This article presents a view of bioethics in the Spanish context. We may identify several features common to Mediterranean countries because of their relatively similar social organisation. Each country has its own distinguishing features but we would point two aspects which are of particular interest¨: the Mediterranean view of autonomy and the importance of Catholicism in Mediterranean culture. The Spanish experience on bioethics field has been marked by these elements, trying to build a civic ethics alternative, (...) with the law as an important support. So, Spanish bioethics has been developed in two parallel levels: in the academic and policy maker field (University and Parliament) and in clinical practice (hospitals and healthcare ethics committees), with different paces and methods. One of the most important changes in the paternalistic mentality has been promoted through the recognition by law of the patient’s rights and also through the new generation of citizens, clearly aware on the exercise of autonomy. Now, the healthcare professionals have a new challenge: adapt their practice to this new paradigm. (shrink)

Three recent studies carried out in the Spanish regions of Madrid, Valencia, and Murcia have shown that medical residents at public hospitals are systematically required to work for more than 48 hours a week. This practice is institutionalised, and there are indicators suggesting that it also occurs in other public hospitals throughout Spain. The obligation to work excessive hours has been shown to have harmful consequences for workers’ physical and psychological health while jeopardizing residents’ and patients’ safety. I argue (...) that behaviours contrary to people’s health and safety imply bioethical and, in this case, institutional, malpractice. (shrink)

The birth of bioethics in Spain—and the rest of Europe—has not necessarily been a replication of what happened in North America, despite the arguments made by a number of mainstream American authors. From a European perspective, this thesis looks incomplete at best, if not entirely erroneous. Let us see why.

Bioethics at the Movies explores the ways in which popular films engage basic bioethical concepts and concerns. Twenty philosophically grounded essays use cinematic tools such as character and plot development, scene-setting, and narrative-framing to demonstrate a range of principles and topics in contemporary medical ethics. The first section plumbs popular and bioethical thought on birth, abortion, genetic selection, and personhood through several films, including The Cider House Rules, Citizen Ruth, Gattaca, and I, Robot. In the second section, the contributors (...) examine medical practice and troubling questions about the quality and commodification of life by way of Dirty Pretty Things, Eternal Sunshine of the Spotless Mind, and other movies. The third section's essays use Million Dollar Baby, Critical Care, Big Fish, and Soylent Green to show how the medical profession and society at large view issues related to aging, death, and dying. A final section makes use of Extreme Measures and select Spanish and Japanese films to discuss two foundational matters in bioethics: the role of theories and principles in medicine and the importance of cultural context in devising care. Structured to mirror bioethics and cinema classes, this innovative work includes end-of-chapter questions for further consideration and contributions from scholars from the United States, Canada, the United Kingdom, Israel, Spain, and Australia. Contributors: Robert Arp, Ph.D., Michael C. Brannigan, Ph.D., Matthew Burstein, Ph.D., Antonio Casado da Rocha, Ph.D., Stephen Coleman, Ph.D., Jason T. Eberl, Ph.D., Paul J. Ford, Ph.D., Helen Frowe, M.A., Colin Gavaghan, Ph.D., Richard Hanley, Ph.D., Nancy Hansen, Ph.D., Al-Yasha Ilhaam, Ph.D., Troy Jollimore, Ph.D., Amy Kind, Ph.D., Zana Marie Lutfiyya, Ph.D., Terrance McConnell, Ph.D., Andy Miah, Ph.D., Nathan Norbis, Ph.D., Kenneth Richman, Ph.D., Karen D. Schwartz, LL.B., M.A., Sandra Shapshay, Ph.D., Daniel Sperling, LL.M., S.J.D., Becky Cox White, R.N., Ph.D., Clark Wolf, Ph.D. (shrink)

Bioethics introduces students to the most relevant historical, epistemological, methodological, and practical aspects of bioethics. The book presents readers with some of the most thought-provoking writing in the field, along with an original introduction to each reading. Selections range from the work of great philosophers like Aristotle, Immanuel Kant, and John Stuart Mill, to contemporary writings and reports. Readers explore various ideologies and philosophies including the seminal work of Tom Beauchamp and James Childress on principles of biomedical ethics (...) and the dialogical approach to bioethics. They also consider controversial topics straight from the headlines of the day, such as the collision between paternalism and autonomy, futility, human research, genetic manipulation, and active and passive euthanasia. Bioethics encourages students to think objectively and impartially in order to resolve the ethical dilemmas that stem from biotechnological empowerment and biomedical techniques. The book is suitable for courses in biomedical, research, and practical ethics, as well as those that discuss moral philosophy. It can be used as a stand-alone text, or as a supplement to standard textbooks. Erick Valdes earned a Ph.D. in philosophy from the University of Chile as well as a Ph.D. in political philosophy from Paris-Sorbonne University in France. He is an adjunct research scholar at the Kennedy Institute of Ethics, Georgetown University, where he conducts advanced research on bioethics and biolaw. In addition, Dr. Valdes teaches bioethics, research ethics, theories of democracy and international human rights at George Mason University and American University. He is the author of nine books on bioethics and political philosophy and has published in both English and Spanish. He has written extensively on bioethics and biolaw for international journals, and served as a visiting professor at universities in England, France, Spain, Russia, Mexico, Colombia, Argentina, and Chile. (shrink)

Where I am, in the late 70s, I find myself being asked to do far more than I am able. I'm at the stage when everyone assumes that I don't have any real work, so it's OK to ask for things. Increasingly the things I'm asked to do are historical: What was it like back then? When did you start doing this or that? How did this or that get started? I guess I'm in the penultimate period. I'm still working (...) every day, much harder than I would like, and upset by the fact that my memory is not working the way it should. With this public confession, I'll now start my penance, that is, to do a little personal history of my involvement with bioethics first here in the United States, then in Spain and Spanish-speaking nations of Latin America. (shrink)

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new (...) models more favourable to research in a post‐genomic context. (shrink)

Background Ethical conflicts generate difficulties in daily clinical activity. Which methods of ethical advice are most frequently used to resolve them among Spanish doctors has not been studied. The objective of this study is to describe what methods hospital internal medicine physicians in Spain use to resolve their ethical doubts and which they consider most useful. Design A cross-sectional observational study was conducted through a voluntary and anonymous survey and distributed through an ad hoc platform of the Spanish (...) Society of Internal Medicine. Measures We measured methods by which to resolve doubts, types of tools sought, frequency of consulting the Clinical Ethics Committees, and satisfaction with resolution of ethical issues. Results Of 261 internists surveyed, 86 per cent resolve their ethical doubts with assistance, the most frequently used method being consultation with colleagues (58.6 per cent), followed by using specific protocols or guides (11.8 per cent) and consultation with experts in bioethics (9.6 per cent). The most preferred tools are the creation of protocols (30.3 per cent) and the establishment of a consultant/expert in bioethics (27.8 per cent). Conclusions Internists in Spain usually seek assistance to resolve their ethical doubts. Consulting colleagues is the most frequently adopted method. The majority regard tools to resolve ethical conflicts as necessary, seeking above all protocols and consultants/experts in bioethics. (shrink)

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives. The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with (...) an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses, chronic diseases, and elderly patients. Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age. (shrink)

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new (...) models more favourable to research in a post-genomic context. (shrink)

Bioethics emerged as a discipline in the 70s of the last century. One of its main objectives has been to analyze clinical cases that pose moral problems. This analysis is generally carried out by a multidisciplinary group, the Health Care Ethics Committee, which is comprised of ethical experts or healthcare providers assisted by a facilitator, depending on the context. Different methodologies are used in these situations. The deliberative method, in its various configurations, is the most widely used in many (...) Committees. Identify whether the deliberative method is included in regulated undergraduate and postgraduate teaching; analyze whether a single model can be identified or whether there is heterogeneity in the proposals. A bibliographic review was carried out, following the scoping review method. With respect to the first objective, there is no evidence on the teaching and use of the deliberative method in the Faculties and Schools of Medicine and Nursing, the emphasis is placed on training oriented to the resolution of clinical cases and a certain deliberative proposal is developed from them, more pragmatic than ethical-philosophical. In relation to the second objective, differences are observed between the two most prevalent schools (D. Gracia and B. Molewijk), with the model proposed by Gracia being used more in the Spanish-speaking world, and Molewijk's model in the English-speaking world. It can be seen that D. Gracia's proposal is more philosophical and Molewijk's more pragmatic. Finally, it is considered pertinent to further disseminate the deliberative method and its advantages, as well as its potential for bioethics education. (shrink)

This volume brings together a set of critical essays on the thought of Professor Doctor H. Tristram Engelhardt Jr., Co-Founding Editor of the Philosophy and Medicine book series. Amongst the founders of bioethics, Professor Engelhardt, looms large. Many of his books and articles have appeared in multiple languages, including Italian, Romanian, Portuguese, Spanish, and Chinese. The essays in this book focus critically on a wide swath of his work, in the process elucidating, critiquing, and/or commending the rigor and (...) reach of his thought. This volume compasses analyses of many different aspects of Engelhardt's work, including social and political philosophy, biopolitics, the philosophy of medicine, and bioethics. It brings together internationally known scholars to assess key elements of Engelhardt's work. (shrink)

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new (...) models more favourable to research in a post‐genomic context. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Day in the Life of a Spanish InterpreterGianna O'LearyThe good thing about Mondays is they almost guarantee I'll be able to sleep at least until 8 am. If I have a double shift, my supervisor will try to "un-zombie me" for the night as much as possible.I get out of my car and head to the three small offices that are the interpreter's dominion. It takes me (...) about ten minutes because the hospital is huge, and our offices are located on the other side of the building. One office is my supervisor's, the other is the sign language supervisor's, and the third is for all of us Spanish interpreters working today.My first hour is all about phones. I sit at the desk and open EPIC, the hospital software where doctors, nurses, therapists, and yes, interpreters, work with the rest of the staff. I listen to the first voicemail; it's nothing unusual. It's from a mom who needs a follow-up appointment with Neurology. I call Mom back (at Children's, all our clients' parents are "Mom" and "Dad," they seem to like it, and I never heard a complaint about it). Her daughter has a seizure disorder, and she's due for a followup. They need to do it because the girl is growing, and she is outgrowing her Keppra medication; the doctor will probably increase the dose. They will also do an EEG to make sure her seizure activity is under control.I continue picking up the phone, listening to messages, calling people back, and documenting the messages that were not answered. Other interpreters will take them later and try to call them again. In the meantime, when nobody answers, I translate a few of the forms for the Autism clinic. Their patients are usually two to three years old, and moms are usually worried they have not talked yet. Usually, when asked what they want for their child, their answer is for them to talk and act like normal children. If you work at a children's hospital, it's a very common goal.My first appointment of the day is with the ENT (ears, nose, and throat) clinic. I go to the clinic's virtual space and see the patient has not arrived. Five minutes later, there is no sign of him, so I call them. Mom forgot about the appointment, and she is very apologetic. We reschedule it and I let ENT know. Then, I send a message to the hospital interpreter to ask if they need help. "Yes, please!" Someone just asked them to go help with rounds. Can I go?"Sure! Send me the name and number of the room."I am glad to have this little app on my phone, and that we text more than anything when we need help. It helps me keep everything on track. I have an anxiety disorder so severe that when I get anxious (and work always makes me anxious), my brain imitates symptoms of ADHD. I do not have ADHD per se, but if I think I am making a mistake, that I am not learning fast enough, or, that lives could be in danger (like, for example, in a hospital), my thoughts race, and it is very hard for me to focus on anything. For functionality purposes, I suffer from ADHD about 70% of the time I'm at work.This little app can be my personal hell. If I am interpreting for a doctor and the pager goes off, my mind will not rest. My anxiety takes over. What if it's urgent? What if someone—not only someone—but a child, is dying? If I haven't checked my messages and the pager is going off, my mind is, too. It has been almost two years since I started this job, and so far, nobody has died during my service, so my brain understands it may be ok to relax a little. In the end, anxiety is anxiety, and it will get you. It will find something to worry about. Anxiety shines with creativity and thrives in a high-paced... (shrink)

Gypsy people are the most poorly considered minority in Spain. Their current circumstances in relation to growth rate and trend variation in this country are not well known. The main objective of this paper is to show what happens to a person's growth process in a transitional minority group affected by the process of globalisation. As target population and the articulation of social actions to have an implementation of quality of life is an additional objective. The research team, in collaboration (...) with “Apoyo”, an NGO, made contact with each Gypsy family. The sample comprised 189 boys aged 5 to 14 years. The boys and their families have been rehoused in two large buildings, named “Ruedo” and “Herradura”, in an attempt to accommodate the marginal Gypsy population following the disappearance of their shanties in Madrid. Morphological and physiological variables were considered as well as social situation and nutritional habits. Large family size (5–6 children), smoking and coffee- drinking habits and the intake of less than the internationally recommended number of calories after the age of 8 years endangers the healthy growth of these European Union citizens. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Spain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates ‘advance directives’ and has prompted various Autonomous Regions to develop legislation in this area. Nevertheless, whilst the variety of legislations in different territories presents advantages, the disparity of criteria also presents problems.Despite significant legislative development, only 23,000 Spanish citizens have filled in an AD. Clearly, AD use is confined to a minority. (...) Several surveys, however, show that the Spanish population views these documents in a positive light. Thus, we must analyse this discrepancy between attitude and practice. A similar situation exists amongst health professionals. Whilst they generally feel that the use of ADs is positive and necessary, they are frequently unwilling to employ them.Bioethical literature and research on ADs has significantly increased in Spain over the last six years. It is likely that this trend will continue in the foreseeable future; but more resources and effort are required if ADs are to become consolidated. (shrink)

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

Spanish culture has recently shown interest about Neuroethics, a new line of research and reflection. It can be said that two general, and somewhat opposing, perspectives are currently being developed in Spain about neuroethics-related topics. One originates from the neuroscientific field and the other from the philosophical field. We will see, throughout this article, that the Spanish authors, who I am going to select here, deal with very diverse neuroethical topics and that they analyse them from different intellectual (...) assumptions. However, I consider that there is one constant concern, which emerges extensively or briefly in each one of the books that I am going to present. I am referring to the problem of freedom. Spanish neuroscientists, in general, stress and accept the new determinism that emanates from recent research about the brain, whilst those who engage in the study of philosophy usually point in their texts to the limitations of empirical research that purport to "demonstrate" the new neurological determinism. I will dedicate the last section, which is more extensive in length, to the work that I consider the most valuable, at least until the present day, and whose title is Neuroética y Neuropolítica (Tecnos, Madrid, 2011). Professor Adela Cortina (chair of Moral Philosophy at Valencia University and member of the Spanish Royal Academy of Moral and Political Science) is its author. But, firstly, I am going to refer to the works written by neuroscientists, and then to those written by philosophers. This will enable us to obtain a global view of the neuroethics models that are being constructed in Spain. (shrink)

BackgroundNational Ethics Committees (NECs) offer important oversight and guidance functions and facilitate public debate on bioethical issues. In an increasingly globalized world where technological advances, multi-national research collaborations, and pandemics are creating ethical dilemmas that transcend national borders, coordination and the joining of efforts among NECs are key. The purpose of this study is to take stock of the current NEC landscape, their varying roles and missions, and the range of bioethical topics on which they deliberated since their inception.MethodsData on (...) the availability, functions, and ethical deliberations (publications) of NECs globally were gathered through a systematic search of NEC websites and through contacts known to the authors. The search was conducted in English, French, and Spanish. The data abstraction was done in Excel and included the NEC’s country, region, functions, and deliberations on bioethical issues. Deliberation topics were classified into thematic categories through an iterative process of regrouping to arrive at the main set of themes.Results124 NECs in 100 countries were identified. 44% of the NECs are in Europe and 47% are in high-income countries. Out of the 1108 retrieved publications, 40% were on bioethics in the context of research, followed by the clinic (28%) and public health issues (22%). The top five topics of these publications were: research ethics (124; 9%), genetics and genomics (62; 6%), organ transplantation (58; 5%), assisted reproductive technology (49; 4%), and end of life (36; 3%).ConclusionOur study makes an important contribution to understanding the current interests and functions of NECs and the range of their bioethics deliberations. By making the data publicly available through this publication, it allows users to conduct tailored analyses and queries based on their interests, and to seek and strengthen collaboration and exchange. It also makes the case for the fruitfulness of developing and maintaining a global repository of current and new deliberations to more effectively advance this field for the greater good of humanity, research, and public health. (shrink)

Este trabajo explora la confluencia entre bioética y comunicación en el contexto de la cobertura mediática sobre la eutanasia, centrándose en cómo la prensa malagueña ha abordado este tema tras la aprobación de la Ley Orgánica 3/2021, que regula la eutanasia en España. El análisis abarca un período clave desde marzo de 2021, fecha de promulgación de la ley, hasta diciembre de 2023, un intervalo seleccionado para observar tanto la implementación inicial de la normativa como la evolución de la percepción (...) pública y mediática a lo largo del tiempo. (shrink)

Books reviewed in this article: The Bible and Postmodern Imagination: Texts Under Negotiation. By Walter Brueggemann. In the Throe of Wonder: Intimations of the Sacred in a Post‐Modern World. By Jerome A. Miller. Interpreting Hebrew Poetry. By David L. Petersen and Kent Harold Richards. Exegetical Dictionary of the New Testament, Volume I: Aαρωυ‐Eυωχ. Edited by Horst Balz and Gerhard Schneiders. The Secretary in the Letters of Paul. By E. Randolph Richards. Revelation. By Wilfrid J. Harrington. Conversion to Christianity: Historical and (...) Anthropological Perspectives on a Great Transformation. Edited by Robert W. Hefner. The Metaphor of God Incarnate. By John Hick. Disputed Questions in Theology and the Philosophy of Religion. By John Hick. The Nature of God. By Gerard J. Hughes. The Animals Issue: Moral Theoy in Practice. By Peter Carruthers. Philosophy and Theology in the Middle Ages. By G. R. Evans. Modalities in Medieval Philosophy. By Simo Knuuttila. Da Descarres a Spinoza: Percorsi della teologia razionale nel seicento. By Maria Emanuela Scribano. Tra Descartes e Bayle: Poiret e la teodicea. By Gianluca Mori. Kierkegaard and the Limits of the Ethical. By Anthony Rudd. Kierkegaard on Art and Communication. Edited by George Pattison. Collected Works of Bernard Lonergan Volume 10: Topics in Education. Edited by Robert M. Doran and Frederick E. Crowe. A Theology of Reconstruction: Nation‐building and Human Rights. By Charles Villa‐Vicencio. Religious Methods and Resources in Bioethics. Edited by Paul F. Camenisch. Theological Developments in Bioethics. Edited by Andrew Lustig et al. Marriage in the Western Church: The Christianization of Marriage During the Patristic and Early Medieval Periods. By Philip L. Reynolds. Marriage in the Early Church. Translated and edited by David G. Hunter. The Clash of Gods: A Reinterpretation of Early Christian Art. By Thomas F. Mathews. A History of Religion in Britain: Practice and Belief from Pre‐Roman Times to the Present. Edited by Sheridan Gilley and W. J. Sheik. The Conversion of Henri IV: Politics, Power and Religious Belief in Early Modern France. By Michael Wolfe. English Polemics at the Spanish Court: Joseph Creswell's ‘Letter to the Ambassador from England’, The English and the Spanish Texts of 1606. Edited by Albert J. Loomie. (shrink)

The social determinants of mental health with respect to the role of a person’s religiosity are examined in this paper, based on personal experience and a review of the literature. The objective is to hypothesize that religiosity can influence a person’s mental health through three factors: a sense of moral value, support from a community of faith, and exercise of spirituality. The Medline and SciElo databases were reviewed as of 1990, in English and Spanish, using the keywords: spirituality, belief, (...) religion and social determinants of mental health. The references related to the subject were taken into account as well. The article concludes that it is important in bioethics to incorporate the theme of religiosity as a factor in mental health, based on deliberative dialogue and considering the patient’s position as an interlocutor. It also is imperative to bear in mind the support provided by a community of faith that has embraced the virtues of solidarity and acceptance of others. (shrink)

Salud reproductiva, legislación y opciones de maternidad brings together articles by fourteen Spanish scholars of law, philosophy, psychology, bioethics, and aesthetics that focus on a central and pressing issue within feminist thought: traditional conceptions of motherhood and how they shape people’s understanding of reproduction, reproductive choices, and women’s agency. The volume includes essays with diverse theoretical and methodological approaches. The organizing thesis is that a fruitful investigation of the issues surrounding reproduction and particularly abortion must challenge the fixed (...) and mistaken set of understandings that have historically been... (shrink)

In 2020, COVID-19 patients overwhelmed hospital beds in several Spanish cities, producing an increase in mortality derived from a lack of resources. The provision of new spaces to be reconfigured as healthcare centers for COVID patients was one of the measures implemented. In Madrid, two of these COVID centers drew enormous media and political repercussions due to their high cost and the controversy surrounding the quality of the care they offered. In this scenario of misinformation, several doctors and patients (...) rejected to be transferred to such medical centers, but they were nonetheless compelled to make the move. This manuscript underscores how this lack of transparency affects health workers, patients, and the relationship between them, and brings out the question of how many essential bioethical principles can be individually violated by a matter of public health. New guidelines for the transfer of patients should be designed from an ethical perspective and updated, as the epidemic continues, to improve the modern understanding of human factors in times of uncertainty. The lesson that these centers provide us is that we must rethink crisis resource management from a new perspective that prioritizes access to quality information. In its absence, the principle of autonomy must prevail. (shrink)

Background In Spain, there has been great effort by lawmakers to put Advance Directives into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very (...) little impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: the training of health professionals about the end of life and AD is lacking; there has been no public process to increase awareness about AD, and therefore people know little about them; the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future. (shrink)

Reproductive technologies produce new babies and new bioethical concerns. This article analyzes how Danish infertile couples negotiate traveling to Spain for egg donation. Fertility travel is situated in light of Danish bioethical discourses, while feminist cultural analysis is used to understand how Spanish clinical discourses choreograph egg donation to involve an intimate and affective exchange between two like-minded women. The Danish travelers employ love and desire to naturalize transnational egg donation as well as anger and disappointment to invoke notions (...) of reproductive rights. The article concludes that empirical research on fertility travel opens up for discussion bioethical perspectives, such as those involving fair trade and reciprocity. (shrink)

A corpus of 60 articles published in Spanish, English, and Portuguese was analyzed to account for the integrative literature review on the concept of vulnerability from bioethics, identifying the following thematic trends: risk, susceptibility, autonomy, and culture in people and communities. The methodological approach has been mainly qualitative. We found that the disciplines that most addressed the concept belong to the human and social sciences. The authors recommend conducting studies of the concept from people’s perspectives and that ethics (...) committees review the informed consent and information guides according to these results. The categories give way to the concept of vulnerability, which must be analyzed beyond principlism in bioethics. (shrink)

The essays in this volume commemorate the 70th anniversary of Jacques Maritain's Pour la Justice, in which the French Thomist and future drafter of the Universal Declaration of Human Rights grappled with the moral, political, and religious challenges facing Europe in the aftermath of World War II. During this time Maritain reflected on humanism, Christian philosophy, the relation between freedom, religion and politics, and increasingly, on education. Several scholars reflect on the historical impact of Maritain's own writings during World War (...) II, Vatican II, and the Spanish Civil war. In other sections, contemporary Thomists suggest ways a resurgent Thomism can engage with the pressing issues of our own day. Essays on Thomistic ethics address problems in bioethics, the philosophy of love, and the foundations of Natural Law, while others tackle perennial problems in metaphysics and epistemology, such as the problem of free will, subjectivity, and the role of creative intuition in aesthetics. Still other essays apply Maritain's work on education to current challenges facing religious universities today. The contributors to this volume include: Noel Adams, Florian Michel, Sr. Anne Frances Ai Le, Brian Kemple, Stephen Chamberlain, Walter Schulz, Francisco Eduardo Plaza, James Jacobs, John Dunaway, Greg Kerr, Megan Furman, Karen Chan, Justin Gable, Federico Tedesco, Michael Torre, Richard Schenk, OP, and Gregory Reichberg. (shrink)

Climate change is an existential risk reinforced by ordinary actions in afuent societies—often silently present in comfortable and enjoyable habits. This silence is sometimes broken, presenting itself as a nagging reminder of how our habits fuel a catastrophe. As a case in point, global warming has created a state of urgency among wine makers in Spain, as the alcohol level has risen to a point where it jeopardises wine quality and thereby Spanish viticulture. Eforts are currently being made to (...) solve this problem technologically by developing (non-GMO) strains of yeast that produce less alcohol. If successful, this could help save Spanish viticulture. This kind of technological solution is routinely criticised for ofering simplistic “techno-fx” solutions to solve complex societal problems. However, it is not clear what features are criticised by the notion of techno-fx and hence how to avoid this criticism. In our interpretation, the techno-fx notion is not exclusively used as a dismissive term. The notion points to a general virtue of engineering: to create technological solutions that work silently in the background. This asset of technological solutions might sometimes be problematic and sometimes not. Hence, it needs to be analysed case-by-case by paying attention to the moral relevance of the hidden implications of the technology and of the unrefective actions and habits that they facilitate. Such moral analysis will in turn inform strategies for foregrounding this technology to counteract silencing. We discuss what this means in the case of modifying yeast as a viticultural climate resilience strategy. (shrink)

Resumen Ésta es la primera traducción al español de las guías “Atención después de la investigación: un marco para los comités de ética de investigación del National Health Service (NHS) (borrador versión 8.0)”. El documento afirma que existe una fuerte obligación moral de garantizar que los participantes enfermos de un estudio clínico hagan una transición después del estudio hacia una atención de la salud apropiada. Con “atención de la salud apropiada” se hace referencia al acceso para los participantes a la (...) atención de la salud, proporcionada principalmente por el National Health Service (en adelante NHS), el sistema de salud del Reino Unido, y/o a la intervención en estudio, también llamada producto o tratamiento en investigación. Las guías “Atención después de la investigación” están dirigidas principalmente a los miembros de los 79 comités de ética de investigación del NHS y a quienes presentan sus estudios de investigación ante estos comités. Se trata de un documento borrador muy avanzado, trabajado en numerosas reuniones, durante más de 3 años, que ha sido discutido por participantes de estudios y miembros de la comunidad, miembros y presidentes de comités de ética de investigación del Reino Unido, especialistas internacionales en ética de la investigación, representantes de la industria y otras partes interesadas. La redacción de las guías es producto de la colaboración de Neema Sofaer y Penney Lewis, ambas investigadoras del King’s College London, en el Centre of Medical Law and Ethics del Dickson Poon School of Law, y Hugh Davies, Asesor en Ética de la Investigación de la Health Research Authority (HRA) del NHS. El traductor del presente documento, Ignacio Mastroleo, participó del workshop en la Fundación Brocher (Ginebra, Suiza, diciembre de 2011) donde se revisó el borrador versión 7.0 y contribuyó en la revisión del borrador de la versión 8.0 durante el 2012. -/- Abstract This is the first Spanish translation of the guidelines “Care after research: a framework for NHS RECs (8th draft)”. The document states that there is a strong moral obligation to ensure that participants in a clinical study who are ill transition after the study to appropriate healthcare. The terms "appropriate healthcare" refer to participants’ access to health care, mainly provided by the National Health Service (NHS), the health system in the UK, and/or to the intervention study also named investigational treatment or product. The guides "Care after research" are mainly directed to members of the 79 NHS committees of research ethics (RECs) and to those who submit their research to these committees. This is a very advanced draft document, worked in several meetings, for more than three years, that has been discussed with study participants and community members, members and chairs of RECs in the UK, international specialists in research ethics, industry representatives and other stakeholders. The drafting of the guidelines is the result of the collaboration of Neema Sofaer and Penney Lewis, both researchers at King's College London, at the Centre of Medical Law and Ethics of Dickson Poon School of Law, and Hugh Davies, Research Ethics Advisor of the Health Research Authority (HRA) of the NHS. The translator of this document, Ignacio Mastroleo, attended the workshop at the Brocher Foundation (Geneva, Switzerland, December 2011) where draft version 7.0 was revised and contributed in the revision of draft version 8.0 during 2012. (shrink)

This article focuses on the ways in which narrative accounts of loneliness in literature problematize current definitions of this important and yet underexplored determinant of health. I argue that the prevailing conceptualization of loneliness in health research, with a general emphasis on social prescribing, obscures other dimensions of loneliness beyond social connectedness that also need to be accounted for in its definition. Drawing on narrative approaches to health and care and taking as a case study Santiago Lorenzo’s Spanish novel (...) _Los asquerosos_ (2018), the article gestures toward a more political—rather than exclusively subjective and relational—reading of loneliness. It shows how the novel’s exploration of loneliness as an ambivalent experience of tranquility and disaffection questions whether there is any direct causation between loneliness and aloneness or social isolation, presenting loneliness not so much as a problem or a social pain in need of curing, but as a symptom of a larger structural crisis. The article also reflects on the ability of literary narratives to illuminate, discuss, and ultimately challenge the underlying dynamics of loneliness, raising questions about how we understand these narratives and the type of agency we attribute to them. (shrink)

The purpose of this paper is to explore the visual representation of dignity, through the particular example of the seventeenth century Spanish painter Diego Velázquez. Velázquez works at a point in Western history when modern conceptions of dignity are beginning to be formed. It is argued that Velázquez' portraits of royalty and aristocracy articulate a tension between a feudal conception of majesty and a modern conception of the dignity of merit. On this level, modern conceptions of dignity of merit (...) are understood in terms of a struggle to excel in particular activities, and thus to overcome the risk of failure. More radically, Velázquez' portraits of dwarfs and the mentally disabled are argued to be expressive of dignity, not by finding a positive representation of the sitter's dignity, or to find scales of activities by which they can be positively assessed, but rather by grounding their dignity, negatively, in a protest against indignity and humiliation. Drawing on Honneth's analysis of dignity in terms of a theory of recognition, it is argued that the indignity of the court dwarf lies in the fracturing of their communication with the rest of society. The task of repairing that fractured communication is achieved, not by representing a dignified ideal, but rather by drawing attention to the prejudices that serve to exclude the humiliated from full participation in society. In conclusion, it is suggested that the conceptualisation and representation of the elderly today finds effective exemplars in Velázquez' portraits of court dwarfs, rather than in his portraits of the elderly. (shrink)

Este trabajo es un comentario sobre la primera traducción al español de las guías del Reino Unido “Atención después de la investigación: un marco para los comités de ética de investigación del NHS (borrador versión 8.0)”. El comentario se divide en tres partes. En la primera parte, se busca resumir la información básica necesaria para mejorar la lectura comprensiva de la traducción de las guías. En la segunda parte, se analiza una selección de la normativa argentina que trata sobre atención (...) después de la investigación. En la tercera parte, se presentan las principales limitaciones del borrador de las guías y su traducción. El propósito de este comentario es que los futuros lectores y lectoras puedan hacer un uso crítico y deliberado de las guías, en la evaluación de estudios clínicos o como base para la redacción de guías propias sobre atención después de la investigación. ***This work is a commentary on the first Spanish translation of the UK guidelines “Care after research: a framework for NHS research ethics committees (draft version 8.0)”. The commentary is divided into three parts. The first part seeks to summarize the basic information needed to improve reading comprehension of the translation of the guidelines. The second part analyzes a selection of Argentinean regulations dealing with care after research. The third part presents the main limitations of the guidelines draft and its translation. The purpose of this commentary is that future readers can make a critical and deliberate use of guidelines in the assessment of clinical studies or as a basis for drafting their own guidelines on care after research. (shrink)

In the last decade, preimplantation genetic testing have become widely used and in 2005 constituted 5 percent of all in vitro fertilization cycles performed in Europe. Their diffusion, however, is not homogenous; while in some countries they are prohibited and in others hardly implemented, Spain performs 33 percent of all the PGD/pgs. While policy guidelines and mainstream bioethics address PGD from a patient choice perspective, disability studies insist on PGD’s potentiality for discrimination. Alternatively, other authors have explored PGD/pgs from (...) the perspective of geneticization but little work has been done on how PGD/pgs are framed by the members of national regulatory bodies. Combining the analysis of juridical documents with semistructured interviews with members of the Spanish National Assisted Reproduction Committee, this study suggests that the remarkable diffusion of PGD/pgs in Spain may be largely due to the interaction between the growing momentum enjoyed by embryonic stem cell research and a vibrant expansion of IVF business along the Mediterranean coast. In this process, genetic issues per se seem to play a minor role, although the prevention of genetic diseases now constitutes the master narrative underpinning the extension of PGD from monogenic, early onset, diseases to polygenic, late-onset, ones. (shrink)

Consider Maria, a 32-year-old Spanish-speaking expectant mother who immigrated to the United States five years ago. Despite taking English classes and working in a predominantly English-speaking en...

Background Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes.Methods We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and (...) thematic development were used to collaboratively interpret fieldnotes and transcripts.Results Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child’s day-to-day life. After sequencing, however, genetic information was not readily converted into improved access to services beyond the clinic, with families often struggling to use a genetic diagnosis to advocate for their child.Conclusion Families’ ability to use a genetic diagnosis as an effective advocacy tool beyond the clinic was limited by the knowledge and resources available to them, and by the eligibility criteria used by therapeutic service providers’ – which focused on clinical diagnosis and functional criteria more than etiologic information. All families undertaking genomic testing, particularly those who are disadvantaged, need additional support to understand the limits and potential benefits of genetic information beyond the clinic. (shrink)

ABSTRACT The demand for basic research ethics training has grown considerably in the past few years. Research and education organizations face the challenge of providing this training with limited resources and training tools available. To meet this need, Family Health International (FHI), a U.S.‐based international research organization, recently developed a Research Ethics Training Curriculum (RETC). It was designed as a practical, user‐friendly tool that provides basic, up‐to‐date, standardized training on the ethics of human research. The curriculum can easily be adapted (...) to different audiences and training requirements. The RETC was reviewed by a group of international experts and field tested in five countries. It is available in English, French, and Spanish as a three‐ring binder and CD‐ROM, as well as on the Web. It may be used as either an interactive self‐study program or for group training. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Are We There Yet?A Narrative of Firsthand Interpreter Experiences in the Medical Field and Insights to Aid Language Access ComplianceHilda Sanchez-HerreraMy Spanish interpreting journey began in 2008. In those days, very little training was available, and online studies were very new and rare. Early trainings involved out-of-town interpreter and translation conferences, reading the recently released Culturally and Linguistically Appropriate Services (CLAS) standards documents, and participating in the diversity (...) events at the hospital and in the community. Eventually, I did three different medical interpreter training programs, each teaching me something new and improving my skills. The first few years opened my eyes to what it meant for one to be trained, qualified, and certified. It has been a marvelous learning experience.Now, with sixteen years of experience and the vastness and richness of being an interpreter in various settings, I continue to learn to be flexible, patient, and courageous. I've also learned to be a teacher because clinical staff have one perspective of what interpreting is, and we have another. I've learned to be courageous because the field of Language Access is very demanding and involves encountering a lot of biases and judgmental perspectives. Language Access champions advocate throughout the nation so that those who are working in this field will have better working conditions. Collaborations started in the community, extending into social services, legal, and beyond.Interpreting sessions that had the most impact are many, but a few stand out, including a patient I assisted who had presumed Locked-In Syndrome and a domestic abuse female at a maternal-fetal appointment. I have had to explain to a family what it means to be brain dead and have interpreted for numerous palliative care sessions.The presumed Locked-In syndrome patient was quite the experience. I had recently started working on the floor at the hospital and was making my rounds to Spanish-speaking inpatients. One morning, I arrived just as the physician team was making their rounds. I listened to the briefing: a 42-year-old female had suffered a stroke. She could not speak and could not use her extremities. The team had done what they could and reached the conclusion that she was "locked-in" because she was aware but their neurological exams were inconclusive. I asked if they had used the video or phone interpreting services and they said yes but it was not fruitful. I offered to rule out a language barrier. They agreed.It was then that the patient began making great progress in her recovery. The team was amazed at the patient's reaction. She cried when she heard her language spoken. We established communication via a board and eye signals. Speech therapy came and they were able to assess her ability to speak and swallow. While she remained approximately 6 months in the hospital, it was not until the last two [End Page 154] months that she made great strides, and it was all due to language access. Eventually, she was transferred to another healthcare facility closer to home. I was overjoyed and wondered why they had not had this success earlier. It was later determined that the connections were not good, and the interpreter could not "see" what the patient was doing.The domestic violence female was an emotional one for me. I was scheduled to assist at two of her appointments that morning: one at maternal fetal and the other at ENT. Upon arrival, I greeted her and noticed her eyes were watery and her face seemed a little swollen, but I did not want to make her feel embarrassed, so I remained quiet. I accompanied her to the ENT appointment first. The doctor asked her questions, and she seemed nervous. Still no intervention. We finished and went to the maternal-fetal appointment. On the way to the office, I asked if she was ok. She began to cry and said in a soft tone, looking around, that her partner had hit her on the way to the clinic.I was shocked! I knew that permission was needed to share this information with the providers and that her safety was critical. She thought... (shrink)

Colombia was one of the first countries to decriminalise euthanasia. However, what is known in the international academic literature about the country's regulations is scarce and outdated. Such lack of information on the situation in Latin America is even more evident in the case of Peru, where the Lima Superior Court of Justice set a precedent by allowing a person to have access to euthanasia in 2021. Ecuador, which has just decriminalised euthanasia for all its citizens in February 2024, risks (...) being similarly absent from the international dialogue. This article summarises for the first time all the regulations in force regarding euthanasia in Latin America, through a study of primary sources in Spanish, and analyses some of the convergences between these three neighbouring countries. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:And When May I Cry?Juggling Emotions in Healthcare InterpretingMateo Rutherford-RojasDisclaimers. All names have been changed to protect the privacy of the patient and the patient's family.Baby Oliver had been in the NICU almost since he was born. Oliver was born with a relatively simple congenital problem, which required him to have a routine corrective surgery.Unfortunately, routine surgeries don't always deliver routine results. Due to unexpected complications during the operation (...) and a prolonged lack of blood flow, several of Oliver's tiny organs suffered partial necrosis. It was just a matter of time until little Oliver's life could no longer be sustained with tubes, pumps, liquids, and pain medications. How much time Oliver's tiny body could hold out was unclear—he had days, maybe a week. The care team had already communicated to Oliver's parents, who were still teens themselves, the options that were available. The team provided sufficient medical detail for the parents to understand the logic of the situation. They faced the most difficult decision any parent—past, present, or future—would ever have to make. Before his birth, the parents expected to take little Oliver home, to love and nurture him, and witness him grow well into adulthood. Now, they had two choices. They could either choose to disconnect Oliver from the machines and let him die in their loving arms or watch him fade away, connected to his incubator and accompanying equipment, barely able to touch him through the multiple life-sustaining wires and tubes.The message had been delivered in Oliver's parents' language many times. In fact, every Spanish interpreter on staff had worked with the care team and Oliver's family at some time during their stay. Their ears heard it, but their minds could not comprehend how a routine operation could end like this. It is in these moments that most people rely heavily on their faith, as did Oliver's parents; waiting for God's miracle to happen.Perhaps it was the Chaplain's suggestion that God's miracles are not dependent on medical machines and life-sustaining equipment. Or that perhaps God needs Oliver and knows his family is strong enough to let him go. But at moments like these, religious philosophy and the nature of God do not provide a simple and clear answer. Still, someone has to decide, "Yes, it's time to hold him and say goodbye" or "No, we are not yet ready to let go of our hope."I don't know what the final deciding factor was or when that moment came for these young parents so full of love and hope for their new family. All I know is that I had the tremendous honor and [End Page E6] responsibility of interpreting for the parents and the care team when the gravity of the situation had penetrated all those human mechanisms of self-preservation. Oliver's parents chose to embrace their son, hold him in their arms one last time, and say, "Goodbye, we love you."This situation is not unusual at our hospital. As one of the nation's primary academic children's hospitals, patients come to us for miracle cures or to die in comfort and peace. In this case, what was unusual and touched the hearts of everyone in the room—surgeons, specialists of every organ system, bedside nurses, chaplains, social workers, and yes, the interpreter—was the final message the parents had for the care team. "Please, please, our only wish is that no parent ever have to make a decision like this again, please." We were all shocked and humbled by these anciently wise teenage souls whose hearts were broken, and their primary concern was for every other parent in the world, whom they would never meet—"May they never feel our pain."How I wish their desires had come true. However, soon after the situation with Baby Oliver, I would find myself again in the NICU interpreting the same messages to two other families, though their stories were distinctly different. Unlike little Oliver, the babies in the later cases were diagnosed with genetic disorders that presented little... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:One Interpreter's Journey of Interpreting for Pregnancy LossMarisa Rueda WillInterpreters have to know everything." This is what I thought as I watched and shadowed a seasoned interpreter at a world-renowned medical center, during my J-term internship. The fact that I had gotten this opportunity was still hard to believe. There I was, shadowing medical interpreters at one of the best hospitals in the world during my senior year of (...) college after abruptly dropping my secondary education minor to pursue a career in medical interpreting. I felt fortunate for the opportunity and seized the chance to learn from the best of the best.When that same institution hired me after I graduated college in 2006, my training consisted of shadowing other interpreters and having them shadow me. There was no strict process, just one-on-one on-the-job training. The training I received was the best it could be at the time, but not even close to what it takes for an interpreter to become confident and prepared to interpret for most appointments.Growing up I hadn't been interested in the medical profession. When I started working as an interpreter, I soon learned that in addition to my A and B languages, I also needed to learn a C language—the language of medicine. Just as I learned Spanish, I had to learn that a CAT scan was a type of imaging study, and a creatinine level was a measure of kidney function. I was fascinated by the language of medicine. The acronyms, medications, diseases, body parts, hormones, markers, genes, everything.As fascinating as medicine was, it wasn't the reason I considered medical interpreting my calling. As soon as I started working as a volunteer healthcare interpreter at a local free clinic, I knew it was the way I wanted to make a difference in the world. The Spanish speakers I was helping were low-income, underprivileged people with serious medical conditions and a host of other socioeconomic problems. These were people who needed help. These were people who needed to be heard. These were people who needed to be seen. As an interpreter, I would be able to give them a voice. Fast forward 18 years and I am still making a difference in the lives of patients with Limited English Proficient (LEP) by giving them the gift of communicative autonomy, or the right to be in control of and responsible for their own communication.Communicative autonomy is one of the founding principles of the medical interpreting profession. It differentiates the professionals from ad-hoc interpreters and bilingual family and friends. This is because upholding communicative autonomy means that regardless of my personal beliefs, I must remain impartial in all situations. I must interpret what is said and allow all parties involved [End Page 156] to guide the conversation as they see fit. Ideally, I only intervene to mediate for cultural or linguistic reasons when needed.Some of the most ethically conflicting cases I have had to interpret have centered around pregnancy loss and abortion. When I started interpreting, I was a young single woman with a relatively liberal view on reproductive rights. However, one stillbirth and three healthy pregnancies later, my personal beliefs on the subject have become more complicated. Each time I interpret for a loss or induced abortion, I must dig deep and ask myself if I can remain impartial. I can still remember the first time I faced this dilemma.One evening, I was called to interpret for a labor and delivery case. When I arrived, I was informed that it was an induction of an 18-week-gestation fetus that had tested positive for Down syndrome on genetic testing. At the time, I didn't have strong beliefs about abortion. I had never been pregnant and really wasn't sure where I stood on the spectrum of a woman's body, a woman's choice, and abortion is murder. However, there I was, smack dab in the middle of an elective abortion on a weeknight.The bereavement nurse was seasoned and experienced. If it hadn't been for her guidance and poise, the ordeal would have been... (shrink)