"The Hopkins Mongol Case": The Dawn of the Bioethics Movement.

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.

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.

¿Responde la Resolución 8430 de 1993 a las necesidades actuales de la ética de la investigación en salud con seres humanos en Colombia? / Does Resolution 8430 of 1993 respond to the current needs of ethics in health research with human beings in Colombia?

Resumen La verificación del cumplimiento de los principios éticos en la investigación en salud legitima su ejercicio ante la sociedad y posibilita la resolución de dilemas éticos frente a nuevos intereses y métodos de investigación. En Colombia, la Resolución 8430 de 1993 es una de las principales pautas éticas que regulan la investigación en salud. Dado que no ha sido revisada ni actualizada desde su adopción, se hace necesario valorar su vigencia y suficiencia para abordar los potenciales dilemas éticos que se plantean actualmente en la investigación en salud en el país. En este contexto, se detallan algunos vacíos y contradicciones, así como aspectos que requieren de una revisión profunda, a partir de una concepción amplia de las áreas y los métodos de investigación en salud. Tras discutir las principales falencias e imprecisiones, se proponen alternativas para que la Resolución responda a las necesidades actuales del país frente a la ética en investigación en salud con seres humanos.

Abstract Verifying the compliance with the ethical principles of health research legitimizes its exercise in the eyes of the society and allows for the resolution of ethical dilemmas that emerge from new research interests and methods. Resolution 8430 of 1993 is one of the main ethical guidelines governing health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation it becomes necessary to evaluate its current validity and adequacy to address the potential ethical dilemmas in the existing country's health research. Some gaps, contradictions, and aspects that require a deep review are detailed in this paper from a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternatives are proposed to adjust the resolution to the present needs in health research with human beings.

[Bioethical issues on the access to drugs in the practice of ophthalmology in Colombia]. / Cuestiones bioéticas relacionadas con el acceso a medicamentos en el ejercicio de la oftalmología en Colombia.

Ophthalmology is a high-cost specialty in terms of medical, surgical and technological innovation and treatment. It is worrisome that in some countries patients are affected in their visual health, and therefore in their quality of life because they do not have the necessary resources for timely access to medications, medical appointments or surgical procedures. We searched in four electronic databases (ScienceDirect, MEDLINE/PubMed, ClinicalKey and SciELO), as well as in books on bioethics and Colombian laws, for articles related to bioethical issues and access to medicines in the exercise of ophthalmology. We reflect on the problem of access to ophthalmological drugs, with particular interest on how to apply the principles of bioethics on the clinical practice of patients with ophthalmological conditions. Ethical considerations are approached from the principles of Beauchamp and Childress, especially regarding the principle of justice, in order to provide health professionals in this field with arguments for medical and ethical decisions that benefit the healthcare and access to medicines for patients with ophthalmological conditions.

La oftalmología se constituye como una especialidad de alto costo en lo que respecta a tratamiento médico, quirúrgico y de innovación tecnológica. Es preocupante que en algunos países los pacientes se vean afectados en su salud visual, y por ende en su calidad de vida, por no contar con los recursos necesarios para un acceso oportuno a medicamentos, citas médicas o procedimientos quirúrgicos. A partir de la búsqueda de artículos relacionados con cuestiones bioéticas y el acceso a medicamentos en el ejercicio de la oftalmología en cuatro bases de datos electrónicas (ScienceDirect, MEDLINE/PubMed, ClinicalKey y SciELO ), así como en libros de bioética y leyes de la jurisdicción colombiana, realizamos una reflexión sobre el problema del acceso a los medicamentos oftalmológicos, centrándonos en el interés por la aplicación de la bioética en la práctica clínica y en el acceso a medicamentos de los pacientes con patologías oftalmológicas. Las consideraciones éticas se abordan desde una mirada del modelo principialista de Beauchamp y Childress, en especial considerando el principio de justicia, de modo que brinde a los profesionales de la salud en este campo, argumentos para la toma de decisiones médicas y éticas que beneficien la atención y el acceso a medicamentos de los pacientes con patologías oftalmológicas.

Cuestiones bioéticas relacionadas con el acceso a medicamentos en el ejercicio de la oftalmología en Colombia / Bioethical issues on the access to drugs in the practice of ophthalmology in Colombia

Resumen La oftalmología se constituye como una especialidad de alto costo en lo que respecta a tratamiento médico, quirúrgico y de innovación tecnológica. Es preocupante que en algunos países los pacientes se vean afectados en su salud visual, y por ende en su calidad de vida, por no contar con los recursos necesarios para un acceso oportuno a medicamentos, citas médicas o procedimientos quirúrgicos. A partir de la búsqueda de artículos relacionados con cuestiones bioéticas y el acceso a medicamentos en el ejercicio de la oftalmología en cuatro bases de datos electrónicas (ScienceDirect, MEDLINE/PubMed, ClinicalKey y SciELO ), así como en libros de bioética y leyes de la jurisdicción colombiana, realizamos una reflexión sobre el problema del acceso a los medicamentos oftalmológicos, centrándonos en el interés por la aplicación de la bioética en la práctica clínica y en el acceso a medicamentos de los pacientes con patologías oftalmológicas. Las consideraciones éticas se abordan desde una mirada del modelo principialista de Beauchamp y Childress, en especial considerando el principio de justicia, de modo que brinde a los profesionales de la salud en este campo, argumentos para la toma de decisiones médicas y éticas que beneficien la atención y el acceso a medicamentos de los pacientes con patologías oftalmológicas.

Abstract Ophthalmology is a high-cost specialty in terms of medical, surgical and technological innovation and treatment. It is worrisome that in some countries patients are affected in their visual health, and therefore in their quality of life because they do not have the necessary resources for timely access to medications, medical appointments or surgical procedures. We searched in four electronic databases (ScienceDirect, MEDLINE/PubMed, ClinicalKey and SciELO), as well as in books on bioethics and Colombian laws, for articles related to bioethical issues and access to medicines in the exercise of ophthalmology. We reflect on the problem of access to ophthalmological drugs, with particular interest on how to apply the principles of bioethics on the clinical practice of patients with ophthalmological conditions. Ethical considerations are approached from the principles of Beauchamp and Childress, especially regarding the principle of justice, in order to provide health professionals in this field with arguments for medical and ethical decisions that benefit the healthcare and access to medicines for patients with ophthalmological conditions.

Doação de gametas: questões sociais e éticas (não) respondidas em Portugal / Gamete donation: (un)answered social and ethical issues in Portugal / Donación de gametos: cuestiones sociales y éticas (no) respondidas en Portugal

Resumo: Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos.

Abstract: Awareness of the discussion surrounding the social and ethical challenges regarding gamete donation is crucial for good governance of assisted reproduction techniques. In this article, we analyze the topics that guided the debate in the Portuguese ethics organizations, discussing their connections with themes addressed internationally. To that end, in March 2018, we systematically searched the websites of the National Council of Medically Assisted Procreation and of the National Ethics Council for Life Sciences. We carried out a thematic content analysis of 25 documents. Results indicate that the debate was focused on accessibility, anonymity and donors' compensation and, to a lesser extent, on professional responsibilities. We observed heterogeneous positions and tensions between multiple rights and ethical principles associated with recipients, donor-conceived individuals and donors. These invoke three similar arguments: the scarcity of scientific evidence; experiences from other countries; and regulations from in international entities. Literature addressed additional topics, namely: a double track that combines donor anonymity/identification; the implementation of reproduction registries for recipients and donors; limits to the genetic screening of donors; donations by family members/acquaintances; and donors' role in decisions regarding the fate of cryopreserved embryos and in choosing the characteristics of recipients of their gametes. There is room to expand the debate and to promote research on the social and ethical implications of gamete donation, considering the participation of all citizens.

Resumen: Conocer la discusión en torno a los desafíos sociales y éticos de la donación de gametos es fundamental para el buen gobierno de las técnicas de reproducción asistida. En este artículo se analizan los temas que orientaron el debate en las organizaciones de ética portuguesas, discutiendo sus conexiones con los temas abordados internacionalmente. Para este fin, en marzo de 2018, investigamos sistemáticamente las páginas webs del Conselho Nacional de Procriação Medicamente Assistida y del Conselho Nacional de Ética para as Ciências da Vida. Asimismo, procedimos al análisis de contenido temático de 25 documentos. Los resultados indican que el debate se centró en la accesibilidad, anonimato y compensación de donadores y, en menor extensión, en las responsabilidades profesionales. Se observaron posicionamientos heterogéneos y tensiones entre múltiples derechos y principios éticos, asociados a receptores, a personas nacidas gracias a la donación de gametos y a donadores. Estos tienen en común tres alegaciones: la escasez de evidencias científicas; las experiencias de otros países; y las regulaciones procedentes de entidades internacionales. En el literatura se abordan temas adicionales, en particular: una vía doble que conjugue anonimato/identificación de donadores; implementación de sistemas de registro reproductivo para receptores y donadores; límites del rastreo genético a donadores; donación por familiares/conocidos; y el papel de los donadores en la decisión respecto al destino de embriones criopreservados y en la elección de las características de los receptores de sus gametos. Existe espacio para abrir más el debate y promover la investigación en torno de las implicaciones sociales y éticas de la donación de gametos, considerando la participación de todos los ciudadanos.

Threats to bioethical principles in medical practice in Brazil: new medical ethics code period

We aimed to outline the profile of medical professionals in Brazil who have violated the deontological norms set forth in the ethics code of the profession, and whose cases were judged by the higher tribunal for medical ethics between 2010 and 2016. This survey was conducted using a database formed from professional ethics cases extracted from the plenary of the medical ethics tribunal of the Federal Council of Medicine. These were disciplinary ethics cases that were judged at appeal level between 2010 and 2016. Most of these professionals were male (88.5%) and their mean age was 59.9 years (SD=11.62) on the date of judgment of their appeals, ranging from 28 to 95 years. Most of them were based in the southeastern region of Brazil (50.89%). Articles 1 and 18 of the medical ethics code were the rules most frequently violated. The sentence given most often was the cancellation of their professional license (37.6%) and the acts most often sentenced involved malpractice, imprudence, and negligence (18.49%). It is acknowledged that concern for the principles of bioethics was present in the appeal decisions made by the plenary of the medical ethics tribunal of the Federal Council of Medicine.

Testemunhas de Jeová e hemotransfusão: revisão integrativa sobre a abordagem do enfermeiro / Jehovah's Witnesses and blood transfusion: integrative review of the nurse approach

O objetivo do estudo foi descrever a abordagem do enfermeiro frente à recusa de hemotransfusão por parte do paciente Testemunha de Jeová, contemplando os aspectos assistenciais, éticos e religiosos. Trata-se de uma revisão integrativa, retrospectiva, exploratória, utilizando as bases de dados SCIELO, BDENF e LlLACS, o corte epistemológico foi de 2010 a 2015, a amostra final constituiu-se de 17 artigos. Os dados analisados foram divididos em 4 categorias: Religião (82,35%), Métodos Alternativos (58,82%), Equipe médica (52,63%) e Enfermagem/Parecer Técnico (11,76%). Conclui-se que a assistência deve advir da ponderação de cada hipótese, ao enfermeiro cabe atuar pautando nos princípios bioéticos, visando a melhor solução para ambas as partes.

The main objective of this study was to describe the approach nurse in the refusal of blood transfusion by the patient Witness, considering the welfare, ethical and religious. This is an integrative review, using the data bases SCIELO, BDENF and LlLACS, the epistemological break was 2010 to 2015, the final sample consisted of 17 articles. The paper were divided into 4 categories: Religion (82.35%), Alternative Methods (58.82%), medical staff (52.63%) and Nursing /Technical Opinion (1176%). We conclude that the assistance should come from the weight of each case, it is up to the nurse to act basing on bioethical principies to the best solution for both the parties. (AU)

El objetivo dei estudio consistió en describir el abordaje dei enfermero frente ai rechazo de la transfusión de sangre por parte dei paciente Testigo de Jehová, contemplando los aspectos asistenciales, éticos y religiosos. Se trata de una revisión integradora, utilizando las bases de datos SCIELO, BDENF Y LlLACS, el corte epistemológico fue dei 2010 ai 2015, Ia muestra final está compuesta por 17 artículos. Los datos analizados se dividieron en 4 categorías: Religión (82,35%), Métodos Alternativos (58,82%), Equipo Médico (52,63%) y Enfermería/Parecer Técnico (11,76%). Se llegó a la conclusión de que la asistencia debe provenir de la ponderación de cada hipótesis, ai enfermero le cabe actuar tomando como referencia las pautas de los principios bioéticos, con el objetivo de encontrar la mejor solución para ambas partes.

[Assisted reproductive techniques in single women: Which proposals for which demands?]. / Assistance médicale à la procréation chez la femme célibataire : quelles propositions pour quelles demandes ?

The French bio-ethic law concerning ART is more restricted than in other countries. Techniques can only be applied in heterosexual couples presenting a documented infertility. Nevertheless, concerns about fertility planning are numerous in young women, leading to a growing demand of reproductive medicine consultations. Two situations can be distinguished: firstly, single patients wishing sperm donation and, secondly, single patients who wish to preserve their fertility for future parenting project. This latter situation can be discussed in the French legislative context while the other will require soliciting the neighboring European teams.

Sedación agónica en niños: ¿es moralmente ética?

La sedación en la agonía (S.A) resulta una práctica profesional aplicable a todos aquellos enfermos que en pocos días u horas irremediablemente transitan el camino hacia la muerte y que por otro lado, presentan síntomas molestos e incontrolables de diverso orden, tales como dolor insoportable, disnea severa, desasosiego o hemorragias. Su aplicabilidad está demostrada y avalada por asociaciones de cuidados paliativos del orden nacional e internacional y su alcance llega a todos los individuos con enfermedades crónicas, progresivas, incurables y en fase terminal, de todas las edades, en quienes los intentos por aliviar síntomas molestos no ha cumplido su cometido, habiendo llevado de modo previo medidas habituales o progresivas para el control de las manifestaciones desagradables, que producen disconfort e indignidad a la hora de morir. En base a los principios extraídos de la deontología médica y de la bioética, que regulan las praxis profesionales, la S.A ha de aplicarse siempre sobre las bases de la refractariedad del síntoma, la definición inequívoca de terminalidad de la enfermedad, sustentándose en sólidas bases de la relación médico paciente, respetando a ultranza el consentimiento informado y apoyándose por fin en el acabado conocimiento de farmacocinética y dinámica de los medicamentos empleados durante su aplicación. Existen controversias y sensaciones desencontradas en la sociedad respecto de la superposición de la técnica de S.A, con formas de eutanasia (pasiva- activa-slow eutanasia), sin embargo la práctica bien entendida y argumentada da por resultado una sensación de “buen morir” y de respeto por la dignidad del ser sufriente. Toda vez que el paciente agónico, en ejercicio de su autonomía lo requiera, la técnica puede y debe ser aplicada

ABSTRACT: The sedation in the agony (S.A) turns out to be a professional practice applicable to all those patients that in a few days or hours irremediably travel the way towards the death and that on the other hand, they present troublesome and uncontrollable symptoms, of diverse order such as unbearable pain, severe difficulty in breathing, uneasiness or hemorrhages. His applicability is demonstrated and supported by associations of taken care palliative of national and international order and his scope comes to all the individuals with chronic, progressive, incurable diseases and in terminal phase, of all the ages, in whom the attempts for relieving troublesome symptoms it has not fulfilled his assignment having led to forward the habitual or progressive measures for the control of the disagreeable manifestations, which produce Indignity at the moment of dying.On the basis of the principles extracted from the medical business ethics and from the bioética, which regulate the professional practices, the S.A it has to be applied always on the bases of the refractariedad of the symptom, the unequivocal definition of terminalidad of the disease, being sustained in solid bases of the relation medical patient, respecting extreme the informed assent and resting finally on the finished knowledge of farmacocinética and dynamics of the medicines used during his application

La identidad interrogada a partir de la reprogenética, en la tensión del discurso jurídico y el discurso del psicoanálisis / The identity interrogated from the reprogenetic, in the tension of the juridical discourse and the discourse of the psychoanalysis

El campo de la identidad se ve interpelado por determinados sucesos, tanto aquellos ligados a hechos sociales y políticos, como así también a los avances tecnológicos, de tal modo que cada vez es necesario pensar su estatuto. En esta ocasión, como uno de los temas de interés en el proyecto de investigación: “Ética y Derechos Humanos: Su Articulación en la Declaración Universal (Unesco 2005) Frente a los Nuevos Dilemas de la Practica Profesional (II Parte)”, se abordarán los interrogantes éticos surgidos en relación a la reprogenética. La construcción de los problemas interrogados se plantean desde el debate abierto en el campo del derecho expresado en el Anteproyecto de reforma al Código Civil y Comercial de la República Argentina, a la luz de la bioética/biopolítica y los aportes del psicoanálisis para pensar la subjetividad...

The field of the identity is questioned by certain events, such as those tied to social and political facts, as well as those related to the technological advances, in such a way that every time it is necessary to think its statute. In this occasion, as one of the topics of interest in the research project: "Ethics and Human rights: Its articulation in the Universal Declaration (Unesco 2005) opposite to the New Dilemmas of the Professional Practice (Part II)", the ethical questions arisen in relation to the reprogenetic will be approached. The formulation of the examined questions is proposed from an opened discussion in the field of Law expressed in the Preliminary design of reform of the Civil and Commercial Code of the Republic of Argentina, in light of the bioethics/biopolitics and the contributions of the psychoanalysis to think the subjectivity

La mirada legal: el estatuto del embrión no implantado / The legal look: the status of the embryo not implemented

En este artículo se analiza la doctrina nacional de la República Argentina en relación al Proyecto de Código Civil y Comercial de la Nación, en particular en relación con la naturaleza jurídica del embrión no implantado y, consecuentemente, la regulación de la filiación que tiene por origen la reproducción humana asistida. Desde que, en 2012, la Corte Interamericana de Derechos Humanos ha indicado que la existencia de la persona humana comienza con la implantación del embrión y, por ende, el embrión no implantado no es persona humana, los Estados que han ratificado la Convención Americana de Derechos Humanos deben seguir estos lineamientos. Por otra parte, se suma al análisis la articulación con la accesibilidad a las tecnologías de reproducción humana asistida, ya que el ordenamiento jurídico debe respetar la libertad reproductiva de todas las personas, las que están a favor o en contra de la FIV; y quienes tengan un posicionamiento contrario a estas prácticas, tienen la libertad de no realizarlas

This article analyzes the national doctrine of the Argentine Republic in relation to the National Civic and Commercial Code Project, particularly with regard to the legal nature of the non-implanted embryo, and consequently the affiliation act which is the result of assisted human reproduction. Since 2012, when the Inter-American Court of Human Rights determined that the existence of a human being starts with the implantation of the embryo, the non-implanted embryo is therefore not a human person; the countries that have ratified the American Convention of Human Rights must follow these guidelines. Also included in the analysis, is the articulation with access to assisted human reproduction technologies, as the legal system must respect the reproductive freedom of all persons, whether or not they are in favor of IVF; and those whose positions are contrary to these practices, have the freedom to abstain

Posiciones ético-políticas en torno a la filiación por TRHA. Una perspectiva desde el campo lacaniano / Ethical-political positions regarding filiation from AHRT. A perspective from the Lacanian Field

En el marco de las nuevas constelaciones familiares, y con la reforma del Código Civil y Comercial de la Nación, está llegando a destino en nuestro país la regulación jurídica del uso de las Técnicas de Reproducción Humana Asistida (TRHA) como fuente de filiación, estableciéndose así una política al respecto. De entre los múltiples debates abiertos sobre los diferentes aspectos que el uso de las técnicas contemplan, el presente artículo se ocupa de uno de los tópicos clave en la nueva legislación: el manejo de la información sobre los aportantes de material genético. Nos interesa particularmente caracterizar los diversos enfoques ético-políticos que se han presentado en los debates sobre el tema, proponiendo una posición sostenida en el campo lacaniano.

Teaching medical ethics and law.

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.

A 5-year review of ethics complaints to the American Society of Plastic Surgeons.

BACKGROUND: The Code of Ethics of the American Society of Plastic Surgeons (ASPS) exists to encourage and enforce ethical behavior among its members. Complaints against individual members may be filed by patients or their representatives, members of the Society, or other members of the public. METHODS: Data from a total of 677 complaints from 2004 to 2008 were reviewed by the author. These complaints were categorized with regard to geographic area, type of complaint, and the outcome of the investigation of the complaint, including disciplinary actions. The system of managing these complaints within the Society is discussed. RESULTS: States with the most complaints filed included California, Florida, Texas, Illinois, and New York, with all others having a minimal number. The most common complaint was filed regarding unethical advertising, followed by unprofessional conduct and participation in a contest. Differences in frequency of complaints were statistically significant (Fisher's exact test, p < 0.001). Fifty-four cases were heard by the Judicial Council, with 31 receiving discipline, primarily the less severe types of censure. The total number of complaints per year seems to be trending downward. CONCLUSIONS: Ethical complaints (filed mostly by ASPS members) vary in frequency according to geographic area and the type of complaint. A downward trend was noted in the total number of complaints over the years 2004 to 2008, although this was not statistically significant. Given the basic purposes of the development of a code of ethics and its subsequent enforcement, the ethical construct within the ASPS seems to serve the specialty well.

El derecho a la calidad de vida y la dignidad de los pacientes terminales / The right to quality of life and dignity of terminally ill patients

Nuestra tesis recae sobre "El Derecho a la Calidad de Vida y la Dignidad de los Enfermos Terminales" desde la bioética de los Derechos Humanos. Esta temática reviste significativa actualidad en el horizonte jurídico y bioético nacional e internacional. Su especial complejidad, impide pueda ser abordado si no es desde una óptica multidimensional enriquecido por el aporte de la interdisciplina.