Bioethical Perspective Research Articles

COVID-19 Vaccine Passports: Derogating Non-Derogable Fundamental Human Rights

The global fervor to develop and deliver a vaccine to protect people against COVID-19, the disease caused by SARS-CoV-2, has been extraordinary. COVID-19 vaccine development has been pursued at an unprecedented speed and scale; following the Emergency Use Authorization (EUA) of COVID-19 vaccines, rapid mass vaccination deployment efforts commenced in all earnest. This fervor to get a needle into every arm has now led to the European Commission president calling on the EU’s 27 member states to consider mandatory vaccination across Europe. With an intensification in COVID-19 vaccine hesitancy and many refusing to be vaccinated, an important question that arises is whether obligatory COVID-19 vaccination policies are ethical and legal in terms of international human rights norms and standards. Article 4(2) of the International Covenant on Civil and Political Rights which was ratified by 193 States Parties worldwide enumerates a specific list of human rights from which no derogation is allowed even in times of a public emergency. Included in this list of non-derogable rights is a sub-category of internationally recognized human rights known as “physical integrity rights” that includes the right to be free from medical or scientific experimentation. International human rights law is unambiguous that all people should be afforded their non-derogable fundamental human right to free and informed consent. Normative ethical perspectives and legal obligations erga omnes dictate that States Parties should not make COVID-19 vaccination mandatory in breach of International Human Rights Law relating to non-derogable rights that are regarded as core human rights, jus cogens. A bioethics perspective, rooted in fundamental human rights, should play a crucial role in the COVID-19 pandemic.

Código de Conduta da Sociedade Brasileira de Nefrologia: uma análise bioética

Introduction:Professional deontology can be defined as a set of principles, values and rules of conduct to be applied in the exercise of functions and inherent to a given profession. Nephrology was one of the medical specialties most affected by the mismatch between the accelerated technological development and the ethical dilemmas resulting from it. Recently, the Brazilian Society of Nephrology (SBN) edited its code of conduct, which until then did not exist.Method:Qualitative study with content analysis of the chapters and articles of the SBN Code of Conduct, from the perspective of principlism bioethics.Results:The four moral principles of beneficence, non-maleficence, autonomy and justice were found asymmetrically throughout the document, with beneficence predominating over the others.Discussion:The SBN Code of Conduct predominantly expresses the ethical duties that an associate must comply with, but also restrictions on malfeasance, autonomy and justice, anchoring decision-making by managers and including the distribution of possible punishments. It is an unfinished document; therefore, it must be periodically revised, as expected, due to the rapid technological changes, as well as the need for constructive moderation in the relations of nephrologists with each other and, between them, with the Industry, as well as all the ethical consequences arising from these factors.

Corruption in the public health sector in South Africa: A global bioethical perspective

It is clear that corruption as the abuse of power is an enormous bioethical issue in the public health sector in SA, but as a challenge, it has not elicited much discussion from a global bioethical perspective. The Universal Declaration of Bioethics and Human Rights (UDBHR) on corruption considers three matters. First, the existence of corruption as a problem of power is recognised in the health environment and condemned (article 18). Second, corruption is indicated as an immoral phenomenon that harms the interests of the patient (article 4), ignores vulnerable people (article 8) and neglects social responsibility (article 14). Third, it can be concluded that the UDBHR expresses the opinion that corruption has to be combated by a process of ethical decision-making (article 18.2-3), the use of ethics committees (article 19) and ethics education (article 23.1).

Qualitative study of GPs’ views and experiences of population-based preconception expanded carrier screening in the Netherlands: bioethical perspectives

ObjectiveBetween 2016 and 2017, a population-based preconception expanded carrier screening (PECS) test was developed in the Netherlands during a pilot study. It was subsequently made possible in mid-2018 for couples...

In love with machines: The bioethical debate about sexual automation

A few companies around the world are now developing and selling sex robots. Questions such as “how will relationships with robots’ impact human relations in the future” emerge when technologies are used to meet the social and emotional needs of individuals. Considering that technology and design have embedded values and biases, this article surveys the use of sex robots from a bioethical perspective. Relationships with robots and computational systems, like Artificial Intelligence, are a possibility for many people around the world. We present questions raised by the voices in favor of robot sex, and against it. Beyond a binary polarization, the bioethical perspective recalls the Foucaultian concepts of biopolitics and biopower to situate the problems with the mechanization of intimate relationships. We argue that sex robots offer the opportunity to review old patterns regarding gender, inequality, and health.

Commercial DNA tests and police investigations: a broad bioethical perspective

Over 30 million people worldwide have taken a commercial at-home DNA test, because they were interested in their genetic ancestry, disease predisposition or inherited traits. Yet, these consumer DNA data...

Covid-19, Media Reporting, and the Role of Bioethicists

"In the aftermath of the 2014 Ebola outbreak, media coverage was scrutinized for sensationalism, weakness in explaining scientific uncertainty, dehumanization of patients, and lack of contextualization. The current COVID-19 crisis presents an opportunity to assess whether the media learned its lesson. Results are mixed. Early reporting on the origin of COVID-19 in “wet markets” indicates that the media continues to do poorly with contextualization. On the other hand, stories on mortality and the infectiousness of COVID-19 indicate there has been improvement. The situation remains fluid as COVID-19 threatens to transform into a pandemic at the time of submission. Data from new countries may alter the reported rates of lethality and infectiousness, and media reporting on these changes may or may not be responsible. The explosion of social media, as a medium to promote reporting, could provide bioethicists a tool to direct the public to reliable stories and criticize inaccurate ones. Using a bioethics perspective, this poster will critically evaluate the quality of U.S. and Italian news media’s reporting on the evolving scientific understanding of COVID-19 and its contextualization. The presentation will employ QR technology to provide links to media coverage of COVID-19 from the U.S. and Italian news media. After critically appraising the quality of COVID-19 reporting, this poster will consider if bioethicists: 1) should provide comment to the media on pandemics; 2) should correct reporting for the public and 3) have a duty to publicly criticize sensationalism in the media. "

Vaccine refusal/hesitancy—the ethical point of view

BackgroundIn 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective.MethodsA combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association).ResultsVaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines.ConclusionsThere are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession.

Perceptions of a Group of Medical Students Regarding the Issue of Abortion: A Qualitative Analysis.

Aim: The medical ethics education given at the faculty of medicine aims to help prospective physicians develop an ethics awareness as part of their professional identity so that they can evaluate the determinants of patient-physician relationship, identify the ethical issues and problems prevailing in medical practice and researches, and find appropriate solutions to the ethical dilemmas faced while protecting ethical values. The objective of this study was to set forth the perceptions of a group of medical students at Hacettepe University regarding the issue of abortion on the basis of the movie If These Walls Could Talk. We aimed to take students’ opinions on abortion, help them ponder on this issue within the context of professional values of physicians, and investigate whether they have gained a critical perspective in terms of feminist bioethics within the framework of the elective courses “Bioethics and Cinema” and “Representation of Physicians in Cinema”, both of which were offered during undergraduate medical education at Faculty of Medicine, Hacettepe University. Method: The assignments submitted by 178 medical students about the movie “If These Walls Could Talk”, which is used as an educational course material at the Department of Medical History and Ethics, Hacettepe University, were evaluated using thematic analysis method. Before conducting the analyses of the assignments, the necessary permissions for the research were obtained from the Ethics Commission of Hacettepe University on 26.05.2017 with the approval numbered 3861. Findings: The data obtained from student assignments were categorized into main and sub themes. The themes determined upon evaluating the students’ perceptions on abortion were “Human Rights”, “Ethical Justification”, and “The Role of Society”. Conclusion and Suggestions: Our findings have demonstrated that the students have gained awareness on both personal values and professional ethical values. It can be said that the students could discuss abortion – which is an important issue of debate in bioethics – with a feminist bioethics perspective and using their critical thinking skills. Therefore, we suggest that film screenings and follow-up film debates be utilized more often in medical ethics/bioethics education.

Bioethical perspective of convalescent plasma therapy for COVID-19: A systematic review.

Convalescent plasma therapy (CP) has long been used to prevent and treat various infectious diseases before COVID-19 such as SARS, MERS, and H1N1. Because the viral and clinical characteristics of COVID-19 share the similarities between SARS and MERS, CP treatment could be a promising treatment option to save COVID-19. With only low quality medical evidence, but massive media support and a very significant public demand for the use of convalescent plasma for COVID-19, we are now faced with an ethical dilemma. Therefore, this paper uses a structured analysis that focuses on the preferred reporting items for a systematic review of ethical issues regarding the use of Convalescent Plasma Therapy for COVID-19. The use of convalescent plasma must meet the ethical principles of autonomy; such as voluntary, informed consent, and confidentiality. Consideration of the risk-benefit ratio for potential donor recipients also needs to be considered in order to meet the beneficence and non-maleficence principles. The principle of justice also needs to be applied both to donors, donor recipients and health workers, such as determining the priority of donor recipients, due to the increasing demand for convalescent plasma amid the limited circumstances of patients who have recovered from Covid-19 who voluntarily donate.

The Maximus of Necessity and Its Application to Organ Transplantation: An Islamic Bioethical Perspective

Islam is second largest religion being practiced around the globe. It is fastest growing believe and rapidly expanding in the western world despite several misunderstanding including Islamic standpoint on organ transplantation and tissue grafting. The objective of this study is to determine the Islamic view point on organ transplantation and tissue grafting with special reference pertaining to human needs under the ambit of Shariah doctrine of necessity and world religions. Since, Islam and other world religions have given immense consideration to humans whether they are alive or dead, and the desecration of human body is considered a violation sufficed to a great sin. Injunctions of the holy Quran and Sunnah have evidently expressed sanctity to human life/body. Hence, taking one’s life without a legal rights or even inflicting any sort of harm, injury, and aggression against an individual is terming an unlawful act. Notably, some scholars contended that, classical jurists’ are silent on the issue of organ transplantation predominantly the transfer of organs from one species to another species. But, in reality, our argument is that, the organ re-plantation can be seen in the Prophetic era. However, as per their view, the reason is obvious, since the organ transplantation associated with the advancement of science. Accordingly, the recent progress in transplant sciences were not totally known to the classical jurists, although, issues pertaining to the sale of human organs have been discussed by them (jurists). Similarly, many other innovative matters can be seen in Prophetic traditions, and that is why, as per jurist’s assertion, it can practically be traced in the Prophetic era.Consequently, this study argues that, the permissibility of organ donation and transplantation somehow mentioned in the main sources of Islamic law and biomedical ethics. Therefore, the basis and rules of permissibility will be derived while discussing organ transplantation, particularly in homo, allotransplant and other inter-related issues under the rubric of necessity doctrine.
 Bangladesh Journal of Medical Science Vol.20(3) 2021 p.511-524

Toward a bioethical perspective for posthumanist aesthetics: Bioart as an example

Toward a bioethical perspective for posthumanist aesthetics: Bioart as an example

Tvingad till autonomi

Utifrån tidigare forskning om öppen psykiatrisk tvångsvård har två paradoxer i förhållande till lagstiftningen identifierats: Öppen psykiatrisk tvångsvård (ÖPT) innebär både mer och mindre autonomi för patienten. ÖPT innebär att autonoma individer tvångsvårdas till autonomi. Syftet med artikeln är att tydliggöra vilka normativa ställningstaganden som ligger till grund för tvångsvårdsformen genom att de två paradoxerna belyses utifrån fyra perspektiv på autonomi. Den första paradoxen förklaras genom att lagstiftaren förhåller sig till både en liberal och en medicinsk-etisk autonomidefinition. I ett liberalt perspektiv är öppen tvångsvård en inskränkning av individens rätt till frihet. I ett medicinsk-etiskt perspektiv kan öppen tvångsvård öka autonomi genom att den ökar eller skyddar patientens autonomi i framtiden. I ett medicinsk-etiskt perspektiv kan andra värden, som hälsa och livskvalitet, också motivera inskränkningar i patientens autonomi. Den andra paradoxen kan förklaras genom att lagstiftaren blandar proceduriella och substantiella rekvisit för autonomi. Patienten förutsätts vara autonom enligt proceduriella rekvisit eftersom patienten inte anses vara beslutsoförmögen. Samtidigt är utfallet av patientens val avgörande för om det respekteras. Om patienten vill avstå vård förutsätts det inte vara patientens autentiska önskan, vilket är ett uttryck för en substantiell syn på autonomi. Vården ska i stället återge patienten dess substantiella autonomi. Vid ÖPT förutsätts patienten i praktiken frivilligt medverka till vården. Det betyder att patienten uppfyller även autenticitetsrekvisiten. Men eftersom syftet med tvångsvården är att återupprätta just den autentiska viljan genom att patienten blir i stånd att frivilligt ta emot tvångsvård är autonomikraven för öppen tvångsvård uppfyllda samtidigt som autonomikraven för vårdens upphörande också är uppfyllda. Om ÖPT ska kunna motiveras utifrån ett medicinsk-etiskt perspektiv krävs att tvångsvården faktiskt ger mer autonomi senare eller andra vinster. I dagsläget finns inget vetenskapligt stöd för att tvångsvårdsformen fungerar. Mot denna bakgrund är det svårt att se vilket värde som tillförs som väger tyngre än patientens autonomi.

Bioethical considerations of cell-cultured meat

In recent years, to solve the increasingly prominent problem of the contradiction between human social development and environmental resources, artificial meat has appeared in public view more and more. Generally speaking, the artificial meat can be divided into vegetable protein meat and cell cultured meat. Among them, vegetable protein meat has gradually begun to be commercialized, and cell cultured meat is cultured with animal cells, which is more similar to the real meat. Based on the analysis of the essence of cell cultured meat, we explore the positive significance of cell cultured meat technology for the meat production industry, consumer groups, and the sustainable development of mankind in the future. From the perspective of bioethics, the research, development and production of cell cultured meat can help ensure the sustainable development of human society, improve animal welfare, reduce resource demand, improve the nutritional function of meat products, and provide new growth points for the development of other industries. In addition, the ethical risks of food safety, technology abuse and technical supervision involved in cell cultured meat production are put forward for deep consideration, hoping to provide reference for the sustainable development of artificial meat industry from the perspective of bioethics.

Elderly people in the context of COVID-19: at the centre of attention or on the margins due to their age?

The present article offers an analysis from a bioethical perspective of the treatment provided to senior citizens in the context of the COVID-19 pandemic. To begin with, the article highlights the paradox that exists when measures are adopted for the care of elderly people during a pandemic, and in some occasions the age of the patient is the determining factor for deciding whether to provide care or not in cases of scarcity. The question that arises then is: What is the adequate treatment for senior citizens? Using the Inter-American Convention on the Protection of the Human Rights of Elderly Persons as a point of reference, this article assesses the problem of the scarce resource allocation in the Third Age during a pandemic. As a conclusion, the pandemic is a great opportunity to reflect on the respect that we should give to every human being at every stage of his/her life.

“Quando ninguém se entende”: conflitos bioéticos num caso real de fim de vida

Introduction: The technical-scientific evolution of the last decades is reflected in the extension of life expectancy, in the reduction of the mortality rate due to infectious diseases and in the increase in mortality due to chronic-degenerative diseases. Added to this is the formation of medical education, increasingly equipped with a model oriented towards the use of highly sophisticated technologies, seeming to neglect the traditional field of the doctor-patient relationship. When the ultimate goal is the cure, death is considered a failure, an unacceptable result. Despite all the effort and technology used, death remains an inevitable outcome. The sick person, when in the background, ceases to be the protagonist of his story. Bioethics is a branch of knowledge that aims to indicate the limits and purposes of man's intervention in life, based on recognition for the dignity of the Human Person. “What should i do against what can I do?” End-of-life care commonly involves ethical issues that lead health professionals, patients and family members to face dilemmas, conflicts. Aim: This paper’s purpose is to show how challenging the decision-making process can be for those involved, namely health professionals, family members and users. Materials and methods: Facing a real case, ethical principles are presented and developed respecting the perspective of bioethics. Results: Starting with the conceptions of dignity, as well as possible weaknesses, covering more technical aspects such as the adequacy of therapeutic effort and proportionality of interventions, contemplating the concepts of obstinacy and therapeutic futility, exploring the dimension of autonomy (including some of its legal aspects) and ending in the field of justice and equity. Having these in hands, it becomes clear the complexity that the decision-making process gains when the humane and multidimensional aspect of the person who suffers, the patient (and family and their loved ones), is called into question. Conclusion: The considerations listed by the bioethical principles help us to base our professional actions, in order to, assist and consider, the environment and principles of the patient, the patient’s family and closed ones along with ours, as an assistance team. Resulting in the neglection of simple and absolute certainties, the lessening of doubts regarding this process and the election of the best possible answer for that specific patient, team and the context that surrounds them. Similarly, on this particular end of life situation, the concept of palliative care is highlighted as a tool of similar impact.

Horas de enfermagem trabalhadas e o estresse no trabalho do enfermeiro

This article aims to analyze the cancer client in times of pandemic of Covid-19 from the perspective of Bioethics. It is an article that reflects on the issue of cancer clients in times of a Covid-19 pandemic, in accordance with the principle of autonomy. It is based on a narrative with discussion of the following relevant aspects: The bioethical challenges with the cancer client in the Covid-19 pandemic, and respect for autonomy and bioethics. It is important to consider the importance of integrating the multidisciplinary team with patients and, more precisely, taking into account the discussions in Bioethics on the principles of beneficence, autonomy and justice. It is important to carry out investigations on cancer clients, contributing to the preparation of health professionals who work, not only in cancer care services in times of Pandemic Covid-19.

Bioethical analysis of sanitary engineering: a critical assessment of the profession at the crossroads of environmental and public health ethics

Sanitary engineering is burdened by several challenges that attract bioethical attention: (1) there are many ambiguities regarding the definition of the profession; (2) its methodology seems to be a combination of several approaches from different sciences; and (3) it often appears to be an amalgam of different disciplines. We argue that the bioethical perspective helps to show that these features can be taken as a stimulating challenge. Moreover, bioethics may illuminate how these features can become an asset to sanitary engineering in light of the growing need for holistic approaches. First, we present a bioethical analysis of the aforementioned features as a useful way to clarify and strengthen the identity of the profession. Second, we argue that professional ethics have received the least attention, but are crucial to giving the profession stronger independence and professional identity and to creating a unique worldview at the crossroads of environmental and public health ethics. Finally, we propose a general framework of sound professional ethics of sanitary engineering as a necessary step towards rethinking the core values of the profession, clearly articulating a genuine professional ethic, and reforming educational politics related to professional education.

Quality of life in Brazilian elderly: an analysis of healthy aging from the perspective of Potter's global bioethics

ABSTRACT Introduction Quality of Life (QOL) is essential for healthy aging and through the WHOQOL-Old, it is possible to analyze factors that increase vulnerability and reduce QOL. Aligned with healthy aging is Potter's global bioethics proposing expanded ethics and social justice. Objective To analyze the QOL of Brazilian elderly from the perspective of Potteŕs global bioethics. Method Analytical observational research with a quantitative approach composed of 280 Brazilian, aged 60 or over, of both gender, volunteers, who answered the WHOQOL-Old online. Result Global score of 77.9%, with the mean ± standard deviation: Functioning of the senses 86% (17.22 ± 2.80); Autonomy 78.5% (15.7 ± 2.60); Past, present, and future activities 77.3% (15.46 ± 2.34); Social participation 74.9% (14.99 ± 2.62); Death and dying 71.6% (14.33 ± 3.88) and Intimacy 79.1% (15.82 ± 2.82). Conclusion Elderly perceived their QOL positively. In the quest to promote healthy aging, it is necessary to broaden the vision for social justice proposed by Potteŕs global bioethics.

Mental illness in some Sub Saharan African communities: the perspective of Bioethics and transcultural nursing

In this paper, transcultural nursing is reviewed in light of bioethical issues arising from the interpretation of mental illness in some Western Sub-Saharan African communities. Four field studies were carried out by the authors of this paper in Sub-Saharan Africa (from 2016 to 2019), during which the traditional “treatment” of enchaining people considered “crazy” by local cultures was explored. These inhuman practices raise the attention of bioethics, which investigate ways to overcome this traditional practice not violating the cultural identity of the peoples who practice it. The model of Gregoire Ahongbonon and of his Association, “Saint Camille de Lellis”, is reported as an example of negotiation between the respect for traditions and the guarantee of human rights. The care practice in force in the Saint Camille is related to transcultural nursing as an adequate form of treatment and strategy for restoring patients’ dignity and rights.