Revista Espanola De Salud Publica最新文献

In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people's behavior to improve the chooser's own welfare without forbidding or significantly restricting their choices. Its promoters invoke libertarian paternalism, which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the other hand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzes the role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinical nudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specific to public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and the ethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and with what limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma between preserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whether in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns and quarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individual rights to promote health measures.

The aim of this article is to explore a philosophical perspective on health linked to the restoration of wild nature, especially on the basis of some lessons that can be drawn from the spread of recent zoonotic diseases. The first section presents the relationship that the COVID-19 pandemic has maintained with social justice, venturing the thesis that ecological justice is a dimension that should be incorporated with deeper attention. To justify this, the following sections propose, first at the conceptual level, to approach a concept of health that is plural, dynamic and interdependent, and, then at the pragmatic level, to take as a reference the casuistry that shows an inverse correlation between the presence of wild biodiversity in a territory and contagion by zoonoses. In sum, these thoughts may lead to justify anticipatory duties for future pandemics and a responsibility for global health that deserve to be analyzed from an ethical point of view.

The pandemic has placed us in a situation of estrangement from ourselves. We have been acutely aware of our vulnerability and fragility. Through the stories of lived experiences, we have learned about and witnessed tragic circumstances in which inhospitality and neglect have become evident. We have been shocked by the awareness of the lack of recognition, accompaniment and welcome. Institutional decisions have prioritized public health, the good for all, but have forgotten the biographies of people, full of suffering. And this has produced a moral damage, a loss of trust, a feeling of injustice that we have not been able to fight against. This is why it is necessary to build hospitality, which can be achieved through care. Care with a political dimension that takes charge of reality and transforms society. The key is a responsibility in solidarity. Faced with the possibility of dehumanizing ourselves, we seek hospitality as an alternative way of narrating lives that have to be reconstructed, that have to relearn how to take care of each other amidst the multiple possibilities of estrangement that threaten us. Hospitality is at the heart of a narrative ethics at the height of our times.

The human milk donation has been an undervalued and very biasedly examined subject until relatively recently, in comparison with other types of human donation (organs, tissues, fluids), not being recognized its dimension of bodily altruistic and philanthropic act in the same way as other (mildly) analogous realities, as well as in its approach from the perspective of feminist and gender studies. On the other hand, although the COVID-19 pandemic and the various lockdown processes have had an onerous impact on human breastfeeding in general, we find data on the global increase in breastfeeding donation as a specific altruistic gesture during the pandemic in Spain and, even, on the decisions in the most complicated moments of the state of alarm about donating one's own milk in the tragedy of perinatal death. These altruistic donations contribute to carrying out the fulfillment of what has already been declared a human right and one of the social investments with the most advantageous cost-benefit index. The recognized, intensified and amplified need for milk banks in a pandemic brings to the fore in a specific way the condition of human milk as capital physiological resource, and, ultimately, as a global good. This article is dedicated to delving into a critical hermeneutics of milk donation in light of the pandemic and as an opportunity to rethink the studies of recent decades in this regard.

During the COVID-19 pandemic, technology has been used to carry out numerous activities. These uses have often been poorly planned, as the urgency of the situation did not allow for careful considerations. Technology has helped us to maintain many aspects of life that the pandemic had done difficult; however, it has also brought some new problems, especially when it comes to situations of vulnerability and care settings. In this article we analyse the nature and use of technology in assistive and care settings during the pandemic, its basis, its scope, and its limitations. To do so, we study the specific case of the use of digital video-calling platforms during the forced isolations caused by the pandemic.

The experience of the COVID-19 pandemic and the horizon of expectations in relation to climate change reminds us that it is a collective responsibility to anticipate to the best of our ability and knowledge the risks of foreseeable disasters and their potential impacts on vulnerable communities. The article will examine the meaning and status of moral duties regarding disaster preparedness by adopting a disaster ethics approach which draws on the interrelationship of bioethics with public health ethics and looks at the full cycle of disaster management and the corresponding cycle of protection of victims and professionals. After discussing some normative controversies accompanying well-known classifications of disasters and characterizing the ethical turn to preparedness in disaster management, it will be argued that preparedness duties include obligations relating to planning, anticipation, and prevention of disasters and that they are derivative and positive duties involving a series of prospective, shared and institutionally mediated responsibilities.

The paper is aimed to analyze if religion plays a relevant role in health promotion and, thus, if it can be included in the interpretations on the positive role of religions in the public sphere. In this regard, Habermas refers to a crisis of meaning in secular societies that has been caused, among other reasons, by individualistic and selfish lifestyles that fail to encourage a moral action when it goes beyond the law. In contrast, it seems that the strong social ties of religious communities foster solidarity and altruistic attitudes, which could be interpreted as a sign of greater social cohesion; but is it really like that? Pandemic and its consequences help to assess whether the religious element (analyzed as belief, belonging, bonding and behavior) has created positive attitudes in the face of the health challenges (i.e., compliance with rules of social distance, vaccination) or, on the contrary, the motivational deficits of some societies have to do with other factors not related to the religious/secular dichotomy.

COVID-19 pandemics gave us relevant lessons that are going to leave a durable mark in our individual and collective experience. Those lessons are both practical and endowed with a moral import. But the pandemic has left a trail of experiences poorly elaborated that leads, with some urgency, to forced silence and to the cancellation of emotional trauma. The aim of this paper was to disentangle the complex relationship that arises, under conditions of uncertainty, between knowledge and ignorance, both from the perspective of experts and of policy makers, and even of the ordinary people, struck or not by the SARS-CoV-2 virus. To that end, I distinguish between three different levels of analysis (agency, institutions, and ideological frameworks) so to argue that the mismatches that occur in all of them, and between them, are sources of avoidable harm. The purpose of this exploration was, therefore, to bring to the floor, relying on the conceptual tools of the political epistemology, both the aspects of the traumatic experience that still lack an adequate elaboration and the features that provide an improved resilience for individuals and societies in tackling with the frightful consequences of the pandemic.

Theorists of the ethics and politics of care, with their feminist and intersectional analyses, have spent decades trying to leave their mark on clinical practice and political structures . In them, extensive processes of humanization of the relationship between professionals and people who need their care are required, without neglecting inequalities due to gender, social class or belonging to vulnerable minority groups that go through health and disease experiences in the community. society. It is evident that our institutions must be extensively rethought in their foundations; from nursing homes to highly technological ICUs; from the saturation of primary care to the lack of specialized personnel. In areas such as nursing, great emphasis is placed on models based on interdependence and the particular context to generate another care framework , while fighting for hierarchies and invisibilities related to highly feminized professions . Not surprisingly, the reflections that follow are signed by three women with hybrid profiles who have dedicated part of our working life to the field of primary and hospital care (both in nursing and in physiotherapy) and, in turn, to research and teaching in bioethics, philosophy and humanities. We have experienced in our flesh the contradictions between a will to serve and some axes of oppression connatural to the institutions.

The COVID-19 pandemic has recalled the importance of prevention and preparedness for highly disastrous events in community health. Several emerging phenomena pose prospective threats to public health. However, the largely future-oriented character of problems, for instance, such as antibiotic resistance, the impact of climate change on health, or the bioengineering of pathogens generates difficulties of analysis. What are the ethical and epistemological challenges raised by future public health problems? How should the moral problems of potentially catastrophic future scenarios be addressed? This article argues in favour of adopting anticipatory ethical approaches from public health ethics. First, it will be argued that addressing these future problems requires reflection on the future as an ethical and epistemic problem. Second, the characteristics of the emerging anticipatory ethics in the fields of ethics of technology and bioethics will be clarified. Third, the application of foresight and anticipatory methodologies in public health ethics debates will be defended. Finally, some reflections will be offered to strengthen anticipatory normative analyses to prevent and address in advance the adverse effects of future health crises.