In this paper we criticize the existing contradictions in the context of bone marrow donor records in Spain. On the one hand there is the necessity to register as many patients as possible to maximize the opportunities to access a bone marrow transplant and on the other the always important economic issue of having to perform the relevant histocompatibility tests. In fact, these records are globally coordinated with each other to provide a wide range of potential donors and make better (...) use of existing resources. It should be noted that many patients who should have a transplant but who do not achieve a sufficient donor support must follow a medical treatment with high economic costs with tragic results for many of them. For example, those suffering from certain types of leukemia, when not finding that compatible donor, must follow chemotherapy-based treatments. There are also cord blood units banks which allow performing these transplants, also coordinated at the international level. Therefore, according to the principle of reciprocity, it is not justifiable that some countries are doing an important economic effort to have a large registration while others take advantage without making an equivalent effort according to their economic and population size. (shrink)

In the present work, an artificial neural network (ANN) will be developed to estimate the relative rotation and translation of the autonomous mobile robot (AMR). The ANN will work as an iterative closed point, which is commonly used with the singular value decomposition algorithm. This development will provide better resolution for a relative positioning technique that is essential for the AMR localization. The ANN requires a specific architecture, although in the current work a neural architecture search will be adapted to (...) select the best ANN for estimating the relative motion. At the end, these ANNs will be compared with conventional algorithms to check the good performance of adopting an intelligent method for relative positioning estimation. (shrink)

This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the participants (...) who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

La idea de “clasicismo” es una de las categorías más usadas en el mundo de las artes y de la estética filosófica. Sin embargo, la variedad de sus usos ha ocasionado que el término presente dificultades de interpretación y ambigüedades a quienes estudian el arte o la literatura clasicistas. El presente artículo se propone introducir algo de claridad y distinción en la discusión sobre la idea de “clasicismo”. Para ello, nos ocupamos, en primer lugar, de las cuestiones que conciernen a (...) su génesis histórica, disociándolo del concepto parejo, pero esencialmente diferente, de lo clásico. En segundo lugar, ofrecemos una caracterización de su estructura mediante una sistematización de sus cuatro sentidos principales tal y como se usan habitualmente en la bibliografía sobre el tema. De esta forma, el clasicismo se nos presenta como el problema de articular las diferentes conceptualizaciones filosóficas que se han adoptado sobre lo clásico. (shrink)

Seroprevalence monitoring of HIV in pregnant women by anonymised unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation (...) of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymised testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymisation is explained. (shrink)

Volume 20, Issue 10, October 2020, Page 77-79.

‘Doing good medical ethics’ involves attending to both the biomedical and existential aspects of illness. For this, we need to bring in a phenomenological perspective to the clinical encounter, adopt a virtue-based ethic and resolve to re-evaluate the goals of medicine, in particular the alleviation of suffering and the role of compassion in everyday ethics.

The maternal‐fetal HIV transmission trials, conducted in developing countries in the 1990s, undoubtedly generated one of the most intense, high profile controversies in international research ethics. They sparked off a prolonged acrimonious and public debate and deeply divided the scientific community. They also provided an impetus for the revision of the Declaration of Helsinki – the most widely known guideline for international research. In this paper, I provide a brief summary of the context, outline the arguments for and against the (...) controversial use of placebo controls, and focus on particular areas that I believe merit further discussion or clarification. On balance, I argue that the researchers failed in their duties to protect the best interests of their research subjects, and to promote distributive justice. I discuss the difficulties of obtaining valid consent in this research context, and argue that it is unethical to inform women of their HIV status without at least offering them prophylactic treatment for their unborn children. A global view of justice, which endorses international equity, cannot be squared with international research guidelines that allow ‘local conditions’ to define the scope of duty to the control group. Finally, I suggest that the heated debate reflects a tension, if not an outright war, between two conflicting meta‐ethical systems, or incommensurable paradigms, that underpin scientific research involving human subjects. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their patients and (...) severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their patients and (...) severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

“Anonymised screening is a research tool to inform policy and practice and individual decision making, but is not a tool to identify those at risk that could directly benefit from intervention.”1The assumption that the information acquired will be used to prioritise health care resources may prove false. A government, after weighing up the costs and benefits, may choose not to adopt appropriate interventions. Or, even if a policy is proposed,, it may not be adhered to. Even as I write, antenatal (...) clinics that serve populations with the highest concentration of refugees from sub-Saharan Africa, and therefore of those at risk, still do not have a policy of universal screening.Anonymised screening is a form of non-therapeutic research, and should comply with the Helsinki Declaration on Non-therapeutic Research involving Human Subjects. I have already argued that physicians who undertake anonymised screening have abrogated their duty, as outlined in article one, “... to remain the protector of the life and health of that person on whom biomedical research is being carried out”.2In addition, article four states: “In research on man, the interest of science and society should never take precedence over considerations related to the wellbeing of the subject.”2The desire for an outcome—perfect epidemiological figures—should not override the ethics of the process whereby this is achieved. The …. (shrink)

The authors of the concept Health-Related Digital Autonomy have laid the first building block to examine the interactions between artificial intelligence, social media, and depression f...

The general mitigating and aggravating circumstances of criminal liability are elements attached to the crime that, when they occur, affect the punishment quantum. Cuban criminal legislation provides a catalog of such circumstances and some general conditions for their application. Such norms give judges broad discretion in assessing circumstances and adjusting punishment based on the intensity of those circumstances. In the interest of broad judicial discretion, the law does not establish specific ways for measuring circumstances’ intensity. This gives judges more freedom (...) and autonomy, but it also imposes on them more social responsibility and challenges them to manage the uncertainty and subjectivity inherent in this complex activity. This paper proposes a model to aid the linguistic assessment of circumstances’ intensity and to provide linguistic and numerical recommendations to determine an appropriate punishment interval. M-LAMAC determines the collective evaluation of circumstances of the same type, determines the prevalence of a type of circumstance by means of a compensation function, recommends the required modification in the input interval, and finally recommends a numerical interval adjusted to the judges’ initially expressed preferences. The model’s applicability is demonstrated by means of several experiments on a fictitious case of bank document forgery. (shrink)

Dr de Zulueta articulates some important and commonly held concerns about the anonymised screening programme for HIV in pregnant women, which is one of a number of such programmes that are current. However, in my view, many of these concerns reflect a failure to understand two key distinctions.In both these regards, there is a danger of putting up a “straw man” for challenge. In this commentary, I wish to pick up some of these issues to help to resolve the (...) apparent ethical tensions that Dr de Zulueta has set out.Firstly, the unlinked seroprevalence surveillance programmes, including that on pregnant women, comprise research studies that are designed to inform policy and practice, as well as individual decision making. They are not screening for the purpose of clinical care. The anonymisation is a procedural research tool, which enables the studies to be done in a way that does not undermine consent or individual autonomy. The ethical standards and duties expected of professionals are thus, in this specific regard, those that relate to the conduct of clinical research. That research is evidently designed to improve the quality of clinical care as a result of the information and insight gained. The duty of care is to apply the results of properly conducted and valid research in order to improve clinical practice on behalf of the individuals receiving care, in this case the mother and unborn child. The research conducted, in this case by a particular form of screening procedure, is not the same as a screening procedure done for clinical purposes to identify individuals who could benefit from an intervention. The ethical debate must therefore focus on the purpose in applying the procedure, not on the procedure itself, regardless of intent.Secondly, it is vital to distinguish, in debating such …. (shrink)

This paper considers the ethics of routine antenatal HIV testing and the role of informed consent within such a policy in order to decide how we should proceed in this area—a decision that ultimately rests on the relative importance we give to public health goals on the one hand and respect for individual autonomy on the other.A recent illuminating qualitative study by Zulueta and Boulton1 explores the practicalities of informed consent in routine antenatal HIV testing. Its results support what (...) I have argued1 is inevitable with routine testing policies of this kind: that routine antenatal testing regimes are incompatible with requirements for informed consent. It has become clear that intervention could reduce the risk of transmitting HIV from mother to child from 15–20%2 to around 8%,3 or possibly as low as 2%.4,5 The evidence of this possibility produced a general trend towards introducing routine antenatal HIV screening in developed countries worldwide.6,7,8,9,10 The aim was to dramatically reduce the rate of HIV transmission from mother to child by encouraging universal antenatal HIV testing. The UK has been no exception, and in 1999 the government instructed health authorities to implement a policy of offering and recommending an HIV test to all pregnant women.11This UK antenatal screening policy and others like it, although well-meaning, are problematic in their formulation. In order to reflect contemporary ethical and legal practice, such policies attempt to marry the public health aims of maximising uptake of testing with a commitment to respect the choices of patients by requiring informed consent before they participate in screening. Thus, in the case of UK policy, health professionals are instructed to recommend the HIV test to all pregnant women in order to achieve the target of a 90% …. (shrink)