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Span J Psychol ; 24: e16, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33745483


A sample of 641 participants were presented with four decision-making tasks during the first stages of the COVID-19 lockdown in Spain: The dictator game, framing problems, utilitarian/deontological and altruistic/egoistic moral dilemmas. Participants also completed questionnaires on mental health status and experiences related to the COVID-19 pandemic. We used boosted regression trees (an advanced form of regression analysis based on machine learning) to model relationships between responses to the questionnaires and decision-making tasks. Results showed that the psychological impact of the COVID-19 pandemic predicted participants' responses to the framing problems and utilitarian/deontological and altruistic/egoistic moral dilemmas (but not to the dictator game). More concretely, the more psychological impact participants suffered, the more they were willing to choose the safest response in the framing problems, and the more deontological/altruistic were their responses to moral dilemmas. These results suggest that the psychological impact of the COVID-19 pandemic might prompt automatic processes.

Ansiedad/psicología , Toma de Decisiones , Depresión/psicología , Estrés Psicológico/psicología , Adolescente , Adulto , Anciano , Altruismo , Teoría Ética , Ética , Femenino , Humanos , Aprendizaje Automático , Masculino , Salud Mental , Persona de Mediana Edad , Principios Morales , Análisis de Regresión , España , Adulto Joven
BMC Med ; 19(1): 45, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33563270


BACKGROUND: All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. METHODS: On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. RESULTS: Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. CONCLUSIONS: The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.

/uso terapéutico , Personal de Salud , Programas de Inmunización/métodos , Selección de Paciente , Policia , Adolescente , Anciano , /mortalidad , Niño , China/epidemiología , Comorbilidad , Teoría Ética , Femenino , Industria de Alimentos , Prioridades en Salud , Hospitalización , Humanos , Programas de Inmunización/organización & administración , Lactante , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Mortalidad , Casas de Salud , Pandemias/prevención & control , Formulación de Políticas , Embarazo , Transportes , Vacunación , Adulto Joven
HEC Forum ; 33(1-2): 45-60, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33449232


This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics-autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician-patient relationship is a deontological construct in which the physician's primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic.

Bioética , Teoría Ética , Pandemias/ética , Relaciones Médico-Paciente/ética , Ética Basada en Principios , Beneficencia , Humanos , Obligaciones Morales , Autonomía Personal , Justicia Social/ética
HEC Forum ; 33(1-2): 125-142, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33481144


As the world held its breath for news surrounding COVID-19 and hunkered down amidst stay-at-home orders, medical students across the U.S. wondered if they would be called to serve on the front lines of the pandemic. Medical school administrators faced the challenge of protecting learners while also minimizing harm to their medical education. This balancing act raised critical questions in medical education as institutions reacted to changing guidelines. COVID-19 has punctuated already contentious areas of medical education and has forced institutions and organizations to take quick action. From the perspectives of a recent medical school graduate and current resident (ES) and a practicing clinician-educator (SHG), we examine the pandemic's impact on undergraduate medical education through an ethical lens. First, we explore the value of medical education, what drives this value, and how COVID-19 may alter it. We next consider student choice and how shifts toward utilitarianism in healthcare during a pandemic may affect learning and career exploration. Then, we inquire how access to technology may impact the experience of medical students from diverse backgrounds and varied institutions during a rapid shift to socially distanced learning. We identify vulnerabilities for students at several phases of the journey: premedical, preclinical, clinical, and preparation for residency. Finally, we address the hidden curriculum of COVID-19, its potential erosion of empathy among current medical students, and possible long-term consequences for future physicians and patients.

/epidemiología , Educación de Pregrado en Medicina/ética , Médicos/psicología , Estudiantes de Medicina/psicología , Curriculum , Difusión de Innovaciones , Teoría Ética , Humanos , Pandemias , Estados Unidos/epidemiología
Rev. med. cine ; 16(4): 315-318, dic. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-199497


El corazón frágil es una miniserie británica, estrenada en 1996. Dado que este drama médico ofrece, entre otras, una variedad de posibilidades de debate sobre facetas deontológicas y actitudinales para médicos en particular y profesionales del área de la salud en general resulta más que recomendable apreciar las varias lecturas que permite. El objetivo de este trabajo es abordarla y presentar algunas de tales posibilidades

The fragile heart is a British miniseries, released in 1996. Since this medical drama offers, among others, a variety of possibilities for debate on deontological and attitudinal features for physicians in particular and professionals in health area in general is more than recommended appreciating the various readings it allows. The aim of this paper is to address it and present some of those possibilities

Humanos , Películas Cinematográficas , Moral , Ética Médica , Cirujanos/ética , Cirugía Torácica/ética , Medicina en las Artes , Teoría Ética
J Int Bioethique Ethique Sci ; 31(2): 11-25, 2020.
Artículo en Español | MEDLINE | ID: mdl-33319939


We address the ethical causes of the global ecological crisis we are currently undergoing, along with the expansion of the instrumental reason that is typical of modernity and the critics arisen from ecological ethics and feminism. Helping to solve the ethical crisis found in the base of ecology, with the intention of universal rationality, is possible from bioethical approach: utilitarianism and radical neoliberalism are useless, and maybe the foundations of our ethical duties with the nature and the rest of the living creatures may be found in the proposals of the dialogic ethics, neoaristotelian perspective and personalisme.

Bioética , Teoría Ética , Principios Morales , Humanos
Texto & contexto enferm ; 29: e20190104, Jan.-Dec. 2020.
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1101972


ABSTRACT Objective: to compare the moral values that nursing teachers and students consider important for vocational training with those they believe are promoted throughout undergraduate study. Method: a qualitative research; an ethnographic study conducted at a public nursing school in the state of Rio de Janeiro, in 2018, involving 40 interviews with teachers and students and a participant observation phase. Results: the moral values that teachers and students consider important for vocational training, as well as those that are promoted, converge on prudence, respect, responsibility, and empathy. It is noteworthy that the knowledge was much cited by the respondents and this article interpreted it as prudence. However, in relation to the values promoted during undergraduation, students warn that these are stimulated when referring to the binomial student-user of health, because they do not feel to the same intensity the presence of these moral values in the teacher-student relationship. Conclusion: a powerful strategy for teaching about moral values is to promote the care of their own students, teachers and staff. In this way, mismatches are avoided between what is said and what is done by experiencing values such as prudence, respect, responsibility and empathy within interpersonal relationships and in the daily life of the school.

RESUMEN Objetivo: comparar los valores morales que los profesores y estudiantes de enfermería consideran importantes para la formación profesional con los que creen que se promueven a lo largo de la carrera de grado. Método: investigación cualitativa; un estudio etnográfico realizado en el año 2018 en una facultad pública de enfermería del estado de Río de Janeiro, por medio de 40 entrevistas con profesores y estudiantes y una fase de observación de los participantes. Resultados: los valores morales que los profesores y estudiantes evalúan como importantes para la formación profesional, al igual como los que se promueven, convergen en la prudencia, el respeto, la responsabilidad y la empatía. Cabe destacar que el conocimiento fue muy citado por los entrevistados y, en este artículo, se lo interpretó como prudencia. Pese a ello, en relación con los valores promovidos a lo largo de la carrera de grado, los estudiantes manifiestan que se los fomenta cuando se refieren al binomio estudiante-usuario de servicios de salud, puesto que no sienten con la misma intensidad la presencia de estos valores en la relación profesor-estudiante. Conclusión: estamos frente a una poderosa estrategia para enseñar sobre los valores morales y promover el cuidado de sus propios estudiantes, profesores y personal administrativo. De esta manera, se evitan desencuentros entre lo que se dice y lo que se hace al respetar valores como la prudencia, el respeto, la responsabilidad y la empatía dentro de las relaciones interpersonales y en la vida cotidiana de la facultad.

RESUMO Objetivo: comparar os valores morais que professores e estudantes de enfermagem consideram importantes para a formação profissional com aqueles que eles acreditam que são promovidos ao longo da graduação. Método: pesquisa qualitativa; um estudo etnográfico realizado em uma faculdade pública de enfermagem do estado do Rio de Janeiro, em 2018, envolvendo 40 entrevistas com professores e estudantes e uma fase de observação participante. Resultados: os valores morais que os professores e estudantes avaliam ser importantes para a formação profissional, bem como aqueles que são promovidos, convergem para a prudência, o respeito, a responsabilidade e a empatia. Vale destacar que o conhecimento foi muito citado pelos entrevistados e, este artigo, interpretou-o como prudência. Todavia, em relação aos valores promovidos ao longo da graduação, os estudantes alertam que estes são estimulados quando referem-se ao binômio estudante-usuário de saúde, pois não sentem na mesma intensidade a presença desses valores morais na relação professor-estudante. Conclusão: uma potente estratégia para ensinar sobre os valores morais é promover o cuidado dos seus próprios estudantes, professores e funcionários. Dessa maneira, evitam-se desencontros entre o que se diz e o que se faz ao vivenciar os valores como a prudência, o respeito, a responsabilidade e a empatia dentro das relações interpessoais e no cotidiano da faculdade.

Humanos , Adulto , Teoría Ética , Ética , Moral , Estudiantes de Enfermería , Enseñanza , Enfermería , Investigación Cualitativa , Educación en Enfermería , Ética en Enfermería , Docentes , Relaciones Interpersonales
Soins Psychiatr ; 41(331): 34-38, 2020.
Artículo en Francés | MEDLINE | ID: mdl-33357666


This health crisis has revealed the difficulties, but also the creativity of the caregiving teams. In this context, assisting health professionals through the creation of an ethical support unit is valuable. However, the implementation of such a unit requires reflection with the definition of the resulting limits. Two questions are raised: is it really possible to externalise ethical reflection? Is there such a thing as ethics of crisis?

Teoría Ética , Personal de Salud/psicología , Humanos , Principios Morales
Am J Bioeth ; 20(11): 22-24, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33103981
Rev. habanera cienc. méd ; 19(5): e2954, sept.-oct. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1144692


RESUMEN Introducción: Los farmacéuticos enfrentan conflictos éticos en la dispensación de medicamentos. La resolución de estos asegura un servicio eficaz, seguro, digno y de calidad. Objetivo: Caracterizar desde una perspectiva ética-deontológica la dispensación de medicamentos en las farmacias de Cuenca-Ecuador, 2018. Material y Métodos: La investigación tuvo un diseño no experimental, descriptivo y transversal. La muestra no probabilística fue de 65 dependientes. Se aplicó un cuestionario para identificar la resolución de conflictos éticos y el nivel de conocimientos sobre Ética y Deontología Farmacéutica. Las respuestas fueron codificadas y analizadas con SPSS 23.0. Resultados: Los conflictos más frecuentes fueron el consentimiento informado (83 por ciento), prescripción médica (95 por ciento) y conflicto de intereses (84 por ciento). La resolución ética de los conflictos fue superior en dependientes capacitados en Ética y Deontología, con una correlación de 0,34 (p= (0,009) con el nivel de conocimientos en Deontología Farmacéutica. El nivel de conocimiento sobre Ética y Deontología Farmacéutica fue bajo en 60 por ciento de la muestra, con asociación inversa a la autopercepción de conocimiento (ρ=-0,259; p≤ 0,001). Conclusiones: La resolución empírica de los conflictos éticos durante el ejercicio de la profesión se realiza sin un fundamento ético-deontológico. El nivel de conocimiento en Ética y Deontología requiere una intervención desde la capacitación institucional y formación profesional de modo que se revierta en la adopción de decisiones acertadas que garanticen la seguridad del paciente como persona(AU)

ABSTRACT Introduction: Pharmacists face ethical conflicts related to the dispensing of medications. Their resolution ensures an effective, safe, dignified, and quality service. Objective: To characterize the dispensing of medications from an ethical-deontological perspective in pharmacies of Cuenca-Ecuador in 2018. Material and methods: A non-experimental, descriptive and cross-sectional study was conducted. The non-probability sample consisted of 65 pharmacists. A survey was applied to identify the resolution of ethical conflicts and the level of knowledge of Pharmaceutical Ethics and Deontology. Data were coded and analyzed with SPSS 23.0. Results: The most frequent conflicts included informed consent (83 percent), medical prescription (95 percent) and conflict of interests (84 percent).The resolution of ethical conflicts was higher in pharmacists with training in Ethics and Deontology, with a correlation of 0.34 (p =0.009) with the level of knowledge of Pharmaceutical Deontology. The level of knowledge of Pharmaceutical Ethics and Deontology was low in 60 percent of the sample, with an inverse association with the self-perception of knowledge (ρ= -0.259; p≤ 0.001). Conclusions: Empirical resolution of ethical conflicts while exercising the profession is carried out without ethical-deontological foundation. The level of knowledge of Ethics and Deontology requires intervention from institutional and professional training so that it is reverted to make the right decisions to guarantee the safety of the patient as a person(AU)

Servicios Farmacéuticos/ética , Teoría Ética , Medicamentos con Supervisión Farmacéutica , Epidemiología Descriptiva , Estudios Transversales , Ecuador
Cuad Bioet ; 31(102): 151-165, 2020.
Artículo en Español | MEDLINE | ID: mdl-32910669


The public health crisis caused by COVID-19 disease has bring again to the public arena the old debate of the role in decision-making process of politics and science. In this paper we analyze, in the context of the current pandemics, how politics has left a stellar role for science, either because science has anticipated in its proposals to politics, or because politics has opted for it as a premeditated strategy. The references to the opinion of scientists as a decision-making criterion or, furthermore, their presence as true spokesmen for authority have been so frequent. This means rediscovering science and health as instruments of power, in terms that remind us of what Foucault denounced almost fifty years ago with his Biopolitics.

Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Política , Ciencia , Infecciones por Coronavirus/prevención & control , Toma de Decisiones , Democracia , Teoría Ética , Política de Salud , Prioridades en Salud , Recursos en Salud/provisión & distribución , Humanos , Pandemias/ética , Pandemias/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Poder Psicológico , Salud Pública , Años de Vida Ajustados por Calidad de Vida , Asignación de Recursos/ética , Rol , Valores Sociales , Sociedades Científicas , España , Vacunas Virales
Cuad Bioet ; 31(102): 183-202, 2020.
Artículo en Español | MEDLINE | ID: mdl-32910671


The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the COVID 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons.

Betacoronavirus , Recursos en Salud/ética , Pandemias/ética , Asignación de Recursos/ética , Constitución y Estatutos , Infecciones por Coronavirus/prevención & control , Teoría Ética , Agencias Gubernamentales , Prioridades en Salud , Recursos en Salud/legislación & jurisprudencia , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Derechos Humanos/legislación & jurisprudencia , Humanos , Grupos Minoritarios , Pandemias/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Publicaciones , Asignación de Recursos/legislación & jurisprudencia , Rol , Justicia Social , Sociedades Médicas , España/epidemiología , Triaje/ética , Poblaciones Vulnerables
J Med Ethics ; 46(11): 732-735, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32958693


A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.

Educación en Salud/ética , Obligaciones Morales , Pandemias/ética , Médicos/ética , Rol Profesional , Responsabilidad Social , Acceso a la Información , Beneficencia , Betacoronavirus , Códigos de Ética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Competencia Cultural , Cultura , Teoría Ética , Equidad en Salud , Promoción de la Salud/ética , Humanos , Internet , Pandemias/prevención & control , Paternalismo , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/virología , Salud Pública/ética , Religión , Justicia Social
Rev. med. cine ; 16(3): 155-163, sept. 2020. ilus
Artículo en Español | IBECS | ID: ibc-197478


Este artículo profundiza en los acontecimientos narrados en el cuarto episodio de la sexta temporada de la serie House M.D. (título en inglés, en España es conocida como House o Dr. House). En él, el Doctor Chase se ve en el dilema de tratar a un dictador africano. Por un lado, el juramento hipocrático al que está ligado le obliga a sanar a su paciente, sin embargo, su moral individual lo empuja a tomar una decisión fatal. Y es que en eso estriba la peculiaridad ética de esta narración, en el choque de actitudes que codifican lo que se considera «el deber». Entre los principios y los fines, es el territorio en el que Chase se encuentra perdido. Una tierra de nadie que atormenta al profesional de la medicina, en general, y al Doctor Chase, en particular. El análisis cinematográfico dilucidará las claves éticas (temas) y estéticas (estrategias narrativas) de esta obra. El demiurgo que controla los aconteceres de la narración decide que el doctor tome el bando de los fines, aunque eso no signifique que sea lo correcto. Sin pretender ser ejemplo de lo que debiera hacerse en la vida real, esta obra, junto al estudio de la misma, invitan a explorar los límites de la deontología médica

This article delves into the events narrated in the fourth episode of the sixth season of House M.D. In it, Dr. Chase finds himself in the dilemma of treating an African dictator. On the one hand, the Hippocratic oath to which he is bound forces him to heal his patient, however, his individual morale pushes him to make a fatal decision. And it is that, in that lies the ethical peculiarity of this narrative, in the clash of attitudes that codify what is considered «duty». Between principles and ends, it’s the territory in which Chase is lost. A no man’s land that torments the medical professional, in general, and Dr. Chase in particular. Cinematic analysis will elucidate the ethical (themes) and aesthetic keys (narrative strategies) of this work. The demiurge that controls the storytelling happenings decides that the doctor takes the side of the ends, even if that does not mean that it is the right thing to do. Without pretending to be an example of what should be done in real life, this article, with the study of it, invites to explore the limits of medical deontology

Humanos , Medicina en las Artes , Películas Cinematográficas , Ética Médica , Teoría Ética , Juicio Moral Retrospectivo , Toma de Decisiones Clínicas/ética , Juramento Hipocrático
Rev. bioét. (Impr.) ; 28(3): 410-417, jul.-set. 2020.
Artículo en Portugués | LILACS | ID: biblio-1137123


Resumo Este artigo busca identificar contribuições da bioética para enfrentar conflitos relacionados à tomada de decisão em tempos de pandemia. Trata-se de texto elaborado a partir de reflexões pessoais dos autores em diálogo com a literatura de diferentes perspectivas da bioética. Com fundamento em relatos históricos, argumenta-se que, durante epidemias, a sociedade passa a atuar em modo de excepcionalidade, o que exige argumentação mais apurada para se posicionar ante os conflitos que surgem. Analisam-se então diferentes vertentes teóricas - principialismo, personalismo, utilitarismo e bioética social -, recolhendo de cada uma elementos que podem nortear a tomada de decisão. Com base nessas contribuições, propõem-se parâmetros para a atuação dos profissionais da saúde, reconhecendo igual valor em cada vida humana, com o propósito de salvar o maior número de pessoas possível. Por fim, aponta-se para a responsabilidade de agentes políticos.

Abstract This article aims to identify the contribution of bioethics to resolve decision-making conflicts in healthcare in times of pandemic. The research was based on the authors' personal reflections in a dialogue with the literature and different bioethical perspectives. Historical accounts show that when a society is experiencing an epidemic it starts to function in a mode of social exceptionality, reinforcing the need for a more appropriate form of reasoning before the ethical conflicts that may arise from this situation. Some approaches to bioethics - principlism, personalism, utilitarianism and social bioethics - are briefly examined in order to obtain the elements for guiding the decision-making process. Finally, we suggest some parameters for health professionals, recognizing the value of all human lives, to save as many lives as possible.

Resumen Este artículo tiene como objetivo identificar la contribución de la bioética para hacer frente a los conflictos relacionados con la toma de decisiones en tiempos de pandemia. Se trata de un texto elaborado con base en las reflexiones personales de los autores en diálogo con la literatura de diferentes perspectivas de la bioética. Con base en los relatos históricos, se argumenta que, durante epidemias, la sociedad pasa a actuar en modo de excepcionalidad, lo que requiere una argumentación más precisa para posicionarse ante los conflictos que surgen. Se analizan entonces diferentes vertientes teóricas -el principialismo, el personalismo, el utilitarismo y la bioética social-, recogiendo de cada una los elementos que pueden orientar la toma de decisiones. Con base en dichas contribuciones, se proponen parámetros para la actuación de los profesionales de la salud, reconociendo el mismo valor en cada vida humana, con el propósito de salvar al mayor número posible de personas. Por fin, se apunta hacia la responsabilidad de los agentes políticos.

Grupos de Riesgo , Bioética , Infecciones por Coronavirus , Teoría Ética , Personeidad , Toma de Decisiones/ética , Pandemias
J Med Ethics ; 46(10): 662-667, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32769094


In March 2020, the Government produced a document entitled "Responding to COVID-19: The Ethical Framework for Adult Social Care" ('The Ethical Framework'). In this article, we summarise the key features of the proposed ethical framework and subject it to critical analysis. We highlight three primary issues. First, the emphasis placed on autonomy as the primary ethical principle. We argue if ever there was a context in which autonomy should dominate the ethical analysis, this is not it. Second, we examine the interface between ethics and law which is largely overlooked in the document. Finally, we explore the surprising lack of attention paid to the concept of responsibility and communal obligations within the framework.

Infecciones por Coronavirus/terapia , Toma de Decisiones/ética , Análisis Ético , Ética Médica , Legislación Médica/ética , Autonomía Personal , Neumonía Viral/terapia , Responsabilidad Social , Adulto , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Teoría Ética , Humanos , Pandemias , Neumonía Viral/epidemiología , Medicina Estatal/ética , Medicina Estatal/legislación & jurisprudencia , Reino Unido
Cad Saude Publica ; 36(8): e00151620, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32756764


This essay aims to discuss the foundations and possibilities for community participation in the fight against COVID-19. The first part discusses the meanings of community, defined according to geographic, aggregate-interest, or epidemiological criteria. In the context of the pandemic, none of the three perspectives can be considered alone. The essay discusses the need to link different approaches in order to produce socially contextualized health interventions. Next, the authors present the four main models in the international literature that provide the basis for community participation practices in various countries. The analysis of community participation in the context of COVID-19 uses conceptual systematization based on two meta-narratives: utilitarian and social justice. The utilitarian perspective involves measures to restrict social contact. Participation is thus understood as collaboration in implementing measures that contribute to controlling the problem. The social justice perspective especially addresses the social determinants of health and reduction in social inequalities. The approach focuses on community empowerment and the search for solutions to the social and economic problems that determine the spread of COVID-19 and other diseases. The essay concludes on the peculiarities and importance of each approach. Community participation in the fight against COVID-19 should consider the emergency contexts to strengthen the health system and the defense of the social protection system and democracy.

Participación de la Comunidad , Infecciones por Coronavirus , Teoría Ética , Pandemias , Neumonía Viral , Justicia Social , Betacoronavirus , Brasil , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología
J Med Philos ; 45(4-5): 560-579, 2020 07 29.
Artículo en Inglés | MEDLINE | ID: mdl-32726810


After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement with our commentators and respond to their critical evaluations.

Bioética , Ética Basada en Principios , Teoría Ética , Humanos , Virtudes