PHYSICIANS' MORAL DUTIES DURING PANDEMICS.

BACKGROUND: Pandemics with devastating morbidity and mortality have occurred repeatedly throughout recorded history. Each new scourge seems to surprise governments, medical experts, and the public. The SARS CoV-2 (COVID-19) pandemic, for example, arrived as an unwelcome surprise to an unprepared world. DISCUSSION: Despite humanity's extensive experience with pandemics and their associated ethical dilemmas, no consensus has emerged on preferred normative standards to deal with them. In this article, we consider the ethical dilemmas faced by physicians who work in these risk-prone situations and propose a set of ethical norms for current and future pandemics. As front-line clinicians for critically ill patients during pandemics, emergency physicians will play a substantial role in making and implementing treatment allocation decisions. CONCLUSION: Our proposed ethical norms should help future physicians make morally challenging choices during pandemics.

Temporalidade no estabelecimento do vínculo parento-filial em adoções malsucedidas / Temporality in establishing the parent-child bond in unsuccessful adoptions / Temporalidad en el establecimiento del vínculo padre-hijo en adopciones fallidas

Este estudo é parte de uma ampla investigação sobre a vivência do processo de adoção malsucedida de crianças e adolescentes sob a perspectiva dos adotantes. Foi realizada uma pesquisa qualitativa, com base em entrevistas semiestruturadas com 11 sujeitos independentes, nove mulheres e dois homens, moradores de diferentes estados do Brasil, que vivenciaram adoções malsucedidas. Buscamos analisar as percepções dos adotantes relacionadas à temporalidade no estabelecimento do vínculo parento-filial nessas adoções. A temporalidade da gestação simbólica foi vivenciada pelos participantes de diferentes formas, podendo ser afetada pela lentidão no processo administrativo e/ou por fantasias e idealizações referentes à origem da criança/adolescente. Tanto a demora quanto a tentativa de agilização do processo de adoção são fatores que podem gerar ansiedade na experiência da gestação simbólica e que não serão amparados no tempo cronológico, afetando o estabelecimento do vínculo parento-filial. Ressaltamos a relevância do cuidado nos períodos iniciais de construção do vínculo parento-filial, considerando a temporalidade particular de cada caso e a história pregressa da criança/adolescente, aspecto que influencia o sucesso do processo de adoção.(AU)

This study is part of a broad investigation about the experience of the unsuccessful adoption process of children and adolescents from the perspective of the adopters. Qualitative research was carried out, based on semi-structured interviews with 11 independent subjects, nine women and two men, living in different states of Brazil, who experienced unsuccessful adoptions. We seek to analyze the perceptions of adopters related to the temporality in establishing the parent-child bond in these adoptions. The temporality of the symbolic gestation was experienced by the participants in different ways, which can be affected by the slowness of the administrative process and/or by fantasies and idealizations regarding the origin of the child/adolescent. Both the delay and the attempt to speed up the adoption process are factors that can generate anxiety in the experience of symbolic gestation and that will not be supported in chronological time, affecting the establishment of the parent-child bond. The relevance of care stands out in the initial periods of parent-child bond construction considering the particular temporality of each case and the child's/adolescent's past history, aspect that influences the success of the adoption process.(AU)

Este estudio es parte de una extensa investigación sobre la experiencia del proceso fallido de adopción de niños y adolescentes desde la perspectiva de los adoptantes. Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas con 11 sujetos independientes, nueve mujeres y dos hombres, residentes en diferentes estados de Brasil, que experimentaron adopciones fallidas. En este trabajo se analizan las percepciones de los adoptantes relacionadas con la temporalidad en el establecimiento del vínculo padre-hijo en adopciones fallidas. La temporalidad del embarazo simbólico fue vivida por los participantes de diferentes formas, las cuales pueden verse afectadas por la lentitud del proceso administrativo y por fantasías e idealizaciones sobre el origen del niño/adolescente. Tanto la demora como el intento de agilizar el proceso de adopción pueden generar ansiedad por la vivencia del embarazo simbólico y que no serán sustentados en el tiempo cronológico, lo que afecta establecer este vínculo. Se enfatiza la relevancia del cuidado en los períodos iniciales de construcción del vínculo considerando la temporalidad particular de cada caso y la historia pasada del niño/adolescente, un aspecto que influye en el éxito del proceso de adopción.(AU)

Componente curricular projeto de vida: perspectivas de professoras da rede estadual de São Paulo / Curricular component life purpose: perspectives of teachers of the São Paulo state network / Componente curricular proyecto de vida: perspectivas de profesores de la red estadual de São Paulo

O objetivo deste estudo foi conhecer a experiência de alguns professores ao lecionar projeto de vida durante a implementação do componente curricular Projeto de Vida no estado de São Paulo. Realizou-se uma pesquisa qualitativa, de caráter exploratório. Participaram do estudo sete professoras que lecionavam o componente curricular Projeto de Vida em duas escolas públicas, de uma cidade do interior do estado de São Paulo, escolhidas por conveniência. Foram utilizados o Questionário de Dados Sociodemográficos e o Protocolo de Entrevista Semiestruturada para Projeto de Vida de Professores, elaborados para este estudo. As professoras foram entrevistadas individualmente, on-line, e as entrevistas foram gravadas em áudio e vídeo. Os dados foram analisados por meio de análise temática. Os resultados indicaram possibilidades e desafios em relação à implementação do componente curricular Projeto de Vida. Constatou- se que a maioria das docentes afirmou que escolheu esse componente curricular devido à necessidade de atingir a carga horária exigida na rede estadual. As professoras criticaram a proposta, os conteúdos e os materiais desse componente curricular. As críticas apresentadas pelas professoras estão em consonância com aquelas presentes na literatura em relação à reforma do Ensino Médio e ao Inova Educação. Esses resultados sugerem a necessidade de formação tanto nos cursos de licenciatura quanto em ações de formação continuada, para que os professores se sintam mais seguros e preparados para lecionar o componente curricular Projeto de Vida na Educação Básica. Propõe-se uma perspectiva de formação pautada na reflexão e na troca entre os pares para a construção de um projeto coletivo da escola para o componente Projeto de Vida.(AU)

This study aimed to know the experience of some teachers when teaching life purpose during the implementation of the curricular component "Life Purpose" (Projeto de Vida) in the state of São Paulo. A qualitative, exploratory research was carried out. Seven teachers who taught the curricular component "Life Purpose" (Projeto de Vida) in two public schools in a city in the inland state of São Paulo, chosen for convenience, participated in the study. The Sociodemographic Data Questionnaire and the Semi-structured Interview Protocol for Teachers' Life Purposes, developed for this study, were used. The teachers were interviewed individually, online, and the interviews were recorded in audio and video. Data were analyzed using thematic analysis. The results indicated possibilities and challenges regarding the implementation of the Life Purpose curricular component. It was found that most teachers chose this curricular component due to the need to reach the required workload in the state network. The teachers criticized the proposal, the contents and the materials of this curricular component. Teacher's critics are in line with the criticisms present in the literature regarding the reform of High School and Inova Educação. Therefore, training is essential, both in undergraduate courses and in continuing education actions, so that teachers can teach the curricular component Life Purpose in Basic Education. A training perspective based on reflection and exchange between peers is proposed for the construction of a collective school project for the Life Purpose component.(AU)

El objetivo de este estudio fue conocer la experiencia de algunos profesores al enseñar proyecto de vida durante la implementación del componente curricular Proyecto de Vida en el estado de São Paulo. Se realizó una investigación cualitativa, exploratoria. Participaron en el estudio siete profesores que impartían el componente curricular Proyecto de Vida en dos escuelas públicas en un municipio del estado de São Paulo, elegidos por conveniencia. Los instrumentos utilizados fueron el cuestionario de datos sociodemográficos y el protocolo de entrevista semiestructurada para proyectos de vida de profesores, desarrollados para este estudio. Las entrevistas a los profesores fueron en línea, de manera individual, y fueron grabadas en audio y video. Los datos se sometieron a un análisis temático. Los resultados indicaron posibilidades y desafíos en relación a la implementación del componente curricular Proyecto de Vida. La mayoría de los profesores declararon elegir este componente curricular por la necesidad de alcanzar la carga horaria requerida en la red estatal. Los profesionales criticaron la propuesta, los contenidos y los materiales de este componente curricular. Las críticas presentadas están en línea con las críticas presentes en la literatura respecto a la reforma de la educación básica e Inova Educação. Por lo tanto, la formación es fundamental, tanto en los cursos de grado como en las acciones de educación permanente, para que los profesores puedan impartir el componente curricular Proyecto de Vida en la educación básica. Se propone una formación basada en la reflexión y el intercambio entre pares para la construcción de un proyecto escolar colectivo en el componente Proyecto de Vida.(AU)

Vagalumes e biografemas: poéticas e políticas públicas no desligamento institucional por maioridade / Fireflies and biographems: poetics and public policies regarding institutional removal due to adulthood / Luciérnagas y biografemas: poéticas y políticas públicas en desconexión institucional debido a la edad adulta

Este artigo versa sobre o processo de desligamento institucional por maioridade de jovens que residem em serviços de acolhimento. Aposta-se em uma política do sensível para visibilizar os encontros e desencontros que acontecem entre as e os jovens e as políticas públicas brasileiras. Para tanto, realizaram-se encontros com jovens que já haviam passado pelo processo de desligamento e com jovens que logo completariam 18 anos e teriam de sair das instituições de acolhimento. Para tornar visíveis essas existências, investiu-se na escrita de biografemas, inspirados na obra de Roland Barthes. Os conceitos de necropolítica e vidas precárias foram fundamentais para compreender as omissões do Estado no momento do desligamento. Verificou-se que o Estado pode maximizar a precariedade de algumas vidas, especialmente daquelas marcadas por características de raça, gênero e classe culturalmente marginalizados. Contudo, é também o encontro com as políticas públicas que garante melhores condições de vida para alguns, facilitando o acesso à universidade e ao mercado de trabalho. A pesquisa aponta que, diante do abandono, as e os jovens se fazem vagalumes, produzindo luminosidades em meio à escuridão e reivindicando o direito à vida.(AU)

This article discusses the process of institutional removal of young people that reside in foster care institutions for reaching adulthood. It relies on a politics of the sensitive to make visible the encounters and mismatches that take place between young people and Brazilian public policies. To do so, meetings were held with young people who had already experienced the removal process and with young people who would soon turn 18 and would have to leave the host institutions. To make these existences visible, this study invested in the writing of biographems, inspired by the works of Roland Barthes. The concepts of necropolitics and precarious lives were fundamental to understand the omissions of the State at the time of removal. It was also found that the State can maximize the precariousness of some lives, especially those marked by culturally marginalized race, gender, and class characteristics. However, it is also the encounter with public policies that ensures better living conditions for some, facilitating access to the university and the labor market. This research points out that, in the face of abandonment, young people become fireflies, producing luminosity amid the darkness and claiming the right to life.(AU)

Este artículo aborda el proceso de desconexión institucional justificado por la edad adulta de los jóvenes que residen en los servicios de acogida. Utilizamos una política sensible para hacer visibles las reuniones y los desajustes que tienen lugar entre los jóvenes y las políticas públicas brasileñas. Con este fin, se celebraron reuniones con los jóvenes que ya habían pasado por el proceso de desconexión institucional y también con los jóvenes que pronto cumplirían los 18 años y tendrían que abandonar las instituciones de acogida. Para hacer visibles estas existencias, se redactaron biografemas, inspirados en el trabajo de Roland Barthes. Los conceptos de necropolítica y vida precaria fueron fundamentales para comprender las omisiones del Estado en el momento de la desconexión. Se encontró que el Estado puede maximizar la precariedad de algunas vidas, principalmente de aquellas marcadas por características de raza, género y clase culturalmente marginadas. Sin embargo, el encuentro con las políticas también puede garantizar mejores condiciones de vida para algunos, facilitándoles el acceso a la universidad y al mercado laboral. Esta investigación señala que, ante el abandono, los jóvenes se convierten en luciérnagas, produciendo luminosidad en medio de la oscuridad y reclamando el derecho a la vida.(AU)

Local deliberative approach to the bioethical controversies: An opportunity for the proper implementation of neonatal screening / [Enfoque local deliberativo de las controversias bioéticas: una oportunidad para la adecuada implementación de la tamización neonatal].

Introduction: The controversial characteristics of neonatal screening influenced by bioethical considerations make its implementation complex. Colombia is not an exception in this sense and local circumstances complicate the panorama. Objective: To establish how bioethical controversies on neonatal screening are approached at a local level as a basis for deliberating on the must-be of this activity in Colombia. Materials and methods: A survey immersed in an interpretative investigation with descriptive and deliberative components of analysis was applied to approach the values exposed by officials of the Colombian Instituto Nacional de Salud. Results: The compulsory offer of screening by the nation, regardless of its opportunity cost and the consent for the use in research of results and residual samples, were not controversial, but, in contrast, the type of information and the consent to authorize screening did arise controversy. The more experienced officials preferred mandatory screening (17.7 vs. 11.79 years on average, p=0.007). Surprisingly, despite the risk of discrimination, keeping the neonate as the purpose, there was agreement on giving all the information to parents and medical records. Another controversial aspect was the follow-up of cases without hiding their identification where officials with more experience in bioethical aspects preferred the use of codes (4.5 vs. 1.26 years on average, p=0.009). In this context, strategies such as informed dissent, specialized advice or public health programs that appreciate diversity would allow to rescue even seemingly opposite values. Conclusion: A local approach regarding what ought to be in neonatal screening based on a deliberative bioethical perspective allowed to present an implementation proposal for this activity

Introducción. Las características controversiales de la tamización neonatal influenciadas por consideraciones bioéticas hacen compleja su implementación. Colombia no es ajena a esta situación y las circunstancias locales complican el panorama. Objetivo. Determinar cómo se abordan en el contexto local las controversias bioéticas en torno a la tamización neonatal como fundamento de las deliberaciones sobre el deber ser de esta actividad en Colombia. Materiales y métodos. Se aplicó una encuesta en el marco de un estudio interpretativo con dos componentes de análisis, uno descriptivo y otro deliberativo, en torno a los valores expuestos por funcionarios del Instituto Nacional de Salud. Resultados. La oferta obligatoria de la tamización por parte de la nación, independientemente del costo de oportunidad y el consentimiento para el uso de sus resultados y de las muestras residuales en la investigación, no suscitaron controversias, pero sí el tipo de información y la autorización para hacer la tamización. Los funcionarios con mayor experiencia expresaron su preferencia por una tamización obligatoria (17,7 Vs. 11,79 años en promedio; p=0,007). Sorpresivamente, a pesar del riesgo de discriminación, teniendo como fin el neonato, hubo acuerdo en entregar toda la información a padres e historia clínica. Otro aspecto controversial fue la identificación de los pacientes en el seguimiento, frente a lo cual los funcionarios de mayor experiencia en aspectos bioéticos prefirieron el uso de códigos (4,5 Vs. 1,26 años en promedio; p=0,009). En este contexto, estrategias como el disentimiento informado, el asesoramiento especializado o los programas de salud pública que aprecien la diversidad permitirían rescatar valores, incluso aquellos aparentemente opuestos. Conclusión. La aproximación local al deber ser de la tamización neonatal desde una perspectiva bioética deliberativa permitió ajustar una propuesta para su implementación.

Enfoque local deliberativo de las controversias bioéticas: una oportunidad para la adecuada implementación de la tamización neonatal / Local deliberative approach to the bioethical controversies: An opportunity for the proper implementation of neonatal screening

Resumen: Introducción. Las características controversiales de la tamización neonatal influenciadas por consideraciones bioéticas hacen compleja su implementación. Colombia no es ajena a esta situación y las circunstancias locales complican el panorama. Objetivo. Determinar cómo se abordan en el contexto local las controversias bioéticas en torno a la tamización neonatal como fundamento de las deliberaciones sobre el deber ser de esta actividad en Colombia. Materiales y métodos. Se aplicó una encuesta en el marco de un estudio interpretativo con dos componentes de análisis, uno descriptivo y otro deliberativo, en torno a los valores expuestos por funcionarios del Instituto Nacional de Salud. Resultados. La oferta obligatoria de la tamización por parte de la nación, independientemente del costo de oportunidad y el consentimiento para el uso de sus resultados y de las muestras residuales en la investigación, no suscitaron controversias, pero sí el tipo de información y la autorización para hacer la tamización. Los funcionarios con mayor experiencia expresaron su preferencia por una tamización obligatoria (17,7 Vs. 11,79 años en promedio; p=0,007). Sorpresivamente, a pesar del riesgo de discriminación, teniendo como fin el neonato, hubo acuerdo en entregar toda la información a padres e historia clínica. Otro aspecto controversial fue la identificación de los pacientes en el seguimiento, frente a lo cual los funcionarios de mayor experiencia en aspectos bioéticos prefirieron el uso de códigos (4,5 Vs. 1,26 años en promedio; p=0,009). En este contexto, estrategias como el disentimiento informado, el asesoramiento especializado o los programas de salud pública que aprecien la diversidad permitirían rescatar valores, incluso aquellos aparentemente opuestos. Conclusión. La aproximación local al deber ser de la tamización neonatal desde una perspectiva bioética deliberativa permitió ajustar una propuesta para su implementación.

Abstract: Introduction: The controversial characteristics of neonatal screening influenced by bioethical considerations make its implementation complex. Colombia is not an exception in this sense and local circumstances complicate the panorama. Objective: To establish how bioethical controversies on neonatal screening are approached at a local level as a basis for deliberating on the must-be of this activity in Colombia. Materials and methods: A survey immersed in an interpretative investigation with descriptive and deliberative components of analysis was applied to approach the values exposed by officials of the Colombian Instituto Nacional de Salud. Results: The compulsory offer of screening by the nation, regardless of its opportunity cost and the consent for the use in research of results and residual samples, were not controversial, but, in contrast, the type of information and the consent to authorize screening did arise controversy. The more experienced officials preferred mandatory screening (17.7 vs. 11.79 years on average, p=0.007). Surprisingly, despite the risk of discrimination, keeping the neonate as the purpose, there was agreement on giving all the information to parents and medical records. Another controversial aspect was the follow-up of cases without hiding their identification where officials with more experience in bioethical aspects preferred the use of codes (4.5 vs. 1.26 years on average, p=0.009). In this context, strategies such as informed dissent, specialized advice or public health programs that appreciate diversity would allow to rescue even seemingly opposite values. Conclusion: A local approach regarding what ought to be in neonatal screening based on a deliberative bioethical perspective allowed to present an implementation proposal for this activity.

Tribulaciones éticas del COVID-19: lo sobrecogedor siniestro, la responsabilidad existencial y Medice, Cura Te Ipsum

The COVID-19 pandemic revealed the vulnerability of the human being in their existential and medical fields. A feeling of uncertainty of an overwhelming and ominous nature indicates that dying is inherent for the human condition, a feeling that is daily hidden behind the mask of a casual, unexpected, random event. The possibility of dying from the viral disease revealed that the essence of man as being-in-the-world is ethical or self-assumption and is expressed through an original rather than a moral conscience, which calls for authenticity, to listen to its nihility as being-referred-to-death. The medical ethical principles based on rights and duties need to be perfected by the ethics of virtues in accordance with the current challenges, requiring a transformation of the moral self of the doctor. A moral failure of duty is inevitable for medicine, it will never reach its final realization.

[Ethical tribulations of COVID-19: the sinister ominous, existential responsibility and Medice, Cura Te Ipsum]. / Tribulaciones éticas del COVID-19: lo sobrecogedor siniestro, la responsabilidad existencial y Medice, Cura Te Ipsum.

The COVID-19 pandemic revealed the vulnerability of the human being in their existential and medical fields. A feeling of uncertainty of an overwhelming and ominous nature indicates that dying is inherent for the human condition, a feeling that is daily hidden behind the mask of a casual, unexpected, random event. The possibility of dying from the viral disease revealed that the essence of man as being-in-the-world is ethical or self-assumption and is expressed through an original rather than a moral conscience, which calls for authenticity, to listen to its nihility as being-referred-to-death. The medical ethical principles based on rights and duties need to be perfected by the ethics of virtues in accordance with the current challenges, requiring a transformation of the moral self of the doctor. A moral failure of duty is inevitable for medicine, it will never reach its final realization.

Nurses' moral deliberation in the child care process.

OBJECTIVE: To understand the nurses' moral deliberation in the face of an ethical problem involving breastfeeding. METHOD: Qualitative study based on the methodological theoretical framework of deliberative bioethics. Data collection was through a vignette-based interview and results were organized by thematic analysis. RESULTS: Nurses tend to take over intermediate courses of action, although extreme courses of action are found as well. FINAL CONSIDERATIONS: When they tend to take extreme courses of action, nurses approach decisions focused on the child welfare to the detriment of the mother's need as a working woman.

'Inglan is a bitch': hostile NHS charging regulations contravene the ethical principles of the medical profession.

Following the recent condemnation of the National Health Service charging regulations by medical colleges and the UK Faculty of Public Health, we demonstrate that through enactment of this policy, the medical profession is betraying its core ethical principles. Through dissection of the policy using Beauchamp and Childress' framework, a disrespect for autonomy becomes evident in the operationalisation of the charging regulations, just as a disregard for confidentiality was apparent in the data sharing Memorandum of Understanding. Negative consequences of the regulations are documented to highlight their importance for clinical decision makers under the principles of beneficence and non-maleficence. Exploration of the principle of justice illuminates the core differentiation between the border-bound duties of the State and borderless duties of the clinician, exposing a fundamental tension.

Research ethics guidelines and moral obligations to developing countries: Capacity-building and benefits.

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit-sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity-building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit because it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity-building, nurture respectful and trusting partnerships that benefit all stakeholders in international research.

Nurses' moral deliberation in the child care process / Deliberación moral de los enfermeros en el proceso de cuidado de los niños / Deliberação moral de enfermeiros no processo de cuidar de crianças

ABSTRACT Objective: To understand the nurses' moral deliberation in the face of an ethical problem involving breastfeeding. Method: Qualitative study based on the methodological theoretical framework of deliberative bioethics. Data collection was through a vignette-based interview and results were organized by thematic analysis. Results: Nurses tend to take over intermediate courses of action, although extreme courses of action are found as well. Final considerations: When they tend to take extreme courses of action, nurses approach decisions focused on the child welfare to the detriment of the mother's need as a working woman.

RESUMEN Objetivo: Comprender la deliberación moral de los enfermeros que enfrentan un problema ético relacionado con la lactancia materna. Método: Investigación cualitativa, basada en el marco teórico metodológico de la bioética deliberativa. La recolección de datos se realizó mediante una entrevista basada en viñeta y los resultados se organizaron mediante el análisis temático. Resultados: Los enfermeros tienden a tomar cursos de acción intermedios, sin embargo, se encuentran cursos de acción extremos. Consideraciones finales: Cuando tienden a tomar cursos de acción extremos, los enfermeros abordan las decisiones sobre el bienestar del niño, en detrimento de las necesidades de la madre como mujer trabajadora.

RESUMO Objetivo: Compreender a deliberação moral de enfermeiros diante de um problema ético envolvendo o aleitamento materno. Método: Estudo qualitativo, fundamentado no referencial teórico-metodológico da bioética deliberativa. A coleta de dados foi através de entrevista orientada por vinheta e os resultados foram organizados por análise temática. Resultados: Os enfermeiros tendem a assumir cursos de ações intermediários, todavia, são encontrados cursos de ação extremos. Considerações finais: Quando tendem a cursos de ação extremos, os enfermeiros acercam-se das decisões voltadas para o bem-estar da criança, em detrimento das necessidades da mãe, enquanto mulher trabalhadora.

Nosedive Caída en picada: La responsabilidad del sujeto y la subjetividad de su época / Nosedive The subject's responsibility and the subjectivity of his/her era

En el mundo contemporáneo la tecnología y, especialmente, las redes sociales, han ganado un lugar preponderante en la vida cotidiana de las personas, imprimiendo modificaciones tanto en las conductas como en los lazos sociales. No obstante, se mantiene el particular de época regido por el sistema jurídico, el valor del dinero, las clases sociales, etc. Ahora bien, ¿qué pasaría si la tecnología disponible y las normas sociales propiciaran un nuevo orden de aceptación y ascenso social? ¿Qué sucedería si la fascinación que producen las redes sociales fuese aprovechada por el poder mercantil elevándola a su máxima potencia, empleando así la popularidad como elemento de selección y pertenencia a un grupo de elite? A partir del episodio "Nosedive", nos proponemos analizar, a través de su protagonista Lacie, algunas cuestiones en relación con el uso de la tecnología y el impacto en la subjetividad, poniendo el foco en la responsabilidad del sujeto.

In our world, technology and social networks have earned a central place in people's daily life, producing modifications in their actions and in their social bonds. Nevertheless, the moral of our time continues to be ruled by the juridical system, the value of money, the social classes, etc. What would happen if the available technology and the social rules produced a new order of acceptance and social ascension? What would happen if the fascination on the social networks was seized by the power of the market to raise it to the maximum degree and to use popularity as a tool of selection and belonging to an elite group? We will analyze the episode "Nosedive", through the vicissitudes of the main character, Lacie, to pose some questions as regards the use of technology and the impact in subjectivity, by placing the focus of interest in the responsibility of the subject.

[Partial disclosure of information in the presence of presumable nocebo effects: an ethical analysis]. / Análisis ético de la entrega parcial de información al paciente para prevenir efectos nocebo.

When prescribing a treatment, the physician should give truthful information about the likely benefits and the potential adverse effects, allowing the patient to make an autonomous decision about whether to take the treatment. However, the mere expectation of adverse effects may precipitate the corresponding symptoms. This is called "nocebo effect", which in contrast to the placebo effect, can lead to harm to the patient due to psychological factors. Nocebo effects are common and clinically significant, although often unnoticed. This situation generates conflicts in medical ethics guiding principles, namely the moral obligation to disclose all possible effects of the prescribed drug as opposed to the duty of avoiding the harm of side effects that are likely to occur in a case. In other words, the physician faces a dilemma between the due respect for autonomy and the duty of non-maleficence. This article reflects about this conflict, by exploring the limits of the principle of autonomy and how to balance it with the principle of non-maleficence. We suggest an interpretation of the principle of autonomy from a patient-centered perspective, suggesting that it is ethically sound to give a prudential, partial disclosure of information to the patient, for the sake of avoiding potential nocebo effects. The article concludes with some cautionary considerations to be considered about this decision.

Applicability of the adapted Moral Distress Scale in the context of nursing in hemato-oncology services. / Aplicabilidade da Moral Distress Scale adaptada no cenário da enfermagem em hemato-oncologia.

OBJECTIVE: To verify the applicability of the adapted Moral Distress Scale in the nursing setting of the hemato-oncology sector of a university hospital. METHOD: Cross-sectional study conducted with 46 nursing workers of a university hospital in the southern region of Brazil with data collected between December 2014 and March 2015 by means of the adapted Moral Distress Scale. Factor analysis, Cronbach's alpha, and descriptive statistics were used to analyze the data. RESULTS: Factor analysis resulted in a group of 26 questions validated based on three factors: Lack of Competence in the Team, Denial of the Nursing Role as the Patient's Advocate, and Disrespect for the Patient's Autonomy. Cronbach's alpha of the instrument was 0.98. CONCLUSION: This study showed that the adapted Moral Distress Scale is an appropriate instrument for the identification of moral distress in nursing workers in the hemato-oncology area.

Advising a woman with suspected Zika virus infection.

The Zika virus (ZIKV) epidemic is spreading: 67 countries are now reporting transmission, and over 2,000 cases of congenital Zika syndrome (CZS) have been confirmed. The heaviest burden has been borne by those living where poverty, poor infrastructure, and lack of access to health services are common and the penetration of Aedes aegypti is high. Because most cases are asymptomatic, the most dramatic signs of the disease appear through the CZS cases. In spite of the need for disaggregated epidemiological data to understand transmission patterns and evaluate interventions in vulnerable populations, there is no reliable count of ZIKV cases by sex and ethnicity (1).

Análisis ético de la entrega parcial de información al paciente para prevenir efectos nocebo / Partial disclosure of information in the presence of presumable nocebo effects: an ethical analysis

When prescribing a treatment, the physician should give truthful information about the likely benefits and the potential adverse effects, allowing the patient to make an autonomous decision about whether to take the treatment. However, the mere expectation of adverse effects may precipitate the corresponding symptoms. This is called "nocebo effect", which in contrast to the placebo effect, can lead to harm to the patient due to psychological factors. Nocebo effects are common and clinically significant, although often unnoticed. This situation generates conflicts in medical ethics guiding principles, namely the moral obligation to disclose all possible effects of the prescribed drug as opposed to the duty of avoiding the harm of side effects that are likely to occur in a case. In other words, the physician faces a dilemma between the due respect for autonomy and the duty of non-maleficence. This article reflects about this conflict, by exploring the limits of the principle of autonomy and how to balance it with the principle of non-maleficence. We suggest an interpretation of the principle of autonomy from a patient-centered perspective, suggesting that it is ethically sound to give a prudential, partial disclosure of information to the patient, for the sake of avoiding potential nocebo effects. The article concludes with some cautionary considerations to be considered about this decision.

How Should Trainees Respond in Situations of Obstetric Violence?

Argentina passed a law for humanized birth in 2004 and another law against obstetric violence in 2009, both of which stipulate the rights of women to achieve respectful maternity care. Clinicians and women might still be unaware of these laws, however. In this article, we discuss the case of a fourth-year medical student who, while visiting Argentina from the United States for his obstetric rotation, witnesses an act of obstetric violence. We show that the student's situation can be understood as one of moral distress and argue that, in this specific instance, it would be appropriate for the student to intervene by providing supportive care to the patient. However, we suggest that medical schools have an obligation to better prepare students for rotations conducted abroad.

Do doctors have a moral duty to work in the public health sector? Ethical considerations regarding the social obligations of medicine. / ¿Tiene el médico el deber moral de trabajar en el sector público de salud? Consideraciones éticas sobre las obligaciones sociales del médico.

This article discusses whether physicians have social obligations and whether these obligations imply a moral duty to work in the public sector. The article focuses on the context of the Chilean health system, which has an unequal distribution of physicians to the detriment of the public sector, thus making the issue a particularly pressing one. After addressing arguments from different ethical theories and some empirical evidence, the article concludes that the physician has some social obligations in relation to a fair distribution of health resources, and that professional excellence should incorporate cultivating virtues related to social justice. In addition, it is argued that the moral duty to work in the public sector can be placed in the context of prima facie obligations which admit exceptions and allow the possibility of conflict with other professional obligations.

El presente artículo discute si los médicos tienen obligaciones sociales, y si de éstas se puede desprender un deber moral de trabajar en el sector público de salud. La discusión se sitúa en el marco del sistema de salud chileno en tanto presenta una desigual distribución de médicos en desmedro del sector público de salud, lo cual confiere especial relevancia al tema en cuestión. Tras evaluar argumentos procedentes de distintas teorías éticas y de la evidencia empírica, se concluye que el médico tiene obligaciones sociales en relación con una repartición justa de los recursos sanitarios, y que la excelencia profesional debiera incorporar el cultivo de virtudes orientadas a una mayor justicia social. Asimismo, se plantea que el deber moral de trabajar en el sector público de salud se sitúa en un plano de obligaciones prima facie que admiten excepciones y la posibilidad de conflicto con otras obligaciones profesionales.

"In our own words": Defining medical professionalism from a Latin American perspective.

BACKGROUND: Latin America has experienced a tremendous growth in a number of medical schools, and there are concerns about their quality of training in critical areas such as professionalism. Medical professionalism is a cultural construct. The aim of the study was to compare published definitions of medical professionalism from Latin American and non-Latin American regions and to design an original and culturally sound definition. METHODS: A mixed methods approach was used with three phases. First, a systematic search and thematic analysis of the literature were conducted. Second, a Delphi methodology was used to design a local definition of medical professionalism. Third, we used a qualitative approach that combined focus groups and personal interviews with students and deans from four medical schools in Chile to understand various aspects of professionalism education. The data were analyzed using NVivo software. RESULTS: A total of 115 nonrepeated articles were identified in the three databases searched. No original definitions of medical professionalism from Latin America were found. Twenty-six articles met at least one of the three decisional criteria defined and were fully reviewed. Three theoretical perspectives were identified: contractualism, personalism, and deontology. Attributes of medical professionalism were classified in five dimensions: personal, interpersonal, societal, formative, and practical. Participants of the Delphi panel, focus groups, and personal interviews included 36 medical students, 12 faculties, and four deans. They took a personalistic approach to design an original definition of medical professionalism and highlighted the relevance of respecting life, human dignity, and the virtue of prudence in medical practice. Students and scholars differed on the value given to empathy and compassion. DISCUSSION: This study provides an original and culturally sound definition of medical professionalism that could be useful in Latin American medical schools. The methodology used in the study could be applied in other regions as a basis to develop culturally appropriate definitions of medical professionalism.