Florencia Luna begins her essay, “Challenges for Assisted Reproduction and Secondary Infertility in Latin America,” by saying: “I want to explore a new way to think about Assisted Reproductive Technologies (ARTs) in the Latin American context.” I think she clearly achieves that objective. I want to suggest that she does more than this, however. In addition to revealing how traditional depictions of infertility in the United States and Europe are anachronistic for Latin America, her analysis offers feminist bioethicists in (...) the United States the opportunity to revisit our own assumptions about infertility and improve our work as a result.Luna states early in her essay that her analysis will center on secondary .. (shrink)
En este artículo sostengo, frente a las explicaciones de carácter general basadas en supuestos doctrinales (p.ej., Allen y Falco), que el tipo de platonismo (y su relación con el orfismo) que revive con las labores filosóficas de Marsilio Ficino está anclado en el ejercicio de las tecnologías textuales que hereda de los neoplatónicos tardíos. Para mostrarlo, examino la negativa de Ficino de comentar el pasaje del Banquete (179d) donde se presenta a Orfeo como contraejemplo del valor de los amantes y (...) la comparo con la posición de Pico della Mirandola. Con ello pretendo distinguir el platonismo ficiniano del posible platonismo piquiano y subrayar su importancia como transmisor de la tradición platónica que incluye, en su caso, un orfismo comprometido no sólo doctrinalmente, sino también textualmente. In this paper I propose, against general explanations based on doctrinal assumptions (e.g., Allen and Falco), that the kind of Platonism (and its relationship with Orpheus) reviving in the philosophical works of Marsilio Ficino is anchored in the exercise of textual technologies inherited from the late Neoplatonists. To show this, I examine Ficino's refusal to comment on Symposium (179d) where Orpheus is presented as a counterexample of the lovers' courage and I compare it to the position of Pico della Mirandola on the same passage. This way, I distinguish Ficino's Platonism from Pico's and I emphasize its importance as a transmitter of the Platonic tradition that includes a committed Orphism not only doctrinally but also in a textual manner. (shrink)
In this article I examine several criticisms of the concept of vulnerability. Rather than rejecting the concept, however, I argue that a sufficiently rich understanding of vulnerability is essential to bioethics. The challenges of international research in developing countries require an understanding of how new vulnerabilities arise from conditions of economic, social and political exclusion. A serious shortcoming of current conceptions of vulnerability in research ethics is the tendency to treat vulnerability as a label fixed on a particular subpopulation. My (...) paper examines the role of this "label" metaphor in current statements of research ethics. In contrast to this prevailing "label" metaphor, my own positive account of vulnerability develops a dynamic way of understanding the structure of the concept of vulnerability based on the idea of "layers of vulnerability." I examine several cases involving women, as they are sometimes labeled as a vulnerable population and sometimes not. My analysis demonstrates the essential role of this revised concept of vulnerability in bioethics and research ethics. (shrink)
The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)
This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion (...) for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)
In this article, the authors focus on Argentina's activity in the developing field of regenerative medicine, specifically stem cell research. They take as a starting point a recent article by Shawn Harmon (published in this journal) who argues that attempts to regulate the practice in Argentina are morally incoherent. The authors try to show first, that there is no such ‘attempt to legislate’ on stem cell research in Argentina and this is due to a number of reasons that they explain. (...) Second, by examining the role played by different values, conflicting legal and moral views, and the influence of various actors, they attempt to show that the legislative silence regarding stem cell research may not necessarily be a manifestation of a legal/moral disconnection but rather a survival strategy for navigating the long and heated battle on the moral status of the embryo and the kind of treatment it deserves. (shrink)
Traditional accounts of vulnerability tend to label entire populations as vulnerable. This approach is of limited utility. Instead, this article utilizes a layered approach to vulnerability, identifying multiple vulnerabilities that older people experience. It focuses on distinguishing the different layers of vulnerability that may be experienced by the elderly in middle-income countries of Latin America. In doing so, I show how the layered approach to vulnerability functions, and demonstrate why it is more interesting and useful than the traditional approach. The (...) article achieves three things. First, it unwraps the different potential layers of vulnerability that develop in old age and the multidimensionality aspects of aging. Second, it reestablishes the usefulness of the concept of vulnerability and explains its functioning. Finally, it shows how different policies can be designed in order to address each vulnerability layer. The layered account promotes a multifaceted approach to public policy analyses and design. In this sense, the layered concept of vulnerability is an appealing concept to consider in public health ethics. (shrink)
This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of ‘usual suspects’, focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different (...) approaches to ‘vulnerability’ are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. (shrink)
El Foro Global de Bioética en Investigación (GFBR por sus siglas en inglés) se reunió el 3 y 4 de noviembre en Buenos Aires, Argentina, con el objetivo de discutir la ética de la investigación con mujeres embarazadas. El GFBR es una plataforma mundial que congrega a actores clave con el objetivo de promover la investigación realizada de manera ética, fortalecer la ética de la investigación en salud, particularmente en países de ingresos bajos y medios, y promover colaboración entre países (...) del norte y del sur.a Los participantes en el GFBR provenientes de Latinoamérica incluyeron a eticistas, investigadores, miembros de comités de ética y representantes de autoridades sanitarias provenientes de Argentina, Brasil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panamá, Perú, Nicaragua y la República Dominicana. Una legítima preocupación por la protección de las mujeres embarazadas y sus embriones o fetos ha llevado a la mayoría de los países de la Región de las Américas a limitar la realización de estudios con mujeres embarazadas exclusivamente a aquellos estudios específicos sobre el embarazo, y a requerir la exclusión sistemática de las mujeres embarazadas o de las mujeres que quedan embarazadas en el curso del estudio. Ciertamente, a lo largo de la historia de la ética de la investigación, se ha creído erróneamente que proteger a una población es sinónimo de excluirla de los estudios. Se sabe ahora que proceder así implica exponer a riesgos mucho mayores a la población que se busca proteger. El embarazo implica cambios fisiológicos sustantivos e impacta profundamente la manera como el cuerpo metaboliza los medicamentos. Sin embargo, por evitar hacer investigación con mujeres embarazadas, no se ha producido la evidencia científica necesaria para tomar decisiones sobre tratamientos e intervenciones preventivas con dosis eficaces y seguras para ellas y sus embriones o fetos. A manera de ilustración, en el 2001 había en los Estados Unidos apenas más de una docena de medicamentos aprobados para uso en el embarazo (1) y en el 2011 la Food and Drug Administration (FDA) aprobó por primera vez en 15 años un medicamento para su uso en el embarazo (2). Como consecuencia de no haber producido la evidencia necesaria, se pone en riesgo la salud de las mujeres embarazadas cada vez que se les da atención médica. Las mujeres embarazadas se enferman y las mujeres enfermas se embarazan, y no se sabe si los medicamentos que se les da son eficaces o siquiera seguros para ellas y sus embriones o fetos. (shrink)
Despite "progressive" legislative changes concerning the LGBT collective and assisted reproductive technologies in Argentina, women and their sexual and reproductive rights have been overlooked. This article presents a critical perspective of some of these legislative modifications in the country. It addresses why some legislators and society are prepared to challenge a conservative or traditional approach for certain groups while ignoring others. Several factors are at play. There is no all-inclusive explanation. I stress that a striking double standard prevails in Argentina (...) with respect to women and their sexual and reproductive rights. I also contend that powerful discrimination exists, in particular against poor women, who continue to suffer and are "punished" by the criminalization of abortion. (shrink)
This book presents some of the challenges bioethics in Latin America faces today. It considers them through the lenses of vulnerable populations, those incapable of protecting their own interests, such as the illiterate, women in societies disrespectful of their reproductive rights, and research subjects in contexts where resources are scarce.
Rice crop diversity hasdecreased dramatically in the recent past.Understanding the causes that underlie theevident genetic erosion is critical for thefood security of subsistence rice farmers andbiodiversity. Our study shows that farmers inthe northeastern Philippines had a markedreduction in rice diversity from 1996 to 1998.The ultimate causes were a drought resultingfrom the El Niño phenomenon in 1997 andflooding due to two successive typhoons in1998. The proximate causes, however, includedlocal water control factors, limitations in thehousehold and village-level seedinfrastructure, farm location in relation (...) tothe goods and services necessary to obtainseeds, policies and programs of the Departmentof Agriculture, and the characteristics of therice varieties themselves. The implications ofour study are that genetic erosion is notalways the result of purposeful acts by farmersnor is it necessarily gradual. Improvingon-farm seed technology will stabilize the seedproduction, distribution, and use system andthereby enhance household food security.Ultimately, rice diversity will be improvedonly if diversity is a safe and viable optionfor farmers. Therefore, public policy thatsupports farmers who maintain a diverse set ofcultivars is critical for any on-farmconservation strategy. (shrink)
In this article I focus on two issues concerning bioethics in Argentina: reproductive health and ethics in research. Although these topics are quite dissimilar, they share a particular feature: their special relationship with context.
El artículo examina un episodio curioso, ocurrido en las relaciones de Galileo Galilei y de su amigo Giovanfrancesco Sagredo -el destacado personaje del Diálogo sobre los dos máximos sistemas del mundo- con el filósofo aristotélico Cesare Cremonini. Estando todavía de profesor en Padua, Galilei entrega al colega y amigo Cremonini, en forma de préstamo, la cuantiosa suma de cuatrocientos ducados. Al trasladarse de Padua a Florencia, el científico confía a Sagredo la tarea de recuperar el dinero prestado. Las cartas (...) numerosas que Sagredo dirigiera a Galilei a tal propósito, nos informan que la cancelación total del préstamo tardó nueve años (1619), gracias a las reiteradas intromisiones del patricio veneciano. Es opinión común de los historiadores, que la tardanza fue causada simplemente por la morosidad y la mala conducta seguida por Cremonini. El autor, en cambio, sugiere una interpretación diferente de los hechos; al tomar en cuenta, de un lado, la presencia de factores financieros que hicieron subir el costo de la deuda; del otro, la forma agresiva con que Sagredo llevó adelante el cuidado de los intereses de Galilei, hasta el extremo de levantar en Cremonini la sospecha de ser objeto de maniobras usureras. (shrink)
The goal of this paper is to show how culture – shared norms and values – is challenged and used to facilitate cooperative behavior within the context of farmer field schools (FFS) in central Luzon, Philippines. The success of the FFS is primarily associated with cultural norms that encourage experiential and collective learning and eventually lead to the adoption of integrated pest management (IPM) methods among the farmers. The study was conducted in central Luzon, the rice granary region of the (...) Philippines, from 1992 to 1995 and again in 1999. Both qualitative and quantitative research methods were employed. Results indicate that a keen understanding of Filipino culture and values is essential if FFS is to be successful and if farmers are to successfully learn and practice IPM. (shrink)
This article examines the problems that research ethics confronts in developing countries and the impact that research in developing countries has had on research ethics. In order to show this it analyzes the first paradigmatic cases that gave rise to the ‘classic’ analysis of research ethics. Hence, in this article, many of the ethical concerns apply wherever research is conducted and are not particular to developing countries. Secondly, the article describes the complex process of research by analyzing different research actors (...) and their interests in the current research process. Thirdly, it sketches some of the recent cases that have prompted fierce ethical debate surrounding research in developing countries. (shrink)
Throughout this essay, I will consider an argument frequently used to justify paternalistic behavior toward a specific class of persons: illiterate people. The argument states that illiterate people are uneducated, lack information and understanding, and are thus unable to make decisions. Therefore, it is argued, paternalism in their case is justified. The conclusion is that illiterate persons cannot be autonomous. The justification for this view is based on an a priori attitude: since it is impossible to communicate, physicians should decide (...) which kind of treatment the illiterate patient should receive. This argument is frequently used even though its proponents may not be aware of its implications. Given the importance and uncritical acceptance this argument has in Argentina, and also in other Latin American countries, I think it is relevant to analyze carefully what it means. I propose a thorough analysis of this argument, of its implications and an evaluation of whether it is acceptable. (shrink)
The specialist literature has investigated extensively the link between Benjamin and German Romanticism and, less frequently, his relation to Kant. However, these contributions tend to take up these links separately, and therefore do not analyse in detail the process which begins with the theoretical sketches on Kant and concludes with the writing of the doctoral thesis on the Frühromantik. This paper argues that there is a marked continuity between the objectives which led Benjamin to plan, in the first place, his (...) doctoral investigation on Kant and those which were finally realized. I try to demonstrate that such continuity consists in a displacement of the problem of the justification of knowledge, from the field of the criticism of knowledge in general to a particular sphere: that of art criticism. In this shift the purpose of linking the justification of knowledge with a messianic philosophy of time and history is also preserved. (shrink)
El siguiente artículo fue presentado en las conferencias en Barcelona, España (Octubre 2011); Santiago, Chile (Octubre 2011) y Buenos Aires, Argentina (Noviembre 2011), celebrando el centenario de los Relatos del Padre Brown. Esta conferencia fue traducida al Catálan por la Dra. Silvia Coll-Vinent para la conferencia en la Facultad de Filosofía de la Universidad Ramon Llul en Barcelona. Traducción de Florencia Velasco-Suárez.
La mayoría de los derechos reconocidos tanto a nivel constitucional como en el derecho internacional de los derechos humanos están destinados a la protección de bienes privados. A diferencia de ellos, el derecho al ambiente sano asegura a los individuos el disfrute de un bien público. Las características propias de los bienes públicos generan profundos problemas de arquitectura jurídica para un sistema de derechos fundamentales que históricamente fue concebido para la protección de bienes privados y han dado lugar a discusiones (...) sobre la titularidad de este derecho. Este trabajo analiza la posición de Carlos S. Nino a favor de considerar el derecho a un ambiente sano como derecho colectivo y señala los problemas que esta postura genera para el ejercicio y contenido del derecho. Most of the rights that have been recognized both at the constitutional level and in international human rights laws entitle individuals to the protection of private goods. In contrast, the right to a healthy environment ensures individuals the enjoyment of a public good. The characteristics of public goods have created significant problems related to the legal architecture for a system of fundamental rights that historically was conceived for the protection of private goods, and have generated considerable debate over whether the right to a healthy environment should be considered an individual right. This paper analyzes Carlos S. Nino’s position, who advocates in favor of considering the right to a healthy environment as a collective right; and it points out the problems that such a position generates for the content of the right and its exercise. (shrink)