Fatores clínicos do bem-estar de mulheres em parturição: perspectivas deontológicas e da bioética principialista / Clinical factors of women in labor well-being: deontological and bioethical principlism perspectives / Factores clínicos del bienestar de la mujer en trabajo de parto: perspectivas deontológicas y de la bioética principialista

Objetivo: avaliar os fatores clínicos associados ao bem-estar das mulheres durante o trabalho de parto e parto à luz da bioética principialista e da deontologia. Método: estudo transversal com abordagem quantitativa. Participaram 396 puérperas internadas em um hospital municipal do sudoeste da Bahia, e os dados foram coletados no período de janeiro a maio de 2023, após aprovação do comitê de ética em pesquisa. Os dados foram organizados no software Excel e analisados via SPSS v.25. a partir da regressão logística multinomial. Resultados: a maior parte da amostra apresentou bem-estar com assistência em saúde, mulheres que tiveram parto realizado por profissionais não médicos apresentaram mais chances de níveis de bem-estar "adequado". E mulheres que não tiveram a via de parto cesárea apresentaram aumento de chances de bem-estar. Conclusão: é necessário que os profissionais reflitam sobre suas ações, condicionando-as à humanização no parto, em observância aos princípios bioéticos.

Objective: to evaluate the clinical factors associated with women's well-being during labor and delivery in the light of bioethics principlism and deontology. Method: a cross-sectional study with a quantitative approach was conducted. It involved 396 postpartum women admitted to a municipal hospital in the southwest of Bahia. Data were collected from January to May 2023, after approval from the research ethics committee. The data were tabulated using Excel software and analyzed using SPSS v.25 through Multinomial Logistic Regression. Results: majority of the sample exhibited well-being with health care assistance. Women who underwent delivery performed by non-medical professionals showed higher chances of "adequate" levels of well-being. Additionally, women who did not undergo cesarean delivery showed increased chances of well-being. Conclusion: It is necessary for professionals to reflect on their actions, conditioning them to the humanization of childbirth, according to bioethical principles.

Objetivo: evaluar los factores clínicos asociados al bienestar de la mujer durante el trabajo de parto y parto a la luz de la bioética y la deontología principialista. Método: estudio transversal con enfoque cuantitativo. Incluyó 396 puérperas ingresadas en un hospital municipal del suroeste de Bahía. Recolección de datos de enero a mayo de 2023, con aprobación del comité de ética en investigación. Los datos se tabularon en el software Excel y se analizaron mediante SPSS v.25. utilizando regresión logística multinomial. Resultados: la mayoría de las participantes de la muestra presentó bienestar con la atención para la salud; las que tuvieron partos realizados por profesionales no médicos tenían más probabilidades de tener niveles "adecuados" de bienestar; las que no tuvieron parto por cesárea tenían mayores probabilidades de tener bienestar. Conclusión: es necesario que los profesionales reflexionen sobre sus acciones y las adecuen para humanizar el parto, respetando los principios bioéticos.

Compassionate Principlism: Towards a Novel Alternative to Standard Principlism in Bioethics.

Principlism appears to be the prevailing applied ethical framework in bioethics. Despite the view's various strengths, critics point out that since the principles are ad hoc, conflicts indubitably emerge leading to inconsistency. There is debate around whether principlism can provide definitive action-guiding moral prescriptions or only help structure intelligent analyses and justifications of moral choices. In this paper, I contend that applying concepts of moral symmetry and moral asymmetry allows us to modify one of principlism's principles-the principle of beneficence-into what I will call the principle of compassion. I argue that the principle of compassion can function as an arbitrating or primary principle within the principlist framework. The result is a view we might call compassionate principlism. Arguably, compassionate principlism leads to fewer inconsistencies and provides more acceptable action-guiding moral prescriptions than traditional principlism.

Ethical Aspects of Human Genome Research in Sports-A Narrative Review.

Human genome research in sports raises complex ethical considerations regarding the intersection of genetics and athletic performance. Pursuing genetic enhancements must uphold fairness, equality, and respect for human dignity. This narrative review explores the ethical dimensions of human genome research in sports, its potential implications on athletes, and the integrity of sports. As a narrative review, this study synthesizes the existing literature and expert insights to examine the ethical aspects of human genome research in sports. This study extensively examined the current literature on genetics, sports performance, ethical concerns, human rights, and legal regulations within the European context. The literature was searched using the SPORTDiscus, Scopus, Google Scholar, and PubMed databases. Exploring human genome research in sports reveals significant ethical implications, including potential genetic discrimination, impacts on human rights, and creating a genetic underclass of athletes. There are also definite benefits surrounding genetic testing. In conclusion, this review contends that integrating ethical considerations into developing and applying genetic technologies in sports is crucial to upholding fundamental principles of fairness, equality, and respect for human dignity. It stresses the importance of open and inclusive dialogue about the potential consequences of genetic advancements on athletic performance, future generations, and the integrity of sports.

[Ethical considerations in the management of premature newborns with severe intraventricular hemorrhage]. / Consideraciones éticas en el manejo del recién nacido prematuro con hemorragia intraventricular grave.

Intracranial hemorrhage continues to be a prevalent pathology in preterm newborns, especially in those with lower gestational age and birth weight. It occurs more frequently in the first days of life, and the severity of bleeding is directly related to the degree of immaturity and other conditions of the patient. Intracranial hemorrhage is associated with a significant increased risk of mortality and, in those who survive, it is associated with an increased risk of neurodevelopmental disorders and long-term disability. Establishing an accurate prognosis is essential but frequently it is difficult to assay, dealing with uncertainty that healthcare team and the family must consider when they have to decide about the goals of care to provide to the newborn, including withholding or withdrawing life support treatments. Reflections regarding the best interest of the newborn, the complexity of quality-of-life, end-of-life shared decision-making process, uncovered biases, parental values, emotions, preferences and hopes, should be included in these challenging bioethical considerations and communications with the family.

La hemorragia intracraneana sigue siendo una enfermedad prevalente en los recién nacidos prematuros, especialmente en aquellos con menor edad gestacional y peso al nacer. Ocurre más frecuentemente en los primeros días de vida y la gravedad del sangrado se relaciona directamente con el grado de inmadurez y otras condiciones que afectan al paciente. La hemorragia intracraneana se asocia a un riesgo significativamente mayor de mortalidad y, en los que sobreviven, con un mayor riesgo de trastornos del neurodesarrollo y discapacidad a largo plazo. Establecer un pronóstico certero es esencial, pero frecuentemente es difícil de determinar, y el equipo de salud y la familia deben enfrentarse con la incertidumbre al momento de decidir acerca de los objetivos de los cuidados para el recién nacido, incluyendo la posible abstención o suspensión de tratamientos de soporte vital. Reflexiones relacionadas con el mejor interés del recién nacido, la complejidad de pronosticar su calidad de vida, el proceso de toma de decisiones sobre el final de la vida, los sesgos subyacentes, los valores, emociones, preferencias y expectativas de los padres, deben ser incluidos en este escenario difícil desde el punto de vista bioético y en las comunicaciones con la familia.

The power and perils of large language models in haematology.

Large language models (LLMs) are a transformative technology poised to fundamentally change multiple fields including haematology. Here, we review the history of large language model development, describe their current capabilities and identify opportunities in haematology poised to benefit from their judicious application. We conclude by suggesting a framework for the safe and ethical development of LLM-derived tools in a way that minimizes risk and maximizes clinical benefit for haematology physicians and patients.

Translational Bioethics in China: Brain-Computer Interface Research as a Case Study.

The research and development of emerging technologies has potential long-term and societal impacts that pose governance challenges. This essay summarizes the development of research ethics in China over the past few decades, as well as the measures taken by the Chinese government to build its ethical governance system of science and technology after the occurrence of the CRISPR-babies incident. The essay then elaborates on the current problems of this system through the case study of ethical governance of brain-computer interface research, and explores how the transition from research ethics to translational bioethics, which encourages interdisciplinary collaboration and focuses on societal implications, may respond to the challenges of ethical governance of science and technology.

One Health Ethics and the Ethics of Zoonoses: A Silent Call for Global Action.

This paper presents a critical review of key issues related to the emergence of new networks for the spread of zoonotic diseases amid the mass extinction of species. Zoonotic and infectious diseases account for approximately 70% of new and existing diseases affecting humans and animals. The initial section argues that the term "zoonoses" should not be confined to single-cause events within veterinary medicine. Instead, zoonoses should be viewed as complex, systemic phenomena shaped by interrelated factors, including environmental, sociocultural, and economic elements, influenced by anthropogenic climate change. The second section presents bioethical principles and potential strategies for those engaged in zoonotic disease prevention. The third section uses the slaughter of animals in disaster settings as a case study to illustrate the need for further clarification of normative and interspecies justice conflicts in One Health ethics. This section concludes with an outlook on "zoonoethics". Section four develops the analysis of the interlinked elements that trigger zoonoses and examines antimicrobial resistance (AMR) from an ethical and political standpoint, concluding with policy recommendations for addressing AMR. Section five offers a critical reflection, integrating contributions from zoonoethics, human ecology, and the ecotheological turn. Finally, section six concludes with a call to action and policy recommendations for an inclusive, intercultural, and gender-sensitive One Health approach.

Ethics of gene and cell therapy development for neurologic disorders.

In this chapter, I provide a condensed overview of nine recurring policy and ethical challenges encountered with the development of gene and cell therapies for neurologic disease. These include the question of when to initiate first-in-human trials, the ethics and policy of expanded/special access, the conduct of individualized therapy trials, subject selection in trials, designing trials for negative results, unintended effects of interventions on personal identity, comparator choice in randomized trials, consent and therapeutic misestimation, and cost and access for effective therapies. Broadly speaking, I argue that early in their development, the justification of risk in trials of gene and cell therapies derives from the social and scientific value of a trial and not the therapeutic value for trial participation. This generates strong imperatives to justify, design, and report trials appropriately and select patient populations that incur the least burden and opportunity cost for trial participation. Late in intervention development, policy makers must contend with the fact that proven effective interventions will almost certainly amplify strains in healthcare budgets as well as the ethical justifications standing behind reimbursement decisions.

Evaluating neuroprivacy concerns in human brain organoid research.

Neuroprivacy, or the privacy of neural data, has attracted considerable interest. Here, we explore the implications of neuroprivacy in human brain organoid research, detailing different interpretations of this right. Findings suggest a limited connection between neuroprivacy and brain organoid research, underscoring the importance of further examination of this critical issue.

Obesity, Metabolic Syndrome, and Sugar-Sweetened Beverages (SSBs) in America: A Novel Bioethical Argument for a Radical Public Health Proposal.

The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer's disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the "consistency argument"). This argument's radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer's disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.

Ethical, legal and social issues related to genetics and genomics in cancer: a scoping review and narrative synthesis.

Genomics is increasingly being incorporated into models of care for cancer. Understanding the ethical, legal and social implications (ELSI) in this domain is important for successful and equitable implementation. We aimed to identify ELSI scholarship specific to cancer control and genomics. To do this, we undertook a scoping literature review and narrative synthesis, identifying 46 articles that met inclusion criteria. Eighteen ELSI themes were developed, including: (i) Equity of access, which included structural barriers to testing and research, access to preventative and follow-up care, and engagement with health systems; (ii) family considerations, such as an ethical obligation to disseminate relevant genomic information to at-risk family members, (iii) legal considerations, including privacy and confidentiality, genetic discrimination, and the prospective duty to reclassify variants; and (iv) optimizing consent processes in clinical care and research. Gaps in the literature were identified with respect to equity for people living in rural or remote areas, and how to provide ethical care within culturally, linguistically and ethnically diverse communities; including First Nations peoples. Our findings suggest a need for a multidisciplinary approach to examining ELSI in cancer genomics beyond initial test indication and within the broader context of the mainstreaming of genomics in health care.

Education in the National Transplant Law as an ethical pathway for the construction of the health care value in Colombia / La enseñanza de la Ley Nacional de Trasplante como camino ético para la construcción del valor de la atención en salud en Colombia.

The national transplant law in Colombia, Law 1805 of 2016, modified the Colombian legislation regarding how a person accesses an organ transplant, but above all, it changed the donor figure, establishing the term derived from the presumptive consent right. This term implies a person's hypothetical willingness to be an organ donor as a manifestation of solidarity and charity towards another person in a situation of need and vulnerability concerning his/her health and the dimensions that define it. In the following text, seven moments are considered fundamental facts when constructing a culture about the value of healthcare in the national transplant policy in Colombia.

La Ley Nacional de Trasplantes en Colombia, Ley 1805 de 2016, modificó la legislación colombiana en cuanto a cómo se accede a un trasplante de órganos, pero, sobre todo, cambió la figura de donatario y dispuso el término derivado del derecho del consentimiento presuntivo. Este define la hipotética voluntad de una persona de ser donante de órganos como manifestación de solidaridad y beneficencia con otra persona en situación de necesidad y vulnerabilidad relacionada con su salud y las dimensiones que la definen. En el siguiente texto se presentan siete momentos que se consideran hechos fundamentales en la construcción de una cultura del valor de la atención en salud en la política nacional de trasplantes de Colombia.

Practising Less is More: An Exploration of What it Means to See "This Patient" Not a "Patient Like This".

In the last decade literature focused on a "less is more" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a "more is worse" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a "less is more" approach works in practice. A hermeneutic phenomenological approach was adopted to allow us to examine the realm of lived experience as a valid data source and as a path from which to understand a "less is more" approach "from the bedside." A Phenomenology of Practice was chosen as a more specific frame for this research because of its added focus on action and practical application in professional settings. Seventy stories written by physicians, patients, nurses, caregivers, and other health professionals have been received and analysed. These stories were gathered as part of a project called "Slow Stories" which aimed to collect clinical cases that have been positively resolved by adopting a "less is more" approach to patient care. After having conducted an in-depth analysis, separately and as a group, the researchers identified five key phenomenological themes; Time to relate is time to heal; Doing more does not mean doing better; Settings for a slow medicine; Slow care at the end of life; and Personalized vs. standardized treatment. Each of these themes offers insights into how a "less is more" approach can be used in practice and illustrates how a "less is more" strategy can play a significant role in positively resolving certain clinical cases.

Medically assisted reproduction (MAR) with sperm donation: Comparison of the profiles and medical pathways of unmarried women and women in heterosexual couples.

RESEARCH QUESTION: The legislation allowing unmarried women to undergo medically assisted reproduction (MAR) with sperm donation was adopted in France on August 2, 2021. This major advancement, and its impact on French society, led us to a closer examination of the requests made by unmarried women and the outcomes of ART attempts. DESIGN: A retrospective single center cohort study was conducted in a fertility center in Paris, France. All unmarried women and women in heterosexual couple seeking for MAR using sperm donation between September 2021 and October 2022 were included. Medical and socio-demographic data, as well as details and outcomes of MAR attempts were analyzed until October 31, 2023. RESULTS: Two hundred seventy-two unmarried women and 76 women in heterosexual couple were included. Results were compared between the two groups. Unmarried women were significantly older, with a significant decrease in anti-Müllerian hormone (AMH) and antral follicle count (AFC). They also exhibited a higher prevalence of gynecological pathologies associated with infertility, such as endometriosis. Unmarried women were more likely to work in intermediate occupations, whereas women in heterosexual couple more often had employee status. Among unmarried women who had undergone at least one MAR attempt by October 31, 2023, significantly lower cumulative early and ongoing pregnancy rates were observed. CONCLUSIONS: Female age appears to play a major role in the likehood of pregnancy and live birth. It is therefore crucial to inform women initiating the process of MAR with sperm donation that success is not guaranteed.

Adolescents' healthcare decisional capacity in the clinical context: a theoretical study and model.

OBJECTIVE: To provide a theoretical study and model for the bioethical foundations of the factors that influence adolescents' healthcare decisional capacity. SOURCES: Materials from diverse sources, including indexed articles in recognized databases and official government documents, were examined for a purposefully selected sample. The research consisted of two stages: selection of documents and reflective thematic analysis, followed by the preparation of a report. The analysis adopted a phenomenological stance and a reflective view compatible with human rights. To reduce bias and ensure the robustness of the results, measures such as data triangulation were employed. Ethical measures were taken to ensure data integrity, including considerations of anonymity and conflicts of interest in the selected studies. SUMMARY OF THE FINDINGS: It was possible to list intrinsic and extrinsic factors of the adolescent patient that influence their decisional capacity regarding health. A theoretical model was developed to discuss these factors for evaluation by means of an infographic. CONCLUSIONS: It seems clear that the evaluation of healthcare decisional capacity of adolescents must position itself ethically regarding the tension between the moral duty to respect the self-determination of the able subject and the need to protect adolescents decidedly unable to make a specific health decision at a given time.

How Can Newborn Toxicology Testing Be More Equitable? An Interactive Ethics Workshop.

Introduction: Practice variation in newborn toxicology testing during the birth hospitalization exists across institutions and legal jurisdictions. While testing can provide benefits, indiscriminate testing has been shown to perpetuate health care inequities. In the backdrop of an opioid epidemic and a charged medicolegal landscape, this workshop guides participants to reexamine newborn toxicology testing through a shared ethical lens. Methods: We conducted a live, 90-minute workshop in English at an international pediatric conference. Physicians, residents, and fellows participated in large- and small-group breakout sessions to learn relevant clinical and bioethical frameworks, share their own local context and expertise, and explore ethical applications through case-based discussions. We administered two anonymous online follow-up surveys to assess self-perceived impact on participant knowledge, behavior, and clinical practice. Results: Seven facilitators and 45 individuals participated in the workshop. Eighteen participants completed survey 1 immediately following workshop conclusion, and six participants completed survey 2 after 3 months had elapsed. Immediately following the workshop, 94% of respondents reported that they had been introduced to a new idea, and 82% were considering practice change. A low response rate to survey 2 limited interpretation, but some respondents reported self-perceived change following workshop attendance. Discussion: This workshop facilitated conversation between physician participants on a complex pediatric health care inequity issue using an ethical framework.

Science and Islamic ethics: Navigating artificial womb technology through Quranic principles.

This paper explores the complex interplay between scientific innovation and religious ethics, with a specific focus on the ethical implications of Artificial Womb Technology (AWT) as interpreted through the lens of Quranic teachings on the essence of life. The objective is to meld the burgeoning field of reproductive technologies with the foundational principles of Islamic theology through an examination of Islamic jurisprudential rulings, contemporary bioethical discourse and innovations in reproductive technology. In addition to attention given to the compatibility of AWT with Islamic teachings concerning the sanctity of life, there is also a focus on the concept of motherhood and the preservation of family structure. This study undertakes an extensive exploration of both historical and contemporary interpretations of Islamic precepts, culminating in the establishment of an ethical framework. This framework is designed to harmonise religious doctrines with the exigencies of reproductive science by proposing normative guidelines for the ethical implementation of AWT and similar technologies. This paper makes a substantial contribution to academic discourse on science and religion by integrating advancements in reproductive health technology with moral principles intrinsic to the Islamic faith.

Ethical and Practical Issues with the Use of Antimicrobial Agents during the End of Life.

The use of antimicrobials in patients receiving end-of-life (EOL) care, which is generally defined as supportive care provided to patients anticipated to live less than 1 year, has been actively debated in the realm of palliative care medicine due to the nebulous nature of the topic. In this article, we explore the use of antimicrobial use near EOL as it relates to both the ethical and practical issues that face physicians. We also discuss the reasons underlying the scarcity of prospective studies on this topic.

Bjørn Ibsen: What Made Intensive Care So Critical?

The COVID-19 pandemic underscored the critical importance of intensive care units (ICUs), a field institutionalized by Bjørn Ibsen during the 1952 polio epidemic in Copenhagen. Ibsen's groundbreaking innovations, including positive pressure ventilation and real-time physiological monitoring, laid the foundation for modern intensive care medicine. Trained in Denmark and the United States, Ibsen demonstrated the effectiveness of manual ventilation during the polio outbreak after successfully resuscitating a young patient, Vivi Ebert, which in turn led to the creation of the world's first multidisciplinary ICU at Blegdams Hospital. This article explores the historical context and significance of Ibsen's contributions, tracing the evolution of the physiology of breathing from the early concepts of Vesalius and Hook to the widespread application of ventilation techniques. The establishment of the ICU introduced new ethical dilemmas, highlighting the delicate balance between prolonging life and maintaining patient dignity. Ibsen's legacy extends beyond medical advancements to the compassionate care he championed, a principle that remains a cornerstone of modern intensive care. This ethical complexity is a crucial aspect of the history of intensive care medicine.