Revista de Bioética y Derecho

2013: Intemperie Moral

Hunger Strike in Adolescents: an Ethical Challenge for the Health Team

En el año 2011, Chile fue testigo por primera vez del ejercicio de la huelga de hambre por parte de un grupo de jóvenes, entre ellos adolescentes, que en defensa de la protección de un derecho que estimaban conculcado, como es el derecho a la educación, creyeron preciso adoptar el ayuno como mecanismo de presión para propiciar con la Autoridad de Gobierno una negociación que hasta entonces sentían fracasada. Bajo el alero del Departamento de Bioética de la Facultad de Medicina de la Universidad de Chile, quienes suscriben, prescindiendo de la personal convicción acerca de la legitimidad o no de la HH, hemos llevado adelante un trabajo todavía en pleno desarrollo, que busca reflexionar sobre los aspectos éticos y la necesidad de proporcionar a los profesionales de la salud guías u orientaciones que les permitan enfrentar el proceso de atención del huelguista adolescente, desde su particular situación de desarrollo del ciclo vital.

In 2011, Chile was witnessed for first time the hunger strike as part of a group of young people, including adolescents, who in defense of protecting a right that felt violated, as is the right to education, believed be taken fasting as a pressure mechanism to encourage the Government Authority negotiations which until then they felt failed. Under the eave of the Department of Bioethics, Faculty of Medicine, University of Chile, the undersigned, regardless of personal conviction about the legitimacy or otherwise of the HH, we have carried out a work still developing, which seeks to reflect on ethical issues and the necessity of provide health professionals guides or guidelines to enable them to meet the care process adolescent striker from their particular development lifecycle.

Distinguish Patients in a Vegetative State from the Minimally Conscious state: moral and legal dilemmas

Research done using current neuroimaging techniques-specifically, positron emission tomography (PET) and functional magnetic resonance imaging (functional MRI)-have provided evidence that vegetative patients may have fragments of consciousness. These findings make all the more urgent the familiar moral and legal dilemmas arising in connection with persons in these "reduced" states, because in debating whether these persons have a will, we have to take into account the possibility that they may have "glimpses of consciousness". In other words, we have to revisit that principle in light of scientific advances enabling us to more accurately detect signs that a patient is expressing a will to be taken off life support.

Decisões judiciais no campo da biotecnociência: a bioética como fonte de legitimação

O presente artigo é apresentado por exigência de qualificação de tese de doutorado em Bioética, Ética Aplicada e Saúde Coletiva. São analisadas três decisões judiciais de cunho existencial com abordagem bioética. A metodologia utilizada é de pesquisa documental em arquivo para análise e compreensão dos conceitos de vida, saúde e liberdade, através do discurso jurídico a partir da teoria de Canguilhem que trabalha com os conceitos de normal e de patológico. Dos acórdãos analisados pode-se inferir a relevância das teorias bioéticas para decisões não somente preocupadas com a legalidade, mas justas.

This article was presented by qualification requirement of the doctoral thesis in Bioethics, Applied Ethics and Public Health. Are analyze three judgments cases with existential nature of bioethics. The methodology is documentary research on file for analysis and understanding of the concepts of life, health and freedom through legal discourse from Canguilhem's theory that works with the concepts of normal and pathological. Of the cases considered above we can infer the importance of bioethical theories for decisions not only concerned about the legality, but fair.

The risk assessment of transgenic plants: from regulation to bioethics

A pesar de las regulaciones no hay guías obligatorias u oficiales que establezcan los elementos mínimos para la evaluación del riesgo ambiental (ERA) de los cultivos transgénicos. No se han definido criterios para la toma de decisiones, no hay investigaciones científicas, ni estudios socio-económicos revisados por pares que muestren los beneficios y riesgos del uso de estos productos, comparados con otras tecnologías en la agricultura. Esta situación ha hecho surgir una "incertidumbre artificial sobre los cultivos transgénicos, por lo que, en este artículo, se propone una estrategia más sustentable con la inclusión de una base bioética en la ERA.

Despite the regulations there are no mandatory nor official guidelines for establishing the minimum elements for environmental risk assessment (ERA) of GM crops. Criteria for decision making have not been defined, and there are no peer-reviewed scientific nor socio - economic studies showing the benefits and risks of these products in comparison with the use of other technologies in agriculture. This situation has raised an "artificial uncertainty" related to transgenic crops and in this paper we propose a more sustainable strategy by including a bioethical soundness ERA.

Por uma bioética da biodiversidade

A Bioética continua a expandir seus horizontes, mas ainda é incipiente a teorização filosófica de uma Ética para o meio ambiente. Este trabalho aborda a questão de fundo dos textos bioéticos ambientais, contra a posição da Ética clássica: é possível construir uma Ética para os outros seres vivos? Avalia-se, ainda, as características dessa nova Ética e a necessidade, principalmente no Brasil, das obras sobre o assunto possuírem uma filiação mais clara a uma teoria ética.

Bioethics continues to expand its horizons, but is still incipient philosophical theorizing of an Ethics for the environment. This paper addresses the fundamental issue of environmental bioethics texts, against the position of classical Ethics: Is it possible to build an Ethics for the other living beings? Evaluates also the characteristics of this new Ethics and the need, especially in Brazil, works on the subject having a membership to a clearer ethical theory.

Evaluation of quality of life in patient over 70 years with multiorgan failure requiring mechanical ventilation and/or continuous renal replacement therapies

Introducción: Un porcentaje muy elevado de los pacientes que ingresan en los Servicios de Medicina Intensiva son mayores de 70 años. La necesidad de evaluar los estados de salud en estos pacientes ha hecho que se desarrollan distintas herramientas o cuestionarios para conocer la calidad de vida tras el alta hospitalaria. Objetivos: Evaluar la calidad de vida mediante escalas de medición en los pacientes ancianos con fracaso multiorgánico (FMO), así como el grado de pacientes con limitación terapéutica del soporte vital (LTSV) y su percepción de la calidad de vida. Material y métodos: Estudio prospectivo de 6 meses de seguimiento a pacientes ingresados en la Unidad de Cuidados Intensivos con edad mayor a 70 a y con FMO. La Calidad de Vida Relacionada con la Salud (CVRS) se documentó al alta y a los 6 meses con el cuestionario de Estado de Salud SF-36 y el índice de Barthel. A los 6 meses recibieron información sobre Documentos de Voluntades Anticipadas (DVA). Otras variables fueron: la edad, sexo, SAPS II, SOFA al ingreso, estancia en UC, índice de Charlson, Score de Sabadell, estancia hospitalaria y mortalidad. Resultados: Se estudiaron 26 pacientes mayores de 70 a y SOFA >3. 15 estaban vivos a los 6 meses, 7 fallecieron, 2 abandonaron y 1 paciente fue traslado a su comunidad. La edad media fue de 78 a. El 66,7% fueron hombres. El 73% tenían mala calidad de vida al ingreso (SF_36 < 50). El 60% de los pacientes precisó ventilación mecánica invasiva (VMI), 60% ventilación mecánica no invasiva (VMNI) y el 14 % hemodiafiltración continua. La estancia hospitalaria se correlacionaba con el rol físico (r=0,427; p=0,042), rol emocional (r=0,497; p=0,013), dolor corporal (r=0,516;p=0,014) y salud mental (r=0,488; p=0,016). De los 8 pacientes que se indicó al alta LTSV, 5 estaban vivos a los 6 meses. En estos pacientes observamos una disminución de la calidad de vida en todos sus componentes no significativa. El 86% de los pacientes conocían el significado crítico de su enfermedad. El 53% conocían de la existencia de las DVA aunque ningún paciente se interesó por su aplicación. Conclusión: La mayoría de pacientes estudiados perciben una calidad de vida a los 6 meses igual o superior que a la previa al ingreso Los pacientes dados de alta con LTSV a los 6 meses presentan una calidad de vida inferior a la previa al ingreso. El Score Sabadell al ingreso se correlaciona con la función social y la vitalidad a los 6 meses. Ningún paciente se mostró interesado en la redacción de las DVA.

Introduction: A very high percentage of patients in Intensive Care Units are > 70 years. The need to assess health status in these patients has led to develop different tools or questionnaires to ascertain the quality of life after hospital discharge. Objetives: To assess the quality of life by measuring scales in elderly patients with multiple organ failure (MOF) and the patients with Limited Care (LC) and your perception of quality of life. Material and methods: Prospective 6-month follow-up patients admitted to the ICU with age > 70 years and with MOF (SOFA>3). Quality of life Related to Health (HRQOL) was documented at discharge and at 6 months with Health Status Questionnaire SF_36 and the Barthel Index. At 6 months, they received information about Living Wills. Other variables: age, sex, SAPS II, SOFA admission, Charlson Index, Sabadell Score, hospital and ICU stay and mortality Results: We studied 26 patients and SOFA > 3. 15 were alive at 6 months, 7 died, 2 left and 1 patients was transferred to the Community. The mean age was 78 years. 66,7 % were men. 73% had poor quality of life at admission (SF_36 < 50). 60% of all patients need invasive ventilation, 60% non invasive ventilation and 14% haemodialysis. The hospital stay was correlated with physical role (r=0,427, p=0,042), emotional role (r=0,497, p=0,013) bodily pain (r=0,516, p=0,014) and mental health (r=0,488, p=0,016). Of the 8 patients with LC, 5 were live at 6 months. These patients observed a decrease in quality of life. 86% of the all patients knew the meaning of your critical illness. 53% patients knew of the existence of the Living Wills although non patient was interested in your application. Conclusion: Most of the patients perceive a quality of life at 6 months equal or higher than the prior at admission ICU. All patients discharged with LC, at 6 months presented a lower quality of life. The Sabadell Score correlates with the social function and vitality at 6 months. No patient was interested in the drafting of the Living Wills.

A propósito de la Bioética en y desde Latinoamérica