The term doctors' orders or physicians' orders is endemic to nurses' work, to the degree perhaps that few nurses give the term much thought. The nursing profession has progressed over its historical trajectory, from a level of considerable dependence upon physicians' directives, in its beginning, to much greater professional autonomy. However, the term order remains a stronghold in nurses' professional reality, despite the fact that this term is laden with anachronistic ideological interests that are embedded within the historical, sociopolitical and (...) gendered contexts in which health care occurs. In this essay I consider the term order through multiple philosophical and semantic lenses. I explore the endowment of power within the word order and how this term disadvantages nurses. I examine how the word order demarcates roles and establishes perceived value of the item represented by the originator of the order. The concept of doctors' orders carries powerful meanings, affirms the power‐as‐knowledge hierarchy so entrenched in the nurse–physician relationship, and can inhibit nurses' full participation as partners in health care. (shrink)

Apresentamos um resumo do desenvolvimento e do contexto institucional do Projecto Humanização dos Cuidados Paliativos em Contexto Domiciliário, aprovado e financiado pela Fundação Calouste Gulbenkian. Utilizam-se largamente os próprios documentos que o justificaram e os relatórios oficiais para dar uma imagem vivida, realista e técnica das dificuldades da profissionalização e reforma dos Cuidados Paliativos, mesmo quando integrada em acções de formação num serviço de um Centro de Tratamento Compreensivo do Cancro. We put forward a synopsis of the development and institutional (...) context of the Project Humanização dos Cuidados Paliativos em Contexto Domiciliário, approved and financed by the Calouste Gulbenkian Foundation. The groundwork documents are widely used as well as official reports so as to convey a lively, realistic and technical image arising from professionalizing and reforming Palliative Medicine even when it is based on in-service training programmes in an Comprehensive Cancer Center. (shrink)

Apresentam-se os resultados clínicos principais de uma primeira investigação efectuada a familiares de doentes sob tratamento paliativo no domicílio da área de Lisboa, com o instrumento de medida da satisfação SERVQUAL Modificado. Dos 58 familiares/doentes que responderam ao questionário apenas uma minona estava insatisfeita (uma classe de 5 indivíduos mostra-se francamente insatisfeita), uma classe de 15 estava moderadamente satisfeita, havendo 38 individuos fortemente satisfeitos com a qualidade e prontidäo dos serviços prestados. Porém urna percentagem elevada de doentes, segundo a opinião (...) retrospectiva dos cuidadores, faleceu com sintomatologia agravada, nomeadamente dores (60%), obstipação (67%) e depressão/ansiedade (43%). Discute-se a consistência e validade do questionáno SERVQUAL Modificado, contextualizam-se os resultados no que é o standard da prática da MCP e integram-se na promoção da dignidade humana no fim da vida. We present the main clinical findings of research on palliative home care, carried out among relatives of patients in the Lisbon area. An adapted version of SERVQUAL was used. Of a total of 58 carers surveyed only a small number (5) was unsatisfied 15 were only moderately satisfied. 38 family carers were strongly satisfied with the services. Yet, a high percentage of patients, as viewed in retrospect by their relatives died with some aggravated symptoms: 60% with more pain, 67% constipation, and 43% anxiety/depression. We discuss the consistency and validity of this adapted SERVQUAL tool and the main results are contextualized beanng in mind the standard practice of palliative medicine and the pursuit of human dignity in death. (shrink)

Collection of parables on Jaina ethics; based on the Jaina Agamas.

A adoção de um catálogo constitucional de direitos e o fortalecimento do judicial review, trouxeram como consequência a judicialização da política em inúmeras democracias, onde se verifica uma expansão da atuação do Poder Judiciário em detrimento das esferas representativas do Estado. Neste contexto, tem se observado em países do Sul Global, o emprego de novos mecanismos procedimentais em casos que envolvem a violação contínua e generalizada de direitos fundamentais, de alguns grupos menos favorecidos, decorrente de bloqueios políticos e institucionais, denominados (...) de “litígios estruturais”. (shrink)

RESUMO O presente ensaio apresenta uma análise crítica das atuais democracias que se esvaziaram do poder deliberativo do demos para se tornarem, cada vez mais, democracias espetaculares. Inicialmente, seguindo os estudos de Foucault, analisam-se as implicações da governamentalidade sobre a democracia, principalmente a partir da emergência da opinião pública como técnica da razão de Estado. Posteriormente, relacionam-se os estudos de Foucault com as teses de Agamben a respeito da burocracia e a hierarquia, a fim de compreendermos como estas pesquisas desembocam (...) no conceito de democracias espetaculares defendido por Agamben. ABSTRACT This essay presents a critical analysis of the current democracies that have emptied themselves of the deliberative power of the demos to become, more and more, spectacular democracies. Initially, following Foucault's studies, we analyze the implications of governmentality on democracy, especially from the emergence of public opinion as a technique of reason of state. Later, Foucault's studies are related to Agamben's theses on bureaucracy and hierarchy, in order to understand how these researches lead to the concept of spectacular democracies defended by Agamben. (shrink)

Unethical behavior coordinated and concealed by teams continues to represent a troubling and all-too-frequent occurrence in organizations. Unfortunately, those who are most knowledgeable about this behavior and thereby best suited to report it to authorities—the complicit members themselves—are susceptible to unique pressures that often discourage them from blowing the whistle. Team members rely on their teammates for relational and other beneficial resources, making it more difficult to potentially break those ties by snitching. However, we argue that the pressure to stay (...) silent is alleviated for members who are ostracized by their team members. Drawing on social exchange theory, we theorize that ostracism decreases positive affect and increases negative affect, decreasing individuals’ communion striving motivation and, in turn, increasing the propensity to blow the whistle. In Study 1, we examined the link between ostracism and whistleblowing utilizing a field sample of diverse employees surveyed over time. In Study 2, we built upon Study 1 and conducted a lab study to examine affect and communion striving motivation as serial mediators. Results were generally supportive of our arguments, although we did not find support for the mediating effect of negative affect. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deflating Psychiatric ClassificationClaudio E. M. Banzato (bio)Keywordsnosography, comorbidity, utility, pragmatismSystems of classification bring order into the world. They are a key part of the informational working infrastructure of the world we inhabit (Bowker and Star 1999). Thus, much of the human interaction hinges on these ordering—pattern identifying and creating—systems. Formal or informal, standardized or ad hoc, visible or invisible, enforced or optional, there are a myriad of classifications we (...) necessarily live by.Typically, classifications convey representations of states of affairs to make interventions on them feasible and, to some extent, predictable. In other words, classificatory systems and schemes try to confer intelligibility to the world. By succeeding in such task, they may provide rational grounds to human operation on reality (toward the most diverse ends). This account fully applies to medical classifications, which struggle to sort out all kinds of diseases, ailments, complaints, and sufferings that can possibly be targeted by medical interventions. This means classifications are instrumental to the ends pursued by medicine, quintessential modificatory activity. In sum, classifications are cognitive tools devised to build up knowledge by making relevant distinctions, which may prove helpful to guide human action.By working well, classifications eventually tend to become invisible. They end up looking just natural, as if they were carved by nature itself. But indeed purpose is the touchstone here. Even if a given class of objects fully qualifies as a 'natural kind' and necessary and sufficient criteria for class membership can be definitely established, it does not entail that it constitutes the best way to classify these objects irrespective of the context. Peter Zachar (2002) offers a compelling example from natural sciences, the utmost practical importance of distinguishing between hydrogen and its isotopes (hydrogen, deuterium, and tritium). In this case, the classificatory thrust stretches beyond the shared atomic number. In his words, "A crucial factor in recognizing them as distinct is that they are used in distinct activities and practices. We get a better neutron bounce with heavy water or D2O. Deciding what aspects of internal structure are important therefore cannot be isolated from external factors." (p. 220)In contemporary psychiatry, diagnostic classification has been center stage for several reasons. But before addressing them, however, a brief historical detour is necessary. Back in the nineteenth century, putting forward a new classification of mental diseases was taken somewhat as a token of psychiatric proficiency according to the witty remark by the French physician and publicist Philippe Buchez: "Upon believing that they have [End Page 23] completed their studies, rhetoricians will compose a tragedy and alienists a classification" (Berrios 1999, 152). By the middle of the twentieth century, many psychiatric classifications (based on diverse principles and underlying theoretical orientations) were still used across the world. The British psychiatrist Erwin Stengel (1959), in his influential report on classification of mental disorders, pointed out that the issue of difficulty of communication was then the order of the day for psychiatry, because it was widely perceived as one of the most serious obstacles to the progress in the field.The broad, worldwide survey carried out by Stengel made it clear that classifications of all shapes were used in different contexts, but they were seldom appealing outside the boundaries of the respective centers that generated them. Such diversity of classifications reflected not only different functions or purposes they were meant to serve, but also the role played by the history of a given problem within a particular medical tradition and cultural background. Thus, Stengel's aims for an acceptable statistical international classification were relatively modest: it should simply ground epidemiological work.Stengel's stance on classification was frankly pragmatic and utilitarian. He understood well the difficulties posed by the 'disease entity' assumption in psychiatry and asked the straight question: "Firstly, what do we classify in this field? Are we classifying diseases or people?", to which he offered a compromised answer: "It may be said that the material the psychiatrist has to classify consists neither of diseases nor of people but of a variety of disorders or reactions, a material which does not readily lend itself to classification" (Stengel 1959, 612). For him, the pursued agreement on the... (shrink)

Discuto neste artigo o fragmento de Protágoras sobre a existência dos deuses e a sua coerência teórica com outras teses do sofista. Primeiramente, utilizo dados históricos e biográficos para iluminar o subjetivismo da primeira linha do fragmento. Em seguida, discuto os obstáculos epistemológicos mencionados por Protágoras e sugiro uma nova tradução para o termo brachýs, um dos conceitos centrais que ele propõe. Na seção 2, analiso o ataque à transcendência que distingue suas ideias sobre a matemática e a percepção sensível. (...) Finalmente, na seção 3, mostro como a sua postura teológica está de acordo com a tese do homo-mensura e com a sua abordagem antilógica. A conclusão ressalta a unidade do pensamento de Protágoras e a sua posição no Iluminismo grego. (shrink)

“Para que isso servirá em minha vida?” Ao longo de minha trajetória como professor do ensino secundário, ouvi esta pergunta algumas vezes. É provável que nós professores de filosofia não sejamos um alvo privilegiado dessa pergunta provocadora. Trata-se mesmo de uma questão legítima, ainda mais para nós: latinoamericanos, brasileiros, nordestinos, piauienses. Trata-se de uma pergunta que evoca um certo desespero, uma certa pressa, um tipo de agonia que é bem nossa; como quando dizemos “estou agoniado”. Queremos tudo “pra já”. Parece (...) que jamais nos daremos o direito de viver e aprender algo pelo simples fato de que o saber é bom e merece ser fruído. (shrink)

The timely feature article by van der Pijl et al 1 highlights not only the widespread frequency with which unconsented episiotomies and other procedures during labour are reported by women but also that there is hardly any discussion in the literature on the ethics of consent for procedures in labour. Those national and international bodies with responsibility for midwifery and obstetric practice need not only to recognise but also act to remedy this unacceptable situation. The studies quoted used the (...) recollection of women in reporting consent or lack of it and, although this is an entirely appropriate measure, it gives no insight into what, if any, informed decision-making the care providers carried out. Such information would be useful to determine how better practice might be achieved. A study into the practice of episiotomies by Dutch midwives and obstetricians is referred to and is not reassuring.2 They frequently expressed surprise that consent should be necessary and women were minimally involved in the decision for performing episiotomy. This and other examples quoted of lack of valid consent have a corrosive effect on the fundamental but fragile trust and necessary trustworthiness of the relationship between the person being cared for …. (shrink)

As análises aqui propostas enfocam, em primeira instância, a leitura do corpus merleau-pontiano, proposta por R. Barbaras em seu Introduction à une phénoménologie de la vie, segundo a qual os vaivens e ambivalências da reflexão de Merleau-Ponty acerca do corpo se explicam pela desconsideração de seu caráter primordialmente vivente. Em segundo lugar, abordamos a filosofia de Merleau-Ponty a partir do propósito de encontrar no corpo uma modalidade originária e absoluta de movimento como abertura de possibilidades, fundante em relação ao objeto (...) que se move e ao espaço, aberto pelo próprio movimento. Em terceiro lugar, pondo em relevo a noção de nascimento, propomos que esta singular modalidade de movimento buscada por Merleau-Ponty encontra sua caracterização mais apropriada no movimento natural e vital, o que permite conciliar, ao menos parcialmente, as perspectivas de ambos os filósofos. (shrink)

Analisa-se a articulação entre a proposição de políticas públicas de saúde mental e as estratégias para a reorientação do modelo assistencial em saúde mental a partir dos movimentos pela Reforma Psiquiátrica brasileira. Parte-se da perspectiva genealógica de Michel Foucault, o que implica descrever ..