. Ecl. 6. 3. El análisis del sentido del verbo volo en este contexto y la confrontación del pasaje con Serv. Ecl. 6. 5 revelan que Servio interpreta la frase cum canerem reges et proelia como referencia a un temprano empeño de Virgilio en componer poesía épica, del que pronto desistió. Esta interpretación está condicionada por la idea de que la secuencia cronológica Églogas - (...) Geórgicas - Eneida tiene un correlato jerárquico, idea que se funda en noticias biográficas y en la teoría de la tripertita varietas. This paper focuses on the connotations and grounds of the paraphrase cum canere vellem in Serv. Ecl. 6. 3. The analysis of the sense of verb volo within this context, as well as the confrontation between that passage and Serv. Ecl. 6. 5, show that Servius interprets the clause cum canerem reges et proelia as a reference to Virgil's early endeavor to compose an epic poem, from which he shortly desisted. This interpretation is conditioned by the idea that the chronological sequence Eclogues - Georgics - Aeneid has a hierarchical correlate, an idea which is founded on biographical information and the theory of tripertita varietas. (shrink)

En el marco de una investigación mayor acerca de la duración en el arte, el cine y la literatura en Colombia, en este trabajo realizamos un estudio de caso de un corpus conformado por la videoinstalación El caballero de la fe, de José Alejandro Restrepo (2011), y los ensayos fílmicos Pirotecnia (2019), de Federico Atehortúa, y Bicentenario, de Pablo Álvarez (2020). La hipótesis que desarrollamos afirma que estas piezas audiovisuales colombianas contemporáneas, mediante un uso de los recursos técnicos disponibles (...) puestos sobre la materialidad de lo visual, transforman, reescriben, subvierten y sublevan el sentido de las imágenes. Son obras que, por un lado, dislocan el tiempo registrado de las imágenes al intervenir en sus tiempos, en las gradaciones de su intensidad y en los movimientos de sus elementos y, a su vez, los recolocan en el tiempo proyectado como parte del proceso de sublevación de la imagen. (shrink)

El presente artículo pretende invitar al estudio del impacto que tuvo _El Evangelio en Triumpho_ de Olavide sobre el pensamiento decimonónico. Con ese fin propone, en primer lugar, leerlo captando en sus rasgos esenciales el valor alegórico de sus personajes en sus relaciones. A continuación, señala qué aspectos de esa lectura habrían influido de manera más marcada en las obras de Maistre y Saint-Simon, con las que abarca las dos tendencias post-revolucionarias de entender la historia, catecóntica y quiliástica. Finalmente, presenta (...) la unidad milenarista de la obra de Olavide, ajena a aquellas interpretaciones precisamente por su ortodoxia, apuntando, como lectura alternativa a la francesa, la que sugiere Dostoyevski en _El Gran Inquisidor_. (shrink)

This paper examines what agents should do when others fail to comply with their responsibilities to prevent dangerous climate change. It distinguishes between six different possible responses to noncompliance. These include what I term (1) 'target modification' (watering down the extent to which we seek to prevent climate change), (2) ‘responsibility reallocation’ (reassigning responsibilities to other duty bearers), (3) ‘burden shifting I’ (allowing duty bearers to implement policies which impose unjust burdens on others, (4) 'burden shifting II’ (allowing some to (...) protect peoples rights in ways which impose otherwise unjustified burdens on the duty bearers, (5) 'compromising moral ideals' (permitting agents to compromise non-justice ideals that they are otherwise bound by); and (6) ‘promoting compliance (implementing policies and creating institutions which reduce noncompliance). It concludes by outlining a methodological framework for evaluating these options, and by setting out my tentative and provisional evaluation of which responses are the least bad. (shrink)

It is commonly accepted that the history of Spanish anarchism started in the early nineteenth century with the economist and social reformer Ramón de la Sagra (1798–1871). In 1845, he launched the first anarchist periodical, El Porvenir, which introduced to Spain the ideas of Proudhon, Fourier, and Saint-Simon. Between 1848 and 1849, de la Sagra and Proudhon founded the Banco Popular. Despite this, the Spanish anarchist movement did not properly get underway until after the International Workingmen's Association (IWA) meeting in (...) London in 1864, when the supporters of Bakunin sent the Italian Giuseppe Fanelli to Spain. His mission was to establish the Spanish section of the First International (Sección Española de la Primera International), which occurred in 1869. The triumph of Bakunin's anarchosyndicalist theories was so great that when Pablo Lafargue arrived in Madrid in 1871 with the intention of founding a workers' political party, he was told by the Catalan statesman Francisco Pi y Margall that a Marxist political party would never succeed in Spain. (shrink)

This book, designed for high-level undergraduates, postgraduates and fellow researchers, introduces the reader to the main areas of metaethical work today. As we as introducing familiar positions and arguments, Kirchin argues clearly and engagingly for a set of distinctive and arresting views.

We study the handicap principle in terms of the Sir Philip Sidney game. The handicap principle asserts that cost is required to allow for honest signalling in the face of conflicts of interest. We show that the significance of the handicap principle can be challenged from two new directions. Firstly, both the costly signalling equilibrium and certain states of no communication are stable under the replicator dynamics ; however, the latter states are more likely in cases where honest signalling should (...) apply. Secondly, we prove the existence and stability of polymorphisms where players mix between being honest and being deceptive and where signalling costs can be very low. Neither the polymorphisms nor the states of no communication are evolutionarily stable, but they turn out to be more important for standard evolutionary dynamics than the costly signalling equilibrium. (shrink)

In a previous paper (see ‘Tolerant, Classical, Strict’, henceforth TCS) we investigated a semantic framework to deal with the idea that vague predicates are tolerant, namely that small changes do not affect the applicability of a vague predicate even if large changes do. Our approach there rests on two main ideas. First, given a classical extension of a predicate, we can define a strict and a tolerant extension depending on an indifference relation associated to that predicate. Second, we can use (...) these notions of satisfaction to define mixed consequence relations that capture non-transitive tolerant reasoning. Although we gave some empirical motivation for the use of strict and tolerant extensions, making use of them commits us to the view that sentences of the form ‘ p∨¬p ’ and ‘ p∧¬p ’ are not automatically valid or unsatisfiable, respectively. Some philosophers might take this commitment as a negative outcome of our previous proposal. We think, however, that the general ideas underlying our previous approach to vagueness can be implemented in a variety of ways. This paper explores the possibility of defining mixed notions of consequence in the more classical super/sub-valuationist setting and examines to what extent any of these notions captures non-transitive tolerant reasoning. (shrink)

The Prologue offers an overview of the Reformation of method from Augustine of Hippo through to the Ramist movement, providing an orientation to the rest of the book. It highlights and explains an important nexus of Realism, exemplarism and illumination fundamental to Ramism. Beginning with Augustine it shows how these themes coalesced into a distinctive Christian philosophy taken up and refined by Franciscans such as Bonaventure of Bagnoregio and John Duns Scotus, as well as by Ramon Lull, the Franciscan-inspired encyclopaedist. (...) It traces the continuation of this methodological impulse into the Platonism and Christian humanism of the Renaissance, highlighting especially the topical and Realist (Scotistic) reform of logic pioneered by Lorenzo Valla and Rudolph Agricola. It concludes by showing the reception of this topical and biblical reform in Philipp Melanchthon and the movement of Reformed scholasticism, revealing Reformed Scotism and Christian philosophy as important preconditions for Ramism. (shrink)

We say that a sentence A is a permissive consequence of a set X of premises whenever, if all the premises of X hold up to some standard, then A holds to some weaker standard. In this paper, we focus on a three-valued version of this notion, which we call strict-to-tolerant consequence, and discuss its fruitfulness toward a unified treatment of the paradoxes of vagueness and self-referential truth. For vagueness, st-consequence supports the principle of tolerance; for truth, it supports the (...) requisite of transparency. Permissive consequence is non-transitive, however, but this feature is argued to be an essential component to the understanding of paradoxical reasoning in cases involving vagueness or self-reference. (shrink)

Is democracy a human right? There is a growing consensus within international legal and political practice that the answer is “Yes.” However, some philosophers doubt that we should see democracy as a human right. In this paper I respond to the most systematic challenge presented so far, which was recently offered by Joshua Cohen. His challenge is directed to the view that democracy is a human right, not to the view that democracy is part of what justice demands. It is (...) instructive because it forces us to consider important questions about the nature and justification of human rights, including the putative human right to democracy. There is a tendency to see every claim of justice as a human right, and Cohen presses us to face the risk that this slip may occur in the case of democracy. Thus my aim is not simply to refute Cohen’s arguments but to engage the questions he forcefully and helpfully puts on the table. I start in section 2 by analyzing Cohen’s account of human rights. In section 3 I defend the human right to democracy against his challenge. I conclude in section 4 by articulating some reasons for the claim that democracy is a human right that mobilize and elaborate on some of Cohen’s own key premises. (shrink)

Europe is inseparable from its history. That history has been extensively studied in terms of its political history, its economic history, its religious history, its literary and cultural history, and so on. Could there be a distinctively philosophical history of Europe? Not a history of philosophy in Europe, but a history of Europe that focuses on what, in its history and identity, ties it to philosophy. In the two volumes of Europe: A Philosophical History - The Promise of Modernity and (...) Beyond Modernity - Simon Glendinning takes up this question, telling the story of Europe's history as a philosophical history. In Part 1, The Promise of Modernity, Glendinning examines the conception of Europe that links it to ideas of rational Enlightenment and modernity. Tracking this self-understanding as it unfolds in the writings of Kant, Hegel and Marx, Glendinning explores the transition in Europe from a conception of its modernity that was philosophical and religious to one which was philosophical and scientific. While this transition profoundly altered Europe's own history, Glendinning shows how its self-confident core remained intact in this development. But not for long. This volume ends with an examination of the abrupt shattering of this confidence brought on by the first world-wide war of European origin - and the imminence of a second. The promise of modernity was in ruins. Nothing, for Europe, would ever be the same again. (shrink)

The main purpose of this paper is to examine the validity of the contention that, over the past decades, we have been witnessing the rise of the ‘posthuman condition’. To this end, the analysis draws on the work of the contemporary philosopher Rosi Braidotti. The paper is divided into four parts. The first part centres on the concept of posthumanism, suggesting that it reflects a systematic attempt to challenge humanist assumptions underlying the construction of ‘the human’. The second part focuses (...) on the concept of post-anthropocentrism, demonstrating that it articulates a desire to reject the twin ideas of ‘species supremacism’ and ‘human exceptionalism’, which it seeks to replace with ‘species egalitarianism’ and ‘monistic vitalism’. The third part is concerned with the concept of critical posthumanities, positing that its advocacy is based on the cross-fertilization of posthumanism and post-anthropocentrism. The fourth part offers an assessment of the ‘posthuman condition’ thesis, evaluating the extent to which it sheds new light on the ways in which our engagements with the world are shaped by the confluence of zoe-, geo-, and techno-based dimensions. The paper concludes with a brief summary of the key insights gained from the preceding inquiry. (shrink)

First published in 1962, this classic study examines the relationship between authority and justice, life, truth, and order. Simon, himself a passionate proponent of liberty, defends authority as an essential concomitant of liberty.

What is the meaning of general covariance? We learn something about it from the hole argument, due originally to Einstein. In his search for a theory of gravity, he noted that if the equations of motion are covariant under arbitrary coordinate transformations, then particle coordinates at a given time can be varied arbitrarily - they are underdetermined - even if their values at all earlier times are held fixed. It is the same for the values of fields. The argument can (...) also be made out in terms of transformations acting on the points of the manifold, rather than on the coordinates assigned to the points. So the equations of motion do not fix the particle positions, or the values of fields at manifold points, or particle coordinates, or fields as functions of the coordinates, even when they are specified at all earlier times. It is surely the business of physics to predict these sorts of quantities, given their values at earlier times. The principle of general covariance therefore seems untenable. (shrink)

The Everett interpretation of quantum mechanics divides naturally into two parts: first, the interpretation of the structure of the quantum state, in terms of branching, and second, the interpretation of this branching structure in terms of probability. This is the first of two reviews of the Everett interpretation, and focuses on structure, with particular attention to the role of decoherence theory. Written in terms of the quantum histories formalism, decoherence theory just is the theory of branching structure, in Everett's sense.