Revista de Bioética y Derecho

Editorial

Eutanasia, empatía, compasión y Derechos Humanos

Resumen Lo problemático en el estudio de la empatía es su ausencia ante el sufrimiento ajeno. La eutanasia resalta el conflicto moral sobre sufrir o dejar de sufrir frente una enfermedad irreversible y dolorosa. Analizaré el conflicto que presenta el respeto pleno por el principio de dignidad humana, establecido en el artículo 51 del Código Civil y Comercial de la Nación Argentina, en relación con las directivas médicas anticipadas que impliquen una práctica eutanásica que, en función del artículo 60 del mismo cuerpo legal, se deberán tener por no escritas. Dos preguntas cerradas guiarán el análisis: ¿Menoscaba a la dignidad humana la eutanasia, en su modalidad activa? ¿Resulta justa o injusta la restricción a la autonomía personal en relación a la eutanasia? Finalmente, exploraré el rol de la compasión en la eutanasia.

Abstract What is problematic in the study of empathy is his absence to the suffering of others. Euthanasia highlights the moral conflict about suffering or stop suffering facing at an irreversible and painful illness. I will analyze the conflict that has full respect of human dignity, laid down in Article 51 of the Civil and Commercial Code of Argentina, in relation to advance medical directives that involve a practice euthanasia, according to the Article 60 of the same legal body, should not be written. Two closed questions will guide this analysis in order to reflect on them: Does euthanasia undermines the human dignity, in its active mode? Is it fair or unfair the restriction of personal autonomy in relation to euthanasia? Finally, I will explore what the role of compassion in euthanasia.

Trasplantes de órganos y su incidencia sobre la relación laboral. Especial referencia a la situación de Incapacidad Permanente de las personas trasplantadas

Resumen Muy pocas veces se han analizado desde un punto de vista jurídico los efectos que el trasplante de órganos puede desplegar en el ámbito del Derecho del Trabajo y de la Seguridad Social. En el presente trabajo se exponen las principales medidas de contenido socio-laboral actualmente vigentes destinadas a ofrecer una protección especial a este tipo de pacientes, a través de las que se trata de evitar que esta situación desencadene el abandono prematuro e involuntario de la vida activa.

Abstract The effects of organ transplantation have been rarely addressed from a legal perspective in the Labor and Social Security Law. This paper analyzes the current, main social and labor regulations, designed to provide special protection to transplanted patients, which prevent the premature and involuntary abandonment of working life.

Medidas de modificación judicial de la capacidad en personas con trastorno mental grave: ¿Protección o iatrogenia?

Resumen Introducción y objetivo. El objetivo del estudio es analizar y reflexionar si se cumplen las directrices de la Convención Internacional de Naciones Unidas sobre los derechos de las personas con Discapacidad sobre el tipo de medida de protección adoptada con los usuarios del Equipo de Tratamiento Asertivo Comunitario de Avilés, España. Material y Método . Participan 26 usuarios que fueron sometidos a procedimientos de modificación judicial de la capacidad desde la apertura del dispositivo hasta 2014. Resultados. En la muestra no se cumplen las condiciones de falta de autogobierno en las distintas esferas. Conclusiones. Se están aplicando medidas de protección muy restrictivas frente a otras menos gravosas, lo que supone una discriminación y una pérdida de autonomía y derechos para la persona. Se incluyen aportaciones que podrían optimizar su calidad de vida.

Abstract Introduction and aim. The aim of the study is to analyze and to reflect on if the directives of the International Convention of United Nations on the Rights of the persons with Disability are fulfilled on the type of measure of protection adopted with the users of the Assertive Community Treatment Equipment from Avilés, España. Material and Method . 26 users take part who were submitted to judicial capacity modification procedures from the opening of the centre until 2014. Results. In the sample there are not fulfilled the conditions of lack of self-government in the different spheres. Conclusions. Very restrictive measures of protection are implemented against other minor gravity measures, which supposes a discrimination and a loss of autonomy and rights for the person. Contributions that could optimize the quality of life are included.

Avances y retos de las Comisiones Estatales de Bioética en México

Resumen Se han realizado estudios comparativos sobre comisiones nacionales de bioética, comités hospitalarios de bioética y de ética en investigación de diversos países; sin embargo existen pocos datos sobre la aplicación de la bioética a nivel subnacional. Este trabajo ofrece una aproximación a la evolución de las Comisiones Estatales de Bioética en México, se identifican como actividades de su quehacer acciones de capacitación, difusión, asesoría y promoción de la bioética en la atención médica y la vinculación con la Comisión Nacional de Bioética y otras instituciones de salud y educativas. Las Comisiones Estatales ayudan a fomentar la bioética a nivel subnacional y a extender la atención integral en situaciones complejas en el ámbito médico e investigativo.

Abstract Comparative studies have been developed on the infrastructure on bioethics of different countries, comprised mainly by national commissions, hospital bioethics and research ethics committees; however, there are few data on the application of bioethics at the subnational level. This work offers an approximation to the evolution of the State Commissions of Bioethics in Mexico and accounts for their work in outreach, education, and counseling, as well as entrenching a culture of bioethics in medical care and networking with the National Bioethics Commission and other health and educational institutions. State Commissions help to promote bioethics at the subnational level and to foster comprehensive care in complex medical and research settings.

Dignity, human and fundamental rights: a new disruptive technology

Resumo A sociedade contemporânea está imersa em profundas transformações que alteram substantivamente as significações e o imaginário, individual e coletivo. A inquietação que é produzida pela exclusão e reclusão (na marginalidade social) é indutora de deterioração da qualidade de vida e organiza a construção de subjetividades marcadas pela miséria em suas mais diversas manifestações. A convergência objetiva das sociedades e de cada um de seus cidadãos e cidadãs na percepção das categorias da Dignidade, da Interculturalidade, dos Direitos Humanos e dos Fundamentais, quando relacionados e bem entendidos, podem formatar uma "Nova Tecnologia", uma tecnologia disruptiva. Uma tecnologia sociopolítica, econômica e jurídica fundada nos Sistemas de Informação, mediante bem articuladas técnicas de comunicação que superem a natural entropia do sistema pela exclusão fundada na falta de "expertise" das partes.

Abstract Contemporary society is immersed in profound changes that substantively alter the meanings and the imaginary, individual and collective. The restlessness that is produced by exclusion and seclusion (on the social fringe), is capable of inducing deterioration of quality of life and organizes the construction of subjectivity marked by poverty in its many manifestations. The objective convergence of societies, and each of its citizens. In the perception of the categories of Dignity, Interculturalism, Human Rights and Fundamental when related and well understood, can format a "New Technology", a disruptive technology. A socio-political, economic and legal technology founded on information systems through well-articulated communication techniques that overcome the natural entropy of the system by exclusion based on lack of "expertise" of the parties.

Autonomy, care and respect: the debate on assisted extension of life

Resumo Os avanços tecnológicos associados às técnicas médicas têm levado os profissionais da saúde a terem como meta incansável o prolongamento da vida. O êxito de tais procedimentos, porém, em pacientes sem possibilidade de cura e com autonomia de decisão tem apenas prolongado o processo de morrer. Neste sentido, por um lado, a renúncia do tratamento passa a ser visualizada como uma forma de suicídio e, por outro, a sua interrupção pela equipe médica como eutanásia ativa. Assim, a qualidade de vida é associada ao curar, e não ao cuidar. Pretende-se, neste artigo, apresentar que o prolongamento assistido da vida significa compatibilizar as dimensões da autonomia, do cuidado e do respeito, sendo estes, portanto, responsáveis pela manutenção do conceito de dignidade.

Abstract Technological advances associated to medical techniques have been leading health professionals to have life extension as their tireless goal. However, the success of such procedures in patients with no chance of recovery and presenting decision-making autonomy has been only extending the process of dying. In this sense, on the one hand giving up the treatment is viewed as a form of suicide, and on the other hand the interruption of the treatment by the medical staff is viewed as active euthanasia. Therefore, quality of life is associated to healing rather than caring. The present article aims to demonstrate that the assisted extension of life reconciles the dimensions of autonomy, care and respect, and that these are responsible for maintaining the concept of dignity.

Human visceral leishmaniasis: ethical and legal reflections on the canine reservoir control in Brazil

Resumo O Brasil enfrenta atualmente dificuldades no combatea leishmaniose visceral humana.De acordo a Organização Mundial da Saúde, a eutanásia dos cães sintomáticos e soropositivos é uma das medidas de controle do agravo, conforme decreto vigente 51.838, de 14 de março de 1963, o que se torna importantediscutir o diálogo entre Saúde e Direito como estratégia para se evitar a expansão da doença, devido à resistência dos proprietários em entregar seus cães, com alto valor afetivo, a zoonoses. Conclui-se que para uma política pública efetiva vários elementos devem levados em consideração, sobretudo a interdisciplinaridade, enfatizando reflexões jurídicas e saúde, envolvendo questões que permeiam as relações humanas no contexto da ética e da legislação.

Abstract Brazil currently faces difficulties in combating human visceral leishmaniasis. According to the World Health Organization, euthanasia of symptomatic and seropositive dogs is one of injury control measures, according to current Decree 51838 of March 14, 1963, which becomes important to discuss the dialogue between health and law as a strategy to prevent the spread of the disease, due to the owners ' resistance to deliver their dogs with high emotional value, zoonoses. It is concluded that for effective public policy more elements are taken into consideration, especially interdisciplinary, emphasizing legal and health considerations involving issues that permeate the human relationships in the context of ethics and law.

Una sentencia brasileña con visión de género

Resumen Este artículo analiza el voto particular de Luis Roberto Barroso, juez del Superior Tribunal de Justicia de Brasil, frente al Habeas Corpus 124.306 de la sala I del Superior Tribunal de Justicia de Brasil (29/11/2016). Barroso argumenta que penalizar la interrupción del embarazo, consentida por la mujer, practicada en los tres primeros meses de gestación, viola derechos fundamentales establecidos en la Constitución de Brasil y en las Convenciones Internacionales de Derechos Humanos. Este artículo sostiene que esta penalización no sólo perjudica al litigante, sino que profundiza el desprestigio del sistema de justicia.

Abstract This article analyzes the dissenting opinion of Luis Roberto Barroso, judge of the Supreme Federal Court of Brazil, on the Habeas Corpus 124.306 of Courtroom I of the Supreme Federal Court of Brazil (29/11/2016). Barroso argues that penalizing the voluntary end of pregnancy, consented by the woman and practiced during the first three months of pregnancy, violates fundamental rights established by Brazilian Constitution and International Conventions of Human Rights. The paper maintained that this penalization not only harms the litigant, but also deepens the discredit of the justice system.

Consentimiento de Zelen y autonomía del paciente: una revisión narrativa

Resumen La obtención del consentimiento informado previo a la inclusión de los participantes en un ensayo clínico es un requisito ético-jurídico. En el diseño de Zelen la aleatorización es previa al consentimiento. En esta revisión se describen los estudios con aleatorización de Zelen y se analizan según lo establecido en España por la Ley 41/2002 Básica de Autonomía del Paciente, el RD 1090/2015 y la Ley 14/2007 de Investigación Biomédica. Se encontraron 78 estudios y se seleccionaron 23. El 61% eran "doble consentimiento". En el 17,3% se justificaba el uso de este consentimiento porque incrementaba el reclutamiento de pacientes. El diseño de Zelen tiene varias limitaciones éticas. En los estudios revisados no aparecen argumentos claros para su utilización.

Abstract Obtaining informed consent (CI) prior to the inclusion of participants in a clinical trial is an ethical- legal requirement. In the Zelen design randomization of subjects is prior to the application for consent to participate. In this review the studies with random of Zelen are described and analyzed according to the established in Spain by the Law 41/2002 Basic of Autonomy of the Patient, the RD 1090/2015 and the Law 14/2007 of Biomedical Investigation. 78 studies were found and 23 were selected. 61% was a "double assent". In 17,3% there was justifying itself the use of this consent because it was increasing the patients' recruitment. Zelen's design has several ethical limitations. In the studies analysed are no clear arguments for his utilization.

"Ser Mortal. La medicina y lo que importa al final", Atul Gawande. Traducción de Alejandro Pradera. Ed. Galaxia Gutenberg, 1015, 280 Páginas