Cuadernos de Bioetica最新文献

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.

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.

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.

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.

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.

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.