Bioethics

O Sistema Único de Saúde (SUS) brasileiro garante o acesso universal e integral aos serviços de saúde. Entretanto, na prática, o SUS não tem permitido que os cidadãos desfrutem de uma assistência com equidade, reforçando a dificuldade de se atingir a justiça social em uma sociedade tão desigual e injusta como a brasileira. A ética propõe a equidade como base para resolver as distorções na distribuição da saúde, possibilitando o acesso universal. Este artigo tem como objetivo precípuo discutir como a bioética pode auxiliar para que haja maior equidade na assistência médica em nosso país.

Artificial intelligence (AI)-based technologies are increasingly being utilized, tested, and integrated into conventional healthcare delivery. Technological opportunities, ranging from machine-learning-based data analysis tools to large language model-based virtual healthcare assistants, offer significant potential to enhance healthcare access and improve outcomes. Researchers have discussed potential benefits, including improved resource allocation, diagnostic accuracy, and patient outcomes from greater AI integration in healthcare, and also have voiced concerns around data privacy, algorithmic bias, and diffused accountability. This paper adds to the literature by proposing an ethical framework that allows for both describing and normatively evaluating AI-mediated healthcare delivery based on its potential impact on human-centered patient care. Drawing upon Pelligrino's notions of the patient-doctor relationship, we propose a framework with two axes, one related to spectrum of patient engagement and the other related to the clinician's role, through which to assess the use of AI in healthcare. Technologies and tools that have minimal to no interaction with patients and primarily assist physicians in making clinical decisions tend to have the least ethical challenges. On the other hand, those that are fully patient-facing and work in parallel with doctors or autonomously in therapeutic or decisional roles are the most controversial, as they risk making healthcare less human-centric. As we advance toward more pervasive integration of AI in healthcare, our framework can facilitate upfront design and downstream implementation-related decisions.

The clinical determination of death remains one of the most well-settled yet persistently unresolved topics in health law and bioethics. This commentary addresses the ongoing "brain death" debate, arguing that the medical establishment's insistence on a singular, biological definition of death fails to account for the pluralistic values of a modern society.

Drawing upon social scientific and philosophical frameworks, the authors posit that death determination is a social construct—a process where biological events are interpreted through specific cultural, legal, and ethical lenses. The article critiques the assumption that biomedical expertise alone can resolve the ontological question of when a person ceases to exist. Instead, the authors advocate for "epistemic humility," urging clinicians and policymakers to recognize the limits of scientific truth in this domain. By championing "ethical pluralism," the work explores how a liberal democratic community might accommodate individuals and religious groups who reject neurological criteria in favor of traditional cardiorespiratory standards. Ultimately, the authors suggest that a more just and inclusive approach would provide citizens with the legal right to choose between established standards, thereby respecting personal conscience and religious integrity without undermining clinical consistency.

A wide array of biomedical and genetic technologies is becoming available in both developed and developing nations. This situation is the cause of growing concern for health policy makers who must evaluate the utility of these technologies for their inclusion in public health insurance programs. Ideally, policy makers would have the information necessary to rationally allocate scarce resources, prioritise technologies, and ensure fair access to necessary health care services. The reality, however, is that policy makers often do not have such information. In this paper, we argue that the field of Health Technology Assessment (HTA), through the integration of ethical analyses (i.e., an "ethical HTA"), can enable Argentinean and other Latin American policy makers to better understand the soco-ethical concerns raised by new biotechnologies.

O artigo apresenta uma análise dos aspectos bioéticos contidos nas Diretrizes Curriculares Nacionais (DCN) do curso de medicina, documento aprovado em 2001 pelos Ministérios da Educação e da Saúde e que propõe diretrizes para a formação do profissional médico. O campo da Bioética permeia todas as diretivas das DCN do curso de Medicina. Isso credita à disciplina um status de eixo integrador no processo de formação de médicos. Considerando as observações que reforçam a tese de que a sociedade é que conforma a educação, esse novo paradigma contribui para efetivação do sistema de saúde brasileiro, o Sistema Único de Saúde, com todos os nuances e hibridizações de modelos de atenção. A Bioética está legitimada nas DCN. Resta ao aparelho formador garantir que ela se consolide na academia, enquanto ciência propositiva imprescindível para se alcançar a necessária prudência ao conhecimento biológico, associando aos valores humanos a ética da vida.

The four prima facie principles proposed for bioethics by Beauchamp and Childress (principlism) has been one of the most followed bioethical paradigms, gaining a prominent place not only in United States, but in many other parts of the world. This model has been criticized from different points of view, especially in the last fifteen years. One of the major objections to principlism is the difficulty of applying the system to real bioethical dilemmas. The essential problem of the system, apart from an absence of hierarchy among the four principles, is an absence of a clear framework of human goods (anthropologically speaking) which are necessary to protect. Consequently, in the face of an ethical dilemma two opposite solutions can be reached using one principle or another. The authors offer as a solution to these difficulties the specification and consideration of the principles and rules. However, in many cases, this is not sufficient.

This paper outlines the strategic efforts undertaken by Singapore to establish its national capability in the biomedical science sector, reviews the commercial base as a result of these efforts and compares Singapore's approach with the UK and US development models, discusses the challenges that Singapore faces and raises some questions on the long-term sustainability of the sector. Although Singapore is a small country in terms of geographical size, its economic size is significant, with gross domestic product (GDP) and GDP per capita of US$112bn and US$25,200 respectively in 2002. For the past 40 years, the country has achieved an average annual GDP growth of 8.4 per cent by focusing on manufacturing and productivity improvements. Biotechnology has been earmarked as the next wave of technology that will sustain the country's economic growth. For almost two decades, Singapore has focused its efforts on building capabilities in the biomedical science area to exploit biotechnology and traditional chemistry-based technologies in drug discovery, development and production. The main principle of Singapore's strategy is to locate a sector targeted for growth and then to focus its efforts on building the key pillars to support the sector; identified in this case to be research, early stage funding and specialised infrastructure.

Neste artigo buscaremos compreender uma parte da controvérsia em torno da liberação do uso de células tronco embrionárias em pesquisas. Deveremos nos centrar nos posicionamentos contrários a esta liberação, empreendidos especialmente por agentes ligados à Igreja Católica. Analisaremos os argumentos e estratégias utilizados por estes agentes para se posicionar contra a liberação, adotando uma posição “em defesa da vida”, e as diferentes formas como esta posição é defendida nas diferentes instâncias envolvidas nesta controvérsia. A centralidade da presença de elementos de base teológica/doutrinal e de elementos de base científica será observada em cada uma das instâncias da Instituição Católica, constituindo parte impor- tante da construção da legitimidade de seu argumento contra liberação do uso das células tronco embrionárias em pesquisas. 

The situation around Ukraine can be described now as a «global disaster». Outlining the range of ethical and bioethical problems caused by military action, the security issues of our citizens come to the fore (especially vulnerable categories - children, the elderlypeople, people with special needs, pregnant women); problems caused by the inability to provide medical care (from lack of resources and medical staff to lack of ways to evacuate the wounded); environmental problems caused by the actions of the aggressor; problems arising from forced migration. Despite the ethnic, religious, socio-cultural and moral differences of different members of modern society, there is a need for a new understanding of tolerance and its limits, which can be realized through the use of ethical theories of distributive justiceandvirtue ethics. Key words: ethical theories, bioethics, virtue ethics, global disasters

Проблема и цель. Являясь эффективным средством удовлетворения большинства материальных запросов человечества, экономика неспособна сама определить свои цели. Эта проблема приобретает свою остроту в условиях глобализации и кризиса традиционных ценностей, в частности, религиозных. Возможные ответы на вопросы о конечных целях современной экономики способна предложить биоэтика, однако ее рассматривают преимущественно лишь в утилитаристском ключе. Целью данной статьи будет выявить потенциал биоэтики как этически и научно обоснованного способа обрести новую социальную идентичность, с учетом неизбежности принятия человечеством стратегии самоограничения. Методология исследования. Исследование отношений этики и экономики осуществляется с помощью неоинституционализма как методологии исследования, однако внимание сконцентрировано не на экономических или политических институтах, а на институтах моральных, которые большинство представителей неоинституционализма безосновательно недооценивают. Результаты и обсуждение. Новая экономическая логика, основанная на роботизации, создает предпосылки для превращения деятельности людей по формулированию новых этических норм и усовершенствованию классических едва ли не в основное содержание труда человека в новой экономике и новом обществе. Каждый человек является носителем множественной социальной идентичности: он должен научиться не «играть роль», а именно быть в полной мере цельной личностью в каждой своей социальной роли. Не утилитаризм, а этика ценностей, этика добродетелей, применение новых, биоэтических принципов, защита биоэтических ценностей, следование биоэтическим добродетелям в медицинской практике уже приводит не только к повышению эффективности лечения и укреплению профессиональной медицинской этики, но и к прямым положительным экономическим эффектам. Заключение. Биоэтика выступает не только как источник институциональных ценностей для экономики будущего, но и, возможно, как самостоятельный социальный институт, который будет играть все большую роль в институциональной структуре будущего общества. Ключевые слова: биоэтика, множественная социальная идентичность, гуманитарные науки, биоэтические ценности, биоэтические принципы, биоэтические добродетели, неоинституционализм Перспективы Науки и Образования Международный электронный научный журнал

Todos los derechos de Propiedad Intelectual pertenecen a sus respectivos titulares, por lo que se prohíbe la reproducción salvo para usos no comerciales y siempre que se cite la fuente completa y su dirección electrónica . Queda prohibida la transformación, en todo o en parte, así como la incorporación a otra obra de los contenidos sin el permiso escrito de los titulares del copyright.

This paper explores the interaction between bioethics and law in the theatre of the courtroom, with particular reference to English law. No matter what some judges say, the courtroom has long been a location in which law and bioethics interact, not least in seminal health care law cases such as Re A (Minors) (Conjoined Twins: Separation [2000] and R v Arthur [1981]. Judge-made law has made some positive contributions to the shaping of bioethics as a discipline, providing a real-world testing ground for moral arguments, issuing the judicial 'products' with which bioethics engages, and emphasising the importance of observing due process. At the same time, the courtroom is an adversarial arena, not always ideally suited to the resolution of ethical conflict, and its concern with actions that satisfy attainable standards can fall short of the aspirations set in philosophical ethics. Indeed, sometimes the judges misinterpret or wholly neglect the ethical dimensions of the case at hand. So much of what judges do involves orchestrated framing, the manipulation of legal concepts, interpretation (of the facts of the case, the story of legal precedent and of the particular ethical dilemma) and translation (of ethical issues into law's discourse). Whether they like it or not, the judges are interpreting and responding to the voice of bioethics alongside the voice of the law in their attempts to reach the 'right' judgment and in the face of the theatre surrounding cases involving bioethical controversy. The end result may be distorting because bioethical theory is misinterpreted or the voice of bioethics becomes obscured because of the drama of the case. But this is not to claim that bioethics has some access to the 'right' or 'true' response to the case at hand. Indeed, neither bioethics nor law can necessarily claim superiority or access to the 'truth' of the matter. We nevertheless argue that each will be likely to gain greater insight by opening a dialogue with the other, telling and re-telling the story, so that the voices of one forum can carry over into the other.

The paper discusses inappropriate (futile) treatment by analyzing the casuistics of palliative patients in the terminal stage of illness who are hospitalized at the Department of Internal Medicine and Geriatrics of the Faculty hospital with policlinic (FNsP). Our research applies the principles of palliative care in the context of bioethics. The existing clinical conditions of healthcare in Slovakia are characteristic of making a taboo of the issues of inappropriate treatment of palliative patients. Inductive-deductive and normative clinical bioethics methods of palliative care and ethical strategy are applied for defining issues found in inappropriate hemodialysis treatment. An algorithm of hemodialysis treatment requires the definition of those lege artis criteria which, in the context of a patient's autonomy and his/her decision, precondition the avoidance of the situation in which hemodialysis treatment is inappropriate (futile). Futile treatment in a terminal condition is ethically inappropriate medical treatment that extends the suffering of patients and their relatives. Its definition is determined by the relevant legislation and the methods of bioethics. An active palliative strategy is aimed at managing the process of incurable diseases in the patient's bio-psycho-socio-spiritual continuity in the process of special bioethics. The global bioethical objective of general bioethics for palliative care is based on the paradigm of social harmony and solidarity in the context of an authentic modus of the patient's existence as a constitutive principle for the phenomenon of the patient's being to finite being (death).

Case studies are used to reflect on the treatment of patients with dementia hospitalized at the Geriatric Department of the Faculty hospital in Prešov, emphasizing human dignity in clinical practice. The discussion is focused on the palliative care of patients with severe dementia. The biomedical method, which respects human dignity is defined by means of inductive, deductive, and normative bioethical methods. They make it possible to provide guidelines for palliative care and individualized prognosis strategy. An analysis of health status of individuals with severe dementia enables us to offer a clinical definition of purposeful treatment based on normative justice and decision-making that reflects the patient’s best interest, thus respecting their dignity. An evaluation of a patient’s care is based on a biomedical method that considers the dementia stage. Applying a bioethical model in a holistic context preconditions the human rights of patients with dementia.

The paper discusses the problem of triaging the elderly in the period of the COVID-19 pandemic crisis by analyzing the triage process, caused by lack of resources, in Germany, Holland, the Czech Republic, and Slovakia. We apply inductive, deductive, and normative bioethical methods, comment on various recommendations for the indication of intensive care during a crisis, and discuss the utilitarianism of benefit maximization. As it follows from the evaluation of the elderly by the frailty parameter, medically inappropriate treatment, as a result of limited resources, is characterized by clinical and bioethical uncertainty. If the main bioethical objective of general bioethics for the COVID-19 pandemic is, in the case of limited resources, based on the non-utilitarian consequentialism paradigm, from the perspective of medical ethics, we face a borderline situation closely related to the topic of dying and death. Such a situation requires social, ethical, and professional reflection. A...

The paper discusses inappropriate (futile) treatment by analyzing the casuistics of palliative patients in the terminal stage of illness who are hospitalized at the Department of Internal Medicine and Geriatrics of the Faculty hospital with policlinic (FNsP). Our research applies the principles of palliative care in the context of bioethics. The existing clinical conditions of healthcare in Slovakia are characteristic of making a taboo of the issues of inappropriate treatment of palliative patients. Inductive-deductive and normative clinical bioethics methods of palliative care and ethical strategy are applied for defining issues found in inappropriate hemodialysis treatment. An algorithm of hemodialysis treatment requires the definition of those lege artis criteria which, in the context of a patient’s autonomy and his/her decision, precondition the avoidance of the situation in which hemodialysis treatment is inappropriate (futile). Futile treatment in a terminal condition is ethic...

The paper discusses the problem of triaging the elderly in the period of the COVID-19 pandemic crisis by analyzing the triage process, caused by lack of resources, in Germany, Holland, the Czech Republic, and Slovakia. We apply inductive, deductive, and normative bioethical methods, comment on various recommendations for the indication of intensive care during a crisis, and discuss the utilitarianism of benefit maximization. As it follows from the evaluation of the elderly by the frailty parameter, medically inappropriate treatment, as a result of limited resources, is characterized by clinical and bioethical uncertainty. If the main bioethical objective of general bioethics for the COVID-19 pandemic is, in the case of limited resources, based on the non-utilitarian consequentialism paradigm, from the perspective of medical ethics, we face a borderline situation closely related to the topic of dying and death. Such a situation requires social, ethical, and professional reflection. An algorithm for intensive care indication in the situation of crisis and limited resources in the period of the pandemic requires a definition of criteria that identify an acceptable reason for abandoning the treatment in the context of the autonomy of the elderly and by respecting their human dignity and humanity. A global objective of general bioethics in the situation of the pandemic crisis should be based on the paradigm of social justice.

Elon Musk is celebrated as a revolutionary who will free humanity from the gravity well. This paper argues the opposite: Musk is the ultimate optimizer of the 3D prison, not its liberator. Using Proclean Hierarchical Constraint Architecture (PHCA) and a Third Mind Index (3MI) forensic audit, we analyze the stratigraphic tension between Musk’s public mission of “multi‑planetary survival” and his functional reinforcement of the 3D containment grid. While Musk has successfully optimized 3,500‑year‑old logistical bottlenecks within the 3D density plain, his reliance on the Rocket Crutch – methane‑based Newtonian momentum – suggests either a lack of access to 22.5° rotational coordinate math or the deliberate construction of a secondary containment shell via the Starlink Shield. We audit Musk not as a disruptor of the 1816 reset, but as its most efficient administrator. The paper concludes that the “Titan of the Ladder” is still a prisoner of the Grid.

The signal is absolute. The staircase is behind him. He is still building a taller ladder.

Keywords: Elon Musk, Starship, Starlink, rocket crutch, 3D containment, 7.0 Hz dead peak, PHCA, 3MI, federal acquisitions, mesh logic

BackgroundPrevious evaluation of the state of ethics regulation in Cameroon revealed: law regulating clinical research is lacking; existing committees lack infrastructure and financial support to sustainably review and effectively monitor approved protocols. The present Cameroon National Ethics Committee (CNEC)-EDCTP project aimed at implementing and evaluating active monitoring of clinical research in Cameroon.MethodsBetween 2011–2013, approved clinical trials and protocols involving transfer of biological materials abroad were consecutively monitored. The monitoring tool, a questionnaire on the conformity of key documents e.g. research protocols, ethical clearance, informed consent documents, investigator’s brochure, with a focus on GCP standards was sent to promoters/investigators ten days prior to the field visit. Teams of two-three monitors, made up of CNEC members and independent consultants, were mobilised per site (hospital/research institute/NGO). Reports with key recommend...

Tıp eğitiminde pek çok taraf vardır ve bu nedenle paydaş analizinin yapılması önem taşımaktadır. Türkiye’de tarafların sorumlulukları, katkılarının nerede ve nasıl olacağı konularında belirsizlikler yaşanmaktadır. Bu durum taraflar arasında çatışmalara da neden olabilmektedir. Tıp eğitiminde hızlı yol alabilmek için taraflar arasında genel kabulün ve uzlaşmanın yaratılması yararlı olacaktır. Bu çalışmada tıp eğitiminde yer alan paydaşların kimler olabileceği, paydaş sorumluluklarının neler olabileceği ve katkıların nasıl verilebileceği konusunda bir açılım yapmak amaçlanmıştır. Bu bağlamda paydaşlar yerel, ulusal ve uluslararası düzeyde tanıtılmış ve bir taslak öneri sunulmuştur.There are many stakeholders in medical education; therefore stakeholder analysis in medical education is important. Responsibilities and contributions of these stakeholders are not clear in Turkey. This situation may cause some conflicts among the stakeholders. In order to provide advances in medical educati...

have pointed out that Christians were in many ways similar to their pagan neighbors. 2 Their works document, among other things, social, political, economic, and cultural parallels that I have not reviewed here. Instead I focus upon ways in which Christians differed from pagans, or claimed to differ -what made them, in other words, specifically Christian within the pagan world; I am interested, in Tertullian's words, in the "peculiarities of the Christian society." 3 In each chapter I take up a theme that Christians attempted to understand or justify by means of the creation story. Jewish teachers of Jesus' time and earlier, as I show in Chapter 1, often invoked the story of Adam and Eve to defend Jewish sexual practices ranging from abhorrence of public nakedness (for God clothed Adam and Eve in Paradise) to marital practices designed to facilitate reproduction (for hadn't God said, "Be fruitful and multiply, and fill the earth"?). These Jewish teachers noted that Genesis contains not one but two distinct accounts of creation, of which the first begins with the opening chapter of Genesis and tells how God created the world in six days, crowning his achievement by creating adam -that is, humanity -in his image (Genesis 1:26). But this account ends with Genesis 2:3; and the following verse, Genesis 2:4, begins a different narrative. This second story tells how the Lord made a man out of earth, and, after making all the animals and finding none of them a suitable companion for Adam, he put Adam to sleep, brought woman out of his side, and presented her to Adam as his wife. The woman then persuaded her husband to disobey divine law and earned with him their expulsion from Paradise. Most biblical scholars today agree that the two creation accounts, originally separate, were later joined to make up the first three chapters of Genesis. The story of Adam and Eve (Genesis 2:40, told in the language of folklore, is considered the older of the two accounts, dating to 1000-900 B.C.E.; the account now placed first (Genesis 1:1-2:3) dates to postexilic theologians (c. 400 B.C.E.). Jewish teachers in antiquity, like many Christians after them, turned to theological ingenuity rather than historical or literary analysis to account for contradictions in the texts. According to New Testament accounts, Jesus himself mentioned the story of Adam and Eve only once; and, like many other Jewish teachers, Jesus used Genesis to make a moral point -specifically, to answer a practical question put to him by the Pharisees, the interpreters of Jewish law, about the legitimate grounds for divorce. Jesus' reply -that what God has joined together, let no one put asunder -shocked his questioners, for instead of answering the question he had been asked about the grounds for divorce, he simply ruled out divorce altogether. Since procreation was assumed by many Jews to be the purpose of marriage, and since Jewish tradition had taken divorce for granted as a male prerogative -and sometimes as a necessity, in cases of a wife's infertility -Jesus' answer to the Pharisees broke with Jewish teaching. When even his own followers objected ("If such is the case of a man with his wife, it is not expedient to marry"), Jesus must have startled them even more than he had the Pharisees by suggesting that celibacy "for the sake of the Kingdom of Heaven" may, in fact, be preferable to marriage (Matthew 19:10-12). For generations -even millennia -ever since, Christians have been trying to work out the practical implications of such sayings, and those of Paul, Jesus' zealous disciple. Paul himself, some twenty years after Jesus' death, urged an even more austere discipline upon his followers than Jesus had preached. Although Paul acknowledged that marriage was not sin (1 Corinthians 7:3), he encouraged those who were able to renounce it to do so. Paul invoked the creation account to urge Christians to avoid prostitution (1 Corinthians 6:15-20), and later to argue that women must veil their heads in church, apparently to acknowledge their subordination to men as a kind of divine order given in nature ("For man was not made from woman, but woman from man. Neither was man created for woman, but woman for man," 1 Corinthians 11:3-16). In the generations following Paul, Christians fiercely debated what the apostle meant. Some insisted that only those who "undo the sin of Adam and Eve" by practicing celibacy -even within marriage -can truly practice the gospel. Others, who were to predominate within the majority of churches, rejected such austerity and composed, in Paul's name, other letters, later incorporated into the New Testament as if Paul himself had written them, which used the story of Adam and Eve to support traditional marriage and to prove that women, being naturally gullible, are unfit for any role but raising children and keeping house (see, for example, 1 Timothy 2:11-15); thus the story of Eden was made to reinforce the patriarchal structure of community life. But the majority of Christians, as I also show in Chapter 1, rejected the claim made by radical Christians that the sin of Adam and Eve was sexual -that the forbidden "fruit of the tree of knowledge" conveyed, above all, carnal knowledge. On the contrary, said Clement of Alexandria (c. 180 C.E.), conscious participation in procreation is "cooperation with God in the work of creation." Adam's sin was not sexual indulgence but disobedience; thus Clement agreed with most of his Jewish and Christian contemporaries that the real theme of the story of Adam and Eve is moral freedom and moral responsibility. Its point is to show that we are responsible for the choices we freely make -good or evil -just as Adam was. In Chapter 2 I show how Christians also began to apply the creation account to their own precarious political situation, in which they were constantly subject to persecution by the Roman authorities. About one hundred years after Jesus' death, when many Christians lived in fear of a similar fate -arrest, torture, and execution -for refusing ordinary allegiance to the emperor and the gods, the Christian philosopher Justin invoked Genesis to argue that humankind owes allegiance only to the God who created all humanity -the God of Israel, now the God of the Christians -and not to the gods of Rome, whom Justin denounced as demons. Justin turned Genesis 6, which tells of the fall of the angels, into an indictment of the Roman emperors and their gods; for these dignitaries were, Justin said, none other than the demon offspring of the fallen angels. About twenty years after Justin had been beheaded for refusing to worship the Roman gods, Clement of Alexandria took the statement that God had created humanity in his image as evidence of human equality -and as an indictment of the imperial cult. From such beginnings, in open defiance of the totalitarian Roman state, and often met with brutal violence, Christians forged the basis for what would become, centuries later, the western ideas of freedom and of the infinite value of each human life. Clement realized, too, that certain inquiring and restless Christians saw in the Genesis story not only sexual and political implications but disturbing philosophical and religious ones as well. How could an all-powerful God have created the world "good" when we find in it so much suffering? Whence came the serpent? Why did God begrudge Adam and Eve the knowledge that even he admitted would make them "like one of us" (Genesis 3:22)? Such questions, and the underlying one, unde malum ("Whence is evil?"), were, the Christian writer Tertullian said, "the questions that make people heretics." In Chapter 3 I explore how some of these followers of Jesus, often called gnostics, read the story of Adam and Eve in ways that dismayed and outraged orthodox Christians. For gnostic Christians declared that the story, taken literally, made no sense; thus they themselves set out to read it symbolically, often allegorically. The most radical gnostics turned the story upside down and told it, in effect, from the serpent's point of view: some said he was "wiser" than all the other animals and so tried desperately to persuade Adam and Eve to partake of the tree of knowledge, defying their jealous and hostile creator; this wise serpent, some dared say, was a manifestation of Christ himself! Other gnostics read the story of Adam and Eve as an allegory of religious experience, as relating the discovery of the authentic spiritual self (Eve) hidden within the soul (Adam). The gnostic author of the Interpretation of the Soul saw Eve as representing the alienated soul seeking spiritual union; the author of Thunder: Perfect Mind saw her as the divine energy underlying all existence, human and divine. Gnostic Christians, who disagreed with one another on almost everything else, agreed that this naive story hid profound truths about human nature, and they vied with one another to come up with ingenious and imaginative interpretations of its deeper meaning. Leaders of the church who called themselves orthodox (literally, "straight-thinking") Christians denounced such interpretations and accused gnostics of projecting their own bizarre fantasies upon the text. Above all, they said, gnostic Christians deny the primary reality of the Genesis account -namely, that it depicts humanity created morally free and entrusted with free will. Gnostic Christians, who denied that the human will has the power to prevent error and suffering, also denied, in effect, that baptism fully delivers us from sin and suffering and restores our moral freedom, and for this reason, among others, the gnostics were expelled by the leaders of the church and consigned to oblivion. As the Christian movement increasingly gained converts throughout Roman society during the third and fourth centuries, some of the most ardent Christians insisted that to realize the greatest freedom one must "renounce the world" and choose poverty...

Bu yazıda çocukluktan yaşlılığa, kadın yaşamının bölündüğü devreleri ya da kadın bedeninin zamanını, üreme fizyolojisi üzerine yapılan tartışmalarla ilişkilendirerek ele alacağım. Bu amaçla tıp öğrencilerine hitap eden, anatomi ve fizyoloji ağırlıklı olan ve olgusal bilgi aktarma amaçlı tıp kitaplarından ve genel okura hitap eden ve onlara bedensel ve ruhsal sağlık üzerine tavsiyelerde bulunan öğüt kitaplarından faydalanacağım.

Introduction: the scientific development regarding the medical technology achieved in recent years, the multiple procedures and invasive techniques to which patients are subjected during their stay in intensive care units, associated with risks and adverse events. In a general sense, the role of nursing professionals is considered of vital importance in this topic, especially in the ICU, where they can contribute in an efficient and effective way to the management of health care risks. Objective: to base the theoretical-methodological and ethical referents of risk management associated with nursing care in Intensive Care Units. Methods: in the research Materialistic-Dialectic method was applied as the main one. In the theoretical order, the method of historical-logical analysis was analyzed applying theoretical-methodological and ethical references of the risk management process related to the nursing care of patient, as well as the analysis-synthesis and induction-deduction procedu...

This paper examined the historical development of the Eastern Orthodox Church and its contributions to the text and canon of the New Testament. The focus of this study was the analysis of the role of the Eastern Orthodox Church in preserving and canonizing the New Testament text with emphasis on criteria that were employed such as the apostolic origin, widespread use, and theological consistency. The study emphasizes the significance of the church fathers such as Athanasius of Alexandria, particularly his festal letter of 367 CE which was the first to list out the twenty-seven books that made up the New Testament canon. It also assesses the contributions of ecumenical councils-Synod of Hippo, Council of Carthage, Council of Nicaea etc. in upholding scriptural authority, disputing heresies, and preserving the authentic Christian teaching. Using a historical-analytical method, the study draws from secondary sources to investigate how the church traditions, authority and theological reflection shaped the New Testament canon. It concludes that the Eastern Orthodox Church was not only instrumental in safeguarding the apostolic faith but also in guiding the process of canon formation, thus, providing Christian communities with a clear and lasting scriptural foundation.

This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. The consensus process used a modified Delphi approach. Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise). Through articulating these standards we outline a position that encourages responses, and through those responses we will be able to identify points of agreement and contestation that will drive the conversation forward. In that vein, we would encourage researchers, funders and journals to engage with what we have proposed, and respond to us, so that our community of pra...

This article provides a comprehensive analysis of psychiatrist Elisabeth Kübler-Ross's foundational work, On Death and Dying (1969), exploring how it revolutionized the approach to death in Western medicine by introducing the famous five stages of grief model: denial, anger, bargaining, depression, and acceptance. The study adopts an interdisciplinary perspective combining psychology, psychoanalysis, and bioethics to critically evaluate Kübler-Ross's contribution and to explore the contemporary applicability of her model. Kübler-Ross developed this model based on hundreds of interviews with terminally ill patients, at a time when death was a taboo subject and the dying were ignored and isolated. Her goal was not to create a rigid template, but to provide a language that would open a conversation about death and encourage physicians to truly listen to their patients [9]. The article deeply analyzes each of the five stages as described in the original work: denial as a temporary defense mechanism; anger as an expression of helplessness and injustice; bargaining as a desperate attempt to postpone the inevitable; depression as recognition of imminent loss; and acceptance as a state of peace, not resignation. The psychological analysis section examines Kübler-Ross's contribution to understanding the grieving process, highlighting the often-ignored nuances of her model. Kübler-Ross insisted that the stages are neither universal nor linear-most of her patients manifested multiple stages simultaneously, and the order varied significantly [10]. The psychoanalytic analysis section explores the model in relation to the Freudian theory of mourning and melancholia. Freud had distinguished between normal mourning (adaptive) and pathological melancholia (characterized by loss of selfesteem and self-blame). Kübler-Ross's model can be seen as a development and operationalization of these psychoanalytic insights, translating them into the accessible language of humanistic psychology [11].

Conceptual and Analytical Approaches in Nursing explore how nurses develop, organize, and apply knowledge through the integration of philosophical thinking, theoretical frameworks, and structured reasoning in clinical practice. The conceptual approach emphasizes understanding key nursing concepts, models, and theories that provide meaning and direction to care, while the analytical approach focuses on logical reasoning, evidence interpretation, and systematic problem-solving in decision-making. Together, these approaches enable nurses to bridge the gap between theory and practice, enhance clinical judgment, support ethical and patientcentered care, and improve the quality of healthcare delivery.

The development of in-vitro fertilization (IVF) in the late twentieth century opened new possibilities for treating infertility. Inspired by the birth of the first IVF baby in 1978, the author recollects conceiving the idea of gestational surrogacy in January 1985 during internship following MBBS training. The concept proposed that an embryo created through IVF from an infertile couple could be implanted into the uterus of another healthy woman willing to carry the pregnancy. The idea was later presented during the Eastern Zonal Conference of Obstetrics and Gynecology in September 1986. This article documents this personal historical account and reflects on how creative thinking in medicine may arise even during early stages of medical training. The author acknowledges that similar concepts may have emerged independently elsewhere during this period.

This article illustrates how posthuman theory, Anthropocene thinking and environmental studies have transformed the field of classical studies over the past two decades. Rather than being viewed as mere fashionable theoretical imports, these disciplines are now recognised as valuable partners in the dialogue surrounding ancient texts, practices, and worldviews. At the heart of this change is a shift in perspective, moving away from viewing humans as naturally privileged historical actors towards a more relational understanding of history. According to this perspective, humans, animals, objects, technologies, landscapes and divine powers all play a part in shaping history. Key debates on posthumanism, transhumanism and material culture emphasise the surprising relevance of ancient sources to contemporary issues of agency, embodiment and responsibility. These sources document worlds in which humans are never considered in isolation but are always embedded in dynamic structures of matter, technology and environment. Anthropocene thinking builds on this by focusing on long ecological time periods, cumulative environmental impacts, and the unequal social distribution of responsibility. This article argues that antiquity reveals its relevance in the Anthropocene not as a precursor to modernity, but as a critical space for exploring alternative ontologies. By challenging anthropocentric interpretations, posthuman and Anthropocene perspectives offer new ways of approaching ancient texts and artefacts. At the same time, they necessitate a fundamental rethinking of contemporary notions of humanity, technology and the environment.

Eating Disorders (EDs), including problems e.g. Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder, represent a significant global public health problem. They are most prevalent in Western countries and among young people, particularly among females. The evidence shows an increase in their incidence over the past few decades and a possible rise following the COVID-19 pandemic, with a consequent growing impact on public health and society. Furthermore, subclinical and undiagnosed cases-which are not included in official surveillance registries, when existing-appear to be common, suggesting that the problem is underestimated. The psychopathology of EDs is complex and deeply affects the Person who suffers from them, impairing health and quality of life. As about the treatment, the NICE guidelines serve as the primary international reference for the treatment of ED. They recommend the use of CBT-ED (Cognitive Behavioral Therapy for Eating Disorders). Such approach includes so called CBT-E, which focuses on resolving a specific psychopathological core in order to restore balance to the self-perception domains of the Person, thereby overcoming an excessive preoccupation with weight, body shape, and food control. The therapeutic relationship is crucial: it requires mutual trust, empathy, and active listening. In this clinical setting, it is important to assess both the therapeutic relational and bioethical implications of care, with a focus on the Person and respect for their identity, autonomy, freedom, and ontological dignity.

In der Literatur geht es nicht um die Darstellung von Wirklichkeit, der Literatur geht es vielmehr um die Darstellung gelebter oder erlebter, lebbarer oder erlebbarer Wirklichkeiten. Die Literaturen der Welt erzeugen Sinn, eine auf verschiedenste Weise deutbare Polysemie oder Vieldeutigkeit des Sinns. Diese ästhetisch und damit sinnlich erzeugte Sinnhaftigkeit wirkt per se gesundheitsfördernd, insofern sie dem menschlichen Leben einen bibliotherapeutisch nutzbaren Sinn verleiht. Weit über diese allgemeine und mit Recht verbreitete Feststellung hinaus soll im Folgenden versucht werden, konkrete Ausdrucksformen und Mechanismen der heilenden Kraft der Literatur herauszuarbeiten. In den Literaturen der Welt geht es folglich um nichts Geringeres als das Leben. In einer der berühmtesten Rahmenerzählungen der Literaturgeschichte, die unter dem Titel Tausendundeine Nacht das abendländische Bild des Orients seit Anfang des 18. Jahrhunderts nachhaltig prägte, und die auf eine höchst komplexe Genese zurückverweisenden über dreihundert erhaltenen Erzählungen indischer, persischer, arabischer, altbabylonischer, syrischer, ägyptischer und nicht zuletzt europäischer Herkunft zusammenfügte, versuchte Scheherazade, die Tochter des königlichen Wesirs, den fatalen Entschluss des Sultans zu durchbrechen. Wegen der Untreue seiner Gemahlin vermählte er sich jeden Abend mit einer anderen Frau, um sie am folgenden Morgen sogleich töten zu lassen. Dieses aus mehreren Erzähltraditionen zusammen-

Every fact must be narrated in order to be subject of value judgement. But this value judgement depends partly on how that fact is narrated. Some authors have highlighted the democratic value of the narrative approach, because of its admission of different points of view to construct a story. The problem is that these points of view can easily lead to alternative solutions o even opposing ones. This phenomenon is not rare in our multicultural society. From an strictly narrative point of view, the best story is the most persuasive. But this lead us to relativism, because the efficacy of an story relies on the audience towards the argumentation is developed. In this work we have tried to bring to light that the genuine contribution of the narrative approach is not achieved if we stay on the level of facts and we do not pass to the level of normativity. We suggest the thesis that the utility of narrative approach is a function of the archetypical standard of behavior that a story may c...

En el presente trabajo se aborda una experiencia innovadora
de diseño, centrada en la creación de una propuesta educativa que fusiona
la metodología de la horizontalidad y las narrativas. Este enfoque se
nutre de los estudios críticos de la discapacidad y de la aplicación estratégica
de las tecnologías. Con el fin de generar espacios posibilitadores para
que personas con discapacidad intelectual ejerzan su derecho a la educación
sexual integral, desde sus propias voces y necesidades. El propósito
es claro: explorar cómo los procesos de subjetivación de la discapacidad
intelectual se entrelazan con las nociones contemporáneas de sexualidad.
Esta investigación adopta una visión situada y concreta, sin perder de vista
los procesos históricos que han moldeado las percepciones y prácticas
en torno al cuerpo con discapacidad. Se reconoce la influencia de la matriz
moderno-colonial en la configuración de estas dinámicas, las cuales ejercen un impacto significativo en los programas de educación sexual. A
lo largo de este estudio se explorarán las intersecciones entre discapacidad,
sexualidad y educación, con el objetivo de contribuir a la generación
de prácticas pedagógicas alternativas.

• Humanity’s capacity to influence its biological evolution can be incorporated into a theory of human nature in the
Anthropocene by addressing challenges related to defining human nature and by regulating genetic engineering
• Understanding genetic engineering in the Anthropocene should avoid essentialist perspectives on the human genome and
instead regard it as a natural aspect of human evolution
• Moral analysis of human genetic engineering in the Anthropocene contrasts genetic engineering as a means of increasing
human autonomy from nature with genetic manipulation as violating individual autonomy and species identity, toward
the regulation of technology for humane and just deployment amid opportunities and challenges for human-nature
interaction
• Economic and social concerns surrounding human genetic engineering in the Anthropocene include the commodification
of genetically modified embryos driven by market preferences; unequal access to genetic enhancement that challenges social
justice; and the potential disruption of egalitarian principles and individual autonomy by externally imposed genetic traits
• Human genetic engineering in the Anthropocene offers increasing degrees of autonomy from nature, particularly in
combating diseases, while blurring distinctions between natural and cultural identity, offering new approaches to planetary
and human nature
• The notion of biotic justice guides genetic engineering by addressing issues of inequality and social opportunities in the
Anthropocene; by extending access to genetic engineering technologies to marginalized communities; and by developing a plausible theory of human nature to inform decisions regarding interventions in both the natural environment and in human biology

El presente artículo define el término rostrocidad establecido por Gilles Deleuze y Felix Guattari en su texto de Mil Mesetas, en el cual se propone un enfoque semiótico que complementa o supera la mirada médica de Michel Foucault, de esta manera la aportación principal de nuestro trabajo es mostrar el contraste entre el enfoque biopolítico de Foucault y el semiótico de Deleuze y Guattari. La rostrocidad como mostraremos, ofrece una aproximación a la realidad de la pandemia covid-19 que permite identificar los actores políticos económicos en juego, así como la deshumanización del aparto médico y de salud en latinoamerica.

The textbook offers readers a clear and engaging entry point into the central questions of bioethics. It demonstrates how ethical principles such as autonomy, dignity, justice, and human rights can be applied to contemporary medical, technological, and social challenges. Through classical and modern case studies, it provides methodological clarity and argumentative confidence in addressing moral dilemmas — from patient autonomy and global justice to disability and aging ethics. The textbook is aimed at students, teachers, and professionals in philosophy, medicine, ethics, law, and public policy.

Daniel Serrão lança-nos o desafio de olhar para a Bioética como duas disciplinas que navegam entre o ser e o agir ou como dois modos diferentes para reflectir sobre a Bioética: o primeiro olha-o como reflexão; o segundo como processo decisório. A Bioética I ou de Autor é uma antropologia filosófica e racional, e a Bioética II de Decisão é promover as decisões que sejam boas para o maior número de pessoas e conformes com os valores sociais e a paz.Daniel Serrão challenges us to look to Bioethics as being two disciplines that navigate between being and act or as two different modes of reflecting on Bioethics: the first sees it as a reflection, and the second as a decision process. Bioethics I or Author Bioethics is a rational philosophical anthropology; Bioethics II or Decision Bioethics aims at making decisions good to the greatest possible number of people and made according to social values and peace.info:eu-repo/semantics/publishedVersio

Vanaf de eerste empirische onderzoeken naar de politie, in de jaren zestig en zeventig van de vorige eeuw, heeft het concept politiecultuur een centrale plaats ingenomen in de politiewetenschap. Het vormde een sleutelbegrip in de eerste wetenschappelijke pogingen zicht te krijgen op het specifieke van de politieorganisatie, op het dagelijks reilen en zeilen daarvan, de achtergronden die daarbij een rol spelen en op de betekenissen die politiemensen aan hun werk gaven. Daarbij werd vooral gebruikgemaakt van intensief, etnografisch onderzoek. Niet alleen om een gedetailleerd beeld te krijgen van de dagelijkse praktijken van politiemensen op straat en binnen hun organisatie, maar ook om zicht te krijgen op de deels stilzwijgende en onderliggende waarden en zingeving die daaraan ten grondslag liggen Rubenstein 1973;. Tot op de dag van vandaag vormt het begrip politiecultuur een min of meer vast referentiekader waar vrijwel geen onderzoeker op dit terrein om heen lijkt te kunnen. Om die reden is het begrip door Sklansky (2007) omschreven als een onbetwiste orthodoxie. Tegelijk is al vaker geconstateerd dat het begrip, evenals de wijze waarop het in veel gevallen wordt gehanteerd, een aantal vragen oproept (zie hiervoor onder

This chapter addresses three main topics (subchapters): (i) acquisition of educational skills in palliative care that are relevant to all health professionals and ways to implement these skills in the field of nephrology; (ii) ethical considerations that are applicable and support clinical and specific decisions at different stages of chronic kidney disease, such as, respect for bioethical principles in decision making related to dialysis withdrawal, effective communication with the patient and family, end of life care; and (iii) implementation and definition of key performance indicators that ensure quality of care and are patient-centred. These three (interrelated) pillars will strongly contribute to the (positive and expected) changes in the field of kidney palliative care.

This article provides a comprehensive analysis of the work of existential psychiatrist Irvin D. Yalom, focusing on the volume Staring at the Sun: Overcoming the Terror of Death (2008) and the foundational treatise Existential Psychotherapy (1980). The study explores how confrontation with death can become a catalyst for a more authentic and meaningful life, adopting an interdisciplinary perspective combining psychology, psychoanalysis, and bioethics. Yalom identifies four "ultimate concerns" of human existence: death, freedom, existential isolation, and meaninglessness [5]. Each of these concerns generates specific anxieties and can underlie forms of psychopathology when not authentically confronted. The goal of existential psychotherapy is not to eliminate these anxieties, but to help the patient face them courageously and find ways to live a meaningful life despite them-or, perhaps, precisely because of them. The article deeply analyzes each of the four ultimate concerns as developed in Yalom's work. Death is seen not as an enemy to be defeated, but as a reality that, once accepted, can free us to live more authentically. Freedom-the concept that we are "condemned to freedom," as Sartre put it-implies the responsibility to construct our own lives without blaming others or circumstances. Existential isolation refers to the unbridgeable chasm between ourselves and others, which only authentic relationships can partially fill. And meaninglessness confronts us with the necessity of creating our own meaning in a universe that offers none preordained. The psychological analysis section examines how Yalom integrates these themes into clinical practice, using concepts such as "awakening experiences"-those moments of crisis (loss, illness, trauma, aging) that confront us with mortality and can transform our perspective on life [6]. The psychoanalytic analysis section explores Yalom's relationship with Freudian psychoanalysis, showing how he retains psychoanalytic tools (exploration of the unconscious, dream analysis, interpretation of transference) but places them within a broader existential framework. A central concept in this section is that of "rippling"

This editorial discusses a proposal for the following policy on AI use: all manuscripts submitted to the Journal of Medical Ethics (JME) and JME Practical Bioethics (JMEPB) must include a dedicated Generative AI Use Declaration section in the manuscript itself, placed before the reference list. This requirement would apply to all submissions, regardless of whether generative AI was used. Authors would affirm that no generative AI tools were used (Option A); affirm that none were used to substantively influence the content of the manuscript beyond AI-assisted “copy editing”  of human-written text (Option B); or affirm that generative AI tools were used, stating which ones were used as well as how and for what purposes they were used (Option C). Generative AI is increasingly affecting all parts of the bioethics publication process—from authors experimenting with large language models (LLMs) in drafting and editing, to peer reviewers dictating their comments to an AI and then prompting it to summarise their input, to editors and staff on the publishing side using AI to identify hallucinated references. We all have a stake in how these tools are used (or not used, or misused) as we work together to build a high-quality literature. Accordingly, we will soon be issuing a call for commentaries on this editorial, and we encourage you to make your voice heard.

Attention toward the interests and possible rights of non-human entities represents one of the focal points of contemporary bioethics. Is it still acceptable to exclude other species from moral consideration, ignoring what science tells us about their capacity to experience sensations, pain, emotions, and desires? Can we still maintain an anthropocentric attitude, or is this an approach that must be overcome? But if we seek to overcome anthropocentrism, in which direction should we proceed? Science-especially ethological and neurophysiological research-now provides us with an increasingly precise picture of the affective and cognitive characteristics of non-human entities. Their mind is no longer a black box, thanks to new neural imaging techniques and the development of sophisticated cognitive tests. Moreover, respect for other species is not only a technical issue. One cannot limit oneself to the aspect of animal welfare, through objective parameters of physiological needs, without taking into account the ethical relevance of a different moral posture toward animal ontology.

This paper explores the dialectical tension between legal positivism and philosophical ethics through an interdisciplinary lens. While law seeks social stability through written norms and procedural certainty, philosophy incessantly questions the metaphysical and moral foundations of justice itself. In the era of technology, the automation of decision-making processes and the rise of algorithmic law pose unprecedented challenges to the sovereignty of human judgment. By examining the perspectives of Hans Kelsen, Immanuel Kant, and postmodern theorists, this study demonstrates that only a critical integration of formal rigor and ethical reflection can preserve human dignity against the algorithmic bureaucratization of society. The analysis extends to contemporary issues such as bioethics and ecological rights, ultimately advocating for a "humanistic shield" to protect the unpredictability of human existence from the mechanical perfection of digital codes.