David Rodríguez

Since the 1960s, organ procurement policies have relied on the boundary of death—advertised as though it were a factual, value‐free, and unobjectionable event—to foster organ donation while minimizing controversy. Death determination, however, involves both discoveries of facts and events and decisions about their meaning (whether the facts and events are relevant to establish a vital status), the latter being subjected to legitimate disagreements requiring deliberation. By revisiting the historical origin of the dead donor rule, including some events that took place in France prior to the report by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, I want to recall that those who first promoted the DDR did not take into account any scientific rationale to support the new proposed criteria to determine death. Rather, through a process of factual re‐semantization, they authorized themselves to decide about the meaning of death in order to implicitly prioritize the interests of organ recipients over those of dying people.

This book offers a theoretical and practical overview of the specific ethical and legal issues in pediatric organ transplantation. Written by a team of leading experts, Ethical Issues in Pediatric Organ Transplantation addresses those difficult ethical questions concerning clinical, organizational, legal and policy issues including donor, recipient and allocation issues. Challenging topics, including children as donors, donation after cardiac death, misattributed paternity, familial conflicts of interest, developmental disability as a listing criteria, small bowel transplant, and considerations in navigating the media are discussed. It serves as a fundamental handbook and resource for pediatricians, transplant health care professionals, trainees, graduate students, scholars, practitioners of bioethics and health policy makers.

The ever‐increasing demand for organs led Spain, France, and other European countries to promote uncontrolled donation after circulatory determination of death (uDCDD). For the same reason, New York City has recently developed its own uDCDD protocol, which differs from European programs in some key ways. The New York protocol incorporates a series of technical and management improvements that address some practical problems identified in response to European uDCDD protocols. However, the more fundamental issue of whether uDCDD donors are dead when organs are procured remains problematic for the New York City protocol and, indeed, for all uDCDD protocols. In the United States, two amendments to the legal criteria of death have been suggested to avoid a formal violation of the dead donor rule in DCDD protocols: first, replacing the requirement “irreversible” with the weaker term “permanent,” and second, using the term “circulatory” instead of “cardiac” to identify the key function that must be lost to declare death. While intended to facilitate controlled DCDD, these modifications create a problem for uDCDD protocols: if extracorporeal membrane oxygenation is introduced to preserve the organs, then circulation is restored after death is declared. In this issue of the Hastings Center Report, Kevin Munjal and colleagues call for a new ethical construct and policy so that uncontrolled and controlled DCDD can coexist.

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

Este libro es un homenaje a la trayectoria intelectual y académica de la profesora María Teresa López de la Vieja, Catedrática emérita de la Universidad de Salamanca. En él se trazan algunos de los caminos que, con su obra, nos invita a transitar. El volumen recoge contribuciones de colegas de varias nacionalidades y procedentes de diversos ámbitos de reflexión que le son afines: la filosofía moral y política, la literatura, la teoría de la argumentación, los estudios feministas, las éticas aplicadas, la bioética. Los capítulos que componen este libro dan voz a varias generaciones de investigadoras e investigadores que han acompañado y acompañan su andadura académica y que aquí dialogan con ella haciendo propias sus preocupaciones intelectuales. Con su participación contribuyen al justo reconocimiento de su dedicación a la labor docente e investigadora.

The ethics of deceased organ procurement (OP) is supposedly based on individual consent to donate, either explicit (opt-in) or presumed (opt-out). However, in many cases, individuals fail to express any preference regarding donation after death. When this happens, the decision to remove or not to remove their organs depends on the policy’s default option or on family preferences. Several studies show that in most countries the family plays a significant and often decisive role in the process of decision-making for OP. Depending on the country, the family may be allowed to take different kinds of actions in different situations, and this may be granted either by law or by clinical practice only. This adds much complexity to the usual classification of consent policies in two categories: opt-in and opt-out. Here we propose a novel and comprehensive taxonomy of the models of consent for OP according to three variables: (1) the deceased’s wishes, if any, (2) family wishes, if any, and (3) default policies. By analysing these models of consent, we show that they rely on at least three different concepts of autonomy: individual autonomy, relational autonomy, and family autonomy. In light of this analysis, we discuss the ethical debates surrounding two policy approaches: presumed consent and family veto.

It was only after James P. Lovette's death, in 2006, that I discovered that the twenty‐four‐year‐old colleague and friend with whom I had spent so many afternoons debating issues in organ transplantation had been the first successful child heart transplantee in the world and one of the longest‐living survivors of a second transplant. During the years we met, he never even hinted at the fact that three different hearts had beaten in his chest. The revelation that his life had been an almost uninterrupted chain of medical challenges suddenly made me appreciate his quirkiness in a whole new light.Organ transplantation crudely exemplifies a traditional moral dilemma between means and ends: in order to save a life, someone else has to die. Bioethicists involved in this field have the role of identifying the ethical issues surrounding organ donation and helping others to argue in an intelligible and convincing way. In my view, bioethicists have the obligation to foster a discussion as open and transparent as possible on these matters. Still, I sometimes fear that I may be helping to cause unnecessary harms to potential recipients who are desperately waiting for a vital organ. Scholars would be chillingly cold if their quest for truth systematically came at the cost of lives lost. Every life can be meaningful and provide meaning to many others. This is true even with organ recipients, who often have short lives full of considerable suffering.

In Italy, judicial and extrajudicial requests for paternity testing have increased in recent years. A retrospective analysis of such private extrajudicial requests received by the legal medicine unit of the Department of Environmental Medicine and Public Health of Padua University was conducted to identify problem areas most helpful in determining whether to accept private parties’ requests for paternity testing. Such testing is most delicate when a presumptive father may be seeking to disown paternity and when testing is wanted without the consent of a member of the mother–child–father triangle. Tests that could establish paternity where none has been recognised are less problematic, as the child will not lose out. Legal and ethical–deontological aspects of consent, of the protection of minors and of children’s and parents’ need for follow-up interviews to deal with the outcome of such testing are carefully considered by the Padua University team when deciding whether to accept a request for testing. It is argued that because such issues are not dealt with by mail-order laboratories, the use of such services is inappropriate

Uncontrolled donation after circulatory death, which occurs when an individual has experienced unexpected cardiac arrest, usually not in a hospital, generates both excitement and concern. On the one hand, uDCD programs have the capacity to significantly increase organ donation rates, with good transplant outcomes—mainly for kidneys, but also for livers and lungs. On the other hand, uDCD raises a number of ethical challenges. In this essay, we focus on an issue that is central to all uDCD protocols: When should we cease resuscitation and shift to organ preservation? Do current uDCD protocols prematurely consider as potential donors patients who could still have some chances of meaningful survival? Can the best interest of patients be fostered once they are considered and treated as potential donors?

En los últimos treinta años se ha transitado desde una concepción del capital humano como una macromagnitud económica a una idea de capital humano corporeizada en el individuo. Hemos asistido a una progresiva infiltración de dicha ideología del capital humano también en la vida de la juventud precaria. Nos centramos aquí en los jóvenes universitarios, para quienes el capital humano, ya de forma hegemónica, dirige y marca sus recorridos laborales y vitales. El análisis de los discursos de estos jóvenes nos permitirá explorar desde la imposición de la lógica de la movilidad laboral, a la sujeción a las formas de "emprendedor de sí mismo" y a la normalización, como parte del proceso de incorporación de capital humano, de formas de empleo progresivamente al margen de los derechos y garantías laborales clásicas del trabajo salariado.In the last thirty years it has been gone from a conception of the human capital as an economic macro magnitude to an idea of human capital embodied in the individuals. We have been witnesses of the progressive infiltration of this ideology of the human capital also in the life of precarious youth. We focus in the university young people, for those who the human capital, already of hegemonic form, directs and marks its labour and vital routes. The analysis of the discourses of these young people will allow us to explore the imposition of the logic of labour mobility, the subjection to the forms of «entrepreneur of itself» and also the normalization of forms of work progressively excluded from the rights and classic labour guarantees as a part of the process of incorporation of human capital.

La normalización de la precariedad entre las personas jóvenes está entrando en lo que parece una nueva fase. De la mano de, entre otros factores, los discursos empresariales y la teoría del capital humano, estamos asistiendo a una vuelta de tuerca en la presión sobre la juventud: ya no basta con la búsqueda «activa» de empleo, ahora hay que invertir en uno mismo como «empresario de sí mismo» y, en esta lógica, si es preciso hay que optar por la «movilidad internacional». Presentamos una revisión teórica y conceptual alrededor de lo que se conoce como fuga de cerebros y su justificación discursiva. Estamos ante un proceso que probablemente dejará una marca importante en una generación que ha visto truncadas sus posibilidades de transición a situaciones estables, idealmente identificadas con el mundo adulto.Normalization of precariousness among young people is entering in a new phase. Led by, among other factors, the human capital theory, we are witnessing a twist in pressure on young people: it is no longer enough with «active» job search, now you have to invest in yourself as entrepreneur of yourself’ and in this logic, maybe young people must choose for the «international mobility», which is represented as a cosmopolitan option. We present a theoretical and conceptual review around what is known as brain drain and its discursive justification. We are facing a process that will probably leave a significant mark on a generation whose chances of transition to stable situations have been truncated, ideally identified with the adult world.

El libro Las generaciones que llegaron tarde presenta los resultados de un trabajo sobre los usos, las estrategias y las percepciones de las generaciones mayores en relación a las tecnologías de la información y de la comunicación. Las apropiaciones de los y las mayores en los ámbitos laboral, relacional y familiar, así como en el ocio, son objeto de análisis a partir de entrevistas en profundidad. Entre los principales resultados destaca el que, a pesar de la gran capacidad de adaptación de las personas mayores a los nuevos entornos digitales, la sociedad informacional sigue avanzando a ritmos desiguales: mientras penetra y media en buena parte de las dinámicas sociales, sigue dejando en los márgenes a una parte de la población perteneciente a las generaciones de más edad.

Several studies have explored differences between North American and European doctor patient relationships. They have focused primarily on differences in philosophical traditions and historic and socioeconomic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultural studies have been carried out to identify in practice these cultural differences. This lack of standard comparative empirical studies led us to compare differences between France and the USA regarding end-of-life decision-making. We tested certain assertions put forward by bioethicists concerning the impact of culture on the acceptance of advance directives in such decisions. In particular, we compared North American and French intensive care professional's attitudes toward: advance directives, and the role of the family in decisions to withhold or withdraw life-support.

Resumen: En el marco del estudio de los discursos gerenciales, se destacan en el presente texto algunas de las aportaciones de Medina-Vicent, especialmente el análisis de los procesos de individualización y despolitización de mensajes que entroncarían con las reivindicaciones del feminismo. En este contexto, se propone la incorporación del concepto foucaultiano de dispositivo para el estudio de los elementos que contribuyen a la difusión de los discursos gerenciales. Este concepto podría ser de utilidad en la investigación empírica, proporcionando una herramienta conceptual para estudiar como un sistema homogéneo de relaciones de saber y poder los distintos elementos que conformarían el dispositivo gerencial.: Within the framework of the study of managerial discourses, this text highlights some of the contributions of Medina-Vicent, especially the analysis of the processes of individualization and depoliticization of messages that are linked to the claims of feminism. In this context, the incorporation of the Foucauldian concept of dispositif is proposed for the study of the elements that contribute to the diffusion of managerial discourses. This concept could be useful in the empirical analysis, as well as providing a conceptual tool to study the different elements that make up the managerial dispositif as a homogeneous system of knowledge and power relations. Palabras clave: gerencialismo, dispositivo, herramientas disciplinarias. Keywords: managerialism, dispositif, disciplinary instruments.

Most analyses of international wildlife law focus on the specifics of implementing particular policies, while there is less engagement with the fundamental philosophies underpinning international conventions. In this article, I argue that a philosophical analysis can achieve a deeper understanding of IWL by helping to identify, assess and compare worldviews reflected in these instruments. Additionally, a philosophical analysis can make visible how international wildlife conventions shape human perceptions of and attitudes towards nature. Based on these premises, I subject two international wildlife conventions that are central to wildlife management in Europe, namely, the Bern Convention on the Conservation of European Wildlife and Natural Habitats and the Convention on International Trade in Endangered Species of Wild Fauna and Flora, to philosophical scrutiny. I argue, first, that the philosophical underpinnings of these instruments are in contention, indicating that their policies might well counteract each other. Second, I postulate that the broad significance of this contention is that the resulting ambivalence when IWL instruments are involved in the same conversation and about the same territoriality results in such high discretional powers for states that they stop being bounded by the conventions’ substratum and can limit themselves to only following the formalities.

En los últimos treinta años se ha transitado desde una concepción del capital humano como una macromagnitud económica a una idea de capital humano corporeizada en el individuo. Hemos asistido a una progresiva infiltración de dicha ideología del capital humano también en la vida de la juventud precaria. Nos centramos aquí en los jóvenes universitarios, para quienes el capital humano, ya de forma hegemónica, dirige y marca sus recorridos laborales y vitales. El análisis de los discursos de estos jóvenes nos permitirá explorar desde la imposición de la lógica de la movilidad laboral, a la sujeción a las formas de "emprendedor de sí mismo" y a la normalización, como parte del proceso de incorporación de capital humano, de formas de empleo progresivamente al margen de los derechos y garantías laborales clásicas del trabajo salariado.

La normalización de la precariedad entre las personas jóvenes está entrando en lo que parece una nueva fase. De la mano de, entre otros factores, los discursos empresariales y la teoría del capital humano, estamos asistiendo a una vuelta de tuerca en la presión sobre la juventud: ya no basta con la búsqueda «activa» de empleo, ahora hay que invertir en uno mismo como «empresario de sí mismo» y, en esta lógica, si es preciso hay que optar por la «movilidad internacional». Presentamos una revisión teórica y conceptual alrededor de lo que se conoce como fuga de cerebros y su justificación discursiva. Estamos ante un proceso que probablemente dejará una marca importante en una generación que ha visto truncadas sus posibilidades de transición a situaciones estables, idealmente identificadas con el mundo adulto.