La promesa de confidencialidad: nuevas luces para la investigación científica y la práctica profesional en salud mental / The promise of confidentiality: new lights for scientific research and professional practice in mental health / A promessa de confidencialidade: novas luzes para a investigação científica e prática profissional em saúde mental

Resumen: 15. En este trabajo se revisita el concepto de confidencialidad, a la luz de nuevos desafíos que surgen de los avances tecnológicos y de comunicaciones, y sus aplicaciones en la práctica profesional clínica y la investigación científica. Se fundamenta el análisis en la presentación de antecedentes filosóficos, así como también la distinción y precisión respecto de conceptos relacionados: intimidad, privacidad, anonimato, secreto profesional. Se hace un contrapunto entre privacidad, como derecho de los pacientes y participantes de la investigación científica, y confidencialidad y secreto profesional, como deber profesional. Se examinan nuevos retos a la confidencialidad en la práctica profesional y en la investigación científica en salud mental, como por ejemplo la protección de la información en la ficha clínica electrónica. Se concluye enfatizando la incorporación del tema en la reflexión ético-legal en la investigación y formación profesional.

Abstract: 19. In this paper the concept of confidentiality is revisited in the light of the challenges arising from technological and communications advances and their applications in clinical practice and scientific research. The analysis is based on the presentation of philosophical background as well as the distinction and precision regarding related concepts: intimacy, privacy, anonymity, and professional secret. A counterpoint between privacy rights of patients and participants of scientific research and professional secrecy and confidentiality as professional duty is done. Also new challenges to privacy are developed in professional practice and scientific research in mental health, like the protection of confidentiality of the electronic clinical file. The authors conclude emphasizing the need to include the subject in the ethical and legal reflection in research and professional education.

Resumo: 23. Neste trabalho foi revisitado o conceito de confidencialidade, à luz dos novos desafios decorrentes de avanços tecnológicos na comunicação e suas aplicações na prática profissional clínica e na investigação científica. A análise foi fundamentada na apresentação dos antecedentes filosóficos, bem como também, na distinção e na precisão a respeito de conceitos relacionados: intimidade, privacidade, anonimato e sigilo profissional. Faz-se um contraponto entre a privacidade como um direito dos pacientes e de participantes de pesquisa científica e a confidencialidade e sigilo profissional, como um dever profissional. Desenvolve-se novos desafios à confidencialidade na prática profissional e na pesquisa científica em saúde mental, por exemplo, a proteção das informações em fichas clínicas electrônicas. Conclui-se enfatizando a importância da incorporação do tema na reflexão ética-legal na pesquisa e na formação profissional.

Sex and the body in the Catholic tradition.

PIP: This article concerns the teachings on sexuality in the Latin Catholic tradition that have influenced ambiguity towards sex and virginity. These teachings were rooted from early Christian asceticism that contain elements of a counter-cultural, subversive movement against the dominant pattern of family and society. In the early Christian family, class and ethnic lines were leveled, and women emancipated to preach alongside men. However, radical movements that linked Christianity with sex rejection and marriage, allows emergence of a complex synthesis of patriarchy and celibacy. Marriage was affirmed to the laity, doubling women's subordination to their husbands and clerical authority, while equating their sexual and reproductive roles to sin and death. Sexual renunciation carried a radical vision through asceticism, and renunciation of sex was seen as a key expression of world renunciation. Christians focused more on the body and the repression of its needs, including sex. There were conflicting views concerning marriage, celibacy and sex. Until the mid-20th century, teachings that rejected the possibility of the goodness of sexual pleasure continued to characterize Catholic teachings. The negative teachings of the church on sexuality as degrading has not resulted in an abstemious Western society and has not produced a healthy view of sex. What is needed for the church and culture, is a new erotic art that seeks to assist people in developing their capacity for sexual pleasure and enjoyment, while incorporating it into deep friendship, so that sex becomes increasingly an expression of mutual love, commitment, and caring.^ieng

Third trimester abortion: is compassion enough?

PIP: One comprehensive ethical framework that can be applied to cases of third trimester abortion is based on the following notion: patient trust depends upon physicians developing specific virtues and basing their professional actions on these virtues. One such virtue, as described by Dr. John Gregory in 1772, is sympathy for the distress of others that overcomes self-interest. This application of sympathy and desire to relieve suffering can justify late term abortion in some cases. The compassionate response to sympathy forwarded by Gregory, however, must be properly regulated by reason, as Gregory himself recognized. Thomas Percival (1740-1803), author of the classic text "Medical Ethics," charged physicians with uniting "tenderness" (Gregory's "sympathy") with "steadiness." This combination of virtues reoccurs in the contemporary work of bioethicists Edmund Pellegrino and David Thomasma. The intellectual component of compassion requires physicians to exhibit compassion towards their patients, and this includes fetal patients. Thus, third trimester abortion is only justified in cases where fetal abnormalities are associated with the certainty or near certainty of early death or of a complete absence of cognitive developmental capacity. Most anomalies fail to meet these criteria, and physicians must exhibit the virtues of self-effacement and integrity to make rigorous, clinical, ethical judgements and properly balance the interests of the pregnant woman and the fetus.^ieng

Return migration to Jamaica and its development potential.

PIP: The return of migrants to Jamaica is closely associated with the persistence of the transnational household, which is established between the family members abroad and those who remain in Jamaica. The strength of transnational linkages is strongly determined by the manner and purpose of migration, by whether the migration involves an individual or a family, and the extent of the migrant's obligations in compensation for the neglect of responsibilities during his or her absence. Remittances precede, accompany, and follow the return of migrants. There was a consistent increase in remittances during the 1990s; they increased in revenue from US$183.3 million in 1991 to US$668.7 million in 1997. Quantitative statistics on return migration to Jamaica have only been gathered officially since 1992. Data showed a steady increase in the volume of return migration from 1992 to 1997. The largest numbers of returning residents were recorded in 1993 (2493) and in 1994 (2417). The majority of the migrants came from the US followed by the UK. A smaller percentage of return migrants came from Canada and other locations, chiefly Caribbean countries. Seeing potential in the Jamaican overseas community, the Government of Jamaica has established programs, such as the Return of Talent program, to encourage the return of its nationals. Two factors have had an impact on return migration to Jamaica: 1) the characteristics of the migrants in terms of skill level, experience, and attitudes and 2) the social and economic condition of the country itself.^ieng

Normatology: a review and commentary with reference to abortion and physician-assisted suicide.

PIP: This article opens with a review of the concept of "normatology," which was developed by Sabshin and Offer in four books published over a period of 30 years. Normatology seeks to produce an "operational definition of normality and health" over the life cycle. Such a definition can be used as a guideline in the deliver of health care. The importance of this field of study is highlighted when considering issues such as abortion or physician-assisted suicide. Fortunately, the proclivity of Americans to conduct public opinion polls helps researchers determine what is considered "normal" at any given time. Gallup Polls, which have posed the same question about the legality of abortion from 1975 to 1995, indicate that about half of all Americans continuously occupy the middle ground on this issue despite a somewhat liberalizing trend. In general, public opinion holds that it is normal to want to avoid giving birth to a damaged child, to place the mother's health and safety above that of the fetus, and to terminate a pregnancy resulting from rape. It is less normal to abort a healthy fetus on demand. Thus, abortion will likely continue to be a source of controversy and confusion in our society and among psychiatric patients. In comparison, psychiatrists express attitudes about abortion that are more liberal than normal. In the case of physician-assisted suicide, public approval has increased since 1950 as scientific advancements have facilitated the prolongation of unproductive and painful life. If legalized, physician-assisted suicide may depend upon psychiatric assessment of an absence of mental disease. Such an assessment is required in the Northern Territory of Australia, where voluntary euthanasia is legal, but not in the Netherlands, where it is government-regulated. Psychiatrists must understand public opinion in order to influence it or deal with it competently.^ieng

Bodies, rights and abortion.

The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies.

PIP: This essay argues against the claim that abortion can be justified by acknowledging that women have property in their bodies or "persons." The essay does not present arguments on either side of the abortion issue; it simply addresses the notion of abortion rights emanating from ownership of self. The first argument notes that ownership implies duties as well as rights. Acknowledging that we have duties in regard to our bodies places limits on our rights in regard to them. Particular rights and obligations are also attendant upon a person's fertility as a capacity of that person's body, but other people are not necessarily encumbered with a duty either not to interfere with a person's method of fertility regulation or to help that person carry out a fertility-related action. This "commonsense" discussion of rights is further elaborated with reference to the writings of three legal scholars about theories of property rights. S. R. Munzer classified body rights into personal rights and weak and strong property rights. Munzer relies on W. N. Hohfeld's use of the terms "claim-right," "privilege," "power," and "immunity" and combines Hohfeld's analysis with that of Honore who specified standard legal "incidents" of ownership. Munzer is reluctant to consider bodies "property" because they cannot be sold. Thus, body rights present a "weak package" of limited property rights and are more likely personal rights than property rights. It is concluded that ownership of our bodies in any sense of the term is not crucial because ownership can be a basis but not a prerequisite for the possession of rights and duties. The question remains as to what bodily rights and duties entail.

Urbanisation in China: a review of its causal mechanisms and spatial relations.

This article reviews "the forces underpinning Chinese urbanization.... This paper is divided into two main parts. The first addresses the (non-spatial) causal mechanisms between 1949 and 1977. Neither the ideological, the class, nor the economic formulation has touched on the more systemic mechanisms related to the socialist state and the shortage economy. This paper attempts to redress the imbalance by examining the advantages of combining Kornai's shortage model with Foucault's concept of governmentality. By drawing on concepts of spatial contingency, spatial boundary and locality effects, the second part of the paper argues that spatial relations do play significant roles in revealing Chinese urbanisation policies and patterns."

Abortion and religion.

PIP: This paper argues that religious communities should pose new questions about abortion in an attempt to reinvigorate the abortion debate and make it more constructive. Such questions would break the current impasse, enlarge the global and ecological scope of abortion inquiry, and engage plural religious perspectives in an interreligious dialogue about justice and abortion. After an introduction, the paper discusses the first impasse in the abortion debate, which is caused by conflicting definitions of personhood that create a fetus/pregnant woman dualism and artificially separate the fetus from its interdependence with the mother. Section 2 looks at how the abortion impasse results from the assertions of competing fetal and maternal rights and from conflict over who controls nature and women's bodies. The third section seeks alternatives to the dichotomizing of individual and community in the abortion debate in Christian theology, such as the notion of the relational self that demands attention to the wider social implications of reproduction. By examining theories that presume that people are relational, section 4 locates the abortion debate in a wider ecological context with concerns about overpopulation and environmental degradation. Section 5 explores questions of what authority can be used to determine whether abortion is ever justifiable for Christians and what authority is relevant for determining a Christian theological ethic of abortion. This section also looks at Jewish, Muslim, Hindu, and Buddhist views of abortion in the belief that the complex ethical issues relating to abortion may be explored through religious ritual.^ieng

"Conservative" views of abortion.

PIP: The introduction to this essay, which presents and defends the "conservative" position on abortion, explains that this position holds that 1) abortion is wrong because it destroys the fetus; 2) the fetus has full personhood from conception (or very near conception); 3) abortion is only justified under special circumstances, such as when the pregnancy poses a threat to the woman's life; and 4) these conclusions should be reflected in law and public policy. Part 2 sets forth the moral foundations for this position. The third part considers the status of the fetus and reviews the various arguments that have been forwarded to resolve the question, such as the species principle, the potentiality principle, the sentience principle, and the conventionalist principle. Part 4 applies the conservative position to problems posed by hard cases, determines that abortion is a form of homicide from two weeks after fertilization (at the latest), reviews circumstances in which various legal definitions of homicide are applicable, argues for the denial of abortion funding by the state, and notes that violent militancy is not the appropriate response to a belief that abortion should be illegal. Section 5 refutes objections to the conservative position based on the fact that some opponents of abortion also oppose contraception, based on feminist ideals, and based on calls for religious freedom in a pluralistic society. In conclusion, the labels applied to the abortion debate are examined, and it is suggested that "communitarian" is the best term for the conservative position.^ieng

Moderate views of abortion.

PIP: This essay offers a moderate view of abortion that imposes a time limit for unrestricted abortion and specific indications for later abortions. The introduction notes that the discussion will provide a defense for this policy based on a moral analysis but that other options for moderates, especially options provided by freestanding views (the defense of which does not rest on any prior commitment about the morality of abortion), will also be considered. The next section considers the moral status of the fetus grounded in a criterion of moral standing that stipulates the necessary characteristics to achieve moral standing. This discussion concludes that a fetus acquires moral standing only when it becomes sentient. Section 3 moves the argument from ethics to politics to prove that a moderate policy must place no limitations on abortion before the time the fetus becomes sentient because before that time the fetus has no interest for the state to protect. The final section notes that some pro-choice advocates may be happier with the moderate policy proposed than with its controversial defense based on the moral status of the fetus and that another defense of a moderate policy could be based on a finding that the ethical issue can not be decided and that no view about abortion ethics is more reasonable than any other. The essay concludes that the ethical debate is ultimately unavoidable.^ieng

[Umberto Eco and abortion]. / Umberto Eco y el aborto.

PIP: The Cardinal of Milan and the linguist and writer Umberto Eco maintained a correspondence in the mid-1990s in connection with the Italian magazine ¿Liberal¿. One of the issues discussed was the conflict between belief in the value of human life and existing abortion legislation. Umberto Eco stated that he would do all in his power to dissuade a woman pregnant with his child from having an abortion, regardless of the personal cost to the parents, because the birth of a child is a miracle. He would not, however, feel capable of imposing his ethical position on anyone else. Terrible moments occur in which women have a right to make autonomous decisions concerning their bodies, their feelings, their futures. Those who disagree cite the right to life, a rather vague concept about which even atheists can be enthusiastic. The moment at which a new human being is formed has been brought to the center of Catholic theology, despite its uncertainty; the beginning of a new life may always need to be understood as a process whose end result is the newborn. Only the mother should decide at what moment the process may be interrupted. The cardinal¿s response distinguished between psychic and physical life, on the one hand, and life participating in the life of God on the other. The threshold is the moment of conception, reflecting a continuity of identity. The new being is worthy of respect. Any violation of the affection and care owed to the being can only be experienced as a profound suffering and painful laceration that may never heal. The response of Eco is unknown.^ieng

Ethics of sex selection for family balancing. Why balance families?

PIP: Guidelines proposed by Pennings in 1996 to allow sex preselection ignore ethical problems, basic aspects of human biology and social behavior, cultural differences in reproductive choice availability, and implementation issues. The proposed guidelines would forbid sex preselection for a first child and in cases where gender balance exists. Sex preselection would only be used if the sex selected were that of the less represented gender in the family except when genetic risk is associated with a specific gender. Pennings did not clarify whether sex preselection would be used after a first child to prevent a gender imbalance or if it would be reserved for correcting gender imbalances after a second birth. The guideline which would forbid sex preselection for a first birth clearly violates the right to freely form a family contained in the UN Declaration of Human Rights. In cases where there is a legal prohibition on family size (China) because of sound population reasons, the guideline which proposes that sex preselection could only occur after two births is not just or practical. Fears about distorted sex ratios ignore the fact that sex ratios can change throughout the life cycle and can not be fixed at birth. Forbidding sex preselection could result in continued infanticide of first-born females. Also, this prohibits couples who freely choose to have only one child from preselecting the sex of that child. It is unreasonable to compel couples to have more than one child in order to have the child of the preferred sex. Limitation of the sex selected to the under-represented sex denies families the right to choose to have additional children of the same sex, which may be a practical necessity in some cases. This guideline also raises unaddressed enforcement questions. The use of reproductive technologies for sex preselection, when not clinically indicated, is a response to a social whim, and there is no indication whether the proposed guidelines would be an option or a limitation for couples. Furthermore, sex preselection would reduce the availability of reproductive technologies for the treatment of infertility.^ieng

To make a seamless garment, use a single piece of cloth.

PIP: While the Roman Catholic Church embraces anyone who does not use contraception and does not encourage others to do so, a similar statement about abortion is not enough; Catholics must also support anti-abortion legislation. This essay argues that decisions about the legality of abortion must be kept separate from individual decisions. This view is justified by reference to Catholic teaching on war which follows a significantly different method of moral decision-making than that applied to abortion. In fact, the methods applied to war would support a different interpretation of abortion. For example, while injunctions against the direct killing of innocent life apply to both abortion and war, there are no religious sanctions against those who destroy innocent life during wars (which is unavoidable in modern warfare) as there are towards women who have abortions. This inconsistency rests in the separation of reality into a public sphere, in which the Church views itself as a newcomer, and the private sphere, in which the Church asserts ownership. Another difference in the treatment of war and abortion can be seen in the fact that the Church's political involvement in abortion seeks to deny rights to some while giving them to persons unrecognized by law. This ignores the fact that real personhood is not possible without having a sense of bodily integrity, but bodily integrity is championed by the Church in other contexts (antislavery, condemnation of torture, etc.). The Church can not say that women accept the possibility of pregnancy when they engage in sexual intercourse, because by teaching that natural methods of contraception are acceptable, the Church has separated intercourse from procreation. Also, many women have no moral choice about their participation in intercourse. As is done in the case of war, abortion should be equated with killing, which is not intrinsically evil, rather than with murder. The Church does not obligate Catholics to perform good deeds or to save innocent life (starving children), yet women are being told they must make extreme sacrifices to protect fetal life.^ieng

An open letter from a Catholic birth mother.

PIP: This open letter was written in response to a reply from a priest to a woman's initial letter describing her experience in giving up a baby for adoption. The mother described how wrenching the experience remains for her, 10 years after the fact. She became pregnant when she was a 23-year-old, unmarried student. Her strong allegiance to the Roman Catholic Church precluded abortion, so she bore the child and reluctantly gave her up for adoption. The mother condemns the pro-life sentiments that label the assessment she made about her inability to keep her child as "courageous, unselfish, and loving" while condemning as an "excuse" the same process undertaken by women who arrive at a different decision (to abort). During her pregnancy, the mother moved from a strongly pro-life stance to one in which she knew she would never tell another woman what choice to make. The mother noted that the Church agencies working toward adoption pushed mothers to do what is "best" for the child but never addressed the problems which caused the mothers to become pregnant in the first place or the damage to the mother caused by the loss of her child. When the mother became pregnant again soon after her loss, she decided to abort and found that experience one of the most peaceful of her life and one which made her face the problems in her life. While she is not glad she had an abortion, the pain of the abortion was much less than the pain of adoption. The mother tells the priest that there are many devastating experiences connected with child bearing, and that the Church should attempt to reach out to women who have been hurt and need healing. The letter ends by referring to a 17-year-old valedictorian who was banned from speaking at her graduation from a Catholic High School because she had a 16-month-old daughter at home. She was punished for choosing not to abort.^ieng

Reflections of a Catholic theologian on visiting an abortion clinic.

PIP: A male Irish Catholic moral theologian paid several visits to an abortion clinic to attempt to reflect a woman's understanding of the abortion decision in his writing and thinking. At the clinic he saw the measures taken to protect clients and staff from attacks by anti-abortion protestors. The clinic director described the clinic's activities and patients and noted that none were rich and that the doctors performing the abortions could all make more money doing something else. Patient counseling stressed reproductive responsibility, and the clinic staff did more to prevent abortion than the protestors outside. During his second visit, he met a woman waiting for an abortion who was 5-6 weeks pregnant and who sustained her mental health by taking lithium which could cause abnormalities in embryos. This made the visitor determine that saving life involves more than cardiopulmonary continuity. He observed interviews with patients and learned that abortion is often caused by economic distress, which was exacerbated among the poor by the anti-abortion President, Reagan's, economic policies. When he met with the picketers outside, he was repulsed by the fact that they equated abortion with the Nazi Holocaust. On his third visit, he viewed the products of abortion and concurred with the Church's Council of Trent that the embryonic clump of cells was not a person. His visits left him eager to keep abortion legal and to reduce the need for abortion in women's lives. He also wished that American Catholic bishops would stop making sanctimonious utterances about abortion and would embrace the more moderate traditional teachings of the church about abortion rather than squandering their moral authority on an issue which allied them with right-wing forces which have a destructive social agenda.^ieng

English TC explains church teaching to college students.

PIP: This article presents an explanation of Church teaching to college students on the meaning of marriage, the religious tenets of natural family planning, sexual abstinence, and human rights within population policies. It is argued that the use of natural family planning and abstinence within marriage involves a change in attitude toward sexuality. Fertility is a gift to be used and enjoyed as part of sexuality. Sex becomes a sign of renewal of the covenant of marriage that strengthens and is being strengthened by a growing love for one another. The Catholic Church teaches that birth regulation is necessary for planning families. Natural family planning is the best way to build relationships and to grow in love. Contraceptive sex is a rejection of the patterns of fertility that are the basis of womanhood. Love within marriage is more than an emotional attachment. It is a commitment to each other that takes love out of peaceful feelings and into the realm of decisions. The covenant of love is complete acceptance of each other that hides nothing. Anything that limits the self-gift to each other is a limit to marriage. Natural family planning takes into account a knowledge and appreciation of fertility in contrast to modern contraception that associates fertility control with a problem to be avoided or destroyed. Abstinence during the most fertile period can be a way of loving in itself, by respecting and valuing this time period in order to focus on growing together in love. The fertility cycle becomes a cycle of love that passes through the stages of courtship and honeymoon. Modern contraception has contributed to the breaking of the link between marriage and the procreative meaning of life. The eugenics movement in the early years of birth control proposed that only the best should be allowed to breed. The randomness of love is a barrier to policies of selective human breeding. The Church reinforces the view that every new life is a gift and parenting is a privilege.^ieng

Islam is for family planning. Husbands and wives can stop pregnancy for medical, psychological, social and/or financial reasons.

PIP: The author believes that all religions have the common objective of offering happiness to all humans, discussing religious matters must depend upon correct knowledge of the facts and the proper understanding of relevant issues, differing opinions are accepted as long as they foster discussion intent upon revealing the truth, children can be the source of happiness if taught morality and ethics, God created the universe and everything is running according to a perfect discipline, and the Islamic Shari'ah has laid the foundation for a detailed system characterized by clear rules to guide humans in their communities on how to enjoy their rights and respect their duties. He discusses the meaning of family planning, explains that family planning is allowed from the religious point of view, and explains that there are no official fatwa which approve of family planning. The call for family planning contradicts no Koranic verses and it is useless for governments to issue laws on family planning. Family planning does not contradict Islam faith and belief in destiny, and any method approved by knowledgeable senior doctors which fails to violate the rules of Shari'ah are approved by Islam. Islam is a religion supportive of family planning.^ieng

Family planning is acceptable. Muslim religion does shed light on all the problems of humankind and leads the people to clarity of mind, satisfied conscience and happiness.

PIP: Our global population of more than 6 billion humans becomes ever more closely linked. Resources are limited and pollution spreads. As such, global population growth affects everyone. As the global population continues to swell, it will become increasingly hard to accommodate the basic food and living needs of the human population. Urbanization, environmental destruction, and poverty are already widespread, serious problems. The rate at which the world's population is growing must be checked. Coercing couples to limit their fertility, however, is not an option. Instead, the small family norm and family planning must be promoted. The author believes that it is not the role of politicians to discuss the compatibility of family planning with Islam. That task should be left to Muslim scholars who will both investigate the issue and pass judgement. As a Muslim, however, the author believes that Islam is founded upon reason, logic, and rationality. The Prophet Mohammed would most likely not like to see before him an overcrowded, unhealthy, unhappy, and ignorant Muslim community on judgement day. The author further stresses that nowhere in the Qur'an is anything found against family planning.^ieng

An obligation to provide abortion services: what happens when physicians refuse?

Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection.

PIP: In California, whereas the state mandates the obligation of counties to provide abortion services for incarcerated and for incompetent women, the state also has "conscience clause" legislation which allows health care workers to be excused from providing abortions simply by signing a written declaration. The existence of this legislation can create a situation whereby a county must provide abortions but has difficulty locating a physician to perform the procedures. Whereas individuals must have the right not to engage in activities they find morally repugnant, the California conscience clause is flawed because it fails to consider the moral obligations of physicians to provide services and because it trivializes the process of moral decision-making since no actual justification is needed. Rather than being at complete liberty to choose which services to offer, physicians have an obligation to provide services. Therefore, the burden of proof lies with those who wish to be excused from certain activities. This obligation arises from the debt physicians owe to society through the receipt of extraordinary social benefits (partially taxpayer-supported education; the privilege of professional licensure; the monopoly granted for most types of medical care through state licensing; large salaries and prestige; and, in some cases, employment at taxpayer-supported institutions) and because of the social harm which would occur if services were not provided. California's conscience clause legislation should be amended to establish review boards to evaluate claims of moral objection to providing abortion. Possible criteria which the Boards could follow would include determining: 1) if the applicant has a sincere scruple-based objection, 2) if the scruple fits an otherwise coherent system of beliefs, 3) if the scruple is consistent with other beliefs and actions, and 4) if the scruple is a key component of the petitioner's moral or religious framework. If an exception is granted, all reasonable alternatives should be explored to ensure that physicians fulfill their obligation to provide service, including having the petitioner provide only follow-up care or substituting some other form of public-benefiting service.

[Urban project and planning: a necessary dialogue]. / Proyecto urbano y planificacion: un dialogo necesario.

PIP: The relationship between urban projects and planning has received increased attention in the past decade or so, simultaneously with changes in modes of construction and increasingly limited availability of new urban spaces. The discussion has reaffirmed the importance of the interaction between a project and the plan; the plan is valuable as an important element of the project, and the project becomes concrete proof of the value of the plan. This view of project and plan is part of the process underway since the 1970s, in which context emerged as a preeminent part of an architectural project along with the conception of the project itself as a critical dialogue with existing structures and their modification. Greater attention has thus been given to the constructed city and its history. This work traces the debate over aesthetic and practical aspects of the relationship, including commentary on the social implications of reactions to the renewed debate among architects and others.^ieng