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The possibility that organ sales by living adults might be made legal is morally distressing to many of us. However, powerful arguments have been provided recently supporting legalisation (I consider two of those arguments: the Consequentialist Argument and the Autonomy Argument). Is our instinctive reaction against a market of organs irrational then? The aim of this paper is not to prove that legalization would be immoral, all things considered, but rather to show, first, that there are some kinds of arguments, offered in favour of legalisation, that are, in an important sense, illegitimate, and second, that even if legalisation might not be wrong all things considered, there are good reasons for our negative moral intuitions. Moreover, identifying these reasons will help highlight some features of moral decisions in non-ideal situations, which in turn might be relevant to some other moral or policy choices.

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In this essay, I analyze two memoirs--Rafael Campo's The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire and Abraham Verghese's My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS--which describe the effects of treating HIV/AIDS on each doctor's identity, on his desire for community and belonging, and on his identification and/or disidentification with the medical profession in the United States. My readings of Campo and Verghese revolve around three key terms provided by Campo's subtitle: identity, empathy, and desire. I shift the order of these terms in Campo's subtitle because I want to read identity, empathy, and desire in Campo and Verghese through and along with the theoretical "pragmatics" of Gilles Deleuze and Felix Guattari.

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I explore the relationship between public health and human rights by examining the Brazilian government's policy of free and universal access to anti-retroviral medicines for people with HIV/AIDS. The Brazilian government's management of the HIV/AIDS epidemic arose from initiatives in both civil society and the governmental sector following the democratization of the country. The dismantling of authoritarian rule in Brazil was accompanied by a strong orientation toward human rights, which formed the sociopolitical framework of Brazil's response to the HIV/AIDS epidemic. Even if the Brazilian experience cannot be easily transferred to other countries, the model of the Brazilian government's response may nonetheless serve as inspiration for finding appropriate and lifesaving solutions in other national contexts.

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To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed.

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This paper focuses on poverty and inequality in the world today. First, it points out how this topic is a main concern for the IAB. Second, it proposes 'new' theoretical tools in order to analyze global justice and our obligations towards the needy. I present John Rawls's denial that the egalitarian principle can be applied to the global sphere, his proposed weak duty of assistance, and his consideration of endemic poverty as essentially homegrown. In opposition, I focus on Thomas Pogge as representative of a cosmopolitan view who also holds a critical position towards the international systems which allow and cause poverty. I endorse the general normative proposal that defends every human being as an ultimate unit of moral concern, as well as the strategy of moving away from the charity model of bilateral aid to the realm of rights and duties. These ideas should redesign and broaden the normative and practical roles of institutions, and should also help provide a new approach on bioethical issues such as drug patenting or the imbalance in global research and neglected diseases.

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For the past several years, diverse and often confused concepts of stigma have been invoked in discussions on AIDS. Many have argued compellingly that AIDS-related stigma acts as a barrier to voluntary counseling and testing. Less compelling are observations regarding the source of stigma or its role in decreasing interest in HIV care. We reviewed these claims as well as literature from anthropology, sociology, and public health. Preliminary data from research in rural Haiti suggest that the introduction of quality HIV care can lead to a rapid reduction in stigma, with resulting increased uptake of testing. Rather than stigma, logistic and economic barriers determine who will access such services. Implications for scale-up of integrated AIDS prevention and care are explored.

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The remarkable success achieved by organ transplantation has also engendered the major problem of organ shortage. As a consequence, the use of living unrelated donors (LURD) has been proposed as an ethically justifiable alternative for developed nations to minimize their waiting lists for organ transplantation (OTx). This change in attitude has caused an ethical dilemma for developing countries like Brazil, which is struggling to increase the cadaver donor pool. Due to a huge socioeconomic gap of values and needs among nations, the incentive to use LURD in developed countries may not only produce a disincentive to cadaver organ donation but also stimulate organ trade in developing countries. In this paper we aimed to show that in Brazil, we do not need to use LURD because we have not optimized our cadaver donor pool. The exploitation of LURD might be a good option for developed countries, but it is not useful for developing countries. The Transplantation Society urgently needs to solve and clarify this problem by establishing basic ethical and justice principles that can serve as a guide for every country, throughout the entire process required, to achieve an adequate pool of cadaver donors.

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The cadaver organ shortage has pushed the transplant community to extend the boundaries beyond the traditional criteria used for living donor transplantation. This new liberal policy involves: (1) the type of donor, such as emotionally related individuals, the direct or indirect interchange of donors, anonymous as well as rewarded donation; (2) challenging immunological criteria, using incompatible ABO blood types and or transplantation across a positive cross-match; (3) relaxing clinical criteria related to elderly, hypertensive, or obese donors, or patients with nephrolithiasis, fibromuscular renal artery disease, hematuria, or renal cell carcinomas. However, these practices may be dangerous. They must be clearly validated to promote a liberal policy of donor acceptance since it may carry a risk for both the donor and the recipient as well as for society. It is crucial to ensure the physical integrity of the donor as well as to provide guarantees, for instance a 1-year policy of life insurance, an indefinite long-term medical follow-up and the assurance of going to the top of the waiting list if the donor becomes uremic in the future.

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This study was aimed at assessing university students' awareness and opinions about aspects of the law no. 10.221/01. This exploratory study was performed among students at the São Paulo Federal University-UNIFESP, from 2001 to July 2002, including 1284 undergraduates in the following courses: nursing, medicine, speech and language therapy, biomedicine, and ophthalmic technology. That data show that 47.7% (333) of undergraduates are aware of the kind of donation established by the new law. Among the adolescents of first and second grades, and courses, there was a difference on the awareness about the kind of donation (P =.000). Most undergraduates (57.6%, 402) agree with consented donation. However, the high percentage--35.1% (245)--that chose the alternative "I don't know" is remarkable. Results show that many undergraduates are unaware of the specifications of the technical files for transplants; only 48.3% (337) of them chose the correct answer, and 79.4% (554) do not believe that the order in the waiting list for transplants is respected. The conclusion is that it is worth emphasizing is that there are different opinions and levels of awareness among students, considering age, religion and religious practice, and course and level at school. In spite of unawareness and lack of belief in the principles of distribution of organs and tissue, most students are willing to be donors (68.2%).

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OBJECTIVE: To evaluate the knowledge and the opinion of medical students at the Pontifical Catholic University of São Paulo related to the general aspects of donation, organ and tissue procurement, and basic concepts of brain death (BD). MATERIALS AND METHODS: Questionnaires of 24 items were distributed among all students related to the concept and diagnosis of BD, personal aspects of tissue and organ donation, and general question concerning organ donation. The answers classified students as good versus bad experts of the concept and the diagnosis of BD. RESULTS: Of a total of 580 students, 361 (62.24%) answered the questionnaire. Although the concept of BD was known to 70%, only 35% had a good knowledge of the diagnosis. One percent of the students were opposed to the organ donation and 76% of them were donors. Approximately 90% would authorize organ retrieval from their family members but 27% had never discussed organ donation with their families. Most students were interested in the general aspects of donation and organ procurement (88.36%). CONCLUSION: The majority of the students know the concept of BD. General aspects regarding tissue and organ donation and diagnosis of BD might be improved with the continued education on the subject.

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During the registration for the second semester of 2002, 779 of the 1001 students from the Medical School, Federal University of Bahia, Brazil, answered an anonymous multiple-choice questionnaire including demographic variables, knowledge about transplantation issues, and willingness to donate organs. Mean age was 21.9 +/- 2.9 years (range: 17 to 51 years); 59.5% were men. Regarding the knowledge of which organs and tissues could be transplanted, 99.1% answered kidneys, 96.1% heart, 88.2% liver, 41.1% lung, 24.0% pancreas, 9% bowel, 98.3% corneas, 89.5% bone marrow, 38.1% heart valves, 47.7% skin, and 18.5% bone and tendons. Regarding the criteria of death, 82.4% answered that it is the lack of all brain activity, 8.2% cardiac arrest, 5.2% irreversible coma, and 4.2% did not know. As to the Brazilian transplantation law, 47.3% did not know, 51% had heard about it, and 1.7% answered that they knew the law in detail. As to the willingness to donate organs, 538 (69.2%) were donors. Of 239 nondonors, 51.1% answered the reason for not donating was the lack of confidence in the heath system, 14.3% had no knowledge of the matter, 17.7% were concerned about organ removal before brain death, and 1.7% for religious reasons. The percentage of those willing to donate organs was greater among spiritualists than among Catholics and Protestants. The results of this study support a greater emphasis on providing information regarding transplantation in medical schools to improve the knowledge of future heath care professionals about transplantation and organ donation issues.

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