Transplants: bioethics and justice

Bioethics, as a branch of philosophy that focuses on questions relative to health and human life, is closely tied to the idea of justice and equality. As such, in understanding the concept of equality in its original sense, that is, in associating it to the idea to treat "unequals" (those who are unequal or different, in terms of conditions or circumstances) unequally (differentially), in proportion to their inequalities (differences), we see that the so-called "one-and-only waiting list" for transplants established in law no. 9.434/97, ends up not addressing the concept of equality and justice, bearing upon bioethics, even when considering the objective criteria of precedence established in regulation no. 9.4347/98, Thus, the organizing of transplants on a one-and-only waiting list, with a few exceptions that are weakly applicable, without a case by case technical and grounded analysis, according to each particular necessity, ends up institutionalizing inequalities, condemning patients to happenstance and, consequently, departs from the ratio legis, which aims at seeking the greatest application of justice in regards to organ transplants. We conclude, therefore, that from an analysis of the legislation and of the principles of bioethics and justice, there is a need for the creation of a collegiate of medical experts, that, based on medical criteria and done in a well established manner, can analyze each case to be included on the waiting list, deferentially and according to the necessity; thus, precluding that people in special circumstances be treated equal to people in normal circumstances.

Physiographic and floristic gradients across topography in transitional seasonally dry evergreen forests of southeast Pará, Brazil

Seasonally dry evergreen forests in southeast Pará, Brazil are transitional between taller closed forests of the interior Amazon Basin and woodland savannas (cerrados) of Brazil's south-central plains. We describe abiotic and biotic gradients in this region near the frontier town of Redenção where forest structure and composition grade subtly across barely undulating topography. Annual precipitation averaged 1859 mm between 1995-2001, with nearly zero rainfall during the dry season months of June August. Annual vertical migrations of deep-soil water caused by seasonal rainfall underlie edaphic and floristic differences between high- and low-ground terrain. Low-ground soils are hydromorphic, shaped by perching water tables during the wet season, pale gray, brown, or white in color, with coarse texture, low moisture retention during the dry season, and relatively high macro-nutrient status in the surface horizons. Forest canopies on low ground are highly irregular, especially along seasonal streams, while overstory community composition differs demonstrably from that on high ground. High-ground soils are dystrophic, well-drained through the wet season, brown or red-yellow in color, with finer texture, higher moisture retention, and low macro-nutrient status in the surface horizons compared to low-ground soils. Forest canopies are, on average, taller, more regular, and more closed on high ground. Low-ground areas can be envisioned as energy and nutrient sinks, where, because of hydrologic cycles, canopy disturbance likely occurs more frequently than at high-ground positions if not necessarily at larger scales.

Horizontal stratification of the sand fly fauna (Diptera: Psychodidae) in a transitional vegetation between caatinga and tropical rain forest, state of Bahia, Brazil

A study about the horizontal stratification of the sand fly fauna in two distinct ecosystems, caatinga area, endemic for visceral leishmaniasis, and the tropical rain forest area, endemic for cutaneous leishmaniasis, was performed in the state of Bahia, Brazil. Lutzomyia longipalpis was predominant in the caatinga, and following it came the species L. capixaba and L. oswaldoi. In the tropical rain forest other species were found, such as L. intermedia, L. migonei, L. whitmani, L. yuilli, L.fischeri, L. damascenoi, L. evandroi, L. monticola, and L. lenti. It was found that the geographical limits of the vector species of visceral and cutaneous leishmaniasis are clearly defined by the biological and phytogeographic characteristics.

Water Erosion on an Oxisol under Integrated Crop-Forest Systems in a Transitional Area between the Amazon and Cerrado Biomes

ABSTRACT Water erosion is one of the main factors driving soil degradation, which has large economic and environmental impacts. Agricultural production systems that are able to provide soil and water conservation are of crucial importance in achieving more sustainable use of natural resources, such as soil and water. The aim of this study was to evaluate soil and water losses in different integrated production systems under natural rainfall. Experimental plots under six different land use and cover systems were established in an experimental field of Embrapa Agrossilvipastoril in Sinop, state of Mato Grosso, Brazil, in a Latossolo Vermelho-Amarelo Distrófico (Udox) with clayey texture. The treatments consisted of perennial pasture (PAS), crop-forest integration (CFI), eucalyptus plantation (EUC), soybean and corn crop succession (CRP), no ground cover (NGC), and forest (FRS). Soil losses in the treatments studied were below the soil loss limits (11.1 Mg ha-1 yr-1), with the exception of the plot under bare soil (NGC), which exhibited soil losses 30 % over the tolerance limit. Water losses on NGC, EUC, CRP, PAS, CFI and FRS were 33.8, 2.9, 2.4, 1.7, 2.4, and 0.5 % of the total rainfall during the period of study, respectively.

JUSTIFYING LIBERAL RETRIBUTIVE JUSTICE: PUNISHMENT, CRIMINALIZATION, AND HOLISTIC RETRIBUTIVISM

ABSTRACT In this article I explore whether liberal retributive justice should be conceived of either individualistically or holistically. I critically examine the individualistic account of retributive justice and suggest that the question of retribution – i.e., whether and when punishment of an individual is compatible with just treatment of that individual – must be answered holistically. By resorting to the ideal of sensitive reasons, a model of legitimacy at the basis of our best normative models of democracy, the article argues that in modern liberal democracies, punishment of an offender A for f is compatible with just treatment of A only if punishment of an individual for f can be legitimate in A's and A's fellow citizens' eyes. Only once retributive justice is understood in this holistic fashion the imposition of punishment can be made compatible with just treatment of individuals.

Transitional cell carcinoma of urinary bladder with metastasis in lumbar vertebrae and spinal cord compression in an ocelot(Leopardus pardalis)

This paper reports a case of nonpapillary and infiltrative transitional cell carcinoma (TCC) of the urinary bladder with metastasis of lumbar vertebrae and spinal cord compression in an adult female ocelot (Leopardus pardalis), from the Mato Grosso state, Brazil. The ocelot had pelvic limb paralysis and skin ulcers in the posterior region of the body and was submitted to euthanasia procedure. At necropsy was observed a multilobulated and irregular shaped, yellowish to white nodule in the urinary bladder. The nodule had a soft consistency and arised from the mucosa of the urinary bladder extending throughout the muscular layers and the serosa. Nodules of similar appearance infiltrating the vertebral column the at L6 and L7 vertebrae with corresponding spinal canal invasion were also observed. The histological evaluation showed epithelial neoplastic proliferation in the urinary bladder with characteristics of nonpapillary and infiltrative TCC, with positive immunohistochemical staining for pancytokeratin, and strong immunostaining for cytokeratin of low molecular weight, and weak or absent labeling for high molecular weight cytokeratin. This is the first report of TCC of urinary bladder in ocelot in Brazil.

Multiple factor analysis of metachronous upper urinary tract transitional cell carcinoma after radical cystectomy

Transitional cell carcinoma (TCC) of the urothelium is often multifocal and subsequent tumors may occur anywhere in the urinary tract after the treatment of a primary carcinoma. Patients initially presenting a bladder cancer are at significant risk of developing metachronous tumors in the upper urinary tract (UUT). We evaluated the prognostic factors of primary invasive bladder cancer that may predict a metachronous UUT TCC after radical cystectomy. The records of 476 patients who underwent radical cystectomy for primary invasive bladder TCC from 1989 to 2001 were reviewed retrospectively. The prognostic factors of UUT TCC were determined by multivariate analysis using the COX proportional hazards regression model. Kaplan-Meier analysis was also used to assess the variable incidence of UUT TCC according to different risk factors. Twenty-two patients (4.6%). developed metachronous UUT TCC. Multiplicity, prostatic urethral involvement by the bladder cancer and the associated carcinoma in situ (CIS) were significant and independent factors affecting the occurrence of metachronous UUT TCC (P = 0.0425, 0.0082, and 0.0006, respectively). These results were supported, to some extent, by analysis of the UUT TCC disease-free rate by the Kaplan-Meier method, whereby patients with prostatic urethral involvement or with associated CIS demonstrated a significantly lower metachronous UUT TCC disease-free rate than patients without prostatic urethral involvement or without associated CIS (log-rank test, P = 0.0116 and 0.0075, respectively). Multiple tumors, prostatic urethral involvement and associated CIS were risk factors for metachronous UUT TCC, a conclusion that may be useful for designing follow-up strategies for primary invasive bladder cancer after radical cystectomy.

Has social justice any legitimacy in Kant's theory of right? The empirical conditions of the legal state as a civil union

This paper aims at shedding light on an obscure point in Kant's theory of the state. It discusses whether Kant's rational theory of the state recognises the fact that certain exceptional social situations, such as the extreme poverty of some parts of the population, could request institutional state support in order to guarantee the attainment of a minimum threshold of civil independence. It has three aims: 1) to show that Kant's Doctrine of Right can offer solutions for the complex relation between economics and politics in our present time; 2) to demonstrate the claim that Kant embraces a pragmatic standpoint when he tackles the social concerns of the state, and so to refute the idea that he argues for an abstract conception of politics; and 3) to suggest that a non-paternalistic theory of rights is not necessarily incompatible with the basic tenets of a welfare state.