Cuadernos de Bioetica最新文献

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.

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.

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.

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.

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.

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.

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.

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 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.