Ernest Everett Just (1883-1941): Hero in Cell Biology and Evolutionary Bioethics.

Ernest Everett Just is celebrated for his contributions to cell biology. Among other firsts, he was first to describe the "wave of negativity" spreading around an egg cell from the entrance point of the fertilizing spermatozoon. His accomplishments in biology are celebrated in Black Apollo of Science (1983) by Kenneth Manning, and by a 1996 Black Heritage postage stamp. What is not yet widely appreciated, however, is that Just connected evolutionary biology to ethical behavior (1933, 1939, 1940). He was probably the first cell biologist to argue that human ethical behavior evolved from our very most primitive cellular origins. Today, Just's contributions to evolutionary bioethics, including "the law of environmental dependence," can be better appreciated because his unpublished booklength manuscript, "The Origin of Man's Ethical Behavior" has been preserved at Howard University's Moorland-Spingarn Research Center.

The Belmont Report and Innovative Practice.

One of the Belmont Report's most important contributions was the clear and serviceable distinction it drew between standard medical practice and biomedical research. A less well-known achievement of the Report was its conceptualization of innovative practice, a type of medical practice that is often mistaken for research because it is new, untested, or experimental. Although the discussion of innovative practice in Belmont is brief and somewhat cryptic, this does not reflect the significant progress its authors made in understanding innovative practice and the distinctive ethical issues it raises. This article explores the history and broader context of Belmont's conception of innovative practice, its strengths and weaknesses, and its contemporary relevance for scholars working in bioethics and health policy. While this conception of innovative practice deserves our attention, it is inherently limited in some important ways.

Why the history of nursing ethics matters.

Modern American nursing has an extensive ethical heritage literature that extends from the 1870s to 1965 when the American Nurses Association issued a policy paper that called for moving nursing education out of hospital diploma programs and into colleges and universities. One consequence of this move was the dispersion of nursing libraries and the loss of nursing ethics textbooks, as they were largely not brought over into the college libraries. In addition to approximately 100 nursing ethics textbooks, the nursing ethics heritage literature also includes hundreds of journal articles that are often made less accessible in modern databases that concentrate on the past 20 or 30 years. A second consequence of nursing's movement into colleges and universities is that ethics was no longer taught by nursing faculty, but becomes separated and placed as a discrete ethics (later bioethics) course in departments of philosophy or theology. These courses were medically identified and rarely incorporated authentic nursing content. This shift in nursing education occurs contemporaneously with the rise of the field of bioethics. Bioethics is rapidly embraced by nursing, and as it develops within nursing, it fails to incorporate the rich ethical heritage, history, and literature of nursing prior to the development of the field of bioethics. This creates a radical disjunction in nursing's ethics; a failure to more adequately explore the moral identity of nursing; the development of an ethics with a lack of fit with nursing's ethical history, literature, and theory; a neglect of nursing's ideal of service; a diminution of the scope and richness of nursing ethics as social ethics; and a loss of nursing ethical heritage of social justice activism and education. We must reclaim nursing's rich and capacious ethics heritage literature; the history of nursing ethics matters profoundly.

Da ética ambiental à bioética ambiental: antecedentes, trajetórias e perspectivas / From environmental ethics to environmental bioethics: antecedents, trajectories, and perspectives

Resumo A relação entre humano e ambiente torna-se problema ético no século XX, quando a aceleração do desenvolvimento econômico e científico acompanhou profundas alterações nos sistemas ecológicos globais. A ética ambiental reivindicou limites na relação dicotômica homem/natureza. Em 1970, Van Potter propôs a bioética como espaço interdisciplinar para o estudo da “sobrevivência humana”. Nos anos seguintes, a disciplina restringiu-se a conflitos clínicos e hospitalares, afastando-se das questões da ética ambiental. Este artigo analisa o conceito de “bioética ambiental” como perspectiva teórica que acompanha um processo de resgate histórico da abordagem de Van Potter da bioética, caracterizado pela perspectiva das dimensões interpessoais, socioeconômicas e políticas dos dilemas éticos ambientais.

Abstract The relationship between humans and the environment became an ethical problem in the twentieth century, when accelerated economic and scientific development was accompanied by profound alterations in global ecological systems. In response, environmental ethics called for limits in the dichotomous relationship between man and nature. In 1970, Van Potter proposed bioethics as the interdisciplinary study of “human survival.” Subsequently, the discipline focused on clinical and hospital conflicts. Environmental bioethics is analyzed in this article as a theoretical perspective that has historically drawn on Van Potter’s approach to bioethics, marked by the interpersonal, socioeconomic, and political dimensions of environmental ethical dilemmas.

Críticas ao principialismo em bioética: perspectivas desde o norte e desde o sul / Criticisms of principlism in bioethics: perspective from the north and from the south

A corrente de pensamento denominada principialismo teve caráter hegemônico no desenvolvimento da bioética desde a publicação do livro Principles of biomedical ethics em 1979. Essa hegemonia se fragilizou com os primeiros estudos críticos realizados por autores norte-americanos e europeus no início dos anos 1990. Logo após, bioeticistas latino-americanos também produziram críticas ao caráter hegemônico e pretensamente universal dessa teoria principialista. Inspirada nos referenciais da colonialidade descritos por Aníbal Quijano, o presente estudo procura sistematizar essas críticas em dois grupos: aquelas vindas de autores do Hemisfério Norte e aquelas provenientes de autores do Hemisfério Sul. As críticas vindas do Norte analisaram conceitualmente o principialismo, explorando seus aspectos filosóficos e sua validade como teoria. Aquelas vindas do Sul, por sua vez, focalizaram a crítica na aplicação dos princípios à realidade concreta de desigualdade existente entre países centrais e periféricos, mostrando como esse discurso pretensamente universal contribui para a manutenção das assimetrias verificadas entre países ricos e pobres. Os estudos sobre a colonialidade contribuem para a análise desse contexto na medida em que desvelam o interesse dos países centrais em monopolizar as formas de controle da subjetividade, da cultura e da produção de conhecimento do mundo ocidental.

The principlism had a hegemonic character in the development of the bioethics since the publication of the book Principles of biomedical ethics, of Beauchamp and Childress, in 1979. This hegemony began to weaken with the first critical studies by authors from the United States and Europe in the 1990s. Immediately, however, bioethicists of Latin America also began to criticize the hegemonic and allegedly universal principlism. This article aims to systematize the criticisms of principlism and drawing on references of coloniality, described by Aníbal Quijano, present two distinct groups of critics: those who make their criticisms from the North and those who make them from the South. The northern group conceptually analyzes the principialism exploring the philosophical aspects and checking its validity as a moral theory. The southern group emphasizes that the application of principialism in poor countries intensifies inequality since this theory ignores the ethical nature of social problems. The prospect of coloniality is useful when shows how Northern countries monopolize the forms of control of subjectivity, culture and knowledge production in the Western world.

Child Rights and Clinical Bioethics: Historical Reflections on Modern Medicine and Ethics.

Why might pediatric bioethicists in the United States reject the U.N. Convention on the Rights of the Child (CRC) as a framework for resolving ethical issues? The essays in this issue present arguments and counterarguments regarding the usefulness of the CRC in various clinical and research cases. But underlying this debate are two historical factors that help explain the seeming paradox of pediatric bioethicists' arguing against child's rights. First, the profession of clinical bioethics emerged in the 1970s as one component of modern medicine's focus on improving health through the application of technologically sophisticated treatments. The everyday work of U.S. bioethicists thus usually involves emerging technologies or practices in clinical or laboratory settings; the articles of the CRC, in contrast, seem better suited to addressing broad policy issues that affect the social determinants of health. Second, U.S. child health policy veered away from a more communitarian approach in the early 20th century for reasons of demography that were reinforced by ideology and concerns about immigration. The divide between clinical medicine and public health in the United States, as well as the relatively meager social safety net, are not based on a failure to recognize the rights of children. Indeed, there is some historical evidence to suggest that "rights language" has hindered progress on child health and well-being in the United States. In today's political climate, efforts to ensure that governments pledge to treat children in accordance with their status as human beings (a child right's perspective) are less likely to improve child health than robust advocacy on behalf of children's unique needs, especially as novel models of health-care financing emerge.

Edmund Pellegrino and the art of civilized dialectics.

I had the good fortune to work with Edmund Pellegrino from 2005 until 2009, while he was chairman and I was a member of the President's Council on Bioethics. We came from different disciplines--medicine and law--and from different generations. Until that point, our paths had rarely crossed. I am so glad that I finally did have an opportunity to get to know him. Pellegrino contributed a great deal to the council during his time as chairman. I cannot begin to cover all that he brought to the council during his four years of leadership. In this essay, I describe how his views of both public bioethics and clinical ethics shaped his council participation.

As interfaces entre a bioética e a saúde coletiva nas publicações brasileiras indexadas / The interfaces between bioethics and collective health in indexed Brazilian publications

Os processos de desenvolvimento da bioética e da saúde coletiva brasileira percorreram caminhos paralelos, que, em determinado momento, passaram a se relacionar, por meio da aproximação de temas comuns, como a questão da equidade do direito à saúde. Os fundamentos éticos de prática de saúde pública sempre foram implicitamente assumidos por ambos os membros da profissão e pelo público em geral. No entanto, até recentemente, os valores básicos que fundamentam decisões de saúde pública e os conflitos inerentes à sua prática raramente foram articulados. O objetivo principal dessa dissertação foi identificar as temáticas, funções e práticas da Saúde Coletiva privilegiados pelos artigos que articulam bioética e saúde Pública/Coletiva publicados em revistas nacionais indexadas, bem como os referenciais teóricos, os conflitos éticos identificados e os posicionamentos morais e ideológicos dos autores. A investigação contou com a aplicação concomitante de dois métodos: uma revisão estruturada com síntese temática, proposta por Thomas e Harden e uma análise de conteúdo no modelo proposto por Bardin. Foram selecionados, 85 artigos, de 22 periódicos diferentes entre os anos de 1996 a 2013. Foram identificados os seguintes temas: Discussão da interface entre bioética e saúde pública/ coletiva; gestão e organização dos serviços de saúde; políticas públicas de saúde e vulnerabilidades específicas; inovação e incorporação tecnológica; cooperação internacional em saúde; Bioética na formação de Recursos Humanos; saúde e meio ambiente; com subtemas correspondentes. Foi verificada ausência significativa de artigos que discutam questões morais em torno de uso de drogas no contexto da saúde coletiva; ausência também de artigos que se dirigissem à política de saúde para a população negra ou discutisse, no âmbito da saúde coletiva, o racismo social e institucional ou a acessibilidade e a qualidade de serviços ofertados a esta população, bem como ausência de artigos relativos à saúde do trabalhador. Observou-se também uma gama de fundamentações teóricas envolvendo, predominantemente, a bioética principialista, as bioéticas Latino-Americanas, de intervenção e proteção, bem como a teoria das capacidades e a teoria da justiça

The developmental process of bioethics and Brazilian public health coursed parallel paths, which at one point, began to relate, through the approximation of common themes, such as the fairness of the right to health. The ethical foundations of the practice of public health have always been implicitly assumed by both members of the profession and the general public. However, until recently, the basic values that underlie public health decisions and conflicts inherent in their practice were rarely articulated. The main objective of this dissertation was to identify the themes, functions and practices of Public Health privileged by articles that articulate Bioethics and Public/collective Health published in indexed national journals, as well as the theoretical framework, the identified ethical conflicts and moral and ideological positions of authors. The investigation involved the simultaneous application of two methods: a structured review with thematic synthesis, proposed by Thomas and Harden and a content analysis of the model proposed by Bardin. There were selected 85 articles in 22 different journals between the years 1996 to 2013. The following themes were identified: Discussion of the interface between bioethics and public/collective health; management and organization of health services; public health policies and specific vulnerabilities; innovation and technological developments; international cooperation in health; bioethics in training of human resources, health and environment, with corresponding subthemes. It was verified absence of significant articles that discuss moral issues around drug use in the context of public health, absence also of articles that were directed to health policy for the black or discuss in the context of public health, population and social racism institutional or accessibility and quality of services offered to this population as well as the absence of articles related to worker health. It was also observed a range of theoretical predictions involving predominantly principlism bioethics, bioethical Latin American, intervention and protection, as well as the theory of capacity and the theory of justice

Cooperação Sul-Sul na área da saúde: dimensões bioéticas / South-South cooperation in the health area: bioethical dimensions

Introdução: apresenta considerações sobre a saúde mundial, mencionando o paradoxal contraste entre a evolução das condições de vida da maioria das populações vis-à-vis o avanço científico, tecnológico e econômico global, bem como a intensificação da cooperação internacional ante essa situação; focaliza a reconfiguração da bipolaridade Leste-Oeste e Norte-Sul e o fortalecimento das relações Sul-Sul no contexto intergovernamental das Nações Unidas; destaca a relevância da bioética ante esses processos na área da saúde e ressalta o potencial dessa contribuição, a partir dos enfoques da bioética da intervenção e seus vínculos com a saúde coletiva na experiência brasileira. Objetivo: visa desenvolver uma reflexão crítica sobre as dimensões bioéticas dos processos de cooperação técnica entre países em saúde, levando em conta o contexto evolucional das relações entre os Estados nacionais (diplomacia). Metodologia: inclui cinco etapas realizadas sinergicamente ­ (1) revisão da produção científica catalogada em duas fontes bibliográficas representativas da literatura mundial sobre ciências da saúde (BVS/BIREME e PubMed), em torno da conjectura sobre um novo campo de conhecimento na confluência da bioética com a diplomacia em saúde; (2) análise histórica sobre a inserção da saúde no contexto das relações internacionais e do surgimento da alternativa Sul-Sul de governança dessas relações; (3) meditação sobre a perspectiva bioética da cooperação internacional em saúde orientado pelas seguintes questões: (i) autonomia versus dependência dos processos de cooperação, (i) disparidades dos sistemas nacionais de ciência, tecnologia e inovação e (iii) mediação das agências intergovernamentais; (4) análise da cooperação Sul-Sul desenvolvida no contexto da CPLP entre o Brasil, via FIOCRUZ, e os ministérios da saúde dos PALOP, como ilustrativa das dimensões bioéticas presentes no entrelaçar dos interesses diplomáticos com a doutrina da cooperação homologada pelas Nações Unidas; e (5) apreciação sobre a criação do Núcleo de Estudos sobre Bioética e Diplomacia em Saúde, como contribuição interinstitucional e interdisciplinar para a interação dessas áreas de conhecimento e prática profissional. Resultados: ressalta a escassez de registros na literatura científica sobre o enfoque interdisciplinar entre saúde, diplomacia e bioética; aponta a pertinência e a relevância da bioética ante processos de cooperação internacional para o desenvolvimento; enfatiza sua aplicação na área da saúde a partir de três referenciais: (i) as condicionalidades das relações diplomáticas versus o altruísmo da cooperação setorial em saúde; (ii) as diferenças de poder econômico e técnicocientífico como razão para a cooperação e, simultaneamente, como fonte potencial de conflitos entre os países em diferentes estágios de desenvolvimento; (iii) as possibilidades e limitações de mediação dos organismos intergovernamentais. Conclusão: sistematiza análises, reflexões e indícios que fortalecem a convicção sobre a intersecção dos campos da bioética, da diplomacia e da saúde, tanto no plano da interdisciplinaridade do conhecimento como das práticas institucionais de governança mundial da cooperação entre países, e que esse enfoque é fundamental para a consolidação da saúde como direito humano fundamental; também aponta alternativas de investigação para a consolidação da confluência temática e das práticas profissionais entre os referidos campos.

Objective: to develop a critical reflection on bioethical dimensions of the processes of technical cooperation among countries in the field of health, taking into account the evolutional context of the relationships among national States (diplomacy). Methodology: includes five stages synergistically done - (1) a review of scientific production catalogued in two representative bibliographic sources of the world literature on health sciences (BVS/BIREME and PubMed), around the conjecture on a new knowledge field in the confluence of bioethics and health diplomacy; (2) a demonstrative historical analyses of the insertion of health in the context of foreign affairs and the emergence of South-South governance alternative to these relationships; (3) meditation on the bioethical perspective of international cooperation in health, guided by the following questions: (i) autonomy versus dependence of cooperation processes, (i) disparities of science, technology and innovation national systems, and (iii) intergovernmental agencies mediation; (4) an analyses of South- South cooperation developed in the context of the Community of Portuguese Language Speaking Countries (CPLP, in Portuguese) between Brazil, through FIOCRUZ (Oswaldo Cruz Foundation) and the ministries of health of the African Portuguese-Speaking Countries (PALOP, in Portuguese), as an illustration of the bioethical dimensions present in the interface of diplomatic interests with the doctrine of cooperation announced by the United Nations; and (5) an appreciation on the creation of the Study Center on Bioethics and Health Diplomacy, as an interinstitutional and interdisciplinary contribution to an interaction among these fields of knowledge and professional practice. Results: highlights the scarcity of registers in scientific literature on the interdisciplinary focus among health, diplomacy and bioethics; points out the pertinence and relevance of bioethics before the processes of international cooperation to the development; highlights its application on the health field under three references: (i) the conditionalities of diplomatic relationships versus the altruism of cooperation in health sector; (ii) the differences of economic and technical and scientific power to cooperation and, simultaneously, as the potential source of conflicts among countries in different levels of development; (iii) the possibilities and limitations of mediation of intergovernmental organizations. Conclusion: systematizes analyses, reflections and clues which strengthen the conviction on the intersection of bioethics, diplomacy and health, either in the knowledge interdisciplinary level or the institutional practices of world governance of cooperation among countries, and that approach is of fundamental importance to health as a fundamental human right; also points out further research alternatives of research to consolidate the thematic confluence and the professional practices among these fields.

La bioética: fundamento de la práctica de enfermería / Bioethics: basis of nursing practice

La bioética surgió en 1971 por el oncólogo norteamericano Rensselaer Van Potter, como una disciplina encaminada a conseguir el bién social. Surge en respuesta a la deshumanización de las ciencias de la salud, en un intento por regular las nuevas tecnologías y avances científicos, para respetar la vida y la dignidad humana. Para resolver estos dilemas, se han enunciado algunos principios: el de beneficencia, no maleficencia, autonomía y justicia, que pueden ser asumidos por todos o la mayoría, independientemente de sus creencias o ideologías. Para hacer valer esos principios la enfermera debe realizar una práctica correcta, adecuada y eficiente, siguiendo las pautas del Código Deontológico de Enfermería. Allí se establece claramente el respeto a los derechos humanos, con inclusión del derecho a la vida, a la dignidad; que son inherentes a la enfermería. El profesional con altos valores morales promoverá el respeto hacia los demás, su actitud siempre será de conciliación, tendrá sensibilidad al dolor ajeno, será comprensivo y el servicio será en función al bienestar común; de otro modo se fragmentaría el enlace con los principios bioéticos. Servicio, amor y responsabilidad, son solo reflejos de cuántos valores se requieren para ejercer esta profesión por vocación, constituyendo una sólida base para orientar las acciones del cuidado.

Bioethics emerged in 1971, by the American oncologist Van Rensselaer Potter, as a discipline aimed at achieving socia welfare. It arises in response to the dehumanization of health sciences, in an attempt to regulate new technologies and scientific advances, to respect life and human dignity. To solve this dilemma, some principles have been stated: beneficence, nonmal eficence, autonomy and justice, which can be assumed by all or most people, regardless of their belirfs or ideologies. To enforce these principles the nurse must perform a correct, adequate, and efficient practice; following the guidelines of the Nursing Code of Ethics. In this code, here is clearly established respect for human rights, including the right to life, dignity, which are inherent in nursing. Nursing Professionals with higt moral values promote respect for others, his attitude will always be of conciliation; they have sensitive to others` pain, will be comprehensive and will be based on service tothe common welfare; otherwise the link with bioetic principles will be fragmented. Service, love and responsibility are just reflections of how values are required for this profession by vocation, constituting a basis for guiding actions of care given.

Core competencies for health care ethics consultants: in search of professional status in a post-modern world.

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social-historical construction (ASBH Core Competencies for Health Care Ethics Consultation, 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered.