La categoria “sacralidad de la vida” es reciente tanto en el ambito de la reflexion teologica com... more La categoria “sacralidad de la vida” es reciente tanto en el ambito de la reflexion teologica como de su empleo por parte del Magisterio de la Iglesia. Aunque algu- nos autores la consideran poco adecuada para una reflexion cristiana sobre el valor y la dignidad de la vida humana, la Enciclica Evangelium vitae (1995) la propone como un concepto que recoge la riqueza de toda la reflexion moral catolica sobre la vida humana. En este articulo se parte de la critica de su empleo que realiza Albert D. Jones, para concluir que, aunque sus premisas sean ciertas, la conclusion no deberia llevar necesariamente a su abandono, sino a una explicacion adecuada de su contenido, teniendo en cuenta que la “sacralidad de la vida” contiene toda la dimension positiva de la reflexion cristiana sobre la vida humana, cosa que otras mas empleadas como “indisponibilidad” o “inviolabilidad” no tienen. The use of the category “sanctity of life” is recent both in theological reflection and in the Magisterium ...
La questione sull’obbligo di impiegare o di non impiegare un mezzo terapeutico, era tradizionalme... more La questione sull’obbligo di impiegare o di non impiegare un mezzo terapeutico, era tradizionalmente risolta definendo obbligatori i mezzi che si consideravano ordinari, e invece non obbligatori quelli che si consideravano straordinari. Dopo le critiche ricevute da questo tentativo di risposta si è provato a risolvere diversamente la questione suddividendo le opzioni terapeutiche in proporzionate e sproporzionate. In questo articolo si tenta di mostrare come le due distinzioni non siano equivalenti e come, anche se necessarie, non siano sufficienti per il buon agire medico. Si deve pertanto sempre ricorrere alla prudenza terapeutica per fornire ad ogni paziente la migliore opzione medica personalizzata.
La ética clínica se refiere a un campo emergente en la medicina clínica que se centra en el proce... more La ética clínica se refiere a un campo emergente en la medicina clínica que se centra en el proceso de toma de decisiones éticas en un entorno clínico. Se ha desarrollado como resultado de una creciente conciencia de que la medicina moderna —caracterizada por el progreso tecnológico, la diversidad cultural y los problemas sociales— está planteando una serie de nuevos “dilemas éticos” que la ciencia médica por sí sola no puede resolver. Por esta razón, la ética clínica suele estar relacionada con la “consulta ética”, que consiste en los servicios prestados por un especialista en ética, un equipo ético o un comité de ética para abordar las cuestiones éticas implicadas en un caso clínico específico. Si bien la ética clínica se desarrolló al principio esencialmente como un análisis metodológico para llegar a una justificación de las decisiones éticas clínicas, rápidamente se hizo evidente que la dificultad en la toma de decisiones clínicas es solo un aspecto de los problemas éticos más ...
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2020
Shared Decision-Making is a widely accepted model of the physician–patient relationship providing... more Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the...
Recent advances in our understanding of the nature of suffering and its different dimensions have... more Recent advances in our understanding of the nature of suffering and its different dimensions have exposed certain deficits in the current definition of suffering. These shortcomings have impacted negatively on the appropriate formulation of precise treatment objectives for each dimension of suffering within the overall framework of the goals of medicine. Existential suffering offers a clear example where the lack of a universally accepted definition has led to confusion regarding what should constitute appropriate relief for this particular dimension of suffering. In this thought piece, we propose a redefinition of suffering based on three elements: first, suffering refers to a specific state of a person (the essence of suffering); second, this state is characterised by a specific psychosomatic anguish reaction (the manifestation of suffering) and third, this reaction is in response to a perceived threat to the integrity of the person (the cause of suffering). The proposed definitio...
Nell’ottobre 2013, a Fortaleza (Brasile), durante la 64ª Assemblea Generale dell’Associazione Med... more Nell’ottobre 2013, a Fortaleza (Brasile), durante la 64ª Assemblea Generale dell’Associazione Medica Mondiale (AMM) è stata approvata l’ultima versione della Dichiarazione di Helsinki (DoH), documento chiave nell’etica della sperimentazione sugli esseri umani, che nel 2014 ha festeggiato il suo 50° anniversario. Tra i punti di maggiore confronto spicca sicuramente quello relativo all’uso del placebo nella ricerca scientifica, soprattutto nei casi in cui sono già disponibili farmaci efficaci per le patologie oggetto di sperimentazione. La domanda di fondo riguarderebbe l’adeguatezza etica e le eventuali condizioni secondo cui si può offrire il placebo a dei pazienti che fanno parte del gruppo di controllo di un protocollo di ricerca su un nuovo farmaco, quando un trattamento efficace per quella malattia già esiste ed è utilizzato con un qualche beneficio. Nel nostro contributo viene offerto un attento esame delle due grandi correnti etico-scientifiche sull’argomento, anche alla luce ...
Cuadernos de bioética : revista oficial de la Asociación Española de Bioética y Ética Médica
Bioethics needs an inherent concept of dignity for each human being if it wants to protect the sa... more Bioethics needs an inherent concept of dignity for each human being if it wants to protect the same values it assigned to itself at the beginning of its history. This affirmation will be evident for many, dubious for others, and for many in the Anglo-Saxon world, unacceptable. The principle of autonomy is avoids some of the abuses that effected the birth of bioethics, but it is not enough to avoid them completely. Dignity or a similar concept is required.
In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kan... more In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.
Cuadernos de bioetica : revista oficial de la Asociacion Espanola de Bioetica y Etica Medica, 2018
In the last few years, the new catch phrase ″voluntary stopping of eating and drinking″ has made ... more In the last few years, the new catch phrase ″voluntary stopping of eating and drinking″ has made its appearance in the medical and bioethical literature. The practice, whose ″primary intention″ is to hasten the death of a person who does not want to continue living, has been proposed as an alternative to euthanasia and assisted suicide. Some authors present it as a valid option from both the ethical and legal point of view arguing that it is basically a ″natural death″ in the same line as a limitation of treatment and does not involve suicide. In this article we present a critical review of the recent literature and reach the conclusion that it is very difficult to consider this practice as anything other than a type of suicide. In consequence, healthcare workers should consider it alien to medical ethos and good clinical practice.
La categoria “sacralidad de la vida” es reciente tanto en el ambito de la reflexion teologica com... more La categoria “sacralidad de la vida” es reciente tanto en el ambito de la reflexion teologica como de su empleo por parte del Magisterio de la Iglesia. Aunque algu- nos autores la consideran poco adecuada para una reflexion cristiana sobre el valor y la dignidad de la vida humana, la Enciclica Evangelium vitae (1995) la propone como un concepto que recoge la riqueza de toda la reflexion moral catolica sobre la vida humana. En este articulo se parte de la critica de su empleo que realiza Albert D. Jones, para concluir que, aunque sus premisas sean ciertas, la conclusion no deberia llevar necesariamente a su abandono, sino a una explicacion adecuada de su contenido, teniendo en cuenta que la “sacralidad de la vida” contiene toda la dimension positiva de la reflexion cristiana sobre la vida humana, cosa que otras mas empleadas como “indisponibilidad” o “inviolabilidad” no tienen. The use of the category “sanctity of life” is recent both in theological reflection and in the Magisterium ...
La questione sull’obbligo di impiegare o di non impiegare un mezzo terapeutico, era tradizionalme... more La questione sull’obbligo di impiegare o di non impiegare un mezzo terapeutico, era tradizionalmente risolta definendo obbligatori i mezzi che si consideravano ordinari, e invece non obbligatori quelli che si consideravano straordinari. Dopo le critiche ricevute da questo tentativo di risposta si è provato a risolvere diversamente la questione suddividendo le opzioni terapeutiche in proporzionate e sproporzionate. In questo articolo si tenta di mostrare come le due distinzioni non siano equivalenti e come, anche se necessarie, non siano sufficienti per il buon agire medico. Si deve pertanto sempre ricorrere alla prudenza terapeutica per fornire ad ogni paziente la migliore opzione medica personalizzata.
La ética clínica se refiere a un campo emergente en la medicina clínica que se centra en el proce... more La ética clínica se refiere a un campo emergente en la medicina clínica que se centra en el proceso de toma de decisiones éticas en un entorno clínico. Se ha desarrollado como resultado de una creciente conciencia de que la medicina moderna —caracterizada por el progreso tecnológico, la diversidad cultural y los problemas sociales— está planteando una serie de nuevos “dilemas éticos” que la ciencia médica por sí sola no puede resolver. Por esta razón, la ética clínica suele estar relacionada con la “consulta ética”, que consiste en los servicios prestados por un especialista en ética, un equipo ético o un comité de ética para abordar las cuestiones éticas implicadas en un caso clínico específico. Si bien la ética clínica se desarrolló al principio esencialmente como un análisis metodológico para llegar a una justificación de las decisiones éticas clínicas, rápidamente se hizo evidente que la dificultad en la toma de decisiones clínicas es solo un aspecto de los problemas éticos más ...
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2020
Shared Decision-Making is a widely accepted model of the physician–patient relationship providing... more Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the...
Recent advances in our understanding of the nature of suffering and its different dimensions have... more Recent advances in our understanding of the nature of suffering and its different dimensions have exposed certain deficits in the current definition of suffering. These shortcomings have impacted negatively on the appropriate formulation of precise treatment objectives for each dimension of suffering within the overall framework of the goals of medicine. Existential suffering offers a clear example where the lack of a universally accepted definition has led to confusion regarding what should constitute appropriate relief for this particular dimension of suffering. In this thought piece, we propose a redefinition of suffering based on three elements: first, suffering refers to a specific state of a person (the essence of suffering); second, this state is characterised by a specific psychosomatic anguish reaction (the manifestation of suffering) and third, this reaction is in response to a perceived threat to the integrity of the person (the cause of suffering). The proposed definitio...
Nell’ottobre 2013, a Fortaleza (Brasile), durante la 64ª Assemblea Generale dell’Associazione Med... more Nell’ottobre 2013, a Fortaleza (Brasile), durante la 64ª Assemblea Generale dell’Associazione Medica Mondiale (AMM) è stata approvata l’ultima versione della Dichiarazione di Helsinki (DoH), documento chiave nell’etica della sperimentazione sugli esseri umani, che nel 2014 ha festeggiato il suo 50° anniversario. Tra i punti di maggiore confronto spicca sicuramente quello relativo all’uso del placebo nella ricerca scientifica, soprattutto nei casi in cui sono già disponibili farmaci efficaci per le patologie oggetto di sperimentazione. La domanda di fondo riguarderebbe l’adeguatezza etica e le eventuali condizioni secondo cui si può offrire il placebo a dei pazienti che fanno parte del gruppo di controllo di un protocollo di ricerca su un nuovo farmaco, quando un trattamento efficace per quella malattia già esiste ed è utilizzato con un qualche beneficio. Nel nostro contributo viene offerto un attento esame delle due grandi correnti etico-scientifiche sull’argomento, anche alla luce ...
Cuadernos de bioética : revista oficial de la Asociación Española de Bioética y Ética Médica
Bioethics needs an inherent concept of dignity for each human being if it wants to protect the sa... more Bioethics needs an inherent concept of dignity for each human being if it wants to protect the same values it assigned to itself at the beginning of its history. This affirmation will be evident for many, dubious for others, and for many in the Anglo-Saxon world, unacceptable. The principle of autonomy is avoids some of the abuses that effected the birth of bioethics, but it is not enough to avoid them completely. Dignity or a similar concept is required.
In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kan... more In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.
Cuadernos de bioetica : revista oficial de la Asociacion Espanola de Bioetica y Etica Medica, 2018
In the last few years, the new catch phrase ″voluntary stopping of eating and drinking″ has made ... more In the last few years, the new catch phrase ″voluntary stopping of eating and drinking″ has made its appearance in the medical and bioethical literature. The practice, whose ″primary intention″ is to hasten the death of a person who does not want to continue living, has been proposed as an alternative to euthanasia and assisted suicide. Some authors present it as a valid option from both the ethical and legal point of view arguing that it is basically a ″natural death″ in the same line as a limitation of treatment and does not involve suicide. In this article we present a critical review of the recent literature and reach the conclusion that it is very difficult to consider this practice as anything other than a type of suicide. In consequence, healthcare workers should consider it alien to medical ethos and good clinical practice.
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Papers by Pablo Requena