Pendiente resbaladiza de la muerte asistida en los Países Bajos, Bélgica y Colombia / An analysis of the "slippery slope" of assisted death

The study analyzes the phenomenon of the "slippery slope" of assisted death in The Netherlands, Belgium, and Colombia after the depenalization or legalization of this practice. Data analysis was performed reviewing the evidence published in scientific journals and in the governments' official reports. We verified a progressive broadening of the limits initially established by the law for the practice of assisted death in these three countries. This confirms the occurrence of the "slippery slope". Also, the exponential increase in the number of assisted deaths in these three countries after the legalization indirectly suggests the presence of the "slippery slope". An analysis of the anthropological and ethical implications of assisted death highlights that its moral assessment should not be exclusively based on consequentialist arguments. Also, a prudential interpretation of the slippery slope argument in the legal debate about assisted death should be incorporated. We conclude that the moral evaluation of assisted death cannot be exclusively grounded on its negative social consequences, but rather on the lack of respect for basic human values such as life and the intrinsic dignity of a person. The verification of the "slippery slope" in these three countries should be regarded as an alarm for an eventual legalization of euthanasia in Chile.

Induction of chorioretinopathy by adrenaline injection in different strains of rabbits / 中华实验眼科杂志

Objective To establish a central serous chorioretinopathy (CSC) model on different strains of rabbits by intravenous injection of adrenaline,which may contribute to related researches of CSC.Methods This study was approved by Bioethics Committee of Fourth Military University and complied with Statement for the Use of Animals in Ophthalmic and Visual Research.Fundus fluorescein angiography (FFA) was initially performed on male New Zealand white rabbits (10),Belgium rabbits (5) and Chinchilla rabbits (10) to make sure that the retinas of subjects were normal.For the New Zealand white rabbits,adrenaline was injected via ear vein at a dose of 0.04 mg/kg once per day for the first 8 weeks and followed by a dose of 0.08 mg/kg for the next 4 weeks,while 0.04 mg/kg adrenaline was injected in the same way for 8 weeks in the Belgium rabbits and Chinchilla rabbits.FFA was performed every week after injection of adrenaline to evaluate the fluorescence leakage in ocular fundus.New Zealand white rabbits were sacrificed in 4 (3 rabbits),8 (3 rabbits) and 12 weeks (4 rabbits) after injection respectively,and Belgium rabbits and Chinchilla rabbits were sacrificed in the 8 weeks after injection.The eyeballs of the rabbits were enucleated to prepare the retinal sections for histopathological examination after hematoxylin-eosin staining.The results of FFA and retinal structure were compared among different strains of rabbits.Results No fluorescence leakage was found by FFA in ocular fundus,and the retinal structure was normal in all the 10 New Zealand white rabbits during the experiment.Fluorescence leakage was found by FFA in 2 Belgium rabbits at 1 week and 2 weeks after injection respectively,and retinal detachment and depigmentation of retinal pigment epithelium (RPE) with an enlarged intercellular space were shown by hematoxylin-eosin staining.For the Chinchilla rabbits,fluorescence leakages were found in 7 rabbits throughout the whole period of adrenaline administration.Circumscribed retinal detachment,depigmentation of RPE with enlarged intercellular space were also found in leakage lesions.Conclusions Repeated intravenous injection of adrenaline can induce CSC-like lesions in colored rabbits but not in albino rabbits.

Changing paradigms in Aedes control: considering the spatial heterogeneity of dengue transmission / Cambio de paradigma en el control de Aedes: consideración de la heterogeneidad espacial de la transmisión del dengue

ABSTRACT Current dengue vector control strategies, focusing on reactive implementation of insecticide-based interventions in response to clinically apparent disease manifestations, tend to be inefficient, short-lived, and unsustainable within the worldwide epidemiological scenario of virus epidemic recrudescence. As a result of a series of expert meetings and deliberations, a paradigm shift is occurring and a new strategy, using risk stratification at the city level in order to concentrate proactive, sustained efforts in areas at high risk for transmission, has emerged. In this article, the authors 1) outline this targeted, proactive intervention strategy, within the context of dengue epidemiology, the dynamics of its transmission, and current Aedes control strategies, and 2) provide support from published literature for the need to empirically test its impact on dengue transmission as well as on the size of disease outbreaks. As chikungunya and Zika viruses continue to expand their range, the need for a science-based, proactive approach for control of urban Aedes spp. mosquitoes will become a central focus of integrated disease management planning.

RESUMEN Las estrategias actuales de control de vectores del dengue, centradas en la ejecución reactiva de intervenciones con insecticidas en respuesta a la aparición de cuadros clínicos evidentes de la enfermedad, suelen ser ineficientes, de duración limitada e insostenibles en el contexto epidemiológico mundial, caracterizado por la recrudescencia de las epidemias virales. Como resultado de una serie de reuniones y deliberaciones entre expertos, está en proceso un cambio de paradigma y ha surgido una nueva estrategia, que consiste en estratificar el riesgo de cada ciudad para concentrar y mantener los esfuerzos proactivos donde hay un alto riesgo de transmisión. En este artículo, los autores 1) describen esta estrategia de intervención específica y proactiva dentro del contexto de las características epidemiológicas del dengue, la dinámica de su transmisión y las estrategias actuales de control de Aedes y 2) fundamentan con fuentes bibliográficas la necesidad de demostrar empíricamente las repercusiones de esta estrategia sobre la transmisión del dengue y el tamaño de los brotes. Dado que los virus del chikunguña y el Zika siguen ampliando su alcance, uno de los objetivos primordiales de la planificación de la atención integrada de estas enfermedades estará determinado por la necesidad de adoptar un enfoque científico y proactivo del control urbano de los mosquitos del género Aedes.

Caso belga de eutanásia em crianças: solução ou problema? / The Belgian case of euthanasia for children, solution or problem?

A aprovação da extensão da prática da eutanásia a menores de idade em 2014, pela Bélgica, reacendeu o debate internacional sobre as decisões médicas em fim de vida em crianças. De fato, a medicina nem sempre tem resposta para a doença grave de uma criança. No entanto, será a eutanásia uma solução equacionável? Partindo da realidade belga, este artigo analisa a premência da nova legislação, considerando, por um lado, a capacidade crescente de autodeterminação das crianças e, por outro, a sua falta de “experiência de vida”, não esquecendo argumentos clássicos que contrariam a prática da eutanásia, como o desrespeito pelo valor da vida humana e a eventual concretização do argumento da ladeira escorregadia. Uma solução óbvia passa pela realização de cuidados paliativos apropriados. Todavia, sendo escassa a evidência sobre a qualidade dos cuidados pediátricos em fim de vida, é necessária investigação adicional para que se possam formular e propor políticas públicas adequadas a respeito da matéria...

By extending its euthanasia law to minors in 2014, Belgium has fuelled the international debate on this issue. In fact, Medicine does not always have something to offer when it comes to a child’s serious disease. Nevertheless, should euthanasia be considered a viable solution? Keeping in mind the Belgian reality, this article analyses the relevance of the new law, considering, on one hand, children’s growing self-determination capacity and, on the other hand, their lack of “life experience”. Let’s not forget, in addition, classical arguments against euthanasia, such as the disrespect for the value of human life and the eventual approaching of the slippery slope. An obvious solution for this problem is the implementation of a proper palliative care system. However, evidence about the quality of pediatric end-of-life care is scarce. Therefore, additional investigation is necessary in order to formulate and propose an appropriate public policy on the matter...

La aprobación de la práctica de la extensión de la eutanasia a menores en 2014 por Bélgica ha reavivado el debate internacional sobre las decisiones médicas en el fin de la vida de los niños. De hecho, la medicina no siempre ha de responder a la enfermedad grave de un hijo. Sin embargo, ¿debería considerarse la eutanasia como una solución viable? Partiendo de la realidad belga, este artículo analiza la emergencia de la nueva ley: considerando, por un lado, la creciente capacidad de autodeterminación de los niños y, en segundo lugar, su falta de “experiencia de vida”, sin olvidar los clásicos argumentos que contradicen la práctica de la eutanasia, como el desprecio por el valor de la vida humana y la eventual realización de “rampa de deslizamiento”. Una solución obvia es implementar los cuidados paliativos adecuados. Sin embargo, puesto que las pruebas sobre la calidad de la atención con el fin de la vida pediátrica son escasas, se requiere investigación adicional para poder formular y proponer políticas públicas adecuadas en esta área...