Cuadernos de Bioetica最新文献

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.

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.

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.

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.

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).

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.

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.

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.