O conflito de convicções traz consigo frequentes interrogações éticas em diferentes esferas das relações sociais. As convicções religiosas não são as únicas nesse sentido. Este ensaio usa um método interdisciplinar em vista de esclarecer alguns conceitos e critérios subjacentes ao tema, que podem ajudar no discernimento ético de tais conflitos. A Bioética Clínica é aqui uma particularização temática que ajuda uma concentração do discurso, ao mesmo tempo em que permite o aproveitamento desta reflexão para outras esferas. Ajuda também (...) a perceber a estreita relação das convicções pessoais com a esfera pública em torno de questões vitais. Entre seus resultados, este ensaio ressalta que os conflitos de convicções podem ser fonte de benefícios para a convivência na sociedade plural. Seus desafios éticos se concentram na necessária abertura das convicções ao diálogo com os diferentes. No exercício do diálogo, a reflexão da Bioética se distingue da Biopolítica e sugere que as convicções subjetivas por vezes se vejam contraditadas por ordenamentos jurídicos, antes que se amadureçam consensos sobre critérios éticos.Palavras-chave: Convicções – Bioética Clínica – Conflitos éticosthe conflict of convictions brings frequent ethical questions in different spheres of social relations. Religious convictions are not the only in this sense. This essay uses an interdisciplinary method in order to clarify some concepts and criteria underlying this issue, which can help in ethical discernment of such conflicts. Clinical Bioethics is a particularization theme here that helps a concentration of discourse, while allowing the use of this reflection to other spheres. It also helps to understand the close relationship of personal convictions with the public sphere around vital issues. Among their results, this paper points out that conflicts of convictions can be a source of benefits to living in a plural society. His ethical challenges are mainly pointed to a necessary openness to dialogue with the different. In exercising this dialogue, reflection of Bioethics is distinguished from Biopolitics and suggests that the subjective convictions sometimes find themselves contradicted by legal before they ripen consensus on ethical criteria.Key words: Convictions - Clinical Bioethics - Ethical Conflicts. (shrink)

The field of genetics has seen major advances in recent decades, particularly in research, prevention and diagnosis. One of the most recent developments, the genomic editing technique Clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9, has opened the possibility for genetic therapies through genome modification. The technique marks an improvement on previous procedures but poses some serious ethical conflicts. Bioethics is the discipline geared at finding answers to ethical challenges posed by progress in medicine and biology and examining (...) their repercussions for society. It can also offer a conceptualization of these ethical dilemmas. The aim of this paper is to offer a map of the ethical dilemmas associated with this technique by way of a critical analysis of current literature. The main issues can be grouped in four areas: efficacy and security; the types of cells which can be targeted by the technique (somatic, embryonic and gametes); the goal of the therapy; and accessibility and justice. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines (...) conflict or come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

Moral conflicts over medical treatment that are the result of differences in fundamental moral commitments of the stakeholders, including religiously grounded commitments, can present difficult challenges for clinical ethics consultants. This article begins with a case example that poses such a conflict, then examines how consultants might use different approaches to clinical ethics consultation in an effort to facilitate the resolution of conflicts of this kind. Among the approaches considered are the authoritarian approach, the pure consensus (...) approach, and the ethics facilitation approach described in the Core Competencies for Healthcare Ethics Consultation report of the American Society for Bioethics and Humanities, as well as a patient advocate approach, a clinician advocate approach, and an institutional advocate approach. The article identifies clear limitations to each of these approaches. An analysis of the introductory case illustrates those limitations, and the article concludes that deep-seated conflicts of this kind may reveal inescapable limits of current approaches to clinical ethics consultation. (shrink)

One area of bioethics education with direct impact on the lives of patients, families, and providers is the training of clinical ethics consultants who practice in hospital‐based settings. There is a universal call for increased skills and knowledge among practicing consultants, broad recognition that many are woefully undertrained, and a clear consensus that CECs must avoid an “authoritarian approach” to consultation—an approach, that is, in which the consultant imposes his or her values, ethical priorities, or religious convictions on (...) the stakeholders in an ethics conflict. Yet little work has been done on how to teach CECs not to impose their values in an ethics consultation, or even on the dimensions of this problem. In this essay, I propose a tool for bioethical instruction that targets this question: how can CECs be taught a nonauthoritarian mode of ethical analysis and consultation that can avert the problem of values imposition? (shrink)

The contribution describes a case report addressed in 2011 by the clinical ethics consultation service team of the Institute of Bioethics and Medical Humanities at the “Agostino Gemelli” School of Medicine of the Università Cattolica del Sacro Cuore, Rome. The clinical case regards ethical dilemmas about the patient’s prospects for receiving an orthotopic liver transplant, because she was a non-resident and lacked a caregiver to assist her during the follow-up period, as well as a place to stay (...) after liver transplant surgery. DOI: 10.5294/pebi.2016.20.1.7. (shrink)

While there is significant consensus that undergraduate medical education should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate (...) that medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME. (shrink)

Se realiza un estudio de los principios básicos o tradicionales de la bioética y su influencia en la práctica de la limitación del esfuerzo terapéutico en las Unidades de Cuidados Intensivos, como condicionante que favorece su aplicación en los pacientes en estado terminal. Se aborda la necesidad de una bioética no importada de otros países, que se corresponda a las características de la realidad latinoamericana y a cada contexto sociocultural. El trabajo tiene como objetivo fundamental resaltar la importancia (...) de estos principios básicos en la discusión ético-clínica para la toma de decisiones, a partir de una bioética que se corresponda a la realidad de los sistemas imperantes. A study of basic or traditional principles of bioethics and its influence in the practice of the limits of the therapeutic effort in the intensive care units, as a requirement that favors its application in terminal ill patients was carried out. The need of having bioethics principles that match Latin-American reality and each sociocultural context, not imported ones from other countries, was stated. This paper main objective is to highlight the importance of these basic principles in ethic-clinic discussion for decision-making, taking as the starting point a bioethics that corresponds to the reality of the dominant system. (shrink)

The article analyzes three different cases of clinical research in which children are asked to participate. Participation of children in researches is one of the major challenges for Bioethics and societies nowadays due to the tensions and issues concerning the guarantee of rights in clinical research, the responsibilities of the different actors involved, and the purpose of improving the quality of life without affecting scientific freedom and new knowledge production. The aim of the article is to establish the (...) way in which autonomy is exercised, considering ethical and regulative aspects within clinical research involving children. In order to achieve such a purpose, case study research methodology is employed, revealing the tensions and ethical issues involved in this particular kind of clinical research as well as considering international documents and the national regulation regarding this particular problem. (shrink)

Clinical ethics refers to an emerging field in clinical medicine that focuses on the process of ethical decision-making in a clinicalsetting. It has developed as a result of a growing awareness that modern medicine – characterized by technological progress, culturaldiversity and social challenges – is posing a range of new “ethical dilemmas” that medical science alone cannot solve. For thisreason, clinical ethics is often linked to “ethics consultation,” which consists of services provided by an individual (...) ethicist, ethicsteam or committee to address the ethical issues involved in a specific clinical case. Although clinical ethics developed in the beginningmainly as a methodological analysis to arrive at a justification for clinical ethical decisions, it quickly has become clear thatthe difficulty in clinical decision-making is only one aspect of wider ethical problems pertaining to the doctor-patient relationshipas a whole and, most likely, to the core value of the medical profession. The principles method is usually presented as the mostpopular methodological approach to an analysis of clinical cases. However, strong criticism of this model has been voiced, and otheralternative approaches are referred to, such as the casuistry model. Recently, significant contributions have been made by narrativemedicine and virtue ethics. According to these methodologies, sound anthropology and a good relationship with the sick person arekey elements required of any person engaged in medical practice who aims to be genuinely appropriate from an ethical perspective. DOI: 10.5294/pebi.2016.20.1.3. (shrink)

Background: The parent of a child with profound cognitive disability will have complex decisions to consider throughout the life of their child. An especially complex decision is whether to place a tracheotomy to support the child’s airway. The decision may involve the parent wanting a tracheotomy and the clinician advising against this intervention or the clinician recommending a tracheotomy while the parent is opposed to the intervention. This conflict over what is best for the child may lead to a bioethics (...) consult. Objective: The study explores the conflicts that may arise around tracheotomy placements. Research design: This study is a retrospective cohort study of pediatric patients for whom a tracheotomy decision required a bioethics consult. Participants and research context: Pediatric patients aged birth to 18 years old with a bioethics consult for a tracheotomy decision conflict between April 2010 and December 2016. A standardized data collection tool was used to review notes entered by the palliative care team, social workers, primary clinical team interim summaries, and the bioethics consult service. Ethical considerations: The study was reviewed and approved by the medical center’s institutional review board. Results: There were 248 clinical bioethics consults during the identified study period. There were 31 consults involving 21 children where the word tracheotomy was mentioned in the consult, and 13 of the 21 consults were for children with profound cognitive disability. Discussion and conclusion: Clinicians need to be aware of their own biases when discussing a child’s prognosis and treatment options while also understanding the parents’ values and what the parent might consider to be burdensome in the care of their child and the acceptable burden for the child to experience. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka (...) O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Clinical ethics consultation not only interprets moral issues at the bedside and is not restricted to giving support for the “technical” handling of these moral issues, but it has to substantively address moral values, norms, and conflicts in the process of discussing cases and problems. We call this the normative dimension and use normative in the sense of embracing moral values and convictions of persons and groups, norms, and relevant professional and ethical guidelines as well as legal (...) frameworks. The roles and activities of the consultant as a person and the quality of CEC as a process are discussed in the American Society of Bioethics and Humanities’ Core Competences for Healthcare Ethics Consultation. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

The health emergency due to the COVID-19 pandemic revealed limitations in health systems worldwide, making it necessary to establish a bioethical framework that provides tools to drive health professionals’ decision-making amid scarce health resources. Bioethical models such as principlism, utilitarianism, and personalism seek to focus clinical decisions on respect for people’s rights and dignity, thus protecting the medical practice. Personalism provides a person-centered approach to respect for human dignity during health emergencies to avoid giving material meaning to the individual. (...) Decision criteria are required to face bioethical conflicts in clinical practice, reducing the legal, emotional, and ethical burden of decision-making in pandemic situations. (shrink)

Clinical ethics records offer bioethics researchers a rich source of cases that clinicians have identified as ethically complex. In this paper, we suggest that clinical ethics records can be used to point to types of cases that lack attention in the current bioethics literature, identifying new areas in need of more detailed bioethical work. We conducted an analysis of the clinical ethics records of one paediatric hospital in Australia, focusing specifically on conflicts between parents and health (...) professionals about a child’s medical treatment. We identified, analysed, and compared cases of this type from the clinical ethics records with cases of this type discussed in bioethics journals. While the cases from journals tended to describe situations involving imminent risk to the child’s life, a significant proportion of the clinical ethics records cases involved different stakes for the child involved. These included distress, poorer functional outcome, poorer psychosocial outcome, or increased risk of surgical complications. Our analysis suggests that one type of case that warrants more detailed ethics research is parental refusal of recommended treatment, where the refusal does not endanger the child’s life but rather some other aspect of the child’s well-being. (shrink)

Ethical Aspects Related to Nursing Care for Persons with Disabilities: A Qualitative Analysis Aspectos éticos relacionados com a atenção de enfermagem em pessoas com deficiência: uma análise qualitativa The purpose of the study is to describe ethical aspects related to nursing care for persons with disabilities; a population considered socially vulnerable and in conditions of inequality. It corresponds to the first phase of a primary study conducted in Atacama, Chile using a qualitative methodology and content analysis. Nursing graduates (...) are interviewed respecting Ezekiel Emanuel’s ethical criteria. The main findings account for ontological categories such as moral reasoning, value system, nurse-patient relationship model, consequences of the ethical nursing action, strategies to overcome moral conflicts, and barriers in care. It is concluded that caring for people with disabilities is a source of dilemma and moral anguish for nurses, especially when it comes to individuals with sensitive or cognitive disabilities. The paternalistic medical model predominates in the clinical context, limiting the right to autonomy of persons with disabilities. Instrumental values such as efficiency are added to traditional moral values promoted by nurses. Civic values considered fundamental to the challenge of human diversity and life in a democracy are not mentioned. Para citar este artículo / To reference this article / Para citar este artigo Campillay-Campillay M, Rivas-Rivero E, Dubó-Araya P, Calle-Carrasco A. Aspectos éticos relacionados con la atención de enfermería en personas en situación de discapacidad: un análisis cualitativo. Pers Bioet. 2020;24:43-56. DOI: https://doi.org/10.5294/pebi.2020.24.1.4 Recibido: 19/07/2019 Aceptado: 12/11/2019 Publicado: 07/05/2020. (shrink)

“Encuentros sobre ética clínica en la medicina paliativa” es un proyecto de formación ética y clínica en el ámbito de los cuidados paliativos. Hace parte de un programa clínico y de investigación más amplio que pertenece a la línea de recuperación de las raíces antropológicas y éticas en la práctica clínica de los cuidados paliativos. Está dirigido a profesionales e investigadores en cuidados paliativos, y contempla el desarrollo de reuniones informales, donde se analizan los valores humanos y profesionales involucrados en (...) casos clínicos reales. En este programa de formación ética y clínica, se consideran esenciales la antropología, la ética general, la epistemología médica y la filosofía de la medicina, además es valiosa la información proporcionada por las humanidades. El objetivo específico no es solo proporcionar una lista de principios éticos, sino también promover una disposición ética de parte de la persona que actúa. DOI: 10.5294/pebi.2016.20.1.4. (shrink)

This paper examines and evaluates the models and the most important methods for solving clinical cases; namely, 1) principlism, 2) deontologism, 3) consequentialism, 4) casuistry, 5) virtue ethics and 6) ethics centered on the person. The strengths and weaknesses of each are weighed and an instrument is proposed to facilitate this type of analysis. As a group, the preference is for a methodology that articulates three models: the virtue approach, the person-centered approach, and these two in harmony with an (...) ethics centered on principles. The reasons for this comprehensive option are based primarily on recognition of the primacy of the dignity of the human person and on acknowledgement that complex clinical situations require a comprehensive view of both the person and clinical practice. The latter requires virtues, ethical principles and recognition of the human person as being endowed with inherent dignity and, in turn, as the foundation of ethics and clinical practice. DOI: 10.5294/pebi.2016.20.1.2. (shrink)

The article deals with the problem of method for a bioethical approach to clinical cases from the standpoint of bioethics, and analyzes the various methodologies that exist, highlighting their contributions and strengths, as well as their difficulties. Tools for reflecting on how to implement a methodology adapted to the context of contemporary Mexican reality are provided as well. They underscore the characteristics particular to Mexico in bioethical analysis and discernment.

Paltrow, Harris, and Marshall argue that the reversal of Roe will impact all pregnant persons, not only those who wish to terminate a pregnancy. I agree that these consequences ar...

Autumn Fiester's “Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure” (2015) demonstrates how a focus on recommendations in clinical ethics consultations (CECs) can fail to...

The article asks about the function of clinical ethics. It does so by confronting the assumption that ethics is supposed to help in the solution of concrete problems, relying upon a defined set of principles and rules. The scientific character of such an approach to clinical ethics complements the very understanding of modern medicine as being increasingly scientific and technical; that is, as oriented toward the production of effects. The paper claims that, rather tan sharing in the “suspension (...) of meaning” pursued by medicine for the sake of scientific objectivity, the main task of clinical ethics consists of a retrieval, or “anamnesis,” of the very questions medicine seems to suspend: the significance of illness and disease, of birth, suffering and death, and of the service to the ethos of generosity that sustains the healing professions. Also, the paper offers a cultural “etiology” of “the suspension of meaning” in ethics, and pleads for a moral reflection that begins with a free and open confrontation with clinical experience. Attending to the moral meaning of concrete situations, the paper argues that formal modes of logical argumentation are only derivative functions of the moral language and, thus, cannot exhaust the broad spectrum of ethical discourse in medicine. DOI: 10.5294/pebi.2016.20.1.9. (shrink)

Background No studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts. Methods Voluntary survey to the members of the Internal Medicine Association of Mexico. Results Responses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most (...) commonplace and relevant conflicts are those resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them. Conclusions 1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants. (shrink)

The aim of this paper is to assess a case report in the field of gynecology, starting from an ethical paradigm that relates primarily to the so-called “sources of morality”. In order to do so, we first will present four ethical paradigms for the evaluation of clinical cases. After introducing the main aspects of these paradigms and pointing out that what matters in an ethical evaluation is not so much the final judgement, but rather the argument (...) that leads to it, we will assess the case report in light of the chosen paradigm. Lastly, we will outline a possible solution to the problem, starting from the previous ethical evaluation. DOI: 10.5294/pebi.2016.20.1.6. (shrink)

Voluntades anticipadas: desafíos éticos en el cuidado del paciente Diretivas antecipadas de vontade: desafios éticos no cuidado do paciente Advance healthcare directives are intended for the individual to personally express their will and preferences about healthcare and treatment ahead of time. This literature review aims to describe the concept and structure of advance directives and the ethical aspects involved in patient care. Using the keywords “Advance Healthcare Directive” AND “Ethical Implication” and its Spanish equivalents, five databases were accessed: (...) ProQuest, Philosophy, PubMed, Web of Science and Scielo. Publications were narrowed down to the 2010-2018 period. Thirty-one articles were obtained and read critically. Results of this review were grouped into the following categories: concept, structure, clinical situations in which advance directives apply, strengths and limitations, as well as the ethical aspects involved. End of life-related experiences in which a person loses their ability to make decisions and cannot express their wishes, so it is impossible to know their will, are more common nowadays. Most health workers are not appropriately trained in the preparation and application of advance directives, which becomes an opportunity to research and delve deeper into the subject. Advance directives are a tool that gives health workers reliable information on a patient’s values and wishes, so it is vital to train them to provide respectful quality care. Para citar este artículo / To reference this article / Para citar este artigo Forero J, Vargas I, Bernales M. Voluntades anticipadas: desafíos éticos en el cuidado del paciente. Pers Bioet. 2019;23:224-244. DOI: https://doi.org/10.5294/pebi.2019.23.2.5 Recibido: 26/01/2019 Aceptado: 22/08/2019. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical (...) commentaries to highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

This paper examines the culture, the dynamics and the financial underpinnings that determine how medical research is being conducted on children in the United States. Children have increasingly become the subject of experiments that offer them no potential direct benefit but expose them to risks of harm and pain. A wide range of such experiments will be examined, including a lethal heartburn drug test, the experimental insertion of a pacemaker, an invasive insulin infusion experiment, and a fenfluramine "violence prediction" experiment. (...) Emphasis, however, is given to psychoactive drug tests because of the inherent ethical and diagnostic problems involved in the absence of any objective, verifiable diagnostic tool. Effort is made to provide readers comprehensive reference sources to evidence-based reports about the serious risks these drugs pose for adults and children so that the reader may judge whether the benefits (if any) outweigh the risks for children. The first ethical issue raised by these experiments is: did the severity of illness in these children justify their exposure to short and long-term risks? The ethics of the experiments will be evaluated by referring to existing codes of medical research ethics-the Nuremberg Code, the Declaration of Helsinki, and the federal Code of Regulations. The thirteen cases presented will demonstrate that children are being used in ever more speculative experiments, often in the absence of a therapeutic intent, but a significant chance for causing harm and / or discomfort. Some of the experiments were designed to explore the mechanisms of pathology and pharmacological interventions, or the response of neurological brain receptors to chemical provocation ("challenge"). Others were designed to test the safety or efficacy of new drugs, even to test these drugs on healthy children who were hypothesized to be "at risk." Children and adolescents have been subjected to "forced dose titration" experiments that induced a spectrum of severe adverse effects, including insomnia, extreme restlessness, agitation, (akathisia) and self-injurious behavior. FDA reports show that suicide is a significant issue in psychotropic drug trials-in pediatric trials the problem is even greater. The paper aims to demonstrate how the enactment of the Better Pharmaceuticals for Children Act (incorporated into the Food and Drug Administration Modernization Act, FDAMA), set in motion a radical shift in public policy by providing huge financial incentives to pharmaceutical companies to test new or patented drugs in children. Federal policy shifted from one aimed at protecting children by setting limits on permissible research risks, to a policy aimed at broadening the inclusion of children as test subjects. It will be shown how the FDA and the Department of Health and Human Services lifted regulatory restrictions to permit research involving greater than minimal risk to be conducted on healthy children, claiming that all children are potentially "at risk" of a future condition. Children were in this way deprived of regulatory protections. An argument will be made that the approval of nontherapeutic, harmful experiments-such as exposure of toddlers to lead poison-under the current gate keeping system raises serious doubts about the sustainability of institutional review boards (IRBs) as protectors of human research subjects. Children, who are precluded from exercising the adult human's right to informed consent, are being exploited as commodities for commercial ends. It is the position of the author that nothing less than the enactment of a federal law mandating a radical overhaul of the current research review system, with independent checks and balances, will provide children the legal protections they need. Ten specific recommendations are offered to protect children from harmful experiments. (shrink)

Volume 31, Issue 1, December 2020, Page 47-66.

Background Ethical conflicts generate difficulties in daily clinical activity. Which methods of ethical advice are most frequently used to resolve them among Spanish doctors has not been studied. The objective of this study is to describe what methods hospital internal medicine physicians in Spain use to resolve their ethical doubts and which they consider most useful. Design A cross-sectional observational study was conducted through a voluntary and anonymous survey and distributed through an ad hoc platform (...) of the Spanish Society of Internal Medicine. Measures We measured methods by which to resolve doubts, types of tools sought, frequency of consulting the Clinical Ethics Committees, and satisfaction with resolution of ethical issues. Results Of 261 internists surveyed, 86 per cent resolve their ethical doubts with assistance, the most frequently used method being consultation with colleagues (58.6 per cent), followed by using specific protocols or guides (11.8 per cent) and consultation with experts in bioethics (9.6 per cent). The most preferred tools are the creation of protocols (30.3 per cent) and the establishment of a consultant/expert in bioethics (27.8 per cent). Conclusions Internists in Spain usually seek assistance to resolve their ethical doubts. Consulting colleagues is the most frequently adopted method. The majority regard tools to resolve ethical conflicts as necessary, seeking above all protocols and consultants/experts in bioethics. (shrink)

Los métodos productivos de enseñanza preparan a los estudiantes para resolver problemas semejantes a los que se enfrentarán en el ejercicio laboral. Este trabajo tiene como objetivo fundamentar la pertinencia de la utilización del caso clínico como herramienta didáctica para la enseñanza en las ciencias básicas biomédicas, mediante un sistema de tareas para abordar los contenidos del tema Fisiología de la sangre de la asignatura Sangre y Sistema Inmune de la carrera de medicina. El caso clínico permite la vinculación de (...) las ciencias básicas biomédicas con las ciencias clínicas. Su utilización contribuye a la aproximación del estudiante de las ciencias básicas al estudio de estas durante su formación médica. El aprendizaje se logra a lo largo del proceso de resolución del mismo, se estimula la incorporación de conceptos necesarios para resolver el problema y se aprende un método para abordar situaciones en la práctica. Se elaboró un sistema de tareas y preguntas derivadas del problema profesional síndrome anémico. El problema docente se basó en un artículo médico que expone un caso de lesiones por empalamiento que produjo un gran sangramiento en un individuo. Se elaboraron preguntas problémicas relacionadas con la fisiología de la sangre y el tratamiento que recibió el paciente con eritropoyetina, factores de la coagulación y soluciones cristaloides en sustitución de la sangre. Se incluyó una pregunta que aborda un conflicto ético para sistematizar los conocimientos adquiridos en la asignatura Sociedad y Salud II. Productive teaching methods train students to solve problems similar to those they will face in their work life. The objective of the paper is to argue pertinence in the use of the clinical case as a didactic tool in biomedical basic sciences teaching by means of a task system that deals with the contents of the Blood Physiology subject in the Blood and Immune System subject matter of the medicine degree. Clinical cases enable the link between biomedical basic sciences and clinical sciences. Their use contributes to basic sciences students' approach to the study of the latter during their medical training. Learning is achieved through its solving process; the introduction of necessary problem-solving concepts is encouraged and a method to deal with in-practice situations is learned. A task and questions system derived from the anemic syndrome professional problem was made. The teaching problem was based on a medical article which presents a case of an individual who suffered impaling injuries which caused a great bleeding. Problem questions related to blood physiology and to the erythropoietin-based treatment the patient received, coagulation factors and crystalloid fluids used as blood substitutes, were prepared. It was included a question that deals with an ethical conflict in order to systematize the knowledge acquired in the Society and Health II subject matter. (shrink)

Rarely do ethics consults focus on genuine moral puzzlement in which people collectively wonder what is the right thing to do. Far more often, consults are about conflict. Each side knows quite well what is “right.” The problem is that the other side is too blind or stubborn to recognize it. And so the ethics consultant is called, perhaps in the hope that s/he will throw the weight of ethics toward one side and end the controversy so everyone can get (...) on with other business. Perhaps the greater problem in these scenarios is that even if one side “wins” by gaining the power to dictate what happens next, the toxicity permeating the relationships often markedly worsens and other conflicts erupt, major and minor. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 175-188 [Access article in PDF] Scope Note 38 Bioethics Resources on the Web * Once described as an "enormous used book store with volumes stacked on shelves and tables and overflowing onto the floor" (Pool, Robert. 1994. Turning an Info-Glut into a Library. Science 266 (7 October): 20-22, p. 20), Internet resources now receive numerous levels of organization, from basic directory listings (...) to elaborate "links" (cross-references to other Internet documents) that flash and glow in the dark. In many ways, the Internet functions as a direct extension of the traditional library. Following linked references across various sites is an electronic version of browsing library stacks, and the serendipitous discoveries made while "surfing the Net" recall the wonders of physically going "book-to-book." Although many of the Internet's best aspects augment library strengths by eliminating physical distance from sources, Net resources pose unique problems for researchers. It is not always clear who is responsible for the content of Web documents, when the document was produced, or how often (if ever) it is updated. Internet resource tools, then, must enable researchers to identify appropriate resources and to evaluate what they find when they get there. Web Research as Taking "Snapshots" Given the Internet's visual nature and fluid content, the process of conducting research on the Web has been likened to taking an informal picture of information on a specific date at a particular time. This metaphor also conveys the "zoom-in" aspect of searching through Web pages by going from general to specific categories. In the first section of this Scope Note, National Reference Center for Bioethics Literature (NRCBL) staff present a snapshot of bioethics resources taken during the spring months of 2000. Entries are divided into the categories of directories, electronic journals, full-text documents, news/current awareness, and teaching resources. In the two subsequent sections, this series of categories is repeated for entries on a specific topic within bioethics-genetics-and again for general search and evaluation tools. Where a Web site may contain pages applicable [End Page 175] to more than one category, multiple entries are made for that site with appropriate information for each category.Much as telecommunication advances have strengthened the relationship of patients and providers as partners, the dynamic nature of the Internet acknowledges that the researcher functions as a librarian whenever accessing the Web. It is our hope that BIOETHICSLINE and the other NRCBL databases not only will enable researchers to search the Web more efficiently, but also will help them to evaluate what they find when they get there. Bioethicsline on the Web: An International Plan in Progress Once only available through libraries, the U.S. National Library of Medicine (NLM), the funding agency for the ongoing development of the BIOETHICS LINE® database from the Kennedy Institute, has provided free Web access to that database of 63,000 citations since September 1998 through Internet Grateful Med. Plans are now underway to eliminate such specialty databases and incorporate all citations into PubMed (for journal articles) or LOCATORplus (for book-like materials and chapters in books). Both of these databases are likewise available at no cost on the Web. In the transition to PubMed and LOCATORplus some features of BIOETHICSLINE that presently are available may be lost. Researchers are encouraged to contact the National Reference Center for Bioethics Literature with search requests or for search strategy assistance with either the current or the future system ([email protected]).The inclusion of bioethics citations in PubMed and LOCATORplus will have several advantages. First, unique keywords from the Bioethics Thesaurus will be considered for inclusion in Medical Subject Headings (MeSH), the indexing vocabulary for PubMed and LOCATORplus, thereby enhancing retrieval of relevant clinical literature by offering more precise terminology covering ethical issues. Second, it will be easier to identify foreign-language materials, which are not currently included in the scope of BIOETHICSLINE. Third, the updating schedule will become more frequent. On the other hand, there may be some loss of searching precision because certain specialized features... (shrink)

Bioethical Proposals to Face Social and Ethical Problems Generated by Neglected Infectious Diseases Propostas bioéticas ante os problemas sociais e éticos que geram as doenças infecciosas desatendidas This review article appointed to the topic of Neglected Tropical Diseases, a group of 18 disabling pathologies, which are sometimes fatal, and often deforming, that prevail in the populations of Asia, Africa and the tropical areas of South America. We presented, categorized, and analyzed, through a bibliographical review, the elements that relate to (...) these diseases from the Universal Declaration of Bioethics and Human Rights, 2005, in terms of equality, justice and equity, the non-discrimination and stigmatization, social responsibility and health approach. Throughout the review, we concluded that the problem around NTDs is multifactorial and we propose solutions to mitigate and to attend the NTDs, from a perspective of focused bioethics around the dignity of the human person and the affected population. We proposed including bioethics in the debate about the care of the NTDs to analyze the problems and examine solutions through transdisciplinary research projects that involve collaborative and formative work among the affected communities, government entities, health professionals and veterinary sciences. Para citar este artículo / To reference this article / Para citar este artigo Sáenz V, Mazzanti di Ruggiero MA. Propuestas bioéticas frente a los problemas sociales y éticos que generan las enfermedades infecciosas desatendidas. Pers Bioet. 2019; 23: 84-110. DOI: https://doi.org/10.5294/pebi.2019.23.1.6 Recepción: 27/09/2018 Aceptación: 06/02/2019. (shrink)

When is clinical research ethical? The difficulty in answering this question lies in the dual nature of research on human subjects, which yields two somewhat conflicting sets of obligations. On the one hand, there is the traditional view of science that includes the idea of an obligation to learn about the world. On the other hand, there is the obligation of care on the part of researchers towards individual participants in the research ...

Bioethics mediators manage a wide range of clinical conflict emanating from diverse sources. Parties to clinical conflict are often not fully aware of, nor willing to express, the true nature and scope of their conflict. As such, a significant task of the bioethics mediator is to help define that conflict. The ability to assess and apply the tools necessary for an effective mediation process can be facilitated by each mediator’s creation of a personal compendium of sources that generate (...) clinical conflict, to provide an orientation for the successful management of complex dilemmatic cases. (shrink)

Mental disorders in university students are very frequent, therefore higher education institutions have established in-campus mental healthcare centres. These clinics have particular characteristics that differ from other mental health centres, as they report to and represent an educational institution, while at the same time looking after the interests and well-being of patients requesting assistance, thus generating unique bioethical conflicts. Ethics Committees are useful tools to offer support to mental health professionals in making ethical decisions. In order to respond (...) to these issues, it was decided that an Ethics Committee would be created in the mental health clinic of a private university in Mexico City. This article describes the implementation process for this Committee, its duties and scope, as well as the case work and review methodology. A list of the most frequent ethical conflicts is attached, jointly with the ethical analysis of the cases treated throughout the year and a half or work by the Committee. (shrink)

Much research is currently being conducted on health care practitioners' experiences of moral distress, especially the experience of nurses. What moral distress is, however, is not always clearly delineated and there is some debate as to how it should be defined. This article aims to help to clarify moral distress. My methodology consists primarily of a conceptual analysis, with especial focus on Andrew Jameton's influential description of moral distress. I will identify and aim to resolve two sources of confusion about (...) moral distress: the compound nature of a narrow definition of distress which stipulates a particular cause, i.e. moral constraint, and the distinction drawn between moral dilemma and moral distress, which implies that the two are mutually exclusive. In light of these concerns, I argue that the definition of moral distress should be revised so that moral constraint should not be a necessary condition of moral distress, and that moral conflict should be included as a potential cause of distress. Ultimately, I claim that moral distress should be understood as a specific psychological response to morally challenging situations such as those of moral constraint or moral conflict, or both. (shrink)

As a well-established service offered at many hospitals internationally, clinical ethics consultation (CEC) is increasingly recognized as a tool to improve patient care quality (Fox et al. 2022; Ta...

La Segunda Guerra Mundial y las atrocidades cometidas en investigaciones con los prisioneros en los campos de concentración nazis y japoneses, despertaron la conciencia por el desarrollo de los derechos humanos que se habían conquistado paulatinamente a lo largo de la historia. Por ello se conforman una serie de leyes, normas y declaraciones donde se tratan los aspectos bioéticos en los ensayos clínicos. Se debe prestar vital atención a la relación médico-paciente en el curso de las investigaciones y considerar la (...) relación beneficio/riesgo cuando se va a experimentar en seres humanos. La retinopatía diabética proliferativa es una de las afecciones oftalmológicas que más ensayos ha suscitado. El objetivo de este trabajo consiste en analizar algunos aspectos éticos en la experimentación en pacientes con esta afección. The Second World War and the atrocities committed in research with prisoners in Japanese and Nazi concentration camps, awakened consciousness for the development of human rights that had gradually been conquered throughout history. That´s why a series of laws, rules and statements that deal with bioethical aspects in clinical trials, were passed. Special attention must be given to the doctor-patient relationship during the research and consider the benefit/risk ratio when conducting experiments on human beings. Proliferative Diabetic Retinopathy is one of the ophthalmological disorders that has given rise to more trials. The research goal is to analyze some ethical aspects when experimenting on patients with this condition. (shrink)

Since Clinical Ethics Consultation has become important in the public health sector in the last decade in Germany, there are on-going questions about effectiveness. Targets have been established by the Ethics Committees, in regard to assisting patients, families and health care teams at times of ethical conflicts during the decision-making process in medical care. Of all the ethics consultations over the last eight years at Erlangen University Hospital the consultations carried out in the pediatric department were chosen (...) to be reviewed by a pediatrician and an ethicist. These were evaluated on the basis of team formation, interdisciplinary orientation, ethical criteria, completeness and methods of documentation. Results of the analysis of those records show a well-organized consultation team with regard to its personnel composition. Discrepancies with ethical questions posed in the literature are revealed, and also some partially incomplete documentation regarding medical facts and descriptions of the patients' or parents' opinion. (shrink)

Dear Editor, -/- One of the recent changes in the UK cabinet, after Liz Truss became the Prime Minister, was that Dr Therese Coffey become the new Health Secretary. Some news outlets were quick to point out her anti-abortion stance (see e.g. (1–3)) and that this, according to them, might be a problem. While pro-lifers might not completely rejoice over this situation as Coffey stated that ‘she wouldn’t “seek to undo” abortion laws’(3), I do not wish to focus here on (...) speculating on the future status of UK abortion legislation. Rather, I wish to focus on some statements quoted by the media as made by Clare Murphy, chief executive of the British Pregnancy Advisory Service (BPAS), who stated that: (2,4) -/- ‘Earlier this year, our new Health Secretary voted to revoke access to at-home abortion care, and recriminalise women who end their own pregnancies without the approval of two doctors.’ ‘In doing so, Therese Coffey voted against the advice of leading medical bodies.’ ‘To have a health secretary who would place their personal beliefs above expert clinical guidance is deeply concerning.’ -/- Coffey is a Catholic, and this brings back to mind some of the aspects of the debate surrounding conflicts of interest in bioethics. There have been, for example, discussions and proposals that having a religious belief should be declared as a conflict of interest.(5,6) But something seems to be missing in these portrayals of conflict of interest and the disagreement between Coffey and these ‘leading medical bodies’. If we regard financial conflicts of interests as the classical case of such conflicts that is used as a reference to other types of conflicts of interest,(5,6) then why do we not see the media complaining that ‘leading medical bodies’ support procedures that will give them more work oppor-tunities and improve their financial stability? To paraphrase Murphy who (according to the BBC 'said while politicians were entitled to their own views on abortion, what mattered was whether their "personal convictions stand in the way of women's ability to act on their own”. (4) perhaps ‘BPAS and the leading medical bodies are entitled to considerations of their financial interests, but what matters is whether the advice they give is clinically sound and founded in the principles of ethical clinical practice. In Matthew 6:24 Our Lord said that one cannot serve two masters, so perhaps we should not be so concerned with Coffey consulting her conscience, but rather scrutinise clinical institutions. (shrink)

The 1995 Encyclopedia of Bioethics is an almost complete reworking of the original 1978 edition, due to the expanding nature of the field. The following article focuses on how the second edition of the Encyclopedia deals with the topic of “clinical ethics” and three related topics: “nursing ethics”, “trust”, and “conflict of interest”. We assess their relevance to the current developments in these fields and the Encyclopedia's usefulness as a resource to ethics consultants, researchers and clinicians. We emphasize the (...) heterogeneity of clinical ethics as a still new and evolving field. (shrink)

_The Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants_ instructs clinical ethics consultants to preserve their professional integrity by “not engaging in activities that involve giving an ethical justification or stamp of approval to practices they believe are inconsistent with agreed-upon standards” (ASBH, 2014, p. 2). This instruction reflects a larger model of how to address value uncertainty and moral conflict in healthcare, and it brings up some intriguing and as yet unanswered questions—ones that the drafters (...) of the _Code_, and the profession more broadly, should seek to address in upcoming revisions. The objective of this article is to raise these questions as a way of urging greater clarification of the _Code’s_ overall approach to professional integrity, its meaning, and implications. (shrink)

El artículo analiza cómo la revista Medicina e Morale ha afrontado en su historia el tema de la ética en la experimentación clínica, que representa una parte muy amplia y compleja de la bioética y también de la deontología médica. Los aspectos que esta temática comprende son ya numerosos y la literatura producida ingentísima. La ética de la experimentación ha recibido particular impulso y atención a continuación de diversas experimentaciones no éticas que han turbado profundamente la opinión pública y (...) hecho necesario una fuerte reconsideración en el ámbito de la investigación clínica. En general, de los años 60's a los años 80's del siglo XX, ha prevalecido en la literatura un intenso empeño e interés en la elaboración de los principios de referencia y en la reflexión teórica relativa a varias cuestiones . De los años 90 en adelante se ha en cambio intensificado -probablemente por las exigencias nacidas en seno de los Comités de ética que precisamente en aquel período han iniciado a difundirse masivamentela elaboración de códigos, reglamentos, líneas-guía que han orientado el desarrollo de la disciplina más en sentido de procedimiento y con un acercamiento ético-deontológico. En particular, Medicina e Morale, ha estado siempre en estas temáticas, desde los inicios de su historia, constituyendo una voz original en el debate, además que un instrumento de difusión de documentos nacionales y sobre todo internacionales. La Revista ha representado, sobre todo en los últimos treinta años, un verdadero punto de referencia a nivel nacional y en algunos casos también internacional, proponiendo a veces orientaciones originales, que han sido luego acogidas en el ámbito de líneas-guía y de normativas.The article deals with how the journal Medicina e Morale has faced ethics in clinical trials, which represents a very large and complex bioethical issue, but also deontological one. This area comprises many questions and the literature is huge. It has risen after unethical clinical trials that have shocked the public and have produced a big rethinking about it. In general, from the '60s to the '80s of the XXth century, an intense commitment and interest have prevailed on the elaboration of the reference principies and on theoretical reflection on various issues, such as informed consent, the ethical significance of clinical research, the protection of vulnerable people, the risk acceptability). Since the '90s onwards the development of codes, regulations, guidelines -that have guided the development of the discipline in a procedural and also deontological sense- has increased, probably due to the large diffusion of ethics committees. Particularly, the journal "Medicina e Morale" has always been present on these issues, since the beginning of its history, creating an original voice in the debate, as well as a dissemination tool of national and especially international documentabon. The journal has been, especially in the last thirty years, a real national, and sometimes international, be nchmark, offering original suggestions which are then accepted in guidelines and regulations. (shrink)