Thiago Rocha da Cunha

Bioética e direito humano à alimentação adequada na terapia nutricional enteral

This study aims to reflect, in the light of bioethics, about the incorporation of the concept of human right to adequate food in the scope of enteral nutritional therapy. This is a longitudinal study performed with patients being fed through enteral nutrition who were admitted to a Brazilian University hospital. The respect for this right was checked by the analysis of the adequacy of the diet offered to the patients. The results show that less than half the patients received adequate diet (quantity and quality), mainly due to disease and treatment factors (diarrhoea, nausea and vomiting, gastric stasis, fasting for exams/procedures). However, it is observed that the limitation of financial resources and fragility in the organisation of services contribute to this reality. Enteral nutritional therapy has evolved in recent decades in relation to regulations and availability of products, but bioethical analysis shows that there are challenges to be faced in order to ensure that the right in question is also guaranteed in the clinical and therapeutic context.

Vulnerabilidade moral: leitura das exclusões no contexto da bioética

This article proposes the discussion of human vulnerability, pointing out that the discussion of social and existential vulnerability is not enough to understand certain situations of discrimination and exclusion to which some people are submitted. It is a theoretical review of the studied subject, with an interdisciplinary approach, as it is used in bioethics. The literature on bioethics already shows the distinction between being vulnerable, an element of human condition and living a situation of specific vulnerability. Being involved in a vulnerable situation indicates the so called ‘social vulnerability’. However, there are situations where the condition of vulnerability of some people is explicitly built from moral, cultural and theoretical elements, that are explicitly espoused and defended. The article approaches the concept of ‘moral vulnerability’ within the framework of bioethics, as a key to understand exclusion and discrimination to which some groups are presently submitted, especially black people, women and homosexuals.This article proposes the discussion of human vulnerability, pointing out that the discussion of social and existential vulnerability is not enough to understand certain situations of discrimination and exclusion to which some people are submitted. It is a theoretical review of the studied subject, with an interdisciplinary approach, as it is used in bioethics. The literature on bioethics already shows the distinction between being vulnerable, an element of human condition and living a situation of specific vulnerability. Being involved in a vulnerable situation indicates the so called ‘social vulnerability’. However, there are situations where the condition of vulnerability of some people is explicitly built from moral, cultural and theoretical elements, that are explicitly espoused and defended. The article approaches the concept of ‘moral vulnerability’ within the framework of bioethics, as a key to understand exclusion and discrimination to which some groups are presently submitted, especially black people, women and homosexuals.

Publicidade de alimentos para crianças e adolescentes: desvelar da perspectiva ética no discurso da autorregulamentação

When it comes to food marketing, children are one of the major targets. Regulatory actions can play a strategic role in health protection. The objective of this research was to characterize the ethical perspective in the discourse against state regulatory actions on food marketing directed at children, aiming to understand the context of the discourses production and how it creates meaning. The methodology adopted was qualitative, with documentary analysis and use of concepts and procedures from Discourse Analysis. The work of Hans Jonas, specifically his Responsibility Principle, and Garrafa and Ports Intervention Bioethics oriented the analysis. The self-regulation discourse analysis showed an ethical perspective in which relations of consumption predominate over the children´s vulnerability. The rhetorical excess is constant, as well as the use of resources like naturalization, untruthfulness, ideological dissimulation and euphemism. An erasure of social conflicts takes place, and an ahistorical perspective is present. The discourse does not align with Jonas´ Responsibility Principle, nor those of Intervention Bioethics. Lastly, the ethical perspective of the discourse represents a double paradox, because it is a business discourse that hides its competitive roots and metamorphoses into an ethical one.Resumo Um dos publicos de maior interesse para a publicidade de alimentos e o infantil. A regulacao da publicidade de alimentos tem papel estrategico na protecao a saude. O objetivo da pesquisa foi caracterizar a perspectiva etica presente no discurso contrario a regulacao pelo Estado, com fins de compreender o contexto de producao e o modo como o discurso gera sentidos. A metodologia adotada foi qualitativa, com analise documental e utilizacao de conceitos e procedimentos da Analise de Discurso. As lentes que pautaram a analise e a discussao foram o pensamento de Hans Jonas e seu Principio Responsabilidade e, de Garrafa e Porto, a Bioetica de Intervencao. A analise do discurso da autorregulamentacao caracterizou uma perspectiva etica em que predominam relacoes de consumo sobre a vulnerabilidade de criancas e adolescentes. E constante o excesso de retorica e recursos de naturalizacao, inverossimilidade, dissimulacao ideologica e eufemizacao. Estao presentes o apagamento de conflitos sociais e a desvalorizacao de perspectivas historicas. O discurso nao se alinha ao principio responsabilidade de Jonas nem aos principios da bioetica de intervencao. A argumentacao apresenta duplo paradoxo, pois a origem empresarial apaga sua raiz competitiva e se metamorfoseia em discurso etico.

El acceso a la salud como derecho humano en políticas internacionales: reflexiones críticas y desafíos contemporáneos

Using the United Nations (UN) and its subordinate body, the World Health Organization (WHO), as a frame of reference, this article explores access to healthcare as a human right in international intergovernmental policies. First, we look at how the theme of health is treated within the UN, focusing on the concept of global health. We then discuss the concept of global health from a human rights perspective and go on to outline the debate surrounding universal coverage versus universal access as a human right, addressing some important ethical questions. Thereafter, we discuss universal coverage versus universal access using the critical and constructivist theories of international relations as a frame of reference. Finally, it is concluded that, faced with the persistence of huge global health inequalities, the WHO began to reshape itself, leaving behind the notion of health as a human right and imposing the challenge of reducing the wide gap that separates international intergovernmental laws from reality.Using the United Nations (UN) and its subordinate body, the World Health Organization (WHO), as a frame of reference, this article explores access to healthcare as a human right in international intergovernmental policies. First, we look at how the theme of health is treated within the UN, focusing on the concept of global health. We then discuss the concept of global health from a human rights perspective and go on to outline the debate surrounding universal coverage versus universal access as a human right, addressing some important ethical questions. Thereafter, we discuss universal coverage versus universal access using the critical and constructivist theories of international relations as a frame of reference. Finally, it is concluded that, faced with the persistence of huge global health inequalities, the WHO began to reshape itself, leaving behind the notion of health as a human right and imposing the challenge of reducing the wide gap that separates international intergovernmental laws from reality.

Controle ético de pesquisas cujos resultados tenham alto risco para a saúde da população

This article discusses the emergence of ethical conflicts between the need to ensure the advances in science and the need to control their possible consequences for humanity. A research was carried out to analyze the scientific Latin-American literature and the Brazilian legal and regulatory bases on the ethical regulation of researches that do not involve humans as subjects of the intervention, and found the absence of norms for the regulation of such researches and the lack of scientific literature on the subject. Considering the severity of the impact that certain researches may cause to the health of the population, the conclusion is that there is the need to establish strong measures for their ethical control.

Percepção de profissionais da saúde sobre abortamento legal

AbstractThe present study examined the knowledge and the perception of health professionals of the “Hospital Ma-terno Infantil de Brasilia” (Mother and Child Hospital of Brasilia) that do not deal directly with legal abortion services as the ethical aspects involved in the Programa de Interrupcao da Gestacao Prevista em Lei [Legal preganancy interruption Program]. The study used a qualitative-quantitative method for which the results showed ignorance about the service and the procedures necessary for the service on the part of these. It was observed that moral, cultural and religious issues exert strong influence on the perception of the theme by health professionals who deal indirectly with the issue. The study points to the lack Program diffusion associated to the stigma and prejudice involved in the theme as the main causes of this situation, indicating the continuing need for ethical training of professionals in order to qualify the care of women who use the Reference Service for Pregnancy Interruption Where Applicable by Law.Keywords: Abortion. Abortion, legal. Sexual violence. Ethics, professional. Bioethics.ResumoPercepcao de profissionais da saude sobre abortamento legalEste estudo analisou o conhecimento e a percepcao dos aspectos eticos envolvidos no Programa de Inter-rupcao Gestacional Prevista em Lei, por parte de profissionais de saude do Hospital Materno Infantil de Brasilia que nao lidam diretamente com os servicos de abortamento legal dessa instituicao. Utilizou-se met-odo quantiqualitativo, cujos resultados indicaram desconhecimento por parte desses profissionais quanto ao funcionamento e aos procedimentos necessarios ao servico. Observou-se que as questoes de cunho etico, moral, cultural e religioso exercem forte influencia sobre a percepcao do tema pelos profissionais da saude que lidam indiretamente com ele. O estudo aponta como principal causa desse quadro a falta de divulgacao do Programa associada ao estigma e ao preconceito presentes nessa tematica, indicando a necessidade de capacitacao etica continua dos profissionais, como forma de qualificar o atendimento as mulheres que recor-rem ao servico de referencia para interrupcao de gravidez nos casos previstos em lei.Palavras-chave: Aborto. Aborto legal. Violencia sexual. Etica profissional. Bioetica.ResumenPercepcion de profesionales de la salud sobre el aborto legalEl presente estudio analizo el conocimiento y la percepcion de los profesionales de la salud del Hospital Materno Infantil de Brasilia que no lidian directamente con los servicios de aborto legal en relacion a los aspectos eticos involucrados en el Programa de Interrupcion de la Gestacion Prevista en la Ley. Se utilizo una metodologia cuali-cuantitativa, cuyos resultados indicaron un desconocimiento por parte de estos profesio-nales acerca del funcionamiento y de los procedimientos necesarios para el servicio. Se observo tambien que ciertas cuestiones de cuno etico, moral, cultural y religioso ejercen una fuerte influencia en la percepcion del tema por parte de los profesionales de la salud que lidian directamente con el tema. El estudio senala como principal causa de este cuadro la falta de divulgacion del Programa asociada al estigma y el prejuicio impli-cados en la tematica, indicando la necesidad permanente de capacitacion etica de los profesionales como forma de brindar calidad a la atencion de mujeres que utilizan el Servicio de Referencia para la Interrupcion del Embarazo en los Casos Previstos en la Ley.Palabras-clave: Aborto. Aborto legal. Violencia sexual. Etica profesional. Bioetica.El presente estudio analizo el conocimiento y la percepcion de los profesionales de la salud del Hospital Materno Infantil de Brasilia que no lidian directamente con los servicios de aborto legal en relacion a los aspectos eticos involucrados en el Programa de Interrupcion de la Gestacion Prevista en la Ley (PIGL). Se utilizo una metodologia cuali-cuantitativa, cuyos resultados indicaron un desconocimiento por parte de estos profesionales acerca del funcionamiento y de los procedimientos necesarios para el servicio. Se observo tambien que ciertas cuestiones de cuno etico, moral, cultural y religioso ejercen una fuerte influencia en la percepcion del tema por parte de los profesionales de la salud que lidian indirectamente con el tema. El estudio senala como principal causa de este cuadro la falta de divulgacion del PIGL asociada al estigma y el prejuicio implicados en la tematica, indicando la necesidad permanente de capacitacion etica de los profesionales como forma de brindar calidad a la atencion de mujeres que utilizan el Servicio de Referencia para la Interrupcion del Embarazo en los Casos Previstos en la Ley.

Percepción de profesionales de la salud sobre el aborto legal

AbstractThe present study examined the knowledge and the perception of health professionals of the “Hospital Ma-terno Infantil de Brasilia” (Mother and Child Hospital of Brasilia) that do not deal directly with legal abortion services as the ethical aspects involved in the Programa de Interrupcao da Gestacao Prevista em Lei [Legal preganancy interruption Program]. The study used a qualitative-quantitative method for which the results showed ignorance about the service and the procedures necessary for the service on the part of these. It was observed that moral, cultural and religious issues exert strong influence on the perception of the theme by health professionals who deal indirectly with the issue. The study points to the lack Program diffusion associated to the stigma and prejudice involved in the theme as the main causes of this situation, indicating the continuing need for ethical training of professionals in order to qualify the care of women who use the Reference Service for Pregnancy Interruption Where Applicable by Law.Keywords: Abortion. Abortion, legal. Sexual violence. Ethics, professional. Bioethics.ResumoPercepcao de profissionais da saude sobre abortamento legalEste estudo analisou o conhecimento e a percepcao dos aspectos eticos envolvidos no Programa de Inter-rupcao Gestacional Prevista em Lei, por parte de profissionais de saude do Hospital Materno Infantil de Brasilia que nao lidam diretamente com os servicos de abortamento legal dessa instituicao. Utilizou-se met-odo quantiqualitativo, cujos resultados indicaram desconhecimento por parte desses profissionais quanto ao funcionamento e aos procedimentos necessarios ao servico. Observou-se que as questoes de cunho etico, moral, cultural e religioso exercem forte influencia sobre a percepcao do tema pelos profissionais da saude que lidam indiretamente com ele. O estudo aponta como principal causa desse quadro a falta de divulgacao do Programa associada ao estigma e ao preconceito presentes nessa tematica, indicando a necessidade de capacitacao etica continua dos profissionais, como forma de qualificar o atendimento as mulheres que recor-rem ao servico de referencia para interrupcao de gravidez nos casos previstos em lei.Palavras-chave: Aborto. Aborto legal. Violencia sexual. Etica profissional. Bioetica.ResumenPercepcion de profesionales de la salud sobre el aborto legalEl presente estudio analizo el conocimiento y la percepcion de los profesionales de la salud del Hospital Materno Infantil de Brasilia que no lidian directamente con los servicios de aborto legal en relacion a los aspectos eticos involucrados en el Programa de Interrupcion de la Gestacion Prevista en la Ley. Se utilizo una metodologia cuali-cuantitativa, cuyos resultados indicaron un desconocimiento por parte de estos profesio-nales acerca del funcionamiento y de los procedimientos necesarios para el servicio. Se observo tambien que ciertas cuestiones de cuno etico, moral, cultural y religioso ejercen una fuerte influencia en la percepcion del tema por parte de los profesionales de la salud que lidian directamente con el tema. El estudio senala como principal causa de este cuadro la falta de divulgacion del Programa asociada al estigma y el prejuicio impli-cados en la tematica, indicando la necesidad permanente de capacitacion etica de los profesionales como forma de brindar calidad a la atencion de mujeres que utilizan el Servicio de Referencia para la Interrupcion del Embarazo en los Casos Previstos en la Ley.Palabras-clave: Aborto. Aborto legal. Violencia sexual. Etica profesional. Bioetica.El presente estudio analizo el conocimiento y la percepcion de los profesionales de la salud del Hospital Materno Infantil de Brasilia que no lidian directamente con los servicios de aborto legal en relacion a los aspectos eticos involucrados en el Programa de Interrupcion de la Gestacion Prevista en la Ley (PIGL). Se utilizo una metodologia cuali-cuantitativa, cuyos resultados indicaron un desconocimiento por parte de estos profesionales acerca del funcionamiento y de los procedimientos necesarios para el servicio. Se observo tambien que ciertas cuestiones de cuno etico, moral, cultural y religioso ejercen una fuerte influencia en la percepcion del tema por parte de los profesionales de la salud que lidian indirectamente con el tema. El estudio senala como principal causa de este cuadro la falta de divulgacion del PIGL asociada al estigma y el prejuicio implicados en la tematica, indicando la necesidad permanente de capacitacion etica de los profesionales como forma de brindar calidad a la atencion de mujeres que utilizan el Servicio de Referencia para la Interrupcion del Embarazo en los Casos Previstos en la Ley.

The perception of health professionals regarding legal abortion

AbstractThe present study examined the knowledge and the perception of health professionals of the “Hospital Ma-terno Infantil de Brasilia” (Mother and Child Hospital of Brasilia) that do not deal directly with legal abortion services as the ethical aspects involved in the Programa de Interrupcao da Gestacao Prevista em Lei [Legal preganancy interruption Program]. The study used a qualitative-quantitative method for which the results showed ignorance about the service and the procedures necessary for the service on the part of these. It was observed that moral, cultural and religious issues exert strong influence on the perception of the theme by health professionals who deal indirectly with the issue. The study points to the lack Program diffusion associated to the stigma and prejudice involved in the theme as the main causes of this situation, indicating the continuing need for ethical training of professionals in order to qualify the care of women who use the Reference Service for Pregnancy Interruption Where Applicable by Law.Keywords: Abortion. Abortion, legal. Sexual violence. Ethics, professional. Bioethics.ResumoPercepcao de profissionais da saude sobre abortamento legalEste estudo analisou o conhecimento e a percepcao dos aspectos eticos envolvidos no Programa de Inter-rupcao Gestacional Prevista em Lei, por parte de profissionais de saude do Hospital Materno Infantil de Brasilia que nao lidam diretamente com os servicos de abortamento legal dessa instituicao. Utilizou-se met-odo quantiqualitativo, cujos resultados indicaram desconhecimento por parte desses profissionais quanto ao funcionamento e aos procedimentos necessarios ao servico. Observou-se que as questoes de cunho etico, moral, cultural e religioso exercem forte influencia sobre a percepcao do tema pelos profissionais da saude que lidam indiretamente com ele. O estudo aponta como principal causa desse quadro a falta de divulgacao do Programa associada ao estigma e ao preconceito presentes nessa tematica, indicando a necessidade de capacitacao etica continua dos profissionais, como forma de qualificar o atendimento as mulheres que recor-rem ao servico de referencia para interrupcao de gravidez nos casos previstos em lei.Palavras-chave: Aborto. Aborto legal. Violencia sexual. Etica profissional. Bioetica.ResumenPercepcion de profesionales de la salud sobre el aborto legalEl presente estudio analizo el conocimiento y la percepcion de los profesionales de la salud del Hospital Materno Infantil de Brasilia que no lidian directamente con los servicios de aborto legal en relacion a los aspectos eticos involucrados en el Programa de Interrupcion de la Gestacion Prevista en la Ley. Se utilizo una metodologia cuali-cuantitativa, cuyos resultados indicaron un desconocimiento por parte de estos profesio-nales acerca del funcionamiento y de los procedimientos necesarios para el servicio. Se observo tambien que ciertas cuestiones de cuno etico, moral, cultural y religioso ejercen una fuerte influencia en la percepcion del tema por parte de los profesionales de la salud que lidian directamente con el tema. El estudio senala como principal causa de este cuadro la falta de divulgacion del Programa asociada al estigma y el prejuicio impli-cados en la tematica, indicando la necesidad permanente de capacitacion etica de los profesionales como forma de brindar calidad a la atencion de mujeres que utilizan el Servicio de Referencia para la Interrupcion del Embarazo en los Casos Previstos en la Ley.Palabras-clave: Aborto. Aborto legal. Violencia sexual. Etica profesional. Bioetica.El presente estudio analizo el conocimiento y la percepcion de los profesionales de la salud del Hospital Materno Infantil de Brasilia que no lidian directamente con los servicios de aborto legal en relacion a los aspectos eticos involucrados en el Programa de Interrupcion de la Gestacion Prevista en la Ley (PIGL). Se utilizo una metodologia cuali-cuantitativa, cuyos resultados indicaron un desconocimiento por parte de estos profesionales acerca del funcionamiento y de los procedimientos necesarios para el servicio. Se observo tambien que ciertas cuestiones de cuno etico, moral, cultural y religioso ejercen una fuerte influencia en la percepcion del tema por parte de los profesionales de la salud que lidian indirectamente con el tema. El estudio senala como principal causa de este cuadro la falta de divulgacion del PIGL asociada al estigma y el prejuicio implicados en la tematica, indicando la necesidad permanente de capacitacion etica de los profesionales como forma de brindar calidad a la atencion de mujeres que utilizan el Servicio de Referencia para la Interrupcion del Embarazo en los Casos Previstos en la Ley.