Guía Práctica para la toma de decisiones clínicas con ética ante la pandemia COVID-19

Nuestras investigadoras Mariel Kalkach Aparicio y Ma. Elizabeth de los Ríos Uriarte junto a un grupo de trabajo interdisciplinario, en diálogo constante y con base en la experiencia de médicos en España, Italia, México y EU, han trabajado sobre una guía práctica con 7 pasos que son recomendaciones para el personal de salud que se enfrenta a la toma de decisiones éticamente difíciles durante COVID19.

Introducción

Coherentes con los esfuerzos de organismos internacionales que exhortan a los países e individuos a proteger y acompañar a los profesionales de la salud en esta pandemia de diversas formas (5, 6), el propósito de esta guía es dar un acompañamiento de ética a la toma de decisiones de los profesionales de la salud. Se propone un listado de siete pasos concretos a tomar en cuenta durante la valoración de lo que se cree que pudiera ser un dilema moral en la atención médica durante la pandemia. De tal modo que el médico que la considere tome decisiones informadas para el beneficio suyo y de la sociedad. Al integrar consideraciones éticas en beneficio de su paciente y su sociedad, el médico comparte su responsabilidad con la sociedad y dicha sana distribución de cargas, permite su alivio psicológico y moral porque ha hecho lo correcto. Aunado a esto, la transparencia en la justificación detrás de cada postura otorga a la sociedad una sensación de certidumbre muy importante en este momento, de acuerdo con las recomendaciones de la Organización Mundial de la Salud (OMS). (4, 7)

Source: https://www.anahuac.mx/mexico/EscuelasyFacultades/bioetica/sites/default/files/inline-files/Decide_directo_con_7_pasos.pdf

The Concept of Person in the Jurisprudence of the Constitutional Court

On December 14th, Prof. Alberto Garcia, our Director, in quality of member of the evaluation commission of the research work in the Faculty of Law of the Complutense University of Madrid, took part in Lorena Velasco Guerrero’ presentation of her 1100-page dissertation on “The concept of person in the Jurisprudence of the Constitutional Court.” She analyzed 36 years of resolutions of the Spanish Supreme Court on the concept of person, a fundamental concept in bioethical issues.

In the conclusion Lorena Velasco Guerrero claims that “the person is affirmed as a living being. Life that constitutionally has to be understood as a path that begins with gestation and ends with death, in which qualitative changes of a somatic and psychic nature take place, due to the physical and a moral —or psychological— dimension that composed the person in “psychosomatic unity”. The person is sexed. Depending on their sex, their biological reality, it can be one of two genders of the human species: male or female. In addition to biological sex, the sexual orientation and sexual identity are considered in the decisions of the High Court.”

She also emphasizes that “The lack of conceptualization and the equivocality in the use of the terms of close significance makes it difficult to clearly determine the reference to the person by any of them. It has to be taken into consideration that, although generally
speaking human being means person, due to the present legislation, only born human beings are persons and only viable individuals are human beings. The term individual might refer both to the person or to the citizen. Citizen generally refer to the individual physical person, although sometimes it include legal persons. Finally, while the term nobody might refer to person, the term all would not refer to every person but to every human being, including the nasciturus – although this express indication is not applied by the TC in the interpretation of the entire article.”

Prof. Alberto Gracia underlines how was interesting that “since the term person has been constitutionalized, it necessarily becomes the subject of constitutional interpretation —the Constitution, after all, does not say anything more or less than what the Constitutional Court says it says—. The multiplicity of interpretative criteria and the absence of justification in their election entails a constitutional voluntarism, a breach of the principle of legal security. Insecurity that is aggravated by the denial of any unavailable elements. There
is nothing, not even the concept of person, that cannot be changed.”

Follow thin link to read the conclucions

Lecturer: Prof. Stefano Mazzoleni from The BioRobotics Institute of Sant’Anna School of Advanced Studies, Pisa

By Giulia Bovassi –

Gruppo di Ricerca interdisciplinare in Neurobioetica (GdN)

Masterclass in “Neurobioethics and Roboethics”, 2nd edition, 1st lesson
Lecturer: Prof. Stefano Mazzoleni from The BioRobotics Institute of Sant’Anna School of Advanced Studies, Pisa

 

Abstract

 

The second Masterclass in Neurobioethics “Neurobioethics and Roboethics”, which will be focused this year upon the proposals coming from robotics. Robotics is a large branch of study in continuous and rapid development, not only from the industrial perspective, but also from the medical, family and private ones. Man-machine hybridization has already come about, occupies numerous daily spaces, and raises the ethical and existential questions about what we have to say about this new identity.

GdN, in partnership with the UNESCO Chair in Bioethics and Human Rights and the Science and Faith Institute, hosted in the prestigious academic headquarters of the Pontifical Athenaeum Regina Apostolorum, has undertaken a watchful, refined interdisciplinary investigation, which will continue during this and the next four years, in order to achieve the best possible result in the professional, academic research, which is dedicated to the new questions that bioethics, philosophy, anthropology, medicine, engineering, law, theology, interreligious and multicultural sciences raise for the today’s man. The studies of the neurosurgeon Sergio Canavero regarding the human head transplantation, have created an intellectual sensation.

Dr. Stefano Mazzoleni, lecturer and Coordinator of the Bioengineering Laboratory of Rehabilitation, through his speech titled “Human-machine interaction: can robots and AI help improve our quality of life, particularly the quality of life of people with disability?”, guided the participants through the logic of robotic engineering applied to the user-help, referring especially to patients who face difficulties managing their daily routine due to their physical limits. The concern for these needs pushes biorobotics in the direction of service, which looks for the good man.
A similar interest in the applications and the ethics of robotics was born recently with the advent of a new engineering oriented to products’ usability, beyond the strictly industrial-mechanical context, to families and citizens’ homes. There is talk of the domestic usage of an entity built to enter into a relationship with the needs of man (an element which has been initially designed almost exclusively to accomplish difficult and complex industrial jobs).

The very origin of the term “robot”, derived from “robota“, refers to heavy work, an index of the nature inherent in the functional-collaborative interaction with human effort, a cooperation that does not (or should not) propose replacement for optimization, namely the efficiency that takes away dignity, but rather should support the thinking subject as the true protagonist. «Observing nature to understand its needs, in the wake of what Leonardo da Vinci has done», educating future engineers in the renaissance model of their profession, so that, seeing trauma or disability, they understand how to take the opportunity to put individual skills at service of others. This fundamental assumption of biorobotics, which has close to its heart the dignity and the good of the person, is absolutely essential; it is indispensable because, without such trajectories, the “ability to make” surrenders to the causes of its birth, namely the “creating know-how” gains the probability of destroying / threatening mankind, a risk that is considered to be therefore acceptable. Cinematography and literature on biorobotics, since the ’80s and decisively surging in the 2000s, suggests new goals. Since 2000, through «bio-inspiration» many capacities not previously explored has taken shape: generation of movement through sensors; wondering why, observing natural and animal bodies to overcome their limits through robotic replication. This progress has led from rigid robotics to neurorobotics and “soft robotics.

Currently, biorobotics explains the medical implant of organs and artificial limbs where they are absent, bringing in close contact doctors, researchers, scientists, engineers whose work will be a qualitative improvement of the life of patients for whom biorobotics will be an advantage. For example, the robotic hand, whose functioning Dr. Mazzoleni has highlighted, and which could be summarized in the interception of the electric impulse, thanks to the study of nerve signals, referring to the intentionality of moving the robotic hand as the human one usually moves. Biorobotics also promises benefits such as smaller incisions, shorter hospitalization, reduced risk of infection, less pain, faster healing times.

Asimov’s “I, Robot” presents a futuristic dystopian vision of distant worlds in which the natural and artificial cohabit a single body, a single identity or dimension. Such works move the collective imagination between nightmare and dream, fear and hope. On the one hand, the expert responds by releasing us from the anxieties related to robot’s autonomy, the exit from the calculated control, the serenity that derives from the construction of a humanoid machine, which can act (according to the dictates of the human) but it is not able to want since they learn what their creator wants to let them know.

 

Considering the robot as a tool does not scare, but to think of it as similar to the human species does frighten. Prof. Mazzoleni spoke of the “Uncanny valley“, a perturbing valley, a “sudden fall” in that place where we lose the serene familiarity with objects which have a human appearance. The technical aspects and scientific disciplines treated so far have noted the positive contributions of the relationship between man and machine, but they do not remove that feeling of extraneousness and uncertainty. In this context, bioethics is called to take a buffer function thanks to the critical and rational reflection that the dialogue between research fields, near or far, can build when the object is a subject, i.e. the human being. It encourages the beneficial contribution that robotics, together with artificial intelligence, are making and are destined to cultivate. Preventive ethical vigilance should not degenerate into the trivialization of itself. Instead it is necessary to consider the hypothesis that not all philosophical-scientific movements have close to heart the integral good of the human being, so acting according to the measure of the productive, empowering or efficient advantage, even if this should force us to consider the human being as an entity not dissimilar to what everyone wants to find in his own nature, which is as a bastion of innovation. Conversing about the irreplaceable nature of the human presence in collaboration with technology is the proactive strategy implemented by this first, very rich, appointment, whose spirit resides exactly in living what we know, together with what remains ahead.

Informed Consent Seminars – LUMSA University

 

By Santiago Marcet –

On October 10th and November 12nd, Prof. Alberto Garcia, Director of UNESCO Chair in Bioethics and Human Rights, attended LUMSA’s venues in Rome and Palermo to give a presentation on the details of the European project of i-CONSENT, as well as to explain the intricacies that go along the practical and theoretical notion of informed consent (IC) in clinical research.

On a theoretical level, Prof. Garcia highlighted the importance of taking into consideration the factors of gender, age and cultural and religious background if one’s approach to constitute successful patterns of informed consent is to be effective. Thinking about these vulnerability factors will help consolidate i-CONSENT as a person-centered project, as it considers how the above mentioned factors change the way in which patients understand information and communicate with others.

He also approached the tensions that arise from a conceptualization of IC that depends on a notion of individual autonomy that is not shared by all cultures and religions: while western culture tends to give importance to the individual and his or her rights, eastern traditions use to put more weight on community and the duties that derive from it. Thinking about how each major religious tradition (namely Buddhism, Confucianism, Christianity, Judaism, Hinduism and Islam) views IC in accordance to their doctrine and traditions will help to outline defined goals for the effectiveness of i-CONSENT.

Prof. Garcia went on to talk about the practical expected outcomes of the project: i-CONSENT intends to be beneficial both for patients and researchers, in a way that will benefit society as a whole. In its person-centered approach it will develop different tests and will aim to involve different physicians in accordance to the profile of the patient, effectively incorporating its principles with their presence on regulatory bodies and ethics groups. The overall goal, according to Prof. Garcia, is to increase the standards of clinical research by making IC form and the whole process more comprehensive and mindful of the patient’s particularities.

You can read more about the i-CONSENT project as it is approached by the UNESCO Chair in Bioethics and Human Rights here: http://www.unescobiochair.org/2017/06/02/new-eu-project-works-on-improving-guidelines-for-informed-consent-including-vulnerable-populations-under-a-gender-perspective/

Visit i-CONSENT’s official website: https://i-consentproject.eu/

VIII International Bioethics Conference in Bogotá

By Santiago Marcet – 

The Director of the UNESCO Chair in Bioethics and Human Rights, Dr. Alberto García Gómez, attended the VII International Congress of Bioethics held by the Universidad Militar Nueva Granada in Bogotá, Colombia, during the 3rd, 4th and 5th of October.

 

In his lecture titled “Neurobioethics, Placing the Human Being at the Center of Neuroscience, Ethics, and Law” Dr. García reviewed some of the most prominent topics in the field of neurotechnology, and as the title suggests, he was able to explore the ways in which the human being ought to remain the gravitational center of such a rapidly evolving reality.

The first issue Dr. García addressed was the need to re-formulate the ways in which we think about our brain. What is the relation between mind and brain? Despite the common claims that both are one and the same thing, we are still unable to locate the human sense of identity and self within any of the 28 substructures of the brain. The intangibility of human singularity invites us to think of the human being not only as an material entity, but also as a transcendent one: by means of rationality, we are able to place our inclinations beyond the contingencies of our material body, interact with others in society and foment virtue.

 

This perception of the human being introduced Dr. García’s next discussion, namely the bioethics of neuroscience. As he insisted, a position open to progress and change must belong to all bioethicists, as long as the overarching anthropological view is not lost. Moral judgement, he stated, must focus on two elements when talking about neuroscientific ends: the means by which they are achieved and their intention. Drawing on this distinction, Dr. García talked about the essential differences between therapy and enhancement, which lead him to address Transhumanism in a neutrally critical way: the disposition to endow the human being with a higher degree of dignity by means of biological enhancement can prove to be a slippery slope, and common good must prevail over individual dispositions. Many questions surround this topic: does all scientific advance constitute progress? Will enhanced human capabilities increase the already existing gap between the rich and the poor? Will the transhuman being constitute a new paradigm that will make the concept of human singularity blur? These and many other issues should always be addressed bearing the idea of human dignity in mind.

 

Reversing the actors of his previous discussion, Dr. García talked about the neuroscience of ethics. Or in other words, the ways in which neuroscience can help us understand the intricacies of our moral thought. He explained the problems that arise from the implantation of recent theories that deny the existence of human free will. If there is indeed a measurable relation between certain brain structures and human behavior, if human choices are nothing more than the end of a chain of causality that is merely material, he states, the concepts of responsibility (in moral terms) and imputability (in legal terms) lose all meaning.

 

Dr. García finished his lecture reminding us that human dignity is not derived from the complexity of our biological structures nor from our mental functions and faculties. Rather, it is found in the metaphysical reality that goes along the fact of being human: transcendence.