JANET DELGADO RODRIGUEZ | : The concept of vulnerability is central to current developments in bioethics, not only because of its analytic nature, but also due to its capacity for criticism. However, this concept has not been sufficiently developed, neither in the area of moral philosophy nor in bioethics. For this reason, it is necessary to define and analyze the conceptual framework in which the notion of vulnerability has been developed within the scope of bioethics. Thus, the (...) purpose of this paper is to indicate how the concept of vulnerability in the field of bioethics has been developed and what the main problems that derive from this approach are. Secondly, the paper analyzes some of the main philosophical approaches that I consider should be articulated in the expansion of a critical bioethics approach focused on the notion of vulnerability. To address this issue, I analyze the reflections that we find in the work of Martha Fineman, emphasizing the main relevant aspects for bioethics. Finally, I highlight the main implications of a theory of vulnerability for bioethics. | : Le concept de vulnérabilité est au coeur des développements actuels de la bioéthique, non seulement en raison de sa nature analytique, mais aussi en raison de son potentiel critique. Cependant, ce concept n’a pas été suffisamment développé, que ce soit dans le domaine de la philosophie morale ou de la bioéthique. Pour cette raison, il est nécessaire de définir et d’analyser le cadre conceptuel dans lequel la notion de vulnérabilité a été développée en bioéthique. Ainsi, le but de cet article est d’indiquer comment le concept de vulnérabilité a été développé dans le domaine de la bioéthique et quels sont les principaux problèmes découlant de cette approche. Deuxièmement, l’article analyse certaines des principales approches philosophiques qui devraient selon moi être articulées à une approche bioéthique critique centrée sur la notion de vulnérabilité. Pour traiter ce problème, j’analyse la réflexion de Martha Fineman, en soulignant les principaux aspects pertinents pour la bioéthique. Enfin, je souligne les principales implications d’une théorie de la vulnérabilité pour la bioéthique. (shrink)

Volume 25, Issue 5, May 2025, Page 38-40.

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps (...) to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. Second, families (...) can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising (...) from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience. (shrink)

The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursue two objectives. First, I focus on understanding and making visible shared vulnerability that arises in clinical settings from a (...) triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term "relational centered-patient professionalism", which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center. (shrink)

The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust relationships among (...) trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates. (shrink)

There has been an increase in the number of jurisdictions legalizing or decriminalizing Medical Assistance in Dying (MAiD). Legal frameworks worldwide strive to balance respect for autonomy with regulatory safeguards that both operationalize voluntary choice and prevent access to MAiD in cases of remediable despair or coerced decision‐making. However, the implementation of such an equilibrium diverges. Some legal systems prioritize personal autonomy and informed consent as the main criterion to access MAiD (e.g., US jurisdictions), while others also add the alleviation (...) of suffering (e.g., The Netherlands). Using the lens of relational autonomy and focusing on Spain's MAiD legislation as a case study, this article poses the question of what notion of autonomy is implied in this system, and whether the imposition of certain safeguards might inadvertently undermine or restrict autonomy, in some specific cases. To that aim, we first analyze its stringent requirements for assessing the so‐called “euthanasic context” which establishes eligibility conditions to access MAiD; then, we highlight how some of its assessments can interfere with the person's autonomy. The analysis highlights how protective measures (e.g., three external assessments before the request is either granted or denied) may imply forms of pathogenic vulnerability, in which safeguards meant to protect autonomy could paradoxically heighten an individual's vulnerability while diminishing autonomy through forms of epistemic injustice. We conclude that these highly protective laws might fall into the “trap of protection,” illustrating the tension between safeguarding autonomy and respecting individuals’ capacity for self‐determination in the context of MAiD. (shrink)

To analyze which ethically relevant biases have been identified by academic literature in artificial intelligence algorithms developed either for patient risk prediction and triage, or for contact tracing to deal with the COVID-19 pandemic. Additionally, to specifically investigate whether the role of social determinants of health have been considered in these AI developments or not. We conducted a scoping review of the literature, which covered publications from March 2020 to April 2021. ​Studies mentioning biases on AI algorithms developed for contact (...) tracing and medical triage or risk prediction regarding COVID-19 were included. From 1054 identified articles, 20 studies were finally included. We propose a typology of biases identified in the literature based on bias, limitations and other ethical issues in both areas of analysis. Results on health disparities and SDOH were classified into five categories: racial disparities, biased data, socio-economic disparities, unequal accessibility and workforce, and information communication. SDOH needs to be considered in the clinical context, where they still seem underestimated. Epidemiological conditions depend on geographic location, so the use of local data in studies to develop international solutions may increase some biases. Gender bias was not specifically addressed in the articles included. The main biases are related to data collection and management. Ethical problems related to privacy, consent, and lack of regulation have been identified in contact tracing while some bias-related health inequalities have been highlighted. There is a need for further research focusing on SDOH and these specific AI apps. (shrink)

Introduction Hospital delirium is a frequent, serious, costly, and underrecognized acute disorder of attention and cognition. Therefore, the prevention of hospital delirium is not only desirable for patients, caregivers, healthcare professionals, and the health system itself, but also a moral duty. Objective To identify and synthetize the main ethical aspects that arise related to the prevention of hospital delirium in patients 65 years and older. Methods A scoping review was carried out in Embase, Medline, and Web of Science (January 2009–January (...) 2022). Articles published in English or Spanish analyzing any pharmacologic, non-pharmacologic, or multicomponent intervention for prevention of delirium in hospitalized patients aged 65 years and over were included. Results Twenty-seven studies were included. Based on the frequency of appearance and the relevance, our findings were organized into three main areas. The first one was related to the principle of nonmaleficence and collected findings about the iatrogenic causes of hospital delirium and the use of restraints systems. The second area analyzed the impact of delirium in patients, families, and healthcare professionals from a relational ethics perspective, and addressed the family presence as a factor to prevent delirium. Finally, the third area is related to the quality of care. Conclusion Prevention of delirium in hospitals is essential to avoid the discomfort and potential clinical complications of patients, as well as the suffering of their relatives, caregivers, and healthcare professionals. Policymakers and healthcare managers are encouraged to make the required efforts to prevent delirium in hospitalized older patients. (shrink)

Theoretical problems concerning concepts of systems and measurement of behavior were encountered during experimental studies of the effects of electrical stimulation of the brain on the social behavior of a monkey colony. General problems involved in the description and measurement of behavior of natural systems, and especially of organisms are discussed. In animals with differentiated brain the general process of stimulation may be divided into four subprocesses: input, throughput, transput and output. Categories of behavior, temporal and spatial units, and logical (...) rules of homogeneity for sorting data and comparing measurements and categories, are discussed. Simple behavioral units are divided into: 1. Individual a. static or postural b. dynamic or gestural 2. Social a. static b. dynamic. Complex behavior is divided into: 1. Simultaneous 2. Sequential 3. Syntactic 4. Roles. The process of interpretation of data by the observer is assumed to be dependent upon actual behavior of the system, techniques of observation and experimentation, theoretical and technical processes of analysis, and synthesis and integration of data. Expression of behavior in mathematical terms insures greater accuracy than descriptive methods and enables data to be processed with computers. (shrink)

In order to understand man's different and often contradictory ideologies we need to explore their deeper roots, analyzing ideas. We do not comprehend the nature of ideas and yet we use and oppose them, realizing that they are wonderful and dangerous entities whose action is comparable to that of drugs. They depress or stimulate the organism, leading men toward great deeds or toward individual and collective disaster. Ideas interfere with the autonomic mechanisms of the body, and are also projected into (...) the social world, creating machines, institutions, methods and goals. Notwithstanding, we usually pay little attention to this tool, creator of all other tools and root of human activity. Assuredly a theory of the idea and of ideologies cannot be developed without the convergent effort of scientists and philosophers, but we can glimpse the possibility of its construction, conscious nevertheless, of our shortcomings and of the provisional character of the presented synthesis. (shrink)

The majority of healthcare professionals regularly witness fragility, suffering, pain and death in their professional lives. Such experiences may increase the risk of burnout and compassion fatigue, especially if they are without self-awareness and a healthy work environment. Acquiring a deeper understanding of vulnerability inherent to their professional work will be of crucial importance to face these risks. From a relational ethics perspective, the role of the team is critical in the development of professional values which can help to cope (...) with the inherent vulnerability of healthcare professionals. The focus of this paper is the role of Communities of Practice as a source of resilience, since they can create a reflective space for recognising and sharing their experiences of vulnerability that arises as part of their work. This shared knowledge can be a source of strength while simultaneously increasing the confidence and resilience of the healthcare team. (shrink)

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection (...) were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

The main aim of this article is to reflect on the impact of biases related to artificial intelligence (AI) systems developed to tackle issues arising from the COVID-19 pandemic, with special focus on those developed for triage and risk prediction. A secondary aim is to review assessment tools that have been developed to prevent biases in AI systems. In addition, we provide a conceptual clarification for some terms related to biases in this particular context. We focus mainly on nonracial biases (...) that may be less considered when addressing biases in AI systems in the existing literature. In the manuscript, we found that the existence of bias in AI systems used for COVID-19 can result in algorithmic justice and that the legal frameworks and strategies developed to prevent the apparition of bias have failed to adequately consider social determinants of health. Finally, we make some recommendations on how to include more diverse professional profiles in order to develop AI systems that increase the epistemic diversity needed to tackle AI biases during the COVID-19 pandemic and beyond. (shrink)

The notion of suffering, inherently linked to the human condition, continues to pose complex and delicate challenges for medical practice. The goals of medicine traditionally place suffering under...

Background Repeated exposure to ethically challenging situations may lead to moral injury (MI). Though MI among healthcare professionals has attracted increasing attention, studies on the process of MI are limited. Aim To elucidate the entire process that psychiatric nurses in Japan undergo from before experiencing MI to their subsequent recovery. Core values in psychiatric nursing, what mitigate MI, and what is important to prevent MI are discussed. Research design A descriptive, qualitative design was adopted. Participants and research context Twelve nurses (...) were interviewed between May 2024 and February 2025. Participants were nurses who had worked in psychiatric settings and had resigned because of witnessing or conducting unethical practices. Purposive snowball sampling, semi-structured interviews, and thematic data analysis were conducted. Ethical consideration Ethical approval was obtained from institutional IRBs. Results Before starting work, the nurses had professional values in psychiatric nursing, and they expected to practice nursing based on these values. On entering the wards, they encountered various events that conflicted with their values. At first, participants doubted whether the practices they observed were appropriate, which gradually intensified and developed into persistent internal conflict. Repeated failure to improve the quality of care led to MI. Participants felt a strong responsibility, which mitigated MI and kept them working. As morally injurious events accumulated, participants developed increasingly negative feelings, ultimately leading to resignation. Their recovery after resignation involved positive and negative emotions. Eventually, they recovered sufficiently to move forward. Conclusion Core values in psychiatric nursing include commitment to patients and respect for their rights. One effective way to mitigate MI is to establish psychologically safe spaces in which shared experiences and values are acknowledged and validated. Moral resilience and courage are important in preventing MI. Both concepts should not be considered personal traits but rather a shared capacity in a group. (shrink)

Background: Several countries have recently changed their model of consent for organ donation from opt-in to opt-out. We undertook a systematic review to determine public knowledge and attitudes towards these models in Europe. Methods: Six databases were explored between 1 January 2008 and 15 December 2017. We selected empirical studies addressing either knowledge or attitudes towards the systems of consent for deceased organ donation by lay people in Europe, including students. Study selection, data extraction, and quality assessment were conducted by (...) two or more reviewers independently. Findings: Awareness of the consent model was lower in opt-out countries than in opt-in countries. A majority of the public agrees with opt-in, regardless of the law in their own country. There are ambivalent attitudes regarding the opt-out system. The public tend to prefer opt-in and mandatory choice over opt-out when several options are offered. Interpretation: The assumption that people in opt-out countries are aware of the legal requirements to be excluded from the pool of potential donors is not supported by the results of this review. This is a concern, since ignorance hinders people's autonomy regarding organ donation decision-making. Higher awareness of consent model in opt-in countries may reflect greater efforts to inform the public through campaigns to motivate donation. Legal moves towards opt-out are at odds with people's expressed preferences. Main limitations of this review are the lack of data from some countries, study population heterogeneity, and methodological shortcomings. (shrink)

Background Moral injury, first identified in military settings, is increasingly recognised in healthcare, yet little is known about its impact on psychiatric nurses, particularly in Japan. Japanese psychiatric care remains heavily institutionalised, with widespread use of involuntary treatment and mechanical restraint, raising ethical concerns. Aim This study explores the experiences and causes of moral injury among psychiatric nurses in Japan who resigned due to moral or ethical distress. Research design A qualitative descriptive design was adopted. Participants and research context Semi-structured (...) interviews were conducted with 12 former psychiatric nurses between May 2024 and February 2025. Participants were nurses who had worked in psychiatric settings and quit due to ethical problems. They were recruited through purposive and snowball sampling. Data were analysed thematically. Ethical consideration The study was conducted after the research ethics committees had approved, written informed consent was obtained from the participants, and their privacy was carefully considered. Results In this study, two of six main themes are reported: (1) causes of moral injury and (2) experiences of moral injury. Nurses reported morally injurious practices such as unjustified mechanical restraints, neglect of patients, long-term institutionalisation for profit, physical abuse, and coercive treatments. These actions often conflicted with their personal and professional values, leading to negative feelings including guilt, shame, anger, and isolation. Many attempted to resist or improve care but faced institutional backlash or apathy from colleagues. Cultural norms valuing conformity and professional hierarchies further hindered ethical action and reinforced silence. Conclusion Moral injury among psychiatric nurses in Japan is deeply tied to systemic and cultural factors that normalise unethical practices and discourage dissent. The findings underscore the need for structural reform in psychiatric care, greater ethical support for nurses, and recognition of resistance not as insubordination but as a vital expression of professional integrity. (shrink)

Background Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. -/- Methods Between 2017–2019, we conducted a convenience sample survey of students (n = 2006) in (...) Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. -/- Results Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support–either informed or uninformed–in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence–either informed or uninformed–among opt-out countries. -/- Conclusion Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data. (shrink)

Several European countries are approving legislative reforms moving to a presumed consent system in order to increase organ donation rates. Nevertheless, irrespective of the consent system in force, family's decisional capacity probably causes a greater impact on such rates. In this contribution we have developed a systematic methodology in order to analyse and compare European organ procurement laws, and we clarify the weight given by each European law to relatives' decisional capacity over individual's preferences (expressed or not while alive) regarding (...) the destination of his or her organs after death. In this sense, the results constitute the first comprehensive and comparative legislative mapping on European transplantation laws. (shrink)

The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between (...) health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility. (shrink)

Organ Donation after Medical Aid in Dying (OD-MAiD) is currently practised in four countries: Belgium, Canada, the Netherlands, and Spain. While OD-MAiD shares some similarities with MAiD (absent the possibility of organ donation) and with standard organ donation protocols, the combination of OD and MAiD involves unique circumstances that present novel ethical challenges. These challenges revolve around donors' consent and protection, the dead donor rule, and organ allocation. This paper explores these moral challenges and proposes strategies to ensure ethical safeguards (...) in the context of OD-MAiD. An underlying question is whether OD-MAiD, if permitted, should follow the ethical guidelines of living donation or deceased donation, as these two practices commonly operate under distinct moral paradigms. While the living donation paradigm is centred on the protection of donors' interests and emphasises individual choice by allowing donors to decide who receives their organs, the deceased donation framework places more emphasis on enabling recipients to benefit from transplant, and organ allocation is typically based on impartiality. OD-MAiD also raises ethical concerns about how the possibility of donation could influence a patient's decision to seek euthanasia and/or interfere with optimal end-of-life care. Proposing organ donation to individuals considering MAiD could conceivably create pressure to proceed with euthanasia, either to realise a social good or to satisfy the needs of loved ones (if a family member requires an organ). This may undermine the patient's autonomy or well-being at the end of life. (shrink)

Background: This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. Materials and Methods: A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. Results: Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have (...) expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. Conclusion: Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain. (shrink)

Objectives To 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. -/- Design Based 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 measures We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. -/- Results Our 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. -/- Conclusions This 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. (shrink)

The main aim of this article is to reflect on the impact of biases related to artificial intelligence (AI) systems developed to tackle issues arising from the COVID-19 pandemic, with special focus on those developed for triage and risk prediction. A secondary aim is to review assessment tools that have been developed to prevent biases in AI systems. In addition, we provide a conceptual clarification for some terms related to biases in this particular context. We focus mainly on non-racial biases (...) that may be less considered when addressing biases in AI systems in the existing literature. In the manuscript, we found that the existence of bias in AI systems used for COVID-19 can result in algorithmic justice and that the legal frameworks and strategies developed to prevent the apparition of bias have failed to adequately consider social determinants of health. Finally, we make some recommendations on how to include more diverse professional profiles in order to develop AI systems that increase the epistemic diversity needed to tackle AI biases during the COVID-19 pandemic and beyond. (shrink)

The main aim of this article is to reflect on the impact of biases related to artificial intelligence (AI) systems developed to tackle issues arising from the COVID-19 pandemic, with special focus on those developed for triage and risk prediction. A secondary aim is to review assessment tools that have been developed to prevent biases in AI systems. In addition, we provide a conceptual clarification for some terms related to biases in this particular context. We focus mainly on non-racial biases (...) that may be less considered when addressing biases in AI systems in the existing literature. In the manuscript, we found that the existence of bias in AI systems used for COVID-19 can result in algorithmic justice and that the legal frameworks and strategies developed to prevent the apparition of bias have failed to adequately consider social determinants of health. Finally, we make some recommendations on how to include more diverse professional profiles in order to develop AI systems that increase the epistemic diversity needed to tackle AI biases during the COVID-19 pandemic and beyond. (shrink)

The Particular Modelling System is a key component of the Global Artificial Intelligence (GAI), designed to generate rational decisions through advanced modelling processes applied to individual programs, cybernetic systems, complex environments, and particular phenomena. Structured in three core stages—(1) the database of rational hypotheses, (2) the construction of mathematical models, and (3) the decision-making process—it enables each particular program to operate autonomously, responding to real-time data and changing conditions with precision. Decisions generated by the system are classified into three main (...) types: research decisions, learning decisions, and decisions based on solving mathematical problems. By replicating structured deductive reasoning at a personalised level, the Particular Modelling System supports adaptive, context-aware intelligence across diverse fields. It also forms a foundational layer in the development of cyborg psychology, where human cognition is enhanced by artificial systems capable of understanding, modelling, and supporting individual behaviour and decision-making. Operating independently while remaining fully integrated within the broader GAI architecture, the Particular Modelling System ensures consistency between global reasoning and local actions—enabling intelligent, scalable decision-making in increasingly complex and dynamic environments. (shrink)

The Final Model unveils the heart of the Global Artificial Intelligence: the Modelling System in its most advanced form—the third stage of integration. In this groundbreaking book, Rubén García Pedraza takes you inside the intelligence that doesn’t just learn from the world—it replicates itself, makes autonomous decisions, and evolves in real time. Discover how the global model is protected, perfected, and projected into the future through a system of rational hypotheses, real-time data flows, and mathematically structured decisions. Explore the powerful (...) roles of the Unified Impact of the Defect and the Unified Effective Distribution as they guide decisions that protect lives and boost global security and productivity. From artificial learning to automated problem-solving, this book reveals how intelligence becomes truly autonomous in the sixth phase. The Final Model is a bold, visionary exploration of what happens when artificial intelligence not only understands reality—but actively shapes it. (shrink)

The “Global Artificial Intelligence (GAI): Categorical Model” is not just a book — it is a gateway into the future of Artificial Intelligence. At its core lies a bold and revolutionary idea: that reality can be understood, modelled, and transformed through a system that unites categories, objects, and decisions into a single, living framework. This work unveils how the categorical Modelling System becomes the foundation for autonomous decision-making, capable of reshaping agriculture, logistics, robotics, medicine, and beyond.

Probabilidad Imposible Vol 1 reúne los fundamentos de una investigación desarrollada entre 2001 y 2018, cuyo propósito es replantear las bases del conocimiento racional y su relación con la probabilidad empírica y teórica. La obra introduce conceptos como el Impacto del Defecto y el Segundo Método, proponiendo un marco alternativo frente a la epistemología de Karl Popper y orientado hacia la búsqueda del conocimiento puro. Este proyecto, originado en el cruce entre matemáticas, inteligencia artificial y psicología, constituye una semilla teórica (...) para el desarrollo de la Inteligencia Artificial Global y para la construcción de una sociedad tecnológica basada en un nuevo paradigma del saber. (shrink)

Ysabel Ydelsa Delgado Del Águila nació el 23 de diciembre de 1990 en Lima (Perú). Estudió la carrera de Traducción e Interpretación en el Instituto de Educación Superior Tecnológico Privado Cibertec, donde se especializó en el aprendizaje de las lenguas del inglés y el portugués y se graduó con una tesis dedicada al escritor portugués José Saramago. Actualmente, trabaja como traductora freelance y es gerente de operaciones en la filial Recife (Brasil) de VFS Global para la misión de Canadá (...) y Reino Unido. Esta organización se encarga del trámite de documentos administrativos y de cobranza para la adquisición de una visa o un permiso temporal en esos países en condición de turista. Durante el tiempo de capacitación de sus empleados, la entidad les brinda la oportunidad de establecer vínculos educativos con las universidades de la India. Ha estudiado el idioma francés en la Alianza Francesa y el italiano en el Instituto Italiano de Cultura. Además, continúa sus estudios de Administración en la Universidad Cruzeiro do Sul (São Paulo, Brasil). (shrink)

Gonzalo Rodriguez-Pereyra offers a fresh philosophical account of properties. How is it that two different things (such as two red roses) can share the same property (redness)? According to resemblance nominalism, things have their properties in virtue of resembling other things. This unfashionable view is championed with clarity and rigor.

Gonzalo Rodriguez-Pereyra presents an original study of the place and role of the Identity of Indiscernibles in Leibniz's philosophy. The Principle of the Identity of Indiscernibles rules out numerically distinct but perfectly similar things; Leibniz derived it from more basic principles and used it to establish important philosophical theses. Rodriguez-Pereyra aims to establish what Leibniz meant by the Principle of Identity of Indiscernibles, what his arguments for and from it were, and to assess those arguments and Leibniz's claims (...) about the Principle of Identity of Indiscernibles. He argues that Leibniz had a very strong version of the principle, according to which no possibilia (whether or not they belong to the same possible world) are intrinsically perfectly similar, where this excludes things that differ in magnitude alone. The book discusses Leibniz's arguments for the Identity of Indiscernibles in the Meditation on the Principle of the Individual, the Discourse on Metaphysics, Notationes Generales, Primary Truths, the letter to Casati of 1689, the correspondence with Clarke, as well as the use of the Identity of Indiscernibles in Leibniz's arguments against the Cartesian conception of the material world, atoms, absolute space and time, the Lockean conception of the mind as a tabula rasa, and freedom of indifference. Rodriguez-Pereyra argues that the Identity of Indiscernibles was a central but inessential principle of Leibniz's philosophy. (shrink)

Esta investigación retoma la obra de Gabriel García Márquez, Noticia de un secuestro (1996), con la volición de cuestionar la idea de Estado nación que está inmersa en el libro. Para ello, es necesario entender que la naturaleza del texto exige un conocimiento amplio al lector o al intérprete, puesto que su contenido revela datos multidisciplinarios. Además, es insoslayable realizar un análisis discursivo de la historia de ese contexto y cotejar con pasajes del mismo libro. Para facilitar esta labor, la (...) extrapolación de conceptos del teórico Luis Rodríguez Manzanera será de utilidad, ya que él despliega definiciones de Criminología, un tema frecuente en la obra. Verbigracia, la macrocriminalidad, una noción que él postula, permite que se comprenda la complexión del periodo histórico finisecular del siglo XX en Colombia, etapa que le corresponde a Noticia de un secuestro. Por otro lado, es menester dilucidar que este estudio no se reduce a lo literario, lo histórico y lo criminológico, sino que abarca distintas disciplinas, por lo que la exigencia en la consolidación epistemológica e interpretativa estará demostrada consuetudinariamente, sin obviar la inmanencia de la obra. Este tipo de análisis interdisciplinarios ya ha sido trabajado desde los Estudios Culturales, tal como se constata en las investigaciones de Richard Johnson (2000) o Néstor García Canclini (1997). De igual modo, el intento de establecer lineamientos y conexiones entre disciplinas como las de Literatura y Derecho ya ha sido desarrollado por Stanley Fish (1986), Faustino Martínez (2005), Carlos Pérez (2006) y Denise Schalet (2014). A diferencia de estos abordajes ya estudiados, el objetivo de esta investigación es detectar y fundamentar cómo se articula una propuesta ideológica desde una configuración que reanuda elementos históricos y literarios. En específico, lo que se busca es argumentar por qué fracasó implícitamente un proyecto sociopolítico de democracia y progreso, a partir de un panorama de violencia, narcoterrorismo, corrupción, negociaciones ilícitas, transgresión a los derechos humanos e inseguridad ciudadana. Con todo ello, esta tesis de maestría terminará siendo fructuosa para análisis postremos de discursos que tienen como esencia un soporte multidisciplinario. (shrink)

El enfoque central de esta investigación es la configuración teórica de la violencia en La ciudad y los perros y la interacción representada entre los personajes principales (para aludir al Jaguar, el Poeta y el Esclavo; para ellos ha usado convencionalmente el término «tríada protagónica»; a la vez, asume que estos personajes podrían ser entidades dispuestas a los posteriores análisis). Desarrolla la metateoría de los triángulos jerárquicos — la cual será convencionalmente graficada de forma piramidal, para que con ello se (...) represente la idea de superioridad e inferioridad con respecto a algún rango asignado a los valores o los personajes —, estos facilitarán la demostración del carácter evolutivo de la violencia en la tríada protagónica (por lo que el Esclavo sería un primer portador mínimo de la violencia; luego, el Poeta, con un poco más de agresión; y, finalmente, el Jaguar, quien estaría configurado como violento, dandi, agresor y manipulador). La forma de demostrar esta metateoría compuesta se basa en una mecánica repetitiva y cíclica, en su mayoría, de apropiación o rechazo hacia un determinado carácter, como también referente al ascenso y el descenso por los cuales atraviesa la valoración del mismo. De alguna manera, se explica que la adquisición de la violencia, como objeto interno de los personajes, provocaría una falsa visión de evolución, seguridad y madurez en un primer momento, mientras que se demostraría que aquella conducta, ilusoriamente adquirida, conllevaría una vía autodestructiva de la interioridad de los sujetos. (shrink)

Although the view that sees proper names as referential singular terms is widely considered orthodoxy, there is a growing popularity to the view that proper names are predicates. This is partly because the orthodoxy faces two anomalies that Predicativism can solve: on the one hand, proper names can have multiple bearers. But multiple bearerhood is a problem to the idea that proper names have just one individual as referent. On the other hand, as Burge noted, proper names can have predicative (...) uses. But the view that proper names are singular terms arguably does not have the resources to deal with Burge’s cases. In this paper I argue that the Predicate View of proper names is mistaken. I first argue against the syntactic evidence used to support the view and against the predicativist’s methodology of inferring a semantic account for proper names based on incomplete syntactic data. I also show that Predicativism can neither explain the behaviour of proper names in full generality, nor claim the fundamentality of predicative names. In developing my own view, however, I accept the insight that proper names in some sense express generality. Hence I propose that proper names—albeit fundamentally singular referential terms—express generality in two senses. First, by being used as predicates, since then they are true of many individuals; and second, by being referentially related to many individuals. I respond to the problem of multiple bearerhood by proposing that proper names are polyreferential, and also explain the behaviour of proper names in light of the wider phenomenon I called category change, and show how Polyreferentialism can account for all uses of proper names. (shrink)

The Stoic conception of “metaphysical” liberty establishes that this is a characteristic of the virtuous person and, therefore, of the person who possesses happiness (eudaimonía). We argue, pushing the ancient Stoic conception of virtue (areté) towards contemporary political-moral conceptions, that, nec essarily, whoever is virtuous and possesses the mentioned metaphysical liberty never discriminates and will always have an anti-discriminatory behavior. We propose, consequently, that those who are discrim inatory and/or promote inequality and/or discrimination are in a metaphysical slavery. We establish (...) that the cause of discrimination, following Stoicism, lies in wrongly considering certain issues as “goods” and in developing passions towards such issues. That is, discrimination is born because we do not rec ognize that only acting virtuously has value. -/- "O professor Francisco Miguel Ortiz Delgado propõe uma releitura contemporânea da concepção estóica de liberdade, entendida em seu sentido metafísico como atributo essencial da pessoa virtuosae feliz (eudaimon). O objetivo consiste em argumentar que, de acordo com concepção estóica, a dis-criminação nasce do erro moral, o de atribuir valor a algo distinto da ação virtuosa, e que somente a conduta guiada pela razão e pela virtude constitui autêntica liberdade" Hefner, Marques Kussler and Rechiki Mireilles. (shrink)

The subtraction argument, originally put forward by Thomas Baldwin (1996), is intended to establish Metaphysical Nihilism, the thesis that there could have been no concrete objects. Some modified versions of the argument have been proposed in order to avoid some difficulties faced by the original argument. In this paper I shall concentrate on two of those versions, the so-called subtraction argument* (presented and defended in Rodriguez-Pereyra 1997, 2000, 2002), and Efird and Stoneham’s recent version of the argument (Efird and (...) Stoneham 2005). I shall defend the subtraction argument* from Alexander Paseau’s (2006) objection that because a crucial premise of the subtraction argument* may have no plausibility independent from Metaphysical Nihilism, the subtraction argument* is not suasive. Although Paseau focuses on the subtraction argument*, I shall point out that Efird and Stoneham could reply to Paseau’s objection in the same way. Thus there are (at least) two suasive versions of the subtraction argument that establish Metaphysical Nihilism. But are those two arguments equally good? I shall argue that the subtraction argument* is preferable to Efird and Stoneham’s argument. (shrink)

El presente trabajo analiza los poemas «III» y «XXVIII» de Trilce (1922) del escritor peruano César Vallejo, considerando que su temática aborda la composición idealizada de la familia desde una posición desfavorable para el yo poético y que, al establecerse de esa manera, logra la perlocución en el lector (lo persuade y lo convence de una realidad específica). Esta configuración semántica se demuestra mediante el análisis del discurso retórico, investigado por C. Fernández Cozman, que adopta los postulados de G. Lakoff (...) y M. Johnson, que recurren a conceptos macro (megametáforas) y micro (metáforas específicas), imprescindibles para la formación de la clasificación tipológica, dispuesta en metáforas orientacionales, ontológicas y estructurales. Igualmente, se confronta con planteamientos asociados, como los de los interlocutores, la cosmovisión y la interdiscursividad. (shrink)