BIOETHICS CENTRE
INTRODUCTION
At a time of profound changes in patterns of morbidity, rapid advance of techno-science and celebration of alterity, there have been remarkable successes in the health field, alongside increased vulnerabilities in a complex and uncertain world.
Health professionals suddenly find themselves both brokered as unconditional supporters of patients and, at the same time, as rational arms of the state in the micro-allocation of resources. Given the risk of their ethos being suffocated, as it is now subject to other attractors (which is important to reflect upon), it is necessary to hydrate, nourish from the inside, reconvert and situate in space and time this ethos undergoing increasing complexity and which needs to be ethically revived.
It is necessary to develop skills and ethical identities that promote informed knowledge, contextualized ethics and reflected action in all areas of life and in the polarity of professional fields.
BACKGROUND
The Bioethics Centre was established in 1999 and stemmed from works and studies on humanization and health started by Professor Barahona Fernandes at our institution in the 1970s.
Its first director was Professor João Ribeiro da Silva, who was assisted by Professor António Barbosa and Professor Fernando Martins do Vale, who were also members of the Council of the Master Degree in Bioethics.
In 2004, Professor António Barbosa was appointed director of the Centre, and the Council of the Master Degree included Professor Fernando Martins do Vale and Professor Paulo Costa
OBJECTIVES
The overall objectives of the Bioethics Centre comprise promoting the study and the dissemination of scientific knowledge, conduct research, train and/or participate in the teaching of bioethics, and establish the national and international contacts whenever deemed necessary.
In the pursuit of its objectives the Bioethics Centre:
• Fosters the stance and the quest for knowledge in bioethics through scientific and intellectual interdisciplinary exchanges between professional and researchers, think tanks, national and international associations, and societies with similar objectives;
• Promotes competence, honesty and scientific rigour, welcoming all currents of thought, models, methodologies and praxis;
• Contributes to renewed and continuing education, with emphasis on the training of health professionals.
ACTIVITIES
Education
Undergraduate
Open Course in Relational Ethics
This course seeks to bring together the fundamentals of reflection on bioethics leading to an appropriate deliberative process in clinical practice and medical research, and to develop communication skills in diverse medical settings (consultation, hospitalization, emergency, diagnostic and prognostic procedures, and public health) integrating bioethical reflection methodology.
The teaching consists of theoretical and theoretical-practical lectures dealing with the futility of treatment, informed consent, non-adherence to therapy, the conspiracy of silence, the double effect, the truth to be conveyed, confidentiality, and the conflict between responsibilities and interests
Medical Anthropology Elective Subject
This subject aims to raise awareness of the plurality of approaches in the different social sciences to medical issues, health, illness, death, and to the socio-cultural context of the medical act, enabling future physicians to become more competent and qualified to deal with the socio-cultural aspects of the doctor-patient relationship in various professional contexts and to be able to develop a professional project taking into account the socio-cultural context.
The teaching consists of theoretical and theoretical-practical lectures addressing key concepts of anthropology, sociology and psycho-sociology of health organizations and practices in the community through internships.
Ethics and Social Sciences subject
The Bioethics Centre in involved in the teaching of the contributions of social sciences in addressing ethical issues applied to the health sciences
Postgraduate
Advanced (master and doctoral degrees)
Master Degree in Bioethics
This degree was set up with the purpose of training sensitive, open-minded, capable and responsible health professionals in acquiring several competencies, such as open dialogue, cooperative negotiation, informed reflection, applied reasoning, reasonable decision-making, and responsible action.
The Master Degree in Bioethics innovatively introduced a proactive teaching methodology and approach to training health professionals and those from other professions (graduates in law, biology, psychology…), involving all Faculty lecturers and also guest lecturers from reputable national and international institutions in the project.
The purpose of the Master in Bioethics is to enable students to:
1. Master a body of knowledge and historical context across several philosophical, ideological, political, religious, and legal perspectives and reasoning;
2. Make a commitment to social justice and respect for human rights, not being held hostage to them;
3. Learn how to listen to those experiencing difficulties or are in a vulnerable situation;
4. Foster the creation of a network of players that may advance the philosophy of care and develop that network by promoting collaboration, sharing and dialogue among people;
5. Be prepared to act independently in research ethical committees for clinical ethics;
6. Be able to conduct research in bioethics
The specific objectives are:
1. Raise awareness of the normative component in clinical decisions to enable identifying their technical and ethical aspects and evaluate their relationship;
2. Foster the acquisition of skills to analyse the normative dimension of clinical decisions, identify moral principles and rules and examine ethical arguments critically;
3. Promote the development of skills to explore and justify personal decisions with regard to ethical issues as they arise in specific clinical settings;
4. Strengthen the capacity to collect, analyse and critically apply, at the level of teams, departments, units and institutions, all relevant information in the various fields of bioethics that offer an overview based on multiple perspectives of the decision making process in health services;
5. Train students to act as experts (institutional ethics committees, clinical bioethics consultant...) in the resolution of ethical conflicts in clinical, hospital and community practice;
6. Master the methodology in order to devise and conduct research in bioethics in health services.
Syllabus:
• History of Bioethics
• Rationale for Bioethics
• Methods in Bioethics
• Ethics of Clinical Decision
• Law and Bioethics
• Ethics of the Clinical Relationship
• Ethical Issues at the End of Life
• Ethical Issues at the Origin of Life
• Social Sciences and Bioethics
• Ethics in Health Sciences Research
• Argumentation and Bioethics
• Bioethical Research in Health Services
Updating an improvement
• 2010, 2012 – Postgraduate Updating Course “Ethics in Health Sciences Research”
• 2009, 2010, 2011, 2012 - Postgraduate Updating Course “Ethical Decisions at the End of Life”
Research/ Intervention
As part of research in bioethics, 54 master dissertations have been completed in the following major fields: Intensive Medicine (6); Transplantation Medicine (1); Transfusion Medicine (1); Paediatrics (7); Obstetrics (3); Ophthalmology (1); Neurology (1); Otorhinolaryngology (1); Psychiatry (2); Palliative Care (8); Gerontology (3); Organizational Ethics (5); Ethics Committees (2); Animal Experimentation (1); Pedagogy (1); Complementary Medicine 81); Occupational Health (1); Dentistry (1); “Conceptual” (8).
The Bioethics Centre is currently developing two major research/intervention strands: clinical bioethics and organizational bioethics.
Clinical Bioethics
We have been developing a model of relational ethics applied to specific clinical situations. This is a perspective that includes dialogical and narrative ethics and hermeneutics that stress the importance of the practical processes in the production of meaning which, in turn, require an attitude of openness to other people’s perspectives, to contingency, context and to practical and pragmatic situations.
This model calls for the joint interpretation of situations (current experiences and their historical background and context), not within a rigid set of principles but with openness and flexibility to new emerging possibilities.
This model demarcates itself from others that address ethical issues in terms of narrowly defined principles, formulated by generic historical interpretations and resolved through abstract procedures
Organizational Bioethics
It has the purpose of complementing the previous strand and of developing organizational mechanisms to prevent and solve emerging ethical issues and help organize the construction and sustainability of a positive ethical atmosphere in the organization.
It aims to implement good ethical practices, making the functioning of the institution or service more efficient and simultaneously fairer by combining the following: quality of patient care, the professional wellbeing of employees, economic sustainability, and accountability to the community.
The mode of action involves a collaborative analysis of the complexities, a relational approach (self-evaluative and non-prescriptive) with a view to attaining a deliberative process that enables the emergence of the ethical values of the department or organization
Dissemination
Documentation Centre
The Bioethics Centre has set up a library/documentation centre that is in growing demand by our undergraduate and postgraduate students and by users from other educational institutions.
Publications
The Centre has disseminated topics in bioethics regularly through various publications, some of which are the responsibility of former master students.
The published works include:
• Ribeiro da Silva, J. (2000). Bioética contemporânea. Lisbon: Bioethics Centre/Faculty of Medicine of Lisbon.
• Ribeiro da Silva, J., Barbosa, A., & Martins Vale, F. (eds) (2002). Contributos para a bioética em Portugal. Lisbon: Ed. Cosmos/ Bioethics Centre/Faculty of Medicine of Lisbon.
• • Barbosa, A., Martins Vale, F., & Costa, P. (eds) (2012). Gravitações bioéticas. Lisbon: Bioethics Centre /Faculty of Medicine of the University of Lisbon.Organization and participation in scientific meetings
Conferences
The Bioethics Centre was responsible for organizing the Annual Meeting of the European Association of Centres of Medical Ethics, held in Lisbon in 2003, and the 7th Portuguese-Brazilian Bioethics Meeting in 2012, thus helping to consolidate a long-standing collaboration.
Seminars, symposia, workshops and short training courses
As a complement to the Master in Bioethics, the Bioethics Centre organizes symposia regularly, at least once a year:
• 1999 – Ethics Committees and their objectives
• 2000 – Bioethical Implications in HIV-AIDS infection
• 2000 – Bioethics and Globalization
• 2000 – Human Rights and Bioethics
• 2000 – Conventions on the Rights of the Child
• 2000 – Spiritual and Human Dimension in Bioethics
• 2001 – Deliberation in Bioethics
• 2001 – Bioethics and Migrations
• 2001 – Ethics of the Future
• 2002 – Bioethics and the Transformations of Society
• 2003 – Bioethics and Vulnerability
• 2004 – Bioethics and Identities
• 2005 – Bioethics and Religions
• 2006 – Bioethics and Psychiatry
• 2007 – Bioethics and Genetics: “ Not yet sick”
• 2008 – Bioethics: Fundamental Concepts
• 2010 – Ethics in Health Organizations
• 2012 – 3rd Workshop Advancing Bioethics at the University of Lisbon “Transplantation”
In addition to the symposia, the Centre has organized short training courses (6 editions) for members of health ethics committees whenever relevant innovations arise in the areas they are interested about.
These events strengthen one of the purposes of the Master in Bioethics and of the Bioethics Centre in developing a network of professional who may help advance an ethical stance in the provision of care. Indeed, about 25 master degree students are part of Ethics Committees of several health or health-related institutions, and other students have created reflection groups and bioethics units all over the country which we have been encouraging and following up.
Presentations at scientific meetings
Barbosa, A. (2007, Abril). Bioética e cuidados de saúde. Comunicação apresentada na Conferência na 1ª Reunião “Ética em Cuidados de Saúde” da Comissão de Ética do Hospital de Dona Estefânia, Lisboa.
Barbosa, A. (2007, Junho). Suffering and relational centred medicine in palliative care. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapeste.
Barbosa, A. (2007, Outubro). Consentimento informado em pediatria. Comunicação apresentada no Núcleo de Investigação da Clínica Pediátrica Universitária do Hospital de Santa Maria, Lisboa.
Barbosa, A. (2008, Abril). O doente na decisão terapêutica. Comunicação apresentada no 3º Congresso da Sociedade Portuguesa de Radioterapia Oncologia. Lisboa, 18 a 19 de.
Barbosa, A. (2008, September). Relationship-centred medicine: conceptual and training developments. Poster presented at the 2008 International Conference on Communication in Healthcare, Oslo.
Barbosa, A. (2008, September). Relational ethics. Poster presented at the 9th World Congress of Bioethics, Rijeka, Croatia.
Barbosa, A. (2009, September). Relational ethics: A theoretical purpose for clinical decision making in consultation liaison psychiatry. Paper presented at the 2009 World Mental Health Congress of the World Federation for Mental Health. Athens, Greece.
Barbosa, A. (2009, October). Relational ethics: a new perspective on bioethics for the clinic relationship? Paper presented at the 12th Philosophy and Psychiatry Conference, Lisbon.
Barbosa, A. (2009, Novembro). Formação pós-graduada em bioética. Comunicação oral na 4ª Reunião de Bioética na UCI-Hospital Santo André, Leiria.
Barbosa, A. (2010, March). Factitious disorder: A relational ethics perspective in consultation liaison-psychiatry. Poster presented at the 18th European Congress of Psychiatry, Munique.
Barbosa, A. (2010, September). Health communication and relational ethics. Poster presented at the International Conference on Communication in Healthcare 2010, Verona.
Barbosa, A. (2011, May). Relational ethics and palliative care. Poster presented at the 12th Congress of the European Association for Palliative Care, Lisboa.
Barbosa, A. (2011, March). Relational ethics and psychiatry. Poster presented at the 19th EPA European Congress of Psychiatry, Viena.
PARTNERSHIPS
University of Lisbon Centro de Filosofia da Ciências (Philosophy of Science Centre)
Centro Filosofia (Philosophy Centre)
Escola Superior de Enfermagem de Lisboa (Higher College of Nursing of Lisbon)
Faculdade de Direito (Law School)
Faculdade de Farmácia (Faculty of Pharmacy)
Faculdade Psicologia (Faculty of Psychology)
Instituto de Ciências Sociais (Social Sciences Institute)
Universidade Nova de Lisboa (New University of Lisbon) Escola Nacional de Saúde Pública (National Public Health College)
Faculdade de Ciências Médicas (Faculty of Medical Sciences)
Faculdade de Ciências Sociais e Humanas (Faculty of Social Sciences and Humanities)
Faculdade de Direito (Law School)
Centro de Estudos de Filosofia da Medicina do IPO-Lisboa (Philosophy of Medicine Studies Centre at IPO – Lisbon)
Universidade Católica Portuguesa (Catholic University of Portugal)
