Espacio, cuerpo y hábito delimitan en este trabajo el entorno en el cual se emplaza el tema de la agencia técnica, en tanto una modalidad de la praxis que ejerce el sujeto en el mundo. En Phénoménologie de la perception Merleau-Ponty hace un análisis que ayuda a rastrear cómo se conforma su sentido en relación a la situación a la que se circunscribe el comportamiento del sujeto con los útiles en la experiencia. Una reconstrucción de estas prácticas requerirá exhibir los (...) mecanismos vitales que plasman una versión efectiva del horizonte de posibilidades del útil. Hay algo que escapa a la lectura teórica, que tiene que ver con la fuerza y la intensidad de las percepciones inherentes a la conducta del sujeto «encarnado». Este plus de sentido que excede el rango objetivo contribuye, sin más, a la constitución elemental de la práctica de una manera que sólo una exploración directa del acto y su sentir nos provee. De este modo, se puede abordar la complejidad y limitaciones de la experiencia que aparecen con una lectura inmanente de su sentido. (shrink)

ResumenEl objetivo de este artículo es demostrar que la doctrina kantiana del esquematismo trascendental trata una problemática ontológica. Con ese fin, en primer lugar, estudiamos las relaciones entre categorías, esquemas y principios del entendimiento. De esta manera señalamos la íntima relación entre los esquemas y los principios. En segundo lugar, mostramos que el sistema de los principios del entendimiento puede entenderse como un tratado de ontología. En tercer lugar, presentamos y criticamos un grupo de interpretaciones semánticas del esquematismo trascendental.Palabras claveKant, (...) filosofía trascendental, esquematismo, ontología.AbstractThe aim of this paper is to demonstrate that the Kantian doctrine of transcendental schematism deals with an ontological problematic. With this purpose in mind, in the first place, I study the relationships between categories, schemata and principles of understanding. In this way I point out the close relationship between schemata and principles. In the second place, I demonstrate that the system of the principles of understanding can be conceived as an ontological treatise. In the third place, I present and review a group of semantic interpretations of transcendental schematism.KeywordsKant, transcendental philosophy, schematism, ontology. (shrink)

From a reading of Sein und Zeit and contemporary courses, we are interested in examining the transcendental structure of Dasein to explain what we understand as its bidimensional character. For this, we analyze the function of the mood in the dynamics of the structure through the anxiety and profound boredom . We emphasize the affective disposition as an existential starting point and condition of possibility for two pathways, since in relation to being we observed tension between two dimensions that are (...) oscillated Dasein towards one concealment and one unconcealed motion of what happens. With this interpretation we intend to show that the tensive dynamics of the bidimensional structure of Dasein proposed here is the effect of the original givenness of being. (shrink)

En este articulo analizamos el fenómeno del Ereignis en la obra de Heidegger posterior a la Kehre para confrontar su origen conflictivo. Para esto, presentamos la influencia de su lectura del πόλεµοç de Heráclito y una interpretación de la estructura y sus dimensiones gracias a la tensión de las partes que se mantienen en continua oscilación por la naturaleza abismal de la donación. Asimismo, revisamos el camino que presentan los ensambles del fenómeno a la luz de su obra Beiträge zur (...) Philosophie. De esto modo, comprenderemos un poco más el sentido complejo de este fenómeno y su aporte al problema de la diferencia. In this paper we analyze the phenomenon of Ereignis in Heidegger's work after the Kehre, in order to question his conflicting origin. To do this, we show the influence of his reading of Heraclitus' πόλεµοç as well as an interpretation of the structure and its dimensions, thanks to the tension between the parts kept in continuous oscillation due to the abysmal nature of donation. We also revised the path shown by the gatherings of the phenomenon, in the light of his work Beiträge zur Philosophie. This way, we may get greater insights into the complex sense of this phenomenon and its contribution to the issue of difference. (shrink)

Los centros de educación superior son por definición espacios de generación de conocimiento, derivado de ello se vincula la aplicación de los valores primordiales que rigen el desarrollo académico y científico. Entre estos valores subyacen tales como honestidad, justicia, respeto, responsabilidad y confianza. Existen múltiples interpretaciones de integridad académica, este estudio se promueve el cual abarca todos los elementos mencionados como valores básicos del desarrollo social y universitario: honestidad, justicia, respeto, responsabilidad y confianza.Este estudio se orienta a conocer el grado (...) de transparencia, compromiso e integridad presente en las universidades en el desarrollo de su labor académica e investigadora. (shrink)

O objetivo deste artigo é investigar a filosofia do diálogo, de Martin Buber, e a ética da alteridade, de Emmanuel Lévinas, como propostas filosóficas de mudança de paradigma em relação à alteridade e sensibilidade. Almeja-se expor as aproximações e divergências entre os pensamentos dos filósofos para, na sequência, analisar sua influência sobre o trabalho de Enrique Dussel. Trata-se de pesquisa qualitativa, que emprega a técnica de pesquisa bibliográfica e se divide em três momentos, cada qual representado por um dos autores (...) elencados neste estudo. Como conclusão, destaca-se que ainda que tanto o pensamento levinasiano quanto o buberiano representem formas distintas (ainda que, em diferentes passagens, aproximadas e quiçá comparáveis) de entender a alteridade, Dussel parece reagir mais vividamente à influência de Lévinas, cujas reflexões constituem uma crítica à lógica do eu egocêntrico. (shrink)

Background: This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation. Objectives: After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated. Research design: In addition to the regular online module evaluation, specific questions referring to the (...) teaching of ethical theories were added using simple (yes/no) and Likert rating answer formats. Participants and research context: At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey. Ethical considerations: The survey was voluntary and anonymous. Students were free to write their name and additional comments. Findings: Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice. Discussion: Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem. Conclusion: The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. (shrink)

Background: Preparing tomorrow’s healthcare workforce for managing the growing complexity of care places high demands on students, educators, and faculties. In the light of worrying data about study-related stress and burnout, understanding how students manage stressors and develop resilience has been identified as a priority topic of research. In addition to study-related stressors, also moral stressors are known to characterize the students’ first clinical experiences. Objectives: However, current debates show that it remains unclear how healthcare ethics education should address them. (...) In order to clarify this issue, this study first develops the notion of moral resilience as a response to moral stressors involving both situations of moral complexity and moral wrongness. Second, it explores the potential of healthcare ethics education in fostering moral resilience. For this purpose, it defines moral resilience operationally as a reduction of moral distress in a given axis of time measured by a validated tool. Research design, participants, and context: The educational transferability was assessed within an explorative, quantitative pre–post interventional study with a purposive sample of 166 nursing students. The educational intervention comprised a lecture introducing the typology of moral stressors. Before and after the lecture, students were presented vignettes depicting morally stressful situations. Ethical considerations: The competent research ethics committee confirmed that no ethical approval was needed. Informed consent was obtained from participants. Findings: Three of four vignettes showed a modest but statistically significant reduction in measured levels of distress after the lecture (p < 0.05, α = 5%). Discussion: The study shows the potential of healthcare ethics education in providing students with transformative knowledge that fosters moral resilience. Conclusion: In times of global scarcity of educational resources, healthcare ethics education has an important contribution to offer in the promotion of students’ mental and physical health by strengthening the knowledge base of moral resilience. This legitimates its costs for societies, faculties, and professional bodies. (shrink)

The whole brain criterion of death has been the subject of intense theological debate since the process of policy shaping fortheGerman transplantation law adopted in 1997. This article identifies tutiorism as the predominant argumentative strategy both for the theological defence and the rejection of a neurological criterion of death. A tutioristic argumentation fails to elucidate the very nature of the problern which is normative and tends to clarify rights and duties of all the actors involved in the clinical setting of (...) organ transplant or withdrawal of life sustaining therapies. A theological defence of the whole brain criterion of death has to avoid that distinctions between life and death become blurred. On the other hand, those who reject this criterion, but still support the current practice of organ transplant, have to be aware that this option is hardly compatible with most part of the moral tradition of Christianity. (shrink)

Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both ‘dramatic’ issues, which constitute the dominant focus of bioethical decision making, and ‘undramatic’ issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of ‘synchronizing’ the (...) clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors. (shrink)

One of the sectors for which Artificial Intelligence applications have been considered as exceptionally promising is the healthcare sector. As a public-facing sector, the introduction of AI applications has been subject to extended news coverage. This article conducts a quantitative and qualitative data analysis of English news media articles covering AI systems that allow the automation of tasks that so far needed to be done by a medical expert such as a doctor or a nurse thereby redistributing their agency. We (...) investigated in this article one particular framing of AI systems and their agency: the framing that positions AI systems as replacing and outperforming the human medical expert, and in which AI systems are personified and/or addressed as a person. The analysis of our data set consisting of 365 articles written between the years 1980 and 2019 will show that there is a tendency to present AI systems as outperforming human expertise. These findings are important given the central role of news coverage in explaining AI and given the fact that the popular frame of ‘outperforming’ might place AI systems above critique and concern including the Hippocratic oath. Our data also showed that the addressing of an AI system as a person is a trend that has been advanced only recently and is a new development in the public discourse about AI. (shrink)

Mercedes Valmisa turns our attention to the relations between truth and practice in classical Chinese philosophy. In this tradition, truth is conceived of, in a pragmatic-like spirit, as a series of embodied beliefs and perspectives that lead to fitting dispositions, emotions, and actions (regardless of whether they accurately describe the world, or whether there are other competing beliefs and perspectives that equally accurately or inaccurately describe the world). This means that we should care about truth because of its normative (...) power to guide our behavior in the most fitting way, not because of a theoretical interest in accurately describing reality. Valmisa Oviedo traces the development of this conception of truth in the Mohists and Zhuangists, leading to two radically different sociopolitical and ethical positions: the Mohists used single-truth discourses to enforce ideological monopolies that could not allow pluralism in values, norms, beliefs, and practices, while the Zhuangists warned us against the dangers of such dogmatism. (shrink)

Albert the Great extracts the best contributions of Neo-Platonism and Aristotelism. He examines the Aristotelian doctrine on the desire for truth present in human nature and the science of Metaphysics, which allows for an inkling of the source of such desire, but this desire is examined more in-depth by the Pseudo-Dionysius, being Theology the science that grants more answers and the most universal because it enables for greater perfection, not just intellectual but of the whole person.

In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the (...) standard account of moral distress elucidated by Jameton :542–551, 1984) does not refer to a discrete phenomenon and/or that it is not sufficiently broad and that this makes measuring its prevalence among health professionals, and other groups of workers, difficult if not impossible. In this paper, we defend the standard account of moral distress. We understand it as a concept that draws attention to the social, political and contextual determinants of moral agency and brings the emotional landscape of the moral realm to the fore. Given the increasing pressure on health professionals worldwide to meet efficiency, financial and corporate targets and reported adverse effects of these for the quality and safety of patient care, we believe that further empirical research that deploys the standard account moral distress is timely and important. (shrink)

En este trabajo me ocuparé de reconstruir los diferentes paradigmas de lectura de Zur Kritik der Gewalt de Benjamin que proponen Jacques Derrida y Werner Hamacher alrededor de 1989. En primer lugar, se analizará cómo de diferente manera ambos autores definen la violencia en los términos de la performatividad del lenguaje: Derrida como una “fuerza diferencial” y Hamacher con el concepto de “afformativo”. En segundo lugar, cómo estos conceptos de performatividad consideran dos ejemplos políticos contrapuestos de la Kritik: la “policía” (...) y la “huelga general proletaria”. Finalmente, cómo el estrecho diálogo entre Derrida y Hamacher, más allá de la Kritik benjamineana, interroga los alcances ético-políticos del método de la deconstrucción. (shrink)

In this article, the author compares two Spanish translations of Virginia Woolf’s A Room of One’s Own. Taking into account that Spanish is a language in which words referring to human beings have a feminine and a masculine form, and grammatical gender corresponds to sex, all translators must interrogate the sex of the referent in order to translate gendered words. They are thus compelled to assign sex to genderless forms in the source text. Patriarchal translation has a long tradition of (...) devaluing and excluding the feminine in this process, as the author demonstrates here by revealing how Jorge Luis Borges translated the pronouns you and we in Woolf’s essay. In contrast, in her feminist translation of the essay, María Milagros Rivera-Garretas not only chooses the gender which most accurately represents the likely intended meaning of the source text, but recovers its message and legacy. (shrink)

This paper presents an empirical study that analyzes everyday practices regarding the health care and education of middle class families grounded in a phenomenological perspective. Everyday practices are linked to the system of expectations and goals built around practices, constituting a configurations of meaning that involves both aspects of the Life-World, which is affected by social class and other social determinants that define areas of experiences and opportunities for social interaction. In this sense, we see that social class and gender (...) intersect each other, enabling and limiting horizons of expectations for children, raising specific jurisdictions to males and females. Finally, we reflect on how the constitution of meanings and everyday practices influences the construction of social relations of the educational and health environments. (shrink)

Spontaneity is an almost inevitable commonplace in discussions of Daoism, especially the Zhuangzi. The idea that spontaneity is one of the most important values in the Zhuangzi was presented by Angus Graham for the Anglo-European audience, and divulged among Chinese readers by Liú Xiàogǎn 劉笑敢 and Chén Gǔyīng 陳鼓應. Hungarian psychologist Csikszentmihalyi popularly combined Daoist spontaneity with the idea of flow. In the state of flow the person carries out an activity for the sake of the activity itself--autotelically--and acts with (...) complete spontaneity given that none of their movements requires thought or mediation. My study consists of three parts: First, I deal with different definitions of “spontaneous” and of the term that is commonly translated as “spontaneous” in Chinese texts, zìrán 自然 (literally, so-of-itself), as well as its use in the Zhuangzi. I conclude that spontaneity is not part of the axiological project of the Zhuangzi. Instead, we find that the idea of adapting is related to normative human values and behaviors, whereas spontaneity is a term merely descriptive of natural objects. Second, I analyze the famous Zhuangzian stories of skills, which are often quoted to argue for the value of spontaneity. I conclude that the goal of these stories is to develop a new type of vital attitude as “second nature” or “background ability” (John Searle). Since this attitude is mediated and achieved through effort, it is not spontaneous. Third, I explain the confusion between this “second nature” with “spontaneity” in recent scholarship has led to the so-called paradoxes of non-action and spontaneity (Edward Slingerland). I argue that these paradoxes disappear when we understand the different layers of meaning of wú-wéi and zìrán in the early Chinese textual context. (shrink)

Philosophy of action in the context of Classical China is radically different from its counterpart in the contemporary Western philosophical narrative. Classical Chinese philosophers began from the assumption that relations are primary to the constitution of the person, hence acting in the early Chinese context necessarily is interacting and co-acting along with others –human and nonhuman actors. This book is the first monograph dedicated to the exploration and rigorous reconstruction of an extraordinary strategy for efficacious relational action devised by Classical (...) Chinese philosophers in order to account for the interdependent and embedded character of human agency –what the author has denominated “adapting” or “adaptive agency” (yin 因). As opposed to more unilateral approaches to action also conceptualized in the Classical Chinese corpus, such as forceful and prescriptive agency, adapting requires great capacity of self and other-awareness, equanimity, flexibility, creativity, and response, which allows the agent to co-raise courses of action ad-hoc: unique and temporary solutions to specific, non-permanent, and non-generalizable life problems. Adapting is one of the world’s oldest philosophies of action, and yet it is shockingly new for contemporary audiences, who will find in it an unlikely source of inspiration to deal with our current global problems. This book explores the core conception of adapting both on autochthonous terms and by cross-cultural comparison, drawing on the European and Analytic philosophical traditions as well as on scholarship from other disciplines, opening a brand-new topic in Chinese and comparative philosophy. (shrink)

The first contribution, by Mercedes Valmisa, begins by repositioning the Zhuangzi 莊子 as a whole within pre-Qin thought under the impact of newly excavated materials. Moving away from the traditional classification of texts according to schools, it focuses instead on varying approaches to life issues. Centering the discussion on life situations and changes we have no control over, including the unpredictable vagaries of fate (ming 命), it outlines several typical responses. One is adaptation, finding ways to go along with (...) what life demands, and even availing oneself of the new opportunities it brings about. Another is a turning inward, a focus on the inner self, holding on to ethical and other standards and making sure on does the right thing regardless of the outcomes of one's actions. While the former appears in several chapters of the Zhuangzi, notably in chapter 6, the latter is central to the Qiongda yishi 窮達以時 (Failure and Success Depend on Opportunity), a manuscript excavated at Guodian. However tempting it may be to characterize one approach as Daoist and the other as Confucian, they both appear within the Zhuangzi together with a third approach to fate, showing the fluidity of philosophical discussion and the futility of thinking along the lines of traditional boundaries. (shrink)

This chapter presents an analysis of Wang Bi’s (226-249 CE) hermeneutics and reception theory via the concept of “forgetting” (wang 忘) in his essay “Clarifying the Images” (Ming xiang 明象).

Professionelles Handeln bedarf moralischen Handlungsvermögens. Im Kontext pflegerischer Weiterbildungen beschreibt der Philosoph Andrew Jameton vor über drei Jahrzehnten psychologische Reaktionen auf kompromittiertes moralisches Handlungsvermögen, die er als moralischen Stress definiert. Diese Standarddefinition hat in der Pflegewissenschaft zu einer dichten Forschung geführt und zum Vorschlag einer weiten Definition. Belegt sind gravierende Folgen von moralischem Stress auf die Patientensicherheit und auf die psychische Gesundheit von Mitarbeitenden. Der Beitrag diskutiert die Rezeption des Konzepts innerhalb der Pflegewissenschaft und die jüngst vorgeschlagene weite Definition von (...) moralischem Stress als Reaktion auf Situationen wahrgenommener moralischer Unerwünschtheit. Er bezweifelt die Kongruenz der Definitionen. Gerade das Verständnis der Prävalenz von moralischem Stress in der Pflegepraxis wird durch die Ausweitung der Definition erschwert, welche den Messinstrumenten jeweils zugrunde liegt. Trotz dieser Unschärfe bleibt der Umgang mit moralischem Stress eine zentrale Herausforderung für alle Gesundheitsfachpersonen. Für die wirksame Bewältigung bedarf er aber einer Schärfung, die die Kernanliegen sowohl der „alten“ wie auch der „neuen“ Definition aufnimmt: Wahrgenommene moralische Unerwünschtheit wird als Gesamtheit an emotionalen Reaktionen auf ethisch belastende Situationen vorgeschlagen, der bei kompromittiertem moralischen Handlungsvermögen moralischer Stress folgen kann, bei erschwertem moralischen Handlungsvermögen hingegen moralisches Unbehagen. In normativer Hinsicht steht moralischer Stress für Reaktionen auf Situationen moralischer Komplizität, moralisches Unbehagen für solche auf moralischer Komplexität. Durch diese Schärfung wird moralischer Stress hinreichend klar bestimmbar und die Standarddefinition im Kern bestätigt. Aber auch das Anliegen der weiten Definition wird aufgenommen für das breite Spektrum ethischer Belastungen, die den Alltag von Gesundheitsfachpersonen prägen und spezifische Strategien zu deren Bewältigung erfordern. (shrink)

A correction to this paper has been published: https://doi.org/10.1007/s00146-021-01218-9.

Business Ethics: A European Review, EarlyView.

Este trabajo analiza la respuesta que el Estado español, como Estado-nación, está dando a la integración del inmigrante como ciudadano. Frente a quienes consideran que la residencia ha de ser la vía de acceso a la ciudadanía ante la crisis del Estado nación y la movilidad geográfica que impone la globalización económica a las personas, aquí se defiende, por el contrario, la relevancia política de la nacionalidad, como parte alícuota individual de pertenencia al poder constituyente, en relación armónica con un (...) concepto flexible de residencia. La investigación está dividida en cinco apartados, en los que se estudia la nacionalidad y el poder constituyente, las vías de acceso a la nacionalidad española, el conflicto Estado o nación, las peculiaridades de la nacionalidad originaria y , finalmente, los criterios que los Estados utilizan para la selección de la inmigración potencial. El recorrido crítico por la legislación española en materia de nacionalidad y ciudadanía acompañado de los debates teóricos al respecto, ha permitido concluir con una propuesta de lege ferenda centrada en una reforma radical en materia de nacionalidad. (shrink)

The most documented juridical studies about hispanic woman in the late Middle Ages, belong to three specialities: political law, civil or common law (matrimonial), and criminal law. It is in the sphere of matrimonial law where the influence of christian principles has been described as prominent, contributing to the juridical conjugal parity, thus recognizing woman a full civil capability.

Aunque durante años hemos asistido a un persistente interés sociológico por la dimensión subjetiva de las prácticas de clase, hasta la fecha pocos son los estudios que han abordado esta problemática desde la perspectiva fenomenológica. Tomando como punto de partida autores que nos antecedieron en esta tarea, el objetivo del presente trabajo es reflexionar sobre los fundamentos de la teoría fenomenológica de Schutz sobre la acción social y su conceptualización de las tipificaciones para el análisis del sentido común y las (...) prácticas de clase. En la primera sección proponemos una breve discusión conceptual en torno a la definición del mundo de la vida proveniente de la teoría de Schutz y su utilidad para el análisis de la estructura social en la línea teórico-metodológica que analiza la reproducción intra-clase y las relaciones entre clases. A continuación resumimos las ideas y conceptos de Weber sobre las clases sociales, acción social y tipo ideal, para luego establecer sus nexos y relaciones con Schutz. Por último, e incorporando la resignificación y complejización que Schutz da a los términos weberianos, proponemos el uso de herramientas fenomenológicas para el análisis de clase. (shrink)

De la materia del sueño nace de un esfuerzo de síntesis entre dos orientaciones vitales. Por un lado, en el plano poético, la poesía y los medios por los que esta logra extenderse en la vida cotidiana a partir de la experiencia de lo maravilloso; por otro, en el plano político, las potencialidades de la Utopía como medio de reactivación del imaginario revolucionario. Es ahí, y no en otra parte, donde debe enmarcarse este ensayo. Si no fuera porque ellos nunca (...) hablaron previamente, podríamos decir que en este libro está basada la última película de Jan Švankmajer, Sobreviviendo a la vida (Teoría y práctica). (shrink)

Der Umgang mit Gesundheit und Krankheit, noch mehr aber die Übergänge zwischen dem einen und dem anderen Zustand, weisen mit der Entwicklung des therapeutischen Wissens und Könnens und der Strukturen in der Gesundheitsversorgung eine Vielfalt an ethischen Bezügen auf.

Since the beginning of the pandemic spread of the Coronavirus, societies have been reminded that the impact of Covid-19 and public health measures of infection containment reflect known gradients of inequality. Measures focusing only the (acknowledged) frontstage of the pandemic and neglecting its (unacknowledged) backstage—understood as those framework conditions indispensable for societies to thrive—have worsened the impact of social determinants of health on the most vulnerable, as shown by the deleterious effects of prolonged social isolation of residents of nursing homes. (...) To reflect this phenomenon ethically, a framework is proposed which is inspired by the feminist philosopher Margret Little. At its core stands the assumption that caring for people and moral ends allows us to identify what is morally salient. This epistemological stance allows a critical look at the alleged dilemmas invoked to enforce brute, long-lasting policies of closing nursing homes in many places—especially in the light of their dubious effectiveness in preventing viral spread and the severe physical and psychological consequences for those affected. If moral salience is only fully perceived through the closeness of the caring relationship, the human suffering resulting from these policies reveals the utter inadequacy of the dilemma rhetoric used to justify them. This insight is illustrated by the personal experience of the author: He describes his role as an essential care partner of his mother living in a nursing home and forced into the role of a “visitor” who witnessed a constant deterioration of care. Based on an epistemological understanding of caring for making reliable moral judgments, potentially exclusionary effects of distinguishing essential from non-essential groups in care will be addressed together with the need to overcome strict boundaries between front- and backstage. Such efforts will strengthen the moral community of persons needing care, professional care givers and essential care partners. (shrink)

ZusammenfassungZwischenfälle, Behandlungsfehler und tragische Verläufe können im Medizinalltag schwerwiegende Auswirkungen auf Patientinnen und Patienten haben, aber auch auf beteiligte Gesundheitsfachpersonen. Don Berwick, ehemaliger Leiter des Institute for Healthcare Improvement in Boston, hob in einem Interview die Unterstützung von „second victims“ als „ethische Angelegenheit“ hervor. Es besteht aber keine Klarheit darüber, was darunter zu verstehen ist. Der vorliegende Beitrag unternimmt eine Klärung dieser Frage aus der Perspektive der Organisationsethik. Ausgehend von Daten aus der Literatur zur Wirksamkeit der Unterstützung von „second victims“ (...) werden Herausforderungen beschrieben und aus organisationsethischer Sicht beurteilt. Es gibt Hinweise, dass Angebote der Unterstützung von „second victims“ zwar bestehen, aber nicht wirksam genug sind, um die psychischen Folgen von unerwünschten Ereignissen zu bewältigen. Dies wirkt sich auf betroffene Fachpersonen negativ aus und kann zu einer erneuten Gefährdung der Patientensicherheit führen. Angesichts dieser Befunde bedarf es eines organisationsethischen Ansatzes, um Don Berwicks Forderung nachzukommen, den Umgang mit „second victims“ als „ethische Angelegenheit“ wahrzunehmen. Dieser Ansatz fördert die Kongruenz zwischen den deklarierten und den faktisch gelebten Werten der Organisation. Sein normatives Fundament besteht in den Fürsorgepflichten der Organisation, gegenüber Patientinnen, Patienten und Mitarbeitenden. Die Organisationsethik ermöglicht es, die Unterstützung von „second victims“ verbindlich und sichtbar in der Sicherheitskultur der Organisation zu verankern. Sie konkretisiert sich in ihrer Verpflichtung, für die Mechanismen der Entstehung des Phänomens zu sensibilisieren und Ressourcen bereitzustellen, die einen effektiven Umgang damit ermöglichen. Dazu gehören evidenzbasierte ethische Leitlinien, standardisierte Prozesse, Schulungen sowie niederschwellige Coaching-Angebote. (shrink)

In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents’ health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the continuation of (...) the practice of shielding as a moral failure. This is affirmed and specified in four dimensions: preventability of foreseeable harm, moral agency, moral character, and moral practice (in MacIntyre’s sense). Moral character is discussed in the context of prudent versus proportionate choices. As to moral practice, it will be shown that the continued practice of shielding no longer met the requirements of an (inherently moral) practice, as external goods such as security thinking and structural deficiencies prevented the pursuit of internal goods focusing on residents’ interests and welfare, which in many places has led to a loss of trust in these facilities. This specification of moral failure also allows a novel perspective on moral distress, which can be understood as the expression of the psychological impact of moral failure on moral agents. Conclusions are formulated about how pandemic events can be understood as character challenges for healthcare professionals within residential care, aimed at preserving the internal goods of residential care even under difficult circumstances, which is understood as a manifestation of moral resilience. Finally, the importance of moral and civic education of healthcare students is emphasized to facilitate students' early identification as trusted members of a profession and a caring society, in order to reduce experiences of moral failure or improve the way to deal with it effectively. (shrink)

Incivility poses a serious threat to any healthcare system striving for effectiveness without sacrificing the requirements of humanity. Threats to civility within healthcare not only come from individual ‘bad apples’ exhibiting borderline and inacceptable behaviour, as seen in many ‘high-tech, high-risk, high-responsibility’ environments such as operating or emergency rooms.1 They may also be facilitated by ‘bad trees’ or system-immanent, poor healthcare environments.2 This may be the case when healthcare administrations, facing the challenges of political austerity, set budgetary targets that cannot (...) be met without seriously compromising quality of care, patient safety, and the well-being of those professionals working at the ‘sharp end’. Both individual and systemic factors fuel the occurrence of incivility,3 and individuals—rather than institutions—are often held responsible for acts of incivility. Nevertheless, explaining what might trigger incivility can never serve as a justification for it, because ‘in-civility’ —in its literal sense—breaches basic rules of civic cooperation and goodwill, and thus grossly violates the social …. (shrink)