The practice of medicine and the search for professional excellence in current times force us to rethink whether only the principles of personalistic and principled bioethics are enough to be able to be better and better...The practice of medicine and the search for professional excellence in current times force us to rethink whether only the principles of personalistic and principled bioethics are enough to be able to be better and better health agents; a renewed interest in the ethics of virtues and their implementation is probably the answer to this question. The intention of this article is to concisely explain some of the virtues that we believe a good health professional should have and how they influence their daily practice.
In pediatric medical practice, there is the case of children and young persons under 18 with gender dysphoria or gender discordance, characterized by an incongruity between biological sex and gender identity. In this way...In pediatric medical practice, there is the case of children and young persons under 18 with gender dysphoria or gender discordance, characterized by an incongruity between biological sex and gender identity. In this way, the medical and juridical possibility of gender affirmation treatment is offered to minors. Although this treatment has been endorsed by some scientific associations, it has also been the subject of serious questioning due to the possible irreversibility of the procedures performed on the minor's body. For this reason, although the law recognizes some autonomy to the minor to make the decision to initiate a gender affirmation treatment, the lack of maturity to understand and assume the information that is provided could affect the validity of the informed consent.
The pandemic caused by SARS-COVID-2 has supposed an extraordinary challenge for prisons. There is an unavoidable need to take action to stop the entry and spread of the virus, however, the measures must respect prisoners...The pandemic caused by SARS-COVID-2 has supposed an extraordinary challenge for prisons. There is an unavoidable need to take action to stop the entry and spread of the virus, however, the measures must respect prisoners' rights and must not constitute any kind of inhuman or degrading treatment. Spanish prison authorities have published and extensive normative that has transformed life in prisons during the pandemic. We have reviewed the content of these norms, which's main treads are: no discrimination and the guarantee of an equivalent treatment than that to the regular population; coordination of medical authorities; interruption or diminution of the spread of the virus from or towards prisons; the strengthening of alternatives to closed regime sentences; mobility restriction methods inside prisons, and measures to minimise the risks employees are exposed to. In general, the measures have respected prisoners' rights. However, indefinite quarantine practices have likely violated them, being that there were other alternative measures. Ultimately, the extensive vaccination of prisoners has public health implications, constitutes an ethical imperative towards this group of vulnerable people and should be implemented promptly.
This article discusses the situation of childbirth in general and home birth in particular from a legal perspective. Taking the context of the social, health and bioethical crisis brought about by Covid-19 as a starting...This article discusses the situation of childbirth in general and home birth in particular from a legal perspective. Taking the context of the social, health and bioethical crisis brought about by Covid-19 as a starting point, we examine the principles that should guide birth care and analyse obstetric violence as denial of these principles. In light of abuse of medicalisation and medical interventionism, it seeks to find the best ways to humanise and dignify the care for the whole birth process. To this end, we consider the main pronouncements on the subject by international and domestic institutions and courts, as well as the case law of the European Court of Human Rights, with emphasis on rulings concerning home births, which deal with possible violations of rights and, in particular, the right to respect for private and family life.
Medical and scientific advances have made it possible to carry out more and more early procedures involving human life within the mother's womb. Based on the above, the dilemma surrounding the perception or experience of...Medical and scientific advances have made it possible to carry out more and more early procedures involving human life within the mother's womb. Based on the above, the dilemma surrounding the perception or experience of fetal pain has emerged and its implications in various fields such as: prenatal diagnosis, fetal surgery and especially around abortion. This document seeks to carry out an approach to the embryological development of pain pathways and their components, to assess the relevance of the current definition of pain in this context, and the bioethical implications of the different interventions carried out on the fetus. We consider that despite the need for scientific evidence in this field, the available knowledge indicates that it is possible to experience pain in the mother's womb especially since the 20th week of gestation, so it is important to reflect on fetal pain and the need to become aware of this, before performing any intervention involving the fetus as a patient.
Medicine today is a field of permanent tensions: between structures and individuals, between public policies and individualised patient care, and between patients and their therapists. This article reflects on the notion...Medicine today is a field of permanent tensions: between structures and individuals, between public policies and individualised patient care, and between patients and their therapists. This article reflects on the notion of care as a way of resolving the problems encountered by health professions by considering one of their fundamental concepts. For this purpose, research was carried out in the medical literature in order to understand the definitions in which care is discussed in current medicine. Based on the findings, three paradigms or constructs related to the notion of care are detailed: a) Patient Centered Care, b) the ethics of care, and c) the idea of Whole Person Care. Even with the notable differences between these constructs, it is possible to rescue the framework of care: the objective being for the good of the patient. Thus, a proposal for the reflection on caring for others is developed, based on what is the concept of ″objective good for the person″ in accordance with the thinking of the philosopher Dietrich von Hildebrand.
In the context of general changes in our societies in relation to health, the healthy organization is proclaimed and accepted as something necessary and legitimate. This phenomenon is expanding globally without being rea...In the context of general changes in our societies in relation to health, the healthy organization is proclaimed and accepted as something necessary and legitimate. This phenomenon is expanding globally without being really questioned and promoted by international organizations and large companies. With a global and growing presence in organizational and professional policies and practices, it appears to be gaining even more strength in the aftermath of the pandemic. Faced with the expansion of the phenomenon and because it directly affects people's health, an analysis of it beyond its general positive image is unavoidable. This article identifies some relevant dangers of promoting a culture of health at work, from an ethical perspective, and among them, not only the non-beneficial nature of some practices not scientifically proven, but also their own malignant condition. In this paper, therefore, the ethical limits for this expansive phenomenon are proposed and the fundamental principle to operate in this area of asymmetric relations between employee and employer is not autonomy but non-maleficence.
Duchenne muscular dystrophy is a rare genetic disease with only ataluren like pharmaceutical treatment available. This drug received a conditional authorization by the European Medicines Agency (EMA) in 2014, meaning tha...Duchenne muscular dystrophy is a rare genetic disease with only ataluren like pharmaceutical treatment available. This drug received a conditional authorization by the European Medicines Agency (EMA) in 2014, meaning that it was commercially available while waiting for more solid results that demonstrate the efficacy and safety. Currently, the authorization still maintains the ″conditional″ modality, and the actual health benefits of the drug still remain unclear. In Spain, ataluren is not financed by the National Health System. The decision of non-financing has generated a heated debate, especially because in those patients who se treatment were started prior to the non-financing decision the drug has continued being funded. This controversial situation encompasses complex aspects of pharmaceutical and health management related to scientific evidence, the motivations of regulatory agencies and the pharmaceutical industry in the processes of drug investigation and authorization. Furthermore, as the center of the debate, some pillars of bioethics such as justice and equity, as well as certain legal principles, such as the protection of minors, are involved.
Illness and disability are forms of vulnerability to which human beings are victims; they limit a person's ability to act and his real possibilities are reduced. These forms of vulnerability may correspond to the loss of...Illness and disability are forms of vulnerability to which human beings are victims; they limit a person's ability to act and his real possibilities are reduced. These forms of vulnerability may correspond to the loss of capabilities. Armatya Sen presents the capabilities approach as a new theory of social justice, a new way of thinking about human well-being that overcomes the shortcomings of utilitarianism, the dominant approach of his time. Capability refers to what a person is really capable of doing. Medical care, therefore, appears as a form of help whose objective is to fight against vulnerability by re-mobilizing the capabilities of the patient who, at some point in his existence due to the disease, is found more or less momentary deprived of them. The development of the power to act and the power to be of the patient, through the care provided by the caregivers, consists of strengthening their capabilities that allow them to participate effectively and actively in social life and in the management of care and health system. The objective of this article is to highlight the contributions of capabilities to patient's care. For us, it will be a matter of considering capabilities as the basis of a new paradigm for understanding the care of sick and vulnerable people in medical practice.
The present article offers an analysis from a bioethical perspective of the treatment provided to senior citizens in the context of the COVID-19 pandemic. To begin with, the article highlights the paradox that exists whe...The present article offers an analysis from a bioethical perspective of the treatment provided to senior citizens in the context of the COVID-19 pandemic. To begin with, the article highlights the paradox that exists when measures are adopted for the care of elderly people during a pandemic, and in some occasions the age of the patient is the determining factor for deciding whether to provide care or not in cases of scarcity. The question that arises then is: What is the adequate treatment for senior citizens? Using the Inter-American Convention on the Protection of the Human Rights of Elderly Persons as a point of reference, this article assesses the problem of the scarce resource allocation in the Third Age during a pandemic. As a conclusion, the pandemic is a great opportunity to reflect on the respect that we should give to every human being at every stage of his/her life.
Our health system runs the risk of ruling out or neglecting a significant proportion of patients who require less technological but closer and humane care, those who require more support and attention. In this scenario,...Our health system runs the risk of ruling out or neglecting a significant proportion of patients who require less technological but closer and humane care, those who require more support and attention. In this scenario, it is easy that both the assistance and close care and the patients who need this care and who would not benefit from aggressive or interventionist treatments may be considered as secondary: as children of a lesser god. It would be necessary to change the paradigm to understand that the quality of care is not limited to technology. And it would also be necessary to promote the dignity of care so that it is not seen as secondary and passive. On the contrary, care should be understood not only as active but also as intense without losing its close and human profile. Promoting the dignity of care also means promoting the dignity of all patients who may have been marginalized or excluded from this health system that is marked by technology and complexity and whose goal is efficiency.
The paper aims to provide an overview of current knowledge related to the ethicality of health-promoting nudges and a further elaboration, particularly in terms of linking the interpretation of the findings of the study...The paper aims to provide an overview of current knowledge related to the ethicality of health-promoting nudges and a further elaboration, particularly in terms of linking the interpretation of the findings of the study and the conclusions adopted. A comprehensive narrative review of literature on the topic of interest was undertaken, aiming to contribute to the current debate on the topic of interest. It is practically hard to determine whether or not the nudgee's agency will be eroded by the particular nudge because the line of distinction between emotions or automatic ways of human reasoning and cognitive ways of human reasoning remains blurry, and the various types of nudges fall on a combination of two continuums: the one ranging from transparent to non-transparent and the other ranging from reflective to automatic. Therefore, the majority of nudges are most likely to work as reason-bypassing nonargumentative influences, thus eroding the nudgee's agency. It is time to accept a deviation from the strict commitment to the principle of (individualistic) autonomy in degrees proportional to the incontestably anticipated patient's benefit. In case that patient's best interest is less than clear or the nudging promotes another individual's best interest (not the decider's one), or even the common good, the ethicality of nudging is not always beyond reasonable doubt. In such cases the deviation should be as minimal as possible (i.e. limited to nudges that are transparent or almost transparent and work reflectively or almost reflectively). Nudging may be used against the COVID-19 pandemic.
The Spanish Congress of Deputies has approved the law regulating euthanasia. Precisely, the article deals at the statements made by its defenders. These revolve around the following concepts: dignity, right, freedom and,...The Spanish Congress of Deputies has approved the law regulating euthanasia. Precisely, the article deals at the statements made by its defenders. These revolve around the following concepts: dignity, right, freedom and, finally, pain-suffering. Human dignity is the individual and social principle par excellence and from which the other three are derived. For this reason, by defending the dignity that the human being possesses, simply, by the fact of being it, it is against said Law. Human dignity is not destroyed by terminal illness, or by dependency, suffering, weakness or frailty. Each human life has value in itself, which must be safeguarded and which makes it non-negotiable in all situations and conditions. That the non-negotiable value of life sustains any democratic system. However, the supposed right to euthanasia is typical of an individualistic and reductionist vision of the human being and his life; and of a freedom detached both from the goodness or badness of the choice and action carried out, and from the responsibility towards the lives of others. Faced with offering euthanasia, as the only solution to the suffering of people in the last stage of their life, quality palliative care should be proposed. These are the only ethical option, consistent with respect for human dignity. Respecting, valuing, caring for, and attending to vulnerable and fragile human life means progress in humanity.
The present work analyzes the classical notion of human nature. He studies this concept in Aristotle, in whom the Greek intellectual understanding of the notion of nature culminates as the later Thomistic reception of it...The present work analyzes the classical notion of human nature. He studies this concept in Aristotle, in whom the Greek intellectual understanding of the notion of nature culminates as the later Thomistic reception of it. The main objective of this work is to provide a brief and concise introduction to the philosophy of man, which underlies in many of the authors who not only consider transhumanist thought reductive, with respect to their conception of what man is, but also they try to provide ethical solutions to take on the great opportunities that technoscience presents to today's man.
This article analyzes the general evolution of human rights due to the influence of transhumanist ideas, which were already present in 1948. Specifically, we will consider their denial of human nature, and self-determina...This article analyzes the general evolution of human rights due to the influence of transhumanist ideas, which were already present in 1948. Specifically, we will consider their denial of human nature, and self-determination as the new cornerstone of the legal order. We will see how nature is no longer considered the foundation of law, and instead how the focus is now on self-determination and the possibilities of technology. Although the 1948 Declaration of Rights has not changed, the anthropological conception has been modified, and new rights have been introduced, thanks to the interpretation made by the courts. The proposal is to recover the notion of human nature and natural law, which offers a universal terrain for dialogue and inspiring keys to find the true rights of the person and the good of society.
More than forty years after the first baby's birth through in vitro fertilization, innovations in the field of human reproduction have experienced a significant growth increase. Those first techniques have led evolved to...More than forty years after the first baby's birth through in vitro fertilization, innovations in the field of human reproduction have experienced a significant growth increase. Those first techniques have led evolved to others that push the biological limits of reproduction. Recent developments in genomic editing -particularly, CRISPR/Cas9 technology- had leaded an intense ethical, social and legal discussion about the boundaries limits of the new models of human reproduction, and their consequences in recent years. The number of conflicting legal interests suggests that the application of these techniques must combine the respect for the law, the defense of the human rights of all the agents involved in the process, and the freedom of scientific research. The present paper tries to deal with the diverse ethical implications and legal limits of three of those techniques, recently developed or to be developed in the near future: surrogacy, uterus transplantation and artificial uterus.
The recent development of NBIC technologies has led to the emergence of new techniques that allow the modification of genetic, morphological, and physiological aspects of the human being to improve their capacities. In l...The recent development of NBIC technologies has led to the emergence of new techniques that allow the modification of genetic, morphological, and physiological aspects of the human being to improve their capacities. In light of this situation, the eternal debate continues: is everything technically possible ethically acceptable? To answer this question, an ethical reflection is needed to assess the scope of enhancement techniques and to direct them to the service of human progress and the common good. Many authors have already begun this reflection, opting for a case-by-case evaluation. However, there is a great lack of specificity in the definition of the criteria that would allow an ethical analysis of each technique, in order to determine the licitness of its application. In response to this need, a practical guide for the ethical assessment of not only human enhancement techniques, but of any intervention on the human body is proposed. This guide is based on the four principles of personalist bioethics proposed by Sgreccia: the principle of defense of physical human life, the principle of totality or the therapeutic principle, the principle of freedom and responsibility, and the principle of sociability and subsidiarity. These principles are the common thread of some questionnaires that serve as support in discerning the licitness of a technique, by virtue of the overall good of the person in their three-dimensional structure: body, mind and spirit, and the respect for their inalienable dignity.