Bioethical Point Of View Research Articles

Asphyxial Circulatory Arrest with a Complex of Resuscitation Measures in an Experimental Model

The majority of asphyxial circulatory arrest (CA) models have a number of disadvantages, such as the lack of uniform criteria for fixing CA and recovery of spontaneous circulation, short duration of CA episode and limited volume of post-resuscitation intensive care, poor similarity with resuscitation measures in current clinical anesthesiology/intensive care settings.The aim of the study: to improve the experimental model of asphyxicial CA by standardizing experimental procedures and using a complex of resuscitation measures replicating current CA management in clinical anesthesiology-intensive care.Materials and methods. The experiments were conducted on 34 male Wistar rats, distributed into 2 groups: Group I included animals subjected to sham procedure (SP, N=12) and Group II – animals subjected to asphyxial circulatory arrest (CA, N=22) and subsequent resuscitation. Asphyxia in anesthetized rats was induced by rocuronium bromide injection, followed by recording of electrocardiogram (ECG), parameters of invasive blood pressure (BP) measurement and laser Doppler fluxmetry (LDF) to assess skin perfusion. CA episode was maintained for 2 min, followed by a series of resuscitation measures and intensive therapy for 2 h. Circulatory parameters (ECG, BP, LDF), gas composition and arterial blood acid-base state (ABS) dynamics were evaluated.Results. Monitored parameters were comparable in both groups at baseline after stabilization period. After exclusion criteria were applied 11 animals from SP group and 18 — from CA were included in the analysis. Tachycardia (heart rate, beats/min–1, SP vs CA) was documented in the CA group: 218 [205; 236] vs 286 [272; 305], P⩽0.0001), as well as recovery of skin perfusion to subnormal parameters in the first minutes after successful resuscitation. At minute 10 in the post-resuscitation period worsening of skin perfusion (M, perfusion units, SP vs CA): 14.7 [12.1; 16.5] vs 10.1 [7.0; 12.5], P=0.0014), and decompensated mixed acidosis (pH, SP vs CA): 7.42 [7.40; 7.43] vs 7.20 [7.13; 7.23], P⩽0.0001) were documented in the CA group, however BP values were comparable (BP, mmHg, SP vs CA): 60 [58; 72] vs 67 [62; 82], P=0.482). At minute 120 post-resuscitation and at the end of intensive care period, both groups demonstrated similar values of the monitored parameters. Three out of 18 animals in the CA group died after resuscitation.Conclusion. Electromechanical dissociation underlies CA in rats subjected to asphyxia. The use of LDF to assess peripheral blood flow makes it possible to standardize the severity of ischemic reperfusion injuries and improve reproducibility of the model. Series of resuscitation measures in experimental setting is justified from a bioethical point of view, and makes it possible to improve repeatability of preclinical research results in clinical practice.

On-line pornography and minors. Diagnosis, challenges and proposals

The consumption of pornography over the Internet by minors has been increasing exponentially in recent years. The use of digital technologies and the ease of access to these contents are causes that explain this event. Simultaneously, there is concern about the increase in sexual violence, associated with discriminatory behavior, despite the efforts of laws and programs that promote sexual reproductive health (SRH) and the principle of equality. From a bioethical point of view, it is urgent to address this issue, which affects the physical and psychological health of minors and their affective-sexual education. The study addresses whether it is possible to relate the consumption of online pornography by minors and sexual violence. To do this, legal sources, reports from associations, audiovisual councils and scientific studies are consulted. In all of them, the relationship between the consumption of online pornography by adolescents and risky behavior in emotional-sexual matters and gender inequality is evident. In the legal and fiscal sphere, it is alerted to the damage that is occurring and points out the need to propose lines of action that reverse this situation. We propose measures to technically regulate access to content. These measures are based on the precautionary principle, a tool that has been applied in fields such as health and the environment. More studies and political actions are needed to make the Internet a safe place for minors.

Psychodeontological prerogatives related to the stigma of patients affected by mental disorders

The American Psychiatric Association defines mental illnesses as alterations in the cognitive, emotional or behavioral sphere (or a combination of these domains), which lead to suffering and/or problems in the person's social, professional or relational interaction skills. Given the range of possible symptoms, when talking about mental illnesses, reference should always be made to a standardized classification system, i.e. a list of disorders recognized to date, accompanied by their description and lists of symptoms and essential criteria for diagnosis. Currently, the most widely used manual in the world is the DSM (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association, whose structure follows a multiaxial system. Other international norms or classification systems include the International Statistical Classification of Diseases and Related Health Problems (ICD), which is often referred to by the WHO in mental health action plans, defining "mental disorders" as the range of disorders that falls under the ICD-10 classification. Within the given classifications, we can find disorders of different severities, with significant differences both in terms of the degree of suffering and in terms of the effects on the person's capacity for social interaction. However, the present paper does not aim to analyze clinical problems related to mental illnesses, but to address the state of care of people suffering from such illnesses in our country. In particular, we are motivated by the need to examine, from a bioethical point of view, critical issues arising from various studies of the current state of psychiatric care, critical issues affecting the lives of people with mental illness and their families, and which are strongly denounced to the institutions by the scientific societies.

False Positive Results in High-Risk Pregnancy for Chromosomal Anomalies: Psychological Considerations

Background: With a high sensitivity and specificity, non-invasive prenatal testing (NIPT) is an incomparable screening test for fetal aneuploidy. However, the method is rather newly introduced, and experiences with false positive results are few. Even rare cases of discordant results may cause psychological stress.
 Aim of the Study: The aim of this study was to examine false positive cases of NIPT tests in high-risk pregnancies. The literature review was also performed to review psychological consequences of discordant results.
 Materials and Methods: A retrospective study was conducted between 2015 and 2022. The Natera Panorama test was used to analyse the risk of trisomies 21 (Down syndrome), 18 (Edwars syndrome), 13 (Patau syndrome), X monosomy (Terner syndrome) and other sex chromosome abnormalities. High risk result of NIPT for aneuploidy was confirmed by the invasive testing.
 Results: 2000 women with a singleton pregnancy participated in the study. Out of 2000 NIPT tests 22 cases with high risk results for chromosomal anomalies were detected. Only one false positive case with high risk result for trisomy 21 was detected. The overall positive predictive value (PPV) of NIPT for trisomies 21, 13, 18, X monosomy and XYY syndrome was 95%.
 Conclusion: Our study has showed only one case with false positive result for trisomy 21. However these cases with discordant results are very sensitive from bioethical point of view. So such couples need further follow up and sometimes even psychological counselling. NIPT due to its high PPV significantly reduces the need for an invasive testing, thereby reducing the risk of miscarriage.

Transgenderism: Bioethical Issues

The article analyses bioethical problems related to the concept of transgenderism and its understanding in the framework of biomedical discourse. The concept of “transgenderism” is linked with medicine, and gender dysphoria (International Classification of Diseases, 11th Edition) in particular. At the same time, the concept of transgenderism interacts with the social context. The article shows that the perception of transgenderism and transgenders by society has an impact both on the medical discourse and the notion of transgenderism in its context, and on the perception of “ordinary” people, or cisgender people, which is due to the gradual normalization of transgenderism. Thus, the concept of transgenderism requires an interdisciplinary approach and ethical, philosophical and bioethical consideration. Since the analyzed concept is directly related to medical problems, this study is based not only on bioethical studies, but also on sources in the field of medicine and sociological studies related to medicine. The article also analyzes the problem of applying the biomedical principles nonmaleficence" and principle of autonomy by Beauchamp and Childress, that have specifics applied to transgender children. This is due to the connection of transgenderism with another problem that lies in the interdisciplinary field —suicide. A number of studies on the quality of life of transgender people, as well as encyclopedic literature, mention suicidal thoughts and suicide attempts of transgenders. The article shows how the reinterpretation of transgenderism and its normalization change the boundaries of medical discourse, deducing transgenderism and suicide from medicine. The author concludes that the normalization of transgenderism and the change of its place in the medical discourse entails not only a transformation of medical discourse, but also affects other concepts like suicide, changes the approach to the treatment of transgender children, making the therapy of such children questionable from bioethical viewpoint.

Terrorism and the Question of Moral Justification: A Bioethical Point of View

Terrorism and the Question of Moral Justification: A Bioethical Point of View

Interpretation of euthanasia in conditions of conflict of bioethical principles

The purpose of the research article is a theoretical and legal analysis of the issue of interpretation of euthanasia in a conflict of bioethical principles, considering philosophical, medical, biological, and legal positions. The novelty of the article is a comparative analysis of the legal regulation of euthanasia in the face of differences in bioethical principles to find optimal ways to interpret the law and apply forms of control of processes related to euthanasia. The author examines the existence of ethical grounds for the legalisation of euthanasia and interprets this phenomenon from the standpoint of the universal and objective value of human life. The ambiguity of the concept of euthanasia naturally contains a set of interrelated bioethical, medical, legal, religious aspects that cannot be considered separately. Each of them is filled with polar thoughts. Moral differences between “death with mercy” and “permission to die” are based on the principles of respect for freedom and non-harm. At the regulatory level, there are differences between the categories of “murder” and “permission to die”. From a bioethical point of view, euthanasia is focused on the principle of “do not kill”, which conflicts with the principles of charity, non-harm, respect for human freedom. The conflict of bioethical principles can be resolved by distinguishing between categories such as “murder” and “permission to die”; “refusal of maintenance treatment” and “discontinuation of maintenance treatment”; “direct and indirect termination of life”; “the patient’s right to euthanasia” and “the right to refuse treatment and other medical intervention”, etc. In Ukraine, euthanasia is prohibited by law. To legalise euthanasia in Ukraine, it is necessary to make appropriate amendments to the Constitution of Ukraine and create an appropriate regulatory framework. A recommendation is made on the expediency of forming substantive and procedural criteria at the UN and WHO levels for permitting euthanasia

Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives.

Background: obstetric violence is still far too invisible; the word “violence” generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. Methodology: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. Results and Discussion: four categories were arrived at; they are “the maleficence of forgetting my vulnerability”, “beneficence requires respect for my integrity and dignity”, “my autonomy is being removed from me” and “a problem of social justice towards us, women”. Conclusion: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

Brain Banking – Bioethical Implications

"Novel biotechnologies like brain banking pose a challenge in neurodegenerative diseases research, being not only a step towards a better understanding for these diseases, but also from a bioethical point of view. Brain banks collect tissue for research purposes from deceased persons suffering from neurodegenerative diseases such as Parkinson’s or Alzheimes’s disease. In order to improve the quality in this research field, confidentiality and a detailed informed consent are aspects that should be emphasized. Moreover, given the fact that the brain collecting takes place during an autopsy, legal aspects also play an important role, hence a legal frame is also needed. The role of the deceased’s family should also be taken into account, especially when and how they can decide if the autopsy can be performed in the first place. The research participant should sign a detailed informed consent that must remain the research basis to which extent the collected data should be disclosed. Finally, only a framework of bioethical and legal norms can improve the quality of brain banking research. A comprehensive perspective for brain banking from obtaining, processing, and storage of brain material to bioethical and legal aspects should increase the scarce sapling of brain banking. "

THE RELEVANCE OF VALUES HISTORY IN ITS RELATIONSHIP WITH THE SO-CALLED “LIVING WILLS”: A RELEVANT QUESTION RAISED BY LEGAL BIOETHICS.

El presente artículo, desde una mirada centrada en la Bioética Jurídica, tiene por objetivo el estudio de la values history en su relación con los ordinariamente denominados “testamentos vitales”, materias que deben incluir en su análisis la influencia ejercida por los respectivos códigos axiológicos. De esta manera, una vez estudiada la génesis de dichas figuras, nos centramos en sus contenidos para finalmente referirnos al Proyecto de Ley sobre Muerte Digna y Cuidados Paliativos, texto actualmente en discusión en nuestro Congreso Nacional. Así, siempre desde un enfoque fundado en la Bioética Jurídica, se trata la relevancia de los valores a los que adhieren las personas con respecto a temas tan trascendentales como la enfermedad, el dolor, los tratamientos médicos y la muerte.

QUIMERAS MACACO-HUMANAS: ASPECTOS CIENTÍFICOS Y CONSIDERACIONES

The obtention by Izpisua and collaborators (2021) of macaque-human chimeric embryos by microinjection of human pluripotent stem cells into early blastocysts of cynomolgus monkey is described. They studied the competency of human pluripotent stem cells in macaque embryos cultured ex vivo until 19 days post-fertilization. A reflection on these experiments is made from the bioethical point of view.

L’argomentazione medico-paziente: il problema della comunicazione dal punto di vista retorico e bioetico

Nell’epoca del post-paternalismo medico, la comunicazione medico-paziente è divenuta oggetto di studio in ambiti disciplinari molto diversi tra loro. In generale, però, tali ricerche sottendono una visione del linguaggio che presenta alcuni problemi sia da un punto di vista teorico sia bioetico. A partire da tale considerazione preliminare, il testo propone, in una prima parte, di analizzare l’interazione discorsiva medico-paziente nel contesto degli studi di filosofia del linguaggio, discutendo in particolare tre false credenze diffuse sulla comunicazione (linguaggio come strumento; modello postale della comunicazione; pregiudizio nei confronti della persuasione). Sgombrato il campo dai pregiudizi sul linguaggio, nella seconda parte il testo mette a confronto due diversi modelli dell’argomentazione (pragma-dialettica e retorica), sostenendo la particolare fecondità dell’intreccio tra retorica e bioetica nella descrizione dell’interazione discorsiva medico-paziente.

Percepção de coerção de pacientes submetidos a procedimento médico invasivo

Resumo Este estudo objetiva avaliar a percepção de coerção em adultos e idosos internados submetidos a procedimento médico invasivo. Utilizou-se método transversal quantitativo, com 300 pacientes internados após cirurgia, com escala de percepção de coerção. Compararam-se proporções e possíveis associações entre grupos, gêneros, procedimentos eletivos, de urgência e grau de complexidade. Foram realizadas análises estatísticas descritivas e inferenciais. Os resultados apontam que a maioria dos pacientes (82,7%) tem baixa percepção de coerção, independente do grau de complexidade das operações. Porém, a percepção aumenta nos procedimentos de urgência, quando comparados aos eletivos, independentemente da idade ( p <0,0001). A percepção de coerção, de modo geral, foi baixa, pois a maioria dos participantes sentiu-se envolvida na decisão de realizar o procedimento. Verificou-se respeito à autonomia dos pacientes, já que a equipe médica compartilhou com eles e a família a decisão de operar, resultado adequado do ponto de vista bioético.

Ontoepistemologías del aborto en Ecuador: reflexiones críticas y bioéticas

El aborto constituye uno de los temas más candentes de la actualidad en cuestiones de salud desde la dimensión bioética. Su estudio ha devenido en inquietante misión para estudiantes, profesionales y demás miembros de la comunidad médica, entre otros interesados, por su impacto psicosocial, mórbido y cultural. El propósito de este artículo-ensayo es realizar una reflexión crítica sobre el aborto en el Ecuador y su impacto desde el punto de vista bioético. A través de este texto se busca ampliar las nociones del lector respecto al aborto y llegar a cuestionarnos: ¿cómo fortalecer juicios bioéticos respecto al aborto?, ¿cuáles son los beneficios, prejuicios y contraindicaciones de este?, ¿se respeta o no la autonomía y beneficencia del paciente? y ¿cómo esto podría afectar la vida de los mismo?

Bioethical motifs in the literary work of Karel Čapek

Abstract This text presents an assessment of the literary work of Karel Čapek from a perspective that has not yet been discussed. It focuses on analysing Čapek’s works from the viewpoint of their possible inspiration by bioethical issues. Čapek’s philosophy and the powerful ethical charge of his texts tend to be associated with his interest in pragmatism, a subject to which he, however, took an individual and critical approach. One of the most important categories of his way of thinking is life. In his prose works and plays we therefore see motifs that may be associated with the thematic definition of bioethics. These are questions concerning the value and quality of human life, issues concerning the dehumanizing impact of science and technology, as well as reflections upon the moral dimension of man’s relationship to nature and also to the relationship between people and animals. Čapek’s work may therefore provide inspiration from the perspective of the history of the gradual formation of the bioethical point of view.

Sexual Patterns Among Medical Students - A Bioethical Look

There are few empirical studies on the teaching of human sexuality in medical curricula, lacking in knowledge of how sexuality is taught, what content is used and how it is offered. The emergence of sexuality for a significant portion of university students occurs in college, which increases the importance of sexual education for this group, even though it constitutes only a small portion of our younger population. This is especially important for health students who should address the issue with their future patients. This research aimed to establish sexual differences between students of both sexes in an entire class of medical students. Evaluating the prevalence of sexual behaviors and sexual dysfunctions in this community was investigated, and finally the sexual patterns of students from a bioethical point of view were analyzed. General and specific questionnaires for both genders were used to evaluate and confront them. As a result, 120 questionnaires were applied in a 3rd year medical class of public universities of a northeastern Brazilian state, representing 100% of the sample. According to the Sexual Exposure Index (SEI), 35% of females predominated in the low risk exposure range. The male gender predominated in the medium exposure range, corresponding to 24.16% of the total target population. Applying the chi-squared test for group B versus A there was a p=8x10-4, X2=15 and OR=1.7. Finally, there is a need to approach this theme in the agenda for inserting it in the curriculum, but more studies are needed to apply this model.

Bioética e condição humana: contribuições para pensar o nascimento

Resumo A bioética recorre à filosofia ao examinar conceitos e valores, problemas e ferramentas metodológicas e ao tratar de problemas específicos da vida humana no mundo moderno. Contudo, tanto na bioética quanto na filosofia, a compreensão existencial do que significa nascer é poucas vezes articulada, enquanto a dimensão existencial da morte e do morrer tem recebido mais atenção. Neste artigo, propomos reconsiderar a condição humana como pano de fundo de uma ética para a vida em seus múltiplos extratos e modulações, e a partir da qual se pode elaborar perspectiva filosófica que pense o nascimento como horizonte mais amplo para tratar problemas bioéticos específicos. Destacamos, neste artigo, algumas contribuições de Hannah Arendt e María Zambrano, duas pensadoras que se ocuparam da condição humana, entre o nascimento e a morte.

Evaluation of EU legislation on blood: a bioethical point of view

A review of the European Union (EU) regulations concerning blood, tissues, and cells of human origin is under way in the EU. From the ethical point of view, the non-remuneration of donations and the ban on deriving gain from human biological materials are of particular significance. While the basic ethical principles involved in the procurement, preservation, and use of these materials are the same, their practical application should be adapted to the specific context of each material. In the case of donation and use of blood, in particular, the issue of legitimate reimbursements to donors and for transfusion centers has to be managed in accordance with the principle of non-commercialization. There is also a need for strict rules to avoid possible commercial spillover effects from blood-derived products. The author proposes ethical criteria regarding reimbursements to donors, costs associated with processing, and the development (and possible marketing) of products.

Reflexiones sobre enfermería desde la biopolítica: relaciones de poder y cuidado

This essay invites to a reflection, from the Foucauldian perspective, about the viewpoint of nursing-care delivery and teaching to future professionals, as well as the analysis of the relations of power in nursing and the link with people “caring objects” from a bioethical point of view. The methodology includes texts analysis from a Foucauldian perspective in health, a retrospective view about the experiences of professionals nurses and the installation of mechanism of power in nursing. Sources related to nursing history and the professional formation with emphasis on professor/student and nurse/patient relationship were analyzed. Bioethical aspects and professional contexts were compared. Currently nurses have normalized the existence of control mechanism within the direct attention of people and their care, which is transferred to the formation of nurses. Nowadays, nursing thoughts have been expanded, become independent and adapted to different contexts. This invites to use a broader perspective to observe the purpose of the discipline and the profession of nursing, using an introspective view that allows to understand that the nursing practice perpetuates subordination and power in both direct care teams and work teams.

La teoría de la vida como daño en la responsabilidad médica en Colombia los aportes y vacíos de la corriente principialista en las tensiones generadas con la aplicación de esta teoría

En el ejercicio de la prestación del servicio médico realizado por los profesionales de la salud, especializados en ginecología, obstetricia, pediatría, neonatología y genética, se puede causar un daño al usuario del servicio médico; daño que puede prevenirse cuando el prestador en salud realiza el ejercicio de ponderación de principios consagrados por la bioética médica, y que pueden ser utilizados con éxito para contribuir a la solución de las tensiones presentadas cuando es aplicada la teoría que considera a la vida como un daño generador de perjuicios. La corriente principialista de la bioética permitiría identificar y tratar de dirimir situaciones conflictivas, derivadas de la incorporación de los avances técnicos y científicos en las pruebas genéticas predictivas. Sin embargo, los principios de la nombrada corriente son insuficientes para dar respuesta a los dilemas éticos, bioéticos, morales y jurídicos que se generan en la prestación de servicios de salud; por esta razón, se propone incorporar a la citada corriente otros principios como son los de solidaridad, protección y responsabilidad, con el objetivo de tratar de dirimir los conflictos que genera la aplicación de la mencionada teoría. El presente artículo es producto de una investigación cualitativa de naturaleza exploratoria de reflexión de tipo bibliográfico, en la que se reconoce, reúne, examina, ordena e integra la información documental con el objetivo de analizar, interpretar y criticar la situación actual en Colombia, relacionada con la aplicación de la teoría de la vida como daño, y estudiar de qué manera la corriente principialista contribuye a la solución de los conflictos generados con la citada teoría. Al finalizar la investigación se concluye que esta teoría genera tensiones porque al presentarse una inadecuada prestación del servicio médico a la madre gestante, podría generar una demanda judicial en contra del prestador en salud, hecho analizado desde el punto de vista bioético, moral y jurídico. Sin embargo, se establece que la corriente principialista de la bioética es insuficiente para dirimir estos conflictos, razón por la cual se hace necesaria la aplicación adicional de los principios de solidaridad, responsabilidad y protección, con el propósito aportar a la solución de las tensiones generadas por las acciones judiciales wrongful birth y wrongful life