Bioethics

Pensar os limites do investimento curativo requer perspectivas a partir da nocao etica de limite, de desenvolvimento da biomedicina e das reflexoes da bioetica, assim como da natureza dos cuidados paliativos. As tres perspectivas – a da etica, a da bioetica e a dos cuidados paliativos – configuram territorios compartilhados. No eixo do compromisso de lutar pela vida sem maximizar as intervencoes e humanizar os cuidados, destaque-se o respeito pela decisao do doente capaz e competente e a conviccao de que existem limites aos cuidados, porque tem de fazer sentido para quem os presta e para aquele a quem sao prestados. Os cuidados paliativos podem assegurar uma assistencia o mais completa possivel a pessoa que se encontra na ultima etapa da vida, considerando a morte como um processo normal, que nao podem nem devem retardar ou acelerar. O objetivo e prover a melhor qualidade de vida possivel para o doente em fase terminal e sua familia, ate o momento da chegada da morte, de modo verdad...

Health care is ubiquitous in the lives of industrialized people. Yet, every medical development, technique, and procedure impact the environment. Green Bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, Green Bioethics addresses, not the structure of environmental sustainability in health care institutions, but the sustainability of individual health care offerings.

Green Bioethics parallels traditional biomedical ethics by providing four principles for ethical guidance. Through these four principles, Green Bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The principles of Green Bioethics are:
- Distributive Justice (Allocate Basic Medical Resources before Special Interest Access)
- Resource Conservation (Provide Health Care Needs before Health Care Wants)
- Simplicity (Reduce Dependence on Medical Interventions)
- Ethical Economics (Humanistic Health Care Instead of Financial Profit)

The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources. The principles of Green Bioethics, in tandem with the concrete examples given in this book, will support sustainability in health care.

Disponible sur : https://www.medicinaemorale.it/mem/article/view/1201

La crise écologique et environnementale pousse les militants à hausser la voix pour prêter plus d'attention au bienêtre animal. Afin que leur voix soit entendue, ils essayent de passer par le droit afin de légiférer leurs réclamations; ceci en présentant comme argument principal la question de la sensibilité à la douleur chez l'animal. La récente étude, datant de novembre 2021, concernant la «souffrance des crustacés» reconnue par le gouvernement britannique et la présentation d'un projet de loi sur le bien-être animal - projet étayé par la science - afin d'être étendu à ces animaux en sont un bon témoin. En France, l'animal a un statut particulier dans le Code civil, depuis 2015, comme étant un «être doué de sensibilité», statut qui lui confère une protection juridique. En parallèle, les législations soutenant l'Interruption Volontaire de Grossesse évoluent à une vitesse en France où on se heurte au dilemme bioéthique touchant au respect de la vie de l'être humain et au statut juridique du fœtus. Cet article vise à répondre à la problématique suivante: est-ce que le fœtus humain jouit d'une protection juridique similaire à celle de l'animal tout en basant sur le critère de la «sensibilité à la douleur»? Il s'agit d'une approche comparative à partir des textes législatifs du droit français.

This article looks at the question of sin and disease in bioethics with a spiritual-theological analysis from the book of Job. The biblical figure Job is an innocent and just man who suffered horrendously. His dialogues with others—his wife, his friends, and God—can give many valuable insights for patients who suffer and for those who interact with them. Family, friends, physicians, nurses, chaplains, and pastoral workers can learn from Job how to communicate properly with sufferers. The main question for Job was how to maintain the tension between God’s justice and God’s mercy and not yield to the temptation of cursing God but to speak well of Him in moments of difficulties.

Although physician-assisted suicide (PAS) is legal in several jurisdictions around the world, debate about its merits and implementation is far from settled. This debate has special, timely significance in Canada, as new PAS legislation is imminent. (Controversial recommendations from the Joint Special Committee on Physician-Assisted Dying include PAS for mature minors, PAS in advance directives, and PAS for people with mental illness.)

Slippery slope concerns are often at the centre of this debate—opponents worry that legalizing PAS in any form, however acceptable now, will inevitably lead to practices that are unacceptable. Concerns include risk of abuse and mistake, expansion of criteria, and an unobstructed path to euthanasia. Opponents also observe that those who support PAS on the basis of autonomy and suffering (common foundational arguments) are logically, on principle, committed to its expansion.

As the literature reveals, the slippery slope debate is confusing and often misunderstood. This essay seeks to achieve clarity by investigating the two types of slippery slope arguments—empirical and logical. The validity of each slippery slope argument is considered, with the following results. Empirical slippery slope concerns have not been validated. Recent data from Oregon and Europe neither support nor disprove slippery slope claims conclusively. Low numbers of usage of PAS, particularly in Oregon, reduce fears. Logical slippery slope concerns, while theoretically compelling, can be assuaged by drawing a bright line between what is acceptable and what is unacceptable. Consistency of principle need not be the highest value if other compelling reasons exist to make this distinction. Generally, slippery slope arguments are addressed (by proponents of PAS) by pointing to qualifying thresholds or criteria, also known as safeguards.

Two particular safeguards are then examined—determinations of capacity and suffering, respectively. Some questions addressed include:

On what basis are physicians expected to assess capacity?
On what basis are physicians expected to assess suffering, especially if terminal illness is not a criterion?
To what extent can physicians make these determinations without also judging the patient’s quality of life?

In exploring answers to these questions, significant doubt is raised as to the extent to which these criteria function as safeguards against slippery slope concerns. Physicians are faced with the near-impossible task of assessing capacity and determining suffering without inserting their personal judgment of whether the person really ought to die, and in this way. In addition, they must do so without meaningful guidelines to assist in making these determinations with fairness and consistency. Other than in obvious cases of incapacity, why would a physician ever say no? More importantly, how could a physician ever say no without risk of accusation of inappropriately judging another’s suffering? Indeed, even if a physician denies a request a more agreeable physician may be found.

I conclude that, with the legalization of PAS in any form–particularly the form proposed in Canada –the promise of safeguards as protections proves illusory.

The concept of antinatalism is now becoming popular on the Internet. Many online newspaper articles deal with this topic, and numerous academic papers on antinatalism have been published over the past ten years in the fields of philosophy and ethics.  The word “antinatalism” was first used in the current meaning in 2006, when the two books that justify the universal negation of procreation were published: one by David Benatar and the other by Théophile de Giraud. However, we can find various prototypes of antinatalistic thoughts in ancient Greece, ancient India, and modern Europe. You might recall the name Schopenhauer.
In this paper, I briefly summarize the history of antinatalistic thoughts and propose a set of categories on antinatalism and related thoughts.

Different definitions of bioethics in American and Italian literature are reported. It is argued that they refer to three different conceptions of the epistemological status of bioethics: the first conceives of it as an application of moral principles to biomedical problems, the second as a methodology for the working out of clinical judgement, the third as a broader and interdisciplinary public inquiry. It is suggested that each approach grasps a part of the truth, for each singles out one level of the bioethical work. Bioethics is in fact a complex, three-level form of knowledge. The misunderstanding of this complexity has led to some confusion and to conflicts of attribution among those who are concerned with it.

Advances in medical science consistently present great promise for humankind coupled with unprecedented ethical challenges. In expanding the scope for possible actions they simultaneously force one to confront difficult decisions. One such decision is whether it is ethically permissible to elect cryopreservation as a means to extend one's life. The practical and theoretical foundations of cryonics were secured by Ettinger's innovative piece The Prospect of Immortality over 50 years ago. 1 Yet the focus of bioethical debate in recent times has rested almost exclusively on determining when human life begins. This paper will shift this focus to a discussion of when human life ends, ultimately contending that cryopreservation offers one an ethical vehicle to "not go gentle into that good night." 2 This paper will begin by simply articulating the prima facie reasons for choosing to undergo cryopreservation. This will entail an examination of the concept of death, and a brief comment on the professional biomedical standards which endorse this treatment. This paper will then present three prudential objections to cryonics: that it has a low probability of success, that it does not guarantee the survival of one's personal identity, and that it would be undesirable to be revived in the future. It shall demonstrate the weaknesses of each of these criticisms successively, before addressing the strongest ethical objections against opting for cryopreservation. These are: it will contribute to over-population, it is a selfish practice, it will exacerbate inequality, and lastly that it is

Abstract: This essay considers the ways in which Hegel's theory of ethical life (Sittlichkeit) can provide us with a different understanding of our ethical obligations to animals. I argue that animal abuse and its toleration constitutes a distortion the ethical substance that we as social beings absorb. As a result, the state has a direct duty to protect animals from pain and suffering and to prevent the emergence of institutions and practices that foster such abuse and suffering. Arguing against the rights-based approach to animal welfare, I argue that we can see a more compelling argument in the anthropocentric understanding of our ethical lives and obligations to others. Seeing ethical life as "functionalist" in nature, I therefore argue that the approach I put forth, what I call "reflexive ethics," can provide us with a more rational basis for the legitimacy of legislation that protects animals from abuse, cruelty, and suffering.

Generally characteristic of poor nations are special or vulnerable populations of the poor, especially the helpless and
malnourished. The global health phenomenon Covid 19 brings to the fore an interplay of how the physical and mental
health of a citizenry could either mitigate or contribute to the deepening of vulnerable populations. With particular
reference to Nigeria, the paper critically examined the bioethical dimensions of the content of governmental responses to
covid19. A philosophical commentary, the paper carried out critical and analytic reflections on data gathered from
existing literature on governmental responses to Covid19 in Nigeria. The major finding is that the phenomenon of
corruption is not only an established ethical threat to the Nigerian nation, but also a threat that has deep bioethical
implications for the health sector in Nigeria; a phenomenon which the paper conceptualized as a twindemic (that is, a
combination of Covid pandemic and Corruption pandemic). In its quest for sustainable healthcare for vulnerable poor
populations in Nigeria, the paper deepened discussions on the need to fight corruption in the health sector - through
conscious adoption and implementation of appropriate bioethical policies and frameworks.
Keywords: Bioethics, Twindemic, Covid-19, corruption

The COVID-19 infection fatality rate for children under the age of 17 is less than 0,003%. Children are at extremely low risk of severe illness from COVID-19, and children do not spread the illness in any significant way. Once a vaccine becomes widely available for schoolchildren, will lawmakers leave it up to parents and guardians to choose whether to vaccinate their children or will they mandate schoolchildren to get a COVID-19 vaccine to attend school? This article assesses both arguments for and against mandatory COVID-19 vaccination for school children. The article further analyzes applicable international bioethical and human rights norms and standards with regard to informed consent as contained in the various international treaties to hold states legally accountable for their actions under international law. To determine whether states may impose vaccine mandates for school children in terms of international human rights law, a proportionality test is applied. The critical focus of this article is explicating the rudiments of the bioethical and human rights standards relating to the mandatory COVID-19 vaccination of schoolchildren that must be confronted to ensure that children, that is, humanity's most valuable asset for the future, are afforded their fundamental human rights. Ultimately, it highlights the importance that these international bioethical norms are built into decision-making by public authorities when measures to prevent the spread of infectious disease with a case fatality rate of less than 0,003% in children are instituted.

From the 5th edition of Beauchamp and Childress' Principles of Biomedical Ethics, the problem of common morality has been given a more prominent role and emphasis. With the publication of the 6th and latest edition, the authors not only attempt to ground their theory in common morality, but there is also an increased tendency to identify the former with the latter. While this stratagem may give the impression of a more robust, and hence stable, foundation for their theoretical construct, we fear that it comes with a cost, namely the need to keep any theory in medical ethics open to, and thereby aware of, the challenges arising from biomedical research and clinical practice, as well as healthcare systems. By too readily identifying the moral life of common morality with rule-following behaviour, Beauchamp and Childress may even be wrong about the nature of common morality as such, thereby founding their, by now, classic theory on quicksand instead of solid rock.

Abstract. This paper proposes an ordering of ideas to create politics that distinguishes itself from conventional politics. It is called extrapolitics. To define extrapolitics, the concept of politics, transhumanism and dialectic - dialogism have been briefly included. The  Politics Path has been schematized as a process of evolution that politics experiments and goes hand in hand with human evolution. A post-politicist proposal was suggested for the proper proliferation of transhumanist objectives, as well as an extension of the conventional political spectrum, one that includes the extra-political spectrum and arguments against human enhancement. It finalizes with the inclusion of two potential phenomena, one harmful and the other one ideal, that define the processes of application of extrapolitical policies, the bio-socio-political singularity and the bio-socio-political inflection, respectively.

Key words: transhumanism, politics, philosophy, extrapolitics, dialogism, ideologies, singularity, postmodernism, complexity.

It is sometimes argued that the non-therapeutic, non-consensual alteration of children’s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed ‘female genital mutilation’ or FGM), and one for boys (in which such alterations should be termed ‘male circumcision’). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children—whether female, male, or intersex—should be free from having parts of their genitals removed unless there is a pressing medical indication.

Hello, I'm Shelley Tremain and I'd like to welcome you to the thirty-ninth installment of Dialogues on Disability, the series of interviews that I'm conducting with disabled philosophers and post here on the third Wednesday of each month. The series is designed to provide a public venue for discussion with disabled philosophers about a range of topics, including their philosophical work on disability; the place of philosophy of disability vis-à-vis the discipline and profession; their experiences of institutional discrimination and personal prejudice in philosophy, in particular, and in academia, more generally; resistance to ableism, racism, sexism, and other apparatuses of power; accessibility; and anti-oppressive pedagogy. I acknowledge that the land on which I sit to conduct these interviews is the traditional territory of the Haudensaunee and Anishnaabeg, covered by the Upper Canada Treaties and directly adjacent to Haldiman Treaty territory. I offer these interviews with respect and in the spirit of reconciliation.

What is 10x more lethal than COVID-19? Viral covidiocy. 9 out of 10 COVID deaths were vaccinated in the K, Israel, Chile and Argentina, where case fatality rate was 1300% higher for the vaccinated than for the unvaccinated, plus a higher 40% contagion rate (5% if unvaccinated): the opposite of the narrative. The USA, also showed worse outcomes for the vaccinated than the unvaxxed. COVID waves seem to have receded due to the increase of herd immunity of the recovered, both vaccinated and unvaccinated.

In the USA and Europe, 5 million adverse reactions and 70 thousand deaths were reported linked to COVID vaccines. Informed consent forms can’t protect COVID-19 vaccine manufacturers against legal actions, even under immunity by law, not only because they are not really “vaccines” but gene hacks to produce the S1 spike protein (or parts), nor because some or all the elements are secret, un-disclosed or hidden, but especially, because the cure had been found, voiding Emergency Use Authorization (EUA): if you get COVID, especially if vaccinated, follow this successful evidence-based treatment: https://covid19criticalcare.com/covid-19-protocols/ ( translations: https://covid19criticalcare.com/covid-19-protocols/translations/ ). Yet, there are many other options in this document.

This research is not “anti-vaccine”, but pro-sane-vaccines. Unlike insane vaccines, it stands for evidence based medicine, i.e. scientifically proven safe and effective treatments. 500 scientific citations prove a systemic bias against cheap effective cures and towards unethical, ineffective and/or unsafe vaccines.

Among dozens of effective treatments here reviewed, ivermectin is the best mass cure for COVID-19 variants. It had been scientifically proven beyond any reasonable doubt by May 2020, yet, instead of informing the public about the amazing results and going back to normal, there was a global scheme to block lifesaving information and promote lock downs, masks, restrictions, experimental vaccines and passports.

1 million dollars of ivermectin would end the pandemic compared to 160 thousand million dollars PER YEAR to keep a perpetual endemic disease, with vaccines always chasing new variants in a never ending lucrative arms race. It is not a matter of unsettled science: there are more RCT studies than for any other standard-of-care treatment. An insane “war on bugs” by legal drug cartels? It was an un-treatment pandemic designed to push vaccines and expensive monoclonal antibodies as the only option.

The pandemic proved that there is neither quality control nor pharmacovigilance in any country of the world, especially the USA. In spite of more deaths linked to COVID vaccines than all deaths reported since 1990 from all vaccines, there was no real follow up of cases, no studies about subclinical side effects like myocarditis and thrombosis, no interest in public health:

Deaths after vaccination (USA, openVAERS.com)


With COVID vaccines, Governments have turned a medical act into an administrative mandate. Yet, practically no medical association protested against this violation of the right of the physician to practice medicine, i.e. a customized treatment according to the best knowledge/possibilities.

Human rights continue to be systematically violated: to life, to informed consent, to fertility, to ethical treatments (where benefits are higher than harms), to healthcare (instead of sickening-care), to treatments for vaccine injuries, to compensation for injuries and death, to privacy (passes), to freedom (to work, move, assemble, worship), etc.

This research presents strong scientific evidence for a planned global genocide:

MAY A PERSON : WITH
COVID
VACCINATION WITH
EFFECTIVE
TREATMENT
AVOID GETTING SICK FROM COVID? 🗴 No ✓ Yes
AVOID INFECTING OTHERS? 🗴 No ✓ Yes
AVOID HOSPITALIZATION? 🗴 No ✓ Yes
AVOID DYING FROM COVID? 🗴 No ✓ Yes
AVOID SIDE-EFFECTS LIKE INFERTILITY, MISCARRIAGE, DISABILITY OR DEATH? 🗴 No ✓ Yes
GET HEALTHCARE OR MANUFACTURER LIABILITY FOR INJURIES, DEATH OR NEGLIGENCE? 🗴 No ✓ Yes
HELP PROTECT OTHERS? 🗴 No ✓ Yes
HELP REDUCE THE SATURATION OF THE HEALTH SYSTEM? 🗴 No ✓ Yes
GENERATE HERD IMMUNITY? 🗴 No ✓ Yes
HELP TO END THE PANDEMIC? 🗴 No ✓ Yes
REDUCE THE GENERATION AND SPREAD OF VARIANTS? 🗴 No ✓ Yes
AVOID COOPERATION WITH VACCINES PRODUCED WITH ABORTION CELL LINES? 🗴 No ✓ Yes
GIVE INFORMED CONSENT WITH A PACKAGE INSERT LISTING ALL THE INGREDIENTS? 🗴 No ✓ Yes
AVOID UNDISCLOSED GENE-HACKING, NANO-TAMPERING AND BLUETOOTH CHIP? 🗴 No ✓ Yes

From the systematic genocide of abortion, they moved on to the 7 COVID genocides:
1. Engineering and releasing of the infertilizing, handicapping and lethal virus.
2. Maximizing spread (delaying alerts with open borders, forbidding open air activities, cloth masks, lock downs, vaccination).
3. Lethal recommendations (the above plus banning autopsies, pre-term delivery/c-sections, mother-baby separation).
4. Censoring, defunding and persecuting effective treatments.
5. Unneeded deadly treatments (ventilation, Remdesivir).
6. Infertilizing, handicapping and lethal vaccines and haccines (especially during pregnancy, breastfeeding and childhood).
7. Magnetoxic attacks: graphenation of haccines, food and beverages, EMF blasts from satellites, towers and phones, etc.

The genocidal trend didn’t change, only the target population. Same serial killers, different weapons.

Hosea 4:6 “My people are dying for lack of knowledge...”

The paper entitled “Bioethics Committees/Commissions in Hospitals — The Experience of Other Countries. Where to Start?” touches upon the topic of calling into being bioethics committees in Polish hospitals. The need for creating such advisory bodies, and the range of their competence, is shown on the basis of western publications (especially those from French and English speaking countries) as well as on the basis of the personal experience of the author as a member of the bioethics committee in an English hospital (Tameside Hospital in Ashton-under-Lyne). The existence of bioethics committees in hospitals contributes to the humanization of medicine and to an holistic approach to the patient, who is no longer treated as a “particular clinical case” but as a human being, with a wealth of psychological and spiritual attributes, and also, as the subject of interpersonal relations with other people and with the whole community. Dynamic progress in the area of medicine in recent decades ...

Mentally ill patients who have been involuntarily confined under civil commitment laws are extraordinarily vulnerable to exploitation. Yet federal research guidelines are silent on whether such patients are legitimate targets for recruitment into medical research studies.  Drawing on the controversial case of Dan Markingson at the University of Minnesota, we argue that action should be taken to restrict the recruitment of these patients as research subjects in psychiatric research studies.

This is a preprint (submitted manuscript pre peer review) of an article, subsequently published in Public Health Ethics, 7 (1): 1--4. The final version contains typographical as well as substantial changes compared to this first submission, and can be accessed online: http://phe.oxfordjournals.org/content/7/1/1.abstract. The entire special symposium introduced can be accessed online: http://phe.oxfordjournals.org/content/7/1.toc The idea of a special journal symposium on the theme of New Media and Risky Behavior of Children and Young People: Ethics and Policy Implications originally arose out of a workshop at the University of Gothenburg held in 2011 as part of a European project coordinated by the University of Central Lancashire Law School, on possible policy responses to the impact on young people of exposure to audiovisual media portrayals of alcohol consumption. 1 A main outcome of that meeting, where selected experts on the empirical research in this area as well as on relevant aspects of ethics and law participated, was that the problem is just an instance of a much more complex and encompassing one, not least the underlying value and normative issues. While we did have in mind as a thematic topic the possible clash between two powerful set of societal norms and concerns -the well--being of children and the freedom of expression, it turned out to be a less than straightforward matter to connect these to the empirical information available and the same turned out to hold for issues about the proper sharing of responsibilities between businesses, societal institutions, parents and young people themselves.

This response document will briefly address concerns about the ethical, legal and methodological flaws with past research informing aspects of present PEPFAR program areas; concerns about adverse consequences of PEPFAR program areas; and concerns about the absence of oversight of the activities of PEPFAR funding recipients.

Part of a series from Visual Aid Publishing, designed for Kindle, iPad etc. Aimed at a general readership but also useful for teaching purposes, as an accessible, thought provoking and inexpensive introduction.  Topics include Abortion, Euthanasia, Acts and Omissions, Kant, Mill, Hume, Law and Morality, Emotivism, Moral Luck, Altruism, Torture, Suicide, Ethics and Religion, Relativism, Justice and many more (another eighty-five, to be precise).

Part of a series from Visual Aid Publishing, designed for Kindle, iPad etc. Aimed at a general readership but also useful for teaching purposes, as an accessible, thought provoking and inexpensive introduction.  Topics include Abortion, Euthanasia, Acts and Omissions, Kant, Mill, Hume, Law and Morality, Emotivism, Moral Luck, Altruism, Torture, Suicide, Ethics and Religion, Relativism, Justice and many more (another eighty-five, to be precise).

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new biotechnology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.

Some people with dementia are transformed by the disease, to the point that family members may describe them as a “different person.” These transformations may be negative or positive. What factors affect the judgements of ordinary people about whether an advance directive (AD) should be followed in such cases? We conducted three studies to test the influence of (1) positive versus negative transformation and (2) “treat” versus “withhold treatment” AD on the judgements of US participants (n = 1676) as to whether the AD should be followed and the extent to which the late-stage dementia patient had become a different person. We found that participants generally endorsed following the AD, irrespective of condition, but much less so when the patient had a positive transformation. Participants also favored “treat” over “withhold treatment” ADs. Unexpectedly, we found that AD type affected “different person” judgments: participants registered significantly weaker agreement with the propos...

Resnicoljubnost na področju medicinske etike Na področju tradicionalne medicinske etike lahko opazimo nenavadno odsotnost zahteve po resnicoljubnosti v odnosu zdravnik-pacient, medtem ko je na področju sodobne medicinske etike postala resnicoljubnost ena izmed osrednjih tem. V zadnjih desetletjih je, skladno s sodobnimi pogledi na človekove pravice in dostojanstvo človeškega bitja, v ospredje stopila avtonomija bolnika, ki je tesno povezana s pravico pacienta do seznanjenosti z lastnim zdravstvenim stanjem. S pregledom najvplivnejših usmeritev glede resnicoljubnosti na področju bioetike ter nekaterimi zakonskimi premisleki skuša članek odgovoriti na vprašanje upravičenosti prikrivanja resnice v odnosu zdravnik-pacient. Ključne besede: resnicoljubnost, bioetika, medicinska etika, etika načel, etika vrlin, nova kazuistika revija za evropsko ustavnost ETIKA IN MEDICINA (2010) 13 www.revus.eu 2 MEDICINSKA ETIKA Kot rečeno, na področju tradicionalne medicinske etike opazimo nenavad no odsotnost zahteve po resnicoljubnosti. V temelju Hipokratove prisege je načelo ne škodovati (Primum non nocere), resnicoljubnost-v smislu zvestobe resničnim dejstvom in stvarnosti-pa neposredno ni omenjena. Prav nasprotno, v nasvetih o obnašanju zdravnika (Decorum), najdemo opozorilo na nevarnost sporočanja pacientu resnice o njegovem zdravstvenem stanju. 1 Tudi različni drugi medicinski kodeksi in dogovori (na primer Ženevska deklaracija iz leta 1948) o resnicoljubnosti in iskrenosti molčijo. Tako je bila v tradicionalnem, paternalističnem odnosu ustaljena praksa, da se je zdravnik v imenu največjega dobrega za pacienta zatekal k taktikam kot so prikrivanje, laganje in izogibanje. Nekako po letu 1960 so se debate usmerile v preseganje paternalističnega odnosa zdravnik-pacient. Spremenjeni odnos med zdravnikom in pacientom prinese večji poudarek na dialogu med zdravnikom in pacientom, pacientovih pravicah do odločanja ali vsaj so-odločanja, in s tem do razmišljanja o tem, katere informacije je treba posredovati pacientu iz spoštovanja njegove avtonomije. 2 Obveščenost pacienta se navadno smatra kot osnovni pogoj za avtonomno delovanje pacienta. Poudarek na resnicoljubnosti v odnosu zdravnik-pacient v veliki meri izhaja iz novosti v medicinski praksi, in sicer iz zakonske zahteve do obveščenega soglasja pred posegom (informed consent). Pacienta je treba obvestiti o njegovem zdravstvenem stanju, se z njimi posvetovati, ter na podlagi tega pridobiti njegovo soglasje. Avtonomija pacienta se tako izraža v obliki konkretne odločitve. Vsekakor pa pravice pacienta do obveščenosti ne gre povezovati zgolj s privolitvijo v medicinske posege. Kot načelo se resnicoljubnost prvič pojavi 1980 v Principles of Ethics Ameriške zdravstvene organizacije (AMA), kjer beremo, da mora biti zdravnik do pacientov in sodelavcev iskren. 3 V zadnjih tridesetih letih je postala resnicoljubnost eno osrednjih vprašanj na področju moderne medicinske bioetike in postala vključena v profesionalne kodekse in zaprisege, katere zdravniki izrečejo pacientom in ustanovam, ki jih zaposlujejo. Poglejmo si sedaj nekaj najvplivnejših usmeritev na področju bioetike ter njihov pogled na resnicoljubnost. V večini etičnih teorij pomeni resnicoljubnost speciikacijo avtonomije, zato bo tudi koncept avtonomije bolj natančno razdelan.

Os avanços tecnocientíficos das últimas décadas contribuíram para o aumento do número de pacientes com doenças terminais no mundo. Em decorrência da milenar conexão entre a fase de terminalidade de vida e os processos espiritualistas, esse fato assumiu aspectos peculiares no Brasil, país em que o número de segmentos religiosos/espiritualistas multiplicou-se nas últimas décadas. Este trabalho procura mostrar que a diversificação das necessidades de pacientes brasileiros com referência ao bemestar espiritual na fase final da vida pode gerar dilemas bioéticos novos para o profissional da saúde que não conheça os fundamentos das principais correntes espiritualistas do país. Defendendo que tal conhecimento é ferramenta útil para o profissional da saúde que quer observar os princípios da beneficência e do respeito à autonomia do paciente, o texto disponibiliza algumas orientações básicas das principais linhas espiritualistas brasileiras sobre os processos da morte e do morrer.

Pharmacogenomics is the study of the myriad interactions between genes and pharmacotherapy. Developments in pharmacogenomics have changed and will affect pharmaceutical research, drug development and the practice of medicine in a significant way. In this article, we make an inventory of the ethical implications that might arise as a result of possible developments in pharmacogenomics and investigate whether the present ethical framework will be able to adequately answer arising questions. We think that many of the questions related to the consequences of pharmacogenomics are answerable along the lines of present ethical thinking. We also believe, however, that many 'changes of degree' may result in a 'change of kind.' We therefore think that pharmacogenomics may potentially have such a profound influence on scientific research and the pharmaceutical industry, the practice of medicine and society at large, that this will generate its own unique dynamic, which will require new ethical research. We suggest that the notion of 'responsibility' will be a major focus of such research.

El presente estudio busca analizar la práctica de los trasplantes de médula ósea en Brasil a la luz de la Bioética. Partiendo del presupuesto constitucional brasileño de que la salud es un derecho de todas las personas, analiza el acceso a estos servicios médicos especializados por parte de los ciudadanos socialmente vulnerables. Presenta el panorama legal de este campo del conocimiento científico en el país, mostrando la legislación general relativa a los trasplantes de órganos y tejidos, además de la reglamentación específica relacionada con los trasplantes de médula ósea, incluyendo la logística pública de apoyo al desarrollo del proceso de atención médica. Considerando aspectos relacionados con el uso de células tronco hematopoyéticas y tomando la bioética como referencia, discute la vulnerabilidad de los pacientes de bajas condiciones socio-económicas, la responsabilidad pública del Estado para con esas personas y la necesidad de darles la debida protección, teniendo en cuenta ...

To date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people's claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age-based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing older persons in developing nations. Existing philosophical approaches to age-based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights-based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation.

Me medicine vs. we medicine: reclaiming biotechnology for the common good, by Donna Dickenson, New York, Columbia University Press, 2013, 296 pp., £19.95 (hardback), ISBN 978-0-231-15974-6

“Is personalised medicine replacing public healthcare in ways that are ultimately detrimental to all of us?” This is the central question that Donna Dickenson sets out to answer in her most recent book Me Medicine vs. We Medicine. Presenting itself as a “reality check” for the much-publicized claims about the desirability –and often the inevitability – of revolution(s) and sundry “paradigm shifts” to be brought about through personalized medicine, the book centres on four case studies: direct-to-consumer genetic testing, private cord blood banking, pharmacogenomics and human enhancement technologies. These represent the “me medicine” of the title; the individualized self-knowledge and self-management offered by direct-to-consumer genetic (and genomic) testing, the patient-tailored drug regimens promised by pharmacogenetics (PGx), the evocation of parental duty to privately bank umbilical cord blood as a future self-repair kit of stem cells for individual children and the possibilities for self-improvement suggested by biomedical
enhancement.

(ONU) tienen como propósito crear un conjunto de objetivos mundiales relacionados con desafíos ambientales, políticos y económicos, haciendo frente a la pobreza extrema y el hambre, entre otros, como prioridades del desarrollo. Los ODS son un llamado urgente para que el mundo haga la transición a una senda más sostenible. Sobre el desarrollo sostenible o sustentable se puede decir en líneas generales que es aquel donde el desarrollo de la generación presente satisface sus necesidades sin limitar a las generaciones futuras para que también puedan satisfacer sus necesidades. En el presente trabajo, se desarrolla una evaluación integral de los procesos de desarrollo sostenible, desde una mirada estatal y desde la perspectiva de organizaciones internacionales como el PNUD. De este modo, se trata de una indagación profunda sobre patrones de bioética.

is a family practice doctor with a steady, yet varied, patient population. Practicing medicine in a small suburban community, he sees whole families ranging from newborn babies to adults well into their 80s. He prides himself on his practice of preventive medicine in particular, and, because he has such a longstanding rapport with his patients, they adhere to his counseling on healthy living and follow up regularly for annual physicals and appropriate screening tests. Among other things, Dr. Jorgensen is particularly diligent in his screening for, and treatment of, diabetes mellitus; he tests all of his patients over age 45 for diabetes and refers all of his diagnosed diabetic patients for annual ophthalmologic exams.

Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional ethics, one should notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more...