The vulnerabilities of Venezuelan immigrants in Brazil and Colombia from the perspective of Intervention Bioethics

OBJECTIVE

To understand the vulnerabilities to which Venezuelan immigrants living in Brazil and Colombia are exposed, from the perspective of Intervention Bioethics.

METHOD

Qualitative study, carried out through a semi-structured interview, with 15 immigrants living in Brasília-Brazil and 20 in Medellín-Colombia, analyzed by the IRAMUTEQ software, in the Descending Hierarchical Classification and Similitude Analysis modalities.

RESULTS

The first thematic axis dealt with the reasons for immigrating, above all, difficulties in accessing food and health services. The second axis revealed the trajectory of the migration process, especially the adversities faced before arriving in the countries. The third axis highlighted the challenges of integration in the destination countries, with emphasis on the processes of exclusion and discrimination faced.

CONCLUSION

It was observed that both Brazil and Colombia need, as proposed by Bioethics of Intervention, to develop policies to reduce the vulnerabilities of immigrants to guarantee a dignified life without discrimination against them.

The care of the patients with hipoplastic left heart syndrome in places of social and economic vulneability. An ethical analysis

The birth of a child means hope and joy, particularly for the parents and the healthcare team. When this child is born with a severe malformation and a poor prognosis, as in the case of hypoplastic left heart syndrome, the scenario is one of great uncertainty and emotional suffering. The role of the health team becomes fundamental for the identification of conflicts of values and for the search for shared decisions that promote the best benefit to the child. When the diagnosis is made during fetal life, it is necessary to develop counseling strategies appropriate to the context of each family. In places with limited care resources, precarious prenatal care and short temporal conditions, the recommended counseling is compromised. Indication of treatment requires technical competence and a detailed analysis of ethical issues, and consultation with institutional clinical bioethics services or commissions is important. The article proposes to address the moral conflicts of two clinical cases and the respective bioethical analysis that involves principles and values in contexts of vulnerability and uncertainty, contrasting two situations where the indication of treatment was based on accessibility to treatment.

Commercial Surrogacy: An Overview

OBJECTIVE

 Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

METHODS

 This is a review of the literature published in the 21st century on commercial surrogacy.

RESULTS

 A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

CONCLUSION

 Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.

[Twenty years of bioethics in Mexico: development and perspectives of the National Bioethics Commission]

Bioethics in Mexico has a history that reveals the vision and ethical commitment of iconic characters in the fields of health sciences and humanities, leading to the creation of the National Bioethics Commission responsible for promoting a bioethics culture in Mexico. Its development and consolidation from the higher perspective of humanism had the aim to preserve health, life and its environment, while at the same time the bases of ethics and professional practice from different perspectives have been the building blocks of medical practice.

[Ethical Attitudes of Brazilian Medical Students and Graduates with Active Methodologies.]

The objective of this study was to conduct a diagnosis of the comprehensive inclusion of ethics in Brazilian medical training with a problem-based learning methodology and to describe students' and graduates' perceptions of ethical attitudes. The methodological design was a descriptive and documental case study with a qualitative and quantitative approach. The sample consisted of 20 students per course year, totaling 120 students and 40 alumni from two graduating classes at the ESCS School of Medicine. The project was approved by the Institutional Review Board of the State Health Secretariat, Federal District, Brazil. ESCS students and graduates showed that they approach ethical conflicts and respect for patients. However, an analysis of ethical sensitivity revealed weak perceptions and inappropriate attitudes by medical students, especially in the early years of medical school, requiring more systematic discussions on ethical and bioethical aspects integrated with practical activities, in order to increase and strengthen ethical reflection by students.

ANÁLISE DA INSERÇÃO DOS TEMAS DE HUMANIDADES E ÉTICA, COM METODOLOGIA DE APRENDIZAGEM BASEADA EM PROBLEMAS, EM CURRICULO MÉDICO INTEGRADO EM ESCOLA PÚBLICA NO DISTRITO FEDERAL, BRASIL

OBJECTIVE: To establish a diagnosis of the insertion of bioethics, ethics and humanistic values and attitudes to the program of the Medical School of ESCS - Escola Superior em Ciências da Saúde, public school of medicine, Distrito Federal, Brazil, in order to contribute to the process of curricular management. METHODOLOGY: The study is cohorte and documental. Thirty-two indicators to the thematic on ethics and twenty-four related to humanization were utilized. The educational purpose and contents of activities in modules such as thematic, abilities, interaction and attitude towards the community for teaching and services, from first to senior years as well as in boarding schools programs were all analyzed in the Medical School curriculum of ESCS (2006) and about the pedagogic project of the Course (2001). RESULTS: It was observed a greater insertion of thematic related to ethics and bioethics in the initial levels of the course, Freshman and Sophomore including boarded students, when compared to the insertion in Junior and Senior clerkship years (IC95%-alpha=0,034, pvalue=0,007). The unit on abilities and attitudes was the axle which presented greater recurrence of the thematic on humanization in programs of 1 and 4 years (IC95%-alpha=0,026, pvalue=0,013). It was observed an increase in the recurrence of the thematic on humanization developed in thematic modules and interaction community-teaching/service in the 2 year and decline in the subsequent ones. The results were very low in the 3 and 4 years. When compared with the clerkship it was observed that the first four series had greater insertion of such thematic (IC95%-alpha=0,042, pvalue=0,029). CONCLUSION: The academic program developed in the year of 2006 at ESCS presented improvements when compared to the pedagogical project of the course.