[Bioethical issues of Covid-19 in Spain. A systematic review].

During the COVID-19 pandemic, bioethical concerns were raised and there was even a ″resurgence of bioethics. ″ In this work, we review the scientific articles published by Spanish authors in relation to bioethical issues in the three years following the declaration of the pandemic. Seventy publications have been selected.

[25 Years from Di Bella affair: what ethical lessons does it leave us?].

Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and, occasionally, chemotherapy proposed by Professor Luigi Di Bella. It was the answer to people demanding Public Health assume the cost of this therapy. Although parallel phase II trials in various tumors demonstrated the lack of activity, some professionals have continued to use this method since then and have published apparently promising results a few various scientific journals.

Analysis of Regional Palliative Care Strategies: Do Health Policies Influence the Development of Assistance Coverage?

In Spain, health competencies are decentralized, and each autonomous community implements its own plans. Our aim is to determine if the existence of regional palliative care plans implies an improvement in health care coverage. We reviewed regional palliative care plans published in Spain and analyzed the following variables: number and profile of palliative care resources, guidelines and objectives of implementation of resources of these plans, and compliance with European standards.

[Theory and Practice of Informed Consent].

Informed consent is the process of communication between the professional (medical staff and/or investigator) and patient culminating in the decision regarding a particular intervention. However, in our country the concept of informed consent is usually limited to the document that must be signed by the patient to undergo diagnostic or therapeutic procedures riskier. This consent is best understood as a process rather than an event, and also it usually gives consent on care processes rather than on specific events: the acceptance of a process involves a tacitly acceptance of the different components that are usually part of this process.

[Do we need a more precise definition of what sedation is?].

Palliative sedation in defined as the deliberate reduction in the level of consciousness of the patient by administering the appropriate drugs in order to avoid intense suffering caused by one or more refractory symptoms; sedation in the patient who is in his last days or hours of life is assumed to be continuous and as deep as needed. Clinical experience shows specific situations where it is likely that there is some confusion of terms. We could erroneously understand as palliative sedation the cases of symptomatic treatment of hyperactive delirium in a patient in its last days (a situation that sometimes is presented as the first cause of palliative sedation) or those in which it is carried out a progressive increase in the palliative treatment that often have a sedative effect, parallel to the increased severity of symptoms because of disease progression in severe ill patients.

[Ethical questions in the Spanish journal "Medicina Paliativa": 1994 - 2013].

Objective: "Medicina Paliativa" is the official journal of the Spanish Society of Palliative Care ("Sociedad Española de Cuidados Paliativos"; SECPAL) and it reflects the interests, also on bioethics, of the professionals caring terminal people. We want to know what the bioethical questions they discuss and their approaches are.

Methods: From all the published articles in "Medicina Paliativa" from 1994 to 2013 we selected those referred to bioethics topics.