RESUMEN
Even among advocates of legalising physician-assisted death, many argue that this should be done only once palliative care has become widely available. Meanwhile, according to them, physician-assisted death should be banned. Four arguments are often presented to support this claim, which we call the argument of lack of autonomy, the argument of existing alternatives, the argument of unfair inequalities and the argument of the antagonism between physician-assisted death and palliative care. We argue that although these arguments provide strong reasons to take appropriate measures to guarantee access to good quality palliative care to everyone who needs it, they do not justify a ban on physician-assisted death until we have achieved this goal.
Asunto(s)
Eutanasia Activa Voluntaria , Accesibilidad a los Servicios de Salud/normas , Cuidados Paliativos , Rol del Médico , Suicidio Asistido , Enfermo Terminal/psicología , Eutanasia Activa Voluntaria/ética , Eutanasia Activa Voluntaria/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/ética , Disparidades en el Estado de Salud , Humanos , Cuidados Paliativos/ética , Autonomía Personal , Filosofía Médica , Médicos/ética , Médicos/psicología , Suicidio Asistido/ética , Suicidio Asistido/legislación & jurisprudencia , Enfermo Terminal/legislación & jurisprudenciaRESUMEN
En años recientes, las directivas anticipadas (DAs) han sido incorporadas de manera creciente en las sociedades latinoamericanas como un instrumento que permite a los pacientes especificar el modo en que desearían ser tratados en caso de que no sean competentes. El objetivo principal de estos instrumentos es, por lo tanto, incrementar el respeto por la autonomía de los pacientes. No obstante, es importante para ello conocer la experiencia que arrojaron las DAs en otros países, para poder diseñar así la mejor manera de implementarlas. Igualmente importante es identificar posibles facilitadores y barreras que pudiera ofrecer el contexto latinoamericano para llevar a cabo dicho proyecto. En este artículo se analiza la evolución de las DAs en los Estados Unidos, se concentra especialmente en las dificultades que surgieron a lo largo de este proceso, y que se deben fundamentalmente a un abordaje excesivamente individualista del proceso de toma de decisiones. En contraste con ello, se argumenta que el rol importante que desempeñan generalmente las familias, u otras personas cercanas al paciente, en las sociedades Latinoamericanas ofrece condiciones favorables para lograr un abordaje más relacional, capaz de superar los problemas del modelo individualista. Sin embargo, se argumenta también que se necesitan esfuerzos importantes para mejorar la calidad de la relación médico-paciente-familia. En particular, la superación de las acciones paternalistas todavía ejercidas por algunos médicos, frecuentemente en conjunto con los familiares, constituye una condición necesaria para la implementación de las DAs.
In recent years, advance directives (ADs) have been increasingly incorporated into Latin American societies as an in-strument that allows patients to specify how they would like to be treated in the event that they are no longer competent. Their main goal is, therefore, to increase respect towards the autonomy of patients. However, learning from the experience yielded by ADs in other countries, in order to work out the best way to implement them is important to achieve this end. Identifying potential facilitators and barriers to carry out such a project that can be found in the Latin American context is also important. In this article, we will analyze the evolution of ADs in the U.S., focusing especially on the difficulties faced during this process which arise mainly from an overly individualistic approach to the process of decision-making. In contrast, we will argue that the role usually played by families or other people close to the patient, in Latin American societies offers favorable conditions to implement a more relational approach, able to overcome the problems encountered by the individualistic model. Nevertheless, we will also argue that significant efforts are needed to improve the quality of the physician-patient-family relationship. In particular, overcoming the paternalistic actions still exerted by some physicians, often concerning relatives, constitutes a necessary condition for the implementation of ADs.
Nos últimos anos, as directivas de avanço foram incorporadas cada vez mais nas sociedades latinoamericanas como um instrumento que permite aos pacientes especificar o modo em que gostaria de ser tratado quando eles não são competentes. O principal objectivo destes instrumentos é então aumentar o respeito pela autonomia dos pacientes. No entanto, é importante conhecer a experiência de avanço de políticas em outros países, para projetar a melhor maneira de implementá-las também. É importante também identificar potenciais facilitadores e barreiras que poderiam ofrecer o contexto latino-americano para realizar este projeto. Este artigo discute a evolução do avanço de políticas nos Estados Unidos, especialmente focando as dificuldades que surgiram durante o processo, e que é devido primeiramente a uma abordagem excessivamente individualista do processo decisório. Em contrapartida, defendemos que o papel importante que as famílias, ou outras pessoas próximas do paciente nas sociedades latino-americanas, geralmente oferece condições favoráveis para alcançar uma abordagem mais relacional, capaz de superar os problemas do modelo individualista. Também discutimos a grande necessidade de esforços para melhorar a qualidade da relação médico-paciente-família. Em particular, a superação das ações paternalistas exercidas por alguns médicos, muitas vezes em conjunto com membros da família, constitui uma condição necessária para a aplicação das directivas de avanço.
Asunto(s)
Humanos , Directivas Anticipadas , Cultura , Directivas Anticipadas/ética , Ética MédicaRESUMEN
Compelling evidence shows that the offspring subjected to uncontrolled hyperlycemia during gestation display behavioral, neurochemical, and cellular abnormalities during adulthood. However, the molecular mechanisms underlying these defects remain elusive. Previous studies have shown an increased rate of apoptosis and a decreased index of neuronal proliferation associated with diabetic embryopathy. The aim of the present study was to determine whether impairments in apoptotic related proteins also occur in the developing central nervous system from non-malformed embryos exposed to uncontrolled gestational hyperglycemia. Pregnant rats injected with either streptozotocin or vehicle were killed on gestational day 19. Offspring brains were quickly removed to evaluate protein expression by Western blotting. Embryonic brains from diabetic rats exhibited a decrease in the cell survival p-Akt expression (52.83 ± 24.35%) and in the pro-apoptotic protein Bax (56.16 ± 6.47%). Moreover, the anti-apoptotic protein Bcl-2 showed a non-significant increase while there were no changes in Procaspase 3 or cleaved Caspase 3 proteins. The cytoskeleton proteins NF-200 and GFAP were also examined. Neither NF-200 nor GFAP showed differences in embryonic brains from diabetic rats compared to controls. Altogether, these results indicate that both proliferation and apoptotic pathways are decreased in the brain from the developing offspring of diabetic rats. Since selective neuronal apoptosis, as well as selective cell proliferation, are specifically involved in brain organogenesis, it is possible that simultaneous impairments during the perinatal period contribute to the long lasting alterations observed in the adult brain.
Asunto(s)
Apoptosis , Encéfalo/embriología , Encéfalo/patología , Diabetes Mellitus Experimental/embriología , Diabetes Mellitus Experimental/patología , Regulación hacia Abajo , Transducción de Señal , Animales , Glucemia/metabolismo , Encéfalo/enzimología , Caspasa 3/metabolismo , Proliferación Celular , Citoesqueleto/metabolismo , Diabetes Mellitus Experimental/sangre , Diabetes Mellitus Experimental/complicaciones , Femenino , Feto/metabolismo , Proteína Ácida Fibrilar de la Glía/metabolismo , Hiperglucemia/complicaciones , Hiperglucemia/patología , Fosforilación , Proteínas Proto-Oncogénicas c-akt/metabolismo , Ratas , Ratas Sprague-DawleyRESUMEN
La teoría de la circulación de la sangre llamó la atención de los historiadores y filósofos de la ciencia durante muchos años. Uno de los objetivos fundamentales de estos trabajos fue estudiar el proceso mediante el cual William Harvey descubrió su teoría, así como el método que empleó para probarla. En general, estos estudios suelen enfatizar la importancia de los experimentos que este investigador realizó en el contexto de la denominada ''revolución científica del siglo XVII''. En este artículo, queremos mostrar que existe una triple argumentación (al menos) en su defensa de la circulación sanguínea, que incluye no solo sus observaciones y experimentos sino también los argumentos por analogía y los argumentos teleológicos.
The theory of the circulation of blood has captured the attention of historians and philosophers of science for many years. One of the main goals of these works was to study the process by which William Harvey discovered his theory, and the method that he applied to prove it. These studies usually emphasize the importance of the experiments he carried out in the context of the so called ''scientific revolution of the 17th century''. In this article, we want to show that there exists a triple argumentation (at least) in his defense of the circulation of the blood, which includes not only his observations and experiments but also arguments by analogy and teleological arguments.
Asunto(s)
Humanos , Circulación Sanguínea , Sistema Cardiovascular , Historia de la MedicinaRESUMEN
BACKGROUND: Integration of compatible or incompatible emotional valence and semantic information is an essential aspect of complex social interactions. A modified version of the Implicit Association Test (IAT) called Dual Valence Association Task (DVAT) was designed in order to measure conflict resolution processing from compatibility/incompatibly of semantic and facial valence. The DVAT involves two emotional valence evaluative tasks which elicits two forms of emotional compatible/incompatible associations (facial and semantic). METHODS: Behavioural measures and Event Related Potentials were recorded while participants performed the DVAT. RESULTS: Behavioural data showed a robust effect that distinguished compatible/incompatible tasks. The effects of valence and contextual association (between facial and semantic stimuli) showed early discrimination in N170 of faces. The LPP component was modulated by the compatibility of the DVAT. CONCLUSIONS: Results suggest that DVAT is a robust paradigm for studying the emotional interference effect in the processing of simultaneous information from semantic and facial stimuli.
Asunto(s)
Corteza Cerebral/fisiología , Discriminación en Psicología/fisiología , Emociones/fisiología , Potenciales Evocados Visuales/fisiología , Expresión Facial , Desempeño Psicomotor/fisiología , Semántica , Adulto , Femenino , Humanos , Masculino , Estimulación Luminosa/métodos , Proyectos Piloto , Tiempo de Reacción/fisiologíaRESUMEN
An undisputable characteristic of cognitive science is its enormous diversity of theories. Not surprisingly, these often belong to different paradigms that focus on different processes and levels of analysis. A related problem is that researchers of cognition frequently seem to ascribe to incompatible approaches to research, creating a Tower of Babel of cognitive knowledge. This text presents a pragmatic model of meta-theoretical analysis, a theory conceived of to examine other theories, which allows cognitive theories to be described, integrated and compared. After a brief introduction to meta-theoretical analysis in cognitive science, the dynamic and structural components of a theory are described. The analysis of conceptual mappings between components and explanation strategies is also described, as well as the processes of intra-theory generalization and inter-theory comparison. The various components of the meta-theoretical model are presented with examples of different cognitive theories, mainly focusing on two current approaches to research: The dynamical approach to cognition and the computer metaphor of mind. Finally, two potential counter arguments to the model are presented and discussed.
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Cognición , Conocimiento , Modelos Psicológicos , Teoría Psicológica , Ciencia Cognitiva , Humanos , InvestigaciónRESUMEN
Over a 100 years have passed since Pick's description of what is now termed frontotemporal lobar degeneration (FTLD). FTLD is a topic of intense current research interest yet some relevant contributions by non-English speaking authors have received little attention, which makes the history of FTLD research incomplete. In the hopes of filling some of the gaps in the history of FTLD research, the present article introduces fundamental work carried out in Argentina during the first half of the 20th century by Christfried Jakob and Braulio A. Moyano. Jakob's neurophilosophy, as well as his empirical descriptions on dementia and theoretic insights into the role of the frontal lobes are highlighted. Moyano's works on frontotemporal dementia (FTD), specifically concerning language deficits and the concept of focal pathology in Alzheimer disease presenting with progressive aphasia are introduced. These early contributions are examined in the light of the current knowledge on FTLD, highlighting some of the authors' early original contributions, as well as their misconceptions. These authors remain largely unknown despite the fact that their contributions were fundamental in kindling interest in behavioral neurology in Latin America, which continues to this day.
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Degeneración Lobar Frontotemporal/historia , Neurología/historia , Argentina , Lóbulo Frontal/patología , Lóbulo Frontal/fisiología , Degeneración Lobar Frontotemporal/patología , Degeneración Lobar Frontotemporal/psicología , Alemania , Historia del Siglo XX , Humanos , Vías Nerviosas , Enfermedad de Pick/historia , Enfermedad de Pick/patologíaAsunto(s)
Mapeo Encefálico , Corteza Cerebral/fisiopatología , Salud de la Familia , Familia , Esquizofrenia/genética , Esquizofrenia/patología , Estimulación Acústica/métodos , Adulto , Análisis de Varianza , Electroencefalografía/métodos , Potenciales Evocados Auditivos/fisiología , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Escalas de Valoración PsiquiátricaRESUMEN
In a recent paper called To think human out of the machine paradigm, it is stated that psychological science operates within a machine paradigm that is committed to mechanical causality. In addition, it is emphasizes the epistemological and methodological limitations of explanations based in deterministic mechanics and instead argues for the need of an 'organic paradigm' that takes into consideration psychological processes such as subjectivity, inter-subjectivity, and agency. Although there is no doubt that much psychological science has operated under a machine paradigm, we argue that recent psychological research is pursued using a wide variety of approaches and with an absence of a partially integrated meta-theoretical corpus. The present situation looks more like a Tower of Babel of epistemological approaches and empirical programs. The reconsideration of the organic paradigm and an explicitly addressed epistemological framework could constitute a step forward and lead to an explanatory pluralism built on greater dialogue within the psychological sciences.
Asunto(s)
Ciencia Cognitiva/métodos , Modelos Psicológicos , Causalidad , Computadores , Humanos , Fenómenos Fisiológicos del Sistema Nervioso , Filosofía , Psicología/métodosRESUMEN
In cognitive neuroscience, the reissue of the notion of emergence and downward causation has been used as an interlevel model of mind-brain interactions from different perspectives. Within this perspective, intentionality has been interpreted as global to local determination (downward causation) on the neurophysiological level. Consciousness would act as the large-scale, global activity of the system that governs or constrains local interactions of neurons. This argument seems to solve several difficulties with regard to descriptions of consciousness on a neurophysiological and mental level. Nevertheless, the inconsistencies of this argument are shown, and a contextual and pragmatic explanation of the downward causation of consciousness is given.
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Causalidad , Procesos Mentales/fisiología , Encéfalo/fisiología , Estado de Conciencia , HumanosRESUMEN
Abstract From everyday cognition to scientific discovery, analogical processes play an important role: bringing connection, integration, and interrelation of information. Recently, a PFC model of analogy has been proposed to explain many cognitive processes and integrate general functional properties of PFC. We argue here that analogical processes do not suffice to explain the cognitive processes and functions of PFC. Moreover the model does not satisfactorily integrate specific explanatory mechanisms required for the different processes involved. Its relevance would be improved if fewer cognitive phenomena were considered and more specific predictions and explanations about those processes were stated.
RESUMEN
UNLABELLED: Perinatal asphyxia occurs in approximately 0.3% full-term newborn babies, and this percentage has not decreased despite medical advances. There are now evidences indicating that neurosteroids are important in neurodevelopment showing neuroprotective effects. We studied the potential protective effect of allopregnanolone (Allo) in vitro using organotypic cultures from neocortex, striatum, and hippocampus. Immunocytochemistry and confocal microscopy showed an increase of the glial fibrillary acidic protein (GFAP) signal in the studied brain areas after hypoxia. Western blot studies supported these results (hippocampus, 193%; neocortex, 306%; and striatum, 231%). Twenty-four-hour pretreatment with Allo showed different effects at the brain areas studied. In the hippocampus and the neocortex, 24-h pretreatment with Allo 5x10(-6) M showed to be neuroprotective as there was a significant decrease of the GFAP signal compared to control cultures exposed to hypoxia. Pretreatment with 5x10(-8) M Allo attenuated the astrogliosis response in the hippocampus and the neocortex in a nonsignificant way. Allo pretreatment at all doses did not show to affect the astrogliosis triggered by hypoxia in the striatum. Cell survival was analyzed by measuring LDH. After 1 h of hypoxia, all cultures showed a nonsignificant increase of LDH, which was greater after 24 h of hypoxia (hippocampus, 180%; striatum-cortex co-cultures, 140%). LDH levels have no changes by Allo pretreatment before hypoxia. CONCLUSION: 24 h pretreatment with 5x10(-6) M of Allo does not change neuronal viability but it prevents astrogliosis induced by hypoxia in the hippocampus and the neocortex.