https://actabioethica.uchile.cl/index.php/AB/issue/feed 2025-09-02T09:58:17+00:00 Alvaro Quezada alquezad@uchile.cl Open Journal Systems <p>Acta Bioethica is a biannual publication by the Interdisciplinary Center for Studies in Bioethics of the University of Chile (ISSN 0717-5906, press edition, y 1726-569-X, electronic edition), which publishes in three languages: Spanish, English and Portuguese.</p> <p>Indexed in Science Citation Index (SCI), Scopus, Lilacs, SciELO y Latindex, and in database from several Institutions; it constitutes a pluralistic source of perspectives and an important tribune which accepts the contributions of authors compromised with the interdisciplinary study of ethical determinants and consequences of techno scientific research.</p> <p>The journal edits a main topic per issue, with articles asked by an invited editor (specialist in the topic chosen), and it also includes a section of articles not solicited of various nature (interfaces), reviews of recent bioethical publications and other significant documents for the inter discipline. It also counts with an International Advisory Committee and a system of arbitration of manuscripts based on peer review.</p> <p>The journal is published on HTML and PDF format in SciELO (Scientific Electronic Library Online) and in PDF in the web site for journals of the University of Chile.</p> https://actabioethica.uchile.cl/index.php/AB/article/view/79994 2025-07-25T11:18:56+00:00 Merih Anar Öztoprak merih.anar@hacettepe.edu.tr

Narrative medicine provokes physicians’ deeper understanding and empathy for both patients and other healthcare providers. Materials that are used to provoke emotions and improve empathy. The aim of this textual close reading and literary analysis work is to discuss examples of life-writings and experiences of cancer patients from the perspective of emotional awareness and their presence during patient-health care professional relationship. To achieve an understanding of the texts and emphasize difficult emotional themes, text analyses are grouped in a thematically manner. The results of the narrative document analysis are categorized and interpreted as difficult emotional themes. Sub-themes are created as psychic pain, fear, shame, and anger. These emotional themes are discussed in terms of patient-physician relationship, empathy and the methods of Narrative Medicine. We may create new alternative roads that can alter and transform patient-physician relations to a more humanistic structure, by close reading and reflective writing. Literary and textual exercises are need to be done regularly to gain narrative competence. Qualitative studies are needed to be done about the reflections of students, health care providers, and patients.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Merih Anar Öztoprak https://actabioethica.uchile.cl/index.php/AB/article/view/79995 2025-07-25T11:36:15+00:00 José Dimas D’Avila Maciel Monteiro Monteiro jose.monteiro@ifc.edu.br Elcio Luiz Bonamigo elcio.bonamigo@unoesc.edu.br Rui Nunes ruinunes@med.up.pt

Despite more than 50 years of existence and their recognized importance, advance directives (ADs) are still the subject of doubts and criticism. The original defect, the instability of decisions, and the argument of personal identity are some of them. In Brazil, this instrument is not regulated by federal law, although Resolution No. 1995/2012 of the Federal Council of Medicine and Resolution No. 41/2018 of the Ministry of Health are in force, contributing to its implementation and to studies in this area. This article proposes to 1st) investigate some doubts and criticisms about ADs, as they challenge their moral authority; 2nd) highlight the repositioning of ADs in the moral field; 3rd) suggest this moral field as a starting point for bioethical investigations on their regulation in Brazil. The approach was philosophical/bioethical (analytical), according to Aristotle’s position in Nicomachean Ethics on the scope of ethical research. It is concluded that ADs can be more robust and effective if their moral field is that of the circumstances, where the manifestation provides the person with moral choices and actions that operate in a grey area, allowing health professionals and their representatives to interpret their wishes according to each situation.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 José Dimas D’Avila Maciel Monteiro Monteiro, Elcio Luiz Bonamigo, Rui Nunes https://actabioethica.uchile.cl/index.php/AB/article/view/79996 2025-07-25T11:54:28+00:00 Qihan Zhang zqhouou@126.com Jinzi Liu 2458832960@qq.com Ke Tan tanke@tjcu.edu.cn

Introduction: The study is grounded in the Stress-Stressor-Health Outcome Model and the Conservation of Resources (COR) theory, by examining the mechanisms through which personal factors, such as psychological capital and work burnout, influence the relationship between work stress and employee depression, aims to provide valuable insights and guidance for future corporate psychological support services. Methods: A total of 1,312 employees participated in an online survey, completing a self-report questionnaire that included the Work Stress Questionnaire, the Patient Health Questionnaire-9, the Psychological Capital Questionnaire, and the Job Burnout Questionnaire. A chain mediation model was employed to explore the relationships among these four variables. Results: The results revealed that: (1) 13.6% of employees suffer from moderate or severe depression; (2) Job burnout mediates the relationship between job stress and employee depression, amplifying the effect of job stress on depression. (3) Psychological capital and job burnout serve as a chain mediator in the relationship between work stress and employee depression. Conclusion: This suggests that under work stress, higher levels of job burnout are associated with a greater risk of depression; improving psychological capital can buffer job burnout and reduce the risk of depression.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Qihan Zhang, Jinzi Liu, Ke Tan https://actabioethica.uchile.cl/index.php/AB/article/view/79998 2025-07-25T13:20:28+00:00 Cecilia Olivari colivari@ucm.cl Rodrigo Núñez colivari@ucm.cl Daniela Ferrufino-Borja colivari@ucm.cl Pablo Méndez-Bustos colivari@ucm.cl

One of the main strategies for mental health prevention is timely access to professional help. However, different barriers make it difficult for adolescents and young people to receive early access to professional care. The aim of this article is to reflect on the role of autonomy in seeking mental health help in the adolescent population. The construct of autonomy is approached from a developmental psychology and bioethical perspective. Then, research evidence is presented and described that relates autonomy with mental health issues, with some constructs related to psychological adjustment, and with help-seeking behavior for mental health problems. Based on this evidence, implications and guidelines for mental health prevention are discussed.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Cecilia Olivari, Rodrigo Núñez, Daniela Ferrufino-Borja, Pablo Méndez-Bustos https://actabioethica.uchile.cl/index.php/AB/article/view/79999 2025-07-25T13:31:38+00:00 Sebastián Pavlovic Jeldres eric.tapia@ucentral.cl Eric Tapia Escobar eric.tapia@ucentral.cl Marcela Riveros Jiménez eric.tapia@ucentral.cl Augusto Mellado eric.tapia@ucentral.cl Diego Silva-Jiménez eric.tapia@ucentral.cl Francisco León eric.tapia@ucentral.cl

The objective of this research was to analyze the historical contribution of public policies to the humanization of the healthcare system in Chile between 2004 and 2024. The methodology was a historical analysis of official documents from the Ministry of Health and its dependent agencies. The results show progressive advances in the regulatory recognition and promotion of principles such as dignity, respect, empathy, and participation in healthcare, especially since the enactment of Law 20.584 in 2012. However, gaps remain in implementing these policies, related to staff training, infrastructure, process adequacy, patient empowerment, and control systems. It is concluded that public policies have played a crucial role in establishing humanization as a central axis of the Chilean health system over the last two decades. It is recommended that mechanisms for enforcing rights be strengthened, training in relational skills intensified, a person-centered model be moved toward, resources for its implementation should be allocated, intersectoral initiatives coordinated, and research should be encouraged.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Sebastián Pavlovic Jeldres, Eric Tapia Escobar, Marcela Riveros Jiménez, Augusto Mellado, Diego Silva-Jiménez, Francisco León https://actabioethica.uchile.cl/index.php/AB/article/view/80000 2025-07-25T13:45:29+00:00 Claire Junga Kim clairejungakim@gmail.com

Korea’s system for end-of-life care and letting people die is quite rigid in the direction of maintaining life. The Life-sustaining Treatment Decision Act was enacted in 2016, but there was little opportunity for the breadth and depth of public discussion to develop before that. This paper aims to show the “concerns about the slippery slope” that some of the participants in the legislative debate had as one of the historical reasons for creating the conservative framework and detailed provisions of Korea’s Life-sustaining Treatment Decision Act. Because of their arguments, the law was structured as a barricade to prevent slippery slopes. However, in 2022, the fifth year after the law took effect, a bill was proposed to legalize physician-assisted dying. This paper makes a worrisome prediction that this radical movement will continue unless it is possible to set treatment goals tailored to the patient’s medical condition and values through the guarantee of the right to refuse treatment.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Claire Junga Kim https://actabioethica.uchile.cl/index.php/AB/article/view/80095 2025-07-31T11:26:36+00:00 Zheng Zang zangzheng@suda.edu.cn Ying Hong zangzheng@suda.edu.cn Jianhai Yang yangjianhai@btbu.edu.com

Hospice care represents the ‘last mile’ of a person-centred health system, mitigating physical suffering while addressing existential, psychosocial and spiritual needs at life’s end. China has recently incorporated hospice services into national health strategies; yet provision remains uneven and, in many regions, embryonic. Drawing on an ethical-humanistic framework that integrates principlism with insights from Confucian care ethics, this review examines the principal barriers to a truly humanised hospice system. We synthesise policy documents and empirical literature to map four interlocking impediments: (i) the marginalization of hospice care in national health priorities; (ii) economic constraints in hospice care access; (iii) lack of scientific understanding of death and hospice care in society; and (iv) inadequate investment in hospice infrastructure and education. Ethical analysis reveals that these barriers compromise the core values of autonomy, beneficence and justice, and undermine the Confucian ideal of yang-sheng shan-zhong (caring for life and dying well). To advance a humanistic hospice model with Chinese characteristics, we propose: (1) optimizing top-level design and government-led mechanisms; (2) increasing financial input and reforming medical insurance policy; (3) optimizing hospice care through education and cultural integration; and (4) accelerating supply-side reform in hospice care. Addressing these ethical and structural deficits is essential to honouring patient dignity and realising equitable, high-quality end-of-life care across China.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Zheng Zang, Ying Hong, Jianhai Yang https://actabioethica.uchile.cl/index.php/AB/article/view/80113 2025-08-01T14:36:46+00:00 Hongda Gao gaohongda008@163.com Tingting Xu xutingting2015@163.com Nan Jiang jiangnan_gxmu@163.com He Chen gaohongda008@163.com

This study aimed to develop a comprehensive evaluation indicator system for assessing the teaching quality (TQ) of graduate students majoring in Health Management. The evaluation indicator system was built using the Delphi Method with 20 senior experts who have extensive experience in health management education and research. The final evaluation system was applied in a case study at Guangxi Medical University. The weight of Teaching Staff (0.381) and Teaching Target (0.381) is higher than that of the Teaching Process (0.237). In the Teaching Staff dimension, experts emphasize that Professional Qualities (0.057) play a key role in TQ, especially Teaching Reflection (0.255) and Political Literacy (0.255). In the Teaching Target dimension, Student Research Output (0.072) and Assessment Criteria (0.065) are the core factors. In the Teaching Process dimension, the weight of Teaching Methods (0.565) is higher than that of Teaching Content (0.435). For the Teaching Staff, experts and students agree that the weight of Professional Expertise is the lowest. In summary, the Professional Qualities in Teaching Staff dimension, especially Teaching Reflection and Political Literacy, are the key factors affecting TQ. Student Research Output and Assessment Criteria are the core factors in the evaluation of Teaching Target.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Hongda Gao, Tingting Xu, Nan Jiang, He Chen https://actabioethica.uchile.cl/index.php/AB/article/view/80115 2025-08-01T15:04:48+00:00 Ulises Massino Peñaloza de La Torre upenalozat@unjbg.edu.pe Maricielo Zevallos Cárdenas mzevallosc@unjbg.edu.pe Carlos Enrique Valdivia Silva cvaldivias@unjbg.edu.pe Omar Pezo Jiménez omapezo@virtual.upt.pe

The objective of the present research was to determine the ethical practices in the dentistry theses of a Public University in Southern Peru between 2016 and 2023, to improve ethical practices in dental research and promote a more responsible academic environment. The method used was quantitative, descriptive, and retrospective, utilizing public data from 150 theses in the institutional repository of the National University Jorge Basadre Grohmann. The variables analyzed included ethics in data collection, data manipulation, collaboration and authorship, and dissemination of results. The data were analyzed using descriptive statistics with IBM SPSS Statistics version 26. The findings show that 100% of the theses were not reviewed by an ethics committee, 52.2% did not present an execution certificate from the institution, 67% adequately recognized the contributions of advisors and collaborators, and 100% did not communicate the results to the study population. Additionally, most of the theses (91.3%) were of a basic type, which contrasts with the university policy that promotes applied research. The ethical practices in the dentistry theses of this university are deficient, especially in ethical review and result dissemination. It is recommended that ethical training be strengthened and agreements established with recognized ethics committees to ensure integrity and responsibility in research.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Ulises Massino Peñaloza de La Torre, Maricielo Zevallos Cárdenas, Carlos Enrique Valdivia Silva, Omar Pezo Jiménez https://actabioethica.uchile.cl/index.php/AB/article/view/80364 2025-08-25T13:52:09+00:00 Pamela Marcone-Dapelo pamela.marcone@upla.cl Bianca Dapelo Pellerano bdapelo@uvm.cl

Objectives: The main objective is to explore the bioethical competencies that aquatic therapists consider important in hydrotherapeutic practice at an international level. Methodology: qualitative of a phenomenological type with an intentional and opinionated sampling. The sample is made up of 14 international senior aquatic therapists, who participate in semi-structured interviews in an online modality. Thematic categorical content analysis is carried out with the support of the Atlas Ti version 23 software. Results: A comprehensive understanding of bioethical competencies is developed from a personalist perspective, highlighting the following components: bioethical sensitivity, bioethical knowledge, bioethical practice, and bioethical relationships. Emerging categories include the need for accredited training, academic integrity, accessibility gaps, and a holistic view of health. Conclusions: The existence of bioethical competencies consistent with the personalist approach, the principle of vulnerability, and values such as respect, humility, and honesty is evident. This highlights the need to develop bioethical competencies related to respect, responsibility, and integrity. A challenge is posed to reach a consensus on bioethical competencies that, from a holistic health perspective, can contribute to the validation and regulation of widespread aquatic practice at an international level.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Pamela Marcone-Dapelo, Bianca Dapelo Pellerano https://actabioethica.uchile.cl/index.php/AB/article/view/80365 2025-08-25T14:03:14+00:00 Verónica Guerra Guerrero vguerra@ucm.cl Marcelo Correa Schnake vguerra@ucm.cl Margarita Poblete Troncoso vguerra@ucm.cl Andrea Páez vguerra@ucm.cl María Carolina Daneck Muñoz vguerra@ucm.cl

The pandemic had multidimensional consequences. Healthcare professionals were affected due to stressful and traumatic situations over time. The objective is to analyze spirituality as one of the main themes derived from the experiences lived by a group of health professionals in critical patient units during the pandemic. This is a study with a hermeneutical phenomenological approach, with in-depth interviews with 30 health professionals in Chile. The data analysis was thematic and the corresponding ethical safeguards were maintained. It was found that spirituality is related to the reflection and spiritual beliefs of the health team, and that spirituality is rediscovered from the dehumanizing professional and personal experience to which the pandemic leads.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Verónica Guerra Guerrero, Marcelo Correa Schnake, Margarita Poblete Troncoso, Andrea Páez, María Carolina Daneck Muñoz https://actabioethica.uchile.cl/index.php/AB/article/view/80366 2025-08-25T14:16:36+00:00 Huizhi Wu wuhuizhi43@gmail.com Wei Wang 903689644@qq.com Talib Hussain 997142@hainanu.edu.cn Manzar Rehman rehman@icloud.com Tong Zelin 993986@hainanu.edu.cn

This study examines the impact of socio-cultural factors and informal business networks on ethical marketing practices in the biomedical industry of Gilgit-Baltistan, Pakistan. Using a qualitative research approach, data were collected through in-depth interviews with 36 respondents, including healthcare providers, biomedical product distributors, and local business stakeholders. Thematic analysis identified six major themes: (1) Trust-Based Marketing & Relationships, (2) Informal Business Networks & Influence, (3) Cultural & Community Influence, (4) Ethical Challenges & Trade-offs, (5) Traditional & Incentive-Driven Marketing, and (6) Regulatory Barriers & Compliance Issues. Findings indicate that trust-based relationships, word-of-mouth referrals, and informal agreements significantly shape marketing strategies, often at the cost of ethical transparency and regulatory compliance. Moreover, cultural expectations and social credibility outweigh formal ethical guidelines, leading to ethical trade-offs and weak policy enforcement. The study highlights the need for context-sensitive ethical marketing frameworks that balance local socio-cultural values with formal regulatory requirements. Strengthening policy interventions, regulatory oversight, and ethical awareness campaigns could help to mitigate the dominance of informal business networks and enhance compliance in biomedical marketing. The findings contribute to the broader discourse on business ethics, marketing regulations, and the role of socio-cultural norms in shaping commercial practices in developing regions.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Huizhi Wu, Wei Wang, Talib Hussain, Manzar Rehman, Tong Zelin https://actabioethica.uchile.cl/index.php/AB/article/view/80367 2025-08-25T14:23:23+00:00 Xiangyu Chen chenxiangyu@szu.edu.cn

Cognitive Enhancers（CEs）have attracted considerable attention due to their capacity to enhance cognitive performance. These agents are classified into two categories: prescription drugs and non-prescription supplements. Despite their efficacy, the potential for addiction and associated risks have given rise to numerous ethical controversies. This article explores the ethical issues of using CEs, including fairness and equality, coercion and autonomy, health and safety risks, and social norms. It proposes that the ethical issues surrounding CEs should be addressed by implementing strict supervision, promoting informed consent, improving research transparency, and encouraging multi-stakeholder collaboration. These approaches aim to achieve a balance between bio-innovation and ethical responsibility.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Xiangyu Chen https://actabioethica.uchile.cl/index.php/AB/article/view/80368 2025-08-25T14:31:02+00:00 Ying Sun haili2021@126.com Lu Ran haili2021@126.com

Medical digital twin technology has shown tremendous potential in personalized medicine, disease prevention and treatment optimization through real-time monitoring, simulation and prediction of individual health conditions by creating virtual models of patients. However, with the rapid development of this technology, its potential ethical issues have also attracted widespread attention. Firstly, medical digital twin technology involves collecting and processing a large amount of personal health data, and ensuring the privacy and security of this data becomes the primary concern. Secondly, the biases and unreliability generated by big data algorithms during the operation of the technology also need to be considered. Lastly, the digital gap and fairness issues generated by medical digital twin technology should not be overlooked. Therefore, in response to these ethical challenges, proposing corresponding ethical regulations becomes necessary, promoting the application of digital twin technology to enhance medical quality without infringing on patients´ legitimate rights and interests, and promoting fairness and justice in the medical field.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Ying Sun, Lu Ran https://actabioethica.uchile.cl/index.php/AB/article/view/80370 2025-08-25T14:39:20+00:00 Pedro Salinas Quintana psalinasquintana@gmail.com

Based on the work of the Cypriot-Australian artist, Stelarc, this article examines some of the fundamental milestones of his work that postulate a potential obsolescence of the human body. Three clear moments are distinguished in the production of the artist’s work that serve as an argument to explain the possible paths of the human body in the face of the irruption of technology and biotechnologies. Finally, the scope of the relation between art, science and technology is questioned from a bioethical and aesthetic perspective that reflects on the figure of the cyborg.

2025-09-02T00:00:00+00:00 Copyright (c) 2025 Pedro Salinas Quintana https://actabioethica.uchile.cl/index.php/AB/article/view/80371 2025-08-25T14:43:34+00:00 Fernando Lolas Stepke flolas@uchile.cl 2025-09-02T00:00:00+00:00 Copyright (c) 2025 Fernando Lolas Stepke https://actabioethica.uchile.cl/index.php/AB/article/view/79993 2025-07-25T11:09:27+00:00 Fernando Lolas Stepke flolas@uchile.cl 2025-09-02T00:00:00+00:00 Copyright (c) 2025 Fernando Lolas Stepke