- LA ÉTICA DEL DEPORTE COMO ÉTICA HERMENÉUTICA: KARL OTTO APEL. UNA REVISIÓN.
- ir my bien - Translation into English - examples Spanish | Reverso Context
- Cirugía y Cirujanos (English Edition)
- Meaning of "ética" in the Spanish dictionary
All of these are questions to which there are no definitive, universally accepted answers, and they have changed over time due to spectacular scientific and technological advances such as extensive oncological surgery with radiotherapy or adjuvant chemotherapy that enable a cure or at least improve the condition of patients for whom up to a few years ago little could be done. The answers to these questions can also vary according to the context in which the patients are treated, the material and human resources available and of course the philosophy and standards of the health institution, the ethics and bioethics of the doctor, of the health team, of the patient and their family, respecting the patient's autonomy and dignity at all times.
However the indications for palliative treatment are more extensive. Patients who have undergone surgery with serious complications that have resulted in irreversible organ and functional impairment are also candidates for palliative care. Candidates also include young people and even children with acute disorders, who have often undergone one or more operations, with serious complications that have irreversibly compromised their body's integrity and functioning despite the appropriate treatment.
For these patients, the prognostic indices Apache I, Glasgow Scale and others evaluate gravity of disease and possibilities of survival. Traumatised patients regardless of their age, with multiple, serious lesions resulting in complications and organ and functional failure, whose response to treatment is poor or null, will also benefit from palliative care. Although as stated earlier, these can be patients with acute or chronic disease, with complications that have caused major organ and functional impairment, and whose chances of recovery are few or null. A lot can be done for these patients, without attempting to use everything that science and technology provide.
The most appropriate care plan should be implemented for each individual patient, taking their organic and functional conditions into consideration, and their possibilities of recovery. This has given rise to the concepts of ordinary or proportionate means as against extraordinary or disproportionate means. Ordinary means, proportionate to the needs of the patient comprise support and assistance, communication, hydration and feeding, position changes, toileting and wound treatment, and procedures and medication to mitigate pain or ease distressing symptoms such as nausea, vomiting, dizziness and insomnia in order to lessen suffering, so that the they can be made more comfortable and achieve better quality of life.
Extraordinary or means disproportionate to the patient's condition, although useful in many patients for a limited time, are not indicated for patients whose prognosis is terminal in the short or mid term due to advanced disease state, serious complications or lack of response to treatment.http://copini.life/wp-includes/map7.php
LA ÉTICA DEL DEPORTE COMO ÉTICA HERMENÉUTICA: KARL OTTO APEL. UNA REVISIÓN.
These include respiratory support, invasive diagnostic studies, surgery, antibiotics, parenteral nutrition or vasoactive drugs. The same could be said of chemotherapy and radiotherapy, with even more reason since these cause distress and undesirable side effects. Palliative care can be provided in settings other than specialist institutions, hospitals and hospices, such as general hospital rooms and wards, intermediate care units and even in the patient's home. It is important to have everything that is required to hand, and in particular a human team willing and available to assist the patient.
The patient's environment should be comfortable, of appropriate temperature and humidity with no excessive noise. A degree of privacy should be provided to enable the patient to communicate with the health team and their family, and to rest and sleep when they need. Palliative medicine comprises a series of simple means, which cause little inconvenience, do not increase care costs and can be implemented in any location.
Of most importance are support and assistance, communication and listening to the patient who will often wish to talk about subjects that they might be reluctant to discuss with their family.
Listening and talking with the patient can be cathartic and help them cope with their emotional burden, stress and anxiety. General means to ensure that the patient is more comfortable and to reduce their distress, such as washing, skin care, active and passive mobilisation, exercises appropriate for their condition, massages, breathing exercises, wound treatment, stoma care, hydration and feeding — preferably orally, providing the foods they desire and can tolerate.
In special cases, with the patient's consent, tube or intravenous feeding can be given, provided the risks do not outweigh the benefits. Informed consent is a requirement for administering palliative medicine. This is understood as providing the patient full and clear information about all aspects of their disease, the diagnostic and therapeutic procedures to be undertaken and their advantages and disadvantages, honestly weighing up the cost-benefits if these are used or stopped, and suggesting other possible alternatives.
For this to be truly informed consent it is important to check that the patient has understood everything that has been explained to them, so that they can reflect and freely make the decision that suits them best.. Some drugs and procedures are essential for treating the symptoms that affect good quality of life, such as analgesics and procedures to mitigate pain, and treatment for nausea, vomiting and insomnia. Occasionally it will be necessary to use procedures to tackle very distressing conditions: catheterisation for urinary retention, nasogastric tube for gastric dilatation, enemas and the removal of impacted faeces, evacuation of pleural effusion or ascites if they affect appropriate ventilation.
In some patients surgery can be palliative: solving intestinal occlusion, removing a bleeding organ or debriding an abscess. An essential aspect of palliative care is the management of psychological alterations, here the intervention of the treating practitioner and psychologist is of vital importance. The intensity of pain should be evaluated in order to treat it correctly. To this end it is useful to use analogue scales according to the circumstances of each patient and administering analgesics with a gradual plan in stages has proven to be useful in cancer patients: Stage I for patients with mild to moderate pain use NSAIDs that should be rotated every 15 days, Stage II for persistent, moderate to severe pain from the start, use NSAIDs with weak opiates such as codeine or tramadol, corticosteroids can be added and also rotated every 15 days, and Stage III for persistent, severe pain from the start, use NSAIs plus a powerful opiate such as morphine or methadone.
In combination, administer proton pump inhibitors, metoclopramide and other antiemetics to prevent or treat side effects, and combined with anti-anxiety and anticonvulsant drugs can improve results in some patients. Fentanyl or buprenorphine patches are useful in the management of these patients at home. There is reluctance to use opiates in many of our country's health institutions for fear of creating an addiction. In this regard, the severity of the disease and the short life expectancy of these patients will not result in addiction to these drugs.
When indicated, the use of opiates and sedatives that affect the central nervous system is acceptable in order to ease pain and prevent suffering, despite the risk of accelerating the final outcome. It is important to assess the use of drugs that inhibit consciousness and in turn suppress the possibility for the patient to communicate with their doctor and other people, which in some cases is vitally important to the patient in order to re-establish relationships with certain individuals, parents, children or siblings with whom they might have severed relations.
It is also necessary to preserve consciousness when reflection and judgement is required to take social and legal decisions. Regional blocks and epidurals, alcohol or phenol infiltration of the ganglion in the course of a surgical examination, guided by ultrasound or CAT, are good alternatives. Pain surgery such as posterior cordotomy is limited to special cases.
Frontal lobotomy which suppresses pain but also suppresses connection with others, emotions and judgement and therefore cannot be considered to enhance quality of life, is not indicated. Although a doctor should always be in charge and responsible for the therapeutic indications as well as establishing communication with the patient and their family, choosing the best alternatives with them in order to improve the patient's condition and quality of life, ideally it should be a multidisciplinary health team who administers palliative care; this is the ethos of the hospice.
ir my bien - Translation into English - examples Spanish | Reverso Context
This team can comprise the treating physician or physicians, nurses, psychologists, social workers, medical and nursing students, family members, friends and ministers of religion, who will willingly work in coordination in the different abovementioned settings: hospices, hospital rooms and wards, care homes and the patient's own home. The cancer patient can enter a hospice where they will only receive conservative treatment with ordinary palliative means, administrated by a multidisciplinary team that ideally should include the participation of family members and friends.
On admission to the hospice all oncological treatment is halted: radiotherapy, chemotherapy and any surgical intervention. The advantage of this management is that the patient can socialise with other patients in a similar situation, with hospice staff, doctors, nurses, psychologists and social workers, and can receive visits from family members, friends, and ministers of their religion, if they so wish.
Of course the patient can change their mind, request to be discharged to continue with their palliative care at home, or return to their prior oncological treatment. Palliative treatment should be used as long as necessary, while the patient is suffering pain and other distressing symptoms: The use of opiate analgesics and central nervous system sedatives can cause an induced state of unconsciousness and coma, at this time extraordinary means such as endotracheal intubation, assisted respiration and cardiopulmonary resuscitation should not be applied.
Occasionally patients will have expressed their wishes in advance, when in full possession of their mental faculties. It is important to ensure that the patient is not in a state of depression when they express their wishes and that they are in an appropriate condition to reflect and make decisions that can be written down in a document and signed before witnesses or a notary. The patient can also express their wish to donate organs for transplantation.. Legislative amendments have already set the legal framework for the appropriate use of the end-of-life directive.
The patient, having considered and envisioned the progression of their disease will have freely expressed their wishes as to how their condition should be managed. An advance directive before a notary is not always practicable, therefore it is enough for it to be signed before two witnesses and placed so that it can be seen by the healthcare team, paramedic staff and family members.
This greatly helps towards ensuring that the patient's will is respected. Therapeutic obstinacy, i. This comprises the abovementioned palliative means applied in the most appropriate environment, chosen by the patient, their family or a responsible person. This can be the hospice, hospital ward or the patient's home.
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In a similar vein, communitarians fault both the utilitarians and the contractarians for having an inadequate conception of the human person and for paying insufficient attention to the moral importance of the fabric that binds human beings together in a mutually beneficial, caring, and nurturing society.
Communitarians have also been critical of an emphasis on the rights claims, powers, and privileges of a person against society of individuals without a corresponding emphasis on the responsibilities of individuals to the society or community to which they belong 21, It is not difficult to understand why communitarian ethics takes on both a kind of leftleaning egalitarian and participatory democratic turn and a more culturally conservative and authoritarian turn.
One orientation strongly committed to social change and cultural transformation, feminist philosophy and the feminist movement, has been an important source of communitarian ethics. This shows how and why communitarianism can move in a progressive direction. Although persons are shaped by culture and relationships, they also shape them, and those cultural traditions, distributions of power, and relationships that are discriminatory and oppressive to certain types or classes of people should be transformed, not for the sake of greater individual liberation and autonomy in some abstract sense, but for the sake of better, more humanly self-fulfilling patterns of relationships and sharing of power By the same token, an emphasis on the need of the individual for stability, order, and cultural roots, coupled with a sense of the limitations of human reason, either as a motivating factor in human conduct or as a faculty that can successfully design and guide deliberate social change, can take the communitarian orientation in a much more conservative and authoritarian direction.
In this it has affinities with the conservative aristocratic heritage, with the civic republican tradition given its emphasis on individual duty, virtue, and common morality , and with the worldview of religious orthodoxy and fundamentalism. But several theorists of communicative ethics have turned away from theoretical constructs, such as the "original position" Rawls or the "ideal speech situation" Habermas , and toward real world social discourse and deliberation, as the basic justifying grounds for ethical argument Turning to political theory, it is not so easy to group various approaches into three clusters.
The basic starting point for understanding American political theory is that most often both public argument and political conflict over ideology and policy have taken place within the parameters of the broad tradition of political and philosophical liberalism that Americans inherited from English revolutionary and Enlightenment thought. With rather short lived and localized exceptions, there has never developed a seriously authoritarian left-wing nor an authoritarian right-wing political theory in the United States.
Thus the classification suggests a large range of variations on liberalism, with a left-communitarian-style emphasis on a more participatory form of democracy, on the one hand, and a right-communitarian-style cultural conservatism, on the other. These two forms of communitarianism, and not an old communist left nor a fascist right, make up what amounts to the main challenges to mainstream liberalism in America today.
Within the spectrum of liberalism broadly construed including large portions of what is ordinarily called "conservativism" in the United States , we have variants that are close to being socialist and collectivist in nature, and these seem to me to grow mainly out of the utilitarian tradition. If one took a survey designed to get at something like these orientations among professionals in the field of public health, my hunch is that one would find large numbers occupying this area. What I am calling "egalitarian liberalism" is also of the left in that it favors the use of national state power to promote a more equal distribution of wealth and power in the society, a conception of justice that requires primary attention to the interests of the least advantaged, and the close regulation of corporate and private economic activity to mitigate deleterious environmental, social, and health effects.
It draws theoretical justification from the individualistically oriented theorists of freedom, justice, equality and human rights that comprise the contractarian approach. Rounding out the liberal spectrum is libertarian liberalism, which favors maximum freedom of individual choice with a minimum of governmental power or coercion. Institutions that bring about social order and cooperation on the basis of unplanned and uncoordinated actions and choices of free individuals e. Liberalism of all types tends to presuppose an institutional framework of representative democracy, the rule of law, freedom of speech and political organization, and competitive elections.
Liberalism and democracy were not always thought to be mutually compatible, but today they are joined at the hip at least in Western political thinking That may be why a regime such as China, which seems to have pried apart economic liberalism from political democracy, embracing the former while rejecting the latter, presents us with something of an enigma. Perhaps the most theoretically innovative and interesting challenge to this liberal paradigm arises from forms of democratic theory that are not satisfied with current institutions of electoral politics and representative, interest group democracy.
One such form, that is close to egalitarian liberalism in many ways, but which nonetheless demands a more direct, active role in both political argument and in civic and political life, is known as deliberative or discursive democracy 27, Another major type of political theory that rivals liberalism, and has long pedigree in the history of Western political theory, has come to be known as civic republicanism. With intellectual roots that can be traced back to classical political thought in ancient Greece and Rome, republicanism was rekindled during the Renaissance, by thinkers such as Machiavelli, and later transmitted to various English revolutionaries in the seventeenth century At that time, democracy was hardly mentioned, but establishing a republic was seen as the main alternative to hereditary and absolute monarchy, which had become the principal governmental form of the powerful nation states in the early modern period France, Spain, England, Russia, the Holy Roman Empire.
In American history republicanism was an important ideological foundation of the revolution and of the governing of the country during its first one hundred years 14, With its sense of the common good and its emphasis on public service and civic virtue, however, civic republicanism is proving to be a theoretical vocabulary of renewed vitality in recent years. It is a straightforward ally of communitarianism and deliberative democracy in many settings.
Finally, no schema of contemporary American political thought would be complete without mention of the kind of cultural conservatism that is so powerfully associated with the fundamentalist and religious revitalization movement now underway here Fortunately this movement has not taken on a guise of collectivism in the manner of national socialism or fascism, although its opposition to the power of government regulation and control seems to be waning during a presidential administration and a congressional majority that seems sympathetic.
For the most part, however, this movement has embraced economic and political liberalism but oriented toward the goals of cultural and sexual conservatism and protestant Christian religious fundamentalism. It is not possible to construct a one-on-one mapping of ethical theories with political theories.
Cirugía y Cirujanos (English Edition)
The lines drawn on Figure 1 are meant to indicate that there is a two-way pattern of influence between political and ethical thinking, and that each configuration of political theory can draw from several different sources within ethical theory. In On Liberty, for example, John Stuart Mill develops a position closely akin to libertarian liberalism on the basis of a utilitarian metatheory, while Robert Nozick grounds his libertarianism on rights-theory and contractarianism 8,9.
Similarly, contractarianism provides the theoretical underpinnings for both egalitarian liberalism and some aspects of deliberative democracy. The main disagreement between these two camps would not be over fundamental values and principles, but over the most effective means to formulate policy and to build support for it in a process of democratic will formation the democrats prefer actual deliberation over hypothetical deliberation.
On the other hand, deliberative democrats and civic republicans these terms have no relationship whatsoever to the American Democratic and Republican political parties draw much in common from the insights of communitarianism about the moral and human importance of relationships of friendship and shared commitment, cultural tradition, and a sense of community. Yet they may differ considerably about the importance and the practicality of direct grassroots participation in deliberation and policymaking.
The republican tradition has never insisted on direct democracy; indeed it is more characteristic of republicans to look toward governance by elites or experts, tempered perhaps by representative democracy and constitutional and other judicial protections. This is because the goal of civic republicanism is not active participation in shared decisionmaking per se public citizenship , but rather the preservation of the public morality and a sense of duty and responsibility among private citizens whose behavioral support and restraint are necessary to achieve public goals and to realize the common good.
Normative Discourse in Public Health Practice. It is my hope that the preceding sketch, brief and oversimplified as it has been, nonetheless conveys a sense of the normative complexity of the semantic field within which public health policies and programs find themselves vying for parliamentary support, funding, and social legitimacy.
This is not the place to elaborate on how various public health issues can be interpreted in light of the basic formations of ethical and political theory outlined above. Let me mention just a few areas where I believe one cannot understand the arguments that swirl around public health measures without sorting out the ideological and theoretical landscape as I have begun to do here. One important area of normative controversy in public health is in health promotion and disease prevention. Such programs inevitably raise questions about the responsibility of individuals to live healthy lives; about the role of government in coercing health-related behavior or in developing educational programs; about the use of incentives, economic or otherwise, to promote good health; and about the relative importance for society of pursuing good health, particularly in a culture that prizes autonomy and does not always look fondly on government intervention.
A second area of public health controversy centers around the goal of risk reduction. Risks to the health of the public are many, and many methods are used to reduce or eliminate them. Almost everyone of them can pose one or more ethical problems. The concept of risk itself is seemingly impossible to define in value neutral terms and is inherently controversial.
Even more ethically charged is the question of what level or degree of risk is socially acceptable, who should decide, and how should exposure to risk be distributed across the affected population. Routine public health practice involves a number of interventions and policies designed to prevent harm to individuals and to lower health risks within the population. Epidemiological research may not always follow strict ethical protocols on the rights of human subjects, and the collection of health information may sometimes put the researcher in a position of having information that a specific individual might have an interest in knowing.
The responsibilities of the public health researcher regarding individual notification and the protection of personal privacy and confidentiality are not yet clearly set out as a matter of consensus within the profession. Like the prevention of harm to others, individual privacy is a lightening rod for the conflicts and tensions between individual liberties and the common good that the main ethical and political theories of our time attempt to adjudicate and set in order.
Finally, there is the issue of structural and socioeconomic disparities in health status. Equitable access to decent health care and reduction in health status disparities have been long-sought goals in American society. What is the appropriate role for the public health community in seeking greater justice in health care, and how ought it to balance its fact-finding and educational role over against its historically strong advocacy mission.
To what extent, if any, ought the field adopt a politically partisan posture? Styles of Practical Ethical Discourse. To complete my analysis of normative inquiry in public health I turn from ethical theories to the available orientations and styles of practical or applied ethical analysis. As before, we need some rough typology or conceptual map to guide further research and interpretation in the normative study of public health. To borrow an analogy from linguistics, if ethical and political theories form the grammar la langue of normative discourse in public health, these styles or rhetorics of ethical discourse form its speech acts la parole.
I want to distinguish four different styles of applied ethics: professional ethics, advocacy ethics, applied ethics, and critical ethics. Professional ethics. The study of professional ethics tends to seek out the values and standards that have been developed by the practitioners and leaders of a given profession over a long period of time, and to identify those values that seem most salient and inherent in the profession itself. Applied to public health, this perspective entails identifying the central mission of the profession e. Like all professionals, public health officers exercise considerable power over the lives of others, and the way they use that power makes a substantial difference in the quality of those lives.
The perspective of professional ethics would seek to express the virtues that practitioners ought to possess and the rules they ought to follow if they are to be permitted by society to exercise such power and authority. A difficulty in using this approach in the arena of public health is the questionable, tenuous status of public health as a single, unified profession today. The power of this ethical approach usually comes from the fact that students and practitioners feel that they have taken on a special role-duty or "calling" when they enter the profession. This ethos and sensibility seem to be lacking in public health at the moment.
Advocacy ethics. If there is a characteristic ethical orientation within the field of public health today, it is probably less theoretical or academic than practical and adversarial. The ethical persuasion most lively in the field is a stance of advocacy for those social goals and reforms that public health professionals believe would enhance the general health and wellbeing, especially of those least well off in society.
Such advocacy is in keeping with the natural priorities of those who devote their careers to improving public health. It has a strong orientation toward equality and social justice, for so much of the research and expertise in public health throughout its history has focused on showing how social deprivation, inequality, poverty, and powerlessness are directly linked to poor health and the burden of disease.
In recent years a growing international movement in support of human rights has exerted an important influence in public health as well And it has moved public health ethics in its advocacy mode toward an agenda of social and welfare rights designed to provide resources and to empower individuals and groups, and not just to protect the so-called "negative" or political rights of the individual against intrusion or harm. The problem raised by this perspective on ethics is the flip side of its passion and commitment.
Meaning of "ética" in the Spanish dictionary
Precisely because it backs the professional service agenda of the field of public health, it has only a limited ability to provide a critical perspective on norms and orientations that are taken for granted in the field. As an ethical approach it aims more toward action than persuasion. By definition an advocacy position is not primarily based on detached rational persuasion. To look beyond the advocacy ethics of public health we need to find an orientation no less critical of powerful interests, but one more committed to careful and inclusive deliberation; deliberation undertaken in an effort to set aside specific moral commitments and political agendas on behalf of gaining some broader perspective in the moral questions at issue.
Applied ethics. Another approach to public health ethics comes from the field that has emerged in recent years as "applied" or "practical" ethics. Bioethics is one area among others within this domain of ethics. The applied ethics perspective differs from the professional ethics perspective principally in that it adopts a point of view from outside the history and values of the profession. From this more general moral and social point of view, applied ethics seeks to devise general principles that can then be applied to real world examples of professional conduct or decisionmaking