Supernumerary robotic limbs are innovative devices in the field of wearable robotics which can provide humans with unprecedented sensorimotor abilities. However, scholars have raised awareness of the ethical issues that would arise from the large adoption of technologies for human augmentation in society. Most negative attitudes towards such technologies seem to rely on an allegedly clear distinction between therapy and enhancement in the use of technological devices. Based on such distinction, people tend to accept technologies when used for therapeutic purposes (e.g., prostheses), but tend to raise issues when similar devices are used for upgrading a physical or cognitive ability (e.g., supernumerary robotics limbs). However, as many scholars have pointed out, the distinction between therapy and enhancement might be theoretically flawed. In this paper, we present an alternative approach to the ethics of supernumerary limbs which is based on two related claims. First, we propose to conceive supernumerary limbs as tools that necessarily modify our psychological and bodily identity. At the same time, we stress that such a modification is not ethically bad in itself; on the contrary, it drives human interaction with the environment. Second, by comparing our view with the extended mind thesis, we claim that the mediation through tools is crucial for the formation of novel meanings and skills that constitute human interaction with the world. We will relate the latter claim to enactivism as a helpful theoretical perspective to frame issues related to artificial limbs and, more in general, to technologies for augmentation. Based on this approach, we finally sketch some suggestions for future directions in the ethics of supernumerary limbs.
Robotics , Humans , Cognition
In this paper, we focus on a novel bioethical approach concerning the ethical implications of the Social Determinants of Health (SDs) in the time of COVID-19, offering a fresh interpretation of our agency and responsibility in the current pandemic era. Our interpretation is grounded on the idea that our health basically depends on factors that go beyond our organism. In this sense, we stress the radical importance of circumstances to ethically assess an action, in the current pandemic context. Moreover, due the centrality of the SDs in our bioethical assessments-that implies that our health does not exclusively depend on our choices, behaviors, and lifestyle-we can affirm that we are not entirely responsible for our wellness or diseases. As health depends on economic, social, cultural, and environmental factors, we argue that the analysis of personal responsibility facing personal health status should receive further consideration. In this sense, following the "social connection model," we stress the importance of the concept of "shared responsibility" in collective decisions: if we make many decisions collectively, we are also collectively responsible of these decisions. Furthermore, to responsibly tackle the social inequalities that are the underlying cause of disparities in health outcomes, we propose two main strategies based on the Capability Approach: 1. empowering the individuals, especially the most vulnerable ones; and 2. designing preventive policies and interventions that provides an opportunity to address the disparities moving forward. This will help us going beyond the "individualistic medical ethics paradigm" and integrating our concept of health with social factors (e.g., the SDs), based on a more relational and interdependent anthropological thought.
The COVID-19 pandemic highlights the relevance of adequate decision making at both public health and healthcare levels. A bioethical response to the demand for medical care, supplies and access to critical care is needed. Ethically sound strategies are required for the allocation of increasingly scarce resources, such as rationing critical care beds. In this regard, it is worth mentioning the so-called 'last bed dilemma'. In this paper, we examine this dilemma, pointing out the main criteria used to solve it and argue that we cannot face these ethical issues as though they are only a dilemma. A more complex ethical view regarding the care of COVID-19 patients that is focused on proportional and ordinary treatments is required. Furthermore, discussions and forward planning are essential because deliberation becomes extremely complex during an emergency and the physicians' sense of responsibility may be increased if it is faced only as a moral dilemma.
COVID-19 , Pandemics , Humans , Critical Care , Delivery of Health Care , Morals , Health Care Rationing , Resource Allocation
El presente artículo ofrece una reflexión bioética a raíz del trato ofrecido a las personas mayores enel contexto de la pandemia de COVID-19. Como punto de partida, expone una paradoja evidenciada alponer el cuidado del adulto mayor en el centro de las medidas adoptadas ante la enfermedad pero que, ala vez, en algunas ocasiones, ha ofrecido la distinción por edad como único criterio para determinar el ac-ceso a recursos y tratamientos en situaciones de escasez. Surge entonces la pregunta sobre cuál es el tratoadecuado a las personas mayores. Utilizando como ejemplo de referencia la Convención Interamericanasobre protección de los derechos humanos de las personas mayores, en el presente artículo se aborda laproblemática de la asignación de recursos escasos en la tercera etapa de la vida en tiempos de pandemia.Se concluye que la pandemia es una oportunidad para reflexionar sobre el respeto y que le debemos a cadaser humano en todas las etapas de su vida.(AU)
The present article offers an analysis from a bioethical perspective of the treatment provided to seniorcitizens in the context of the COVID-19 pandemic. To begin with, the article highlights the paradox thatexists when measures are adopted for the care of elderly people during a pandemic, and in some occasionsthe age of the patient is the determining factor for deciding whether to provide care or not in cases ofscarcity. The question that arises then is: What is the adequate treatment for senior citizens? Using theInter-American Convention on the Protection of the Human Rights of Elderly Persons as a point of referen-ce, this article assesses the problem of the scarce resource allocation in the Third Age during a pandemic.As a conclusion, the pandemic is a great opportunity to reflect on the respect that we should give to everyhuman being at every stage of his/her life.(AU)
Humans , Male , Female , Aged , Old Age Assistance , Health of the Elderly , Pandemics , Nursing Care , Coronavirus Infections/epidemiology , Bioethics , Human Rights , Ethics, Clinical
The present article offers an analysis from a bioethical perspective of the treatment provided to senior citizens in the context of the COVID-19 pandemic. To begin with, the article highlights the paradox that exists when measures are adopted for the care of elderly people during a pandemic, and in some occasions the age of the patient is the determining factor for deciding whether to provide care or not in cases of scarcity. The question that arises then is: What is the adequate treatment for senior citizens? Using the Inter-American Convention on the Protection of the Human Rights of Elderly Persons as a point of reference, this article assesses the problem of the scarce resource allocation in the Third Age during a pandemic. As a conclusion, the pandemic is a great opportunity to reflect on the respect that we should give to every human being at every stage of his/her life.
COVID-19 , Pandemics , Aged , Attention , Female , Human Rights , Humans , Male , SARS-CoV-2 , United States
The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.
Euthanasia , Palliative Care , Chile , Humans , Physician-Patient Relations
Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.
Patient Rights , Vulnerable Populations , Chile , Humans
The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.
Humans , Palliative Care , Euthanasia , Physician-Patient Relations , Chile
This paper aims to determine whether it is necessary to propose the extreme of putrefaction as the only unmistakable sign in diagnosing the death of the human organism, as David Oderberg does in a recent paper. To that end, we compare Oderberg's claims to those of other authors who align with him in espousing the so-called theory of hylomorphism but who defend either a neurological or a circulatory-respiratory criterion for death. We then establish which interpretation of biological phenomena is the most reasonable within the metaphysical framework of hylomorphism. In this regard, we hold that technology does not obscure the difference between life and death or confect metaphysically anomalous beings, such as living human bodies who are not organisms or animals of the human species who are informed by a vegetative soul, but instead demands a closer and more careful look at the "fuzzy area" between a healthy (living) organism and a decaying corpse. In the light of hylomorphism, we conclude that neurological and circulatory-respiratory criteria are not good instruments for diagnosing death, since they can offer only probabilistic prognoses of death. Of the two, brain death is further away from the moment of death as it merely predicts cardiac arrest that will likely result in death. Putrefaction, the criterion that Oderberg proposes, is at the opposite end of the fuzzy area. This is undoubtedly a true diagnosis of death, but it is not necessary to wait for putrefaction proper-a relatively late stage of decomposition-to be sure that death has already occurred. Rather, early cadaveric phenomena demonstrate that the matter composing a body is subject to the basic forces governing all matter in its environment and has thus succumbed to the universal current of entropy, meaning that the entropy-resisting activity has ceased to constitute an organismal unity. When this unity is lost, there is no possibility of return.
Brain Death , Metaphysics , Death , Humans , Male
Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.
Humans , Patient Rights , Vulnerable Populations , Chile
The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.
Clinical Decision-Making/ethics , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Care Rationing/ethics , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , COVID-19 , Chile/epidemiology , Humans , Practice Guidelines as Topic
INTRODUCTION: The idea of video recording (VR) in the operating room (OR) with panoramic cameras and microphones is a new concept that is changing the approach to medical activities in the OR. However, VR in the OR has brought up many concerns regarding patient privacy and has highlighted legal and ethical issues that were never previously exposed. AIM: To review the literature concerning these aspects and provide a better ethical and legal understanding of the new challenges concerning VR in the OR. CONCLUSIONS: There is a disparity between the two main legal models concerning VR in the OR, namely the European legal system (General Data Protection Regulation (GDPR)) and the American legal framework (Health Insurance Portability and Accountability Act (HIPAA)). This difference mainly deals with two distinct bioethical paradigms: GDPR places a strong emphasis on protecting patients' privacy to improve the public health system, whereas HIPAA indicates the need to generate protocols to safeguard the risks connected to medical activity and patient privacy. Following from this point, we may argue that, at the ethical and bioethical level, GDPR and HIPAA depend mainly on two different ethical models: a perspective based on moral acquaintances and weak proceduralism, respectively. It is worth noting the importance of developing additional guidelines concerning different world regions to avoid the ethical problems that may emerge when simply applying a foreign paradigm to a very different culture.
The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.
Humans , Pneumonia, Viral/therapy , Pneumonia, Viral/epidemiology , Health Care Rationing/ethics , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Pandemics , Clinical Decision-Making/ethics , Chile/epidemiology , Practice Guidelines as Topic
Resumen: Este artículo se presenta como una reflexión ética y jurídica acerca de la tendencia actual de los pa dres a rechazar la vacunación de sus hijos en un régimen jurídico que establece la obligatoriedad de determinadas vacunas. Se analizan los principales argumentos que los padres usan para rechazar las vacunaciones obligatorias, y, en concreto: el temor a los efectos negativos que la vacunación pueda provocar en el menor; la violación del "derecho a la autonomía"; las creencias religiosas o pseudo- filosóficas; la resistencia a la intervención del Estado en asuntos personales o familiares. De esto, nace un necesario análisis ético sobre la vacunación infantil. Finalmente, se discute la responsabilidad de los padres y del Estado (autoridad sanitaria) en el cuidado de los menores de edad. La vacunación es un beneficio tanto para el inoculado como para la comunidad, la mejor política preventiva. Al mismo tiempo, se configura como un caso complejo que demanda un debate profundo, cuyo fin debe ser el tránsito desde un aparente conflicto entre los padres y el Estado, a una convergencia por el cuidado de los menores de edad. En otros términos, se recalca el hecho de que los padres, más allá del cum plimiento de un deber normativo heterogéneo, deben actuar motivados por la adhesión voluntaria al bien del hijo y de la comunidad.
Abstract: This article is an ethical and legal reflection about the current trend of parents to refuse vaccination of their children under a legal regime that establishes mandatory use of certain vaccines. We analyze the main arguments used by parents to refuse obligatory vaccination, i.e., the fear of the negative effects that vaccination may have on the child; the violation of the "right to autonomy"; religious or pseudo-philosophical beliefs; and the resistance to the State intervention in personal or family mat ters. Therefore, this statement implies a necessary ethical analysis of childhood vaccination. Finally, it will be discussed the responsibility of parents and the State -the health authority- in the care of mi nors. Vaccination is a benefit for both the inoculated and the community, the best preventive policy. At the same time, it is considered a complex case that demands a profound debate, whose purpose should be the transition from an apparent conflict between parents and the State, to convergence for the care of minors. In other words, it is emphasized the fact that parents, beyond the fulfillment of a heterogeneous normative duty, must act motivated by voluntary adherence to the best interest of the child and the community.
Humans , Mandatory Programs/legislation & jurisprudence , Mandatory Programs/ethics , Vaccination Refusal/legislation & jurisprudence , Vaccination Refusal/ethics , Parents , Philosophy , Religion , Chile , Personal Autonomy , Government Regulation , Anti-Vaccination Movement
This article is an ethical and legal reflection about the current trend of parents to refuse vaccination of their children under a legal regime that establishes mandatory use of certain vaccines. We analyze the main arguments used by parents to refuse obligatory vaccination, i.e., the fear of the negative effects that vaccination may have on the child; the violation of the "right to autonomy"; religious or pseudo-philosophical beliefs; and the resistance to the State intervention in personal or family mat ters. Therefore, this statement implies a necessary ethical analysis of childhood vaccination. Finally, it will be discussed the responsibility of parents and the State -the health authority- in the care of mi nors. Vaccination is a benefit for both the inoculated and the community, the best preventive policy. At the same time, it is considered a complex case that demands a profound debate, whose purpose should be the transition from an apparent conflict between parents and the State, to convergence for the care of minors. In other words, it is emphasized the fact that parents, beyond the fulfillment of a heterogeneous normative duty, must act motivated by voluntary adherence to the best interest of the child and the community.
Mandatory Programs/ethics , Mandatory Programs/legislation & jurisprudence , Vaccination Refusal/ethics , Vaccination Refusal/legislation & jurisprudence , Anti-Vaccination Movement , Chile , Government Regulation , Humans , Parents , Personal Autonomy , Philosophy , Religion
We argue that, given that the act of eating is rational and relational, it should also be an educational issue dealing with society and environment, politics and health, tastes and trends, as well as genetic and epigenetic factors. This hypothesis arises from a particular theory of the human act and an anthropological approach based on the philosophical speculations of MacIntyre and Aristotle. We argue that eating choices are "hybrids of freedom," rationality, and unconscious and environmental elements. Finally, we suggest that people have to change their habits in order to transform the human way of acting, since every human act can change the human essence and vice versa.
Sostenemos que, siendo el acto de comer racional y relacional, también debe ser un tema educativo que tiene que ver con la sociedad y el ambiente, la política y la salud, los gustos y las tendencias, así como los factores genéticos y epigenéticos. Esta hipótesis tiene que ver con una cierta teoría del acto humano y una antropología basada en las especulaciones filosóficas de MacIntyre y Aristóteles. En este sentido, argumentamos que las opciones alimenticias son un "híbrido de libertad", racionalidad, y elementos inconscientes y ambientales, y se relacionan con las dimensiones espirituales y biológicas de los seres humanos. Finalmente, sugerimos que debemos cambiar los hábitos humanos para transformar la forma humana de actuar, ya que cada acto humano puede cambiar la esencia humana y viceversa.
Sostenemos que, siendo el acto de comer racional y relacional, también debe ser un tema educativo que tiene que ver con la sociedad y el ambiente, la política y la salud, los gustos y las tendencias, así como los factores genéticos y epigenéticos. Esta hipótesis tiene que ver con una cierta teoría del acto humano y una antropología basada en las especulaciones filosóficas de MacIntyre y Aristóteles. En este sentido, argumentamos que las opciones alimenticias son un "híbrido de libertad", racionalidad, y elementos inconscientes y ambientales, y se relacionan con las dimensiones espirituales y biológicas de los seres humanos. Finalmente, sugerimos que debemos cambiar los hábitos humanos para transformar la forma humana de actuar, ya que cada acto humano puede cambiar la esencia humana y viceversa.
