[Bioethics guide on scarce medical resource allocation in Mexico]. / Guía bioética de asignación de recursos de medicina crítica del Consejo de Salubridad General en México.

The bioethical inquiry about allocating fairly scarce health resources is not new, all countries around the world that were seriously afflicted by SARS-CoV-2 have issued triage guidelines in order to address the dilemmas raised by the pandemic. There is no question about the need to create bioethical guidelines, since its creation provides a degree of certainty that fair and ethical decisions are taken. This also prevents that decisions are made in solitary and maybe motivated by corrupted actions. In Mexico, the creation of this guideline was a proactive and preventive measure to what was unavoidable, the exponential contagion phase of the pandemical scenario caused by Covid-19. On April 30, 2020 the General Sanitary Council published the Bioethical Guide to Allocate Scarce Resources on Critical Care Medicine in Emergency Situation. This guide has at its core that principle of utmost importance in social justice which main thesis is: "All lives have the same value". The aim of this contribution is to provide the ethical and legal principles established in the aforementioned bioethi-cal guideline. In sum, a brief exploration of the ethical reasons that support a specific way to allocate scarce health resources is provided, as well as the foundations of the procedural part from a human rights-based approach.

El tema bioético sobre la asignación de recursos escasos no es nuevo, todos los países que han sido gravemente afectados por el SARS-CoV-2 han tenido que desarrollar y utilizar guías de triaje. Esto resulta más adecuado pues así la asignación de recursos limitados se hace de manera ética y justa, y no de manera discrecional y abierta a la corrupción. En México, en anticipación a la fase exponencial de la pandemia por SARS-CoV-2, el 30 de abril el Consejo de Salubridad General publicó la Guía bioética para asignación de recursos limitados de medicina crítica en situación de emergencia. Dicha guía tiene como base criterios de justicia social y parte de la tesis: todas las vidas tienen el mismo valor. Este texto tiene como objetivo propor-cionar las razones bioéticas y biojurídicas que conforman esta guía de triaje en nuestro país. En resumen, proporciona una breve exploración de las razones éticas que justifican cierta manera específica de asignar recursos escasos en medicina crítica, así como del sustento procedimental apegado a los estándares en materia de derechos humanos.

Allocating medical resources fairly:the CSG bioethics guide.

On April 12, 2020, a bioethics guide for allocating scarce hospital resources during the current Covid-19 pandemic was posted on the website of the Consejo de Salubridad General(CSG) of the Government of Mexico. The guide, entitled Guía bioética para asignación de recursos limitados de medicina crítica en situación de emergencia, was intended as a preliminary document, but the website posting did not describe it as a first step in the process. The publicity resulted in a wide array of comments and criticisms. That first version posted on the CSG website contained an age-based criterion for breaking a tie between two or more medically eligible patients who needed of a ventilator: younger patients would have prefer-ence over older ones. The final version of the guide eliminated that criterion and instead, relied on the leading public health principle, "save the most lives", without regard to personal characteristics other than the possibility of benefitting from the scarce medical resources.

El 12 de abril de 2020, se publicó en el sitio web del Consejo de Salubridad General (CSG) del Gobierno de México una guía de bioética para asignar recursos hospitalarios escasos durante la actual pandemia de Covid-19. La guía titulada Guía bioética para asignación de recursos limitados de medicina crítica en situación de emergencia pretendía ser un documento pre-liminar, pero la publicación en el sitio web no lo describió como un primer paso en el proceso. La publicación resultó en una amplia gama de comentarios y críticas. La primera versión publicada en el sitio web del CSG contenía un cri-terio basado en la edad para romper el empate entre dos o más pacientes médicamente elegibles que necesitaran un ventilador: los pacientes más jóvenes tendrían preferencia sobre los de mayor edad. La versión final de la guía eliminó ese criterio y, en cambio, se basó en el principio principal de salud pública, "salvar la mayoría de las vidas", sin tener en cuenta las características personales que no sean la posibilidad de beneficiarse de los escasos recursos médicos.

Balancing cultural pluralism and universal bioethical standards: a multiple strategy.

If we want to take firm the importance of universal principles in Bioethics, but at the same time we want to take seriously the importance of cultural diversity and pluralism, it is necessary to adopt a multifaceted approach. In the article I argue that a possible way out is a sort of hermeneutic approach, in order to reduce the ambivalence that stems from the dual recognition of cultural diversity and universal value of human rights. Through this approach conflicting principles and traditions can be harmonized within a common framework, at least to some extent. Such an approach, in my perspective, can be implemented as a strategy of interpretation, which can hold together different conceptions and common principles.

Taming Our Brave New World.

Advances in reproductive technology have already revolutionized our culture in various ways, and future potential developments, particularly in genetics, promise more of the same. The practice of surrogacy threatens to upend the way we understand the family. Germline engineering of human embryos could, among other things, lead to the treatment of genetic diseases hitherto incurable; but the widespread use of such engineering could have broader ramifications for our culture, for better and for worse. Parents may eventually be able to select for desirable traits in their offspring, whether by genetic modification at conception or by choosing to implant one of several genetically profiled embryos. Authors in this issue of The Journal of Medicine and Philosophy address some of the ethical implications of these technological and cultural changes.

Ethics, politics and protests: using contentious issues in reproductive sciences as educational opportunities.

Contentious issues and polarized viewpoints can be utilized in the classroom and beyond to create a reflective dialogue among students and citizens. This dialogue leads to both a greater understanding, as well as an enhanced appreciation of alternative viewpoints. Exploring and discussing the scientific, ethical, moral, political, legal and societal aspects of contentious issues of human reproduction provides ideal subject matter for developing critical thinking skills in the field of reproductive science.

[Searching for a social consensus in the establishment of bioethical norms]. / La recherche du consensus social dans l'établissement des normes de bioéthique.

Although France has just acquired a third generation bioethics law, the convention on bioethics that was held in the spring of 2009, as well as all the reports drawn up in France with a view to revising the 2004 bioethics law, raise questions about the process by which bioethics norms are formed. This is a consideration of the formation of the norm and its content. As for the formation of the norm, since the early 1980s, it can be seen that in France there has been a study of the place of the bioethic norm in the hierarchy of positive law. While the legislator's intervention was delayed in 1988 (in particular by the Braibant report), 2008 saw questions about the place of the Constitution in the process. Although the rl61e of the legislator emerged consolidated, at the same time the participation of the citizens by means of the convention is seen to be reinforced. The place of agencies, in particular the bioethics agency created in 2004, also has a great impact on the production of norms. Next, as far as the content is concerned, the debates on biomedical ethics for the last 30 years seem curiously to keep raising the same questions (post-mortem insemination, surrogate motherhood, presumed consent to organ donation...). This recurrence is interesting. Why can't France, or rather the French, manage to answer these questions once and for all? While our neighbours, in particular the United Kingdom and Spain, behave more serenely in this area (eg the giving up of anonymity for donated gametes in the UK), France is perpetually questioning, caught between the need to follow the evolution of our neighbours' norms and maintaining our more conservative position. On this point too the Convention and the life of the biomedicine agency make it possible to take stock of French social values which are growing stronger as the years go by. It is then tempting to draw a parallel with the founding texts of the French republic, and particularly the declaration of human rights in 1789 in order to find the place of man.

Guidelines for genetic counselling for neurological diseases: ethical issues.

Genetic testing are available for a long list of neurodegenerative diseases. The most authoritative scientific and health-care institutions agree that dementia is going to be one of the major problems and most challenging priorities for public health care in upcoming years. Genetic counselling is a complex field. Technically speaking, the term "guideline" has a very specific meaning. Several guidelines for genetic testing for neurology diseases are available. The article summarizes, from an ethical perspective, the main guidelines for genetic counselling in the neurological filed and suggests four main conclusions: 1) guidelines contain a superabundance of indications for genetic counselling for persons who are potentially at risk of developing neurological disorders, but perhaps are lacking with regard to the question of genetic counselling for persons already affected by mental disorders; 2) there is a risk that genetic testing abuses for disorders of neurological complexity will lead to confusion; 3) there is a risk that confusion will derive not only from the overuse of genetic testing, but also from the proliferation of guidelines; 4) codes and guidelines do not eliminate the need for ethical awareness in interpreting them.

[Conflict of interest: the World Medical Association statement]. / Stret zájmu v medicíne: stanovisko Svetové lékarské asociace.

This article presents a translation of the World Medical Association Statement on Conflict of Interest (2009) and Statement concerning the Relationship between Physicians and Commercial Enterprises (2009). The introduction illuminates the objectives of this recommendation in the context of healthcare in the Czech Republic.

ISSCR Guidelines for Stem Cell Research and Clinical Translation: The 2021 update.

The International Society for Stem Cell Research has updated its Guidelines for Stem Cell Research and Clinical Translation in order to address advances in stem cell science and other relevant fields, together with the associated ethical, social, and policy issues that have arisen since the last update in 2016. While growing to encompass the evolving science, clinical applications of stem cells, and the increasingly complex implications of stem cell research for society, the basic principles underlying the Guidelines remain unchanged, and they will continue to serve as the standard for the field and as a resource for scientists, regulators, funders, physicians, and members of the public, including patients. A summary of the key updates and issues is presented here.

Application of the community dialogues method to identify ethical values and priorities related to pharmacogenomics.

Given the expansion of genetics in medicine, there is a growing need to develop approaches to engage patients in understanding how genetics affects their health. Various qualitative methods have been applied to gain a deeper understanding of patient perspectives in topics related to genetics. Community dialogues (CD) are a bi-directional research method that invites community members to discuss a pertinent, challenging topic over the course of a multi-week period and the community members openly discuss their positions on the topic. Authors discuss the first application of the CD method to the topic of pharmacogenetics testing. Additional CD are needed to engage diverse participant populations on this topic to improve genetics literacy, enhance physician engagement and drive policy change.

What Has Covid-19 Exposed in Bioethics? Four Myths.

The Covid-19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake-up call, and bioethics must rise to the challenge.

Bioethics and professionalism in popular television medical dramas.

Television medical dramas sometimes depict medical professionalism and bioethical issues, but their nature and extent are unclear. The authors systematically analysed the bioethical and professionalism content of one season each of Grey's Anatomy and House M.D., two of the most popular current television medical dramas. The results indicate that these programmes are rife with powerful portrayals of bioethical issues and egregious deviations from the norms of professionalism and contain exemplary depictions of professionalism to a much lesser degree.

Ethical models in bioethics: theory and application in organ allocation policies.

Policies for allocating organs to people awaiting a transplant constitute a major ethical challenge. First and foremost, they demand balance between the principles of beneficence and justice, but many other ethically relevant principles are also involved: autonomy, responsibility, equity, efficiency, utility, therapeutic outcome, medical urgency, and so forth. Various organ allocation models can be developed based on the hierarchical importance assigned to a given principle over the others, but none of the principles should be completely disregarded. An ethically acceptable organ allocation policy must therefore be in conformity, to a certain extent, with the requirements of all the principles. Many models for organ allocation can be derived. The utilitarian model aims to maximize benefits, which can be of various types on a social or individual level, such as the number of lives saved, prognosis, and so forth. The prioritarian model favours the neediest or those who suffer most. The egalitarian model privileges equity and justice, suggesting that all people should have an equal opportunity (casual allocation) or priority should be given to those who have been waiting longer. The personalist model focuses on each individual patient, attempting to mesh together all the various aspects affecting the person: therapeutic needs (urgency), fairness, clinical outcomes, respect for persons. In the individualistic model the main element is free choice and the system of opting-in is privileged. Contrary to the individualistic model, the communitarian model identities in the community the fundamental elements for the legitimacy of choices: therefore, the system of opting-out is privileged. This article does not aim at suggesting practical solutions. Rather, it furnishes to decision makers an overview on the possible ethical approach to this matter.

Ethics and Industry Interactions: Impact on Specialty Training, Clinical Practice, and Research.

Physicians in training and their mentors must be cognizant of ethical concerns related to industry interactions. Mentors perceived to have conflicts of interest or to be engaging in misconduct can unconsciously and profoundly affect the learning and academic environment by implying certain values and expectations. Despite increased awareness of ethical concerns related to industry interactions in clinical practice and research, there remains a need for interventions to prevent ethical transgressions. Ethics education is essential and a move in the right direction, but it alone is likely inadequate in preventing unethical behavior. Education should be supplemented with ethical environments at institutions.

Navigating the Intersection between Genomic Research and Clinical Practice.

The Risk Assessment Program (RAP) at Fox Chase Cancer Center (Philadelphia, PA) is a multi-generational prospective cohort, enhanced for personal and family history of cancer, consisting of over 10,000 individuals for whom data on personal and family history of cancer, risk factors, genetic and genomic data, health behaviors, and biospecimens are available. The RAP has a broad research agenda including the characterization of genes with known or potential relevance to cancer, gene-gene and gene-environment interactions, and their contribution to clinically useful risk assessment and risk reduction strategies. Increasingly, this body of research is identifying genetic changes which may have clinical significance for RAP research participants, leading us to confront the issue of whether to return genetic results emerging from research laboratories. This review will describe some of the important fundamental points that must be debated as we develop a paradigm for return of research results. The key issues to address as the scientific community moves toward adopting a policy of return of research results include the best criteria for determining which results to offer, the consent document components necessary to ensure that the participant makes a truly informed decision about receiving their results, and associated logistical and cost challenges.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.