[The role of solidarity in a pandemic.] / El papel de la solidaridad en una pandemia.

Solidarity is part of the map of values and ethical principles of the COVID-19 pandemic that has devastated the world since the end of 2019. Solidarity has been behind the justification for public health measures such as confinement, quarantines, lockdowns, the mandatory use of masks, and the financing, distribution and inoculation of vaccines against the virus; it has also been used to economic compensation, intergenerational sacrifices, the importance of public health care and even mutual aid between citizens, institutions and countries to face the worst effects of the pandemic. However, solidarity has been used interchangeably as a descriptive and normative, motivational and justificatory, sentimental and political, moral and legal idea, thus increasing confusion about its meaning, use and scope. This article reviews the rhetorical use of solidarity during the pandemic, shows the contradictions derived from that use, and sheds light on the normative use it should have in order to more rigorously address responses to future pandemics.

La solidaridad forma parte del mapa de los valores y principios éticos de la pandemia por la COVID-19 que ha asolado al mundo desde finales de 2019. La solidaridad ha estado detrás de la justificación de medidas de Salud Pública como el confinamiento, las cuarentenas, el cierre de espacios públicos y privados, el uso obligatorio de mascarillas y la financiación, distribución e inoculación de las vacunas contra el virus; también se ha utilizado para resaltar las compensaciones económicas, los sacrificios intergeneracionales, la importancia de la sanidad pública y hasta la ayuda mutua entre ciudadanos, instituciones y países para hacer frente a los peores efectos de la pandemia. No obstante, la solidaridad se ha utilizado indistintamente como una idea descriptiva y normativa, motivacional y justificativa, sentimental y política, moral y legal, aumentando, de este modo, la confusión sobre su significado, su uso y su alcance. En este artículo se repasa el uso retórico de la solidaridad durante la pandemia, se muestran las contradicciones derivadas de ese uso y se arroja luz sobre el uso normativo que debería tener la solidaridad para afrontar con más rigor las respuestas a las pandemias del futuro.

El papel de la solidaridad en una pandemia / The role of solidarity in a pandemic

La solidaridad forma parte del mapa de los valores y principios éticos de la pandemia por la COVID-19 que ha asolado al mundo desde finales de 2019. La solidaridad ha estado detrás de la justificación de medidas de Salud Pública como el confinamiento, las cuarentenas, el cierre de espacios públicos y privados, el uso obligatorio de mascarillas y la financiación, distribución e inoculación de las vacunas contra el virus; también se ha utilizado para resaltar las compensaciones económicas, los sacrificios intergeneracionales, la importancia de la sanidad pública y hasta la ayuda mutua entre ciudadanos, instituciones y países para hacer frente a los peores efectos de la pandemia. No obstante, la solidaridad se ha utilizado indistintamente como una idea descriptiva y normativa, motivacional y justificativa, sentimental y política, moral y legal, aumentando, de este modo, la confusión sobre su significado, su uso y su alcance. En este artículo se repasa el uso retórico de la solidaridad durante la pandemia, se muestran las contradicciones derivadas de ese uso y se arroja luz sobre el uso normativo que debería tener la solidaridad para afrontar con más rigor las respuestas a las pandemias del futuro.(AU)

Solidarity is part of the map of values and ethical principles of the COVID-19 pandemic that has devastated the world since the end of 2019. Solidarity has been behind the justification for public health measures such as confinement, quarantines, lockdowns, the mandatory use of masks, and the financing, distribution and inoculation of vaccines against the virus; it has also been used to economic compensation, intergenerational sacrifices, the importance of public health care and even mutual aid between citizens, institutions and countries to face the worst effects of the pandemic. However, solidarity has been used interchangeably as a descriptive and normative, motivational and justificatory, sentimental and political, moral and legal idea, thus increasing confusion about its meaning, use and scope. This article reviews the rhetorical use of solidarity during the pandemic, shows the contradictions derived from that use, and sheds light on the normative use it should have in order to more rigorously address responses to future pandemics.(AU)

Bias in algorithms of AI systems developed for COVID-19: A scoping review.

To analyze which ethically relevant biases have been identified by academic literature in artificial intelligence (AI) algorithms developed either for patient risk prediction and triage, or for contact tracing to deal with the COVID-19 pandemic. Additionally, to specifically investigate whether the role of social determinants of health (SDOH) have been considered in these AI developments or not. We conducted a scoping review of the literature, which covered publications from March 2020 to April 2021. ​Studies mentioning biases on AI algorithms developed for contact tracing and medical triage or risk prediction regarding COVID-19 were included. From 1054 identified articles, 20 studies were finally included. We propose a typology of biases identified in the literature based on bias, limitations and other ethical issues in both areas of analysis. Results on health disparities and SDOH were classified into five categories: racial disparities, biased data, socio-economic disparities, unequal accessibility and workforce, and information communication. SDOH needs to be considered in the clinical context, where they still seem underestimated. Epidemiological conditions depend on geographic location, so the use of local data in studies to develop international solutions may increase some biases. Gender bias was not specifically addressed in the articles included. The main biases are related to data collection and management. Ethical problems related to privacy, consent, and lack of regulation have been identified in contact tracing while some bias-related health inequalities have been highlighted. There is a need for further research focusing on SDOH and these specific AI apps.

La eficiencia no basta. Análisis ético y recomendaciones para la distribución de recursos escasos en situación de pandemia / Efficiency is not enough. Ethical analysis and recommendations for the allocation of scarce resources in a pandemic situation

Objetivo: Elaborar una herramienta de apoyo que ayude a tomar decisiones en el marco de la pandemia de COVID19. Método: Se parte de una búsqueda de diferentes recomendaciones éticas surgidas en España sobre priorización de recursos sanitarios escasos en la pandemia de COVID19, así como de una revisión narrativa de modelos teóricos sobre distribución en pandemias para definir una fundamentación ética. Finalmente, se extraen recomendaciones para su posible aplicación en distintos ámbitos asistenciales. Resultados: Se identifican tres principios, igualdad estricta, equidad y eficiencia, que se sustancian en criterios de distribución específicos. Conclusiones: Se propone un modelo de distribución de recursos sanitarios escasos en situación de pandemia que parte de un procedimiento de toma de decisiones y adapta los criterios de distribución a los escenarios de la atención sanitaria: atención primaria, residencias sociosanitarias y atención hospitalaria. (AU)

Objective: To develop a support tool to decision-making in the framework of the COVID19 pandemic. Method: Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID19 pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings. Results: Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria. Conclusions: A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals. (AU)

[Efficiency is not enough. Ethical analysis and recommendations for the allocation of scarce resources in a pandemic situation]. / La eficiencia no basta. Análisis ético y recomendaciones para la distribución de recursos escasos en situación de pandemia.

OBJECTIVE: To develop a support tool to decision-making in the framework of the COVID-19 pandemic. METHOD: Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID-19 pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings. RESULTS: Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria. CONCLUSIONS: A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals.

Ética, solidaridad y donación de sangre. Cuatro perspectivas a debate / Ethics, Solidarity and Blood Donation. Four Perspectives to Debate / Ètica, solidaritat i donació de sang. Quatre perspectives a debat

En este artículo, expongo los pros y contras éticos de cuatro políticas públicas diferentes de provisión de sangre para los bancos de sangre con el fin de satisfacer la demanda de productos sanguíneos y hemoderivados destinados a atender a los enfermos que los necesitan. Esas cuatro políticas se basan, respectivamente, en la donación altruista, la remuneración a los donantes, los estímulos no monetarios o nudging, y la obligatoriedad equitativa. En la última parte del artículo, y tras comparar las cuatro políticas, muestro la deseabilidad ética de la última de ellas junto a algunos de sus principales problemas

In this article, I expose the ethical pros and cons of four different public blood supply policies for blood banks in order to meet the demand for blood products intended to care for the patients who need them. These four policies are based, respectively, on altruistic donation, remuneration to donors, non-monetary or nudging stimuli, and equitable obligatoriness. In the last part of the article, and after comparing the four policies, I show the ethical desirability of the last one and some of its main problems

En aquest article, exposo els pros i contres ètics de quatre polítiques públiques diferents de provisió de sang per als bancs de sang amb la finalitat de satisfer la demanda de productes sanguinis i hemoderivats destinats a atendre els malalts que els necessiten. Aquestes quatre polítiques es basen, respectivament, en la donació altruista, la remuneració als donants, els estímuls no monetaris o nudging, i l'obligatorietat equitativa. En l'última part de l'article, i després de comparar les quatre polítiques, mostro la desitjabilitat ètica de l'última d'elles al costat d'alguns dels seus principals problemas

La idea de solidaridad en la ética de la salud pública / The idea of solidarity in public health ethics

Tradicionalmente, la solidaridad ha pasado inadvertida en ética de la salud pública. Sin embargo, algunos autores están reivindicando actualmente la necesidad de tener en cuenta a la solidaridad como un principio rector. Dawson y Jennings son unos de esos autores, pero su concepción de la solidaridad presenta al menos tres contradicciones: en ella, se confunde lo descriptivo con lo normativo, el papel motivacional con el papel justificador de una acción, y el lugar que la solidaridad debe ocupar en una teoría de la justicia en salud. Hace falta resolver estas contradicciones para conceptualizar adecuadamente la idea de solidaridad en la ética de la salud pública si queremos que tenga un rol relevante y deje de ser un valor meramente testimonial

Traditionally, solidarity has gone unnoticed in public health ethics. However, some authors are currently demanding the need to take into account solidarity as a guiding principle. Dawson and Jennings are one of those authors, but their concept of solidarity has at least three contradictions: in it, the descriptive with the normative are confused, as the motivational role with the justifier role of an action, and also the place which solidarity must occupy in a theory of justice in health. We need to resolve these contradictions to properly conceptualize the idea of solidarity in public health ethics if we want that it to have a relevant role and no longer a purely testimonial value

An ethics training specific for European public health.

Training in public health ethics is not at the core of public health programmes in Europe. The fruitful progress of the United States could stimulate the European schools of public health and other academic institutions to develop specifically European teaching programmes for ethics that embrace both transatlantic innovations and some adaptations based on the evolution of moral values in European societies. This paper reviews the arguments for a European public health ethics curriculum and recommends the main features of such a programme. Europe shares common values and, above all, the three major ethical principles that were socially and politically crystallized by the French Revolution: liberty, equality, and fraternity. Fraternity, otherwise known as solidarity, although rarely mentioned in the literature on ethical issues, is the moral value that best defines the European concept of public health expressed as a common good, mutual aid, and a collective or shared responsibility for health of the population. Specific political motivations were responsible for the origin of European health systems and for current policy proposals led by the European Union, such as Europe's commitments, at least in theory, to: reduce social inequities in health and to develop the health in all policies approach. These and other initiatives, albeit not exclusively European, have political and legal repercussions that pose unique ethical challenges. Europe combines homogeneity in social determinants of health with heterogeneity in public health approaches and interventions. It is therefore necessary to develop training in ethics and good government for all public health workers in Europe, especially since a large segment of the population's health depends on actions and decisions adopted by the European Commission and its regulatory agencies as well as for non EU European Region countries. Based on these arguments, the paper concludes with several recommendations for a common nucleus for the ethics curriculum in Europe.

Hay bioética más allá de la autonomía / There is bioethics beyond autonomy

La historia de la bioética desde mediados del siglo XX ha supuesto una constante reivindicación del principio de autonomía del enfermo. Esta trayectoria ha engrandecido a la bioética como disciplina y la ha adaptado a las exigencias de una sociedad comprometida con las libertades individuales. Sin embargo, este firme y deseable compromiso con la autonomía del enfermo también ha dificultado que la bioética tome en consideración, con el mismo rigor e interés, todos aquellos temas y problemas éticos relacionados con la salud y la vida que no se pueden abordar correctamente con una mayor protección de la autonomía. En la bioética del futuro, presidida por los desafíos de la potenciación genética y las desigualdades extremas de salud, habrá que reivindicar con mayor fuerza que hasta ahora los valores y principios de la beneficencia y la justicia (AU)

The history of bioethics since the mid‐twentieth century has been a constant claim of the principle of autonomy of the patient. This path has enlarged the field of bioethics as a discipline and has adapted it to the demands of a society committed to individual freedoms. However, this strong and desirable commitment to autonomy has also made it difficult for bioethics consider, with the same rigor and interest, all those issues and ethical issues related to health and life can not be addressed properly with greater protection of autonomy. In bioethics of the future, chaired by the challenges of genetic enhancement and extreme inequalities of health, we must assert more strongly than now the values and principles of beneficence and justice (AU)

[Who is the guardian of our own health? Individual and social responsibility for health]. / ¿Quién es el guardián de nuestra propia salud?: responsabilidad individual y social por la salud.

Most people believe they have a duty to promote and protect the health of the population and treating the sick in case of medical need. And many also believe each person have a responsibility to his/her own health. Both beliefs can lead to a conflict of values with social and political implications. If people sick from individual choices (or unhealthy lifestyles), should we offer them a lower priority in access to health resources? The most popular example to refer to this situation is that of the diseases associated with smoking, but it is extensible to any disease that originates in a voluntary choice of the patient, as the abandonment of the medication, the practice of sport or unsafe sex, or the lack of preventive measures against influenza. In such cases, does social responsibility still prevail? My answer is yes. In this article, I argue that social responsibility for the health of the population prevails even if morally can and must empower people about their health.

¿Quién es el guardián de nuestra propia saluld? Responsabilidad individual y social por la salud / Who is the guardian of our own health? Individual and social responsability for health

La mayoría de las personas creen que tenemos el deber de promover y proteger la salud de la población y de tratar a los enfermos en caso de necesidad médica. Y muchas creen también que tenemos una responsabilidad con nuestra propia salud. Ambas creencias pueden llevarnos a un conflicto de valores con implicaciones sociales y políticas. Si la gente enferma a causa de un estilo de vida voluntario poco saludable ¿debemos ofrecerles una prioridad menor en el acceso a los recursos sanitarios? El ejemplo más popular para referirse a esta situación es el de las enfermedades que se asocian con el hábito de fumar, pero es extensible a cualquier patología que tenga su origen en alguna elección voluntaria del enfermo, como el abandono de la medicación, la práctica de deporte o de sexo inseguro o la ausencia de medidas de prevención contra la gripe. En esos casos, ¿sigue prevaleciendo la responsabilidad social? Mi respuesta es que sí. En este artículo defiendo que la responsabilidad social por la salud de la población prevalece aun en caso de que podamos y debamos responsabilizar moralmente a las personas por su salud (AU)

Most people believe they have a duty to promote and protect the health of the population and treating the sick in case of medical need. And many also believe each person have a responsibility to his/her own health. Both beliefs can lead to a conflict of values with social and political implications. If people sick from individual choices (or unhealthy lifestyles), should we offer them a lower priority in access to health resources? The most popular example to refer to this situation is that of the diseases associated with smoking, but it is extensible to any disease that originates in a voluntary choice of the patient, as the abandonment of the medication, the practice of sport or unsafe sex, or the lack of preventive measures against influenza. In such cases, you still prevailing social responsibility?My answer is yes. In this article, I argue that social responsibility for the health of the population prevails even if morally can and must empower people about their health (AU)

Ética, equidad y determinantes sociales de la salud / Ethics, equity and social determinants of health

Resumen Las evidencias aportadas por los estudios sobre los determinantes sociales de la salud modifican la relación entre la ética y la medicina, entre lo normativo y lo descriptivo en el estudio de la salud pública. También modifican la concepción tradicional de la equidad, las políticas sanitarias necesarias y el futuro de la bioética. Más concretamente: 1) la frontera entre la medicina y la ética se vuelve mucho más difusa, sobre todo en el campo de la epidemiología, cuyos objetivos son ahora inseparables de consideraciones éticas; 2) la concepción de la equidad en salud definida tradicionalmente a partir del acceso al sistema sanitario debe corregirse o ampliarse para incorporar las desigualdades injustas de salud que se producen antes de que los enfermos lleguen al sistema sanitario; y 3) el tradicional sesgo autonomista de la bioética debe sustituirse por una preocupación prioritaria por la justicia social y su relación con la salud(AU)

Abstract The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine. The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine, and between a normative and a descriptive approach. Studies on the social determinants of health have also modified the traditional concept of equity, necessary health policies and the future of bioethics. More specifically: 1) the boundary between medicine and ethics has become much fuzzier, especially in the field of epidemiology, whose objectives are now inseparable from ethical considerations; 2) the concept of health equity traditionally defined as access to healthcare should be corrected or expanded to incorporate unfair health inequalities that occur before patients reach the healthcare system; and 3) the traditional autonomy bias of bioethics should be replaced by a primary concern for social justice and its relationship with health (AU)

[Ethics, equity and social determinants of health]. / Ética, equidad y determinantes sociales de la salud.

The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine. The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine, and between a normative and a descriptive approach. Studies on the social determinants of health have also modified the traditional concept of equity, necessary health policies and the future of bioethics. More specifically: 1) the boundary between medicine and ethics has become much fuzzier, especially in the field of epidemiology, whose objectives are now inseparable from ethical considerations; 2) the concept of health equity traditionally defined as access to healthcare should be corrected or expanded to incorporate unfair health inequalities that occur before patients reach the healthcare system; and 3) the traditional autonomy bias of bioethics should be replaced by a primary concern for social justice and its relationship with health.