Ethics & Rights as a
meaningful relationship:
6th Annual A. David Kline Symposium
on Public Philosophy:
Exploring the Syne...
Pillars of the presentation
Briefly describe the history of
bioethics.
Analyze Latin America’s view and
its context.
Share...
Bioethics: History
Latin America: Bioethics is a boom in the region:
Frequent conferences, Master Degree Programs.
Coexist...
A Latin American View ?
 The South.
 Developing countries.
 Non industrialized countries.
 Latin America.
A Latin America view:
The Context
A Latin America view:
The Context
 Bioethics is rooted in reality.
 Specific regions and cultures perspectives.
 Ethica...
The Context
 Heterogeneity.
 Great variety in size and natural resources.
 Composition of their populations is quite di...
 Social class and power inequalities.
 Coexistence of wealth and pervasive poverty.
 High-grade healthcare vs lack of b...
Health Sector
Health Sector
"… Equity is an Ethical Imperative …”
Halfdan Malher
Buenos Aires, Argentina 2007
Rights-based Equity Policies
Child Health
Margaret Whitehead; Göran Dahlgren
Concepts and principles for tackling social i...
… in this regard
 Need to construct a moral/rights language
 Build bridges between ethics and rights.
to fit the reality...
The “rights” language
Used in different but overlapping ways.
Set of entitlements under
international laws.
Aspirational o...
When “rights” language is invoked to
 Convey the fundamental importance of the claim.
“Rights”  symbol  reverence and r...
Pillars of the presentation
Briefly describe the history of
bioethics.
Analyze Latin America’s view and
its context.
Share...
Is this effort an attempt to build strong connections
between moral values and rights?
Is this link  ethics & rights sou...
Ethics & Rights
Common Aspects
Subjective construct
 it is hard to conceptualize.
Valued and respected.
Importance not on...
* Required
#1. 5/8 Neither disagree or agree International Declarations on
Human Rights, such as the CRC do not consider, in particul...
Answers
#4. 7/8 As a member of a Clinical Ethics Committee or Pediatric
Research Ethics Committee, do you think you apply ...
In summary:
Bridges between Ethics & Rights
Avoid options White and Black
…contribute Gray area
to understand the reality.
… The gray area
• What is the gray area?
• Complexity due to the number of variables involved.
• Dilemma: pros and cons of...
… Gray areas
Dominic Wilkinson, Nuffield Medical Research
Shedding Light on the Gray Zone, 6th Annual Pediatric Bioethics ...
Challenges/Ideas
1. Moral Value of Actions
Vulnerability
Actions
Ethics of Omissions
2. Integrating paradigms
for moral reasoning
 Morality of rights
 Morality of care  takes care of others
(real world co...
3. Challenges/Ideas
 Mainstream the ethics/rights perspective.
 Pose new questions:
Which are the rights that are not ac...
4. Challenges/Ideas
Clarifying Myths:
The speech of rights is associated in the wrong way
with that of responsibility.
Chi...
5. Challenges/Ideas
(1) María Casado, Observatory of Bioethics, University of Barcelona
To bring to the debate the flexibl...
To conclude ...
Acknowledging the stories,
the wills, the contexts…
…to enlighten the “gray area”
Ethics & Rights
Thanks for
your attention
Irene Melamed
Pediatric and
Adolescent Care
dramelamed@gmail.com
Ethics/Rights presentation
Ethics/Rights presentation
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Ethics/Rights presentation

  1. 1. Ethics & Rights as a meaningful relationship: 6th Annual A. David Kline Symposium on Public Philosophy: Exploring the Synergy between Pediatric Bio Ethics and Child Rights March 6th, 2014 In Collaboration With: University of Florida College of Medicine-Jacksonville Florida Blue Center of Ethics College of Arts and Sciences A Latin America view Irene Melamed MD, MSc. Pediatric and Adolescent Care
  2. 2. Pillars of the presentation Briefly describe the history of bioethics. Analyze Latin America’s view and its context. Share some concerns, challenges and ideas. Recognize the importance of building bridges between ethics & rights.
  3. 3. Bioethics: History Latin America: Bioethics is a boom in the region: Frequent conferences, Master Degree Programs. Coexistence of a secular and a religious approach. Emerging local biomedical laws  recognize health as a human right. US: Bioethics  perspectives of the law, medicine, public policy, philosophy, sociology and anthropology.
  4. 4. A Latin American View ?
  5. 5.  The South.  Developing countries.  Non industrialized countries.  Latin America. A Latin America view: The Context
  6. 6. A Latin America view: The Context  Bioethics is rooted in reality.  Specific regions and cultures perspectives.  Ethical issues: health technologies/lack of access.  Approaches to vulnerability: a broader concept (Florencia Luna, layers vs labels*) address people’s situation (impoverishment, helplessness, oppression). Failure to approach the social determinants of health. * Luna F. Elucidating the concept of vulnerability. Layers not labels. IJFAB. 2009; 2(1):121-135
  7. 7. The Context  Heterogeneity.  Great variety in size and natural resources.  Composition of their populations is quite different.  Ethnic, cultural, historical and social diversity.
  8. 8.  Social class and power inequalities.  Coexistence of wealth and pervasive poverty.  High-grade healthcare vs lack of basic public services (no drinking water and sewer system).  Health sector: Fragmentation and Segmentation. The Context: Common features
  9. 9. Health Sector
  10. 10. Health Sector "… Equity is an Ethical Imperative …” Halfdan Malher Buenos Aires, Argentina 2007
  11. 11. Rights-based Equity Policies Child Health Margaret Whitehead; Göran Dahlgren Concepts and principles for tackling social inequities in health: Levelling up Part 1 Child Health Worse off Better off Child Health Child Health Worse off Better off ChildHealthimprovement
  12. 12. … in this regard  Need to construct a moral/rights language  Build bridges between ethics and rights. to fit the reality of multiculturalism and diversity.
  13. 13. The “rights” language Used in different but overlapping ways. Set of entitlements under international laws. Aspirational or rhetorical qualities. Gostin Lawrence O. PUBLIC HEALTH ETHICS: TRADITION, PROFESSION, AND VALUES. Acta bioeth. [revista en la Internet]. 2003 [citado 2014 Feb 22] ; 9( 2 ): 177-188. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S1726- 569X2003000200004&lng=es. http://dx.doi.org/10.4067/S1726-569X2003000200004
  14. 14. When “rights” language is invoked to  Convey the fundamental importance of the claim. “Rights”  symbol  reverence and respect.  Adhering to certain standards or services by the government. Gostin Lawrence O. PUBLIC HEALTH ETHICS: TRADITION, PROFESSION, AND VALUES. Acta bioeth. [revista en la Internet]. 2003 [citado 2014 Feb 22] ; 9( 2 ): 177-188. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S1726- 569X2003000200004&lng=es. http://dx.doi.org/10.4067/S1726-569X2003000200004
  15. 15. Pillars of the presentation Briefly describe the history of bioethics. Analyze Latin America’s view and its context. Share some concerns, challenges and ideas. Recognize the importance of building bridges between ethics & rights.
  16. 16. Is this effort an attempt to build strong connections between moral values and rights? Is this link  ethics & rights source of additional commitment and enforceability? There is a clear need to incorporate the “rights” perspective on child health care daily issues… Is this approach a good starting point? Bridges between Ethics & Rights
  17. 17. Ethics & Rights Common Aspects Subjective construct  it is hard to conceptualize. Valued and respected. Importance not only of “having rights” but also its perception. Legal frameworks in both cases are in need of an ethical interpretation.
  18. 18. * Required
  19. 19. #1. 5/8 Neither disagree or agree International Declarations on Human Rights, such as the CRC do not consider, in particularly, medical bioethic principles. (2/8 Disagree, 1/8 Agree) #2. 3/8 Neither disagree or agree Medical bioethics has its own standards and they seldom mention or refer to either Rights of the Child’s principles and/or to the Convention text. (2 Disagree, 1/8 Do not know, 2/8 Agree) #3. 7/8 There are many connections between the Medical Bioethic principles and those of the International Convention on the Rights of the Child. (1/8 Do not know) Answers
  20. 20. Answers #4. 7/8 As a member of a Clinical Ethics Committee or Pediatric Research Ethics Committee, do you think you apply the Right of the Child’s perspective when conducting the analysis and/or ethical review? “It is possible I do”. (1/8 If I do, it would be imperceptibly) #7. 5/8 Absolutely Establishing a strong connection between Bioethics and Rights’ perspectives will give the latter more legitimacy an enforceability. (2/8 I do not think so, 1/8 “I think that Rights’ perspective is more relevant as the mandate to Rights fulfillment”) #8. Professional background  Philosophy:1  Health Sciences:8  Law  Other Acknowledgments to the colleagues from FLACEIS that kindly answer the questions.
  21. 21. In summary: Bridges between Ethics & Rights Avoid options White and Black …contribute Gray area to understand the reality.
  22. 22. … The gray area • What is the gray area? • Complexity due to the number of variables involved. • Dilemma: pros and cons of both options. • Where are the limits and/or frontiers of the gray area*? *Dominic Wilkinson, Shedding Light on the Gray Zone, 6th Annual Pediatric Bioethics Conference, Seattle, 2010
  23. 23. … Gray areas Dominic Wilkinson, Nuffield Medical Research Shedding Light on the Gray Zone, 6th Annual Pediatric Bioethics Conference, Seattle, 2010 0 0 0
  24. 24. Challenges/Ideas
  25. 25. 1. Moral Value of Actions Vulnerability Actions
  26. 26. Ethics of Omissions
  27. 27. 2. Integrating paradigms for moral reasoning  Morality of rights  Morality of care  takes care of others (real world conflicts & contexts).  Deepen the ethical discussion.  Produce more nuanced strategies.  Identify and reinforce a more responsive professional viewpoint to health disparities and changing needs.
  28. 28. 3. Challenges/Ideas  Mainstream the ethics/rights perspective.  Pose new questions: Which are the rights that are not acknowledged? Which are the ethical principles that are not visualized? How do I gather evidence that allows a better understanding of the children’s best interest?
  29. 29. 4. Challenges/Ideas Clarifying Myths: The speech of rights is associated in the wrong way with that of responsibility. Children’s rights ARE NOT consequent to the exercise of responsibilities. The responsibilities are being gradually acquired while they develop greater abilities. (Article 5, 12, CRC)
  30. 30. 5. Challenges/Ideas (1) María Casado, Observatory of Bioethics, University of Barcelona To bring to the debate the flexible and pluralist (1) Bioethics. Reduce gaps between words and actions (Implementation research) Ethics committees? Are they fulfilling the duties expected from them?
  31. 31. To conclude ...
  32. 32. Acknowledging the stories, the wills, the contexts… …to enlighten the “gray area” Ethics & Rights
  33. 33. Thanks for your attention Irene Melamed Pediatric and Adolescent Care dramelamed@gmail.com
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