Comentarios al proyecto de ley "Muerte digna y cuidados paliativos" / Remarks on the "Dignified death and palliative care" bill

The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.

Efectos negativos en la investigación y el quehacer médico en Chile de la Ley 20.584 y la Ley de Neuroderechos en discusión: la urgente necesidad de aprender de nuestros errores / Negative effects of the patients' rights law and neuro-rights bill in Chile

Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.

Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile / Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Rechazo de los padres a la vacunación obligatoria en Chile. Desafíos éticos y jurídicos / Parental refusal to mandatory vaccination in Chile. Ethical and legal challenges

Resumen: Este artículo se presenta como una reflexión ética y jurídica acerca de la tendencia actual de los pa dres a rechazar la vacunación de sus hijos en un régimen jurídico que establece la obligatoriedad de determinadas vacunas. Se analizan los principales argumentos que los padres usan para rechazar las vacunaciones obligatorias, y, en concreto: el temor a los efectos negativos que la vacunación pueda provocar en el menor; la violación del "derecho a la autonomía"; las creencias religiosas o pseudo- filosóficas; la resistencia a la intervención del Estado en asuntos personales o familiares. De esto, nace un necesario análisis ético sobre la vacunación infantil. Finalmente, se discute la responsabilidad de los padres y del Estado (autoridad sanitaria) en el cuidado de los menores de edad. La vacunación es un beneficio tanto para el inoculado como para la comunidad, la mejor política preventiva. Al mismo tiempo, se configura como un caso complejo que demanda un debate profundo, cuyo fin debe ser el tránsito desde un aparente conflicto entre los padres y el Estado, a una convergencia por el cuidado de los menores de edad. En otros términos, se recalca el hecho de que los padres, más allá del cum plimiento de un deber normativo heterogéneo, deben actuar motivados por la adhesión voluntaria al bien del hijo y de la comunidad.

Abstract: This article is an ethical and legal reflection about the current trend of parents to refuse vaccination of their children under a legal regime that establishes mandatory use of certain vaccines. We analyze the main arguments used by parents to refuse obligatory vaccination, i.e., the fear of the negative effects that vaccination may have on the child; the violation of the "right to autonomy"; religious or pseudo-philosophical beliefs; and the resistance to the State intervention in personal or family mat ters. Therefore, this statement implies a necessary ethical analysis of childhood vaccination. Finally, it will be discussed the responsibility of parents and the State -the health authority- in the care of mi nors. Vaccination is a benefit for both the inoculated and the community, the best preventive policy. At the same time, it is considered a complex case that demands a profound debate, whose purpose should be the transition from an apparent conflict between parents and the State, to convergence for the care of minors. In other words, it is emphasized the fact that parents, beyond the fulfillment of a heterogeneous normative duty, must act motivated by voluntary adherence to the best interest of the child and the community.

Edo, ergo sum: anthropological, ethical and educational considerations about eating

We argue that, given that the act of eating is rational and relational, it should also be an educational issue dealing with society and environment, politics and health, tastes and trends, as well as genetic and epigenetic factors. This hypothesis arises from a particular theory of the human act and an anthropological approach based on the philosophical speculations of MacIntyre and Aristotle. We argue that eating choices are "hybrids of freedom," rationality, and unconscious and environmental elements. Finally, we suggest that people have to change their habits in order to transform the human way of acting, since every human act can change the human essence and vice versa.

Sostenemos que, siendo el acto de comer racional y relacional, también debe ser un tema educativo que tiene que ver con la sociedad y el ambiente, la política y la salud, los gustos y las tendencias, así como los factores genéticos y epigenéticos. Esta hipótesis tiene que ver con una cierta teoría del acto humano y una antropología basada en las especulaciones filosóficas de MacIntyre y Aristóteles. En este sentido, argumentamos que las opciones alimenticias son un "híbrido de libertad", racionalidad, y elementos inconscientes y ambientales, y se relacionan con las dimensiones espirituales y biológicas de los seres humanos. Finalmente, sugerimos que debemos cambiar los hábitos humanos para transformar la forma humana de actuar, ya que cada acto humano puede cambiar la esencia humana y viceversa.

Sostenemos que, siendo el acto de comer racional y relacional, también debe ser un tema educativo que tiene que ver con la sociedad y el ambiente, la política y la salud, los gustos y las tendencias, así como los factores genéticos y epigenéticos. Esta hipótesis tiene que ver con una cierta teoría del acto humano y una antropología basada en las especulaciones filosóficas de MacIntyre y Aristóteles. En este sentido, argumentamos que las opciones alimenticias son un "híbrido de libertad", racionalidad, y elementos inconscientes y ambientales, y se relacionan con las dimensiones espirituales y biológicas de los seres humanos. Finalmente, sugerimos que debemos cambiar los hábitos humanos para transformar la forma humana de actuar, ya que cada acto humano puede cambiar la esencia humana y viceversa.

AN ETHICAL DILEMMA IN THE FIELD OF GYNECOLOGY / UN DILEMA ÉTICO EN EL CAMPO DE LA GINECOLOGÍA / UM DILEMA ÉTICO NO CAMPO DA GINECOLOGIA

The aim of this paper is to assess a case report in the field of gynecology, starting from an ethical paradigm that relates primarily to the so-called "sources of morality" (objective structure, circumstances, aim). In order to do so, we first will present four ethical paradigms for the evaluation of clinical cases (preference utilitarianism, principlism, ontologically-grounded personalism and Aristotelian/Thomist objective ethics). After introducing the main aspects of these paradigms and pointing out that what matters in an ethical evaluation is not so much the final judgement, but rather the argument that leads to it, we will assess the case report in light of the chosen paradigm. Lastly, we will outline a possible solution to the problem, starting from the previous ethical evaluation.

El objetivo de este texto es evaluar el informe de un caso clínico en el campo de la ginecología, a partir de un paradigma ético que se refiere principalmente a las denominadas "fuentes de la moral" (la estructura objetiva, las circunstancias, el objetivo). Primero se presentan cuatro paradigmas éticos para la evaluación de casos clínicos (utilitarismo de preferencia, principialismo, personalismo fundado ontológicamente y ética objetiva aristotélica/tomista). Después de la introducción de los aspectos principales de estos paradigmas y al señalar que lo que importa en una evaluación ética no es tanto el juicio final, sino más bien el argumento que conduce a ella, se evalúa el informe del caso a la luz del paradigma elegido. Por último, se esboza una posible solución al problema, a partir de la evaluación ética anterior.

O objetivo deste trabalho é avaliar o relatório de um caso clínico no campo da ginecologia a partir de um paradigma ético que se refere principalmente às denominadas "fontes da moral" (a estrutura objetiva, as circunstâncias, o objetivo). Nesse sentido, primeiramente apresentamos quatro paradigmas éticos para a avaliação de casos clínicos (utilitarismo de preferência, principialismo, personalismo fundado ontologicamente e ética objetiva aristotélica/tomista). Após introduzir os aspectos principais desses paradigmas e indicar que o importante numa avaliação ética não é tanto o julgamento final, mas sim o argumento de que conduz a ela, avaliamos o relatório do caso à luz do paradigma escolhido. Por último, esboçamos uma possível solução ao problema a partir da avaliação ética anterior.