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Pediatrics ; 146(Suppl 1): S33-S41, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737230


Cases of adolescents in organ failure who refuse solid organ transplant are not common, but several have been discussed in the media in the United States and the United Kingdom. Using the framework developed by Buchanan and Brock for surrogate decision-making, I examine what role the adolescent should morally play when deciding about therapy for life-threatening conditions. I argue that the greater the efficacy of treatment, the less voice the adolescent (and the parent) should have. I then consider how refusals of highly effective transplant cases are similar to and different from refusals of other lifesaving therapies (eg, chemotherapy for leukemia), which is more commonly discussed in the media and medical literature. I examine whether organ scarcity and the need for lifelong immunosuppression justify differences in whether the state intervenes when an adolescent and his or her parents refuse a transplant. I argue that the state, as parens patriae, has an obligation to provide the social supports needed for a successful transplant and follow-up treatment plan, although family refusals may be permissible when the transplant is experimental or of low efficacy because of comorbidities or other factors. I conclude by discussing the need to limit media coverage of pediatric treatment refusals.

Temas Bioéticos , Meios de Comunicação de Massa/ética , Transplante de Órgãos/ética , Consentimento dos Pais/ética , Recusa do Paciente ao Tratamento/ética , Adolescente , Família , Feminino , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Masculino , Transplante de Órgãos/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Participação do Paciente , Patient Self-Determination Act , Ética Baseada em Princípios , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Gêmeos Monozigóticos , Reino Unido , Estados Unidos
J Med Philos ; 45(4-5): 560-579, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32726810


After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement with our commentators and respond to their critical evaluations.

Bioética , Ética Baseada em Princípios , Teoria Ética , Humanos , Virtudes
J. negat. no posit. results ; 5(7): 674-682, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194129


Las tentadoras promesas del transhumanismo parecen estar cada vez más cerca, pero cabe preguntarse si no resultarán contraproducentes en algún sentido. El profesor Sandel expone los problemas sociales que conllevaría el desarrollo de seres humanos mejorados en nuestra concepción del mérito, la libertad y responsabilidad, el aprecio de la vida como un don, la inclinación a compartir nuestro destino con el de los demás y la concepción de los derechos individuales

The tempting promises of transhumanism seem to be getting closer and closer, but in some way counterproductive in some way. Professor Sandel presents the social problems that the development of improved human beings would entail in our understanding of merit, freedom and responsibility, the appreciation of life as a gift, the inclination to share our destiny with others and the conception of individual rights

Humanos , Humanismo , Ética Baseada em Princípios , Melhoramento Biomédico/ética , Melhoramento Genético/ética , Genética Humana/tendências , Biotecnologia/tendências , Responsabilidade Civil , Seleção Genética
J Med Ethics ; 46(8): 505-507, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32532825


COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients' outcome within the constraints of pandemic management and its long-term outlook.

Infecções por Coronavirus/complicações , Tomada de Decisões/ética , Ética Médica , Cirurgia Geral/ética , Equidade em Saúde/ética , Pandemias/ética , Seleção de Pacientes/ética , Pneumonia Viral/complicações , Betacoronavirus , Infecções por Coronavirus/virologia , Análise Custo-Benefício , Inglaterra , Análise Ética , Teoria Ética , Humanos , Consentimento Livre e Esclarecido/ética , Obrigações Morais , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Ética Baseada em Princípios , Medição de Risco , Medicina Estatal , Cirurgiões , Procedimentos Cirúrgicos Operatórios
Br J Nurs ; 29(5): 314-317, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32167808


Person-first thinking makes it a virtue to 'see the person, not the disability', overlooking, or making an effort to overlook, a person's impairment in order to see 'the person within'. This might seem a caring and compassionate approach in everyday nursing practice, but on closer examination it can be seen as unhelpful and even discriminatory. This article considers why this should be the case and introduces the affirmation model as a basis for a different way of thinking about the issue.

Pessoas com Deficiência , Empatia , Filosofia em Enfermagem , Humanos , Princípios Morais , Ética Baseada em Princípios
Am J Emerg Med ; 38(1): 138-142, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31378410


There is considerable diversity in compensation models in the specialty of Emergency Medicine (EM). We review different compensation models and examine moral consequences possibly associated with the use of various models. The article will consider how different models may promote or undermine health care's quadruple aim of providing quality care, improving population health, reducing health care costs, and improving the work-life balance of health care professionals. It will also assess how different models may promote or undermine the basic bioethical principles of beneficence, non-maleficence, respect for autonomy, and justice.

Temas Bioéticos , Compensação e Reparação/ética , Medicina de Emergência/economia , Medicina de Emergência/ética , Modelos Econômicos , Medicina de Emergência/normas , Custos de Cuidados de Saúde , Humanos , Satisfação no Emprego , Ética Baseada em Princípios , Qualidade da Assistência à Saúde , Sociedades Médicas
Bioethics ; 34(1): 123-134, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31617217


In vitro gametogenesis (IVG) might offer numerous research and clinical benefits. Some potential clinical applications of IVG, such as allowing opposite-sex couples experiencing infertility to have genetically related children, have attracted support. Others, such as enabling same-sex reproduction and solo reproduction, have attracted significantly more criticism. In this paper, we examine how different ethical principles might help us to draw lines and distinguish between ethically desirable and undesirable uses of IVG. We discuss the alleged distinction between therapeutic and non-therapeutic uses of assisted reproduction in the context of IVG, and show how it is both problematic to apply in practice and theoretically dubious. We then discuss how the ethical principles of reproductive justice and beneficence apply to IVG for opposite-sex reproduction, same-sex reproduction, and solo reproduction. We suggest that these principles generate strong reasons for the use of IVG for opposite-sex and same-sex reproduction, but not for solo reproduction.

Análise Ética , Gametogênese , Técnicas In Vitro/ética , Técnicas In Vitro/métodos , Pais , Ética Baseada em Princípios , Técnicas de Reprodução Assistida/ética , Beneficência , Família/psicologia , Feminino , Redução do Dano/ética , Acesso aos Serviços de Saúde/ética , Humanos , Masculino , Direitos Sexuais e Reprodutivos/ética , Direitos Sexuais e Reprodutivos/psicologia , Risco
Bioethics ; 34(1): 49-59, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31247677


The precautionary principle aims to influence decision-making in contexts where some activity poses uncertain but potentially grave threats. This perfectly describes the controversy surrounding germline gene editing. This article considers whether the precautionary principle should influence how we weigh the risks and benefits of human germline interventions, focusing especially on the possible threats to the health of future generations. We distinguish between several existing forms of the precautionary principle, assess their plausibility and consider their implications for the ethics of germline modification. We also offer a novel form of the precautionary principle: the sufficientarian precautionary principle. Some plausible versions of the precautionary principle recommend placing somewhat greater weight on avoiding threats to future generations than on achieving short-term benefits. However, no plausible versions of the precautionary principle entail that we should outright reject the use germline gene editing in human reproduction and some, such as the sufficientarian version, might endorse its use.

Tomada de Decisões/ética , Edição de Genes/ética , Células Germinativas , Ética Baseada em Princípios , Humanos , Medição de Risco
Dev World Bioeth ; 20(1): 5-15, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30993868


Research ethics regulation in parts of the Global North has sometimes been initiated in the face of biomedical scandal. More recently, developing and recently developed countries have had additional reasons to regulate, doing so to attract international clinical trials and American research funding, publish in international journals, or to respond to broader social changes. In Taiwan, biomedical research ethics policy based on 'principlism' and committee-based review were imported from the United States. Professionalisation of research ethics displaced other longer-standing ways of conceiving ethics connected with Taiwanese cultural traditions. Subsequently, the model and its discursive practices were extended to other disciplines. Regulation was also shaped by decolonizing discourses associated with asserting Indigenous peoples' rights. Locating research ethics regulation within the language and practices of public policy formation and transfer as well as decolonization, allows analysis to move beyond the self-referential and attend to the social, economic and political context within which regulation operates.

Pesquisa Biomédica/ética , Pesquisa Biomédica/legislação & jurisprudência , Comitês de Ética em Pesquisa/legislação & jurisprudência , Ética em Pesquisa , Regulamentação Governamental , Política Pública , Sujeitos da Pesquisa/legislação & jurisprudência , Humanos , Povos Indígenas/legislação & jurisprudência , Ética Baseada em Princípios , Ciências Sociais/ética , Taiwan , Universidades/ética
Bioethics ; 34(3): 242-251, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31769873


Some people (e.g., Drs. Paul and Susan Lim) and, with them, organizations (e.g., the National Embryo Donation Center) believe that, morally speaking, the death of a frozen human embryo is a very bad thing. With such people and organizations in mind, the question to be addressed here is as follows: if one believes that the death of a frozen embryo is a very bad thing, ought, morally speaking, one prevent the death of at least one frozen embryo via embryo adoption? By way of a three-premise argument, one of which is a moral principle first introduced by Peter Singer, my answer to this question is: at least some of those who believe this ought to. (Just who the "some" are is identified in the paper.) If this is correct, then, for said people, preventing the death of a frozen embryo via embryo adoption is not a morally neutral matter; it is, instead, a morally laden one. Specifically, their intentional refusal to prevent the death of a frozen embryo via embryo adoption is, at a minimum, morally criticizable and, arguably, morally forbidden. Either way, it is, to one extent or another, a moral failing.

Adoção , Destinação do Embrião/ética , Transferência Embrionária/ética , Obrigações Morais , Cristianismo , Criopreservação/ética , Eticistas , Humanos , Ética Baseada em Princípios
Hell J Nucl Med ; 22 Suppl 2: 77-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31802049


BACKGROUND: Conscientious objection (CO) is a complex topic of great clinical and philosophical importance which recently came again under fire. Both the so-called absolutist and pro-choice extreme positions (pro and against CO, respectively) cannot stand up to arguments. Moreover, there is not satisfactory compromise position between the conflicting rights. DISCUSSION: The conflicting claims (objectors' and patients') are (almost) equally strong and as such should be accommodated at the same time, when the following conditions are met: objectors' claims are entrenched in society, no anti-democratic values are manifested, and patients' claim is incontestably de lege lata legitimate. The judgment about the de lege lata legitimacy of any given patient's claim should result from the dynamic process of an ongoing dialogue in accordance with the rawlsean "reflective equilibrium" held against a background of shifting sand: people change, medicine changes, society changes. The dialogue should be informed by the ongoing universal dialectic between absolutism and relativism. In accordance with the principle of mutuality, the state and other involved stakeholders (i.e. institutions) have the moral obligation to investigate all the "alternative options and circumstances" under which the conflict can be eliminated, circumvent or a true compromise can be achieved. With this path locked, the conflicting parties should find a fair mutual concession accommodating both the conflicting claims to the greatest extent possible, at the same time. Both the conflicting parties are placed under the obligation to tolerate a "reasonably" minimal harm. This may be the case with referral obligation. If an objective (not personal) referral obligation would be recognized the right to CO would be limited without, however, losing its core physiognomy, provided that the right to CO is a flimsy subjective right that is structured like a molecular aggregation. Besides, a very low amount of wrongness can be conferred upon the act of referral. Who makes it is an in-the-rear-actor in a "wrongdoing" which, in addition, is preparatory act of the principal moral wrongdoing. CONCLUSION: On the basis of the bioethical principle of mutuality the paper provides a proposal in two steps for obtaining a normatively reasonable (if not true) compromise position.

Recusa Consciente em Tratar-se/ética , Ética Médica , Obrigações Morais , Filosofia , Aborto Induzido/ética , Atitude do Pessoal de Saúde , Assistência à Saúde , Dissidências e Disputas , Ética , Eutanásia/ética , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Médicos , Ética Baseada em Princípios , Técnicas de Reprodução Assistida
Arq. bras. cardiol ; 115(6): 1178-1179, dez. 2019.
Artigo em Português | Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1147640


Resumo O manejo de dispositivos cardíacos eletrônicos implantáveis de pacientes que evoluem a óbito tem sido motivo de controvérsia. Em nosso meio, não há recomendações uniformes, estando baseadas exclusivamente em protocolos institucionais e em costumes regionais. Quando o cadáver é submetido para cremação, além de outros cuidados, recomenda-se a retirada do dispositivo devido ao risco de explosão e dano do equipamento crematório. Principalmente no contexto da pandemia causada pelo SARS-Cov-2, a orientação e organização de unidades hospitalares e serviços funerários é imprescindível para minimizar o fluxo de pessoas em contato com fluidos corporais de indivíduos falecidos por COVID-19. Nesse sentido, a Sociedade Brasileira de Arritmias Cardíacas elaborou este documento com orientações práticas, tendo como base publicações internacionais e recomendação emitida pelo Conselho Federal de Medicina do Brasil.

Autopsia/métodos , Desfibriladores Implantáveis , Ética Baseada em Princípios
Rev. medica electron ; 41(6): 1533-1549, oct.-dic. 2019. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1094148


RESUMEN La revisión por pares garantiza que los materiales publicados sean válidos y confiables, tanto como sea posible. El objetivo fue reconocer la importancia del trabajo de los revisores en las publicaciones científicas médicas y de la observación de los aspectos éticos durante su desempeño. Las revisiones por pares pueden ser a ciegas, a doble ciegas o abiertas, cada una de ellas con ventajas y desventajas. Durante las publicaciones de resultados de investigaciones científicas pueden producirse sesgos por parte de los revisores. Entre los sesgos de los revisores relacionados con faltas éticas se encuentran: los incumplimientos en plazos de revisión, la superficialidad de las revisiones, el lenguaje ofensivo contra editores o autores, el "amiguismo cognitivo" y el "sesgo de ego" por propia voluntad, entre otros. No obstante, es posible implementar acciones para minimizar los sesgos relacionados con esas faltas éticas. El trabajo de los revisores es digno de reconocer, teniendo en cuenta que casi siempre es realizado durante el tiempo libre, de forma voluntaria y por personas de alto prestigio como investigadores. En el mundo actual esta labor ha sido amenazada con la proliferación de revistas predadoras, pero también destacan los intentos para su reivindicación y promoción, como el del sitio web Publons. En el trabajo de los revisores intervienen múltiples factores, a veces contradictorios: intereses, deberes, derechos; pero todos ellos deben ponderarse sobre la base de una sólida formación y desempeño éticos (AU).

ABSTRACT Peer reviews guarantee published materials be as valid and reliable as it be possible. Recognize reviewers' work importance on scientific medical publication as well as the ethics issues to be accomplished during their performance. Development: Peer reviews could be single blind, double blind or open, each one with its advantages and disadvantages. During scientific research results publications, peer reviewer biases could be occurred. Some peer reviewer biases are related to ethical mistakes: no fulfillment of time limits, superficial evaluations, offense languages against editors or authors, at will cognitive cronyism and "ego bias", among others. Nevertheless, measures' implementation to minimize biases related to ethical mistakes is possible. The reviewers' work is suitable to be recognized, taking into account it is done almost all the times on free time, without financial compensation and by researchers with recognized prestige. In the present word, even when this work has been threat by predatory journals spreads, some intent to do it justice and promotion are highlight, as do the website Publons. Multiple factors, contradictory sometime, are involved in the reviewers' work: interests, duties, rights; but all of them should be pondering over the base of a solid ethic education and behavior (AU).

Viés de Publicação , Revisão da Pesquisa por Pares/ética , Ética Baseada em Princípios , Ética em Pesquisa , Comunicação , Confidencialidade , Publicações Científicas e Técnicas , Ética Profissional , Anonimização de Dados/ética , Gerenciamento de Dados/ética
Cuad. bioét ; 30(100): 253-262, sept.-dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-185239


El concepto de vulnerabilidad ha determinado múltiples actuaciones en el ámbito sanitario. En los últimos años este concepto ha originado diversos modelos holísticos que oscilan entre considerar la vulnerabilidad como un elemento descriptivo de una situación accidental hasta su consideración como principio orientador de la práctica médica. Se percibe la necesidad de profundizar en este fenómeno desde el punto de vista de la filosofía moral. La reflexión moral revela un desequilibrio en el binomio autonomía-dependencia, generando soluciones opuestas en la toma de decisiones. Aunque la autonomía ha fundamentado hasta ahora gran parte de la acción médica, la dependencia plantea una nueva óptica sobre la vulnerabilidad, ra-dicada en la ética del cuidado. Esta perspectiva permite superar la consideración de la vulnerabilidad como una característica, un accidente o un principio. La vulnerabilidad aparece como una dimensión intrínseca del ser humano que, lejos de alterar su dignidad o su autonomía, permite evidenciar la necesidad de los otros para alcanzar su plenitud

The concept of vulnerability has determined multiple actions in the health field. In recent years, this concept has originated various holistic models that oscillate between considering vulnerability as a descriptive element of an accidental situation until it is considered a guiding principle of medical practice. The need to deepen this phenomenon from the point of view of moral philosophy is perceived. The moral reflection reveals an imbalance in the binomial autonomy-dependence, generating opposite solutions in decision-making. Although autonomy has so far supported much of the medical action, the dependency raises a new perspective on vulnerability, rooted in the ethics of care. This perspective allows us to overcome the consideration of vulnerability as a characteristic, an accident or a principle. Vulnerability appears as an intrinsic dimension of the human being that, far from altering its dignity or autonomy, makes it possible to demonstrate the need of others to reach their fullness

Humanos , Vulnerabilidade Social , Bioética , Nível de Saúde , Grupos Minoritários , Saúde das Minorias/ética , Pobreza , Ética Baseada em Princípios , Populações Vulneráveis , Grupos de Risco , Autonomia Pessoal , Deambulação com Auxílio/ética , Indigência Médica , Responsabilidade Social
J Bioeth Inq ; 16(3): 405-414, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31418161


Preimplantation genetic diagnosis (PGD) allows the detection of genetic abnormalities in embryos produced through in vitro fertilization (IVF). Current funding models in Australia provide governmental subsidies for couples undergoing IVF, but do not extend to PGD. There are strong reasons for publicly funding PGD that follow from the moral principles of autonomy, beneficence and justice for both parents and children. We examine the objections to our proposal, specifically concerns regarding designer babies and the harm of disabled individuals, and show why these are substantially outweighed by arguments for subsidizing PGD. We argue that an acceptance of PGD is aligned with present attitudes towards procreative decision making and IVF use, and that it should therefore receive government funding.

Financiamento Governamental/ética , Custos de Cuidados de Saúde/ética , Pais/psicologia , Diagnóstico Pré-Implantação/economia , Diagnóstico Pré-Implantação/ética , Ética Baseada em Princípios , Austrália , Beneficência , Tomada de Decisões/ética , Feminino , Humanos , Masculino , Autonomia Pessoal , Gravidez , Seleção Genética , Justiça Social
Eur J Haematol ; 103(5): 478-482, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31418923


PURPOSE OF THE STUDY: To discuss the ethical challenges for the therapeutic team when dealing with a young savior sibling as a potential tissue donor. BASIC PROCEDURES: Savior siblings are children that are created to serve a sibling as a donor of umbilical cord blood, bone marrow, or peripheral blood from which hematopoietic stem cells are derived. These cells are used for hematopoietic stem cell therapy, which is the only curative treatment for certain hemoglobinopathies. We used a case including a 19-year-old thalassemia patient and his two and a half year old sister from our practice as ethics consultants. Our methodological basis is the principlism approach by Beauchamp and Childress, consisting of four principles: autonomy, non-maleficence, beneficence, and justice. MAIN FINDINGS: We found that the main conflict arises between the autonomy of the savior sibling as well as the non-maleficence regarding her and the beneficence of the thalassemia patient. PRINCIPAL CONCLUSIONS: Decision-making is complex when decisions within the family are concerned, especially when non-competent young children are involved. The therapeutic team does not only have to recognize the principal vulnerability of children but also the different scales of vulnerability depending on their age.

Temas Bioéticos , Tomada de Decisão Clínica/ética , Ética Baseada em Princípios , Irmãos , Obtenção de Tecidos e Órgãos/ética , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Adulto Jovem
Rev. medica electron ; 41(4): 1053-1062, jul.-ago. 2019.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1094111


RESUMEN La educación en el trabajo es la forma de organización de la enseñanza donde se desarrollan las competencias laborales. Para desarrollar esta actividad en el pregrado, los estudiantes necesitan estar capacitado para resolver problemas médicos, tomar decisiones y poseer habilidades que permitan actuar correctamente en la práctica. Este artículo pretende abordar las cuestiones principales sobre esta actividad como el medio para el cumplimiento de los principios del derecho médico en la carrera de Medicina. Esta actividad es asumida como la acción transformadora de la realidad. Es el medio para construir los sistemas de valores, conocimientos y habilidades esenciales que requieren los educandos en los procesos educacionales, por ello no debe estar alejado de los preceptos relacionados con el cumplimiento del derecho médico. Lo que se manifiesta a través del conocimiento de los principios y la relación médico-paciente, la cual tiene su máxima expresión en las actividades formativas que se realizan en esa forma de organización de la enseñanza. Se comprobó que el Plan de Estudios de la Carrera Medicina está sustentado en: Leyes, Reglamentos, Resoluciones, Indicaciones Metodológicas del MINSAP y Lineamientos de la Política Económica y Social en Cuba que refrendan y soportan la calidad en los servicios de salud. Los autores consideran que no se aprovechan todas las potencialidades que brinda la educación en el trabajo en su vínculo con los aspectos teórico prácticos del derecho médico cubano (AU).

ABSTRACT The education at work is the organizational form of teaching when job skills are developed. To carry on this activity in the undergraduate level, students have to be able of solving medical problems, taking decisions and having skills allowing them to perform right in the practice. This article pretends to approach the main questions on this activity as the mean for the fulfillment of the principles of the medical right in Medicine studies. This activity is assumed as an action transforming reality. It is the mean to build the main systems of values, knowledge and skills required by the students in the teaching processes; therefore it should not be strange to the precepts related with the fulfillment of the medical right, manifested through the knowledge of the principles and the relation doctor-patient having its maximal expression in the training activities carried out in this kind of organization of teaching. It was proved that the curriculum of Medicine studies is based on Laws, Rules, Resolutions, Methodological Guidelines of the Ministry of Public Health and the Guidance of the Social and Economical Politics in Cuba endorsing and supporting the health services quality. The authors consider that the possibilities given by the education at work in its relation to the theoretical and practical aspects of the Cuban medical right are not exploited the most (AU).

Humanos , Competência Profissional , Educação Médica , Educação Profissionalizante , Ética Médica , Relações Médico-Paciente , Qualidade da Assistência à Saúde , Ensino , Educação Baseada em Competências , Ética Baseada em Princípios
Cuad. bioét ; 30(99): 135-147, mayo-ago. 2019.
Artigo em Inglês | IBECS | ID: ibc-185230


This year marks the 40th anniversary of the Belmont Report that formally ushered in an era of principlism and proceduralism in the field of bioethics, an era which shaped the form of bioethical debate according to the combination of Enlightenment-inspired dualism and Liberal pragmatism characteristic of the United States. While ostensibly seeking to protect the vulnerable in a pluralistic society, in reality, recent critiques have argued, the development of bioethics has been directed at legitimizing the bureaucratization of ethics into a self-referential and isolated instrument for socio-political control. As a result, bioethical proceduralism often subverts the very values it is supposed to defend. These critiques, while valuable, do not reach the heart of the problem, which is rooted in the ontological level. The philosophical heritage of modern bioethics - the ontological presuppositions about human nature, freedom and the supposed "neutrality" towards any claims about the good, among others - must be rectified so bioethics may better achieve its stated goals and uphold its own principles. While recounting the entire ontological vision that would undergird such a renewal is beyond the scope of this paper, reconceiving the presuppositions behind the notions of freedom, consensus, and autonomy through an understanding of the human being as a person-in-community constitutively related to others opens a path through which principles and procedures can be preserved, not subverted, within bioethics today

Este año se cumple el 40º aniversario de la publicación del Informe Belmont que formalmente marcó el inicio de una época de principialismo y procedimentalismo en el campo de la bioética, una época que dio forma al debate bioético marcado tanto por el dualismo inspirado en la Ilustración como el pragmatismo Liberal característico en los Estados Unidos de América. Mientras ostensiblemente se buscaba proteger a los más vulnerables dentro de una sociedad pluralista, en realidad, críticas recientes han sostenido que el desarrollo de la bioética ha pretendido legitimar una burocratización de la ética, convirtiéndola en un instrumento aislado y autorreferencial para el control socio-político. Como consecuencia, el procedimentalismo bioético suele subvertir los mismísimos valores que debería defender. Estas críticas, aun siendo valiosas, no llegan al núcleo del problema, el cual está enraizado a nivel ontológico. La herencia filosófica de la bioética moderna - y los presupuestos ontológicos sobre la naturaleza humana, su libertad, y la su-puesta "neutralidad" hacia toda afirmación sobre el bien, entre otras - deben ser rectificadas para que la bioética pueda lograr mejor sus objetivos declarados y defender sus propios principios. Aunque describir la visión ontológica completa que afianzaría tal renovación supera el alcance de este trabajo, repensar los presupuestos que existen detrás de las nociones de libertad, consenso, y autonomía, a través de una comprensión del ser humano como persona-en-comunidad, relacionada constitutivamente a los demás, nos abre un camino por el cual los principios y procedimientos puedan ser preservados, no subvertidos, en la bioética de hoy

Humanos , Consenso , Bioética , Teoria Ética , Diversidade Cultural , Valores Sociais , Ética Baseada em Princípios , Características Culturais