Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and (...) some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles to the donor and recipient parties. (shrink)

Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

Jean Hamburger is considered the founder of the concept of medical intensive care and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world, in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca (...) prize, awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service”, the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options. The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. (shrink)

Paula Modersohn-Becker, widely considered to have been one of the most important independent Expressionist painters of the early twentieth century, was thirty-one years old when she gave birth to her first child. Following the then-common practice of putting women to bed rest for two-four weeks after delivery, she died of massive pulmonary embolism when she was first allowed to stand, eighteen days after giving birth. Paula had foreseen her death at a young age and was apprehensive about her pregnancy, yet (...) she painted herself as pregnant in her best known self-portrait, thus underlining the importance of the pregnancy in her life. In the light of knowledge available at the time, the authors present a brief discussion of the life and death of Paula Modersohn-Becker as a reflection on the potential dangers of blindly following conventional wisdom in the medical profession. (shrink)

Essays by Jurgen Habermas on truth, objectivity, normativity, naturalism, and realism after the linguistic turn.

The prototypes of definiteness and indefiniteness in English are the definite article the and the indefinite article a/an, and singular noun phrases (NPs)1 determined by them. That being the case it is not to be predicted that the concepts, whatever their content, will extend satisfactorily to other determiners or NP types. However it has become standard to extend these notions. Of the two categories definites have received rather more attention, and more than one researcher has characterized the category of definite (...) NPs by enumerating NP types. Westerståhl (1985), who is concerned only with determiners in the paper cited, gives a very short list: demonstrative NPs, possessive NPs, and definite descriptions. Prince (1992) lists proper names and personal pronouns, as well as NPs with the, a demonstrative, or a possessive NP as determiner. She notes, in addition, that “certain quantifiers (e.g. all, every) have been argued to be definite” (Prince 1992: 299). This list, with the quantifiers added, agrees with that given by Birner & Ward (1998, 114). Ariel (1988, 1990) adds null anaphoric NPs. (shrink)

Socio-economic status and mathematical performance seem to be risk factors of mathematics anxiety in both children and adults. However, there is little evidence about how exactly these three constructs are related, especially during early stages of mathematical learning. In the present study, we assessed longitudinal performance in symbolic and non-symbolic basic numerical skills in pre-school and second grade students, as well as MA in second grade students. Participants were 451 children from 12 schools in Chile, which differed in school vulnerability (...) index, an indicator of SES. We tested an explanatory model of MA that included SES and longitudinal performance in basic numerical skills as predictors. The results showed a direct effect of SES on MA and a mediating effect of performance in symbolic and non-symbolic comparison tasks in pre-school. However, in second grade, only performance in symbolic comparison significantly mediated the SES-MA relationship. These findings suggest that performance in non-symbolic comparison plays an important role in explaining MA at initial stages, but that its influence is no longer significant by the time children reach formal instruction in second grade. By contrast, as children’s formal educational experience in mathematics increases, MA becomes linked primarily to symbolic numerical tasks. In sum, SES affects MA and this is due in part to the effect of SES on the development of numerical learning in pre-school, which in turn has an impact on subsequent, more complex learning, ultimately leading to differences in MA. We discuss the implications of these findings for preventing and acting upon the emergence of MA. (shrink)

This collection breaks new ground in four key areas of feminist social thought: the sex/gender debates; challenges to liberalism/equality; feminist ethics; and feminist perspectives on global ethics and politics in the 21st century. Altogether, the essays provide an innovative look at feminist philosophy while making substantive contributions to current debates in gender theory, ethics, and political thought.

The construction of embodied conversational agents - robots as well as avatars - seem to be a new challenge in the field of both cognitive AI and human-computer-interface development. On the one hand, one aims at gaining new insights in the development of cognition and communication by constructing intelligent, physical instantiated artefacts. On the other hand people are driven by the idea, that humanlike mechanical dialog-partners will have a positive effect on human-machine-communication. In this contribution I put for discussion whether (...) the visions of scientist in this field are plausible and which problems might arise by the realization of such projects. (shrink)

The word ‘social’ is used in many different contexts, in each of which the word has a general root meaning, common to all contexts in which it is found. But in addition, there are other specific meanings, peculiar to each context, which are intended by the user of the term. Frequently, these other meanings of the term are not made explicit, and hence ambiguities arise.The root meaning of the term involves some sort of relationship among two or more people. ‘Social’ (...) is derived from the Latin socius, meaning ‘companion’. At least two people are involved here: 1) the person having the companion, and 2) the companion. Nothing is intended as to the nature of the relationship between the two or more people. In each context in which the term ‘social’ is used it has this root meaning. This paper is concerned, however, with those other aspects of the meanings of the term which are intended to specify more precisely the nature of this relationship among two or more people, and therefore are different in different contexts. The contexts will be isolated, and the more specific meanings of the term in these different contexts will be distinguished and made explicit. (shrink)

The controversies related to John Taurek’s rescue case concern the importance of numbers in deciding about whom to help in situations in which there is a shortage of means. Taurek thinks that the number of the needy does not matter; we can save one person rather than many people. Since both common sense and the duty to responsibly administer help make us approve the decision to help those who are more in number, Taurek’s thesis seems counterintuitive. The majority of authors (...) discussing Taurek’s thesis defend the importance of numbers in such decisions, and few are inclined to accept some of his intuitions, recognizing the counting of people who need help as morally problematic. However, the authors who defend the importance of numbers reject a simple utilitarian approach and try to justify the claim that the majority should have priority in such a way that no person involved in the conflict of distribution could charge the rescuer with not having taken his or her claims into account. (shrink)

In the early 12th century, a Jewish community first settled in the medieval city of Erfurt (Thuringia). The synagogue, the mikvah (ritual bath), and several private dwellings of this community are preserved until today. A room in one of the private houses formerly inhabited by Jews has a wooden beam ceiling, dating from 1244, which is colourfully painted with tendrils, leaves and blossoms. This ceiling was added to the room together with other extensive refurbishments: the former door in the eastern (...) wall was replaced with a built-in cupboard, a new door as well as a recess for an oil lamp were added to the northern wall, and the room received an oriel window. Furthermore, the ceiling shows the remains of suspensions for lamps, and traces of shelves are still visible on the walls. As an ensemble, these alterations suggest that the chamber was converted into a prayer room in the mid-13th century. As the only preserved example of a medieval Jewish private room for prayer, it constitutes an important source for understanding Jewish piety in the German-speaking lands. (shrink)

A one-of-a-kind reference to the international vocabulary of the humanities This is an encyclopedic dictionary of close to 400 important philosophical, literary, and political terms and concepts that defy easy—or any—translation from one language and culture to another. Drawn from more than a dozen languages, terms such as Dasein (German), pravda (Russian), saudade (Portuguese), and stato (Italian) are thoroughly examined in all their cross-linguistic and cross-cultural complexities. Spanning the classical, medieval, early modern, modern, and contemporary periods, these are terms that (...) influence thinking across the humanities. The entries, written by more than 150 distinguished scholars, describe the origins and meanings of each term, the history and context of its usage, its translations into other languages, and its use in notable texts. The dictionary also includes essays on the special characteristics of particular languages—English, French, German, Greek, Italian, Portuguese, Russian, and Spanish. Originally published in French, this one-of-a-kind reference work is now available in English for the first time, with new contributions from Judith Butler, Daniel Heller-Roazen, Ben Kafka, Kevin McLaughlin, Kenneth Reinhard, Stella Sandford, Gayatri Chakravorty Spivak, Jane Tylus, Anthony Vidler, Susan Wolfson, Robert J. C. Young, and many more.The result is an invaluable reference for students, scholars, and general readers interested in the multilingual lives of some of our most influential words and ideas. Covers close to 400 important philosophical, literary, and political terms that defy easy translation between languages and cultures Includes terms from more than a dozen languages Entries written by more than 150 distinguished thinkers Available in English for the first time, with new contributions by Judith Butler, Daniel Heller-Roazen, Ben Kafka, Kevin McLaughlin, Kenneth Reinhard, Stella Sandford, Gayatri Chakravorty Spivak, Jane Tylus, Anthony Vidler, Susan Wolfson, Robert J. C. Young, and many more Contains extensive cross-references and bibliographies An invaluable resource for students and scholars across the humanities. (shrink)

Background Citizen science and models for public participation in health research share normative ideals of participation, inclusion, and public and patient engagement. Academic researchers collaborate in research with members of the public involved in an issue, maximizing all involved assets, competencies, and knowledge. In citizen science new ethical issues arise, such as who decides, who participates, who is excluded, what it means to share power equally, or whose knowledge counts. This article aims to present an ethics framework that offers a (...) lens of understanding and heuristic guidelines to deal with ethical issues in citizen science. -/- Methods We conducted seven case studies between 2015 and 2021 to attune and validate the ethics framework for the context of citizen science. The cases related to studies with older adults, people with a psychiatric vulnerability, people dependent on community care, people who are unemployed or living in poverty or both, and young adults with respiratory disease. -/- Results Ethics in citizen science reaches beyond the ethical issues in traditional biomedical and health research. It entails more than following procedures about informed consent and privacy and submitting a proposal to a Medical Research Ethics Committee. Ethics in citizen science relates to everyday ethical issues during the study, including relational and moral complexities concerning collaboration, sharing power, and democratic decision-making. Dealing with these issues requires ethics work of researchers. This entails seeing ethically salient issues and reflecting on everyday ethical issues. Ethics work consists of seven features: framing work, role work, emotion work, identity work, reason work, relationship work, and performance work. All are relevant for researchers in citizen science. -/- Conclusions Ethical issues in citizen science often relate to power differentials, partnership, and collaboration between academics and non-academics. The ethics framework prepares researchers for the work needed in citizen science to act responsibly and offers a heuristic guide to reflect on ethics. Reflection on ethics is a pathway towards ethical citizen science, especially if researchers collaboratively reflect in partnership with non-academics who are subject to the moral issue. (shrink)

This paper has two main goals: first, it reconstructs Aristotle’s account of measurement in his Metaphysics and shows how it connects to modern notions of measurement. Second, it demonstrates that Aristotle’s notion of measurement only works for simple measures, but leads him into a dilemma once it comes to measuring complex phenomena, like mo-tion, where two or more different aspects, such as time and space, have to be taken into account. This is shown with the help of Aristotle’s reaction to (...) one of the problems Zeno’s dichotomy paradox raises: Aristotle implicitly employs a complex measure of motion when solving this problem, while he explicitly characterizes the measure of motion as a simple measure in his Physics. (shrink)

Pace Dummett, the issue between molecularism and holism does not turn on whether a meaning theory is compositional, but on how successful communication is conceived. Given a notion of partial understanding, molecularism escapes the two most prevalent objections against holism (learnability and communication). Holism, too, can escape these objections, provided we also grant the holist a notion of partial understanding and suitably amend our conception of successful communication.

En este artículo discuto las conexiones entre el poeta, los personajes y los lectores. Mi enfoque se funda en lo siguiente: ¿Cómo se imaginan los lectores al autor, cómo imagina el autor a los personajes y de qué modo los lectores son inspirados por los personajes? He seleccionado ejemplos de la tradición homérica y, más específicamente, de algunas estrategias de interpretación en la exégesis antigua, particularmente lo que se ha dado en denominar “soluciones desde el personaje”, para proponer vinculaciones con (...) la interpretación literaria y la crítica textual moderna. In this article I discuss the connections between poet, characters and readers. My focus is based on the following question: How is the author imagined by readers, how are the characters imagined by the author and how the characters inspire readers? I have taken my examples from the Homeric tradition and, more specifically, from some manoeuvres of interpretation in ancient exegesis, particularly the so-called ‘solutions from character’, suggesting a connection with modern textual criticism and literary interpretation. (shrink)

Like Spanish moss on a live oak tree, the scientific study of meaning in language has expanded in the last 100 years, and continues to expand steadily. In this essay I want to chart some central themes in that expansion, including their histories and their important figures. Our attention will be directed toward what is called 'formal semantics', which is the adaptation to natural language of analytical techniques from logic.[1] The first, background, section of the paper will survey the changing (...) attitudes of linguists toward semantics into the last third of the century. The second and third sections will examine current formal approaches to meaning. In the final section I will summarize some of the common assumptions of the approaches examined in the middle sections of the paper, sketch a few alternatives, and make some daring predictions. (shrink)

O presente artigo tem como objetivo problematizar o discurso de emagrecimento presente na mídia contemporânea. Para tanto, foi realizada uma discussão teórico-conceitual acerca de uma política de corpo como alvo das tecnologias de poder em Michel Foucault, tomando-se, como corpus empírico, reportagens da seção “dieta” de alguns exemplares das edições semanais da revista AnaMaria. Tal revista é uma mídia impressa e eletrônica, com periodicidade semanal. Na análise, utilizam-se ferramentas foucaultianas para tensionar e provocar fissuras em discursividades que reverberam pelos mais (...) diversos ambientes de circulação social e que corroboram a fabricação de um padrão corporal. Tal padrão parece ser o modelo estético vigente na atualidade, segundo o qual os corpos “devem” ser magros. Compreende-se que o corpo dos sujeitos é fabricação condizente com os contextos histórico e social aos quais pertencem, e que tais corpos são subjetivados pelas e nas relações de poder em que estão inseridos. Entende-se que há um processo de subjetivação operacionalizado não só pela revista, mas também pela mídia contemporânea em geral, através de uma interpelação sutil e convidativa. Toma-se a mídia como uma pedagogia cultural, que ensina, educa e fabrica sujeitos e subjetividades para além dos muros escolares. O referencial teórico-metodológico operou com alguns conceitos do filósofo Michel Foucault como ferramentas de análise. A pesquisa possibilitou compreender que existem processos de subjetivação que perpassam a vida dos sujeitos, aqui especialmente, modos de subjetivação atrelados ao corpo que deve transformar-se num corpo considerado normal, saudável, belo e feliz. Palavras-chave: Emagrecimento em discurso. Relações de poder. Corpo. (shrink)

Confusion surrounds Catholic teaching on the use of assisted nutrition and hydration, specifically the question of when, if ever, its refusal or removal is ethical. This paper focuses on two often-neglected considerations: the relationship between means and mechanism, and an assessment of proportionality of the mechanism from the patient’s perspective. The authors draw on two critical principles of Catholic moral teaching: only ordinary means are required, and proportionality is subject to the perspective of the patient, not just that of experts (...) or the culture. The mechanisms that provide food and water have distinct benefits and burdens. Their proportionality is properly subject to analysis by the patient or surrogate, who determines which mechanism is acceptable in the patient’s situation. (shrink)