Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine.

Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

Terrorism and lethal moralism in the United States and United Kingdom, 1970-2017.

The current paper examines terrorism as a special form of moralistic violence, with several key features that distinguish such behaviour from other types of violence. The theory of lethal moralism highlights the importance of social polarization, characterized by vast differences in social space and inequality between adversaries as crucial to explaining deadly terrorist attacks. Where the differences are more permanent or chronic - and the groups in question define and justify their existence specifically in contradistinction to 'other' groups - then the polarization intensifies and attacks tend to be more lethal. In contrast, groups that appeal to broader audiences or the general public as potential allies more often use non-lethal terrorism to their strategic advantage. The study examines the United States and the United Kingdom to classify each of more than 8,000 attacks between 1970 and 2017 in terms of their ideological orientations. The evidence highlights the arc of terrorism in relation to different types of groups, as well as confirms the more lethal nature of terrorism linked especially to radical Islam, right-wing religious extremists, hate groups, ethno-nationalist sectarian violence, and anti-government anarchists. Yet apart from the extensive use of terrorism associated with 'The Troubles' in Northern Ireland, the majority of terrorist attacks in the US and the UK have not produced deaths. Most terrorism instead has been perpetrated by groups aiming to rally support for a general cause and has been far less deadly on balance. The implications of these findings are discussed with a view toward developing more powerful explanatory models that focus on the socio-cultural contexts and justification frameworks that inspire extremism and the use of lethal moralism to settle disputes.

The Unabomber's ethics.

In this paper, I present and criticize Ted Kaczynski's ("The Unabomber") theory that industrialization has been terrible for humanity, and that we should use any means necessary, including violent means, to induce a return to pre-industrial ways of living. Although Kaczynski's manifesto, Industrial society and its future, has become widely known, his ideas have never before been subject to careful philosophical criticism. In this paper I show how Kaczynski's arguments rely on a number of highly implausible philosophical premises. I further make the case that, although his theory as a whole should be rejected, Kaczynski raises a number of worries about technological development that ought to receive serious attention. Some of these worries have recently come to be shared by prominent defenders of human enhancement, including Nick Bostrom and Julian Savulescu. In the last section I indicate why I believe it is important that academic philosophers scrutinize ideas that motivate acts of violence.

Agents of the Father's law in a society of brothers: A philosophic and psychoanalytic perspective on legitimate use of violence.

This paper explores subjective processes of "Agents of Law" - individuals who the state grants the authority to use violence - and the dissonance stemming from the contradictory demands posed on them as legitimate users of violence despite the societal taboo against violence. A conceptual model will be offered based on two theoretical legs, Lacanian psychoanalysis and political theories of legitimacy. Specifically, psychoanalytic ideas would serve to examine unconscious processes, subject position and various identifications related to the question of "self-legitimacy" of Agents of Law. A central link between psychoanalysis and political thought is found in the image of the father and in the triad ruler-God-Father, which calls for an oedipal analysis. A psychoanalytic reading of two philosophical schools that elaborated on the question of legitimacy will be presented, and yield two analytic poles of a model for the understanding of possible subject positions of agents of Law: identification with a "Living Father" vs. identification with a "Dead Father". The psychoanalytic reading will shed light on the limitations of the philosophical perspectives in reflecting on the various (im)possible psychological positions of agents of Law. Finally, then, it will be shown how psychoanalysis helps finding words to characterize different nuances in the coping of agents of Law with the contradictory demands posed on them in an age in which God is dead, the father was murdered and the king was beheaded.

["There can be no unnecessary risks"]. / « Il ne saurait y avoir de risque inutile ¼.

The psychoanalytical point of view regarding the notion of risks helps us to understand the concept of transference and counter transference. Practice analysis groups provide an opportunity for collective discussion and the sharing of experience of clinical situations. Interview with Didier Gauchy, a psychiatrist-psychoanalyst in Lyon.

Factores causales de la explotación sexual infantil en niños, niñas y adolescentes en Colombia / Causal factors of child sexual exploitation in boys, girls, and adolescents in Colombia

El propósito de la presente investigación fue identificar factores causales de laexplotación sexual comercial en la infancia y la adolescencia en Colombia. Para ello se analizaron tres casos de estudio: Medellín, Sincelejo y Magangué. Se realizaron talleres y se aplicaron encuestas en cada una de las ciudades en Instituciones gubernamentales encargadas de intervenir el fenómeno y en algunas instituciones educativas, con la participación de funcionarios, profesionales, docentes, directivosy estudiantes. Para el análisis de datos se realizó una matriz explicativa con laparticipación de 4 jurados. Las categorías de análisis fueron factores medioambientales, familiares e individuales.

The purpose of this piece of research aimed to identify causal factors of trade sexual exploitation on children and adolescents in Colombia. For this purpose, three case studies were analyzed: Medellín, Sincelejo, and Magangué. Workshops wereconducted and surveys were implemented in each of the cities in both governmental institutions, in charge of intervening the phenomenon and in some educationalinstitutions, with the participation of officials, professionals, teachers, directors, and students. As for the data analysis, an explanatory matrix was carried out, with the participation of 4 judges. The categories of analysis were those related to the environment, the family, and the individual.

Análisis de la figura humana en niños y niñas desplazados en Colombia / Analysis of the human figure in displaced children in Colombia

Esta es una investigación exploratoria cuyo objetivo es analizar las características psicológicasproyectadas en el dibujo de la figura humana en 45 niños y niñas en situación de desplazadosen Colombia. El estudio se ha realizó en el departamento del Quindío, a partir de la aplicación del Test del Dibujo de la Figura Humana de Karen Machover a niños y niñas en situación dedesplazamiento forzado. Muchos niños y niñas presentan problemas de ajuste a los nuevos entornos de socialización como efecto de las secuelas del conflicto armado evidentes en áreas conflictivas proyectadas en el dibujo tales como cabeza, expresiones faciales, extremidades, tronco y escases de movimiento. El conflicto persiste de formas simbólicas en los niños yniñas, lo cual dificulta sus habilidades sociales, la relación intrafamiliar y el aprendizaje, mostrando en muchos casos reacciones defensivas tales como, elevados niveles de ansiedad,depresión, ensimismamiento, al igual que impulsividad, agresión y aptitudes desafiantes.

This is an exploratory research that aims to analyze the psychological characteristics in analyzing the human figure in 45 displaced children in Colombia. The study was conductedin the State of Quindío, based on the application of the Karen Machover - Human Figure Drawing Test to children in a situation of forced displacement. Many children experience problems adjusting to new environments of socialization as a result of the aftermath of the armed conflict, which are made evident in conflict areas projected in the drawing, such as head, facial expressions, limbs, trunk and scarcity of movement. The conflict persists ofsymbolic forms in children, which hinders their social skills, family relationship and learning, showing in many cases defensive reactions such as high levels of anxiety, depression andself-absorption, as well as impulsivity, aggression, and challenging abilities.

Sofrimento moral dos agentes comunitários de saúde / Moral distress of health community agents

O trabalho desenvolvido na Estratégia da Saúde da Família (ESF) pode desencadear nos agentes comunitários de saúde (ACS) o enfrentamento de distintas manifestações de problemas morais que lhes podem provocar sofrimento moral (SM). Com o objetivo de compreender como o trabalho desempenhado pela equipe multiprofissional na ESF contribui para a vivência de SM pelos ACS, realizou-se um estudo qualitativo descritivo -exploratório. A partir da observação participante e de entrevistas semiestruturadas realizadas no período de junho a setembro de 2010, com onze ACS de Unidades de Saúde da Família do município do Rio Grande (RS), realizou-se análise textual discursiva dos dados, definindo-se três categorias: proximidade com a comunidade; organização do trabalho; modos de viver da comunidade. Muitas dessas situações vivenciadas pelos ACS envolvem questões éticas que decorrem do modo como o trabalho se organiza e da falta de percepção dos conflitos morais decorrentes, os quais envolvem valores, crenças, sentimentos e conhecimentos. A aparente invisibilidade, silêncio e, até, desconhecimento deste sofrimento por parte dos ACS e dos demais trabalhadores da equipe pode estar contribuindo para a continuidade de situações que poderiam e deveriam ser evitadas, de modo a favorecer a atenção à saúde da comunidade.

Working in the Family Health Strategy (FHS) may have health community agents (HCA) experience the confrontation with different expressions of moral problems that might cause moral distress (MD). We have made a qualitative, exploratory-descriptive study to understand how the work of the multi professional team in the FHS contributes to the experience of moraldistress by the agents. We did a discursive textual analysis based on participant observations and semi-structured interviews carried out between June and September 2010 with eleven HCAs from Family Health Units. Three categories were defined: the proximity with the community, work organization, and the ways of life of the community. Many of the situations experienced by the agents involve ethical questions that derive from the way the work is organized and the lack of perception of the resulting moral conflicts, which include values, beliefs, feelings and knowledge. The apparent invisibility, silence and even unawareness of this distress by HCAs and other workers in the team may contribute to the continuity of situations that could and should be avoided,in order to favor the attention to the health care of the community.

Gustavo Rojas Pinilla: dictadura o presidencia: la hegemonía conservadora en contravía de la lucha popular / Gustavo Rojas Pinilla: dictatorship or presidency: the conservative hegemony in contravention with the popular fight

El presente texto derivado de investigación, tiene como objetivo analizar los discursos de Rojas Pinilla y la influencia que tuvo sobre ellos, los aires fascistas de finales del siglo XIX y principios del XX y como crearon enemigos del pueblo, con el fin de justificar su accionar sobre sectores de la sociedad por parte del ejército,como garantizador de un orden social.

The current text, derived from a piece of research, aims to analyze the discourses of Rojas Pinilla and the influence played by the fascist hints of the late nineteenth century and the early twentieth century and how they created enemies of the people in order to justify their actions on sectors of society by the army as a guarantor of a social order.

Peace through a healing transformation of human dignity: possibilities and dilemmas in global health and peace.

Collective violence leads to grievous harm for affected populations, impacting both combatants and noncombatants. In recent years there has been an increased focus on the relationship between peace and health, with the World Health Organization calling for health professionals to engage in efforts to promote peace. While the notion of "health as a bridge for peace" is promising, there are many ambiguities in this emerging field, creating moral and practical dilemmas. In this manuscript I will discuss some of the challenges within the paradigm of health and peace using an exemplar of my research within the Israeli-Palestinian conflict.

Factores de riesgo para el desplazamiento, protección de tierras y garantías de no repetición en zonas vulnerables de antioquia / Socio-demographic profile of Displaced population in antioquia

El siguiente artículo es un informe de investigación que recoge apartes del documento sobre el estado actual del Goce Efectivo de Derechos de la población víctima del desplazamiento Forzado en Antioquia. El artículo se centra, en particular, en establecer de manera estadística tanto el comportamiento anual del desplazamiento forzado desde 1997 como de algunos indicadores del conflicto armado en territorios vulnerables del departamento (reconocidos como aquellos sobre los cuales han recaído alertas tempranas). Para tal efecto el artículo da cuenta de la metodología utilizada para dimensionar el nivel de protección que cuentan los territorios, ofrece un balance de algunas afectaciones que vulneran la seguridad de tales zonas (acciones armadas, homicidios, eventos de minas antipersona) y establece el estado y alcance actual de la protección de tierras en Antioquia.

This article contains the main results of a research oriented to the carrying out of a demographic characterization of the population victim of displacement in Antioquia. In order to carry out a rigorous exercise that would pick up the conditions of life of this population, the research team designed a methodological strategy starting from the crossing of different official databases. Such a strategy enabled the characterization of reliable, up-to-date and verifiable data on more than the third part of the population.

Impactos del paramilitarismo en la región urabá/chocó 1998-2006. claves para la lectura de las afectaciones colectivas / Horizontality, expression, and shared knowledge: an approach on pproach on psychological processes of acccompanient to victm of political violence in colombia

Este informe de investigación recoge los resultados de una exploración sobre la naturaleza de las afectaciones de un grupo armado, lo paramilitares, en una región colombiana; este ejercicio ha sido la antesala para planteamiento de una investigación que, recientemente aprobada, se propone ofrecer pautas para dar cuenta de aquellos impactos de la guerra que puedan ser definidos como “daño colectivo”. En este orden de ideas, este artículo se propone exponer de la los resultados de esta aproximación preliminar que, a la manera de un estudio de caso, permiten establecer los alcances y limites analíticos de las aproximaciones de este carácter para dar cuenta de la dimensión de los daños colectivos a partir de la inspección de los tipos y naturaleza de las acciones paramilitares en el Chocó y Urabá antioqueños, durante el periodo 1998-2006.

The following article presents a deep discussion about the processes of psychosocial intervention with victims of political violence, in the light of their life stories in a context of research on the role of memory in the reconstruction of the social fabric. The category of the psychosocial emerged as a result of these life stories and discussion groups and allowed a critical look at the intervention processes that take place in Colombia, from the voice and the testimony of the participants. Finally, it also collects proposals from this same voice, that of the people, and forms of action involving a revision to the individualistic, pathological, vertical, technocratic, and bureaucratic models of the action, to propose comprehensive and systemic actions for the recovery of dignity and the subjective transformation from participation, dialogue of knowledge, playful and performative expression, and horizontal relationships, mutual support and construction of citizenship and subjectivity of rights.

la acción y el enfoque psicosocial de la intervención en contextos sociales: ¿podemos pasar de la moda a la precisión teórica, epistemológica y metodológica? / The action and the psychosocial approach of the intervention in social contexts: can we move from the fashion to the theoretical, epistemological, and methodological precision?

El siguiente artículo derivado de investigación, se plantea la pregunta en torno a una realidad que viene creciendo en Colombia: el incremento de los proyectos de intervención psicosocial en diversos sectores sociales, especialmente con víctimas del conflicto armado, violencia social, violencia de género e intrafamiliar, entre otras; además de población en situación de pobreza extrema, desplazamiento forzado y víctimas de catástrofes naturales. En relación con esta lógica de intervención y de acción, la reflexión académica aún sigue siendo escasa, poco clara y repetitiva de concepciones y disquisiciones internas de las disciplinas sociales, especialmente de la psicología. Por lo tanto, desde la experiencia de trabajo, desde la propia investigación y desde los procesos de acompañamiento psicosocial desarrollados por cerca de 15 años, el autor presenta una propuesta de reflexión, que implica una mirada desde el pensamiento crítico social y una postura que permita darle un marco a la acción psicosocial en una perspectiva emancipatoria.

The following article, derived from research, poses the question about a growing issue in Colombia: the increase in projects of psychosocial intervention in diverse social sectors, particularly with victims of the armed conflict, social violence, violence of gender and family, etc., as well as population in a situation of extreme poverty, forced displacement and victims of natural disasters. In relation to this logic of intervention and action, the academic reflection tends to be scarce, unclear and repetitive of concepts and internal disquisitions of the social disciplines, especially of psychology. Therefore, from the work experience, from the research itself and from the processes of psychosocial accompaniment for about 15 years, the author presents a reflective proposal, which implies a look from the social critical thought and a stance that allows to give a framework for the psychosocial action in an emancipatory perspective.

Estratégias de enfrentamento dos dilemas bioéticos gerados pela violência na escola / Coping strategies to bioethical dilemmas generated by school violence

A violência na escola é um problema social que perpassa o âmbito da educação e da saúde pública, envolve aspectos bioéticos e requer mecanismos de enfrentamento, a partir da educação em saúde. Este estudo objetiva discutir estratégias fundamentadoras da educação em saúde, sobre aspectos bioéticos no domínio da violência escolar. Consiste em uma revisão bibliográfica crítico-reflexiva por meio do acesso a banco de dados da Biblioteca Virtual de Saúde (BVS), utilizando os descritores "violência and bioética" e "violência na escola", considerando os estudos publicados no período de 2004 a 2009. Realizamos também levantamento das obras de Paulo Freire e Pedro Demo, teóricos da Educação Libertadora. A leitura do material conduziu-nos a definição e discussão de três eixos temáticos: 1) bioética como instrumento reflexivo para a retomada dos valores morais na sociedade; 2) escola como formadora ética e de exercício de cidadania; 3) educação em saúde como instrumento para o enfrentamento da violência na escola. Acreditamos que a violência escolar envolve questões bioéticas que devem ser alvo de intervenções educativas na perspectiva libertadora, no intuito de gerar reflexões sobre o caráter negativo da violência escolar, tanto para o ensino-aprendizagem, como para o adoecimento dos atores envolvidos nessa problemática. Os profissionais da saúde poderão estabelecer a intersetorialidade com a educação e contribuir na prevenção da violência na escola, por meio de ações educativas em saúde, mobilizando cidadãos para uma sociedade comprometida em promover a vida; e que os profissionais da educação sejam receptivos e coparticipantes do processo intersetorial de educação e saúde.

School violence is a social problem that pervades the educational and public health context, involving bioethical issues and requires coping mechanisms from health education. This study aims to discuss strategies that underlie health education, on bioethical issues in the school violence field. It consists of a critical-reflexive literature review by accessing the Virtual Health Library (VHL) database, using the keywords: "violence and bioethics", and "violence at school", considering the studies published from 2004 to 2009. We also surveyed Paulo Freire's and Pedro Demo's works, theorists of Libertarian Education, which led us define and discuss three thematic areas: 1) bioethics as a reflective instrument for the moral values resumption in the society, 2) school as an ethics and citizenship practice creator, 3) health education as a contributor to coping with violence at school. We believe that school violence involves bioethical issues that should be the target of educational interventions in the liberating perspective, in order to generate reflections on the negative character of school violence, both for teaching and learning, as to the sickening of the actors involved in this issue. Health professionals may establish the intersectoriality with the education and contribute in preventing violence at school, through health education actions, mobilizing citizens for a society committed to promoting life. And the education professionals must be receptive and co-participants in the education and health intersectorial process.

The precarious practice of forensic psychiatric risk assessments.

The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, "dangerousness" has been reworded into "risk". Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of "mental disorder" and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.

Racial disparities in involuntary outpatient commitment: are they real?

In this paper we explore racial disparities in outpatient civil commitment, using data from Kendra's Law in New York State. Overall, African Americans are more likely than whites to be involuntarily committed for outpatient psychiatric care in New York. However, candidates for outpatient commitment are largely drawn from a population in which blacks are overrepresented: psychiatric patients with multiple involuntary hospitalizations in public facilities. Whether this overrepresentation under court-ordered outpatient treatment is unfair depends on one's view: is it access to treatment and a less restrictive alternative to hospitalization, or a coercive deprivation of personal liberty?

A violência contra o idoso: dimensão ética e política de uma problemática em ascensão / Violence against the elderly: ethical and political dimensions of an ascendant problematic / La violencia contra el anciano: una dimensión ética y política de una problemática en ascensión

A violência contra os idosos é um fenômeno evidente dentro do atual processo de envelhecimento populacional mundial. Este artigo tem como objetivo apresentar uma reflexão sobre o tema da violência contra os idosos, apoiada em artigos científicos publicados. Trata-se de uma atualização, que além de abordar temas principais do assunto, pretende enfatizar como o mesmo é tratado pela atual política de saúde do idoso no Brasil, e também dar um enfoque ético. Percebe-se que a questão da violência contra os idosos é pouco considerada pela sociedade em geral e pelos profissionais de saúde. No Brasil existe uma política de promoção da saúde dos idosos e de prevenção à violência que ainda não está implementada em sua totalidade, e nem de acordo com as singularidades de cada região. Os enfermeiros, mais especificamente, precisam tratar com empatia e resolutividade os casos de violência contra idosos por eles identificados.

Elder abuse is an evident phenomenon into the current worldwide ageing population. This paper intents to show a reflection about elder abuse, based on scientific reviews. This is an actualization paper that intents to approach the main themes about the matter; also aims to emphasize how this subject is treated by the current elder health policy in Brazil, by an ethical focus. It was noticed that elders abuse is a low worked matter by the society and health professionals. Brazil has a policy of promotion and prevention on elder abuse, that do not have been fully implemented yet, neither by the singularity of each area. Nurses, specifically, have to treat their abused patients with empathy and resolubility.

La violencia contra los ancianos es un fenómeno evidente dentro del actual proceso de envejecimiento poblacional mundial. Este artículo tiene como objetivo presentar una reflexión sobre el tema de la violencia contra los ancianos, apoyado en artículos científicos publicados. Se trata de una actualización, que además de abordar temas principales del asunto, pretende enfatizar cómo el mismo es tratado por la atual política de salud del anciano en Brasil, y también dar un enfoque ético. Se percibió que la cuestión de la violencia contra ancianos es poco considerada por la sociedad en general y por los profesionales de salud. En Brasil existe una política de promoción de la salud del anciano y de prevención a la violencia que aún no está implementada en su totalidad, de acuerdo con las singularidades de cada región, para que se puedan obtener mejoras efectivas. Los enfermeros más específicamente necesitan cuidar con empatía y resolutividad los casos de violencia contra ancianos por ellos identificados.

The role of religious fundamentalism in terrorist violence: a social psychological analysis.

This paper examines the social-psychological factors often implicated in discussions of terrorist violence/martyrdom, with a particular focus on the role of religion. We offer a brief description of the psychological theories underpinning terrorist research before focusing on social-psychological factors. The roles of psychopathology, irrationality and grievance/threat are examined, followed by empirical research on the beliefs which have been associated with the perpetration and support of terrorist violence, and the social factors which foster those beliefs, including social identity, socially carried interpretations, group leadership and individual differences. Although religion is not a single, simple causal factor in terrorist violence, religious elements often feature strongly in the belief systems associated with terrorist violence, and can also feature in other important fostering factors for terrorist violence, such as the use of rhetoric. Finally, the status of lay explanations of terrorist violence, focusing on the role of religious fundamentalism is examined.