Reflection on Global Public Health Ethics from the Perspective of Community / 中国医学伦理学

The global spread of COVID -19 indicates that cultivating public health awareness and constructing the concept of human health community has become an urgent need and a long-term plan in the current social situation. In the post-epidemic period, only by adhering to the concept of human health community, strengthening the cooperation among individuals, families, communities, institutions, urban and rural areas, countries and so on, weaving closely and consolidating the "net bottom" of grass-roots prevention and control from point to area, and establishing the mechanism of group prevention, group control and joint prevention and control, can we thoroughly curb the spread of the epidemic in the world. Under the development concept and value orientation of human health community, the individual is not only a booster of public health, but also a component of public health, and also a beneficiary of public health. The realization of public health is inseparable from the practice of each individual. Under the guidance of the concept of human health community and the awareness of individual health first responsibility, all citizens need to shape health promotion behaviors that fit the individual’s own situation, promote the health maintenance atmosphere consciously followed by the whole society, create a healthy ecological environment accessible to everyone, and let all citizens share the good results of public health management, so as to achieve the good vision of human health community.

Ethical Consideration of Chinese Ancient Disasters and Diseases: Centered on the Basic Principles of Public Health Ethics / 中国医学伦理学

The ethical problems in the prevention and control of public disasters and epidemics have attracted more and more attention. Briefly combed the disaster and epidemic events in ancient China. From the view of the several basic principles of public health ethics, this paper took four aspects of the distribution of medical and health resources for epidemic diseases, the isolation prevention and control, the skeleton convergence and the protection of public health conditions as examples, to dialectically treat the measures taken by ancient people to deal with disasters and epidemics and explore some enlightenment of public health ethics in ancient Chinese disasters and epidemics. The measures of epidemic prevention and disaster resistance in ancient China have their own formation and development process. Although the historical limitations are insurmountable, interpreting it by using the basic principles of public health ethics will help us understand the development process of epidemic prevention and control, promote the development of medical archaeology, and provide some reference for the construction of public health undertakings today.

Ethics in infectious diseases: latent challenges. Part I / Ética en enfermedades infecciosas: retos latentes. Parte I

Abstract Infectious diseases socially imply individual and community medical problems. Therefore, they require actions aimed at social processes that affect the well-being of the individuals without losing sight of social groups. Faced with this panorama, we ask ourselves: is there a direct relationship between ethics and infectious diseases? To elucidate an answer, let us remember the peak period of the COVID-19 pandemic when guidelines based on ethical principles were issued to facilitate medical decisions on allocating scarce resources in periods of maximum demand. In those moments, since there was no inclusive component of society, the decisions made produced massive criticism. The reactions demonstrated the need to analyze in detail the criteria that had been considered correct. Consequently, we affirm that bioethical principles are transcendental in medical decisions and must be examined, not only for the individual but also with a view to public health. Moreover, the acquired immunodeficiency syndrome (AIDS) epidemic has lived with us for decades, and it continues to show its tragic face in the form of new cases, chronic illnesses, and deaths. Joint United Nations Programme on HIV/AIDS brings us closer to a complex reality where the fight against disease and global health are interrelated with other problems, such as the need to reduce inequality, for which human rights, gender equality, social protection, and the development of research projects, where the ethics committees in research in community processes are constituents.

Resumen Las enfermedades infecciosas implican problemas médicos individuales y comunitarios, por lo que requieren acciones dirigidas a procesos sociales que incidan en el bienestar de los individuos, sin perder de vista a los grupos sociales. Nos preguntamos: ¿existe relación directa entre la ética y las enfermedades infecciosas? Para dilucidar una respuesta, recordemos el periodo más álgido de la pandemia por COVID-19, cuando se emitieron guías fundamentadas en principios éticos para facilitar las decisiones médicas en la asignación de recursos escasos en periodos de máxima demanda. Al no haber un componente inclusivo con la sociedad, las decisiones que se tomaron produjeron críticas masivas, que demostraron la necesidad de analizar a detalle los criterios que se habían considerado correctos. En consecuencia, afirmamos que los principios bioéticos son trascendentales en las decisiones médicas y deben ser examinados, no solo frente al individuo, sino de cara a la salud pública (bien común e individualidad). Por otra parte, la epidemia del SIDA (síndrome de inmunodeficiencia adquirida) convive con nosotros desde hace décadas. ONUSIDA (Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA) nos acerca una realidad compleja, como es que la lucha contra la enfermedad y por la salud global se interrelaciona con otros problemas como la necesidad de reducer la desigualdad, por los derechos humanos, la igualdad de género, la protección social y el desarrollo de proyectos de investigación, donde los comités de Ética en investigación en procesos comunitarios son constituyentes.

Study on Strategies to Deal with Ethical Dilemmas in Public Health Emergencies / 中国医学伦理学

Public health emergencies not only bring great challenges to the conventional public health system, but also face some ethical dilemmas in the governance process. For example, the compulsory isolation measures affect the normal lives of some citizens, the normal medical treatment of non-epidemic patients may be constrained by complex governance environments, and the relationship between patient privacy protection and the public’s right to know needs to be deeply considered and balanced. To respond the ethical dilemmas in public health emergencies, it is necessary to explore more effective new ideas and methods under ethical concepts, combine with ethical needs in the governance of public health emergencies, comprehensively improve governance capabilities starting from the basic principles and behavioral standards of governance, with a view to providing more effective ethical support for the governance of public health emergencies.

Ethical Dilemma of "Virus Sovereignty" / 中国医学伦理学

The concept of "virus sovereignty" proposed by Indonesia in 2007 challenges the international tradition of virus sharing. In the context of the global outbreak of coronavirus disease 2019, the issue of virus sharing has become an important topic in the reform of the global health governance mechanisms. Virus sharing is an important guarantee of dealing with major global infectious diseases. However, the emergence of the concept of "virus sovereignty" shows that there are defects in the operation of virus sharing mechanism in the international community. The "virus sovereignty" problem is an ethical issue essentially, involving asymmetric interests hindering unity and cooperation, intellectual property rights expansion challenging the principle of solidarity, and excessive self-defense amplifying utility risks. "Community of common health for mankind" provides a constructive and feasible option to solve the dilemma of "virus sovereignty".

Research on Ethical Issues in the Prevention and Control of Major Infectious Diseases / 中国医学伦理学

Major infectious diseases have the characteristics of sudden, group and harmfulness. Isolation is widely used in the field of infectious disease prevention and control as an emergency management tool to control the source of infection and protect susceptible populations in emergencies. However, while it has achieved good results, there are also objective ethical disputes between personal freedom and public health, personal privacy and public knowledge. This paper fully discusses the ethical problems exposed in the implementation stage of isolation, follows the ethical principles of minimum infringement, utility and respect, and puts forward suggestions to strengthen the ethical decision-making ability of grassroots personnel, improve the operation procedures of isolation, and give more humanistic care to the isolated population. On the premise of the unity of public interest and individual rights and interests, we hope to promote the benign interaction between individuals and the public, properly solve the practical problems existing in the disposal of major infectious diseases, and give full play to the optimal function of public policy objectives.

Reflection on Improving College Students’ Health Literacy from the Perspective of Health Ethics / 中国医学伦理学

Contemporary college students have low levels of health literacy, facing problems such as weak awareness of health care, unhealthy diet habits, insufficient physical activity, and inadequate emergency response to public health emergencies. The reasons may be related to weak personal awareness of health literacy, imperfect health education system, shortage of health literacy education talents, lack of family health literacy education, and the insufficient social investment in health literacy cultivation. Faced with this current situation, the government, universities, families, individuals, and society should respond to the call of "Healthy China 2030" Plan Outline, regard improving college students’ health literacy level as their own responsibility, help them eliminate or reduce the risk factors affecting health, improve their health literacy level and quality of life, and contribute to the Healthy China strategy.

On Socrates’ Health Ethics Thought / 中国医学伦理学

Socrates understood the significance of health and disease to humans from the dimensions of body and soul, and advocated that humans should live a life consistent with nature. Socrates’ virtue of temperance, which is most closely related to health, emphasizes that self-control is the foundation of training a healthy body and mind, and having temperance is the premise for constructing healthy city-state. Faced with the problems of unhealthy lifestyle, infinite expansion of consuming desires, and materialization of interpersonal relations in modern society, Socrates’ health ethics thought has certain practical significance in transforming medical model and reconstructing positive health concept.

Preparation of a Questionnaire on Medical Students’ Cognition Level of Public Health Ethics / 中国医学伦理学

【Objective:】 To construct a questionnaire on medical students’ cognition level of public health ethics, and to provide a scientific and objective evaluation tool for understanding the cognitive level of medical students on public health ethics. 【Methods:】 Based on the literature review and focus group discussion, the initial questionnaire was constructed. The Delphi method was used to conduct three rounds of correspondence with 12 experts, and the final questionnaire was drafted. And exploratory factor analysis and internal consistency were used to evaluate the questionnaire. 【Results:】 In the three rounds of correspondence, the enthusiasms of experts were all 100%, the authority coefficients were all 0.84, the coefficients of variation were 0~0.32, 0~0.26, 0~0.12, respectively, and the coordination coefficients were 0.206, 0.163, and 0.250, respectively (all P<0.05). The analysis of the items showed that the critical ratio values and related coefficients of the questionnaire items were statistically different. The structural validity analysis showed that the cumulative variance contribution rate of the extracted two common factors was 61.015%. The intrinsic consistency reliability analysis showed that the questionnaire Cronbach’s coefficient was 0.956. Finally, the questionnaire of 26 items was formed, including two dimensions: knowledge of public health ethics and application of public health ethics. 【Conclusion:】 The questionnaire on medical students’ cognition level of public health ethics is reliable and has good reliability and validity, and can be used as a tool for medical students’ public health ethics cognition level.

Capacity building of community health workers: One size does not fit both rural and urban settings

The Accredited Social Health Activist (ASHA) programme in India is the world's largest all-female Community Health Workers (CHWs) programme. ASHAs are supposed to bridge the gap between community and health services by functioning as healthcare catalysts, service providers, and community-level health activists. This paper discusses the ethical challenges posed by using the same template for capacity building of ASHAs in rural and urban contexts, without accounting for the differences. Urban heterogeneity and rapidly growing urbanisation demand special attention for crucial programme activities like the capacity-building of ASHAs. When the relevant literature like policy and programme documents, training modules, and implementation guidelines were analysed, it was evident that the simple transplantation of rural models to urban contexts would not be a useful strategy. The recommended areas for improvement are the urban-specific customisation of ASHAs’ roles, the consideration of urban heterogeneity in the training content and pedagogy, utilising the advantages of the urban set-up, ensuring supportive supervision mechanisms for ASHAs, strengthening overall inter-sectoral convergence and community processes in urban areas.

Does India’s Menstrual Hygiene Management Scheme exclude the disabled?

The Menstrual Hygiene Scheme of the Government of India wishes to generate awareness among adolescent girls, and provide them with hygienic and affordable sanitary napkins. The scheme has been criticised for many reasons by various reviewers. However, we draw attention to a hitherto unaddressed gap that the scheme has effectively overlooked, the menstrual hygiene needs of disabled adolescent girls, and has thereby denied them their right to health and healthcare. This exacerbates health disparities, and raises questions of public health ethics. We conclude with recommendations on how to redress the situation and make the scheme more inclusive.

A theoretical framework for ethical decision-making during public health emergencies / Un marco teórico para la toma de decisiones éticas durante emergencias de salud pública / Um referencial teórico para tomada de decisão ética durante emergências de saúde pública

Abstract: The new theoretical ethical framework is a general frame or tool for ethical agents, developed to guide ethical reasoning during public health emergency preparedness and response. The TEF is based on the assumption that no existing ethical discourse in medical ethics alone is sufficient to address ethical issues of a PHE. The solutions suggested by existing approaches are limited in practicability and effectiveness, because they cannot address root problems and interplay among ethical problems. The reason for this insufficiency rests on the argument that ethical problems of PHEs have causal and reciprocal relationships, and any ethical decision-making framework should provide a wide enough perspective to consider relevant ethical norms and theories to suggest practical, implementable, coherent solutions compatible with the communal values and cultural norms. The TEF we suggest for PHEs embraces a holistic and integrated ethical perspective that enables us to comprehend that ethical problems that arise in various settings caused by PHE phenomena are in relationship with each other instead of addressing them as a standalone problem. The TEF provides decision-makers to achieve a coherent web of considered judgements compatible with ethical values and principles in various settings. This type of conceptualization offers a wide perspective to see causal and relational relationships among problems and produce outcomes that would not be possible by eclectic approaches.

Resumen: El nuevo Marco Ético Teórico (MET) es una estructura general o herramienta para eticistas, desarrollada para guiar el razonamiento ético durante la preparación y respuesta a emergencias de salud pública (ESP). Supone que no existe un discurso ético en la ética médica que por sí solo sea suficiente para abordar temas éticos de ESP. Las soluciones sugeridas de aproximaciones existentes son limitadas en la práctica y en la efectividad, debido a que no pueden abordar problemas de raíz sin considerar las interacciones entre los problemas éticos. Esta insuficiencia es porque los problemas éticos de ESP tiene relaciones causales y recíprocas, y cualquier estructura de toma de decisiones éticas debería proporcionar una perspectiva suficientemente amplia como para considerar normas éticas y teorías relevantes, y sugerir soluciones prácticas que sean coherentes y compatibles con valores comunes y normas culturales. El MET que sugerimos para ESP abarca una perspectiva ética integral e integrada, que posibilita la comprensión de que los problemas éticos que surgen en varías situaciones causadas por fenómenos ESP se hallan en relación entre ellos, en vez de abordarlos como un problema aislado. El MET proporciona a los que toman decisiones el lograr una red coherente de juicios compatibles con los valores y principios éticos en varias situaciones. Este tipo de conceptualización ofrece una amplia perspectiva para ver relaciones causales y relacionales entre problemas y producir resultados que no serían posibles mediante aproximaciones eclécticas.

Resumo: O novo referencial ético teórico (NT: TEF, sigla em inglês) é um referencial geral ou instrumento para agentes éticos, desenvolvido para guiar o raciocínio ético durante o preparo e resposta a emergências de saúde pública (NT: PHE, sigla em inglês). O TEF é baseado na suposição de que nenhum discurso ético existente em ética médica sozinho é suficiente para abordar aspectos éticos de uma PHE. As soluções sugeridas pelas abordagens existentes são limitadas em praticabilidade e efetividade, porque elas não podem abordar problemas fundamentais e inter-relacionar problemas éticos. A razão para essa insuficiência repousa no argumento de que problemas éticos de PHEs têm relações causais e recíprocas, e qualquer referencial para tomada de decisão ética deve propiciar uma perspectiva ampla o suficiente para considerar normas e teorias éticas relevantes para sugerir soluções práticas, implementáveis e coerentes, compatíveis com valores comunitários e normas culturais. A TEF que sugerimos para PHEs abarca uma perspectiva ética holística e integrada que nos permite compreender que os problemas éticos que surgem em diversos ambientes causados pelo fenômeno da PHE estão em relação entre si, ao invés de abordá-los como um problema isolado. O TFE propicia a tomadores de decisões alcançar uma rede de julgamentos considerados compatíveis com valores e princípios éticos em ambientes diversos. Esse tipo de conceitualização oferece uma perspectiva ampla para observar relações causais e relacionais entre problemas e produzir desfechos que não seriam possíveis por abordagens ecléticas.

Ethical issues for e-cigarette control policies in Australia

Although tobacco smoking in Australia is at a historical low, electronic cigarette (e-cigarette) use, especially among the youth is increasing. Policies around e-cigarette control in Australia are currently evolving, even during the pandemic, thus demonstrating its priority status. The current article discusses ethical issues for e-cigarette control policies in Australia using a public health ethics framework. The article is structured using the domains of the WHO-MPOWER framework of tobacco control to enable a comprehensive coverage of all elements of e-cigarette control policies in Australia. It highlights several ethical issues, from different stakeholder perspectives, and indicates moral and ethical tensions in different public health actions that might be considered in framing policies around e-cigarette control. Keywords: Electronic nicotine delivery systems, e-cigarettes, Australia,, smoke-free policy, public health ethics

Review of Health Ethics Research and Exploration of Its Contemporary Values / 中国医学伦理学

The research on health ethics has gone through three stages: the discussion of concepts, the all-round theoretical extension and become the spiritual power of healthy China. The paper mainly discussed the theoretical support and practical guidance provided by health ethics as a category of ethics for the development of public health undertakings in various eras, and its concept had gradually penetrated into many fields such as economy, politics, society, ecology and culture. Under the guidance of the Healthy China strategy, health ethics plays an important role in maintaining individual health, solving social public health problems, building a healthy China and constructing a community of human health.

Thinking on Integrating Health Ethics into Health Education and Prospect of Its Practice Path / 中国医学伦理学

Since the reform and opening-up, China’s health care has made great progress, and the level of national health literacy has steadily improved. However, there is still a disconnect between the health literacy and healthy behavior of Chinese residents, and traditional health education has little effect on behavior change. Based on the limitations of current traditional health education on improving health level of the whole people, this paper explored more effective education methods, deeply discussed how to integrate health ethics into health education to achieve the purpose of effectively promoting individual health behaviors. At the same time, this paper systematically expounded how the theory of behavioral economics provides theoretical support for the rationality and feasibility of health ethics education to promote healthy behavior, further explained the internal psychological mechanism of health ethics education affecting people’s healthy behavior, and provided feasible solutions for how to integrate health ethics into the new model of health education in practical application. To sum up, the integration of health ethics into health education is conducive to disseminating health concepts, improving health literacy, as well as promoting health behaviors, and then promoting the effective implementation of individual health and Healthy China.

Involuntary Hospitalization System: An Ethical Analysis Based on Mental Health Law of the People’s Republic of China / 中国医学伦理学

Involuntary hospitalization system is a controversial issue in international mental health legislation. During the legislation and implementation process of Mental Health Law of the People’s Republic of China, the substantive and procedural elements of the involuntary hospitalization system have always been under dispute and discussion. These disputes have profound ethical implications, highlighting the phenomenon of the coexistence of "insufficient" and "excessive" regarding China’s involuntary hospitalization system in protecting individual autonomy. From the perspective of public health ethics, the values of respect, justice, and care can provide ethical guidance for improving the involuntary hospitalization system and promoting the construction of mental health law.

Challenges to ethical integration of reproductive health education in schools of Tshwane District, South Africa

The Integrated School Health Policy was set to ensure the incorporation of a multi-disciplinary approach to health care in South African schools. However, the implementation of sexuality and reproductive health teaching and learning has not been without problems. Central to sexuality and reproductive health education is the common ethical application of the subject in teaching. School sexuality and reproductive health education have proved to be a sensitive issue across a socio-cultural environment. Compliance with ISHP programs in sexuality and gender orientation is related to the inclusion of a more comprehensive education for learners to cover human rights and sexual diversity. This paper aims to reflect on the ethical challenges related to the integration of reproductive health education and teaching in schools in the City of Tshwane. This study applied a descriptive exploratoryquantitative research design. Data was collected using a survey questionnaire and a checklist, and applied stratified random sampling to select schools that participated in the study. Data were analysed using descriptive statistics which included frequencies and percentages (%). The results show that the absence of health care values in organisational strategies will challenge the ethical dimension relating to sexuality and reproductive health education. The ethical dilemma of teaching sexual and reproductive health in schools can prove to be a challenging exercise since its a sensitive issue in most societies. Sexuality and reproductive health education is compounded by a lack of clear guidelines in the ISHP programs and the diversity of stakeholders that do not hold a common or standardised ethical framework. Furthermore, lack of sufficient teacher preparation adds to the ethical dilemma in managing school ethical issues in general. (Afr J Reprod Health 2022; 26[4]: 75-81).

El cuidar de enfermería y los derechos de la infancia: experiencia en Centros de Salud Familiar / Nursing care and children's rights: Experience in Family Health Centers / Cuidados de enfermagem e direitos da criança: experiência em Centros de Saúde da Família

RESUMEN Introducción En la última década, la política pública de salud presenta una efectiva transformación e innovación. La acción de legitimar la protección del ejercicio de los derechos de la infancia transita desde los riesgos y problemas imperantes, hasta la visualización de sus potencialidades y anhelos. Objetivo Develar el cuidado en el marco en derechos de la infancia desde la política pública de salud. Métodos Investigación cualitativa según Charmaz. Se abordó la perspectiva de 12 trabajadores de enfermería adheridos a la salud comunitaria a través de una entrevista semiestructurada. El análisis de los datos fue simultáneo, identificando las categorías fundamentales y la categoría central. La investigación cumplió con los criterios éticos de Ezekiel Emanuel; fue aprobada por el comité ético científico. Resultados Surgen las categorías: 1) negativa socialización con la construcción de identidad de género; 2) brecha entre derechos de la infancia y el rol del personal de enfermería. Discusión Estudios muestran que la enfermería ejecuta el manejo del rol en el análisis de las realidades familiares en derechos, pero frente a disparidades sanitarias se devela la influencia de sus puntos de vista sociales, sesgos y prejuicios, que pueden reflejarse en su comportamiento e influir en la forma en que los pacientes utilizan los servicios. Conclusiones Las acciones del cuidado de enfermería dirigidas a la niñez coexisten con un déficit de herramientas para el manejo del derecho infantil. Por su parte, la política pública de salud se desarrolla desde los programas con una mirada biologicista, asistencialista, racionalista, entendiendo el cuidar desde el enfoque biomédico.

ABSTRACT Introduction During the last decade, the public health policies have experienced diverse effective transformations and innovations. Now, the Lawful protection of children's rights has a broader scope and can go from considering their prevailing problems and risks to visualizing their potential and desires. Objective To explore nursing care within the children's rights frame from a public health perspective. Methods This is a qualitative research study that follows the guidelines of Charmaz. The perceptions of 12 community health nursing workers were analyzed through semi- structured interviews. The central and fundamental categories were simultaneously analyzed. The research study met Ezekiel Emanuel's ethics criteria and was approved by the scientific ethics committee. Results Two main categories arose: 1) the negative socialization towards the construction of gender identity; and 2) the gap between the children's rights and the role of the nursing personnel. Discussion Diverse studies show that nurses shape their roles in the context of family rights; however, while dealing with health disparities, they are further driven by their social points of view, their biases, and their prejudices, and these behaviors can have an influence on the way patients utilize health services. Conclusions Children's healthcare that nurses provide is not always based on tools to handle the children's rights. Moreover, there are still some public health policies that rely on biology, assistance, and reason-focused programs which consider care only from a biomedical perspective.

RESUMO Introdução Na última década, ases políticas públicas de saúde apresentaram uma efetiva transformação e inovação. A ação de legitimar a proteção do exercício dos direitos da criança passa pelos riscos e problemas predominantes, até a visualização de suas potencialidades e desejos. Objetivo Revelar o cuidado no marco dos direitos da criança a partir da política pública de saúde. Métodos Pesquisa qualitativa segundo Charmaz. A perspectiva de 12 trabalhadores de enfermagem vinculados à saúde comunitária foi abordada por meio de entrevista semiestruturada. A análise dos dados foi simultânea, identificando as categorias fundamentais e a categoria central. A pesquisa obedeceu aos critérios éticos de Ezekiel Emanuel; foi aprovado pelo comitê de ética científica. Resultados Emergiram as categorias: 1) socialização negativa com a construção da identidade de gênero; 2) lacuna entre os direitos da criança e o papel da equipe de enfermagem. Discussão Estudos mostram que a enfermagem desempenha papel gerencial na análise das realidades familiares em direitos, mas diante das disparidades de saúde, revela-se a influência de seus pontos de vista sociais, rumos e preconceitos, o que pode se refletir em seu comportamento e influência na forma como os pacientes utilizam os serviços. Conclusões As ações de cuidado de enfermagem voltadas à criança convivem com a falta de instrumentos para a gestão dos direitos da criança. Por sua vez, a política pública de saúde é desenvolvida a partir dos programas com uma perspectiva biologística, assistencialista, racionalista, compreendendo o cuidado a partir de uma abordagem biomédica.

Tendencia de la cesárea: una reflexión desde la ética / Cesarean section trend: a reflection from ethics / Tendência à cesárea: uma reflexão a partir da ética

Resumen: Las estadísticas mundiales muestran una tendencia al alza en las tasas de cesáreas que superan el 15% recomendado por la OPS/OMS. Esta cirugía se ha convertido en la más frecuente en los países de ingresos medios y altos. Algunos estudios sugieren que no todas estas cesáreas estarían justificadas. Al respecto se plantean algunas reflexiones sobre los dilemas éticos que se pueden observar desde varias posiciones teóricas, como el consecuencialismo, el kantianismo, la ética de la virtud y la teoría feminista. A su vez, estos dilemas están inmersos en múltiples factores individuales, sociales y culturales, entre otros. Desde la salud pública se debe revisar el parámetro actual definido como "rango aceptable" de cesáreas, ya que puede ser demasiado bajo. Igualmente se recomienda la aplicación de medidas para fortalecer en los pacientes el deseo de un parto normal, cuando sea posible, a través de información y educación oportuna durante la atención prenatal. Las decisiones del profesional de la salud y de las mujeres deben estar respaldadas por la mejor información disponible.

Abstract: World statistics show an upward trend in Cesarean section rates that exceed the 15% recommended by PAHO / WHO. This surgery has become the most common in high- and middle-income countries. Some studies suggest that not all these caesarean sections would be justified. In this regard, some reflections are made on the ethical dilemmas that can be observed from various theoretical positions such as consequentialism, Kantianism, the ethics of virtue and feminist theory. In turn, these dilemmas are immersed in multiple individuals, social and cultural factors, among others. From Public Health, the current parameter defined as the "acceptable range" of Caesarean sections should be reviewed as it may be too low. It is also recommended that measures be applied to strengthen patients' desire for a normal delivery whenever possible through timely information and education during prenatal care. The decisions of the health professional and women must be supported by the best information available.

Resumo: As estatísticas mundiais mostram uma tendência de alta nas taxas de cesáreas que superam em 15% o recomendado pela OPAS/OMS. Esta cirurgia se converteu na mais frequente em países de renda média e alta. Alguns estudos sugerem que não todas estas cesáreas seriam justificadas. A esse respeito se colocam algumas reflexões sobre os dilemas éticos que se podem observar desde várias posiciones teóricas, como o consequencialismo, o kantianismo, a ética da virtude e a teoria feminista. Por sua vez, estes dilemas estão imersos em múltiplos fatores individuais, sociais e culturais, entre outros. Deve-se revisar, a partir da saúde pública, o parâmetro atual definido como "faixa aceitável" de cesáreas, já que pode ser demasiado baixo. Igualmente se recomenda a aplicação de medidas para fortalecer nas pacientes o desejo de um parto normal, quando possível, através de informação e educação oportuna durante a assistência pré-natal. As decisões do profissional da saúde e das mulheres devem estar respaldadas pela melhor informação disponível.

Atuação ética e contextualizada nos estágios básicos supervisionados em Psicologia da Saúde: um relato de experiência de docentes / Ethical and contextualized performance in supervised basic internships in Health Psychology: an experience report by professor

A Psicologia, enquanto ciência e profissão, passou por algumas propostas curriculares e, com isso, discussões sobre ensino em psicologia têm se adensado, assim como os debates acerca das práticas na formação, com o reconhecimento da contribuição de estágios básicos ao longo do curso. O Sistema Único de Saúde auxiliou sobremaneira na demonstração do quanto a aproximação das diversas realidades em saúde ainda se faz necessária para uma atuação engajada da categoria. O objetivo deste trabalho é discutir a importância dos estágios para a formação da futura psicóloga. Utilizamos o relato de experiência de professoras do Internato em psicologia, uma modalidade específica em estágio básico, para problematizar a relevância do desenvolvimento de competências profissionais, que auxiliem na qualificação dessa atuação. Esse Internato está presente no quarto ano do curso de Psicologia de uma faculdade em Salvador, Bahia, e propõe a passagem de pequenos grupos de estudantes por campos variados da saúde e das organizações de trabalho. Compreendemos que o transitar do estudante por diversos contextos de prática na saúde e ter a mediação de uma professora são diferenciais para a formação na área. Essa proposta de estágio contribui para o desenvolvimento de um profissional crítico, ético, reflexivo e mais atento aos fenômenos que ocorrem com aqueles a quem presta serviço e a si mesmo. Estudos como este e outros com metodologias diversas podem auxiliar na construção de práticas profissionais e pedagógicas em Psicologia mais reflexivas e comprometidas com a nossa realidade brasileira.

Psychology, as a science and profession, has gone by some curricular proposals and, as a result, discussions about teaching in psychology have become more intense, as well as debates about practices in training with the recognition of the contribution of basic internships throughout the course. The Unified Brazilian Health System (SUS) helped a lot in demonstrating how much the approximation of the different realities in health is still necessary for an engaged performance of the category. The objective of this work is to discuss the importance of internships for the future psychologist's formation. We used the teachers of the internship in psychology's experience, a specific modality in basic internship, to problematize the relevance of the development of professional skills which help in the qualification of this performance. This internship is present in the fourth year of the Psychology course at a college in Salvador, Bahia, and proposes the passage of small groups of students through different fields of health and work organizations. We understood that the transit of the student through different contexts of practice in health and having the mediation of a teacher are differentials for training in the area. This internship proposal contributes to the development of a professional more critical, ethical, reflective and attentive to the phenomena that occur with those to himself and those whom he provides service. Studies like this and others with different methodologies can help in the construction of professional and pedagogical practices in Psychology that are more reflective and committed to our Brazilian reality.