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

7th International Bioethics, Multiculturalism and Religion Workshop

By Camila Salcedo

On November 11-13, the 7th International Bioethics, Multiculturalism and Religion Workshop was held in Casablanca, Morocco. It was organized by the UNESCO Chair in Bioethics and Human Rights, in partnership with Foundation Cultures du Monde and the Fondation de la Mosquée Hassan II.

This year, the conference was centered on Article 16 of the UNESCO Declaration on Bioethics and Human Rights, “The impact of life sciences on future generations, including on their genetic constitution should be given due regard.” Under this framework, it focused on the ethics of human reproduction, more specifically on pre-natal Testing, pre-implantation genetic diagnosis, and maternal surrogacy. The conference was divided into ten sessions, out of which seven were panels focusing on specific religious or secular traditions. Each of these panels included one main talk by an expert, commentary from an expert from the same tradition, and commentary from an expert from another tradition. These interventions were then followed by hour-long discussions open to all attendees.

The first two sessions set the framework for the workshop. The first session included welcoming remarks by the directors of the three organizing institutions; the director of the Médiathèque de la Fondation de la Mosquée Hassan II, Driss Alaui of the Foundation Cultures du Monde and Come to My Home, and Alberto García and Fr. Joseph Tham, LC, of the UNESCO Chair in Bioethics and Human Rights. The second session held the keynote talks, including an introduction on the latest radical innovations on assisted reproductive technologies (ART) by Prof. John Appleby, an introduction to the use of ART in Israel and Jewish views on these technologies by Dr. Jonathan Halevy, and gynecologist Dr. Paul Lee’s introduction to NaProTechnology, a possible treatment that addresses the underlying causes of infertility.

The third session–and first religious panel–was on Islamic views on ART. The main talk was given by Dr. Aasim Padela, who explained a Sunni Islam position, which rejects most forms of ART. Prof. Padela described several theological arguments and shared polls on the views of American Muslim women on these technologies. Katherine Klima, DNP, co-author of the paper presented by Padela, also joined the panel and later–in the discussion–called for a greater emphasis on the perspectives of ordinary Muslims and on the concept of human flourishing. This paper was commented upon by Prof. Mohammed Ghaly who explained the most prevalent Muslim views of ART by focusing on their understanding of parenthood. Finally, Prof. Mirko Garasic, in his comments, shared a few reflections on ectogenesis (artificial womb) from a secular Jewish perspective. The subsequent discussion centered on the topics of sterility, ectogenesis, parenthood, and the concept of the family.

The fourth session was on Christian views on ART. The main talk was given by Prof. Laura Palazzani, who explained the Catholic views on ART by explaining its emphasis on human dignity and the sanctity of human life, and the Catholic understanding of sex and procreation. Her talk was commented upon by Prof. Chris Durante, who, after an introduction to virtue ethics framework, explained the central role of individual discernment in Orthodoxy for these issues, and shared that the Greek Orthodox Church strongly discourages these practices but does not officially prohibit them. The second commenter was Prof. Paul MacNeill, who spoke from a secular position, calling the audience to try to approach common conclusions and called for the taking of a less legalistic-normative approach to ethics. The discussion that followed included several interventions from the audience who said that dogmatic and legalistic views were misunderstandings of the Catholic approach to ethics as a whole. Another key idea discussed among the experts was the possibility of a religion to reject any given action in its entirety versus only in certain instances.

The fifth session discussed Jewish positions on the current generation’s responsibilities to future generations. The main talk was given by Prof. David Heyd, who explored a section of the Babylonian Talmud that discussed whether it is better to be born or not. While he argued that this debate is meaningless because of the questions that matter are those related to what to do when existence is assumed. He then argued that unconceived people have no moral standing. This was commented upon by Prof. Jonathan Crane, who explored the Scriptural story of Leah and Rachel, on which there was divine intervention to change the children’s sex–or the children were swapped before birth–to prevent a family problem. From this, Prof. Crane deduced the permissibility of embryonic or fetal selection for gender and therapeutic purposes. The second comment was made by Fr. Joseph Tham, LC, who explored the Catholic understanding of existence and the soul, and then analyzed the story of Abraham impregnating Hagar. Fr. Tham interpreted this action as the result of Sarah and Abraham becoming impatient because God had not yet given him descendants and then trying to take destiny into their own hands. Fr. Tham spoke on the question of control in the use of ART and maternal surrogacy. The discussion that followed covered points raised by all three speakers, and it had a special focus on Heyd’s argument for non-responsibility.

The sixth session explored secular perspectives on ART. The first talk was given by Prof. Peter Mills, who discussed the intentions of couples, socio-technical contexts, and current international conventions. Prof. Mills then delved on questions of prenatal testing and human dignity, its possible impact on interpersonal relationships and the freedom of the future person, as well as some discussion on the ethics of the development of new ART techniques. The next intervention was made by Prof. Vardit Ravitsky, who called for a greater focus on the justice principle in bioethics, raising questions about inequity issues with couples who cannot afford ART, the morality of investing in ART given the number of existing children, the complexity of the concept of “healthy” children, and the subject of children who look for their genetic parents. These two interventions were commented upon by Fr. Gonzalo Miranda, LC, who talked from a Christian point of view, focusing on the concepts of human dignity and exploring the importance of metaphysical foundations in bioethics. The discussion covered topics on transhumanism, the concept of ethical boundaries, Catholic views on IVF and assistance versus substitution, interpretations of human rights and dignity, and the concept of the family.

The seventh session explored Buddhist perspectives on ART. The main talk was given by Prof. Ellen Zhang, who explained how hard it is to analyze this topic from Buddhism for lack of applicable content on ancient Buddhist texts. Zhang discussed the use of ARTs and sex selection, which is often condemned by Buddhists, but the gender preference is possibly supported by an ancient text. Prof. Zhang also talked about considerations on the qi energy of wasted sperm and a possible distinction between surrogate motherhood out of compassion and due to commodification. The first commentary was made by Prof. Soraj Hongladarom, who also insisted on the lack of sources and argued on the possible permissibility of surrogacy–even paid surrogacy–out of compassion for both the gestating mother and the couple. These points were responded to by Prof. Nouzha Gessous, who spoke from a Muslim women’s rights perspective, and expressed concerns for how ART could impact women by increasing pressures on child-rearing and through objectification and exploitation in surrogacy. Prof. Gessous also invited the panel to focus more on the children themselves and expressed concern for the idea of the right to have a child, especially a child that fits a set of desired characteristics. The subsequent discussion focused on topics related to the meaning of karma, self-cultivation and ART, international regulations on ART, and how ART impacts cultural expectations for women.

The eighth session–and last panel–was on Hinduism and ART . The first talk was given by Dr. RR Kishore, who explained some basic concepts of Hindu thought, and, using deduction from stories of Indian gods, expressed support for ART due to the interests of the couple, concerns for the possible exploitation of underprivileged women, and concerns for commodification of the embryo–for whom Kishore recognizes a sanctity of life. The first commentary was made by Prof. John Lunstroth, who questioned Kishore’s conclusions by examining his method; especially his deduction from mythical stories and his use of texts not meant for those who are not in the householder stage of life. The second comment was made by Fr. Saamer Advani, LC, who offered a Christian Catholic perspective, and raised questions about Kishore’s definition of the sanctity of life and of how Kishore argued, from ancient stories of self-sacrifice, that embryos (third parties) can be sacrificed for the interests of the couple. The discussion of this panel focused on Kishore and Lunstroth’s understandings of Indian philosophies, especially on moksha, the four stages of life, the soul, the role of women according to the ancient Vedas, and commodification in ART.

The ninth session–and last panel–was on Confucianism and ART. The main talk was given by Prof. Wenquin Zhao, who started by explaining the importance of reproduction in Confucianism and then reflected on the ethical considerations of ART as a possible way of reproduction. Prof. Zhao insisted that these methods must be taken seriously, offering surrogacy as an option (suggesting rituals like to those of adoption to mitigate alienation from the parents), and reflecting on the ambiguities related to PNT and PGD for therapeutic purposes. The first commentator was Prof. Ruiping Fan, who explained further the concept of the Qi’s–which, in Confucianism, is passed on from ancestors–and talked about Confucian hexagrams as a primary source of guidance. The second commentator was Prof. Martha Tarasco, who offered a Catholic perspective, expressing concerns for exploitation in surrogacy and the prioritization of the parental desire to have a biological child over the embryo’s right to life. The session’s discussion centered on the moral status of the unborn–with Fan disagreeing with Zhao–on the value of hexagrams in Confucianism, the value of sperm in Confucianism and Chinese society and discussion on whether loyalty to parents or children should come first.

The last session included final remarks by the organizers and speakers, as well as space for all participants to share thoughts, recommendations, and comments. Several experts said that the event surpassed their expectations–even those who said they were really looking forward to it. An expert also expressed gratitude to the partners for the venue and the cultural events. Many discussed the possible inclusion of speakers from Africa and more speakers from Latin America and suggested a greater diversity in the religious perspectives of discussants. Several also insisted on greater engagement with the local community and with younger scholars and students. Finally, the topics and locations for the next conference were discussed, but no definite topic or location was settled.

Follow this link to see more pictures of the event. 

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/

Civic Dimensions for Social Inclusion – CivicAL

Civic Dimensions for Social Inclusion – CivicAL

Follow the Official Facebook Page @Civicalproject 

The UNESCO Chair in Bioethics and Human Rights for the last year has been involved and active in raising awareness of the situation of migrants and refugees in Europe, specifically in Italy. Within the project European Citizens for Solidarity (EUROSOL), co-funded by the Europe for Citizens programme of the European Union, the UNESCO Chair was committed to overcome the misconceptions regarding migrants and refugees in Italy by organizing a debate on  “Human Dignity and Human Rights of Refugees”.

As a continuation of this project, the UNESCO Chair has signed an agreement to participate in Civic Dimensions for Social Inclusion (CivicAL) project within the Erasmus + programme coordinated by the Altius Francisco de Vitoria Foundation, Spain. The aim of this project, which started in October 2018 and will end in September 2020, is to give to migrant and refugee adults access to civic education to integrate more fully into the community. In other words, CivicAL is responding to the increasing demands of the European Union (EU) to be a large family of multiethnic and multicultural societies, to witness in each state to a growing diversity due to the migration flows where a national cultural identity is compatible with a European identity.

While much has been done, the level of knowledge of the EU, its policies and institutions, is not enough. This is particularly valid for adults in disadvantaged situations, such as those who are migrants, of an ethnic minority background, refugees and recently arrived migrants. The current proposal will address the gap in civic education for adults in disadvantaged situation in six EU countries. The consortium is composed of Bulgaria, Cyprus, Germany, Italy, Romania, and Spain from different public and private sectors. In two years, the consortium is going to develop the Trainer’s Manual entitled “Civic Education for Disadvantaged Learners” and the EU citizenship game, both translated into six EU languages.

The UNESCO Chair team involved in this project will be focused on:

  • Organizing the kick off meeting;
  • Developing unit 3 of the manual: EU citizens’ rights and responsibilities;
  • Developing level 2 of the game: Learn the citizens’ rights and responsibilities
  • Organizing Regional CivicAL Forum to disseminate the development CivicAL output, tested and available for free use by the project targets.
  • Opening and managing Facebook Group.

Moreover, to facilitate the aforementioned project, the UNESCO Chair will also provide a Code of Ethics to guide the work of the consortium.

“As Professor of Philosophy of Law, International Law, and Chairholder of UNESCO Chair, I granted the request to participate in CivicAL project, because I think it is fundamental to understand that on one hand migrants’ rights need to be respected, and on the other, migrants have their responsibilities towards the host countries. Education is a pillar in the existence of a person, a tool that frees minds and gives access to opportunities. As a UNESCO Chair, which seeks to Foster the Art of Convergence and Cooperation in Global Ethics, in EU, it is our duty to provide education tools to migrants, but it is also their responsibility to be committed to it.” Alberto Garcia, Chairholder of UNESCO Chair in Bioethics and Human Rights.

Meterials