This article tries to set up the epistemological bases of the science of ″human ecology″. This term has started to be used as a synonymous of morality, especially in the Catholic moral social doctrine that used for the f...This article tries to set up the epistemological bases of the science of ″human ecology″. This term has started to be used as a synonymous of morality, especially in the Catholic moral social doctrine that used for the first time to justify its marriage prospectives. We look at both terms together (human plus ecology) and we propose that human ecology should be a discipline that in the first time study human behavior and population (objective) using the postulates of the science of ecology (method) and then, once a conceptual framework for social sciences disciplines such as bioethics can be settle, could be used as a way to support or not moral postulates in the name of ecology. We conclude by defining which should be the methods of knowledge acquisition, the limits and the validity of what should be considered ″Human ecology″, that is to say, the ecology of the humans.
Organic Law 3/2021, of March 24, regulating euthanasia, has intensified a harsh debate. A priori, it is a conflict of bioethical values and a different anthropological vision between the different parties, however, we mu...Organic Law 3/2021, of March 24, regulating euthanasia, has intensified a harsh debate. A priori, it is a conflict of bioethical values and a different anthropological vision between the different parties, however, we must not forget that perhaps before considering any debate, it is necessary to correctly interpret what the patient really wants when he states that he wants to die. In our health system and in our society, there are certain traits and needs of the person that are ignored, and that urgently require attention for the patient. Discovering the meaning of one's life, considering human transcendence, finding personal order and being able to experience love are vital elements of life, which at such a critical moment as high-grade suffering or imminent death, require all the attention of the health personnel. All this can contrast sharply with the values of our society, not dedicating adequate attention to it, among other reasons, due to the effort involved in carrying out comprehensive care of this type, thus making it much easier to carry out the procedures required by law regulation of euthanasia than addressing such intimate deficiencies of the being, despite the fact that these may be the real problem of the patient, who in his dramatic experience asks for help.
Health care for trans people has not been among the priorities of Bioethics, so that in most of the manuals of this discipline there is no reference to this issue, or it is covered in a rather simple or measured way. How...Health care for trans people has not been among the priorities of Bioethics, so that in most of the manuals of this discipline there is no reference to this issue, or it is covered in a rather simple or measured way. However, it is necessary to note that in the last decade the bioethical debate, on gender issues in general and on transsexualism in particular, has increased significantly. This work seeks to offer the transsexual person, the health professional or the student on the trans topic tools to articulate their particular bioethical reflection. It has two clearly differentiated parts. In the first, the aspects that are considered necessary to consider when assessing the ethics of a gender change intervention are presented. In the second part, a reflection is offered on the lines of argument that support the different bioethical currents..
It is common base the teaching of bioethics on the learning of the principles of autonomy, beneficence, non-maleficence and justice, widely used today. In terms of ethical practice, these principles suffer from a notable...It is common base the teaching of bioethics on the learning of the principles of autonomy, beneficence, non-maleficence and justice, widely used today. In terms of ethical practice, these principles suffer from a notable inadequacy, leaving aside their ambiguity and other problems. Nevertheless, as a teaching method, they show a special incongruity, for several reasons: a) little adequacy of the terms to the concepts that want to be expressed, b) formalism that hinders the approach to reality, c) little adaptation to the needs of the student and d) be specialized terms in a field that should be fundamentally informative. These four limitations, which advise another approach in the teaching of bioethics, are examined in detail; a final reflection is provided on the difference between the principles of bioethics and ethics.
The so-called ″eugenic″ abortion has an extraordinary differential nuance compared to the other legally established modalities of abortion, which is specified in the way the woman's decision is formed, which is not prior...The so-called ″eugenic″ abortion has an extraordinary differential nuance compared to the other legally established modalities of abortion, which is specified in the way the woman's decision is formed, which is not prior, but a consequence of medical information received about the foetus; a decision, moreover, in which there is a clear ″discriminatory″ component, since the abortion is produced exclusively because of the disability of the foetus. This uniqueness requires attention to the context in which eugenic decisions are made, because they involve three fundamental elements which, depending on how they are made, may or may not lead to abortion: firstly, the opportunity to carry out certain prenatal tests in the absence of risk factors. Secondly, the enormous responsibility of health professionals in informing parents about the results of a prenatal test. Thirdly, the point of view of future parents, who should avoid a eugenic conception of parenthood, being aware that what is developing in the woman's womb is their son or daughter, not a generic embryo affected by anomalies; and that a son or daughter is a personal reality,beyond his o her capabilities. The paper addresses these three issues, which make eugenic abortion a discriminatory and avoidable practice, since the aim is not to prevent the woman's decision to abort, but to endorse her primary decision to continue with the pregnancy on the basis of a positive, non-eugenic view of disability.
Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and...Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and, occasionally, chemotherapy proposed by Professor Luigi Di Bella. It was the answer to people demanding Public Health assume the cost of this therapy. Although parallel phase II trials in various tumors demonstrated the lack of activity, some professionals have continued to use this method since then and have published apparently promising results a few various scientific journals. This real example raises three interesting ethical scenarios. The first one is the ethics of alternative treatments proposed by medical professionals or from the academic field. In these cases, the difficulty in differentiating between hypothesis and real efficacy. This problem impacts on patients and relatives' expectations who must face a potentially fatal disease with little or no hope of a cure with traditional treatments. The second scenario is the design and good practice in the development of clinical trials, which was also the subject of debate in relation to the Di Bella method. And the last one, the ethics of scientific publications. Di Bella's followers published since 2000 12 papers with limited quality on series of patients treated with his method, the majority in a pay-per-publication journal of which Giuseppe Di Bella, son of Professor Di Bella, is included in the board of editors.
Epigenetics deals with the study of modifications that affect gene expression without altering the base composition of DNA. It can take place in a programmed way, such as the one that determines the different cellular sp...Epigenetics deals with the study of modifications that affect gene expression without altering the base composition of DNA. It can take place in a programmed way, such as the one that determines the different cellular specialties and tissues that arise during embryonic development, or it can occur randomly due to the influence of uncontrolled environmental factors, with possible consequences for health. The different epigenetic mechanisms that determine the states of activity or silencing of genes and their biological role in the regulation of gene expression, especially in higher animals, are presented. In general, epigenetic modifications are erased during early embryogenesis, so they are not transmitted from generation to generation, but their incidence during embryogenesis may be the cause of the appearance of effects that can affect health after birth, the F1 , or its offspring, F2 (intergenerational inheritance). At least in animals, transgenerational inheritance (more than two generations) has been undemonstrated until now. There is no experimental basis to support the role of transgenerational epigenetics in genome remodeling or to maintain its incidence in the evolution of species, which would mean a return to Lamarckism. We discuss the special influence of transposition, characterized by its randomness and influence on the remodeling of the genome of higher species, more in plants than in animals. Transposition is a phenomenon that influences genome remodeling, with long-term effects. We point out the myths and bioethical consequences derived from a false interpretation of the role of epigenetics as a determinant of the phenotype in the offspring of future generations.
Every pregnant woman in the Spanish national health system is offered the option of controlling her pregnancy by means of prenatal screening. For women in a high-risk situation, non-invasive techniques for the detection...Every pregnant woman in the Spanish national health system is offered the option of controlling her pregnancy by means of prenatal screening. For women in a high-risk situation, non-invasive techniques for the detection of chromosomal aneuploidies are now available, which have the advantage of not endangering the life of the fetus, facilitating subsequent prenatal genetic diagnosis. However, despite the potential medical benefits for both pregnant women and fetuses, the widespread implementation of non-invasive prenatal testing (NIPT) raises a number of ethical issues. The objective of this work is to explore the ethical aspects derived from the implementation of the NIPT from the perspective of the main philosophical currents in bioethics and their implications for the health professional. In particular, it focus on the ethical aspects raised by the NIPT according to the major bioethical currents, the possible ethical dilemmas that the clinical advisor faces based on these currents and the requirements that genetic counseling for an ethical implementation of NIPT in clinical practice taking advantage of its advantages without violate human dignity.
As health-related big data research (HRBDR) has drastically increased over the last years due to the rapid development of big data analytics, a range of important ethical issues are raised. In this study, a systematic li...As health-related big data research (HRBDR) has drastically increased over the last years due to the rapid development of big data analytics, a range of important ethical issues are raised. In this study, a systematic literature review was conducted. Several and interesting results emerged from this review. The term ″big data″ has not yet been clearly defined. The already existing ethical principles and concepts need to be revisited in the new HRBDR context. Traditional research ethics notions like privacy and informed consent are to be reconsidered. HRBDR creates new ethical issues such those related to trust / trustworthiness and public values such as reciprocity, transparency, inclusivity and common good. The implementation of dynamic consent rather than broad consent is currently highlighted as the more satisfying solution. Ethical review committees in their current form are ill-suited to provide exclusive ethical oversight on HRBDR projects. Expanding Ethical Review Committees' purview and members' expertise, as well as creating novel oversight bodies by promoting a co-governance system including public and all the stakeholders involved are strongly recommended. The mechanism of ″social licence″, that is, informal permissions granted to researchers by society, can serve as a guideline. High-stakes decisions are often made under uncertainty. Machine learning algorithms are highly complex and in some cases opaque, and may yield biased decisions or discrimination. Improved interdisciplinary dialogue along with considering aspects like auditing, benchmarking, confidence / trust and explainability /interpretability may address concerns about HRBDR ethics. Finally and most importantly, research ethics shifts towards a population-based model of ethics.
Human-animal chimera research has gradually evolved to the present day, in which large projects related to the attempt to solve pathologies that help us human beings to alleviate diseases. However, it must be considered...Human-animal chimera research has gradually evolved to the present day, in which large projects related to the attempt to solve pathologies that help us human beings to alleviate diseases. However, it must be considered that many of these advances in science imply an important ethical dilemma in many cases, and even more so if we involve people in said experiments. In the present systematic review we sought to identify these ethical problems related to chimeras, as well as possible solutions to them proposed in the literature, including technical means for the realization of less humanized chimeras. A bibliographic search was carried out in the Pubmed, Embase and Medes databases on January 4 th, 2022. The articles that strictly comply with the objectives selected for the completion of the work will be selected. A total of 21 articles makes up our sample, from which ethical problems related to chimeras, possible solutions and technical means to avoid obtaining too humanized chimeras will be extracted. The issues identified in the articles are problems related to animal welfare, acquisition of human traits from chimeras, medical concerns derived from experimentation such as zoonoses, the origin of pluripotential cells for chimera production, the creation of human gametes by said chimeras, neurological chimerism and the moral status of chimeras. This paper provides solutions for these problems, such as the use of suicide genes in human cells that would be activated if they differentiate into neuronal cells or the use of gene editing through the CRISPR/Cas9 mechanism to incapacitate these cells so that they do not differentiate into neuronal cells. The only question that remains elusive to the proposal of solutions is the one related to the potential moral status of chimeras. It is certainly a complex issue given the variety of proposals on the concept of moral status available in literature. It is therefore necessary to bring these proposals closer to reflection on human-animal chimeras in order to initiate a discussion that can shed light on this issue.
Medical practice has two main dimensions, one scientific and the other human, and in both, the commitment of the doctor is essential. Medical deontology, as a branch of ethics that deals with the duties and obligations o...Medical practice has two main dimensions, one scientific and the other human, and in both, the commitment of the doctor is essential. Medical deontology, as a branch of ethics that deals with the duties and obligations of doctors, embodies in the codes of deontology the ethical principles and standards of mandatory compliance. From this point, medical practice should guarantee that patients receive an quality medical care, and to be treated with dignity and respect. In December 2022, the General Council of Official Medical Associations of Spain published a new version of the Spanish Code of Medical Ethics that aims, among other purposes, to standardize medical care of scientific and human quality. Medical practice supported by scientifically-based medicine, lex artis medica, patient safety, professional responsibility, honesty and integrity are some of the aspects that in this updated document of medical ethics frame and define the work of the doctor for a performance of medicine with quality.
The article describes and analyses the General Principles of the 2022 Code of Medical Ethics that are included in the articles 4 to 6 of the second chapter. The General Principles make it possible to understand and inter...The article describes and analyses the General Principles of the 2022 Code of Medical Ethics that are included in the articles 4 to 6 of the second chapter. The General Principles make it possible to understand and interpret the set of precepts and recommendations of the code, for which reason the study of this second chapter is of special relevance. In addition, I contextualize General Principles by relating them to other current international ethical-deontological documents. We will also review how they are extended in the broad articles of the new code. We will observe that there is a clear relationship between the General Principles of the new code with respect to previous Spanish Medical Codes, which is logical since they gather permanent values of Medical Ethics. In the General Principles is proposed that each doctor is at the service of the human being and of society and has as primary duties, respect for human life, dignity of each person, as well as the health care of the individual and the society (Article 4.1).
This article describes the elaboration process of the new Spanish Code of Medical Deontology ap- proved by the General Assembly of the General Council of Medical Colleges of Spain in December 2022. The reasons for updati...This article describes the elaboration process of the new Spanish Code of Medical Deontology ap- proved by the General Assembly of the General Council of Medical Colleges of Spain in December 2022. The reasons for updating the deontological rules, the works carried out, the principles followed in the development of the Code and the most relevant new rules are described.
The article reviews the evolution of the deontology of the Spanish Medical Organization through how it has been reflected in the diverse codes of deontology approved by this institution. After an approximation to the spi...The article reviews the evolution of the deontology of the Spanish Medical Organization through how it has been reflected in the diverse codes of deontology approved by this institution. After an approximation to the spirit and contents of the first Code of ethics approved in 1978, born after the Spanish Constitution, passed that same year, which established the recognition and the need to regulate professional associations and the exercise of qualified professionals. The 1978 Code is compared with the one recently approved in December 2022, using the second 1990 Code as a bridge. In the comparison we find many bioethical issues on which, through the last decades, reflections have been made and answers have been introduced that respond to the many social and technological changes that have occurred. Special reference is made to the concept of respect, embodied in the relationship between the doctor and the patient. It is a relationship that is often not symmetrical because the sufferer may feel or endure extreme vulnerability. The article also reflects on the evolution of relevant issues or those that may raise more controversies, such as respect for initial and final life. The synthesis of the current 2022 Code of Medical Ethics can be done in three words: Respect and Human Rights.
The review of research protocols by Research Ethics Committees (RECs), essential to ensure the protection of participants, has been managed in the City of Buenos Aires through the PRIISA.BA electronic platform since Janu...The review of research protocols by Research Ethics Committees (RECs), essential to ensure the protection of participants, has been managed in the City of Buenos Aires through the PRIISA.BA electronic platform since January 2020. The aim of the present study was to describe ethical review times, their temporal evolution, and predictors of their duration. We conducted an observational study that included all the protocols reviewed between January 2020 and September 2021. Times to approval and to first observation were calculated. Temporal trends in times, and the multivariate association between these and protocol and IRB characteristics were evaluated. 2,781 protocols reviewed in 62 RECs were included. The median time to approval was 29.11 (RIQ 11.29 to 63.35) days, and time to first observation was 8.92 (RIQ 2.05 to 18.18) days. The times were significantly reduced throughout the study period. We detected as variables independently associated with shorter time to approval to be a COVID proposal, having funding and the number of centers to perform the study and having been reviewed by an RECs with more than 10 members. Making observations to the protocol was associated with more time. The results of the present work suggest that ethical review times were reduced during study period. In addition, variables associated with time were identified that could be the object of interventions to improve the process.
The phenomenon of ageism in healthcare is a significant threat to elderly people's well-being. There is a literature gap regarding the topic of ageism among dental professionals in Greece. This study aims to contribute t...The phenomenon of ageism in healthcare is a significant threat to elderly people's well-being. There is a literature gap regarding the topic of ageism among dental professionals in Greece. This study aims to contribute to filling this gap. A cross-sectional study was conducted using recently validated in Greece 15-item ageism 6-point Likert-scale. The scale has been previously validated in the environment of senior dental students. Purposive sampling was used to select participants. A total of 365 dentists responded to the questionnaire. As to the internal consistency of the scale, Cronbach's alpha found to be very low (α = 0.590) to support the reliability of a total of 15 Likert-type questions (items) of the scale. However, the factor analysis resulted in three factors that achieved high reliability towards validity. The demographic comparison with these factors and single items revealed statistically significant gender differences in ageism (with males being more ageist than females), and differences related to other socio-demographic factors, which however, were related to factors or items individually. The study revealed that the Greek version of the ageism scale for dental students had not further validity and reliability among dentists. However, some items were distributed into three factors that presented significant validity and reliability. This is of great importance for the ongoing research on the topic ″ageism in dental healthcare″.
OBJECTIVE: to analyse the activity of the Medical Ethics and Deontology Commission (MEDC) of the College of Physicians of Cordoba regarding conflictive situations in the profession from 2013 through 2021. MATERIAL AND ME...OBJECTIVE: to analyse the activity of the Medical Ethics and Deontology Commission (MEDC) of the College of Physicians of Cordoba regarding conflictive situations in the profession from 2013 through 2021. MATERIAL AND METHODS: cross-sectional observational study, in which 83 cases of complaints submitted to the College were collected. RESULTS: the incidence was 2.6 complaints‰ members/year, with a total of 92 doctors reported. 61.4% were submitted by the patient, 92.8% of which were addressed to a single doctor. 30.1% were in the speciality of family medicine, 50.6% in the public sector and 72% in outpatient care. In 37.7% the chapter of the Code of Medical Ethics concerned was chapter IV (quality of medical care). In 89.2% of cases the parties came to make a statement, with a higher risk of disciplinary proceedings being observed when the statement was both, oral and written (OR:4.61; p=0.026). The median resolution time was 63 days, significantly longer in cases proposed for disciplinary proceedings (146 days vs. 58.50 days; OR:1.01; p=0.008). The MEDC found 15.7% (n=13) to be in breach of ethics, with 15 doctors being disciplined (16.3%) and 4 sanctioned (26.7%) with a warning and temporary suspension from practice. CONCLUSIONS: The role of the MEDC is fundamental in the self-regulation of professional practice. Inappropriate behaviour during patient care or between colleagues has serious ethical implications, disciplinary repercussions for the physician, and it particularly undermines patients' trust in the medical profession.