RESUMO
The microbiome of freshwater sponges is rarely studied, and not a single novel bacterial species has been isolated and subsequently characterized from a freshwater sponge to date. A previous study showed that 14.4% of the microbiome from Ephydatia fluviatilis belong to the phylum Planctomycetes. Therefore, we sampled an Ephydatia sponge from a freshwater lake and employed enrichment techniques targeting bacteria from the phylum Planctomycetes. The obtained strain spb1T was subject to genomic and phenomic characterization and found to represent a novel planctomycetal species proposed as Planctopirus ephydatiae sp. nov. (DSM 106606â¯=â¯CECT 9866). In the process of differentiating spb1T from its next relative Planctopirus limnophila DSM 3776T, we identified and characterized the first phage - Planctopirus phage vB_PlimS_J1 - infecting planctomycetes that was only mentioned anecdotally before. Interestingly, classical chemotaxonomic methods would have failed to distinguish Planctopirus ephydatiae strain spb1T from Planctopirus limnophila DSM 3776T. Our findings demonstrate and underpin the need for whole genome-based taxonomy to detect and differentiate planctomycetal species.
Assuntos
Filogenia , Planctomycetales/classificação , Poríferos/microbiologia , Animais , Água Doce , Microbiota , Planctomycetales/isolamento & purificaçãoRESUMO
BACKGROUND: Little is known about country-specific variations in suicidal ideation (SID) by sex and how they correspond with completed suicide rate. Therefore, the aim of the present study was to assess variations in SID prevalence rates by sex and its correlation to completed suicide rates across European countries. METHOD: SHARE is a cross-national European survey of individuals over the age of 50 and their spouse of any age. The present study relied on wave 4 conducted in 2010-2012 including 49,008 participants aged 55 to 104years from 16 countries. SID was evaluated using a single item from the Euro-D. Data on completed suicide rates were taken from the WHO mortality database. RESULTS: Of the study population (n=49,008, 44.3% men, mean age 68.2±9.1years), a total of 4139 (8.5%, 95% CI 8.2-8.7) reported suicidal ideation within the last month. The women:men ratio in SID prevalence ranged from 1.30 in Estonia to 2.25 in Spain and Portugal. Regarding country-specific variation, the SID prevalence patterns of both men and women did not correspond to the completed suicide rates for males and females aged 55+ reported by the WHO (2013). Correlations were rather moderate in men (r=0.45) and especially weak in women (r=0.16). CONCLUSION: The study showed remarkable differences in SID prevalence by sex. The most exciting finding was that SID rates did not correspond with completed suicide rates in each country under investigation. However, the strength of these patterns substantially differs across countries. This unexpected finding need to be further evaluated.
Assuntos
Transtornos Mentais/epidemiologia , Ideação Suicida , Suicídio/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Morte , Europa (Continente)/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Prevalência , Aposentadoria , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Suicídio/psicologia , Inquéritos e QuestionáriosRESUMO
Ostrich farming and keeping in Germany is of increasing interest. Ostrich farming includes keeping the animals as agricultural livestock (production of meat, leather, eggs), for display, hobby farming and keeping in zoological collections. Based on scientific research there is a steady increase in knowledge of keeping ratites according to sophisticated standards in terms of animal welfare legislation. Legislation and recommondations for keeping of ratitae are described.
Assuntos
Criação de Animais Domésticos/educação , Criação de Animais Domésticos/legislação & jurisprudência , Bem-Estar do Animal/legislação & jurisprudência , Paleógnatas , Animais , AlemanhaAssuntos
Temas Bioéticos , Coragem , Diversidade Cultural , Princípios Morais , Humanos , Filosofia Médica , ReligiãoRESUMO
BACKGROUND AND PURPOSE: The histamine H4 receptor, originally thought to signal merely through Gαi proteins, has recently been shown to also recruit and signal via ß-arrestin2. Following the discovery that the reference antagonist indolecarboxamide JNJ 7777120 appears to be a partial agonist in ß-arrestin2 recruitment, we have identified additional biased hH4R ligands that preferentially couple to Gαi or ß-arrestin2 proteins. In this study, we explored ligand and receptor regions that are important for biased hH4R signalling. EXPERIMENTAL APPROACH: We evaluated a series of 48 indolecarboxamides with subtle structural differences for their ability to induce hH4R-mediated Gαi protein signalling or ß-arrestin2 recruitment. Subsequently, a Fingerprints for Ligands and Proteins three-dimensional quantitative structure-activity relationship analysis correlated intrinsic activity values with structural ligand requirements. Moreover, a hH4R homology model was used to identify receptor regions important for biased hH4R signalling. KEY RESULTS: One indolecarboxamide (75) with a nitro substituent on position R7 of the aromatic ring displayed an equal preference for the Gαi and ß-arrestin2 pathway and was classified as unbiased hH4R ligand. The other 47 indolecarboxamides were ß-arrestin2-biased agonists. Intrinsic activities of the unbiased as well as ß-arrestin2-biased indolecarboxamides to induce ß-arrestin2 recruitment could be correlated with different ligand features and hH4R regions. CONCLUSION AND IMPLICATIONS: Small structural modifications resulted in diverse intrinsic activities for unbiased (75) and ß-arrestin2-biased indolecarboxamides. Analysis of ligand and receptor features revealed efficacy hotspots responsible for biased-ß-arrestin2 recruitment. This knowledge is useful for the design of hH4R ligands with biased intrinsic activities and aids our understanding of the mechanism of H4R activation.
Assuntos
Arrestinas/metabolismo , Indóis/farmacologia , Piperazinas/farmacologia , Receptores Acoplados a Proteínas G/efeitos dos fármacos , Receptores Histamínicos/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Linhagem Celular Tumoral , Desenho de Fármacos , Subunidades alfa Gi-Go de Proteínas de Ligação ao GTP/metabolismo , Células HEK293 , Antagonistas dos Receptores Histamínicos/química , Antagonistas dos Receptores Histamínicos/farmacologia , Humanos , Indóis/química , Ligantes , Modelos Moleculares , Piperazinas/química , Relação Quantitativa Estrutura-Atividade , Receptores Acoplados a Proteínas G/metabolismo , Receptores Histamínicos/metabolismo , Receptores Histamínicos H4 , beta-ArrestinasRESUMO
BACKGROUND AND PURPOSE: The recently proposed binding mode of 2-aminopyrimidines to the human (h) histamine H4 receptor suggests that the 2-amino group of these ligands interacts with glutamic acid residue E182(5.46) in the transmembrane (TM) helix 5 of this receptor. Interestingly, substituents at the 2-position of this pyrimidine are also in close proximity to the cysteine residue C98(3.36) in TM3. We hypothesized that an ethenyl group at this position will form a covalent bond with C98(3.36) by functioning as a Michael acceptor. A covalent pyrimidine analogue will not only prove this proposed binding mode, but will also provide a valuable tool for H4 receptor research. EXPERIMENTAL APPROACH: We designed and synthesized VUF14480, and pharmacologically characterized this compound in hH4 receptor radioligand binding, G protein activation and ß-arrestin2 recruitment experiments. The ability of VUF14480 to act as a covalent binder was assessed both chemically and pharmacologically. KEY RESULTS: VUF14480 was shown to be a partial agonist of hH4 receptor-mediated G protein signalling and ß-arrestin2 recruitment. VUF14480 bound covalently to the hH4 receptor with submicromolar affinity. Serine substitution of C98(3.36) prevented this covalent interaction. CONCLUSION AND IMPLICATIONS: VUF14480 is thought to bind covalently to the hH4 receptor-C98(3.36) residue and partially induce hH4 receptor-mediated G protein activation and ß-arrestin2 recruitment. Moreover, these observations confirm our previously proposed binding mode of 2-aminopyrimidines. VUF14480 will be a useful tool to stabilize the receptor into an active confirmation and further investigate the structure of the active hH4 receptor.
Assuntos
Arrestinas/metabolismo , Agonistas dos Receptores Histamínicos/farmacologia , Pirimidinas/farmacologia , Receptores Acoplados a Proteínas G/agonistas , Compostos de Vinila/farmacologia , Sequência de Aminoácidos , Substituição de Aminoácidos , Desenho de Fármacos , Agonismo Parcial de Drogas , Proteínas de Ligação ao GTP/metabolismo , Células HEK293 , Humanos , Ligantes , Conformação Proteica , Receptores Acoplados a Proteínas G/química , Receptores Acoplados a Proteínas G/metabolismo , Receptores Histamínicos/química , Receptores Histamínicos/metabolismo , Receptores Histamínicos H4 , Transdução de Sinais/efeitos dos fármacos , beta-ArrestinasRESUMO
A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy.
Assuntos
Reforma dos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde , Direitos Humanos , Avaliação das Necessidades/organização & administração , Relações Familiares , Feminino , Humanos , Masculino , Justiça Social , Percepção Social , Estados UnidosRESUMO
Given intractable moral pluralism, what ought one to make of the bioethics that arose in the early 1970s, grounded as it was in the false assumption that there is a common secular morality that secular bioethics ought to apply? It is as if bioethics developed without recognition of the crisis at the heart of secular morality itself. Secular moral rationality cannot of itself provide the foundations to identify a particular morality and its bioethics as canonical. One is not just confronted with intractable moral and bioethical pluralism, but with the absence of a secular ground that can show why one should act morally rather than self-interestedly. The result is not merely the deflation of much of traditional Western morality to life-style and death-style choices, but the threat of deflating to political slogans the now-dominant secular morality, including its affirmation of human autonomy, equality, social justice, and human dignity. All of this invites one critically to reconsider the meaning and force of secular bioethics.
Assuntos
Temas Bioéticos , Bioética , Diversidade Cultural , Princípios Morais , Secularismo , Eticistas , Fundações , Humanos , Política , TeologiaRESUMO
The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social-historical construction (ASBH Core Competencies for Health Care Ethics Consultation, 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered.
Assuntos
Eticistas/normas , Ética Clínica , Guias como Assunto , Princípios Morais , Competência Profissional , Mudança Social , Bioética/história , Bioética/tendências , Ética Clínica/história , Europa (Continente) , História do Século XVIII , História do Século XIX , História do Século XX , História Medieval , Hospitais/ética , Humanos , Papel Profissional , Gestão de Riscos/ética , Estados UnidosRESUMO
In the face of the moral pluralism that results from the death of God and the abandonment of a God's eye perspective in secular philosophy, bioethics arose in a context that renders it essentially incapable of giving answers to substantive moral questions, such as concerning the permissibility of abortion, human embryonic stem cell research, euthanasia, etc. Indeed, it is only when bioethics understands its own limitations and those of secular moral philosophy in general can it better appreciate those tasks that it can actually usefully perform in both the clinical and academic setting. It is the task of this paper to understand and reevaluate bioethics by understanding these limits. Academic bioethicists can analyze ideas, concepts, and claims necessary to understanding the moral questions raised in health care, assessing the arguments related to these issues, and provide an understanding of the different moral perspectives on bioethical issues. In the clinical setting, bioethicists can provide legal advice, serve as experts on IRBs, mediating disputes, facilitating decision-making and risk management, and clarifying normative issues. However, understanding this is only possible when one understands the history, genesis, and foundations of bioethics and its inability to provide a resolution to postmodern moral pluralism.
Assuntos
Temas Bioéticos , Bioética , Teoria Ética , Princípios Morais , Filosofia Médica , Valores Sociais , Diversidade Cultural , Humanos , Opinião Pública , Responsabilidade Social , OcidenteRESUMO
This paper presents four different understandings of the family and their concomitant views of the authority of the family in pediatric medical decision making. These different views are grounded in robustly developed, and conflicting, worldviews supported by disparate basic premises about the nature of morality. The traditional worldviews are often found within religious communities that embrace foundational metaphysical premises at odds with the commitments of the liberal account of the family dominant in the secular culture of the West. These disputes are substantial and ultimately irresolvable by sound rational argument because of the failure to share common foundational premises and rules of evidence. It is in light of these fundamental disagreements that there is a need to evaluate critically the claims and agenda advanced by the Convention on the Rights of the Child.
Assuntos
Defesa da Criança e do Adolescente/estatística & dados numéricos , Proteção da Criança/estatística & dados numéricos , Características Culturais , Tomada de Decisões , Dissidências e Disputas , Relações Profissional-Família , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Criança , Defesa da Criança e do Adolescente/legislação & jurisprudência , Proteção da Criança/legislação & jurisprudência , Saúde Global , Humanos , Pais , Direitos do Paciente , Autonomia Pessoal , Filosofia Médica , Padrões de Prática Médica/estatística & dados numéricos , Nações UnidasRESUMO
HISTORY AND CLINICAL SYMPTOMS: A 58-year-old man was admitted to our hospital with acute chest pain and subfebrile temperatures. Two years ago, endovascular aortic stent-graft placement had been performed for acute type B aortic dissection complicated by malperfusion syndrome. DIAGNOSTIC ASSESSMENT: CT angiography showed a discrete soft-tissue attenuation mass between the aorta and esophagus. The patient developed progressive swallow disorder and esophago-gastro-duodenoscopy demonstrated deep esophageal ulcerations at the level of the implanted aortic stent-graft. Intravenous treatment with broad spectrum antibiotics was started. The FDG-PET/CT scan showed increased FDG uptake and air entrapment in the affected region establishing the diagnosis of aortoesophageal fistula formation. THERAPY AND OUTCOME: Given the generally poor condition of the patient and the high risk of any aggressive surgical intervention, a new limited surgical approach was chosen consisting of open transthoracic esophageal resection, blind closure of the stomach and cervical esophagostomy. A percutaneous endoscopic gastrostomy tube was placed. After three months, esophageal continuity was restored by retrosternal colon interposition. The presented therapeutic management resulted in a full recovery of the patient. CONCLUSION: Aortoesophageal fistula is a rare complication of thoracic aortic stent-graft placement. Patient may present with unspecific symptoms such as fever and rised inflammatory markers, but may also present with massive upper gastrointestinal bleeding. The herein presented limited therapy with esophageal resection represents a promising to the otherwise difficult therapy of aortoesophageal fistula.
Assuntos
Angioplastia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aortografia , Implante de Prótese Vascular , Fístula Esofágica/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico por imagem , Anastomose Cirúrgica , Doenças da Aorta/cirurgia , Colo/transplante , Endoscopia do Sistema Digestório , Fístula Esofágica/cirurgia , Esôfago/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Mediastinite/diagnóstico por imagem , Mediastinite/cirurgia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/cirurgia , Reoperação , Fístula Vascular/cirurgiaAssuntos
Consultores , Credenciamento , Ética Clínica , Comportamento Social , Cultura , Humanos , Princípios MoraisRESUMO
Hoffmann von Fallersleben is quoted with the sentence "Self-help is worthwhile, because it does not demand anything from others". This sounds catchy; it is, however, wrong: Self-help groups ask for support, particularly for financial resources for the work of either individual, highly organized self-help associations or for general support of self-help groups via local contact and information centers ("contact points for self-help groups"). With this request for economic "investments" in self-help, the question arises whether this is profitable for the country, the local authority or the social health insurance. In principle, the initial answer to this is: yes, the work of self-help groups is worthwhile for a single person, but also for the larger community, as various kinds of services are provided by self-help groups and organizations. Despite many surveys of members or co-operation partners which show positive effects of self-help groups, the question remains whether services of self-help groups can be measured and economically evaluated. The socio- political question regarding funding is closely connected to the idea of an economic evaluation of self-help groups. The aim of this article is to summarize and discuss which empiric approaches and findings are available on this subject. The monetary value for the work done per member of self-help groups and year lies between approximately 700 and 900 EUR.
Assuntos
Atenção à Saúde/economia , Atenção à Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Autocuidado/economia , Autocuidado/estatística & dados numéricos , Autocuidado/tendências , Grupos de Autoajuda/economia , Grupos de Autoajuda/estatística & dados numéricos , Simulação por Computador , Análise Custo-Benefício , Alemanha , Humanos , Modelos Econômicos , Autocuidado/métodosRESUMO
OBJECTIVES: This article primarily reflects on the economic benefits of self-help associations, and the problems of their adequate evaluation. METHODS: We present a critical discussion of the concepts in the economic evaluation and empiricism by secondary analysis of data available based on a review of published studies as well as the re-analysis of primary data from our Hamburg study in 2003 (n=345 or 52.4% of the self-help associations registered in Hamburg). RESULTS: Most approaches to evaluate the economic benefits of self-help groups were inspired by the idea of output-related, cost-benefit analysis, by which activities of members were monetarily estimated. Projected for Hamburg, the productive performance amounts to nearly 1.8 million Euro per month, and 21.5 million per year. Furthermore, additional voluntary commitment can be mobilized at 300,000 Euro per month. CONCLUSION: All calculations are based on some assumptions (e.g., coefficient of productivity, wages) which cannot be finally verified. In view of the state of research reviewed we strongly recommend to bring forward both outcome-oriented approaches of economic evaluation, and new representative studies of self-help groups for Germany as a whole.
Assuntos
Atenção à Saúde/economia , Atenção à Saúde/estatística & dados numéricos , Grupos de Autoajuda/economia , Grupos de Autoajuda/estatística & dados numéricos , Análise Custo-Benefício , AlemanhaRESUMO
In the bioanalytical era, novel nano-materials for the selective extraction, pre-concentration and purification of biomolecules prior to analysis are vital. Their application as affinity binding in this regard is needed to be authentic. We report here the comparative application of derivatised materials and surfaces on the basis of nano-crystalline diamond, carbon nanotubes and fullerenes for the analysis of marker peptides and proteins by material enhanced laser desorption ionisation mass spectrometry MELDI-MS. In this particular work, the emphasis is placed on the derivatization, termed as immobilised metal affinity chromatography (IMAC), with three different support materials, to show the effectiveness of MELDI technique. For the physicochemical characterisation of the phases, near infrared reflectance spectroscopy (NIRS) is used, which is a well-established method within the analytical chemistry, covering a wide range of applications. NIRS enables differentiation between silica materials and different fullerenes derivatives, in a 3-dimensional factor-plot, depending on their derivatizations and physical characteristics. The method offers a physicochemical quantitative description in the nano-scale level of particle size, specific surface area, pore diameter, pore porosity, pore volume and total porosity with high linearity and improved precision. The measurement takes only a few seconds while high sample throughput is guaranteed.
Assuntos
Proteínas Sanguíneas/química , Cromatografia de Afinidade/métodos , Nanoestruturas , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Fulerenos/química , Nanotubos/química , Dióxido de Silício/química , Espectroscopia de Luz Próxima ao Infravermelho/métodosRESUMO
Long-term care is controversial because it involves foundational disputes. Some are moral-economic, bearing on whether the individual, the family, or the state is primarily responsible for long-term care, as well as on how one can establish a morally and financially sustainable long-term-care policy, given the moral hazard of people over-using entitlements once established, the political hazard of media democracies promising unfundable entitlements, the demographic hazard of relatively fewer workers to support those in need of long-term care, the moral hazard to responsibility of shifting accountability to third parties, and the bureaucratic hazard of moving from individual and family choice to bureaucratic oversight. These disputes are compounded by controversies regarding the nature of the family (Is it to be regarded primarily as a socio-biological category, a fundamental ontological category of social reality, or a construct resulting from the consent of the participants?), as well as its legal and moral autonomy and authority over its members. As the disputes show, there is no common understanding of respect and human dignity that will easily lead out of these disputes. The reflections on long-term care in this issue underscore the plurality of moralities defining bioethics.
Assuntos
Família , Assistência de Longa Duração/psicologia , Princípios Morais , Idoso , Características Culturais , Tomada de Decisões , Financiamento Pessoal/organização & administração , Humanos , Autoimagem , Apoio SocialRESUMO
The globalizing or totalizing imposition of a particular understanding of justice, fairness, or equality, as seen, for example, in Canada's single health care system, which forbids the sale of private insurance and the purchase of better basic health care, cannot be justified in general secular terms because of the following limitations: (1) the plurality of understandings of justice, fairness, and equality, and (2) the inability to establish one understanding as canonical. The secular state lacks plausible moral authority for the coercive imposition of one such account on peaceable, consenting adults. This state of affairs, with regard to the weakness of human moral epistemological powers, means that the secular state fails to have the moral authority to forbid coercively the sale and purchase of organs. It further lacks the secular, moral authority to impose equal access to organ transplantations. Assertions of such authority amount to reckless claims of fairness, and for this reason, health care policy must be set within the constraints of limited, constitutional regimes.
Assuntos
Princípios Morais , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Filosofia , Humanos , Justiça SocialRESUMO
Contemporary Christians are separated by foundationally disparate understandings of Christianity itself. Christians do not share one theology, much less a common understanding of the significance of sin, suffering, disease, and death. These foundational disagreements not only stand as impediments to an intellectually defensible ecumenism, but they also form the underpinnings of major disputes in the culture wars, particularly as these are expressed in healthcare. There is not one Christian bioethics of sin, suffering, sickness, and death. In this article, the character of the moral-theological visions separating the various Christianities and thus their bioethics is examined. Particular emphasis is placed on the differences that set contemporary Western theology at odds with the theology of the Christianity of the first millennium. As is shown, the ground for this gulf lies in the divide between traditional and post-traditional views of the appropriate role of philosophy in theology, a difference rooted in disparate understandings of the meaning of church and of the meaning of the logos, the Son of God.
RESUMO
PURPOSE OF REVIEW: The possibility of content-full, universal, bioethical norms is assessed. The literature brings into question a global bioethics. A salient moral and bioethical pluralism undermines the plausibility of imposing of uniform bioethical norms on critical care. Addressing the tension between the aspiration to a global bioethics and the presence of moral pluralism is timely, given the United Nations Educational, Scientific and Cultural Organization's development of universal, bioethical norms. The practice of critical care in the 21st century will be influenced by the tension between bioethical pluralism and counter-assertions on behalf of a global bioethics. RECENT FINDINGS: A growing literature reflects a bioethical pluralism with significant implications for critical care. Much of the literature supporting pluralism is rooted in a reaction in the Pacific Rim against North American and Western European moral and philosophical commitments. These voices of moral dissent join an already salient moral diversity in the West regarding issues ranging from abortion to end-of-life decision-making, physician-assisted suicide, and euthanasia, as well as conflicting understandings of the bioethics of appropriate approaches to the allocation of scarce medical resources. This literature acknowledging bioethical diversity contrasts with announcements of universal bioethical norms. SUMMARY: Clinicians need to appreciate the sources of moral controversy that divide them from their patients and from their colleagues and to recognize that moral and economic differences may lead to different standards of care. Taking bioethical diversity seriously supports focusing on procedural moral approaches that allow peaceable collaboration in the face of substantive moral disagreement.