Bioethics, cultural differences and the problem of moral disagreements in end-Of-life care : a terror management theory

Cultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face a perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made.

A TRAINING COURSE ON BIOETHICS FOR FAMILY HEALTH STRATEGY PROFESSIONALS IN SANTO ANDRE, SP

This case report presents the experience of a training course on bioethics for nurses and physicians of the Family Health Strategy in Santo Andre, SP. This study is based on problem-based learning and deliberative bioethics, and aimed at presenting the deliberation procedure as a means of handling ethical issues. Contents were addressed in a cross-section manner through five sequential activity sessions at two different moments of concentration with one dispersion interval. In the first moment of concentration, key concepts and deliberative bioethics contents were developed. The second involved deliberation sessions on moral conflicts, which were selected and prepared during the dispersion interval. Participants evaluated the deliberation as an appropriate instrument to deal with the ethical issues they are faced with. Problem-based learning was an effective educational strategy for continuing education in deliberative bioethics.

Bioethics and medical/legal considerations on cochlear implants in children

Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. Objective: This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. Materials and Methods: The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. Results: Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subject's degree of understanding and determination when carrying out the acts for which he/she has been charged. Conclusion: Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the child's parents/guardians and get their written consent before performing the procedure.

Bioethics and Mental Health: The Rights of Patients With a Disorder

Bioethics can be included in the context of psychiatric patients' recovery of dignity and rights, creating a therapeutic interface of social rehabilitation, respect and closeness between professionals and the treated persons. The completion of the analysis of the facts occurred by reviewing 22 articles dated between 1999-2011, from a prior reading, selecting the ones that mention bioethics and mental health. Before the Psychiatric Reform, often, a lack of commitment to the mentally ill was noticed, isolating the patient from a social life. Before the Psychiatric Reform, often, a lack of commitment to the mentally ill was noticed by isolating the patient from a social life. After the Reform, the person with mental illness began to receive a more attentive care. It can be concluded that the Reform tried to bring life to those who had no respect and attention, these patients who needed to be included in a social and urban interaction.

The U.N. convention on the rights of the child: Relevance and application to pediatric clinical bioethics

This article provides an overview of the relevance and import of the U.N. Convention on the Rights of the Child (CRC) to child health practice and pediatric bioethics. We discuss the four general principles of the CRC that apply to the implementation of all rights contained in the document, the right to health articulated in Article 24, and the important position ascribed to parents in fulfilling the rights of their children. We then examine how the CRC is implemented and monitored in law and practice. The CRC and associated principles of child rights provide strategies for rights-based approaches to clinical practice and health systems, as well as to policy design, professional training, and health services research. In light of the relevance of the CRC and principles of child rights to children’s health and child health practice, it follows that there is an intersection between child rights and pediatric bioethics. Pediatric bioethicists and child rights advocates should work together to define this intersection in all domains of pediatric practice.

Proposal for bioethics education in Animal Ethics

This study proposes the continuous bioethics education in university health and biology courses. A field study was conducted with matriculating students at a university in southern Brazil about the ethics and legal questions regarding the use of animals in research and teaching. It was found that almost half of the students were unaware of important animal ethics issues, showing that these themes are merely incipient in the education provided within this particular university. Considering this reality, the inclusion of bioethics only as a discipline and isolated from the formal curriculum has not been effective and that bioethics education, incorporating polemic subjects such as animal ethics, should be included in an all-encompassing and constant approach throughout the training of students in biomedical fields.

Bioethics, culture and infanticide in brazilian indigenous communities : the Zuruahá case

O artigo analisa a prática do infanticídio em comunidades indígenas brasileiras. Tomando como referência um caso específico envolvendo duas crianças do povo Zuruahá, focaliza o tema sob uma abordagem mais abrangente e discute como o infanticídio é interpretado em outros povos indígenas. Foram considerados, na discussão, os debates ocorridos durante a Audiência Pública realizada no Congresso Nacional Brasileiro, em dezembro de 2005, que analisou o tema, além de revisão bibliográfica. Diante dos posicionamentos assumidos naquela audiência, procurou-se identificar os problemas éticos e os dilemas morais, contextualizando-os e analisando-os à luz do respeito ao pluralismo cultural. A fim de contribuir com o debate, os autores analisam as possibilidades de intervenção nas práticas tradicionais de infanticídio, recusando qualquer opção que não esteja ancorada numa atitude de profundo respeito pela cultura de outros povos ou que não apresente condição de dialogar com indivíduos ou grupos com diferentes moralidades. ______________________________________________________________________________ ABSTRACT