Análisis ético del principio de vulnerabilidad sanitaria / Ethical analysis of the principle of health vulnerability

El concepto de vulnerabilidad ha determinado múltiples actuaciones en el ámbito sanitario. En los últimos años este concepto ha originado diversos modelos holísticos que oscilan entre considerar la vulnerabilidad como un elemento descriptivo de una situación accidental hasta su consideración como principio orientador de la práctica médica. Se percibe la necesidad de profundizar en este fenómeno desde el punto de vista de la filosofía moral. La reflexión moral revela un desequilibrio en el binomio autonomía-dependencia, generando soluciones opuestas en la toma de decisiones. Aunque la autonomía ha fundamentado hasta ahora gran parte de la acción médica, la dependencia plantea una nueva óptica sobre la vulnerabilidad, ra-dicada en la ética del cuidado. Esta perspectiva permite superar la consideración de la vulnerabilidad como una característica, un accidente o un principio. La vulnerabilidad aparece como una dimensión intrínseca del ser humano que, lejos de alterar su dignidad o su autonomía, permite evidenciar la necesidad de los otros para alcanzar su plenitud

The concept of vulnerability has determined multiple actions in the health field. In recent years, this concept has originated various holistic models that oscillate between considering vulnerability as a descriptive element of an accidental situation until it is considered a guiding principle of medical practice. The need to deepen this phenomenon from the point of view of moral philosophy is perceived. The moral reflection reveals an imbalance in the binomial autonomy-dependence, generating opposite solutions in decision-making. Although autonomy has so far supported much of the medical action, the dependency raises a new perspective on vulnerability, rooted in the ethics of care. This perspective allows us to overcome the consideration of vulnerability as a characteristic, an accident or a principle. Vulnerability appears as an intrinsic dimension of the human being that, far from altering its dignity or autonomy, makes it possible to demonstrate the need of others to reach their fullness

[Ethical analysis of the principle of health vulnerability]. / Análisis ético del principio de vulnerabilidad sanitaria.

The concept of vulnerability has determined multiple actions in the health field. In recent years, this concept has originated various holistic models that oscillate between considering vulnerability as a descriptive element of an accidental situation until it is considered a guiding principle of medical practice. The need to deepen this phenomenon from the point of view of moral philosophy is perceived. The moral reflection reveals an imbalance in the binomial autonomy-dependence, generating opposite solutions in decision-making. Although autonomy has so far supported much of the medical action, the dependency raises a new perspective on vulnerability, rooted in the ethics of care. This perspective allows us to overcome the consideration of vulnerability as a characteristic, an accident or a principle. Vulnerability appears as an intrinsic dimension of the human being that, far from altering its dignity or autonomy, makes it posible to demonstrate the need of others to reach their fullness.

Análise da ética de princípios, 40 anos depois / An analysis of the ethics of principles, 40 years later / Análisis de la ética de principios, 40 años después

Resumen La Bioética de principios se ha convertido en un paradigma de la valoración moral en la práctica clínica. La estructuración en cuatro principios (autonomía, beneficencia, no maleficencia y justicia), elaborada por Beauchamp y Childress hace casi 40 años, trata de facilitar la toma de decisiones en un contexto universal. Aun así, este objetivo genera una serie de dudas que afectan profundamente a la praxis ética de la medicina y a la teoría moral. Por ello, se hace imprescindible un análisis crítico de los principios de la Bioética, su fundamentación teórica y su aplicabilidad, a la vista de los resultados en estos últimos decenios.

Abstract Bioethics of principles has become a paradigm of moral evaluation in clinical practice. This model is based on four principles (autonomy, beneficence, non-maleficence and justice), as defined by Beauchamp and Childress almost 40 years ago. The four principles try to facilitate decision-making in a universal context. However, this objective generates a series of questions that deeply affect the ethical practice of medicine and the moral theory. Therefore, a critical analysis of the bioethical principles, its theoretical foundation and its application, in view of the results in recent decades, is needed.

Resumo A Bioética dos princípios tornou-se paradigma de avaliação moral na prática clínica. A estruturação desse modelo em quatro princípios (autonomia, beneficência, não maleficência e justiça), desenvolvidos por Beauchamp e Childress há quase 40 anos, visa facilitar a tomada de decisão em contexto universal. No entanto, esse objetivo gera uma série de questões que afetam profundamente a prática ética da medicina e a teoria moral. Por essa razão, a análise crítica dos princípios da Bioética, sua fundamentação teórica e sua aplicabilidade, levando em consideração os resultados das últimas décadas, são essenciais.

A hermeneutic phenomenological explorations of living in old age.

Although there have been some studies that explore the meaning of aging and give voice to older people, the impact that the aging experience can have on them justifies continued research in this area. In this study, with a hermeneutic phenomenological design and an interpretation method inspired by the philosophy of Ricoeur, we conducted in-depth interviews with 14 elderly people at a social day center in Rome (Italy). The analysis revealed three central themes associated with the experience of being old: changes and limitations related with being aged, the experience that comes from having lived a long life, and an awareness of death. The findings could help health professionals, families and caregivers to achieve a deeper understanding of what old age entails, and may also serve as a platform for interventions that seek to enable older people to experience aging as a meaningful and positive process.

El estatuto epistemológico de la bioética / The epistemological stature of the bioethics

El artículo expone el debate teórico acerca de la configuración epistemológica de la Bioética. Se realiza un análisis descriptivo y crítico de las principales aportaciones. Muestra como la Bioética siempre ha tenido dificultades para ser definida, los límites y las características internas de lo definido han sufrido importantes modificaciones en su corta historia. Otro problema presente, no menos sustancial, se debe a los distintos modos de entenderla y por tanto a que no exista un concepto unívoco de Bioética. Por último, se apuntan tres rasgos esenciales que sustentan su base conceptual, y que a nuestro entender, están todavía por resolver (AU)

The article exposes the theoretical debate brings over of the configuration epistemological of the Bioethics. There is realized a descriptive and critical analysis of the principal contributions. Sample like the Bioethics always has had difficulties to be defined; the limits and the internal characteristics of the definite thing have suffered important modifications in his short history. Another present, not less substantial problem, it owes to the different manners of understanding it and therefore to that there does not exist Bioethical univocal concept. Finally, there sign three essential features that sustain his conceptual base, and that to ours to deal, are still for resolving (AU)

[Comparative study of three Western models of deontological codes for dentists]. / Estudio Comparativo de Tres Modelos Occidentales de Códigos Deontológicos para Odontólogos.

We performed a comparative analysis of the codes of ethics of three official organizations in Dentistry professional ethics: Code of Ethics for Dentists in the European Union, drawn up by the Council of European Dentists (CED); Código Español de Ética y Deontología Dental, published by the Consejo General de Colegios de Odontólogos y Estomatólogos de España (CGCOE); and Principles of Ethics and Code of Professional Conduct, of the American Dental Association (ADA). The analysis of the structure of the codes allows the discovery of different approaches governing professional ethics according to the ethical and legislative tradition from which they derive. While there are common elements inherent in Western culture, there are nuances in the grounds, the layout and wording of articles that allows to deduce the ethical foundations that underlie each code, and reflects the real problems encountered by dentists in the practice of their profession.

[The epistemological statute of the bioethics]. / El Estatuto Epistemológico de la Bioética.

The article exposes the theoretical debate brings over of the configuration epistemological of the Bioethics. There is realized a descriptive and critical analysis of the principal contributions. Sample like the Bioethics always has had difficulties to be defined; the limits and the internal characteristics of the definite thing have suffered important modifications in his short history. Another present, not less substantial problem, it owes to the different manners of understanding it and therefore to that there does not exist Bioethical univocal concept. Finally, there sign three essential features that sustain his conceptual base, and that to ours to deal, are still for resolving.

[Misunderstandings on concepts life and quality of life]. / Equívocos en Torno a los Conceptos de Vida y Calidad de Vida.

The rationale of this work is to indicate some of the ethical and anthropological conceptions that, to my understanding, underlie present day medicine when more relevance is granted to the quality of life than to life itself.