[Bioethical principles in public health: limitations and proposals]. / Principios bioéticos en salud pública: limitaciones y propuestas.

We propose to analyze the specificity of ethical problems in public health issues and to elucidate the applicability of principlism as a problem-solving strategy in this realm. Although well-established in clinical ethics, principlism is not an adequate model to be used in public health, since it is basically intended to serve as a moral guide in the physician-patient encounter. We discuss the possible adequacy of principles like "solidarity", "ontic responsibility" (as proposed by Jonas), and "caring or diaconal responsibility" as presented by Lévinas. Solidarity appears to be insufficiently specified, whereas the other two perspectives may be adapted to public health issues by bringing together Jonas' ontological and Lévinas' transcendental concerns to form a principle of protection that might better serve the purposes of such an ethics. This principle would help to identify more clearly the goals and agents involved in the implementation of public policies that are expected to be both morally correct and pragmatically effective.

[Bioethics and health care technology assessment]. / Bioética e avaliação tecnológica em saúde.

The simultaneous existence of a biotechnoscientific paradigm (which emphasizes technological incorporation) and a culture of limits (which selects technologies) challenges current health systems, raising ethical and political discussions as to the choices to be made. Health care technology assessment is mainly concerned with the consequences of health care and health care policies. Thus, there is significant overlap between this activity and bioethics, even though they are different fields of knowledge. Although the importance of ethical and social issues arising in technology assessment has been recognized, most publications emphasize only methodological and scientific aspects. There are different interests involved in technological incorporation, and many value conflicts arise. Ethical implications include those related to clinical trials, medical care assessment, incorporation of technology, resource allocation, equity, and the effectiveness gap. Incorporating the ethical dimension into technology assessment will foster a better understanding of health care practice and progress in its improvement.

[Ethical implications of domestic violence against child for the health care professionals]. / Implicações éticas da violência doméstica contra a criança para profissionais de saúde.

Based upon some problems faced by health professionals in the care of abused children, this is a discussion of the ethical implications in family interventions aiming to protect these children. Accepting the prima facie principle that violence is morally wrong, some issues related to the children's rights as well as some ethical theories such as consequentialism, utilitarianism and deontology are discussed. The conclusion is that the protection of these children is morally justifiable and the maintenance of the families' unity should always be attempted.

Paradigm shift, metamorphosis of medical ethics, and the rise of bioethics.

Both the increasing incorporation of medical technology and new social demands (including those for health care) beginning in the 1960s have brought about significant changes in medical practice. This situation has in turn sparked a growth in the philosophical debate over problems pertaining to ethical practice. These issues no longer find answers in the Hippocratic ethical model. The authors believe that the crisis in Hippocratic ethics could be described as a period of paradigm shift in which a new set of values appears to be emerging. Beginning with the bioethics movement, the authors expound on the different ethical theories applied to medical practice and conclude that principlism is the most appropriate approach for solving the new moral dilemma imposed on clinical practice.

The Dolly case, the Polly drug, and the morality of human cloning.

The year 1996 witnessed the cloning of the lamb Dolly, based on the revolutionary somatic cell nuclear transfer (SCNT) technique, developed by researchers from the Roslin Institute in Edinburgh, Scotland. This fact marked a relevant biotechnoscientific innovation, with probable significant consequences in the field of public health, since in principle it allows for expanding possibilities for the reproductive autonomy of infertile couples and carriers of diseases of mitochondrial origin. This article expounds on 1) the experiment's technical data and the theoretical implications for the biological sciences; 2) the public's perception thereof and the main international documents aimed at the legal and moral regulation of the technique; and 3) the moral arguments for and against cloning, from the point of view of consequentialist moral theory. We conclude that in the current stage of the debate on the morality of cloning, in which there are no cogent deontological arguments either for or against, weighing the probability of risks and benefits is the only reasonable way of dealing with the issue in societies that consider themselves democratic, pluralistic, and tolerant.

Ethics and animal experimentation: what is debated?

The purpose of this article is to raise some points for an understanding of the contemporary debate over the ethics of using animals in scientific experiments. We present the various positions from scientific and moral perspectives establishing different ways of viewing animals, as well as several concepts like 'animal ethics', 'animal rights', and 'animal welfare'. The paper thus aims to analyze the importance and growth of this debate, while proposing to expand the academic approach to this theme in the field of health.