Mandatory vaccination and the ‘seat belt analogy’ argument: a critical analysis in the context of the Covid-19 pandemic

The seat belt analogy argument is aimed at furthering the success of coercive vaccination efforts on the basis that the latter is similar to compulsory use of seat belts. However, this article demonstrated that this argument does not work so well in practice due to several reasons. The possibility of saving resources in health care does not usually apply in our societies, and the paternalist mentality that contributed to the implementation of seat belt-wearing obligation was predominant 30 years ago, but it does not apply at this moment. Furthermore, the risk/benefit analysis is totally different in both scenarios. In the case of seat belts, there is no way to discriminate between the users. In the case of vaccines, individuals present with unique circumstances that may differ substantially from those of another and might be foreseen a priori. This means that an analysis must be performed individually before vaccination is imposed. Finally, one must keep in mind that seat belts are often the only way in which we can protect third parties against a tragic hit by the occupant of another vehicle and are very efficient tools for this purpose. Vaccines, in contrast, do not always create sterilising immunity and are definitely not the only way by which we can avoid spreading a virus; immunity certificates, isolation, or even confinement may also serve as viable methods to achieve this purpose.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This research is part of the Panelfit project. This project received funding under the European Union's H2020 research and innovation programme (https://ec.europa.eu/programmes/horizon2020/) under Grant Agreement No 788039. This research is also funded by the Basque Country Department of Education. Grant number IT-1066-16

Should we have a right to refuse diagnostics and treatment planning by artificial intelligence?

This is a post-peer-review, pre-copyedit version of an article published in Medicine, Health Care and Philosophy (2020) 23:247-252. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11019-020-09939-2Should we be allowed to refuse any involvement of artificial intelligence (AI) technology in diagnosis and treatment planning? This is the relevant question posed by Ploug and Holm in a recent article in Medicine, Health Care and Philosophy. In this article, I adhere to their conclusions, but not necessarily to the rationale that supports them. First, I argue that the idea that we should recognize this right on the basis of a rational interest defence is not plausible, unless we are willing to judge each patient’s ideology or religion. Instead, I consider that the right must be recognized by virtue of values such as social pluralism or individual autonomy. Second, I point out that the scope of such a right should be limited at least under three circumstances: (1) if it is against a physician’s obligation to not cause unnecessary harm to a patient or to not provide futile treatment, (2) in cases where the costs of implementing this right are too high, or (3) if recognizing the right would deprive other patients of their own rights to adequate health careThis work was supported by Eusko Jaurlaritza [grant number Ayudas a grupos de investigación IT-1066-16]; H2020 Science with and for Society [grant number GRANT AGREEMENT NUMBER — 788039 — PANELFIT]

We should not vaccinate the young to protect the old: a response to Giubilini, Savulescu, and Wilkinson.

A recent article by Giubilini, Savulescu, and Wilkinson1 exposes an ethical issue that deserves careful analysis: should we vaccinate children to save the old? The answer provided by the authors is ‘yes’ under the condition that some circumstances apply, namely: (i) the vaccines provide better results in children than in old people; (ii) children are a vector for the contagion of the elderly, who are not adequately protected by the vaccine; (iii) there is only a small harm to the children; and (iv) this demonstrates to be the most effective strategy to save the greatest number of people. If all of these conditions apply, then we should target children for vaccination instead of the elderly, even though this might be considered as using children as mere means. In this comment, I would like to address some of the statements made by the authors, clarify some misconceptions and provide reasons to support that vaccinating children instead of the elderly is not a good idea in the case of COVID-19.European Commission (H2020 SWAFS Programme, PANELFIT Project, research grant number 788039), Eusko Jaurlaritza (Ayudas a Grupos de Investigación IT-1066-16), and La Caixa Foundation (LCF/BQ/ DR20/11790005)

Gene editing and disabled people: a response to Felicity Boardman

Short CommunicationIs the germline gene editing (GEE) of embryos with disabling conditions a moral obligation? According to a recent editorial by F. Broadmann, there are strong reasons to hold the opposite, since “ such a focus on the benefit to individual embryos is to overlook the broader societal changes that genome editing will signal, as well as the potential negative impacts on existing persons with genetic conditions”. This paper is aimed at rebuking these arguments by invoking the human dignity principleThis study was funded by the Government of theBasque Country, Grant IT-1066-16 and the EU Commission, H2020SWAFS Programme, PANELFIT Project, research grant number 788039

Health Information Counselors Help Avoid Automatized Decisions in Health Care

Letters to the EditorThis work was supported by Eusko Jaurlaritza [grant number Ayudas a grupos de investigación IT-1066-16]; H2020 Science with and for Society [grant number GRANT AGREEMENT NUMBER — 788039 — PANELFIT]

Embryo-like features of induced pluripotent stem cells defy legal and ethical boundaries

Peer reviewe

¿Modificar o no modificar el genoma de nuestra descendencia? Algunos comentarios a raíz de la Declaración del Comité de Bioética de España sobre la edición genómica en humanos

La modificación genética de la línea germinal humana presenta grandes problemas de carácter ético y jurídico. El Comité de Bioética de España ha publicado una Declaración ofreciendo una respuesta a estos retos. Este artículo analiza críticamente su postura, subrayando la escasa consistencia de cualquier argumento que pretenda censurar cualquier forma de mejora en la salud humana. Con tal fin, se exponen cuestiones como la relación entre dignidad humana y modificación genética o la inconsistencia de la apelación al argumento de la pendiente resbaladiza en este contexto. Asimismo, se afirma la necesidad de trazar distinciones entre las intervenciones que afectan a bienes absolutos, como la salud, y los que no lo son

Modificando la línea germinal humana: un estudio de la normativa española aplicable

The question of the legal regulation of genetic editing in Spain is, at least, thorny, because it covers, in general, norms elaborated in a historical context very different from the current one, a context in which gene therapies were still considered very dangerous. Hence, the regulation of the time was very strict, prioritizing safety over the possible (although unlikely) benefit that its use could bring. To this must be added that the legislative technique used was not refined, because it contained arcane clauses, difficult to understand and ductile interpretation, which did not help too much to obtain the precious legal certainty. Unfortunately, this framework has not undergone substantial changes until now despite the fact that the state of science certainly has. As a consequence, we can only speak of a certain mismatch between the needs of biological research and the legal responses that, hopefully, will be solved at any time. Entering now to expose the keys of the system, it is convenient to underline that there are three great normative documents that deal with regulating this matter: the Oviedo Convention, Law 14/2007, on biomedical research and the same Spanish Penal Code. In the following pages we will dedicate ourselves to expose what is exactly (and what is not) deduced from its articles.La cuestión de la regulación jurídica de la edición ge- nética en España es, cuando menos, espinosa, por cuanto abarca, en general, normas elaboradas en un contexto histórico muy diferente al actual, un contexto en el que las terapias génicas se consideraban aún sumamente pe- ligrosas. De ahí que la regulación de la época fuera muy estricta, primando la seguridad sobre el posible (aunque poco probable) beneficio que su uso pudiera reportar. A ello hay que añadir que la técnica legislativa utilizada no fue depurada, por cuanto contenía cláusulas arcanas, de difícil comprensión y dúctil interpretación, lo que no ayu- daba demasiado a obtener la preciada seguridad jurídica. Por desgracia, este marco no ha experimentado cam- bios sustanciales hasta ahora a pesar de que el estado de la ciencia ciertamente sí lo ha hecho. Como consecuencia, no nos queda sino hablar de un cierto desfase entre las necesidades de la investigación biológica y las respuestas jurídicas que, esperemos, se solucionará en cualquier mo- mento. Entrando ahora a exponer las claves del sistema, conviene subrayar que hay tres grandes documentos nor- mativos que se ocupan de regular esta materia: el Convenio de Oviedo, la Ley 14/2007, de investigación biomédica y el mismo Código Penal. En las siguientes páginas nos dedicaremos a exponer qué es lo que cabe exactamente (y lo que no cabe) deducir de su articulado

Un estudio de impacto ético y social de las nuevas tecnología en la práctica de la biomedicina.

155 p.En los últimos años la práctica de la biomedicina se está viendo afectada por la aparición de nuevas tecnologías que inciden directamente en el enfoque de la actuación biosanitaria y las posibilidades de mejorar considerablemente las intervenciones enfocadas a la prevención y tratamiento de diversas patologias. Entre estas tecnologías destacan dos, que serán las que se estudiarán particularmente en este trabajo: la edición genética de seres humanos mediante la tecnología CRISPR-Cas y la irrupción de las tecnologías que hacen uso de los datos personales, como los nuevos mecanismos de inteligencia artificial o los dispositivos capaces de recoger datos que se transmiten a los profesionales sanitarios de manera automatizada. En esta tesis se analizan las principales cuestiones éticas y sociales que despiertan estas nuevas herramientas. Sus principales conclusiones vienen a ser las siguientes: la edición de la línea germinal humana todavía es demasiado insegura para su uso en la práctica clínica. No obstante, podría ya investigarse con embriones disponibles, siempre que no se implantaran en una mujer. De por sí, no es una práctica que desafíe a la dignidad humana. Por el contrario, una vez superados los obstáculos técnicos que muestra ahora mismo, su implementación puede ser considerada una exigencia del principio de beneficencia. De hecho, una de sus grandes virtudes es ampliar los beneficios que proporciona el diagnóstico genético preimplantatorio deshaciéndose a la vez de su vertiente eugenésica. Con respecto a la inteligencia artificial y, en general, al uso de mecanismos de decisión automatizada, la tesis pone el acento en la necesidad de dotar tanto a los profesionales sanitarios como a los pacientes de herramientas que en la práctica sirvan para evitar que se tomen decisiones sobre terceros sin su intervención directa. La implementación de figuras nuevas que sirvan de intermediadores, o la creación de un derecho a la objeción de conciencia relacionado con el uso de estos mecanismos resultan particularmente interesantes en este sentido