Ethica (Canada)

ABSTRACT This meta-ethnography aims to unravel the meaning of suffering in the context of euthanasia and assisted suicide (EAS) using a multiperspective and international framework. More precisely, we seek to understand how the experience of suffering is (1) interpreted by the patients with a request, their close ones, and physicians and nurse practitioners who provide EAS and (2) how the cultural context may shape the way suffering is described. Using PRISMA guidelines, we included 19 articles (1) focusing on the experience of suffering; (2) written in Dutch, English, or French; (3) published in a peer-reviewed journal; and (4) using a qualitative design or containing rich qualitative data. Five intertwined dimensions were identified: existential, physical-neurocognitive, psycho-emotional, socio-environmental and systemic. Our results underline the nuances in the description of suffering across perspectives and cultural contexts. Our results may inspire those working on the threshold of suffering to adopt a nuanced and holistic approach when assessing patients with an EAS request.

Diferentes Filosofias

Access to effective interventions aimed at reducing the mental health consequences of exposure to traumatic events is hampered by barriers to treatment. Mobile applications (apps) are one way to overcome these barriers. However, the effectiveness of apps in reducing posttraumatic stress symptoms (PTSS) is limited, which could be explained by low user engagement. A better understanding of the needs and preferences of individuals with PTSS could help in developing apps that are more engaging and possibly more effective. This review aims to synthesize qualitative findings from studies examining the subjective experiences of individuals who use apps for PTSS. A systematic search was conducted in PubMed and PsycINFO. Empirical studies that report qualitative data and focus on one or more apps designed for the self-assessment or the self-management of PTSS were included. Sixteen articles focusing on 14 apps met the inclusion criteria. Participants reported barriers (e.g., lack of perceived benefits), facilitators (e.g., ease of use), benefits (e.g., improved mental health), and adverse effects (e.g., increased symptoms) related to the use of the apps. They also made suggestions aimed at improving user experience, such as increasing customization. In conclusion, developing apps with a user-centered approach, promoting social support through the use of the apps, and including gamification elements might increase user engagement with apps for PTSS. Further research should test if that is the case.

O Amor em Adorno ultrapassa o sentido subjetivista e romântico e considera contradições inerentes à teoria do conhecimento; constitui fonte de representação social ideológica, mediada pela relação entre sujeito e objeto. Nessa medida suas contradições o eleva a construto cultural perpassado pela dialética negativa. Logo, para Adorno, o amor é um princípio de aspiração humanista ao lado de valores como: ética, esperança, gratidão, bondade, solidariedade, justiça e democracia. Tais valores, se desmistificados, postulam oposição à frieza, ao totalitarismo e ao horror do nazismo e do fascismo; em resistência ao sofrimento, preconceito e à barbárie recorrentes na civilização. Não obstante, desmistificar o amor ideal e romântico, como a outros valores configura experiência autorreflexiva, não-idêntica e formativa com vistas a umasociedade consciente, emancipada e humanista, que reconhece riscos de alienação e inversão de totalidade a totalitarismo, democracia a pseudodemocracia. O amor consciente, verdadeiro e crítico transpõe-se em iminente ação social. À luz de Adorno, o amor dialético pressupõe esperança de uma real sociedade justa em termos políticos, culturais e sociais. Palavras-chave: Adorno. Amor. Dialética negativa. Barbárie. Educação. Teoria crítica

A retrospective, propensity-matched observational study. To assess the impact of cell saver (CS) homologous transfusion on perioperative medical complications in adult patients undergoing spinal deformity surgery. Despite many endorsing its use, many analyses still refute the efficacy of CS on decreasing total perioperative allogenic red blood cell transfusions, cost efficiency, and its effect on perioperative complications. Adult patients who underwent spinal deformity surgery at a single center between 2015 and 2021 were retrospectively reviewed. Patient-specific, operative, radiographic, and 30-day complications/readmission data were collected for further analysis. Two methods were utilized to test our hypothesis: (1) absolute threshold model: two cohorts created among patients who received ≥550mL of CS intraoperatively and those who received less; (2) adjusted ratio model: two cohorts created dependent on the ratio of CS to estimated blood loss (EBL). Propensity-score matching and various statistical tests were utilized to test the association between CS and perioperative medical complications. Two hundred seventy-eight patients were included in this analysis with a mean age of 61.3±15.7yrs and 67.6% being female. Using the first method, 73 patients received ≥550mL of CS, and 205 received less. Propensity-score matching resulted in 28 pairs of patients. 39.3% of patients with ≥550mL CS required readmission within 30 days compared with 3.57% of patients in the <550mL cohort ( P =0.016), despite a nearly identical proportion of patients requiring intraoperative blood transfusions ( P >0.9999). Using the second method, 155 patients had CS/EBL<0.33 and 123 with CS/EBL ≥0.33. 5.16% and 21.9% among patients with CS/EBL<0.33 and CS/EBL≥0.33, respectively, were readmitted by the 30-day marker ( P <0.0001). Our findings indicate that greater CS volumes transfused are associated with higher rates of 30-day readmissions. Thus, surgeons should consider limiting CS volume intraoperatively to 550mL and when greater volumes are required or preferred, ensuring that the ratio of CS:EBL remains under 0.33.

En el presente artículo se reflexiona sobre los retos que enfrentan las Humanidades en la educación superior y los impactos negativos que conlleva su exclusión en los currículos formativos, como la pérdida de libertad y el debilitamiento de la democracia. A partir de una reflexión hermenéutica, se analizan las propuestas de Martha Nussbaum y Boaventura Sousa Santos para construir una metodología pedagógica que integre las humanidades, la música y el arte en los programas de educación superior. Esto supondría que los alumnos cuenten con un aparato crítico que les permita poner en acción innovaciones que hagan frente a las problemáticas de su entorno inmediato, con una actitud ética, reflexiva, responsable y empática. A lo largo del texto se busca, de igual forma, advertir al lector sobre otros efectos de debilitar el aprendizaje humanístico, tanto en la educación de los alumnos universitarios como en las sociedades actuales, si se le considera una estrategia del sistema económico neoliberal de acondicionamiento de los individuos a un esquema de producción y consumo, sin que garantice, de ninguna forma, la calidad de vida de las personas.

Introducción: Los científicos han explorado las capacidades intelectuales de los animales, su importancia para la salud física y emocional de los humanos, su uso como sujetos en la investigación biomédica y psicológica, pero se ha prestado poca atención a las valoraciones que hacen las personas del común sobre estas prácticas sociales. El objetivo de esta investigación fue presentar los resultados sobre las valoraciones de prácticas de divertimiento, producción industrial, investigación biológica y psicológica, que involucran animales, a partir de las dimensiones: ética, legal, las capacidades intelectuales, los beneficios para la salud física y emocional de las personas y la preocupación por su bienestar. Método: Se construyó un instrumento online a partir una frase mapa compuesto por 28 ítems, que exploran la evaluación de 255 personas, hombres y mujeres sobre estas prácticas, bajo la condición de tener o no mascota. Las respuestas se analizaron mediante un análisis de escalamiento multidimensional. Resultados: Queda en evidencia la preocupación de las personas por las condiciones en que se usan los animales, en particular, de quienes tienen o han tenido mascota. Conclusiones: Los hallazgos se discuten a partir del soporte de las facetas incluidas en la frase mapa y la propuesta para nuevos estudios sobre prácticas sociales que involucre animales en la población general.

The aim is to analyze the relation of psychosocial factors to COVID-19 contraction, vaccination, and preventive health behavior in and outside work. The questionnaire data from hospital-workers in Turkey is analyzed using independent-samples t-test, logistic regression, linear regression, and mediation analyses. We developed a questionnaire on mask-hygiene-distance measures and also used previously developed scales including the Big Five Personality Questionnaire, Young Schema Questionnaire Short Form 3, Schwartz's Basic Human Values Scale, Short Dark Triad. The odds of being infected by COVID-19 increases by self-direction. The odds of being vaccinated increases by age and conformity, and decreases by emotional stability. Education predicts certain preventive behaviors at work negatively and outside work positively. Older age, being a woman, having chronic disease, the self-transcendence and conservation values, agreeableness, and conscientiousness predict more preventive behaviors. The self-enhancement and openness to change values, the Dark Triad, and early maladaptive schemas predict more risky behaviors. Designing prohealth policies requires further elaboration on the relation of psychosocial factors to preventive behaviors.

ObjectivesTo increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives.DesignBased on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply.Main outcome measuresWe measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery.ResultsOur analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%–5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out.ConclusionsThis study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families.

Despite public health measures and collective efforts, millions of individuals have unfortunately died from COVID-19 complications worldwide, leaving several million family members at risk of developing bereavement complications. In the Canadian province of Quebec, where substantial deaths were associated with COVID-19, we established an online support community for bereaved caregivers who lost a loved one during the pandemic. We explain how we created a community that recognized pandemic grief and advocated for its wider acknowledgment. We discuss "compassionate communities," the theoretical underpinning of our initiative, as a means to foster solidarity, normalize finitude, create and maintain a safe social space through group sharing, and challenging capitalist principles. We then describe the eight areas of activities inspired by the Charter of Pallium Canada: education and training, hospices and nursing homes, media and social media, commemoration, celebrations, artistic practices and storytelling, marginalized populations, and review and evaluate. We propose that online communities constitute a powerful space for community members to gather and advocate for greater awareness of the inequities found in end-of-life care and bereavement services, to denounce abusive situations experienced by many individuals who died from COVID-19 complications, and to fight against the lack of recognition experienced by numerous caregivers.