This study focuses on the theme of conflict among the three underlying moral and political princi... more This study focuses on the theme of conflict among the three underlying moral and political principles in the Brazilian Public Health System (SUS), from the perspective of the bioethics of protection: the right to equality and comprehensiveness in health care, as well as universal access. We include this theme in the sphere of Public Health Bioethics, reviewing several previous studies
Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members ... more Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members provide meaningful care, especially during terminal illness. A literature review focused on the impact for families and the physical, psychological, social, and economic burden for family caregivers of seniors with advanced cancer, as well as related interventions. More studies are needed on family caregivers of elderly with advanced cancer in Brazil in order to develop programs to protect these important social actors.
The world is aging. In Brazil, and in several other countries in the world, changes in population... more The world is aging. In Brazil, and in several other countries in the world, changes in population's age composition have been accompanied by an increase in demand for types of health care whose cost is high. Actually, some moral conflicts are arising from allocation of public resources for health, because the magnitude of social inequalities in health and limited resources require that priorities for public management are based on knowledge of the health situation and the impact of policies, programs, projects and actions on health. In this context, the intensive medicine, managers and physicians in intensive care are subject to moral conflicts, especially at the fair micro allocation resources for the elderly in the intensive care unit level. This paper attempts to review the situation of conflicts in the light of the tools of bioethics.
Journal international de bioéthique = International journal of bioethics
Bioethics of protection is a tool which appeared in the scope of the applied ethics in Latin Amer... more Bioethics of protection is a tool which appeared in the scope of the applied ethics in Latin America, related initially to the existing moral conflicts in Public Health, approached from the dialogue with the consecrated tools of the bioethics, but enrolled in the context of the praxis of the Latin American actors, who, even though they have proper problems, share many of those of the globalized world, of the planet. To the traditional descriptive and normative functions of the applied ethics, the bioethics of protection proposes an additional function consisting in the "protection" with priority of individuals and harmed groups, in order to permit them to develop, if possible, their capabilities, necessary to their empowerment, i.e. necessary to a decent life in a conflagrated world, and, possibly, searching for rational and/or reasonable solutions. The bioethics of protection is not applied, therefore, to those affected that are able to live a decent life with their own m...
To identify ethically conflicting situations experienced by medical students of UERJ and recommen... more To identify ethically conflicting situations experienced by medical students of UERJ and recommend new bioethic contents to be incorporated in the curriculum. We have carried out an observational, cross sectional study with medical students in the last two years of the course, the period when the practice probation of interns occurs. The students had to fill out a questionnaire with personal data and open questions about conflicting situations from the point of view of ethics and how these situations had been solved, In addition there was a question about ethical issues which they would like to be included in the medical curriculum. Nearly seventy per cent of the students (n = 128) filled out the questionnaire and reported situations and suggestions involving a wide variety of ethical issues, which, in most cases, are not a part of the school curriculum. Conflicts were identified and suggestions were separated into three broad groups: medical learning situations; situations related ...
This article reflects on the moral legitimacy of implementing public policies for targeting advan... more This article reflects on the moral legitimacy of implementing public policies for targeting advanced medical care, specifically in the case of organ and tissue transplants. The article refers to two theoretical approaches: the theory of capabilities by Nussbaum and Sen and the bioethics of protection by Schramm and Kottow, considered complementary in this context. The article begins by characterizing the issue of resource scarcity in transplantation, as well as strategies to overcome this problem. Next, the capabilities approach and bioethics of protection are briefly presented. Finally, from the perspective of the above-mentioned ethical approaches, in situations of scarce health resources such as the Brazilian case, the author contends that it would be morally justified to adopt targeted policies in advanced medical care, including organ transplantation.
Home care for the elderly has become an important health care tool in both developed and developi... more Home care for the elderly has become an important health care tool in both developed and developing countries. However, several ethical, social, and operational concerns have received insufficient attention, and the Brazilian literature on this theme is limited. Starting with a bibliographic review on home care, this paper takes a bioethical approach to potential problems arising from this growing and important patient care modality. A broader ethical approach is needed to implement home care for the elderly, with policies to protect the patient, family, and caregiver, aimed at improving the quality of this program format.
The purpose of this article is to reflect on the pertinence and moral legitimacy of basing the al... more The purpose of this article is to reflect on the pertinence and moral legitimacy of basing the allocation of public resources for health on the age variable, considered from the perspective of the theory of "justice as equity" as formulated by John Rawls. After characterizing the problem of public resource allocation for health -- confronted with the challenge posed by population aging -- and briefly presenting the concept of equity adopted in this study, as well as discussing the approach by Norman Daniels and Daniel Callahan to resource allocation among different age groups, we conclude that basing resource allocation on the age variable may be considered ethically adequate if we conceive the individual's life as a limited cycle of existence formed by different stages (childhood, adolescence, maturity, old age, and death), during which the needs vary, such that the distribution of resources among different age groups should be based on an ethics of protection.
Resumo: As normas brasileiras condicionam o acesso às modificações corporais para alteração da id... more Resumo: As normas brasileiras condicionam o acesso às modificações corporais para alteração da identidade sexual à confirmação do diagnóstico psiquiátrico de transexualismotranstorno de identidade de gênero ou sexual -, e o acompanhamento psiquiátrico por dois anos para sua realização. O desconforto com o sexo anatômico e o desejo de a pessoa modificar a genitália para a do sexo oposto é o principal critério definidor do diagnóstico de transexualismo. A cirurgia de transgenitalização é considerada etapa final do tratamento, e vem sendo admitida pela instância judicial como condição necessária para a alteração da identidade sexual legal. O artigo discute o conflito moral entre o sujeito transexual e as normas vigentes em relação ao exercício da autonomia individual nas práticas terapêuticas, aplicando as ferramentas da bioética, a partir da análise dos argumentos utilizados pelas instâncias de saúde e judicial sobre o tema, nos artigos, documentos e decisões judiciais nacionais. Observa-se que houve avanços no acesso aos recursos terapêuticos e legais, mas as limitações e restrições ainda impostas ao exercício da autonomia do/a transexual podem ter efeitos negativos para a saúde e os direitos daqueles não considerados pela norma vigente como "verdadeiros transexuais". Os direitos da pessoa transexual à assistência integral à saúde, inclusive sexual, e ao livre desenvolvimento de sua personalidade são infringidos no momento em que a autonomia do paciente não é adequadamente preservada pelas normas vigentes, convertendo-se os direitos humanos num tipo de dever de a pessoa adequar-se à moralidade sexual dominante.
The purpose of this article is to raise some points for an understanding of the contemporary deba... more 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.
Rev Assoc Med Bras 2005; 51(1): 23-8 23 SITUAÇÕES ETICAMENTE CONFLITUOSAS VIVENCIADAS POR ESTUDAN... more Rev Assoc Med Bras 2005; 51(1): 23-8 23 SITUAÇÕES ETICAMENTE CONFLITUOSAS VIVENCIADAS POR ESTUDANTES DE MEDICINA RESUMO -OBJETIVO. Identificar situações eticamente conflituosas vivenciadas pelos estudantes de medicina da UERJ e dar subsídios a novos conteúdos de bioética a serem introduzidos no currículo. MÉTODOS. Realizamos um estudo observacional tipo cortetransversal com estudantes de medicina dos dois últimos anos do curso, período em que se encontram no estágio prático do internato. Os alunos responderam a um questionário com dados pessoais e perguntas abertas a respeito de situações conflituosas do ponto de vista da ética e como estas foram solucionadas e uma questão sobre os temas de ética que gostariam de ver contemplados no currículo médico. RESULTADOS. Cerca de 70% dos alunos (n=128) responderam ao questionário e reportaram situações e sugestões
This study focuses on the theme of conflict among the three underlying moral and political princi... more This study focuses on the theme of conflict among the three underlying moral and political principles in the Brazilian Public Health System (SUS), from the perspective of the bioethics of protection: the right to equality and comprehensiveness in health care, as well as universal access. We include this theme in the sphere of Public Health Bioethics, reviewing several previous studies
Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members ... more Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members provide meaningful care, especially during terminal illness. A literature review focused on the impact for families and the physical, psychological, social, and economic burden for family caregivers of seniors with advanced cancer, as well as related interventions. More studies are needed on family caregivers of elderly with advanced cancer in Brazil in order to develop programs to protect these important social actors.
The world is aging. In Brazil, and in several other countries in the world, changes in population... more The world is aging. In Brazil, and in several other countries in the world, changes in population's age composition have been accompanied by an increase in demand for types of health care whose cost is high. Actually, some moral conflicts are arising from allocation of public resources for health, because the magnitude of social inequalities in health and limited resources require that priorities for public management are based on knowledge of the health situation and the impact of policies, programs, projects and actions on health. In this context, the intensive medicine, managers and physicians in intensive care are subject to moral conflicts, especially at the fair micro allocation resources for the elderly in the intensive care unit level. This paper attempts to review the situation of conflicts in the light of the tools of bioethics.
Journal international de bioéthique = International journal of bioethics
Bioethics of protection is a tool which appeared in the scope of the applied ethics in Latin Amer... more Bioethics of protection is a tool which appeared in the scope of the applied ethics in Latin America, related initially to the existing moral conflicts in Public Health, approached from the dialogue with the consecrated tools of the bioethics, but enrolled in the context of the praxis of the Latin American actors, who, even though they have proper problems, share many of those of the globalized world, of the planet. To the traditional descriptive and normative functions of the applied ethics, the bioethics of protection proposes an additional function consisting in the "protection" with priority of individuals and harmed groups, in order to permit them to develop, if possible, their capabilities, necessary to their empowerment, i.e. necessary to a decent life in a conflagrated world, and, possibly, searching for rational and/or reasonable solutions. The bioethics of protection is not applied, therefore, to those affected that are able to live a decent life with their own m...
To identify ethically conflicting situations experienced by medical students of UERJ and recommen... more To identify ethically conflicting situations experienced by medical students of UERJ and recommend new bioethic contents to be incorporated in the curriculum. We have carried out an observational, cross sectional study with medical students in the last two years of the course, the period when the practice probation of interns occurs. The students had to fill out a questionnaire with personal data and open questions about conflicting situations from the point of view of ethics and how these situations had been solved, In addition there was a question about ethical issues which they would like to be included in the medical curriculum. Nearly seventy per cent of the students (n = 128) filled out the questionnaire and reported situations and suggestions involving a wide variety of ethical issues, which, in most cases, are not a part of the school curriculum. Conflicts were identified and suggestions were separated into three broad groups: medical learning situations; situations related ...
This article reflects on the moral legitimacy of implementing public policies for targeting advan... more This article reflects on the moral legitimacy of implementing public policies for targeting advanced medical care, specifically in the case of organ and tissue transplants. The article refers to two theoretical approaches: the theory of capabilities by Nussbaum and Sen and the bioethics of protection by Schramm and Kottow, considered complementary in this context. The article begins by characterizing the issue of resource scarcity in transplantation, as well as strategies to overcome this problem. Next, the capabilities approach and bioethics of protection are briefly presented. Finally, from the perspective of the above-mentioned ethical approaches, in situations of scarce health resources such as the Brazilian case, the author contends that it would be morally justified to adopt targeted policies in advanced medical care, including organ transplantation.
Home care for the elderly has become an important health care tool in both developed and developi... more Home care for the elderly has become an important health care tool in both developed and developing countries. However, several ethical, social, and operational concerns have received insufficient attention, and the Brazilian literature on this theme is limited. Starting with a bibliographic review on home care, this paper takes a bioethical approach to potential problems arising from this growing and important patient care modality. A broader ethical approach is needed to implement home care for the elderly, with policies to protect the patient, family, and caregiver, aimed at improving the quality of this program format.
The purpose of this article is to reflect on the pertinence and moral legitimacy of basing the al... more The purpose of this article is to reflect on the pertinence and moral legitimacy of basing the allocation of public resources for health on the age variable, considered from the perspective of the theory of "justice as equity" as formulated by John Rawls. After characterizing the problem of public resource allocation for health -- confronted with the challenge posed by population aging -- and briefly presenting the concept of equity adopted in this study, as well as discussing the approach by Norman Daniels and Daniel Callahan to resource allocation among different age groups, we conclude that basing resource allocation on the age variable may be considered ethically adequate if we conceive the individual's life as a limited cycle of existence formed by different stages (childhood, adolescence, maturity, old age, and death), during which the needs vary, such that the distribution of resources among different age groups should be based on an ethics of protection.
Resumo: As normas brasileiras condicionam o acesso às modificações corporais para alteração da id... more Resumo: As normas brasileiras condicionam o acesso às modificações corporais para alteração da identidade sexual à confirmação do diagnóstico psiquiátrico de transexualismotranstorno de identidade de gênero ou sexual -, e o acompanhamento psiquiátrico por dois anos para sua realização. O desconforto com o sexo anatômico e o desejo de a pessoa modificar a genitália para a do sexo oposto é o principal critério definidor do diagnóstico de transexualismo. A cirurgia de transgenitalização é considerada etapa final do tratamento, e vem sendo admitida pela instância judicial como condição necessária para a alteração da identidade sexual legal. O artigo discute o conflito moral entre o sujeito transexual e as normas vigentes em relação ao exercício da autonomia individual nas práticas terapêuticas, aplicando as ferramentas da bioética, a partir da análise dos argumentos utilizados pelas instâncias de saúde e judicial sobre o tema, nos artigos, documentos e decisões judiciais nacionais. Observa-se que houve avanços no acesso aos recursos terapêuticos e legais, mas as limitações e restrições ainda impostas ao exercício da autonomia do/a transexual podem ter efeitos negativos para a saúde e os direitos daqueles não considerados pela norma vigente como "verdadeiros transexuais". Os direitos da pessoa transexual à assistência integral à saúde, inclusive sexual, e ao livre desenvolvimento de sua personalidade são infringidos no momento em que a autonomia do paciente não é adequadamente preservada pelas normas vigentes, convertendo-se os direitos humanos num tipo de dever de a pessoa adequar-se à moralidade sexual dominante.
The purpose of this article is to raise some points for an understanding of the contemporary deba... more 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.
Rev Assoc Med Bras 2005; 51(1): 23-8 23 SITUAÇÕES ETICAMENTE CONFLITUOSAS VIVENCIADAS POR ESTUDAN... more Rev Assoc Med Bras 2005; 51(1): 23-8 23 SITUAÇÕES ETICAMENTE CONFLITUOSAS VIVENCIADAS POR ESTUDANTES DE MEDICINA RESUMO -OBJETIVO. Identificar situações eticamente conflituosas vivenciadas pelos estudantes de medicina da UERJ e dar subsídios a novos conteúdos de bioética a serem introduzidos no currículo. MÉTODOS. Realizamos um estudo observacional tipo cortetransversal com estudantes de medicina dos dois últimos anos do curso, período em que se encontram no estágio prático do internato. Os alunos responderam a um questionário com dados pessoais e perguntas abertas a respeito de situações conflituosas do ponto de vista da ética e como estas foram solucionadas e uma questão sobre os temas de ética que gostariam de ver contemplados no currículo médico. RESULTADOS. Cerca de 70% dos alunos (n=128) responderam ao questionário e reportaram situações e sugestões
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