La vacuna frente a la COVID-19 y la confianza institucional / The vaccine against COVID-19 and institutional trust

Los principales laboratorios públicos y privados han entrado en una carrera para encontrar una vacuna eficaz contra la COVID-19. Cuando esa vacuna llegue, los gobiernos tendrán que implementar los programas de vacunación que permitan alcanzar los niveles de inmunización necesarios para evitar la transmisión de la enfermedad. En este contexto, se planteará el dilema ético de la vacunación obligatoria vs. vacunación voluntaria. En el fondo de este dilema subyace el problema de los modelos éticos en los que se basan las decisiones políticas de los gobiernos en materias de salud. El artículo propone y argumenta la necesidad de fundamentar dichas políticas en un modelo ético de «primera persona», basado en la responsabilidad, que permita pasar de una ética normativa a una ética del comportamiento responsable. Este cambio de modelo ético, junto con determinadas propuestas de acción de tipo político, ayudará a recuperar la confianza institucional para que se puedan alcanzar los niveles necesarios de inmunidad colectiva frente a la COVID-19 a través de la vacunación voluntaria de los ciudadanos.(AU)

Major public and private laboratories have entered into a race to find an effective COVID-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical «first person» model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against COVID-19 can be achieved through the voluntary vaccination of the citizens.(AU)

The vaccine against COVID-19 and institutional trust.

Major public and private laboratories have entered into a race to find an effective Covid-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical "first person" model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against Covid-19 can be achieved through the voluntary vaccination of the citizens.

National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: ethical implications.

In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread of the virus, both of which have seen decreases in the number of intensive care beds and have been marked by financial cuts during the last ten years. It is a fact that a greater number of people, especially those over 70 years of age, have been left without respiratory support treatment, and therefore, there have been a greater number of deaths. It is also a fact that there has been a higher infection rate among healthcare professionals due to the delay in the management of protective measures and the inability to provide adequate care for those in nursing homes, as recognised by WHO. In the context of this health emergency, healthcare professionals have suffered a real 'moral distress' because, knowing first-hand the causes of the limitation of resources, they have had to put triage protocols into practice. Finally, we set forth a series of concrete ethical proposals with which to face the successive waves of COVID-19 infection, as well as other future pandemics.

The vaccine against COVID-19 and institutional trust. / La vacuna frente a la COVID-19 y la confianza institucional.

Major public and private laboratories have entered into a race to find an effective COVID-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical «first person¼ model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against COVID-19 can be achieved through the voluntary vaccination of the citizens.

The therapeutic proportionality standard: a new content for the best interests standard.

The standard of the patient's best interests is the main bioethical standard used in the decision-making process that involves incompetent patients (i.e. neonatology, pediatric patients and incompetent adults). This standard has been widely criticized as being self-destructive, individualistic, vague, unknown, dangerous and open to abuse. With the purpose of defending it, several reforms of this standard have been proposed, especially in the pediatric field. We propose a redefinition of the standard based on two concepts: 1) medical futility as a negative criterion, and 2) the principle of proportionality as a positive criterion. Our work includes a new relationship between concepts in classical moral theology (i.e. ordinary / extraordinary; proportionate / disproportionate) applied to the bioethics of life-sustaining treatments for incompetent patients.

The therapeutic proportionality standard: a new content for the best interests standard / El estándar de proporcionalidad terapéutica: Un nuevo contenido para el mejor interes estándar

The standard of the patient's best interests is the main bioethical standard used in the decision-making process that involves incompetent patients (i.e. neonatology, pediatric patients and incompetent adults). This standard has been widely criticized as being self-destructive, individualistic, vague, unknown, dangerous and open to abuse. With the purpose of defending it, several reforms of this standard have been proposed, especially in the pediatric field. We propose a redefinition of the standard based on two concepts: 1) medical futility as a negative criterion, and 2) the principle of proportionality as a positive criterion. Our work includes a new relationship between concepts in classical moral theology (i.e. ordinary / extraordinary; proportionate / disproportionate) applied to the bioethics of life-sustaining treatments for incompetent patients

El estándar del mejor interés del paciente es el único estándar bioético utilizado en los procesos de decisión de tratamientos en enfermos no competentes (neonatología, pediatría y adultos no competentes). Este estándar ha sido ampliamente criticado por autodestructivo, individualista, vago, desconocido, peligroso y abierto a abusos. Para defender el estándar se han propuesto varias reformulaciones especialmente en el ámbito pediátrico. Nosotros proponemos una redefinición del estándar basada en dos conceptos: 1) el de futilidad médica como criterio negativo, y 2) el principio de proporcionalidad como criterio positivo. Nuestro trabajo incluye una nueva relación entre los conceptos de la teología moral clásica (ordinario / extraordinario; proporcionado / desproporcionado) aplicados a la bioética de los tratamientos de soporte vital en pacientes no competentes

La vacuna frente a la COVID-19 y la confianza institucional / The vaccine against COVID-19 and institutional trust

Los principales laboratorios públicos y privados han entrado en una carrera para encontrar una vacuna eficaz contra la COVID-19. Cuando esa vacuna llegue, los gobiernos tendrán que implementar los programas de vacunación que permitan alcanzar los niveles de inmunización necesarios para evitar la transmisión de la enfermedad. En este contexto, se planteará el dilema ético de la vacunación obligatoria vs. vacunación voluntaria. En el fondo de este dilema subyace el problema de los modelos éticos en los que se basan las decisiones políticas de los gobiernos en materias de salud. El artículo propone y argumenta la necesidad de fundamentar dichas políticas en un modelo ético de «primera persona», basado en la responsabilidad, que permita pasar de una ética normativa a una ética del comportamiento responsable. Este cambio de modelo ético, junto con determinadas propuestas de acción de tipo político, ayudará a recuperar la confianza institucional para que se puedan alcanzar los niveles necesarios de inmunidad colectiva frente a la COVID-19 a través de la vacunación voluntaria de los ciudadanos

Major public and private laboratories have entered into a race to find an effective COVID-19 vaccine. When that vaccine arrives, the governments will have to implement vaccination programs to achieve the necessary immunization levels to prevent the disease transmission. In this context, the ethical dilemma of compulsory vaccination vs. voluntary vaccination will be raised. Underlying this dilemma, lies the problem of the ethical models on which the political decisions of governments in matters of health are based. The article proposes and argues the need to base health policy decisions on an ethical «first person» model, based on responsibility, that allows us to move from a normative ethic to an ethic of responsible behavior. This change in the ethical model, together with certain proposals for political action, will help us to restore institutional trust so that the necessary levels of collective immunity against COVID-19 can be achieved through the voluntary vaccination of the citizens