Cadernos de Saúde Públicahttps://www.scielosp.org/feed/csp/1999.v15suppl1/2017-01-28T00:11:00ZUnknown authorVol. 15 - 1999WerkzeugUnknow titleS0102-311X19990005000012017-01-28T00:11:00Z2017-01-28T00:11:00ZThe principles of medical ethics and medical researchS0102-311X19990005000022017-01-28T00:11:00Z2017-01-28T00:11:00ZHarris, John
<em>Harris, John</em>;
<br/><br/>
In this paper I discuss the application of the principles of medical ethics and of medical research to the case of children and others whose consent to treatment and to research is problematic. Public health depends substantially on the possibility of ongoing research into all conditions which affect the health of the people. Constraints on this research are therefore a public health issue. Moreover and more importantly the possibility of predictive testing and indeed of screening for health-relevant conditions is an important public health tool, and limitations on the use of this tool are of great significance to public health medicine. Having considered the particular problems created by research and predictive testing on children for late-onset conditions I go on to discuss research on those whose consent is problematic more generally. I conclude with radical recommendations for the reform of The Declaration of Helsinki and of the International Ethics Guidelines for Biomedical Research Involving Human Subjects, prepared by the Council for International Organizations of Medical Sciences (CIOMS).Paradigm shift, metamorphosis of medical ethics, and the rise of bioethicsS0102-311X19990005000032017-01-28T00:11:00Z2017-01-28T00:11:00ZAlmeida, José Luiz Telles deSchramm, Fermin Roland
<em>Almeida, José Luiz Telles De</em>;
<em>Schramm, Fermin Roland</em>;
<br/><br/>
Both the increasing incorporation of medical technology and new social demands (including those for health care) beginning in the 1960s have brought about significant changes in medical practice. This situation has in turn sparked a growth in the philosophical debate over problems pertaining to ethical practice. These issues no longer find answers in the Hippocratic ethical model. The authors believe that the crisis in Hippocratic ethics could be described as a period of paradigm shift in which a new set of values appears to be emerging. Beginning with the bioethics movement, the authors expound on the different ethical theories applied to medical practice and conclude that principlism is the most appropriate approach for solving the new moral dilemma imposed on clinical practice.On the concept of eugenics: preliminaries to a critical appraisalS0102-311X19990005000042017-01-28T00:11:00Z2017-01-28T00:11:00ZNeri, Demetrio
<em>Neri, Demetrio</em>;
<br/><br/>
This paper's main issue is linked to what can be foreseen as the increasing capability of medical genetics to modify the genetic composition of the human species through direct interventions in the human genome for medical and non-medical purposes, i.e., the 'risk' of a resurgence of eugenics. In current discussions on the topic (briefly presented in the first section), the 'phantom of eugenics' is raised several times, but there is a great deal of confusion on what counts as eugenics, partly because of broad conceptual disagreement over the notion itself. Furthermore, according to some scholars there is no hope of overcoming this unsatisfactory conceptual uncertainty. Partly challenging this opinion, the second and third sections of this paper attempt to identify some basic features which could be seen as intrinsically linked to the notion of eugenics, with the aim of reducing the range of conceptual disagreement as a preliminary step in bringing into focus what exactly is wrong with practicing eugenics. The subsequent sections deal with the substantive issue of whether or not to practice eugenics from the point of view of the interest of future generations in the human species' genetic composition. The main moral arguments for and against eugenics are examined from the point of view of our obligations towards future generations, and the conclusion is in favor of a cautious 'open-door' position.Bioethical language and its dialects and idiolectsS0102-311X19990005000052017-01-28T00:11:00Z2017-01-28T00:11:00ZGarrafa, VolneiDiniz, DeboraGuilhem, Dirce Bellez
<em>Garrafa, Volnei</em>;
<em>Diniz, Debora</em>;
<em>Guilhem, Dirce Bellez</em>;
<br/><br/>
In their search for answers to the relevant theoretical questions on importing knowledge in practical ethics, the authors take an instrumental approach to metaphor. This figure of language allows one to compare language and linguistic variants to bioethics and knowledge. As defined by the dictionary, an 'idiom' is the official language of a nation, a 'dialect' is a regional variant of an idiom, and an 'idiolect' is an individual variant of a dialect. The bioethical idiom is thus seen as a linguistic set constituting a 'bioethical nation'. Since it is situated above particular dialects, it exercises more than a regulatory role over the discipline. In this article, in order to focus on the process of transmission of knowledge in bioethics, the authors chose Diego Gracia's work as a paradigmatic reference to the question on the transculturation of dialects and the relations in bioethics which are considered 'peripheral' or 'central'. Although this researcher found the key question pointing to the core of the problem of importing dialects, he is still searching for a proper answer to the cultural/bioethical context/contradictionSanitary justice in scarcityS0102-311X19990005000062017-01-28T00:11:00Z2017-01-28T00:11:00ZKottow, Miguel
<em>Kottow, Miguel</em>;
<br/><br/>
Justice in health care and the allocation of scarce medical resources must be analyzed differently in affluent as compared to economically weaker societies. The protective functions of the state must be extended to cover basic needs for those too poor to meet them on their own. Medical needs are a high priority, since poor health hampers the ability to secure other basic needs. The state may operate as either a health care provider or supervisor, guaranteeing that citizens be treated fairly by nongovernmental institutions. Two-tiered systems with a vigorous private health care sector are compatible with the explicit right to health care, provided the private tier operates without directly or indirectly draining public funds.The Dolly case, the Polly drug, and the morality of human cloningS0102-311X19990005000072017-01-28T00:11:00Z2017-01-28T00:11:00ZSchramm, Fermin Roland
<em>Schramm, Fermin Roland</em>;
<br/><br/>
The year 1996 witnessed the cloning of the lamb Dolly, based on the revolutionary somatic cell nuclear transfer (SCNT) technique, developed by researchers from the Roslin Institute in Edinburgh, Scotland. This fact marked a relevant biotechnoscientific innovation, with probable significant consequences in the field of public health, since in principle it allows for expanding possibilities for the reproductive autonomy of infertile couples and carriers of diseases of mitochondrial origin. This article expounds on 1) the experiment's technical data and the theoretical implications for the biological sciences; 2) the public's perception thereof and the main international documents aimed at the legal and moral regulation of the technique; and 3) the moral arguments for and against cloning, from the point of view of consequentialist moral theory. We conclude that in the current stage of the debate on the morality of cloning, in which there are no cogent deontological arguments either for or against, weighing the probability of risks and benefits is the only reasonable way of dealing with the issue in societies that consider themselves democratic, pluralistic, and tolerantThe morality of assisted reproduction and genetic manipulationS0102-311X19990005000082017-01-28T00:11:00Z2017-01-28T00:11:00ZMori, Maurizio
<em>Mori, Maurizio</em>;
<br/><br/>
The author analyzes the pros and cons of various forms of assisted reproduction, including the use of so-called 'genetic manipulation'. He shows how in ethics the only arguments with any chance of reaching a consensus (or at least an agreement) are those of the rational type, based on universally acceptable ethical principles or corroborated by empirical facts and real life experience (as the starting point for identifying problems requiring analysis). After an analysis in which he identifies the incoherence and inconsistency of arguments against assisted reproduction, the author defends the right of human beings to decide autonomously about the most healthy forms of procreation, including those involving genetic manipulation. His starting point is the moral principle by which it is morally preferable to intervene in natural processes (as opposed to not intervening) whenever this implies preventing and reducing disease and sufferingApocalypse... Now? Molecular epidemiology, predictive genetic tests, and social communication of genetic contentsS0102-311X19990005000092017-01-28T00:11:00Z2017-01-28T00:11:00ZCastiel, Luis David
<em>Castiel, Luis David</em>;
<br/><br/>
The author analyzes the underlying theoretical aspects in the construction of the molecular watershed of epidemiology and the concept of genetic risk, focusing on issues raised by contemporary reality: new technologies, globalization, proliferation of communications strategies, and the dilution of identity matrices. He discusses problems pertaining to the establishment of such new interdisciplinary fields as molecular epidemiology and molecular genetics. Finally, he analyzes the repercussions of the social communication of genetic content, especially as related to predictive genetic tests and cloning of animals, based on triumphal, deterministic metaphors sustaining beliefs relating to the existence and supremacy of concepts such as 'purity', 'essence', and 'unification' of rational, integrated 'I's/egos'.Reflections on bioethics: consolidation of the principle of autonomy and legal aspectsS0102-311X19990005000102017-01-28T00:11:00Z2017-01-28T00:11:00ZSegre, Marco
<em>Segre, Marco</em>;
<br/><br/>
The author highlights the importance of emotions in all ethical reflections. He describes the most common positions of ethicists employing duties and rights as the basis for ethical thought. The author, goes to Freudian theory as viewed by the utilitarians, stating that the 'quest for pleasure' is not necessarily egocentric, especially for adults. For example, the feeling of solidarity emerges 'from the inside out', making irrelevant all the emphasis laid on obedience to duty (from the outside in). The article questions the essence of Kantian theory, based exclusively on 'reason' with disregard for feelings, by establishing what he considers a 'positivist' view of rational thought. It emphasizes the principle of autonomy, which it seen as basically opposing the principles of beneficence and fairness. It is proposed that the latter should be seen as what he calls heteronomy (a concept different from that of the rational ethicists). In theory, autonomy is not assigned to anyone on the basis of an external assessment. Any intervention in individual autonomy must be made (by the intervenor) when it becomes imperative in the defense of social or cultural values. The article distinguishes between ethics and morals) and states that the sole acceptable ethical principle is that ethics (theoretically) has no principle.Ethics and animal experimentation: what is debated?S0102-311X19990005000112017-01-28T00:11:00Z2017-01-28T00:11:00ZPaixão, Rita LealSchramm, Fermin Roland
<em>Paixão, Rita Leal</em>;
<em>Schramm, Fermin Roland</em>;
<br/><br/>
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.Population, ethics, and equityS0102-311X19990005000122017-01-28T00:11:00Z2017-01-28T00:11:00ZBerlinguer, Giovanni
<em>Berlinguer, Giovanni</em>;
<br/><br/>
Demography is impregnated, more or less explicitly, with ethical contents. This is apparent in the words used to support data, which change over time (e.g., the term "illegitimate child" is no longer used). Ethical principles must be analyzed because demography concerns both public policies and individual choice. There is a conflict in this area between the idea of the ethical state, dictating personal behaviors to citizens, and that of decisions based on freedom, supported by three shared values: human rights, pluralism, and equity. This paper examines how these could be reinterpreted in the context of choices regarding population.