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PERSPECTIVAS BIOÉTICAS. NRO. 33 -- PÁGINA LEGAL -- SUMARIO -- PRESENTACIÓN -- DE TRAYECTORIAS, CÓDIGOS Y DOCUMENTOS -- ACTUALIDADES -- ARTÍCULOS -- PERSPECTIVAS BIOÉTICAS. HACIENDO CAMINO AL -- ATENCIÓN DESPUÉS DE LA INVESTIGACIÓN: -- GUÍAS PARA LOS COMITÉS DE ÉTICA DE -- DOSSIER SOBRE EL PROYECTO DE CÓDIGO CIVIL (...) -- PROYECTO DE REFORMA DEL CÓDIGO CIVIL Y -- EN BUSCA DE UNA ARMONÍA INARMÓNICA -- CON EL IMPULSO DE LA CIENCIA -- ¿CUÁNTO HAY DE PROGRESISMO EN EL NUEVO -- NUEVO CÓDIGO CIVIL, SIN FUNDAMENTALISMOS -- BIOÉTICA Y DERECHO EN EL PROYECTO DE CÓDIGO -- EL DERECHO DE FAMILIA Y LA BIOÉTICA EN EL -- CON EL IMPULSO DE LA CIENCIA, -- COMENTARIO SOBRE EL ARTÍCULO "CON EL -- NO TODO LO QUE SE PUEDE HACER SE DEBE HACER. -- DESDE LA TRINCHERA -- CASO IGNACIO BALLESTEROS -- EL DERECHO A LA CONCIENCIA: REFLEXIONES -- CALENDARIO -- INSTRUCCIONES A LOS COLABORADORES

This book presents some of the challenges bioethics in Latin America faces today. It considers them through the lenses of vulnerable populations, those incapable of protecting their own interests, such as the illiterate, women in societies disrespectful of their reproductive rights, and research subjects in contexts where resources are scarce

Despite "progressive" legislative changes concerning the LGBT collective and assisted reproductive technologies (ARTs) in Argentina, women and their sexual and reproductive rights have been overlooked. This article presents a critical perspective of some of these legislative modifications in the country. It addresses why some legislators and society are prepared to challenge a conservative or traditional approach for certain groups while ignoring others. Several factors are at play. There is no all-inclusive explanation. I stress that a striking double standard prevails in Argentina with respect to women and their sexual and reproductive rights. I also contend that powerful discrimination exists, in particular against poor women, who continue to suffer and are "punished" by the criminalization of abortion. ; Malgré des changements législatifs "progressifs" concernant la communauté des lesbiennes, gays, bisexuels et transgenres et les technologies de reproduction assistée en Argentine, les femmes et leurs droits sexuels et reproductifs ont été négligés. Cet article présente une perspective critique de certaines de ces modifications législatives dans le pays. Il explique pourquoi certains législateurs et membres de la société sont prêts à défier une approche conservatrice, voire traditionnelle, pour certains groupes tout en ignorant les autres. Plusieurs facteurs sont en jeu. Il n'y a pas une seule explication. Je souligne qu'un double standard frappant prévaut en Argentine en ce qui concerne les femmes et leurs droits sexuels et reproductifs. Je soutiens également qu'il existe une discrimination puissante, en particulier contre les femmes pauvres, qui continuent de souffrir et d'être "punies" à travers la criminalisation de l'avortement.

En este trabajo argumento que debería tomarse a la infertilidad como un problema de salud pública y analizo la situación de infertilidad en Latinoamérica. Sin embargo, no apoyo una extensión y copia del modelo privado de tratamiento al ámbito público. Argumento, en cambio, a favor de la necesidad de repensar el modelo de implementación de las técnicas de asistencia en la reproducción con una mirada diferente, que debería ser amplia e inclusiva. La infertilidad está directamente ligada a la salud de la mujer, por lo tanto un enfoque legítimo desde la salud pública, para Latinoamérica, debiera formar parte de una aproximación integral a la salud sexual y reproductiva de las personas. Uno de mis objetivos es tener particularmente en cuenta el flagelo de la infertilidad secundaria en la región. Así, la nueva mirada desde la salud pública que defiendo implica hacerse cargo de la salud sexual y reproductiva de la mujer desde sus inicios, abarcando las diferentes etapas y problemas que ésta involucra, ya sea desde la adolescencia para evitar un embarazo no deseado (cuidarla para evitar enfermedades de transmisión sexual así como abortos inseguros); como en la juventud para lograr la maternidad y el hijo ansiado. También abordo el problema de la infertilidad desde una mirada ético- política. Pregunto por la falta de un planteo coherente y estratégico en Latinoamérica, sobre todo, desde el feminismo y desde posiciones progresistas. ; In this article I consider the situation of infertility in Latin America and argue infertility should be considered a public health issue. However, I contest the copy of the private model of assisted reproductive technologies (ART) to the public health arena. I argue instead that we should rethink the implementation procedure and stand for a holistic and inclusive proposal. My aim is to consider secondary infertility due to a lack of access to sexual health as well as the consequence of unsafe and illegal abortions whose prevalence is much higher than in Europe or the USA. This implies looking to infertility as part of our sexual and reproductive life. Thus beginning with prevention and care at adolescence where pregnancies might not be desired and continuing through all the reproductive life of the woman until the time when pregnancy and building a family might be the aim. I also bring in a political analysis of the situation and ask why there is such a reluctance to endorse ART by feminists and progressive positions in Latin America. ; Fil: Luna, Florencia. Facultad Latinoamericana de Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Several training programs sponsored by the NIH/Fogarty International Center's International Research Ethics Education and Curriculum Development Program offer online graduate-level courses in research ethics to participants in low- and middle-income countries. This paper describes the evaluation of four of these online courses and recommendations for improvements to achieve the highest-quality design and delivery. We used an evaluation matrix consisting of 95 criteria based on recommended best practices in eLearning. Our results showed that these courses are developing or meeting nearly 73% of the criteria, while they are not meeting approximately 21% of the criteria. Together, one or more of the courses are developing or meeting 89 of the 95 criteria. These results suggest that the necessary skills and expertise exist in these programs to bring all of the eLearning courses close to 100% proficiency by sharing a common set of best practices. This paper is part of a collection of articles analyzing the Fogarty International Center's International Research Ethics Education and Curriculum Development Program.

The landscape in research ethics has changed significantly in Latin America and the Caribbean over the past two decades. Research ethics has gone from being a largely foreign concept and unfamiliar practice to an integral and growing feature of regional health research systems. Four bioethics training programs have been funded by the Fogarty International Center (FIC) in this region in the past 12 years. Overall, they have contributed significantly to changing the face of research ethics through the creation of locally relevant training materials and courses (including distance learning), academic publications, workshops, and conferences in Spanish, and strengthening ethics review committees and national systems of governance. This paper outlines their achievements and challenges, and reflects on current regional needs and what the future may hold for research ethics and bioethics training in Latin America and the Caribbean.

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents (FPR) framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This "flu-risk standard" is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: (1) having developed a vaccine, (2) raising taxes to pay for vaccine research and purchase, (3) wanting to eliminate economic and social burdens, and (4) being ineffective in combating COVID-19 through public health interventions.

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents (FPR) framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This "flu-risk standard" is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: (1) having developed a vaccine, (2) raising taxes to pay for vaccine research and purchase, (3) wanting to eliminate economic and social burdens, and (4) being ineffective in combating COVID-19 through public health interventions.

Once effective coronavirus disease 2019 (COVID-19) vaccines are developed, they will be scarce. This presents the question of how to distribute them fairly across countries. Vaccine allocation among countries raises complex and controversial issues involving public opinion, diplomacy, economics, public health, and other considerations. Nevertheless, many national leaders, international organizations, and vaccine producers recognize that one central factor in this decision-making is ethics (1, 2). Yet little progress has been made toward delineating what constitutes fair international distribution of vaccine. Many have endorsed ?equitable distribution of COVID-19?vaccine? without describing a framework or recommendations (3, 4). Two substantive proposals for the international allocation of a COVID-19 vaccine have been advanced, but are seriously flawed. We offer a more ethically defensible and practical proposal for the fair distribution of COVID-19 vaccine: the Fair Priority Model.The Fair Priority Model is primarily addressed to three groups. One is the COVAX facility?led by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI)?which intends to purchase vaccines for fair distribution across countries (5). A second group is vaccine producers. Thankfully, many producers have publicly committed to a ?broad and equitable? international distribution of vaccine (2). The last group is national governments, some of whom have also publicly committed to a fair distribution (1).These groups need a clear framework for reconciling competing values, one that they and others will rightly accept as ethical and not just as an assertion of power. The Fair Priority Model specifies what a fair distribution of vaccines entails, giving content to their commitments. Moreover, acceptance of this common ethical framework will reduce duplication and waste, easing efforts at a fair distribution. That, in turn, will enhance producers' confidence that vaccines will be fairly allocated to benefit people, thereby motivating an increase in vaccine supply for international distribution. ; Fil: Emanuel, Ezekiel J. University of Pennsylvania; Estados Unidos ; Fil: Persad, Govind. University of Denver.; Estados Unidos ; Fil: Kern, Adam. University of Princeton; Estados Unidos ; Fil: Buchanan, Allen. University of Arizona; Estados Unidos ; Fil: Fabre, Cécile. All Souls College; Reino Unido ; Fil: Halliday, Daniel. University of Melbourne; Australia ; Fil: Heath, Joseph. University of Toronto; Canadá ; Fil: Herzog, Lisa. University of Groningen; Países Bajos ; Fil: Leland, R. J. University of Manitoba; Canadá ; Fil: Lemango, Ephrem T. No especifíca; ; Fil: Luna, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales; Argentina ; Fil: McCoy, Matthew S. University of Pennsylvania; Estados Unidos ; Fil: Norheim, Ole F. University of Bergen; Noruega ; Fil: Ottersen, Trygve. Norwegian Institute Of Public Health; Noruega ; Fil: Schaefer, G. Owen. Yong Loo Lin School Of Medicine; Singapur ; Fil: Tan, Kok-Chor. University of Pennsylvania; Estados Unidos ; Fil: Wellman, Christopher Heath. Washington University in St. Louis; Estados Unidos ; Fil: Wolff, Jonathan. University of Oxford; Reino Unido ; Fil: Richardson, Henry S. Kennedy Institute Of Ethics; Estados Unidos