La Razonabilidad como virtud

Consultable des del TDXTítol obtingut de la portada digitalitzadaEsta tesis doctoral explora la idea de que la razonabilidad es una virtud fundamental para que las sociedades plurales puedan convertirse en, o mantenerse como, un sistema de cooperación donde la justicia sea posible. La hipótesis central es que la razonabilidad como virtud es una manera de ser tolerante de forma solidaria, es entender al conciudadano, escucharlo, saber que juntos acordaron las reglas de cooperación y actuar y dar razones a partir de tales normas. El discurso «razonable» marcará los límites de lo tolerable y la tolerancia defenderá el espacio público donde los «razonables» pueden ser libres y resolver sus diferencias dándose razones. Aquel que es «razonable» se refrena con prudencia, escucha y coopera de acuerdo con los resultados del debate que se lleva a cabo en el seno de la vida democrática. Para mostrar lo anterior este trabajo explora la teoría liberal de Rawls, revisa sus bases kantianas y cómo es que se yergue como una alternativa al utilitarismo. Después detalla los elementos constitutivos de la teoría y cómo evolucionan a lo largo de la obra de Rawls. De todos los objetos que aquí se estudian, dos resultan fundamentales para el discurso: la «razón pública» y la «razonabilidad». Una vez esclarecidos estos y otros conceptos afines, se discute el papel de lo «razonable» en la «razón pública» a partir de las críticas que les hace Habermas. Esto sirve, por un lado, para intentar refutar las críticas y, por el otro, para profundizar en el entendimiento de la razonabilidad. Después se objetan los desencuentros de varios autores con la «neutralidad» del Estado liberal, que ellos confunden con secularismo. Mostraremos que el Estado Liberal es agnóstico. Stephen Toulmin defiende que la razón esta desequilibrada y que es importante regresarla a un estado balanceado entre lógica y retórica. Lo anterior resulta muy importante en un mundo tan incierto como el nuestro, donde la Teoría que lo explica y predice todo es imposible. Para analizar los episodios de las artes clínicas y los problemas morales, la razonabilidad y la prudencia son fundamentales y debemos volver a darles su lugar, afirma. Esto último, se muestra en este trabajo, resultará realmente útil para los defensores de ciertos derechos diferentes para personas desaventajadas. En esta tesis, además, se revisa qué hacer para contener a los «irrazonables» y evitar así que pongan en jaque la posibilidad de la justicia. Para concluir en esta tesis se vincula la razonabilidad con la tolerancia y la solidaridad. Además se revisa cómo su papel es vital para la democracia.The present dissertation explores the idea that reasonableness is a fundamental virtue that enables plural societies to become, or stay as, a system of cooperation where justice is possible. The central hypothesis is that reasonableness as a virtue is a way of being tolerant with solidarity, to understand fellow citizens and to listen to them knowing that the rules of cooperation and conduct were agreed together. It is also to reason from those rules. «Reasonable» discourse points out the limits of what is tolerable. Tolerance defends the public space where those who are «reasonable» can be free and solve their differences giving each other reasons. Whoever is «reasonable» refrains him or herself with prudence, listens and cooperates according to the results of the debate that takes place in the heart of democratic life. To show what has been just said, this work explores Rawls's liberal theory, reviews its Kantian basis and how Rawls's theory becomes an alternative to Utilitarianism. Later, this dissertation details the constitutive elements of Rawls's theory and how these elements evolve through Rawls's work. Of all the elements that the present research studies, two become fundamental for its discourse: «public reason» and «reasonableness». Once these and some related concepts have been reviewed, it's possible to find a discussion of the role of the «reasonable» in «public reason». The discussion starts with Habermas's critique of these two concepts. This is useful, on one hand, to try to refute Habermas's critique and, on the other, because it allows to deepen the understanding of reasonableness. After this we object several misunderstandings about the neutrality of the Liberal State. We will show that the Liberal State is agnostic. Stephen Toulmin argues that reason is unbalanced and that it is important to bring it back to a state of equilibrium between Logic and Rhetoric. This will result very important in a world that is as uncertain as ours, where the Theory that explains and predicts everything is impossible. To analyze the problems of the clinic arts and those of morals, reasonableness and prudence are fundamental and we should give them back its place, Toulmin says. This idea will result very useful to the defenders of specific rights for disadvantaged people. In this dissertation we also review what to do to contain those who are unreasonable and avoid the risk that they represent for justice. To conclude, as we said, in this research we link reasonableness with tolerance and solidarity and review how their role is vital for democracy

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Latinoamérica : desigualdad, violencia entre jóvenes y carencia de autonomía

Argumenta en su texto que las desigualdades han sido un caldo de cultivo por demás eficiente para generar falta de expectativas, baja calidad de vida y carencia de alternativas vitales reales. Todo lo anterior impide que las juventudes latinoamericanas se vean con posibilidades reales de alcanzar niveles de vida mínimos y, más allá de estos, deseables. Muñoz sostiene que la carencia de tales elementos, producto de ancestrales desigualdades, genera la violencia que asola la región. Situación que hace de América Latina una de las zonas no solo más desiguales del planeta, sino de las más violentas y generadoras de ansiedad para sus habitantes. Los conceptos de justicia, desigualdad, esperanza y calidad de vida están presentes en el análisis del autor.Fundación Nacional para la Investigación de Corea y el Ministerio de Educación de la República de Corea (NRF-2018S1A6A3A02081030)Capítulo

El sustento evolutivo del principio de igual dignidad

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La ética de Putnam contra el “pluralismo inconmensurabilista”

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Estudios sobre discriminación incorrecta

Enfrentar la discriminación incorrecta es asunto urgente porque lastima, profundiza el maltrato y perpetúa la desigualdad. Además, es inmoral, diluye el tejido social, a veces evita el crecimiento y la creación de riqueza. En muchos casos es ilegítima, ineficiente, inequitativa, absurda, irracional, dañina e injusta. Latinoamérica la padece en cada una de sus sociedades: desde México hasta Chile se discrimina a indígenas, mujeres, migrantes, afrodescendientes, pobres, homosexuales, jóvenes, ancianos. Frente a tal estado de cosas, decidimos reunir en este libro distintos niveles de análisis teórico sobre el asunto; desde discusiones éticas sobre cuándo es incorrecta la discriminación, hasta la revisión no ideal de casos de injusticia, donde el trato desigual es nocivo: migración y fronteras, libertad de expresión, injusticia epistémica, tolerancia religiosa y Estado laico. También escogimos abordar algunos estudios que expanden la discusión a terrenos inexplorados: ¿el arte puede establecer maneras de escucha y de diálogo que nos extraigan de círculos discriminatorios inevitables? ¿son los animales objeto de discriminación incorrecta?, si no tuviéramos opción, ¿cómo escoger entre no discriminar y salvar el planeta? Los textos que seleccionamos para formar parte de este volumen tienen distintos niveles de abstracción y dificultad. Unos pueden parecer demasiado teóricos y especializados y otros introductorios. Es la idea, discutir sobre el tema de la discriminación incorrecta en varios niveles y en distintos contextos.Trabajo realizado con el apoyo del Programa UNAM DGAPA-PAPIIT IN401519Libro