28. Ethics in health institutions: the logic of care and the logic of management
In hospitals and other healthcare institutions there are at least two different ways of thinking that must live side by side: the healthcare viewpoint and the management viewpoint. The different viewpoints stem from values, principles and decision making criteria that do not always coincide. However despite the dissonance, we can find many points in common. This monograph considers the different viewpoints, the values and the roles of the different professionals in the healthcare sector.
27. Ethics and public health
This report aims at encouraging more awareness of ethics within the public health sector. It includes those aspects that are susceptible to ethical consideration and also elements for the development of a casuistry of application of bioethics to public health. Proposals for designing an educational training program are also included.
26. The three ages of medicine and the doctor-patient relationship
Mark Siegler, the guest speaker at the IV Josep Egozcue Conferences, dedicated this cycle of lectures to discussing the three ages of medicine and the doctor-patient relationship. During the first lecture he focused on the transformation that the relationship with the patient has undergone throughout history. During the second lecture he talked about the past and future contributions of clinical ethics. He developed this term to refer to ethics applied in the practice of medicine. Several other experts enriched the debate with their contributions to the discussion.
25. Ethics: the essence of scientific and medical communication
Information and communications technologies have revolutionized the world of journalism and, in general, the way in which the public has access to medical and healthcare knowledge and information. Ethics now has new perspectives in this field that are worthy of analysis. In this monograph Vladimir de Semir, director of the Observatori de Comunicació Científica de la Universitat Pompeu Fabra, (Scientific Communications Observatory of the Pompeu Fabra University) analyzes the current situation with regard to scientific communications. Other experts have also contributed with their thoughts on the transformations that have affected healthcare journalism.
24. Maleficence in prevention programmes
Bioethics is a discipline which is of growing importance in the healthcare world. However, up to now, interest has been centered on its clinical application rather than on the public health sector. This monograph goes in to the subject in more depth, by studying prevention programs; specific reference is made to secondary prevention programs for the detection of breast cancer. These types of programs offer benefits to the community as a whole but not always to the individual involved. Several experts analyze non-maleficence and other basic ethical principals that arise when faced with such programs.
23. Ethics and Clinical Research
Ruth Macklin, professor of bioethics at the Albert Einstein College of Medicine in New York, was responsible for delivering the 3rd Josep Egozcue Lecture Cycle. Macklin dedicated this year's lectures to Ethics and Clinical Research. This monograph includes her three talks: Research Ethics Today, Multinational Research; and Grey Areas: Drawing the Line Between Research and Non-research.
22. Consent by representation
Although consent must now be obtained before performing any medical treatment, the question of informed consent remains problematic. These problems are accentuated when the patient does not have the capacity to take decisions and it is necessary to obtain consent by representation. This monograph analyses consent by representation from both a health and a legal perspective, with papers from Emilia Civeira, an intensive care specialist, and Jacobo Dopico, lecturer in criminal law. In addition, it contains contributions from professionals in a variety of fields, providing a broad perspective on this topic.
21. Ethics in care services for people with severe mental disability
In the course of their daily work, those caring for people with serious learning difficulties continuously encounter ethical dilemmas which have to be resolved. This monograph brings together the thoughts and concerns of experts in ethics of and professionals who work in care centres. It is designed as a working document which we hope will provide a starting point for drawing up a code of good practice.
20. Ethical challenges of e-health
In recent years, the expansion of the internet has given rise to significant changes in the health sector, affecting both access to information and the relationship between service users, medical professionals, the health industry and researchers. This monograph explores these issues and the ethical challenges they raise. It includes a working paper by Gema Revuelta and Cristina Aced of the Scientific Communication Observatory of the Pompeu Fabra University, an account of the development of a virtual nursing portal, by Gisel Fontanet of the College of Nurses of Barcelona, and contributions from a number of experts in the field.
19. The person as the subject of medicine
In recent years, the expansion of the internet has given rise to significant changes in the health sector, affecting both access to information and the relationship between service users, medical professionals, the health industry and researchers. This monograph explores these issues and the ethical challenges they raise. It includes a working paper by Gema Revuelta and Cristina Aced of the Scientific Communication Observatory of the Pompeu Fabra University, an account of the development of a virtual nursing portal, by Gisel Fontanet of the College of Nurses of Barcelona, and contributions from a number of experts in the field.
18. Waiting lists. Can we improve them?
This monograph analyzes one of the major problems in public health, that of waiting lists. Despite the theoretically universal nature of public health coverage, not all patients have the same access to it. Concepts such as equity, distributive justice or inequality between patients arise when we consider this issue in more depth. The monograph sets out the key drawbacks of waiting lists and suggests ways of addressing these. Contributors included Marisol Rodríguez, professor of Health Economics at the University of Barcelona, Àngel Puyol, doctor in Philosophy at the Autonomous University of Barcelona, and Juan del Llano, director of the Fundació Gaspar Casal.
17. Individual Good and Common Good in Bioethics
Achieving a balance between the individual good and the common good is one of the aims of ethics. In health issues, the challenge of reconciling individual desires with the common good is intensified by the fact that while our demands grow inexorably, the resources to fully satisfy these demands are scarce. Professor Daniel Callahan dedicated the first edition of the Egozcue Lectures to addressing this issue, considering it in the light of medical progress, medicine and the market, and declining birthrates.
16. Autonomy and Dependency in Old Age
The autonomy of elderly people who suffer from functional limitations is a key challenge for societies seeking to adapt to the problems of ageing and rising life expectancy. In this monograph, papers by Bernadette Puijalon, Josep Vila and Moisés Broggi provide contrasting perspectives on this challenge, drawing on anthropology, applied psychology and lived experience, respectively. Together, they make it clear just how many different aspects there are to the issue of autonomy, while at the same time stimulating new questions.
15. Informed consent and cultural diversity
Informed consent is a concept which outlines the responsibility of effective communication between doctor and patient, and is designed to inform the patient of their medical situation so that they can subsequently make informed decisions. If the communication is already difficult in "normal" situations, it is further complicated when there is no common language or where the same words have different meanings. The objective of this notebook is to detail certain features of informed consent in a multicultural context with contributions from researchers, professors and professionals in the field of health services.
14. Addressing the problem of patient competency
Much progress remains to be made about patient competency in decision-making, and this issue requires new skills and techniques. How should we respond to a patient's refusal to undergo surgery? How do we distinguish between normal and incompetent decisions? This monograph explores these and other questions regarding the competency and autonomy of the patient.
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13. Health information and the active participation of users
The aim of the study was to find out to what extent the information that patients and their relatives or friends receive, relating to the particular pathology they are suffering from, or the chances they have to play an active role in the taking of necessary decisions involved in the treatment of their disease, are satisfactory or not. The process undertaken in the interview stages and in the conclusions deduced were presented by the authors to a group of experts who amply debated.
12. The management of nursing care
According to the ethics of caring there is an ethical dimension which is intrinsic to any care act, and this enriches the discourse of health ethics and helps us to view it from the perspective of the health service user, patient or family receiving care. The way in which nurses care proposes a concept of what has to be done and how it has to be implemented, and becomes particularly important if we genuinely want to focus our care model on the patient or service user. In the organization of a health service, we must consider the basic principles of professional care as a minimum standard which has the same importance as the basic principles of treating illnesses.
11. Los fines de la medicina (The Goals of Medicine)
A group of researchers from the Hastings Center wrote an essay which has been translated by the Victor Grifols i Lucas Foundation into Spanish and Catalan. This document attempts to demystify medicine so that putting it to use can truly mean progress for all of humanity. The goals of medicine at the end of the twentieth century should go beyond curing the ill and lengthening life.
The Grifols Foundation has translated this document to highlight the values which the contents transmit and which articulate the objectives of the Foundation's activities. The translation of this document is intended to spread these values to those who work in the health sciences.
10. Corresponsabilidad empresarial en el desarrollo sostenible (Corporate responsibility in sustainable development)
The need for sustainable development is widely recognized by society, many governments, local administrations, social agencies and by a large part of the business sector. It is well known that the current economic growth cannot be sustained in perpetuity. Society must ensure that growth can be maintained for future generations without being limited by the current way of doing things.
A cultural change is necessary so that the citizenry assumes responsibility and actively participates in this new "way of life". Many different parties would be implicated in such a change: the business sector, government, NGO's, business schools and universities, unions and the press. This essay takes all these points of view into consideration. The monograph includes all of these points of view, in addition to which it contains an appendix of case studies
09. Ethics and sedation at the close of life
Sedation is something which requires both respect for the autonomy and dignity of the patient and also the best care on the part of the health professionals who look after for patients nearing death.
The objective of this monograph is to publish the debate between palliative care professionals, oncologists, internists, surgeons, health administrators, journalists, psychiatrists, psychologists, nurses, lawyers and bio-ethicists on advancing knowledge and good praxis in sedation to facilitate the work of clinicians.