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.
{"title":"The ethics of health-promoting nudges.","authors":"Polychronis Voultsos","doi":"10.30444/CB.104","DOIUrl":"https://doi.org/10.30444/CB.104","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 106","pages":"301-320"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39851006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"[Care and support: children of a lesser god?]","authors":"Francisco Barón, Álvaro Sanz","doi":"10.30444/CB.105","DOIUrl":"https://doi.org/10.30444/CB.105","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 106","pages":"321-327"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39851007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[AEBI regarding the entry into force of the Organic Law for the Regulation of Euthanasia in Spain.]","authors":"","doi":"10.30444/CB.109","DOIUrl":"https://doi.org/10.30444/CB.109","url":null,"abstract":"","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 106","pages":"365-367"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39851011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pilar Pacheco López, María Antonia Meroño Saura, Ana Aranda García
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.
{"title":"[Use of ataluren in Spain: administrative incoherences and ethical implications].","authors":"Pilar Pacheco López, María Antonia Meroño Saura, Ana Aranda García","doi":"10.30444/CB.108","DOIUrl":"https://doi.org/10.30444/CB.108","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 106","pages":"353-362"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39851012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"[Surrogacy, uterus transplantation and artificial uterus: approaches from the biolaw].","authors":"María Valle Robles","doi":"10.30444/CB.99","DOIUrl":"https://doi.org/10.30444/CB.99","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 105","pages":"213-223"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39432519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this article we approach to understand the presuppositions of the transhumanist current to recognize some of the fundamental and universal notes of human nature that are manifested through its proposals. From the approaches of transhumanism, the human being can be recognized as a yearning being, a being who naturally desires. Moreover, it is recognized that this desire motivates the action of man and that the person is always on the way to perfection, motivated to overcome without limits what reality offers him to fulfill his desire for fulfillment. In addition, the main proposals for human improvement sustained from transhumanism are analyzed to understand which are the desires of the heart of man that are manifested through them. The recognition of these desires can be taken as a good starting point for the dialogue between transhumanism and other currents that recognize desire as a fundamental part of a human nature. We also judge whether transhumanism can be understood as an adequate response to satisfy the deepest desires of the human heart for happiness and fulfillment, concluding that transhumanist theses are insufficient when it comes to calming the fundamental concerns of human heart.
{"title":"[Transhumanism and desire: phenomenological approach].","authors":"David García Díaz","doi":"10.30444/CB.95","DOIUrl":"https://doi.org/10.30444/CB.95","url":null,"abstract":"<p><p>In this article we approach to understand the presuppositions of the transhumanist current to recognize some of the fundamental and universal notes of human nature that are manifested through its proposals. From the approaches of transhumanism, the human being can be recognized as a yearning being, a being who naturally desires. Moreover, it is recognized that this desire motivates the action of man and that the person is always on the way to perfection, motivated to overcome without limits what reality offers him to fulfill his desire for fulfillment. In addition, the main proposals for human improvement sustained from transhumanism are analyzed to understand which are the desires of the heart of man that are manifested through them. The recognition of these desires can be taken as a good starting point for the dialogue between transhumanism and other currents that recognize desire as a fundamental part of a human nature. We also judge whether transhumanism can be understood as an adequate response to satisfy the deepest desires of the human heart for happiness and fulfillment, concluding that transhumanist theses are insufficient when it comes to calming the fundamental concerns of human heart.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 105","pages":"159-169"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39433092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"[Human nature in the Aristotelian-Thomist tradition: a brief exposition].","authors":"Ángel Sánchez-Palencia Martí","doi":"10.30444/CB.101","DOIUrl":"https://doi.org/10.30444/CB.101","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 105","pages":"237-247"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39432997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"[Transhumanism and law: from human nature to self-determination as the foundation of human rights].","authors":"María Lacalle Noriega","doi":"10.30444/CB.100","DOIUrl":"https://doi.org/10.30444/CB.100","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 105","pages":"225-235"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39432998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"[Organic Law 3/2021 on regulation of Euthanasia: A dehumanizing law?]","authors":"Roberto Germán Zurriaráin","doi":"10.30444/CB.102","DOIUrl":"https://doi.org/10.30444/CB.102","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 105","pages":"251-267"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39433000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this article we start by submitting a definition of transhumanism and then turn to the main bioethical problems that arise from it, with particular attention to the so-called human enhancement perspective. Secondly, and without being exhaustive, we shall seek to identify some of the main challenges posed by emerging sciences in the 21st century, specially with an eye to convergent technologies or NBICs (nanotechnology, biotechnology, informatics and cognitive sciences). And finally, we end up by enumerating some of the bioethical questions every researcher should take into account before considering applying any new technology on humans in the coming decades.
{"title":"[Transhumanism, human enhancement and bioethical challenges of emerging technologies for the 21st century].","authors":"Elena Postigo Solano","doi":"10.30444/CB.92","DOIUrl":"https://doi.org/10.30444/CB.92","url":null,"abstract":"<p><p>In this article we start by submitting a definition of transhumanism and then turn to the main bioethical problems that arise from it, with particular attention to the so-called human enhancement perspective. Secondly, and without being exhaustive, we shall seek to identify some of the main challenges posed by emerging sciences in the 21st century, specially with an eye to convergent technologies or NBICs (nanotechnology, biotechnology, informatics and cognitive sciences). And finally, we end up by enumerating some of the bioethical questions every researcher should take into account before considering applying any new technology on humans in the coming decades.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"32 105","pages":"133-139"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39433091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}