Organ transplantation is a lifesaving procedure for end-organ damage and remains up to today as the most cost-effective alternative to treat these conditions. However, the main limitation to performing organ transplants is the availability of donor organs suitable for transplantation. To increase the donor pool, expanding organ donation from the conventional neurologic determination of death (NDD) to include circulatory determination of death (DCD) has been a well-established method of increasing donors in other countries. In this article, we discuss the clinical (...) and ethical considerations for introducing DCD in Chile. The concepts we have used could very well be translatable to other similar countries which have not implemented this donation system yet. The most relevant issue to date is that DCD needs to alter the care of dying patients to obtain quality donor organs. In some countries, including Chile, there are some cultural barriers regarding withdrawal-of-care. These barriers include confusing withdrawal of care with acceleration of death, which leads to many practitioners refusing to remove artificial life support, and in turn only minimize ventilatory support or switch to a T-tube (without extubation). This cultural barrier could be overcome with careful consideration of the opinions of healthcare workers, family members, community and policy-based stakeholders. We also identified ethical issues related to informed consent of both donor and recipients, among other relevant ethical considerations. In conclusion, DCD donation in Chile can increase organ donation numbers in one of Latin America's countries with the lowest effective donor rate. However, this opportunity must be taken with caution to avoid the opposite effect if this policy is not well implemented, respecting the sound ethical principles mentioned in this paper. (shrink)

Lougheed, in his paper ‘African vital force and the permissibility of euthanasia’,1 offers a non-western perspective rooted in African traditions, broadening the debate on euthanasia by emphasising the importance of culture and context. We first challenge Lougheed’s stance that being an object of harmonious relationships serves as an argument against the permissibility of a patient requesting euthanasia. Then, based on the Latin American (LATAM) experience and by introducing the concept of relational autonomy, we aim to further contribute to Lougheed’s call (...) for a broader dialogue on euthanasia that incorporates non-western values. A communitarian approach, rather than necessarily opposing euthanasia, can support the right to it by promoting both individual dignity and collective well-being. Although ethical norms are highly influenced by culture, certain ethical principles, such as ‘respect for persons’, should be universal.2 Considering Kant’s categorical imperative, ‘ So act as to treat humanity, whether in your own person or in another, always as an end and never as only a means ’, as the foundation of the principle respect for persons, Lougheed’s argument against the permissibility of euthanasia grounded on a person being the object of something for someone else, neglects this universal principle. While some individuals in collectivistic societies would give more weight to the benefits to others when considering ending their own lives, and we acknowledge that patients with advanced illnesses or in end-of-life processes can still nurture harmonious and meaningful relationships, …. (shrink)

This study examines the ethical dilemmas and difficulties encountered by Portuguese school psychologists. As part of a larger survey, participants were asked about ethical issues faced in daily practice and asked to describe ethical incidents. Of the 477 respondents, 274 reported 441 ethically troubling or challenging situations. Responses were coded into a six-category system based on the code of ethics of Portuguese psychologists. Most of the reported dilemmas concerned privacy and confidentiality principles. Results are discussed in light of relevant literature (...) and international findings. Implications for the development of the profession and future research are provided. (shrink)

Cet article présente les résultats de l'analyse d'isotopes stables du carbone et de l'azote pratiquée sur des échantillons d'ossements humains issus des fouilles de l'habitat mésohelladique de l'Aspis. L'objectif de l'analyse est de reconstituer le régime alimentaire des habitants de l'Aspis et d'étudier les variations de régime entre des sous-groupes de population définis par des critères d'âge et de sexe et/ou de statut social. Sept échantillons ont été prélevés, dont quatre seulement ont fourni suffisamment de collagène pour être analysés. Les (...) données isotopiques indiquent que les habitants de l'Aspis avaient un régime alimentaire de type terrestre C3 relativement homogène ; toutefois, le seul individu de sexe masculin inhumé dans le cimetière semble avoir consommé plus de protéines animales (viande et/ou produits laitiers). Les ressources marines semblent avoir occupé une place négligeable dans l'alimentation des habitants de l'Aspis. D'une façon générale, le signal isotopique de leur régime alimentaire ne diffère pas fondamentalement de celui qui a été observé pour leurs contemporains de Lerne ou pour le groupe inhumé dans le Cercle Β de Mycènes. (shrink)

RESENHA: REIMER, Haroldo. Liberdade religiosa na História e nas Constituições do Brasil . São Leopoldo: Oikos, 2013. 120 p.

Objective: Illness perceptions are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors and examine the impacts of IP on perceived stress and preventive behaviors.Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed (...) considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution. (shrink)

In this book symposium text, I focus on Ciurria’s critique of P. F. Strawson’s incredibly influential paper “Freedom and Resentment”, and more generally present-day Strawsonians about moral responsibility. Ciurria rightfully argues that the picture painted of “our responsibility practices” is highly idealized; it ignores crucial power asymmetries and oppression. I agree with this. However, it seems to me that Ciurria sometimes lacks awareness of exactly how profound the disagreement between her and Strawson and his followers is.

Desde o século XIX o catolicismo foi assinalado por uma divisão interna advinda das demandas pastorais de como a Igreja Católica deveria se situar e responder aos novos desafios lançados pela modernidade. Uns entendiam que ela deveria dialogar com modernidade, abrindo-se àquelas perspectivas positivas do projeto moderno, outros negavam qualquer possibilidade de tal diálogo, vendo nos valores modernos apenas anticristianismo e perdição, defendendo o lançamento de anátemas aqueles que, possivelmente, se desviassem da ortodoxia. O Concílio Vaticano II (1962-1965) pode ser (...) compreendido como um campo de lutas simbólico-normativas, no qual estas duas tendências colocaram-se frente a frente nos inúmeros debates. Este artigo tem como objetivo principal apresentar brevemente a atuação de dois bispos brasileiros conservadores no concílio: D. Antônio de Castro Mayer e D. Geraldo de Proença Sigaud (1962-1965). Para tanto, apresentaremos algumas das principais intervenções dos bispos na assembleia conciliar, chamando atenção para os temas em que travaram maior combate, como liberdade religiosa, liturgia e organização hierárquica da Igreja.Since the 19th century Catholicism has been marked by internal divisions arising from the pastoral demands of how the Catholic Church should position itself and deal with the new challenges launched by modern times. Some people understood that the Catholic Church was supposed to evolve with modern times and open itself to new perspectives related to the modern project. Others denied any possibility of dialogue with the modern times and believed that modern values would encourage scepticism and anti Christianity, defending also the excommunication of those who deviate from orthodoxy. The Second Vatican Council (1962-1965) can be understood as a symbolic-normative battle field, in which two divergent positions are in continuous confrontation. This article aims to briefly present the opinions of two Brazilian conservative Bishops in the Council: D. Antônio de Castro Mayer and D. Geraldo Proença Sigaud (1962-1965). For this purpose, the main points made by the Bishops at the Conciliar Assembly, will be outlined. Therefore, the focus of the article will be on the more controversial themes discussed at that time, such as religious freedom, liturgy and hierarchical Church organization. Keywords: Brazilian bishops. Catholic conservatism. Second Vatican Council. Coetus Internationalis Patrum. (shrink)

It has been argued that a retributivist criminal justice system treats offenders with a respect lacking in alternative criminal justice systems; retributivism presumably recognizes that offenders are fellow members of the moral community who can be held responsible for their actions. One version of the respect argument builds on P.F. Strawson’s moral responsibility theory. According to Strawson, we may take either a participant or objective attitude toward other people. The former is the default attitude when interacting with other adults, whereas (...) the latter is fit for children and the mentally disabled or ill, whom we merely try to manage and handle as best we can. The participant attitude also involves holding people responsible when they do wrong. Supposedly, a retributivist criminal justice system functions as a natural continuation of our everyday, participant, and responsibility-holding practices, unlike alternative systems that adopt an objective attitude toward offenders. I argue that this is wrong. The participant attitude requires reciprocity and, usually, some level of equality too. Even an idealized retributivist system has little room for this, not to mention the flawed versions of this system we see in reality. (shrink)

Book reviews ROY-LYSENCOURT, Philippe. Les membres du Coetus Internationalis Patrum au Concilie Vatican II. Inventaire des interventions et souscriptions des adhérents et sympathisants. Liste des signataires d’occasion et des théologiens. Leuven: Peeters, 2014. 484 p.

A relação entre os quatro livros de O mundo como Vontade e Representação, isto é, entre as quatro partes da filosofia de Schopenhauer, tem sido uma das questões mais controversas da pesquisa sobre seu pensamento. Saber se a ética é de fato mais importante que a estética, ou se a metafísica deve ser subordinada à teoria do conhecimento, são questões que têm ocupado frequentemente os intérpretes do filósofo. Há diversas interpretações rivais sobre o modo como a filosofia de Schopenhauer deve (...) ser lida, se como um sistema arquitetônico e linear, ou orgânico e sem subordinação de uma parte à outra, por exemplo. As afirmações do próprio autor sobre o estatuto de sua filosofia nem sempre são suficientes para dirimir as controvérsias. No presente artigo, procurarei reconstruir algumas dessas leituras e propor uma interpretação própria para o que entendo ser o sistema filosófico de Schopenhauer. (shrink)

Este trabajo se propone explorar las particularidades literarias y morfosintácticas de la canción de cuna presente en el _ Poema de Dánae _ _ _(fr. 271 P.) de Simónides, _Arrastradores de redes_ _ _(fr. 47a R.) de Esquilo y el _Idilio_ XXIV de Teócrito. El objetivo es demarcar las características comunes entre los cantos y analizar los recursos retóricos y temáticos utilizados como estrategia de los poetas para caracterizar el discurso directo de determinados personajes (mujeres y sátiros). Se espera llegar (...) a una delimitación del género de la canción de cuna como tal y considerar tanto su contexto de performance como lo escaso de su conservación. (shrink)

Hybridization is a method invented by Arthur Prior for extending the expressive power of modal languages. Although developed in interesting ways by Robert Bull, and by the Sofia school , the method remains little known. In our view this has deprived temporal logic of a valuable tool.The aim of the paper is to explain why hybridization is useful in temporal logic. We make two major points, the first technical, the second conceptual. First, we show that hybridization gives rise to (...) well-behaved logics that exhibit an interesting synergy between modal and classical ideas. This synergy, obvious for hybrid languages with full first-order expressive strength, is demonstrated for a weaker local language capable of defining the Until operator; we provide a minimal axiomatization, and show that in a wide range of temporally interesting cases extended completeness results can be obtained automatically. Second, we argue that the idea of sorted atomic symbols which underpins the hybrid enterprise can be developed further. To illustrate this, we discuss the advantages and disadvantages of a simple hybrid language which can quantify over paths. (shrink)

Em intervalos frequentes ao longo dos anos, o professor Chomsky vituperou tanto contra noções do senso comum quanto contra noções técnicas de linguagem pública ou “linguagem externalizada”, afirmando que elas são confusas, mal definidas ou desprovidas de qualquer interesse científico. Como cientista, ele somente estaria interessado na linguagem pública se ela fosse um “objeto real do mundo real” (Chomsky, 1993, p. 39), e não uma noção “artificial” e “arbitrária” (Chomsky, 1985, p. 26). Proponho articular tal noção de linguagem pública para (...) ele. Chomsky também condena a noção que de o propósito da linguagem é a comunicação. Sustentarei, ao contrário, que uma função primária da faculdade humana da linguagem é apoiar convenções linguísticas, e que estas têm uma função essencialmente comunicativa. (shrink)

The need for new models of social development capable of increasing the resilience of society and of counteracting the destructive processes that ruined a once-powerful state edifice has led to an interest in Eurasianism-a philosophical-historical, culturological, and intellectual-political movement that arose in Russian émigré circles in the early 1920s. Eurasianism made itself known by the publication in 1921 in Sofia of a collection with the symbolic title Exodus to the East [Iskhod k Vostoku]. The initiators of this work were (...) the economist and geographer P.N. Savitskii, the linguist N.S. Trubetskoi, the theologian and philosopher G.V. Florovskii, and the art critic P.P. Suvchinskii. The legal scholar N.N. Alekseev, the historian and philosopher L.P. Karsavin, the historian G.V. Vernadskii, and other eminent Russian émigré scholarly and cultural figures also took part in the movement. (shrink)

New trends in the economic systems management in the context of modern global challenges: collective monograph / scientific edited by M. Bezpartochnyi, in 2 Vol. // VUZF University of Finance, Business and Entrepreneurship. – Sofia: VUZF Publishing House “St. Grigorii Bogoslov”, 2020. – Vol. 1. – 309 p.

Ettore Regàlia.--Herbert Spencer.--F. C. S. Schiller.--Giorgio Hegel.--Giorgio Berkeley.--Giovanni Ruskin.--Rodolfo Eucken.--Federico Nietzsche.--Carlo Michelstaedter.--Giambattista Vico.--Enrico Bergson.--Giovanni Vailati.--Otto Weininger.--Mario Galderoni.--Ciuang-tse.--La Toscana e la filosofia italiana.--Nota bibliografica (p. 351) Indice alfabetico.

This is a well-behaved concept in Newtonian physics. But a center of gravity is not an atom or a subatomic particle or any other physical item in the world. It has no mass; it has no color; it has no physical properties at all, except for spatio-temporal location. It is a fine example of what Hans Reichenbach would call an abstractum. It is a purely abstract object. It is, if you like , a theorist's fiction. It is not one of (...) the real things in the universe in addition to the atoms. But it is a fiction that has nicely defined, well delineated and well behaved role within physics. (shrink)

Kick off the year right... and you will find yourself capable of recognizing the depth and breadth of John's genius. This event, commented on by Bujar Hoxha (South-East European University) chaired by Elma Berisha (Lyceum Institute), is part of the activities of the 2022 International Open Seminar on Semiotics: a Tribute to John Deely on the Fifth Anniversary of His Passing, cooperatively organized by the Institute for Philosophical Studies of the Faculty of Arts and Humanities of the University of Coimbra, (...) the Lyceum Institute, the Deely Project, Saint Vincent College, the Iranian Society for Phenomenology at the Iranian Political Science Association, the International Association for Semiotics of Space and Time, the Institute for Scientific Information on Social Sciences of the Russian Academy of Sciences, the Semiotic Society of America, the American Maritain Association, the International Association for Semiotic Studies, the International Society for Biosemiotic Studies, the International Center for Semiotics and Intercultural Dialogue, Moscow State Academic University for the Humanities and the Mansarda Acesa with the support of the FCT - Foundation for Science and Technology, I.P., of the Ministry of Science, Technology and Higher Education of the Government of Portugal under the UID/FIL/00010/2020 project. *** Eero Tarasti, professor of musicology at the University of Helsinki (chair) in 1984-2016. He was President of the IASS/AIS - International Association for Semiotic Studies, 2004-2014 and is now its Honorary President. In 2016 he has founded the Academy of Cultural Heritages. He studied music in Sibelius Academy, Helsinki, and then in Vienna, Paris, Rio de Janeiro and Bloomington. He got his PhD from the University of Helsinki (1978) after studies in Paris with Claude Lévi-Strauss and A. J. Greimas. He is one of the founders and the director of the international research group Musical Signification since 1984.Tarasti has become Honorary Doctor at Estonian Estonian Academy of Music and Theatre, New Bulgarian University (Sofia), Indiana University (Bloomington), University of Aix-Marseille, and Gheorghe Dima National Music Academy in Cluj-Napoca, Rumania. He has published about 400 articles, edited 50 anthologies, and written 30 monographs; among them one finds: Myth and Music (1979), A Theory of Musical Semiotics (1994), Heitor Villa-Lobos (1996), Existential Semiotics (2000), Signs of Music (2003), Fondéments de la sémiotique existentielle (2009), Fondamenti di semiotica esistenziale (2010), Semiotics of Classical Music (2012, in French 2016), Sein und Schein, Explorations in Existential Semiotics (2015), and Transcending Signs: Essays in Existential Semiotics (2023); two novels: Le secret du professeur Amfortas (2002) and Retour à la Villa Nevski (2014, in Italian L’heredità di Villa Nevski 2014, in Finnish Eurooppa/Ehkä 2016). He has supervised 150 PhDs in Finland and abroad. *** Dr. Bujar Hoxha is a full professor of Communication Sciences at the South-East European University in Tetovo and Skopje, North Macedonia. His teaching courses include communication theory, introduction to communication sciences, and Semiotics of Mass Communication. His main scientific interests are structural semiotics, semiotics of passions, semiotics of disabilities, and existential semiotics. He gained his PhD from the University of Skopje in 2008 on the semiotics of Umberto Eco. Out of his creative and intellectual work, one can number two published novels, a book, as well as several scientific articles published in prestigious scientific journals, such as: “Semiotics of Precision and Imprecision” (2016) and “Multilingualism and Sameness vs Otherness in a Semiotic Context”, (2018) both in de Gruyter Mouton's Semiotica, Berlin and Boston, as well as “On the Applicability of the Semiotics of Passions” (2018) and “The Signs’ Behavior in Autistic Children: Semiosis of an Unspoken Language” (2021), both in the Humanities Bulletin, issued by London Academic Publishing, London, United Kingdom. Recently, Dr. Hoxha has published a monograph entitled: Umberto Eco’s Semiotics: Theory, Methodology and Poetics, issued by Cambridge Scholars Publishing in January 2022, New Castle upon Tyne, UK. *** Homepage: https://www.uc.pt/fluc/uidief/io2s Auditorium: https://www.uc.pt/fluc/uidief/io2s/auditorium *** Technical support assured by Robert Junqueira. The cover image for the video was designed by Zahra Soltani. (shrink)

Engineering is 'the people-serving profession'. The work of engineers involves interaction with clients, other engineers, and the public at large. More than any other profession, their work also directly involves and affects the environment. This book makes the case that engineers have special professional obligations to protect and enhance the environment, and the authors - one, an engineer and the other, a philosopher - seek to provide an ethical basis for these obligations. In exploring these ethical issues, the authors aim (...) to show that engineers make a difference. The text opens with a series of case studies in which engineers face complex and challenging decisions about the environment. Succeeding chapters examine different ideas about environmental ethics for engineers, including professional codes and both modern and historical discussions of environmental responsibility. The book concludes with a collection of readings that complement the text. Students, as well as practising engineers, will find much of interest in this well-argued and thought-provoking book. (shrink)

This article explores three ways in which a cognitively entrenched mindreading (or 'theory of mind') system may bias our thinking as cognitive scientists. One issues in a form of tacit dualism, impacting scientific debates about phenomenal consciousness. Another leads us to think that our own minds are easier to know than they really are, influencing debates about self-knowledge, and about mindreading itself. And the third results in a bias in favour of empiricist over nativist accounts of cognitive development. The discussion (...) throughout is tentative and speculative, and can be regarded as an appeal for caution, as well as a call for further research. (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

Traduçáo. texto Normal 0 21 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} retirado de Carlos E. Caorsi (Ed.). Ensayos sobre Strawson . Universidad de la República/Faculdad de Humanidades y Ciencias de la Educación, Montevidéo,1992, p. 55-71.

The theme of this volume is the multi-faceted 'computational turn' that is occurring through the interaction of the disciplines of philosophy and computing. In computer and information sciences, there are significant conceptual and methodological questions that require reflection and analysis. Moreover, digital, information and communication technologies have had tremendous impact on society, which raises further philosophical questions. This book tries to facilitate the task to continuously work to ensure that its diversity of perspectives and methods proves a source of strength (...) and collaboration rather than a source of instability and disintegration. The first three contributions explore the phenomenon of virtual worlds. The next four focus on robots and artificial agents. Then a group of chapters discusses the relation between human mentality and information processing in computers and the final section covers a broad range of issues at the interface of computers and society. (shrink)