Bioethics

Background: The article studies specific ethical issues arising from the use of big data in Life Sciences and Healthcare. Methods: Main consensus documents, other studies, and particular cases are analyzed. Results: New concepts that emerged in five key areas for the bioethical debate on big data and health are identified-the accuracy and validity of data and algorithms, questions related to transparency and confidentiality in the use of data; aspects that raise the coding or pseudonymization and the anonymization of data, and also problems derived from the possible individual or group identification; the new ways of obtaining consent for the transfer of personal data; the relationship between big data and the responsibility of professional decision; and the commitment of the Institutions and Public Administrations. Conclusions: Good practices in the management of big data related to Life Sciences and Healthcare depend on respect for the rights of individuals, the improvement that these practices can introduce in assistance to individual patients, the promotion of society's health in general and the advancement of scientific knowledge.

Background: The article studies specific ethical issues arising from the use of big data in Life Sciences and Healthcare. Methods: Main consensus documents, other studies, and particular cases are analyzed. Results: New concepts that emerged in five key areas for the bioethical debate on big data and health are identified—the accuracy and validity of data and algorithms, questions related to transparency and confidentiality in the use of data; aspects that raise the coding or pseudonymization and the anonymization of data, and also problems derived from the possible individual or group identification; the new ways of obtaining consent for the transfer of personal data; the relationship between big data and the responsibility of professional decision; and the commitment of the Institutions and Public Administrations. Conclusions: Good practices in the management of big data related to Life Sciences and Healthcare depend on respect for the rights of individuals, the improvement that t...

Law schools at three US universities, which also house substantial biomedical research programs, are to join a small but growing number of schools around the country offering courses in animal rights. In response to a demand from law students, Harvard, Georgetown and Northwestern University, Chicago, will join the University of California Los Angeles (UCLA), in providing legal tuition in this field. Membership of the Animal Legal Defense Fund (ALDF), a national organization that is pushing for stricter regulation of laboratory animals under the 1966 Animal Welfare Act, has grown from around 100 to 700 over the past 15 years. And the movement was buoyed by ALDF's Supreme Court victory this May in obtaining permission to represent laboratory animalslegal standing-in a case against the US Department of Agriculture (Nature, 400, 197; 1999). Tutor of the new Harvard course and well-known animal rights lawyer Steven Wise says that activist groups are much better funded and more likely to take to the courts than in the past. In response, more lawyers want to specialize in the field. "Many of our students can expect to face an animal law issue at some point in their careers," admits Harvard's assistant dean for Academic Affairs, Alan Ray. But will the course also train lawyers inclined to sue biomedical research centers like Harvard someday? UCLA's

In this paper I will review one of the prevailing arguments used to refute that animals can be considered subjects of rights-that animals cannot be subjects of rights because they cannot assume duties. The canonical way to respond to this question is to appeal to the arguments of "species overlap" (i.e. there are humans without certain abilities that are nonetheless subject of rights); and the "moral relevance" argument (highlighting the irrelevance of that incapability to gain right's protection). At the legal level, both arguments suggest that de facto incapacity to assume obligations is not an obstacle to being a subject of rights (at least in matters involving humans). Although obviously flawed, the argument from obligations persists in rulings and doctrine. In this paper, I will take a critical look at the obligations argument and propose that the best way to address the argument is to examine the political theory that supports it. That political theory will be evaluated in light of Donaldson and Kymlicka's proposal of citizenship for other animals whereby the authors argue that animals can and do fulfill some obligations in today's interspecies societies.

Assisted reproduction in a global world produces not only new babies and new parents but also new citizens and raises new bioethical concerns (e.g., Campbell 2007;. This essay outlines an interdisciplinary theoretical perspective in understanding how fertility travel and transnational reproduction unfold from the perspectives of the different actors involved. Three theoretical pairs-care and engineering, reproscapes and reproflows, and gifts and commodities-are suggested as theoretical frameworks for understanding transnationalized reproduction. The authors conclude that reproductive movements and fragmentary bodies confront legal and administrative systems in interesting and often highly complex ways.

Palliative care should be understood from a broader perspective rather than the notion of palliative medicine, offering, from an interdisciplinary approach, the required care to address the multiple dimensions of experience suffered by patients and family members facing a terminal disease. This article will assess the fundamental concepts of a patient-centered care, when it involves a progressive disease without known therapeutic alternatives. The movie My life will be used as an example through the text to compare, contrast and evidence the main ideas. There is a moment through the treatment, where it seems to be "nothing else to do", palliative care provides support, with special attention to assertive communication that facilitates family and personal confrontation in a situation of physical, mental and emotional suffering. A fundamental strategy to address these feelings is a prompt intervention, by helping advance planning of decisions about care, and adapting efforts in order to optimize the quality of life of the patient and his family. It also supports the reorientation of therapeutic interventions and considers alternatives such as sedation at the end of life as an option to control refractory symptoms.

For about five decades the phrase "sanctity-of-life" has been part of the Anglo-American biomedical ethical discussion related to abortion and end-of-life questions. Nevertheless, the concept's origin and meaning are unclear. Much controversy is based on the mistaken assumption that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. In this paper, I offer an analysis of the religious and philosophical history of the idea of "sanctity-of-life." Drawing on biblical texts and interpretation as well as Kant's secularization of the concept, I argue that "sanctity" has been misunderstood as an ontological feature of biological human life, and instead locate the idea within the historical virtue-ethical tradition, which understands sanctification as a personal achievement through one's own actions.

A plurality of concerns within the European Union triggers debates on innovations in agriculture and food production. The ethical assessment of new agricultural and food technologies has thus become important for governmental regulators, the general public and actors in all segments of the food chain.

La implantació de la política antidopatge i de verificació del sexe en l'esport internacional va tenir un impacte negatiu en la vida personal i professional dels i les esportistes. Si bé les autoritats esportives ja van formular la necessitat d'implantar ambdues polítiques abans dels anys seixanta del segle XX, va ser en aquesta dècada quan els controls de drogues i de verificació del sexe van esdevenir sistemàtics en l'esdeveniment esportiu més important de la nostra època, els Jocs Olímpics. Principalment, hem realitzat la nostra recerca a partir de fonts espanyoles elaborades durant la Dictadura, de manera que un dels nostres objectius principals ha estat analitzar la contribució del règim franquista en la implantació de totes dues polítiques a escala internacional i la seva aplicació en l'esport espanyol. Volem assenyalar que a causa de la particularitat del model esportiu que es va anar consolidant al llarg del segle XX, els controls de drogues i de verificació ...

The use of empirical research methods in bioethics has been increasing in the last decades. It has resulted in discussions about the 'empirical turn of bioethics' and raised questions related to the value of empirical work for this field, methodological questions about its quality and rigor, and how this integration of the normative and the empirical can be achieved. The aim of this paper is to describe the attitudes of bioethics researchers in this field towards the use of empirical research, and examine their actual conduct: whether they use empirical research methods (and if so, what methods), and whether (and how) they have made attempts at integrating the empirical and the normative. An anonymous online survey was conducted to reach scholars working in bioethics/biomedical ethics/ethics institutes or centers in 12 European countries. A total of 225 bioethics researchers participated in the study. Of those, 200 questionnaires were fully completed, representing a response...

Objective: In this qualitative study, we investigate how lesbian couples experience and deal with the difference in genetic relatedness in their family. Background: Previous research showed that lesbian couples handle the difference with regard to genetic relatedness by, for instance, creating a narrative about physical resemblances or by focusing on the social bond and its influence on children. Methods: The findings are based on qualitative in-depth interviews with 10 lesbian couples who had at least one donor-conceived child aged 7-10. The difference with regard to the genetic link brought up complex and contextspecific experiences for these parents. Generally, the genetic link was described as irrelevant: equality between both parents was presented as a given. However, some experiences of difference due to the presence of one genetic link were found. In these accounts, the genetic link was described as a valuable extra that created an inequality between them as parents. Conclusion: The findings show that these mothers have a complex attitude towards genetic relatedness.

Resumen: La clonación humana por transferencia nuclear ha sido propuesta como solución para que el tratamiento con células madre embrionarias no produzca rechazo. Sin embargo, desde el punto de vista científico hasta ahora no es posible llevarla a cabo por las dificultades que conlleva la reprogramación celular, como se demostró a consecuencia del fraude en Corea del Sur. A pesar de esto y de la aparición de las células iPS (induced pluripotent stem cells) (1), que abren otro camino para el estudio de las enfermedades y su posible curación, aunque también podrían ser mal utilizadas, y a pesar de los grandes avances con células madre adultas, la ley española apuesta por la mal llamada "clonación terapéutica". Después de revisar algunos documentos internacionales y las leyes españolas sobre el particular, en este trabajo se trata de exponer los fundamentos éticos y filosóficos que se esgrimen para justificar la clonación por transferencia nuclear, como vía para investigar y alcanzar tratamientos a partir de las células de la masa interna del embrión clónico. Posteriormente, se realiza un análisis crítico desde la ética general y la bioética personalista. Palabras clave: clonación humana, transferencia nuclear, embrión clónico, bioética personalista.

When hope is discussed in bioethics' literature, it is most often in the context of 'false hopes' and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. 'I'd rather have hope than be able to define it.' 1 1

In order to document two consecutive terms leading the Sociedade Brasileira de Bioética (the Brazilian Society for Bioethics), the authors provide a retrospect of Brazilian bioethics since the inception of the SBB, including the establishment of dedicated ethical journals, national and international events, and of academic programs aimed at qualifying professionals in multidisciplinary fields and to disseminate this knowledge among Brazilian, Latin-American and Lusophone societies. They emphasize that since the beginning of the bioethical debate in Brazil there has been a clear focus on human rights protection. During the current board's term, challenges have included population aging in Brazil; the impact of emerging/reemerging illnesses; the increase of urbanization; the impact of technological progress; pressures to lower ethical requirements for human research; economic and communication globalization. This has come amid a severe international economic and political crisis, culminating in Brazil with the impeachment of an elected president and with the succeeding government proposing privatizations and reforms that will negatively affect workers' rights. All these points set the agenda for the new term of office.

In order to document two consecutive terms leading the Sociedade Brasileira de Bioética (the Brazilian Society for Bioethics), the authors provide a retrospect of Brazilian bioethics since the inception of the SBB, including the establishment of dedicated ethical journals, national and international events, and of academic programs aimed at qualifying professionals in multidisciplinary fields and to disseminate this knowledge among Brazilian, Latin-American and Lusophone societies. They emphasize that since the beginning of the bioethical debate in Brazil there has been a clear focus on human rights protection. During the current board's term, challenges have included population aging in Brazil; the impact of emerging/reemerging illnesses; the increase of urbanization; the impact of technological progress; pressures to lower ethical requirements for human research; economic and communication globalization. This has come amid a severe international economic and political crisis, culminating in Brazil with the impeachment of an elected president and with the succeeding government proposing privatizations and reforms that will negatively affect workers' rights. All these points set the agenda for the new term of office.

Este artigo apresenta como estudo de caso os aspectos mais controversos de pesquisa conduzida na Guatemala (1946-1948), patrocinada pelo Serviço de Saúde Pública dos Estados Unidos e envolvendo participantes infectados intencionalmente pelo Treponema pallidum. Analisando as alterações de 2008 na Declaração de Helsinque e a ainda pequena adesão a outros instrumentos internacionais, como a Declaração Universal sobre Bioética e Direitos Humanos, da Unesco, a discussão enfatiza a importância da implantação de diretrizes éticas internacionalmente aceitas para impedir que voluntários humanos sejam envolvidos em pesquisas não éticas. Conclui considerando que é indispensável o envolvimento de cientistas e ativistas para alcançar padrões éticos universalmente aceitos e aplicáveis, visando evitar duplo standard. Além disso, que a participação igualitária em pesquisas e distribuição justa de seus benefícios será importante passo para atingir o acesso universal a cuidados de saúde de qualidade para todos. Palavras-chave: Ética em pesquisa. Saúde pública. Declaração de Helsinque. Proteção. Efetividade. Este artículo presenta como estudio de caso los aspectos más controvertidos de la investigación realizadas en Guatemala (1946-1948), patrocinada por el Servicio de Salud Pública de los Estados Unidos e involucrando participantes infectados por el Treponema pallidum por todo el mundo. Analizando los cambios en la Declaración de Helsinki de 2008 y la pequeña adhesión, en aquel entonces, a directrices internacionales como la

The information provided regarding the prevalence and reasons why volunteers refuse to participate in scientific research is sparse. This article aims to describe the prevalence and reasons for refusing to voluntarily participate in the cohort study whose objective is to evaluate morbidity and mortality amongst people living with HIV/AIDS (PLWHA), through a cross-sectional study conducted at the Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias (Training and Referral Center for Infectious and Parasitic Diseases). The following information was obtained: origin, date of birth, age, gender, and reason for not consenting, when applicable. The lack of time to devote to the research was the main reason given (63%), followed by fear of lack of confidentiality (17%). There was no statistical difference among those who accepted or not to participate in terms of gender, age or origin of the service. The percentage of PLWHA who refused to participate in the study (40.7%) and lack of time available for their participation (63%) were considered high.

Mental health is recognised under the right to health in Article 12(1) of the International Covenant on Economic, Social and Cultural Rights. This article refers to the gross violation of mental health rights by the South African government, regarding the Life Esidimeni scandal that ended in tragedy. A failed de-institutionalisation policy implementation was to
blame. The article further aims to assess the state of psychiatric health care in South Africa, 30 years into democracy. This milestone signifies a litmus test of how South Africa has advanced or not, in protecting the rights of people with mental disorders. An analysis of events after the Esidimeni tragedy suggests that the government must take more robust action to advance the rights of people in mental health care. The author highlights certain challenges towards ensuring that mental health institutions are considered in promoting the right to health. This article examines the theoretical foundations of mental health rights and the background of international and regional law approaches to mental health issues. The right to access to mental health services in South African jurisprudence and the law will be examined as well as the hurdles of implementing this policy. The Esidimeni tragedy and its aftermath will be discussed, followed by submissions and a conclusion.

Cuando el paciente acude al medico en busca de ayuda para la curacion de su enfermedad, de su alivio o de prevenir la aparicion de cualquier mal, pone su confianza en el y al seguir las indicaciones o recomendaciones que se le dan, actua como un agente moral libre”; por lo tanto debe tener la libertad personal para seguir o no las indicaciones; esto es el ejercicio de la autonomia del paciente bien entendida.

estandarizado de consentimiento informado. Se tuvo además como propósito el analizar los criterios de los representantes válidos sobre la información que le brindaría el consentimiento informado. Métodos: se estudió a los 32 integrantes del equipo multidisciplinario y a 9 representantes válidos de los pacientes para así constatar el grado de conocimiento sobre los principios de Ética Médica y Bioética. Resultados: se mostró que la mayoría tuvo un nivel bajo en cuanto a Ética Médica y niveles medio o alto en la Bioética. Los representantes válidos presentaron un nivel bajo. Se confirmó el reconocimiento de la necesidad e importancia del consentimiento informado aunque el equipo de salud refirió que no lo utiliza adecuadamente. Se elaboró una propuesta metodológica del proceso de consentimiento informado. Conclusiones: el nivel de conocimiento sobre los principios de la Ética Médica y la Bioética de los profesionales no se correspondió con la percepción que ellos tuvieron ni con la expresión práctica de dichos elementos.

I denne artikel foretager vi et skift fra den traditionelle beliefsteori til anvendelsen af patterns of participation. Først beskrives laererviden og patterns of participation, derefter beskrives og analyseres data omhandlende to laerere, Susanne og Astrid, som vi har fulgt gennem en laengere periode. Den overordnede intention er at vise potentialerne ved at anvende patterns of participation som forskningstilgang og at vise at man herved kan komme til en bedre forståelse af matematiklaererens praksis. Det er en generel opfattelse, både i matematikdidaktisk forskning og blandt politiskadministrative beslutningstagere, at laereren er den vigtigste enkeltfaktor for kvaliteten af matematikundervisningen og for elevernes laering (OECD, 2005;. Hvis vi skal forbedre elevernes laering, skal vi derfor ikke alene saette fokus på eleverne, men i lige så høj grad på laereren og laererens udvikling af matematiklaererviden. Forskning omhandlende laerere er ofte analyserende omkring hvad der er god og mindre god matematikundervisning, men forskningen kommer sjaeldent til en direkte forståelse af hvorfor laerere agerer som de gør i undervisningen. I denne artikel vil vi undersøge og vise hvordan man kan komme til en bedre forståelse af matematiklaererens praksis. I artiklen analyserer vi den praksis der udvikler sig i to forskellige matematikklassevaerelser på to forskellige folkeskoler i Danmark. De to laerere er Susanne der arbejder på Vestervangskolen, og Astrid der arbejder på Rosenengsskolen. I artiklen viser vi at man ved at anlaegge et deltagelsesperspektiv på undervisning og ved brug af et nyt begreb kaldet patterns of participation (Skott et al., 2011) kommer til en bedre forståelse af hvorfor laerere handler som de gør i matematikundervisningen. I artiklen viser vi at de forskellige praksisser som laererne deltager i, ikke nødvendigvis danner et ligevaerdigt mønster, men at nogle praksisser dominerer, mens andre traeder i baggrunden. I casen Susanne på Vestervangskolen er den traditionsbundne

I et dansk forsknings- og udviklingsprojekt ved navn KiDM blev der udviklet tre maneders undersogelsesorienteret undervisning i matematik til 4. og 5. klasse. Undersogelsesorienteret undervisning i matematik har dog en bred definition, og for at hjaelpe laererne blev der udviklet en kategorisering af forskellige typer af undersogende aktiviteter i matematik. Denne artikel definerer og beskriver disse fem forskellige kategorier. Herefter udvaelges to aktiviteter (“Opdagelsen” og “Grubleren”) som bliver undersogt med fokus pa hvilke raesonnementer der kommer i spil i dialogen i opsamlingsfasen. Der bliver afslutningsvis reflekteret over forskellen pa elevernes raesonnerende virksomhed i de to forskellige aktiviteter.

| 2 | FORMÅLET Formålet med denne udgivelse er gennem en sammenfatning og praesentation af en større forsknings-og praksiskortlaegning at bidrage til kvalitet af matematikundervisningen i grundskolen. Udgivelsen henvender sig til alle med interesse i matematikundervisning i grundskolen, men retter sig isaer mod matematiklaerere, vejledere og ledere med ansvar for den faglige kvalitet i undervisningen. Matematiske kundskaber tillaegges traditionelt stor betydning i alle dele af samfundet, ikke mindst inden for teknologi og økonomi. Matematiklaereren har et saerligt ansvar for, at eleverne bliver bevidste om relevansen af at erhverve sig matematikkundskaber og beskaeftige sig med matematik. Udgivelsen praesenterer de vaesentligste resultater og konklusioner fra kortlaegningen af nyere forskning og praksis i matematikundervisning med vaegt på undersøgende tilgange. Målet er at praesentere konkrete tiltag og metoder, der har en positiv og dokumenteret virkning for eleverne både fagligt og personligt. Undersøgelsen af praksis tegner et billede af en forholdsvis traditionel praksis, hvor der er divergerende opfattelser af den undersøgende matematikundervisning.

Best interest vs. Substituted judgment. Criterios para el consentimiento informado prestado por representante JACOBO DOPICO GÓMEZ-ALLER (1) El tratamiento médico a niños, incapaces o a personas sin posibilidad de expresar su voluntad ha de ser consentido por un representante. Sin embargo, la Ley española no da prácticamente ninguna orientación acerca de cuáles son los criterios que deben guiar esa decisión. En este trabajo se analizan los dos criterios básicos de decisión (protección objetiva de la salud en sentido amplio frente a cumplimiento de la voluntad del paciente), determinando cuál debe prevalecer en las distintas situaciones. Especial atención requiere la cuestión de si el sustituto puede rechazar el tratamiento médico cuando ello implica un alto riesgo de muerte para el paciente menor, inconsciente o incapaz. Palabras clave: Bioética, consentimiento informado, consentimiento por representación, interés objetivo del paciente, voluntad hipotética del paciente, voluntad anticipada del paciente.

Discurso pronunciado por la Dra. Dña. Silvia Nicolás Alonso leído en el solemne acto de su recepción pública como Académica Correspondiente de la Academia de Ciencias Veterinarias de Castilla y León, celebrado el día 19 de marzo de 2025 en León.

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and ...

RESUMO: A COVID-19 é responsável direta pelo aumento da litigiosidade de saúde, individual e coletiva, no Brasil e no mundo. O estudo tem como objetivo principal apresentar o projeto de pesquisa conjunto entre Direito, Medicina e Ética (Ufes e Fiocruz) para avaliar o impacto da COVID-19 no Sistema de Justiça e como os profissionais do direito e da saúde compreendem essa litigância e reagem a ela. Para alcançar tal objetivo, serão pesquisadas a quantidade e a qualidade da litigância desde o início da ocorrência da pandemia de COVID-19 no Brasil, especialmente no Espírito Santo, com foco na litigância de saúde. A análise qualitativa levará em conta que em tempos de pandemia, o processo de tomada de decisões em saúde pública tem sido marcado por uma

We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0-7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%)...

Este ensayo aborda el tema del aborto desde una perspectiva filosófica especulativa, considerando su naturaleza polarizadora en la sociedad y su impacto en las relaciones interpersonales. Se exponen las posturas opuestas de dos facciones principales: la provida, que argumenta en favor del derecho a la vida desde la concepción, y quienes apoyan el aborto, considerando que cigotos, embriones y fetos no poseen personalidad jurídica ni derechos propios. A partir de estas posiciones, se analiza críticamente la fundamentación teórica que sostiene dichas afirmaciones. Este trabajo no pretende establecer un criterio ético definitivo, sino ofrecer una serie de reflexiones orientadas a problematizar el tema desde un enfoque filosófico más allá de la práctica tradicional.

Humans are social beings, namely beings who are naturally living in society. As social beings, humans need other humans who live in society. Realize it or not to fulfill their life needs in exercising the rights and obligations to obtain health. Organizing effective and efficient health efforts requires health information, health information as referred to is carried out through an information system and through cross-sectors. In addition, further provisions regarding the information system as referred to are regulated by Government Regulation. it is emphasized that everyone has the right to health and even everyone has the same rights in obtaining access to resources in the health sector. Likewise, everyone has the right to obtain safe, quality, and affordable health services. The research method uses a normative legal method using an analysis method that is qualitative analysis with a statutory regulatory approach. 1. Legal framework regarding patient consultation using telemedicine in Indonesia. The use of telemedicine-based health services is stated in the Decree of the Minister of Health of the Republic of Indonesia concerning the benefits of telemedicine-based health services as an effort to achieve equitable health services, improve the quality of health services in remote areas and reduce referrals to hospitals, especially in handling emergency cases. Telemedicine can be said to be a solution for the community and medical personnel when faced with field situations that are not possible, so to provide a sense of security to medical personnel and patients, there are several legal bases related to the implementation of telemedicine in Indonesia which are regulated in laws and regulations. Telemedicine services have four obstacles, namely the Technological Environment, the Human Environment, the Economic Environment, and the Organizational Environment. The willingness of patients to use technology (45.7%) and the obstacles are limited infrastructure, Community Acceptance, and the Human Development Index (HDI). 2. Legal protection of the parties is associated with the application of the precautionary principle in diagnosing diseases through telemedicine. The legal basis for online consultation services or telemedicine still does not have concrete legal certainty at the national level. There are no national regulations that specifically regulate the implementation of telemedicine services and health workers who provide these services in Indonesia. Legal protection for related parties through telemedicine can be seen that related parties in this case medical service providers must comply with the rules governing human actions based on law, justice and morality.

In 2001 an International Advisory Committee was instituted in Revista Médica de Chile, including in it prominent physicians working out of Chile who maintain regular contacts with different Chilean societies in the fields of Internal Medicine and its subspecialties. Members in this Committee are expected to contribute with their advice in the contents of our journal and also as expert reviewers and writers.

ZABALETA, Daniela Beatriz Buenos Aires, Octubre de 2019.- Reflexionaremos en el presente capítulo sobre el concepto de las acciones de wrongful birth y wrongful life. Para ello, principiaremos por un primer apartado donde estudiaremos las distintas reclamaciones de responsabilidad civil relacionadas con el inicio de la vida. Luego, en el segundo apartado, y tras brindar una definición de las acciones de wrongful birth y wrongful life, dedicaremos algunas palabras a considerar lo atinente a su legitimación, por ser éste uno de los rasgos característico que permite diferenciarlas. También, consideraremos por separado cada uno de los presupuestos de hechos necesarios para su articulación. Así, desarrollaremos la estrecha conexión que existe entre éstas pretensiones y los diagnósticos indirectos, preconceptivos, preimplantatorios y prenatales e indagaremos acerca de su legalidad a la luz de nuestro ordenamiento jurídico. Todo ello, claro está, con una constante remisión al derecho comparado. 1.1.-Las reclamaciones de responsabilidad civil relacionadas con el inicio de la vida: distintos supuestos.

This paper describes the change ofemphasis that occurred in the teaching ofethics to smallgroups ofclinical students. Although the originalfocus ofthe course was on the analysis ofethical dilemmas associated with individual patients known to the students, it soon became evident that there were, for the students themselves, more fundamental ethical dilemmas in their new role as clinical students. These included worries about how to respond when patients asked questions which their consultants had previously deceived them about, worries about inflicting pain on patients, as with intravenous cannulation, and the role of the medical student in the clinical team. We emphasise the need to explore student experiences aspart oftheprocess of ethics teaching.

1. Vid: A. PALA: CIOS," El derecho a la igualdad de las personas con discapacidad y la oblIgaCIón de realIzar ajustes razonables", en 1. CAMPOY (ed.), Los derechos de las pers~ nas con discapacidad, coL" Debates del Instituto Bartolomé de las Casas", núm. 2, Dykinson, Madrid, 2004, pp. 187 Y ss.

Este libro recoge una serie de exposiciones realizadas durante el año 2022, año en que se conmemoraron los 150 años del nacimiento del gran filósofo uruguayo Carlos Vaz Ferreira (1872-1958), y cien años de la publicación la obra que recoge sus conferencias sobre los problemas sociales. Su obra "Sobre los problemas sociales" junto con sus conferencias sobre los problemas de la tierra (1918), son textos de avanzada en que el filósofo demuestra una gran sensibilidad ante las injusticias del orden social consagrado en su época y actualmente. Allí advierte sobre las contradicciones y el exceso de desigualdad que supone el régimen vigente signado por el individualismo liberal. Cuestiones como la prioridad de los derechos económicos y sociales, la justificación de un mínimo social consagrado a la persona solo por ser tal o la crítica al derecho ilimitado a la herencia, particularmente de la tierra, son aspectos de su obra que aún nos interpelan y que justifican que continuemos visitando, resignificando y dialogando con ella.

Introduction The process of controlled organ donation after circulatory determination of death (cDCDD) results in ischaemic injury to organs and leads to poorer outcomes in organ recipients. Although not yet used in Canada, normothermic regional perfusion (NRP) is a perfusion technology used postmortem with cDCDD donors to selectively restore perfusion of oxygenated blood to target organs in situ, reversing ischaemic injury and improving organ viability and post-transplant outcomes. However, NRP poses significant ethical challenges. To preserve trust in deceased donation, these ethical challenges must be addressed to the satisfaction of Canadian stakeholders before NRP's implementation. This study will identify ethical issues pertaining to NRP and explore perspectives of NRP among key stakeholders. By developing an explanatory framework delineating how stakeholder perceptions of NRP's ethical implications impact trust in Canada's donation and transplantation systems, this study will inform the development of responsible policy on NRP's use in Canada. Methods and analysis This study includes two workstreams. Workstream 1 is a scoping review of medical and bioethical literature to identify ethical issues stemming from NRP. We will apply a common search string across Medline, PubMed (other than Medline) and Embase to identify relevant articles. We will identify grey literature through Google searches, websites of organ donation organisations and consultation with our research network. No date limits will be applied. All peer-reviewed publications, commentaries, editorials or documents that engage with ethical issues in NRP (or conceptual and empirical issues as they relate to these ethical issues) will be included. News articles, conference abstracts and publications not in English will be excluded. Workstream 2 consists of interviews with healthcare providers, institutional stakeholders, organ recipients and deceased donors' family members (n=24-36), as well as focus groups with healthcare providers involved in deceased donation and transplantation (n=20-32). Constructivist grounded theory methodology will guide data collection and analysis in workstream 2. Ethics and dissemination This study was approved by Western University's research ethics committee (Western REM; ID: 120001). All participants will be asked to provide written informed consent to participate. Findings will be shared with Canadian organ donation and transplantation organisations, presented at national conferences and published in medical journals.