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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[The human corpse in arts and bioethics: Michelangelo´s Pietà Rondanini]. / El cadáver humano en el arte y la bioética: la Pietà Rondanini de Miguel Ángel.

According to bioethics, life is a fundamental but not an absolute good. Therefore the value of a person resides in being alive, no matter in which state such person is. The concept of brain death is legally and ethically accepted as the definition of death. In artworks, human beings are revealed as they are. Michelangelo's Pietà Rondanini captures and captures what a human corpse is, in its most intimate appearance. The artist boldly reveals its essence.

El cadáver humano en el arte y la bioética: la Pietà Rondanini de Miguel Ángel / The human corpse in arts and bioethics: Michelangelo´s Pietà Rondanini

According to bioethics, life is a fundamental but not an absolute good. Therefore the value of a person resides in being alive, no matter in which state such person is. The concept of brain death is legally and ethically accepted as the definition of death. In artworks, human beings are revealed as they are. Michelangelo’s Pietà Rondanini captures and captures what a human corpse is, in its most intimate appearance. The artist boldly reveals its essence.

[Bioethics in clinical practice]. / La bioética en la práctica clínica.

Bioethics has grown exponentially in recent decades. Its most important schools include principlism, casuistry, virtue ethics and the ethics of care. These schools are not exclusive. Within bioethics, clinical ethics addresses the inherent clinical practice ethical problems, problems which are many and very varied. Bioethics training is essential for clinicians to address these bioethics' problems. But even the professionals are trained, there are problems that cannot be solved individually and require advisory groups in clinical ethics: clinical ethics committees. These committees are also responsible for education in bioethics in health institutions. Clinical bioethics is a practical discipline, oriented to address specific problems, so its development is necessary to improve the decision making in such complex problems, inevitable problems in healthcare.

La bioética ha tenido un desarrollo exponencial en las últimas décadas. Entre sus escuelas más importantes destacan el principialismo, el casuismo, la ética de la virtud y la ética del cuidado, las cuales no son mutuamente excluyentes. Dentro de la bioética, la ética clínica aborda los problemas éticos de la práctica clínica, problemas que son numerosos y muy variados. La formación en bioética es fundamental para que los clínicos aborden adecuadamente estos problemas. Pero aunque los profesionales estén formados, existen problemas que precisan del concurso de grupos asesores en ética clínica: los comités de ética para la asistencia sanitaria. Estos comités son además los responsables de la formación en bioética en las instituciones sanitarias. La bioética clínica es una disciplina práctica, orientada a dar respuesta a problemas concretos, por lo que su desarrollo es necesario para mejorar la toma de decisiones ante estos complejos problemas, inevitables en la asistencia sanitaria.

[Bioethics of Sigmund Freud´s death: euthanasia or appropriation?]. / Bioética de la muerte de Sigmund Freud: ¿Eutanasia o apropiación?

The death of Freud raises the ethical dilemma about euthanasia. It can be characterized as indirect active euthanasia according to the rule of double effect, or terminal sedation, or palliated death. The primacy of the principle of autonomy over non maleficence, conditioned the physician's attitude toward his patient Freud. The physician assisted death was and remains punishable in western medicine. Therefore, a fundamental tradition was infringed. In contrast, the present study attempts to characterize the final position of Freud himself to his death and called it appropriation of his finitude; he assumes his being-unto-death, that is, he now projects his being not as a being-at-his-end but as a being-unto-end, indicating thereby that he understood that the end always penetrated his whole existence.

Redes sociales virtuales y la Bioética / Virtual social networks and bioethics

La investigación tiende a indagar por las condiciones psicológicas (obsesivas), socio – familiares, fisiológicas y emocionales de los estudiantes de la Universidad de San Buenaventura –Medellín de mes de agosto de 2010, que tienden a destinar parte de su tiempo a las Redes Sociales Virtuales y hacer una reflexión desde la Bioética frente al tema

This piece of research tends to inquire into the (obsessive) psychological, socio-family, physiological, and emotional conditions of the students at Saint Bonaventure University, Medellin Branch, back in the month of August 2010, who have the tendency to spend their free time in the Virtual Social Networks and then make an analysis of this issue, from the Bioethical viewpoint

Bioética de la muerte de Sigmund Freud: ¿Eutanasia o apropiación? / Bioethics of Sigmund Freud´s death: Euthanasia or appropriation?

The death of Freud raises the ethical dilemma about euthanasia. It can be characterized as indirect active euthanasia according to the rule of double effect, or terminal sedation, or palliated death. The primacy of the principle of autonomy over non maleficence, conditioned the physician’s attitude toward his patient Freud. The physician assisted death was and remains punishable in western medicine. Therefore, a fundamental tradition was infringed. In contrast, the present study attempts to characterize the final position of Freud himself to his death and called it appropriation of his finitude; he assumes his being-unto-death, that is, he now projects his being not as a being-at-his-end but as a being-unto-end, indicating thereby that he understood that the end always penetrated his whole existence.

Bioethics and animal research: a personal perspective and a note on the contribution of Fritz Jahr.

Reviewing fundamental aspects of bioethics and outlining the work of the Bioethics Program of the Pan American Health Organization, this paper draws attention to the work of a forgotten pioneer- Fritz Jahr- who coined the term bioethics in 1927 and anticipated many of the arguments and discussions now current in biological research involving animals.

History of bioethics in Brazil: pioneering voices, educational programs and future perspectives.

Although Brazilian bioethics has appeared in a globalized and dynamic context in which the main problems on the current agenda of bioethical questions had already been formulated (e. g., abortion, euthanasia, organ transplants, etc.), it contributed to the bioethics questions agenda by bringing in specific and original problems, linked to the socio-economic-political and cultural reality of Latin America countries and especially the Brazilian one, for instance, public health problems and the accompanying challenges stemming from unjust situations and social exclusion. Historically, first there was a dependence on a foreign ethical model, the North-American principialist bioethical paradigm, almost hegemonic in the first 25 years of world bioethics history. This would be Brazilian bioethics "infancy", the 1990s stage. There follows a movement with a critical attitude about "imported" models, particularly the principialist model, when it comes to public health. We enter here into the "adolescence" of Brazilian bioethics. As we arrive at "the adult" phase, we begin to make a deep evaluation, where the main challenge to face will be complex, involving knowing how to distinguish without severing, and to unite without confounding, bioethical problems of a personal character and those of a public one, that is, knowing how to distinguish among relevance types and scopes of some problems to be faced, in order for us to integrate them in a domain marked by a greater understanding.

Bioethics and animal research: A personal perspective and a note on the contribution of Fritz Jahr

Reviewing fundamental aspects of bioethics and outlining the work of the Bioethics Program of the Pan American Health Organization, this paper draws attention to the work of a forgotten pioneer- Fritz Jahr- who coined the term bioethics in 1927 and anticipated many of the arguments and discussions now current in biological research involving animals.

Algunas deficiencias del discurso bioético contemporáneo / Some deficiencies(faults) of the contemporary Bioethical discourse

El discurso bioético contemporáneo presente 2 deficiencias críticas: no dá mayor atención a los aspectos sociales de los problemas éticos de la biomedicina y tiende a excluir los aportes de las instancias religiosas.

Pertinencia de la bioética global en la educación universitaria / Relevancy of the global bioéthics in the university education

Este artículo es la 3a parte del ensayo "Bioetica en Educación Universitaria: una hermeneutica con prospectivas biopolíticas. Se propone establecer un diálogo trasdisciplianrio entre bioetica, educación universitaria y praxis humana. Se propone mostrarle a la academia universitaria una alternativa de análisis a los diferentes problemas que plantea hoy la globalización, la ciencia, la técnica y la tecnología de cara a la situación social del país desde la bioética con características hermeneuticas.

De la provocación bioética a la provocación biopolítica Los desafíos humanos vistos desde un país como el nuestro / From the bioethics provocation to the biopolitics provocation The human challengers seen from a country as ours

El artículo que se escribe desde el horizonte de la complejidad, quiere proponer una lectura heterodoxa de la bioética,no sólo para los enfoques de la bioética en su determinación biomédica y biotecnológica, sino también, de aquellos enfoques que queriendo superar la primera, buscan una mediación más social y política para los dilemas bioéticos. Se sostiene que más que hablar de dos bioéticas: la bioética clínica y la bioética global, se trata de dos tratamientos de lo mismo: la supervivencia de la especie, pero en dos niveles dentro del horizonte de la complejidad. Con ello, se pretende mostrar que la pro-vocación bioética, leída desde la periferia, puede expresar de manera teórico-conceptual lo queaquí se llama la provocación biopolítica, es decir la superación de una “sobrevida miserable” que padecen los terceros mundos. La provocación biopolítica, pone en el concepto aquello que está en juego para los habitantes de esta tierra-patria desde los proyectos políticos y económicos que se implementan, -en los primeros mundos- y se imponen, -en los tercerosmediante los mecanismos de la globalización y más exactamente de globalización económica

[The critical scientists' voice]. / A voz dos cientistas críticos.

The intricate debate over genetically modified organisms (GMOs) involves powerful economic interests, as well as ethical, legal, emotional and scientific aspects, some of which are dealt with in this paper.(It is possible to identify two main groups of scientists across the GMOs divide: the triumphalist and the critical group.) Scientists in the triumphalist group state that GMOs and their derivatives are safe for the environment and do not offer health hazards any more than similar, non-genetically modified, products. This view is disputed by the critical scientists, who are prompted by the scarcity of studies on the environmental impacts and toxicity of GMOs, and who point out flaws in tests performed by the same companies which hold the patents. They are also critical of the current state of the process of gene transference, lacking accuracy, a fact which, coupled with the scant knowledge available about 97% of the genome functions, may produce unforseeable effects with risks for the environment and public health yet to be assessed. Examples of such effects are: the transference of alien genes [??] to other species, the emergence of toxins, the creation of new viruses, the impacts on beneficial insects and on biodiversity in general.