Acta Bioethica

Foundation of a realistic method for the analysis of Ethics and Bioethics cases

José Carlos Abellán Salort — 2025-04-06

Through a bibliographic review of publications in Spanish and English from the last three decades, a critique of the foundations and characteristics of case analysis methods in contemporary Western bioethics is carried out, among which the most relevant for the analysis of bioethical cases and problems turn out to be the Deliberative Method (typical of principlism, consensualism, and utilitarianism) and the Triangular Method (proposed by ontologically based personalism) which present limitations of foundation and practical application, respectively. The author justifies the need to train professionals and students for the analysis of practical cases in Ethics and Bioethics, proposing a new method, the “Realistic Method”, which tries to bring together the virtualities and utilities of the deliberative and the triangular, overcoming the deficiencies of both from the approaches of classical realist philosophy and personalist-based anthropology.

Narrative Medicine in China: A Critical Reflection

Tiancheng Xia — 2025-04-06

In recent years, narrative medicine has become a hot topic in Chinese humanistic medicine and has gained considerable influence. It is believed that narrative medicine can provide a constructive approach to balancing biomedical and humanities sciences, but there are many anti-narrative factors in China's culture and medical practice. It is controversial whether narrative medicine can improve medical diagnosis and the doctor-patient relationship in China, therefore, despite many researchers believing that narrative medicine is very suitable for China, some critical reflections are still needed, to avoid doctors and patients spending too much energy on narrative, which may lead to treatment opportunities missing or create new troubles.

The ethical risks and solutions of the algorithm black box in medical artificial intelligence

Hu Qinggui — 2025-04-06

The application of artificial intelligence (AI) in the medical industry is becoming increasingly widespread. Relying on its powerful machine-learning capabilities, it has gradually become an important auxiliary diagnostic device. At the same time, it gradually has a certain degree of autonomy. But this also leads to the problem of lack of transparency in algorithms. A critical ethical issue known as the “algorithmic black-box” problem has emerged. For the ethical challenges associated with the opacity of medical artificial intelligence algorithms, enabling artificial intelligence systems to have reasoning and moral judgment abilities, namely constructing medical artificial moral agents, has been proposed as a viable solution. This article analyzes the solutions of constructing medical artificial moral agents including “top-down” and “bottom-up” approaches. After that, the new hybrid ethical design approach is proposed, integrating the advantages of both top-down and bottom-up approaches.

Ethical challenges related to capacity, competence and autonomy in individuals with dementia

Valeska Delineau — 2025-04-06

Dementia is a syndrome characterised by the development of multiple cognitive deficits and behavioural changes that significantly interfere with various aspects of life. The study aims to discuss capacity, competence and autonomy in individuals with dementia, and some ethical challenges related to these concepts, such as healthcare decision-making capacity, financial capacity, driving and voting. Secondarily, we aim to discuss a new ethical issue emerging from using artificial intelligence and machine learning to improve autonomy in individuals with dementia. Furthermore, we will discuss the ethical importance of obtaining informed consent for healthcare decision-making and Advance Care Planning in dementia patients. This study provides a comprehensive overview of the complex issues related to autonomy and competence in individuals with dementia, highlighting the importance of striking a balance between upholding individual rights and protecting the well-being of those affected by the disease. In conclusion, the study emphasizes the importance of Advance Care Planning in helping patients, families, caregivers, and healthcare professionals address ethical issues related to autonomy, capacity, and competence in dementia care.

Development of intercultural communicative competence. Challenges and contributions for the training of health professionals

Juan Beltrán-Véliz — 2025-04-06

This paper reflects on intercultural communicative competence as a contribution to the training of professionals in health sciences. A reductionist, technocratic and culturally decontextualized health model is visualized, and the scarce development of "intercultural communicative competence" in health professionals is seen as a great barrier, which hinders communication with patients from other cultures. Therefore, it is vitally important to develop this competence in the training of these professionals. This will imply developing components that underlie this competence, that is, awareness, sensitivity and intercultural efficacy, which will allow the acquisition of cognitive, affective and behavioral skills that benefit effective and appropriate communication with patients from diverse cultural and social contexts. Likewise, they will allow them to understand in depth aspects, values and practices that underlie a culturally different health system, and will promote the advancement in the knowledge, understanding and development of innovative and relevant practices in the health system, from an intercultural and comprehensive approach. Finally, it will make it possible to overcome inequalities, misunderstandings, prejudices, exclusions and social injustices.

Promoting ethical governance: A collaborative framework for End-of-Life care policies for the elderly in China

Zheng Zang — 2025-04-06

Delivering end-of-life care services to elderly patients, addressing their physical and psychological needs, enhancing their quality of life, and preserving their dignity represent not only advances in human civilization, but also crucial benchmarks for a country’s social development and justice. Effective provision of end-of-life care services hinges on robust national policies, adequate investment, and a cohesive societal effort. Clearly defining the roles and interplay between the government and society is paramount. This study examines China’s end-of-life care policies through an ethical lens, aiming to elucidate the nation’s stance on national and societal duties and ethical dynamics in end-of-life care development. The research reveals that, ethically, China’s end-of-life care services require enhancements in legislative empowerment, regulatory oversight, financial backing, and the functioning of social entities. The absence of government and societal functions, along with inadequate collaboration and synergy between the two sectors, has led to incomplete fulfillment of the diverse end-of-life needs of the elderly. Consequently, China’s end-of-life care sector should strive for a transparent delineation of responsibilities between the government and society, as well as precise ethical positioning.

The relationship between communication skills of nursing students and their attitudes towards teamwork: A case from Turkey

Ramazan Güneşer — 2025-04-06

Effective communication and teamwork have a critical role in nursing. This study aims to determine the relationship between nursing students' communication skills and attitudes toward teamwork (n=334). The communication skills (104.82±11.47) and teamwork attitudes (120.41±13.28) scores of the students were found to be at a high level. The total scores of the communication skills scale (p=0.007) and the scores of the communication principles and basic skills (p=0.001), effective listening, and nonverbal communication (p=0.008) sub-dimensions of the students who received training on teamwork were higher than those of the students who did not receive training. The total scores of the teamwork attitudes questionnaire (p=0.024) and the sub-dimension scores of team structure (p=0.020) and situation monitoring (p=0.048) of the students who received training on teamwork were higher than those who did not receive training. It was found that the scores of male students in the mutual support sub-dimension of the teamwork attitudes questionnaire were significantly higher (p=0.026) compared to female students. There was a moderate positive correlation between the scores of communication skills and teamwork attitudes (r= 0.467, p<0.001). Nursing students had high communication skills and attitudes toward teamwork, and the relationship between them was significant.

Quality of life in infertile patients in Brazil: religious spirituality as a coping mechanism

Drauzio Oppenheimer — 2025-04-06

Due to social pressure and individual desire to have children, infertility is often accompanied by suffering and decreased quality of life. Among possible coping mechanisms, religion has been suggested to help improve quality of life. The objective of this study was to verify, in a cohort of Brazilian women undergoing infertility treatment, if there is a relationship between religiosity and quality of life. The sample consisted of 104 volunteer Brazilian women who sought infertility treatment. A FertiQoL and a Religiosity questionnaire were administered. Descriptive statistics were computed, and groups were compared using a Chi-square test. Most of the participants in the study stated that religiosity was associated with well-being, and 90% of them concluded that religiosity was an important process during infertility treatment. The study found that religiosity leads to improved adaptive coping capacity. Although it is difficult to demonstrate causality, results strongly suggest that religiosity plays an important role in adjusting the psychological aspects of infertile women.

Sustainable Oral Healthcare from Ethical Standpoint

Funda Gülay Kadioglu — 2025-04-06

Sustainability refers to the efficient and balanced use of resources, considering the needs of future generations. Sustainable development and sustainability address the most significant and complex challenges humanity has ever faced. Sustainable healthcare systems consider the long-term social and environmental impacts of health services, utilizing existing resources effectively, and concurrently addressing the health rights of the population. The key components of such systems include reducing, recycling, and reusing medical waste, energy efficiency, minimally invasive practices, and reduced carbon footprint by eco-friendly principles. Oral healthcare, integral to overall well-being, must align with sustainability. Ethical delivery of oral healthcare demands a delicate balance between current patient needs and preserving resources for future generations. Professionals in the field increasingly recognize the imperative to minimize environmental footprints while upholding standards of care. Eco-friendly dentistry emphasizes waste reduction, energy conservation, and the adoption of innovative, sustainable materials and practices. Environmental ethics underscore the interconnectedness of human health and environmental well-being. They advocate for strategies to mitigate environmental health risks and promote sustainable practices in oral healthcare. By embracing sustainability, oral healthcare professionals contribute to a healthier planet and ensure the longevity of their practice for generations to come.

Probing Key Concepts of Medically assisted death. Analyzing the Portuguese Constitutional Court’s Rulings

Luís Cordeiro-Rodrigues — 2025-04-06

From 2021, the Portuguese parliament tried to get four versions of a law on medically assisted death approved. Two were rejected by the Portuguese Constitutional Court (PCC) because they were unconstitutional, and the President politically vetoed another. Finally, the parliament passed the law in 2023, even though the President and the PCC seem to oppose it. In this article, we analyze the PCC’s rulings on the medically assisted death law and contend that, broadly speaking, the PCC’s decisions to reject the law were justified. We focus on two core questions that have been critical in this debate: the meaning of ‘suffering’ and of ‘permanent injury of extreme gravity’. Further, we point to possible directions whereby the legislators may revise the law and thus solve the problems raised by the PCC.

The influence of managed care on the physician's perception of professional autonomy: a scoping review

Raphael Antonio Ovidio — 2025-04-06

The present study undertakes a scoping review on the influence of managed care on the perception of physicians’ professional autonomy to determine how many studies there are in the literature on the perception of decreased physician’s professional autonomy with the introduction of managed care, the consequences of this for the health system and studies that indicate possible coping strategies for this problem. Online databases were used to identify articles published from 2017 to 2021. Two articles related managed care to a decrease in professional autonomy, six articles showed a relationship between independence and professional satisfaction, and three articles concluded that a decrease in autonomy contributes to physicians’ rejection of managed care. Two articles related physicians’ resistance to innovation in information technology (IT) due to fear of reduced autonomy. One article related the decrease in autonomy to the decline in the supply of new professionals and three articles indicated that the management model focused on stimulating intrinsic motivators, such as professional autonomy, can generate promising results. Although robust studies are showing that managed care interferes with the perception of the physician’s professional autonomy with consequences for the health system, there is still a lack of studies that assess the best strategy for coping with this problem.

The importance of overlapping bioethics and business ethics in managed care: A scoping review

Raphael Antonio Ovidio — 2025-04-06

Implementing diagnostic and therapeutic procedures that use advanced technologies in clinical practice has made medicine assume the responsibility of rationally using these modern and scarce resources. The development of managed health care has contributed to the emergence of ethical dilemmas that go beyond the ability of business ethics or bioethics alone to find answers. This article examines the existing literature on the importance of overlapping bioethics and business ethics in crafting the moral foundations of managed care. A scoping review was carried out with an analysis of articles published on the theme "Bioethics" and "Business Ethics" related to health organizations and health management. The search identified 156 articles. After applying the eligibility criteria, 11 articles were selected. The 11 articles highlighted the economics of health and health as a type of business. They presented the objective of demonstrating the importance of overlapping the disciplines of bioethics and business ethics in forming the ethos on which the health system will be based in this market economy context. This scoping review reinforces the importance of the approach of bioethics and business ethics in health management.

How should we treat pet robots?

Wei Li — 2025-04-06

Pet robots can overcome the shortcomings of pets and accompany people instead of pets. There are also some ethical concerns about pet robots, including that pet robots will cause people to deceive themselves, that people's attachment to pet robots will make people miserable, that people will change their original value hierarchy, and that people will behave unethically toward pet robots. To make pet robots better integrate into society, people must treat them correctly, such as enjoying the happiness brought by pet robots, strengthening the independent training of robot pets, not easily changing the value hierarchy of self and being forbidden to behave immorally towards pet robots.

Investigación en el contexto universitario. Necesidad de una ética institucional

Fernando Lolas Stepke — 2025-04-06

LOLAS STEPKE, FERNANDO y RODRÍGUEZ YUNTA, EDUARDO, Perspectivas en bioética

Pablo Ruiz-Tagle Vial — 2025-04-06

LAHERA, GUILLERMO, Las palabras de la bestia hermosa. Breve Manual de Psiquiatría con alma

Fernando Lolas Stepke — 2025-04-06

BURROW, JOHN, A History of Histories. Epics, Chronicles, Romances and Enquiries from Herodotus and Thucydices to the Twentieth Century

Fernando Lolas Stepke — 2025-04-06

CÁRDENAS KRENZ, Ronald, ¿Libertad individual vs. bien común? Lecciones de la pandemia y nudges como estrategia de vacunación

Esther Torrelles Torrea — 2025-04-06

In Memoriam Jorge José Ferrer Negrón SJ. (Puerto Rico, 14/09/1951 - 21/09/2024)

Javier Rivas Flores — 2025-04-06

Seminario Internacional “Neurociencias, Inteligencia Artificial y Derecho”, Universidad Autónoma de Querétaro, 28-30 agosto de 2024

Jesús Armando Martínez Gómez — 2025-04-06

“Seminario Internacional de Biomedicina, Ética y Derechos Humanos”: bioética, religión y espiritualidad a debate

José Miguel Hernández Mansilla — 2025-04-06

Laudatio de Fernando Lolas, con ocasión de la IX Lección Magistral en Bioética James Drane, en el marco del “Seminario internacional de Biomedicina, Ética y Derechos Humanos”

María Inés López-Ibor — 2025-04-06

Centro Investigación en Estudios Socio jurídicos, Criminológicos y Éticos

Carolina Valdebenito Herrera — 2025-04-06