Hasil untuk "Medical philosophy. Medical ethics"

Lyufan BAO

In the U.S., affairs relating to the compulsory immunization are mainly regulated by state police powers. Since the Jacobson case, the government's power to require citizens to be vaccinated has been consistently affirmed by the courts. Although skepticism surrounding this authority has not shaken the foundation of the compulsory immunization system, it has not transformed into a universal vaccination mandate. Immunization exemptions, as an institutional exception to compulsory immunization, not only bridge the gap between government compulsion and individual autonomy but also ensure the flexibility of the system. In China, laws similarly empower the government to establish vaccination plans. However, under the absolute compulsory immunization requirement, introducing the vaccination exemption may be an effective way to balance individual freedom and public interest.

Laurindo Carlos Miji Viagem

Este artículo es una reflexión sobre los dilemas éticos de la intervención y la toma de decisiones en contextos poco habituales, como es la asistencia a personas de otras culturas. Los contextos multiculturales representan un gran desafío para los profesionales sanitarios. Un ejemplo es la gestión del tiempo: al haber sido formados en una cultura monocrónica, estos profesionales a menudo encuentran dificultades para comprender y adaptarse a las perspectivas temporales de personas provenientes de culturas policrónicas. El desconocimiento de las claves culturales de las personas inmigrantes que son atendidas en las estructuras sanitarias se ha convertido en un factor de estrés para muchos profesionales y constituye un riesgo para una praxis clínica alejada de los estándares éticos. El artículo tiene por objetivo identificar las cuestiones éticas en la relación asistencial multicultural y proponer algunas estrategias que pensamos que pueden contribuir en la gestión ética de los conflictos que surgen en estos ámbitos.

Zeinab Soleimani, Abolghasem Issa Morad Roudbaneh, Abdollah Motamedi et al.

Background and Objectives: Given the importance of the family system in Iranian-Islamic culture and the necessity of addressing marital conflicts, this study aimed to develop and validate an educational protocol for promoting family spiritual health, focusing on reducing marital disputes and improving the quality of family life. The developed protocol, focusing on spiritual concepts, such as spiritual self-awareness, forgiveness, patience, hope, and trust, aims to help manage conflicts and improve marital relationships by strengthening the spiritual dimensions of couples. Methods: The study was conducted in two stages. In the first stage, data were collected from three statistical populations and three samples: the population and sample of couples experiencing conflict, the population and sample of experts, and the population and sample of related articles and texts in the research literature. The data were analyzed using a qualitative content analysis approach. This analysis led to the identification of central themes and the development of a training protocol. In the second stage, the training protocol developed using the Delphi method was validated by experts. Results: The educational protocol was developed in the form of eleven sessions with the main components, including spiritual self-awareness, principles of dialogue, forgiveness, spiritual problem solving, patience, hope, indifference, gratitude, and finally. The relative content validity coefficient and content validity index were calculated for each item. The main reasons for the content validity of this protocol are its comprehensiveness and coherence in addressing fundamental spiritual concepts and their application in marital life. In contrast, designing this protocol using a qualitative approach and content analysis has provided an opportunity to identify the real needs and challenges faced by couples. Conclusion: The protocol developed in this study to educate families about spiritual health and reduce marital conflicts had acceptable content validity. The studies conducted demonstrated that all sessions of this protocol were designed based on themes extracted from scientific and religious sources, as well as the experiences of couples and experts, and included the necessary indicators for content validation. It is recommended that the effectiveness of this protocol be evaluated through empirical studies to better understand its impact on reducing marital conflicts and improving couples’ quality of life (QoL).

Su MA, Tiantian WEI, Xinmiao CHEN

The increasing detection of nodules in young women has sparked widespread concern, with emotional factors often discussed as potential contributors. Young women have traced the etiology from both internal and external perspectives, employing a governance chain of "rebuilding 'knowledge'-reshaping 'self '-reconsidering 'gender'" to "contain" and "manage" their emotions. These nodule-related emotional management practices are a form of governance of the body and the social relationships it connects. This research also demonstrates women's agency in emotional management and suggests that the loosening of gender structures has weakened women's constraints. Ultimately, this study calls for closer public attention to youth health issues.

Mehrdad Hamednia, Mohammad Mahdi Babaei

Background and Objectives: One of the necessities in anthropology is considering the spiritual dimension of man from the point of view of scientists and experts in the health field who define man as a biological, psychological, social, and spiritual being. This study investigates the relationship between religious attitude and psychological hardiness with the mediating role of spiritual intelligence of women living in Ardabil City, Iran. Methods: This was a descriptive and correlational study. The statistical population included women in Ardabil City, Iran. A total of 384 women were selected from the statistical population based on the Cochran formula by random sampling. The research tools were religious attitude, spiritual intelligence, and psychological hardiness questionnaire. The data were analyzed using the Pearson correlation coefficient and multiple regression. Results: There is a negative relationship between religious attitudes and women’s psychological hardiness. Meanwhile, there is a positive relationship between religious attitudes and the psychological hardiness of women. In addition, a positive relationship exists between one of the components of spiritual intelligence and psychological hardiness. Also, the results of the path analysis showed that worship and social issues have an indirect effect on the psychological hardiness of women by the mediating role of spiritual intelligence. Spiritual intelligence has also a direct effect on the psychological hardiness of women. Conclusion: The findings of this research emphasized the application of attitude towards religion and spiritual intelligence in the psychological hardiness of women.

O. Vysotska, Mykhailo Romanenko

The article is devoted to the philosophical aspects of interpretation and understanding of the concept of health. The study of the essence of the concept of health allows authors to get a complete picture of the dichotomy of the categories «health» - «disease». In the course of the work, the concept of Health is analyzed from the point of view of its methodological foundations, namely through the prism of holistic epistemology. Using the historical and genetic method, the stages of development of the concept of health from the ancient period to the latest are analyzed and highlighted. It is proved that the concept of Health has been the focus of many researchers for a very long time. Even the first philosophers and healers considered health as a complete complex phenomenon. At the same time, health has long remained on the periphery of research in the philosophy and theory of Medicine. The authors analyzed the concept of health as a basic concept of the philosophy of Medicine, based on the hermeneutical approach and current trends in considering the dichotomy of the categories «health» ‒ «disease» based on holistic epistemology. Using the historical and genetic method, the authors identified the stages of development of the concept of Health. In contrast to the ancient period, when medical knowledge is formed, the basic principles of medical ethics are created, which have not yet lost their relevance (the famous «Hippocratic oath»), in the Middle Ages there is a significant departure from the ancient concept of Health, which is due to a new reading of the idea of integrity. The concept of medieval health is based on the ideas of sin and salvation. Man is devoid of integrity, because from birth he is defined as a sinful being. Life is understood as the path to death in the moment of salvation and resurrection, the transition from a divided, lower existence in sin to a holistic stay with God. Instead of the ancient ideal of harmony of soul and body, the idea of salvation becomes the leading one, which involves giving up bodily desires and mastering spiritual exercises. The transition to the classical concept of Health is taking place in our time and involves an appeal to the physical dimension of Health, the formation of a mechanistic view of the relationship between the categories «health» and «disease», which leads to the loss of a holistic vision of a person. The return to integrity in the interpretation of a person occurs with the formation of a non-classical concept of Health, in which life becomes the main object of study, taking into account rational-objective and irrational-subjective factors. The post-non-classical concept of Health is characterized by the desubstantialization of the categories «health» and «disease». Health is described as an integral phenomenon, an open dynamic system in the unity of biological, psychological, social and environmental factors.

Marcio Rodrigues de Castro, Alexandre de Araújo Pereira, Patrícia Unger Raphael Bataglia

Resumo A fim de avaliar a competência moral de estudantes de medicina, este artigo compara diferentes momentos do curso, identificando aspectos sociodemográficos e acadêmicos relacionados a essa competência e discutindo a ferramenta de avaliação. Trata-se de estudo quantitativo observacional transversal, com aplicação da versão estendida do Teste de Competência Moral, de Lind, e questionário sociodemográfico-acadêmico. Identificaram-se escores médios baixos nos períodos avaliados – com média do primeiro período superior aos demais – e comportamento destoante do “dilema do médico” em relação aos demais, independentemente do período. Detectaram-se escores de competência moral baixos em todos os períodos avaliados, com declínio ou estagnação no decorrer do curso e “fenômeno de segmentação” do teste, e não se identificou correlação relevante das variáveis sociodemográficas e acadêmicas. Por fim constatou-se que escores dos períodos iniciais inferiores aos descritos na literatura prévia podem sugerir tendência geracional.

Henk ten Have

The Covid-19 pandemic is associated with an increase in ethics publications and an upsurge of interest in global bioethics. This commentary argues that global bioethics is broader than international bioethics, as defined by Macklin, because the nature of moral problems is determined by processes and practices of globalization, and because a broader theoretical perspective is required. Such perspective acknowledges the connectedness and relationality of human beings, as assumed in the care-based feminist bioethics defended by Tong. The commentary finally claims that a rights-based approach is not opposed to but reinforces a care-based global bioethics.

Keymanthri Moodley, Siti Mukaumbya Kabanda, Anita Kleinsmidt et al.

Abstract Background The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa. Methods Twenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses. Results Kenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking. Conclusions This study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.

Lynette Cederquist, Jamie Nicole LaBuzetta, Edward Cachay et al.

Abstract Background Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization. Methods This was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR). Results From January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations. Conclusions Based on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs.

Ivana Bogicevic, Kristoffer Staal Rohrberg, Estrid Høgdall et al.

This article explores the ethical challenges following the use of genetic information in experimental cancer treatment. In Danish healthcare, current ethical debates on the wider use of genetic information are highly focused on the heredity of genetic information. This focus accords with the international bioethical literature and the established practices of assessing inherited risks for cancer. Drawing on Pols’ (2003. “Enforcing Rights or Improving Care? The Interference of two Modes of Doing Good in Mental Health Care.” Sociology of Health & Illness 25 (4): 320–347. doi:10.1111/1467-9566.00349) concept of modes of doing good, we show that this has led to a certain understanding of the ethical challenges regarding genetic information – an understanding we term the germline mode. We argue that the germline mode overlooks crucial dilemmas facing healthcare professionals who use genetic information to target treatment directly at patients’ somatic mutations, i.e. alterations in the DNA occurring only in the tumor. In this article, we develop the concept of the somatic mode and explore the ethical challenges that emerge when genetic information takes a somatic turn.

Kirsty E. Squires, D. Errickson, N. Márquez-Grant

G. Wong

T. Ryan

Osler demonstrated two cultures in his practice, in accordance with the conventions of his time: humanity and science. He was aware that ill health is best managed by one who is both ‘a scientist and a humanist in one’. (This was the title of seminars that took place at 13 Norham Gardens Oxford, his former home, to celebrate the Osler centenary. See figure 1.) In terms of humanity, his friendliness was itself therapeutic. As for science, his accurate observations of symptoms in the living, and of signs in both the living and dead, were more numerous. well described and analysed than ever before. Those who state nowadays that there are two separate cultures that do not speak to each other should recall Osler’s last communication to be published in the British Medical Journal: ‘The old humanities and the new science’.1 Here, he complained himself that the culture of humanities in Oxford, while embracing the philosophy of ancient Greeks, was giving too little attention to their contributions to science. Later, CP Snow2 and others such as the American philanthropist John McGovern3 discussed how these two cultures should both be embraced by practicing physicians I will reinterpret these as the ‘attitude of care’ and the ‘technology of care’. Osler was the greatest exponent of both in his time, deserving the claim that he was both a bringer of cheer and a scientist in what he brought to the bedside, rather more than most of his contemporaries. Figure 1 13 Norham Gardens, built in 1870. Much has been written about Osler the clinician and it is no longer easy to find something new to say. One such attempt was in a recent article by a contemporary student of ethics and his supervisor in Melbourne, Fiddes and Komesaroff was entitled ‘An emperor …

L. Kopelman

Edmund Pellegrino and David Thomasma's writings have had a worldwide impact on discourse about the philosophy of medicine, professionalism, bioethics, healthcare ethics, and patients' rights. Given their works' importance, it is surprising that commentators have ignored their admission of an unresolved and troubling dilemma and inconsistency in their theory. The purpose of this article is to identify and state what problems worried them and to consider possible solutions. It is argued that their dilemma stems from their concerns about how to justify professional rules restricting colleagues from performing acts they view as direct, active, and formal (intentional) killings, such as physician-assisted suicide, mercy killing, and abortion. It is further argued that their inconsistency is that they both assert and deny that professional colleagues should not use their moral or theological values to impose professional restrictions on other colleagues without adequate philosophical grounds. At risk are their arguments about the nature of an internal morality for medicine, a secular and multicultural basis for medical ethics, and a nonarbitrary way to determine what acts fall outside the ends of medicine. These are arguments they claim also apply to other healthcare professions. The article begins with a brief overview of their key positions to provide the context in which they make their admission.

Gregg D. Caruso

S. Arnold, L. Mackenzie, M. Millington et al.

BACKGROUND/AIM Estimating domestic assistance requirements within the medicolegal field is a role for occupational therapists. It is a complex multidimensional process of clinical reasoning with no published research outlining how an occupational therapist translates assessment data into the number of hours of domestic assistance required. This study describes the current occupational therapy practice of estimating domestic assistance hours within the medicolegal context. METHOD Three focus groups, totalling 14 occupational therapists providing medicolegal reports in New South Wales, were conducted. Sydney University provided ethics approval. Focus group data were thematically analysed. RESULTS Four themes were identified: Tasks included as housework. Assessment process - interview of pre-injury and recovery status; functional performance on specific tasks and a tour of the home. Influential factors - include legal system restrictions, medical management, cultural and society values, family expectations, location and impact of diagnosis. Strategies to determine care - triangulation of observed data with medical reports and clinical experience. Knowledge of community and own performance times within the framework of occupational therapy philosophy DISCUSSION: No single method of translating assessment data to hours of care was identified. Therapists use of their own housework performance raises ethical issues. Use of claimant only statements raises issues of inaccurate data on which to base decisions. Therapists should refer to occupational therapy process of clinical reasoning to explain their recommendations even though the reasoning does not give a definite number of care hours. CONCLUSION Therapists need to understand the factors influencing their clinical reasoning when integrating all available information into an estimating of domestic assistance hours. Further study analysing the content of medicolegal report may provide information as to how therapists document their clinical reasoning for court.

Ricardo Andres Gómez Camacho, Tania Meneses

El presente artículo es el resultado de un ejercicio de reflexión desde la bioética social de los conflictos de género y la necesidad de vincular las masculinidades tanto en el campo de estudios de género como en los movimientos sociales y las políticas públicas. Se presenta una genealogía de algunas fuerzas sociales que han dinamizado los estudios de género a partir de comprender la violencia basada en el género, la salud pública, la alimentación y la degradación ambiental, en clave diferencial y de bioproblemas. Desde esta perspectiva se plantean algunos retos que enfrenta la sociedad al vincular estas comprensiones y estrategias de cambio, si de construir un horizonte de accionar político se trata. Desde las políticas públicas, la sociedad y la academia, es necesario continuar un trabajo frente a los factores estructurales que hacen que permanezcan las violencias contra las mujeres, la legitimación de violencia entre hombres y la vinculación a grupos armados, así como la promoción del ejercicio de las paternidades y las éticas del cuidado y la incidencia de estas en la política y la economía, como puntos del debate necesario para la construcción de sociedades más igualitarias.

John Lin

Harvey has been a nightmare for every Houstonian, but some have faced more challenges than others. During the period before the hurricane struck, Harris County and Houston officials refused to order an evacuation, arguing that residents should stay put, even as CNN meteorologists forecasted more than 20 inches of rain for the first weekend, and the National Weather Service placed Houston under a Flash Flood Watch on the Thursday before the storm struck [1]. Despite knowing that the poorest residents of Houston live in unelevated, flood-prone areas that could not handle the rain, city officials steadfastly refused to evacuate these neighborhoods, forcing residents to pray for search-and-rescue operations. From the beginning, low-income Houstonians of color have struggled to receive the same treatment provided to their wealthy counterparts. As Houston continues its reconstruction efforts, the city must reduce the disparity between aid to privileged and marginalized communities. This inequality predates Hurricane Harvey, especially in the Texas Medical Center. During Tropical Storm Allison in 2001, the entire Medical Center was flooded. Decades of medical research at Baylor College of Medicine was wiped away as water entered the basement [2]. In the years since Allison, almost every hospital that could afford renovations chose to improve their facilities. However, Ben Taub, which is run by a governmental entity named Harris Health System, was unable to obtain the funding needed to fix its flooding problem. In part because Ben Taub specializes in patients who cannot afford most treatments, Harris Health System has faced increasingly wide funding gaps, as the Houston Chronicle reported as far back as June 2015 [3]. The shortfall hurt their primary care clinics, health centers, and homeless outreach programs, ensuring that no building upgrades could be completed. During Hurricane Harvey, while almost every hospital in the Texas Medical Center continued operations, largely unaffected by the rising waters, Ben Taub was forced to evacuate its patients [2,4]. The basements in all three of its buildings were flooded, displacing pharmacy and food services. Compared with other Houston health systems, Ben Taub’s continued shortage of funds because of its focus on low-income patients likely contributed to its failure at the hands of Harvey. The working class Houstonians who relied on Ben Taub were thus unable to receive care they needed during the hurricane. This issue was not limited to the Texas Medical Center. According to a December 2017 report by the Kaiser Family Foundation and Episcopal Health Foundation, lower-income adults and people of color were statistically more likely to lack health insurance and to say that they are unsure about where to go for medical care [5]. Considering that 1 in 6 storm victims said that a family member’s health condition was created or worsened by Harvey, it is likely that many Houstonians need to see a physician, but the wealthier ones will be more likely to actually have their medical condition treated [5]. Over the same time period, vulnerable minority communities found their concerns ignored by the local government, resulting in considerable damage during Hurricane Harvey. In fact, according to the U.S. Department of Housing and Urban Development, the City of Houston is in violation of the Civil Rights Act [6]. One of the biggest problems with maps showing the relationship between ethnicity and location in Houston is the east-west segregation of White, non-Hispanic households from minority communities. But these divisions are not just racial; West Houston–which is overwhelmingly white–also dominates Houston Properties’ list of the most expensive Houston neighborhoods, comprising nineteen of the twenty areas listed [7]. This may seem coincidental, but the City Council has perpetuated this division. Over the past four years, 91 percent of buildings that they considered for tax credits were in majority-minority areas [6]. When the Houston Housing Authority decided, for the first time in its history, to affirmatively invest in a majority white, low-poverty neighborhood, the project was blocked by the City [7]. Having different racial and ethnic groups neatly split by clear lines has allowed the City to provide better resources for predominantly White, non-Hispanic groups and distribute hazardous materials almost entirely in minority neighborhoods. Overwhelmingly non-white areas bear the vast majority of the city's pollution: 84 percent of carcinogen emitters, 78 percent of closed landfills, and 88 percent of hazardous waste sites. This has had major effects on cancer rates in various Houston racial communities [8]. According to a 2014 case study of South and Southeast Houston by the Houston Department of Health and Human Services, compared to white women, African American women are more likely to develop more aggressive, more advanced-stage breast cancer earlier and die from breast cancer [9]. When Harvey arrived, the impact became more severe. According to Texas Southern University sociologist Robert Bullard, the "father of environmental justice," the petrochemical plants in neighborhoods of color spread toxic waste whenever the city floods [10]. Data from Air Alliance Houston shows that petrochemical plants will send over 1 million pounds of harmful pollution into the air because of Harvey [11]. For low-income communities of color that already cannot afford the cleanup from the flooding, the long-term health issues that will arise as a result of Harvey will ruin their lives. Communities of color have already faced major difficulties in their attempts to receive aid when compared to predominantly white areas. The same study conducted by Kaiser Family Foundation and Episcopal Health Foundation found that while half of all storm victims believed they were not getting the help they need, this was true for sixty-six percent of black residents [12]. This disparity is shown through FEMA assistance numbers, too. While black, Hispanic, and low-income respondents were more likely to have experienced property damage or income loss, they were less likely to receive aid [12]. Only 13 percent of black Houstonians had their FEMA applications approved, compared to 34 percent of white residents [12]. Without this aid, medical bills become near impossible for most low-income people, many of whom were already uninsured before Harvey. Sixty percent of respondents say they have skipped or postponed needed treatment or medication, problems that will exacerbate treatable illnesses and chronic conditions like diabetes [12]. Although the colossal volume of rainfall drenched every part of Houston, the most impacted people were the most marginalized. Harvey may not have specifically targeted the poor, but the poor have struggled the most to recover from it. Because of racially and economically discriminatory policies by the City of Houston, low-income communities of color were the least prepared for and most impacted by Hurricane Harvey. Even as the cleanup effort continues, poor minorities face more hurdles than their wealthy, White counterparts. The local, state, and federal governments should ensure that their aid distribution policies are fair and non-discriminatory to ensure that all communities can effectively recover. Photo by Siednji Leon on Unsplash Works Cited • Andone, Dakin. "Why didn't Houston evacuate?" CNN. August 29, 2017. Accessed January 06, 2018. https://www.cnn.com/2017/08/27/us/houston-evacuation-hurricane-harvey/index.html • Bentsen, Ken. "Bentsen: The Texas Medical Center defeated Harvey." Houston Chronicle. September 04, 2017. Accessed January 06, 2018. https://www.houstonchronicle.com/opinion/outlook/article/Bentsen-The-Texas-Medical-Center-defeated-Harvey-12172307.php • Hawryluk, Markian. "Ben Taub 'under assault' as funds from many sources cut, threatened." Houston Chronicle. June 05, 2015. Accessed January 06, 2018. https://www.houstonchronicle.com/news/health/article/Ben-Taub-under-assault-as-funds-from-many-6310020.php • Khazan, Olga. "The Houston Hospital Running Out of Food." The Atlantic. August 28, 2017. Accessed January 06, 2018. https://www.theatlantic.com/health/archive/2017/08/the-houston-hospital-running-out-of-food/538266/ • Hamel, Liz, Bryan Wu, Mollyann Brodie, Shao-Chee Sim, and Elena Marks. An Early Assessment of Hurricane Harvey’s Impact on Vulnerable Texans in the Gulf Coast Region. Report. Episcopal Health Foundation. December 2017. Accessed January 6, 2018. http://files.kff.org/attachment/Report-An-Early-Assessment-of-Hurricane-Harveys-Impact-on-Vulnerable-Texans-in-the-Gulf • Elliott, Rebecca. "HUD: City's subsidized housing procedures promote segregation, violate Civil Rights Act." Houston Chronicle. January 13, 2017. Accessed January 06, 2018. https://www.houstonchronicle.com/news/politics/houston/article/HUD-City-s-subsidized-housing-procedures-promote-10857101.php • "2017's 20 Most Expensive Neighborhoods In Houston." Houston Properties. Accessed January 06, 2018. https://www.houstonproperties.com/houston-neighborhoods/most-expensive-houston-neighborhoods • Julian, Elizabeth, Ann Lott, Demetria McCain, and Chrishelle Palay. “Why Houston remains segregated.” Houston Chronicle. Accessed January 06, 2018. https://www.houstonchronicle.com/local/gray-matters/article/Why-Houston-remains-segregated-10935311.php • Community Health Profile. Report. Houston Department of Health and Human Services, City of Houston. July 16, 2014. Accessed January 06, 2018. http://www.houstontx.gov/health/chs/2014CommunityHealthProfile%20Area%20A-Nov%202014.pdf • Kaufman, Alexander C. "Houston Flooding Always Hits Poor, Non-White Neighborhoods Hardest." The Huffington Post. August 29, 2017. Accessed January 06, 2018. https://www.huffingtonpost.com/entry/houston-harvey-environmental-justice_us_59a41c90e4b06d67e3390993 • “Shutdowns of petrochemical plants b/c of #Harvey will send1M+ pounds of harmful pollution into air.” Air Alliance Houston. August 28, 2017. Accessed January 06, 2018. • Hamel, Liz, Bryan Wu, Mollyann Brodie, Shao-Chee Sim, and Elena Marks. An Early Assessment of Hurricane Harvey’s Impact on Vulnerable Texans in the Gulf Coast Region. Report. Episcopal Health Foundation. December 2017. Accessed January 6, 2018. http://files.kff.org/attachment/Report-An-Early-Assessment-of-Hurricane-Harveys-Impact-on-Vulnerable-Texans-in-the-Gulf

Yordanis Enríquez Canto

Algunos enfoques bioéticos consideran central la racionalidad en la noción de persona. Jeff McMahan supedita la condición personal a las capacidades cognitivas, por consecuencia quien presenta discapacidad intelectual no es considerado persona. La noción de persona es central en la Bioética general y medular en la fundamentación de tratados y convenciones. El modelo considerado influye en la bioética clínica, ya que la práctica biomédica deduce normas a partir de reflexiones teóricas. El artículo examina el criterio de las capacidades cognitivas para determinar la condición personal en la discapacidad intelectual empleando la crítica a la teoría ideal. A tal fin, se parte de las críticas a la teoría ideal identificando problemas en la idealización de capacidades. Posteriormente se describe la discapacidad intelectual y cómo esta es contrastada por las conceptualizaciones de Jeff McMahan. Seguidamente se realiza un análisis de cuatro limitaciones del criterio de las capacidades cognitivas para establecer la condición personal. Por último, se argumenta que la corporeidad complementa los modelos que en Bioética describen la persona humana. El criterio de las capacidades cognitivas no debe considerarse normativo puesto que la corporeidad condiciona la pérdida de nuestras capacidades y expone a la discapacidad misma.