Disability and equal rights
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.
Care in the pandemic society
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.
Attending to social and health needs: working together or working against each other
This publication addresses the need to bring together the two spheres of health care and social care. The healthcare model and the social care model often fail to combine forces to provide the most effective response to the needs of elderly people with health problems and associated social issues.
It is time to reconsider an approach based on two separate models that fail to take account of the fact that people's needs do not exist in separate compartments but, rather, require coordination and dialogue between the health and social sectors if we really want a society that provides integrated care, particularly in old age and at the end of life, and does so in a way that optimizes resources and makes efficient use of the system.
This monograph is the result of a partnership between the Víctor Grífols Foundation and Fundación Mémora, launched within the framework of the Ciudades que Cuidan project (Cities that Care), which focuses on preventing the death of people in situations of vulnerability and unwanted solitude.
58. Salud pública y COVID
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).
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.
56. La salud pública, el género y la ética
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.
Soledad, envejecimiento y final de la vida
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.
54. Sexualidad y diversidad funcional (Sexuality and functional Sexuality and functional diversity)
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.
51. Una mirada ética en la gestión de conflictos
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.
50. Pensar la maternidad (Thinking about motherhood)
In recent years, motherhood has changed rapidly, raising new ethical problems. This publication reflects on the psychological, social, economic, political and employment issues that condition motherhood in today's society.
49. Publicidad y salud (Advertising and health)
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.
Q48. Prioridades y políticas sanitarias (Health priorities and health policies)
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.
47. Ethics and plasma donation: an overview
Publication analysing the paid and altruistic models of plasma donation. Offers ethical considerations and describes the models that exist in Catalonia and the United States. Draws on contributions from industry experts, blood bank professionals, doctors, donors and patients.
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.
45. CRISPR… ¿debemos poner límites a la edición genética? (CRISPR: Should there be limits on genome editing?)
New genome editing techniques such as CRISPR/Cas9 open up a whole range of possibilities for human health. They can be used to correct genetic defects to cure disease, and also to modify individuals and entire plant or animal species. Who should be responsible for determining their use? Do we need to establish limits?
44. Crisis y salud mental en niños y jóvenes: ¿causa o consecuencia? (The crisis and mental health in children and young people: cause or effect?)
The Probitas Foundation and the Víctor Grífols i Lucas Foundation organized a workshop to analyze the impact of the crisis on the mental health of children and young people. The session also considered the need for close coordination between the health, social care and education systems to promote mental health among children and young people, and to detect risk situations at the earliest possible stage. This monograph includes the papers presented at the seminar.
43. ¿Debemos revisar el concepto de muerte? (Do we need to reconsider the concept of death?)
There are a number of controversial issues linked to the concept of death. This publication focuses on the ethical, medical, and legal questions linked to brain death and persistent vegetative states. It includes articles by James Bernat, Professor of Neurology and Medicine at the University of Dartmouth, and other experts from different professional spheres.
Only available in Spanish.
42. Iatrogenia y medicina defensiva (Iatrogenesis and defensive medicine) (pub)
Iatrogenesis – the adverse effects caused by medical treatment – is often associated with professional errors or negligence. Paradoxically, one of the reasons for its increase is the rise of ‘defensive medicine', designed not to promote the well-being of patients but to protect medical professionals against possible claims. A number of professionals discuss this issue from a medical, legal and philosophical perspective.