The beginning of the end of principlism

Book reviewed in this article: Principles of Biomedical Ethics . By Tom L. Beauchamp and James F. Childress.     

Dynamics of care, situations of choice: HIV tests in times of ART

In the 1990s, African AIDS programs followed a voluntary counseling and testing (VCT) approach to HIV testing. In the wake of large scale AIDS treatment programs, policymakers opted for routine provider-initiated testing (PITC) with less emphasis on counseling, which led to concerns about the ethical conduct of HIV testing. Inspired by Annemarie Mol, we ask if PITC can be framed as good care, rather than as medical domination that threatens to violate patients' rights. Based on fieldwork in Ugandan and Kenyan health facilities, we reveal that situations of choice vary: patients in hospital wards, are given time to decide whether they want a test, while in antenatal care testing women find it very hard to opt-out. We argue that the medical context inherent in PITC provides an attractive moral space for people to undergo HIV tests.     

Evolution of medical education in the Department of Medicine of the Complutense University of Madrid in the last decade

Abstract

Objectives: This paper aims to show changes in Medical Education in the Department of Medicine at the Complutense University of Madrid in the last 10–15 years.

Results: Medical education in the Department of Medicine at the Complutense University of Madrid has undergone significant changes in the last 10–15 years. An attempt to summarize these shows that radical change in the teaching of medicine for both teachers and students has taken place in three areas: 1. Progressive development of Patient-centered medical education. 2. Development of a competency-based training concerned with the mastering of knowledge and skills and their evaluation through objective and structured clinical assessment tests. 3. Introducing simulation techniques and virtual reality in the teaching of clinical practice aimed at improving our students' training and enhancing patient safety.

Conclusions: We believe that the changes applied have pleased students as well as teachers and even patients and are helping to improve the training of our students.     

A Defense of the Whole-Brain Concept of Death

The concept of whole-brain death is under attack again. Scholars are arguing that the concept of brain death per se—regardless of the focus on “higher,” “stem” or “whole”—is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole-brain death remains the standard for determining death in much of the Western world and its defenders believe this concept best maps onto our everyday conception of death.