Fundamentación de la bioética : Bioética: quo vadis? Veinte tesis
Javier de la Torre. Bioética: quo vadis? Veinte tesis. Bioètica & debat. 2015; 21 (75): 2.
Este artículo ofrece una reflexión personal, interesante y original sobre las tendencias de futuro de la bioética española, portuguesa e iberoamericana. Entre estas tendencias, resumidas en veinte tesis, se destaca que la bioética de los próximos años será: más consciente de sus propios límites, más filosófica, más virtual, más internacional, más inclusiva, más social, con más presencia femenina, más ecológica, más abierta al transcendente.
Este artículo ofrece una reflexión personal, interesante y original sobre las tendencias de futuro de la bioética española, portuguesa e iberoamericana. Entre estas tendencias, resumidas en veinte tesis, se destaca que la bioética de los próximos años será: más consciente de sus propios límites, más filosófica, más virtual, más internacional, más inclusiva, más social, con más presencia femenina, más ecológica, más abierta al transcendente.
Fundamentación de la bioética : Ethical Integrity in Health Care Organizations: Currents in Contemporary Bioethi
http://onlinelibrary.wiley.com/doi/10.1111/jlme.12308/abstract
Mantel, J. (2015), Ethical Integrity in Health Care Organizations: Currents in Contemporary Bioethics. The Journal of Law, Medicine & Ethics, 43: 661–665. doi: 10.1111/jlme.12308
Ethical Integrity in Health Care Organizations: Currents in Contemporary Bioethics
Jessica Mantel
Article first published online: 19 OCT 2015
DOI: 10.1111/jlme.12308
© 2015 American Society of Law, Medicine & Ethics, Inc.
Mantel, J. (2015), Ethical Integrity in Health Care Organizations: Currents in Contemporary Bioethics. The Journal of Law, Medicine & Ethics, 43: 661–665. doi: 10.1111/jlme.12308
Ethical Integrity in Health Care Organizations: Currents in Contemporary Bioethics
Jessica Mantel
Article first published online: 19 OCT 2015
DOI: 10.1111/jlme.12308
© 2015 American Society of Law, Medicine & Ethics, Inc.
Fundamentación de la bioética : La construcción de un nuevo campo de conocimiento: el caso de la bioética en Ven
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S1726-569X2015000100017&lng=es&nrm=iso&tlng=es
Acta bioeth. vol.21 no.1 Santiago jun. 2015
http://dx.doi.org/10.4067/S1726-569X2015000100017
INTERFACES
La construcción de un nuevo campo de conocimiento: el caso de la bioética en Venezuela
Enrique Cubero-Castillo
Resumen: En este artículo se describe y analiza el proceso de institucionalización de la bioética en Venezuela, en términos tanto de su organización, composición y actividades, como del nivel de gestión pública en el cual se ha institucionalizado. El método empleado es documental, estructurado de manera cronológico-descriptiva, el cual permite establecer relaciones, diferencias, etapas, posiciones y estado actual de los conocimientos en el área de estudio. Se concluye que dicho proceso no ha estado articulado con un programa de formación de capacidades, tanto para el área de investigación como para la gestión.
Palabras clave: bioética, bioética en Venezuela, comités de bioética, institucionalización
Acta bioeth. vol.21 no.1 Santiago jun. 2015
http://dx.doi.org/10.4067/S1726-569X2015000100017
INTERFACES
La construcción de un nuevo campo de conocimiento: el caso de la bioética en Venezuela
Enrique Cubero-Castillo
Resumen: En este artículo se describe y analiza el proceso de institucionalización de la bioética en Venezuela, en términos tanto de su organización, composición y actividades, como del nivel de gestión pública en el cual se ha institucionalizado. El método empleado es documental, estructurado de manera cronológico-descriptiva, el cual permite establecer relaciones, diferencias, etapas, posiciones y estado actual de los conocimientos en el área de estudio. Se concluye que dicho proceso no ha estado articulado con un programa de formación de capacidades, tanto para el área de investigación como para la gestión.
Palabras clave: bioética, bioética en Venezuela, comités de bioética, institucionalización
http://jme.bmj.com/content/early/2016/01/21/medethics-2015-103047?papetoc
J Med Ethics doi:10.1136/medethics-2015-103047
Public health ethics
Paper
Is risk stratification ever the same as ‘profiling’?
R Scott Braithwaite, Elizabeth R Stevens, Arthur Caplan
Received 28 July 2015
Revised 2 December 2015
Accepted 4 January 2016
Published Online First 21 January 2016
Abstract
Physicians engage in risk stratification as a normative part of their professional duties. Risk stratification has the potential to be beneficial in many ways, and implicit recognition of this potential benefit underlies its acceptance as a cornerstone of the medical profession. However, risk stratification also has the potential to be harmful. We argue that ‘profiling’ is a term that corresponds to risk stratification strategies in which there is concern that ethical harms exceed likely or proven benefits. In the case of risk stratification for health goals, this would occur most frequently if benefits were obtained by threats to justice, autonomy or privacy. We discuss implications of the potential overlap between risk stratification and profiling for researchers and for clinicians, and we consider whether there are salient characteristics that make a particular risk stratification algorithm more or less likely to overlap with profiling, such as whether the risk stratification algorithm is based on voluntary versus non-voluntary characteristics, based on causal versus non-causal characteristics, or based on signifiers of historical disadvantage. We also discuss the ethical challenges created when a risk stratification scheme helps all subgroups but some more than others, or when risk stratification harms some subgroups but benefits the aggregate group.
J Med Ethics doi:10.1136/medethics-2015-103047
Public health ethics
Paper
Is risk stratification ever the same as ‘profiling’?
R Scott Braithwaite, Elizabeth R Stevens, Arthur Caplan
Received 28 July 2015
Revised 2 December 2015
Accepted 4 January 2016
Published Online First 21 January 2016
Abstract
Physicians engage in risk stratification as a normative part of their professional duties. Risk stratification has the potential to be beneficial in many ways, and implicit recognition of this potential benefit underlies its acceptance as a cornerstone of the medical profession. However, risk stratification also has the potential to be harmful. We argue that ‘profiling’ is a term that corresponds to risk stratification strategies in which there is concern that ethical harms exceed likely or proven benefits. In the case of risk stratification for health goals, this would occur most frequently if benefits were obtained by threats to justice, autonomy or privacy. We discuss implications of the potential overlap between risk stratification and profiling for researchers and for clinicians, and we consider whether there are salient characteristics that make a particular risk stratification algorithm more or less likely to overlap with profiling, such as whether the risk stratification algorithm is based on voluntary versus non-voluntary characteristics, based on causal versus non-causal characteristics, or based on signifiers of historical disadvantage. We also discuss the ethical challenges created when a risk stratification scheme helps all subgroups but some more than others, or when risk stratification harms some subgroups but benefits the aggregate group.
https://phe.oxfordjournals.org/content/5/1/6
Public Health Ethics (2012) 5 (1): 6-15.
doi: 10.1093/phe/phs002
Liberty, Mill and the Framework of Public Health Ethics
Madison Powers
Ruth Faden
Yashar Saghai
In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a presumption in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty.
© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
Public Health Ethics (2012) 5 (1): 6-15.
doi: 10.1093/phe/phs002
Liberty, Mill and the Framework of Public Health Ethics
Madison Powers
Ruth Faden
Yashar Saghai
In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a presumption in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty.
© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
Fundamentación de la bioética : Empirical Support for the Moral Salience of the Therapy-Enhancement Distinction
http://link.springer.com/article/10.1007/s12152-014-9223-2
Neuroethics
December 2015, Volume 8, Issue 3, pp 243-256
First online: 19 October 2014
Empirical Support for the Moral Salience of the Therapy-Enhancement Distinction in the Debate Over Cognitive, Affective and Social Enhancement
Laura Y. Cabrera , Nicholas S. Fitz, Peter B. Reiner
Abstract
The ambiguity regarding whether a given intervention is perceived as enhancement or as therapy might contribute to the angst that the public expresses with respect to endorsement of enhancement. We set out to develop empirical data that explored this. We used Amazon Mechanical Turk to recruit participants (N = 2776) from Canada and the United States. Each individual was randomly assigned to read one (and only one) vignette describing the use of a pill to enhance one of 12 cognitive, affective or social (CAS) domains. The vignettes described a situation in which an individual was using a pill to enhance the relevant domain under one of two possible enhancement conditions, one perceived as enhancing above the norm (EAN), what most people recognize as a clear case of enhancement, whereas the other perceived as enhancing towards the norm (ETN), with the individual using the enhancement having a modest, but subclinical deficit. Participants were asked how comfortable they were with the individual using the enhancement and about the impact the enhancement might have had in the individuals’ success in life. We found that irrespective of the domain to be enhanced, participants felt significantly more comfortable with ETN than with EAN, and they regarded the enhancement intervention as contributing to greater success in life with ETN rather than EAN. These data demonstrate that the therapy enhancement distinction is morally salient to the public, and that this distinction contributes to the angst that people feel when considering the propriety of CAS enhancement.
Keywords
Enhancement to the norm Enhancement above the norm Experimental neuroethics Public attitudes Cognitive Social Affective
Neuroethics
December 2015, Volume 8, Issue 3, pp 243-256
First online: 19 October 2014
Empirical Support for the Moral Salience of the Therapy-Enhancement Distinction in the Debate Over Cognitive, Affective and Social Enhancement
Laura Y. Cabrera , Nicholas S. Fitz, Peter B. Reiner
Abstract
The ambiguity regarding whether a given intervention is perceived as enhancement or as therapy might contribute to the angst that the public expresses with respect to endorsement of enhancement. We set out to develop empirical data that explored this. We used Amazon Mechanical Turk to recruit participants (N = 2776) from Canada and the United States. Each individual was randomly assigned to read one (and only one) vignette describing the use of a pill to enhance one of 12 cognitive, affective or social (CAS) domains. The vignettes described a situation in which an individual was using a pill to enhance the relevant domain under one of two possible enhancement conditions, one perceived as enhancing above the norm (EAN), what most people recognize as a clear case of enhancement, whereas the other perceived as enhancing towards the norm (ETN), with the individual using the enhancement having a modest, but subclinical deficit. Participants were asked how comfortable they were with the individual using the enhancement and about the impact the enhancement might have had in the individuals’ success in life. We found that irrespective of the domain to be enhanced, participants felt significantly more comfortable with ETN than with EAN, and they regarded the enhancement intervention as contributing to greater success in life with ETN rather than EAN. These data demonstrate that the therapy enhancement distinction is morally salient to the public, and that this distinction contributes to the angst that people feel when considering the propriety of CAS enhancement.
Keywords
Enhancement to the norm Enhancement above the norm Experimental neuroethics Public attitudes Cognitive Social Affective
J Med Ethics doi:10.1136/medethics-2015-103030
Commentary
In defence of genital autonomy for children
Brian D Earp
Received 27 November 2015
Accepted 2 December 2015
Published Online First 20 January 2016
Abstract
Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate—or even encourage—what the authors regard as ‘de minimis’ forms of female genital mutilation (as defined by the World Health Organization). In this commentary, I argue that many serious problems would be likely to follow from a policy of increased tolerance for female genital mutilation, and that it may therefore be time to consider a less tolerant attitude toward non-therapeutic infant male circumcision. Ultimately, I suggest that children of whatever sex or gender should be free from having healthy parts of their most intimate sexual organs either damaged or removed, before they can understand what is at stake in such an intervention and agree to it themselves.
Commentary
In defence of genital autonomy for children
Brian D Earp
Received 27 November 2015
Accepted 2 December 2015
Published Online First 20 January 2016
Abstract
Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate—or even encourage—what the authors regard as ‘de minimis’ forms of female genital mutilation (as defined by the World Health Organization). In this commentary, I argue that many serious problems would be likely to follow from a policy of increased tolerance for female genital mutilation, and that it may therefore be time to consider a less tolerant attitude toward non-therapeutic infant male circumcision. Ultimately, I suggest that children of whatever sex or gender should be free from having healthy parts of their most intimate sexual organs either damaged or removed, before they can understand what is at stake in such an intervention and agree to it themselves.
Fundamentación de la bioética : An Ethical Evaluation of Evidence: A Stewardship Approach to Public Health Polic
https://phe.oxfordjournals.org/content/5/1/16
Public Health Ethics (2012) 5 (1): 16-21.
doi: 10.1093/phe/phr037
An Ethical Evaluation of Evidence: A Stewardship Approach to Public Health Policy
Mat Walton*
Eva Mengwasser
Abstract
This article aims to contribute to the application of ethical frameworks to public health policy. In particular, the article considers the use of the Nuffield Council on Bioethics stewardship model, as an applied framework for the evaluation of evidence within public health policymaking. The ‘Stewardship framework’ was applied to a policy proposal to restrict marketing of food and beverages to children. Reflections on applying the stewardship model as a framework are provided. The article concludes that the questions used to apply the stewardship model usefully introduced ethical considerations into the evidence review. However, the real value will likely come from the type of policy process within which the framework is used, identifying competing value positions and capturing local value requirements.
© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
Public Health Ethics (2012) 5 (1): 16-21.
doi: 10.1093/phe/phr037
An Ethical Evaluation of Evidence: A Stewardship Approach to Public Health Policy
Mat Walton*
Eva Mengwasser
Abstract
This article aims to contribute to the application of ethical frameworks to public health policy. In particular, the article considers the use of the Nuffield Council on Bioethics stewardship model, as an applied framework for the evaluation of evidence within public health policymaking. The ‘Stewardship framework’ was applied to a policy proposal to restrict marketing of food and beverages to children. Reflections on applying the stewardship model as a framework are provided. The article concludes that the questions used to apply the stewardship model usefully introduced ethical considerations into the evidence review. However, the real value will likely come from the type of policy process within which the framework is used, identifying competing value positions and capturing local value requirements.
© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
http://dialnet.unirioja.es/servlet/articulo?codigo=5305729
¿Es necesaria una estrategia integrada de biosocioética?
Autores: Federico Alonso Trujillo, Raquel López Medel, Inmaculada Asensio Fernández, Sandra Pinzón Pulido, M. Carmen González Montero
Localización: Enfermería clínica, ISSN 1130-8621, Vol. 26, Nº. 1, 2016 (Ejemplar dedicado a: Coordinación sociosanitaria), págs. 7-14
Idioma: español
Títulos paralelos:
Is a strategy of bio-socio-ethic necessary?
Resumen
Objetivo El presente artículo reflexiona sobre la necesidad de apostar por la articulación de una estrategia de ética que incluya 2 de los pilares básicos que afectan al bienestar de las personas, la atención de los servicios sanitarios y de los servicios sociales. El objetivo es realizar un acercamiento a la percepción de profesionales de los servicios sociales y sanitarios en Andalucía acerca de la necesidad de desarrollar un espacio de encuentro entre la bioética y la ética de la intervención social.
Método Estudio observacional, transversal y descriptivo, mediante encuesta a profesionales de los servicios sociales y sanitarios. Se utilizó una técnica de muestreo intencional. El cuestionario constaba de 10 preguntas sobre conflictos éticos en la práctica profesional social y sanitaria, y la percepción de desarrollo de un espacio compartido para la bioética y la ética de la intervención social.
Resultados La muestra constó de 124 profesionales, un 56% del sector sanitario y un 44% del sector de servicios sociales. Alrededor del 90% de las personas encuestadas se habían enfrentado a decisiones éticas difíciles de abordar en su práctica profesional y valoraron positivamente un abordaje común social y sanitario. El 75% afirmaron que los conflictos se presentan en los 2 ámbitos simultáneamente más que por separado. La gestión de los asuntos éticos se realizaba preferentemente de manera individual y de forma independiente.
Conclusiones El social y el sanitario son sistemas que poseen identidad y características diferenciadas, pero tienen una afinidad especial pues comparten saberes, espacios y valores comunes, que requieren de una profunda y comprometida reflexión, en aras a crear metodologías conjuntas de actuación, gestión y deliberación ética.
¿Es necesaria una estrategia integrada de biosocioética?
Autores: Federico Alonso Trujillo, Raquel López Medel, Inmaculada Asensio Fernández, Sandra Pinzón Pulido, M. Carmen González Montero
Localización: Enfermería clínica, ISSN 1130-8621, Vol. 26, Nº. 1, 2016 (Ejemplar dedicado a: Coordinación sociosanitaria), págs. 7-14
Idioma: español
Títulos paralelos:
Is a strategy of bio-socio-ethic necessary?
Resumen
Objetivo El presente artículo reflexiona sobre la necesidad de apostar por la articulación de una estrategia de ética que incluya 2 de los pilares básicos que afectan al bienestar de las personas, la atención de los servicios sanitarios y de los servicios sociales. El objetivo es realizar un acercamiento a la percepción de profesionales de los servicios sociales y sanitarios en Andalucía acerca de la necesidad de desarrollar un espacio de encuentro entre la bioética y la ética de la intervención social.
Método Estudio observacional, transversal y descriptivo, mediante encuesta a profesionales de los servicios sociales y sanitarios. Se utilizó una técnica de muestreo intencional. El cuestionario constaba de 10 preguntas sobre conflictos éticos en la práctica profesional social y sanitaria, y la percepción de desarrollo de un espacio compartido para la bioética y la ética de la intervención social.
Resultados La muestra constó de 124 profesionales, un 56% del sector sanitario y un 44% del sector de servicios sociales. Alrededor del 90% de las personas encuestadas se habían enfrentado a decisiones éticas difíciles de abordar en su práctica profesional y valoraron positivamente un abordaje común social y sanitario. El 75% afirmaron que los conflictos se presentan en los 2 ámbitos simultáneamente más que por separado. La gestión de los asuntos éticos se realizaba preferentemente de manera individual y de forma independiente.
Conclusiones El social y el sanitario son sistemas que poseen identidad y características diferenciadas, pero tienen una afinidad especial pues comparten saberes, espacios y valores comunes, que requieren de una profunda y comprometida reflexión, en aras a crear metodologías conjuntas de actuación, gestión y deliberación ética.
http://onlinelibrary.wiley.com/doi/10.1111/bioe.12214/abstract
Schuklenk, U. (2015), Fighting Imaginary Enemies In Bioethics Publishing. Bioethics, 29: ii–iii. doi: 10.1111/bioe.12214
Fighting Imaginary Enemies In Bioethics Publishing
Udo Schuklenk
Article first published online: 6 SEP 2015
DOI: 10.1111/bioe.12214
Schuklenk, U. (2015), Fighting Imaginary Enemies In Bioethics Publishing. Bioethics, 29: ii–iii. doi: 10.1111/bioe.12214
Fighting Imaginary Enemies In Bioethics Publishing
Udo Schuklenk
Article first published online: 6 SEP 2015
DOI: 10.1111/bioe.12214
https://www.google.es/search?q=Ethics+of+tobacco+harm+reduction+from+a+liberal+perspective&oq=Ethics+of+tobacco+harm+reduction+from+a+liberal+perspective&aqs=chrome..69i57j69i65&sourceid=chrome&es_sm=0&ie=UTF-8
J Med Ethics doi:10.1136/medethics-2015-102974
Public health ethics
Paper
Ethics of tobacco harm reduction from a liberal perspective
Yvette van der Eijk
Correspondence to
Yvette van der Eijk, Centre for Biomedical Ethics, National University of Singapore, 10 Medical Drive 02-01, Singapore 117597, Singapore; yvette.eijk@gmail.com
Received 31 July 2015
Revised 27 October 2015
Accepted 2 November 2015
Published Online First 26 November 2015
Abstract
Mixed evidence on the possible harms, benefits and usage patterns of electronic nicotine delivery systems (ENDS, or ‘e-cigarettes’), has led to vigorous and ongoing debates on the issue. The ethical trade-off often represented is that, though smokers should be permitted access to ENDS as a less harmful alternative to smoking, this comes at the expense of non-smokers and children who may experiment with ENDS, become addicted to them, or experience health issues from long-term exposure to passive ENDS vapour. Lacking from many debates is a balanced analysis based on sound ethical reasoning, so this paper aims to examine the issue from a liberal perspective. More specifically, focus is on how ENDS policy can help to promote freedom in a broader sense, with ‘freedom’ considered as originating from having options and the necessary information and ability to autonomously choose between these options.
J Med Ethics doi:10.1136/medethics-2015-102974
Public health ethics
Paper
Ethics of tobacco harm reduction from a liberal perspective
Yvette van der Eijk
Correspondence to
Yvette van der Eijk, Centre for Biomedical Ethics, National University of Singapore, 10 Medical Drive 02-01, Singapore 117597, Singapore; yvette.eijk@gmail.com
Received 31 July 2015
Revised 27 October 2015
Accepted 2 November 2015
Published Online First 26 November 2015
Abstract
Mixed evidence on the possible harms, benefits and usage patterns of electronic nicotine delivery systems (ENDS, or ‘e-cigarettes’), has led to vigorous and ongoing debates on the issue. The ethical trade-off often represented is that, though smokers should be permitted access to ENDS as a less harmful alternative to smoking, this comes at the expense of non-smokers and children who may experiment with ENDS, become addicted to them, or experience health issues from long-term exposure to passive ENDS vapour. Lacking from many debates is a balanced analysis based on sound ethical reasoning, so this paper aims to examine the issue from a liberal perspective. More specifically, focus is on how ENDS policy can help to promote freedom in a broader sense, with ‘freedom’ considered as originating from having options and the necessary information and ability to autonomously choose between these options.
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