Responsabilidad civil médica en telemedicina: una propuesta de principios para una lex artis telemédica / Responsabilitat civil mèdica en telemedicina: una proposta de principis per a una lex artis telemèdica / Medical liability in telemedicine: a proposal of principles for a telemedical leges artis

El presente artículo analiza la responsabilidad civil médica atribuible a los profesionales de la salud que intervienen en el proceso de atención a distancia. Con este objeto, se propone un conjunto de principios de los cuales se derivan deberes de cuidado en la telemedicina exigibles a los profesionales de salud y a los prestadores. A partir de los principios de analogía con y complementariedad de la atención presencial, se desarrollan tres categorías de principios especiales para la atención a distancia: principios habilitantes, principios operativos y principios de protección al paciente. Bajo este esquema de principios se especifican deberes de cuidado, distinguiendo aquellos que responden a los riesgos causados por la distancia física de aquellos que surgen de los cambios organizacionales necesarios para este tipo de atención. La aplicación de estos deberes se analiza en tres escenarios de telemedicina: la teleconsulta, la teleinterconsulta y la teleconsultoría. Esta estructura de principios y deberes en la prestación de salud a distancia permite delimitar los alcances de la lex artis para cada escenario específico y, al mismo tiempo, elaborar estrategias regulatorias considerando criterios de necesidad, racionalidad y suficiencia, según los contenidos específicos que caracterizan cada escenario de atención de salud a distancia. (AU)

El present article analitza la responsabilitat civil mèdica atribuïble als professionals de la salut que intervenen en el procés d'atenció a distància. Amb aquest objecte, es proposa un conjunt de principis dels quals es deriven deures de cura en la telemedicina exigibles als professionals de salut i als prestadors. A partir delsprincipis d'analogia amb i complementarietat de l'atenció presencial, es desenvolupen tres categories de principis especials per a l'atenció a distància: principis habilitants, principis operatius i principis de protecció al pacient. Sota aquest esquema de principis s'especifiquen deures de cura, distingint aquells que responen als riscos causats per la distància física d'aquells que sorgeixen dels canvis organitzacionals necessaris per a aquesta mena d'atenció. L'aplicació d'aquests deures s'analitza en tres escenaris de telemedicina: la teleconsulta, la teleinterconsulta i la teleconsultoría. Aquesta estructura de principis i deures en la prestació de salut a distància permet delimitar els abastos de la lex artis per a cada escenari específic i, al mateixtemps, elaborar estratègies reguladores considerant criteris de necessitat, racionalitat i suficiència, segons els continguts específics que caracteritzen cada escenari d'atenció de salut a distància.(AU)

This article analyzes the civil medical liability imputable to health professionals involved at remote healthcare. To this end, a set of principles is proposed from which health professionals and telemedicine providers are required to perform care duties. Based on the principles of analogy with and complementarity of face-to-face healthcare, three categories of special principles for remote healthcare are developed: enabling principles, operational principles, and patient protection principles. Under this scheme of principles, duties of care are specified, distinguishing those that respond to the risks caused by physical distance from those that arise from the organizational changes necessary for this type of healthcare. The application of these duties is analyzed in three telemedicine scenarios: virtual visit, virtual consult and eConsult. This structure of principles and duties in the provision of remote healthcare allows to delimit the scope of leges artis for each specific scenario and, at the same time, to develop regulatory strategies considering criteria of necessity, rationality and sufficiency, according to the specific contents that characterize each scenario of remote healthcare.(AU)

Bioética y Derechos Humanos en una mirada latinoamericana / Bioètica i Drets Humans en una mirada llatinoamericana / Bioethics and Human Rights in a LatinAmerican perspective

Si bien parten del mismo contexto histórico y comparten preocupaciones centrales de fondo relacionadas con la protección de la persona humana, la interfaz entre Bioética y Derechos Humanos aún está experimentando un lento proceso de consolidación. Este artículo presenta un análisis histórico y conceptual de esta interfaz desde una perspectiva latinoamericana de la Bioética. Presenta dos temas que ejemplifican la complejidad -y el potencial -de este enfoque: la educación en bioética y la promoción de los Derechos de Pacientes. Sin desconocer las divergencias éticas y políticas que impregnan la discusión, el trabajo concluye en la necesidad de profundizar en este enfoque como vía para hacer efectivas las principales tareas que dieron origen a los dos campos:Bioética y Derechos Humanos, teniendo en cuenta el contexto histórico de la región.(AU)

Tot i que parteixen del mateix context històric i comparteixen preocupacions centrals de fons relacionades amb la protecció de la persona humana, la interfície entre Bioètica i Drets Humans encara està experimentant un lent procés de consolidació. Aquest article presenta una anàlisi històrica i conceptuald'aquesta interfície des d'una perspectiva llatinoamericana de la bioètica. Presenta dos temes que exemplifiquen la complexitat –i el potencial –d'aquest enfocament: l'educació en bioètica i la promoció dels Drets de Pacients. Sense desconèixer les divergències ètiques i polítiques que impregnen la discussió, el treball conclou en la necessitat d'aprofundir en aquest enfocament com a via per fer efectives les tasques principals que van donar origen als dos camps: Bioètica i Drets Humans, tenint en compteel context històric de la regió.

Although they start from the same historical context and share central fundamental concerns related to the protection of the human person, the interface between bioethics and human rights is still undergoing a slow consolidation process. This article presents a historical and conceptual analysis of this interface from a Latin American perspective of bioethics. It presents two themes that exemplify the complexity –and potential –of this approach: education in bioethics and the promotion of patients' rights. Without ignoring the ethical and political divergences that permeate the discussion, the work concludes for the need to deepen this approach as a way to make effective the main tasks that gave rise to the two fields: Bioethics and Human Rights, taking into account the historical context of the region.(AU)

It takes guts to be a rebel! A dynamic coordination account of the relationship between motivational reactivity, social morality, and political ideology.

This study tests two sets of competing hypotheses about the relationship between trait reactivity to positive and negative stimuli (i.e., motivational reactivity), moral stances on social principles (i.e., social morality), and political ideology. The classic view contends that a specific political ideology or social morality results from a specific motivational reactivity pattern, whereas the dynamic coordination account suggests that trait motivational reactivity modulates an individual's political ideology and social morality as a result of the majority political beliefs in their immediate social context. A survey using subjects recruited from a liberal-leaning social context was conducted to test these hypotheses. Results support the dynamic coordination account. Reactivity to negativity (indexed by defensive system activation scores) is associated with the adoption of the dominant social morality and political ideology. Reactivity to positivity (indexed by appetitive system activation scores) is associated with the adoption of nondominant social moral and political stances.

Social evolution as moral truth tracking in natural law.

Morality can be adaptive or maladaptive. From this fact come polarizing disputes on the meta-ethical status of moral adaptation. The realist tracking account of morality claims that it is possible to track objective moral truths and that these truths correspond to moral rules that are adaptive. In contrast, evolutionary anti-realism rejects the existence of moral objectivity and thus asserts that adaptive moral rules cannot represent objective moral truths, since those truths do not exist. This article develops a novel evolutionary view of natural law to defend the realist tracking account. It argues that we can identify objective moral truths through cultural group selection and that adaptive moral rules are likely to reflect such truths.

Moral reasoning and moral competence as predictors of cooperative behavior in a social dilemma.

The level of moral development may be crucial to understand behavior when people have to choose between prioritizing individual gains or pursuing general social benefits. This study evaluated whether two different psychological constructs, moral reasoning and moral competence, are associated with cooperative behavior in the context of the prisoner's dilemma game, a two-person social dilemma where individuals choose between cooperation or defection. One hundred and eighty-nine Mexican university students completed the Defining Issues Test (DIT-2; measuring moral reasoning) and the Moral Competence Test (MCT) and played an online version of the prisoner's dilemma game, once against each participant in a group of 6-10 players. Our results indicate that cooperative behavior is strongly affected by the outcomes in previous rounds: Except when both participants cooperated, the probability of cooperation with other participants in subsequent rounds decreased. Both the DIT-2 and MCT independently moderated this effect of previous experiences, particularly in the case of sucker-outcomes. Individuals with high scores on both tests were not affected when in previous rounds the other player defected while they cooperated. Our findings suggest that more sophisticated moral reasoning and moral competence promote the maintenance of cooperative behaviors despite facing adverse situations.

Moral injury as an inclusive mental health framework for addressing climate change distress and promoting justice-oriented care.

The unequal exposure to clinical conditions and other psychological responses associated with climate change and ecological degradation is due to resource access, geographical location, and other systemic factors. Ecological distress is further determined by values, beliefs, identity presentations, and group affiliations. Current models, such as climate anxiety, have made helpful distinctions between impairment and cognitive-emotional processes but obscure underlying ethical dilemmas and fundamental inequalities, restricting our understanding of accountability and the distress emerging from intergroup dynamics. In this Viewpoint, we argue that the concept of moral injury is essential because it foregrounds social position and ethics. It identifies spectrums of both agency and responsibility (guilt, shame, and anger) and powerlessness (depression, grief, and betrayal). The moral injury framework thus goes beyond an acontextual definition of wellbeing to identify how differential access to political power influences the diversity of psychological responses and conditions related to climate change and ecological degradation. A moral injury lens supports clinicians and policy makers to transform despair and stasis into care and action by delineating both the psychological and structural elements that determine the possibilities (and limits) of individual and community agency.

Biases in bioethics: a narrative review.

Given that biases can distort bioethics work, it has received surprisingly little and fragmented attention compared to in other fields of research. This article provides an overview of potentially relevant biases in bioethics, such as cognitive biases, affective biases, imperatives, and moral biases. Special attention is given to moral biases, which are discussed in terms of (1) Framings, (2) Moral theory bias, (3) Analysis bias, (4) Argumentation bias, and (5) Decision bias. While the overview is not exhaustive and the taxonomy by no means is absolute, it provides initial guidance with respect to assessing the relevance of various biases for specific kinds of bioethics work. One reason why we should identify and address biases in bioethics is that it can help us assess and improve the quality of bioethics work.

Neuro-computational mechanisms and individual biases in action-outcome learning under moral conflict.

Learning to predict action outcomes in morally conflicting situations is essential for social decision-making but poorly understood. Here we tested which forms of Reinforcement Learning Theory capture how participants learn to choose between self-money and other-shocks, and how they adapt to changes in contingencies. We find choices were better described by a reinforcement learning model based on the current value of separately expected outcomes than by one based on the combined historical values of past outcomes. Participants track expected values of self-money and other-shocks separately, with the substantial individual difference in preference reflected in a valuation parameter balancing their relative weight. This valuation parameter also predicted choices in an independent costly helping task. The expectations of self-money and other-shocks were biased toward the favored outcome but fMRI revealed this bias to be reflected in the ventromedial prefrontal cortex while the pain-observation network represented pain prediction errors independently of individual preferences.

Personal health monitoring in the armed forces - scouting the ethical dimension : A case study in the Netherlands Armed Forces during the Covid-19 pandemic.

BACKGROUND: The field of personal health monitoring (PHM) develops rapidly in different contexts, including the armed forces. Understanding the ethical dimension of this type of monitoring is key to a morally responsible development, implementation and usage of PHM within the armed forces. Research on the ethics of PHM has primarily been carried out in civilian settings, while the ethical dimension of PHM in the armed forces remains understudied. Yet, PHM of military personnel by design takes place in a different setting than PHM of civilians, because of their tasks and the context in which they operate. This case study therefore focusses on obtaining insights into the experiences and related values of different stakeholders regarding an existing form of PHM, the Covid-19 Radar app, in the Netherlands Armed Forces. METHODS: We carried out an exploratory qualitative study, using semi-structured interviews with twelve stakeholders in the Netherlands Armed Forces. We focussed on participation in the use of PHM, reflections on the practical use and use of data, moral dilemmas and the need for ethics support, all in regard to PHM. The data was analysed using an inductive thematic approach. RESULTS: Three interlinking categories reflecting ethical dimensions of PHM emerged: (1) values, (2) moral dilemmas, and (3) external norms. The main values identified were: security (in relation to data), trust and hierarchy. Multiple related values were found. Some, but no broadly shared, moral dilemmas were identified and no strong need for ethics support was expressed. CONCLUSION: This study shed light on key values, provide insights in the experienced and presumed moral dilemmas and bring to mind ethics support considerations when looking at PHM in the armed forces. Some values bring a certain vulnerability to military users when personal and organisational interests are not aligned. Furthermore, some identified values may hinder a careful consideration of PHM because they potentially conceal parts of ethical dimensions of PHM. Ethics support can assist in uncovering and addressing these concealed parts. The findings highlight a moral responsibility for the armed forces to devote attention to the ethical dimensions of PHM.

Physicians' Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions.

In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.

The acute effects of stress on dishonesty are moderated by individual differences in moral default.

In daily life we regularly must decide whether to act dishonestly for personal gain or to be honest and maintain a positive image of ourselves. While evidence suggests that acute stress influences moral decisions, it is unclear whether stress increases or decreases immoral behavior. Here, we hypothesize that stress, through its effects on cognitive control, has different effects on moral decision making for different individuals, depending on their moral default. We test this hypothesis by combining a task which allows for inconspicuously measuring spontaneous cheating with a well-established stress induction task. Our findings confirm our hypothesis, revealing that effects of stress on dishonesty are not uniform, but instead depend on the individual: for those who are relatively dishonest, stress increases dishonesty, whereas for participants who are relatively honest stress makes them more honest. These findings go a long way in resolving the conflicting findings in the literature on the effects of stress on moral decisions, suggesting that stress affects dishonesty differently for different individuals, depending on their moral default.

MEDICAL CONTRACTS WITH CONDITIONS CONTRARY TO PUBLIC POLICY.

OBJECTIVE: The aim: To reveal some features of medical contracts with conditions contrary to public policy. PATIENTS AND METHODS: Materials and methods: The study is based on the statutory acts of countries of European Union. The author also uses acts of international law in the field of medical services, the law and cases court practice of EU. CONCLUSION: Conclusions: The sphere of medical services objectively requires increased control by the state. There are various legal mechanisms for ensuring the rights of the patient and the proper level of medicine. It is important to invalidate the unfair terms of medical contracts, compensation for losses and moral damage. These remedies are obtained through judicial protection and, in some cases, through other jurisdictional means. It is important to implement European standards in national legislation.

The Contribution of Moral Case Deliberation to Teaching RCR to PhD Students.

Teaching responsible conduct of research (RCR) to PhD students is crucial for fostering responsible research practice. In this paper, we show how the use of Moral Case Deliberation-a case reflection method used in the Amsterdam UMC RCR PhD course-is particularity valuable to address three goals of RCR education: (1) making students aware of, and internalize, RCR principles and values, (2) supporting reflection on good conduct in personal daily practice, and (3) developing students' dialogical attitude and skills so that they can deliberate on RCR issues when they arise. What makes this method relevant for RCR education is the focus on values and personal motivations, the structured reflection on real experiences and dilemmas and the cultivation of participants' dialogical skills. During these structured conversations, students reflect on the personal motives that drive them to adhere to the principles of good science, thereby building connections between those principles and their personal values and motives. Moreover, by exploring personal questions and dilemmas related to RCR, they learn how to address these with colleagues and supervisors. The reflection on personal experiences with RCR issues and questions combined with the study of relevant normative frameworks, support students to act responsibly and to pursue RCR in their day-to-day research practice in spite of difficulties and external constraints.

Self and Others: Empirical and Neuropsychoanalytic Considerations of Superego and Conscience.

Freud's mature theorizing about human morality entrenched the functioning of the superego in anxiety stemming from the fear of punishment, a view with which many later psychoanalysts took issue, producing a debate as to the distinction between superego and conscience. This debate would later be mirrored more broadly in academic psychology concerning distinctions between shame and guilt. This is an area where the clinical observations and theoretical discussions of psychoanalysis have subtly guided research in cognitive psychology and the cognitive and affective neurosciences. These areas, in turn, have both clarified and supported psychoanalytic theory and practice without negating the rich phenomenological and theoretical basis on which psychoanalysis rests.

"She looked ten years older": Mechanisms of the new Woman's marriage and premature aging under patriarchy in Sarah Grand's The Heavenly Twins.

This article examines how the New Woman's premature aging happens in tandem with patriarchal marriage at the fin de siècle through a scrutiny of Sarah Grand's New Woman novel, The Heavenly Twins (1893/1992). The novel is a narrative of female degeneration, in which its three young and married New Woman characters become impuissant to realize the cumbersome feminized ideals of national regeneration and age or die prematurely in their twenties. Their premature decline is caused by moral and sexual degeneration of their military husbands who practice the ideology of progress at the imperial frontier. In the article, I explain how the patriarchal culture of the late Victorian society expedites women's aging process in marriage. The symptoms of mental and physical sickness experienced by the novel's Victorian wives in their twenties are a product not merely of excruciating syphilis but also the patriarchal culture. I ultimately contend that Grand unveils the other side of the male-oriented ideology of progress in criticizing the late Victorian reality where there is negligible scope for the New Woman's vision of female-led regeneration.

Local knowledge and unliveable narratives: How insights from family caregiving narratives can inform locally relevant ageing policy.

BACKGROUND AND OBJECTIVES: Accommodating local knowledge in national ageing policy demonstrates a country's intention to preserve local values, including cultural values of older adults' care. However, including local knowledge must provide space for nuanced and adaptive responses to it so that ageing policies can support families in adapting to changes and challenges around caregiving. RESEARCH DESIGN AND METHODS: This study interviewed members of 11 multigenerational households in Bali to understand the ways family carers use and resist local knowledge about multigenerational caregiving for older adults. RESULTS: Using qualitative analysis of the interplay between personal and public narratives, we found that narratives of local knowledge provide moral imperatives related to care, which shape expectations and a standard for evaluating the younger generations' behaviour. While most of the participants' accounts fit comfortably with these local narratives, some described challenges in which their life circumstances prevented them from identifying themselves as a virtuous carer. DISCUSSION AND IMPLICATIONS: Findings provide insight into the role of local knowledge in constructing caregiving function, carers' identities, family relationships, families' adaptation, and the influence of social structure (e.g., poverty and gender) on caregiving issues in Bali. These local narratives both confirm and dispute findings from other locations.

Filial piety, love or money? Foundation of old-age support in urban China.

This article explores the intertwining issues of filial obligation, material interest and emotional intimacy in driving adult children's provision of old-age support in family settings. Drawing upon multi-generational life history interviews with urban Chinese families, this article reveals how the configuration of these multiple forces is governed by the socio-economic and demographic context of a particular time. The findings dispute a lineal modernization model of transition and generational change (from past family relations structured by filial obligation to the present emotion-laden nuclear family). Instead the multi-generational analysis reveals a tightening association of multiple forces around the younger generation, intensified by the one-child demographic structure, post-Mao commercialization of urban housing and establishment of the market economy. Finally, this article highlights the role of performance in carrying out old-age support. "Surface work" is enacted in situations where tensions between conformity to public morality and private intents (emotional or material) cannot be reconciled.

Racial differences in legal socialization models across adolescence and emerging adulthood.

OBJECTIVE: White and non-White adolescents report different experiences in the legal system. This disparity impacts their evaluations of, and attitudes toward, legal authorities such that non-White and older adolescents tend to perceive the legal system more negatively. Yet, many researchers assume that the process of legal socialization, which involves internalizing norms and information about the law and the legal system, is universal for all ages and races. HYPOTHESES: We hypothesized that legal socialization models would change over the course of adolescent development and would differ by race. METHOD: We used data from two longitudinal studies to examine racial differences in the integrated legal socialization model in early, middle, and late adolescence. Study 1 included 140 young adolescents (59% White, 41% non-White), and Study 2 included 296 midadolescents (82% White, 18% non-White) followed into late adolescence/emerging adulthood. RESULTS: Study 1 identified differences in the integrated legal socialization model for young White and non-White adolescents. Normative status predicted rule-violating behavior for White participants, whereas no predictors or mediators related to rule-violating behavior for non-White participants. In Study 2, legal and moral reasoning during midadolescence became relevant in the model for both groups. Enforcement status predicted rule-violating behavior for non-White youth, whereas normative status continued to predict rule-violating behavior for White youth. In late adolescence/emerging adulthood, differences in the model shifted toward the relation between reasoning and legal attitudes. CONCLUSIONS: Our findings suggest that legal socialization is a developmental process occurring and changing throughout adolescence and that this developmental process differs for White and non-White youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).