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Enviado por Biblio on 30/11/2015 11:28:40 (7 Lecturas)

Jacob Moses et al. "Bioethics Casebook 2.0: Using Web-Based Design and Tools to Promote Ethical Reflection and Practice in Health Care." Hastings Center Report 45, no. 6 (2015): 19-25.

Bioethics Casebook 2.0: Using Web-Based Design and Tools to Promote Ethical Reflection and Practice in Health Care An online tool is designed to aid physicians in Singapore in making difficult decisions with patients and families.
Jacob Moses, Nancy Berlinger, Michael C. Dunn, Michael K. Gusmano, and Jacqueline J. Chin
The idea of the Internet as Gutenberg 2.0—a true revolution in disseminating information—is now a routine part of how bioethics education works. The Internet has become indispensable as a channel for sharing teaching materials and connecting learners with a central platform (such as a professional society’s website or a course page on a university’s web portal) that houses materials to support an online or hybrid curriculum or a traditional course. A newer idea in bioethics education reflects developments in web-based medical education more broadly and draws on design principles developed for the Internet. This approach to online bioethics education requires thinking about web-based learning as an engaging, potentially immersive experience, about learners’ expectations concerning web-based learning, and about differences between self-directed learning and teaching to support group learning.

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Enviado por Biblio on 30/11/2015 11:28:19 (8 Lecturas)

J Med Ethics 2015;41:927-928 doi:10.1136/medethics-2014-102604
Author meets critics: response
Do we need an alternative ‘relational approach’ to saviour siblings?

Stephen Wilkinson

Received 12 February 2015
Accepted 20 February 2015
Published Online First 9 March 2015

Michelle Taylor-Sands rejects the argument ‘commonly used to justify selective reproduction, that it is better to be born than not’.1 The supposed inadequacy of this position is one of the things that pushes her towards an alternative ‘relational’ approach. Here, I consider briefly her three main objections:

The Non-Identity Problem does not apply to all the risks associated with the preimplantation genetic diagnosis (PGD) process.

The ‘life not worth living’ standard applied in wrongful life cases is not suitable for selective reproduction.

The reasoning described above has ‘morally objectionable’ implications.

Risks from the PGD process
One of Taylor-Sands’ most interesting suggestions is that there might be a difference between selecting a (future) child because it is congenitally deaf and some other forms of selective reproduction. Taylor-Sands accepts that
An embryo selected because it is deaf could only ever become a deaf child. There are no other options for that child apart from becoming a deaf child, apart from non-existence (p. 18).1

But what goes for the deafness case does not, she claims, apply to the whole of selective reproduction
… additional risks of harm associated with the PGD process (which involves ART and embryo biopsy) … could be avoided if the child is born naturally. The non-identity problem is not relevant to these risks of harm because there is another option for the child—to be born as a result of natural conception (p. 18).1

It is difficult, however, to see much difference between the deafness case and the saviour sibling case in this respect. In the choosing deafness case, the parents have a choice between several embryos, one of …

Enviado por Biblio on 30/11/2015 11:27:48 (7 Lecturas)

Med Humanities 2015;41:145-146 doi:10.1136/medhum-2015-010715
The reading room
Book review
Being Mortal: Illness, Medicine and What Matters in the End
By Atul Gawande. Published by Profile Books in association with the Wellcome Collection, 2014, hardback, 288 pages. ISBN 978-1846685811,
Neil Vickers

This book is a jeremiad against the way Western society views mortality in general and old age in particular. We have tried to deal with mortality by treating it as a medical problem. “The prevailing fantasy”, Atul Gawande writes, “is that we can be ageless”. We bundle elderly people into nursing homes because when it comes to our loved ones we think safety should trump autonomy at any cost (when it comes to ourselves it is the other way around). We pay remarkably little attention to the kind of social capital that is available in these places. Gawande observes that in the USA most nursing homes market their services according to what they think will please their residents’ families, not their residents. When his wife's grandmother, Alice Hobson, became unable to continue living on her own, her family moved her into a ‘senior-living complex’ that “involved the imposition of more structure and supervision than she'd ever had to deal with before”. After a fall, Alice was moved to a skilled nursing floor, where all privacy and control were gone. “She woke when they told her, bathed and dressed when they told her, ate when they told her. She lived with whomever they said she had to… She felt incarcerated, like she was in prison for being old.”

Enviado por Biblio on 30/11/2015 11:25:53 (8 Lecturas)

Cardozo de Martínez Carmen Alicia, Maldonado Gómez Olga del Carmen, García González Alicia, Segovia Baus Galo. Definición de la política pública en prevención y manejo del maltrato y el abuso: bioética hermenéutica y salud pública como referentes. Acta bioeth. [Internet]. 2015 Jun [citado 2015 Nov 26] ; 21( 1 ): 93-101. Disponible en:

Resumen: La bioética hermenéutica, como práctica racional, razonada y sensitiva, permite poner en movimiento, a través de la deliberación, el diálogo y el análisis interpretativo, diferentes respuestas discursivas que contribuyen a dar un nuevo significado a las condiciones de las relaciones intersubjetivas sociales y familiares, en el marco tanto de la intencionalidad ética, orientada a la vida buena (teleológico), como en el marco normativo (deontológico), como complementarios. En el maltrato y abuso infantiles es necesario generar nuevas comprensiones y discursos, como resultado de las nuevas configuraciones sociales, culturales y filiales, que simultáneamente superen la dicotomía persistente víctima-victimario y que permitan interpretar, reinterpretar y proponer nuevos planteamientos para la política pública y la salud pública. Este artículo evidencia la posibilidad de generar nuevos enfoques integradores —éticos, políticos y sociales—, sobre la manera como se comprende el maltrato infantil, en una perspectiva compleja y dinámica, que lo sitúa en el campo de las interacciones humanas y de sus vicisitudes.

Palabras clave: bioética hermenéutica, salud pública, política pública, categorías de encuentro, maltrato y abuso infantil

Enviado por Biblio on 30/11/2015 11:07:15 (7 Lecturas)

How do ‘Public’ Values Influence Individual Health Behaviour? An Empirical-Normative Analysis of Young Men’s Discourse Regarding HIV Testing Practices
Rod Knight


Philosophical arguments stemming from the public health ethics arena suggest that public health interventions ought to be subject to normative inquiry that considers relational values, including concepts such as solidarity, reciprocity and health equity. As yet, however, the extent to which ‘public’ values influence the ‘autonomous’ decisions of the public remains largely unexplored. Drawing on interviews with 50 men in Vancouver, Canada, this study employs a critical discourse analysis to examine participants’ decisions and motivations to voluntarily access HIV testing and/or to accept a routine HIV test offer. Within a sub-set of interviews, a transactional discourse emerged in which the decision to test features an arrangement of ‘giving and receiving’. Discourses related to notions of solidarity emphasize considerations of justice and positions testing as a ‘public’ act. Lastly, ‘individualistic’ discourses focused on individual-level considerations, with less concern for the broader public ‘good’. These findings underscore how normative dimensions pertaining to men’s decisions to test are dialectically interrelated with the broader social and structural influences on individual and collective health-related behaviour, thereby suggesting a need to advance an explicit empirical-normative research agenda related to population and public health intervention research.

© The Author 2015. Published by Oxford University Press. Available online at

Enviado por Biblio on 30/11/2015 11:02:06 (7 Lecturas)

Med Humanities 2015;41:77-80 doi:10.1136/medhum-2014-010642
Original article
Who speaks for whom? Health humanities and the ethics of representation

Received 13 November 2014
Revised 25 February 2015
Accepted 2 March 2015
Published Online First 20 March 2015

The medical or health humanities are in essence a form of advocacy, a means of addressing a problem of underrepresentation. They focus on suffering, rather than pathology, and on sociocultural understandings of illness and disability, rather than a narrow biomedical perspective. The health humanities thus analyse and attempt to recalibrate the power imbalance in healthcare. This article reviews health humanities scholarship that addresses underrepresentation through the analysis of illness and disability narratives. It examines the ethics of representation by exploring how literary representation functions, its aesthetic as well as political dimensions, and how it operates as a relay mechanism for power. The mechanism of representation is further explored through a reading of Eli Clare's narrative Exile and Pride. Donna Haraway's notion of articulations is proposed as a tool for a more ethical approach to representation. The article suggests that transparency about the power health humanities scholars stand to gain through representation may contribute to a more ethical health humanities practice.

Enviado por Biblio on 27/11/2015 10:19:53 (18 Lecturas)

Conflicting Values: A Case Study in Patient Choice and Caregiver Perspectives
Margot M. Eves, Phoebe Day Danziger, Ruth M. Farrell, Cristie M. Cole
From: Narrative Inquiry in Bioethics
Volume 5, Number 2, Summer 2015
pp. 167-178 | 10.1353/nib.2015.0054

Decisions related to births in the “gray zone” of periviability are particularly challenging. Despite published management guidelines, clinicians and families struggle to negotiate care management plans. Stakeholders must reconcile conflicting values in the context of evolving circumstances with a high degree of uncertainty within a short time period. Even skilled clinicians may struggle to guide the patient in making value–laden decisions without imposing their own values. Exploring the experiences of one pregnant woman and her caregivers, this case study highlights how bias may undermine caregivers’ ability to meet their obligation to enhance patient autonomy and the moral distress they may experience when a patient’s values do not align with their own. Management strategies to mitigate the potential impact of bias and related moral distress are identified. The authors then describe one management strategy used in this case, facilitated ethics consultation, which is focused on thoughtful consideration of the patient’s perspective.

Enviado por Biblio on 27/11/2015 10:16:56 (16 Lecturas)

Biobanks and human health research: Balancing progress and protections
A Dhai, S Mahomed, I Sanne

Biobanks are repositories that store human biological materials and their associated data. They are rapidly becoming part of national and international networks and give rise to unique ethico-regulatory issues. Whether consent is informed and whether this term should be used when specimens are collected for biobank research is questionable. Where risks occur, they are usually social and relate to identifiability. Public trust and confidence are important for the success of this type of research. Consensus is growing that governance of biobanks should be harmonised. Controlled specimen and data access agreements are essential. The South African National Health Act (NHA) and its Regulations, that provide the foundation for the legal framework with regard to human tissue and research in South Africa, are silent on the issue of biobanks and the law lags behind while science and technology advance rapidly. The use of biobank assets will lead to significant benefits in human health and should be encouraged while taking account of the associated ethical, legal and social issues and working towards a balance between these two positions.

Enviado por Biblio on 27/11/2015 10:16:25 (18 Lecturas)

Leadership in the clinical workplace: what residents report to observe and supervisors report to display: an exploratory questionnaire study
Martha A. van der Wal, Fedde Scheele, Johanna Schönrock-Adema, A. Debbie C. Jaarsma and Janke Cohen-Schotanus

BMC Medical Education 2015, 15:195 doi:10.1186/s12909-015-0480-5

The electronic version of this article is the complete one and can be found online at:

Received: 16 April 2015
Accepted: 25 October 2015
Published: 2 November 2015
© 2015 van der Wal et al.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Within the current health care system, leadership is considered important for physicians. leadership is mostly self-taught, through observing and practicing. Does the practice environment offer residents enough opportunities to observe the supervisor leadership behaviours they have to learn? In the current study we investigate which leadership behaviours residents observe throughout their training, which behaviours supervisors report to display and whether residents and supervisors have a need for more formal training.

We performed two questionnaire studies. Study 1: Residents (n = 117) answered questions about the extent to which they observed four basic and observable Situational Leadership behaviours in their supervisors. Study 2: Supervisors (n = 201) answered questions about the extent to which they perceived to display these Situational Leadership behaviours in medical practice. We asked both groups of participants whether they experienced a need for formal leadership training.

One-third of the residents did not observe the four basic Situational Leadership behaviours. The same pattern was found among starting, intermediate and experienced residents. Moreover, not all supervisors showed these 4 leadership behaviours. Both supervisors and residents expressed a need for formal leadership training.

Both findings together suggest that current practice does not offer residents enough opportunities to acquire these leadership behaviours by solely observing their supervisors. Moreover, residents and supervisors both express a need for more formal leadership training. More explicit attention should be paid to leadership development, for example by providing formal leadership training for supervisors and residents.

Keywords: Leadership development; Residency; Postgraduate medical education; Work-based learning

Enviado por Biblio on 27/11/2015 10:15:40 (17 Lecturas)

Azevedo Bruno Del Sarto, Biondo Chrisne Santana, Sena Edite Lago da Silva, Boery Rita Narriman Silva de Oliveira, Yarid Sérgio Donha. Reflexão bioética sobre o acesso à saúde suplementar no Brasil. Acta bioeth. [Internet]. 2015 Jun [citado 2015 Nov 26] ; 21( 1 ): 117-125. Disponible en:

Resumo: Trata-se de uma revisão integrativa que objetivadesenvolver uma reflexão bioética a partir do que a literatura científica tem pesquisado sobre o acesso da população brasileira à saúde suplementar. Realizou-se uma busca na Biblioteca Virtual em Saúde, utilizando descritores, dos Descritores em Ciências da Saúde, relacionados à temática estudada, resultando na seleção de sete artigos. Evidenciou-se que o acesso aos serviços da saúde suplementar é conseguido apenas por grupos específicos de pessoas, o que representa um dado sintomático do mal-estar que vive a sociedade brasileira em razão do sucateamento do setor público e da elitização dos serviços particulares. Fato estequeconduz à consequente transgressão de princípios bioéticos como igualdade, justiça e equidade. Faz-se mister, então, a incorporação de reflexões bioéticas nas discussões sobre o respeito à autonomia do indivíduo, com total direito de buscar o acesso a planos privados como meio de ver seus problemas de saúde resolvidos,e sobre a responsabilidade do Estado quantoà implementação de um acesso à saúde equitativo e de qualidade aos cidadãos.

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