Miguel Esteban

In this paper, a framework incorporating flexibility as a characteristic is proposed for designing complex, resilient socio-ecological systems. In an interconnected complex system, flexibility allows prompt deployment of resources where they are needed and is crucial for both innovation and robustness. A comparative analysis of flexible manufacturing systems, economics, evolutionary biology, and supply chain management is conducted to identify the most important characteristics of flexibility. Evolutionary biology emphasises overlapping functions and multi-functionality, which allow a system with structurally different elements to perform the same function, enhancing resilience. In economics, marginal cost and marginal expected profit are factors that are considered to be important in incorporating flexibility while making changes to the system. In flexible manufacturing systems, the size of choice sets is important in creating flexibility, as initial actions preserve more options for future actions that will enhance resilience. Given the dynamic nature of flexibility, identifying the characteristics that can lead to flexibility will introduce a crucial dimension to designing resilient and sustainable socio-ecological systems with a long-term perspective in mind.

OBJECTIVES: To analyse the attitudes of medical personnel towards terminally ill patients and their right to be fully informed. DESIGN: Self-administered questionnaire composed of 56 closed questions. SETTING: Three general hospitals and eleven health centres in Granada (Spain). The sample comprised 168 doctors and 207 nurses. RESULTS: A high percentage of medical personnel (24.1%) do not think that informing the terminally ill would help them face their illness with greater serenity. Eighty-four per cent think the patient's own home is the best place to die: 8.9% of the subjects questioned state that the would not like to be informed of an incurable illness. CONCLUSION: In our opinion any information given should depend on the patient's personality, the stage of the illness and family circumstances. Our study confirms that a hospital is not the ideal environment for attending to the needs of the terminally ill and their families