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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)

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Estudos indicam que o estresse altera o sistema imune e pode influir na etiologia, progressão e severidade de doenças. A resiliência pode ser definida como a capacidade que algumas pessoas desenvolvem e as ajudam a passar por situações adversas na vida, a superá-las, e ainda a saírem fortalecidas ou..

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ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

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Caracterización de un grupo de comités de ética en investigación en Colombia Caracterização de um grupo de comitês de ética em pesquisa na Colômbia In the last decades, controlled clinical trials sponsored by the pharmaceutical industry have increased considerably. This has led to the need for greater control and assistance by regulators and ethics committees to ensure appropriate compliance with established ethical standards and good clinical practices in general. In Colombia, the National Food and Drug Surveillance Institute, the regulator in (...) the country, controls and monitors the operation of clinical research with drugs. In 2008, this entity issued Resolution 2378, which provides and regulates research actors in Colombia, including ethics committees. After being in force for several years, it is necessary to know whether research ethics committees in Colombia operate in accordance with this regulation and to determine the status of implementation of the requirements therein. For this purpose, a survey was designed to be voluntarily answered and a response was obtained from 25 of the 69 certified committees in Colombia. Twenty-two of them could be analyzed because their information was complete. Compared with previous studies, favorable changes in development and organization were observed in accordance with the current proposed regulation. Para citar este artículo / To reference this article / Para citar este artigo Suárez-Obando F, Reynales H, Urina M, Camacho J, Viteri M. Caracterización de un grupo de comités de ética en investigación en Colombia. pers. bioét. 2018; 22: 303-318. DOI: 10.5294/pebi.2018.22.2.8. (shrink)

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In this groundbreaking new study,Lowell Nissen explores the use of teleological language in the study of subjects such as behaviorism, negative feedback, and natural selection. He argues that all existing analyses fail to explain how teleological language can be used legitimately, and provides his own analysis in terms of intentionality.

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Josefa Amar y Borbón, une intellectuelle espagnole du XVIIIe siècle, défendit dans ses ouvrages et dans sa vie la raison des femmes, à partir de sa propre tradition culturelle mais simultanément avec d’autres intellectuelles européennes de son temps. Elle se forgea un prestige intellectuel et intervint publiquement dans le débat sur l’admission des femmes dans les sociétés réformistes, contre l’opinion négative d’une partie des hommes des élites éclairées espagnoles. La lecture de ses textes et leur comparaison avec la pensée de (...) sa contemporaine Mme d’Épinay montre que, dans des contextes sociaux et culturels différents, ces deux femmes avait des idées concordantes sur la raison, l’éducation et la condition social des femmes, loin des opinions plus répandues, celles des auteurs comme Thomas, Rousseau et d’autres contemporains espagnols. Elles avaient aussi des stratégies vitales communes, qui visaient à occuper et à revendiquer pour les femmes des possibilités et des espaces dans l’activité culturelle et la sociabilité des Lumières. (shrink)

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This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction technologies (ART), particularly the surrogacy. For that purpose, we interviewed: 1) a lesbian woman who had her daughter through her partner's pregnancy, using ART with anonymous donor semen; 2) a gay man who, together with his partner, used a surrogacy service under contract via a specialised offshore agency; 3) a woman who was a surrogate, in Brazil, for her sister-in-law and (...) brother who lived abroad and, from abroad, sent an embryo fertilised for surrogacy; 4) a woman who resorted to her sister-in-law in order to be a mother by surrogacy, with ovules from the woman herself fertilised with semen from her husband; and 5) the sister-in-law mentioned in 4), who acted as surrogate for her brother and his wife. These interviews made it possible to think about the discursive construction of the legitimacy of such parenthoods, as it is produced by access to, and manipulation and circulation of, reproductive technologies and persons. This biomedical management of bodies sets up a material and discursive circuit that, in turn, produces a complex web of personal, normative, legal, professional and market relationships, particularly with a view to construction of a parenthood anchored in a notion of biologically-constituted origin. In this respect, biological, affective and social bonds merge to produce a precise placement of who is the father and/or who is the mother, as well as who are the important others and how they are linked to the child in a broader web of parenthood. (shrink)

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The last decade has seen a slow but steady increase in the number of postdoctoral scholars employed in faculties of education. In this article, seven postdoctoral scholars who worked in the same Ca...

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ObjectiveIndividuals with an evening chronotype prefer to sleep later at night, wake up later in the day and perform best later in the day as compared to individuals with morning chronotype. Thus, college students without ADHD symptoms with evening chronotypes show reduced cognitive performance in the morning relative to nighttime. In combination with symptoms presented in attention deficit hyperactivity disorder, we predicted that having evening chronotype renders impairment in attention during the morning, when students require optimal performance, amplifying desynchrony.MethodFour hundred (...) college students were surveyed for evening chronotype and symptoms of ADHD. Of those surveyed, 43 students with evening chronotype performed laboratory attention tasks and were queried about fatigue during morning and evening sessions.ResultsStudents with ADHD symptoms demonstrated a greater decrement in sustained attentional vigilance when abstaining from stimulants and asked to perform cognitive tests at times misaligned with natural circadian rhythms in arousal compared to their non-ADHD counterparts with the same chronotype. While individuals with ADHD symptoms had slower reaction-times during sustained attention tasks in the morning session compared to those without symptoms, there was no significant group difference in working memory performance, even though both groups made more errors in the morning session compared to the evening session.ConclusionThese findings suggest that evening chronotype students with ADHD symptoms are at a greater disadvantage when having to perform sustained attention tasks at times that are not aligned to their circadian rhythm compared to their neuro-typical peers. The implications of this finding may be useful for the provision of disability accommodations to college age students with ADHD when they are expected to perform tasks requiring sustained attention at times misaligned with their circadian rhythms. (shrink)

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La presente investigación surge como parte del análisis para la creación de políticas de ecoeficiencia en las empresas y tiene como finalidad el conocer las buenas prácticas ambientales aplicadas por las empresas del sector servicios en la ciudad de Girardot. Se presenta como un estudio descriptivo-analítico con enfoque cualitativo, utilizando como instrumento la ficha de observación aplicada a una muestra de 30 empresas del sector de servicios. Dentro de los resultados obtenidos se encuentra la calificación de acuerdo con un puntaje (...) entre 0.0 y 1.0 y el análisis del resultado total con ponderación de 0% a 100% a 11 criterios evaluados. (shrink)

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There is growing interest in the role of new urban agriculture models to increase local food production capacity in cities of the Global North. Urban rooftop greenhouses and hydroponics are examples of such models receiving increasing attention as a technological approach to year-round local food production in cities. Yet, little research has addressed the unintended consequences of new modes of urban farming and food distribution, such as increased competition with existing peri-urban and rural farmers. We examine how small-scale farmers perceive (...) and have responded to a recently established rooftop greenhouse and online marketplace enterprise in Montréal, Canada. Drawing on interviews with key informants and small-scale farmers, we find that peri-urban and rural producers have been affected in three key ways that represent tensions, adaptations, and synergies arising from this new urban agriculture and food distribution enterprise. First, many farmers are concerned about increased competition and value conflation with the ideals of community supported agriculture and organic farming. Second, some farmers have adapted by developing novel marketing strategies and working with local bridge organizations to collectively market their produce to urban consumers. Third, a few farmers have decided to wholesale their produce to this new enterprise, allowing them to specialize production and avoid marketing their produce directly to urban consumers. Our study suggests that the emergence of a new form of alternative food network in Montréal has created both positive and negative disruptions for existing small-scale producers. Advocates for the expansion of new urban food production and distribution models should therefore give greater consideration to the effects on other actors in the local food system. (shrink)

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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)

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We question whether altruistic motivation links identity fusion and extreme self-sacrifice. We review two lines of research suggesting that the underlying motivation is plausibly egoistic.

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To entertain an idea is to take it in, pay attention to it, give it breathing room, dwell with it for a time. The practice of entertaining ideas suggests rumination and meditation, inviting us to think of philosophy as a form of hospitality and a kind of mental theatre. In this collection, organized around key words shared by philosophy and performance, the editors suggest that Shakespeare's plays supply readers, listeners, viewers, and performers with equipment for living. In plays ranging from (...) A Midsummer Night's Dream to King Lear and The Winter's Tale, Shakespeare invites readers and audiences to be more responsive to the texture and meaning of daily encounters, whether in the intimacies of love, the demands of social and political life, or moments of ethical decision. Entertaining the Idea features established and emerging scholars, addressing key words such as role play, acknowledgment, judgment, and entertainment as well as curse and care. The volume also includes longer essays on Shakespeare, Kant, Husserl, and Hegel as well as an afterword by theatre critic Charles McNulty on the philosophy and performance history of King Lear. (shrink)

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Eleven primary social needs are defined, which if attained, fulfil the generic needs of all societies. Balanced attention to all these needs is the key to sustainability. Based on an analysis of constitutions, media content, citizen surveys, and participant observation, such balance is compared in 28 countries. The dangers of prioritization in China (economic opportunity), Japan (economic opportunity), the former Soviet Union (collective security), and the United States (individual freedom/individual security) are explored in great detail. Finally, homeostatic social mechanisms designed (...) to allocate attention to the full range of needs are discussed. (shrink)

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National and international research cultures for the innovation of new medicines involve various value claims about the ethics of the placebo entity as differentiating comparator. Yet, in turn, the instantiation of the placebo comparator as cultural artefact for the creation and identification of the ‘control group’ depends also upon prior social understandings of ‘comparability’. Reading back the ethics controversies surrounding the Risperidone psychiatry trials in India, the paper illustrates why drug efficacies need to be studied not only through comparative techniques (...) such as randomised controlled trials, but also through analytical modes of inquiry that can begin to place the problem of efficacy within particular social and cultural contexts, as well as across disciplines. It is suggested that future bioethics debates could benefit from a revised conception of the interdisciplinary placebo — one that is rooted in ‘placebo politics’ and that listens responsively to the voices of the global South. (shrink)

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This article is the first in a series that looks at the technological transformation of Des Moines Public Schools (DMPS). It concentrates on the costs, some financial but mostly human and organizational, that are emerging as the district begins to implement its plans for dramatically increasing computer technology use. The conclusion reached here is that not only ave the costs been greatly underestimated, they may even force a gradual shift of control over the learning environment.

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To date, COVID-19 has spread across the world, changing our way of life and forcing us to wear face masks. This report demonstrates that face masks influence the human ability to infer emotions by observing facial configurations. Specifically, a mask obstructing a face limits the ability of people of all ages to infer emotions expressed by facial features, but the difficulties associated with the mask’s use are significantly pronounced in children aged between 3 and 5 years old. These findings are (...) of essential importance, as they suggest that we live in a time that may potentially affect the development of social and emotion reasoning, and young children’s future social abilities should be monitored to assess the true impact of the use of masks. (shrink)

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Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

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There are compelling medical, ethical, and legal arguments that support mandating use of a central institutional review board for the review of clinical trials performed at multiple institutional sites. Progress against serious diseases depends on this.

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Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task remains of ensuring that the right sorts of information reach the right sorts of people. In what follows we defend the thesis that efforts to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations, and that the communication of healthcare information and knowledge needs to rest (...) on a sound ontology of social interaction. We illustrate this thesis in relation to the HL7 RIM, which is one centrally important tool for communication in the healthcare domain. (shrink)

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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)

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During the postpartum period, the paternal brain suffers extensive and complex neurobiological alterations, through the experience of father–infant interactions. Although the impact of such experience in the mother has been increasingly studied over the past years, less is known about the neurobiological correlates of fatherhood—that is, the alterations in the brain and other physiological systems associated with the experience of fatherhood. With the present study, we aimed to perform a scoping review of the available literature on the genetic, neuroendocrine, and (...) brain correlates of fatherhood and identify the main gaps in the current knowledge. PubMed, Scopus, and Web of Science electronic databases were searched for eligible studies on paternal neuroplasticity during the postpartum period, over the past 15 years. Reference lists of relevant key studies and reviews were also hand-searched. The research team independently screened the identified studies based on the established inclusion criteria. Extracted data were analyzed using tables and descriptive synthesis. Among the 29 studies that met our inclusion criteria, the vast majority pertained to neuroendocrine correlates of fatherhood, followed by brain activity or connectivity, association studies of candidate genes, and brain structure correlates. Collectively, studies published during the past 15 years suggest the existence of significant endocrine and neurofunctional alterations as a result of fatherhood, as well as preliminary evidence of genetic variability accounting for individual differences during the postpartum period in fathers. No studies were so far published evaluating epigenetic mechanisms associated with the paternal brain, something that was also the focus of the current review. We highlight the need for further research that examines neuroplasticity during the experience of fatherhood and that considers both the interplay between hormones and simultaneous assessment of the different biomarkers ; data collection protocols and assessment times should also be refined. (shrink)

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Orphan drug policy often gives ‘special treatment’ to rare diseases, by giving additional priority or making exceptions to specific drugs, based on the rarity of the conditions they aim to treat. This essay argues that the goal of orphan drug policy should be to make prevalence irrelevant to funding decisions. It aims to demonstrate that it is severity, not prevalence, which drives our judgments that important claims are being overlooked when treatments for severe rare diseases are not funded. It shows (...) that prioritising severity avoids problems caused by prioritising rarity, and that it is compatible with a range of normative frameworks. The implications of a severity-based view for drug development are then derived. The severity-based view also accounts for what is wrong with how the current system of drug development unfairly neglects common diseases that burden the developing world. Lastly, the implications of a severity-based view for current orphan drug policies are discussed. There are no data in this work. (shrink)

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Significant scientific and technological advances in intensive care have been made. However, patients in the intensive care unit may experience discomfort, loss of control, and surreal experiences. This has generated relevant debates about how to humanize the intensive care units and whether humanization is necessary at all. This paper aimed to explore how humanizing intensive care is described in the literature. A scoping review was performed. Studies published between 01.01.1999 and 02.03.2020 were identified in the CINAHL, Embase, PubMed, and Scopus (...) databases. After removing 185 duplicates, 363 papers were screened by title and abstract. Full-text screening of 116 papers led to the inclusion of 68 papers in the review based on the inclusion criteria; these papers mentioned humanizing or dehumanizing intensive care in the title or abstract. Humanizing care was defined as holistic care, as a general attitude of professionals toward patients and relatives and an organizational ideal encompassing all subjects of the healthcare system. Technology was considered an integral component of intensive care that must be balanced with caring for the patient as a whole and autonomous person. This holistic view of patients and relatives could ameliorate the negative effects of technology. There were geographical differences and the large number of studies from Spain and Brazil reflect the growing interest in humanizing intensive care in these particular countries. In conclusion, a more holistic approach with a greater emphasis on the individual patient, relatives, and social context is the foundation for humanizing intensive care, as reflected in the attitudes of nurses and other healthcare professionals. Demands for mastering technology may dominate nurses’ attention toward patients and relatives; therefore, humanized intensive care requires a holistic attitude from health professionals and organizations toward patients and relatives. Healthcare organizations, society, and regulatory frameworks demanding humanized intensive care may enforce humanized intensive care. (shrink)

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En el texto se exponen algunas reflexiones sobre la importancia que tiene el rescatar los conocimientos tradicionales de las comunidades rurales, indígenas y campesinas sobre las prácticas agrícolas y alimenticias como recurso y mecanismo para favorecer la seguridad alimnetaria y de esta manera la sustentabilidad comunitaria. Se parte de una revisión bibliográfica sobre el tema, y se exponen casos específicos, como ejemplo, donde la experiencia se ha convertido en una oportunidad de algunas comunidades para hacer valer sus derechos de manejo (...) de la tierra, los procesos que se requieren para la diversidad de cultivos, de su propio sistema de producción y de esta forma mitigar los efectos de la pobreza y consolidad una propuesta alterna para el ejercicio de la soberanía y seguridad alimentaria de las comunidades. (shrink)

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