La atención sanitaria a personas trans: una reflexión bioética / Health care for trans people: a bioethical reflection

La atención sanitaria a personas transexuales no ha estado dentro de las prioridades de la Bioética, de tal forma que en la mayoría de los manuales de esta disciplina no se hace alusión a esta cuestión, o se pasa por ella de una forma bastante simple o comedida. Sin embargo, es preciso hacer constar que en el último decenio el debate bioético, sobre cuestiones de género en general y sobre transexualismo en particular, se ha incrementado notablemente. Este trabajo persigue ofrecer a la persona transexual, al profesional sanitario o al estudioso sobre el tema trans, herramientas para articular una reflexión bioética. Tiene dos partes claramente diferenciadas. En la primera, se exponen los aspectos que se estima necesario considerar cuando se valora la eticidad de una intervención de cambio de género. En la segunda parte, se ofrece una reflexión sobre las líneas argumentales que, sobre este punto, sustentan las distintas corrientes bioéticas (AU)

Health care for trans people has not been among the priorities of Bioethics, so that in most of the ma nuals of this discipline there is no reference to this issue, or it is covered in a rather simple or measured way. However, it is necessary to note that in the last decade the bioethical debate, on gender issues in general and on transsexualism in particular, has increased significantly. This work seeks to offer the transsexual per son, the health professional or the student on the trans topic tools to articulate their particular bioethical reflection. It has two clearly differentiated parts. In the first, the aspects that are considered necessary to consider when assessing the ethics of a gender change intervention are presented. In the second part, a reflection is offered on the lines of argument that support the different bioethical currents (AU)

[Health care for trans people: a bioethical reflection]. / http://aebioetica.org/revistas/2023/34/112/309.pdf.

Health care for trans people has not been among the priorities of Bioethics, so that in most of the manuals of this discipline there is no reference to this issue, or it is covered in a rather simple or measured way. However, it is necessary to note that in the last decade the bioethical debate, on gender issues in general and on transsexualism in particular, has increased significantly. This work seeks to offer the transsexual person, the health professional or the student on the trans topic tools to articulate their particular bioethical reflection. It has two clearly differentiated parts. In the first, the aspects that are considered necessary to consider when assessing the ethics of a gender change intervention are presented. In the second part, a reflection is offered on the lines of argument that support the different bioethical currents..

[Health conscientious objection in Gonzalo Herranz's thought]. / La objeción de conciencia sanitaria en el pensamiento de Gonzalo Herranz.

Conscientious objection in the healthcare professions was a topic that Gonzalo Herranz addressed early on and with a very particular perspective. At all times he moved away from a strictly legal discussion to delve into the real grounds that justify a healthcare agent's refusal to submit to a certain rule, considering that it goes against his or her conscience. This article presents some of the main issues that Professor He- rranz addressed in his publications and conferences in relation to conscientious objection.

La objeción de conciencia sanitaria en el pensamiento de gonzalo herranz / Health conscientious objection in gonzalo herranz’s thought

La objeción de conciencia de las profesiones sanitarias fue un tema que Gonzalo Herranz abordó deforma temprana y con una perspectiva muy particular. En todo momento se alejó de la discusión estricta-mente legal para ahondar en los auténticos fundamentos que justifican que un agente sanitario no quierasometerse a una determinada norma, al considerar que atenta contra su conciencia. En este artículo semuestran algunas de las principales cuestiones que, en relación a la objeción de conciencia, abordó el pro-fesor Herranz en sus publicaciones y conferencias.(AU)

Conscientious objection in the healthcare professions was a topic that Gonzalo Herranz addressed earlyon and with a very particular perspective. At all times he moved away from a strictly legal discussion todelve into the real grounds that justify a healthcare agent’s refusal to submit to a certain rule, consideringthat it goes against his or her conscience. This article presents some of the main issues that Professor He-rranz addressed in his publications and conferences in relation to conscientious objection.(AU)

Reflexión acerca del desarrollo de la bioética en las organizaciones profesionales farmacéuticas. La excelencia profesional / Reflection on the development of bioethics in pharmaceutical professional organizations. Professional excellence / Reflexão sobre o desenvolvimento da Bioética nas organizações profissionais farmacêuticas. A excelência professional

Resumen Desde hace unos años, las organizaciones colegiadas de la profesión farmacéutica se han visto desafiadas, no solo por agentes externos, sino también por los propios profesionales. Hay una cierta crítica de respuesta, especialmente en aspectos que tienen que ver con el rol que deben jugar en el desarrollo y la actividad de la práctica profesional, en sus fines domésticos, externos e internos, y en las características que deben poseer como organizaciones al servicio de estos profesionales y la sociedad. Entendemos que el desarrollo, la revisión y actualización de la bioética, así como la formación en esta materia en las organizaciones profesionales, contribuye a esa excelencia transversal en la profesión, provoca un conocimiento real de esta en todas sus dimensiones y otorga poder para actuar en total libertad frente a las amenazas o restricciones internas o externas.

Abstract For some years, the collegiate organizations of the pharmaceutical profession are being challenged, not only by external agents, but also by the professionals themselves. There is a certain criticism in the response, especially in aspects that have to do with the role they must play in the development and activity of professional practice, in their domestic, external and internal purposes and in the characteristics they must possess as organizations in service of these professionals and society. We understand that the development, revision and updating of Bioethics, as well as training in this field in professional organizations, contributes to that transcendent excellence in the profession, provokes a real knowledge of it in all its dimensions and with the power to act in total freedom from threats or internal or external restrictions.

Resumo Há alguns anos, as organizações colegiadas da profissão farmacêutica estão sendo desafiadas, não somente por agentes externos, mas também pelos próprios profissionais. Existe certa crítica de resposta, em especial em aspectos que estão relacionados com o papel que devem desempenhar e com a atividade da prática profissional, em seus fins domésticos, externos e internos, e nas características que devem possuir como organizações ao serviço desses profissionais e da sociedade. Entendemos que o desenvolvimento, a revisão e a atualização da Bioética, bem como a formação nessa matéria nas organizações profissionais, contribuem para a excelência transversal na profissão, promovem um conhecimento real desta em todas suas dimensões e outorgam poder para agir em total liberdade ante as ameaças ou as restrições internas ou externas.

Valoración de la supresión de la pubertad en menores con problemas de identidad de género / Assessment of the suppression of puberty in children with gender identity problems

El objetivo del presente trabajo es reflexionar sobre la oportunidad y el riesgo que conllevan los tratamientos propuestos para tratar los problemas de identidad de género en ese sector de la población. En la mayoría de los protocolos de atención de menores con problemas de identidad de género se propone la supresión de la pubertad como método de elección. La técnica consiste en la administración de agonistas reversibles de la GnRH para provocar una supresión de la expresión hormonal del menor y, con ello, el desarrollo de los caracteres sexuales propios de su género. La oportunidad o adecuación del empleo sistemático de agonistas reversibles de la GnRH puede ser cuestionada por varias razones. La primera, porque el diagnóstico de transexualismo en menores conlleva una gran complejidad y dificultad, por lo que existe un amplio margen de error. La segunda, porque la supresión de la pubertad tiene consecuencias directas en el desarrollo del menor. En tercer lugar, porque los citados tratamientos tienen unos riesgos y efectos secundarios en los menores, algunos de ellos no estudiados y desconocidos, lo cual, sin duda, debería ser ponderado. Por último, porque los medicamentos utilizados no están ni diseñados, ni experimentados, para atención de menores con problemas de identidad de género. Por ello, se utilizan sin estar aprobados por las agencias reguladoras del medicamento para esa finalidad. Estas cuestiones tienen que ser abordadas y, además, transmitidas en la información que se proporciona a los interesados

The objective of this article is to reflect on the opportunity and risk of the proposed treatments to address gender identity problems in that sector of the population. In most of the protocols for the care of minors with gender identity problems, the abolition of puberty is proposed as a method of choice. This technique consists in the administration of reversible agonists of GnRH to provoke a suppression of the hormonal expression of the minor and, thus, the development of the sexual characters of their gender. The opportunity or adequacy of the systematic use of reversible GnRH agonists may be questioned for several reasons. The first, because the diagnosis of transsexualism in minors carries a great complexity and difficulty, so there is a wide margin of error. The second, because the suppression of puberty has direct consequences in the development of the child. Thirdly, because the aforementioned treatments have some risks and side effects in minors, some of them not studied and unknown, which, without a doubt, should be weighted. Finally, because the drugs used are neither designed nor experienced, for the care of minors with gender identity problems. Therefore, they are used without being approved by the regulatory agencies of the medicinal product for that purpose. These issues need to be addressed and also transmitted in the information provided to the stakeholders

[Assessment of the suppression of puberty in children with gender identity problems]. / Valoración de la supresión de la pubertad en menores con problemas de identidad de género.

The objective of this article is to reflect on the opportunity and risk of the proposed treatments to address gender identity problems in that sector of the population. In most of the protocols for the care of minors with gender identity problems, the abolition of puberty is proposed as a method of choice. This technique consists in the administration of reversible agonists of GnRH to provoke a suppression of the hormonal expression of the minor and, thus, the development of the sexual characters of their gender. The opportunity or adequacy of the systematic use of reversible GnRH agonists may be questioned for several reasons. The first, because the diagnosis of transsexualism in minors carries a great complexity and difficulty, so there is a wide margin of error. The second, because the suppression of puberty has direct consequences in the development of the child. Thirdly, because the aforementioned treatments have some risks and side effects in minors, some of them not studied and unknown, which, without a doubt, should be weighted. Finally, because the drugs used are neither designed nor experienced, for the care of minors with gender identity problems. Therefore, they are used without being approved by the regulatory agencies of the medicinal product for that purpose. These issues need to be addressed and also transmitted in the information provided to the stakeholders.

Medicamentos off-label: cuestiones terminológicas y conceptuales / Off-label use: terms and concepts

En situaciones clínicas comprometidas el uso especial de los medicamentos puede ser de gran utilidad para el tratamiento farmacológico. El uso especial de los medicamentos generaliza varios términos y conceptos que pueden crear errores en la prescripción y dispensación de los medicamentos. Es conveniente diferenciar los medicamentos de uso compasivo, de los usos fuera de ficha técnica y de los medicamentos extranjeros, sabiendo que cualquiera de ellos puede presentar contraindicaciones

In clinical delicate situations the special use of drugs can be of great usefulness for pharmacological treatment. The special use of the medicines generalizes several terms and concepts could generate mistakes of prescription and dispensation drugs. It is suitable to differentiate the medicines of compassionate use, off-label and unlicensed or disapproved drugs

Dimensión económica de la maternidad subrogada ("habitaciones en alquiler") / Economic dimensión of surrogacy maternity "romms for rent")

La maternidad por subrogación tiene una importante dimensión económica que, en los últimos años, se ha visto aún más potenciada. Se trata de una industria multimillonaria que, por otro lado, se aprovecha de mujeres con bajos recursos económicos. Frente a ello, existe una importante crítica, ejercida por distintos colectivos, que se refieren a este sector con términos tan cuestionables como "industria de alquiler de vientre", "granjas de bebé", "fábricas de niños", etc. Dichas críticas están siendo fuertemente contrarrestadas por los centros de maternidad por subrogación. A ello dedican ingentes presupuestos con estrategias que, asentadas en grandes dosis de sentimentalismo, logran transmitir una imagen positiva del proceso. El objetivo es proporcionar tranquilidad a los usuarios y a la sociedad en general. Para ello distorsionan las implicaciones éticas y jurídicas del proceso; en particular, niegan la explotación de las mujeres y la instrumentalización de los hijos que, necesariamente, implica esta técnica

Maternity by subrogation has an important economic dimension that, in the last years, has been even more potentiated. It is a multimillion-dollar industry that, on the other hand, takes advantage of women with low economic resources. Faced with this, there is an important criticism, carried out by different groups, that refer to this sector with such questionable terms as "uterine rental industry", "baby farms", "children's factories", etc. These criticisms are being strongly counteracted by maternity centers by subrogation. To this they dedicate enormous budgets with strategies that, based on great doses of sentimentality, manage to transmit a positive image of the process. The objective is to provide tranquility to users and to society in general. To this end they distort the ethical and legal implications of the process; in particular, deny the exploitation of women and the instrumentalization of the children that, necessarily, implies this technique

[Economic Dimension of Surrogacy Maternity (″Rooms For Rent″)]. / Dimensión Económica de la Maternidad Subrogada (″Habitaciones en Alquiler″ ).

Maternity by subrogation has an important economic dimension that, in the last years, has been even more potentiated. It is a multimillion-dollar industry that, on the other hand, takes advantage of women with low economic resources. Faced with this, there is an important criticism, carried out by different groups, that refer to this sector with such questionable terms as ″uterine rental industry″, ″baby farms″, ″children's factories″, etc. These criticisms are being strongly counteracted by maternity centers by subrogation. To this they dedicate enormous budgets with strategies that, based on great doses of sentimentality, manage to transmit a positive image of the process. The objective is to provide tranquility to users and to society in general. To this end they distort the ethical and legal implications of the process; in particular, deny the exploitation of women and the instrumentalization of the children that, necessarily, implies this technique.

Balneario de San Nicolás de Alhama (Almería). Historia y generalidades / The San Nicolás de Alhama's Spa (Almería). History and generalities

Se hace una reseña de la situación geográfica del Balneario de San Nicolás, de los antecedentes históricos del mismo y situación actual, así como de sus aguas minero‐medicinales, sus propietarios, el primer análisis realizado por un farmacéutico, la dirección médica y los pacientes que le han frecuentado (AU)

An a ccount of the geographical position of Alhama de Almería'Spa is given, including a brief history of it and its situation nowdays. An particularly reference it is made about the minero‐medicinal waters of this Spa, their proprietaries, the pharmacist who made the first chemical analysis, the sanitary direction and the patients frequented it (AU)

El Balneario de Villavieja (Castellón). Historia y generalidades / The Villavieja’s Spa (Castellón). History and generalities

Se hace una reseña de la situación geográfica del Balneario de Villavieja, de los antecedentes históricos del mismo y situación actual. Se hace mención a sus propietarios, al primer análisis químico de las aguas mineromedicinales de este Balneario así como a los médicos directores, a los pacientes que lo han frecuentado y a las referencias a la acción terapéutica de sus aguas (AU)

An account of the geographical position of Villavieja’s Spa is given, including a brief history of it and its situation nowdays. An particularly reference it is made about their propietaries and the first chemical composition of the mineral waters of this spa, the medical direction of the spa and the patients frequented the spa and another ones in relationship the medically effects of the waters and muthbath (AU)

[The social stigma of obesity]. / La Estigmatización Social de la Obesidad.

People who are overweight are at increased risk of certain chronic diseases and premature death. However, the physiological consequences are not limited to health symptoms and signs but transcend the social field. In fact, the stigma and discrimination faced by obese people has been proven in multiple areas (work, family, education, etc...). This can contribute to reduce the quality of patients life. From a gender perspective, in the literature there seems to be evidence that the undesirable social effects of obesity affect women more than men. To minimize the obesity impact people adopt proactive methods to lose weight. However the solution to this problem is not on medication but changes in lifestyle and in the proposal of inclusive aesthetic models. Also it is necessary to clear that the complex etiology of obesity can help to reduce the weight stigma and the negative consequences of this condition.

La "medicalizaióón" de los alimentos / The "mediclizatiion" of food / A "medicalizaço"" dos alimentos

Desde hace décadas, tanto las autoridades sanitarias como los profesionales de la salud han hecho un énfasis especial en la importancia de la relación entre la alimentación y el mantenimiento de la salud. No obstante, conviene tener en cuenta que, aunque esta vinculación no es nueva, en los últimos años se ha desbordado del marco estrictamente alimentario-nutricional, lo que ha generado una proliferación de productos alimenticios que alegan declaraciones vinculadas con la salud. Ante esta situación, y con el fin de proteger a los consumidores, en la Unión Europea el legislador ha creado una figura jurídica mientras que, en el ámbito científico, se han seguido investigando las propiedades saludables de estos alimentos. En este contexto se ha desarrollado, no sin polémica, la "medicalización de la alimentación".

For decades, both the health authorities and health professionals placed special emphasis on the importance of the relationship between food and health maintenance. However, it should be noted that although this relationship is not new, in recent years it has overflown the strict food and nutrition framework, which has generated a plethora of food products claiming health-related statements. Given this situation, and in order to protect consumers, legislators in the European Union have created a new legal form while, in the scientific field, it continues to investigate the health benefits of these foods. The "medicalization of food" has, not without controversy, been developed in this context.

Há décadas, tanto as autoridades sanitárias quanto os profissionais da saúde têm dado ênfase especial à importância da relação entre a alimentação e a manutenção da saúde. Contudo, convém considerar que, embora essa vinculação não seja nova, nos últimos anos, tem passado do limite estritamente alimentar-nutricional, o que tem gerado uma proliferação de produtos alimentares que alegam declarações vinculadas com a saúde. Diante dessa situação e a fim de proteger os consumidores, na União Europeia, o legislador criou uma nova figura jurídica enquanto, no âmbito científico, continuam investigando as propriedades saudáveis desses alimentos. Nesse contexto, desenvolve-se, não sem polêmica, a "medicalização da alimentação".

[Personalist bioethics in the university curriculum]. / La bioética personalista en los planes de estudio universitarios.

Growing awareness of the importance of Bioethics has meant that this subject has taken on an increasingly important role in higher education. However, its incorporation into the educational syllabus at different levels has been slower than might have been expected, particularly at pre-university and undergraduate level. This article reviews the current situation of personalist Bioethics in the university curriculum. Starting from an analysis of the way Bioethics has been included at undergraduate and graduate level, it goes on to explore the factors that may aid or hinder the development of this subject. The conclusion explains how teaching and learning about Bioethics in the university curriculum requires rigorous research with a sound theoretical basis in personalist philosophy, as understood by the 20th century personalist school of philosophers.

[An approach to the legal and ethical problem of surrogate motherhood]. / Aproximación a la Problemática Etica y Jurídica de la Maternidad Subrogada.

Surrogate motherhood is an issue which currently gives rise to considerable complexity. Some consider that it is a justifiable practice which should be permitted by law. However, western legal systems have traditionally understood that whereas objects can be traded freely, persons, including the human body, its organs and most essential functions, cannot be the object of commerce. This means that the freedom of the individual to make contracts for mutual benefit is limited. Regarding the child, legalization of surrogate motherhood means converting the parent-child relationship into a commercial relationship, since in the last instance this would depend on a financial transaction. Moreover, experience has shown that the child is left in a very vulnerable position, since his or her situation depends on the clauses set forth in the contract, which in no sense guarantees that his or her interests and rights will be protected. For all these reasons, we must conclude that the wish on the part of infertile couples should be taken seriously by society. However, not all desires that adults have should be regarded as rights, particularly if this is detrimental to the dignity and rights of other subjects involved, particularly those of vulnerable women and their children.

[Bias in publications about the mechanism of action of the morning-after pill]. / Sesgos en la Publicación Sobre El Mecanismo de Acción de la Píldora del Día Siguiente.

The morning-after pill or ECP (levonorgestrel) first came into use in the late 20th century, but has only become widely available in the last ten years. Its introduction has been facilitated by health policies which have led to the removal of certain obstacles hindering its use. In this context, sociological, statistical and scientific data have been employed which have often turned out to be biased or partial in nature. The reliability of the information provided by health authorities, pharmaceutical companies and other social entities has been called into question in various respects, particularly as far as the mechanism of action, side effects and pregnancy rate are concerned. This study focuses on the mechanism by which levonorgestrel acts, since a wider discussion would fall beyond the scope of a single study, and the mechanism of action is the aspect which is least understood and most controversial. It remains to be determined whether levonorgestrel is a product which only acts prior to ovulation or which has an effect on the human embryo.

[AIDS and social justice: pharmaceutical industry and economics]. / Sida y Justicia Social: Industria Farmacéutica y Economía.

This article takes a broad look at the complicated framework of relationships between the third world and pharmaceutical companies. In the first part of the work reference is made to the poverty of these countries, their lack of education in terms of health, the scarcity of basic hygiene, and their greatly limited access to medicines, especially those for treating AIDS. The article then proceeds to the issue of the pharmaceutical companies' degree of responsibility for the reduced availability of medicines in certain areas of the world. One of the factors that most limits access to medicines is their price, and many sectors of society propose taking action on the patents of drugs (rescinding or limiting them) in order to lower their price. However, the problem of patent exemption is more complicated than it seems at first glance, and comes with its own risks. If, for lack of funds or the uncertainty concerning a return on the capital invested, pharmaceutical companies discontinue research and development of new drugs, AIDS therapy would worsen. It is imperative and urgent to develop new drugs against the AIDS because of its resistance to the drugs currently available. The article concludes with the pharmaceutical industry's effort to look for possible forms of collaboration with developing countries.

El derecho a la objeción de conciencia en el supuesto del aborto. De la fundamentación filosófico-jurídica a su reconocimiento legal / El derecho a la objeción de conciencia en el supuesto del aborto. De la fundamentación filosófico-jurídica a su reconocimiento legal

La objeción de conciencia consiste en el incumplimiento de una obligación de naturaleza legal, cuya realización produciría en el individuo una grave lesión de la propia conciencia. Desde los mismos orígenes del Estado de Derecho, el respeto a la libertad de conciencia ha sido considerado uno de los derechos más fundamentales, ya que se presupone que la libertad y la dignidad humanas se encuentran por encima del mismo Estado. El derecho a la objeción de conciencia puede entenderse como la dimensión externa de la libertad ideológica y de conciencia. Este derecho, pilar esencial en todo Estado de Derecho, posee especial relevancia en el debate bioético, al tratarse de una vía muy adecuada para solucionar, en un sistema democrático, los inevitables conflictos que genera la tensión entre legalidad y justicia. En las últimas décadas, el derecho a la objeción de conciencia ha desarrollado toda su virtualidad en aquellos países en los que se han aprobado leyes despenalizadoras del aborto. Las profesiones sanitarias tienen un horizonte y un sentido claros: el cuidado y el respeto de la vida, la salud y la integridad de todos los seres humanos. En consecuencia, cuando una norma legal vulnera o contradice este principio, surgen sólidas razones para fundamentar el derecho a la objeción de conciencia de los sanitarios.