Evaluation of relational factor in patient satisfaction with the treatment received by dental students.

INTRODUCTION: The study focused on the importance of the relational factor and empathy in the general satisfaction of patients for the treatment received by university dental students. To achieve this objective, a tool capable of evaluating the most humanistic dimensions (empathy, kindness, trust) in the development of dental treatment has been designed. MATERIALS AND METHODS: A review of the literature was carried out and, based on its findings, a questionnaire was designed to assess patient satisfaction with the dental student's empathy. It consisted of 20 questions and was completed by 80 patients. The questionnaire was subjected to a validation process using the Delphi method (content validity) and psychometric analysis (construct validity), through a principal components analysis (PCA). RESULTS: The results of the PCA showed the existence of four components that suggest grouping the 20 questions into three blocks with a sequential structure, in which the questions would describe the patient's satisfaction throughout their treatment: reception and explanation of the treatment; development and progress of treatment; and expectations and completion of treatment. In each of these blocks, satisfaction was determined by a specific humanistic dimension: communication, trust and benevolence. CONCLUSION: The validated questionnaire is an effective tool to analyse the relational factors that determine patient satisfaction in a treatment. Furthermore, the analysis of the questionnaire suggests that communication, trust and benevolence are elements that acquire singular importance throughout the care process. This analysis is essential for the acquisition of humanistic skills by future professionals and to optimize the dentist-patient relationship.

Women's health, hormonal balance, and personal autonomy.

Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning.

INTRODUCTION: Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes. MATERIALS AND METHODS: A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge. RESULTS: Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women. CONCLUSION: Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum.

BACKGROUND: Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant. OBJECTIVE: The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency. RESEARCH DESIGN: The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies. ETHICAL CONSIDERATIONS: No significant ethical considerations as this is a discussion paper. FINDINGS: The model was structured from the anthropology's concepts and decision-making process, applied to real situations. The structure of the three domains theoretical-practical-communicative is present in each session. DISCUSSION: It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students' resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied. CONCLUSION: We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.

Ethical Challenges of Germline Genetic Enhancement.

The new reproductive technologies have opened the door to different processes of germline genetic enhancement by which the characteristics of an individual according to the interests of the agents involved could be selected during its gestation. Although the initiative is apparently oriented towards developing individuals that would excel in society, critical voices raise the concerns about that this approach would generate and need for a reflection on the ethical, social and legal implications of these techniques and their implementation in society. We reviewed the literature about these issues throughout their historical records to date, focusing on the moral arguments and non-clinical aspects that affect the legal and social environment. We have observed various trends of thought with divergent positions (proactive, preventive, and regulatory) as well as a large number of articles that try to reconcile the different approaches. This review illustrates a series of concepts from the ethics and philosophy fields which are frequently used in studies that evaluate the ethical implications of germline genetic enhancement, such as dignity, benefit, autonomy, and identity. In addition, amongst the many unresolved controversies surrounding genetic enhancement, we identify procreative beneficence, genetic disassociation, gender selection, the value of disability, embryo chimerization, and the psychosocial inequality of potentially enhanced individuals as crucial. We also develop possible scenarios for future debate. We consider especially important the definition and specification of three aspects which are essential for the deployment of new reproductive technologies: the moral status of the embryo undergoing enhancement, the legal status of the enhanced individual, and the responsibility of the agents executing the enhancement. Finally, we propose the precautionary principle as a means to navigate ethical uncertainties.

Moral enhancement, at the peak of pharmacology and at the limit of ethics.

The debate over the improvement of moral capacity or moral enhancement through pharmacology has gained momentum in the last decade as a result of advances in neuroscience. These advances have led to the discovery and allowed the alteration of patterns of human behavior, and have permitted direct interventions on the neuronal structure of behavior. In recent years, this analysis has deepened regarding the anthropological foundations of morality and the reasons that would justify the acceptance or rejection of such technology. We present a review of proposals for pharmacological interventions directed directly towards moral enhancement. In addition, we identify the ethical dilemmas that such interventions may generate, as well as the moral assessment of the authors of these studies. There is a moderate consensus on the risks of any intervention on the intimate structure of the human condition, its autonomy and identity, but there are large differences in explaining the reasons for this concern and especially in justifying such interventions. These findings show that it is necessary to investigate the moral assessment of authors and the ethical dimension within the field of pharmacology in order to identify future trends.

El principio depprecaución y los límites en biomedicnna / The precutionaryy principle and limits in biomedicine / O pincípio de prrecaução e os limites em biomedicina

Los actuales avances en tecnología biomédica han alcanzado resultados hasta ahora inimaginables, tanto en la terapia de enfermedades como en el perfeccionamiento de la especie humana. Es necesario plantearse si el deseo de perfección posee límites precisos, y si es necesario aplicar un principio limitador que garantice el respeto de la naturaleza humana e impida la asunción de riesgos que puedan afectar a generaciones futuras. El principio de precaución se presenta como elemento racionalizador frente a cualquier intento de un progreso ciego o despótico. Pero dicho principio puede derivar hacia concepciones confusas cuando se desliga de su componente constitutivo: la virtud de la prudencia.

Current advances in biomedical technology have achieved previously unimaginable results in terms of both disease therapy and improvement of the human species. Accordingly, it is crucial to consider whether the desire for perfection has specific limits, and if it is necessary apply a limiting principle to ensure respect for human nature and to prevent risk-taking that might affect future generations. The precautionary principle is presented as a rationalizing element against any attempt by blind or despotic progress. However, this principle can lead to confusing concepts when it becomes separated from its basic component: the virtue of prudence.

Os atuais avanços em tecnologia biomédica têm atingido resultados até agora não imagináveis, tanto na terapia de doenças quanto no aperfeiçoamento da espécie humana. Nesse contexto, é necessário questionar se o desejo de aperfeiçoamento possui limites precisos e se é necessário aplicar um princípio limitador que garanta o respeito da natureza humana e impeça a assunção de riscos que possam afetar gerações futuras. O princípio de precaução apresenta-se como elemento racionalizador ante qualquer tentativa de um progresso cego ou despótico. Porém, esse princípio pode derivar a concepções confusas quando se desliga de seu componente constitutivo: a virtude da prudência.

La calidad de Vida, un mensaje cifrado / Quality of life, vagueness message

Alcanzar una edad avanzada con cierto bienestar es uno de los objetivos perseguidos por los hombres desde la antigüedad. El planteamiento para conseguirlo, por parte del Estado del Bienestar y determinadas políticas asistenciales, resulta muy atractivo: todos queremos el bienestar para nosotros y para los demás, y como individualmente no podemos, el Estado se ocupa de ello. En el lenguaje actual nos encontramos con tres términos que fácilmente se identifican en el área sanitaria: salud, calidad de vida y bienestar. La definición de salud que hace la OMS (1998) se superpone prácticamente a la de calidad de vida y abarca el término bienestar, que se convierte en exigencia de la salud. La calidad de vida tiene su origen en la literatura socioeconómica (1964) y pronto se extendió a otras disciplinas. En medicina, la calidad de vida se ha convertido en uno de los parámetros de la acción médica; es el bien supremo al que debe tender el hombre, es condición de vida. Es una visión reduccionista y deshumanizadora, que por su simplicidad y ambigüedad es de fácil aceptación universal.

A relaçäo pessoal como acesso privilegiado para o doente mental grave / Personal relations as a provileged approach to the seriously mentally disabled

A maioria dos problemas bioéticos atualmente apresentados estäo centrados na biotecnologia, mas para encontrar a orientaçäo e o sentido autêntico do progresso científico faz-se necessária uma fundamentaçäo na pessoa humana, ou seja, uma antropologia. No caso das demências graves, como a de Alzheimer, as intervençöes terapêuticas nos níveis farmacológico e psicológico resultam insuficientes para o paciente; portanto, para um efetivo tratamento, é indispensável o acesso a todas as dimensöes da pessoa doente, das quais a dimensäo relacional, constitutiva de todo ser humano, é extremamente importante. Ela precisa, apesar de sua deterioraçäo físico-mental, estabelecer conosco uma relaçäo interpessoal, que temos que estimular, ao mesmo tempo que nos aporta um incremento de valores