[Addressing the issue of seclusion and restraint in psychiatry]. / Envisager la question de l'isolement et de la contention en psychiatrie.

In an ever-changing environment, the question of the meaning of care within a caring, ethical framework is of paramount importance. The development of a patient-centred approach relies on an understanding of the Other. Caring and empathy are the essential foundations of this approach. An attempt to analyze practices through a few notions of ethics can be proposed.

The policy and politics of healthcare corporatisation: The case of the English NHS.

RATIONALE: Few accounts of healthcare corporatisation examine the effects of the 2008 financial crisis. New Politics of the Welfare State (NPWS) theories recognise the relevance of crises but give more attention to programmatic than systemic (structural) retrenchment, and little to healthcare corporatisation. OBJECTIVE: To examine what changes the 2008 financial crisis produced in the pattern of healthcare corporatisation, and the implications for NPWS theories. METHODS: Using administrative data from the English NHS during 1995-2019 we formulated a multi-dimensional index of corporatisation, tested its validity, and used it to analyse longitudinally how the financial crisis affected the balance between the responsibilization of management and re-commodification (introduction of market-like practices) in provider corporatisation. RESULTS: The financial crisis influenced NHS corporatisation through the fiscal austerity with which governments responded. The re-commodification of NHS providers stalled but not the responsibilization of NHS managers. CONCLUSIONS: The corporatisation of NHS providers faltered after the financial crisis. These findings corroborate parts of NPWS theory but also reveal scope for further elaborating its accounts of systemic retrenchment in health systems.

The Legacy of Slavery and the Socialization of Black Female Health and Human Services Workforce Members in Addressing Social Determinants of Health.

BACKGROUND: One legacy of slavery and colonialist structures is that minority populations, particularly the Black populations, experience higher rates of poverty, disease, job insecurity, and housing instability today - all indicators of poor health or negative social determinants of health (SDOH). While the historical legacy of slavery may explain why certain populations currently experience social determinants, they may also embody Post Traumatic Slave Syndrome (PTSS) through manifestations of negative health outcomes. MATERIAL AND METHODS: Black female health and human services (HHS) workforce members, who have taken SDOH trainings through a medical-legal partnership (MLP), were recruited for an ethnographic study to determine how historical context, specifically PTSS, can help Black female HHS workforce members understand and advocate for their patients as well as challenge the medial and legal institutions. RESULTS: Themes emerged around how Black women in HHS have persisted and resisted, struggled, and strived to protect and raise a resistant community that is perpetually threatened. Black women constantly exist in the past, present, and future, negotiating their identities and reproducing the modeled behavior of the parents, particularly their Black mothers, who taught them how to exist in the world as Black women. CONCLUSIONS: As sufferers of negative social determinants, Black women, especially those working in HHS, use their lived experiences and historical trauma to challenge the systems within which they work. They use their intersectional identities and their reimagined definitions of SDOH to rethink how the HHS workforce can move forward in working in the best interests of their patients. Future SDOH trainings may consider integrating historical legacies to challenge medical-legal institutions.

A mercantilização anunciada da Pesquisa na Espanha dos anos 2000 / The announced commodification of Research in Spain in the 2000s

Resumo: Este artigo problematiza o processo de mercantilização universitária na Espanha, relacionando-o às tendências globais, mediante realização de pesquisa bibliográfica. Destaca o papel crucial desempenhado pela Agência Nacional de Avaliação da Qualidade e Acreditação (ANECA) e a imposição progressiva de fatores de impacto em periódicos científicos como expressão do fortalecimento do denominado capitalismo acadêmico e do trabalho digital nas universidades, no âmbito das reformas universitárias dos anos 2000.

Abstract: This article problematizes the process of university commodification in Spain, relating it to global trends, through bibliographic research. It highlights the crucial role played by the National Agency for Quality Evaluation and Accreditation (ANECA) and the progressive imposition of impact factors in scientific journals as an expression of the strengthening of academic capitalism and digital work in universities, within the framework of the university reforms of the 2000s.

Narrativization of human population genetics: Two cases in Iceland and Russia.

Using the two cases of the Icelandic Health Sector Database and Russian initiatives in biobanking, the article criticizes the view of narratives and imaginaries as a sufficient and unproblematic means of shaping public understanding of genetics and justifying population-wide projects. Narrative representations of national biobanking engage particular imaginaries that are not bound by the universal normative framework of human rights, promote affective thinking, distract the public from recognizing and discussing tangible ethical and socioeconomic issues, and harm trust in science and technology. In the Icelandic case, the presentation of the project in association with national imaginaries concealed its market identity and could lead to the commodification of biodata. In the Russian case, framing in terms of "genetic sovereignty" and "civilizational code" offers pretexts for state securitization. Adherence to normative framework of human rights and public discussion of genetics in an argumentative and factual mode can counter these trends.

Locked Within.

Description In this work, Locked Within, I examine my relationship with Western and alternative medicines, exploring how both areas can provide holistic treatment when used together. Seen here through the medium of photography, my illness relates to common experiences in Western medical care. Through images that consider themes of time, choice, faith, the effects of illness, the medical gaze, and health as a commodity, this series provides commentary on medical experiences and the influence of the American healthcare system. With a nod toward scientific documentation, this photographic study documents my journey toward health. The element of typology in my work forms a narrative account of a journey through different medicines to find the ideal state of healthiness. By considering each medicine, I gain a new understanding of myself.

A Market of Lived Experience-User Involvement and the Commodification of Personal Experiences of Mental Illness.

Working actively to engage service users in participatory practices is both a policy expectation and a moral imperative for mental health social workers in contemporary Western mental health care. Recent research suggests that such practices of service user involvement are becoming increasingly individualised and driven by market logic. Based on an ethnographic study within a Swedish public psychiatric organisation, this article applies the concept of commodification to examine this trend. By showing how the practice of user involvement takes the form of a market where personal narratives and experiences of mental health problems are bought and sold as commodities, the analysis illuminates how market logic permeates the everyday practice of user involvement. One consequence of this commodification is that user organisations, as well as individual service users, are restricted in their role as independent actors pursuing their own agenda, and instead increasingly act on behalf of the public and as providers of personal experiences. While it is vital that service user perspectives are heard and recognised within mental health services, mental health social workers need to be aware of the risks of commodifying lived experience. When attention is directed to individual experiences and narratives, there is a risk that opportunities to advocate on behalf of the user collective as a whole and speak from a more principled and socio-political standpoint are lost. In addition, the commodification of personal experience tends to rationalise and privilege user narratives that conform to the dominant institutional logic of the mental health organisation, while excluding more uncomfortable and challenging voices, thereby undermining the ability of service users to raise critical issues that do not align with the interests of the mental health organisation.

Against commercial-assisted suicide.

The idea of commercial-assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial-assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service-provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician-assisted suicide (PAS), I defend the idea that adopting it as policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will.

Eggonomics: Vitrification and bioeconomies of egg donation in the United States and Spain.

Regulations governing assisted reproduction control the degree to which gamete donation is legal and how people providing genetic material are selected and compensated. The United States and Spain are both global leaders in fertility treatment with donor oocytes. Yet both countries take different approaches to how egg donation is regulated. The US model reveals a hierarchically organized form of gendered eugenics. In Spain, the eugenic aspects of donor selection are more subtle. Drawing upon fieldwork in the United States and Spain, this article examines (1) how compensated egg donation operates under two regulatory settings, (2) the implications for egg donors as providers of bioproducts, and (3) how advances in oocyte vitrification enhances the commodity quality of human eggs. By comparing these two reproductive bioeconomies we gain insight into how different cultural, medical, and ethical frameworks intersect with egg donor embodied experiences.

New Zealand's Approaches to Regulating the Commodification of the Female Body : A Comparative Analysis Reveals Ethical Inconsistencies.

In 2003 and 2004, Aotearoa New Zealand enacted two key laws that regulate two very different ways in which the female body may be commodified. The Prostitution Reform Act 2003 (PRA) decriminalized prostitution, removing legal barriers to the buying and selling of commercial sexual services. The Human Assisted Reproductive Technology Act 2004 (HART Act), on the other hand, put a prohibition on commercial surrogacy agreements. This paper undertakes a comparative analysis of the ethical arguments underlying New Zealand's legislative solutions to prostitution and commercial surrogacy. While the regulation of prostitution is approached with a Marxist feminist lens with the aim to ensure the health and safety of sex workers, commercial surrogacy is prohibited outright for concerns of negative impacts on present and future persons. I ground the principles of each Act in their ethical foundations and compare these two against one another. I conclude that New Zealand's legislative approach to regulating the commodification of the female body is ethically inconsistent.

Teleradiology: good practice guide.

Teleradiology is the electronic transmission of radiological images from one location to another with the main purpose of interpreting or consulting a diagnosis and must be subject to codes of conduct agreed upon by professional societies. The content of fourteen teleradiology best practice guidelines is analyzed. Their guiding principles are: the best interest and benefit of the patient, quality and safety standards homologous to the local radiology service, and use as a complement and support of the same. As legal obligations: guaranteeing rights by applying the principle of the patient's country of origin, establishing requirements in international teleradiology and civil liability insurance. Regarding the radiological process: integration with the local service process, guaranteeing the quality of images and reports, access to previous studies and reports and complying with the principles of radioprotection. Regarding professional requirements: compliance with the required registrations, licenses and qualifications, training and qualification of the radiologist and technician, prevention of fraudulent practices, respect for labor standards and remuneration of the radiologist. Subcontracting must be justified, managing the risk of commoditization. Compliance with the system's technical standards.

Telerradiología: guía de buenas prácticas / Teleradiology: good practice guide

La telerradiología es la trasmisión electrónica de imágenes radiológicas de una localización a otra con el propósito principal de interpretar o consultar un diagnóstico y debe estar sujeta a códigos de conducta consensuados por sociedades profesionales. Se analiza el contenido de 14 guías de buenas prácticas de telerradiología. Sus principios rectores son: el mejor interés y beneficio del paciente, estándares de calidad y seguridad homologables al servicio de radiología local, y utilización como complemento y apoyo del mismo. Como obligaciones legales: garantizar los derechos aplicando el principio de país de origen del paciente, establecer requisitos en telerradiología internacional y seguro de responsabilidad civil. Con respecto al proceso radiológico: integración con el proceso del servicio local, garantizar la calidad de imágenes e informes, el acceso a los estudios e informes previos y cumplir los principios de radioprotección. En relación con los requisitos profesionales: cumplir con los registros, licencias y cualificaciones exigidas, formación y capacitación del radiólogo y técnico, prevención de prácticas fraudulentas, respeto a las normas laborales y remuneración del radiólogo. La subcontratación debe estar justificada, gestionando el riesgo de comoditización. Cumplimiento de estándares técnicos del sistema (AU)

Teleradiology is the electronic transmission of radiological images from one location to another with the main purpose of interpreting or consulting a diagnosis and must be subject to codes of conduct agreed upon by professional societies. The content of fourteen teleradiology best practice guidelines is analyzed. Their guiding principles are: the best interest and benefit of the patient, quality and safety standards homologous to the local radiology service, and use as a complement and support of the same. As legal obligations: guaranteeing rights by applying the principle of the patient's country of origin, establishing requirements in international teleradiology and civil liability insurance. Regarding the radiological process: integration with the local service process, guaranteeing the quality of images and reports, access to previous studies and reports and complying with the principles of radioprotection. Regarding professional requirements: compliance with the required registrations, licenses and qualifications, training and qualification of the radiologist and technician, prevention of fraudulent practices, respect for labor standards and remuneration of the radiologist. Subcontracting must be justified, managing the risk of commoditization. Compliance with the system's technical standards (AU)

El cuerpo femenino: una visión general desde la filosofía tradicional a la gestación subrogada / The female body: an overview from traditional philosophy to surrogacy / O corpo feminino: um panorama desde a filosofia tradicional até a gestação por substituição

La llamada gestación subrogada es una práctica cada vez más difundida en varios países del mundo. Tras las apariencias de una supuesta libertad de las mujeres para disponer libremente de su cuerpo, se esconde la realidad de una explotación de las mujeres pertenecientes a los grupos social y geográficamente más vulnerables, que tiene todas las características de una forma moderna de esclavitud puesta al servicio de conspicuos intereses económicos. Las raíces de este fenómeno se encuentran en una tradición secular de desvalorización de la mujer y de su corporeidad que ha impregnado las más diversas culturas y que aún hoy continúa, de forma latente, a pesar del reconocimiento oficial de su igual dignidad a nivel legal.

So-called surrogacy is a widespread practice in several countries around the world. Behind the appearance of a supposed freedom to dispose of their bodies, lies the exploitation of women belonging to the most socially and geographically vulnerable groups, which has all the characteristics of a modern form of slavery in the service of economic interests. The roots of this phenomenon lie in a secular tradition of devaluation of women and their corporeality that has permeated the most diverse cultures and which, despite the official recognition of their equal dignity at the national legal level, continues latently to this day.

A chamada gravidez por substituição é uma prática cada vez mais difundida em vários países do mundo. Por trás das aparências de uma suposta liberdade das mulheres de disporem de seus corpos, esconde-se a realidade de exploração das mulheres pertencentes aos grupos sociais e geográficos mais vulneráveis, que tem todas as características de uma forma moderna de escravidão a serviço de interesses econômicos conspícuos. As raízes desse fenômeno estão em uma tradição secular de desvalorização da mulher e de sua corporeidade, que permeou as mais diversas culturas e que continua até hoje, de forma latente, apesar do reconhecimento oficial de sua igual dignidade no plano jurídico.

Feral pharmaceuticalization-Biomedical uses of animal life in light of the global donkey hide trade.

Medical and pharmaceutical uses of animal life have gone through vast changes in the past centuries. Although the commodification of animals and animal parts is by no means an invention of modernity, its procedures and practices have evolved in multiple ways across time. Most notably, the exploitation of non-human animal life has been increasingly segmented, industrialized, and globalized. The collateral expansion of scientific and market institutions has led to specific modes of rationalization of animal breeding, culture, and trade for pharmaceutical purposes. However, this rationalization process has never been immune to its own matter-and the materiality of non-human commodification processes irrigates seemingly ordered and layered practices. Based upon a study on the international trade of donkey hide, this paper offers a characterization of the current pharmaceutical uses of animal life through a series of epistemic and environmental tensions expressing frictions between the market's absorptive logic and non-human modes of existence. We describe this set of tensions as 'feral pharmaceuticalization' and contend that they offer new perspectives on the analysis of the contemporary pharmaceuticalization process. In addition, such tensions showcase the importance of investigating the expansion of technological markets not only as simultaneous knowledge and milieux (or bodies) making, or as simple science and market hegemonic processes, but also as the construction of new stages of conflict.

Communities of Hope: Sharing Economies and the Production of Material Worlds.

How do we learn to share? As contemporary Western folks, what do we share, under what conditions, and with whom? Through two personal "material stories," our paper explores how archaeologists can think beyond capitalism when interpreting material worlds. We consider the dynamics (and limits) of sharing economies as an emerging form of collective production. Starting from the blunt force "consolidation" of a leading British archaeology department, we trace the subsequent fissures and spaces of opportunity created by this disruptive moment of neoliberal closure. We tell stories about the collective production of a replica lithic assemblage, and the construction of a community chicken hutch, to explore the intricacies of everyday sharing as an intentional means of resource creation. Through these two disparate case studies, we aim to not only demonstrate the complex social networks and object meanings generated by sharing (versus capitalist) economies, but also consider wider implications (both benefits and conflicts) generated through collective resource production.

An auto-ethnographic reflection on the nature of nursing in the UK during the Covid-19 pandemic.

In this article I discuss the effects on the patient experience of isolation nursing during the CoronaVirus Disease (COVID)-19 pandemic. An unintended consequence of isolation nursing has been to distance patients from nurses and emphasise the technical side of nursing while at the same time reducing the relational or affective potential of nursing. Such distanced forms of nursing normalise the distal patient in hospital. I consider ways in which this new form of distanced nursing has unwittingly contributed to the continued commodification of nursing care in the British NHS. Autoethnography is used to describe and reflect on the illness experience, the experiences of caregivers and the sociocultural organisation of health care. The findings discuss three areas of the illness experience: intimate nursing care; communication; the 'distanced' patient experience.

Conserving traditional wisdom in a commodified landscape: Unpacking brand Ayurveda.

As Ayurveda continues to gain global recognition as a sanctioned system of health care, the essence of Ayurveda's identity has become prey to commoditization and commodification for commercial undertakings in the holistic health milieu of India, but also in emerging markets such as Europe. This paper critically assesses the commodification of Ayurveda as a cultural signifier within Europe that separates the indigenous artefact from its Vedic origins. Often presented as an elite commodity in Western settings, Ayurveda has become embedded as a cultural artifact within consumer society as the epitome of holistic care with an emphasis on its spiritual attributes, yet simultaneously isolating it from the customary elements that motivated its inception. The paper argues that Ayurveda's discursive detachment from its ontological tenets facilitates its rearticulation as a malleable experience as it crosses national boundaries, and in this process fosters the misinterpretation of the ancient healing tradition. This process may provide Ayurvedic treatments and principles with increased visibility in Europe's health sector. However, brands are exploiting this niche with push-marketing strategies to capitalize on the budding Ayurveda industry, turning traditional medicines into emblematic commodities. To advance this argument, we examine product diversions in the commodification of classical Ayurvedic medicines in the Netherlands and Germany, focusing on the over-the-counter (OTC) segment. We present an interpretive analysis of the processes that are (de)constructing traditional practices and principles as Ayurveda travels beyond India, and how this complicates issues of authenticity and expertise as herbal medicines diverge from the indications ratified in Ayurveda's classical compendiums.

On the Donation of Eggs, Sperm, and Selves.

Every single human being who has ever been conceived has come into existence precisely because God wants him or her to exist. The present article offers psychological and spiritual considerations to assist people who, in a variety of settings, are evaluating medical-assisted technologies that require the removal of gametes from the body, especially those procedures that involve the buying and selling of gametes. Gamete "donation" is a misnomer when the transactions involve cash payment. Gamete "donation" is contrasted with the "self-donation" that a married couple makes to each other, and by extension to their children, in the marital embrace. The article draws out some of the implications of this contrast, particularly to the child's sense of identity. Particular attention is drawn to the mistakes and mix-ups that can occur when the gametes are removed from the body, which would be literally impossible under the circumstances of natural procreation. I conclude that the perennial teaching of the Catholic Church makes a uniquely humane and personalist contribution to the important public conversation about the use of assisted reproduction.

Ethics of Buying DNA.

DNA databases have significant commercial value. Direct-to-consumer genetic testing companies have built databanks using samples and information voluntarily provided by customers. As the price of genetic analysis falls, there is growing interest in building such databases by paying individuals for their DNA and personal data. This paper maps the ethical issues associated with private companies paying for DNA. We outline the benefits of building better genomic databases and describe possible concerns about crowding out, undue inducement, exploitation, and commodification. While certain objections deserve more empirical and philosophical investigation, we argue that none currently provide decisive reasons against using financial incentives to secure DNA samples.

Medicina de precisión y transhumanismo: una mirada desde la Bioética

Propósito/Contexto. Mostrar la concatenación de la digitalización médica con fines terapéuticos perfeccionados por la medicina de precisión, la cual arrastra consigo a la medicina desiderativa del realce para incrementar y sobrepasar el funcionamiento y la morfología del cuerpo humano considerado normal. Las técnicas de realce culminan con la pretensión de crear entes transhumanos. Metodología/Enfoque. Selección de publicaciones bioéticas que reflexionan sobre las investigaciones y detallan posibles aplicaciones prácticas de la medicina de precisión, así como textos que promulgan proyectos de transhumanismo, extremos que engloban las múltiples aristas de la medicina desiderativa en la cual todo objetivo o fin sirve de medio para una próxima meta. Resultados/Hallazgos. Tanto la medicina de precisión como el transhumanismo han despertado expectativas públicas de terapias más eficaces y de posibilidades de realce funcional tanto cognitivo como moral, investigaciones que han logrado capturar importantes recursos financieros dispuestos por empresas que anticipan una mercantilización lucrativa de estos proyectos. Discusión/Conclusiones/Contribuciones. Dadas las incertidumbres, las expectativas desmesuradas y los intereses económicos que se juegan en las diversas formas de digitalización biomédica, la Bioética no ha podido generar un debate sólido en la materia, por lo que ha de centrarse en alertar sobre dos consecuencias inevitables: la desigualdad de acceso, los efectos negativos de la expansión biotecnológica sobre el equilibrio adaptativo entre lo humano, los seres vivos no humanos y el medioambiente común. Es urgente llamar la atención sobre los ingentes recursos de la biotecnociencia sofisticada, en desmedro del apoyo al estudio de problemas sociales y éticos por ella exacerbados.

Purpose/Background. To present the concatenation of medical digitalization that unravels from the goal of therapeutic improvement through precision medicine and moves on to enhancement medicine beyond the normal function and form of the human body in order to reach the final purpose of creating transhuman beings. Methodology/Approach. To select papers that discuss research and eventual practical applications of precision medicine and encourage the possible development of transhumanism through the progression of biomedical enhancement procedures. Results/Findings. Both precision medicine and transhumanism have nourished public expectations for more effective therapies, and the possibilities of functional enhancement in the areas of cognition and ethics. Research has poured huge resources in anticipation of products allowing for lucrative marketing. Discussion/Conclusions/Contributions. Given the incertitude, excessive expectations and vested interests that play a large part in biomedical digitalization, bioethics has been unable to generate a robust debate on these matters. Some inevitable consequences need to be addressed: Unequal access and the negative effects of biotechnological expansion, have a destabilizing impact on adaptation between humans, nonhuman living beings and global environment. It is urgent to call attention about the huge amounts of resources poured into sophisticated biomedical research to the detriment of the ensuing social and ethical problems.

Finalidade/Contexto. Mostrar a concatenação da digitalização médica com fins terapêuticos aperfeiçoados pela medicina de precisão, o que traz consigo a medicina desiderativa de aperfeiçoamento para aumentar e superar o funcionamento e morfologia do corpo humano considerado normal. As técnicas de aperfeiçoamento culminam com a reivindicação da criação de entidades transhumanas. Metodologia/Aproximação. Publicações bioéticas seleccionadas que reflectem sobre a investigação e detalham possíveis aplicações práticas da medicina de precisão, bem como textos promulgando projectos de transumanismo, extremos que abrangem as múltiplas vertentes da medicina desiderativa em que cada objectivo ou fim serve como um meio para um próximo objectivo. Resultados/Descobertas. Tanto a medicina de precisão como o transhumanismo suscitaram na opinião pública expectativas de terapias mais eficazes e possibilidades de melhoria funcional tanto cognitiva como moral, investigação que capturou recursos financeiros significativos de empresas que antecipam uma mercantilização lucrativa destes projectos. Discussão/Conclusões/Contribuições. Dadas as incertezas, expectativas pouco razoáveis e interesses económicos em jogo nas várias formas de digitalização biomédica, a bioética não tem sido capaz de gerar um debate robusto sobre o assunto e deve, portanto, concentrar-se em alertar para duas consequências inevitáveis: a desigualdade de acesso, e os efeitos negativos da expansão biotecnológica sobre o equilíbrio adaptativo entre seres vivos humanos, não humanos e o ambiente comum. É urgente chamar a atenção para os enormes recursos da sofisticada biotecnociência, em detrimento do apoio ao estudo dos problemas sociais e éticos por ela exacerbados.