Acta Bioethica

The Challenges of Transhumanism to Bioethics

Ricardo Camargo Brito, Nicolás Ried — Sat, 15 Jun 2024 00:00:00 +0000

This article explores the challenges presented to bioethics by the emergence of transhumanism in the West. The exploration is approached from a genealogical research perspective. A genealogical investigation aims to question the conditions of intelligibility of transhumanism and from there analyze its impacts on the updating of a central debate in bioethics, namely: the limits to the manipulation of human life. Transhumanism, inhabiting the crisis of humanism that precedes and compels it, updates the issue of the human condition by presenting a line of argument that at least authorizes to formulate again the limit question: can we/should we go beyond the human?

Ethical conflicts in a public management context: conscientious objection and abortion in the Spanish public health network

María Soledad Vilas-Iglesias, José Caamaño-Alegre — Sat, 15 Jun 2024 00:00:00 +0000

This article argues, first, that (1) the persistence at the international level of ethical debates on the moral status of nasciturus and (2) the traditional ethical commitment of health professionals to the health of both the pregnant woman and the unborn child, give full sense and validity to the right to conscientious objection of these professionals. However, where legal abortion is configured as a health care service, the difficulty of managing this service and, at the same time, the moral conflict expressed by conscientious objection arises. If, in a public health institution, objection is widespread, there is a dilemma with ethical implications between referring pregnant women to other institutions or implementing staff integration strategies at the health service level. In the case of Spain, a reform of the Organic Law on Sexual and Reproductive Health and the Voluntary Interruption of Pregnancy (LOSSRIVE) was approved this year, which shows a more stringent willingness that conscientious objection does not prevent access to abortion in public health institutions, establishing specific provisions to that effect. Based on the parliamentary work, we identified the main points of political discrepancy, which remit to different basic positions on abortion and affect the very approach of the reform, as well as other not always new elements —some of them were already in the LOSSRIVE or were already being applied at the regional level with the approval of the Constitutional Court.

Surrogacy in Portugal: Guidelines for clinical practice

Sofia Pinheiro, Miguel Ricou, Helena Pereira — Sat, 15 Jun 2024 00:00:00 +0000

Introduction: The approval by the Portuguese Parliament, in December 2021, of the law applicable to Surrogate Pregnancy, raises reflection on the practical aspects in which the scheme will be implemented and the necessary guidelines for health professionals involved. For this reason, the following objectives were defined: to analyze a set of recommendations for clinical practice in surrogacy in countries with experience in the procedure and to promote a discussion with experts in Medically Assisted Reproduction. Material and Methods: A documental analysis of publications and official documents on the theme was conducted. This served as a basis for the qualitative design study based on focus groups with different professionals —physicians, and psychologists— with experience in Medically Assisted Reproduction. The discussion was realized through sessions via Zoom®, held separately with the two focus groups. Results: In the debate, the experts made their appreciation and proposals for improvement concerning the initial version of the document resulting from the document analysis. Conclusion: A consolidated version of the set of guidelines for health professionals was obtained with the dimensions to evaluate and follow up with the surrogate and beneficiaries in Surrogacy.

The ethical principle of human intervention in civil liability

María Magdalena Bustos Díaz — Sat, 15 Jun 2024 00:00:00 +0000

One of the main challenges associated with regard to civil liability for damages resulting from artificial intelligence systems is the difficulty of attributing the behavior that led to harm to a specific individual. The aim of this article is to highlight the significance of the ethical principle of human intervention for civil liability. This principle serves as a guide for interpreting and applying rules when artificial intelligence systems cause harm to individuals due to actions, decisions, recommendations or predictions.

The application of bioethics as legal basis in judicial sentences concerning right to health in Brazil

Evandro Antonio Sbalcheiro Mariot, Stela Barbas, Rui Nunes — Sat, 15 Jun 2024 00:00:00 +0000

The right to health is linked to life and human dignity. Among the instruments to make it effective, the phenomenon of health litigation has become prominent. In Brazil, courts are increasingly faced with the task of rendering verdicts concerning matters related to health. Nowadays, judges have to deal with issues about health policies, technology incorporations, drug supplies, human autonomy, genetics, and biotechnologies, among others. Lawsuit sentences are now to be built upon the resolution of ethical, legal and philosophical questions. Bioethics presents itself as an instrument and method to help solve legal cases involving the right to health. This paper intends to show that bioethics can be applied in verdicts of lawsuits regarding to right to health in Brazil. It highlights that bioethics can be considered a source of law due to its normative dimension, as well as a hermeneutic method. This essay also aims to show the role for bioethics to help interpret the law and solve hard cases within health law and the right to health. Lastly, it aims to justify the presence of bioethics as legal reasoning to be used by judges in the foundation of their verdicts in lawsuits involving the right to health.

Normalized epistemic injustices and restriction of the agency of persons with disabilities

Raynier Hernández, Beatriz Revuelta — Sat, 15 Jun 2024 00:00:00 +0000

Epistemic injustices refer to those forms of unfair treatment that are related to the production, transmission, or use of knowledge by the subjects. The ethical-epistemic and socio-epistemic framework provided by these injustices is linked to themes that cross the main philosophical traditions such as pragmatism, phenomenology, and critical theory. These injustices are further intertwined with social and intellectual movements such as feminism, critical race theory, critical disability studies, and decolonizing epistemologies. However, there is a question that people with disabilities have not been sufficiently addressed. This article is positioned in the current debates on epistemic injustices and disability, and its purpose is to contribute the concept of "normalized epistemic injustices". Starting from the verification of the ways in which subjects with disabilities are oppressively recognized, as far from the "norm", it establishes that there are epistemic injustices associated with this identification. It proposes that normalized epistemic injustices occur at the intersection of two realms: a capacitist hermeneutic system and a constrained epistemic agency where at least three types of configurations are produced: non-agency; diminished epistemic agencies and epistemic agencies in resistance. Thinking about epistemic injustices considering the weight of "normality" in the constitution as subjects of people with disabilities allows us to recognize a critical situation of epistemic exclusion for some people, while others resist and fight to be understood in collective hermeneutical resources.

A perspective on research ethics committees in the brazilian amazon

Aparício Carvalho de Moraes, Rui Nunes — Sat, 15 Jun 2024 00:00:00 +0000

This study presents the importance of the Research Ethics Committees (CEP) in the context of the Brazilian North Region, formed by the Amazon rainforest, which is occupied by traditional populations and those constituted by migratory currents. This study aims to analyze the bioethical implications arising from the activities of CEPs in the ethical evaluation of research projects and their essential role in protecting vulnerable populations. The authors seek to highlight the importance of ethics committees in the Amazon and their importance face the modern bioethical values that can contribute to the preservation of one of the most valuable and diverse environments on earth.

Evolution and importance of the Research Ethics Committee, CEP, in higher education institutions: a study in a western Amazonian institution between 2018 to 2022

Aparício Carvalho de Moraes, Rui Nunes — Sat, 15 Jun 2024 00:00:00 +0000

The Research Ethics Committee (CEP) has become an essential mechanism for social control in Brazilian research involving human subjects, contributing to the development of studies guided by ethical standards and to the protection of research participants. This article analyzes the performance of CEP in Western Amazonian institution, its history, operating conditions, trends, and different aspects between 2018 to 2022. The theoretical framework addresses the history of research involving human subjects, the origins and evolution of bioethics in the international context, bioethics in Brazil, and regulations on the ethical analysis of research. The data were collected through the Brazil Platform and reports from the institution's CEP. The CEP evaluated 865 research protocols, most of which were from Health Sciences. Additionally, it was observed that during 2018 to 2022 the covid-19 pandemic had a negative impact on the number of projects submitted for evaluation to the CEP. The 57% drop in the number of projects registered during 2020/2022 reveals the negative impact of this event on the execution of projects with human participants.

Ethical assessment of privacy breaches in epidemiological investigations and information disclosure in the internet age: Safeguarding identity information for infectious patients

Zhen Zhang, Zheng Zang — Sat, 15 Jun 2024 00:00:00 +0000

While the Internet has brought convenience and speed to human life, it has also led to frequent privacy violations. In the context of epidemiological investigations and information disclosure regarding confirmed Covid-19 patients, many individuals have utilized the Internet as a means to disseminate information and engage in cyber manhunts, resulting in breaches of privacy for those involved. This phenomenon is particularly prevalent within the realm of the Internet, where the boundaries of privacy invasion become blurred. Various types of privacy infringements, both active and passive negligence, are evident on social networking platforms. The juxtaposition of the virtual world of the Internet with real-life scenarios presents novel challenges in the realm of privacy violations. The Internet era, coupled with the widespread use and integration of big data, has diminished the absolute right to privacy on the Internet. This paper examines the challenge of safeguarding the identity information of infectious patients through the lens of two theoretical frameworks —Kantianism and Utilitarianism— in an effort to address this ethical dilemma.

Validation of an instrument for the application of principled bioethical principles in clinical research protocols

Rafael Bustos Saldaña, Grupo de Investigación en Bioética de América Latina — Sat, 15 Jun 2024 00:00:00 +0000

The aim of this article is to report on the validation of an instrument on the application of principialist bioethical principles in each of the elements of clinical research protocols. To this end, a 173-item instrument was evaluated using the Delphi method, with the collaboration of 12 Latin American experts in research bioethics. The instrument underwent two rounds of revision. In the end there were only 171 items, in which the bioethical principles were applied 208 times, of which 87 (41.82%) belonged to Beneficence, 63 (30.29%) to Non-Maleficence, 36 (17.31%) to Justice and 22 (10.58%) to Autonomy. Regarding the congruence of the principles in general with respect to the variables of the elements of the clinical research protocol, it was found on 189 (90.87% CI 95% 86.10 to 94.41) occasions, K=0.98 (0.01), p=<0.0001. It is concluded that the validated instrument gives us the option of applying the bioethical principles of the principialist current to each of the elements of the clinical research protocols.

Efficiency, planning and good management, determining factors for a greater equity on health care expenses: the experience from the program family health strategy in Brazil

Sat, 15 Jun 2024 00:00:00 +0000

The present work presents as a research problem the importance of efficiency, planning, and principles of good management aiming at capillarity and equity to generate greater access and quality of services. The objective of this article was to identify the expansion of the Family Health Strategy in Brazil between 2007 and 2020, and which variables may explain this evolution. This is a descriptive, ecological research, developed between 2007 and 2020 in Brazil; its variable of interest was the estimated population coverage of this strategy (%). An increase in the coverage of the Family Health Strategy was observed in all regions of Brazil between 2007 and 2020, especially in the Northeast region. At the state level, this coverage showed a significant positive relationship with the following variables: towns with fewer than 40,000 inhabitants and monthly income inferior to half a minimum salary. The Brazilian version of the Family Health Strategy seeks inspiration from the best and most successful health models to achieve high performance and efficiency to provide equity and access to health services.

Perception of bioethical principles applied in hydrotherapeutic practices: echoes of therapists

Pamela Marcone-Dapelo — Sat, 15 Jun 2024 00:00:00 +0000

Article reports an investigation into the application of the bioethical principles of personalism in hydrotherapeutic practice internationally. A qualitative, phenomenological, purposive and opinionated sampling methodology was used. The sample consisted of 12 international senior aquatic therapists, who participated in semi-structured online interviews. Thematic categorical content analysis was carried out with the support of Atlas Ti software, version 9. As a result, four principles of personalism and three emerging categories were identified: values, principle of vulnerability and the cost-benefit principle. It is concluded that hydrotherapeutic practice is consistent with the personalist current. A principle of utilitarianism and the Barcelona Declaration emerges, as well as values such as honesty, respect and humility. The need to deepen the bioethical principles of personalism in general aquatic practice, as well as in the training processes and bioethical competences acquired by therapists, is raised.

Intellectual Property and Competition Law in the Pharmaceutical Sector during the covid-19 Pandemic

Sat, 15 Jun 2024 00:00:00 +0000

The covid 19 pandemic demonstrated that public policies related to intellectual property and competition law were not adequate or sufficiently articulated to allow timely access to vaccines in an equitable manner, due to distortions in the manufacture, distribution, and sale of covid-19 vaccines when they were available during the pandemic. This research aims to analyze, from a legal perspective, whether the observed problems originate in an inadequate application of intellectual property legislation and its relationship with other public policies related to competition, or, eventually, in the abusive exercise of such rights, which, as a consequence, would distort the process of competition in national and regional markets.

Study on the policy implementation effect of serious Illness medical insurance in the ethnic minority autonomous area of Western China

Sat, 15 Jun 2024 00:00:00 +0000

Objective: To evaluate the implementation effect of serious illness medical insurance in Guang Xi Zhuang Autonomous Region of western China. Study design: Through the collection of 2017-2021 Guang Xi serious illness medical insurance specific policy making such as fund usage, serious illness compensation, medical expenses data, and data analysis of a serious illness medical insurance effect. Method: Literature research, Policy text analysis, quantitative data collection method, using Excel and SPSS 19.0 data descriptive statistical analysis and comparative analysis. Results: Serious illness medical insurance has had some effect, e.g., from 2017 to 2021, the utilization rate of serious illness medical insurance fund in Guang Xi was 109.49% and 103.87% respectively, the fund balance rate was -9.45% and -8.54% respectively, and the accumulated balance was -2.3871 million CNY and -70.7955 million CNY. Conclusion: The serious illness medical insurance has reduced the burden of large medical expenses of patients to a certain extent, but the fund is under too much pressure, and there is a payment deficit. The coverage and security of serious illness medical insurance need to be expanded and strengthened, and the cooperation mechanism with commercial insurance institutions should be gradually explored to improve the serious illness medical insurance.

A PROPÓSITO DE METÁFORAS

Fernando Lolas Stepke — Sat, 15 Jun 2024 00:00:00 +0000

MEDICINA EN EL ROMANTICISMO Y EL IDEALISMO ALEMÁN

Fernando Lolas Stepke — Sat, 15 Jun 2024 00:00:00 +0000

EL FUTURO ANTROPOLÓGICO DE LA MEDICINA

Fernando Lolas Stepke — Sat, 15 Jun 2024 00:00:00 +0000

The Centre for Medical Humanities and Bioethics, Linköping University

Sofia Morberg Jämterud, Lisa Guntram, Kristin Zeiler — Sat, 15 Jun 2024 00:00:00 +0000

Una vida dedicada a vivir y enseñar la bioética

Sandra M. Fabregas Troche — Sat, 15 Jun 2024 00:00:00 +0000