Sergio Litewka

Ethical challenges of telemedicine and telehealth.

As healthcare institutions expand and vertically integrate, healthcare delivery is less constrained by geography, nationality, or even by institutional boundaries. As part of this trend, some aspects of the healthcare process are shifted from medical centers back into the home and communities. Telehealth applications intended for health promotion, social services, and other activities—for the healthy as well as for the ill—provide services outside clinical settings in homes, schools, libraries, and other governmental and community sites. Such developments include health information web sites, on-line support groups, automated telephone counseling, interactive health promotion programs, and electronic mail exchanges. Concomitant with these developments is the growth of consumer health informatics, in which individuals seeking medical care or information are able to find various health information resources that take advantage of new information technologies.

Telemedicina: un desafío para América Latina

La telemedicina es una tendencia creciente en la prestación de los servicios médicos. Aunque la eficacia de esta práctica no ha estado bien establecida, es probable que los países en desarrollo compartirán este nuevo paradigma con los desarrollados. Los defensores de la telemedicina en América Latina sostienen que será una herramienta útil para reducir las disparidades y mejorar la accesibilidad de atención de salud. Aunque América Latina quizá se convierta en un lugar para la investigación e investigación de estos procedimientos, no está claro cómo la telemedicina podría contribuir a mejorar la accesibilidad para las poblaciones desfavorecidas, o coexistir con sistemas de atención de salud públicos crónicamente enfermos.Telemedicine is a growing trend in the provision of medical services. Although the effectiveness of this practice has not been well established, it is likely that developing countries will share this new paradigm with developed ones. Supporters of telemedicine in Latin America maintain that it will be a useful tool for reducing disparities and improving health care accessibility. Although Latin America might become a place for research and investigation of these procedures, it is not clear how telemedicine could contribute to improving accessibility for disadvantaged populations, or coexist with chronically ill-funded public healthcare systems.

Twelve Years of Fogarty-Funded Bioethics Training in Latin America and the Caribbean: Achievements and Challenges

The landscape in research ethics has changed significantly in Latin America and the Caribbean over the past two decades. Research ethics has gone from being a largely foreign concept and unfamiliar practice to an integral and growing feature of regional health research systems. Four bioethics training programs have been funded by the Fogarty International Center (FIC) in this region in the past 12 years. Overall, they have contributed significantly to changing the face of research ethics through the creation of locally relevant training materials and courses (including distance learning), academic publications, workshops, and conferences in Spanish, and strengthening ethics review committees and national systems of governance. This paper outlines their achievements and challenges, and reflects on current regional needs and what the future may hold for research ethics and bioethics training in Latin America and the Caribbean.

Paediatric Research in Latin America: Focus on Governance and Populations

Research with children is globally subjected to specific safeguards. There are natural aspects related to their cognitive development and their capacity to assent and consent to their participation as subjects. Developing countries, and overall, countries with high levels of inequality due to socio-economic reasons create additional concerns for investigators and research ethics committees members. Several Latin American countries are emerging from decades of political unrest, civil wars and different levels of corruption—situations that are reflected in the number of children living on the street. These children are prone to being used in petty crime, sexual abuse and human trafficking. All research carried out with this particular vulnerable population must adhere to strict ethical safeguards. Although there is no evidence that these minors could be used as subjects in clinical trials, all studies that are to be conducted with these children must respond to specific hypotheses that could ameliorate or even improve their living conditions. The uneven capabilities of local research ethics committees and lax regulatory framework in some Latin American countries are of further concern to this population.

CALIDAD, SISTEMA DE SALUD Y GOBERNANZA: EL CASO ARGENTINO

Argentina had been a fertile ground for reform attempts, focusing in the quality of its health services and subsequently, improving the accessibility and equity to the system. Even though bioethics, as a tool for interdisciplinary reflection, should had been a participant for the foundations of health policies and the impact on its users, it seems that local bioethics had omitted the deleterious consequences created by the lack of governance and corruption on the Argentinean public and social security healthcare systems, choosing instead for focusing in blurry discussions about universal issues related to solidarity and justice, blaming for the failures to the imposition of foreign economical models.Argentina had been a fertile ground for reform attempts, focusing in the quality of its health services and subsequently, improving the accessibility and equity to the system. Even though bioethics, as a tool for interdisciplinary reflection, should had been a participant for the foundations of health policies and the impact on its users, it seems that local bioethics had omitted the deleterious consequences created by the lack of governance and corruption on the Argentinean public and social security healthcare systems, choosing instead for focusing in blurry discussions about universal issues related to solidarity and justice, blaming for the failures to the imposition of foreign economical models.

QUALITY, HEALTH SYSTEM AND GOVERNANCE: THE ARGENTINEAN CASE

Argentina had been a fertile ground for reform attempts, focusing in the quality of its health services and subsequently, improving the accessibility and equity to the system. Even though bioethics, as a tool for interdisciplinary reflection, should had been a participant for the foundations of health policies and the impact on its users, it seems that local bioethics had omitted the deleterious consequences created by the lack of governance and corruption on the Argentinean public and social security healthcare systems, choosing instead for focusing in blurry discussions about universal issues related to solidarity and justice, blaming for the failures to the imposition of foreign economical models.Argentina had been a fertile ground for reform attempts, focusing in the quality of its health services and subsequently, improving the accessibility and equity to the system. Even though bioethics, as a tool for interdisciplinary reflection, should had been a participant for the foundations of health policies and the impact on its users, it seems that local bioethics had omitted the deleterious consequences created by the lack of governance and corruption on the Argentinean public and social security healthcare systems, choosing instead for focusing in blurry discussions about universal issues related to solidarity and justice, blaming for the failures to the imposition of foreign economical models.

QUALIDADE, SISTEMA DE SAÚDE E GOVERNANÇA: O CASO ARGENTINO

Argentina had been a fertile ground for reform attempts, focusing in the quality of its health services and subsequently, improving the accessibility and equity to the system. Even though bioethics, as a tool for interdisciplinary reflection, should had been a participant for the foundations of health policies and the impact on its users, it seems that local bioethics had omitted the deleterious consequences created by the lack of governance and corruption on the Argentinean public and social security healthcare systems, choosing instead for focusing in blurry discussions about universal issues related to solidarity and justice, blaming for the failures to the imposition of foreign economical models.Argentina had been a fertile ground for reform attempts, focusing in the quality of its health services and subsequently, improving the accessibility and equity to the system. Even though bioethics, as a tool for interdisciplinary reflection, should had been a participant for the foundations of health policies and the impact on its users, it seems that local bioethics had omitted the deleterious consequences created by the lack of governance and corruption on the Argentinean public and social security healthcare systems, choosing instead for focusing in blurry discussions about universal issues related to solidarity and justice, blaming for the failures to the imposition of foreign economical models.