Critical Bioethics

Although physician-assisted suicide (PAS) is legal in several jurisdictions around the world, debate about its merits and implementation is far from settled. This debate has special, timely significance in Canada, as new PAS legislation is imminent. (Controversial recommendations from the Joint Special Committee on Physician-Assisted Dying include PAS for mature minors, PAS in advance directives, and PAS for people with mental illness.)

Slippery slope concerns are often at the centre of this debate—opponents worry that legalizing PAS in any form, however acceptable now, will inevitably lead to practices that are unacceptable. Concerns include risk of abuse and mistake, expansion of criteria, and an unobstructed path to euthanasia. Opponents also observe that those who support PAS on the basis of autonomy and suffering (common foundational arguments) are logically, on principle, committed to its expansion.

As the literature reveals, the slippery slope debate is confusing and often misunderstood. This essay seeks to achieve clarity by investigating the two types of slippery slope arguments—empirical and logical. The validity of each slippery slope argument is considered, with the following results. Empirical slippery slope concerns have not been validated. Recent data from Oregon and Europe neither support nor disprove slippery slope claims conclusively. Low numbers of usage of PAS, particularly in Oregon, reduce fears. Logical slippery slope concerns, while theoretically compelling, can be assuaged by drawing a bright line between what is acceptable and what is unacceptable. Consistency of principle need not be the highest value if other compelling reasons exist to make this distinction. Generally, slippery slope arguments are addressed (by proponents of PAS) by pointing to qualifying thresholds or criteria, also known as safeguards.

Two particular safeguards are then examined—determinations of capacity and suffering, respectively. Some questions addressed include:

On what basis are physicians expected to assess capacity?
On what basis are physicians expected to assess suffering, especially if terminal illness is not a criterion?
To what extent can physicians make these determinations without also judging the patient’s quality of life?

In exploring answers to these questions, significant doubt is raised as to the extent to which these criteria function as safeguards against slippery slope concerns. Physicians are faced with the near-impossible task of assessing capacity and determining suffering without inserting their personal judgment of whether the person really ought to die, and in this way. In addition, they must do so without meaningful guidelines to assist in making these determinations with fairness and consistency. Other than in obvious cases of incapacity, why would a physician ever say no? More importantly, how could a physician ever say no without risk of accusation of inappropriately judging another’s suffering? Indeed, even if a physician denies a request a more agreeable physician may be found.

I conclude that, with the legalization of PAS in any form–particularly the form proposed in Canada –the promise of safeguards as protections proves illusory.

The concept of antinatalism is now becoming popular on the Internet. Many online newspaper articles deal with this topic, and numerous academic papers on antinatalism have been published over the past ten years in the fields of philosophy and ethics.  The word “antinatalism” was first used in the current meaning in 2006, when the two books that justify the universal negation of procreation were published: one by David Benatar and the other by Théophile de Giraud. However, we can find various prototypes of antinatalistic thoughts in ancient Greece, ancient India, and modern Europe. You might recall the name Schopenhauer.
In this paper, I briefly summarize the history of antinatalistic thoughts and propose a set of categories on antinatalism and related thoughts.

Abstract: This essay considers the ways in which Hegel's theory of ethical life (Sittlichkeit) can provide us with a different understanding of our ethical obligations to animals. I argue that animal abuse and its toleration constitutes a distortion the ethical substance that we as social beings absorb. As a result, the state has a direct duty to protect animals from pain and suffering and to prevent the emergence of institutions and practices that foster such abuse and suffering. Arguing against the rights-based approach to animal welfare, I argue that we can see a more compelling argument in the anthropocentric understanding of our ethical lives and obligations to others. Seeing ethical life as "functionalist" in nature, I therefore argue that the approach I put forth, what I call "reflexive ethics," can provide us with a more rational basis for the legitimacy of legislation that protects animals from abuse, cruelty, and suffering.

Some people with dementia are transformed by the disease, to the point that family members may describe them as a “different person.” These transformations may be negative or positive. What factors affect the judgements of ordinary people about whether an advance directive (AD) should be followed in such cases? We conducted three studies to test the influence of (1) positive versus negative transformation and (2) “treat” versus “withhold treatment” AD on the judgements of US participants (n = 1676) as to whether the AD should be followed and the extent to which the late-stage dementia patient had become a different person. We found that participants generally endorsed following the AD, irrespective of condition, but much less so when the patient had a positive transformation. Participants also favored “treat” over “withhold treatment” ADs. Unexpectedly, we found that AD type affected “different person” judgments: participants registered significantly weaker agreement with the propos...

In recent years there has been an increase in the number of requests for“mercy killings” by patients and their relatives. Under certain conditions,the patient may prefer death to a life devoid of quality. In contrast to thosewho uphold this “quality of life” approach, those who hold the “sanctity oflife” approach claim that life has intrinsic value and must be preservedregardless of its quality. This essay describes these two approaches,examines their flaws, and offers a “golden path” between the two extremepositions.We discuss the halachic and the secular views, arguing for a balancebetween the sanctity of life and the quality of life. We argue that, indeed,such a balance exists in practice, and that life is important, but it is not sacred. Life can be evaluated, but quality of life is not the solecriterion.

Although bioethics seeks to address the basic problems of human flourishing, the articulation of a consensus moral framework remains almost elusive due to charges including intellectual hegemony, cultural domination and moral imperialism. This paper explores a phenomenological approach in relation to developing a global ethical framework. It fashions a vulnerability/solidarity framework drawing on trans-geographical narratives of domestic and trans-Atlantic slavery in West Africa as well as the Euro-American evolution of the human rights rhetoric and praxis. Applying this to the contemporary issue of medical brain drain, the paper shows how such a framework may help engage the local and global dimensions of bioethical issues.

Learning from a forgotten story: the episode of Azul.

A field trial of a genetically engineered rabies vaccine was conducted in
Argentina in the mid-eighties, without informing the Argentine government. In
July 1986, 20 cows were inoculated at a PAHO agriculture station in Azul, 180
miles south of Buenos Aires. In September, government heard about the trial
from an Argentine Wistar scientist and barred further tests. According to a
government commission, this episode resulted in the infection of some of the
farm workers. Unless Wistar Institute maintained that the test had not been
conducted in secret and that the vaccine was both safe and efficient, the way
the experiment of Azul was a violation of ethical, ecological and safety rules
that could have dangerous consequences. This forgotten episode also raises
important questions about the ways in which modern research is conducted in
the developing world. People have to learn that all countries, particularly Third
World countries, require regulations for the conducting of all experiments in
order to preserve the human bean rights and the ecosystems. The present
scientific revolution challenges the bioethical attempt to decide the limits that
would have to respect those who conduct the biomedical research.

REVIEWS:
In Medicine, Health Care and Philosophy: http://www.springerlink.com/content/44275q410286r7q1/

ABSTRACT
Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.


This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs. It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise – both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?

These questions are addressed by applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to a large number of ongoing and proposed screening programs which makes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public.

CONTENTS
Acknowledgements

Chapter 1: Introduction

1.1 The Wilson and Jungner Criteria
1.2 Point and Plan
1.3 The Concept of Screening

Chapter 2: Why Screening?

2.1 Screening, Treatment and Prevention: Preliminary Remarks
2.2 Health: Life and Well-being
2.2.1 Health and Counselling
2.2.2 The Good of People and of the Population
2.3 Autonomy
2.3.1 Respecting and Promoting Autonomy
2.3.2 Promoting Autonomy through Screening
2.4 Justice
2.5 Summary

Chapter 3: Screening – What, When and Whom?

3.1 Diseases and Groups
3.1.1 Prenatal Screening
3.1.2 Neonatal Screening
3.1.2.1 Reasons for Screening in the Neonatal Period
3.1.2.2 Neonatal Screening and Parental Informed Consent
3.1.2.3 Expanding Neonatal Screening – How Far?
3.1.3 Child and Adolescent Screening
3.1.3.1 Stigmatisation
3.1.3.2 The Child as Decision Maker
3.1.4 Adult Screening

3.2 Testing and Analysis
3.2.1 Safety
3.2.2 Validity
3.2.3 Predictive Value

3.3 Treatments
3.3.1 Abortion as Treatment
3.3.2 Counselling as Treatment

3.4 Summary

Chapter 4: Screening – How?

4.1 Informed Consent
4.2 Counselling
4.2.1 Genetic Counselling as a Template
4.2.2 Expansion: Shared Decision Making

4.3 Funding and Participation
4.4 Summary

Chapter 5: Case Studies

5.1 Non-Invasive Prenatal Diagnosis
5.2 Neonatal Screening for Fragile X
5.3 Mammography Screening
5.4 PSA Screening for Prostate Cancer


Chapter 6: Serving Society or Serving the Patient?

6.1 Summary of the Analysis So far
6.2 The Public Health – Health Care Tension Area
6.3 The Relevance of a Social Science Perspective
6.4 An Institutional Approach to health-related Ethics: A Sketch
6.5 Applying the Institutional Approach: Three Cases
6.5.1 Institutions, Functions and Ethics: Reproductive Care vs. Communicable Disease
6.5.2 Direct to Consumer Genetic Testing: The Limits of Context Relativity
6.5.3 Screening and Justice: The Case Against Allocating Health Care Resources to Screening


6.6 Revisiting the Wilson and Jungner Criteria for Screening
6.7 Closing

Refrences
Index

Mindfulness is a burgeoning field of study and practice within mental health care and medicine. Yet ethical codes, and the philosophy of the therapist-client relationship, differ greatly between disciplines, and even more between those disciplines and mindfulness-based approaches. The potential for ethical dilemmas is therefore significant.

The book breaks new ground by taking a focused look at an ethics derived from contemporary clinical mindfulness practice itself. What does a secular ethics of mindfulness look like? Who is competent to work therapeutically with mindfulness, and how does one delimit areas and levels of competence? How do clinicians ethically understand the therapist-client relationship from the therapeutic position of mindfulness? And how do clinicians respond when the necessary restraints of their professional role and ethics code come into conflict with the mindfulness-based relationship and therapeutic position?

This book makes a vital contribution to the understanding of ethics as the cornerstone of mindfulness-based practice, and will be of interest to all those involved in delivering mindfulness-based interventions, including psychologists, counselors, spiritual directors, occupational therapists, physicians, nurses, and educators.

The book reflects on some of the troubling questions in medical ethics:  Medicine, Technology, Law and Decisions at the Beginning of Life; Planned Orphanage; Wrongful Life; Ethical Education and Research in Medical Schools and Hospitals; Organ Transplantation; Allocation of Resources, Health Care Systems and Health Rights; Decisions at the End of Life: Mercy Killings and the Right to Die in Dignity; Clinical Ethical Issues. The book is comprised of essays that were written by members of the Medical Ethics Think-tank that worked under the auspices of The Van Leer Jerusalem Institute during 1995-1998. The contributors come from different disciplines: physicians, philosophers, ethicists, legal theorists, social workers and religious authorities. The scholars represent all six Israeli universities and some of them are also affiliated to the principal medical centers in the country. These are top scientists, renowned for their quality research and scholarship, who have been working together for three years. The group has produced in its brain storming sessions high quality papers that will enrich the thinking and knowledge on various issues in the field of medical ethics, especially on decision making at the beginning of life and at the end of life. The book offers significant contribution to the analysis of practical questions from theoretical and analytical perspectives, combining theory and fieldwork conducted in hospitals.

We want this book to evoke a debate on major issues in medical ethics in Israel and to serve all those who are interested in the issue.












דילמות באתיקה רפואית
רפאל כהן-אלמגור (עורך)


תוכן עניינים

רפאל כהן-אלמגור
הקדמה

שער ראשון
על זכויות בריאות וחינוך לאתיקה רפואית

כרמל שלו
זכויות בריאות

שמעון גליק ועדנה בנשלום
ההתמודדויות האתיות של סטודנטים לרפואה

גרשון ב. גרונפלד
ועדות אתיקה במוסדות רפואיים


שער שני
תחילת החיים: על הזכות להורות, יתמות מתוכננת, והזכות לא להיוולד בפגם

רות הלפרין-קדרי
"להשאיר חיים אחריך": יילוד העובר מגוף הנפטרת - האמנם בכל מקרה?
ורדית רביצקי
הזכות להורות בעידן ההפריה הטכנולוגית
מרדכי הלפרין
הגדרת הורות וזכות איתור השורשים הביולוגים

רוזלי בר
סוגיות אתיות ביצירת ילדים באמצעות אם פונדקאית

רות לנדאו
יתמות מתוכננת

אסא כשר
"יתמות מתוכננת": התמונה המאוזנת

עמוס שפירא
הזכות לא להיוולד בפגם: פלוגתות של לוגיקה, ערכים ומדיניות משפטית

דוד הד
האם קיימת זכות לא להיוולד בפגם? תגובה פילוסופית לעמוס שפירא

שער שלישי
השתלות איברים וסוף החיים בראי ערכים הלכתיים וליברליים

משה זמר
תרומת איברים וההלכה

אברהם שטיינברג
החולה הסופני - מבט השוואתי בין "ערכים דמוקרטיים והלכתיים"

רפאל כהן-אלמגור
על אוטונומיה, המתות חסד והזכות למות בכבוד


שער רביעי
מדיניות טיפולית

איתי בנטוב וצ'רלס ספרונג
בעיות אתיות בברירת חולים לטיפול נמרץ

אבי עורי
היבטים אתיים ברפואה שיקומית

ברוך מודן ושלומית פרי
גורמי סיכון וגורמי פיצוי: מדיניות הממשלה מול מוקרני הגזזת

El libro impreso puede conseguirse en:

https://casadelibrosabiertos.uam.mx/gpd-neuroetica-relaciones-entre-mente-cerebro-y-moral-etica.html

Se adjuntan forros, página legal e índice de la primera edición (2019) y de la primera reimpresión (2020; solamente cambia la página legal). Además, se agregan las reseñas que han aparecido hasta la primera mitad de 2021. Debido al avance científico y filosófico sobre estos temas, así como el éxito editorial que ha tenido, ya se prepara una segunda edición revisada.

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient's request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome...

Ethics is a growing concern in the realm of data science, artificial intelligence (AI), and data-centric technologies in general. There are good reasons for this. We are all familiar with concerns over such issues as data privacy, data-driven surveillance, and the increased intertwining of the data industry with the finance industry and the so-called defense industry. We are all familiar with the fact that data-extracting and data-driven algorithms increasingly regulate the temporal , affective, and intersubjective modalities of everyday life. And we are all familiar with how this regulation-along with the sometimes over-the-top, but sometimes legitimate, concerns of how AI may change the very definition of the human, as well as life itself-is increasingly of not only ethical but also existential concern. Indeed, there are good reasons we are experiencing what I would call an ethical demand made by the data-centric situation in which we now find ourselves. In this essay, I will discuss the dominant ways in which ethics is talked about vis-à-vis data-centric practices and technologies today. I will then turn to a more adequate ethical response to the demand of our current data-centric situation: this is what I call relational ethics.

The topic of organ donation has always been a heated debate between the rights of the donors to give up their organs for strangers and the rights of the recipients in their fight for survival.  Though many countries have some sort of legislation that outlines organ donation, the results are often disappointing and often many potential donors are lost along with their viable organs. Last month, the BMA released a report that discusses the state of organ donation in the UK.  In the report, not only does it outline the current laws and practices in effect, but proposes a series of initiatives that has sparked controversy and rage from people of all walks of life; from the pro-life activists to the patients’ rights advocates.  The suggestions are radical in their approach, but did the British Medical Association go too far? Is the increase in donors worth the risk that patients will face as the recipients of these questionable sources? Ultimately, the propositions set forth in the report must be adapted to the law or else deserving patients will continue to die as a result of the organ shortage crisis. This paper seeks to outline the suggestions set forth by the BMA and to explore their bioethical benefits or consequences.

There are few issues more emotional and divisive than what has become known as “the right to die.” One camp advocates the “death with dignity” approach, according to which the patient is an autonomous being who can form his or her own judgment on the timing and process of dying. The other camp advocates the sanctity of life approach, in which life is intrinsically valuable and should be sustained as long as possible. Is
there a right answer?
    In The Right to Die With Dignity, Raphael Cohen-Almagor takes a balanced approach in analyzing this emotionally charged debate, viewing the dispute uniquely from public policy and international perspectives. This book offers an interdisciplinary, compelling study in medicine, law, religion and ethics. It is, arguably, the most comprehensive book yet to be written on the fascinating question of whether physician-assisted suicide should be allowed. Cohen-Almagor delineates the distinctions between active and passive euthanasia and discusses some of the legal measures that have been invoked in the United States and abroad. He outlines the reasons non-blood relatives should be given a role in deciding a patients’ last wishes. He examines euthanasia policies in the Netherlands and the 1994 Oregon Death with Dignity Act, suggesting improvements to each. Finally, he makes a circumscribed plea for voluntary physician-assisted suicide.

La bioética es un campo de conocimiento casi con medio siglo de desarrollo. Puede considerarse que se inició en la década de 1970 con dos ramas que confluyen, una biomédica y otra medioambiental. Sigue existiendo mucha confusión y aún existen personas que creen que la bioética es sinónimo de ética médica. Son tantos los campos que abarca esta ética de la vida, que se inicia con un bosquejo de qué es lo que puede entenderse por bioética actualmente. La propuesta incluye un análisis por niveles: microbioética, mesobioética y macrobioética. Tras exponer algunos antecedentes relevantes de la bioética ambiental en relación con plaguicidas, se analizan problemáticas y propuestas por niveles. El nivel de la microbioética analiza problemática en relación con la toma de decisiones sobre el propio cuerpo. El de la mesobioética examina cuestiones relacionadas con la toma de decisiones institucionales y estructurales. La macrobioética inspecciona problemas globales. Los plaguicidas plantean problemáticas distintas en estos niveles, por lo que las estrategias para soluciones eventuales deben considerar las implicaciones multinivel.

This paper combines insights from political philosophy, bioethics, and political geography to examine the practice of medicine by the Khmer Rouge during the Cambodian genocide. Through a discussion of both destructive and constructive health-related policies and practices enacted by the Khmer Rouge between 1975 and 1979, this paper documents how the practice of medicine provides a broader understanding of state sovereignty and the right to live or to let die. In so doing this paper contributes to our understanding in two areas: fi rst, to the specifi c geographies of the Cambodian genocide and, second, the politics surrounding the calculated management of life and death.

In his film Hable con Ella (2002) Pedro Almodóvar features the character of Benigno, a nurse who is in permanent charge of Alicia, a young patient in a persistent vegetative state. Benigno talks continuously to Alicia. Almodóvar wants the audience to be torn between diagnosing insanity and rationality; and obtains his result in equipping Benigno with good arguments supporting his behaviour. I try to show that Benigno’s “talking to her” is not less reasonable than the doctors’ treating Alicia, since both acts can be found to be grounded in the same kind of Pascalian wager concerning the possibility of Alicia’s awakening.
Benigno also loves Alicia, and rapes her. Again, Almodóvar supply the audience with conflicting moral arguments, and tempts it to arrive at this frightening conclusion: Benigno may be not guilty. In fact, as an individual whose higher-brain is apparently dead, Alicia has lost forever her capacity to be conscious. If such capacity is constitutive of being a person, then Alicia properly is an ex-person – just as any dead body is. Since ex-persons cannot be harmed or wronged, it seems we cannot say that Benigno either harms or wrongs Alicia. May be we cannot even say that he rapes her, since the concept of rape may not apply to non-persons. But do all our moral feelings align with these conclusions? Indeed rival rational arguments seem to contrast them too. Almodóvar tries to render acceptable the idea of both moral condemnation and innocence of Benigno, and the film actually is a rational, open ethical discussion where opposite arguments collapse.

ABSTRACT
The article aims at challenging the very idea of bioethics. Starting with a thought experiment which puts into perspective relations between law and ethics, a reflexion on founding moments of bioethics as a distinctive discipline will be proposed in order to contest some of its assumptions. Less traditional ways of seeing the field will be subsequently analysed, yet the conclusion of this exploration will remain critical: we should rather think of an alternative way of seeing moral expertise in the biomedical sphere, founded on plural knowledge of diverse agents who leave their moral presuppositions aside as much as this is possible

RESUME
L’article vise à contester l’idée même de la bioéthique. En commençant par une expérience de pensée permettant de mettre en évidence les relations entre le droit et l’éthique, on retracera ensuite quelques moments fondateurs de la bioéthique pour s’interroger sur ses présupposés ; on examinera enfin des façons moins classiques de voir cette discipline. Dans la conclusion, sera formulée une invitation à une autre façon de voir l’expertise éthique dans la sphère biomédicale, qui s’appuierait sur des savoirs pluriels venant d’agents différents, en laissant, dans la mesure du possible, leurs présupposés moraux de côté.

The last half of the twentieth century was the scene of the development of new technologies to improve maternal and fetal health. Thus, new possibilities to gestate and birth have been offered to pregnant women and fetuses at high risk whose future, in another historic moment would have been at least uncertain. However, the systematic use of such technology without a proper categorization of patients who would benefit from it, or without a thorough critical review of risks and benefits associated with its implementation, has helped put human birth in a whole new level : the quasi-industrial event. In turn, this reality produces other joints, and from the medical point of view and from the social and cultural aspects Human birth has been medicalized so much so that generated the short-and long-term consequences for both mothers and their children. The concept of reproductive success should be rethought in light of these and other realities that all those in relation to human birth, we see daily in our professional practice.

Some people change dramatically over time, and often those changes result partly from what they have chosen to do for a living. Drawing on the work of Richard Sennett and Sandeep Jauhar, I explore how practicing in a market-driven medical system can corrupt the character of doctors.

Human enhancement is one of the hottest bioethical debates because the two parts have strong foundation on their arguments. Human enhancement is both naturally and technologically. Many people agree upon natural human enhancement because it is part of human dignity. Technological human enhancement spark debates pros and cons. We will learn from Jean-Jacques Rousseau to inspire our discussion. We will use Rousseau's famous statement, "the faculty of self-improvement" in developing argument to arrive in the final conclusion.

This study was conducted in order to provide a possible solution to the myriad of healthcare access problems affecting Zimbabwe. A desktop analytic review of literature, reports, legal and policy documents was carried out on the historical development of healthcare delivery in Zimbabwe spanning the pre-colonial, colonial, and post-colonial periods. Relevant literature was identified by electronic searches using Mendeley, Google chrome, and other internet search platforms.  Summaries of the articles were analyzed for emerging themes and conclusions were drawn.
This thesis traces the development of healthcare policies in Zimbabwe starting from the pre-independence period to the post-independence period (2020). It critically analyses the egalitarian, utilitarian, and ubuntu moral theories bringing out their potential application to the design of a new model that has the potential to address challenges of access to healthcare in Zimbabwe. Selected influential healthcare models and systems such as the Beveridge, Bismarck, National Health Insurance, Single-payer systems, Multi-payer systems, and the Out-of-Pocket Spending systems are also critiqued, based on their social, legal, and ethical relevance to the aims and objectives of this thesis.
The thesis presents a suggested new ethically justified healthcare model for Zimbabwe, called the Citizen Centred Healthcare Model (CCHM). It is premised on six fundamental building pillars or blocks which guarantee human rights and citizen-oriented service provision: Prioritized Healthcare Financing, Equitable Rationing of Healthcare Services, Social Solidarity and Human Rights Culture Promotion, Effective Monitoring and Evaluation, Inclusive Healthcare and Stable Political and Macroeconomic Environment.

In short, this essay does for the concept of the assemblage what Deleuze and Giorgio Agamben did for Foucault in their essays on the dispositif: it extracts from a large body of work the core formal features of its operative methodology or logic.

What are the effects of circumcision  on sexual function and experience? And what does sex—in the sense related to gender—have to do with the ethics of circumcision? Jacobs and Arora (2015) give short shrift to the first of these questions; and they do not seem to have considered the second. In this commentary, I explore the relationship between sex (in both senses) and infant male circumcision, and draw some conclusions about the ongoing debate regarding this controversial practice.

Carpeta sobre Cuidados Paliativos 2009 2 CONTENIDO 1. OBJETIVOS 2. ¿QUÉ SON LOS CUIDADOS PALIATIVOS? 3. ANTECEDENTES DE LOS CUIDADOS PALIATIVOS 4. CONTEXTO ACTUAL DE CUIDADOS PALIATIVOS EN LATINOAMÉRICA: NUEVOS AVANCES a. Casos: Brasil y Argentina 5. DIFERENCIA ESENCIAL ENTRE CLÍNICA PARA EL DOLOR Y CUIDADOS PALIATIVOS 6. ESQUEMA INTEGRAL DE BENEFICIOS DEL TRATAMIENTO CON CUIDADOS PALIATIVOS 7. COSTOS APROXIMADOS PREVISTOS PARA BRINDAR CUIDADOS PALIATIVOS 8. PROGRAMA NACIONAL DE CUIDADOS PALIATIVOS 9. FORMACIÓN EN POSTGRADO 10. PROGRAMA DE ATENCIÓN MÉDICA ESPECIALIZADA DOMICILIARIA, (PAMED, E.S.)

In questo lavoro di tesi ho cercato di analizzare alcune questioni fondamentali riguardanti i problemi etici nel fine vita. Nel mio percorso di studi ho avuto la possibilità di frequentare il corso di Bioetica ed etica clinica, una serie di appuntamenti particolarmente formativi fondati sul confronto diretto con i medici degli ospedali di Trento e Rovereto, in cui venivano esposti ed affrontati problemi concreti e reali che gli operatori sanitari (e ovviamente i degenti) sono costretti a fronteggiare nella quotidianità. L'idea di ragionare su questo argomento particolarmente delicato è nata dalla presa di coscienza che alla base del rapporto medico / paziente si trovi spesso una situazione di conflitto, dubbio e contrattazione.
Innanzitutto, nella prima parte del mio elaborato esaminerò approfonditamente la tematica della morte, la sua interpretazione biologica, cerebrale, metafisica, per riuscire a capire se esista un criterio di morte generalmente ed unanimemente accettato, ma soprattutto per specificare quando una persona possa essere definita realmente e legalmente deceduta.
Posta questa necessaria premessa, nel secondo capitolo proverò a delineare che cosa siano la patologia e il benessere, nonché i parametri in base a cui un individuo possa essere riconosciuto come soggetto sano o patologico. Da tale considerazione, proporrò in seguito un'analisi del concetto di precarietà del vivere, cercando di approfondire la concezione per cui ogni vita debba considerarsi come degna di essere vissuta, in modo da avere tutti gli strumenti necessari per poter rispondere ad alcuni quesiti fondamentali: l'uomo rimane se stesso anche nella malattia? Nel momento in cui il mio corpo cessa di svolgere le sue funzioni più proprie, sono vivo o morto? Cosa significa l'espressione morte sociale?
A questo punto, a partire dal terzo capitolo analizzerò accuratamente i casi concreti più emblematici e controversi; in particolare, le persone affette da gravi e debilitanti patologie, lo stato vegetativo permanente e il tema della richiesta d'eutanasia si pongono come protagonisti di questa parte dell'elaborato. Che cos'è lo stato vegetativo permanente? Come vivono le persone costrette in questo stato? Cosa significa eutanasia? Quali principi caratterizzano la richiesta di tale pratica? In questi passaggi, ragionando sul concetto di accanimento terapeutico, cercherò di capire se la sospensione delle cure sia da considerarsi inequivocabilmente come eutanasia ed esaminerò l'ambiguo parallelismo eutanasia / suicidio. Grazie a queste riflessioni, sarà inoltre possibile affrontare un altro interrogativo essenziale del lavoro di tesi: lo scopo della medicina deve essere identificato nel curare le disfunzioni fisiche del corpo umano oppure nell'assistere il soggetto considerato nella sua totalità?
Detto ciò, nel quarto capitolo prenderò in considerazione la tematica dei trapianti, cercando di comprendere come e perché una modificazione del proprio corpo possa portare ad una profonda sensazione di smarrimento: la pratica dei trapianti mette a rischio l'identità personale? E in altri termini, l'integrità del corpo deve reputarsi una prerogativa fondamentale per l'identità del soggetto?
Quali problematiche etiche possono implicitamente sorgere nell'analizzare la pratica dei trapianti?
In conclusione, dopo aver riscontrato le difficoltà che l'uomo si trova ad affrontare nel periodo patologico, proporrò un'analisi approfondita del principio di autodeterminazione che fonda (o dovrebbe fondare?) la natura di ogni individuo. Come viene definito tale diritto nella Costituzione della Repubblica Italiana e nel Codice di deontologia medica? Fino a che punto l'uomo può essere legittimato nell'esprimere le proprie volontà? E d'altra parte, entro quali termini il personale sanitario è tenuto a rispettarle? Cosa succede se un paziente rifiuta un trattamento, ma il medico decide di praticarlo comunque? È possibile affermare che, in Italia, il principio di autodeterminazione venga esclusivamente proclamato e non garantito nel concreto?
Il programma di questo elaborato è certamente ambizioso nella sua fase conclusiva, ma penso che il porsi degli interrogativi sia la via più rapida e semplice per pervenire a delle risposte.

State regulation of reproductive practices secure the hetero- sexual infrastructure of kinship through means that include elitization, institutional hostility, and plain criminalization. This article draws on personal experiences of gay fathers through transnational gestational surrogacy in Spain to show the extent to which that is the case even in those contexts where some gay and lesbian kinship rights are available. Public and aca- demic debates on the possible regulation of gestational surro- gacy will be analyzed through the lens of Gayle Rubin’s intervention in the sex wars that divided feminism in the 1980s, with which contemporary anti-surrogacy movements show crucial genealogical links. In addition, in order to unearth some gendered assumptions on the ahistorical link between surrogacy and motherhood, the role of the gestational carrier will be read in relation to the figure of the “bad mother.”

Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate—or even encourage—what the authors regard as ‘de minimis’ forms of female genital mutilation (as defined by the World Health Organization). In this commentary, I argue that many serious problems would be likely to follow from a policy of increased tolerance for female genital mutilation, and that it may therefore be time to consider a less tolerant attitude toward non-therapeutic infant male circumcision. Ultimately, I suggest that children of whatever sex or gender should be free from having healthy parts of their most intimate sexual organs either damaged or removed, before they can understand what is at stake in such an intervention and agree to it themselves.

The non-therapeutic alteration of children’s genitals is typically discussed in two separate ethical discourses: one for girls, in which such alteration is conventionally referred to as “female genital mutilation” (or FGM), and one for boys, in which it is conventionally referred to as “male circumcision.” The former is typically regarded as objectionable or even barbaric; the latter, benign or beneficial. In this paper, however, I call into ques- tion the moral and empirical basis for such a distinction, and I argue that it is untenable. As an alternative, I propose an ethical framework for evaluating such alterations that is based upon considerations of bodily autonomy and informed consent, rather than sex or gender.