[Cognitive, ethical, social and political aspects in risk assessment: regarding vaccines against SARS-CoV-2]. / Aspectos cognitivos, éticos, sociales y políticos en la evaluación de riesgos: a propósito de las vacunas contra el SARS-CoV-2.

Risk is a concept that is usually evaluated by scientists and public health experts by comparing probabilities. However, this ethical utilitarian perspective, which considers that the best decision is the one that has less probability of harm than of benefit, does not consider normative aspects based on other ethical perspectives. Interpreting the origin of public controversies arising from people's reactions to the small risks of attenuated SARS-CoV-2 vaccines and evaluating the responses of public institutions requires an understanding of both the cognitive aspects that introduce systematic biases in the assessment of probabilities and the sociological, ethical, and political framework that contextualizes risk management in modern societies.

[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

[Family Medicine in the face of the law on medical aid in dying responsibility and guarantees]. / La Medicina de Familia ante la ley sobre la ayuda médica para morir: responsabilidad y garantías.

The approval of the euthanasia law represents a challenge for medicine and culminates a process of civic maturation of society in the face of death. There are challenges that the application of the law will have to meet. Seeking an objective and irreversible medical solution to subjective suffering - where there may be conditioning social determinants - implies a serious risk of inequity that requires policies that establish a pre-decisional guaranteeing framework. Euthanasia should be an exception thanks to the existence of strong clinical, informational and relational safeguards that can only be guaranteed in the context of a solvent primary care that accompanies people throughout their lives. In this primarist and community context, euthanasia can be the last resort of a professional committed to not abandoning a patient with severe and irreversible suffering who requests it.

[Ethical aspects of overdiagnosis: Between the utilitarianism and the ethics of responsibility]. / Aspectos éticos del sobrediagnóstico: entre el utilitarismo y la ética de la responsabilidad.

Overdiagnosis is an emerging and unexpected phenomenon in medicine with multiple causes: social, cognitive and technical. The most prevalent ethical assessment is the utilitarian one: in medicine it is not ethical to carry out any intervention with a negative benefit risk balance. However, there are non-utilitarian moral criteria, based on principles or individual rights, and personal utilities that must also be considered in the decision-making processes. The ethical approach of overdiagnosis has to be carried out from an ethics of responsibility that contemplates principles and consequences assuming that the decisions of managers, clinicians and citizens will introduce different moral perspectives. The solutions go through training and research; have a reliable biomedical knowledge; avoid conflicts of interest, both business and organizational, and improve shared decision-making in the public, clinical and individual spheres.