The current scenario of health sciences, and of Medicine in particular, is characterized by the growing role of Artificial Intelligence (AI), thus projecting towards the consolidation of a new model of Medicine. Along wi...The current scenario of health sciences, and of Medicine in particular, is characterized by the growing role of Artificial Intelligence (AI), thus projecting towards the consolidation of a new model of Medicine. Along with the undeniable advantages offered by the application of AI for the diagnosis and treatment of complex clinical problems, some ethical questions arise, which demand careful reflection. However, most of the literature that addresses the ethical issues associated with the use of AI in medicine does so from the poiesis' perspective. Indeed, a large part of that evidence is related to the design, programming, training and operation of algorithms, problems that exceed the competences of the health professionals that use them. Our proposal is framed in the ethics of virtue outlined by Edmund Pellegrino, which is a valuable epistemological perspective to trace a path of reflection on the ethical problems arising from the use of AI in Medicine. This perspective -based on a sound philosophy of Medicine- adopts the praxis' point of view, that is, of the acting subject. Since the health professional is a moral agent who uses AI as a tool to achieve an end -the good of the patient-,from Pellegrino's perspective it is possible to ask how the use of AI might influence the achievement of the goal of medical work and thus, be considered a criterion of ethical orientation.
Spirituality is the human dimension that helps human beings to reflect about their own existence, to try to answer to questions like: what are we living for? This search of meaning is still more pronounced in those who s...Spirituality is the human dimension that helps human beings to reflect about their own existence, to try to answer to questions like: what are we living for? This search of meaning is still more pronounced in those who suffer an advanced and incurable disease. This clear need is nevertheless not always acknowledge by the patient, making it difficult to detect and manage it in the daily care by healthcare professionals. In an effort to establish an effective therapeutic relationship, they have to keep in mind also this spiritual dimension, already integrated in the concept of comprehensive care and usually offered to all patients, especially in those who are at the end of life. With this work we have tried, on the one hand, to know the opinion of nurses and TCAE about spirituality through a self-design survey. On the other hand, we wanted to know how this suffering experience may impact on the professionals, as well as if the development of their own spirituality, differently expressed, may have positive effects on the patients. To this end, healthcare professionals have been selected from an oncology unit, those who day by day are facing the impact of suffering and death of their patients.
Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle...Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, these are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions of women in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hormonal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of women. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currently used by some 214 million women around the world, with an annual market of close to 18 billion dollars), very little research has been done on the consequences of suppressing the HHO axis. Only in recent years, and in parallel to the demonstration of the existence of functional receptors for gonadotropins at different levels in the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAs begun to appear. It is also striking that, despite being the most widely used drugs and for the longest time for the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., they are used for purposes other than those listed in the official indication approved in their technical data sheet and which appear in the package insert). Although the use of these hormonal products causes a wide variety of side effects, which have been widely studied in the medical literature, the present study proposes, after an exposition of the different aspects of the use of HCAs, a detailed review of the available literature on the neuropsychological effects due to the annulment of the HHO axis. This in order to, after a biological analysis, subsequently establish whether there is an ethical appropriateness in the use that concerns us.
In 2008 Ingmar Persson and Julian Savulescu published an article arguing for the need to biotechnologically enhance moral capacities in order to address the risks implicit in the development of cognitive enhancements. In...In 2008 Ingmar Persson and Julian Savulescu published an article arguing for the need to biotechnologically enhance moral capacities in order to address the risks implicit in the development of cognitive enhancements. In their view, the more individuals are intellectually enhanced, the greater the possibility of causing harm. To balance this risk, cognitive enhancement must be accompanied by moral enhancement (genetic, pharmacological or cybernetic) that extends to the entire population. This thesis has been made explicit over time in various works, in dialogue with other experts. This paper explores the development of this argument in contrast to later criticisms, as well as responses from Persson and Savulescu. Finally, it raises three problematic issues in the development of the above argument, around the following areas: (a) the difference between cognitive and moral enhancements; (b) the merely biological character of human nature; and (c) the relationship between human freedom and the notion of ″moral enhancement″ employed by the authors.
Social and communication skills play an important role in the relationship between healthcare professionals and their patients. In this field, it is plausible that clinical empathy and loneliness play an important role o...Social and communication skills play an important role in the relationship between healthcare professionals and their patients. In this field, it is plausible that clinical empathy and loneliness play an important role of influence. However, the knowledge about this roll is still scarce. The main purpose of this review was to collect findings reported on this matter in students and healthcare professionals. The review included: articles published in English or Spanish during the last fifty years that were indexed in MedLine or SCOPUS, with students or health professionals as participants, and where empathy and loneliness had been used as main measures. Eleven articles, published between 1986 and 2020, that met the abovementioned criteria were included in the analysis. From them, eight corresponded to observational studies and three to interventional studies. Eight studies included students and the other three included healthcare professionals in their study samples. A negative correlation between empathy and loneliness was found in four studies. Furthermore, loneliness in the family environment was described as a negative predictor of empathy towards patients. Training programs in empathic skills and group accompaniment proved not only effective in the improvement of empathy in students, but also in the reduction of loneliness. These findings confirm a close relationship between clinical empathy and loneliness. They also show that the improvement in empathic skills not only has a positive effect on the professional ethical behavior towards patients, but it also helps improving the professional's well-being by reducing loneliness.
The concept of natural death has been present in philosophical, medical and social reflection for centuries, fulfilling a double function: understanding human finitude and hoping for a desirable way to reach the end of o...The concept of natural death has been present in philosophical, medical and social reflection for centuries, fulfilling a double function: understanding human finitude and hoping for a desirable way to reach the end of our days. Today, those goals have been blurred by the sense of control over death that comes from the high technology of medicine, the dreams of immortality nurtured by the media, and the confusing line drawn between autonomy and dignity. This article studies the concept of natural death that in the past 20th century was the subject of debate between health workers and bioethicists and that at the beginning of this 21st century has already begun to be questioned. The ″naturalness″ of death was intended to be a kind of ethical frontier in the face of any form of violence, injustice, excessive technicalization or interference with the human will. Today, many of these aspects are blurred in a context as unnatural as he hospital one. In addition, the forensic field has also encountered serious difficulties in excluding any human, voluntary or involuntary intervention, in a large part of the deaths, since there is little natural in what we breathe, eat or drink. Based on all this, a redefinition proposal is offered that responds to a double need: the social need to integrate the inevitable mortality and the shared personal need to reach the end after a humanizing process that excludes all human responsibility. It is anthropologically possible and ethically desirable natural death.
Conscientious objection in the healthcare professions was a topic that Gonzalo Herranz addressed early on and with a very particular perspective. At all times he moved away from a strictly legal discussion to delve into...Conscientious objection in the healthcare professions was a topic that Gonzalo Herranz addressed early on and with a very particular perspective. At all times he moved away from a strictly legal discussion to delve into the real grounds that justify a healthcare agent's refusal to submit to a certain rule, considering that it goes against his or her conscience. This article presents some of the main issues that Professor He- rranz addressed in his publications and conferences in relation to conscientious objection.
Palliative medicine is the medicine that accompanies the person in their process of dying for alleviate their unwanted suffering, is a medicine that offers comfort care to the patient and his family, a medicine that does...Palliative medicine is the medicine that accompanies the person in their process of dying for alleviate their unwanted suffering, is a medicine that offers comfort care to the patient and his family, a medicine that does not prolong life unnecessarily at the expense of suffering, but rather it widens it, it is a medicine that takes care of life. Medical deontology tells us how our good medical practice through the rules contained in the Code of Ethics. In this article I address the practice of palliative medicine taking into account medical deontology, focusing on two issues that generate controversy such as palliative sedation and euthanasia. I consider that the good practice of palliative medicine consists, not in intentionally causing the death of the patient, but neither in unnecessarily prolong his agony, but to alleviate his suffering until death comes.
Legal duties of information, obtaining consent, confidentiality and protection of patient's privacy must be scrupulously fulfilled. However, Medical Ethics and Deontology impose a higher level of requirement on the docto...Legal duties of information, obtaining consent, confidentiality and protection of patient's privacy must be scrupulously fulfilled. However, Medical Ethics and Deontology impose a higher level of requirement on the doctor-patient relationship, namely, to adapt these duties to the specific patient and the specific situation. This means individualizing the medical act and making it absolutely personal; personalization in the doctor-patient relationship makes it unique and excellent, the moral objective of the medical profession from the Hippocratic precepts to the present day.
This paper explains basic ideas of Gonzalo Herranz on research ethics, in general and on human beings, obtained from the study of the fragmentary material that has been preserved (drafts and class outlines). Among other...This paper explains basic ideas of Gonzalo Herranz on research ethics, in general and on human beings, obtained from the study of the fragmentary material that has been preserved (drafts and class outlines). Among other ideas, I present his thoughts on the ethical foundations of the researcher's actions: the target of the researcher, the active and passive duty to investigate, the freedom of research and the peculiarities of the relationship between the researcher and the subject of research/patient.
Those who knew Prof. Gonzalo Herranz Rodríguez share a common feeling in which respect and admiration are intermingled, transmitted from a natural and simple personality. He generated a remarkable capacity for attraction...Those who knew Prof. Gonzalo Herranz Rodríguez share a common feeling in which respect and admiration are intermingled, transmitted from a natural and simple personality. He generated a remarkable capacity for attraction. In the broad field of bioethics he has left an indelible example of passionate and tenacious defence of scientific truth, both in the multiple facets that mark the daily life of medical action with respect to the sick, and in his clear international leadership when it was necessary to point out where authenticity was to be found in the biological findings on the first stages of the human embryo that later enable correct medical action to be guaranteed. His tenacious effort in the search for scientific truth, together with his defence of an attitude of closeness and humanity towards the patient, stemmed both from his rigour in the study of illness and his gifts of fine observation that allowed him to find solutions, a mixture of science and humanity, to the thousand incidences of medical action. For this reason, it is necessary to disseminate his work, as it constitutes a reference that marks the level of quality that is required for correct medical action.
It seems beyond doubt that the practice of certain sports requires gender differentiation, given the sexlinked characteristics that determine different levels of performance and skills. Moreover, there is a consensus on...It seems beyond doubt that the practice of certain sports requires gender differentiation, given the sexlinked characteristics that determine different levels of performance and skills. Moreover, there is a consensus on condemning doping practices, such as attempts to artificially alter the physical performance of athletes through the use of certain substances, because they involve tampering with the physical or mental conditions of the persons involved, as well as practices that have health risks, with consequences that can become serious and irreversible. In the case of ″trans″ athletes, their genetics, physiology, and endocrine system, responsible for typically male testosterone levels, would provide an insurmountable barrier to their eligibility in female athletic competition. However, the case of athletes diagnosed with Disorders of Sex Development does not fit into any of the above scenarios. They are biologically women and competes in the female category. They have not taken any anabolic substances that may be considered doping. We propose a bioethical evaluation of these cases.
The aim of this article is to explore John Henry Newman's reflections on the meaning of the medical profession in a lecture to medical students in Dublin. Specifically, it will show how Newman's exposition of what we hav...The aim of this article is to explore John Henry Newman's reflections on the meaning of the medical profession in a lecture to medical students in Dublin. Specifically, it will show how Newman's exposition of what we have called the ″medical fallacy″ allows us to consider him as an authoritative interlocutor in the debate on the naturalistic fallacy and the indefinition of the good, led by David Hume and Georg Edward Moore. Thus, in times of COVID-19, euthanasia and emotivism, delving into the thought of the English author can contribute to illuminating the bioethical problems of our time.
Renal dysfunction is common and can be severe in patients requiring cardiac surgery. There is currently a growing international interest in the declaration of Safe Health Units, around the safety of the surgical patient....Renal dysfunction is common and can be severe in patients requiring cardiac surgery. There is currently a growing international interest in the declaration of Safe Health Units, around the safety of the surgical patient. This interest is influenced at the same time by utilitarianism and the defense of the great value of human life. The general objective was to analyze, from the bioethics of health care and the contents of surgical patient safety, acute kidney injury associated with cardiac surgery. A systematic review was carried out using the PRISMA methodology in PubMed databases with articles published in the last five years. The pathophysiology of the entity studied is complex and still poorly understood. In this period, there was a great interest in investigating acute kidney injury associated with cardiac surgery, however, no other studies were found that addressed this issue from a personalist bioethical approach. High scientific quality and methodological rigor were found in the included studies, assessed by the predominance of systematic reviews, meta-analyses, and multicenter, randomized, double-blind controlled studies. An interesting and novel field is initiated, which facilitates, from perspectives with a comprehensive and more humane assessment, decision-making on acute kidney injury associated with cardiac surgery.
This article aims to explore the bioethical problems that are concentrated around the Umbilical Cord Blood. The publication in the year 2020 in Spain of the new National Umbilical Cord Blood Plan recalls the current stat...This article aims to explore the bioethical problems that are concentrated around the Umbilical Cord Blood. The publication in the year 2020 in Spain of the new National Umbilical Cord Blood Plan recalls the current status of the issue. The bioethical problems of umbilical cord blood have not been specially studied, rather there are few studies in this regard and above all they have focused on the controversy over its autologous use and its storage in private banks. This work, the result of reading twenty-six institutional statements from the most diverse institutions in different countries, offers a detailed and systematic enumeration of the bioethical problems that arise around the life of umbilical cord blood and proposes, fundamentally, a classification with an evolutionary criterion, that is, following the course of the Umbilical Cord Blood, from its donation to its use, passing through the problems of donors and storage. The sources used cover a period from 1998 to 2019 and are practically all the existing ones. This work offers a conclusive analysis of a synchronic nature, in which the bioethical constants are detected in the 31 years analyzed, specifically the principles of autonomy and solidarity, in addition to the so-called bioethics of expectations; and another of a diachronic nature in which the bioethical nuclei in which the questions are concentrated stand out: the lack of personalistic principles and the conflict between freedom and solidarity.
Until 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands admitted, under differentiated legal coverage, requests for euthanasia and / or assisted suicide in patients with non-terminal illnesses, and for rea...Until 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands admitted, under differentiated legal coverage, requests for euthanasia and / or assisted suicide in patients with non-terminal illnesses, and for reasons of intractable and unbearable suffering. Since March 2021 this is also possible in Spain. The objective of this work is to review the existing studies and characteristics of the practice of euthanasia and assisted suicide (ESA) in people with mental disorders (TM) and / or dementia (D) and see if the legal requirements essential in ESA applications in these patients are to be met. The hypothesis is that compliance with these requirements is especially difficult in patients with TM-D, either because of the characteristics of the disease itself, or because of the recognized legal security failures. Likewise, there may be sources of fraud not actually prosecuted by the State, either due to the complicity of society and / or due to the necessary cooperation of Medicine. As a result of this review, we raise criticaethical-deontological considerations about the approval of ESA for patients with TM-D, and its errors and consequences, to the reflection of the readers. We propose as an alternative to ESA the so-called ″palliative psychiatry″, which aims at improving the quality of life of patients and their families by facing the problems associated with severe persistent mental illness -potentially fatal- through the prevention and relief of suffering.
Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must perf...Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must performed by another specialist. In this scenario that involves different professionals, it is reasonable a certain debate about which of them should obtain the informed consent of the patient. The first error would be to pose this process as a confrontation between professionals who derive or delegate their own responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. On the one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a procedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And, since everything is understood as a shared process, it would also be advisable that the physician in charge of the care and follow-up of the patient, and who has taken the initiative to request this technique, had already provided basic information, more focused on the reason for the indication, and that a pre-consent had been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection. And it would be convenient to record this information in the medical record as well.