Article (Mirabilia Medicinæ)
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Human dignity and conflicts of interest in clinical trials in the book "The Constant Gardener"
Márcia de Cássia CASSIMIRO, Joana ARAÚJO, Teresa Adão da FONSECA
Original title: Dignidade humana e conflitos de interesse nos ensaios clínicos na obra O Fiel Jardineiro
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Keywords: Clinical trials, Conflict of interest (COI), Human Dignity, The Constant Gardener.
The cruel and violent history of humanity, full of injustices and tyrannies revealing indifference and disrespect for human dignity, has nevertheless shown real progress in understanding and recognising each person's dignity and in establishing such dignity as the foundation for the rights and ethical imperatives with which human society has been built. Nowadays, however, human progress in the fields of medicine, biotechnology and scientific research entails unacceptable abuse and heralds serious threats to human dignity. Objectively, loss of dignity can occur in situations of war, poverty, or social misery, but people in these situations can still preserve great dignity in their behaviour, not feeling unworthy in the eyes of others. There are situations of great indignity. The issue in The Constant Gardener involves a clear violation of dignity. The way the pharmaceutical industry, lacking any scientific integrity, conducts a clinical trial in a country who’s political and social situation is completely disrupted and where the population is highly vulnerable due to several factors such as their economic and social condition, food shortages, and high illiteracy is without a doubt a clear violation of human dignity. Conflicts of interest in scientific research, particularly in clinical trials and how they are conducted, represent a point of convergence of two different areas, science and ethics, encouraging reflection and the search for solutions that will promote not only scientific, but also moral progress.
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The body in the pedagogical philosophy of Ramon Llull (1232-1316)
GIUBERTI, Fabricia dos Santos
Original title: O corpo na filosofia pedagógica de Ramon Llull (1232-1316)
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Keywords: Body, Doctrine for Children, History of Medicine, Ramon Llull.
Ramon Llull (1232-1316) in his work Doctrine for Children (c. 1274-1276) teaches his son Dominic that the human body is composed of four elements, an idea inherited from Greek medicine, and that such elements corrupt the man’s body. There are five senses: sight, hearing, smell, taste and touch. Through them, the man participates in external things. For the Mallorcan, bodily life is the actuality by which the body lives, and the spiritual life is to love God. From these principles, Llull teaches the child that he must love the bodily life and health because, through health, the soul and the body are convenient to each other, and the man lives by convenience.The purpose of this paper is to present the conception of Ramon Llull about the body as exposed on Doctrine for Children, methodologically combined with the historical perspective of Jacques Le Goff and Nicholas Truong in the work "A History of the Body in the Middle Ages".
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Living Will´s History: understanding the past and reflecting about the present
DADALTO, Luciana
Original title: História do Testamento Vital: entendendo o passado e refletindo sobre o presente
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Keywords: History, Living Will, Patient autonomy.
This article aims to make a historic effort about the living will, analyzing the emergence and development in the United States and the reception of the institute in Europe and Latin America. It is expected, therefore, to present to the reader an overview of the subject and a critical view of the institute in order to question the implementation of living wills and other patient consent from instruments in Brazil.
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Humanizing the Biomedical Model, and the Quality-of-Care Crisis
James A. MARCUM
Original title: Humanização do Modelo Biomédico e a Crise na Qualidade do Cuidado com a Saúde
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Keywords: Biomedical Model, Humanistic Medicine, Quality-of-Care Crisis.
In this paper, I explore the philosophical issues concerning the efforts of philosophers and clinicians to humanize the biomedical model of medical knowledge and practice to address the quality-of-care crisis. To that end, I discuss the metaphysical, epistemological, and ethical dimensions of the biomedical model and its humanization. I begin with metaphysics, exploring the presuppositions upon which modern medical knowledge and practice are founded; for presuppositions determine the entities that compose the medical worldview. Next, I examine the epistemological issues that face the humanization of the biomedical model, particularly those driven by methodological procedures undertaken by epistemic agents to constitute medical knowledge and practice. Finally, I investigate the ethical implications of the biomedical model and of its humanization, especially in terms of the physician-patient relationship. In a concluding section, I discuss the issues surrounding the question of the humanization of the biomedical model in terms of the quality-of-care crisis.
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The Heart’s Emptiness XĪN XŪ 心虛: interpretations about the book of Chinese medicine HUÁNG DÌ NÈI JĪNG LÍNG SHŪ 黃帝內經靈樞
Renata Palandri Sigolo SELL, Luis Fernando Bernardi JUNQUEIRA
Original title: O Vazio do Coração XĪN XŪ 心虛: interpretações sobre o livro de medicina chinesa HUÁNG DÌ NÈI JĪNG LÍNG SHŪ 黃帝內經靈樞
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Keywords: Chinese Medicine – History of Ancient China – Huang Di Nei Jing – Daoism.
This article is a study about the concept of Heart XĪN 心 in the book of Chinese medicine HUÁNG DÌ NÈI JĪNG LÍNG SHŪ 黃帝內經靈樞, which plays a very important role in Chinese medicine history from more than two thousand years until today. Available evidence suggests that at the basis of LÍNG SHŪ 靈樞 is a layer of texts written during the end of the Warring States period (475-221 B.C), through Qin dynasty (221-206 B.C) and the beginning of Western Han dynasty (206 B.C – 9 A.C). In LÍNG SHŪ chapter 8, the Heart is presented as Emptiness XŪ 虚, empty as Heaven TIĀN 天 and, thereby, the residence of the Spirits SHÉN 神 and connection between us and nature. The Heart is Empty because it is able to remain free from attachment and aversion to any experience, phenomenon or living being. The notion of Heart’s Emptiness XĪN XŪ 心虛 was written under the influence of Daoists texts such as LǍOZǏ 老子 and ZHŪANGZǏ 莊子, thus we can comprehend the strong relation between Chinese medicine and several another aspects of Chinese culture.
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The use of three-dimensional clay model in the teaching-learning process of Human Embryology
Sheila Recepute SILVEIRA, Nilce Marzola IDERIHA
Original title: Uso de modelo tridimensional de argila no ensino-aprendizagem de Embriologia Humana
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Keywords: 3D Model – Human Embryology – Teaching – Learning.
Human embryological development is complex and involves three-dimensional changes. Therefore, the correspondence between the 2D and 3D views is very important for communication and learning in embryo development. It´s essential for students to understand such morphological changes in normal development to provide an explanation for the anatomy observed in child and adult. Besides, they need to learn normal development to understand the origins of developmental anomalies. It is difficult for students to imagine three-dimensionally and grasp the different changes that occur simultaneously during human development. For this, teaching embryology has been considered a challenge for most of the teachers who are committed to this task. This paper reports the experience of using three-dimensional models in embryology classes and presents some testimonials from students.
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The abortion of useless life: the life between secularization and the sacred
Euler Renato WESTPHAL
Original title: O aborto de vida inútil: a vida entre a secularização e o sagrado
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Keywords: Bioethics, Cultural Heritage, Sustainability, Theology, Universal Human Rights.
This article approached the utilitarian ethic view about the human dignity. According to utilitarianism, the human life does not have dignity and it does not have worth by itself. The infanticide could be a possibility to free the parents of children who have any handicaps. Human life only has value if there is self-consciousness and a life project. From that moment on, the genetic improvement would also be justified by the PGD (Preimplantation Genetic Diagnosis) so that children would not get serious diseases. Which are the limits between eugenics and therapy, among utility and human dignity? Alberto Giubilini, Francesca Minerva, Peter Singer, Hannah Arendt, Jürgen Habermas, Joachim Jeremias, Oscar Cullmann were partners of discussion in this article. It is remarked that the human dignity, the universal rights of human being are heritages of the Judeo-Christian theology. God unconditionally loves the sinner, the patient, the weak and the excluded. From that moment on, the Christian theology indicates to the solidarity of God to those who are considered, by the liberal eugenic, “not worth living”. The critical dialogue among bioethics and theology has the aim of seeking criteria so that the human life will not be instrumentalized by interests of human designers.
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Have we learned from the mistakes of the past? Segregation of leprosy patients until the twentieth century
Patrícia Duarte DEPS, Brunella de A. FREITAS, Cícero D. CHICON, Larissa C. CASER, Líbia A. MENDES, Marianna M. SIQUEIRA, Luciana QUINTELA, Manoel A. CATARINA
Original title: Será que aprendemos com os erros do passado? Segregação dos pacientes portadores de hanseníase até o século XX
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Keywords: Colony hospital, Human rights, Leprosy, Segregation.
Hansen’s disease, also known as "leprosy" in Brazil until the end of the 60s in the last century, is an infectious disease of low contagiousness. Once the cause was unknown, in Medieval Age, leprosy was a disease related to divine punishment, and leprosy patients were stigmatized and isolated in "leper colonies". The suffering of those who were diagnosed with leprosy lingers to nowadays, and the current article brings events that occurred with carriers of the disease in Brazil until 1979 mainly. In the State of Espírito Santo was built Dr. Pedro Fontes Hospital, also known as Colony of Itanhenga, which was opened in 1937. That Colony Hospital worked for several decades as a place of compulsory isolation of leprosy patients. We show the vision of former leprosy patients and former staffs of Dr. Pedro Fontes Hospital, and former inmates of Alzira Bley Educational Establishment, a site dedicated to the segregation of children born from leprosy patients while hospitalized at Dr. Pedro Fontes Hospital. The article presents the theme to bring up the reflection about decisions made by the society that hurts the basic principles of human rights.
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Research integrity and the impact of conflicts of interests on society: An Analysis in the Light of the Theory of Recognition of Axel Honneth
Márcia Cássia CASSIMIRO, Agemir BAVARESCO, André Marcelo M. SOARES
Original title: Integridade científica e o impacto dos conflitos de interesses na sociedade: Uma Análise à Luz da Teoria do Reconhecimento de Axel Honneth
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Keywords: Axel Honneth, Conflict of interest (COI), Research integrity, Theory of Recognition.
Conflicts of interest (COI) is a set of conditions in which professional judgment concerning a primary interest tends to be unduly influenced by a secondary interest. In biomedical research, for example, secondary interests may affect research participants and bias research results. From a Honnethian perspective, struggles for recognition of COIs can be seen as a moral force driving social development with a focus on human dignity. Accordingly, Vasconcelos et al. have shown that in the last decades, the dialogue between science and society has reflected concerns over COIs and management of these conflicts in the realm of scientific publications. In this context, research supported by the pharmaceutical industry, for example, is a case in point. Although the extent to which this funding influences the behavior of researchers is not fully understood, there has been an increase in research misconduct in the last decades, and COIs play a role in many cases. As part of an ongoing doctoral project, this contribution makes a case that the training of Brazilian researchers in the health sciences and their understanding of science and society need to be revisited. We will address the process of construction of scientific knowledge and the ethical dilemmas encountered by these researchers when it comes to COIs in their professional and academic activities. Using elements of Honnethian philosophy, we aim to identify whether notions of COIs among this group arise from a mistaken understanding of public management of the research sector, resulting in social disrespect, reifying individuals in the process of participation in social control of the resources involved in research.
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The unity of opposites: the theory YĪN YÁNG 陰陽 in the book of Chinese medicine HUÁNG DÌ NÈI JĪNG 黃帝內經
Renata Palandri Sigolo SELL, Luis Fernando Bernardi JUNQUEIRA
Original title: A união dos opostos: a teoria YĪN YÁNG 陰陽 no livro de medicina chinesa HUÁNG DÌ NÈI JĪNG 黃帝內經
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Keywords: Huang Di Nei Jing – Health History – History of Ancient China..
The HUÁNG DÌ NÈI JĪNG 黃帝內經 is considered one of the most important and valuable books about Chinese medicine. Available evidence suggests that at the basis of HUÁNG DÌ NÈI JĪNG is a layer of texts written during the end of the Warring States period (475-221 B.C), through Qin dynasty (221-206 B.C) and beginning of Western Han dynasty (206 B.C – 9 A.C). Sharing world views with several ancient Chinese philosophical schools, the HUÁNG DÌ NÈI JĪNG understand human beings and nature as inseparable entities in incessant mutation, impermanence, interdependence and relations. This cosmology was explained by, specially, two systematic correspondence theories: Five Movements WǓ XÍNG五行 and YĪN YÁNG 陰陽. According to this last one, all universe aspects, including the human body itself, could be understood as a polarity denominate YĪN YÁNG: the reality as a dynamic unity of opposites. This theory, besides be present in several aspects of ancient Chinese culture like politics, astrology, history and philosophy, since the compilation of HUÁNG DÌ NÈI JĪNG also became one of the main keys of systematization, interpretation and understanding of Chinese medicine in general and human beings in particular.
