Cuadernos de Bioetica最新文献

{"title":"[The good practice of medicine: Between scientific progress and the permanence of human essence].","authors":"Pedro Martínez Ayala","doi":"10.30444/CB.209","DOIUrl":"10.30444/CB.209","url":null,"abstract":"<p><p>Contemporary medicine evolves with unprecedented speed in its technical and scientific dimensions, while the essential traits of good clinical practice -compassion, prudence, empathy, and accompaniment- show remarkable historical persistence since the documented origins of the profession. Drawing on the author's lived experience with early goal-directed therapy for sepsis (Surviving Sepsis Campaign, 2008) and its subsequent abandonment, and inspired by Francis W. Peabody's The Care of the Patient (1927), this essay articulates a distinction between medical science -progressive and perfectible by nature- and the ethical essence of medical practice, understood not as a set of fixed pre-given traits, but as the anthropological capacity to cultivate the virtues constitutive of the clinical relationship. From that distinction it proposes a prototype of good clinical practice -following Pellegrino and Thomasma, as a normative representation of the clinician embodying the virtues proper to the moral enterprise of medicine- grounded in four cardinal virtues, contrasted with the contemporary prototype of professional ″success″ -research, dissemination, digital presence-, while acknowledging their legitimacy and tempering the critique to their hypertrophy. It discusses the dynamics that erode this core and emphasizes, drawing on educational evidence and the main international frameworks, that clinical virtues can and should be taught through structured curricula.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 120","pages":"161-170"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lexusus: when the law uses the healthcare professional].","authors":"Juan Santos Suárez","doi":"10.30444/CB.208","DOIUrl":"https://doi.org/10.30444/CB.208","url":null,"abstract":"<p><p>The methodological and ethical analysis of clinical studies is a responsibility of the Research Ethics Committees. There are scenarios in which this assessment can be very difficult. This is the case with the TRASMETIR trial that studies liver transplantation in patients with unresectable metastases of colorectal carcinoma. It was conducted in several Spanish hospitals as a clinical trial because liver transplantation was not previously considered a treatment indication for these patients. To justify and supervise the trial, it was stated that it would not represent an additional financial burden for the hospitals and that it was a study based on routine clinical practice. Thus, the infrastructure and professionals dedicated to performing liver transplantation for approved indications could participate in this prospective clinical trial as if it were part of their ordinary work. Upon a detailed analysis of this new and interesting experience, we observed that there are ethical issues that require closer attention. These include the distinction between clinical practice and clinical studies, the impact of possible public sponsorship in clinical trials, the information received in order to participate in a trial by the different professional profiles that collaborate in the systematics of each transplant, the priority and availability of biological resources such as organs for transplantation for their integration into clinical trials, or the way in which information is given and the content of this information to the donor or relatives.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 120","pages":"151-159"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Gender dysphoria in children and preadolescents: state of the art. Review and ethical assessment of therapeutic strategies].","authors":"María Font, Natalia López-Moratalla","doi":"10.30444/CB.204","DOIUrl":"https://doi.org/10.30444/CB.204","url":null,"abstract":"<p><p>Gender dysphoria (GD) can be defined as a persistent and intense experience of incongruence between biological sex and perceived gender identity, accompanied by significant distress and, frequently, an explicit desire to modify bodily characteristics. In the current scientific context, the study of GD is structured around several lines of research, including the possible existence of neurobiological differences between cisgender children/pre-adolescents (controls) and transgender individuals, alterations in the networks involved in body self-perception, and the potential contribution of biological factors - including genetic components - to the development of transsexuality, as has been demonstrated in some adult trans individuals, as well as to gender identity more broadly. In the clinical domain, interventions aimed at children and pre-adolescents with GD - primarily based on the administration of puberty blockers, followed in some cases by cross-sex hormone therapies and, exceptionally, surgical interventions - raise specific questions that go beyond those already identified in adult populations. These issues are particularly related to the role played by sex hormones in brain development during critical stages of neurodevelopment, as well as to the potential long-term effects on endocrine systems and reproductive function. The analysis of the available evidence on side effects, together with consideration of their potentially irreversible nature in certain cases, highlights the need for especially rigorous ethical evaluation. In this regard, the principle of primum non nocere assumes central importance, given that significant uncertainties remain as to whether the potential benefits of these interventions outweigh their inherent risks. Likewise, it is essential to ensure an interpretation of scientific data free from ideological bias, as well as to reinforce the requirement for a comprehensive diagnostic approach encompassing endocrinological, psychological, and social dimensions. This is further compounded by the critical issue of the validity of informed consent in minors, particularly in relation to their level of maturity. Finally, recent advances in the study of genetic bases and in the understanding of the neural networks involved in bodily self-perception open up the possibility of new therapeutic approaches, the exploration of which requires deeper and more systematic scientific development.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 120","pages":"183-214"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Privacy After Death].","authors":"Ana Santurtún","doi":"10.30444/CB.210","DOIUrl":"10.30444/CB.210","url":null,"abstract":"<p><p>When a patient requests that information about their diagnosis not be disclosed to family members, physicians are bound by their duty of confidentiality to withhold any health-related data. Medical data relating to living patients are protected under the Spanish legal system; subject to certain limits when other overriding legal interests are at stake. The protection of privacy must be maintained after death as an extension of the individual's memory in life. Upon a patient's death, however, once death has been conclusively established, the physician must issue (in cases of natural death) the medical death certificate, which must state the causes of death with precision; this certificate is provided to the family. This raises a central question: does the duty of confidentiality lapse upon the patient's death? This article examines what follows the patient's death from legal, procedural, and ethical perspectives.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 120","pages":"173-179"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The stigma of vulnerability and the autonomy fallacy in care. Ethical keys from a relational anthropology].","authors":"María Antonia Quesada Blasco, Luis E Echarte Alonso, María Victoria Roqué Sánchez","doi":"10.30444/CB.207","DOIUrl":"10.30444/CB.207","url":null,"abstract":"<p><p>Vulnerability has become a bridging concept capable of traversing clinical bioethics, research ethics, and contemporary discussions on social justice, without a stable consensus on what the term exactly designates, what it normatively justifies, and how it is operationalized in specific contexts. This article offers an argumentative synthesis based on a systematic literature review (January 2015-August 2025) conducted in PubMed, Scopus, and Web of Science. This study, inspired by PRISMA, identifies four thematic areas encompassing the most significant ethical challenges and emerging approaches in both care and research with vulnerable individuals and populations. The discussion concludes that the ethical quality of clinical, institutional, and regulatory responses depends on achieving a balance between protection and inclusion through personalized assessment. This approach avoids both stigmatizing labeling and preventive exclusion, which compromises equity in care. The reviewed literature supports the notion that reducing vulnerability to a lack of autonomy is conceptually flawed and normatively dangerous.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 120","pages":"137-149"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical trial or ″regular clinical practice″? The trasmetir study example].","authors":"Álvaro Sanz Rubiales, María Luisa Del Valle Rivero, Juan Carlos Torrego García, Sofía Morán Valverde","doi":"0.30444/CB.200","DOIUrl":"0.30444/CB.200","url":null,"abstract":"<p><p>The methodological and ethical analysis of clinical studies is a responsibility of the Research Ethics Committees. There are scenarios in which this assessment can be very difficult. This is the case with the TRASMETIR trial that studies liver transplantation in patients with unresectable metastases of colorectal carcinoma. It was conducted in several Spanish hospitals as a clinical trial because liver transplantation was not previously considered a treatment indication for these patients. To justify and supervise the trial, it was stated that it would not represent an additional financial burden for the hospitals and that it was a study based on routine clinical practice. Thus, the infrastructure and professionals dedicated to performing liver transplantation for approved indications could participate in this prospective clinical trial as if it were part of their ordinary work. Upon a detailed analysis of this new and interesting experience, we observed that there are ethical issues that require closer attention. These include the distinction between clinical practice and clinical studies, the impact of possible public sponsorship in clinical trials, the information received in order to participate in a trial by the different professional profiles that collaborate in the systematics of each transplant, the priority and availability of biological resources such as organs for transplantation for their integration into clinical trials, or the way in which information is given and the content of this information to the donor or relatives.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 119","pages":"13-22"},"PeriodicalIF":0.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative evidence synthesis on the bioethical issues of the use of artificial intelligence in healthcare and proposed solutions.","authors":"Ramón J Palmer-Coll, Verónica A Brokke, Patrici Calvo","doi":"10.30444/CB.201","DOIUrl":"10.30444/CB.201","url":null,"abstract":"<p><strong>Background: </strong>The exponential increase of the use and development of artificial intelligence (AI) in healthcare has brought several ethical concerns, but there is no clear guidance on how to guarantee an ethical use of Medical-AI.</p><p><strong>Method: </strong>We carried out a qualitative systematic review of studies about the bioethical landscape regarding ethical issues, principles and solutions of using Medical-AI. We searched MEDLINE, Scopus, and three other databases, together with relevant guidelines and frameworks. The GRACECERQual tool was used for confidence assessment of findings. Thematic analysis was used to analyze results.</p><p><strong>Results: </strong>180 studies were selected. We developed a framework to classify our findings into: Ethical Issues, Ethical Principles and Solutions.</p><p><strong>Discussion: </strong>We used our findings to develop a theoretical logic model for an ethical medical-AI. We defined and discussed the need for explicability as the fifth bioethical principle and developed a checklist for an ethical use of medical-AI by clinicians.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 119","pages":"23-50"},"PeriodicalIF":0.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ectogenesis. Artificial womb tecnology and clinical practice: Ethical and legal limits].","authors":"Gianina Rossana Villalobos Salas","doi":"10.30444/CB.203","DOIUrl":"10.30444/CB.203","url":null,"abstract":"<p><p>The possibility of gestating outside the woman's body, through technologies such as ectogenesis, has moved from a speculative concept to a tangible horizon in the biomedical field. Over the past decade, experimental advances in animal models have demonstrated the feasibility of sustaining prematurely extracted fetuses in extrauterine devices, a process known as partial ectogenesis. However, these advances have fueled the belief that the reproductive future of humanity may ultimately lie in total ectogenesis that is, the complete development of an embryo within an artificial womb, entirely independent of the maternal body. This article examines the ethical and regulatory implications of artificial gestation, with particular emphasis on its clinical applications (neonatology or reproduction) and the potential effects on the meaning of pregnancy, maternity, and the protection of the gestated subject. Through a rigorous review of specialized literature, it identifies the main challenges this technology poses to traditional legal and bioethical categories like birth and filiation. The analysis is structured around three key axes: (1) the clinical analysis of partial and total ectogenesis; (2) the ethical and anthropological implications arising from the use of both technologies; and (3) the legal gaps concerning so-called reproductive rights and the need to adapt existing regulatory frameworks. Ultimately, the future of partial or complete ectogenesis will depend on our societies' ability to integrate technological progress with an ethics grounded in respect for the human person, ensuring that biotechnology does not supplant the very value of life it seeks to protect.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 119","pages":"69-86"},"PeriodicalIF":0.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fraud in scientific research and its implications for healthcare professional educators.","authors":"Karina Ordoñez-Torres, Rodrigo Lopez-Barreda","doi":"10.30444/CB.202","DOIUrl":"10.30444/CB.202","url":null,"abstract":"<p><strong>Background: </strong>This study aims to contribute to the reflection on the impact of fraud in medical publications and to offer suggestions to health science educators to limit the potential harm of fraudulent publications concerning scientific literature integrity and patient wellbeing.</p><p><strong>Methods: </strong>We analyze the retractions of Joachim Boldt and Yoshitaka Fujii, the two researchers with the most cases of retractions due to fraud. The Web of Science and Retraction Watch Database were consulted in December 5th 2023. We also carried out a bibliographic search on scientific integrity and critical thinking to identify ways for preventing fraud and mitigating its consequences.</p><p><strong>Results: </strong>194 studies were obtained for Boldt and 151 for Fujii. These studies generated 5,450 citations for Boldt and 2,245 for Fujii. After filtering to include only citations from systematic reviews, 734 systematic reviews were found to have cited Boldt's retracted studies, while 140 systematic reviews cited Fujii's studies. The literature reports that several non-technical skills linked to leadership and management are important for researchers, such as effective communication, teamwork, coaching, task sharing, strategic planning, budgeting, personnel selection and evaluation, and situational awareness.</p><p><strong>Conclusions: </strong>All actors must work to foster a culture of integrity at all stages of the research process to prevent harm to patients. It is essential to identify appropriate pedagogical strategies to influence the skills, attitudes and behaviors of future professionals. Developing integrity and critical judgment may require the use of different methodological approaches to those traditionally used in the medical sciences.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 119","pages":"51-66"},"PeriodicalIF":0.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The pathologization of the human condition: A critique of the transhumanist rejection of human nature].","authors":"Javier Rodríguez Comellas","doi":"10.30444/CB.204","DOIUrl":"10.30444/CB.204","url":null,"abstract":"<p><p>This article develops an ethical critique of transhumanism through the concept of bioideology, understood as a contemporary ideology that replaces the classical conception of human nature with a deficient, surpassable reality subject to technical optimization. In contrast to the Aristotelian approach, which recognized natural ends (telos) within the human structure, transhumanism advances a naturalistic ethics based on indefinite enhancement, where health-understood as biotechnological functionalitybecomes the ultimate goal. The article examines the different meanings attributed to the term ″nature″ within transhumanist discourse: as what is biologically given, as opposed to the artificial, as human essence, and as a limit. This semantic ambiguity serves to justify the overcoming of nature and to neutralize ethical objections. Furthermore, the analysis highlights the ″moralization of nature,″ in which certain biological traits-such as health, youth, or intelligence-are elevated to moral norms, while fragility, illness, or old age are interpreted as defects to be corrected. By conceiving nature as an obstacle, transhumanism fosters the medicalization of existence and of moral evil, while redefining identity as a technical project. Human dignity ceases to be inherent and becomes contingent upon the degree of perfection achieved. In response, the article defends a conception of human nature as embodied, vulnerable, and open to moral perfection, from which it is possible to ground an ethics of limits, care, and unconditional respect for the concrete person.</p>","PeriodicalId":42510,"journal":{"name":"Cuadernos de Bioetica","volume":"37 119","pages":"87-99"},"PeriodicalIF":0.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}