The Journal Medicine and Ethics is an international journal of Bioethics, Deontology and Medical Ethics, edited by the Faculties of Bioethics and Health Sciences of the Universidad Anáhuac México. Began its publication in April 1990, and it has been published since then without interruption, being the first publication on bioethics in Mexico. As of 2017, it is under the format of free online access.
Medicina y Ética is distributed under a Creative Commons License Atribución-NoComercial-CompartirIgual 4.0 Internacional. The author keeps the property rights with no restriction whatsoever and guarantees the magazine the right to be the first publication of the work. The author is free to deposit the published version in any other medium, such as an institutional archive or on his own website.
This work, presented in Spanish, was coordinated by Justo Aznar, head of the Department of Clinical Biopathology at La Fe University Hospital and former director of the Bioethics Observatory and the Institute of Life Sciences (Catholic University of Valencia). It was developed using a methodology of two hundred questions and answers with the participation of various specialists who give the work the interdisciplinary perspective it requires.
Copyright (c) 2025 José Alberto Castilla Barajas http://creativecommons.org/licenses/by-nc-sa/4.0
Recognizing and strengthening the humanistic dimension of the medical act
The training of a humanistic physician involves education in values, through which it is possible to integrate knowledge with good practice. Based on a study conducted to review the elements to be considered in the training of a humanistic physician, the quality of bioethics training in medical schools was evaluated. This article describes the story of a physician who recounts how his patients have shaped his professional profile. Excerpts from an interview with a cardiologist who is a member of an interventional cardiology service at a high-complexity hospital are highlighted. His account of his experience allows us to appreciate and find value in the affective and emotional relationship that clinical practice entails.
Copyright (c) 2025 María de la Victoria Rosales, Rubén Oscar Revello http://creativecommons.org/licenses/by-nc-sa/4.0
Nudges, paternalism, the patient and ethics in medicine
Medical advice and recommendations should always consider the patient as a person, considering their dignity in particular. Analyzing the decision-making process is important to understand that the patient must make the decision freely, and the doctor must strive to consider their reasons, feelings, and context to create a therapeutic alliance, with respect and compassion, avoiding the dominant and authoritarian paternalism of the past. Thaler and Sunstein’s proposal of “libertarian paternalism” to change the environment and facilitate good decisions without coercion may be appropriate, provided that the doctor-patient relationship is capable of achieving that human bond of friendship, so that the patient trusts and accepts what the doctor proposes when they have been informed and educated about what is best for their health, promoting a more humanized, ethical medicine committed to the overall well-being of the human being.
Copyright (c) 2025 Alejandro Weber Sánchez http://creativecommons.org/licenses/by-nc-sa/4.0
Application of the do no-harm approach to informed consent among women with intellectual disabilities in Colombia
This article analyzes the relevance of the “Action No Harm Approach” (ANHA; in Spanish, Enfoque de Acción sin Daño, EASD) in obtaining informed consent in reproductive decisions of women with intellectual disabilities, who also face multiple forms of vulnerability. From a bioethical perspective, it raises the need to guarantee respect for the autonomy and dignity of these women, avoiding paternalistic practices or interventions that, although well-intentioned, may have adverse effects. The methodological proposal is qualitative and structured around the categories of ANHA, informed consent, reproductive decisions, intellectual disability, and vulnerability. Through a review of literature and case law, the study seeks to identify the models used in practice to obtain consent, noting the need for reasonable adjustments. The ANHA allows for a rethinking of interventions so that they are context-sensitive and promote truly informed decisions, without imposing undue burdens or substituting the will of the women involved.
Copyright (c) 2025 Inés Yohanna Pinzón Marín http://creativecommons.org/licenses/by-nc-sa/4.0
Bioethical reflections on advanced oral cavity cancer in oral and maxillofacial surgery. Systematic review
Advanced oral cavity cancer is the most common oncological pathology among head and neck tumors for maxillofacial surgeons. That is why, as the disease progresses, a whole series of complex situations can arise, ranging from severe complications to a possible fatal outcome. This review sought to identify and analyze these situations, which are presented as dilemmas that must be addressed through informed and reasoned reflection. This poses a significant challenge for today’s maxillofacial surgeons, who must understand bioethics as a scientific and humanistic discipline that is essential for reflecting on and responding appropriately to these situations. The enormous scientific and technical development of the specialty cannot be ignored when it comes to the care that must be provided to cancer patients, especially in the face of the possibility of abandonment, futility, and therapeutic obstinacy. On the contrary, it must be a guarantee that the vulnerability of the patient will be cared for and protected at all times. This requires the acquisition of new skills that allow us to integrate all the useful elements that ensure respect for the dignity and quality of life of the person.
Copyright (c) 2025 Martín Fernández Ferro http://creativecommons.org/licenses/by-nc-sa/4.0
Towards an ethics of care in public hospitals: a critical review of structural dehumanization
Clinical practice in public hospitals in Latin America is undergoing an institutional transformation that, in the name of efficiency, has eroded the ethical foundations of care. This article problematizes the dehumanization of the clinical act, not as an anomaly, but as a symptom of an order that has displaced the patient from a moral subject to an object of management. It argues that the depersonalization of care responds to institutional frameworks that naturalize the subordination of dignity to performance indicators. Rethinking the healthcare system requires more than administrative reforms: it demands a profound epistemological and normative reconfiguration and the recovery of a situat-ed ethics that recognizes human vulnerability. The rehumanization of health, understood as a political and ethical project, will only be possible by articulating a critique of the mechanisms of exclusion with proposals that restore the centrality of care as a relational, just, and transformative practice.
Copyright (c) 2025 Andherson Jhordan Aguirre-Lanegra http://creativecommons.org/licenses/by-nc-sa/4.0
Biases in AI? An analysis of algorithmic bias and a proposed solution
Since its inception as a series of algorithms used to obtain information immediately and rationally, Artificial Intelligence (AI) has raised considerable dilemmas regarding what and how programming is designed, especially because those behind the process can, and in fact do, transfer their own biases to programming based on their human perspective. This transfer process is called algorithmic bias, which will be discussed in this article. We will analyze its impacts and how we could mitigate or even eliminate them. In this sense, it is proposed that interdisciplinary teams, with transparent designs that take ethical and bioethical considerations into account, mitigate biases, thus promoting human dignity and social justice.
Copyright (c) 2025 Pablo de Robina Duhart http://creativecommons.org/licenses/by-nc-sa/4.0
The right to die through the prism of the right to dispose of one’s body in Physician-Assisted Suicide
This article explores the legal and ethical challenges associated with the recognition of a “right to die” in France following the adoption on first reading of the bill enshrining a “right to aid in dying”, i.e. Physician-Assisted Suicide (PAS). The article examines how medicalization, institutional norms, and individual autonomy have redefined the end-of-life experience. The analysis focuses on interpretations of the “right to die” and the “right to dispose of one’s body,” as well as their legal foundations. It reveals significant constraints tied to human dignity, moral responsibility, and third-party involvement. The study argues that establishing the “right to die” would undermine the foundation of the “right to life”. Instead of presenting death as a right, the article proposes strengthening palliative care and developing legal and ethical approaches that honor vulnerability and human solidarity.
Copyright (c) 2025 Maroun Badr http://creativecommons.org/licenses/by-nc-sa/4.0
Medical knowledge and application of the advance directives document for decision-making
This study investigated the knowledge, applicability, and barriers related to advance directives document (ADD) among healthcare professionals at the San Ignacio University Hospital in Bogotá, Colombia. Quantitative surveys were applied, which will be followed by semi-structured interviews to assess the understanding and experiences of doctors regarding the ADD. The results showed that 79.2% of participants recognize the importance of planning medical wishes, and 92.5% know that doctors must respect the ADD by law. However, only 75% would recommend it, and only 67.9% are aware of the moral obligation to transfer the case to another professional if they do not want to follow the patient’s wishes. A gap in knowledge of the process and barriers such as lack of time and training in communication were identified. The findings highlight the need to improve training and resources to incorporate the ADD into clinical practice.
Copyright (c) 2025 http://creativecommons.org/licenses/by-nc-sa/4.0
Abortion among underage girls. A comparative bioethical analysis between France and Italy
In recent decades, women’s sexual behavior has changed by invoking the principle of self-determination/autonomy and management of their own bodies. Self-determination is exercised through freedom of choice. The ability to decide requires maturity, which is acquired in adulthood commonly at the age of 18. The early onset of sexual activity at a younger age can result in unplanned and unwanted pregnancies. Many factors prompt minors to choose to terminate a pregnancy through the health services offered by the state, consequently questioning such a decision’s validity. The aim of this article is to draw up a comparative analysis of this practice in France and Italy, while highlighting the challenges and bioethical issues involved.
Pain Without Consciousness? Rethinking pain-suffering in Disorders of Consciousness
Disorders of consciousness (DoC) are a challenge for understanding pain and suffering, as they are complex subjective experiences involving multiple neural networks. Neurophysiological studies and neuroimaging suggest that some patients in a vegetative state may experience pain, and those with covert consciousness are more likely to perceive it. However, these patients are often ignored by medical staff because they cannot express it. This narrative review addresses recent neuroscientific research on pain in these patients, highlighting the need to reconsider it in clinical practice. In the context of diagnostic and prognostic uncertainty, it is crucial to deepen and establish ethical frameworks to ensure respect for the autonomy and well-being of there patients, addressing the bioethical dilemmas derived from the uso of neurotechnologies in patients who cannot express consent.
vegetative state / unresponsive wakefulness syndrome
Copyright (c) 2025 Zamira Verónika Montiel Boehringer http://creativecommons.org/licenses/by-nc-sa/4.0
Human Enhancement: Philosophical, Ethical, and Bioethical Reflections
The book Human Enhancement: reflexiones filosóficas, éticas y bioéticas was originally published in Spanish, and to our knowledge, has not been translated into other languages. The work is the result of a collaborative effort by several scholars specializing in bioethics, philosophy, and theology, who have contributed their perspectives to discuss the topic of human enhancement, particularly from the perspective of transhumanism. In a context where the debate on human enhancement and the use of biotechnology is at a critical juncture, this work emerges as a necessary and urgent reflection. Published at a time when technological advances promise, and at the same time threaten, to redefine what it means to be human, the book seeks to offer a critical and in-depth look at the ethical and philosophical challenges these technologies present.
Copyright (c) 2025 Regina Castro Aguinaga, Victoria Abarzua http://creativecommons.org/licenses/by-nc-sa/4.0
Modafinil, pharmacologisation, technoscience and the tension of values
Modafinil is a non-amphetamine central nervous system (CNS) stimulant drug, with properties that increase wakefulness. It is also prescribed for attention deficit disorder and bipolar affective disorder. One of the most problematic uses is cognitive enhancement. This essay proposes an analysis of technoscience and ethical values in tension through a critical literature review of the drug modafinil. While the therapeutic possibilities of the drug need to be recognized, the values in tension cannot be ignored, including that the drug per se represents values oriented towards efficacy and effectiveness, decreasing time lost to sleep, increasing productivity and consumption time.
Copyright (c) 2025 John Camilo García Uribe, Andrea Almeida, Tania Yaritza Carrero http://creativecommons.org/licenses/by-nc-sa/4.0
Ethical challenges in Uganda’s health insurance models: addressing dilemmas to improve equity, access and sustainability
Uganda’s health insurance sector remains underdeveloped, with low coverage and a heavy reliance on out-of-pocket payments. This paper explores the ethical challenges in Uganda’s health insurance models, focusing on equity, access, and sustainability. Using bioethical principles, human rights frameworks, and the Ubuntu moral perspective, it examines issues such as affordability, exclusion of vulnerable populations, and weak regulatory oversight. Key solutions include implementing a National Health Insurance Scheme (NHIS), strengthening community-based insurance, improving regulation, ensuring political commitment, and enhancing transparency and accountability. Drawing on insights from existing literature and policy analyses, this study highlights the urgent need for ethical and policy reforms to create an inclusive and sustainable health insurance system. Addressing these challenges will advance universal health coverage, improve health outcomes, and contribute to social and economic development through a collaborative, justice-driven approach.
Copyright (c) 2025 Bernard Rabwoni http://creativecommons.org/licenses/by-nc-sa/4.0
An analysis of global bioethics from the perspective of international human rights law
This article discusses the need to integrate global bioethics with International Human Rights Law (IHRL) in order to coherently address the ethical and legal dilemmas of an interconnected world. Starting from the principle of universality, it argues that certain values, such as human dignity, care for future generations, and the protection of the common home, must be guaranteed to all people without distinction. Based on this foundation, global bioethics provides an interdisciplinary framework that allows for addressing issues such as the climate crisis, health inequities, and the violation of the rights of vulnerable groups. At the same time, the interdependence and indivisibility of human rights is recognized, meaning that their defense requires comprehensive approaches that do not fragment reality, but instead offer integrated ethical, legal, and political solutions.
Copyright (c) 2025 María Victoria Fernández Molina http://creativecommons.org/licenses/by-nc-sa/4.0
Transhumanism and Human Enhancement Technologies
Transhumanismo y Tecnologías de Mejoramiento Humano (2020), coordinated by Jorge Enrique Linares Salgado and Edgar Tafoya Ledesma, is a work published by the National Autonomous University of Mexico. Both coordinators are distinguished academics in the fields of philosophy, sociology, and science and technology studies at UNAM. Linares Salgado is a professor at the Faculty of Philosophy and Letters at UNAM, with 25 years of experience, specializing in bioethics and the philosophy of technology, making him a key contributor to this text. Tafoya Ledesma is a professor and researcher at theFaculty of Political and Social Sciences, which focuses on contemporary sociology and the social implications of technology. Transhumanism is the central theme of the book. This is a movement that promotes the use of emerging technologies, such as artificial intelligence, gene editing, and advanced prosthetics, to enhance human capabilities. This, of course, raises many philosophical, ethical, and social questions about human identity, technological progress, and social justice. The book is set in a global context where technologies are advancing rapidly, along with marked inequality in access to and distribution among consumers.
Copyright (c) 2025 Alfredo Jose Bajetti Bermudez, Alan Uriel Olivarez Torreblanca http://creativecommons.org/licenses/by-nc-sa/4.0
As the scientific publication of the Faculty of Bioethics at Anáhuac University, a Christian-inspired institution, we are deeply saddened by the death of Pope Francis on April 21 of this year. His Holiness Francis was a great defender of life and human dignity, emphasizing the necessary interconnection between the care for life and the care for the environment, and defending the dignity of all people, especially the excluded and discarded, migrants, the elderly, and the sick. His legacy in bioethics was and will continue to be a benchmark in issues of equality and inclusion.
Copyright (c) 2025 Dra. María Elizabeth de los Rios Uriarte http://creativecommons.org/licenses/by-nc-sa/4.0
The Triangle of Decadence in ethics dumping and unethical research with Indigenous peoples
This study documents some elements of unethical research involving Indigenous populations, including lack of informed consent of participants, lack of community involvement for consultation or permission for use of data or biological samples collected, and concerns about cultur- al sensitivity. The Triangle of Decadence has been proposed as a possible way to promote a change of mentality among researchers that helps to identify the core problems of unethical research. It gives a possible explanation of what triggers ethical dumping, describing the three points as 1) abuse of power, 2) ignorance of ethical research regulations, and 3) economic interests, and in the middle of the triangle is 4) the silence and complicity of third parties that aggravate the situation. Possible solutions to these problems are presented. Finally, we explain that there is also a risk of selective representation and tokenization of Indigenous communities.
Copyright (c) 2025 Carlos Alberto Rosas Jiménez http://creativecommons.org/licenses/by-nc-sa/4.0
Water Poverty and Sustainable Development in México
Sustainable development is a priority objective in contemporary societies. In this context, the un has established clear limits for the ecological footprint of countries. Mexico, with moderate and extreme water poverty levels, obtained a score of 57/100 points, positioning it as one of the most polluting countries in the world and moving away from the goals of the 2030 Agenda. This scenario requires nations, especially developed ones, to be more responsible in their investments in developing countries. The implementation of innovative technologies for water supply and sanitation, aligned with un proposals, is crucial to move towards a sustainable future and meet global commitments.
Copyright (c) 2025 José Guillermo Vazquez Pacheco http://creativecommons.org/licenses/by-nc-sa/4.0
Current Academic Relevance of Personalist Bioethics. Quantitative Analysis and Comparison with Elio Sgreccia’s Original Proposal
Ontological personalism and personalist bioethics place the human person at the center of ethical considerations, advocating respect that reflects the intrinsic dignity and value of the person. This paper seeks to quantitatively evidence what is the academic influence of BPOF in today’s world and what is the vision that current bioethicists, considered personalists, have of BPOF itself, in order to establish a comparison with the original proposal. This helps us to better understand their criticisms and updates to favor a better understanding of the BPOF proposal and its dialogue with today’s world. The number of publications shows the influence of the BPOF in the academic world. The analysis of these reveals that many of the bioethical publications catalogued as personalist are not specific to the BPOF, as they lack the foundation, methodology or argumentation of the BPOF itself. This lack can lead to these singular proposals not being truly effective in the defense and promotion of the dignity of every human being, in addition to generating confusion in the understanding of the BPOF due to its lack of unity.
Copyright (c) 2025 Mairon Wesley Galvik Mendes http://creativecommons.org/licenses/by-nc-sa/4.0
Clinical characteristics and palliative needs of patients with non-oncological liver failure care in a palliative care service
Liver failure is the fourth leading cause of death in Mexico. Treatment is exclusively symptomatic support, since the only curative therapy is liver transplantation, and Mexico is one of the countries with the fewest transplants worldwide, making the inclusion of early palliative care vital. The aim of this article is to describe the clinical characteristics and palliative needs of patients with non-oncologic liver failure in the palliative care service of the Hospital Gea González. An observational and retrospective study was carried out, of 80 records of patients with non-oncologic liver failure, attended from January 2021 to June 2023. All patients required palliative care, according to the palliative needs scale (NECPAL), and 80% had advanced chronic disease criteria, the main etiology being alcoholism. The need to include an early palliative care program is justified, which will have a lesser economic, social and psychological impact on Mexican families.
Copyright (c) 2025 Martha Esthela Vázquez Navarro, Luz Adriana Templos Esteban, Paola García Valdés http://creativecommons.org/licenses/by-nc-sa/4.0
Towards a new classification of contraceptive methods for a better sustainable development. A global bioethical approach
Sustainable Development Goals (SDG) 3.7 and 5.6 aim to achieve universal access to sexual and reproductive health services and rights by 2030. These services include family planning, in particular contraception. According to un statistics, the use of modern contraceptive methods far exceeds that of traditional methods. However, this division between “modern” and “traditional” seems to have several incon- sistencies. Based on a global bioethical approach, this article aims to propose a new classification of contraceptive methods. The need for complete and accurate information on family planning, and the involvement of both partners in contraceptive decisions, are key takeaways.
Copyright (c) 2025 Maroun BADR http://creativecommons.org/licenses/by-nc-sa/4.0
The origin of physicians’ positive attitudes towards drug advertising: a reflection for educators and medical students
The available evidence shows that medical students are prematurely related to drug advertising. This relationship generates a phenomenon called “socialization”, where students naturally cooperate with the pharmaceutical industry. Therefore, the objective of the present review is to investigate socialization as an origin of the positive attitude towards drug advertising during professional practice. Through a review underprism methodology, the academic literature in English and Spanish from January 2019 to June 2024 was analyzed, obtaining three emerging situations: 1) negative impact of drug advertising to the health system; 2) socialization in medical students; and 3) lack of university regulatory policies. It is concluded that socialization generates a positive attitude towards drug advertising during medical education and professional practice.
Copyright (c) 2025 Jonathan Tipán-Barros, Jennifer Freire-Ochoa, German Novoa-Heckel http://creativecommons.org/licenses/by-nc-sa/4.0
The availability of advanced technology, proximity to specialized therapeutic measures and highly qualified medical staff are some of the characteristics that make Intensive Care Units (ICUs) indispensable in hospital institutions. The admission of patients with complex pathologies, situations of high emotional stress, crucial decision making and the resolution of ethically challenging problems make up the “day to day” of ICUs.
Copyright (c) 2025 Marcial Orlando Cabrera Cantarero, Diana María del Consuelo Arce Sosa http://creativecommons.org/licenses/by-nc-sa/4.0
Is the truth important for bioethics today?
The book Biografía de la verdad: ¿Cuándo dejó de importarnos la verdad y por qué deberíamos recuperarla? by philosopher Guillermo Hurtado seeks to show that the traditional theories on truth; coherentists, pragmatist, deflationist, nihilist have been insufficient. In response, the author offers a perspective that makes explicit the relationship between truth and life. In the face of any definition the author offers a genealogical narrative, and in the face of theories he offers the possibility of a moral pedagogy that seeks to guide understanding and practical application to the great questions “what is truth, what makes the true true?”. These questions are fundamental, for example, in the field of Bioethics the search for truth is fundamental to making informed decisions about the health or welfare of people and Guillermo Hurtado’s text suggests that truth is not just an abstract concept but is linked to life. By considering the relationship between truth and life, the possibility of thinking of this relationship as co-principles is brought into play, that is, that one is not understood without the other. This is relevant in Bioethics because it seeks to promote an understanding of human experience based on communication and charity in medical contexts.
Copyright (c) 2025 Jovani Fernández Puentes http://creativecommons.org/licenses/by-nc-sa/4.0
We present the second issue of 2025 with a variety of topics that strengthen reflection and open up dialogue on highly relevant issues such as ethical research on human beings, the environmental question and its repercussions on the life and health of populations, palliative care and some new developments in the rethinking of contraception and personalist bioethics and its current relevance. The topics published here represent philosophical analyses that are pertinent to addressing the bioethical challenges of our time. This issue is thus made up of six interesting articles and two reviews.
Copyright (c) 2025 María Elizabeth de los Rios Uriarte http://creativecommons.org/licenses/by-nc-sa/4.0
Scientific objectives: Publicize ongoing or completed research on bioethics issues. Contribute to generate academic debate regarding current issues of bioethics. Disseminate academically solid works on issues related to bioethics. Promote interdisciplinary dialogue on relevant and current issues in health and life sciences.