Aspectos cognitivos, éticos, sociales y políticos en la evaluación de riesgos: a propósito de las vacunas contra el SARS-CoV-2 / Cognitive, ethical, social and political aspects in risk assessment: regarding vaccines against SARS-CoV-2

El riesgo es un concepto que suele ser evaluado por los científicos y expertos en salud pública mediante la comparación de probabilidades. Sin embargo, esta perspectiva inscrita en el utilitarismo ético, que considera que la mejor decisión es aquella que tiene menos probabilidad de daño que de beneficio, no contempla aspectos normativos fundamentados en otras perspectivas éticas. La interpretación del origen de las polémicas públicas derivadas de las reacciones de las personas ante los pequeños riesgos de las vacunas con virus atenuados contra el SARS-CoV-2 y la evaluación de las respuestas de las instituciones públicas requiere conocer tanto los aspectos cognitivos que introducen sesgos sistemáticos en la valoración de probabilidades como el marco sociológico, ético y político que contextualiza la gestión de los riesgos en las sociedades modernas. (AU)

Risk is a concept that is usually evaluated by scientists and public health experts by comparing probabilities. However, this ethical utilitarian perspective, which considers that the best decision is the one that has less probability of harm than of benefit, does not consider normative aspects based on other ethical perspectives. Interpreting the origin of public controversies arising from people's reactions to the small risks of attenuated SARS-CoV-2 vaccines and evaluating the responses of public institutions requires an understanding of both the cognitive aspects that introduce systematic biases in the assessment of probabilities and the sociological, ethical, and political framework that contextualizes risk management in modern societies. (AU)

[Cognitive, ethical, social and political aspects in risk assessment: regarding vaccines against SARS-CoV-2]. / Aspectos cognitivos, éticos, sociales y políticos en la evaluación de riesgos: a propósito de las vacunas contra el SARS-CoV-2.

Risk is a concept that is usually evaluated by scientists and public health experts by comparing probabilities. However, this ethical utilitarian perspective, which considers that the best decision is the one that has less probability of harm than of benefit, does not consider normative aspects based on other ethical perspectives. Interpreting the origin of public controversies arising from people's reactions to the small risks of attenuated SARS-CoV-2 vaccines and evaluating the responses of public institutions requires an understanding of both the cognitive aspects that introduce systematic biases in the assessment of probabilities and the sociological, ethical, and political framework that contextualizes risk management in modern societies.

[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

La Medicina de Familia ante la ley sobre la ayuda médica para morir: responsabilidad y garantías / Family Medicine in the face of the law on medical aid in dying responsibility and guarantees

La aprobación de la ley de eutanasia supone un reto para la medicina y culmina un proceso de maduración cívica de la sociedad ante el morir. Existen desafíos que la aplicación de la ley deberá solventar. Buscar una solución médica objetiva e irreversible a un sufrimiento subjetivo, donde pueden existir determinantes sociales condicionantes, implica un grave riesgo de inequidad que requiere políticas que establezcan un marco pre-decisional garantista. La eutanasia debería ser una excepción gracias a la existencia de fuertes salvaguardas clínicas, informativas y relacionales que solo pueden garantizarse en el contexto de una atención primaria solvente que acompañe a las personas a lo largo de sus vidas. En este contexto primarista y comunitario, la eutanasia puede ser el último recurso de un profesional comprometido con el no abandono de un paciente con sufrimiento grave e irreversible que la solicita.(AU)

The approval of the euthanasia law represents a challenge for medicine and culminates a process of civic maturation of society in the face of death. There are challenges that the application of the law will have to meet. Seeking an objective and irreversible medical solution to subjective suffering - where there may be conditioning social determinants - implies a serious risk of inequity that requires policies that establish a pre-decisional guaranteeing framework. Euthanasia should be an exception thanks to the existence of strong clinical, informational and relational safeguards that can only be guaranteed in the context of a solvent primary care that accompanies people throughout their lives. In this primarist and community context, euthanasia can be the last resort of a professional committed to not abandoning a patient with severe and irreversible suffering who requests it.(AU)

[Family Medicine in the face of the law on medical aid in dying responsibility and guarantees]. / La Medicina de Familia ante la ley sobre la ayuda médica para morir: responsabilidad y garantías.

The approval of the euthanasia law represents a challenge for medicine and culminates a process of civic maturation of society in the face of death. There are challenges that the application of the law will have to meet. Seeking an objective and irreversible medical solution to subjective suffering - where there may be conditioning social determinants - implies a serious risk of inequity that requires policies that establish a pre-decisional guaranteeing framework. Euthanasia should be an exception thanks to the existence of strong clinical, informational and relational safeguards that can only be guaranteed in the context of a solvent primary care that accompanies people throughout their lives. In this primarist and community context, euthanasia can be the last resort of a professional committed to not abandoning a patient with severe and irreversible suffering who requests it.

Gobierno democrático de la ciencia y la tecnología en biomedicina: De la declaración de los conflictos de interés a la deliberación sobre los intereses en conflicto / Democratic governance of science and technology in biomedicine: from declaration of conflicts of interest to deliberation about conflicting interests

No disponible

[Ethical aspects of overdiagnosis: Between the utilitarianism and the ethics of responsibility]. / Aspectos éticos del sobrediagnóstico: entre el utilitarismo y la ética de la responsabilidad.

Overdiagnosis is an emerging and unexpected phenomenon in medicine with multiple causes: social, cognitive and technical. The most prevalent ethical assessment is the utilitarian one: in medicine it is not ethical to carry out any intervention with a negative benefit risk balance. However, there are non-utilitarian moral criteria, based on principles or individual rights, and personal utilities that must also be considered in the decision-making processes. The ethical approach of overdiagnosis has to be carried out from an ethics of responsibility that contemplates principles and consequences assuming that the decisions of managers, clinicians and citizens will introduce different moral perspectives. The solutions go through training and research; have a reliable biomedical knowledge; avoid conflicts of interest, both business and organizational, and improve shared decision-making in the public, clinical and individual spheres.

Aspectos éticos del sobrediagnóstico: entre el utilitarismo y la ética de la responsabilidad / Ethical aspects of overdiagnosis: Between the utilitarianism and the ethics of responsibility

El sobrediagnóstico es un fenómeno emergente e inesperado en medicina con múltiples causas: sociales, cognitivas y técnicas. La valoración ética más prevalente es la utilitarista: en medicina no es ético realizar ninguna intervención con un balance riesgo-beneficio negativo. Sin embargo, hay criterios morales no utilitaristas, basados en principios o derechos individuales, y utilidades personales que también se han de considerar en los procesos de toma de decisiones. El abordaje ético del sobrediagnóstico tiene que realizarse desde una ética de la responsabilidad que contemple principios y consecuencias asumiendo que las decisiones de gestores, clínicos y ciudadanos introducirán diferentes perspectivas morales. Las soluciones pasan por la formación y la investigación; contar con un conocimiento biomédico fiable; evitar conflictos de interés, tanto empresariales como organizativos, y mejorar la toma de decisiones compartidas, tanto en el ámbito público como en el clínico o individual

Overdiagnosis is an emerging and unexpected phenomenon in medicine with multiple causes: social, cognitive and technical. The most prevalent ethical assessment is the utilitarian one: in medicine it is not ethical to carry out any intervention with a negative benefit risk balance. However, there are non-utilitarian moral criteria, based on principles or individual rights, and personal utilities that must also be considered in the decision-making processes. The ethical approach of overdiagnosis has to be carried out from an ethics of responsibility that contemplates principles and consequences assuming that the decisions of managers, clinicians and citizens will introduce different moral perspectives. The solutions go through training and research; have a reliable biomedical knowledge; avoid conflicts of interest, both business and organizational, and improve shared decision-making in the public, clinical and individual spheres

Duda vacunal y democracia / Vaccine hesitancy and democracy

No disponible

No podemos esperar y cruzar los dedos / We cannot wait with fingers crossed

No disponible

Una forma de hacer operativo el pragmatismo clínico: sistematización del modo de acción de los médicos. Réplica / A way to make clinical pragmatism operative: sistematizaation of the actuation of competent physicians. Reply

No disponible