The COVID-19 pandemic has had a profound impact on older people, particularly those residing in elderly care facilities. In addition, they have endured the adverse consequences of various measures implemented to prevent and control the spread of the virus.
This situation serves as a stimulus for profound reflection on the role of the aged in society, the values that encompass their existence, and the imperative to address the challenges arising from physical frailty, unwanted loneliness, and social exclusion.
This monograph is published in conjunction with the Spanish Society of Public Health (SESPAS).
This publication reflects upon the limitations to individual rights and the restrictions experienced during the epidemiological response to the pandemic. The discussion it offers ranges from an analysis of the legal framework sustaining such actions to the ethical questioning of these measures and their proportionality. It also examines the legal conflict between individual and collective rights and offers an analysis of the various criteria applied by health authorities.
Have we learned anything? Should the legal framework be changed to unify the ethical criteria for action in future situations? This book contains contributions from professionals and experts from various disciplines such as epidemiology, law and ethics as well as from the political sphere.
63. Inteligencia artificial en salud. Retos éticos y científicos (Artificial intelligence in health: ethical and scientific challenges)
Artificial Intelligence is already having an impact in society in general and in the health sphere in particular. However, while it brings undeniable technological benefits, it is also important to consider other aspects of the health sphere that are affected. How does it affect patient autonomy? Are diagnostic algorithms safe? Does it threaten confidentiality? Who is responsible for possible errors?
This monograph explores the use and application of technology to help mitigate involuntary solitude. Here, readers will find a good number of initiatives linked to the support of the elderly living alone, such as tools that make use of AI-based algorithms, social robotics, or applications for use in healthcare and social work.
Are they all valid and do they address the needs of these individuals? Are they respectful of the autonomy and privacy of the citizens they target? Are we responding with tools that are accessible to people often affected by the digital gap?
These are the issues discussed by the various contributors to this book, who examine the subject from the technological, philosophical, social, anthropological, and governmental standpoint. This volume has been produced as part of the “Ciudades que Cuidan” (Cities that Care) project, supported with the participation of Fundación Mémoria and the Fundación Víctor Grífols i Lucas.
The recent reform of Spanish legislation recognizes that people with disability have legal capacity on equal conditions with others, and obliges the state to take measures to provide the necessary support to make this effective.
This change entails moving from a care model in which decisions are primarily made by representatives to one based on respecting the wishes and preferences of the individual, who is responsible for taking their own decisions. The role of guardians in modifying the individual's capacity gives way to new forms of support, which may be voluntary or the result of a legal decision but are always based on recognizing the legal capacity of the person affected.
This change entails uncertainty and contradictions, in so far as it modifies people's rights, and it needs to be accompanied by a change in the way society views disability, which continues to be characterized by paternalism.
This publication offers a considered reflection on the current status of this change and the challenges it poses.
This publication includes ethical and public health reflections on the preventive recommendations that limited physical contact between people during the pandemic.
How have public health policies affected the idea of care? Care can be understood as the quality of interdependence between people, which is essential to the viability of human groups, whether these are prehistoric bands and clans or the most complex modern societies. This means that individuals assume certain risks, threats and uncertainties, including those associated with epidemics.
These risks and threats are worth preventing, avoiding or at least mitigating, so long as the undesirable effects of the preventive measures are acceptable. And this is why it is important to reflect on the potential negative consequences of isolation and quarantine, to question the assumed moral superiority of the value of health, and to explore the dilemmas that arise when making health interventions in situations such as homes for old people or others in a situation of dependency.
La atención a las necesidades sociales y sanitarias, ¿sumamos o dividimos? (59. Attending to social and health needs: working together or working against each other?)
No other pandemic has persuaded so many people to accept the imposition of preventive measures as drastic as those taken in response to Covid-19. These have included the suspension of some fundamental human rights, and far-reaching interference in the daily lives of individuals and organizations.
This publication looks at how Covid-19 has affected public health from three perspectives: citizens' participation; paternalism and freedom; and transparency and communication. It contains contributions from a number of professionals and was produced in coordination with the Spanish Society for Public Health and Health Administration (SESPAS).
57. Ciudades que cuidan, también al final de la vida (Cities that care, including at the end of life)
Ensuring that our cities are places where we care for the vulnerable is everyone's responsibility, and this is never more true than at the end of life. The requirement to attend to those who unwillingly find themselves alone requires us to make our cities friendlier and more welcoming, creating environments that can be inhabited by people of different ages and with different capacities. Published in Spanish.
Most human societies continue to embody patriarchal attitudes and behaviours which lead to gender discrimination, both with regard to health protection and with respect to care practice and the design of health policies. This monograph addresses the issues from these three perspectives, drawing on the contributions of philosophers and health professionals with expertise in gender and health.
Increased life expectancy and low birth rates are leading to the rapid ageing of the population, along with a rise in chronic illness and high levels of dependency. Our society has an ethical duty to support settings designed to ensure that those who are alone can be accompanied during the end of life process, receiving appropriate care that respects their values and preferences.
Some people with disabilities or functional diversity have emotional, erotic and sexual needs that can only be satisfied with the help of specialist services (for example involving a sexual assistant). Families, guardians and institutions often do not provide this support because they do not recognize the person's sexuality or they do not approve of such services, for moral or political reasons. This monograph addresses this issue, taking as its starting point a document drawn up by Fundación Pere Mitjans.
53. Nuevos escenarios en salud e investigación clínica (New scenarios for health and clinical research)
What is the future of healthcare? How will healthcare and health management change? Ezekiel J. Emanuel identifies six healthcare trends that will dominate our healthcare systems over the coming decade. His perspective is complemented by the contributions of scientists and health professionals, who identify the challenges currently faced by biomedical research.
52. Ética y promoción de la salud. Libertad-paternalismo. (Ethics and health promotion. Freedom vs. Paternalism)
Health promotion requires an explicit ethical commitment that charts a path between excessive paternalism, on the one hand, and the neglect of those who stand to benefit from community health promotion projects, on the other. This publication, the product of a seminar held jointly with SESPAS, addresses the ethical debate about how to combine these opposing values (freedom and paternalism) from a variety of perspectives.
Only available in Spanish.
During the provision of health services, conflicts with service users often arise, and these may lead to complaints and even end up in the courts. Mediation can help prevent further harm for all parties. But this mediation must be ethical, and guided by values such as dialogue, impartiality and transparency.
During the last two decades, the world of communication has undergone a radical transformation, which has also affected the health sector. This has had an impact not just on medical advertising but also – more widely – on all publicity that has an impact on health and lifestyles. This publication reflects on the main dilemmas raised by this new situation.
Health systems have to prioritize, and are under a moral and political obligation to decide which services and which patients will receive preferential treatment given the inevitable fact that resources are limited. This monograph considers how to establish these priorities, combining theory and philosophical analysis with specific experience of resource distribution.
46. Comités de Ética y consultores clínicos: ¿complemento o alternativa en la ética assistencial? (Ethics committees and clinical advisors: complementary or alternative approaches to clinical ethics?)
This publication compares the two models of clinical ethics advice currently in use, and draws on experiences in Spain and internationally to analyse their compatibility. It includes special contributions from Joseph J. Fins and Juan Pablo Beca, who describe how the figure of clinical advisor in bioethics has been incorporated in the United States and Chile.