A snapshot of cancer in Chile II: an update on research, strategies and analytical frameworks for equity, innovation and national development.

Introduction: Chile has achieved developed nation status and boasts a life expectancy of 81 + years; however, the healthcare and research systems are unprepared for the social and economic burden of cancer. One decade ago, the authors put forward a comprehensive analysis of cancer infrastructure, together with a series of suggestions on research orientated political policy.

Objectives: Provide an update and comment on policy, infrastructure, gender equality, stakeholder participation and new challenges in national oncology.

Knowledge, practice and communication barriers for oncology doctors in Chile when addressing the sexuality of their patients.

Introduction: Communication in a doctor-patient relationship constitutes a crucial aspect in medicine, and its multiple dimensions encompass a wide variety of ethical issues. Communication is particularly relevant in oncology, because it requires continually dealing with sensitive topics in one of the most highly vulnerable situations as a human: illness and proximity to death. Sexuality is one of these topics because it constitutes an area that is frequently affected by cancer and cancer treatment, which may include causing significant distress, the reinforcement of a negative self-image, relationship conflicts and a permanent memory of having cancer.

[Medical teleconsultation. Analysis and recommendations from the ethics department of the Chilean medical association].

The possibility of allowing patients access to health professionals, has been greatly facilitated by advances in technology. Indeed, nowadays it is possible not only direct contact between one health professional with another, but also the possibility of sending images and other tests to consult distant colleagues. This has undoubtedly enabled better health care for many patients.

Ethical Challenges Experienced by Healthcare Workers Delivering Clinical Care during Health Emergencies and Disasters: A Rapid Review of Qualitative Studies and Thematic Synthesis.

The COVID-19 pandemic has posed several ethical challenges worldwide. Understanding care providers' experiences during health emergencies is key to develop comprehensive ethical guidelines for emergency and disaster circumstances. To identify and synthetize available empirical data on ethical challenges experienced by health care workers (HCWs) providing direct patient care in health emergencies and disaster scenarios that occurred prior to COVID-19, considering there might be a significant body of evidence yet to be reported on the current pandemic.

COVID-19 vaccine trials with children: ethics pointers.

As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed clinical trials involving children are important to ensure safety, efficacy, and dosage of therapies in (developing) children. Within the complex health, social, and political scenario of the ongoing pandemic, ethics committees and policy makers in low-income and middle-income settings need to consider additional ethical questions when called on to review phase III COVID-19 vaccine trials involving in children.

Ethical issues of organ donation after circulatory death: Considerations for a successful implementation in Chile.

Organ transplantation is a lifesaving procedure for end-organ damage and remains up to today as the most cost-effective alternative to treat these conditions. However, the main limitation to performing organ transplants is the availability of donor organs suitable for transplantation. To increase the donor pool, expanding organ donation from the conventional neurologic determination of death (NDD) to include circulatory determination of death (DCD) has been a well-established method of increasing donors in other countries.

Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey.

Background: The World Health Organization's "Coordinated Global Research Roadmap: 2019 Novel Coronavirus" outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID-19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health.

[Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical Association].

The discussion of a bill that allows medically assisted death (MAD) in Chile, revived the debate about the ethics of this practice. The Department of Ethics of the Chilean Medical Association herein analyzes arguments in favor or against the participation of the medical profession in MAD. Among the main arguments against the participation of physicians in this practice are that MAD conflicts with the basic ethical principles of medical practice, that it is contrary to the purposes of medicine and that it could erode the patients’ and society’s confidence in physicians.

[Decision making among older adults in hemodialysis. A qualitative assessment].

Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy.

Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD.

[Conscientious objectors in Chilean medical education].

The Chilean Law regulating the voluntary interruption of pregnancy, contemplates the possibility that health personnel may refrain from doing the procedure if they have stated that they are conscientious objectors (CO). There are numerous articles on the subject. However, the impact on medical training centers when a student or resident abstain from performing certain clinical procedures invoking CO, has seldom been analyzed.

[Experience in the global forum of bioethics in research. Challenges for the ethical review in Chile].

The Global Forum on Bioethics in Research annually convenes a number of researchers, bioethicists and stakeholders with a shared interest in the ethics of conducting research in low and middle-income countries (LMIC). It provides a useful platform to discuss ethical issues that affect research practice in different scenarios, promoting ethically conducted research, global development for health research ethics and partnerships between the global north and south. As participant of the last three meetings, in this article the author analyzes the main ethical issues that were discussed in this forum, namely "Emerging epidemic infections and experimental medical treatments" (Annecy, France, 2015); "Ethics of research in pregnancy" (Buenos Aires, Argentina, 2016), and "The ethics of alternative clinical trial designs and methods in LMIC research" (Bangkok, Thailand, 2017).

Percepciones y creencias sobre criopreservación embrionaria en mujeres y hombres que se realizan técnicas de reproducción asistida en Santiago, Chile.

Background And Objetive: Although embryo cryopreservation is frequently used as part of assisted reproductive technology, quantitave information addressing how infertile couples live the experience of having cryopreserved embryos is lacking in Chile. The aim of this study is to examine men and women's perception and beliefs regarding their cryopreserved embryos, as well as their perspective on embryo donation and disposition. Methods: 153 women and men with frozen embryos from a public hospital, Instituto de Investigactiones Materno Infantil, and a private clinic, Clínica Las Condes, in Santiago, Chile, responded between May 2015 and May 2016 to an anonymous online survey addressing their perceptions and beliefs concerning their cryopreserved embryos.

Ethical challenges posed by clinical trials in preterm labor: a case study.

This paper explores the ethical implications of a randomized double-blind clinical trial aimed to determine effectiveness and safety of an oxytocin receptor antagonist versus a betamimetic in the treatment of preterm labor, presented to a teaching hospital affiliated with a private university in Santiago, Chile. Though this trial protocol fulfills one of the conditions under which pregnant women could be enrolled in a clinical trial-the intervention has the potential to benefit the pregnant woman (by reducing adverse effects associated to salbutamol administration) and her fetus (if the new drug prolongs pregnancy)-there are some specific ethical issues raised. First, when to obtain consent is an important issue for clinical trials involving acute and unforeseen conditions that affect pregnant woman, e.

[Differentiated review of biomedical research projects by ethics committees].

Ten years after the approval of the Chilean bill that regulates scientific research in humans (Law Nº 20.120), and considering the current status of accreditation and training of many Research Ethics Committee (REC), it is necessary to analyze their performance. We analyzed the Chilean experience with REC aiming to propose a differential type of review, considering the risks to research participants.