On Replacement Body Parts.

Technological advances are making devices that functionally replace body parts-artificial organs and limbs-more widely used, and more capable of providing patients with lives that are close to "normal." Some of the ethical issues this is likely to raise relate to how such prostheses are conceptualized. Prostheses are ambiguous between being inanimate objects and sharing in the status of human bodies-which already have an ambiguous status, as both objects and subjects. At the same time, the possibility of replacing body parts with artificial objects puts pressure on the normative status typically accorded to human bodies, seemingly confirming that body parts are replaceable objects. The paper argues that bodies' normative status relies on the relation of a body to a person and shows that persons could have similar relations to prostheses. This suggests that in approaching ethical issues surrounding prostheses, it is appropriate to regard them as more like body parts than like objects.

Consideraciones clínicas y éticas en la implementación de rehabilitaciones implantoprotésicas en el adulto mayor / Clinical and ethical considerations in the implementation of dental implants rehabilitations in senior adults

La falta de equidad y justicia en la distribución de alta tecnología no excluye la salud pública en casos donde la disponibilidad es inferior a la demanda. Dentro de la estomatología, la implantología en Cuba dispone de recursos limitados y la valoración multidisciplinaria para rehabilitar mediante implantes dentales al adulto mayor depende de factores objetivos y subjetivos. En el presente artículo, en la medida que se identifican los factores que determinan en la exclusión de adultos mayores para rehabilitarse mediante implantes dentales; se pretende como objetivo exponer consideraciones clínicas y éticas a considerar para una justa y eficaz selección. Se concluyó que los factores subjetivos influyen en los bajos índices de ingresos de adultos mayores para rehabilitarse, y que la consulta multidisciplinaria debe impartir equidad y justicia en la selección considerando la calidad de vida como un factor primordial para alcanzar un envejecimiento saludable(AU)

The lack of justness and justice in the distribution of high technology don't exclude the public health in cases where the readiness is inferior to the demand. Inside of dentistry, the implantology has in our country limited resources, and the multidisciplinary assesment to rehabilitate by means of dental implant to senior adult it depends on objective and subjective factors. In this article, in the measure that the factors which determine an bigger exclusion of senior adult are identified to become rehabilitated by means of dental implant; it is sought as objective to expose clinical and ethical considerations to consider for a fair and effective selection. Was concluded that in spite of having an established systematical diagnoses, subjective factors influence in the low index of senior adult to become rehabilitated, and that the multidisciplinary consultation should impart justness and justice in the selection considering the quality of life like a primordial factor to reach a healthy(AU)

Simetrização com implantes submusculares na busca de resultados duradouros em reconstruções mamárias / Symmetrization using submuscular implants to achieve lasting results in breast reconstruction

Introdução: Nas reconstruções de mama com implante é incomum a ptose no decorrer do tempo, fato não observado nas mamoplastias de simetrização, principalmente sem implantes, ocasionando precocemente a recidiva da assimetria mamária. O objetivo desse trabalho foi demonstrar a mamoplastia de simetrização contralateral com uso de implantes submusculares e os resultados alcançados. Métodos: No período de 2 anos foram estudados, retrospectivamente, 18 casos de mamoplastia de simetrização com implante submuscular. Resultados: A comorbidade mais encontrada foi a obesidade, com p = 0,007. As pacientes obesas tiveram maior volume de tecido mamário ressecado, com p = 0,0013. O acompanhamento médio foi de 13 meses. A taxa de reoperação foi de 5,5% (1 caso) devido à pseudoptose. Não houve infecção dos implantes. As complicações encontradas foram: necrose parcial do complexo areolopapilar em 1 caso, deiscência superficial de ferida em 1 caso, seroma em 3 casos e dor moderada em 3 casos. Conclusão: A mamoplastia de simetrização contralateral com uso de implantes submusculares, associada ao adequado esvaziamento do tecido mamário, proporcionou resultados duradouros com baixo índice de complicações, minimizando as sequelas decorrentes da mastectomia.

Introduction: In breast reconstruction with implants, ptosis is uncommon over time, in contrast to symmetrization mammoplasty without implants, which causes premature recurrence of breast asymmetry. The objective of this study was to describe the procedure and results of contralateral symmetrization mammoplasty with the use of submuscular implants. Methods: A total of 18 cases of symmetrization mammoplasty with submuscular implants performed over a 2-year period were retrospectively studied. Results: The most common comorbidity was obesity (p = 0.007). Obese patients had a higher volume of resected breast tissue (p = 0.0013). The mean follow-up was 13 months. The reoperation rate was 5.5% (1 case) for pseudoptosis. There were no implant infections. Complications included partial necrosis of the nipple-areola complex in 1 case, superficial wound dehiscence in 1 case, seroma in 3 cases, and moderate pain in 3 cases. Conclusion: Contralateral symmetrization mammoplasty with submuscular implants, associated with adequate emptying of breast tissue, provided long-lasting results with a low rate of complications, minimizing the sequelae of mastectomy.

Scientific evaluation of spinal implants: an ethical necessity.

The clinical introduction of novel medical devices often occurs without evidence of good methodological quality and with relatively little oversight and regulation. As a consequence, the safety, efficacy, and long-term effects of devices are frequently insufficiently known upon device approval. Recent controversies surrounding the Poly Implant Prothèse (PIP) breast implants, metal-on-metal hip implants, and interspinous implants underscore the need to reconsider how innovation in medical devices can adhere to sound ethical standards without inhibiting surgical research and development. In this article, the introduction of spinal implants is taken as an example to firstly discuss the scientific and ethical challenges of developing, testing, and introducing novel medical devices and to secondly identify avenues for improving the existing regulatory frameworks for such innovation. Two measures for improvement are most feasible in the short term: demanding prospective studies before device introduction and developing registries to monitor and evaluate new medical devices. Level of evidence: 5.

Identity and conflicts in the ethics of neural implants / Identidad y conflicto en la ética de los implantes neuroprostéticos

The development of neuroprosthetics has given rise to significant theoretical and practical challenges concerning personal identity. The Extended Mind Theory (EMT) attempts to provide an answer to these challenges by arguing that the mind and the external world are co-extensive to the point that both can make a seamless unified entity. The EMT also proposes that physical states determine the nature of mental states. Here, we propose a non-deterministic and less locationist view of mental states that we will call iEMT. The iEMT articulates, firstly, that the co-extensivity of the mind and the world does not justify the dissolution of the mind in the objects of the external world with which the mind interacts. Consequently, the agent’s mind is still part of his unique personal identity. Secondly, neural implants cannot be regarded as mere replacement parts in the context of a weak concept of personal identity. Thirdly, there are no compelling reasons to believe or to fear that neuroprosthetics can alter personal identity at the profound level

El desarrollo de la tecnología neuroprostética está generando importantes problemas teóricos y prácticos relacionados con la identidad personal. En este contexto, la Extended Mind Theory (EMT) es una teoría que da una respuesta a dichos problemas señalando que la mente es coextensa con el mundo, y que como tal, la mente y el mundo se entremezclan hasta forman una única entidad. La EMT también presupone que los estados físicos determina la naturaleza de los estados mentales. En este artículo, proponemos una versión no determinista y aún menos locacionista de los estados mentales que la de la EMT a la que llamaremos iEMT. Defendemos, primero, que la coextensión de mente y mundo no justifica la disolución de la mente, y como consecuencia, de la identidad humana en el medio; segundo, que no está justificado pensar que los neuro-implantes constituyan simples piezas de reemplazo en el contexto de una identidad que llamamos débil; y tercero, que no hay razones de peso para creer, y en esa medida, para temer, que el uso de tecnología neuroprostética pueda alterar la identidad personal

Identity and conflicts in the ethics of neural implants.

The development of neuroprosthetics has given rise to significant theoretical and practical challenges concerning personal identity. The Extended Mind Theory (EMT) attempts to provide an answer to these challenges by arguing that the mind and the external world are co-extensive to the point that both can make a seamless unified entity. The EMT also proposes that physical states determine the nature of mental states. Here, we propose a non-deterministic and less locationist view of mental states that we will call iEMT. The iEMT articulates, firstly, that the co-extensivity of the mind and the world does not justify the dissolution of the mind in the objects of the external world with which the mind interacts. Consequently, the agent's mind is still part of his unique personal identity. Secondly, neural implants cannot be regarded as mere replacement parts in the context of a weak concept of personal identity. Thirdly, there are no compelling reasons to believe or to fear that neuroprosthetics can alter personal identity at the profound level.

Harms and responsibilities associated with battery-operated implants (BOI): who controls postmortem explantation?

The postmortem issues raised by battery-operated implants (BOI) are complex and issues of consent, setting (clinical vs research), and environmental risks have received little attention in bioethics literature. Analyzing the issues, the following are argued: (1) Patients receiving BOIs should sign a consent form that includes a requirement for postmortem explant of the device; (2) BOI consent forms should require the explanted devices be returned to their manufacturers for Returned Product Analysis; (3) Failure to explant and analyze devices from the research setting fails the research goal of generation of knowledge for the benefit of future patients; (4) Failure to explant and analyze devices from the clinical setting allows product defects to be potentially hidden from patients, families, clinicians, manufacturers, and regulatory agencies; (5) Bodies buried with BOIs potentially harm the environment; (6) Religious or philosophical objections to autopsy should not supersede the duty to explant and analyze BOIs; (7) The concepts herein for BOIs could potentially extend to non-BOI if the device has failure modes that can lead to a potentially life-threatening event or can cause permanent debilitating health issues, and the burial or cremation of the device poses environmental harm. In these situations, neither the patient (premortem) nor family (postmortem) should have the right to refuse explant.

Ethical, anatomical and physiological issues in developing vestibular implants for human use.

Effort towards the development of a vestibular implant for human use are being made. This paper will summarize the first important steps conducted in Geneva towards this ambitious goal. Basically, we have faced three major issues. First, an ethical issue. While it was clear that such development would require the collaboration of human volunteers, it was also clear that stimulation of the vestibular system may produce periods of significant incomfort. We know today how to minimize (and potentially eliminate) this type of incomfort. The second issue was anatomical. The anatomical topology of the vestibular system is complex, and of potentially dangerous access (i.e. facial nerve damage). We choose not to place the electrodes inside the ampullae but close the vestibular nerve branches, to avoid any opening of the inner ear and limit the risk of hearing loss. Work on cadaver heads, confirmed by acute stimulations trials on patients undergoing ear surgery under local anesthesia, demonstrated that it is possible to stimulate selectively both the posterior and lateral ampullary nerves, and elicit the expected vertical and horizontal nystagmic responses. The third issue was physiological. One of the goal of a vestibular implant will be to produce smooth eye movements to stabilize gaze direction when the head is moving. Indeed, after restoring a baseline or "rest" activity in the vestibular pathways with steady-state electrical stimulation, we demonstrated that modulation of this stimulation is producing smooth eye movements. In conclusion, humans can adapt to electrical stimulation of the vestibular system without too much discomfort. Surgical access to the posterior and lateral ampullary nerves have been developed and, electrical stimulation of the vestibular system can be used to artificially elicit smooth eye movements of different speeds and directions, once the system is in adapted state. Therefore, the major prerequisites to develop a prototype vestibular implant for human use are fulfilled.

Ethical issues in the development of a vestibular prosthesis.

During the development of a neural prosthesis, various ethical aspects have to be considered. These range from the basic design of the prosthesis and manufacturing of the various components and the system using biocompatible materials to extensive in vitro and in vivo testing and investigations in the animal model, before taking the final step and going to human trials. As medical systems, neural prostheses have to be proven absolutely safe before considering any clinical study. In this work, the various steps accompanying the development are described taking the example of a vestibular prosthesis currently developed within the European project CLONS.

Cronología de la erupción implantaria / Chronology of the implant eruption

El título ya de por sí tiene que resultarle al lector inmediatamente sospechoso, si no fuera así, sentiríamos desde el principio que no hemos sido capaces de trasmitir nuestro todavía hoy por hoy irrealizable proyecto de poderlo llevar a efecto con fines primero reales y en definitiva prácticos. La idea nos ha surgido quizás fundamentalmente de las películas de ciencia ficción más recientes y nos referimos sobre todo a aquellas que tratan sobre avatares y su entorno(AU)

The title in itself has to make the reader suspicious immediately, if it were not so, we would feel from the beginning that we still have been unable to transmit, at this moment in time, to be able to put an unfeasible project into effect, firstly with real aims and finally into practice. The idea has arisen, perhaps mainly due to more recent science fiction films and in particular those that are about Avatars and their environment(AU)

Brain-machine interface: the challenge of neuroethics.

The burning question surrounding the use of Brain-Machine Interface (BMI) devices is not merely whether they should be used, but how widely they should be used, especially in view of some ethical implications that arise concerning the social and legal aspects of human life. As technology advances, it can be exploited to affect the quality of life. Since the effects of BMIs can be both positive and negative, it is imperative to address the issue of the ethics surrounding them. This paper presents the ways in which BMIs can be used and focuses on the ethical concerns to which neuroscience is thus exposed. The argument put forward supports the use of BMIs solely for purposes of medical treatment, and invites the legal framing of this.

Enhancing disabilities: transhumanism under the veil of inclusion?

Technological developments for disabled athletes may facilitate their competition in standard elite sports. They raise intriguing philosophical questions that challenge dominant notions of body and normality. The case of 'bladerunner' Oscar Pistorius in particular is used to illustrate and defend 'transhumanist' ideologies that promote the use of technology to extend human capabilities. Some argue that new technologies will undermine the sharp contrast between the athlete as a cultural hero and icon and the disabled person that needs extra attention or care; the one exemplary of the peak of normality, human functioning at its best, the other representing a way of coping with the opposite. Do current ways of classification do justice to the performances of disabled athletes? The case of Oscar Pistorius will be used to further illustrate the complexities of these questions, in particular when related to notions of normality and extraordinary performances. Pistorius' desire to become part of 'normal' elite sport may be interpreted as an expression of a right to 'inclusion' or 'integration', but at the same time it reproduces new inequalities and asymmetries between performances of able and dis-abled athletes: we propose that if one accepts that Pistorius should compete in the 'regular' Olympic Games, this would paradoxically underline the differences between able and disabled and it would reproduce the current order and hierarchy between able and disabled bodies.

Carga inmediata en implantología oral / Immediate loading in oral implantology

La gran demanda estética y funcional hace que cada día se intenten disminuir más los tiempos de espera para cargar los implantes en los tratamientos con pacientes desdentados, surgiendo la carga inmediata como hecho biofísico de someter a carga masticatoria funcional uno o varios implantes en las primeras 24 horas de su implantación. Con el objetivo de caracterizar el procedimiento de carga inmediata como alternativa de tratamiento, se realizó una exhaustiva revisión de 22 bibliografías, consultando a autores como Bechelli, Maló, Degidi, Uribe, entre otros especialistas en el tema. El éxito del tratamiento puede alcanzarse con una correcta selección y evaluación del paciente, teniendo en cuenta la calidad ósea y la estabilidad inicial del implante. El procedimiento quirúrgico se simplifica haciendo esta técnica más confiable y ofreciéndole ventajas como: estética en un mismo tiempo quirúrgico, conformación de la arquitectura gingival, elevación de la calidad de vida y confort de nuestros pacientes.

The big aesthetics and functional demand makes to try to decrease more the time of waiting to load the implants in the treatments in edentulism patients appearing the immediate load as a biophysics fact to submit to a masticatory functional load one or several implants in the first 24 hours of it implantation. In order to characterize the procedure of immediate load like an alternative of treatment. It has been realized an exhaustive revision of 22 bibliographies consulting to authors such as Bechelli, Maló, Degidi, Uribe between other specialist in the topic. The success of the treatment can be reaching with a correct selection and evaluation of the patient, bearing in mind the ossea quality and the initial stability of the implant. The surgical procedure is simplified making this technical more reliable, it offers advantages such as: aesthetics in the same surgical time, conformation of the gingival architecture, elevation of the quality of life and the comfort of our patients.

Carga inmediata en implantología oral / Immediate loading in oral implantology

La gran demanda estética y funcional hace que cada día se intenten disminuir más los tiempos de espera para cargar los implantes en los tratamientos con pacientes desdentados, surgiendo la carga inmediata como hecho biofísico de someter a carga masticatoria funcional uno o varios implantes en las primeras 24 horas de su implantación. Con el objetivo de caracterizar el procedimiento de carga inmediata como alternativa de tratamiento, se realizó una exhaustiva revisión de 22 bibliografías, consultando a autores como Bechelli, Maló, Degidi, Uribe, entre otros especialistas en el tema. El éxito del tratamiento puede alcanzarse con una correcta selección y evaluación del paciente, teniendo en cuenta la calidad ósea y la estabilidad inicial del implante. El procedimiento quirúrgico se simplifica haciendo esta técnica más confiable y ofreciéndole ventajas como: estética en un mismo tiempo quirúrgico, conformación de la arquitectura gingival, elevación de la calidad de vida y confort de nuestros pacientes(AU)

The big aesthetics and functional demand makes to try to decrease more the time of waiting to load the implants in the treatments in edentulism patients appearing the immediate load as a biophysics fact to submit to a masticatory functional load one or several implants in the first 24 hours of it implantation. In order to characterize the procedure of immediate load like an alternative of treatment. It has been realized an exhaustive revision of 22 bibliographies consulting to authors such as Bechelli, Maló, Degidi, Uribe between other specialist in the topic. The success of the treatment can be reaching with a correct selection and evaluation of the patient, bearing in mind the ossea quality and the initial stability of the implant. The surgical procedure is simplified making this technical more reliable, it offers advantages such as: aesthetics in the same surgical time, conformation of the gingival architecture, elevation of the quality of life and the comfort of our patients(AU)