Digitalización de la comunicación y atención a personas LGBTIQ+: dos conflictos éticos emergentes para la Psicología en la Atención Primaria de Salud chilena / Digitalització de la comunicació i atenció a persones LGBTIQ+: dos conflictes ètics emergents per a la psicologia en l'Atenció Primària de Salut xilena / Digitalization of communication and attention to LGBTIQ+ people: Two emerging ethical conflicts for psychology in Chilean Primary Health Care

El artículo analiza los conflictos éticos detectados por Psicólogas/os en la Atención Primaria de Salud en Chile, centrando la descripción y análisis en los percibidos como emergentes, a través de un estudio cualitativo, tipo exploratorio-descriptivo. Dos fueron los principales conflictos identificados: a) resguardo de información sensible en ficha clínica electrónica y b) atención a personas LGBTIQ+ sin capacitación correspondiente. El estudio transparenta la importancia de visibilizar demandas incipientesen salud pública a través de las perspectivas de los propios profesionales, dotándoles de notoriedad para avanzar en su priorización y resolución. Explorar la dimensión ética es relevante para el ejercicio de la psicología contemporánea, porque da cuenta de las necesidades de la sociedad, permitiendo incluso anticiparse a ellas.(AU)

L'article analitza els conflictes ètics detectats pels psicòlegs en l'Atenció Primària de Salut a Xile, centrant-se en la descripció i anàlisi dels que es perceben com a emergents mitjançant un estudi qualitatiu de tipus exploratori-descriptiu. Es van identificar dos conflictes principals: a) la protecció de la informació sensible en els registres clínics electrònics i b) l'atenció a persones LGBTIQ+ sense la formació adequada. L'estudi destaca la importància de fer visibles les demandes incipients en la salut pública a través de les perspectives dels mateixos professionals, donant-los rellevància per avançar en la seva prioritat i resolució. Explorar la dimensió ètica és rellevant per a l'exercici de la psicologia contemporània, ja que reflecteix les necessitats de la societat, fins i tot permetent anticipar-se a elles.(AU)

The article analyzesthe ethical conflicts detected by psychologists in Primary Health Care in Chile, centering the description and analysis on those perceived as emerging, through an exploratory-descriptive qualitative study. There were two main conflicts identified: a) safeguarding of sensitive information in electronic clinical records and b) healthcare for LGBTIQ+ persons without the corresponding qualification. The study illustrates the importance of highlighting developing demands in public healthcare through the perspectives of the professionals themselves, providing the demands with notoriety in order to advance in their prioritization and resolution. Exploring the ethical dimension is relevant for contemporary psychology practice because it accounts for the needs of society, even making it possible to anticipate them.(AU)

The Limits of the Rights to Free Thought and Expression.

It is often held that people have a moral right to believe and say whatever they want. For instance, one might claim that they have a right to believe racist things as long as they keep those thoughts to themselves. Or, one might claim that they have a right to pursue any scholarly question they want as long as they do so with a civil tone. This paper rejects those claims and argues that no one has such unlimited moral rights. Part 1 explores the value of the freedoms of thought and expression. Part 2 argues against the unlimited moral right to free expression, focusing in particular on the special obligations and moral constraints that obtain for academics. Part 3 argues against the unlimited moral right to free thought.

Comparative strategic approaches to COVID-19 in Africa: Balancing public interest with civil liberties.

As COVID-19 spreads rapidly across Africa, causing havoc to economies and disruption to already fragile healthcare systems, it is becoming clear that despite standardised global health strategies, national and local government responses must be tailored to their individual settings. Some African countries have adopted stringent measures such as national lockdown, quarantine or isolation, in combination with good hand hygiene, mandatory wearing of masks and physical distancing, to prevent an impending healthcare crisis. The impact of stringent measures in low- to middle-income African countries has bought time for healthcare facilities to prepare for the onslaught of COVID-19 cases, but some measures have been challenging to implement. In some settings, public health measures have been associated with serious violations of individual rights owing to abuse of power and gaps in implementation of well-intentioned policy. Collateral damage with regard to non-COVID-19 diseases that were suboptimally managed in pre-pandemic times may mean that lives lost from other diseases could exceed those saved from COVID-19. While individuals complying with lockdown regulations have embraced an acceptance of the concept of the common good, at a broad community level many are finding the transition from individualism to collective thinking required during a pandemic difficult to navigate. In this article, we look at government responses to the pandemic in six African countries (Malawi, South Africa, Uganda, Zambia, Zimbabwe and Botswana), and highlight ethical concerns arising in these contexts.

Conscience, tolerance, and pluralism in health care.

Increasingly, physicians are being asked to provide technical services that many (in some cases, most) believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices.

Disentangling Conscience Protections.

Earlier this year, the U.S. Department of Health and Human Services announced its intent to strengthen enforcement of legal protections for health care providers' conscience rights. It proposed regulations that would give the DHHS Office of Civil Rights greater authority to ensure that recipients of federal funding comply with federal conscience laws. This recent development creates an opportunity for scholars and policy-makers to revisit the perennial debate about whether and how law should protect health care providers' rights of conscience. Arguments about who should be protected, what actions should be protected, and whether there should be any limitations on the exercise of conscience rights have brought us no closer to a resolution. However, there is one remaining avenue for analysis that has, surprisingly, received very little attention-the question of how providers are protected, and from what consequences. Existing U.S. conscience laws immunize health care providers from a wide range of adverse consequences-including civil liability, criminal prosecution, administrative penalties, adverse action by employers, and discrimination by private actors, among others. However, academic and public policy debates rarely acknowledge the breadth of these protections. It is essential to disentangle this network of possible protections.

Autonomia e capacidade sanitária: proposta de arcabouço teórico-normativo / Autonomía y capacidad sanitaria: propuesta de un marco teórico-normativo / Self-determination and health capacity: a proposal of theoretical-normative framework / Autonomia i capacitat sanitària: proposta d'un marc teòric-normatiu

Este artigo tem como objetivo propor reflexão sobre a substituição dos conceitos de autonomia privada e capacidade civil no âmbito dos cuidados em saúde do paciente no contexto brasileiro, pelos conceitos de autonomia e capacidade sanitária, de modo a consolidar o entendimento de que os institutos civilistas não são adequados para amparar decisões sobre cuidados em saúde. Sob o prisma metodológico, este estudo trata-se de pesquisa de cunho teórico. Conclui-se que há um longo caminho a ser percorrido na direção da suplantação da visão anacrônica de que os civilmente incapazes não têm autonomia e, logo, não detêm o direito de participarem ativamente dos seus cuidados em saúde, o que se desvela incompatível com os comandos derivados da de dignidade humana

El artículo es una reflexión teórica que propone sustituir los conceptos de autonomía privada y capacidad civil en el ámbito de los cuidados sanitarios del paciente, por los conceptos de autonomía y capacidad sanitaria, para consolidar la idea que de que los institutos civiles no son adecuados para respaldas las decisiones sobre cuidados en salud. Se concluye que hay un largo camino para superar la visión anacrónica de que los incapaces civiles no tienen autonomía y, por lo tanto, no tienen el derecho de participar activamente en las decisiones relacionadas a su salud. Esta posición se muestra incompatible con las normas derivadas de la dignidad humana

This article aims to propose a reflection on the replacement of the concepts of private autonomy and civil capacity concerning patient health care in the Brazilian context, through the concepts of autonomy and sanitary capacity, in order to consolidate the understanding that civilian institutes are not adequate for supporting decisions about health care. Under the methodological prism, this study is a theoretical research. I have concluded that there is a long path in order to overcoming the anachronistic view that the civil incapable haven’t autonomy and, therefore, they do not have the right to be considered in decisions concerning their health and their bodies. This position shows incompatible with the derived norms from human dignity

L'article és una reflexió teòrica que proposa substituir els conceptes d'autonomia privada i capacitat civil en l'àmbit de les cures sanitàries del pacient pels conceptes d'autonomia i capacitat sanitària, a fi de consolidar la idea que les institucions civils no són adequades per recolzar les decisions sobre les actuacions en matèria de salut. Es conclou que hi ha un llarg camí per aconseguir superar la visió anacrònica segons la qual les persones civilment incapacitades no tenen autonomia i, per tant, no tenen el dret de participar activament en les decisions relacionades amb la seva salut. Aquesta posició és del tot incompatible amb la dignitat humana

My Path to Bioethics.

In this series of essays, The Road Less Traveled, noted bioethicists share their stories and the personal experiences that prompted them to pursue the field. These memoirs are less professional chronologies and more descriptions of the seminal touchstone events and turning points that led-often unexpectedly-to their career path.