Seminário - Bioética: pensando sua inserção curricular na educação profissional técnica em saúde

Trabalhamos com a definição do MEC sobre educação profissional técnica de nível médio. Ela corresponde às "qualificações profissionais técnicas de nível médio, como saídas intermediárias, até a correspondente habilitação profissional do técnico de nível médio", além das especializações técnicas de nível médio. Quanto à bioética fazer parte dos processos formativos de técnicos na área da saúde, compreendemos que as questões morais perpassam o fazer em saúde, inclusive dos técnicos. Então, a bioética, com suas diversas teorias (e não apenas uma), auxilia na reflexão sobre tais questões.

Kazuto Kato: the ethics of editing humanity.

Gary Humphreys talks to Kazuto Kato about the ethical and societal challenges posed by biotechnologies that allow for the editing of the human genome.

"The Hopkins Mongol Case": The Dawn of the Bioethics Movement.

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.

Clinical trials and the origins of pharmaceutical fraud: Parke, Davis & Company, virtue epistemology, and the history of the fundamental antagonism.

This paper describes one possible origin point for fraudulent behavior within the American pharmaceutical industry. We argue that during the late nineteenth century therapeutic reformers sought to promote both laboratory science and increasingly systematized forms of clinical experiment as a new basis for therapeutic knowledge. This process was intertwined with a transformation in the ethical framework in which medical science took place, one in which monopoly status was replaced by clinical utility as the primary arbiter of pharmaceutical legitimacy. This new framework fundamentally altered the set of epistemic virtues-a phrase we draw from the philosophical field of virtue epistemology-considered necessary to conduct reliable scientific inquiry regarding drugs. In doing so, it also made possible new forms of fraud in which newly emergent epistemic virtues were violated. To make this argument, we focus on the efforts of Francis E. Stewart and George S. Davis of Parke, Davis & Company. Therapeutic reformers within the pharmaceutical industry, such as Stewart and Davis, were an important part of the broader normative and epistemic transformation we describe in that they sought to promote laboratory science and systematized clinical trials toward the twin goals of improving pharmaceutical science and promoting their own commercial interests. Yet, as we suggest, Parke, Davis & Company also serves as an example of a company that violated the very norms that Stewart and Davis helped introduce. We thus seek to describe one possible origin point for the widespread fraudulent practices that now characterize the pharmaceutical industry. We also seek to describe an origin point for why we conceptualize such practices as fraudulent in the first place.

Coletânea: memórias da câmara técnica de bioética / Collection: memories of the technical chamber of bioethics

O Conselho Federal de Medicina (CFM) tem sido incansável na busca pelo respeito e valorização de princípios éticos e bioéticos correlatos à prática médica. Trata-se de uma meta prioritária para a autarquia, que reconhece o impacto positivo que sua incorporação traz para as relações estabelecidas entre médicos, pacientes, familiares e profissionais que integram as equipes de atendimento. Baseada em parâmetros como a beneficência, a não maleficência, a autonomia e a justiça, todos de fundamental relevância, a bioética ­ um campo de estudos que nasceu na década de 1970 ­ permeia intrinsecamente o exercício da medicina. Por outro lado, essas premissas deveriam igualmente serem norteadoras da ação de gestores, públicos e privados. Como forma de estimular o comportamento de indivíduos e instituições lastreado na bioética, o CFM tem se debruçado sobre o estudo de temas de alta relevância no mundo contemporâneo, cujo entendimento passa, necessariamente, pelo confronto com os princípios e parâmetros já citados. É o que ocorre, por exemplo, no caso de debates e normatizações sobre cuidados paliativos, terminalidade da vida, genética médica e reprodução humana. No Conselho Federal de Medicina, a Câmara Técnica de Bioética se tornou o epicentro dessas acaloradas e profícuas análises, com a participação ativa de conselheiros e de especialistas convidados. Como resultado, há a produção de inúmeros documentos que subsidiam o Plenário do CFM em seu processo de tomada de decisões.

El modelo médico como generador de discapacidad / The Medical Model as a Disability Generator / O modelo médico como gerador de deficiência

Resumen: La discapacidad ha tenido diferentes conceptualizaciones, incluyendo aportes religiosos, científicos, médicos y sociales. El modelo médico es fundamental en la prevención y la rehabilitación adecuada, sin embargo, es también un gran generador de discapacidad. El objetivo de este trabajo es presentar la relación del modelo médico de discapacidad y el enfoque biomédico como generadores de discapacidad y proponer una aproximación teórica a nuevos modelos y enfoques que permitan un abordaje ético-ontológico. El presente es un artículo de exposición en dos etapas: en la primera se hizo una revisión de literatura sobre discapacidad. En la segunda, se presentan los resultados de la discusión entre los autores para comparar e identificar argumentos y contraargumentos de los modelos tradicionales, con respecto a las nuevas formas de análisis con una visión desde la bioética. Una de las principales conclusiones de este análisis es que el modelo médico ha hecho aportes fundamentales en la conceptualización y clasificación de la discapacidad; sin embargo, el enfoque mono -causal positivista termina favoreciendo la medicalización, la discapacidad y demanda más recursos. La discapacidad es un asunto en evolución en el que interactúan las deficiencias individuales y las barreras personales y ambientales, por lo que es necesario superar el paradigma médico y fortalecer el biopsicosocial.

Abstract: Disability has had different conceptualizations, which have included religious, scientific, medical and social contributions. The medical model is fundamental for appropriate prevention and rehabilitation. The goal of this paper is to show the relationship of the disability medical model and the biomedical approach as generators of disability and to propose a theoretical approach to new models and perspectives that allow for an ethical-ontological approach. This is an expository article presented in two stages: in the first one a literature review on disability was carried out. In the second one, the results of the discussion are presented amongst the authors to compare and identify arguments and counterarguments of the traditional models, with regards to the forms of analysis with a view from bioethics. One of the main conclusions of this analysis is that the medical model has made fundamental contributions to the conceptualization of disability; however, the positivistic monocausal approach ends up favoring medicalization, disability and it demands more resources. Disability is a subject in evolution where the individual deficiencies and the personal and environmental barriers interact, therefore it is necessary to overcome the medical paradigm and to strengthen the biopsychosocial.

Resumo: O conceito de deficiência recebeu diferentes contribuições, incluindo as religiosas, científicas, médicas e sociais. O modelo médico é fundamental na prevenção e reabilitação adequada, no entanto, é também um grande gerador de deficiências. O objetivo deste trabalho é apresentar a relação do modelo médico de deficiência e do enfoque biomédico como geradores de deficiência e propor uma aproximação teórica para novos modelos e enfoques que permitam uma abordagem ético-ontológica. Trata-se de um artigo de exposição em duas etapas: na primeira, foi feita uma revisão da literatura sobre deficiência. Na segunda, são apresentados os resultados da discussão entre os autores para comparar e identificar argumentos e contra-argumentos dos modelos tradicionais, no que diz respeito às novas formas de análise a partir da bioética. Uma das principais conclusões dessa análise é que o modelo médico fez contribuições fundamentais na conceituação e classificação da deficiência. No entanto, o enfoque monocausal positivista acaba favorecendo a medicalização e a deficiência, além de demandar mais recursos. A deficiência é uma questão em evolução, na qual as carências individuais e as barreiras pessoais e ambientais interagem, sendo necessário superar o paradigma médico e fortalecer o biopsicossocial.

Dan Callahan's Press Clips.

For more than eleven years, I worked with Dan Callahan as an editor, a liaison with journalists, and a sounding board for ideas. To Dan, every new writing project was a thrill, whether it was for the New Republic or a blog. He consumed a wide range of professional and scholarly literature, followed the news with the eye of a reporter, and called experts when he wanted to learn more about something he had read. The result was a volcanic bubbling of story ideas. If he didn't turn them into articles or books, I sometimes had the feeling that he might burst.

Daniel Callahan and the Vocation of Bioethics.

Did Dan Callahan know the calling he was displaying in his own work and offering to others in the special intellectual garden of The Hastings Center, which he cocreated, with Will Gaylin, and went on to prune and tend for nearly four decades? I would say, yes, he knew what he was about. Successful people usually have self-confidence and drive in abundance, but in Dan's case, there was something more profound and interesting at work. Having gone through the endnotes of his latest book one day, I asked him how he found time to read so widely. He said he had learned to be an efficient skimmer who could pull out the nuggets he valued from another's work because he had a few magnetic ideas from which he would brook no distraction.

A Champion for the Unestablished.

As a student in bioethics, I knew that The Hastings Center and its founders were the height of excellence in this field, and therefore I found them both intimidating and intriguing. When I began working there, Dan Callahan was supportive of my endeavors to provide a venue for students and other young writers to express their views on bioethics. I started my own blog called Bioethx under 25 that featured short essays by anyone who wished to submit, generally individuals who had a genuine philosophical interest but were not yet at the level of pursuing a Ph.D. Dan's support of my project culminated in his sponsorship of the Daniel Callahan Young Writer's Prize, an essay contest run through the blog. This was one of the many ways he demonstrated that making theoretical contributions to bioethics should not be limited to a select few.

Crossing Boundaries.

I met Dan Callahan in 1986-when I came to pitch him. Coming from a sleek office setting near Boston, I was intrigued by The Hastings Center's higgledy-piggledy environment where so many smart people got to work in a relaxed, inviting atmosphere. I had noticed that the Center was producing a great deal of policy work on a wide range of topics but didn't seem to go further than publishing the highly valuable guidance developed under Dan Callahan's leadership. I ended my pitch, "Look, Dan, where Hastings gets bored and wants to go on to the next topic, my group in Boston gets interested." To my great pleasure, and despite his skepticism, Dan accepted the pitch. Beyond his generous responsiveness to unproven young people, Dan had many other virtues. For one, he was a boundary crosser.

[The energy metaphor for the human body and its effect on the rise of neurasthenia, neurosis and depression]. / La metáfora energética del ser humano y su incidencia en el auge de la neurastenia, la neurosis y la depresión.

This article aims to provide a historical critique of the rise of three diagnostic categories: neurasthenia (late nineteenth century), neurosis (first half of the twentieth century) and depression (mid-twentieth century to the present). The hypothesis is that their broad dissemination can be explained through their link to the energy metaphor for the human body. From the mid-nineteenth century on, the concept of energy spread through western culture, encouraging certain fictions about what we are - the ontological dimension - and what we could be - the ethical dimension. The article shows that these pathologies have codified and made intelligible a set of life trajectories that did not obey the imperatives of those onto-ethical fictions.

El artículo tiene por objetivo realizar una historia crítica del auge de tres categorías diagnósticas: la neurastenia (fin del siglo XIX), la neurosis (primera mitad del siglo XX) y la depresión (segunda mitad del siglo XX hasta nuestros días). La hipótesis es que su amplia difusión se explicaría debido al vínculo que ellas han tenido con la metáfora energética del ser humano. Desde mediados del siglo XIX, la concepción energética se difundió por la cultura occidental, habilitando ciertas ficciones acerca de lo que somos ­ dimensión ontológica ­ y lo que podríamos llegar a ser ­ dimensión ética. El artículo muestra que estas patologías han codificado y tornado inteligible determinadas trayectorias vitales que no cumplían con los imperativos de tales ficciones onto-éticas.

La metáfora energética del ser humano y su incidencia en el auge de la neurastenia, la neurosis y la depresión / The energy metaphor for the human body and its effect on the rise of neurasthenia, neurosis and depression

Resumen El artículo tiene por objetivo realizar una historia crítica del auge de tres categorías diagnósticas: la neurastenia (fin del siglo XIX), la neurosis (primera mitad del siglo XX) y la depresión (segunda mitad del siglo XX hasta nuestros días). La hipótesis es que su amplia difusión se explicaría debido al vínculo que ellas han tenido con la metáfora energética del ser humano. Desde mediados del siglo XIX, la concepción energética se difundió por la cultura occidental, habilitando ciertas ficciones acerca de lo que somos - dimensión ontológica - y lo que podríamos llegar a ser - dimensión ética. El artículo muestra que estas patologías han codificado y tornado inteligible determinadas trayectorias vitales que no cumplían con los imperativos de tales ficciones onto-éticas.

Abstract This article aims to provide a historical critique of the rise of three diagnostic categories: neurasthenia (late nineteenth century), neurosis (first half of the twentieth century) and depression (mid-twentieth century to the present). The hypothesis is that their broad dissemination can be explained through their link to the energy metaphor for the human body. From the mid-nineteenth century on, the concept of energy spread through western culture, encouraging certain fictions about what we are - the ontological dimension - and what we could be - the ethical dimension. The article shows that these pathologies have codified and made intelligible a set of life trajectories that did not obey the imperatives of those onto-ethical fictions.

Constructive Disappointment and Disbelief: Building a Career in Neuroethics.

Sometimes one's greatest academic disappointments can have unexpected outcomes. This is especially true when one is trying to change career trajectories or do something that others did not take seriously. My path into neuroethics was an unexpected journey catalyzed in part by constructive disappointment and the disbelief of colleagues who thought that the work I was pursuing nearly two decades prior was a fool's errand. After all, could anyone-in his or her right mind-ever conceive of waking up a person unconscious from brain injury and getting him to speak? 1.

Doctrines and Dimensions of Justice: Their Historical Backgrounds and Ideological Underpinnings.

Justice can be approached from many angles in ethical and political debates, including those involving healthcare, biomedical research, and well-being. The main doctrines of justice are liberal egalitarianism, libertarianism, luck egalitarianism, socialism, utilitarianism, capability approach, communitarianism, and care ethics. These can be further elaborated in the light of traditional moral and social theories, values, ideals, and interests, and there are distinct dimensions of justice that are captured better by some tactics than by others. In this article, questions surrounding these matters are approached with the hermeneutic idea of a distinction between "American" and "European" ways of thinking.

[When to consult the institutional bioethics committee? The deliberative method for resolving possible dilemmas]. / ¿Cuándo acudir al comité de bioética institucional? El método deliberativo para resolver posibles dilemas.

In healthcare, an ethical concern that arises during the decision making process is considered to be a bioethical dilemma. It is often the case that in the absence of proper deliberation, the problem is transferred to a bioethics committee, not even representing precisely a dilemma. Bioethics emerged as a discipline in the mid-20th century. It is defined as a support to decision-making in ethical dilemmas centered on two aspects: ethics of clinical investigation, focused on protecting the rights of research subjects, and bioethics in medical practice, of an advisory nature. To recognize the difference among difficult or complex clinical circumstances and ethical dilemmas could allow knowing when it is necessary to request for advice of a committee. It is not so much a question of deciding what is right or wrong, but which is the most advisable solution to a problem. We review the history of Bioethics Committees in Argentina that are facing today the challenge of promoting social responsibility and opening deliberations to community and health professionals. In the 20th century two historical moments are recognized: a pioneering and slow first period, and a second one of legal regulatory framework. Considering deliberation as a method of ethics, this article proposes a case analysis procedure and the deliberative method to elucidate dilemmas, with or without the help of a Committee.

¿Cuándo acudir al comité de bioética institucional?: El método deliberativo para resolver posibles dilemas / When to consult the institutional bioethics committee? The deliberative method for resolving possible dilemmas

En cuestiones de salud, cuando en el proceso de toma de decisiones se produce alguna tensión entre principios éticos, se considera estar frente a un dilema bioético. Puede suceder que, ante la falta de reflexión, se traslade a un Comité de Bioética Asistencial la resolución de problemas complejos que no constituyen estrictamente un dilema. La bioética surge como disciplina a mediados del siglo XX. Se define como una ayuda para la toma de decisiones en los dilemas éticos, centrada en dos aspectos: la ética de investigación para proteger los derechos de los sujetos de investigación; y la bioética asistencial, de carácter consultivo. Diferenciar entre situaciones clínicas difíciles o complejas y dilemas éticos, propiamente dichos, teniendo en cuenta los valores implicados, permitiría saber cuándo es necesario pedir un asesoramiento a un Comité. No se trata tanto de decidir qué es correcto o incorrecto, cuanto de cuál es la solución más recomendable a un problema. Se revisa la historia de los Comités de Bioética en Argentina que afrontan hoy el desafío de promover la responsabilidad social, abriendo las deliberaciones hacia la comunidad y los profesionales de la salud. En el siglo XX se distinguen dos momentos históricos: una primera etapa lenta y pionera y una segunda que obedece a la existencia del marco regulatorio legal. Teniendo en cuenta a la deliberación como método de la ética, este artículo propone un procedimiento de análisis de casos y el método deliberativo para resolver situaciones dilemáticas, con o sin la ayuda de un Comité.

In healthcare, an ethical concern that arises during the decision making process is considered to be a bioethical dilemma. It is often the case that in the absence of proper deliberation, the problem is transferred to a bioethics committee, not even representing precisely a dilemma. Bioethics emerged as a discipline in the mid-20th century. It is defined as a support to decision-making in ethical dilemmas centered on two aspects: ethics of clinical investigation, focused on protecting the rights of research subjects, and bioethics in medical practice, of an advisory nature. To recognize the difference among difficult or complex clinical circumstances and ethical dilemmas could allow knowing when it is necessary to request for advice of a committee. It is not so much a question of deciding what is right or wrong, but which is the most advisable solution to a problem. We review the history of Bioethics Committees in Argentina that are facing today the challenge of promoting social responsibility and opening deliberations to community and health professionals. In the 20th century two historical moments are recognized: a pioneering and slow first period, and a second one of legal regulatory framework. Considering deliberation as a method of ethics, this article proposes a case analysis procedure and the deliberative method to elucidate dilemmas, with or without the help of a Committee.

[Ethical aspects of medical thought on the madness in the enlightenment]. / Aspetti etici del pensiero medico sulla folia il epoca illuministica.

The seventeenth century is a period of transition from religious views that are not authentic but dogmatic about demonic influences to the application of scientific and methodological criteria in science. During Enlightenment there was an approach heavily influenced by ethical issues. In this context, there is a rational recognition of the value of man free from the teleological type references. Mental illnesses are treated using scientific criteria. During the seventeenth century clinical interest is also extended to psychosis and not only to neurosis. There are several significant changes in the care of psychiatric patient, and healthcare institutions are improved and increased. Many behaviors are inspired by the values of philanthropy.