Global health, planetary health, One Health: conceptual and ethical challenges and concerns.

The Covid-19 pandemic has dramatically shown the level of interconnectedness of the human population, the direct relation between human health and the ecosystem, as well as the enormous ethical challenges required for a global response. Relatedly, society has been directly confronted by issues of 'Global health,' both in terms of awareness of health conditions and health systems resiliency all around the world, as well as in terms of governance of the worldwide response and its implications at national and local levels. While Global health is often used as a cosmetic label for neocolonial approaches, it is really an interdisciplinary approach consisting of the interaction between globalization and the determinants of health. Thus, it involves the ecosystem and its transformation and implies a systemic 'One Health' decolonized approach in the definition of its strategies. The Covid-19 pandemic has highlighted the inequities and the limits of the current hegemonic Global health system governance; calling for ethics to provide a renewed, comprehensive, inclusive, and decolonized conceptualization of Global health.

Cultural competency and ethical behavior for collaboration in limited-resource settings: Guidelines from the Society of University Surgeons Academic Global Surgery Committee and the Association for Academic Global Surgery.

BACKGROUND: There are an increasing number of global surgery activities worldwide. With such tremendous growth, there is a potential risk for untoward interactions between high-income country members and low-middle income country members, leading to programmatic failure, poor results, and/or low impact. METHODS: Key concepts for cultural competency and ethical behavior were generated by the Academic Global Surgery Committee of the Society for University Surgeons in collaboration with the Association for Academic Global Surgery. Both societies ensured active participation from high-income countries and low-middle income countries. RESULTS: The guidelines provide a framework for cultural competency and ethical behavior for high-income country members when collaborating with low-middle income country partners by offering recommendations for: (1) preparation for work with low-middle income countries; (2) process standardization; (3) working with the local community; (4) limits of practice; (5) patient autonomy and consent; (6) trainees; (7) potential pitfalls; and (8) gray areas. CONCLUSION: The article provides an actionable framework to address potential cultural competency and ethical behavior issues in high-income country - low-middle income country global surgery collaborations.

O acesso global e nacional ao tratamento da hemofilia: reflexões da bioética crítica sobre exclusão em saúde / Global and national access to the treatment of hemophilia: reflections from critical bioethics on health exclusion / El acceso global y nacional al tratamiento de la hemofilia: reflexiones de la bioética crítica sobre exclusión en salud

A hemofilia é uma doença rara, hereditária e caracterizada pela falta de fatores de coagulação, o que provoca sangramentos espontâneos e artropatias incapacitantes. O componente mais dispendioso em seu tratamento é a reposição do fator de coagulação. O presente ensaio examina, a partir da perspectiva da Bioética Crítica, modelo teórico baseado na articulação da Teoria Crítica com os Estudos da Colonialidade, o panorama do acesso global ao tratamento e o programa brasileiro. Demonstrou-se um quadro marcado por extremas disparidades de acesso em nível tanto global quanto nacional, cujas causas estão diretamente relacionadas com a formação histórica de um sistema-mundo baseado na dominação dos meios materiais, ideias e instituições pelos países centrais. Para seu enfrentamento, concluiu-se pela necessidade de contínuas pressões sociais, estímulo a uma produção científica e regulação tecnológica verdadeiramente comprometida com o cumprimento do direito fundamental à saúde.(AU)

Hemophilia is a rare, hereditary disease characterized by a lack of clotting factors, which causes spontaneous bleeding and disabling arthropathy. The most expensive component in its treatment is clotting factor replacement therapy. This essay examines, based on the perspective of Critical Bioethics - a theoretical model based on the articulation between Critical Theory and Coloniality Studies -, the panorama related to the global access to that treatment and the Brazilian program. A scenario marked by extreme disparities of access was found, both in the global and in the national levels, whose causes are directly related to the historical formation of a world system based on the domination of material means, ideas and institutions by central countries. To face this situation, a continuous social pressure is needed, as well as incentive to scientific production and technological regulation truly committed to the enforcement of the fundamental right to health.(AU)

La hemofilia es una enfermedad rara, hereditaria, caracterizada por la falta de factores de coagulación, lo que provoca sangrados espontáneos y artropatías discapacitantes. El componente más caro de su tratamiento es la reposición del factor de coagulación. El presente ensayo examina, a partir de la perspectiva de la Bioética Crítica, un modelo teórico basado en la articulación de la Teoría Crítica con los Estudios de la Colonialidad, el panorama del acceso global al tratamiento y el programa brasileño. Demostró ser un cuadro marcado por disparidades extremas de acceso, tanto en nivel global como nacional, cuyas causas están directamente relacionadas con la formación histórica de un sistema de mundo basado en la dominación de los medios materiales, ideas e instituciones por los países centrales. La conclusión para enfrentarlo fue la necesidad de continuas presiones sociales y estímulo a una producción científica y regulación tecnológica verdaderamente comprometidas con el cumplimiento del derecho fundamental a la salud.(AU)

Human Capital and Self-entrepreneurship. The concept of robbed time / Capital humano y auto-emprendimiento. El concepto de tiempo sustraído

The notions of "human capital" and "self-entrepreneurship" are by now widespread. The present work takes a critical look at their pervasive acceptance and stresses the self-exploitation to which they give rise. The concept of self-entrepreneurship needs to take into account, in fact, the nature of a revolution in temporal phenomenology. This revolution not only blurs the distinction between time dedicated to life and time dedicated to one's profession. It means that time spent on whatever is traditionally irrelevant to work is potentially time robbed from successful self-entrepreneurship. An analysis is made, lastly, of the relationship between body and "bio-labor", recognizable in the emergence of new forms of manual labor. Emblematic, in this sense, is gestational surrogacy. This provides an opportunity to rediscover the pregnancy of M. Foucault's biopolitical interpretation of neoliberalism as opposed to the more recent category of "psychopolitics" defined by B.C. Han. In the current scenario, indeed, the body maintains a role that remains as central as it is paradoxical, on account of its configuration as an "entrepreneurial resource"

Las nociones de "capital humano" y "auto-emprendimiento" actualmente tienen gran difusión. El presente trabajo revisa críticamente su aceptación generalizada y enfatiza la auto-explotación a la que dan lugar. El concepto de auto-emprendimiento debe tener en cuenta, de hecho, la naturaleza de una revolución fenomenológica de lo temporal. Esta revolución no solo oscurece la distinción entre el tiempo dedicado a la vida y aquel dedicado a la profesión. Significa, a su vez, que el tiempo que se gasta en lo que tradicionalmente es irrelevante para el trabajo es potencialmente sustraído al tiempo de un autoemprendimiento exitoso. Por último, se realiza un análisis de la relación entre el cuerpo y la "bio-labor", reconocible en el surgimiento de nuevas formas de trabajo manual. Emblemática, en este sentido, es la subrogación gestacional. Esto brinda la oportunidad de redescubrir el embarazo en la interpretación biopolítica del neoliberalismo de M. Foucault como oposición a la categoría más reciente de "psicopolítica" definida por B.C. Han. En el escenario actual, de hecho, el cuerpo mantiene un papel que permanece tanto central como paradójico, debido a su configuración como "recurso empresarial"

Global Mental Health: challenges for a global ethics / Salud Mental Global: retos para una ética global / Saúde Mental Global: desafios para uma ética global

This paper aims at presenting a perspective on a global ethics useful for conducting and evaluating research on global mental health. It includes the proposal of expanding the scope of "global" to include different aspects of cultural diversity and a plea for a "differential ethics" approach that accepts diversity and sociocultural determinants of health. The contention is advanced that ethics is a linguistic justification of moral norms based on customs, beliefs, and traditions. Besides its foundation on rational or religious beliefs, ethics should also be conceived of as a way of attaining human fulfillment of interests and expectations in the context of different forms of humanity.

Este texto se propone presentar una perspectiva sobre una ética global útil para conducir y evaluar investigaciones sobre salud mental global. Incluye la propuesta de expandir el significado de "global" para incluir la diversidad cultural y la demanda por una "ética diferencial" que acepte la diversidad y considere los determinantes socioculturales de la salud. Se sugiere que la ética constituye una justificación lingüística de las normas morales basadas en costumbres, creencias y tradiciones. Además de fundarse en convicciones religiosas o racionales, la ética también debe concebirse como una forma de alcanzar plenitud humana en intereses y expectativas en el contexto de diversas formas de humanidad.

Este texto se propõe apresentar uma perspectiva sobre uma ética global útil para conduzir e avaliar pesquisas sobre saúde mental global. Inclui a proposta de expandir o significado de "global" para incluir a diversidade cultural e a demanda por uma "ética diferenciada" que aceite a diversidade e considere as determinantes socioculturais da saúde. É sugerido que a ética constitui uma justificação linguística das normas morais baseadas em costumes, crenças e tradições. Além de fundamentar-se em convicções religiosas ou racionais, a ética também deve ser concebida como uma forma de alcançar a plenitude humana em interesses e expectativas no contexto de diversas formas de humanidade.

Implicaciones éticas de las investigaciones con virus: el Principio de Colaboración Global / Ethical implications of flu investigations: the Principle of Global Colaboration

Dos equipos de investigadores encabezados por Fouchier, en Holanda, y Kawaoka, en Estados Unidos, han efectuado modificaciones en el virus de la gripe aviar para demostrar que puede transmitirse con facilidad entre seres humanos. Al tratar de publicar sus trabajos se abrió un intenso debate en la comunidad científica sobre si los resultados de las investigaciones debían difundirse o no. Finalmente, los trabajos se publicaron al amparo de un nuevo principio en bioética, el Principio de Colaboración Global, dado que los resultados de las investigaciones podían tener alcance planetario. Analizaremos en el presente artículo el sentido y alcance de dicho principio, y cómo la polémica generada por estas investigaciones han tambaleado los cimientos de la ética científica (AU)

Two equipments of investigators headed by Fouchier, in Holland, and Kawaoka, in The United States, has effected modifications in the virus of the avian flu to demonstrate that it can be transmitted by facility between human beings. On having tried to publish his works an intense debate was opened in the scientific community on if the results of the investigations had to spread or not. Finally, the works were published under the protection of a new principle in bioethics, the Principle of Global Collaboration, provided that the results of the investigations could have planetary scope. We will analyze in the present article the sense and scope of the above mentioned principle, and how the polemic generated by these investigations there have staggered the foundations of the scientific ethics (AU)

Bioética global na perspectiva da bioética crítica / Bioética global desde la perspectiva de la bioética crítica / Global bioethics from the perspective of critical bioethics

Desde os anos 1990 a bioética tem se aproximado cada vez mais das discussões internacionais relacionadas à saúde e às ciências da vida, o que levou alguns autores a referir-se à "bioética global". O presente artigo analisa este conceito tal como elaborado nas perspectivas de três formulações teóricas da bioética norte-americana: a de Van Rensselaer Potter, a de Tristam Engelhardt e a de Beauchamp e Childress. Ao balancear as potencialidades e as insuficiências das abordagens destes autores, propõe a "bioética crítica" como alternativa teórica melhor capacitada para enfrentar os temas globais da bioética a partir da perspectiva histórica dos países do Sul global...

Desde la década de 1990 la bioética se ha acercado cada vez más a los debates relacionados con las ciencias de la vida y la salud internacional, lo que llevó a algunos autores a referirse a la "bioética global". En este artículo se examina este concepto desarrollado en las perspectivas teóricas de tres formulaciones de la bioética estadunidense: Van Rensselaer Potter, Tristram Engelhardt y Beauchamp y Childress. Al evaluar las fortalezas y debilidades de los enfoques de estos autores, propone la "bioética crítica" como una alternativa teórica más cualificada para hacer frente a los problemas mundiales de la bioética desde la perspectiva histórica de los países del Sur global...

Since the 1990s bioethics has increasingly approached the discussions related to international health and life sciences, which led some authors to refer to the "global bioethics". This article examines this concept as elaborated in the theoretical perspectives of three formulations of North American bioethics: Van Rensselaer Potter, the Tristram Engelhardt, and Beauchamp and Childress. By balancing the strengths and weaknesses of the approaches of these authors, it is proposed the "critical bioethics" as the best qualified alternative theoretical to address the global issues of bioethics from the historical perspective of the countries of the Global South...